While reducing oral intake is a natural occurrence when a person is dying, there may be situations where the healthcare team need to decide whether to withhold, initiate, continue or withdraw clinically assisted hydration (CAH), in discussion with the dying person and significant others. Speech and language therapists (SLTs) are increasingly part of the healthcare team, managing a person's dysphagia and communication when they are nearing the end of their life. An SLT can assist with differentiating between clinical symptoms, help determine whether oral fluid intake is as comfortable as possible, enhance oral hygiene, ensure a person can make informed choices around their hydration, and support the person and those close to them to understand the healthcare team's decision-making. The SLT's specialist knowledge and skills can enhance the multidisciplinary team's care quality. This article aims to provide an overview of the clinical and ethical considerations of CAH in adults, relevant to the field of SLT, alongside the SLT role. Given there is no clinical consensus on the benefits and risks of CAH in the last week of life, healthcare teams need to take a person-centred approach when considering the options around CAH. Oral fluid intake, where possible, should be encouraged. Respect for a person's autonomy, alongside effective communication, ensures that a competent individual can decide whether to accept CAH if offered.

This study comprehensively investigates the structure-function relationship of bigels tailored by varying oleogel-to-hydrogel ratios (3O:7H, 5O:5H, and 7O:3H v/v) for the delivery of the model bioactive compound, galangin (GAL). Through microstructural, spectroscopic, rheological, and in vitro analyses, it was shown that the ratio of oleogel/hydrogel greatly influences the physicochemical, mechanical, digestive, and release properties. The 5O:5H bigels exhibited excellent structural stability, optimal swelling behavior, and IDDSI Level 5-6 compliance, making it suitable for dysphagia-friendly foods. FTIR and XRD analyses confirmed the role of monoglyceride in promoting β-sheet formation and crystalline network development, while LF-NMR and rheology revealed composition-dependent water distribution and viscoelastic behavior. During in vitro digestion, hydrogel-rich bigels exhibited faster lipid digestion and greater FFA release, with cumulative FFA release decreasing from 93.87% in 3O:7H to 56.32% in 5O:5H and 52.80% in 7O:3H. In contrast, oleogel-rich systems showed slower lipid digestion, suggesting improved potential for controlled release. Electronic nose results further highlighted temperature- and composition-dependent volatile release profiles. Overall, this work establishes that bigel composition can be precisely modulated to meet specific requirements in functional foods and pharmaceutical formulations. The 5O:5H bigel, conforming to IDDSI Level 5-6, is identified as the optimal formulation for dysphagia-friendly food due to its excellent structural stability and swallowing safety. The 7O:3H bigel exhibits superior sustained-release capacity and high bioavailability, making it the optimal candidate for controlled delivery of GAL. These findings provide a theoretical basis for the precise formulation design of bigels.

BackgroundAccurate prognostication during the actively dying phase remains a major challenge in palliative care, particularly in home hospice settings where bedside assessment plays a central role. Neurological deterioration preceding death may provide clinically useful indicators of impending death; however, its temporal progression has not been well characterized.MethodsWe conducted a prospective observational study of terminal cancer patients receiving home hospice care between April 2022 and March 2025. A total of 236 patients who died at home were included. Neurological signs-including newly developed neuropathic pain, urinary retention, loss of facial expression, dysphagia, neck rigidity, head rotation, seizures, impaired consciousness, open mouth posture, hyperpyrexia, apnea episodes, and pupillary dilation-were prospectively recorded. The timing of each neurological sign relative to death was documented.ResultsNeurological signs appeared in a recognizable temporal sequence preceding death. Urinary retention appeared earliest, with a median onset of 4 days before death (interquartile range [IQR], 1-7 days), followed by newly developed neuropathic pain at 3 days (IQR, 1-5 days). Loss of facial expression, dysphagia, neck rigidity, head rotation, seizures, and apnea episodes typically occurred approximately 2 days before death. Impaired consciousness, open mouth posture, hyperpyrexia, and pupillary dilation occurred closer to death, with median onset times of 1 day before death. Loss of facial expression was the most frequent neurological sign (96.6%).ConclusionsNeurological deterioration follows a recognizable temporal pattern in terminal cancer patients receiving home hospice care. Systematic assessment of these neurological signs may support bedside prognostication, facilitate anticipatory guidance, and help families prepare for the dying process at home.

Aberrant right subclavian artery (ARSA) is the most common anomaly of the aortic arch and is usually asymptomatic. In a minority of patients, ARSA may cause dysphagia due to esophageal compression (dysphagia lusoria). The coexistence of symptomatic ARSA and severe aortic stenosis requiring surgical treatment is extremely rare, and the optimal management strategy remains unclear. A 43-year-old woman presenting with acute decompensated heart failure was diagnosed with severe aortic stenosis and concomitant dysphagia lusoria. Following medical stabilization in the intensive care unit, she underwent a single-stage total correction. To minimize surgical trauma and avoid multiple incisions, a conventional median sternotomy was slightly extended into the right supraclavicular region, serving as a single unified incision. Through this approach, transposition of the ARSA to the right common carotid artery was performed first, followed by mechanical aortic valve replacement with bovine pericardial patch repair of a focal annular defect secondary to decalcification and primary closure of a patent foramen ovale. Postoperatively, valve hemodynamics improved markedly, and dysphagia resolved completely, leading to a significant recovery of the patient's nutritional status. This case demonstrates that a single-stage, single-incision approach is a highly effective and viable strategy, providing valuable clinical insight into the management of these combined rare pathologies.

Oral care is essential for residents in long-term care (LTC) facilities to reduce complications such as aspiration pneumonia. While routine oral hygiene is standard practice, comprehensive oral care (COC)-which includes facial and intraoral muscle massage, salivary gland stimulation, and oral moisturization-may further enhance swallowing function. However, evidence linking COC directly to nasogastric (NG) tube removal remains limited. This study evaluated the effectiveness of COC in facilitating NG tube removal and improving swallowing function among LTC residents with dysphagia. A multicenter, open-label randomized controlled trial was conducted across eight LTC facilities. The intervention group (n = 40) received daily one-on-one COC sessions lasting 30-40 min, while the control group (n = 37) received routine oral hygiene. Participants were followed for six months, with outcomes including NG tube removal, swallowing function, body weight, and pneumonia incidence. At six months, the COC group demonstrated a significantly higher NG tube removal rate, with eight participants achieving full oral intake (p = 0.005). Functional Oral Intake Scale scores were also significantly higher in the intervention group (p = 0.005). Time to NG tube removal ranged from 17 to 182 days. Under intention-to-treat principles, the NG tube removal rate remained significantly higher in the COC group (16.7%vs. 0%, p = 0.005). Competing risks analysis using the Aalen-Johansen estimator confirmed a 6-month cumulative incidence of NG tube removal of 14.6% in the COC group versus 0% in the control group (Gray's test: p = 0.005), with no significant between-group difference in mortality (p = 0.500). No significant differences were observed in body weight change or pneumonia incidence between groups. Among participants who successfully discontinued NG tube use, dementia was the most common underlying condition. These findings suggest that daily one-on-one COC is a feasible intervention in LTC settings and may improve swallowing function while facilitating NG tube removal in residents with dysphagia.