The impact of ear disease and hearing impairment on the lives of Nepali patients in Pokhara: a qualitative study.

BACKGROUND: Ear disease in Nepal is a common problem which, left untreated, can cause serious complications such as hearing impairment (HI). Evidence shows that HI is associated with educational difficulties, employment problems and social isolation. Currently, there is little qualitative literature investigating the long-term impact of ear disease, and none specifically reporting on Nepali populations. This qualitative study explored the experiences of individuals affected by ear disease, with a view to informing hospital services and educational programmes. METHODS: A quota sampling technique was used, with 21 face-to-face semi-structured interviews conducted in Pokhara, Nepal during February-March 2014. Interviews were audiotaped, and verbatim transcripts were analysed using a conventional content analysis approach. RESULTS: Three overarching themes were identified: stigma, non-disclosure and barriers as a result of HI, stigma and non-disclosure. Stigma was both experienced and feared by participants throughout their lives, and as a result, they would not disclose their problem to friends, teachers and employers. Participants faced barriers in their education and work but did not receive the support they required because people were unaware of their condition. CONCLUSIONS: This research suggests that a 'stigma cycle' has developed and that participants are being trapped within it. This impacts adversely upon individuals' personal, social and economic development, limiting the human capital available to Nepal.

Is a preoperative group and save necessary for enhanced recovery joint replacement patients?

AIM: To consider the financial benefit to the authors' trust of omitting a preoperative group and save in enhanced recovery arthroplasty patients, and to estimate the scope for national savings. Patient safety was considered to determine acceptability for routine practice. METHODS: A total of 121 patients receiving a total knee replacement or total hip replacement on the authors' enhanced recovery protocol were selected. Pre- and postoperative haemoglobin levels were obtained. The transfusion team were contacted when the postoperative haemoglobin level was ≤8 g/dl to determine whether blood products had been issued. Costs for group and save were obtained from the pathology department. RESULTS: Mean postoperative reduction in haemoglobin level was 2.6 g/dl (P≤0.001) and 2.1 g/dl (P≤0.001) for total hip replacement and total knee replacement respectively. No patients were transfused. One group and save costs £12.00, and omission of this test in these patients would have saved £1452.00. Potentially, £1 605 408 could have been saved in the 133 784 patients undergoing NHS arthroplasty in 2012. Group and save omission would not affect management of intraoperative haemorrhage where O negative blood would be available. If a transfusion is required postoperatively it would take 100 minutes to issue crossmatched blood - a time delay unlikely to compromise patient safety. CONCLUSIONS: These results suggest that a preoperative group and save could be omitted in arthroplasty patients on this enhanced recovery programme to prevent needless expenditure, but more long-term follow up is required to ensure patients are not put at risk.

What patients consider important: temporal variations by early and late stage oral, oropharyngeal and laryngeal subsites.

Functional outcomes are of high priority to cancer patients and are relevant when considering treatment strategies. This study aimed to collate and analyse importance rankings of UW-QOL over time for patients treated with curative intent for primary head and neck squamous cell carcinoma between 2000 and 2010, and to compare early and late stage oral, oropharyngeal and laryngeal subsites. There were 1614 patients comprising oral cavity 47% (751), oropharyngeal 24% (382), laryngeal 20% (320) and other HNC locations 10% (161). Items of importance remained relatively stable within clinical groups but there were notable differences between groups. For patients with early oral tumours no domain was especially dominant, whereas for late oral tumours swallowing, chewing, speech and saliva were selected more often. Swallowing and saliva were more important in oropharyngeal tumours, as was taste with more advanced oropharyngeal tumours. Speech and activity were important for those with early laryngeal tumours, as were swallowing and speech for more advanced laryngeal tumours. Swallowing and saliva were more important in advanced tumours for all sites. This data confirms the priority patients place on swallowing, chewing, speech, and saliva, therefore curative treatments should optimise these functions wherever possible and provide access to post-treatment interventions as required.