Investigation of the microbiology and antibiotic sensitivity of skin and soft tissue infections of the head and neck region

Investigation of the microbiology and antibiotic sensitivity of skin and soft tissue infections of the head and neck region

e124 Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153 - The “next steps” declared inc...

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Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153

- The “next steps” declared include use of HSCIC material described for Commissioning, and the process is active and proceeding, regardless of OMFS opinion and representations to the CDO.

P173 An audit of the efficacy of Botulinum toxin for myofascial pain Stephanie Milne ∗ , Lachlan Carter, Tamsin Cooper

http://dx.doi.org/10.1016/j.bjoms.2016.11.164 P172 10,000 Steps; A pedometer study of Dental Core Trainees (DCTs) Ross Keat ∗ , Mathew Thomas Sheffield Teaching Hospital Introduction: Sedentary behaviour is associated with deleterious health outcomes including, but not limited to: anxiety, cardiovascular disease, depression, obesity, diabetes and high blood pressure. Indeed, the effect of a sedentary lifestyle has the same negative connotations in modern medicine as smoking and excessive alcohol consumption. The integration of e-portfolio, e-logbook, BNF and encrypted emails has made smartphones necessity to all trainees. Additionally, cross-site communication is paramount for patient safety and care, meaning members of staff carry phones as a matter of course. Smartphones have the ability to record exercise, meaning activity in the workplace can easily be monitored. Guidelines: Recommendation in regards to exercise varies slightly from source to source. The Centre for Disease Control and Prevention recommends 150 minutes of ‘moderate activity,’ a week (roughly 7000-8000 steps a day). The NHS ‘Live Well,’ scheme advises a target of 10,000 steps a day. For the purpose of this study, I shall be following the NHS guidelines. Aims: The aim of this study to assess activity levels of DCTs whilst at work, and ascertain if supplemental ‘moderate exercise,’ is needed outside of work to ensure 10,000 steps are walked every day. Method: Data was collected from smartphones. To ensure continuity, data was only collected from individuals with calibrated iPhones; meaning 10 DCTs were involved in the study. Conclusion: Walking at work provides the full quota of recommended daily exercise a majority of the time to DCTs, however additional exercise is infrequently needed to consistently meet the NHS guidelines. http://dx.doi.org/10.1016/j.bjoms.2016.11.165

Leeds General Infirmary We undertook a prospective audit of the efficacy of botox use for myofascial pain in the face. Inclusion criteria were age over 16, diagnosis of myofascial pain only (ie no joint component), failed conservative measures, and attended follow upat 3 and 6 months. Outcome measures were pain score (recorded on a visual analogue pain chart) and maximal interincisal opening (MIO). We used an evidence based gold standard of a 50% reduction in pain score and 17% increase in MIO.The first cycle included eight patients, patents were given25 units of botulinum toxin into the masseter muscles, with a further 50u. At3/12 pain score showed a 29% reduction at 3/12 and a 36% reduction at 6/12, MIO shows a 7% improvement at 3/12 and an 11% improvement at 6/12. As this fell short of the gold standard, the protocol was changed to add 25units into the temporalis muscles. Sixteen patients were included in this second cycle. Results showed a27% reduction at 3/12 and a 37% reduction at 6/12 in pain score, but a 2% decrease at 3/12 and a 5% decrease at 6/12 in MIO. Although patients did show improvement in symptoms, it fell short of the chosen Gold standard. Botulinum injections into the temporalis muscle appeared to worsen MIO. We recommend using only masseteric botulinum injections for myofascial pain. http://dx.doi.org/10.1016/j.bjoms.2016.11.166 P174 Investigation of the microbiology and antibiotic sensitivity of skin and soft tissue infections of the head and neck region Marta Cabral ∗ , Siddarth Gowrishankar, Phillip Ameerally NGH NHS Trust Background and objectives: Due to a growing concern regarding antibiotic resistance, we aim to investigate if there has been a change in the microbiology and antibiotic sensitivity of skin and soft tissue infections of the head and neck region over the last years. Patients and method: A retrospective study was undertaken of 93 patients admitted for inpatient management of skin and soft tissue infections of the head and neck region. Results: There were 51 male and 42 female patients. The range of infections included cellulitis, erysipelas, impetigo, infected lacerations, infected cutaneous cysts etc. 27 patients had no swabs sent. Of patients with swabs, there was no growth in 16 (24%). Of the positive cultures, the most common bacteria isolated were Staphylococcus aureus (48%), MRSA (2%), skin flora microbiota (18%) and Streptococci (14%). 31% of patients were immunocompromised, of which

Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153

8 were diabetic and 11 undergoing treatment for cancer. Increased CRP levels (>50) were not significantly associated with having surgical intervention. The vast majority of patients received flucloxacillin and benzyl penicillin or coamoxiclav unless they were allergic. Conclusion: Staphylococcus aureus and Streptococcus sp are still the most common pathogens responsible for head and neck skin infections. The emergence of MRSA raises concerns, as MRSA infections are associated with higher mortality rates, longer hospital stays, and higher hospital costs compared with other infections. Penicillin continues to be an effective empirical drug for skin and soft tissue head and neck infections. http://dx.doi.org/10.1016/j.bjoms.2016.11.167 P175 Coding OMFS procedures and a simple intervention to improve remuneration Ruchika Aggarwal ∗ , Marta Cabral, Siddharth Gowrishankar, Philip Ameerally Northampton General Hospital Background: Commissioning data sets developed by Department of Health are used to provide remuneration for surgical procedures in secondary care. Procedures carry specific codes as laid out by OPCS. Accurate coding results in accurate payment for services Aim: To assess if the surgical procedure carried out in our OMFS department are accurately coded to ensure appropriate remuneration. If there are errors, use simple interventions to prevent them. Materials and Methods: Initial survey carried out among junior doctors in the OMFS team on their knowledge of clinical coding. 100 consecutive OMFS surgical interventions analysed to check accuracy of coding to clinical procedure. Intervention used was to have a joint meeting with clinical coding department and junior doctors to explain parameters that influences coding. (example comorbidities) Re analysis on 100 patients after the intervention to assess improvement in accuracy of coding Results: Based on the electronic discharge summary data coding errors were found in 95 out of the 100 patients reviewed, amounting to significant loss of revenue. Inadequate insertion of comorbidities (58%), smoking status (52.5%), investigations (84%) Post intervention, accurate coding found in 93 out of the 100 patients. Discussion and Conclusion: Accurate coding is essential to ensure full remuneration of services provided. Often clinicians completing discharge paperwork have little to no exposure on what information is essential to improve coding. Our simple intervention enhances accuracy and improves funding. This is a simple and effective technique that can be

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adopted in other OMFS units across the country to enhance their remuneration. http://dx.doi.org/10.1016/j.bjoms.2016.11.168 P176 An outline of the location and number of graduate entry medicine and dentistry courses for OMFS trainees Steele Peter ∗ , Peter Van Den Bosch, Lyndon Cobat, Patrick Magennis Kings College London Aims: Collect data on UK universities providing medical and or dental courses for singly qualified OMFS trainees wishing to obtain a second degree. Ascertain how many places are available and how many of those places are available on shortened programmes. Method: All universities providing medical and dental courses were identified via the UCAS website. 6 year courses were not included in this study. Admissions offices of each university were contacted by telephone. Results: There are 33 medical schools providing 5,387 places and 16 dental schools providing 1095 places to which singly qualified OMFS trainees can apply. For medicine 674 (12.5%) places are on four year courses and 21 (0.4%) on three year medical courses. Of these places 24 are specifically for those with a dental qualification. For dentistry 74 (6.6%) places on a four year course and 10 (0.1%) a three year course.. The three year dental course is specifically for medical graduates. Conclusion: It was difficult to get exact numbers due to the changing nature of university places, some figures obtained were ‘best estimates’ based on previous year’s admissions. There are a large number of places to which singly qualified OMFS trainees can apply. There are comparatively few graduate places on shortened courses and fewer still on courses specifically for OMFS trainees. Locations of the shortened courses for OMFS trainees will be outlined and strategies for OMFS involvement with medical and dental graduate entry programmes will be discussed. http://dx.doi.org/10.1016/j.bjoms.2016.11.169 P177 Mitchell’s trimmer: who was Mitchell and what was he trimming? Amit Dattani ∗ , Simon Jeremy Hayes Alder Hey Children’s Hospital, Liverpool Introduction: Mitchell’s trimmer, also known as an osteotrimmer, osteocarver or osteocarver#4, is a commonly used instrument in a dentalprofessional’s armamentarium. Today the instrument is used in a range of dental specialties; however, its modern use has no association to trimming. In