Doing More with Fewer: Optimizing Value with Limited Numbers of Autopsies

The value of autopsy is best demonstrated when the procedure is competently practiced in an appropriate clinical setting. Autopsy performance is expectedly restricted when a death raises certain forensic, religious, legal, or safety concerns. Additionally, limiting the scope of postmortem examinations to deaths that fulfill various clinical indications for the procedure will be important moving forward. This is especially true as institutions that finance autopsy services face uncertain and likely difficult financial conditions in the wake of the coronavirus disease 2019 pandemic. Autopsy pathologists should actively engage with clinicians in promoting responsible autopsy practice and delivering quality postmortem care. Using a problem-oriented autopsy record, thoughtfully evaluating postmortem histology, and purposefully reporting autopsy findings can help pathologists provide valuable data to autopsy's various stakeholders. Copyright © Wolters Kluwer Health, Inc. All rights reserved.

Problem Identification of Islamic Law Implementation in COVID-19 Mortuary Practice in Indonesia from the Perspective of Forensic Pathologists

Indonesia consists of many different ethnic groups and religions. Islam is the major religion in Indonesia, thus also rendering Islamic tradition as being significant in Indonesia. This is also the case with Islamic law. In March 11, 2020, COVID-19 was declared as pandemic by WHO. Since then, there were reported cases of forceful seizure of deceased bodies by the deceased's family in Indonesia. The aim of this research is to understand the problems related with Islamic law implementation in COVID-19 mortuary practice in Indonesia from the perspective of forensic pathologists. This study also aims to analyze whether the solutions given are in accordance with Islamic law. The sampling method used was convenience sampling. The respondents were forensic pathologists from different areas in Indonesia. 19 out of 20 respondents reported problems and solutions. The solutions were in accordance to Islamic law. Problem that is present in mortuary practice in the context of muslim COVID-19 patients are related to the bathing and shrouding process. There is distrust on whether proper care had been carried out. The situation happened due to the community's lack of comprehensive understanding of proper Islamic mortuary practice in COVID-19 pandemic context.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

An exploratory study of speech-language pathologists' clinical practice in the literacy domain: Comparing onsite practices with telepractice services during COVID-19.

Purpose: To explore speech-language pathologists' (SLP) practice in literacy prior to, and during, COVID-19 to understand the practicalities, feasibility and sustainability of telepractice literacy services.Method: This exploratory study employed a cross-sectional survey comprising 46 questions covering participants' caseload profile and service delivery models, their assessment and intervention practices and telepractice delivery of literacy services.Result: Participants were 44 SLPs working primarily in private practice and education with children and adolescents. Students with literacy difficulties comprised a significant proportion of SLPs' caseloads. Individual and group sessions were the most common format of delivery prior to COVID-19. In a telepractice model during COVID-19, SLPs saw fewer students overall. Most provided individual sessions only and reported cancellation of group sessions. SLPs described their practice in literacy as being aligned with evidence-based principles. A range of resources were used for literacy assessment and intervention. For most, their usual practice changed for telepractice. Many felt underprepared to use telepractice and experienced numerous challenges mostly relating to technology and family engagement.Conclusion: Literacy has become a core area of practice for SLPs; however, continued advocacy towards consultative and collaborative services is needed within onsite and telepractice models. Telepractice required SLPs to develop additional skills and modify usual practice. Despite experiencing challenges, many indicated they would continue with telepractice given its perceived benefits.

Telepractice in the diagnosis and treatment of pediatric speech-language disorders: The opinions and experiences of speech-language pathologists.

PURPOSE: This prospective cross-sectional study aimed to investigate the opinions and experiences with telepractice (TP) of Dutch-speaking speech-language pathologists (SLPs) living in the Dutch-speaking part of Belgium (Flanders). This study will help to optimize care for children with speech-language disorders as we will gain more insight into the experienced barriers and facilitators while using TP for assessing and treating these disorders. METHOD: Twenty-nine Dutch-speaking speech-language pathologists living in Flanders (age category 20-30 years: n = 16/29, 55.2%, 31-40 years: n = 10/29, 34.2%, 41-50 years: n = 2/29, 6.9%, 51-60 years: n = 1/29, 3.4%) were recruited through the social media. An online questionnaire was developed based on the available literature and administered to the SLPs. To compare the opinions and experiences of SLPs with TP, χ2 tests or Fisher's exact tests were used. RESULTS: The study showed a statistically significant association between years of clinical experience of SLPs and their opinion that TP does not provide more options in a clinical setting compared to face-to-face contact. SLPs who had expertise in multiple domains experienced significantly more added value of TP during the corona pandemic than SLPs who had expertise in only one specific domain. Additionally, SLPs who worked in a private practice indicated significantly more difficulties in developing a therapeutic relationship due to a lack of personal contact than SLPs who worked in other settings. 51.7% (15/29) of the SLPs experienced technical barriers using TP. CONCLUSION: Expertise in multiple domains of pediatric speech-language therapy resulted in experiencing more added value of TP during the corona pandemic, possibly because of the experience of multiple different and simultaneous advantages of TP in several domains. Additionally, SLPs in a private practice experienced more difficulties in developing a therapeutic relationship due to a lack of personal contact with their clients. This is in contrast to hospitals where children are often seen for a shorter period. Hence, there may be less chance of a negative perception of relationships with clients. Another conclusion is that treatment drop-out was not larger using TP compared to face-to-face therapy. However, SLPs experienced that the use of TP was not promoted/encouraged by their employer possibly because of technical barriers. It is hoped that the findings of this study will help SLPs and policymakers overthrow existing barriers and make telepractice a substantial, effective, and efficient service delivery model.

Studying the use of a proposed three-level grossing protocol in the histopathological diagnosis of COVID-19-associated rhinomaxillary mucormycosis.

Introduction: Mucormycosis is an acute and rapidly progressing opportunistic fungal infection. COVID-19-associated mucormycosis (CAM) had re-emerged as a complication of COVID-19 infection during the second wave of the pandemic in 2021. The rhinomaxillary form is a variant of the rhino-cerebral mucormycosis that presents a diagnostic challenge to the dentist and the oral and maxillofacial pathologist. Gross examination of pathological specimens is the most undermined step even though it plays a vital role in the final diagnosis. No studies have described this post-clinical step for the maxillofacial soft and hard tissue submitted for examination. Material and Methods: A prospective comparative study was carried out on 52 COVID-19-associated rhinomaxillary mucormycosis (CARM) cases to achieve complete, representative, and informative sampling of the submitted tissue and establish a three-level gross macroscopic examination protocol. Complete clinical and radiological histories were recorded after informed, written consent from every patient was received. Details of the number and type of samples received were recorded, grossing procedure was done as per the proposed three-level grossing protocol and were then compared to the presence of fungal hyphae in the soft tissue or decalcified hard tissue. Result: All 100% of the samples consisted of soft tissue (maxillary sinus lining), while 90.4% of the samples contained different hard tissue specimens. Seventy percent of the grossing workload was carried out by first-year oral pathology residents. Sixty-seven point three percent of the total soft tissue samples submitted showed no presence of fungal hyphae, while 69.2% of total decalcified sections of hard tissue were positive for fungal hyphae with a positive correlation. Out of the 29 cases grossed via the three-level grossing protocol, 89.6% of the cases were histopathologically positive for fungal hyphae. Thus a positive association (P < 0.05) between histopathological diagnosis and the proposed three-level grossing protocol was found. Conclusion: It is imperative to recognise that no mucormycosis report is to be signed out without multi-site (three-level grossed) bone decalcified reports. There is an immediate need to realise how vital documentation, correct laboratory practices, and grossing are for accurate histopathological diagnosis.

The Impact of COVID-19 on Speech-Language Pathologists Engaged in Clinical Practices With Elevated Coronavirus Transmission Risk: A 2021 Follow-Up Study

Purpose: This study assessed changes in speech-language pathology practice 1 year following the onset of the COVID-19 pandemic. The specific focus was on speech-language pathologists (SLPs) engaged in evaluation and treatment activities that pose an increased risk of virus transmission, namely, aerosol-generating procedures. Method: SLPs from the United States and Canada (n = 609) who were engaged in clinical activities with an elevated risk of COVID-19 exposure completed an online survey regarding their clinical practices. Topics assessed included continuation, modification, or cessation of clinical services, personal protective equipment (PPE) use, COVID-19 infections and vaccinations among SLPs, and financial impacts. For comparison, the results from the 2020 survey are included, and the percentage change (2020% - 2021%) is reported. Results: A majority of SLPs (90%) who completed the current survey reported that they were not experiencing PPE shortages, a marked change from the 2020 survey. Over half of the SLPs (52%) reported changes in clinical duties in 2021, with in-person visits and endoscopy being the most impacted. Nearly half of the respondents (49%) reported conducting virtual/telehealth clinical activities during the pandemic, and of these, 78% had not done any virtual/telehealth work prior to COVID-19. A positive COVID-19 test was reported by 10% of the SLPs (5% higher than in 2020). Most SLPs (92%) indicated they were vaccinated at the time of this survey. Conclusions: The 2021 survey data indicated an overall increase in SLP clinical activities compared with 2020 but have not yet returned to prepandemic levels. These results highlight a notable uptake of virtual/telehealth practice by SLPs, including those who had not previously done so. SLP vaccination rates also exceeded that of the general population.

Entry-Level Expectations for Pathologists' Assistants.

OBJECTIVES: The aim of this study was to assess expectations of performance that exist in the marketplace for entry-level pathologists' assistants (PathAs), defined as recent graduates of a pathologists' assistant program on their first day of employment. METHODS: A voluntary, anonymous survey was distributed to pathologist and PathA members of the American Society for Clinical Pathology by email. We assessed 98 professional activities of PathAs using a 5-point scale of expectations based on levels of trust placed in them. We also collected demographic information. RESULTS: A total of 728 participants responded to this survey, including 280 pathologists and 448 PathAs. We classified 98 activities according to expectations: independent performance (20/98), developing independence (48/98), and not expected of PathAs (5/98). Some activities (25/98) were indeterminate yet likely represent areas of developing independence. CONCLUSIONS: This study demonstrates an expectation for entry-level PathAs to perform some activities included in the scope of practice independently but eventually to develop independent proficiency for most professional activities. A minority of activities were identified as responsibilities that are not expected of PathAs. Entry-level PathAs, therefore, remain "works in progress," with an expectation for independent performance of core activities while developing abilities in many areas of professional practice.

Professional Training and Therapeutic Resources Needed for the Adoption of Telepractice in the Philippines

With the COVID-19 pandemic necessitating the adoption of telepractice for providing speech and language therapy services, this study investigated the factors affecting the perceptions and the implementation of telepractice for school-age children by speech language speech-language pathologists (SLPs) in the Philippines. Sixty-four SLPs completed a 36-item online survey assessing the adoption of telepractice, implementation concerns, student candidacy, continuous training in telepractice, and the SLPs' demographics. The SLPs reported that they quickly adopted telepractice in their services for school-age students at the start of the pandemic. Multiple linear regression analyses revealed that SLPs' perceptions of the effectiveness of telepractice were significantly affected by implementation difficulties while SLPs' future use of telepractice was significantly predicted by training and resource availability. These results suggest that professional training and other therapeutic resources are needed to alleviate SLPs' concerns about difficulties in implementing and continuing use of telepractice.

Feeding practices in public hospitals' neonatal intensive care units: An exploration into the ways in which COVID-19 affected the best practice in Gauteng.

BACKGROUND:  South Africa's healthcare system has a multitude of pre-existing challenges prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, ranging from reduced number of staff, lack of resources and units being at overcapacity both in the adult and paediatric populations. The neonatal intensive care units (NICUs) require a team approach to ensure best practice with vulnerable infants, but little is known about how the onset of the COVID-19 pandemic and the resultant lockdown restrictions impacted the feeding practices within the NICU. OBJECTIVES:  This study aimed to explore the impact that COVID-19 had on the feeding practices within the NICU settings in public hospitals in Gauteng. METHODS:  A qualitative design was employed with data collected in two NICUs in Gauteng. Data were collected in the form of observations and semi-structured interviews with healthcare workers (HCWs) in the NICU. Data were analysed using inductive thematic analysis. RESULTS:  Although the sample size of participants was limited, social distancing proved to be a challenge resulting in mothers and healthcare workers being given restricted access. This had effects on the ability to provide adequate feeding practices and resulted in anxiety for the mothers and mental health challenges for the HCWs when feeding these at-risk infants. A limitation of this study was the use of only two sites. CONCLUSION:  COVID-19 amplified the existing challenges in the NICU. A multidisciplinary and family-centred approach to address feeding challenges is required to offset the challenges resulting from the pandemic and subsequent lockdown.

Problems of organizing the work of pathological and anatomical bureau (devices), forensic medical examination bureau in the conditions of COVID-19

The work of medical professionals is always associated with a risk to life, but during the onset of the COVID-19 pandemic, forensic experts and pathologists were faced with the need to diagnose a new and highly contagious disease in the presence of inadequate specific methodological guidelines. Optimization of work organization processes, analysis of risk factors for the spread of COVID-19 infection in pathological and anatomical bureaus (departments) and forensic medical examination bureaus is an urgent task of public health. Forensic pathologists and pathologists are among the most vulnerable groups of healthcare workers exposed to the risk of infection in the workplace during epidemics, pandemics, and in high-risk conditions when emerging infections such as COVID-19 coronavirus. The purpose of the study was to analyze and identify the problems of organizing the work of persons involved in forensic medical examinations, post-mortem examinations in the context of the COVID-19 coronavirus. The study showed that the existing regulatory organization of the work of persons involved in the conduct of forensic medical examinations, post-mortem examinations does not allow to fully ensure the structural and procedural factors that regulate the activities of the personnel of pathological bureaus (departments) and forensic medical examination bureaus under the risk of coronavirus infection COVID-19. © 2022 by the authors.

Pragmatic impairment and COVID-19

The COVID-19 pandemic is the greatest global health threat in over 100 years. Its impact is seen in large numbers of premature deaths and the loss of economic stability for many millions of people. A significant number of people who contract the SARS-CoV-2 virus – the virus that causes COVID disease – experience symptoms many months after their acute illness. So-called Long COVID is now a recognized condition, with many affected individuals unable to return to work and engage in other daily activities. Among the complex symptoms of this condition is “brain fog”, a constellation of cognitive-linguistic problems that manifest as forgetfulness, word-finding difficulty, a lack of attention and concentration, and problems engaging in conversation. In this paper, I examine two women who had moderate COVID-19 infection during the first wave of the pandemic in Belgium and the UK. Both participants reported cognitive-linguistic difficulties several months after first becoming unwell. The UK participant is a native English speaker while the participant in Belgium speaks English as a second language. Case studies are used to examine their pre-morbid functioning and lifestyle, the onset and course of their COVID illness, and its impact on their language skills. It is argued that Long COVID has the potential to disrupt pragmatic and discourse skills even as structural language skills are intact. As such, this condition requires further systematic study by clinical linguists and speech-language pathologists.

Over view for the truth of COVID -19 pandemic: A guide for the Pathologists, Health care workers and community'.

Pakistan is in the grip of COVID-19, due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) since 26 February 2020, and the number of infected people and mortality is rising gradually. The health workers, doctors, pathologists and laboratory staff are front line fighters who are facing the risk. Few things are important for public and health workers, human behavior is at the core of preparedness and response i.e, personal protective measures, (handwashing, face masks, respiratory etiquette, surface and objects cleansing), social distancing and travel measures because the virus spreads through the respiratory channels, eyes, nose and mouth. While working in the Pathology labs, use the personal protection equipment (PPE), during the work in the duty. Avoiding the over duties and long shifts. It is good to keep the immune system healthy by taking a healthy balanced diet, vitamin supplements, and a night of proper sleep. It is also important to avoid taking food during duties and avoid making close contact without wearing safety dress.

Tele-Ethics in Communication Disorders: Asking the Right Questions, Finding the Right Answers

Purpose: A hypothetical case is used to illustrate legal and ethical issues involving the decision to replace the traditional in-person service delivery model with telepractice in schools beyond the context of the initial COVID-19 health emergency. In this clinical focus article, the reader follows Maria, the lead speech-language pathologist (SLP) in the district, as she determines the feasibility of continuing telepractice in her district now that students and clinicians are returning to schools. First, she considers the support needed to implement this service delivery model within the school setting given the anticipated changes to the rules and regulations governing lawful and ethical provision of telepractice after the health emergency ends. Next, she decides if telepractice is warranted in the district by considering the rationales behind the requests. Faced with balancing school, student, and clinician needs, Maria uses an ethical decision-making model to determine if requests for telepractice, tied to health safety concerns and potentially influenced by implicit bias, reflect legal, ethical, and/or moral issues driven by fear or unconscious discriminatory motives. Conclusions: The health emergency gave SLPs working in schools the unique opportunity to experience the benefits and utility of telepractice. Following the return to schools, continuation of telepractice services will require support and training of SLPs. Many factors must be considered including equivalency of services, technology, and protection of privacy as they relate to the changes to the laws and regulations governing telepractice after the health emergency allowances end. Of primary importance is the selection of telepractice to address student needs, not to avoid specific schools because of their characteristics or location. An ethical decision-making model can be used as a framework to guide service delivery model decisions that balance the needs of the student, the clinician, and the district.

Restraining SARS-CoV-2 in histopathology laboratory amid COVID-19 pandemic.

Medical laboratory personnel encounter diverse health and workplace-related hazards leading to severe health challenges including the ravaging SARS-CoV-2 infection, which is the causal agent of COVID-19. It was first announced in Wuhan, China in December 2019 but started to spread globally by late January 2020. COVID-19 pandemic and subsequent global spreading poses additional danger to healthcare personnel particularly the laboratorians. Other health practitioners may engage patients by observing social / physical distancing, but how laboratory staff observe or apply same rule to infectious samples remain a notable question. Activities of laboratorians result in repeated exposure at close interactions to patient's samples including SARS-CoV-2 infected specimens, which make them susceptible to COVID-19. Therefore, it is imperative to review mitigating measures in restraining possible exposure and spreading of SARS-CoV-2 in the best interest of laboratory staff and pathologists. It is against this backdrop that this paper intends to update readers on measures to restrain SARS-CoV-2 invasion in histopathology laboratory and deduce precautionary measures for observation by healthcare providers in COVID-19 era. Also discussed, is health hazards associated with histopathology laboratory with the objective of encouraging safety consciousness and safe laboratory practices in the face of COVID-19 pandemic.

Another Moment in Time: A Follow-Up Survey on Speech-Language Pathologists' Experiences With the COVID-19 Pandemic During the Fall of 2020

Purpose: Although the COVID-19 pandemic had been impacting K--12 education since spring 2020, educational professionals working in schools faced unique challenges at the beginning of the 2020-2021 school year. This study focused on gaining a deeper understanding of the experiences of school-based speech-language pathologists (SLPs) during the first half of the 2020-2021 school year and comparing these experiences to the previous spring. Method: This study involved a survey of 333 school-based SLPs working across the United States. The results of the survey were analyzed both qualitatively and quantitatively to identify key themes and trends related to communication, service delivery models, changes in job requirements, confidence levels, and personal challenges.

Understanding Clinician Perspectives and Actions to Address Caregiver Burden in Caregivers of Adults

Purpose: The purpose of this study was to determine how speech-language pathologists (SLPs) perceive and address caregiver burden. Method: A 29-question survey was distributed virtually via relevant Facebook pages and professional associations. Ninety-three responses from Englishspeaking SLPs working with adults in the United States or Canada were analyzed descriptively. Other analyses included one-way analysis of variance and chi-square tests to assess relationships between years of experiences, primary work setting, and other relevant variables, as well as a thematic analysis of one free-text response detailing how respondents defined caregiver burden. Results: Respondents associated caregiver burden with physical, psychological, financial, and social strain, loss of personal time, and the COVID-19 pandemic. The most described theme (80%) was physical strain. Almost all respondents (92%) believed that caregiver burden is a prominent issue and reported using strategies such as education and training to reduce burden. Most respondents (86%) would consider adopting a standardized tool to identify caregiver burden. Common barriers to addressing caregiver burden were lack of tools, time, and expertise. Additionally, less than half of respondents reported being confident in their ability to appropriately refer caregivers for support (45%). Conclusions: Most SLPs interacted with caregivers and used strategies such as education and training within their areas of expertise to try and address caregiver burden. Further research into the resources SLPs need to address caregiver burden is required. This study provides a preliminary understanding of current SLP perspectives and the strategies currently used to address caregiver burden in the United States and Canada.

TeleCPT: Delivery of a Better Conversations Approach to Communication Partner Training During a Global Pandemic and Beyond

Purpose: This case report provides an overview of telehealth delivery of our Better Conversations approach to communication partner training (CPT) for people with primary progressive aphasia (PPA) and their communication partner (CP). The purpose is to advance the knowledge of speech and language therapists/pathologists (SLTs) on this type of CPT and empower them to deliver teleCPT as part of their clinical practice. Method: We provide a case report describing therapy delivery, outcomes, and self-reflections from our clinical practice, which represents a collaboration between a UK National Health Service CPT clinic and the Better Conversations Research Lab at University College London, UK. A man with PPA and his CP (a dyad) video-recorded everyday conversations at home using a video conferencing platform. These formed the basis of an evaluation of conversation barriers and facilitators, which led to four weekly 1-hr therapy sessions covering the mechanics of conversation, identification of barriers and facilitators, goal setting, and practice of positive conversation strategies. Results: Dyad self-rating of goal attainment revealed that three of four conversation strategies were achieved much more than expected, a positive outcome given the progressive nature of F.F.'s condition. SLT access to the dyad at home via teleCPT facilitated the carryover of strategies from the session to everyday conversations in the home environment. TeleCPT was acceptable to this couple during a global pandemic, with benefits including no travel, ease of therapy scheduling around the CP's work and family commitments, and access to a specialist CPT clinic outside their geographical area. Conclusions: TeleCPT is feasible and acceptable to clients, improving access to therapy in a way that should not just be the preserve of service delivery during a global pandemic. SLTs can enable clients and their families to have better conversations despite communication difficulties by offering teleCPT. We have shared practical suggestions for delivering teleCPT.

Top 5 Junior Member Program Award Winners Announced

The article announces the Top 5 Junior Member Program Award winners for 2021 announced by the College of American Pathologists (CAP), including "Breast Cancers That Are HER2 FISH Amplified But 1+ by Immunohistochemistry--Do They Truly Exist?" by Swati Bhardwaj, and "Evaluating Nasopharyngeal Versus Tracheal Samples for Postmortem COVID-19 Testing," by Jamie Kendrick.

Current state of diagnostic, screening and surveillance testing methods for COVID-19 from an analytical chemistry point of view.

Since December 2019, we have been in the battlefield with a new threat to the humanity known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this review, we describe the four main methods used for diagnosis, screening and/or surveillance of SARS-CoV-2: Real-time reverse transcription polymerase chain reaction (RT-PCR); chest computed tomography (CT); and different complementary alternatives developed in order to obtain rapid results, antigen and antibody detection. All of them compare the highlighting advantages and disadvantages from an analytical point of view. The gold standard method in terms of sensitivity and specificity is the RT-PCR. The different modifications propose to make it more rapid and applicable at point of care (POC) are also presented and discussed. CT images are limited to central hospitals. However, being combined with RT-PCR is the most robust and accurate way to confirm COVID-19 infection. Antibody tests, although unable to provide reliable results on the status of the infection, are suitable for carrying out maximum screening of the population in order to know the immune capacity. More recently, antigen tests, less sensitive than RT-PCR, have been authorized to determine in a quicker way whether the patient is infected at the time of analysis and without the need of specific instruments.

COVID-19 Rehab Fright Management.

Being diagnosed as positive for SARS-2 CoV RNA on PCR generates anxiety and stress as well as depression due to the prospects of being isolated. With genetically varied forms of virus on the rise the widely adopted manner to protect oneself is social distancing. This is frightening for rehabilitation professionals who at times are exposed at close quarters to the patients as rehabilitation is essential. Data in this backdrop is lacking, as this is a recent and ongoing pandemic. As such the current study was conducted with an attempt to review and highlight the causes of fright among rehabilitation professionals and possible management options in the wake of current pandemic of COVID-19 in the perspective of Pakistan. For this purpose literature was searched from major electronic databases including PubMed, Google, Google Scholar and Web-of-science, with keywords "Covid-19, mental health, telehealth, telemedicine, tele-rehabilitation and combination of words". Eighty English, full text articles were studied out of which 36 were used for the literature review. With this literature review we conclude that COVID-19 has resulted in fear of contracting and transmitting this disease among health professionals and can be reduced and managed by provision of tele-rehabilitation and telehealth facilities. Patients emerging from prolonged mechanical ventilations require extensive rehabilitation to restore routine body functions. The role of the otolaryngologist and speech language pathologist (SLP) is formal and direct to ensure appropriate and timely long term intervention and rehabilitation to ensure that these individuals re-enter mainstream activities.