Search

The absence of face-to-face teaching during the COVID-19 pandemic has created particular challenges for clinical postgraduate educators. Induction for dental core trainees (DCTs) entering secondary care posts for the first time is of prime importance, with the aim of delivering a comprehensive course covering core topics, fundamental to patient safety. This paper describes the adaptation and delivery of a remote DCT induction programme for the Midlands and East of England area. Using a 'flipped classroom' approach, prior induction content was adapted to provide online pre-recorded lectures and learning resources to prepare for web-based video conferencing case-based discussions. In order to assess the quality of teaching and success of the course, participants completed three questionnaires: identical assessments before and after the course to evaluate a change in knowledge and confidence, and a course evaluation survey. In total, 126 DCTs attended the induction course, with response rates of 82%, 75% and 61% for the 3 questionnaires respectively. Comparing DCT knowledge and confidence in treating patients before and after the course, there was a statistically significant increase in 13 of 14 domains. Despite being a web-based course, 100% of participants described the case-based small group discussions as ‘interactive and enjoyable’, with overall positive feedback for the delivery of a remote induction course We demonstrate how a remote web-based induction course for DCTs is achievable and has potential advantages with regard to pooling of resources and faculty. Several key learning points are discussed, in addition to the potential for a standardised framework for national DCT induction.

631 Background: Combination therapy with A + Ax in patients with previously untreated aRCC has shown superior progression-free survival (PFS) and objective response rate (ORR) vs sunitinib across all International Metastatic RCC Database Consortium (IMDC) risk groups. This study reports 24-month real-world outcomes in patients with aRCC receiving A + Ax in the UK. Methods: Patients were recruited from 9 UK sites. Inclusion criteria were diagnosis of aRCC, initiation of A + Ax on or after August 1, 2019, via the Early Access to Medicines Scheme, and age ≥18 years. The primary endpoints were overall survival (OS), PFS, ORR, and best response at 24 months post-A + Ax initiation. Data were analyzed descriptively. Total recruitment was 130 patients. Follow-up will continue until July 2023. Results: This analysis includes 78 patients with a minimum follow-up of 24 months. Median age at baseline was 66.6 years (range, 39.8-84.1 years); 76% (n=59) of patients were male, 63% (n=49) were White, 5% (n=4) were Asian/Asian British, and ethnicity was not recorded in 32% (n=25); 91% (n=71) had an Eastern Cooperative Oncology Group score of 0 or 1. IMDC risk status was favorable in 42% (n=33) of patients, intermediate in 41% (n=32), and poor in 17% (n=13). Median time between aRCC diagnosis and A + Ax initiation was 2.5 months (range, 0.03-90.4 months; n=77). Clear cell histology was the most prevalent (81% [n=63]); 68% (n=53) of patients had undergone nephrectomy, and 74% (n=58) had 1 or 2 metastatic sites at the index date. The OS rate at 24 months was 60% (95% CI, 49.4%-71.1%). The OS rates by IMDC risk status were: favorable, 76% (95% CI, 61.1%-90.4%); intermediate, 63% (95% CI, 45.7%-79.3%); and poor, 15% (95% CI, 0%-35.0%). The PFS rate at 24 months was 31% (95% CI, 20.5%-41.0%); median PFS was 9.1 months (95% CI, 7.9-13.4 months). ORR (n=76) at 24 months was 59% (95% CI, 48.2%-70.3%), with 4% (n=3) achieving complete response (CR) and 55% (n=42) partial response (PR). Best responses observed within 24 months were CR in 4% (n=3), PR in 54% (n=42), stable disease in 29% (n=23), and progressive disease in 10% (n=8) (2 not recorded). Median duration of response was 11.9 months (range, 0.4-23.7 months). Median time to discontinuation (TTD) of either A or Ax was 5.5 months (range, 0.5-20.5 months; n=50). Median TTD of A + Ax combined was 5.6 months (range, 0.8-20.5 months; n=43). Of 78 patients, 62 experienced an adverse event (AE) due to A + Ax treatment, 8 of whom had 14 serious AEs in total. The most common AEs were diarrhea (n=31), fatigue (n=22), and rash or oral mucositis (n=18 each); 3 patients discontinued Ax due to AEs including diarrhea (n=2), abnormal hepatic function (n=1), and abdominal pain (n=1). Conclusions: This UK-based real-world study of A + Ax treatment reports 24-month clinical outcomes in patients with aRCC. OS, PFS, ORR, and best response were in line with findings from prior clinical trials, with no new emerging AEs.

The aim of surgical management of benign facial skin lumps is to remove the lesion in its entirety, with minimal damage to adjacent tissue structures, while maintaining facial aesthetics. A method to achieve these goals is to remove peri-oral lesions in the labial and buccal zones via an intra-oral approach. We report an extended cases series of facial skin lumps that were excised using an intra-oral approach. A retrospective analysis was performed on all patients who underwent excisions of benign cutaneous lesions on the face via an intra-oral approach. Patient demographics, indication for surgery and complications were noted. Forty-seven lesions were excised over a 15-year period. Indications for surgery included benign lesion with minimal skin involvement, risks of keloid/scar hypertrophy and cosmetic factors. Lesions were predominantly epidermoid cysts and lipomas. Mean follow-up was 2.9 years with a 6.4% recurrence rate and 2.1% rate of haematoma and transient facial nerve weakness. There are established techniques to remove facial skin lumps. We believe that in selected cases, an intra-oral approach to such lesions, particularly in cases with high risk of scar pathology or where there is strong patient preference, may be an important tool in the oral and maxillofacial surgeon’s armamentarium.

Oral and Maxillofacial Surgery (OMFS) remains an enigmatic specialty in Irish medicine and many students are unaware of its scope and the unique career pathway involved. We completed a multicentre cross-sectional study to identify their ability to identify the requirements for entry to specialty training year 3 (ST3) in OMFS, to assess their awareness of OMFS surgeons, and their general awareness of, and exposure to, the specialty. Data were collected through an electronic questionnaire. Participants were asked to select the most suitable surgical specialty to treat a number of common conditions in the head and neck, and to choose the requirements they deemed essential for specialist training. Knowledge was measured by the number of correct responses. A total of 443 medical students participated (University College Cork (UCC) n=328, 74%; Royal College of Surgeons in Ireland (RCSI) n=113, 26%). A total of 318/374 (85%) had had no previous experience of OMFS, 38/374 (10%) had had theoretical teaching only, and 18/374 (5%) had had clinical experience. A total of 212/329 (64%) wished for greater exposure as a student, but only 34/329 (9%) would consider a career in the specialty. The median (IQR) number of correct responses for OMFS procedures was 3.0/10 (2.0), with women, direct entrants, and RCSI students scoring highest. Only 11/367 (3%) could identify the minimum entry requirements for a post of specialist registrar. This study has identified a potential gap in the undergraduate curriculum. Although medical students are rarely taught about OMFS, they show an interest in learning more.

Open access (OA) publication has become an increasingly common route for dissemination of scientific research findings. However, it remains a contentious issue with continued debate as to its impact on the peer-review process and a potential change in the quality of subsequent evidence published. There is little research that looks into OA in oral and maxillofacial surgery.We investigated the OA policy in the 30 relevant journals listed in the Institute for Scientific Information Web of Knowledge journal citation report, comparing bibliometric data and quality of evidence produced in journals offering OA and those with subscription-only policies.3474 articles were graded for evidence level and the results correlated to journal OA status. 76.7 % of journals offered authors OA services. There was no difference between impact factor, self-citation rate, total citations or quality of evidence between OA and subscription journals.These findings should send clear messages to both clinicians and researchers and should re- assure readers that scientific findings that are disseminated in open access form do not differ in quality to those in subscription-only format. It should reinforce that open access formats are a credible way to display research findings in oral and maxillofacial surgery.

This review summarises all orthognathic and related papers published between January 2011 and December 2012 in the British Journal of Oral and Maxillofacial Surgery (BJOMS). A total of 36 articles were published, a high proportion of which (78%) were full-length papers. The remainder consisted of short communications and technical notes. The topics included operative planning and postoperative outcomes, and there was a strong focus on distraction osteogenesis. There were fewer orthognathic articles published in BJOMS than articles on other subspecialties such as trauma or head and neck oncology. Only 8 (29%) of the full-length articles were prospective studies or randomised trials, which highlights a need for well-designed clinical studies in orthognathic research.

This paper is a synopsis of all articles relating to oral surgery that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) between January 2011 and December 2012. Of the 57 published, 40 (70%) were full-length articles that predominantly focused on implantology, dentoalveolar surgery, and bisphosphonate osteonecrosis of the jaws (BONJs). In addition, a number of short communications, technical notes, and letters to the editor described rare cases, unusual complications, and novel surgical techniques.

In this study we investigate the five most cited articles in the British Journal of Oral and Maxillofacial Surgery (BJOMS). Articles cited were usually published in other OMFS journals (40%) or dentistry journals (32%). The mean (SD) SCImago Journal and Country Rank, (SJR) (an interface to access the bibliometric database of journals) for cited papers was 0.64 (SD=0.56). Nearly one third of citations were of research in OMFS and dentistry, suggesting its relevance to the wider academic community.

Summary Background: Clinicians are required by law to keep personal patient data secure. Data protection training (DPT) has been suggested to educate medical professionals in how to most appropriately manage such information. Methods: Information regarding the handling, storage and disposal of patient information and prevalence of DPT was gathered using anonymous questionnaires. Results: The vast majority of doctors (98.6%) handle patient lists containing patient-sensitive information: 15.8 per cent used general waste bins for the disposal of lists and 57.3 per cent removed printed patient lists from hospital premises; 43.3 per cent of doctors had received DPT. A significantly greater proportion of consultants have received DPT, compared with doctors in training. Doctors who have received DPT were less likely to take patient lists away from a hospital site (p = 0.011). DPT led to a trend towards increased awareness of the security of the storage location of their patient lists and of trust policy regarding the use of personal USB devices. Discussion: With the expansion of patient data collection and storage, it is important for doctors to maintain an awareness of how to handle such data. DPT is not currently common practice. Our study suggests positive benefits from DPT, and we suggest it could improve the safety with which patient data is handled.

Background: NHS Library Services are utilised by NHS staff and junior trainees to locate scientific papers that provide them with the evidence base required for modern medical practice. The cost of accessing articles can be considerable particularly for junior trainees. Objectives: This survey looks at variations in cost of journal article loans and investigates access to particular orthopaedic journals across the country. Methods: A national survey of UK Health Libraries was performed. Access to and costs of journals and interlibrary loan services were assessed. Availability of five wide-reaching orthopaedic journals was investigated. Results: Seven hundred and ten libraries were identified. One hundred and ten libraries completed the questionnaire (16.7%). Of these, 96.2% reported free access to scientific journals for users. 99.1% of libraries used interlibrary loan services with 38.2% passing costs on to the user at an average of £2.99 per article. 72.7% of libraries supported orthopaedic services. Journal of Bone and Joint Surgery (British) had greatest onsite availability. Conclusions: The study demonstrates fluctuations in cost of access to interlibrary loan services and variation in access to important orthopaedic journals. It provides a reflection of current policy of charging for the acquisition of medical evidence by libraries in the UK.

Length of post-operative stay is an important factor in improving cost-effectiveness of total hip arthroplasty (THA). Short stem femoral components may reduce soft tissue and bone damage, permitting earlier mobilization and earlier safe discharge from hospital. This study compares the length of stay of patients undergoing THA using a short stem femoral component compared to an age matched group undergoing standard THA. The mean age in the standard stem group was 52.7 years and 50.4 years in the short femoral stem group (p=0.57). Total theatre time, blood loss and post-operative Oxford hip scores in the groups were not statistically different (p=0.11, p=0.91, p=0.16). Mean post-operative stay for the short stem group was shorter (3 vs 5 days, p=0.010), resulting in 10% cost saving per patient episode.

This review summarises all trauma and related papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) from January 2010 to December 2011. In total 45 articles were published, of which 42% (19) were full-length articles. These articles primarily focused on the management of mandibular condyle and orbital fractures, with several papers discussing maxillofacial surgery by the British military. There were no articles discussing midfacial fractures or massive facial trauma. The remaining papers included short communications, technical notes, and letters; and provided discussion of interesting cases, new surgical techniques and fracture classifications. The number of trauma papers published in BJOMS appears to be less than other sub-specialties such as head and neck oncology. The number of prospective and randomised studies remains low, highlighting a need to foster further research within maxillofacial trauma.

NHS Library Services are utilised by NHS staff and junior trainees to locate scientific papers that provide them with the evidence base required for modern medical practice. The cost of accessing articles can be considerable particularly for junior trainees. This survey looks at variations in cost of journal article loans and investigates access to particular orthopaedic journals across the country. A national survey of UK Health Libraries was performed. Access to and costs of journals and interlibrary loan services were assessed. Availability of five wide-reaching orthopaedic journals was investigated. Seven hundred and ten libraries were identified. One hundred and ten libraries completed the questionnaire (16.7%). Of these, 96.2% reported free access to scientific journals for users. 99.1% of libraries used interlibrary loan services with 38.2% passing costs on to the user at an average of £2.99 per article. 72.7% of libraries supported orthopaedic services. Journal of Bone and Joint Surgery (British) had greatest onsite availability. The study demonstrates fluctuations in cost of access to interlibrary loan services and variation in access to important orthopaedic journals. It provides a reflection of current policy of charging for the acquisition of medical evidence by libraries in the UK.

Introduction Professional identity is becoming increasingly important in medical education in terms of developing appropriately trained and safely practising doctors. Oral and maxillofacial surgery (OMFS) is a unique surgical speciality that requires dual qualification in medicine and dentistry. Its junior trainees move between the various roles of student, doctor and dentist, and at certain times these roles may overlap. This heterogeneous early training may raise significant barriers for them in terms of understanding their professional identity and developing their own sustainable sense of belonging. This study looks to understand current trainees’ perceptions of the professional identity of an oral and maxillofacial surgeon. Method A qualitative research methodology based on a grounded theory approach was used in this study. Data were collected using in-depth, semi-structured interviews with OMFS specialist trainees. Subsequent theories were constructed after thematic analysis. Results A model of the professional identity of an oral and maxillofacial surgeon is proposed. Discussion This study represents the first attempt to understand professional identity in OMFS trainees. It will provide insight into what trainees understand by the term in this speciality, as well as outlining what trainees feel are important elements to develop a sense of belonging within the speciality.