Patients with tracheostomies require multidisciplinary care in complex environments from multiple healthcare professionals. This can lead to delays and frustration for the patient and their family, compounded if systems are inconsistent, uncoordinated or ineffective. Improving Tracheostomy Care (ITC) is a three-year Quality Improvement (QI) programme guiding the implementation of the Global Tracheostomy Collaborative’s (GTC) resources into 20 diverse UK sites. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a patient satisfaction survey required for all hospitals in the United States providing Medicaid services and for the NHS Patient Experience Framework. We aimed to evaluate the impact of the ITC program on patient satisfaction using HCAHPS.

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Staff engagement is key to implementing change, especially for tracheostomy care, where leaders influence multidisciplinary teams from different specialties and sites. Improving Tracheostomy Care Quality Improvement program guided 20 diverse UK sites in implementing the resources of the Global Tracheostomy (QI) Collaborative. The NoMAD instrument is a theorybased validated research instrument that measures implementation processes from the perspective of professionals directly involved in implementing complex healthcare interventions.

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The Improving Tracheostomy Care (ITC) Quality Improvement (QI) programme is a national initiative aiming improve care by incorporating best practice initiatives from the Global Tracheostomy Collaborative (GTC) into 20 diverse NHS trusts. Successful implementation into complex healthcare settings relies on individual and organisational factors. NoMAD is a theory-based validated research instrument used to measure implementation processes of complex interventions into the healthcare setting, from the perspective of those directly involved.

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Temporal bone malignancies (TBM) are a rare but distinct group of conditions accounting for less than 0.2% of head and neck cancers and have an estimated annual incidence of less than 6 in 1 million. Squamous cell carcinoma (SCC) accounts for the majority of these malignancies, which is reflected in the literature since there are 21 published case series on temporal bone SCC and only case reports for non-squamous malignancies. TBMSCC has a poor prognosis in part due to their locally aggressive nature and complex anatomy. Progress in treatment remains slow given the rarity of this condition. Additionally, two main issues remain: 1. Lack of prognostic factors; 2. Multiple treatment strategies with little evidence on their effectiveness.

Dehiscence of the superior semicircular canal (SSC) as a cause of disequilibrium was first described by Minor et al in 1998 (Minor et al., 1998). In the subsequent two decades a large body of information has been generated and the condition has become well recognized. In this review we will examine the characteristic clinical manifestations of superior semicircular canal dehiscence (SSCD) and the current diagnostic modalities and treatment options.

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