Life After the Event: A Review of Basic Life Support Training for Parents Following Apparent Life-Threatening Events and Their Experience and Practices Following Discharge.

Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17/25 (68%) were trained and 13/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2/13 (15%) of children. Non-medical grade monitors were in use by 10/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge.

Pedestrian deaths in children--potential for prevention.

The National Paediatric Mortality Database was reviewed for the six year period 1st January 2006 to 31st December 2011 and all pedestrian deaths extracted, after review of available data the deaths were categorized as either traffic or non-traffic related. There were 45 child pedestrian fatalities in the period examined. Traffic related deaths accounted for 26 (58%) vs. 19 (42%) non-traffic related. Analysis of the deaths showed there was a male preponderance 28 (62%), weekend trend 22 (49%) with an evening 16 (35%) and summer peak 20 (44%). The highest proportion of deaths occurred in the 1-4 year age group 24 (53%), with 13 (28%) due to low speed vehicle rollovers, mainly occurring in residential driveways 8 (61%). Child pedestrian fatalities are highly preventable through the modification of risk factors including behavioural, social and environmental. Preventative action needs to be addressed, particularly in relation to non-traffic related deaths i.e, low speed vehicle rollovers.

Not written, not done: are we identifying elderly at-risk patients for pneumococcal vaccination?

BACKGROUND: Pneumococcal disease, especially in its invasive form, is a significant cause of morbidity and mortality worldwide. However, with the advent of vaccination, invasive disease is potentially avoidable. This study aimed to assess the documentation of pneumococcal vaccination status in elderly patients by healthcare professionals in a busy teaching hospital environment. METHODS: One hundred and fifty-seven open (active) medical records of inpatients and outpatients aged over 65 years were reviewed, to examine for evidence of documentation of pneumococcal vaccination status. RESULTS: From the medical records, 338 patient encounters were studied. Overall, there was a mean of 2.4±1.2 indications for pneumococcal vaccination, with more indications in medical than in surgical patients (P=0.04). The rate of recording in respiratory outpatient clinics was 71.4% in comparison to 0% in other medical and surgical outpatient clinics. Overall the documentation rate was 2.1%. CONCLUSIONS: Only respiratory physicians had demonstrable evidence of actively asking about pneumococcal vaccination on a regular basis. There is considerable need for increased awareness among healthcare professionals and improvement in methods of recording vaccination status.

The impact of broadband noise on serial memory: changes in band-pass frequency increase disruption.

Irrelevant sound consisting of bursts of broadband noise, in which centre frequency changes with each burst, markedly impaired short-term memory for order. In contrast, a sequence of irrelevant sound in which the same band-pass noise burst was repeated did not produce significant disruption. Serial recall for both visual-verbal (Experiment 1) and visual-spatial items (Experiment 2) was sensitive to the increased disruption produced by changing irrelevant noise. The results provide evidence that sounds that are largely aperiodic can produce marked disruption of serial recall in a similar manner to periodic sounds (e.g., speech, musical streams, and tones), and thus show a changing-state effect.

Auditory distraction and short-term memory: phenomena and practical implications.

Irrelevant sound tends to break through selective attention and impair cognitive performance. This observation has been brought under systematic scrutiny by laboratory studies measuring interference with memory performance during exposure to irrelevant sound. These studies established that the degree of interference depends on the properties of the irrelevant sound as well as those of the cognitive task. The way in which this interference increases or diminishes as characteristics of the sound and of the cognitive task are changed reveals key functional characteristics of auditory distraction. A number of important practical implications that arise from these studies are discussed, including the finding that relatively quiet background sound will have a marked effect on efficiency in performing cognitive tasks.

Interference from degraded auditory stimuli: linear effects of changing-state in the irrelevant sequence.

Cognitive performance, particularly on a number of tasks involving short-term memory for order, is impaired by the mere presence of irrelevant background sound. The current study examines the features of the irrelevant sound that determine its disruptive potency. Previous research suggests that the amount of variability in an irrelevant stream is related to the degree of disruption of memory. The present experiments used a parametric approach to manipulate degree of change more precisely. Increasing levels of degradation, effected either by low-pass filtering (speech) or by digital manipulation (speech and nonspeech), monotonically decreased the degree of interference. The findings support the following propositions: (i) the degree of physical change within an auditory stream is the primary determinant of the degree of disruption; and, (ii) the effects of irrelevant speech and irrelevant nonspeech sounds are functionally similar.

Elimination of the word length effect by irrelevant sound revisited.

The word length effect refers to the tendency for lists of long words to be recalled less well than lists of short words. Theoretical and empirical objections are raised to a recent claim that irrelevant speech eliminates the word length effect (Neath, Suprenant, & LeCompte, 1998). A first experiment using a within-subjects design of adequate power (N = 65) fails to replicate their finding, showing instead that the word length effect is not differentially eliminated by speech as opposed to tones. In a second experiment, the effect of change (repeated vs. changing sounds) is shown to be additive to the effect of word length for both speech and nonspeech. Irrelevant speech and irrelevant tones have comparable effects on lists of short or lists of long words. These results are at variance with the feature model (e.g., Nairne, 1990).

Disruption of short-term recognition memory for tones: streaming or interference?

A sequence of auditory stimuli interpolated between the initial presentation of a tone and a comparison tone impairs recognition performance. Notably, the impairment is much less with interpolated speech than with tones. Six experiments converge on the conclusion that this pattern of impairment is due more to the organization of the interpolated sequence than to its similarity to the to-be-remembered standard. Factors that contribute to the coherence of the interpolated sequence into a stream distinct from the initial tone are primary determinants of the level of impairment. This is demonstrated by manipulating factors that contribute to the coherence of the interpolated sequence by the action of temporal, spatial, timbral, and tonal attributes. However, the relative immunity of recognition performance to the interpolation of unprocessed digit sequences is not explained wholly by such coherence.

Organizational factors in the effect of irrelevant speech: the role of spatial location and timing.

Typically, hearing a repeated syllable produces minimal disruption of serial recall of visual lists, but a sequence of different syllables impairs performance markedly. Two conditions for presenting an identical sequence of three syllables are compared: one, in which, by means of stereophony, each syllable is assigned to the left, center, or right auditory locus (three streams not changing in state), and another, in which the same syllable sequence occurs in one location only (one stream with changing state). Disruption was significantly less in the stereophonic than in the monophonic condition. There was a joint effect of changing state and location, not an effect of the number of locations alone. In Experiment 2, temporal predictability was used to manipulate changing state. The disruptive effect of regular presentation of a repeated syllable was markedly increased when it was presented irregularly. The results are discussed in the context of organizational factors in short-term memory.

Functional characteristics of the inner voice and the inner ear: single or double agency?

Double agency theories of short-term memory posit the functional independence of a phonological store (inner ear) and articulatory process (inner voice). A series of 5 experiments challenges this view. Articulatory suppression during retention of 9-item lists gives rise to a changing-state effect similar to that shown for irrelevant speech. Also, vocalized suppression is more disruptive than silently mouthed suppression, but this difference arises from vocalization itself rather than from any auditory feedback to which it gives rise. Class similarity between the to-be-remembered items and the articulatory material is not a critical determinant, but the effect occurs only with tests of serial order. For mouthed suppression, the irrelevant speech effect is only attenuated with changing-state suppression. Also, the presence of changing-state irrelevant speech abolishes the changing-state effect of articulatory suppression. Functional equivalence of codes from auditory, visual, and articulatory sources is claimed.

Disruption of visual short-term memory by changing-state auditory stimuli: the role of segmentation.

Typically, serial recall performance can be disrupted by the presence of an irrelevant stream of background auditory stimulation, but only if the background stream changes over time (the auditory changing-state effect). It was hypothesized that segmentation of the auditory stream is necessary for changing state to be signified. In Experiment 1, continuous random pitch glides failed to disrupt serial recall, but glides interrupted regularly by silence brought about the usual auditory changing-state effect. In Experiment 2, a physically continuous stream of synthesized vowel sounds was found to have disruptive effects. In Experiment 3, the technique of auditory induction showed that preattentive organization rather than critical features of the sound could account for the disruption by glides. With pitch glides, silence plays a preeminent role in the temporal segmentation of the sound stream, but speech contains correlated time-varying changes in frequency and amplitude that make silent intervals superfluous.