This study reviews the body of existing research undertaken to explore head and neck cancer patients experiences of treatment for surgery, their information needs and their views regarding decision-making. Patients who suffer head and neck cancers and undergo surgery often report considerable psychological distress and impaired social functioning. To optimize survival, the decision about what treatment option to follow is often made quickly, with little support in terms of counsel or the provision of information. It is suggested that there is inadequate previous work exploring the content and delivery of information required by patients, their experiences and their views regarding decision-making to guide appropriate clinical interventions. By assimilating and critiquing existing work in this review an appropriate focus for further research is likely to be determined. An electronic search of relevant databases was undertaken including Cinahl, Medline, Psychinfo, Assia, the Cochrane Library and British Nursing Index. In addition, a grey literature search was also undertaken by hand. The search strategy was developed using recommendations from the Centre for Reviews and Dissemination 'Guidance for Those Carrying Out or Commissioning Reviews' (CRD Report Number 4, 2001). There is significant psychosocial and other functional disturbance amongst survivors of head and neck cancer surgery. Improved information giving may play a part in determining these outcomes.

H ead and neck squamous cell carcinoma (HNSCC) comprises approximately 4% of all solid tumours in the UK. Because of the anatomical site of this disease, longterm problems with morbidity are disproportionately large when compared with tumours at other sites. Difficulties with speech, swallowing and physical appearance are all common results of surgical, and indeed radiotherapeutic, treatment. The largest subgroup of HNSCCs is cancer of the larynx and pharynx for which the overall 5-year survival is of the order of 25%. It is, therefore, not surprising that this patient group frequently suffers significant long-term psychological morbidity. Patients and Methods: Participants included patients who had undergone surgery for head or neck cancer (n = 29) and their immediate relatives who were present at the initial consultation with the surgeon (n = 13). Patients were recruited from out-patient departments in two hospitals in the north of England. All interviews were conducted in participants' homes and were guided by a semistructured interview schedule devised both from literature and a pilot study. Results: Whilst most participants felt well informed about the surgical procedure they were undergoing, many reported feeling unprepared for the long-term lifestyle changes that occurred. Information, support and advice throughout the 3-6 months postoperative period was reported to be inadequate. The majority of participants did not ask any questions and did not perceive there was a choice regarding treatment. Individuals who wanted to take an active role in decisionmaking reported difficulties accessing information to enable them to do so. Conclusion:The findings of this study emphasise the need for individualised information provision defined not exclusively by the surgical procedure.

The effect of the pH of hypertonic saline nasal douching solutions on mucociliary clearance was studied in order to investigate the common notion that such solutions should be buffered alkaline. Thirty normal subjects were included in a randomised controlled crossover trial. Mucociliary clearance was measured by the saccharin clearance time. There was no difference in mucociliary clearance after douching with a non-buffered solution and a solution buffered to pH 8. However both solutions significantly improved mucociliary clearance compared to the baseline (P < 0.001) probably on account of their hypertonicity.

Objective This article reviews psychological therapies in the treatment of bipolar disorder, in particular psychoeducation, and how the inclusion of four fundamental principles – patient/therapist communication, flow of information, patient involvement and a trusting relationship – can improve patient outcomes. Method The content of this article is based on the proceedings of a 1‐day standalone symposium in November 2011 exploring how to establish a bipolar clinic within the context of existing services in the UK's National Health Service. Results Certain psychological interventions have emerged as beneficial add‐on treatments to pharmacotherapy in bipolar disorder and are associated with greater stabilisation of symptoms, fewer relapses and longer time to relapse. Psychoeducation is a simple approach to support prevention of future episodes by delivering behavioural training to improve illness insight, early symptom identification and development of coping strategies. Empowering patients to actively participate in their treatment provides independence, counteracts the current disconnect of therapist and patient, and increases awareness and understanding of the challenges of living with and treating bipolar disorder. Conclusion Psychoeducation enables patients to understand bipolar disorder, get actively involved in therapy planning, and be aware of methods for episode prevention, therefore effectively contributing to improved treatment outcomes and patient quality of life.

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