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Bola S, Shrivastava MK, Brown J, Cherko M, Emmanouil B. A force sensor improves trainee technique for rigid endoscopy. J Laryngol Otol 2024; 138:692-695. [PMID: 38230422 DOI: 10.1017/s0022215124000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Developing skills in rigid endoscopy poses challenges to the surgical trainee. This study investigates whether a modified manikin can improve the technical skill of junior operators by providing direct quantitative feedback. METHODS A force-sensing pad was incorporated into the oral cavity of a life support manikin. Junior trainees and senior otolaryngologists were invited to perform rigid endoscopy and received real-time feedback from the force sensor during the procedure. RESULTS There was a significant inverse correlation between operator seniority and the weight applied to the oral cavity (p < 0.0001). All junior trainee operators applied less weight after five attempts (346 ± 90.95 g) compared to their first attempt (464 ± 85.79 g). This gave a statistically significant decrease of 118 g (standard deviation = 107.27 g, p = 0.007) when quantitative feedback was provided to learning operators. CONCLUSION This low-cost, simple model allows trainees to rehearse a high-risk procedure in a safe environment and adjust their operative technique.
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Affiliation(s)
- Sumrit Bola
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Josh Brown
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew Cherko
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Beatrice Emmanouil
- Department of Psychology, Health and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Bola S, Jaikaransingh D, Winter SC. COVID-19 and the return to head and neck outpatient activity in the United Kingdom: what is the new normal? Eur Arch Otorhinolaryngol 2021; 278:2641-2648. [PMID: 33159248 PMCID: PMC7647194 DOI: 10.1007/s00405-020-06458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE As surgical specialties now begin the graduated return to elective activity and face-to-face clinics, this paper investigates the current head and neck outpatient practices across the United Kingdom. METHODS A cross-sectional study comprised of an online 20-item survey was distributed to members of the British Association of Head & Neck Oncologists (BAHNO). The survey was open on a web-based platform and covered topics including safety measures for patients, protective equipment for healthcare staff and protocols for the use of flexible nasendoscopy in the clinic. RESULTS The survey was completed by 117 participants covering 66 NHS Trusts across the UK. There was a significant reduction in face-to-face Otolaryngology, Maxillofacial and Speech and Language clinic patients when compared to pre-pandemic numbers (p < 0.0001). Risk assessments for flexible nasendoscopy were done for 69% of clinics and 58% had an established protocol. Room downtime after flexible nasendoscopy ranged from 0 to 6 h and there was a significant increase in allocated downtime after a patient had coughed/sneezed (p < 0.001). Natural ventilation existed in 36% of clinics and the majority of responders didn't know the Air Change Per Hour (ACPH) of the clinic room (77%). Where ACPH was known, it often did not match the allocated room downtime. CONCLUSION There is a wide variation in outpatient activity across the United Kingdom, but adaptations are being made to try and maintain staff and patient safety. However, more can still be done by liaising with allied teams to clarify outpatient protocols.
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Affiliation(s)
- Sumrit Bola
- Otolaryngology Department, Oxford University NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Dominic Jaikaransingh
- Otolaryngology Department, Oxford University NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Stuart C Winter
- Otolaryngology Department, Oxford University NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Jaikaransingh D, Bola S, Winter S. 417 COVID-19 and the Return to Head and Neck Outpatient Activity in The United Kingdom: What Is the New Normal? Br J Surg 2021. [PMCID: PMC8135680 DOI: 10.1093/bjs/znab134.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background We aim to investigate current head and neck outpatient practices across the United Kingdom during the COVID-19 pandemic. Method A cross-sectional study comprising of an online 20-item survey was emailed to members of the British Association of Head and Neck Oncologists (BAHNO). Topics covered included safety measures, protective equipment used and protocols around the use of flexible nasendoscopy (FNE) in clinic. Results 117 participants completed the survey covering 66 Trusts across the UK. There was a significant reduction in face-to-face clinic patients compared to pre-pandemic numbers. Room down-time after FNE ranged from 0-6 hours and there was a significant increase in allocated down-time after the patient had coughed or sneezed. Natural ventilation existed in 36% of clinics and the majority of responders didn’t know the calculated Air Change Per Hour (ACPH) of the room (77%). Where ACPH was known, it often did not match the allocated room down-time. Conclusions Adaptations are being made across the UK to maintain staff and patient safety, but more can still be done by liaising with hospital infectious diseases and the hospital estates team to clarify outpatient protocols.Outpatient activity will likely remain limited and alternative strategies will need to develop to manage the backlog in face-to-face clinics.
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Affiliation(s)
- D Jaikaransingh
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - S Bola
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - S Winter
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, United Kingdom
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Leonetti A, Bola S, Minari R, Scarlattei M, Buti S, Bordi P, Baldari G, Gnetti L, Sammartano A, Migliari S, Cosenza A, Ferri L, Bonatti F, Mastrodomenico L, Ruffini L, Tiseo M. P76.52 Liquid Biopsy and PET Parameters as Predictive Factors of Osimertinib Treatment in Advanced EGFR-Mutated NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abbas Y, Abdelkader M, Adams M, Addison A, Advani R, Ahmed T, Alexander V, Alexander V, Alli B, Alvi S, Amiraraghi N, Ashman A, Balakumar R, Bewick J, Bhasker D, Bola S, Bowles P, Campbell N, Can Guru Naidu N, Caton N, Chapman J, Chawdhary G, Cherko M, Coates M, Conroy K, Coyle P, Cozar O, Cresswell M, Dalton L, Danino J, Daultrey C, Davies K, Carrie S, Dick D, Dimitriadis PA, Doddi N, Dowling M, Easto R, Edmiston R, Ellul D, Erskine S, Evans A, Farboud A, Forde C, Fussey J, Gaunt A, Gilchrist J, Gohil R, Gosnell E, Grech Marguerat D, Green R, Grounds R, Hall A, Hardman J, Harris A, Harrison L, Hone R, Hoskison E, Howard J, Ioannidis D, Iqbal I, Janjua N, Jolly K, Kamal S, Kanzara T, Keates N, Kelly A, Khan H, Korampalli T, Kuet M, Kul‐loo P, Lakhani R, Lambert A, Lancer H, Leonard C, Lloyd G, Lowe E, Mair J, Maughan E, Gao C, Mayberry T, McCadden L, McClenaghan F, McKenzie G, Mcleod R, Meghji S, Mian M, Millington A, Mirza O, Mistry S, Molena E, Morris J, Myuran T, Navaratnam A, Noon E, Okonkwo O, Oremule B, Pabla L, Papesch E, Puranik V, Roplekar R, Ross E, Rudd J, Schechter E, Senior A, Sethi N, Sharma S, Sharma R, Shelton F, Sherazi Z, Tahir A, Tikka T, Tkachuk Hlinicanova O, To K, Tse A, Toll E, Ubayasiri K, Unadkat S, Upile N, Vijendren A, Walijee H, Wilkie M, Williams R, Williams M, Wilson G, Wong W, Wong G, Xie C, Yao A, Zhang H, Ellis M, Mehta N, Milinis K, Tikka T, Slovick A, Swords C, Hutson K, Smith ME, Hopkins C, Ng Kee Kwong F. Nasal Packs for Epistaxis: Predictors of Success. Clin Otolaryngol 2020; 45:659-666. [DOI: 10.1111/coa.13555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/08/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
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Affiliation(s)
- A Ashman
- Ear, Nose and Throat Registrar, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU
| | - S Bola
- Ear, Nose and Throat Registrar, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU
| | - A Topiwala
- Consultant Psychiatrist, Oxford Psychological Medicine Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
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Bola S, Ashman A, Winter S. Endoscopic pharyngeal pouch stapling: A retrospective study of 55 patients comparing intubation difficulty and body mass index as factors for success. Clin Otolaryngol 2019; 45:135-138. [DOI: 10.1111/coa.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 06/29/2019] [Accepted: 10/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sumrit Bola
- ENT Registrar Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Alexander Ashman
- ENT Registrar Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Stuart Winter
- Consultant Head & Neck Surgeon Oxford University Hospitals NHS Foundation Trust Oxford UK
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Zhang L, Bola S, Camp D. Improving the quality of volar slabs using a thermoplastic splint. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bola S, Dash I, Naidoo M, Aldous C. Interpersonal violence: quantifying the burden of injury in a South African trauma centre. Emerg Med J 2015; 33:208-12. [PMID: 26362579 DOI: 10.1136/emermed-2014-204160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/24/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Interpersonal violence is an epidemic in South Africa and remains an under-reported and expensive burden on health resources. In most of the developing world there is little or no descriptive information about the expense of treating the consequences of interpersonal violence. OBJECTIVE To review the direct burden of interpersonal violence on a tertiary hospital in Northern KwaZulu-Natal, an area known to have high rates of poverty and violent crime. MATERIAL AND METHODS A retrospective case note review of emergency hospital admissions between January and March 2013 was carried out. The reports included demographic characteristics, admitting diagnosis and surgical management. Case files were reviewed to determine cost drivers, such as radiological investigations, blood products, theatre usage and specialist care. RESULTS Trauma accounted for 374 hospital admissions from the emergency department, of which 142 (38%) were attributable to interpersonal violence (16% of total admissions). One hundred and fifty-six hospital bed days were used over the study period. The average inpatient stay was 9.8 days with 58% requiring a resuscitation bed on admission. One-third of patients underwent emergency surgery and eight patients required postoperative intensive care. The minimum hospital expenditure for interpersonal violence injuries over 3 months was R8 367 788 ($783 960). DISCUSSION Interpersonal violence is the source of a significant financial burden on the South African health system. Patients are often severely injured and require a high level of specialist investigations and surgical care. This study gives evidence to improve budget and workload planning for regional surgical departments and supports the need for more effective primary prevention.
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Affiliation(s)
- Sumrit Bola
- Department of Surgery, Ngwelezane Hospital, Empangeni, KwaZulu-Natal, South Africa
| | - Isabella Dash
- Department of Surgery, Ngwelezane Hospital, Empangeni, KwaZulu-Natal, South Africa
| | - Maheshwar Naidoo
- Department of Surgery, Ngwelezane Hospital, Empangeni, KwaZulu-Natal, South Africa
| | - Colleen Aldous
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Abstract
AbstractAcute tonsillitis may be defined as inflammation of the tonsils, predominantly due to infection. It is part of the spectrum of pharyngitis, which ranges from localised tonsillar infection to generalised infection of the pharynx and commonly affects young healthy adults. Simple sore throats secondary to viral or bacterial pharyngitis are very common and generally do not require hospital admission or antimicrobial treatment. Supportive management in the form of analgesia and adequate hydration is often sufficient. However, there is potential for life-threatening complications to develop, highlighting the need for basic knowledge in the management of these conditions.This article aims to provide an overview of acute tonsillitis and its complications, including peritonsillar and parapharyngeal abscess formation. Specific attention will be given to the pathogenesis, diagnosis, investigation and management of each condition, in particular advising on emergency pre-shore treatment and indications for referral to an Ear, Nose and Throat Department. We will also summarise important guidelines and evidence from the literature to support these management decisions.
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Bartlett A, Bola S, Williams R. Acute tonsillitis and its complications: an overview. J R Nav Med Serv 2015; 101:69-73. [PMID: 26292396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute tonsillitis may be defined as inflammation of the tonsils, predominantly due to infection. It is part of the spectrum of pharyngitis, which ranges from localised tonsillar infection to generalised infection of the pharynx and commonly affects young healthy adults. Simple sore throats secondary to viral or bacterial pharyngitis are very common and generally do not require hospital admission or antimicrobial treatment. Supportive management in the form of analgesia and adequate hydration is often sufficient. However, there is potential for life-threatening complications to develop, highlighting the need for basic knowledge in the management of these conditions. This article aims to provide an overview of acute tonsillitis and its complications, including peritonsillar and parapharyngeal abscess formation. Specific attention will be given to the pathogenesis, diagnosis, investigation and management of each condition, in particular advising on emergency pre-shore treatment and indications for referral to an Ear, Nose and Throat Department. We will also summarise important guidelines and evidence from the literature to support these management decisions.
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Bola S, Rashid M, Hickey S. Penetration through otowicks. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.07.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dash I, Bola S. How beneficial to surgical training is a ‘year out’ in rural South Africa? Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.08.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bola S, Rashid M, Hickey S. Permeability of Otowicks and Bacterial Penetration. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Otowicks are used to treat otitis externa with significant ear canal oedema. They ensure close contact between administered drops and the canal skin. How well drops penetrate through to reach the deep canal has not been accurately investigated. This in vitro study aims to investigate: (1) the permeability of otowicks to commonly used ear drops; (2) The ability of bacteria to penetrate through the otowick. Methods: Sterile otowicks were inserted into mock ear canals fabricated from plastic pipettes. These were held vertically over pseudomonas-seeded agar plates while Gentisone HC or CiloxinTM drops were administered; 4 drops, TDS for 5 days. Time taken for the drops to penetrate through the otowick was recorded. Separately, pseudomonas-seeded otowicks were inserted into plastic pipettes and treated with saline or antibacterial drops. The penetrating drops were observed for bacterial growth on sterile agar. Results: It took 6-8 drops before penetration occurred for both ear drops. Thereafter, otowicks treated with Ciloxan showed delayed penetration after 5 days (60-240 seconds) when compared with Gentisone (50-91 seconds). When sterile saline drops were applied to bacterially-contaminated otowicks, the penetrating drops displayed bacterial growth on agar, indicating that pseudomonas penetrated through the otowicks. However, when Gentasone or Ciloxan were applied, penetrating drops showed no bacteria growth on the corresponding agar plate. Conclusions: Bacteria can penetrate otowicks but this can be prevented by continuous application of antibacterial ear drops. Ear wicks need priming with 8 drops before starting a regime as the initial dose is fully absorbed by the otowick.
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