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Aim: Evidence shows that 20%–30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration. Materials and methods: We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 – neurological diseases (n = 93), G2 – head and neck surgery (n = 200), G3 – gastroenterological diseases (n = 94) and G4 – other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered. Results: There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX–X). Conclusions: Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery. WHAT THIS PAPER ADDS: What is already known on the subject: Clinical signs of penetration or aspiration include coughing, throat clearing and voice changes, while silent penetration or aspiration patients aspirate without demonstrating any clinical symptoms. The most common consequences of silent aspiration include aspiration pneumonia, recurrent lower respiratory tract infections and respiratory failure. Additionally, malnutrition and dehydration can be indicators of silent aspiration. Patients may unknowingly reduce their oral intake and lose weight. Retrospective studies have shown that 20%–30% of patients aspirate silently (e.g. patients after stroke, acquired brain injury, head and neck cancer treatment, prolonged intubation). Clinical examination of swallowing can miss up to 50% of cases of silent aspiration. What this paper adds to existing knowledge: Currently, silent aspiration is often discussed in neurological literature, but its applications to head and neck surgery are limited. In this study, we identify head and neck surgery patients who should be prioritised or considered to be in higher need of instrumental swallowing evaluation due to a higher risk of silent aspiration. What are the potential or actual clinical implications of this work?: Post‐treatment structural changes can result in lower cranial nerve paresis (IX, X, XII) and face injury, in which vagus and glossopharyngeal nerves are injured. After tracheostomy and radiotherapy, patients with problems swallowing saliva need careful clinical examination, particularly cranial nerve examination. [ABSTRACT FROM AUTHOR]

Aim: Contribution to the authorship, including that for case reports, should be appropriately evaluated. I have noticed a scarcity of case reports with clinic doctors listed as coauthors, prompting this investigation. I sought to offer suggestions on the possible reasons for this trend. Methods: I checked case reports published in the Journal of Obstetrics and Gynaecology Research, the Journal of Medical Case Reports, and the BMJ Case Reports. I identified case reports listing a clinic doctor as a coauthor. I consulted eight professors at Jichi Medical University to ascertain whether case reports from their departments included clinic doctors as coauthors and, if not, the reasons. Results: Among 65 case reports from Japanese institutes published in the Journal of Obstetrics and Gynaecology Research, only one paper lists a clinic doctor as a coauthor. Of 100 and 50 papers published in the Journal of Medical Case Reports and BMJ Case Reports, respectively, none listed a clinic doctor as a coauthor. Six out of eight professors admitted to never considering the idea of including clinic doctors as coauthors. Conclusions: The scarcity of case reports with clinic doctors as coauthors extends beyond Japanese obstetrics and gynecology, encompassing various specialties worldwide. Center doctors do not think of the idea that a clinic doctor should be a coauthor. A clinic doctor who transferred the patient should be considered as a candidate coauthor depending on his/her scientific contribution. Such an approach could foster an environment encouraging doctors to contribute to academic writing, regardless of their workplace. [ABSTRACT FROM AUTHOR]

Background: In 2016–17 an important consensus was established regarding the use of the diagnostic label 'developmental language disorder' (DLD) to describe children with a persistent language problem having a functional impact on communication or learning and in the absence of any other biomedical condition. Despite this consensus, past research has revealed ongoing uncertainty regarding when to use the DLD label among speech–language pathologists (SLPs). Aims: In response to this uncertainty, a survey of SLPs was conducted aimed at investigating which types of clinical language profiles, and specific assessment results, were viewed as warranting the diagnostic label DLD. Methods & Procedures: SLPs were presented with 10 childhood language profiles and assessment results. Participants reviewed each case and described if they felt a diagnosis of DLD was warranted, which presented symptoms were consistent/inconsistent with DLD and if further information/testing was desired. Additionally, participants provided details regarding their personal diagnostic processes. Outcomes & Results: Results indicated a general consensus among SLPs as to when the DLD label should be applied. However, free‐text responses demonstrated considerable variation between clinicians regarding symptoms of importance, points of contention/confusion in language profiles and minimal assessment results viewed as necessary in the diagnostic process. Conclusions & Implications: This detailed look at the assessment/diagnostic process for DLD provides valuable insight into how to build further practice consistency in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. WHAT THIS PAPER ADDS: What is already known on this subject: The label DLD should be used as a diagnostic label to describe children with persistent language problems having a functional impact on communication or learning and in the absence of any biomedical condition. However, in current clinical practice, actual use of the label is inconsistent and SLPs face a number of challenges in diagnosing DLD. What this paper adds to the existing knowledge: This investigation provides clarity regarding which complexities in paediatric language profiles are most challenging for SLPs when determining if a child does/does not have DLD. Additionally, details regarding current assessment beliefs and practices are explored. What are the practical and clinical implications of this work?: By providing a detailed look at the diagnostic processes of practising SLPs, valuable insight is provided into how to build further practice consistency and confidence in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. [ABSTRACT FROM AUTHOR]

Purpose: In 2021, an opportunity arose to place four counselling and psychotherapy (C&P) students in three care homes across Greater Manchester as part of a 6‐week interprofessional education (IPE) care home scheme. Whilst, due to ethical concerns around confidentiality, the C&P students could not participate in interprofessional activities as intended, they still undertook their clinical placement in the home to provide accessible therapy support for care home staff. This paper aims at reporting on the varied factors that influenced the implementation of C&P student placements in care homes. Methods: At the start and end of their placement, four C&P students were interviewed about their experiences. We draw on data from these eight interviews and two reflective vignettes: one from a C&P student and the other from the C&P programme coordinator (C&PPC). Results: The data were thematically analysed, and two key themes and six subthemes were constructed. They broadly unpack the factors that facilitate and challenge the implementation of C&P student placements in care homes. Conclusion: This paper highlights the value of utilising care homes as placement sites for C&P students. We propose four key recommendations for future practice: (1) it is important to establish clear lines of communication, support and collaboration; (2) a dual‐space supervisory approach supports student learning in this "new" placement environment; (3) preplacement supportive frameworks are important to clarify initial role uncertainties within the care home; and (4) opportunities to provide therapy services should be well defined and referral processes put in place before the student arrives. [ABSTRACT FROM AUTHOR]

The present study aims to explore the forms paternalistic communication can take in doctor–patient interactions and how they should be considered from a normative perspective. In contemporary philosophical debate, the problem with paternalism is often perceived as either undermining autonomy (the autonomy problem) or the paternalist viewing their judgment as superior (the superiority problem). In either case, paternalism is problematized mainly in a general, theoretical sense. In contrast, this paper investigates specific doctor–patient encounters, revealing distinct types of paternalistic communication. For this study, I reviewed videorecorded encounters from a Norwegian hospital to detect paternalism—specifically, doctors overriding patients' expressed preferences, presumably to benefit or protect the patients. I identified variations in paternalistic communication styles—termed paternalist modes—which I categorized into four types: the fighter, the advocate, the sympathizer, and the fisher. Drawing on these findings, I aim to nuance the debate on paternalism. Specifically, I argue that each paternalist mode carries its own normative implications and that the autonomy and the superiority problems manifest differently across the modes. Furthermore, by illustrating paternalism in communication through real‐life cases, I aim to reach a more comprehensive understanding of what we mean by paternalistic doctors. [ABSTRACT FROM AUTHOR]

Introduction: Sternal pseudotumour is an important but rare entity thought to be an inflammatory, non‐neoplastic lesion that can mimic tumours. The purpose of this paper was to illustrate the imaging features of this lesion to avoid unnecessary investigations. Methods: The clinical notes and imaging features of four patients with a diagnosis of sternal pseudotumour were reviewed over a period from February 2016 to July 2019. Results: All patients were afebrile with no history of trauma. The median age at presentation was 12.5 months. The median length of symptoms prior to presentation was 3.5 days. One patient had a mildly elevated C‐reactive protein. Chest radiographs showed a pre‐sternal soft‐tissue mass, with or without osseous destruction of the subjacent sternum. Ultrasound showed a heterogeneous, hypoechoic pre‐sternal soft‐tissue mass with variable internal vascularity with extension between sternal ossification centres. CT and MRI showed an enhancing dumbbell‐shaped lesion with a pre‐sternal and retro‐sternal soft‐tissue component. The median time to complete resolution was 3 months. One patient had a biopsy that showed chronic inflammation and fibrosis. Discussion: These lesions present in young children typically with a 1‐ to 2‐week history of a focal 2‐ to 4‐cm swelling over the sternum. The aetiology is unknown but may be on the basis of a yet‐to‐be identified pathogen. Inflammatory markers and cultures are normal or mildly elevated. Important differential considerations include sternal osteomyelitis or neoplastic causes such as Ewing sarcoma, rhabdomyosarcoma, Langerhans cell histiocytosis and infantile fibrosarcoma. Conclusion: Sternal pseudotumor is a rare but important entity to be aware of to avoid unnecessary invasive biopsy or further investigations. Our suggestion is that this is a 'Don't touch' lesion that requires close short‐interval follow‐up at a surgical outpatient clinic and with ultrasound until resolution. [ABSTRACT FROM AUTHOR]

Background: Artificial Intelligence (AI) literacy is a crucial part of digital literacy that all individuals should possess in today's technologically advanced world. Despite the potential benefits that AI education offers, little research has been done on how to teach AI literacy to children. Objectives: This study aimed to fill that gap by investigating how children were engaged in AI literacy activities that are supported by intelligent agents. These activities were implemented in a Hong Kong kindergarten with a class of six 5‐year‐olds (Mage = 62.83 months, SD = 2.91) over a 6‐week period. Methods: The study gathered data from multiple sources, including classroom observations, teacher interviews, and documents/artefacts. Results and Conclusions: The results showed that children could learn about AI through interaction with intelligent agents in embodied learning contexts. The findings of this study have implications for the broader field of digital technology education, particularly in the context of early childhood education. Lay Description: What is already known about this topic: Artificial Intelligence (AI) literacy is essential in today's world.Little research exists on engaging young children in learning AI literacy. What this paper adds: Technology‐enhanced embodied learning approach affords multimodality in enabling young children's learning with AI‐related agents.Project‐based learning and real‐life examples can enhance children's learning. Implications for practice and/or policy: Early exposure to AI can help children navigate the increasingly digital world.Practical approaches, such as embodied and multimodal learning, seem to be effective.Teachers can enhance children's digital learning by using pedagogical strategies like project‐based learning and real‐life examples. [ABSTRACT FROM AUTHOR]

Introduction: Problem‐solving skills (PSS) help to provide a systematic approach to dealing with and managing complex problems. The overall aim of this study was to assess the acceptability and feasibility of developing and adapting a prison‐based PSS workbook for adults within a medium‐ and low‐secure hospital. Method: We used the Medical Research Council framework in our participatory mixed methods study incorporating an adapted survey (to identify what types of problems people experience in secure hospitals), a series of three interactive workshops (to co‐produce two case study examples for a workbook) and we gathered feedback from patients and hospital staff on the acceptability and feasibility of the workbook. Data from the survey were used to inform the case study examples, and the feedback from patients and hospital staff was descriptively summarised and the results consolidated. Results: In total, 82 (51%) patients took part in the survey; 22 patients and 49 hospital staff provided feedback on the workbook. The survey results indicated that patients regularly experience problems while in the hospital. Patients reported problems relating to restrictions of freedom and boredom. The workshops produced two case studies for the workbooks, with mainly positive patient and staff feedback. More work is required to improve the visual representation of the characters in the case studies, the amount and content of the language and the mechanism of the intervention delivery. Conclusion: The adaptation process proved acceptable and feasible to both patients and staff. The co‐production methodology for the workbook and feedback from patients and staff was an effective way of iteratively refining the materials to ensure that they were both meaningful and acceptable to staff and patients. Subsequent work is required to develop the workbook and evaluate the feasibility of the intervention delivery, recruitment rates, uptake and adherence to the PSS using a randomised controlled trial. Patient or Public Contribution: At each stage of the project consultation with patients and/or hospital staff was involved. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the clinical application of posterior tibial artery or peroneal artery perforator flap in the treatment of plate exposure after ankle fracture fixation. A posterior tibial artery or peroneal artery perforator flap was used on 16 patients with plate exposure after ankle fracture fixation in our hospital between July 2018 and July 2021. The time required to harvest the flap, the amount of intraoperative blood loss, the duration of postoperative drainage tube placement, the outcome of the flap and the healing observed at the donor site are reported. The sizes of the flaps were 2.5–7.0 cm × 5.0–18.0 cm and averaged 4.0 cm × 12.0 cm. The time required to harvest the posterior tibial artery or peroneal artery perforator flap ranged from 35 to 55 min and averaged 45 min. The amount of intraoperative blood loss ranged from 20 to 50 mL and averaged 35 mL. The duration of postoperative drainage tube placement ranged from 3 to 5 days and averaged 4 days. A total of 15 flaps survived and one flap had partial necrosis and survived after conservative treatment. All donor area defects were directly sewed and stitched without complications. There are multiple advantages of the posterior tibial artery or peroneal artery perforator flap, including simple preparation technique, reliable repair of the defects and without the need for performing microvascular anastomosis. It can be safely used in curing plate exposure after ankle fracture fixation and worth popularizing in grassroots hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Service users are increasingly participating in health research. Although collaborative research is assumed to give users a sense of psychological ownership, little is known about the specific psychosocial processes through which ownership develops and is displayed. The present study yields insight into a process in which service users, researchers and a website designer collaborated to design a website. Aim: The aim of this study was to explore how participants developed and displayed feelings of ownership during a collaborative process to design a website. Methods: A case study design was adopted by which audio recordings were subjected to thematic analysis and interpreted by drawing on the concept of psychological ownership. Findings: A sense of psychological ownership of the website design process emerged in two distinct and overlapping phases. In the first phase, 'sense of ownership during the early design phase', only researchers and the website designer displayed a sense of ownership, which was facilitated by the research context preceding the collaborative workshops. In the second phase, 'sense of ownership during the collaborative design phase', service users gradually started to develop parallel feelings of ownership that were facilitated by workshop design activities. These activities enabled service users to increasingly control the process, to invest themselves in the process and to gain intimate knowledge of the process and its outcome. Service users' sense of ownership was displayed in their statements about the website and its elements. Conclusion: Participants engaged in codesign processes may develop a sense of psychological ownership at different speeds because of contextual factors. It is important to take this into account as it may complicate the formation of egalitarian work groups. Patient and Public Contribution: Parents of children with suicidal behaviour and a counsellor participated as service users in a website design process. [ABSTRACT FROM AUTHOR]