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The purpose of this paper is to illuminate strengths and limitations in quality improvement work, when involving patients.

The experience-based co-design (EBCD) method was used when improving care for patients undergoing otosclerosis surgery. Individual interviews and focus groups were interpreted using qualitative content analysis.

Strengths mentioned by patients were that their participation made a difference. The first steps were found effective in giving an in-depth view of patients’ experiences and the staff got an increased understanding about specific patient needs. However, weaknesses were found in the latter phases, those of improving and follow-up, health care staff had difficulties to keep their focus on patients’ experiences and invite patients to be involved. Patients’ participation decreased, and there was a lack of tools to support the process.

The content in this paper is mainly based on one case. However, the findings are in congruence with earlier research and add further knowledge to the research area.

The findings can be used in healthcare when involving patients in improvement work.

There is no earlier study which involves patients with otosclerosis when using EBCD. Furthermore, this paper illuminates that there is a need to increase collaboration with patients. The latter phases often seem to be handled by health care professionals without involving patients; this paper suggest a development using dedicated quality tools.

A day conference at the Institution of Mechanical Engineers on 14 November 2000 brought together engineers engaged in development of robotic aids, and surgeons, some of whom are currently using robotic assistance in their work. The meeting provided a valuable opportunity for sharing of experience. Chairman of the event was Dr Patrick Finlay, who, as founder of Armstrong Healthcare, has been a pioneer in the development of medical robotics. Dr Finlay himself spoke about the Pathfinder image‐guided robot for neurosurgery. The aim of this is to free the surgeon and patient from the rigid stereotactic frame which has been necessary to secure the required 1mm precision of positioning for a tool tip. Mr Rory McCloy described his use of robots in laparoscopic surgery. A delicate drilling operation on flexible bone tissue in the ear was described by Professor Peter Brett, and among other presentations were three relating to 3D image capture for surgery.

The purpose of this paper is to investigate the mediating role of psychological problems (stress, anxiety, depression) between hearing impairment (HI) and tinnitus in tinnitus patients. Sample comprised of 110 patients (male, n=70; female, n=40).

The purposive sampling technique was used based on correlational design. Two scales, tinnitus handicap inventory developed by Newman et al. (1996), and depression, anxiety and stress scale developed by Lovibond and Lovibond (1995), were employed to assess tinnitus, anxiety, stress and depression among tinnitus patients.

The study revealed that tinnitus was positively significant correlated with depression (r=0.55, p<0.001), anxiety (r=0.63, p<0.001), stress (r=0.54, p<0.001) and hearing loss (r=0.81, p<0.001). The results also revealed that hearing loss was positively significant predictor for tinnitus (β=20.72, p<0.001). Further, it was revealed that tinnitus was positively significant predicted by anxiety (β=2.62, p<0.001), stress (β=2.33, p<0.001) and depression (β=2.71, p<0.001); the interaction between psychological symptoms and hearing loss was negatively significant predictor for stress (β=−0.51, p<0.001), anxiety (β=−0.57, p<0.001) and depression (β=−0.62, p<0.001). Moreover, it was revealed that female tinnitus patients were more predisposed to stress, anxiety and depression as compared to male tinnitus patients. Results also elaborated that those tinnitus patient who had profound HI were less inclined toward psychological problems as compared to those tinnitus patients who had mild to moderate level of HI. This study would be helpful for the clinical setting to tackle the psychological problems of tinnitus patients.

This study consisted on population from urban cities of Pakistan; therefore, the findings cannot be generalized on overall population. In future, descriptive as well as experimental studies will be beneficial to describe the mechanism of tinnitus across gender in detail. Native tool for measuring gender-related problems would be effective in future as it integrates cultural aspects as well.

There is a consensus across researchers that tinnitus is one of the most important biological problem which initiates various other psychological problem (Minen et al., 2014; Vogel et al., 2014). Numerous studies have been conducted to find out the relationship of tinnitus with various psychological and biological factors (Boi et al., 2012; Li et al., 2014; Marciano et al., 2003; McCormack et al., 2015; Møller et al., 2010; Udupi et al., 2013; Zöger et al., 2006).

December 6, 1971 Master and servant — Negligence — Noise — Deafness — Workman subjected to loud noise at work — Ear plugs providing inadequate protection — Ear muffs not supplied — No encouragement or persuasion to wear ear muffs — Whether negligence — Further loss of hearing resulting from continued negligence after statute‐barred period — Whether full damages recoverable.

Bisphosphonate (BP) medications can be applied to prohibit the damage of bone density and the remedy of bone illnesses such as osteoporosis. As the metal chelating of phosphonate groups are nearby large with six O atoms possessing the high negative charge, these compounds are active toward producing the chelated complexes through drug design method. BP agents have attracted much attention for the clinical treatment of some skeletal diseases depicted by enhancing of osteoclast-mediated bone resorption.

In this work, it has been accomplished the CAM-B3LYP/6–311+G(d, p)/LANL2DZ to estimate the susceptibility of SWCNT for adsorbing alendronate, ibandronate, neridronate and pamidronate chelated to two metal cations of 2Mg²⁺, 2Ca²⁺, 2Sr²⁺ through nuclear magnetic resonance and thermodynamic parameters. Therefore, the data has explained that the feasibility of using SWCNT and BP agents becomes the norm in metal chelating of drug delivery system which has been selected through alendronate → 2X, ibandronate → 2X, neridronate → 2X and pamidronate → 2X (X = Mg²⁺/Ca²⁺/Sr²⁺) complexes.

The thermodynamic results have exhibited that the substitution of 2Ca²⁺ cation by 2Sr²⁺ cation in the structure of bioactive glasses can be efficient for treating vertebral complex fractures. However, it has been observed the most fluctuation in the Gibbs free energy for BPs → 2Sr²⁺ at 300 K. Furthermore, Monte Carlo simulation has resulted by increasing the dielectric constant in the aqueous medium can enhance the stability and efficiency of BP drugs for preventing the loss of bone density and treating the osteoporosis.

According to this research, by incorporation of chelated 2Mg²⁺, 2Ca²⁺ and 2Sr²⁺ cations to BP drugs adsorbed onto (5, 5) armchair SWCNT, the network compaction would increase owing to the larger atomic radius of Sr²⁺ cation rather than Ca²⁺ and Mg²⁺, respectively.