Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction.

The British Association of Oral and Maxillofacial Surgeons (BAOMS) Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) reconstructive audit aims to provide surgical teams with risk adjusted comparative performance data. The goal is to enable surgeons to optimise surgical pathways. Risk adjustment requires that data on appropriate predictive variables are collected.

Confidence biases in problem gambling.

Background And Aims: Subjective confidence plays an important role in guiding behaviour, especially when objective feedback is unavailable. Systematic misjudgements in confidence can foster maladaptive behaviours and have been linked to various psychiatric disorders. In this study, we adopted a transdiagnostic approach to examine confidence biases in problem gamblers across three levels: local decision confidence, global task performance confidence, and overall self-esteem.

Multimodality Imaging of Patent Ductus Arteriosus Complicated by Severe Pulmonary Arterial Hypertension in a Pregnant Patient.

• Large uncorrected PDA may first be diagnosed during pregnancy. • Multimodality imaging may be safely utilized in these patients. • Multimodality imaging is safely utilized in these patients.

Insights Into the Standard Echocardiographic Views From Multimodality Imaging: Ventricles, Pericardium, Valves, and Atria.

The widespread use of cardiac computed tomography and cardiac magnetic resonance imaging in patients undergoing echocardiography presents an opportunity to correlate the images side by side. Accordingly, the aim of this report is to review aspects of the standard echocardiographic examination alongside similarly oriented images from the two tomographic imaging modalities. It is hoped that this exercise will enhance understanding of the structures depicted by echocardiography as they relate to other structures in the thorax.

Machine learning methods applied to audit of surgical margins after curative surgery for facial (non-melanoma) skin cancer.

We aimed to build a model to predict positive margin status after curative excision of facial non-melanoma skin cancer based on known risk factors that contribute to the complexity of the case mix. A pathology output of consecutive histology reports was requested from three oral and maxillofacial units in the south east of England. The dependent variable was a deep margin with peripheral margin clearance at a 0.

Machine learning methods applied to risk adjustment of cumulative sum chart methodology to audit free flap outcomes after head and neck surgery.

We describe a risk adjustment algorithm to benchmark and report free flap failure rates after immediate reconstruction of head and neck defects. A dataset of surgical care episodes for curative surgery for head and neck cancer and immediate reconstruction (n = 1593) was compiled from multiple NHS hospitals (n = 8). The outcome variable was complete flap failure.

Exploring assessment of balance using virtual reality in patients at risk of chemotherapy-induced peripheral neuropathy.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity for people treated for cancer. Impaired balance and falls are functional consequences of CIPN. Virtual reality (VR) technology may be able to assess balance and identify patients at risk of falls.

Validation of a post operative complication risk prediction algorithm in a non-head and neck squamous cell carcinoma cohort.

Risk-adjusted algorithms in surgical audit attempt to adjust for patient case mix and complexity in order that published outcomes fairly reflect surgical performance and quality of care. Such risk-adjustment models have applied to head and neck squamous cell carcinoma (HNSCC). We test one algorithm, currently embedded in the oncology and reconstruction dataset within the Quality and Outcomes in Oral and Maxillofacial (QOMS) Audit, which is an artificial neural network, for its predictive accuracy on a surgical cohort receiving curative surgery for non-HNSCC pathology.

Centralised pathology service for sentinel node biopsy in oral cavity cancer: The Southeast England Consortium experience.

Background: Sentinel lymph node biopsy is an increasingly recognised option for accurate staging and subsequent management of the clinically negative neck in early stage oral cavity squamous cell carcinoma. However, the technique is currently underused due to several logistic constraints including increased burden on pathology services. Here, we describe the feasibility of an outsourced centralised pathology processing and reporting service for sentinel lymph node biopsies in oral cavity squamous cell carcinoma.

BAOMS QOMS: findings from the pilot phase and lessons learned in the feasibility evaluation of a national quality improvement initiative.

The BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent. The pilot included a series of six audits (oral and dentoalveolar [ODA], oncology, orthognathic, reconstruction, trauma, and skin).

Machine learning methods applied to audit of surgical margins after curative surgery for head and neck cancer.

Most surgical specialties have attempted to address concerns about the unfair comparison of outcomes by 'risk-adjusting' data to benchmark specialty-specific outcomes that are indicative of quality of care. We explore the ability to predict for positive margin status so that effective benchmarking that will account for complexity of case mix is possible. A dataset of care episodes recorded as a clinical audit of margin status after surgery for head and neck squamous cell carcinoma (n=1316) was analysed within the Waikato Environment for Knowledge Analyisis (WEKA) machine learning programme.

Comparative left ventricular mechanical deformation in acute apical variant stress cardiomyopathy and acute anterior myocardial infarction utilizing 2-dimensional longitudinal strain imaging.

Aims: Despite three decades of study, it is still challenging to discriminate acute apical variant stress cardiomyopathy (AVSCM) from acute left anterior descending-myocardial infarction (LAD-MI) at the time of presentation. A biomarker or practical imaging modality that can differentiate these two entities is highly desirable. Our objective was to characterize left ventricular (LV) mechanical deformation using 2-dimensional (2D) echocardiographic strain imaging in an attempt to discriminate AVSCM from LAD-MI at presentation.

Predicting pathology on small bowel capsule endoscopy: a good FIT.

 Small bowel capsule endoscopy [SBCE) has an established role in investigating suspected small bowel bleeding [SSBB). Identification of a biomarker to predict pathology would maximize utility of this valuable diagnostic modality. This study aimed to investigate if fecal immunochemical test [FIT) could predict likelihood of small bowel pathology on SBCE.

Machine learning methods applied to audit of surgical outcomes after treatment for cancer of the head and neck.

Most surgical specialties have attempted to address concerns about unfair comparison of outcomes by "risk-adjusting" data to benchmark specialty-specific outcomes that are indicative of the quality of care. We are building on previous work in head and neck surgery to address the current need for a robust validated means of risk adjustment. A dataset of care episodes, which were recorded as a clinical audit of complications after operations for squamous cell carcinoma (SCC) of the head and neck (n=1254), was analysed with the Waikarto Environment for Knowledge Analysis (WEKA) machine learning tool.

Validating a risk stratification tool for audit of early outcome after operations for squamous cell carcinoma of the head and neck.

The aim of this study was to validate a case-mix adjustment tool (neural network) for the audit of postoperative outcomes. We tested its calibration and discrimination on two unseen groups of patients being treated for squamous cell carcinoma (SCC) of the head and neck and compared observed complication rates with predicted rates. A total of 196 patients who were treated at two UK NHS institutions between 2016 and 2018 were audited.

Case-mix adjustment in audit of length of hospital stay in patients operated on for cancer of the head and neck.

Patients treated surgically for squamous cell carcinoma (SCC) of the head and neck form a heterogeneous group, and it is difficult to take this variation into account when measuring the quality of care. We have tested the feasibility of mathematical models that allow for the adjustment for case mix when auditing the length of hospital stay as a proxy indicator of the quality of care. We completed a case-note audit of 733 surgical episodes of care for SCC of the head and neck in five cancer networks, and used logistic regression and decision tree analysis to adjust for case mix using pertinent preoperative variables.

Is Left Ventricular Global Longitudinal Strain by Two-Dimensional Speckle Tracking Echocardiography in Sepsis Cardiomyopathy Ready for Prime Time Use in the ICU?

Myocardial deformation imaging (strain imaging) is a technique to directly quantify the extent of myocardial contractility and overcomes several of the limitations of ejection fraction. The application of the most commonly used strain imaging method; speckle-tracking echocardiography to patients with sepsis cardiomyopathy heralds an exciting development to the field. However; the body of evidence and knowledge on the utility, feasibility and prognostic value of left ventricular global longitudinal strain in sepsis cardiomyopathy is still evolving.

The presbycardia phenotype: Cardiac remodeling and valvular degeneration in nonagenarians.

Background: Nonagenarians (NON) are a growing segment of the population and have a high prevalence of cardiac disease. Many findings encountered on their echocardiograms are also found in younger individuals with valvular or myocardial disease. Therefore, the purpose of this study was to describe this distinct echocardiographic phenotype.

Subjective perception of paraesthesia of the lower lip after bilateral sagittal split osteotomy at a district general hospital.

Our aim was to assess patients' perception of paraesthesia of the lower lip after bilateral sagittal split osteotomy (BSSO) at a district general hospital. Patients who had BSSO between August 2013 and August 2014 (n=46) were asked to score their perception of numbness between 0-10 (0=normal sensation. 10=complete loss of sensation/total numbness) one day postoperatively and then weekly for seven weeks, and at three months, 6 months, and one year.