Application of human factors at hybrid meetings: facilitating productivity and inclusivity.

The COVID-19 pandemic has resulted in the widespread use of virtual meetings and conferences. As the healthcare sector attempts to return to normality, face-to-face meetings have started to resume. However, ongoing travel restrictions, risk of viral transmission, the Omicron variant, and requirements for self-isolation, have necessitated the use of novel hybrid meeting formats. These enable participants to attend either in person or virtually using various online platforms such as Microsoft Teams and Zoom. Well organised and facilitated hybrid meetings can combine the advantages of in-person meetings with virtual participation, although the dynamics of communication between attendees is considerably different. This article discusses the benefits and pitfalls of the hybrid format, the human factors that impact productivity and inclusivity, and how to address them in future meetings.

Project Wingman - A short survey of staff perception and lounge benefit in a large UK NHS Trust.

Project Wingman is a novel initiative conceived early in the COVID-19 pandemic by two airline captains and a psychologist, which brings airline style lounges, staffed by volunteer air crew to NHS Trusts. The aim was to boost morale by providing airline style customer service for staff while on breaks. Over 50 lounges were opened across the NHS, staffed by up to 5000 volunteers. In this pilot study of one large Trust, we surveyed staff who visited the Wingman lounge. 100 completed questionnaires were used as an end point. All staff felt that the lounge was beneficial during COVID. 62% reported that they would visit the lounge even it was not attended by aircrew. 57% felt their wellbeing had suffered during the pandemic. A national study would be useful to assess the impact of the Wingman Lounges, but our pilot study highlights the importance of staff wellbeing and the value of taking breaks while at work. Many of the lessons learned in supporting colleagues during the pandemic could be used and adapted to help future wellbeing initiatives and aid retention of staff across the NHS.

COVID-19 associated mucormycosis (CAM) in India: a formidable challenge.

Together with the ongoing serious COVID-19 second wave in India, a serious fungal infection, mucormycosis has been increasingly found in COVID-19-recovered patients. Colloquially known as 'black fungus', mucormycosis commonly causes necrosis in the head and neck including the nose, paranasal sinuses, orbits, and facial bones, with possible intracranial spread. The disease causes high morbidity and mortality given that it progresses rapidly and diagnosis is often delayed. Given the sheer magnitude of the outbreak, the Indian Health Ministry has advised all states to declare mucormycosis an epidemic. Typically, the disease has been found to be linked to COVID-19 infections caused by the B.1.617.2 (Delta) variant, which has spread rapidly throughout the country. This variant has already become a cause for global concern, having spread to at least 40 countries, including the USA and UK. We present the findings of a study conducted on COVID-19 associated mucormycosis (CAM) patients, and discuss the associated risk factors to raise awareness for OMFS colleagues.

Digital breast tomosynthesis: sensitivity for cancer in younger symptomatic women.

OBJECTIVE: Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer. METHODS: This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted. RESULTS: Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases. CONCLUSIONS: Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. ADVANCES IN KNOWLEDGE: This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.

Human factors awareness and recognition during multidisciplinary team meetings.

Multidisciplinary team (MDT) meetings are widely used throughout medicine and dentistry, bringing together expertise and different opinions across many disciplines to benefit patient care. Depending on the cancer site and specialties involved, some MDTs can last for several hours, especially if there are many complex patients to discuss. However, concentration and attention can vary and distraction is almost inevitable with separate conversations between MDT members and the ever-increasing use of smartphones. The role of human factors (HF) in contributing to error is well known in high-risk activities including medicine and surgery. Surprisingly, while there is increasing awareness of their importance by medical and dental professionals to enhance patient safety, to our knowledge nothing to date has been published about the possible effect and role of HF at MDTs. Here we provide a brief HF overview and focus on the factors at an MDT that could lead to distraction, providing suggestions (including some from aviation) for possible ways to enhance and improve discussion during these often-long meetings. It is hoped that this paper will generate some thought and discussion around the current "normal" MDT practice in head and neck and other specialties and challenge colleagues to embrace HF and safety principles in a just and learning culture.

WITHDRAWN: CT staging in breast cancer: Can we select patients requiring staging with CT?

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Educational article: what gets accepted for presentation?--a study of submitted abstracts for the 2009 BAOMS Conference.

The Annual Scientific Conference of the British Association of Oral and Maxillofacial Surgeons (BAOMS) provides an opportunity for colleagues to present papers to their peers, which can be beneficial both for professional development and for trainees to enhance their future career prospects. Each year far more abstracts are submitted than slots are available for oral presentation. These abstracts are reviewed by a paper selection committee, made up of several BAOMS colleagues. To our knowledge, there have not been any previous studies that have evaluated whether the type of study submitted (retrospective study, audit, prospective and so on) or the surgical sub-specialty is more likely to be accepted for presentation. Of 237 abstracts submitted for oral presentation at the 2009 conference, 99 were accepted (42% overall acceptance rate). Oncology and salivary gland disease formed the greatest proportion of total submissions (23%) followed by miscellaneous clinical papers (19%). The commonest type of submissions were retrospective studies (19%) followed by case report/series (15%). The greatest acceptance rate in this series was for orthognathic and TMJ papers (P<0.01) while for type of presentation, research/laboratory studies, technical procedures and randomised trials were most likely to be accepted (P<0.01 for all). It is possible that there are a certain number of slots allocated for presentation in each sub-category, which may increase competition in certain areas, but further work is necessary in this area. We recommend some general points for the successful acceptance of abstracts.

An update on the use of ultrasound imaging in oral and maxillofacial surgery.

Ultrasound is a relatively inexpensive, non-invasive, and readily available technique that is well tolerated by patients. It is particularly useful in the examination of superficial structures where the use of a high frequency linear probe (7.5-12 MHz) produces high definition multi-planar images. The spatial resolution achieved is superior to other methods of cross-sectional imaging and, when combined with tissue biopsying techniques such as fine needle aspiration cytology (FNAC) or core biopsy samples, it is rendered a highly specific diagnostic tool. This article provides an overview of the use of ultrasound for common head and neck conditions, including its use in salivary gland disease, and for the assessment of cervical lymphadenopathy.

Fine needle aspiration cytology (FNAC) of salivary gland tumours: repeat aspiration provides further information in cases with an unclear initial cytological diagnosis.

INTRODUCTION: Fine needle aspiration cytology (FNAC) for salivary gland tumours requires expertise in interpretation. When a diagnosis is not clear (despite a cellular aspirate), published work is lacking on the value of repeating the test. METHODS: A retrospective study of 135 patients who had FNAC followed by definitive excision for a suspected salivary gland tumour. Accuracy was compared among those requiring repeat FNAC on one more occasion because of a non-diagnostic initial cytology report. RESULTS: 33 patients (24% of study group) had repeat FNAC. A definite cytological diagnosis was subsequently made in 27/33 patients (82%). The sensitivity (84%) and specificity (93%) of repeat FNAC in distinguishing benign from malignant tumours was similar to initial FNAC (70% and 95%, respectively). CONCLUSIONS: Repeat FNAC may provide a cytological diagnosis in cases where the initial diagnosis is not clear, although cytology should be used in conjunction with other investigations of salivary tumours, including image-guided biopsy examination where appropriate. Ideally salivary gland FNAC should be interpreted by a specialist pathologist.

CT and duplex scanning: a comparison of imaging techniques for evaluation of the carotid tree in head and neck cancer patients.

Carotid artery disease is a common condition which, like head and neck cancer, is primarily smoking related. Internal carotid stenosis may result in cerebro-vascular complications, while severe stenosis of the external carotid can potentially compromise microvascular free tissue transfer reconstruction. We were interested to see whether any co-existing carotid artery disease could be assessed on the neck CT scan by comparing it to definitive duplex scanning in head and neck cancer patients. CT and duplex scanning of the common, internal and external carotid arteries was compared in 30 patients (180 vessels). The arterial phase of the neck CT scans were reviewed by two radiologists and all duplex scans were performed by one vascular technician to minimise inter-operator variability. The respective findings were blinded. Significant correlations were found between CT and duplex in confirming stenosis of the common and internal carotid arteries (P<0.001). There was a weak correlation between CT and duplex in the assessment of the external carotid system (P=0.02 and P=0.08), with CT under-estimating the true extent of stenosis in this vessel. The sensitivity and specificity of CT compared to duplex was 77% and 94% respectively. CT is useful not only for imaging the neck of head and neck cancer patients, but also in screening for carotid stenosis. Duplex scanning is more accurate than CT in assessing the external artery, and is useful for evaluating patients with significant stenosis of the carotid tree.

Prospective randomized clinical trial of the effect of needle size on pain, sample adequacy and accuracy in head and neck fine-needle aspiration cytology.

BACKGROUND: Fine-needle aspiration cytology (FNAC) is useful in the diagnosis of many conditions of the head and neck. No reported studies have investigated the optimal needle gauge in the head and neck region. METHODS: This was a prospective randomized trial of 100 patients who required FNAC performed with either a 21G or 23G needle. Discomfort was scored by patients using a visual analogue scale. Sample accuracy was assessed in patients who subsequently had excision biopsy. RESULTS: FNAC performed with a 23G needle was less painful (mean +/- SE, 1.6 +/- 1.01) than FNAC with a 21G needle (3.3 +/- 1.94; p < .001). There was no difference in sample adequacy between the 2 needle sizes (p = .59). The sensitivities and specificities of both needles were similar. CONCLUSION: Head and neck FNAC should routinely be performed with a 23G needle, resulting in less patient discomfort, and giving sample adequacy comparable to a conventional 21G needle.

Neuromuscular hamartoma: imaging features of a rare paediatric craniofacial tumour.

Neuromuscular hamartoma (also referred to as neuromuscular choristoma or benign triton tumour) has not previously been described in the radiological literature. It is a rare benign lesion composed of mature elements of striated muscle and neural tissue. We report a case of neuromuscular hamartoma involving the skull base, nasopharynx, orbit and maxilla in a 2.5-year-old child who presented with facial swelling. The CT and MRI appearances of this unusual soft-tissue tumour are emphasized, together with a discussion of the pathological findings, differential diagnosis and review of the literature.