Prospective Service Evaluation Research Articles

A Prospective Analysis of Screen-Detected Cancers Recalled and Not Recalled by Artificial Intelligence.

The use of artificial intelligence has potential in assisting many aspects of imaging interpretation. We undertook a prospective service evaluation from March to October 2022 of Mammography Intelligent Assessment (MIA) operating "silently" within our Breast Screening Service, with a view to establishing its performance in the local population and setting. This evaluation addressed the performance of standalone MIA vs conventional double human reading of mammograms. MIA analyzed 8779 screening events over an 8-month period. The MIA outcome did not influence the decisions made on the clinicalpathway. Cases were reviewed approximately 6 weeks after the screen reading decision when human reading and/or MIA indicated a recall. There were 146 women with positive concordance between human reading and MIA (human reader and MIA recalled) in whom 58 breast cancers were detected. There were 270 women with negative discordance (MIA no recall, human reader recall) for whom 19 breast cancers and 1 breast lymphoma were detected, with 1 cancer being an incidental finding at assessment. Six hundred and four women had positive discordance (MIA recall, human reader no recall) in whom 2 breast cancers were detected at review. The breast cancers demonstrated a wide spectrum of mammographic features, sites, sizes, and pathologies, with no statistically significant difference in features between the negative discordant and positive concordant cases. Of 79 breast cancers identified by human readers, 18 were not identified by MIA, and these had no specific features or site to suggest a systematic error for MIA analysis of 2D screening mammograms.

Prospective evaluation of the impact of multi-channel studies on treatment outcomes in children with sleep disordered breathing

There are significant variations in practice regarding the use of sleep studies in children with symptoms of sleep disordered breathing (SDB) prior to adenotonsillectomy. Current UK guidance recommends the selective use of sleep studies to confirm a diagnosis of obstructive sleep apnoea (OSA) when there is diagnostic uncertainty, in children with comorbidities, or to assess perioperative risk when severe OSA is suspected. We have developed a novel paediatric sleep service over the past decade based on the routine use of multi-channel sleep studies (MCSS) before adenotonsillectomy. We present the results of a prospective evaluation assessing the impact of our service on treatment outcomes.We conducted a prospective service evaluation of 49 children with SDB seen between July 2021 and August 2022. We used medical records and a sleep study database to determine treatment outcomes. Otolaryngologists completed a questionnaire before each multi-channel sleep study to help evaluate the impact of sleep study findings on surgical decision making.Questionnaire responses before MCSS showed that clinicians thought 66 % of children were ‘likely’, ‘very likely’ or ‘definitely’ would require surgery but only 54 % of children underwent surgery following their sleep study. We estimate that the use of MCSS was associated with a 21 % reduction in children undergoing surgery in this small sample.We conclude that our use of MCSS facilitates conservative management, allowing a significant reduction in the number of children with SDB undergoing surgery, but further validation of MCSS against polysomnography is required.

Intermediate Cervical Plexus Block in the Management of Refractory Somatosensory Tinnitus Following Whiplash: Prospective Series in 30 Patients.

Whiplash-associated disorder comprises of a constellation of persistent symptoms after neck trauma. Tinnitus that develops postwhiplash is termed somatosensory tinnitus. The objective is to assess the role of intermediate cervical plexus block (iCPB) in patients with somatosensory tinnitus secondary to whiplash. Prospective service evaluation in adults with whiplash-associated disorder and concomitant somatosensory tinnitus. Patients underwent specialist otorhinolaryngology review before pain clinic referral. Patients were offered ultrasound-guided iCPB with steroids. Intensity of tinnitus was recorded on a numerical rating scale at baseline, 3 and 6 months posttreatment. Brief Pain Inventory Short Form and Hospital Anxiety Depression Scale questionnaires were also completed. Over a 36-month period, 32 patients with refractory somatosensory tinnitus following whiplash were offered iCPB(s). Two patients refused because of needle phobia. iCPB(s) was performed in 30 patients as an outpatient procedure. One patient (1/30, 3.3%) was lost to follow-up. Twenty-three patients (23/30, 77%) reported clinically significant reduction in intensity of tinnitus at 3 months postprocedure. Nineteen patients (19/30, 63%) reported ongoing benefit at 6-month follow-up. Six patients failed to report any benefit (6/30, 20%). The cervical plexus could play a significant role in the development of somatosensory tinnitus after whiplash. iCPB may have a role in the management of somatosensory tinnitus in this cohort.

ObsTIVA-UK: a service evaluation of obstetric total intravenous anaesthesia in the United Kingdom.

We conducted a prospective observational service evaluation across the United Kingdom on the use of total intravenous anaesthesia (TIVA) for obstetric surgery between November 2022 and June 2023. The primary aim was to describe the incidence of TIVA for obstetric surgery within participating units, with secondary aims to describe maternal and neonatal postoperative recovery indicators. Of 184 maternity units in the United Kingdom, 30 (16%) contributed data to the service evaluation. There were 104 patients who underwent caesarean delivery under TIVA and 19 patients had TIVA for other reasons. Infusions of propofol and remifentanil were used in 100% and 84% of cases, respectively. Fifty-nine out of 103 live neonates (57%) required some form of respiratory support. Of the neonates with recorded data, 73% and 17% had Apgar scores < 7 at 1 and 5 min respectively. No neonates were recorded to have Apgar scores < 7 at 10 min. Further prospective research is required to investigate the impact of obstetric TIVA on maternal and neonatal outcomes and inform best practice recommendations.

Fatigue risk assessment of a Helicopter Emergency Medical Service crew working a 24/7 shift pattern: results of a prospective service evaluation

BackgroundThe work of Helicopter Emergency Medical Services (HEMS) teams crosses the boundaries of several high-risk occupations including medicine, aviation, and transport. Working conditions can be challenging and operational demands requires a 24-h rota, resulting in disruption of the normal circadian rhythm. HEMS crews are therefore prone to both mental and physical fatigue. As fatigue in medical providers is linked to poor cognitive performance, degradation of psychomotor skills and error, this study aimed to explore the existence of predictable patterns of crew-fatigue in a HEMS service.MethodsHEMS medical crew members working a 3-on 3-off forward rotating rota with a 5-week shift cycle were asked to do psychomotor vigilance tests (PVT) as an objective measure of fatigue. PVT testing was undertaken at the start, mid- and at the end of every shift during a full 5-week shift cycle. In addition, they were asked to score subjective tiredness with the Samn-Perelli Fatigue Scale (SPFS), and to keep a Transport Fatigue Assessment shift log, wherein they noted shift characteristics potentially related to fatigue. Primary outcome of interest was defined as the change in PVT and SPFS scores over time.ResultsMean baseline resting PVT in milliseconds at the start of the study period was 427 [390–464]. There was an overall trend towards higher PVT-scores with shift progression mean [95% CI] PVT at the start of shifts 447 [433–460]; halfway through the shift 452 [440–463]; end of the shift 459 [444–475], p = 0.10), whereas SPFS scores remained constant. Within a 5 week forward-rotating cycle, an overall trend towards a gradual increase in both average PVT (from 436 [238–454] to 460 [371–527, p = 0.68] ms;) and SPFS (from 2.9 [2.6–3.2] to 3.6 [3.1–4.0], p = 0.38) was observed, although significant interindividual variation was present. Reported SPFS scores ≥ 4 (moderate fatigue) were mainly related to workload (number of jobs) and transport mode (car-based shifts).ConclusionAn overall trend towards a decline in psychomotor vigilance and an increase in self-reported tiredness was found for HEMS crew over a 5-week shift cycle. Using a bespoke predictive fatigue tool on a day-to-day basis could increase fatigue awareness and provide a framework to which relevant mitigating options can be applied.

The incidence of post cholecystectomy pain (PCP) syndrome at 12months following laparoscopic cholecystectomy: a prospective evaluation in 200 patients.

Post cholecystectomy pain syndrome can cause significant distress, impairs quality of life and exacerbations often result in emergency visits. Poorly controlled postoperative pain is a recognized cause of persistent postsurgical pain. Abdominal myofascial pain syndrome is an underdiagnosed cause of persistent pain in this cohort. The objective was to estimate the incidence of poorly controlled postoperative pain in the first 48 h after surgery and the likelihood of developing persistent pain at 12 months. The patients undergoing laparoscopic cholecystectomy at a tertiary unit were consented for participation in a prospective service evaluation. A telephone review was performed at three, six and twelve months after surgery. Incidence of poorly controlled pain in the first 48 h after surgery was assessed. Patients with persistent pain were referred to the pain clinic. Over a six-month period, 200 patients were assessed. Eleven patients were excluded (5.5 %). Twelve patients were lost to follow-up (6.6 %, 12/189). Patient satisfaction with acute postoperative pain management was low in 40 % (76/189). Poorly controlled postoperative pain was reported by 36 % (68/189) of patients. Incidence of persistent pain was 29 % (54/189) at 12 months post-surgery. Over half of patients with persistent pain (63 %, 34/54) reported poorly controlled postoperative pain. A somatic source was diagnosed in 54 % (29/54) with post cholecystectomy pain syndrome. Poorly controlled postoperative pain was reported by a third of patients. Persistent pain was present in 29 % at twelve months post-surgery. Abdominal myofascial pain syndrome should be considered as a differential diagnosis in post cholecystectomy pain syndrome.

Neptune versus canister-based surgical waste management in Europe: results of the GREEN study.

Ineffective surgical fluid waste management in operating rooms (OR) creates a significant environmental burden, reduces OR efficiency, and adds physical challenges for surgical staff. There is a need for waste management systems that improve OR efficiency, safety, and sustainability. The GREEN study (Greening operating Rooms in EuropE comparing Neptune vs. canisters) was conducted to compare the impact of two fluid waste management systems. This 2-arm, nonrandomized, prospective service evaluation of fluid waste extraction was conducted using observational time series and surveys. Fluid waste-related data were collected from routine urologic and orthopedic surgeries across three European hospital sites. The primary endpoint of waste disposal impact was the volume of treated waste after surgery (kilograms) using Stryker's Neptune device (n=43) or canisters (n=41). The authors hypothesized that the surgical waste volume related to Neptune is less than the waste volume related to canisters. Secondary endpoints included time efficiency, user satisfaction, and staff ergonomics. The total weight of device-related treated waste products was reduced by 98.5% when using Neptune (0.2±0.7kg) compared with traditional canisters (13.2±16.6kg; P<0.001). Decreased waste weight also translated to enhanced ergonomic safety for surgical staff, as Neptune reduced surgical fluid weight handled by staff by an average of 34kg per procedure, a 96% reduction compared to canisters. Furthermore, the use of the Neptune system improved OR efficiency by reducing the number of staff required to manage the fluid suction device (P<0.001) and the time spent disposing of fluid waste (P<0.001). Stryker's Neptune waste management system significantly reduces the volume of treated waste per surgery and improves OR efficiency, staff safety, and user satisfaction over the traditional canister system. This is a more eco-responsible approach to OR fluid waste management and could be considered in any healthcare establishment that generates fluid waste.

SP8.1 Patient perception of the informed consent process: A single centre cohort study comparing paper and digital consent

Abstract Aims NHS Digital set eConsent as a priority for 2021-2022 and digital consent is now being adopted by many hospitals. This study aims to compare how patients perceive the consenting process on both paper and digital platforms. Methods A prospective service evaluation was conducted in a university hospital (May 2022-December 2022), across 9 specialities, to compare paper with digital consent. as a part of an SBRI-granted project (SBRIH19P3055) to identify the economic benefits of digital consent. The digital consent solution was provided by Concentric Health. Time-motion study assessing the consultation time required to consent a patient was conducted in clinics. Patient feedback was obtained through structured questionnaires, including the CollaboRATE score (validated to measure shared decision-making, SDM). Results Patient feedback was compared for 151 responders from each group. 92 (60.9%) responders in the digital group scored the CollaboRATE Topscore (representative of gold standard SDM) in comparison to 71 (47%) responders in the paper consent group. 113 patients had experienced both paper and digital consent, of which 73 (64.6%) patients prefer digital consent and 40 (35.3%) prefer paper consent. Sub-analysis of consultation time (including both consent and clinic time) revealed no significant difference P=0.102 between the use of paper (n=21) and digital (n=26) consent. Conclusion Digital consent is favoured by patients perhaps because it enables more meaningful and detailed discussion of information before surgery. Patient satisfaction regarding their involvement in SDM is higher with digital consent than with paper consent. Further studies are needed to evaluate the value of digital consent.

ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom

IntroductionORTHOPOD: Day Case Trauma is a multicentre prospective service evaluation of day-case trauma surgery across four countries. It is an epidemiological assessment of injury burden, patient pathways, theatre capacity, time to surgery and cancellation. It is the first evaluation of day-case trauma processes and system performance at nationwide scale. MethodsData was prospectively recorded through a collaborative approach. Arm one captured weekly caseload burden and operating theatre capacity. Arm two detailed patient and injury demographics, and time to surgery for specific injury groups. Patients scheduled for surgery between 22/08/22 and 16/10/22 and operated on before 31/10/22, were included. For this analysis, hand and spine injuries were excluded. ResultsData was obtained from 86 Data Access Groups (70 in England, 2 in Wales, 10 in Scotland and 4 in Northern Ireland). After exclusions, 709 weeks worth of data representing 23,138 operative cases were analysed. Day-case trauma patients (DCTP) accounted for 29.1% of overall trauma burden and utilised 25.7% of general trauma list capacity. They were predominantly adults aged 18 to 59 (56.7%) with upper limb Injuries (65.7%). Across the four nations, the median number of day-case trauma lists (DCTL) available per week was 0 (IQR 1). 6 of 84 (7.1%) hospitals had at least five DCTLs per week. Rates of cancellation (13.2% day-case; 11.9% inpatient) and escalation to elective operating lists (9.1% day-case; 3.4% inpatient) were higher in DCTPs. For equivalent injuries, DCTPs waited longer for surgery. Distal radius and ankle fractures had median times to surgery within national recommendations: 3 days and 6 days respectively. Outpatient route to surgery was varied. Dominant pathways (>50% patients listed at that episode) in England and Wales were uncommon but the most frequently seen was listing patients in the emergency department, 16 of 80 hospitals (20%). ConclusionThere is significant mismatch in DCTP management and resource availability. There is also considerable variation in DCTP route to surgery. Suitable DCTL patients are often managed as inpatients. Improving day-case trauma services reduces the burden on general trauma lists and this study demonstrates there is considerable scope for service and pathway development and improved patient experience.

International, prospective cohort study comparing non-absorbable versus absorbable sutures for skin surgery: CANVAS service evaluation.

Absorbable or non-absorbable sutures can be used for superficial skin closure following excisional skin surgery. There is no consensus among clinicians nor high-quality evidence supporting the choice of suture. The aim of the present study was to determine current suture use and complications at 30 days after excisional skin surgery. An international, prospective service evaluation of adults undergoing excision of skin lesions (benign and malignant) in primary and secondary care was conducted from 1 September 2020 to 15 April 2021. Routine patient data collected by UK and Australasian collaborator networks were uploaded to REDCap©. Choice of suture and risk of complications were modelled using multivariable logistic regression. Some 3494 patients (4066 excisions) were included; 3246 (92.9 per cent) were from the UK and Ireland. Most patients were men (1945, 55.7 per cent), Caucasian (2849, 81.5 per cent) and aged 75-84 years (965, 27.6 per cent). The most common clinical diagnosis was basal cell carcinoma (1712, 42.1 per cent). Dermatologists performed most procedures, with 1803 excisions (44.3 per cent) on 1657 patients (47.4 per cent). Most defects were closed primarily (2856, 81.9 per cent), and there was equipoise in regard to use of absorbable (2127, 57.7 per cent) or non-absorbable (1558, 42.2 per cent) sutures for superficial closure. The most common complications were surgical-site infection (103, 2.9 per cent) and delayed wound healing (77, 2.2 per cent). In multivariable analysis, use of absorbable suture type was associated with increased patient age, geographical location (UK and Ireland), and surgeon specialty (oral and maxillofacial surgery and plastic surgery), but not with complications. There was equipoise in suture use, and no association between suture type and complications. Definitive evidence from randomized trials is needed.

Venous thromboembolism risk following temporary immobilisation after injury: evaluation of the Aberdeen VTE risk tool

BackgroundTemporary lower limb immobilisation following injury is a risk factor for symptomatic venous thromboembolism (VTE). Pharmacological thromboprophylaxis can mitigate this risk but it is unclear which patients benefit from this...

Intermediate Cervical Plexus Block (ICPB) In Refractory Chronic Daily Headache After Whiplash: Prospective Audit In 43 Patients

Background: Chronic daily headache can develop or pre-existing episodic headache can worsen after whiplash and is termed persistent headache attributed to whiplash. It can be a therapeutic challenge and often results in severe disability. The objective was to assess the management of patients with refractory secondary chronic daily headache referred to a pain physician in consideration for greater occipital nerve block. Methods: Prospective service evaluation in adult patients with oro-facial pain and headaches. Patients underwent specialist neurology review and analgesic overuse headache was excluded. Patients with chronic daily headache with a past history of neck trauma were included. Cervical facet joint dysfunction and intracranial pathology were excluded. An initial cohort of 27 patients received occipital nerve block without benefit. Subsequently, all patients were offered ultrasound guided intermediate cervical plexus block with local anesthetic and steroid mixture. Four-week headache diary, Brief Pain Inventory-Short Form and Hospital Anxiety Depression Scale questionnaires were completed at baseline and three months post-intervention. Results: Over a 41-month period, 43 patients were reviewed. The first 27 patients (27/43, 63%) reported no benefit with occipital nerve block. Subsequently, patients were offered intermediate cervical plexus block(s). Four patients refused. Thirty-nine patients received the intervention. Thirty-two patients (32/39, 82%) reported significant reduction in headache frequency and intensity at three months. Failure rate was 18% (7/39). Conclusion: The cervical plexus could play a significant role in the development or worsening of pre-existing headache after whiplash. Intermediate cervical plexus block may have a role in the management of refractory chronic daily headache following whiplash injury.

Feasibility and evaluation of an emergency department-based general practitioner streaming and treatment service.

Offering a primary care service that can provide good quality primary care at emergency departments may reduce pressure on usual emergency department (ED) services. To evaluate the acceptability, satisfaction, and potential impacts of a co-located primary care service at an emergency department. This is a prospective feasibility study and service evaluation comprising a narrative summary of activity, satisfaction, well-being, and safety, and comparisons of wait times for ED services by patient category ('minor', 'majors', 'paediatric' or 'resus') before and during the service operation. Patients and staff were asked using semistructured interview topic guides about service perception, well-being, representation within 48 h, safety concerns, and/or satisfaction. Wait times for patient categories in usual ED care service were in secondary care electronic records. Pathway changes were captured under primary care electronic records. Approximately 96% of general practitioner streaming and treatment(GPST) patients were seen within 1 h. There was a statistically significant reduction in ED patients with minor injuries or illnesses waiting>4 h for admission or discharge 'breaches' during the 3 months that GPST was operating compared with the previous 3 months (p ≤ 0.005). Wait times for other ED services did not significantly improve. A total of 769 walk-in patients received GPST consultation and 661 (86%) needed no further ED intervention. Fast discharge was a major determinant of patient satisfaction. No staff expressed dissatisfaction, but some suggested possible improvements in eligibility criteria and built environment design features. Provision of GPST correlated with shorter waits for discharge from ED. Patient and staff experiences of GPST were positive.

The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists.

Introduction Surgical site infections (SSIs) are a universally dreaded complication of any surgical procedure. The goal of this single-center study was to examine the issue of orthopaedic instrument wrapping defects with a focus on the importance of a high level of surveillance to enable identification of these defects in order to reduce the risk of instrument contamination. We also evaluated the impact on patient care, theatre staff, hospital finances and resource utilization during a defined study period in order to stimulate critical discussion and further research into potentially eliminating this problem via change in practice and advances in technology. To the best of our knowledge, this will be the first paper that looks at this problem from the above perspective within the United Kingdom National Health Service. Methods We conducted a prospective service evaluation project over a 30-week period from December 2021 to July 2022 across our three hospital sites within the United Kingdom National Health Service.We collated data on defects found in orthopaedic instrument wrappings as detected by visual inspection under ambient or theater lighting and the resulting surgical case cancellations. Defect types included in the study were all puncture holes, abrasions or tears visible to the naked eye irrespective of their size. Results A total of 601 orthopaedic sets were rejected during the study period due to defects identified in the sterile instrument wrappings. Of these, 437 were due to holes/tears in the wrapping, 129 were due to wet inner wrappings and 35 were due to insecure wrappings. This directly resulted in same-day cancellation of 13 surgical cases or 0.27% of booked cases with extra sets required for the other affected cases. These 13 cases could not proceed as they involved loan kits where no remedial action could be taken. Remedial action was required for the other 588 operation list cases affected by the sterile wrapping defects. The majority of the identified defects and resulting theatre case cancellations (61.5%) were in hip and knee arthroplasty surgery. The calculated potential financial loss due to these problems was £145,000 over the seven-month study period. This financial cost is equivalent to the best practice top-up tariff in England for treating approximately 108 hip fracture patientsbased on £1,335 per patient. Conclusion Our study identified defects in the sterile instrument wrappings affecting both the inner with or without involving theouter wrapping layerand resulting in cancellation of elective and trauma orthopaedic cases with resultant clinical and financial implications. There is a need to be more vigilant in identifying defects in drapes. Further research is warranted to improve ways of identifying defects in sterile wrappings and devise new protective mechanisms during sterilisation that can eliminate the use of sterile instrument wrappings.

Evaluation of a teleaudiology service in regional Australia

Objective Evaluate accessibility, effectiveness, acceptability and efficiency of a student- assisted teleaudiology model of care in a regional hospital in Queensland, Australia. Design Prospective mixed method service evaluation study. Study sample Demographic, service and satisfaction data were collected from 233 patients (children aged ≥5 and adults) who received teleaudiology assessment. Satisfaction data was collected from 27 hospital clinic staff (medical, nursing and clinic assistants) and 28 university audiology clinical educator participants. Experience and satisfaction data were collected from 16 teleaudiology clinic university students. Quantitative data was analysed using SPSS software. Qualitative data were analysed using inductive content analysis. Results Following introduction of the teleaudiology service in 2017 and evaluation during the first 6 months, 95% of patients were able to access audiology assessments on the same day as their Ear, Nose and Throat appointments. New referrals to the service were seen within a month. The audiology assessment battery was completed 95% of the time within an average of 33 minutes by the end of the study period. Patients, hospital and university staff and students reported high satisfaction with their experiences of teleaudiology, including its convenience and efficiency. Conclusions A student-assisted teleaudiology model of care can deliver accessible, effective, and efficient services with high levels of satisfaction by participants.

Total autologous breast reconstruction with the Kiss Latissimus Dorsi Flap

Patients presenting breast actinic damage or implant-related complications require an autologous approach to breast reconstruction. However, when they are not good candidates for microsurgical procedures, alternative solutions must be sought. Latissimus dorsi (LD) is a workhorse flap in breast reconstruction, but often the amount of skin and volume achievable are insufficient. Taking inspiration from the Kiss flap concept, the authors hereby describe the "Kiss" LD flap to achieve totally autologous breast reconstruction. A prospective service evaluation of all patients who underwent breast reconstruction with Kiss LD flap between 2018 and 2020 was performed. Patient demographics and operative variables were recorded, together with early and late complications. Patient satisfaction and quality of life were registered using the latest BREAST-Q reconstruction module, which includes specific LD scales. The questionnaire was administered to patients preoperatively and six months postoperatively. Thirty patients underwent total autologous breast reconstruction with Kiss LD flap. Breast cancer and breast sarcoma resection were followed by reconstruction. The timing of reconstruction was immediate in 3 cases and delayed in 27 cases. No major complications nor total flap loss were registered. BREAST-Q scores postoperatively were significantly higher than the preoperative ones in every domain (p<0.0001) except for the physical well-being of back and shoulder, where the scores differed slightly and non-significantly (p=0.05). The Kiss LD flap allows to harvest a large amount of skin to restore the breast envelope and a considerable volume to reconstruct the breast mound in a completely autologous procedure.

Do children get dry socket?—The incidence and pattern of presentation of alveolar osteitis in children and adolescents following dental extractions

AbstractBackgroundAlveolar osteitis (AO) is widely reported as the most common post‐operative complication following surgical and non‐surgical exodontia. Despite being one of the most studied complications in dentistry, there is no established consensus on its aetiology, alongside a relative paucity of studies looking exclusively into AO incidence in children and adolescents.ObjectivesTo determine the incidence, risk factors and pattern of presentation of AO in children and adolescents following exodontia, as well as identifying concepts and theories to provide a basis regarding why such a common post‐operative complication reportedly manifests so rarely in the paediatric population.MethodsThis cross‐sectional analysis forms part of a prospective service evaluation of the exodontia service provided by Newcastle Dental Hospital. All patients aged 5–16 who underwent dental extractions of deciduous and/or permanent teeth under general anaesthetic (GA) between 15 June 2020 and the 15 July 2020 were telephoned 1 week following their procedure to determine if any had developed post‐operative complications. Data were cleaned manually and analysed using descriptive statistics, exploratory analysis with chi‐squared tests and multivariable analyses. A scoping review was performed using the PubMed, OVID Medline and Scopus databases.ResultsFour of 150 patients (2.8%) developed AO and reported extreme pain which began 2–3 days after removal, lasted 2 days after onset, and were all associated with the non‐surgical removal of lower first permanent molar teeth. All patients who developed AO were female and aged between 9 and 10 years old. Mandibular sockets were significantly associated with development of AO (p = 0.026).ConclusionsDespite the belief that AO rarely manifests in children, the incidence of paediatric AO in this study is in line with that of AO found in the adult literature. The literature is inconsistent and conflicting regarding current understanding of AO. As far as possible, an atraumatic approach to exodontia should be adopted. We have proposed four underlying concepts which may benefit from future research given the paucity of research exclusively into dry socket in children and adolescents.

171 Systemic infections and acute admission in long-term neurological conditions

BackgroundPeople living with a long-term neurological condition (LTNC) make up nearly one-fifth of hospital admissions in the UK. Though LTNCs are diverse, the common trigger for deterioration is often systemic infection. More data on the problem is required to inform service planning.MethodsThe case notes of 157 consecutive patients with an LTNC presenting to University Hospital South- ampton for urgent care, were reviewed, as part of an ongoing and prospective service evaluation. Data was collected on mode of presentation, acute diagnosis, specialty input, length of stay, complications, and change in social needs.ResultsDementia (43%) and stroke (27%) were the most common LTNCs. Systemic infection was the trigger for admission in 52% of patients. The mode of presentation was most commonly deterioration in func- tional abilities and cognition. Mean length of stay was 5.7 days. Care needs increased in 11% of patients.ConclusionThis data provides a snapshot of the urgent care needs of people with LTNCs, which should help inform future service planning. In particular, the impact of systemic infection is significant and strate- gies to mitigate this are discussed.ritaramos.jc4@gmail.com

Service Evaluation of the Impact of Capnography on the Safety of Procedural Sedation.

BackgroundCapnography has been associated with a reduced incidence of events related to respiratory compromise during procedural sedation.MethodsA prospective service evaluation was conducted at a large United Kingdom (UK) teaching hospital to assess the impact of capnography on patient safety within four speciality services: bronchoscopy, endoscopy, interventional cardiology, and interventional radiology. Events were defined as provided by the World Society of Intravenous Anaesthesia. One thousand four hundred one patients were enrolled in the evaluation, with 666 patients before and 735 after implementation of capnography. Data was entered as a convenience sample on site in an offline data-collection tool. Results were assessed for the relative reduction in the incidence and resulting adjusted odds ratio for the combined incidence of oxygen desaturation (75–90% for <60s), severe oxygen desaturation (<75% at any time) or prolonged oxygen desaturation (<90% for >60s), bradycardia (>25% from baseline) and tachycardia (>25% from baseline). The adjusted odds ratio was controlled for both procedure and patient characteristics.ResultsAfter implementation of capnography, a significant reduction (43.2%, p ≤ 0.05) in adverse events was observed: 147 adverse events occurred during 666 procedures without capnography compared with 93 adverse events that occurred during 735 procedures with capnography. The adjusted odds ratio for the occurrence of the target adverse events was 0.57 (95% CI: 0.42–0.77). Multivariable linear regression indicated that capnography was a significant predictor (p 0.001) of reduced adverse events.ConclusionThese results suggest improved patient safety following capnography implementation.

PD03-12 COVID-19 DISRUPTION TO PROSTATE CANCER MANAGEMENT IN A UK TERTIARY REFERRAL CENTRE

You have accessJournal of UrologyCME1 May 2022PD03-12 COVID-19 DISRUPTION TO PROSTATE CANCER MANAGEMENT IN A UK TERTIARY REFERRAL CENTRE Matthew Byrne, Nithesh Ranasinha, Claudia Mercader, Mutie Raslan, Caroline Gordon, Kate Hutton, Sarah Head, Ruth MacPherson, Charlotte Minett, Louise Flaxman, Jessica Smyth, Natasha Young, Fergus Gleeson, Clare Verrill, Richard Colling, Francisco Lopez, Richard Bell, Tom Leslie, Richard Bryant, Freddie Hamdy, and Alastair D. Lamb Matthew ByrneMatthew Byrne More articles by this author , Nithesh RanasinhaNithesh Ranasinha More articles by this author , Claudia MercaderClaudia Mercader More articles by this author , Mutie RaslanMutie Raslan More articles by this author , Caroline GordonCaroline Gordon More articles by this author , Kate HuttonKate Hutton More articles by this author , Sarah HeadSarah Head More articles by this author , Ruth MacPhersonRuth MacPherson More articles by this author , Charlotte MinettCharlotte Minett More articles by this author , Louise FlaxmanLouise Flaxman More articles by this author , Jessica SmythJessica Smyth More articles by this author , Natasha YoungNatasha Young More articles by this author , Fergus GleesonFergus Gleeson More articles by this author , Clare VerrillClare Verrill More articles by this author , Richard CollingRichard Colling More articles by this author , Francisco LopezFrancisco Lopez More articles by this author , Richard BellRichard Bell More articles by this author , Tom LeslieTom Leslie More articles by this author , Richard BryantRichard Bryant More articles by this author , Freddie HamdyFreddie Hamdy More articles by this author , and Alastair D. LambAlastair D. Lamb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002518.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Covid-19 caused major disruptions to cancer diagnosis and treatment. We aimed to evaluate the longitudinal disruption to prostate cancer management. METHODS: We completed a prospective service evaluation from 01/09/2019 to 31/08/2021 of all referrals, investigations, and treatments for prostate cancer at a single centre. The first UK Covid-19 lockdown occurred from 23/03/20 to 04/07/2020: monthly data for the time period before, during, and after the first UK lockdown were compared using ANOVA and Tukey HSD. RESULTS: We identified 4501 patients for inclusion. There was a profound decrease in all aspects of prostate cancer management during the first lockdown period. For pre-lockdown, lockdown, and post-lockdown periods respectively, the mean monthly rates were: 256 v 125 v 363 PSA tests (p=0.0003); 86 v 40 v 79 two-week-wait referrals (p=0.0005); 62 v 18 v 54 MRI imaging for possible cancer (p<0.0001); 32 v 15 v 36 diagnoses (p=0.002); 17 v 9 v 14 prostatectomies (p=0.06). In the period after the first lockdown, despite the previous drop, we did not observe an increase in the number of referrals, MRI imaging, diagnoses, or treatment required (including active monitoring, chemotherapy, radiotherapy, prostatectomy, and palliative care) in comparison to pre-lockdown levels (all p>0.05). However, interestingly, we did see an increase in the number of PSA tests performed (p=0.04), which continued through the two subsequent UK lockdowns. CONCLUSIONS: To our knowledge, this is the first study to provide an overview of the impact of COVID-19 national lockdowns on the whole prostate cancer management pathway - from initial referral to final treatment. Despite the disruption to prostate cancer management during the first UK Covid-19 lockdown leading to a decrease in referrals, diagnoses and treatment in the context of reduced PSA testing, we have not seen a subsequent increase in these numbers after lockdown despite a rise in PSA testing. The rise in the number PSA tests performed post-lockdown may suggest a degree of compensatory PSA observation in the community. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e47 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Byrne More articles by this author Nithesh Ranasinha More articles by this author Claudia Mercader More articles by this author Mutie Raslan More articles by this author Caroline Gordon More articles by this author Kate Hutton More articles by this author Sarah Head More articles by this author Ruth MacPherson More articles by this author Charlotte Minett More articles by this author Louise Flaxman More articles by this author Jessica Smyth More articles by this author Natasha Young More articles by this author Fergus Gleeson More articles by this author Clare Verrill More articles by this author Richard Colling More articles by this author Francisco Lopez More articles by this author Richard Bell More articles by this author Tom Leslie More articles by this author Richard Bryant More articles by this author Freddie Hamdy More articles by this author Alastair D. 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