This pilot showed that trainee collaboratives can work together to deliver an audit using an encrypted data capture tool cost-effectively, whilst maintaining the highest levels of data quality.
Objectives:The roles of Allied Health Care Professionals (AHPs) in Head and Neck Cancer (HNC) are wide ranging but not clearly defined. Inter-regional variability in practice results from a lack of standardisation in approaches to the Multidisciplinary Team (MDT) make-up and structure. Traditionally, the follow-up of HNC patients is clinician led with multiple scheduled follow-up appointments. The increasing population of HNC patients provides logistical, monetary and efficiency challenges. This systematic review presents the roles of the multiple AHP sub-groups in HNC with the aim of presenting how their differing skill sets can be integrated to modernise our approach in follow-up.
Pneumoperitoneum, gas under the diaphragm, is often a sign of significant intra-abdominal pathology, be it perforation in the stomach or duodenum secondary to peptic ulcer disease or in the small or large bowel as a result of inflammatory bowel diseases, diverticulitis or cancer, it can also be iatrogenic as a result of endoscopy or laparoscopy. The diagnosis is made with erect chest and abdominal radiographs, air is usually most visible under the right hemi-diaphragm. Here, we present a troublesome case of recurrent pneumoperitoneum, which despite extensive investigations and laparotomy no cause was found.
Background
The ‘second victim phenomenon’ is a term attributed to the traumatic effect a medical error can have on healthcare professionals. Patient safety incidents have been shown to occur in as many as one in seven patients in hospital. These incidents cause significant, potentially devastating, trauma to patients and their relatives, and can have deep and long-lasting effects on the health professionals involved. These incidents can have a negative impact on doctors’ emotional wellbeing; their professional practice in relation to this impact has not been extensively investigated in surgical trainees.
Method
A survey of UK otolaryngology trainees was conducted to investigate the effects of complications and medical errors on trainees, and examine how these are discussed within departments.
Results and conclusion
The findings suggest that further training is required and would be warmly received by otolaryngology trainees as part of higher surgical training.
A 79-year-old man, with a history of well-controlled diabetes mellitus, presented with left-sided otalgia. With an initial diagnosis of simple otitis externa, he was discharged on topical drops. He represented 2 months later with worsening otalgia and discharge. A diagnosis of malignant otitis externa was made based on clinical and radiological findings. Intravenous Tazocin and Gentamicin were given based on previous bacterial culture from ear swabs. The patient failed to improve and developed left-sided facial nerve palsy. His condition stabilised following a change in antimicrobial therapy and his management continued in the community on intravenous Meropenem with twice weekly aural toilet. Repeated nuclear medicine imaging failed to demonstrate resolution. A bony sequestration was removed from the external auditory canal in the outpatient clinic, which following extended culture grew Scedosporium apiospermum; his management was subsequently changed to oral Voriconazole. This led to rapid clinical improvement and disease resolution over a 6 -week period.
ObjectiveAcute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.MethodsA retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.ResultsThe rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.ConclusionThe tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.
Objective
There is currently no consensus on the ideal protocol of imaging for post-treatment surveillance of head and neck squamous cell carcinoma. This study aimed to consolidate existing evidence on the diagnostic effectiveness of positron emission tomography-computed tomography versus magnetic resonance imaging.
Method
Systematic electronic searches were conducted using Medline, Embase and Cochrane Library (updated February 2021) to identify studies directly comparing positron emission tomography-computed tomography and magnetic resonance imaging scans for detecting locoregional recurrence or residual disease for post-treatment surveillance.
Results
Searches identified 3164 unique records, with three studies included for meta-analysis, comprising 176 patients. The weighted pooled estimates of sensitivity and specificity for scans performed three to six months post-curative treatment were: positron emission tomography-computed tomography, 0.68 (95 per cent confidence interval, 0.49–0.84) and 0.89 (95 per cent confidence interval, 0.84–0.93); magnetic resonance imaging, 0.72 (95 per cent confidence interval, 0.54–0.88) and 0.85 (95 per cent confidence interval, 0.79–0.89), respectively.
Conclusion
Existing studies do not provide evidence for superiority of either positron emission tomography-computed tomography or magnetic resonance imaging in detecting locoregional recurrence or residual disease following curative treatment of head and neck squamous cell carcinoma.
Direct-listing pathways for grommet insertion can reduce waiting times and expedite surgery. Implementation involves a simple alteration of current practice, adhering to National Institute for Health and Care Excellence Clinical Guideline 60. The ultimate decision regarding surgery still rests with ENT specialists.
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