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  1. Article ; Online: Management of internal carotid artery injury sustained during routine endoscopic sinus surgery.

    Lingamanaicker, V / Irune, E / Joshi, Y

    Annals of the Royal College of Surgeons of England

    2021  Volume 104, Issue 4, Page(s) e122–e124

    Abstract: A 49-year-old patient with a history of aspirin-exacerbated respiratory disease presented with carotid artery injury following revision functional endoscopic sinus surgery. Carotid artery injury is a rare but catastrophic complication of this surgery. ... ...

    Abstract A 49-year-old patient with a history of aspirin-exacerbated respiratory disease presented with carotid artery injury following revision functional endoscopic sinus surgery. Carotid artery injury is a rare but catastrophic complication of this surgery. The patient was transferred to our tertiary facility with interventional radiology for immediate management of the carotid artery injury. This case reaffirms that any surgery can have disastrous complications and highlights the importance of multidisciplinary management of complications such as carotid artery injury.
    MeSH term(s) Carotid Artery Injuries/diagnostic imaging ; Carotid Artery Injuries/etiology ; Carotid Artery Injuries/surgery ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/surgery ; Endoscopy/adverse effects ; Humans ; Middle Aged ; Sinusitis
    Language English
    Publishing date 2021-12-23
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 80044-2
    ISSN 1478-7083 ; 0035-8843
    ISSN (online) 1478-7083
    ISSN 0035-8843
    DOI 10.1308/rcsann.2021.0278
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  2. Article ; Online: Introducing day case thyroid lobectomy at a tertiary head and neck centre.

    Sheikh, Z / Lingamanaicker, V / Irune, E / Fish, B / Jani, P

    Annals of the Royal College of Surgeons of England

    2021  Volume 103, Issue 7, Page(s) 499–503

    Abstract: Background: Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy ... ...

    Abstract Background: Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy with same-day discharge could safely be introduced in our centre.
    Methods: We analysed all thyroid lobectomy surgeries performed between April 2015 and May 2019. Exclusion criteria included completion surgery, revision surgery, additional procedures and disseminated disease. Outcomes were benchmarked against surgeon-reported complications from the British Association of Endocrine and Thyroid Surgery's 5
    Results: In total, 259 thyroid lobectomy surgeries were undertaken and of these 173 met the inclusion criteria. There was no mortality, return to theatre for evacuation of postoperative haematoma or readmission. There was one postoperative haematoma which was drained at the bedside. Some 47 of the 173 (27.2%) patients met day case criteria currently in use at our centre.
    Conclusions: Day case surgery provides a cost-effective solution to rising bed pressures and a coherent protocol can optimise patient safety and experience.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ambulatory Surgical Procedures/adverse effects ; Child ; Cost-Benefit Analysis ; Feasibility Studies ; Female ; Hematoma/epidemiology ; Hematoma/etiology ; Humans ; Male ; Middle Aged ; Patient Readmission/economics ; Patient Readmission/statistics & numerical data ; Patient Safety ; Postoperative Complications/economics ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Reoperation/economics ; Reoperation/statistics & numerical data ; Retrospective Studies ; Tertiary Care Centers/economics ; Tertiary Care Centers/statistics & numerical data ; Thyroid Diseases/economics ; Thyroid Diseases/surgery ; Thyroidectomy/adverse effects ; Thyroidectomy/economics ; Thyroidectomy/methods ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2021-06-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 80044-2
    ISSN 1478-7083 ; 0035-8843
    ISSN (online) 1478-7083
    ISSN 0035-8843
    DOI 10.1308/rcsann.2020.7063
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  3. Article ; Online: Day-case thyroid lobectomy parameters at a tertiary referral head and neck centre: a sensitivity and cost analysis.

    Sheikh, Zara / Irune, Ekpemi

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2020  Volume 277, Issue 9, Page(s) 2527–2531

    Abstract: Purpose: Day-case thyroid surgery has been endorsed by the American Thyroid Association and the British Association of Day Surgery. Despite the many benefits of day surgery, day-case thyroid surgery is not widely practiced. We describe the use of ... ...

    Abstract Purpose: Day-case thyroid surgery has been endorsed by the American Thyroid Association and the British Association of Day Surgery. Despite the many benefits of day surgery, day-case thyroid surgery is not widely practiced. We describe the use of sensitivity analysis modelling and cost analysis in determining and refining the patient cohort that safely meet the threshold for a new day-case thyroid lobectomy service at a tertiary referral head and neck centre.
    Methods: All cases of first-time thyroid lobectomy were identified between 2015 and Q2 2019. Patients suitable for day-case thyroid lobectomy were identified retrospectively, according to the following criteria: Age < 65 years, ASA grade < 3, BMI < 30 kg/m
    Results: 259 Thyroid lobectomy procedures were performed, 173 of these met inclusion criteria. Sensitivity analysis revealed that after increasing all day-case parameters by four increments, eligibility increased from 47 (27%) to 112 patients (64.7%), with only one outpatient to inpatient conversion. Multivariate logistical regression analysis found that age was the only variable to increase the risk of adverse outcomes (OR = 1.10, p < 0.05). Using data from the NHS reference costs, if 60% of all thyroid lobectomies nationally were undertaken as day-case, this would have amounted to savings of £26.3 m over five years.
    Conclusion: Through sensitivity analysis, we determined that we could safely offer day-case thyroid lobectomy to 64.7% of our patient cohort.
    MeSH term(s) Aged ; Ambulatory Surgical Procedures ; Humans ; Referral and Consultation ; Retrospective Studies ; Thyroid Gland ; Thyroidectomy
    Language English
    Publishing date 2020-04-03
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-020-05921-z
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  4. Article ; Online: Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance.

    Glibbery, N / Karamali, K / Walker, C / Fitzgerald O'Connor, I / Fish, B / Irune, E

    The Journal of laryngology and otology

    2020  Volume 134, Issue 8, Page(s) 688–695

    Abstract: Objectives: To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient.: Methods: Twenty-eight coronavirus disease 2019 patients ...

    Abstract Objectives: To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient.
    Methods: Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed.
    Results: The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8-26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001).
    Conclusion: Performing a tracheostomy in coronavirus disease 2019 positive patients at 8-14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Betacoronavirus/isolation & purification ; COVID-19 ; Case-Control Studies ; Coronavirus Infections/epidemiology ; Coronavirus Infections/transmission ; Coronavirus Infections/virology ; Critical Illness/epidemiology ; Female ; Humans ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Pandemics ; Personal Protective Equipment/standards ; Personal Protective Equipment/supply & distribution ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/transmission ; Pneumonia, Viral/virology ; Prospective Studies ; Respiration, Artificial/adverse effects ; Respiration, Artificial/methods ; Respiration, Artificial/statistics & numerical data ; Risk Factors ; SARS-CoV-2 ; Tertiary Care Centers/statistics & numerical data ; Tracheostomy/adverse effects ; Tracheostomy/methods ; Tracheostomy/statistics & numerical data ; United Kingdom/epidemiology
    Keywords covid19
    Language English
    Publishing date 2020-08-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 218299-3
    ISSN 1748-5460 ; 0022-2151
    ISSN (online) 1748-5460
    ISSN 0022-2151
    DOI 10.1017/S0022215120001759
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  5. Article ; Online: Blood transfusion demands in a tertiary otolaryngology, head and neck centre: A 5-year retrospective cohort study.

    Luke, Louis / Ranmuthu, Charindu K I / Ranmuthu, Chanuka D S / Habeeb, Amir / Appukutty, Jithesh / Irune, Ekpemi

    Transfusion medicine (Oxford, England)

    2021  Volume 31, Issue 6, Page(s) 431–438

    Abstract: Objectives: To retrospectively analyse and report the utilisation of red blood cell (RBC) transfusion in a tertiary otolaryngology, head and neck centre in the United Kingdom.: Background: Twenty-seven per cent of RBC transfusions were for surgical ... ...

    Abstract Objectives: To retrospectively analyse and report the utilisation of red blood cell (RBC) transfusion in a tertiary otolaryngology, head and neck centre in the United Kingdom.
    Background: Twenty-seven per cent of RBC transfusions were for surgical indications in a 2014 England and North Wales survey. Currently, there is limited literature on RBC transfusions in Otolaryngology.
    Methods/materials: All inpatients admitted primarily under the care of the Otolaryngology, Head and Neck service between January 2015 and December 2019 were analysed. The primary outcomes of interest were number of units of RBC transfused over 5 years and distribution across clinical indications. Secondary outcome measure was cost of RBC transfusions over the same time period.
    Results: Most patients receiving transfusions are aged in their sixth and seventh decades. Epistaxis patients utilised 105 RBC units over the 5 years (56% of total RBC units) with emergency epistaxis accounting for 78% of use. Post-operative Head & Neck Cancer surgery with and without reconstruction required 47 RBC units over 5 years (25% of total RBC units). The mean cost incurred by the department over the 5-year period was £6171.49 (SD 1460.25). The cost has fallen by over £2000 over the 5-year period.
    Conclusion: Blood transfusion use has fluctuated over the last 5 years. Epistaxis and post-operative Head and Neck cancer cases account for significant use compared with other patient groups. Prehabilitation strategies will add value towards mitigating future consumption of RBC.
    MeSH term(s) Aged ; Blood Transfusion ; Erythrocyte Transfusion ; Humans ; Otolaryngology ; Retrospective Studies ; United Kingdom
    Language English
    Publishing date 2021-10-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 1067989-3
    ISSN 1365-3148 ; 0958-7578
    ISSN (online) 1365-3148
    ISSN 0958-7578
    DOI 10.1111/tme.12822
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  6. Article: Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

    Glibbery, N / Karamali, K / Walker, C / O039, Fitzgerald / Connor, I / Fish, B / Irune, E

    J Laryngol Otol

    Abstract: OBJECTIVES: To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient. METHODS: Twenty-eight coronavirus disease 2019 patients ... ...

    Abstract OBJECTIVES: To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient. METHODS: Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed. RESULTS: The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8-26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001). CONCLUSION: Performing a tracheostomy in coronavirus disease 2019 positive patients at 8-14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #695722
    Database COVID19

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  7. Article: Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study.

    Babiker, Samar / Ogunmwonyi, Innocent / Georgi, Maria W / Tan, Lawrence / Haque, Sharmi / Mullins, William / Singh, Prisca / Ang, Nadya / Fu, Howell / Patel, Krunal / Khera, Jevan / Fricker, Monty / Fleming, Simon / Giwa-Brown, Lolade / A Brennan, Peter / Irune, Ekpemi / Vig, Stella / Nathan, Arjun

    JMIR research protocols

    2023  Volume 12, Page(s) e40545

    Abstract: Background: The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the ... ...

    Abstract Background: The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students.
    Objective: The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities.
    Methods: This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment.
    Results: Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations.
    Conclusions: Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research.
    International registered report identifier (irrid): DERR1-10.2196/40545.
    Language English
    Publishing date 2023-06-16
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2719222-2
    ISSN 1929-0748
    ISSN 1929-0748
    DOI 10.2196/40545
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  8. Article: Recovery of Transplanted Eyebrow From Radiation-Induced Anagen Effluvium.

    Irune, Ekpemi / Bast, Florian / Williams, Gregory / Kirkpatrick, Niall

    Journal of cutaneous medicine and surgery

    2015  Volume 19, Issue 4, Page(s) 400–403

    Abstract: Ablative surgery for skin cancer of the face can often leave patients with significant deformities. These disfigurements can include loss of hair in conspicuous areas such as the eyebrows, leaving the patients with unsightly facial asymmetry. Eyebrow ... ...

    Abstract Ablative surgery for skin cancer of the face can often leave patients with significant deformities. These disfigurements can include loss of hair in conspicuous areas such as the eyebrows, leaving the patients with unsightly facial asymmetry. Eyebrow transplantation serves to address this issue; however, it has often been discouraged in patients who are destined to receive radiotherapy to the cutaneous area in question. This is due to the anagen effluvium effect of radiation therapy on hair follicles. We present a case in which the transplanted eyebrow hair follicles survived the deleterious effects of radiotherapy, leaving the patient with a symmetrical and aesthetically satisfactory eyebrow appearance.
    MeSH term(s) Alopecia/etiology ; Alopecia/surgery ; Eyebrows/pathology ; Eyebrows/radiation effects ; Eyebrows/transplantation ; Female ; Hair Follicle/radiation effects ; Humans ; Laser Therapy/adverse effects ; Middle Aged ; Mohs Surgery ; Radiation Injuries/etiology ; Radiation Injuries/surgery ; Skin Neoplasms/pathology ; Skin Neoplasms/radiotherapy ; Skin Neoplasms/surgery
    Language English
    Publishing date 2015-07
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1361720-5
    ISSN 1615-7109 ; 1203-4754
    ISSN (online) 1615-7109
    ISSN 1203-4754
    DOI 10.1177/1203475415575009
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    Zs.A 4987: Show issues Location:
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  9. Article ; Online: The relationship between preoperative tympanograms and intraoperative ear examination results in children.

    Knopke, Steffen / Irune, Ekpemi / Olze, Heidi / Bast, Florian

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2015  Volume 272, Issue 12, Page(s) 3651–3654

    Abstract: The tympanogram is an objective audiological method in adults and children which is often used in the evaluation of middle ear pathology. This should be alongside a thorough patient history and clinical examination prior to the decision to carry out a ... ...

    Abstract The tympanogram is an objective audiological method in adults and children which is often used in the evaluation of middle ear pathology. This should be alongside a thorough patient history and clinical examination prior to the decision to carry out a paracentesis or tympanostomy tube insertion. The goal of the study was to evaluate the relationship between the preoperative tympanogram and intraoperative ear examination results or middle ear findings. The retrospective study included 654 ears in 333 patients who underwent paracentesis with or without tympanostomy tube insertion between January and December 2011. The study cohort consisted of 206 male and 127 female patients with an average age of 3.7 ± 2.5 years. The results of the preoperative tympanogram were compared to those of the intraoperative ear findings. In 18.4 % of ears with a flat tympanogram, an air-filled middle ear was found intraoperatively (p < 0.01). Thus, tympanometry results cannot serve as the only indication for surgical intervention. A decision to treat should always be based on the merits of the symptomatology of the patient in conjunction with tympanometry findings.
    MeSH term(s) Acoustic Impedance Tests/methods ; Child ; Child, Preschool ; Ear, Middle/pathology ; Ear, Middle/physiopathology ; Ear, Middle/surgery ; Female ; Humans ; Infant ; Male ; Middle Ear Ventilation/methods ; Otitis Media with Effusion/diagnosis ; Otitis Media with Effusion/physiopathology ; Otitis Media with Effusion/surgery ; Paracentesis/methods ; Patient Care Planning ; Preoperative Care/methods ; Retrospective Studies
    Language English
    Publishing date 2015-12
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-014-3421-8
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  10. Article ; Online: Radio opacity of various ENT foreign bodies in sheep's neck preparation.

    Manickavasagam, J / Bateman, N / Street, I / Irune, E / Brammer, A

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2008  Volume 266, Issue 10, Page(s) 1641–1644

    Abstract: We conducted an experimental study to evaluate the radio densities of different ENT foreign bodies. Various ENT foreign bodies were placed in the oesophagus of a sheep's neck preparation. An X-ray lateral view of the neck was taken, following the soft ... ...

    Abstract We conducted an experimental study to evaluate the radio densities of different ENT foreign bodies. Various ENT foreign bodies were placed in the oesophagus of a sheep's neck preparation. An X-ray lateral view of the neck was taken, following the soft tissue neck protocol. Foreign bodies were grouped depending upon their radio densities and pixel value. The visibility of different materials on plain radiographs depends on their ability to absorb X-rays, and their inherent radio density and relation between it and the tissue in which they are embedded.
    MeSH term(s) Animals ; Esophagus/diagnostic imaging ; Foreign Bodies/diagnostic imaging ; Metals ; Neck/diagnostic imaging ; Radiography ; Sensitivity and Specificity ; Sheep
    Chemical Substances Metals
    Language English
    Publishing date 2008-12-04
    Publishing country Germany
    Document type Comparative Study ; Journal Article
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-008-0880-9
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