Prospective Service Evaluation Research Articles

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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Multi-centre prospective cohort study of diaphragmatic defect phenotype and repair in neonates with congenital diaphragmatic hernia: ‘The Defect Study’

Abstract Defect size and closure technique in neonates with congenital diaphragmatic hernia (CDH) has long-term consequences for morbidity in survivors. Although subjective operative reporting of the defect size has been standardized, objective evaluation is lacking. There is no reported optimum closure technique related to the size and position of the diaphragmatic defect. We aim to objectively describe diaphragmatic defects and repair methods, at the time of neonatal CDH repair, through a prospective multi-centre service evaluation project. We will evaluate all neonates born with CDH surviving to diaphragmatic repair. All specialist paediatric surgical centres in the UK, Ireland and New Zealand will be invited to participate. Non-identifiable patient data will be collected over a 24-month period using a REDCap database. Diaphragmatic defects and hemidiaphragm measurements will be recorded intra-operatively alongside standardized defect reporting. Closure technique and 1-year outcomes will be captured. Demographics and peri-operative data will be reported as median (interquartile range), mean (standard deviation) or categorical variables. Defect measurement will be calculated as an ellipse with area displayed as a histogram. Patch usage will be compared to the defect area using univariate logistic regression analysis. Univariate logistic regression analysis will also be used to assess for the association between peri-operative variables and complications. Where possible, a multi-variate regression analysis will be performed. Centres will register the project as service evaluation at each participating hospital site. The results will be submitted to an international peer reviewed journal and will be disseminated via appropriate international forums and through patient support networks (CDH-UK).

Introduction of a novel telescopic pathway to streamline 2-week-wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation.

ObjectivesThis study summarizes the introduction of a novel telescopic pathway, which streamlines 2‐week‐wait suspected head and neck cancer referrals to our unit, describes the logistics of the pathway, and analyzes referral numbers and outcomes. We also discuss wider issues surrounding remote assessment in head and neck cancer.MethodsData were collected prospectively between January and May 2021, capturing all 2‐week‐wait referrals to our unit following the introduction of a telescopic pathway which utilized a nurse‐led clinic for nasendoscopic examination of selected patients and consultant‐led remote assessment using store and forward technology. Information on referral numbers, waiting times and outcomes was recorded.ResultsThree hundred and forty (185 high risk, 155 low risk) patients entered the telescopic pathway with the remaining 74 patients seen on the conventional standard of care pathway. Cancer conversion rates were 17%, <1%, and 5.4% for the high‐risk telescopic, low‐risk telescopic and standard of care pathways respectively. No patients discharged from the telescopic pathway were re‐referred within 3 months. Review capacity for endoscopic examination was higher per consultant on the telescopic pathway versus the standard of care (p = .01).ConclusionA combination of risk stratification and asynchronous telescopic assessment shows promise for the management of suspected head and neck cancer referrals. Potential benefits include consultant‐led care for all patients and enhanced documentation. Digital communication with patients may also assist with adherence to the new NHS 28‐day diagnostic standard for cancer referrals. Ongoing data collection is required to assess how the pathway functions over a longer period.Level of Evidence2c

Impact of rapid susceptibility testing on antimicrobial therapy and clinical outcomes in Gram-negative bloodstream infections.

Rapid antimicrobial susceptibility testing (rAST) has the potential to improve care of bloodstream infections. The aim of this service evaluation was to assess the impact of rAST on antimicrobial therapy and clinical outcomes in patients with Gram-negative bloodstream infection. A prospective service evaluation was conducted from March 2018 to December 2018. A rAST system (Alfred 60AST) was run Monday-Friday before midday and results were communicated to clinicians on the same day as positive blood culture, with subsequent conventional AST performed. Times to antibiotic therapy and clinical outcomes were compared between rAST and conventional AST. One hundred and ninety-one patients with Gram-negative bacteraemia were included (93 in the rapid group and 98 in the conventional group). Aminoglycoside combination therapy was stopped earlier in the rapid group [32 h (0-795) versus 54 h (4-216), P = 0.002]. The median time to optimal antibiotic based on AST results was significantly shorter than that in the conventional group [50 h (10-339) versus 69.5 h (20-872), P = 0.034]. In the subgroup of patients on ineffective empirical antibiotic, time to effective antibiotic was shorter in the rapid group [39.5 h (32-97) versus 57 h (49-83), P = 0.036]. No differences were found in 28 day mortality or length of stay. Rapid susceptibility testing resulted in faster discontinuation of aminoglycosides and a shorter time to starting effective and optimal antibiotic when compared with conventional AST results. rAST has potential clinical benefits and points to the need for larger future studies in areas of high antibiotic resistance.

Evaluating paediatric dermatology telephone clinics during COVID-19 from a dual clinician and patient perspective: a prospective study.

SummaryBackgroundThe landscape of dermatology services, already rapidly evolving into an increasingly digital one, has been irretrievably altered by the COVID‐19 (SARS‐CoV‐2) pandemic. Data are needed to assess how best to deliver virtual dermatology services in specific patient subgroups in an era of ongoing social distancing and beyond. Initial studies of teledermatology in paediatric populations suggest that many of the problems experienced in adult telemedicine are more apparent when treating children and come with additional challenges.AimTo evaluate the efficacy of a virtual paediatric dermatology telephone clinic in comparison to traditional face‐to‐face (FTF) clinics, both from the clinician and patient/parental perspective.MethodsWe carried out a prospective service evaluation examining a single centre cohort of paediatric dermatology patients managed during the COVID‐19 pandemic via a telephone clinic supported by images. The study period covered June–September 2020. Data on outcomes were collected from clinicians and a qualitative patient/parental telephone survey was undertaken separately. A five‐point Likert scale was used to assess both satisfaction and levels of agreement regarding whether a telephone clinic was more convenient than an FTF clinic.ResultsOf 116 patients included, 24% were new and 76% were follow‐up patients, with a mixture of inflammatory dermatoses (75%) and lesions (25%). From the clinician's perspective, most consultations (91%) were successfully completed over the telephone. However, qualitative patient and parent feedback paradoxically illustrated that although nearly all (98%) respondents had no outstanding concerns, 52% felt highly unsatisfied and only 22% agreed that telephone clinics were more convenient. Most (65%) preferred FTF follow‐up in the future. Statistical analysis using χ² test showed that among those with established follow‐ups, the preference for future consultation type was independent of specific reasons for follow‐up.ConclusionsOur study demonstrates a clear discrepancy between the practical successes of a virtual service from the clinician’s perspective compared with the patient/parental perspective. Parental anxiety appears to be less effectively allayed virtually than with FTF. This raises the question of whether there is a role for virtual paediatric telephone clinics in the postpandemic future, which may be better left to patients/parents to decide on an individual basis.

1117 Managing Cosmetic Surgery Complications: A Retrospective Service Evaluation

Abstract Aim The cosmetic surgery industry continues to grow, both within the UK and internationally. There is a perception that the NHS is often left to deal with the complications of these procedures, particularly those performed abroad. This study aimed to evaluate the burden of cosmetic surgery complications on a tertiary London plastics service with an appraisal of the financial costs incurred. Method This one-year retrospective service evaluation included all emergent referrals following cosmetic surgical interventions in the UK private sector and abroad. Outpatient referrals and planned revisional procedures were excluded. Financial costs were based upon current Clinical Commissioning Group tariffs. Results In total, 14 patients were included (seven from the UK and seven from Europe or North Africa). Remote telemedicine advice was provided for six patients; eight patients required admission. All eight admissions were female with an average age of 42.6 years. The most common complication was infection (75%) with an average length of stay of 2.3 nights. These eight patients required six trips to theatre, two CT scans and 37 outpatient visits. The median tariff per patient was £1,510 (range £242 to £5,196), leading to an overall reimbursement of £16,471. The majority of these costs were generated during inpatient admissions (£12,855) with a lesser contribution from outpatient episodes (£3,616). Conclusions This project provides an overview of the impact of managing emergent complications following cosmetic surgery, both in terms of service activity and financial cost. A long-term, prospective service evaluation of both elective and emergency referrals based upon patient-level costing data is now underway.

392 Magseed-Guided Wide Local Excision During the COVID-19 Pandemic: A Tenable Solution to Barriers in Accessing Elective Breast Cancer Surgery

IntroductionMagseed-guided localisation has emerged as a suitable alternative to wire-guided localisation (WGL) for impalpable breast cancers, with advantages including advanced insertion and simpler logistical planning. Given the severe disruption to elective surgeries during the Covid-19 pandemic, a local Magseed pathway was developed enabling safe patient flow. Magseed was inserted well in advance of the operation, enabling time to self-isolate and obtain a negative COVID swab prior to admission to a dedicated COVID -free suite. We present the patient-reported outcomes of the new pathway.MethodA prospective service evaluation was conducted in a University hospital. Patients undergoing Magseed-guided wide local excision (WLE) from 01/07/2020 to present were surveyed to detail their experiences on the Magseed pathway. Qualitative data investigating anxiety and comfort post-insertion were reported using 10-fold Likert scales. Quantitative data was collected on patient demographics and tumour specification.Results41/46 women who underwent Magseed localisation WLE completed the survey, with median age 65 years (IQR 53-72) and median BMI 26.5 kg/m2 (IQR 22.4-30.8). 71% had invasive ductal carcinoma with or without ductal carcinoma in-situ. 10% women found the procedure uncomfortable (<5) and 98% women reported low anxiety (<5) over seed displacement. If given the choice, 98% patients would prefer Magseed over WGL.ConclusionsThe new Magseed pathway is regarded positively among patients, despite ongoing disruption in elective breast cancer services. Given the progression of the second wave and likelihood of future outbreaks, Magseed localisation could be adopted widely to ensure continuous provision of safe elective surgeries.

General Versus Regional Anaesthesia for Lower Limb Arthroplasty and Associated Patient Satisfaction Levels: A Prospective Service Evaluation in the Oxford University Hospitals.

IntroductionLower limb arthroplasty is performed under general anaesthesia (GA) or regional anaesthesia (RA). There is increasing evidence of the surgical and anaesthetic benefits of RA. National Institute for Health and Care Excellence (NICE) guidelines advise using either but highlight a lack of data comparing outcomes of RA and GA for these procedures. We conducted a service evaluation, prospectively analysing elective orthopaedic cases performed at the Nuffield Orthopaedic Centre, Oxford, UK from 19/11/2018 to 03/04/2019. We aimed to compare data on anaesthetic assessment, intra-operative parameters and patient satisfaction for RA and GA cases.MethodsWe selected elective patients, aged above 18, undergoing total hip, total knee or unilateral knee arthroplasties. Prospective quantitative and qualitative data were collected using two forms. Firstly, anaesthetists completed a case report recording demographic data, intra-operative details and reason for anaesthetic choice. Secondly a questionnaire gathered patient satisfaction data. This was analysed using descriptive statistics and presented in tables.ResultsData for 132 patients were collected over the service evaluation period. After exclusion, 99 patients were included for final analysis; 59 underwent GA and 40 had RA. GA was used predominantly due to patient preference (74.6%). RA was used primarily due to anaesthetic preference (75%); most commonly due to speed of list and duration of operation. Overall patients had low pain scores (0.3/10) and high pre-operative anxiety levels (4.6/10) regardless of anaesthetic.ConclusionOur results show high patient satisfaction with GA and RA for lower limb arthroplasty; however, pre-operative anxiety was common for both. Patient preference and comfort influenced choice of anaesthesia, highlighting the importance of pre-operative counselling and education to facilitate shared decision making, leading to favourable post-operative outcomes.

Evaluation of the impact of the addition of a heart failure prescribing pharmacist to consultant-led heart failure ward round at a tertiary hospital

ObjectivePharmacists attending general medical post-admission ward rounds is established good practice. However, there is a lack of evidence on the impact of specialist heart failure (HF) prescribing pharmacists on consultant...

Seeking Excellence in End of Life Care (SEE Care): A Multi-Centered Acute Hospitals Service Evaluation.

A proportion of UK hospital inpatients have palliative care needs but do not access specialist services. To contemporaneously evaluate the significance of unmet specialist palliative care needs within the hospital inpatient population. Prospective multi-centered service evaluation was conducted through 4 snapshots across 4 acute NHS hospital trusts. All patients identified as dying in each hospital were included. Data extraction included symptom burden, medications and completion of care plans. End-of-life care plans were completed for 73%, symptom-focused prescribing present in 96%. Symptoms were not well managed for 22%, with 4% suffering moderate to severely. Specific intervention was triggered in 56% of patients, consisting of prescribing advice and holistic support. There are significant unmet specialist palliative care needs within the hospital inpatient population. Contemporaneous data collection coupled with an outreach approach helps palliative care services better understand the experiences of dying people, alongside where improvement is needed.

The Colorectal Telephone Clinic: a new normal post-COVID-19?

In light of the COVID-19 recommendations from the Association of Coloproctology of Great Britain and Ireland, we aimed to study patient and clinician satisfaction with a newly established telephone (TP) colorectal clinic service in lieu of traditional face-to-face (FTF) appointments. Comparative outcomes included patient versus clinician satisfaction; patient versus clinician desire to continue TP clinics postpandemic; and views of Specialty Trainee 3+ (ST3+)/Specialty Associate Specialist (SAS) doctors versus consultants on TP compared with FTF appointments. We conducted a prospective service evaluation of patient and clinician satisfaction with colorectal surgery TP clinics between 1 June 2020 and 30 June 2020 in a British District General Hospital. Patients had higher satisfaction than clinicians with TP clinics: 91.5% versus 66.6% reported above-average experience [odds ratio (OR) = 5.35, 95% confidence interval (CI) 1.53 to 18.75, p = 0.01]. Clinicians had lower demand to continue TP clinics post-COVID-19 versus patients, with a trend towards significance (60% versus 82.9%, OR = 0.31, 95% CI 0.10 to 0.97, p = 0.08). ST3+/SAS doctors were more likely than consultants to find TP clinics inferior to FTF consultation for patient assessment (48.3% versus 23.7%, OR = 3.00, 95% CI 1.17 to 7.71, p = 0.03). While clinicians may be concerned that patient assessment suffers, patient satisfaction with TP clinics is high. There should be a place for TP clinics post-COVID-19 but there must be a robust process for patient selection as well as adequate training for current and future generations of clinicians.

Trauma Laparotomy in the UK: A Prospective National Service Evaluation

Trauma patients requiring abdominal operation have considerable morbidity and mortality, yet no specific quality indicators are measured in the trauma systems of the UK. The aims of this study were to describe the characteristics and outcomes of patients undergoing emergency abdominal operation and key processes of care. A prospective multicenter service evaluation was conducted within all of the major trauma centers in the UK. The study was conducted during 6 months beginning in January 2019. Patients of any age undergoing laparotomy or laparoscopy within 24 hours of injury were included. Existing standards for related emergent conditions were used. The study included 363 patients from 34 hospitals. The majority were young men with no comorbidities who required operation to control bleeding (51%). More than 90% received attending-delivered care in the emergency department (318 of 363) and operating room (321 of 363). The overall mortality rate was 9%. Patients with blunt trauma had a greater risk of death compared with patients with penetrating injuries (16.6% vs 3.8%; risk ratio 4.3; 95% CI, 2.0 to 9.4). Patients in which the Major Hemorrhage Protocol (MHP) was activated and who received a blood transfusion (n= 154) constituted a high-risk subgroup, accounting for 45% of the study cohort but 97% of deaths and 96% of blood components transfused. The MHP subgroup had expedited timelines from emergency department arrival to knife to skin (MHP: median 119 minutes [interquartile range 64 to 218 minutes] vs no MHP: median 211 minutes [interquartile range 135 to 425 minutes]; p < 0.001). The majority of trauma patients requiring emergency abdominal operation received a high standard of expedited care in a maturing national trauma system. Despite this, mortality and resource use among high-risk patients remains considerable.

P053. Prospective single-centre qualitative service evaluation on magseed for wide local excision

Magseed is an effective non-inferior alternative to wire guidance (WGL) that enables intraoperative localisation of tumours during breast conserving surgery (BCS). The COVID-19 pandemic has necessitated a Magseed pathway in our hospital to enable patients to self-isolate preoperatively. Previous studies have not evaluated patient experience; thus, here we report the qualitative data on patients' perspectives regarding Magseed. A prospective service evaluation of BCS patients was conducted between 1st July 2020 and 1st December 2020 (Audit Committee Approval Registration No 410). Data was collected on patient demographics, tumour specification, and procedural outcomes. Qualitative results were obtained using binary outcomes and 10-point Likert scales. 41 women were included, with median age 62 years (IQR 53-69) and median BMI 27.3 kg/m2 (IQR 22.6-30.8). 29 patients had IDC, 5 had other invasive carcinomas, 4 had preinvasive disease, and 3 had benign lesions. 25 patients were ER+, 21 PR+, 3 HER2+, and 1 was triple negative. Median waiting time between insertion and operation for Magseed was 13 days (IQR 4-119). 11 patients had close margins, 6 of whom required re-operative intervention. 1 (2.4%) seed was misplaced, 4 (10%) found the procedure uncomfortable, and 2 (5%) had complications (1 difficult insertion, 1 developed pain). All excisions had successful retrieval. After an explanation of Magseed and WGL techniques, 43/49 (88%) patients said they preferred the Magseed approach. Magseed localisation methods are acceptable to staff and patients based on our prospective service evaluation. Magseed enables preoperative self-isolation in the era of Covid-19 in view of safer surgical outcomes.

P114 STING. Steroid Injections DurinG Covid-19. A cross speciality call

IntroductionAn important clinical question during the Covid -19 pandemic is the safety of steroid use. Guidelines published by rheumatology, physiotherapy, orthopaedic and pain medicine societies have advised on the restricted use of corticosteroids for musculoskeletal and rheumatic conditions. For clinicians across the specialities there is a challenge to safely conducting best practice, yet ensuring patients have access to the significant functional benefits of steroid injections.MethodsThe STING prospective service evaluation will collect data on steroid injections undertaken during this part of the pandemic. Clinicians will be able to input information on patient demographics, background Covid risk and steroid injection specifics. At follow up at 4-6 weeks complications and Covid specific outcomes will be recorded, as well as patient perceived symptom improvement.Each unit collecting data will have assigned collaborator(s), with a senior consultant validating the data.Data will be collected and managed using Research Electronic Data Capture (REDCap). Data collection and management will adhere to Caldicott II principles and GDPR.ResultsResults will be analysed through RedCap and compared to national Covid incidence. Local complication and patient reported outcomes will be compared between specialities, environments and steroid specifics (volume, location etc.).ConclusionA pan-speciality look at steroid injection use during the pandemic will be useful primarily to contribute to understanding the safety of steroid use. Secondarily to look at cross speciality differences in administration, PROMs and to appreciate patient groups who may be excluded from steroid treatment.Join the team! Head to RSTN to get involved.

Prevalence of Prandial Aspiration, before and after Lung Transplantation: Proof of Concept in a UK Tertiary Hospital

Purpose There are no guidelines or standardised protocols in the UK to assess, identify or manage aspiration in patients who undergo bilateral lung transplant either pre or post operatively, despite literature detailing high incidence of aspiration, ranging from 54%1 -77%2 . Aspiration is clinically important, as it is correlated with post-operative complications including re-intubation, tracheostomy, prolonged length of stay and mortality3. Given these adverse outcomes for patients with suspected prandial aspiration during their Intensive Treatment Unit recovery, we analysed our cohort to better understand our treatment outcomes, and to improve clinical pathways. Methods Prospective service evaluation. SLT and the Ear Nose and Throat (ENT) team carried out fibreoptic endoscopic evaluation of swallow (FEES) on 10 patients post transplantation and 2 patients pre-transplantation. Results All patients included had a degree of dysphagia, ranging in severity, pre and post transplantation. 9/10 patients post-transplant silently aspirated- there were no signs observable at bedside. 4/10 post-transplant patients had vocal cord palsies/praxis not obvious on bedside examination. 2/2 patients pre-transplant had dysphagia related to breathe-swallow co-ordination All patients required specific swallow rehabilitation and management strategies from the SLT teamAll patients seen by SLT and ENT were able to eat and drink normally following targeted rehabilitation. Conclusion Patients undergoing double lung transplant may present with and experience swallowing problems. We noted complex motor-sensory impairments, alongside dysfunctional respiratory patterns which seem to further exacerbate dysphagia. The collaborative multi-disciplinary role of ENT, SLT and the Respiratory teams resulted in proactive clinical interventions, including but not limited to algorithm development and targeted rehabilitation, potentially reducing the impact of undiagnosed prandial aspiration. Detailed research is required to explore prevalence, impact and potential rehabilitation strategies for this complex cohort of patients.

The Post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part II: Clinical engagement and future directions for the national Post-Intensive care Rehabilitation Collaborative.

Many Intensive Care Unit (ICU) survivors suffer from a multi- system disability, termed the post-intensive care syndrome. There is no current national coordination of either rehabilitation pathways or related data collection for them. In the last year, the need for tools to systematically identify the multidisciplinary rehabilitation needs of severely affected COVID-19 survivors has become clear. Such tools offer the opportunity to improve rehabilitation for all critical illness survivors through provision of a personalised Rehabilitation Prescription (RP). The initial development and secondary refinement of such an assessment and data tools is described in the linked paper. We report here the clinical and workforce data that was generated as a result. Prospective service evaluation of 26 acute hospitals in England using the Post-ICU Presentation Screen (PICUPS) tool and the RP. The PICUPS tool comprised items in domains of a) Medical and essential care, b) Breathing and nutrition; c) Physical movement and d) Communication, cognition and behaviour. No difference was seen in total PICUPS scores between patients with or without COVID-19 (77 (IQR 60-92) vs. 84 (IQR 68-97); Mann-Whitney z = -1.46, p = 0.144. A network analysis demonstrated that requirements for physiotherapy, occupational therapy, speech and language therapy, dietetics and clinical psychology were closely related and unaffected by COVID-19 infection status. A greater proportion of COVID-19 patients were referred for inpatient rehabilitation (13% vs. 7%) and community-based rehabilitation (36% vs.15%). The RP informed by the PICUPS tool generally specified a greater need for multi-professional input when compared to rehabilitation plans instituted. The PICUPS tool is feasible to implement as a screening mechanism for post-intensive care syndrome. No differences are seen in the rehabilitation needs of patients with and without COVID-19 infection. The RP could be the vehicle that drives the professional interventions across the transitions from acute to community care. No single discipline dominates the rehabilitation requirements of these patients, reinforcing the need for a personalised RP for critical illness survivors.

Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area.

PurposeThe UK government introduced a nationwide lockdown on the 23rd March 2020 to prevent the spread of COVID-19. All elective hospital and dental practice assessments and procedures were mandated to stop. Key hospital dental workers were required to work, and Guy’s and St Thomas’ NHS Foundation Trust became a designated Urgent Dental Care Centre (UDC) for the greater London area. The paediatric dental emergency walk-in service was suspended and replaced with a telephone triage system and evaluation of digital images sent by parents/carers when needed. The aim of this paper is to describe the emergency service provided by staff in the department of Paediatric Dentistry at St Thomas’ Hospital during the first lockdown.MethodsA prospective service evaluation of the modified paediatric dental emergency service was carried out between 25th March and 29th May 2020.ResultsFour-hundred and sixty-four patients accessed the paediatric dental emergency service via telephone during the service evaluation period. Of these, 192 (41%) had dental pain, 121 (26%) had pain and swelling of dental origin, and 89 (19%) had trauma.ConclusionsRemote telephone consultations and digital photographs were useful to screen emergency paediatric dental patients, but lack of face-to-face consultations with radiographic assessment and access to general anaesthetic services were major limiting factors.

Patient and clinician satisfaction and clinical outcomes of Magseed compared with wire-guided localisation for impalpable breast lesions

BackgroundGuide-wire localisation remains the most commonly used technique for localisation of impalpable breast lesions in the UK. One alternative is magnetic seed localisation. We aimed to investigate patient and clinician satisfaction in two consecutive cohorts, describe re-excision and positive margin rates, and explore reasons for positive margins and the implications for localisation techniques.MethodsA single-institution prospective service evaluation of two cohorts of consecutive cases of wire and then Magseed localisation was carried out. Data were collected on patient and clinician satisfaction, clinico-pathological findings, and causes of involved margins. T tests were used to compare continuous variables and Chi-squared test for satisfaction outcomes.Results168 consecutive cases used wire-guided localisation (WGL) and 128 subsequent cases used Magseeds. Patients reported less anxiety between localisation and surgery in the Magseed group, and clinicians reported greater ease of use of Magseeds. There were no differences in lesion size, surgical complexity, or re-excision rate between the groups. In a subset of patients receiving standard wide local excision (i.e., excluding mammoplasties), the impact on margin involvement was investigated. There was no significant difference in radiological under-sizing or accuracy of localisation. However, specimen weight and eccentricity of the lesion were statistically significantly lower in the Magseed group. Despite this, re-excision rates were not significantly different (p = 0.4).ConclusionsThis is the first large study of satisfaction with localisation and showed clinician preference for Magseed and a reduction in patient anxiety. It also demonstrated similar positive margin rates despite smaller specimen weights in the Magseed group. Magnetic seed localisation offers an acceptable clinical alternative to guide wire localisation. The impact on local service provision should also be considered.

Lifetime visual outcomes of patients undergoing trabeculectomy

BackgroundThe most important outcome for patients undergoing trabeculectomy is to maintain the quality of life in their remaining years. This study quantifies end of life vision in terms of visual...