To explore the extent to which national policy in end-of-life care (EOLC) in England influences and guides local practice, helping to ensure that care for older people at the EOL is of a consistently good quality.

Whilst policy is recognised as an important component in determining the effectiveness of EOLC, there is scant literature which attempts to interrogate how this happens or to hypothesise the mechanisms linking policy to better outcomes.

This article reports on the second phase of a realist evaluation comprising three case studies of clinical commissioning groups, including 98 in-depth interviews with stakeholders, meeting observation and documentary analysis.

This study reveals the key contextual factors which need to be in place at micro, meso and macro levels if good quality EOLC for older people is to be achieved. The findings provide insight into rising local inequalities and reveal areas of dissonance between stakeholder priorities. Whilst patients privilege the importance of receiving care and compassion in familiar surroundings at EOL, there remains a clear tension between this and the medical drive to cure disease and extend life. The apparent devaluing of social care and subsequent lack of resource has impacted significantly on the way in which dying is experienced.

Patient experience at EOL, shaped by the care received both formally and informally, is driven by a fragmented health and social care system. Whilst the importance of system integration appears to have been recognised, significant challenges remain in terms of shaping policy to adequately reflect this. This study highlights the priority attached by patients and their families to the social and relational aspect of death and dying and shines a light on the stark disparities between the health and social care systems which became even more evident at the height of the Covid-19 pandemic.

This study investigated whether inferior turbinate reduction combined with septoplasty improves patients’ outcomes, as assessed by objective and subjective methods.

A single-centre, parallel-group, randomised, open-label trial was conducted at a tertiary hospital ENT clinic. Patients who underwent septoplasty were divided into two groups: group A underwent septoplasty with radiofrequency ablation; group B underwent only septoplasty. All patients were assessed before and three months after surgery using acoustic rhinometry and peak nasal inspiratory flow measurements, as well as Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22 scores.

Seventy-four patients completed the study (36 in group A and 38 in group B). The patients in both groups showed significant improvements in acoustic rhinometry and peak nasal inspiratory flow measurements and in Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22 scores after the surgery (p < 0.05). However, the differences between the groups were not significant (p > 0.05).

Inferior turbinate ablation combined with septoplasty does not provide any more benefit to the objective and subjective outcomes of patients than septoplasty alone.

Microbial infection plays an important role in exacerbation of chronic otitis media. The aim of this study was to analyse the microbiota in chronic otitis media in the context of local treatment.

In this prospective study, samples for microbiological examination were taken from 119 patients who underwent operation because of chronic otitis media.

The results were compared between groups depending on the type of operation (none, tympanoplasty or radical), the presence of cholesteatoma or granulomatous tissue or discharge from the ear as a symptom of exacerbation. Antibiotic susceptibility of germs was analysed to define the strategy of treatment. A total of 209 samples were collected from 119 patients with chronic otitis media.

Pseudomonas aeruginosa and Staphylococcus aureus were pathogens most frequently identified from the ear in the course of chronic otitis media. Pseudomonas aeruginosa was concerned with major pathology of the middle ear (radical surgery, cholesteatoma or granulomatous tissue, persisting discharge after treatment), whereas Staphylococcus aureus was obtained in dry perforations without other pathology in the middle-ear cavity. Ciprofloxacin was effective against Staphylococcus aureus, but Pseudomonas aeruginosa strains were ciprofloxacin resistant.

Oral floor ranulas are pseudocysts located in the floor of the mouth that result from the extravasation of mucus from a sublingual gland. Historically, there has been little consensus on the ideal first-line treatment. Currently, definitive treatment involves sublingual gland excision, which can injure the lingual nerve and submandibular duct. Minimally invasive surgical techniques have been proposed, but so far have been associated with a high rate of recurrence.

The so-called piercing–stretching suture technique was performed in 14 naïve adult and paediatric patients (6 females, with a mean age of 20.3 years (range, 7–55 years)). Clinical and ultrasonographic evaluations were performed in all patients; post-operative sialendoscopy was conducted in two paediatric patients.

The surgical procedure was successful in all patients, and complete recovery of the ranula was seen in all but one of the patients who underwent suture replacement. No major or minor complications were encountered.

This minimally invasive procedure may be considered a reliable and first-line treatment for management of simple oral floor ranulas.