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Using a pocket computer for maintaining logbooks and for audit
256
British
Journal
of Oral
and Maxillofacial
Surgery
pulmonary malignancy, arteriovenous malformation, lymphoma and myeloma. The cases are presented with full clinical details, photographs and discussion. Using a pocket computer for maintaining logbooks and for audit. & P. Magennis. Department of Oral & Maxillofacial Surgery, The Royal London Hospital, UK. K. M. Coghlan
The use of a computer for recording clinical data is rapidly becoming a necessity. The BAOMS is currently choosing a cancer database and S. F. Worrall has developed an excellent computerised logbook on which trainees can record their surgical experience. Collecting data on a computer requires either keeping paper copies of the data with later transcription onto your PC, or else having a computer always available for direct data entry. The disadvantages of the former are transcription errors and the fact that pieces of paper are easily lost. The disadvantages of the latter are that even compact lap-tops are expensive, cumbersome, and very difficult to insure if used for business purposes. The Psion 3a is a pocket sized computer which is powerful for its size and whose software is extremely adaptable. The programmes and cables supplied with the Psion 3a make the collection and direct transfer of audit and log-book data to a PC very easy. Although the small size of the key-board makes large amounts of typing impractical, it is ideal for recording patient’s names, numbers and operations. It is possible to customise the Psion 3a and record specific audit information. There will be the opportunity for hands-on experience of the pocket computer and a PC. The development of a temporomandibular joint prosthesis. M R. Cope & K. F. Moos. Canniesbum Hospital, Glasgow, UK. The authors have previously reported on the long-term success of a series of compressible hollow silicone rubber prostheses used in temporomandibular joint reconstruction.’ This series used modified Nicolle-Calnan metacarpo-phalangeal joint (MCPJ) prostheses which are no longer available. The concept has been further explored with the development of a prosthesis specifically designed for the temporomandibular joint (TMJ). A brief historical introduction is followed by description of an anatomical study carried out on 12 cadaveric and 60 dried mandibular condyles. The results are presented and applied to the design of a new TMJ prosthesis. Design considerations are described and the stages of development illustrated. Examples of the pioneering modified MCPJ prosthesis and of the new compressible hollow silicone TMJ prosthesis are displayed. Finally, clinical cases are presented and the conduct of a prospective clinical trial is defined.
Reference 1. Cope MR, Moos KF, Hammersley N. The compressible silicone rubber prosthesis in temporomandibular joint disease. Br J Oral Maxillofac Surg 1993; 31: 376-384. A comparison of antibiotic prescribing in the primary care & hospital setting. J. Farrier, M. A. 0. Lewis, E. G. Absi & D. W. Thomas. Department of Oral & Maxillofacial Surgery, Cardiff, UK. The prescription of antimicrobial therapy can be influenced by a number of factors including undergraduate and postgraduate teaching, clinical experience and clinical promotion. To determine the complaints, source, and type and of antibiotic therapies prescribed in the primary care setting a prospective study was undertaken of 500 consecutive new patients (260M: 240F; mean age 39.16 range 15-85), attending the primary care unit of the Cardiff Dental School in May 1994. On presentation 6b patients (12%) had been prescribed antibiotics, principally prescribed by GDPs (55%) and GMPs (33%). The principal complaints of the patients receiving antibiotics were
related to pulpal (57%) problems, as they were in the complete study group (49%). Antibiotics were prescribed at the examination and emergency clinic for an additional 102 patients (13 of whom were already receiving antibiotics). Treatment for 30% (149/500) of the patients attending the examination and emergency clinic. Penicillin V, metronidazole and amoxycillin were the commonest antibiotics prescribed and comprised 83% of prescriptions for these patients. The results show that antimicrobial therapy is a central component of the management of a large number of the patients. Whilst prescribing is limited to a small spectrum of antibiotics in the majority of cases, a number of cases are receiving alternative antimicrobials as first choice on initial presentation in the primary care setting.
Emergency workload in maxillofacial surgery. C. J. Kerawala. Newcastle General Hospital, Westgate Road, Newcastle-uponTyne, UK. Although the impact of emergency caseload on general surgery and orthopaedic practice has long been established, the situation in other acute specialties remains under reported. The Royal College of Surgeons of England state that 30-50% of general surgery admissions are emergencies, whereas the figure quoted for overall ENT surgical emergency workload is lower at less than 10%. Comparable data regarding maxillofacial surgery is lacking. In order to define the problem further, a 3 month prospective audit of the emergency workload at Newcastle General Hospital was undertaken. This typical district general hospital has 577 beds and provides a sub-regional service in maxillofacial surgery to a population of approximately 1 million. Two hundred and ninety six cases were referred in the time period. The male: female ratio was 2.6 : 1 with a mean age of 30 years. Seventy-six percent of cases were referred from Accident and Emergency departments, with only 2% of referrals being received directly from general dental practitioners. Although the majority of conditions were minor enough to be managed in the Accident and Emergency department or clinical treatment room and either discharged (20%) or followed up as out-patients (45%), nearly one half of the patients (42%) required management by a post-fellowship surgeon. Thirty-five percent of the patients (103/296) were admitted, of whom 77 (75%) required an operation under a general anaesthetic. The consequent maxillofacial emergency workload will be further discussed with reference to new patient referrals, ward admissions and surgical caseload during the time period. Practice in relation to NCEPOD guidelines will also be considered.
The great wisdom tooth debate. The Shropshire experience. Some facts and figure-s. A. Rogers, S. F. Olley & D. Wedgwood. Royal Shrewsbury Hospital, Shropshire, UK. Following Professor Shepherd’s Editorial in the British Medical Journal September 1994, it was suggested to the Consultant body in Shropshire that a considerable amount of unnecessary third molar surgery was being performed in the County. Using the guidelines laid down in The Pilot Clinical Guidelines, Dentoalveolar Surgery, Impacted and Ectopic Teeth, issued by the Faculty Audit Committee Roval College of Surgeons of Enaland. Septeiber 1994, an audit ass&sment &as devised for use gy the Clinical Audit department at The Royal Shrewsbury Hospital. This was used to assessthe reasons for removal of third molars and the clinical outcome of surgery on 200 sets of wisdom teeth, 100 cases taken from each of the two units in Shropshire. The Audit Clerk involved currently works full time in the Clinical Audit department, but trained as a Hygienist and was therefore familiar with dentoalveolar notation. We should like to present the findings of this audit and to demonstrate that in Shropshire removal of third molars complies closely with the recommended reasons for removal as suggested by Faculty.
British
Journal
of Oral
and Maxillofacial
Surgery
pulmonary malignancy, arteriovenous malformation, lymphoma and myeloma. The cases are presented with full clinical details, photographs and discussion. Using a pocket computer for maintaining logbooks and for audit. & P. Magennis. Department of Oral & Maxillofacial Surgery, The Royal London Hospital, UK. K. M. Coghlan
The use of a computer for recording clinical data is rapidly becoming a necessity. The BAOMS is currently choosing a cancer database and S. F. Worrall has developed an excellent computerised logbook on which trainees can record their surgical experience. Collecting data on a computer requires either keeping paper copies of the data with later transcription onto your PC, or else having a computer always available for direct data entry. The disadvantages of the former are transcription errors and the fact that pieces of paper are easily lost. The disadvantages of the latter are that even compact lap-tops are expensive, cumbersome, and very difficult to insure if used for business purposes. The Psion 3a is a pocket sized computer which is powerful for its size and whose software is extremely adaptable. The programmes and cables supplied with the Psion 3a make the collection and direct transfer of audit and log-book data to a PC very easy. Although the small size of the key-board makes large amounts of typing impractical, it is ideal for recording patient’s names, numbers and operations. It is possible to customise the Psion 3a and record specific audit information. There will be the opportunity for hands-on experience of the pocket computer and a PC. The development of a temporomandibular joint prosthesis. M R. Cope & K. F. Moos. Canniesbum Hospital, Glasgow, UK. The authors have previously reported on the long-term success of a series of compressible hollow silicone rubber prostheses used in temporomandibular joint reconstruction.’ This series used modified Nicolle-Calnan metacarpo-phalangeal joint (MCPJ) prostheses which are no longer available. The concept has been further explored with the development of a prosthesis specifically designed for the temporomandibular joint (TMJ). A brief historical introduction is followed by description of an anatomical study carried out on 12 cadaveric and 60 dried mandibular condyles. The results are presented and applied to the design of a new TMJ prosthesis. Design considerations are described and the stages of development illustrated. Examples of the pioneering modified MCPJ prosthesis and of the new compressible hollow silicone TMJ prosthesis are displayed. Finally, clinical cases are presented and the conduct of a prospective clinical trial is defined.
Reference 1. Cope MR, Moos KF, Hammersley N. The compressible silicone rubber prosthesis in temporomandibular joint disease. Br J Oral Maxillofac Surg 1993; 31: 376-384. A comparison of antibiotic prescribing in the primary care & hospital setting. J. Farrier, M. A. 0. Lewis, E. G. Absi & D. W. Thomas. Department of Oral & Maxillofacial Surgery, Cardiff, UK. The prescription of antimicrobial therapy can be influenced by a number of factors including undergraduate and postgraduate teaching, clinical experience and clinical promotion. To determine the complaints, source, and type and of antibiotic therapies prescribed in the primary care setting a prospective study was undertaken of 500 consecutive new patients (260M: 240F; mean age 39.16 range 15-85), attending the primary care unit of the Cardiff Dental School in May 1994. On presentation 6b patients (12%) had been prescribed antibiotics, principally prescribed by GDPs (55%) and GMPs (33%). The principal complaints of the patients receiving antibiotics were
related to pulpal (57%) problems, as they were in the complete study group (49%). Antibiotics were prescribed at the examination and emergency clinic for an additional 102 patients (13 of whom were already receiving antibiotics). Treatment for 30% (149/500) of the patients attending the examination and emergency clinic. Penicillin V, metronidazole and amoxycillin were the commonest antibiotics prescribed and comprised 83% of prescriptions for these patients. The results show that antimicrobial therapy is a central component of the management of a large number of the patients. Whilst prescribing is limited to a small spectrum of antibiotics in the majority of cases, a number of cases are receiving alternative antimicrobials as first choice on initial presentation in the primary care setting.
Emergency workload in maxillofacial surgery. C. J. Kerawala. Newcastle General Hospital, Westgate Road, Newcastle-uponTyne, UK. Although the impact of emergency caseload on general surgery and orthopaedic practice has long been established, the situation in other acute specialties remains under reported. The Royal College of Surgeons of England state that 30-50% of general surgery admissions are emergencies, whereas the figure quoted for overall ENT surgical emergency workload is lower at less than 10%. Comparable data regarding maxillofacial surgery is lacking. In order to define the problem further, a 3 month prospective audit of the emergency workload at Newcastle General Hospital was undertaken. This typical district general hospital has 577 beds and provides a sub-regional service in maxillofacial surgery to a population of approximately 1 million. Two hundred and ninety six cases were referred in the time period. The male: female ratio was 2.6 : 1 with a mean age of 30 years. Seventy-six percent of cases were referred from Accident and Emergency departments, with only 2% of referrals being received directly from general dental practitioners. Although the majority of conditions were minor enough to be managed in the Accident and Emergency department or clinical treatment room and either discharged (20%) or followed up as out-patients (45%), nearly one half of the patients (42%) required management by a post-fellowship surgeon. Thirty-five percent of the patients (103/296) were admitted, of whom 77 (75%) required an operation under a general anaesthetic. The consequent maxillofacial emergency workload will be further discussed with reference to new patient referrals, ward admissions and surgical caseload during the time period. Practice in relation to NCEPOD guidelines will also be considered.
The great wisdom tooth debate. The Shropshire experience. Some facts and figure-s. A. Rogers, S. F. Olley & D. Wedgwood. Royal Shrewsbury Hospital, Shropshire, UK. Following Professor Shepherd’s Editorial in the British Medical Journal September 1994, it was suggested to the Consultant body in Shropshire that a considerable amount of unnecessary third molar surgery was being performed in the County. Using the guidelines laid down in The Pilot Clinical Guidelines, Dentoalveolar Surgery, Impacted and Ectopic Teeth, issued by the Faculty Audit Committee Roval College of Surgeons of Enaland. Septeiber 1994, an audit ass&sment &as devised for use gy the Clinical Audit department at The Royal Shrewsbury Hospital. This was used to assessthe reasons for removal of third molars and the clinical outcome of surgery on 200 sets of wisdom teeth, 100 cases taken from each of the two units in Shropshire. The Audit Clerk involved currently works full time in the Clinical Audit department, but trained as a Hygienist and was therefore familiar with dentoalveolar notation. We should like to present the findings of this audit and to demonstrate that in Shropshire removal of third molars complies closely with the recommended reasons for removal as suggested by Faculty.