Evaluation of a newly introduced tonsillectomy operation record for the analysis of regional post-tonsillectomy bleed data: a quality improvement project at the London North West Healthcare NHS Trust

The primary objective of this audit and quality improvement project was to retrospectively analyse regional post-tonsillectomy haemorrhage data as per national recommendations. However, this process highlighted the need for high-quality routinely collected data; something that was not always available via retrospective audit and thus does not enable formal aetiological factor analyses. We therefore created further secondary objectives to facilitate our primary audit objective. These secondary objectives were (1) to introduce a standardised tonsillectomy operation proforma to improve completeness and quality of routinely collected data and (2) to evaluate and validate proforma use and usefulness in improving using routine data collection to help with a repeated audit of post-tonsillectomy haemorrhages with the eventual aim to help improve operative outcomes by identifying potential associated factors. The retrospective audit component, the prospective audit and the quality improvement component were all carried out at the Northwick Park Hospital and Central Middlesex Hospital (London North West Healthcare NHS Trust). First, 642 tonsillectomy records (2012-2014) were retrospectively reviewed. Free-text operative documentation and, where possible, potential factors associated with post-tonsillectomy haemorrhages were analysed. In addition, completeness of data available before and after the introduction of (A) a new paper-based and (B) electronic surgical record proforma was reviewed (2014-2015). Over a 2-year period, 62 of the 642 (9.7%) audited tonsillectomy patients had a post-tonsillectomy haemorrhage, and 19 of these (2.9%) had to return to theatre for surgical arrest of the haemorrhage. Bipolar diathermy was the most commonly used technique. During this period, data available from routine operative documentation in the surgical operation notes were variable and thus did not allow identification of potential factors associated with post-tonsillectomy haemorrhage. The completeness and quality of data significantly improved after the introduction of a standardised paper-based proforma with sections for required details based on known risk factors for post-tonsillectomy haemorrhage and required operative details. Quality and completeness of data was further improved after the introduction of an electronic version. This electronic proforma will allow prospective spiral auditing results, early identification of raised bleeding rate, and provide individual surgeon audit results

A tablet computer-assisted motor and language skills training programme to promote communication development in children with autism: development and pilot study

Autism is a heterogenous condition, encompassing many different subtypes and presentations. Of those people with autism who lack communicative speech, some are more skilled at receptive language than their expressive difficulty might suggest. This disparity between what can be spoken and what can be understood correlates with motor and especially oral motor abilities, and thus may be a consequence of limits to oral motor skill. Point OutWords, tablet-based software targeted for this subgroup, builds on autistic perceptual and cognitive strengths to develop manual motor and oral motor skills prerequisite to communication by pointing or speaking. Although typical implementations of user-centred design rely on communicative speech, Point OutWords users were involved as co-creators both directly via their own nonverbal behavioural choices and indirectly via their communication therapists’ reports; resulting features include vectorised, high-contrast graphics, exogenous cues to help capture and maintain attention, customisable reinforcement prompts, and accommodation of open-loop visuomotor control

Cross-sectional survey of a sample of UK primary care dental professionals' experiences of sharps injuries and perception of access to occupational health support

Background: The 2013 Sharps Regulations were introduced to minimise the risk of sharps injuries and blood borne virus transmission throughout healthcare. Occupational health (OH) services are pivotal for helping employers implement these regulations. Despite this, no research has been conducted on the prevalence of sharps injuries, underreporting of injuries or access to OH among primary care dental professionals in the UK since 2013. Aim: To estimate the prevalence of sharps injuries, the level of underreporting and of self-reported access to an OH service both for the care of sharps injuries and for general health and wellbeing. Method: A cross-sectional survey was administered at the 2017 British Dental Association (BDA) Conference and Exhibition in Manchester, and at the 2017 BDA Scottish Conference and Exhibition in Glasgow. The survey covered questions relating to sharps injuries and OH support. Statistical analyses were conducted using SPSS Version 22 (IBM Corp., 2013). Results: A total of 796 delegates participated, of whom 166 (20.8%) had experienced a sharps injury in the past year and 58 (35%) did not report the incident. Of the participants, 190 (23.9%) reported no, or uncertain, access to OH support. Most respondents' practices had a sharps safety policy (771; 96.9%), but fewer (611; 76.8%) had received training on the prevention of sharps injuries and neither policy nor training were associated with incident reporting. Conclusion: Despite the introduction of the sharps regulations, sharps injuries and underreporting of injuries remain prevalent among those practising in primary dental care. Our results also suggest that there are significant shortfalls in OH support, at a time when changes to guidance on health clearance and management of BBV infected healthcare workers, in addition to sharps injury management, increase the need for such services

Optimising outcomes in the management of spontaneous cerebrospinal fluid rhinorrhoea

Background: To describe our experience of the management of spontaneous cerebrospinal fluid (CSF) rhinorrhoea in a large case series focusing on surgical approach, peri-operative management and outcomes; to evaluate the efficacy of endoscopic CSF leak repairs. Methodology: Retrospective chart review was performed for all patients with spontaneous CSF rhinorrhoea managed from 2003 to 2011 at a tertiary referral centre. Data regarding demographics, presentation, site of leak, peri-operative management, surgical approach, body mass index (BMI), follow up and success rates was collated. Results: Thirty-six patients were identified: 9 male and 27 female with a mean age of 50.4 years. Eight patients had previous failed repairs in other units. Success rate after first surgery was 89 % and after second surgery was 100 %. Four patients had recurrences, 3 underwent successful revisions and the fourth had complete cessation of the leak after gastric bypass surgery and weight reduction. All failures were before 2004 prior to instigation of an anatomic three-layered repair with no further failures in the following 7 years. Mean follow up was 21.5 months. Mean body mass index was 34.0 kg/m2. Fifty percent of spontaneous leaks were from the cribriform plate, 22 % sphenoid, 14 % ethmoid and 14 % frontal sinus. Conclusion: Endoscopic CSF fistula closure has become the gold standard of care. In order to optimise the outcome, we recommend a multidisciplinary approach to manage the associated idiopathic intracranial hypertension and an anatomic three-layered closure technique for recalcitrant cases.</jats:p