Active learning in head and neck trauma: outcomes after an innovative educational course.

Excellence in teaching and learning is fundamental to the provision of quality training for doctors and for this a sound knowledge of the principles of adult learning theory is important. We present an educational course in head and neck trauma skills for emergency medicine (EM) registrars, using the pedagogical principle of active learning. Our aim was to provide trainees with skills in the evaluation and management of hard and soft tissue injuries to the head, neck, and mouth. Active learning has been shown to provide a superior experience in classrooms, creating a 'deep' understanding of the material. To maximise learning, we used these principles to develop small group seminars led by a diverse range of teachers that allowed trainees to acquire hands-on skills. Questionnaires that were completed before and after the course showed an appreciable educational impact. We conclude that innovative teaching methods facilitate the sharing of knowledge that will benefit patient care.

The effect of lockdown during SARS-CoV-2 pandemic on maxillofacial injuries in a level I trauma centre: a comparative study.

INTRODUCTION: The SARS-CoV-2 pandemic forced many governments to impose nation-wide lockdowns. Government legislation forced limited travel on the population with restrictions on the normal way of life to limit spread of the SARS-CoV-2 virus. The aim of this study is to explore the effects of lockdown on the presentation of maxillofacial trauma in a level I trauma centre. METHODS: Comparative analysis was carried out using prospective and retrospective review of all consecutive patients admitted with any maxillofacial fracture in the lockdown period between 15th March and 15th June 2020 with the same period in 2019 to a Regional Trauma Maxillofacial Surgery Unit. Data included basic demographics and mechanism of injury including alcohol/drug influence, polytrauma, site of injury and treatment modality including escalation of care. RESULTS: Across both periods, there were a total of one hundred and five (n = 105) recorded episodes of traumatic fractures with fifty-three (n = 53) in the pre-lockdown cohort and fifty-two (n = 52) in the lockdown. Included patients were significantly (p = 0.024) older during lockdown (mean age 41.44 years SD 20.70, range 5-96) with no differences in gender distribution between cohorts (p = 0.270). Patients in lockdown were more likely to be involved in polytrauma (p < 0.05) and have sustained their injury by cycling/running or any outdoor related activity (p = 0.013). Lockdown saw a significant reduction in alcohol and drug related violence (p < 0.05). Significantly more patients required operative management (p = 0.038). CONCLUSION: Local lockdowns form part of the governments public health strategy for managing future outbreaks of SARS-CoV-2. Our study showed no significant reduction in volume of trauma during lockdown. It is vital that hospitals maintain trauma capacity to ensure that patients are treated in a timely manner.

Application of multiple locus variable number of tandem repeat analysis (MLVA), phage typing and antimicrobial susceptibility testing to subtype Salmonella enterica serovar Typhimurium isolated from pig farms, pork slaughterhouses and meat producing plants in Ireland.

Salmonella enterica subsp. enterica serovar Typhimurium is a common zoonotic pathogen encountered in Irish pigs and the pork industry and its characterisation using highly discriminatory typing methods is necessary for epidemiological studies, outbreak investigation and control. Multiple locus variable number of tandem repeat analysis (MLVA), phage typing and antimicrobial susceptibility testing were applied to characterise 301 S. typhimurium isolates of porcine origin isolated from farms, slaughterhouses and pork meat producing plants in Ireland over a four-year period. 154 MLVA patterns were obtained compared to 19 phage types and 38 AMR patterns, and MLVA was particularly useful for discriminating isolates of the same phage type, e.g. DT104 and DT104b, or isolates that were Untypable or in the category of "react with phage but does not conform to a recognised phage type" (RDNC) by the phage typing method. Cluster analysis of MLVA profiles using a minimum spanning tree (MST) demonstrated two major clusters (I and II), which showed to have a clear association with phage types, cluster I associated to phage types DT104, U302 and DT120 and cluster II associated to DT193 and U288. The results of this present study showed that MLVA is highly discriminatory and permitted the identification of identical profiles among isolates obtained at different points of the pork food chain. The same MLVA profile was observed in some cases among isolates with different phage types. While this can be explained by the fact that some phage types are closely related, it also indicates that combining phage typing and MLVA enhances strain typing of S. typhimurium.

Medication-related osteonecrosis of the jaws and quality of life: review and structured analysis.

Medication-related osteonecrosis of the jaws (MRONJ) is a rare complication of bisphosphonates, or antiresorptive or antiangiogenic medication. Treatment is difficult as the bone has a poor capacity for healing, and further progression after surgery can occur. Quality of life (QoL) in patients with MRONJ has not been well documented. The aim of this study therefore was to identify and analyse data on QoL in this group of patients. Eight studies that were identified through a systematic search of the literature were qualitatively analysed. Overall, data on QoL are lacking and are complicated by concurrent disease such as cancer. Patients generally have a poor QoL because of MRONJ, and multiple oral-specific complaints including pain and problems with speech. Development of a questionnaire specific to patients with MRONJ would help improve the specificity of the data collected. Prospective questionnaires before and after intervention, including information on stage and comorbidities, would guide future treatment strategies.

The 'R' word - do dental core trainees possess it?

Resilience is the process of 'bouncing back' from stresses in life. High resilience is associated with less anxiety and psychological distress, and is therefore an important trait for health professionals. We know of no work to date on the resilience of dental core trainees (DCT) as they make the unique transition from dental practice to a hospital-based setting. To elicit data on the self-perceived resilience of this group, and to find out if resilience correlated with the perceived stress of scenarios in Oral and Maxillofacial Surgery (OMFS), we distributed surveys (the Brief Resilience Scale (BRS) and five clinical scenarios) to DCTs in the Yorkshire and Humber region, and asked them what would improve their resilience. A total of 38 responded: 4 had high, 11 had normal, and 23 had low levels of resilience. An inverse correlation was seen between resilience and the perceived stress of the scenarios. A total of 28/31 OMFS DCT1s responded (90%). Self-perceived resilience was low. High levels of resilience were associated with low levels of perceived stress from the scenarios. The trainees felt that approaches that were supported by the literature would improve their resilience. Resilience training could therefore be considered for this group, and it could have a positive impact on their well-being and potential benefits for patient care.

Oromandibular dystonia: a diagnosis not to miss.

Oromandibular dystonia (OMD) is characterised by sustained or repetitive involuntary movements of the jaw, face, and tongue. People with the condition may present to their dentist, general practitioner, or a secondary care specialist with non-specific symptoms including jaw or facial pain, bruxism, subluxations or dislocations of the jaw; fractured teeth or dental restorations, or both; or jaw tremor. Many clinicians are not aware of the disorder and this can lead to delayed diagnoses, unnecessary complications, and inappropriate treatment. OMD is an important diagnosis not to miss because referral for specialist management can provide good long-term results. To aid early, accurate diagnosis, this paper focuses on the key clinical features of the disorder and its dental and medical mimics.

Maintaining medical team communication using video conferencing during the COVID-19 lockdown.

COVID-19 is a global pandemic of unprecedented proportions. It has resulted in changes to all aspects of our lives. The impact on medicine has been significant. Clear and effective communication during these times is vital. We present an evaluation of the use of video conferencing (VC) and offer a simple format to structure meetings for their effectiveness and promotion of team communication and wellbeing.

Biomarkers of abnormally invasive placenta.

INTRODUCTION: Abnormally invasive placenta (AIP, aka placenta accreta spectrum; PAS) is an increasingly common pregnancy pathology, which, despite significant morbidity risk to the mother, is often undiagnosed prior to delivery. We tested several potential biomarkers in plasma from PAS mothers to determine whether any were sufficiently robust for a formal, diagnostic accuracy study. METHODS: We examined hyperglycosylated hCG (h-hCG), decorin and IL-8, based on biological plausibility and literature indications that they might be altered in PAS. These analytes were assayed by ELISA in maternal plasma from five groups, comprising (1) normal term controls, (2) placenta previa controls, and cases of (3) placenta increta/percreta without placenta previa, (4) placenta previa increta/percreta and (5) placenta previa accreta. RESULTS: There were no differences in h-hCG, ß-hCG or the h-hCG/ß-hCG ratio between the groups. Mean decorin levels were increased in previa controls (Group 2) compared to the other groups, but there was substantial overlap between the individual values. While an initial multiplex assay showed a greater value for IL-8 in the placenta previa increta/percreta group (Group 4) compared to placenta previa controls (Group 2), the subsequent validation ELISA for IL-8 showed no differences between the groups. DISCUSSION: We conclude that the absence of differences and the extent of overlap between cases and controls does not justify further assessment of these biomarkers.

Immigrant patients with type 2 diabetes mellitus have poorer initial and on-going glycemic control than a matched population of Irish patients.

We compared the glycemic and cardiovascular risk status of non-Caucasian patients with type 2 diabetes mellitus (T2DM) who recently emigrated to Ireland with a matched population of Irish patients. We identified 105 non-Caucasian patients with T2DM who recently emigrated to Ireland and compared them with 105 Irish patients with T2DM, who were matched for age, sex and duration of diabetes. Immigrants with T2DM had significantly worse initial (9.8% vs 9.1%, p<0.05) and on-going (8.3% vs 7.1, p<0.05) glycemic control and higher microalbumin to creatinine ratio compared to the Irish patients. A greater proportion of immigrants with T2DM were on insulin therapy for their diabetes. Irish patients had significantly higher fasting triglyceride concentrations compared to the immigrants (1.9+/-0.1 mmol/l vs 1.6+/-0.1 mmol/l, p<0.05). This vulnerable population of immigrants with T2DM is currently at higher risk of complications of diabetes and warrants greater attention to glycemic control and control of other risk factors.

The SAS grade: underused and under recognised?

The speciality and associate specialist grade doctor is an important part of many specialist departments in both medicine and dentistry. In this article we highlight their vital (and often forgotten) contribution in providing and delivering excellent patient care within the dental specialties. We suggest that more should be done to address the needs of this important section of our workforce. Encouraging a programme of continued professional development together with a more structured path for career progression should be considered.

Dentists are humans too - education in human factors within dental care.

The role of human factors in healthcare has become increasingly well recognised, particularly following the Francis inquiry into the failings in care at the Mid Staffordshire NHS Foundation Trust and Berwick Reports. The recognition of human factors in dentistry, particularly in primary care, is less well developed. This paper aims to explore the relevance of human factors in dentistry and highlight the importance of considering their role in any adverse patient outcomes and, importantly for the future, the continued recognition and integration of teaching about human factors in healthcare in both undergraduate and postgraduate education.

Aggression directed towards members of the oral and maxillofacial surgical team.

Oral and maxillofacial surgery (OMFS) is an acute surgical specialty, and members of the surgical team may be exposed to challenging incidents. We have evaluated the experiences of members of OMFS teams and their experiences of aggressive and abusive behaviour. Education and training in the resolution of such conflicts should be offered to all members of the team to allow a safe and secure working environment.

Efficacy of cleaning and disinfection on pig farms in Ireland.

Little is known about the effectiveness of the cleaning and disinfection methods used on commercial pig farms either in Ireland or worldwide. A National Salmonella Control Programme was implemented in Ireland in August 2002 to monitor and control the infection of pigs with Salmonella species. Commercial pig herds must be categorised according to their Salmonella status as either category 1, 2 or 3, having a serological prevalence of infection with Salmonella serotypes up to 10 per cent, between 10 and 50 per cent or more than 50 per cent, respectively. The aim of this study was to assess the efficacy of washing and disinfecting finisher units on category 1 and category 3 farms in reducing or eliminating the levels of contamination. Counts of Enterobacteriaceae were used as indicators of the contamination of the environment with enteric bacteria, which could include Salmonella species. Samples were taken from the pen floors, feeders and drinkers of seven category 1 and seven category 3 farms, and Enterobacteriaceae and salmonellae were enumerated in each sample. The results suggested that intensive cleaning and disinfection was effective at reducing levels of Enterobacteriaceae on the pen floors of both categories, but that residual contamination remained on the surfaces of the feeders and drinkers on all the farms, particularly on the category 3 farms.

Dog bites - are vets missing an educational opportunity?

Veterinary surgeons have a key role to play in tackling the public health problem of dog bites, say CHRISTOPHER MANNION: and DANIELLE GREENBERG: , who argue that a multiprofessional approach to the problem is needed.

Dog bites and maxillofacial surgery: what can we do?

The number of injuries caused by dog bites is increasing in the United Kingdom. We review patients admitted with dog bites to a single maxillofacial department in a district general hospital over a 21-month period. Data include patients' characteristics, and the site and severity of injury. The relationship of the victim to the animal and its breed and classification were added where possible. In total, 65 patients, mean age 22 years (range 1-71, median 14) were included. There were 84 wounds, and their site and severity were recorded according to the Lackmann classification. Twelve different breeds of dog were responsible for the bites. An appreciable proportion of those injured were young children. Educational strategies should aim to reduce the incidence of all dog bites, particularly in young children, as their needs after initial treatment are complex. We propose specific strategies to reduce the number of these injuries.

American Society of Clinical Pathologists--Resident Physician Section. Results of autopsy survey (Winter 1994-1995)

The recent debate on autopsy and the role of this unique doctor-patient relationship in the modern medical profession prompted the Resident Physician Section of the American Society of Clinical Pathologists to conduct a survey on postmortem practice as it relates to pathology residents. A total of 102 of 176 (58%) Resident Physician Section (RPS) liaisons from pathology residency programs in the United States, Canada, and Puerto Rico responded to a survey that consisted of 30 questions. The findings of the survey confirm the decrease in autopsy numbers, highlighting the problem of providing sufficient autopsy training to pathology residents. Interestingly, the majority of programs showed a striking similarity with regard to basic autopsy protocol procedures. Liaisons identified incorporation of clinical pathology, basic science, and clinicopathologic interaction as areas of weakness. In the final analysis, the majority of liaisons had a favorable opinion of their autopsy experience.

Allelic losses at 3p and 11p are detected in both epithelial and stromal components of cervical small-cell neuroendocrine carcinoma.

Microdissected epithelial and stromal cells from 15 cervical small-cell carcinoma patients and 9 healthy control subjects were assessed for loss of heterozygosity with polymorphic DNA markers at chromosomes 3p and 11p. Among malignant lesions assessed with 7 markers at 3p, 21 allelic losses were detected from 193 informative samples. Of losses, 20 were in epithelial and 1 was in normal-appearing stromal cells. Among losses in epithelial cells, 16 were from 44 samples informative for 3 markers within 3p21.2-p14.2 (0.36 loss/sample), whereas only 4 were from 54 samples informative for 4 markers outside the region (0.09 loss/sample), suggesting a "hot spot" of genetic alterations within 3p21.2-p14.2. Among malignant lesions assessed with 2 markers within 11p14-p12, 15 losses were seen in 52 informative samples. Of losses, 10 were in epithelial and 5 were in normal-appearing stromal cells. Of 10 epithelial samples showing losses within 11p14-p12, 8 also displayed losses within 3p21.2-p14.2, suggesting a concurrent involvement of these loci in tumor development or progression. The five losses in stromal cells were in four cases that showed no loss in epithelial cells with same markers, suggesting that stromal cells might play initiative roles in tumor development.

Interaction between halofenozide and the entomopathogenic nematode Heterorhabditis marelatus for control of Japanese beetle (Coleoptera: Scarabaeidae) larvae.

Japanese beetle, Popillia japonica Newman is a major pest of turf and ornamentals. Laboratory bioassays were conducted to evaluate the potential interactions between a biological control agent, Heterorhabditis marelatus (Nematoda: Heterorhabditidae) IN strain and the insecticide halofenozide against both overwintered and nonoverwintered 3rd instars of Japanese beetle. Treatments consisted of all combinations of 2 rates of halofenozid with H. marelatus nematodes Imidacloprid was used as a standard. Percentage larval mortality was evaluated at 7, 14, and 21 d after treatment. No deleterious effects were observed. The nematode treatments generally produced significantly greater larval mortality relative to both chemical treatments. Twenty-one days after treatment, both rates of nematodes resulted in 100% mortality, whereas insecticide treatments did not surpass 60% mortality. No synergism was detected in any of the combination treatments. There were no significant differences in nematode reproduction in larvae exposed to halofenozide and nematodes versus larvae exposed to only nematodes.