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Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.

A panel of experts reviewed the SLP CMG document, including (1) three SLPs with distinguishedresearch careers, clinical expertise, and publications as subject matter experts in cognitive-communication rehabilitation for individuals with TBI (Diane R. Paul, PhD; McKay M. Sohlberg, PhD; and Lyn S. Turkstra, PhD); (2) a physiatrist/audiologist/researcher whoserves as chair of an academic program in communication sciences and disorders and a consultant to the DVBIC (Henry L. Lew, MD, PhD); and (3) a U.S. Army S3 Operations Officer who earned advanced degrees at the Command and General StaffCollege and the School of Advanced Military Studies after completing cognitive-communication rehabilitationand treatment for polytrauma injuries sustained during his deployment in Iraq (MAJ Beau Hendricks). TRAUMATIC BRAIN INJURY Mild Traumatic Brain Injury TBI refers to a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force and is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event [10]: (1) any period of loss of consciousness (LOC) or a decreased level of consciousness, (2) any loss of memory of events immediately before or after the injury, (3) any alteration of consciousness (AOC) or alteration in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.\\n Criteria for discharge are based on the individualized treatment plan for each SM or veteran.

Objectives: Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the integrity of laryngopharyngeal sensory and motor components. The pharyngeal squeeze is a maneuver used during fiberoptic endoscopic evaluation of swallowing with sensory testing to assess pharyngeal motor function. Although the pharyngeal squeeze manuever has been used in numerous scientific publications, its reliability has not been critically evaluated. Therefore, we sought to evaluate the reliability of the pharyngeal squeeze maneuver. Methods: Forty individuals who were undergoing fiberoptic laryngoscopy for various reasons were instructed to perform the pharyngeal squeeze maneuver. Three different clinicians reviewed the videotape on 4 separate occasions. The clinicians were first asked to rate each side of the pharynx as normal, diminished, or absent. They were then instructed to simply rate the maneuver as normal or abnormal. The interobserver and intraobserver reliability of the pharyngeal squeeze maneuver were assessed with the kappa coefficient. Results: The mean age of the cohort was 58 years. Fifty-eight percent (23 of 40) were male. When the clinicians were instructed to rate each side of the pharynx as normal, diminished, or absent, the interobserver and intraobserver reliabilities were poor (63% to 68% agreement; kappa = 0.18 to 0.67). When the clinicians were asked to rate the pharyngeal squeeze maneuver as normal or abnormal, both interobserver and intraobserver reliabilities were excellent (85% to 98% agreement; kappa = 0.75 to 0.95). Conclusions: The pharyngeal squeeze maneuver displayed poor reliability when motor function was classified into unilateral or bilateral normal, diminished, and absent categories. The pharyngeal squeeze maneuver was very reliable when simply graded as normal or abnormal. Clinicians could not reliably distinguish between diminished and absent pharyngeal motor functions.

Background Emergency department (ED) crowding is a significant challenge to providing safe and quality care to patients. We know that hospital and ED crowding is exacerbated on Mondays because fewer in-patients are discharged on the weekend. We evaluated barriers and potential solutions to improve in-patient flow and diminished weekend discharges, in hopes of decreasing the severe ED crowding observed on Mondays. Methods In this observational study, we conducted interviews of (a) leaders at The Ottawa Hospital, a major academic health sciences centre (nursing, allied health, physicians), and (b) leaders of community facilities (long-term care and chronic hospital) that receive patients from the hospital, and (c) home care. Each interview was conducted individually and addressed perceived barriers to the discharge of hospital in-patients on weekends as well as potential solutions. An inductive thematic analysis was conducted whereby themes were organized into a summary table of barriers and solutions. Results We interviewed 40 leaders including 30 nursing, physician, and allied health leaders from the hospital as well as 10 senior personnel from community facilities and home care. Many barriers to weekend discharges were identified, highlighting that this problem is complex with many interdependent internal and external factors. Fortunately, many specific potential solutions were suggested, in immediate, short-term and long-term time horizons. While many solutions require additional resources, others require a culture change whereby hospital and community stakeholders recognize that services must be provided consistently, seven days a week. Interpretation We have identified the complex and interdependent barriers to weekend discharges of in-patients. There are numerous specific opportunities for hospital staff and services, physicians, and community facilities to provide the same patient care on weekends as on weekdays. This will lead to improved patient flow and safety, and to decreased ED crowding on Mondays.

Background We believe that hospital and emergency department (ED) crowding is exacerbated on Mondays because fewer in-patients are discharged on the weekend. In part 1 of 3 concurrent studies, we documented the number of weekend discharges and the extent of hospital and ED crowding on the days following weekends. Methods We conducted a data analysis study at The Ottawa Hospital, a major academic health sciences center with two EDs. We created reports of the 18-month period (January 1, 2022–June 30, 2023) regarding the status of in-patients at the two campuses. We compared the total admissions, discharges, and hospital occupancy on weekends (or long weekends), the Monday following weekends (or Tuesday following long weekends), or Tuesdays–Fridays. For these three time periods, we also compared the proportion of ED beds occupied by admitted patients to all ED beds, as well as the proportion of days with > 70% admitted patients housed in the ED at 8:00am. Results Our data for 55,692 patients demonstrated that on weekends compared to weekdays, there were almost 50% fewer discharges with the ratio of admissions to discharges averaging 1.16 (95% CI 1.10–1.22). This was accompanied by a 2.4% absolute increase ( P  < 0.001) in hospital occupancy on Mondays or Tuesdays, often exceeding 100%. Both EDs are particularly crowded on these Mondays and Tuesdays with the proportion of admitted patients to regular ED beds averaging 68%. We observed serious crowding with > 70% occupancy with admitted patients on almost 50% of Mondays. Interpretation We have demonstrated that there are much fewer discharges on weekends, and this is associated with significant hospital and ED crowding on Mondays. This blocks safe and timely access to beds for newly arriving patients in the ED. These results should spur Canadian hospitals to evaluate their own data and seek solutions to this important problem.

Our children must be educated about their allergy, for it is their allergy and not the entire school population's. If we ban all nut products from the schools, what is going to happen to our children when they are in an environment that does not conform to their nut-free standard?

Closed head injury (CHI) frequently results in cognitive deficits (e.g., attention and concentration). The P300 event-related potential (ERP) has been suggested for measuring cognition after CHI. This cortically-evoked potential has been associated with neuro-electrical events believed to underly cognition. Differences in amplitude and latency measures of the ERP have been demonstrated with patients with dementia and schizophrenia. Curry (1980) and Papanicolaou et al. (1984) investigated differences in the P300 ERP measured from CHI subjects and normals. They concluded that the P300 is associated with cognitive status. This study was proposed to further evaluate the ERP morphology in relation to cortical behavior and cognitive functioning following CHI. Questions posed included: Do latency and amplitude measures of the P300 ERP differ between CHI and normal subjects? Is there a correlation between latency and amplitude measures of the P300 component? Fifteen CHI and 15 normal males participated in this study. Auditory ERPs were measured in an 'oddball' task paradigm involving the presentation of a random series of tones: 85% were 1000 Hz and 15% were 2000 Hz. Subjects listened to the tones and kept track of the total number of infrequently occurring tones. Auditory ERPs were recorded and peak latency and amplitude measures were analyzed using the Nicolet Pathfinder II. Significant differences between the CHI and normal subjects were revealed using a two-factor repeated measures analysis of variance. A moderate correlation was found between latency and amplitude measures. This study demonstrated differences in electro-cortical functioning between CHI and normal males. As a group, CHI subjects showed significantly prolonged P300 peak latencies and diminished amplitudes compared with normals, suggesting differences in both the patterns and rates of cognitive processes considered responsible for generating the P300 ERP. Different neurophysiological processes believed to contribute to the amplitude and latency measures of the P300 waveform, thereby accounting for the correlational findings. Future research should include the evaluation of CHI patients ranging in severity of injury. Increasing and varying task demands would also yield important information. Another valuable direction for research would be the longitudinal, serial evaluation of CHI patients.

[Theresa Dunkel], the mother of two small children, received her bachelor of fine arts degree from Carnegie-Mellon University in Pittsburgh. She works part-time for an architectural firm, has done personal portrait commissions, designs and drawings for homes, and has taught figure drawing classes.