Management of acute dental problems: an aide-mémoire for referrals to oral and maxillofacial surgery.

The acute management of a facial swelling is a core competency for the dental practitioner. Onward referral to secondary care for acutely unwell patients requires timely decisions, with the referrer's initial assessment often critical in later management. Oral and maxillofacial triage is essential to ensure appropriate care is provided in the appropriate environment. Acute swelling and haemorrhage referrals to secondary care are not a common, everyday occurrence in general dental practice; however, the ability to provide a sufficient and safe handover will improve patient outcomes and ensure timely transfer to appropriate care providers. This article aims to provide the dental practitioner with insight into the oral and maxillofacial assessment of acute facial swellings and dental haemorrhage. The reader should be able to make an appropriate clinical assessment and communicate an effective referral to oral and maxillofacial care.

Has the length of time from symptom onset to cancer diagnosis in children increased during the COVID-19 pandemic?

BackgroundThe COVID-19 pandemic has had unprecedented and far-reaching effects on global society throughout 2020, and especially so on healthcare systems. Delayed presentation to hospital and, therefore, delayed diagnosis of many conditions has been well documented during the COVID-19 pandemic. However, there is a paucity of data on the effect of time to cancer diagnosis in children within the UK during this period.Sustaining time critical services such as paediatric oncology during prolonged periods of extraordinary pressure on the NHS is of key importance in patient care. Through evaluating our secondary care service, we aimed to identify learning points from the pandemic and lockdown measures.ObjectivesTo evaluate the following key metrics in children who received a cancer diagnosis during the COVID-19 pandemic versus an equivalent time period pre-pandemic:Time from first symptom(s) onset to cancer diagnosis.Time from referral to tertiary paediatric oncology service to cancer diagnosis.The number of healthcare encounters between first symptom(s) to final encounter leading to cancer diagnosis.Identify learning points and service improvement opportunities, to avoid future cancer diagnosis delays.MethodsThe medical records of all cancer diagnoses in patients under 16 years when they presented to our NHS Trust from the date of 1st UK lockdown, 23rd March, until 31st December 2020 (pandemic cohort) were evaluated and compared to a matched control cohort (pre-pandemic cohort). Evaluation included determining:Date of symptom(s) onset relating to their malignancy.The number of primary healthcare encounters relating to their cancer symptoms.The number of secondary healthcare encounters relating to their cancer symptoms.Date of referral to tertiary centre for diagnostic investigations.A breakdown of type of patient-healthcare encounters (face-to-face or virtual).One-tailed T-testing was used to evaluate any differences in the two cohorts.ResultsOur analysis showed: Pre-pandemic cohort (N = 21) Pandemic cohort (N = 21) P-value Symptom(s) onset to diagnosis 32 days 118 days 0.03* Tertiary centre referral to diagnosis 6 days 9 days 0.32 Average number of clinical encounters from symptom(s) onset to final diagnostic encounter 1.6 4.2 0.18 * = significant result.We identified three cases with significant delays in cancer diagnosis during the pandemic (range = 216–599 days). Key learning points from these cases included inappropriate pathway referral, COVID-19 related cancelled appointments, and delayed referral from non-paediatric specialties.ConclusionsAn increased time from symptoms(s) onset to cancer diagnosis was observed during the COVID-19 pandemic. Additionally, a trend towards an increased number of clinical encounters before cancer diagnosis was observed during the COVID-19 pandemic. This likely represents patient and carer hesitancy in accessing healthcare services during the pandemic, as well as the possibility of diminished clinical assessment or hesitancy in onward referral at various clinical encounters. Somewhat reassuringly, the time from tertiary centre referral to diagnosis appeared unaffected during the pandemic reflecting maintenance of a consistent service during the pandemic. Overall, these findings represent important learning points to avoid delays in cancer diagnosis during any prolonged period of extraordinary pressure on healthcare systems and can inform healthcare service development and contingency planning going forward.