How did we do? An investigation into the suitability of patient questionnaires (PREMs and PROMs) in three primary care oral surgery practices.

Introduction With the expansion of oral surgery services into the primary care sector there is a need to monitor the quality of the care provided. The Guide for Commissioning Oral Surgery and Oral Medicine proposed a set of questions to be used as patient related experience and outcome measures (PREMs and PROMs).Aim The British Association of Oral Surgeons (BAOS) primary care group (which includes the authors) were tasked by the Chief Dental Officer for England to test the suitability of these PREMs and PROMs.Method The questions as published in the commissioning guide were piloted in primary care oral surgery practices and patient feedback was sought. The authors then proposed and implemented an amended series of questions that they felt would be more practical as generic templates for oral surgery services.Results Our data demonstrates that the revised questions have produced data that is easy to interpret and attracted a greater number of feedback comments from patients.Discussion and conclusion The revised questionnaires incorporate the NHS Friends and Family Test as the collection of this data is normally a contractual requirement for providers of NHS services. They also use questions from other validated healthcare satisfaction survey tools. The use of Likert scales provides a richer data set which makes the interpretation of data easier and highlights areas for improvement. It is important to note that the data provided by PREMs and PROMs is subject to a number of biases and should be used for local quality improvement and longitudinal analysis of outcome data rather than comparison between providers.

An investigation into the variability of primary care oral surgery contracts and tariffs in England and Wales (2014/2015).

Primary care oral surgery services vary markedly throughout the country but until now there has been a paucity of data on these services. The British Association of Oral Surgeons (BAOS) primary care group (the authors) were tasked to gather data around primary care oral surgery contracts and tariffs and provide evidence-based recommendations on the commissioning of these services. Following a freedom of information (FOI) request, data were obtained for 27 English local area teams and seven Welsh local health boards. The data demonstrated both regional and national variability with respect to primary care oral surgery contracts, concerning both contract type and level of remuneration. These differences are discussed and the authors make recommendations for standardising oral surgery contracts and tariffs.

Postoperative radiographs after open reduction and internal fixation of the mandible: are they useful?

Mandibular fractures are common in oral and maxillofacial departments in the UK. The aim of this study was to find out the national practice in preoperative and postoperative radiographic investigations for fractured mandibles and to audit their diagnostic capacity, including specificity and sensitivity to short-term complications. The audit took place over a 4-month period and involved 100 patients across the Northern region. Ninety percent of patients were reviewed up to discharge and five of these patients developed a short-term postoperative complication. The postoperative radiograph was diagnostic in only one of the five cases. Overall, postoperative radiographs had a sensitivity of 20% and a specificity of 5% in their ability to predict short-term postoperative complications.

Investigation of inhalational conscious sedation as a tool for reducing anxiety in adults undergoing exodontia.

AIM: To determine whether adult patients' dental anxiety levels decrease following exodontia carried out under inhalational conscious sedation with nitrous oxide and oxygen (IHS) and local anaesthetic (LA). DESIGN: Retrospective analysis of pre- and post-operative modified dental anxiety score (MDAS) questionnaires completed by patients treated in a primary care oral surgery service between 21 July 2010 and 17 December 2010. METHODOLOGY: 138 patients who had undergone exodontia were divided into three groups: moderate to severe anxiety (MDAS scores 11-25) treated under IHS and LA (n = 60), mild anxiety (MDAS scores 5-10) treated under IHS and LA (n = 43) and mixed anxiety (MDAS scores 5-15) treated under LA only (n = 35). The mean pre- and post-operative MDAS scores were analysed by means of one-tailed, paired t-tests. RESULTS: The moderate to severely anxious group treated under IHS and LA showed a statistically significant decrease of 3.68 between the mean pre- and post-operative MDAS scores (p = 0.000). The IHS mildly anxious group showed a decrease of 0.07 (p = 0.392) and the LA group showed a decrease of 0.23 (p = 0.227). Neither of these results were statistically significant. CONCLUSION: These results support the use of IHS, to reduce anxiety of exodontia, in moderate to severely anxious adults undergoing minor oral surgery (MOS) procedures under LA in primary care oral surgery.

Clinical and toxicological investigations of a case of delayed neuropathy in man after acute poisoning by an organophosphorus pesticide.

Progressive neuropathy developed in a man during 2--8 weeks after acute poisoning by a pesticide said to contain trichlorphon. The neuropathy was typical of that caused by organophosphorus esters in the delay and in the maintenance of normal conduction velocity in surviving nerve fibres. A sample alleged to be typical of the ingested material was not more active against hen brain neurotoxic esterase (NTE) than was pure trichlorphon. Delayed neuropathy has never been produced in hens by a single dose of trichlorphon. This incident and studies of human brain in vitro suggest that the ratio neurotoxicity/lethality for trichlorphon is higher in man than in the hen. Suggestion is made of laboratory tests to improve neurotoxicity screening.

Bilateral optic neuritis. A long-term follow-up.

We have endeavoured to determine the fate of the adults and children presenting with bilateral optic neuritis who were reported by Hierons and Lyle (1959) and Meadows (1969). We have follow-up information from a variety of sources on 31 of the 34 adults for up to thirty-seven years, and on 17 of 19 children after up to thirty-two years. Three adult cases were excluded after review. The visual prognosis was variable in the adults but excellent in the children. None of the children has developed clinically definite multiple sclerosis. Two of the 11 adults with simultaneous bilateral optic neuritis developed multiple sclerosis, compared with 8 of 20 with sequential optic neuritis. We conclude that the risk of developing multiple sclerosis after simultaneous bilateral optic neurities in childhood is low; in adult life it is probably higher, but some patients even after more than two decades have no clinical evidence of the disseminated disease. Bilateral optic neuritis is aetiologically and prognostically diverse.

The late effects of necrotizing encephalitis of the temporal lobes and limbic areas: a clinico-pathological study of 10 cases.

The clinical and neuropathological features are reported of 10 patients who had suffered, usually for several years, from the after effects of an acute or sub-acute necrotizing encephalitis of the limbic grey matter and of the adjacent temporal lobes. Emphasis is laid on the memory disturbance and on the behavioural and emotional aberrations that tended to occur and that are in some ways reminiscent of the Klüver-Bucy syndrome.

Lessons from a remarkable family with dopa-responsive dystonia.

A family is described in which dopa-responsive dystonia affected six members and segregated in an autosomal dominant fashion. Patients either presented in childhood with dystonia of the legs, going to develop parkinsonism and pseudo-pyramidal deficits, or in adult life with parkinsonian tremor and rigidity, with pseudo-pyramidal signs. Remarkably, in the three cases with childhood onset the symptoms and signs of the condition were abolished 36 to 52 years later by small doses of levodopa. No long term side effects of levodopa have appeared after 15 years of treatment.