Improving the safety of rapid tranquilisation in older people

AimsTo identify intramuscular rapid tranquilisation (IMRT) events in all >65 years inpatients in Sussex Partnership NHS Foundation Trust (SPFT) and to establish whether accompanying documentation meets SPFT guidelines. This is a re-audit, initial data were collected in 2016. Multimodal intervention has been implemented since initial data collection. In psychiatric inpatients IMRT should be administered as a last resort to calm acutely disturbed patients after verbal de-escalation and an offer of oral medication has failed. IMRT can cause physical health complications and impact therapeutic relationships. Quality improvements made since initial data collection were: an IMRT treatment algorithm for >65s, a teaching package for staff, IMRT prescription area on medicine cards and post IMRT physical monitoring forms – in line with updates to trust IMRT policy.MethodRetrospective case note audit cycle of 119 patients. Electronic and paper records were reviewed for inpatients >65 years on 1/9/2019. Records were examined for instances of IMRT– the following features were noted: diagnosis; verbal de-escalation; oral medication offered prior to IMRT; IMRT prescription location; and post-IMRT monitoring. Descriptive statistics were performed. This audit was approved by the trust audit committee.ResultThere were 34 RT events in 17 patients, reduced from 83 RT events in 20 patients in 2016. De-escalation was attempted in 62% versus 34% in 2016, oral medication offered first in 71% versus 59% in 2016. Physical monitoring was fully completed in 50% of instances in 2019, an improvement from 23% in 2016.ConclusionEducation, a new treatment algorithm, medicine card changes, and IMRT physical monitoring forms have improved adherence to trust standards. There was a 49% reduction in IMRT events in 2019 versus 2016. De-escalation is being performed more frequently, and oral sedation offered in more cases. The physical monitoring of patients has improved.

Unlearning the boundary-crossing constraint: processing instruction and the acquisition of motion event construal

This study explores the effects of instruction on the acquisition of motion event construal among learners of English as a second language. The challenge for learners with Verb-framed first languages is that they need to ‘unlearn’ the boundary-crossing constraint and conflate manner and motion in the main verb, as in she ran into the bank, however, there is little research on how this domain can be taught. We evaluate performance on story-telling productive tasks using three experimental treatments involving 1) an input-only approach based on the principles of Processing Instruction, 2) combined input and output training and 3) explicit information only about the target construction. The findings show that boundary-crossing constructions expressing manner can be taught and learning effects generalised to non-boundary-crossing structures not included in the training material. The effectiveness of input-only instruction persists over a two-week period, and compares positively with that of an input+output teaching package.

Neonatal videolaryngoscopy as a teaching aid: the trainees’ perspective

IntroductionNeonatal intubation is a challenging skill to acquire. A randomised controlled trial (RCT) found junior trainees had higher intubation success rates if their supervisor shared their airway view on a videolaryngoscope screen compared with intubations where the supervisor could not see the videolaryngoscope screen. The intubations in the trial were supervised by a group of experienced neonatologists who developed an intubation teaching package that aimed to be informative, consistent and supportive. We surveyed the trainees to assess their experiences of the intubation attempts.MethodsTrainees participating in the RCT completed questionnaires anonymously after each intubation attempt. Questionnaires used 5-point Likert scales and free comment sections. Quantitative analysis was performed using descriptive statistics. In a qualitative analysis, free comments were coded to identify central recurring themes.ResultsTwo hundred and six questionnaires were completed by 36 trainees. The majority reported that the guidance received during intubation was helpful, the postprocedure feedback was educational and their confidence levels were increased. Trainees appreciated a controlled environment and calm, consistent guidance. They found intubations in the delivery room, those involving unstable infants, large audiences and parental presence more stressful. Responses were positive whether the videolaryngoscope screen was visible or covered, emphasising the importance of consistent guidance. Overall, 16% of intubations were reported as intimidating.ConclusionThe shared airway view offered by videolaryngoscopy was well received. In addition, taking measures to control the setting, with standardised guidance and feedback, improved confidence and created a more positive learning experience.

Claude V. Palisca as Music Educator: The Yale Seminar on Music Education and the Norton Anthology of Western Music

Claude V. Palisca (1921–2001) was a prominent American musicologist and music educator. He authored books and articles about Renaissance and Baroque music theory and developments in musicology, but is most widely known as the founder and first editor of the Norton Anthology of Western Music ( NAWM) and coauthor of A History of Western Music, the two music history textbooks that are still in use in classrooms worldwide. In this article, we trace Palisca’s first idea of the NAWM’s structure, content, and purpose through his writings and activities between the 1950s and late 1970s. The central part among Palisca’s activities in music education belongs to his organization of the Yale Seminar on Music Education, his seminar report, and the listening curriculum designed to instill more balance between performance and academic study in largely performance-oriented public school music programs. In his listening curriculum, Palisca argued for emphasis on understanding music through listening within the historical and theoretical context of the music work, an approach he would later pursue in the NAWM. Palisca hinted that a similar teaching “package” is needed for the undergraduate level, thus identifying the listening curriculum from his Yale Seminar report as the first glimmer of the future NAWM.