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  1. Article ; Online: Use of online educational resources before and during the COVID-19 era in oral and maxillofacial surgery.

    Hancock, Angela J / Pepper, Thomas / Messiha, Ashraf / Millwaters, Michael

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

    2024  Volume 52, Issue 4, Page(s) 406–412

    Abstract: Restrictions to traditional face-to-face meetings were mandated by many government authorities during the COVID-19 pandemic, impacting the delivery of educational training sessions for maxillofacial surgery trainees in the traditional group manner. An ... ...

    Abstract Restrictions to traditional face-to-face meetings were mandated by many government authorities during the COVID-19 pandemic, impacting the delivery of educational training sessions for maxillofacial surgery trainees in the traditional group manner. An online survey was designed to review what effect the pandemic had on the use and uptake of online educational sources amongst a representative cohort of maxillofacial surgery trainees in higher specialist training. Their attitudes and satisfaction with online resources were considered. The use of live sources such as webinars and pre-recorded materials (e.g. YouTube videos) was investigated. Engagement with online sources was considered prior to, and then during the pandemic. Alterations in the behaviour of trainees were demonstrated, with increasing online resource use seen once the COVID-19 pandemic took hold. Online pre-recorded resource use increased by 26% during the pandemic, with the median number of hours watched per month increasing from 1-5 h to 5-10 h (p < 0.001). Engagement with live online sources (webinars) increased by 52% and median time watched increased from 15 h per month to 10-20 h per month (p < 0.001). Trainees expressed satisfaction with the quality and flexibility of the resources. There was a firmly positive response to live webinars with regard to teaching quality, audio and video quality, ease of access and relevance to training needs. Pre-recorded and live online resources may prove a useful alternative or adjunct to face-to-face teaching when regulations limit or restrict social interactions.
    MeSH term(s) Humans ; COVID-19/epidemiology ; COVID-19/prevention & control ; SARS-CoV-2 ; Pandemics/prevention & control ; Surgery, Oral ; Curriculum
    Language English
    Publishing date 2024-01-11
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 91267-0
    ISSN 1878-4119 ; 1010-5182 ; 0301-0503
    ISSN (online) 1878-4119
    ISSN 1010-5182 ; 0301-0503
    DOI 10.1016/j.jcms.2023.12.013
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    Zs.A 882: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  2. Article: Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury - Is It Safe? Radiological Simulation in a Healthy Volunteer.

    Pepper, Thomas / Spiers, Harry / Weller, Alex / Schilling, Clare

    Craniomaxillofacial trauma & reconstruction

    2022  Volume 15, Issue 4, Page(s) 312–317

    Abstract: Study design: Observational.: Objective: To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures.: Methods: Magnetic resonance ...

    Abstract Study design: Observational.
    Objective: To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures.
    Methods: Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations - neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer.
    Results: In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4-C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1-2) joints.
    Conclusions: Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.
    Language English
    Publishing date 2022-01-03
    Publishing country United States
    Document type Journal Article
    ISSN 1943-3875
    ISSN 1943-3875
    DOI 10.1177/19433875211053091
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  3. Article: Six weeks' notice of the on-call roster: fact or fantasy? An audit study.

    Pepper, Thomas / Hicks, Georgina

    British journal of hospital medicine (London, England : 2005)

    2018  Volume 79, Issue 12, Page(s) 708–710

    Abstract: Introduction:: Work-life balance is directly linked to morale, job satisfaction and staff retention - all of which are linked to high quality patient care. Receiving the duty roster in advance is the first step towards achieving any work-life balance, ... ...

    Abstract Introduction:: Work-life balance is directly linked to morale, job satisfaction and staff retention - all of which are linked to high quality patient care. Receiving the duty roster in advance is the first step towards achieving any work-life balance, but anecdotally doctors frequently receive very little notice of this. This audit assessed NHS trusts' compliance with the Code of Practice, with specific reference to advance notification of duty rosters.
    Method:: The duty roster should be made available 6 weeks before commencement of post. The initial audit comprised a survey sent to all London surgical CT1s starting in October 2016. The interventions introduced following this were creation of a shared spreadsheet containing roster coordinator contact details, reminder emails sent to roster coordinators and distribution of results to NHS Improvement. A repeat survey was sent to all London surgical CT1s and CT2s starting in October 2017.
    Results:: In the initial audit 48/88 (55%) responded, of whom 4/48 (8%) received their duty roster in accordance with the standard and 9/48 (19%) did not receive the roster at all before starting. A total of 40/48 (83%) of trainees had to make specific contact with their future NHS trust in order to obtain their roster. In this initial audit 12/48 (25%) of trainees were satisfied or very satisfied with the amount of notice given. In the reaudit 133/178 (75%) responded, of whom 23/133 (17%) had received their roster in accordance with the standard and 25/133 (19%) did not receive the roster at all before starting. A total of 97/133 (73%) of trainees had to make specific contact with their future NHS trust in order to obtain their roster. In the reaudit 56/133 (42%) of trainees were satisfied or very satisfied with the amount of notice given.
    Conclusions:: This closed loop audit led to a doubling in the proportion of trainees receiving their rosters in accordance with the standard, and this was associated with an increase in trainee satisfaction levels. However, adherence to the standard remained low in both phases of the audit, and a significant proportion of trainees continue to commence jobs without any knowledge of their on-call roster. A range of measures is proposed to address this.
    MeSH term(s) Attitude of Health Personnel ; Humans ; Job Satisfaction ; Medical Staff, Hospital/organization & administration ; Personnel Staffing and Scheduling/organization & administration ; Personnel Staffing and Scheduling/standards ; State Medicine ; United Kingdom ; Work-Life Balance
    Language English
    Publishing date 2018-08-27
    Publishing country England
    Document type Journal Article
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2018.79.12.708
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  4. Article ; Online: Unilateral aberrant anatomy of the hypoglossal nerve.

    Aruede, Glenda / Brar, Jasdeep / Pepper, Thomas / Andi, Kavin / Hyde, Nicholas

    Surgical and radiologic anatomy : SRA

    2021  Volume 43, Issue 11, Page(s) 1809–1811

    Abstract: Purpose: Neck dissection is often performed in patients with oral cancer to both treat and reduce the risk of subsequent neck metastases. Injury to the hypoglossal nerve may result in dysarthria, dysphagia, and profound difficulty with upper airway ... ...

    Abstract Purpose: Neck dissection is often performed in patients with oral cancer to both treat and reduce the risk of subsequent neck metastases. Injury to the hypoglossal nerve may result in dysarthria, dysphagia, and profound difficulty with upper airway control. Although surgical landmarks facilitate intra-operative identification of vital structures to be preserved, they should not be an absolute measure, due to anatomical variants. We present a rare case of unilateral aberrant anatomy of the hypoglossal nerve, passing superficial to the internal jugular vein.
    Methods: A 70-year-old female presented to the emergency department with an indurated and ulcerated floor of mouth lesion, later confirmed to be a squamous cell carcinoma. She was treated with wide local excision, bilateral selective neck dissection of levels I to III, surgical tracheostomy, anterior mandibulectomy and reconstruction with a left composite radial forearm free flap.
    Results: A nerve-like structure was identified crossing superficially and perpendicular to the internal jugular vein within the left neck, which was later determined to be an anatomical variant of the hypoglossal nerve. This was carefully dissected and preserved, and the remainder of the surgery completed uneventfully. On the right, the hypoglossal nerve followed its normal anatomical course. The patient made a good recovery and suffered no neurological complications.
    Conclusion: Identification, meticulous dissection and preservation of the hypoglossal nerve is essential in lymphadenectomy involving levels I and II. Detailed knowledge of both normal and variant anatomy is fundamental for surgeons, which will allow for identification and protection of important neurovascular structures, thereby minimising surgical morbidity.
    MeSH term(s) Aged ; Dissection ; Female ; Humans ; Hypoglossal Nerve ; Neck ; Neck Dissection ; Neck Muscles
    Language English
    Publishing date 2021-09-09
    Publishing country Germany
    Document type Case Reports ; Journal Article
    ZDB-ID 632839-8
    ISSN 1279-8517 ; 0930-312X ; 0930-1038
    ISSN (online) 1279-8517
    ISSN 0930-312X ; 0930-1038
    DOI 10.1007/s00276-021-02828-0
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1456: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  5. Article ; Online: Electric scooters: a quick way to get to the emergency department?

    Pepper, Thomas / Barker, Matthew / Smyth, Delia / Kingham, Matthew / Dua, Radhika / Fan, Kathleen

    British dental journal

    2022  Volume 232, Issue 8, Page(s) 535–537

    Abstract: Introduction Electric scooters (e-scooters) are rife but are yet to be legalised in the UK. The aim of this paper was to investigate whether there had been an increase in the number of e-scooter injuries referred to the oral and maxillofacial surgery ( ... ...

    Abstract Introduction Electric scooters (e-scooters) are rife but are yet to be legalised in the UK. The aim of this paper was to investigate whether there had been an increase in the number of e-scooter injuries referred to the oral and maxillofacial surgery (OMFS) service at our unit. We present here what is, to our knowledge, the largest dataset regarding e-scooter-related injuries in the UK.Method A double cohort study in which details of patients sustaining e-scooter-related injuries that were referred to the OMFS department were collected, prospectively, for a 16-week period in 2020 (investigation period). This was compared with data collected, retrospectively, from the emergency department (ED) referral database for the same date range in 2019 (control period).Results In the investigation period, 12/649 referrals to OMFS from the ED were for e-scooter-related injuries. There were eight male patients and four female patients with a mean age of 35 years (interquartile range 24-48). Of these, only one patient was wearing a helmet and 8/12 had consumed alcohol. Head and neck injuries sustained included avulsed teeth, mandibular and midface fractures, skull fractures, facial lacerations and cervical spine injuries. One patient died as a result of their injuries. During the control period, 2/997 ED referrals to OMFS were for e-scooter-related injuries (12/649 versus 2/997; Fisher's exact test p <0.001).Conclusion There was a significant rise in e-scooter-related injuries seen at our major trauma unit compared with 2019. We recommend that e-scooters are subject to at least the same requirements in safety equipment and sobriety as bicycles and that their top speed is limited to 12.5 mph. We hope that these measures will allow the benefits of this technology to be enjoyed while reducing associated morbidity and mortality.
    MeSH term(s) Adult ; Cohort Studies ; Emergency Service, Hospital ; Female ; Fractures, Bone ; Head Protective Devices ; Humans ; Male ; Retrospective Studies
    Language English
    Publishing date 2022-04-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 218090-x
    ISSN 1476-5373 ; 0007-0610
    ISSN (online) 1476-5373
    ISSN 0007-0610
    DOI 10.1038/s41415-022-4153-6
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    Ul III Zs.143: Show issues Location:
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    Zs.MO 447: Show issues

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  6. Article ; Online: The role of nipple punch biopsy.

    Hicks, Georgina / Brown, Sarah / Pepper, Thomas / Sait, Razick / Barkeji, Musa

    The breast journal

    2019  Volume 25, Issue 6, Page(s) 1328–1329

    MeSH term(s) Biopsy/methods ; Breast Neoplasms/pathology ; Female ; Humans ; Nipples/pathology
    Language English
    Publishing date 2019-07-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1289960-4
    ISSN 1524-4741 ; 1075-122X
    ISSN (online) 1524-4741
    ISSN 1075-122X
    DOI 10.1111/tbj.13468
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    Zs.A 4483: Show issues Location:
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  7. Article ; Online: Treatment of mandibular third molars and pericoronitis in British military personnel: influence of guidelines from the National Institute for Health and Clinical Excellence.

    Pepper, Thomas / Konarzewski, Thomas / Grimshaw, Paul / Combes, James

    The British journal of oral & maxillofacial surgery

    2016  Volume 54, Issue 10, Page(s) 1111–1115

    Abstract: We studied the dental records of British military personnel who were less than 20 years old on enlistment, and had at least five years' service with at least five recorded dental inspections, at three military dental centres in the UK. The median (IQR) ... ...

    Abstract We studied the dental records of British military personnel who were less than 20 years old on enlistment, and had at least five years' service with at least five recorded dental inspections, at three military dental centres in the UK. The median (IQR) period from first to last inspection in 720 subjects was 15 (10-19) years, and the median frequency of inspection was every 14 (13-16) months. A total of 288/1250 mandibular third molars were extracted (23%). There were significant increases in the proportion of extractions stating caries in the mandibular third molar or multi-episode pericoronitis as indications (n=13, 14%, p <0.001) (n=15, 19%, p <0.001) post-introduction of NICE guidance. The number of extractions with no documented indication was reduced by 50 (26%, p<0.001) and that for a single episode of pericoronitis by 20 (9%, p =0.02). Extractions of mandibular third molars because of caries in the adjacent second molar increased by 4 (4%, p=0.045). The median age at the time of extraction before introduction of the guidelines was 23 years compared with 25 years afterwards (p<0.001). Twenty-five of 114 (22%) extractions of mandibular third molars were in patients over the age of 30 after the introduction of guidelines compared with 1/174 (<1%) before. The introduction of the NICE guidelines on the management of third molars has significantly changed our practice. Whether or not these changes have resulted in a net benefit to patients is still a matter for debate.
    Language English
    Publishing date 2016-12
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 605685-4
    ISSN 1532-1940 ; 0266-4356
    ISSN (online) 1532-1940
    ISSN 0266-4356
    DOI 10.1016/j.bjoms.2016.08.005
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    Uk I Zs.238: Show issues Location:
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  8. Book: The place of Maurice Blanchot

    Pepper, Thomas

    (Yale French studies ; 93)

    1998  

    Author's details [Thomas Pepper, special editor for this issue]
    Series title Yale French studies ; 93
    Language English
    Size 283 S., 24 cm
    Publisher Yale Univ. Press
    Publishing place New Haven, Conn
    Document type Book
    ISBN 0300073755 ; 9780300073751
    Database Former special subject collection: coastal and deep sea fishing

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  9. Article ; Online: Bacterial contamination of fabric and metal-bead identity card lanyards: a cross-sectional study.

    Pepper, Thomas / Hicks, Georgina / Glass, Stephen / Philpott-Howard, John

    Journal of infection and public health

    2014  Volume 7, Issue 6, Page(s) 542–546

    Abstract: In healthcare, fabric or metal-bead lanyards are universally used for carrying identity cards. However there is little information on microbial contamination with potential pathogens that may readily re-contaminate disinfected hands. We examined 108 ... ...

    Abstract In healthcare, fabric or metal-bead lanyards are universally used for carrying identity cards. However there is little information on microbial contamination with potential pathogens that may readily re-contaminate disinfected hands. We examined 108 lanyards from hospital staff. Most grew skin flora but 7/108 (6%) had potentially pathogenic bacteria: four grew methicillin-susceptible Staphylococcus aureus, and four grew probable fecal flora: 3 Clostridium perfringens and 1 Clostridium bifermentans (one lanyard grew both S. aureus and C. bifermentans). Unused (control) lanyards had little or no such contamination. The median duration of lanyard wear was 12 months (interquartile range 3-36 months). 17/108 (16%) of the lanyards had reportedly undergone decontamination including wiping with alcohol, chlorhexidine or chlorine dioxide; and washing with soap and water or by washing machine. Metal-bead lanyards had significantly lower median bacterial counts than those from fabric lanyards (1 vs. 4 CFU/cm(2); Mann-Whitney U=300.5; P<0.001). 12/32 (38%) of the metal-bead lanyards grew no bacteria, compared with 2/76 (3%) of fabric lanyards. We recommend that an effective decontamination regimen be instituted by those who use fabric lanyards, or that fabric lanyards be discarded altogether in preference for metal-bead lanyards or clip-on identity cards.
    MeSH term(s) Bacteria/classification ; Bacteria/isolation & purification ; Cross-Sectional Studies ; Environmental Microbiology ; Health Personnel ; Hospitals ; Humans ; Infection Control/methods ; Metals ; Records as Topic ; Textiles
    Chemical Substances Metals
    Language English
    Publishing date 2014-11
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1876-035X
    ISSN (online) 1876-035X
    DOI 10.1016/j.jiph.2014.07.009
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  10. Book: Singularities

    Pepper, Thomas Adam

    extremes of theory in the twentieth century

    (Literature, Culture, Theory ; 22)

    1997  

    Author's details Thomas Adam Pepper
    Series title Literature, Culture, Theory ; 22
    Language English
    Size XVIII, 249 S, 22cm
    Publisher Cambridge Univ. Press
    Publishing place Cambridge u.a.
    Document type Book
    Note Includes bibliographical references and index
    ISBN 0521573823 ; 0521574781 ; 9780521573825 ; 9780521574785
    Database Former special subject collection: coastal and deep sea fishing

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