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Objective Prehospital and retrieval medicine (PHRM) occurs in a complex work environment. Appropriate training is essential to ensure high standards of clinical care and logistic decision making. Before commencing the role, PHRM doctors have varying levels of experience. This narrative review article aims to describe and compare 6 internationally accepted PHRM courses. Methods Six PHRM course directors were asked to describe their course in terms of education methods used, course content, and assessment processes. Each of the directors contributed to the discussion process. Results Although developed independently, all 6 courses use a comparable combination of lectures, simulations, and discussion groups. The amount of each pedagogical modality varies between the courses. Conclusion We have identified significant similarities and some important differences among some well-accepted independently developed PHRM courses worldwide. Differences in content and the methods of delivery appear linked to the background of participants and service case mix. The authors believe that even in the small niche of PHRM, courses need to be tailored to the participants and the “destination of the participants” (ie, where they are going to use their skills).

Converting a matrix from row-order storage to column-order storage involves permuting the entries of the matrix. How can we determine this permutation given only the size of the matrix? Unexpectedl...

IntroductionFirst attempt intubation success is used by many prehospital services as a marker of quality and safety. An increasing complication rate is associated with repeated intubation attempts. The aim of this study was to identify changes to intubation technique following a failed intubation attempt.MethodsLifeFlight Retrieval Medicine provides aeromedical retrieval services in Queensland, Australia. This retrospective study identified cases of failed intubation attempts from an electronic database registry over a 41-month period from March 2015 to July 2018. These data were analysed using descriptive statistics.ResultsOf the 762 patients who required intubation 758 (99.5%) were successfully intubated, with 684 intubated at the first attempt (89.8%; 95% CI: 0.87 to 0.92). There was no difference in first attempt success between direct and video laryngoscopy (511/563 (90.8%) vs 172/194 (88.6%) p=0.38), trauma or medical (374/419 (89.3%) vs 310/343 (90.4%), p=0.61), primary or interhospital missions (329/370 (88.7%) vs 355/392 (90.8%), p=0.33). 78 cases of failed first attempt intubations were identified. In 65 of these cases, intubation was successful at the second attempt. A single change was made to the intubation procedure prior to a second successful attempt in 28/78 cases (35.9%), and more than one change was made in 41/78 (52.6%). The changes included the operator, intubation device, patient position, intubating aid and external laryngeal manipulation. No change between attempts was recorded in 9/78 (11.5%). 9 cases were successfully intubated at the third attempt, and changes prior to the third attempt included operator, device and intubating aid.ConclusionAlthough a high overall intubation success was found, one in ten patients who were intubated had a failed first attempt. The majority of successful subsequent attempts were preceded by at least one change to intubating technique. Intubating clinicians need the ability to identify and correct issues leading to a failed first attempt.

Objective Traumatic cardiac arrest (TCA) has been associated with poor outcome, but there are survivors with good neurological outcome. Treatment of hypoxia plays a key part in resuscitation algorithms, but little evidence exists on the ideal method of airway management in TCA. Methods LifeFlight Retrieval Medicine is an aeromedical retrieval service based in Queensland, Australia. Data regarding all intubations performed over a 28-month period were accessed from an electronic airway registry. Results 13/22 TCA patients were male, age range 2-81 years. 7/22 (31.8%) survived to hospital admission. During the same period 271 patients were intubated due to trauma, but were not in cardiac arrest (N-TCA). There was no difference in the likelihood of difficult laryngoscopy in the TCA group (16/22 (72.7%) compared to N-TCA (215/271 (79.3%); p = 0.46). The first attempt success rate was similar in TCA group (19/22 (86.4%)) and N-TCA (241/271 (88.9%) p = 0.71.). TCA patients were more likely to be intubated while lying on the ground than the N-TCA group (11/22 (50%) versus 17/271 (6.3%) p = Conclusion Resuscitation for predominantly blunt TCA is not futile. The endotracheal intubation first attempt success rate for TCA is comparable to that of N-TCA trauma patients.

This study reports the effect of relaxing music on the anxiety and agitation of a disturbed mentally handicapped woman. While the emphasis is on the short term effect of treatment, the study suggests that there may be other long term effects which in turn reflect an improved quality of life.

There is a long tradition of writing that considers how individuals with an intellectual disability respond to, and are affected by music. This paper, which examines descriptive and philosophical literature, discusses surveys that consider client responses, methodological issues, and music therapy provision; reports that provide general accounts of work settings and music therapy programmes; and case studies that illustrate the potential benefits of improvisation, Music Activity Therapy, and receptive music interventions. Finally, this paper identifies philosophical writing that is underpinned by the desire to promote music as a viable and credible treatment option for individuals with an intellectual disability. This paper not only considers clinical practice by directing readers towards examples from the extant literature that identify outcomes, but it also reflects on the relative strengths, and weaknesses, of the different methods of enquiry. In 1959, Juliette Alvin, widely considered the mother of mu- sic therapy in Great Britain, outlined how 24 children (6 to 16 years) with mild to severe intellectual disability responded to six short concerts that also included contact with the per- former (the author), and her instrument (a cello). She de- scribed their vocal and physical reactions ("some made noises as if trying to sing or whistled softly; others moved their hands or feet, beat time with their fingers" (Alvin, 1959, page 991)); identified changes in their level of engagement ("immediate curiosity became interest, and their desire to participate was more than mere imitation" (page 991)); and noted how the children's "self control and confidence developed" as they "came forward to play a note on the cello" (page 992). Juliette Alvin was not the first music therapist to indicate how music therapy met the needs, and developed the potential, of individuals with an intellectual disability, and she was not to be the last. This paper, and a subsequent one, will provide a detailed appraisal of that writing: something hitherto absent from the music therapy literature. Intellectual disability is the term used by the World Health Organisation (WHO), and adopted in Australasia, that equates with developmental disability and mental retardation in North America, and learning disability in the UK (McConkey, 2003). The person with an intellectual disability is limited intellectually. The difficulty they experience understanding, learning, and remembering new things, and generalising any learning to new situations, affects their communication, self-care, home living, self-direction, functional academic, and social/interpersonal skills. Furthermore, it may limit access to community services, and have an impact on work, leisure, health, and safety (American Psychiatric Association, 2000). This review is organised according to the method of enquiry. The literature is arranged into three of the four broad categories put forward by Jellison (1973), and subsequently employed by Bunt (1984), and Hooper, Lindsay, and Richardson (1991) when they discussed music therapy research in Great Britain. The three categories are: (1) descriptive (surveys, reports, case studies, literature reviews/meta-analyses). (2) philosophical (speculation, criticism, indicators for research). (3) experimental (i.e. either controlled research carried out within or between subjects, comparing interventions, or recording pre- and post- intervention responses). (Jellison's fourth method of enquiry is historical writing. It is not included as a separate category in this review, although reference is made to an historical account when the reports are discussed). This paper deals with the descriptive and philosophical writing. A second paper focuses on the experimental category. In each case, the aim is not only to highlight examples from clinical practice that identify outcomes, but also, by organising the review by method of enquiry, to allow some reflection on the strengths, and weaknesses, of the music therapy research in this area of clinical practice. …

The paper begins by introducing Joan – the subject of the case study. A description of Joan's music therapy gives a glimpse of a session in which the primary focus is on how Joan responds to various physical challenges. The paper examines the therapeutic significance of this response by looking at sensory integration, sensory integrative dysfunction and Sensory Integration (SI) theory. The paper considers the link between music therapy and sensory integration before concluding with a description and evaluation of a multi-disciplinary programme developed to meet Joan's sensory needs.

Summary The paper examines the response of two subjects who attended a programme of music activity therapy in which the music activities encouraged peer interaction. Music activity therapy was compared with a control condition (i.e. ball and target games). Both treatment conditions increased the level of positive interaction. The absence of negative interaction was also significant. The results affirmed the value of nonverbal interventions in encouraging interaction, and offered insights into the relationship between the two subjects.

Mathematical novices – including students in introductory mathematics and statistics service courses – increasingly need to engage in online mathematical collaboration. Using currently-available interfaces for their mobile and touch-enabled devices, however, this group faces difficulties, for those interfaces are text-based and not directly suitable for mathematical communication and collaboration.

Vibroacoustic (VA) therapy transmits to the body pre-recorded music, or pre-recorded music combined with sinusoidal low frequency sound, through loud speakers built into a chair, table or bed unit. The development of VA therapy has not been confined to one country or one product and, after examining the theoretical background to VA therapy, the author describes four VA systems. In Europe, music therapy is traditionally seen as a process which develops from an ‘active’ musical relationship. In contrast VA therapy is a ‘receptive’ intervention. The author discusses completed and on-going research with VA equipment, and concludes by asking – is VA therapy music therapy? He suggests that the principles of VA therapy can inform active music-making.

People with learning disabilities can disrupt mealtimes with non-cooperative, aggressive and self-injurious behaviours that challenge other people to tolerate and manage them. These behaviours appear to arise because the proximity of other people, and the heightened activity and noise of a dining room, causes anxiety and agitation.To examine how delivering calming background music via headphones affected anxiety-driven behaviours that disrupted mealtimes.A sample of 30 adults with mild, moderate or severe learning disabilities were videotaped during mealtimes on two consecutive days. On the first day, half the group ate without any calming music while the other half sat opposite them wearing earphones and listening to calming music. On the second day, the non-music and music groups swapped around.Of the participants who tolerated the earphones, only three showed disruptive behaviour; all three had been sitting at the table waiting for their food. With so few examples, meaningful inferential analysis was not possible. However, there were signs that calming music had a positive effect on disruptive mealtime behaviours. It eliminated physical harm, complaining and verbal repetition in one person, and stopped another from shouting/swearing. It also reduced the incidence of shouting/swearing, restlessness and vocalising.Calming music and reduced waiting at tables for food may reduce disruptive behaviours.

Accessible summary • I found out how people with an intellectual disability and people without an intellectual disability reacted to different pieces of music. • People with an intellectual disability reacted in the same way as people without an intellectual disability. • If you have difficulty deciding the type of music that helps you stay calm, ask your parents or carers what music helps them relax when they feel anxious. The type of music they like might help you stay calm too. Summary Previous researchers who compared how people with, and without, an intellectual disability respond to music focused on musical aptitude, but not on arousal. This paper presents the background, methodology, and results of a study that selected fifteen different pieces of music, and compared the arousal response of adults with (n = 48), and without (n = 48), an intellectual disability. There was a very strong significant positive correlation (rho = 0.831, N = 15, P

The paper outlines current trends in experimental research in music therapy and then presents an individual case study which examines the impact of recreational musical activities on the subject.

This paper begins by looking at musical aptitude. It identifies research that compared the musical aptitude of people with, and without, an intellectual disability, and investigations that assessed the musical aptitude of diagnostic subgroups from within the intellectual disability population (Down syndrome, musical savants, autistic spectrum disorder, Williams syndrome). This paper then goes on to consider research that examined how individuals with an intellectual disability responded to active (improvisation, and Music Activity Therapy) and receptive (contingent, contingent-interrupted, and non-contingent music) interventions. The studies are ordered according to therapeutic outcome, and it describes their method, and considers various issues that arose. The conclusion summarises the strengths and weaknesses of the experimental writing, and identifies agendas for music therapy research with this population. It argues that the experimental research should not be considered in isolation. Instead, it suggests, that along with the descriptive writing (discussed in part one of the review), the experimental writing is part of a body of work that captures both the richness of clinical experiences, and the cause-effect relationships underlying those experiences. Music therapists have always been convinced that the in- terventions they offered were of great value to individuals with an intellectual disability (Watson, 2002). Early pioneers of the music therapy profession, described their clinical work in journals and newsletters, and documented the social and cog- nitive, physical, and emotional and psychological outcomes. For example, Juliette Alvin, who is widely considered the mother of music therapy in Great Britain, summed up her own experiences working with people with an intellectual disabil- ity by asserting "we know that music is an essentially flexible means of communication which can work at every mental, emotional, and social level" (Alvin, 1975, p. 2). A strong tradition of descriptive and philosophical writing developed; it not only demonstrated the efficacy of music therapy as an intervention for individuals with an intellectual disability, but also identified clinical outcomes, and informed and advanced clinical practice. (This writing was discussed in detail in part one of this review of music and intellectual disability literature (1943-2006)). However, while acknowledging the important role descriptive and philosophical writing has played, and will continue to play, in understanding and developing the role of music in the treatment of intellectual disability, the Evidence Based Medicine (EBM) framework incorporated into healthcare practice in Australasia, the UK, and the United States, is challenging practitioners to provide experimental evidence demonstrating the merits of the interventions they are offering. This part of the review documents how they have risen to that challenge, and how they have evaluated their work with people who have an intellectual disability. This paper is divided into three sections. It begins by reviewing investigations that considered musical aptitude (n = 81). It then goes on to discuss literature that examines how people with an intellectual disability respond to active music therapy techniques (n = 71), and concludes by examining material that evaluates their response to receptive music therapy techniques (n = 112). (In receptive music therapy the client is a recipient of the music experience, as distinct from active music therapy when s/he is involved in music making (Grocke & Wigram, 2007)). Musical aptitude (1) Background Musical aptitude is innate sensitivity to the elements of music, and, alongside learning, it plays a part in musical ability: the general term used to describe the level of musical skill and understanding. The relationship between musical ability, aptitude, and learning has been argued within the nature-nurture debate (Sadie, 2001). …

This study reports the effects of music on the anxiety and agitation of four women with moderate and mild mental handicap. Music therapy and recorded music were compared with a control condition using controlled case studies. Two measures of anxiety were recorded — pulse rate and a behavioural rating. No improvement was found under the control conditions, while both music conditions produced some improvements. Variations in the pattern of responses to each form of music are discussed.