Abstract Introduction Covid-19 and social distancing has triggered a seismic shift in clinical work especially during the first part of lockdown. This work looks to evaluate the experience and opinions of key stakeholders who took part in the process and use this to improve follow up in the future. Method 3 Focus groups following the same semi structured format discussed key considerations in follow up in general, telephone follow up, key aspects in its delivery and how this could benefit the service provided to patients. The focus groups involved Juniors (registrar level doctors), Consultants and support staff (clinical and non-clinical). Results Several themes and subthemes were identified. Key points were that patients were universally in favour of telephone consultations; they find them convenient and enjoy not attending the hospital. All clinicians agreed that although Covid-19 lead us to review New patients via telephone this increased workload as they needed to attend later for an examination and felt it did not provide safe care. Conclusions There is certainly an increasing role for telephone follow ups in the wake of Covid-19 which can benefit ongoing patient care and aid in managing the departments follow up capacity. Further work is needed to review this.

Objectives COVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure. Design Data on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure. Setting UK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation. Participants The cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020. Main outcome measures Mortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators. Results The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2weeks of the procedure. Conclusions Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.

Abstract Background Epistaxis is a common emergency presentation to ENT. The ‘Epistaxis 2016: national audit of management’ collected prospective data over a 30-day audit window in 113 centres. A 30-day all-cause mortality rate of 3.4 per cent was identified. This study examines in more detail the subgroup of patients who died during the audit period. Methods There were 985 eligible patients identified. Of these, 33 patients died within the audit period. World Health Organization bleeding score, Modified Early Warning System score, haemostasis time, source of referral, co-morbidities and cause of death were investigated from the dataset. Results Patients who died were more likely to come from a ward environment, have co-existing cardiovascular disease, diabetes or a bleeding diathesis, be on antithrombotic medication, or have received a blood transfusion. Patients did not die from exsanguination. Conclusion Epistaxis may be seen as a general marker of poor health and a poor prognostic sign.

Nous décrivons notre expérience de fermeture chirurgicale de la base antérieure du crâne après exérèse tumorale, à l’aide de la paroi postérieure du sinus frontal.Nous décrivons notre technique de fermeture de la base antérieure du crâne telle que nous l’avons effectuée chez trois patients après chirurgie d’exérèse tumorale. Après une approche transglabellaire et une résection de la tumeur, il apparaissait un defect de la base antérieure du crâne. La reconstruction consistait en l’implantation directe de la paroi postérieure du sinus frontal sans mise en place de substitut osseux (hormis pour l’obstruction des canaux naso-frontaux).Trois patients ont été opérés avec cette procédure chirurgicale. La tumeur a été à chaque fois réséquée totalement. Aucun cas d’infection n’est à déplorer. Cette méthode était facile à réaliser, malgré une persistance d’un cas de fuite de LCS. Les imageries de contrôle ne montraient aucun déplacement du greffon osseux.La reconstruction d’un defect de la base antérieure du crâne après chirurgie est facile à réaliser avec le greffon osseux autologue du sinus frontal avec un faible taux de complication.