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BackgroundDespite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay.MethodsIn this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols.ResultsA total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those

Reducing restrictive practices toward individuals with intellectual and developmental disabilities is a globally recognized imperative and human rights priority. This paper presents a novel tool called LibRe for assessing and reducing restrictive practices. This tool involved an instrumental multistage design and collaboration between professionals, individuals with disabilities, family members, and experts from different fields. It addresses diverse restrictive practices in five key domains: physical or mechanical, chemical or pharmacological, structural, relational, and practices related to contexts and supports. It addresses practices that are pertinent to the Spanish context and that existing tools have not covered. Embedded as a step within an organizational approach, LibRe fosters organizational transformation and provides resources to achieve outcomes within reduction plans for restrictive practices. In total, 156 teams comprising 585 professionals, 64 people with disabilities, and 44 family members responded to the tool. In terms of evidence for internal structure validity, the oblique five-factor model exhibited an adequate fit through confirmatory factor analysis, along with satisfactory reliability indices, according to ordinal alpha and omega. Users positively appraised the tool's usefulness and identified its strengths and challenges. Although further research is needed, preliminary evidence frames LibRe as a useful resource for practice and research. [ABSTRACT FROM AUTHOR]

Aim: This study aims to understand the perceptions regarding physical restraints of the elder‐care professional's stakeholders. Design: A qualitative methodology was employed. Methods: Semi‐structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. Results: Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework. [ABSTRACT FROM AUTHOR]

Nianqi Cui,1,2,* Hui Zhang,3,* Sijie Gan,4 Yuping Zhang,1 Dandan Chen,5 Pingping Guo,5 Jingjie Wu,5 Zhuang Li,6 Jingfen Jin1,7,8 1Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, People’s Republic of China; 2School of Nursing, Kunming Medical University, Kunming, Yunnan, People’s Republic of China; 3Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China; 4Product Development Center, Zhejiang Xinhua Mobile Media Co. Ltd, Hangzhou, Zhejiang, People’s Republic of China; 5Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 6Medical Faculty, Yunnan College of Business Management, Kunming, Yunnan, People’s Republic of China; 7Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China; 8Dean’s Office, Changxing Branch Hospital of SAHZU, Huzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhuang Li, Medical Faculty, Yunnan College of Business Management, No. 296 Haitun Road, Wuhua District, Kunming, Yunnan, 650106, People’s Republic of China, Tel + 86 15198859387, Fax +86 0871-68314770, Email lz15198859387@163.com Jingfen Jin, Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), No. 88 Jiefang road, Shangcheng District, Hangzhou, Zhejiang, 310009, People’s Republic of China, Tel + 86 137 5711 8239, Fax +86 0571-87783887, Email zrjzkhl@zju.edu.cnPurpose: Physical restraints are used routinely in intensive care units (ICUs) and have negative effects. It is critical to identify the impact factors of physical restraints on critically ill patients. The present study investigated the prevalence of physical restraints and impact factors associated with their use in a large cohort of critically ill patients over one year.Patients and Methods: A retrospective cohort study was performed in multiple ICUs at a tertiary hospital in China in 2019 using observational data from electronic medical records. The data consisted of demographics and clinical variables. Logistic regression was used to assess the independent impact factors for the use of physical restraint.Results: The analysis consisted of 3776 critically ill patients with a prevalence of physical restraint use of 48.8%. The logistic regression analysis indicated that physical restraint use was associated with independent risk factors, including surgical ICU admission, pain, tracheal tube placement, and abdominal drainage tube placement. Physical restraint use was associated with independent protective factors, including male sex, light sedation, muscle strength, and ICU length of stay.Conclusion: The prevalence of physical restraint use in critically ill patients was high. Tracheal tubes, surgical ICU, pain, abdominal drainage tubes, light sedation, and muscle strength were independent variables associated with the use of physical restraint. These results will assist health professionals in identifying high-risk physical restraint patients based on their impact factors. Early removal of the tracheal tube and abdominal drainage tube, pain relief, light sedation, and improvements in muscle strength may help reduce the use of physical restraints.Keywords: critical care, restraints, physical, epidemiology, nursing

Abstract Aim This study aims to understand the perceptions regarding physical restraints of the elder‐care professional's stakeholders. Design A qualitative methodology was employed. Methods Semi‐structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. Results Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the ‘zero restraints’ feasibility, with divergent views on the need for a stronger regulatory framework.

When concrete is exposed to high temperatures during initial hydration, delayed ettringite formation (DEF) may occur and cause expansion, with consequences similar to that of the alkali-silica reaction (ASR). This study investigated the structural performance of prestressed concrete (PC) beams exhibiting expansion owing to DEF and the combined effects of DEF and ASR. In both cases, concrete cylinders were cast to determine the expansion, compressive strength, and dynamic elastic modulus at different expansion levels. The compressive strength and Young's modulus of the plain concrete specimens were significantly reduced with large free expansion, which caused map cracking on the surface. Because of the restraining effects of the reinforcement and prestressing load, the expansion of the PC beams was anisotropic, with more longitudinal cracks. The Young's modulus determined from stiffness of the cross-section of the DEF and ASR–DEF-affected beams at a low load level without bending cracking decreased moderately (22 % for DEF and 30 % for ASR–DEF beams) as compared to that of the non-reactive companion beam. The load capacities of DEF and ASR–DEF-damaged beams, even with many cracks, were reduced by 16 % and 23 %, respectively, compared to those of the non-reactive beam. Though the compressive strength of deteriorated plain concrete decreased significantly, less compressive strength reduction in concrete of DEF and ASR–DEF-damaged beams owing to confinement resulted in the lesser load capacity reduction in beams. • Flexural behaviour of DEF and ASR-DEF affected prestressed beams was investigated. • Dynamic elastic modulus variations in plain concrete were measured with DEF and ASR-DEF expansion. • Strain evolution in reinforcements and prestress tendon of the beams was observed during the expansion. • Young's modulus of the beam cross section under low loads was measured at different ages of deterioration. [ABSTRACT FROM AUTHOR]

Accurate geometric restraints are vital in the automation of macromolecular crystallographic structure refinement. A set of restraints for the Fe4S4 cubane-type cluster was created using the Cambridge Structural Database (CSD) and high-resolution structures from the Protein Data Bank. Geometries from each source were compared and pairs of refinements were performed to validate these new restraints. In addition to the restraints internal to the cluster, the CSD was mined to generate bond and angle restraints to be applied to the most common linking motif for Fe4S4: coordination of the four Fe atoms to the side-chain sulfurs of four cysteine residues. Furthermore, computational tools were developed to assist researchers when refining Fe4S4-containing proteins.

Abstract Aim The focus was to explore the perceptions and experiences of healthcare workers with respect to the use of restraints in acute care hospitals. Design The study followed a qualitative design. Methods Three topic‐based focus group interviews were conducted, involving 19 participants from the fields of nursing, physical therapy and medicine. For data collection and analysis, the method of mapping techniques for rapid qualitative data analysis was used. After discussing and validating the individual mind maps, all data were condensed to identify the key findings. Results Participants described restraints as safety measures for the patients. The implementation of most restraints was led by nurses. The use of restraints differed significantly, even in the interprofessional team. Attitudes and experiences were the main determinants for restraint use. Nurses asked for more discussion about restraints in the team, for more support at an interprofessional level and for better guidelines to help with the decision‐making process.

Abstract Background Despite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay. Methods In this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols. Results A total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those

Abstract Background In this quality improvement project, we set out to study the effectiveness and feasibility of using music as an adjunct or replacement for pharmacologic agitation management on an inpatient psychiatric unit. We hypothesized music intervention would not only assist in de-escalation/calming of agitated patients, but also reduce overall administration of PRN medications on the unit. Method The project included 172 volunteer participants over 6 months: Three months without music available and 3 months with a music de-escalation option. During the latter period, patients were given the option of selecting a preferred music genre and provided with wireless headphones for up to 30 min. The number of as needed (PRN) medications administered for agitation and anxiety (including oral, sublingual, and intramuscular routes) was compiled from raw data using pharmacy records. Patients and nurses were provided with self-report surveys regarding the music intervention. Results The average weekly PRN medication administrations decreased significantly during the 3 months with music for both haloperidol (8.46 [+/− 1.79, p

Potential benefits of implementing trauma-informed care practice in psychiatry range from reduction of patient behaviours that may result in use of coercive practices, to addressing clinician biases. Keywords: coercion; trauma-informed care; equity; restraints EN coercion trauma-informed care equity restraints 86 88 3 02/13/23 20230201 NES 230201 Coercion in Mental Health Settings Coercion is the use of force or threat to compel another to act in a particular way. [Extracted from the article]

Aim: The focus was to explore the perceptions and experiences of healthcare workers with respect to the use of restraints in acute care hospitals. Design: The study followed a qualitative design. Methods: Three topic‐based focus group interviews were conducted, involving 19 participants from the fields of nursing, physical therapy and medicine. For data collection and analysis, the method of mapping techniques for rapid qualitative data analysis was used. After discussing and validating the individual mind maps, all data were condensed to identify the key findings. Results: Participants described restraints as safety measures for the patients. The implementation of most restraints was led by nurses. The use of restraints differed significantly, even in the interprofessional team. Attitudes and experiences were the main determinants for restraint use. Nurses asked for more discussion about restraints in the team, for more support at an interprofessional level and for better guidelines to help with the decision‐making process. [ABSTRACT FROM AUTHOR]

BackgroundThere is a relationship between the application of physical restraints and negative physiological and psychological effects on critically ill patients. Many organizations have supported and advocated minimizing the use of physical restraints. However, it is still common practice in many countries to apply physical restraints to patients in intensive care.ObjectiveThis study aimed to assess the effectiveness of various non-pharmacological interventions used to minimize physical restraints in intensive care units and provide a supplement to the evidence summary for physical restraints guideline adaptation.MethodsBased on the methodology of umbrella review, electronic databases, including Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, MEDLINE, EMBASE, CINAHL, Web of Science, PsycInfo/Psyc Articles/Psychology and Behavioral Science Collection, China National Knowledge Infrastructure, SinoMed, and Wanfang Data, were searched to identify systematic reviews published from January 2016 to December 2020. Two independent reviewers undertook screening, data extraction, and quality appraisal. The methodological quality of systematic reviews was evaluated by AMSTAR 2. Evidence quality of each intervention was assessed according to GRADE. The corrected covered area was calculated as a measure of overlap.ResultsA total of 47 systematic reviews were included in the umbrella review, of which six were evaluated as high quality, five were of moderate quality, and the rest were of low or critically low quality. The corrected covered area range was from 0.0 to 0.269, which indicated that there was mild overlap between systematic reviews. The included systematic reviews evaluated various types of non-pharmacological interventions for minimizing physical restraints in intensive care units, which included multicomponent interventions involving healthcare professionals' education, family engagement/support, specific consultations and communication, rehabilitation and mobilization (rehabilitation techniques, early mobilization, inspiratory muscle training), interventions related to reducing the duration of mechanical ventilation (weaning modes or protocols, ventilator bundle or cough augmentation techniques, early tracheostomy, high-flow nasal cannula), and management of specific symptoms (delirium, agitation, pain, and sleep disturbances).ConclusionThe number of systematic reviews related to physical restraints was limited. Multicomponent interventions involving healthcare professionals' education may be the most direct non-pharmacological intervention for minimizing physical restraints use in intensive care units. However, the quality of evidence was very low, and conclusions should be taken with caution. Policymakers should consider incorporating non-pharmacological interventions related to family engagement/support, specific consultations and communication, rehabilitation and mobilization, interventions related to reducing the duration of mechanical ventilation, and management of specific symptoms as part of the physical restraints minimization bundle. All the evidence contained in the umbrella review provides a supplement to the evidence summary for physical restraints guideline adaptation.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242586, identifier: CRD42021242586.

Improvements in structural biology methods, in particular crystallography and cryo-electron microscopy, have created an increased demand for the refinement of atomic models against low-resolution experimental data. One way to compensate for the lack of high-resolution experimental data is to use a priori information about model geometry that can be utilized in refinement in the form of stereochemical restraints or constraints. Here, the definition and calculation of the restraints that can be imposed on planar atomic groups, in particular the angle between such groups, are described. Detailed derivations of the restraint targets and their gradients are provided so that they can be readily implemented in other contexts. Practical implementations of the restraints, and of associated data structures, in the Computational Crystallography Toolbox (cctbx) are presented.

Background: Numerous validation studies support the use of the interRAI Mental Health (MH) assessment system for inpatient mental health assessment, triage, treatment planning, and outcome measurement. However, there have been suggestions that the interRAI MH does not include sufficient content relevant to forensic mental health. We address this potential deficiency through the development of a Forensic Supplement (FS) to the interRAI MH system. Using three forensic risk assessment instruments (PCL-R; HCR-20; VRAG) that had a record of independent cross validation in the forensic literature, we identified forensic content domains that were missing in the interRAI MH. We then independently developed items to provide forensic coverage. The resulting FS is a single-page, 19-item supplementary document that can be scored along with the interRAI MH, adding approximately 10–15 min to administration time.We constructed the Problem Behavior Scale (PBS) using 11 items from the interRAI MH and FS. The Developmental Sample, 168 forensic mental health inpatients from two large mental health specialty hospitals, was assessed with both an earlier version of the interRAI MH and FS. This sample also provided us access to scores on the PCL-R, the HCR-20 and the VRAG. To validate our initial findings, we sought additional samples where scoring of the interRAI MH and the FS had been done. The first, the Forensic Sample (N = 587), consisted of forensic inpatients in other mental health units/hospitals. The second, the Correctional Sample (N = 618) was a random, representative sample of inmates in prisons, and the third, the Youth Sample (N = 90) comprised a group of youth in police custody.Results: The PBS ranged from 0 to 11, was positively skewed with most scores below 3, and had good internal consistency (Cronbach's Alpha = 0.80). In a test of concurrent validity, correlations between PBS scores and forensic risk scores were moderate to high (i.e., r with PCL-R Factor two of 0.317; with HCR-20 Clinical of 0.46; and with HCR-20 Risk of 0.39). In a test of convergent validity, we used Binary Logistic Regression to demonstrate that the PBS was related to three negative patient experiences (recent verbal abuse, use of a seclusion room, and failure to attain an unaccompanied leave). For each of these three samples, we conducted the same convergent validity statistical analyses as we had for the Developmental Sample and the earlier findings were replicated. Finally, we examined the relationship between PBS scores and care planning triggers, part of the interRAI systems Clinical Assessment Protocols (CAPs). In all three validity samples, the PBS was significantly related to the following CAPs being triggered: Harm to Others, Interpersonal Conflict, Traumatic Life Events, and Control Interventions. These additional validations generalize our findings across age groups (adult, youth) and across health care and correctional settings.Conclusions: The FS improves the interRAI MH's ability to identify risk for negative patient experiences and assess clinical needs in hospitalized/incarcerated forensic patients. These results generalize across age groups and across health care and correctional settings.

Background: The use of control interventions (CIs; acute control medications, physical/mechanical restraint) is associated with negative physical and psychological outcomes, particularly in older adults who are physically vulnerable. The aims of this study were to: (i) report the rates of CI use in older psychiatric inpatients (age 65 – 84 and age 85+), and compare them with younger age groups (18 – 44, age 45 – 64); and (ii) identify the factors associated with non-emergency CI use in older psychiatric inpatients.Methods: Routinely collected interRAI Mental Health assessments from 2005 – 2018 in Ontario, Canada, were analyzed to determine the rates of CI use. Logistic regression models were used to examine the sociodemographic and clinical determinants of non-emergency and any CI use.Results: There were 226,119 (female: 48.6%) interRAI assessments, and 85% of those assessed were under 65 years of age. The rates of non-emergency CI use in the four age groups were: 18 – 44 = 9.4%, 45 – 64 = 8.3%, 65 – 84 = 9.9%, 85+ = 13.2%. The most significant determinants of non-emergency CI use in older adults were highest impairments in activities of daily living (ADL Short Form score 8–16: OR = 2.72, 95% CI = 2.42 – 3.06), highest levels of aggression (Aggressive Behavior Scale score 4 – 6: OR = 1.76, 95% CI = 1.57 – 1.98), and highest levels of positive psychotic symptoms (Positive Symptoms Scale score 9+: OR = 1.65, 95% CI = 1.43 – 1.90). Delirium, cognitive disorder diagnosis, cognitive impairment, and falls were also associated with increased CI use odds, as were having the reasons for admission be danger to self, danger to others or inability to care for self. Females were less likely to have non-emergency CI use (OR = 0.84, 95% CI = 0.73 – 0.95). Patients admitted from long-term care homes had significantly greater odds of non-emergency CI use compared with community admissions (OR = 1.18; 95% CI = 1.07 – 1.29).Conclusion: The higher rates of non-emergency CI use in older psychiatric inpatients is concerning. Alternative non-pharmacological and person-centered management strategies should be considered to support older psychiatric inpatients with functional impairment, positive symptoms, aggressive behavior, cognitive impairment and delirium. The use of CIs could be incorporated as a quality improvement activity to monitor changes at various service provision levels.

Background: The use of control interventions (CIs; acute control medications, physical/mechanical restraint) is associated with negative physical and psychological outcomes, particularly in older adults who are physically vulnerable. The aims of this study were to: (i) report the rates of CI use in older psychiatric inpatients (age 65 – 84 and age 85+), and compare them with younger age groups (18 – 44, age 45 – 64); and (ii) identify the factors associated with non-emergency CI use in older psychiatric inpatients. Methods: Routinely collected interRAI Mental Health assessments from 2005 – 2018 in Ontario, Canada, were analyzed to determine the rates of CI use. Logistic regression models were used to examine the sociodemographic and clinical determinants of non-emergency and any CI use. Results: There were 226,119 (female: 48.6%) interRAI assessments, and 85% of those assessed were under 65 years of age. The rates of non-emergency CI use in the four age groups were: 18 – 44 = 9.4%, 45 – 64 = 8.3%, 65 – 84 = 9.9%, 85+ = 13.2%. The most significant determinants of non-emergency CI use in older adults were highest impairments in activities of daily living (ADL Short Form score 8–16: OR = 2.72, 95% CI = 2.42 – 3.06), highest levels of aggression (Aggressive Behavior Scale score 4 – 6: OR = 1.76, 95% CI = 1.57 – 1.98), and highest levels of positive psychotic symptoms (Positive Symptoms Scale score 9+: OR = 1.65, 95% CI = 1.43 – 1.90). Delirium, cognitive disorder diagnosis, cognitive impairment, and falls were also associated with increased CI use odds, as were having the reasons for admission be danger to self, danger to others or inability to care for self. Females were less likely to have non-emergency CI use (OR = 0.84, 95% CI = 0.73 – 0.95). Patients admitted from long-term care homes had significantly greater odds of non-emergency CI use compared with community admissions (OR = 1.18; 95% CI = 1.07 – 1.29). Conclusion: The higher rates of non-emergency CI use in older psychiatric inpatients is concerning. Alternative non-pharmacological and person-centered management strategies should be considered to support older psychiatric inpatients with functional impairment, positive symptoms, aggressive behavior, cognitive impairment and delirium. The use of CIs could be incorporated as a quality improvement activity to monitor changes at various service provision levels. [ABSTRACT FROM AUTHOR]

Background: Research regarding disparities in physical restraint use in the emergency department (ED) is limited. We evaluated the role of race, ethnicity, and preferred language on the application of physical restraint among ED patients held under a Massachusetts section 12(a) order for mandatory psychiatric evaluation. Methods: We identified all ED patient encounters with a section 12(a) order across a large integrated 11‐hospital health system from January 2018 through December 2019. Information on age, race, ethnicity, preferred language, insurance, mental illness, substance use, history of homelessness, and in‐network primary care provider was obtained from the electronic health record. We evaluated for differences in physical restraint use between subgroups via a mixed‐effect logistic regression with random‐intercept model. Results: We identified 32,054 encounters involving a section 12(a) order. Physical restraints were used in 2,458 (7.7%) encounters. Factors associated with physical restraint included male sex (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.28 to 1.63), Black/African American race (aOR = 1.22, 95% CI = 1.01 to 1.48), Hispanic ethnicity (aOR = 1.45, 95% CI = 1.22 to 1.73), Medicaid insurance (aOR = 1.21, 95% CI = 1.05 to 1.39), and a diagnosis of bipolar disorder or psychotic disorder (aOR = 1.51, 95% CI = 1.31 to 1.74). Across all age groups, patients who were 25 to 34 years of age were at highest risk of restraint (aOR = 2.01, 95% CI = 1.69 to 2.39). Patients with a primary care provider within our network (aOR = 0.81, 95% CI = 0.72 to 0.92) were at lower risk of restraint. No associations were found between restraint use and language, history of alcohol or substance use, or homelessness. Conclusion: Black/African American and Hispanic patients under an involuntary mandatory emergency psychiatric evaluation hold order experience higher rates of physical restraint in the ED. Factors contributing to racial disparities in the use of physical restraint, including the potential role of structural racism and other forms of bias, merits further investigation. [ABSTRACT FROM AUTHOR]

Abstract Background Use of physical restraint is a common practice in mental healthcare, but is controversial due to risk of physical and psychological harm to patients and creating ethical dilemmas for care providers. Post-incident review (PIR), that involve patient and care providers after restraints, have been deployed to prevent harm and to reduce restraint use. However, this intervention has an unclear scientific knowledge base. Thus, the aim of this scoping review was to explore the current knowledge of PIR and to assess to what extent PIR can minimize restraint-related use and harm, support care providers in handling professional and ethical dilemmas, and improve the quality of care in mental healthcare. Methods Systematic searches in the MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Science databases were carried out. The search terms were derived from the population, intervention and settings. Results Twelve studies were included, six quantitative, four qualitative and two mixed methods. The studies were from Sweden, United Kingdom, Canada and United States. The studies’ design and quality varied, and PIR s’ were conducted differently. Five studies explored PIR s’ as a separate intervention after restraint use, in the other studies, PIR s’ were described as one of several components in restraint reduction programs. Outcomes seemed promising, but no significant outcome were related to using PIR alone. Patients and care providers reported PIR to: 1) be an opportunity to review restraint events, they would not have had otherwise, and 2) promote patients’ personal recovery processes, and 3) stimulate professional reflection on organizational development and care. Conclusion Scientific literature directly addressing PIR s’ after restraint use is lacking. However, results indicate that PIR may contribute to more professional and ethical practice regarding restraint promotion and the way restraint is executed. The practice of PIR varied, so a specific manual cannot be recommended. More research on PIR use and consequences is needed, especially PIR’s potential to contribute to restraint prevention in mental healthcare.

Background: In this quality improvement project, we set out to study the effectiveness and feasibility of using music as an adjunct or replacement for pharmacologic agitation management on an inpatient psychiatric unit. We hypothesized music intervention would not only assist in de-escalation/calming of agitated patients, but also reduce overall administration of PRN medications on the unit. Method: The project included 172 volunteer participants over 6 months: Three months without music available and 3 months with a music de-escalation option. During the latter period, patients were given the option of selecting a preferred music genre and provided with wireless headphones for up to 30 min. The number of as needed (PRN) medications administered for agitation and anxiety (including oral, sublingual, and intramuscular routes) was compiled from raw data using pharmacy records. Patients and nurses were provided with self-report surveys regarding the music intervention. Results: The average weekly PRN medication administrations decreased significantly during the 3 months with music for both haloperidol (8.46 [+/− 1.79, p < 0.05] to 5.00 [+/− 1.44, p < 0.05] administrations/week) and olanzapine (9.69 [+/− 2.32, p < 0.05] to 4.62 [+/− 1.51, p < 0.05] administrations/week), compared to the 3 months prior to music implementation. There was a non-significant increase in administration of lorazepam (3.23 [+/− 1.09, p < 0.05] to 6.38 [+/− 2.46, p < 0.05] average administrations/week). The patient survey responses were 96% positive (non-neutral; either agree or strongly agree with calming effect). Nurses agreed that the project was easy to implement; 56% agreed that music helped to calm patients down. Other exploratory outcomes included observed reductions in average length of hospital stay and number of seclusion events. Conclusion: Music may play a significant role in reducing the utilization of PRN agitation medications on acute inpatient psychiatric units. More studies are needed to expand on these findings and explore the effect of PRN music on other therapeutic outcomes. Trial registration: Protocol registration NCT04514432, retrospectively registered on 08/13/2020. [ABSTRACT FROM AUTHOR]

Background: Turnover rate for new graduate nurses at a midwestern community hospital was 30% for the first two years. Central clinical orientation for new hire registered nurses and care assistants was heavily executed via didactic format. Feedback from instructors suggested boredom and disengagement of learners during these sessions. Post central orientation evaluations resulted in 49% of attendees feeling not "very confident" to apply skills in clinical practice. Methods: Clinical educators created an escape room to improve learner satisfaction, interprofessional communication, and confidence in applying skills in practice. A convenience sample of twenty-three (23) registered nurses and care assistants participated in an escape room, Contagion Crisis, covering basic knowledge of infection control, emergency response, restraints, and drug calculation. Results: Average Likert scores on the post survey for satisfaction and communication were 4.67 and 4.0 respectively. Confidence in applying skills to practice averaged 4.72. Subjective feedback from participants included enjoyment of a fun, non-pressure environment. Conclusion: Multiple clinical disciplines can use this escape room, as it covers topics from central hospital orientation. Learners preferred the escape room format versus a high-fidelity simulation, due to it being less "high stakes" and not a judgement of individual performance. [ABSTRACT FROM AUTHOR]

This paper presents experimental results and numerical simulation of postfire structural performance of prestressed concrete hollow-core floor slabs with edge beam supports. In total, four tests were carried out, including one test at room temperature and three postfire tests. The three postfire tests all had a load ratio of 0.3 and were exposed to 30, 60, and 90 min of the a standard fire before being cooled down and tested at ambient temperature to determine their residual postfire load-carrying capacities. All specimens exhibited flexural failure with rupture of the bottom pretensioned steel rebars. All three heated specimens suffered degradation in initial stiffness and load-carrying capacity compared with the ambient-temperature specimen. However, the residual deflections of the postfire test specimens were within serviceability deflection limits, and the specimens achieved load-carrying capacities greater than the design load-carrying capacity of the undamaged slab. This indicates that the fire-damaged slabs can be reused after superficial repair. This good postfire performance of the slabs can be attributed to restraint effects of the supporting beams. Numerical simulations were performed to further investigate the load-carrying mechanism of prestressed concrete hollow-core floor slabs. [ABSTRACT FROM AUTHOR]

The electronic Ligand Builder and Optimisation Workbench (eLBOW) is a program module of the PHENIX suite of computational crystallographic software. It's designed to be a flexible procedure using simple and fast quantum chemical techniques to provide chemically accurate information for novel and known ligands alike. A variety of input formats and options allow for the attainment of a number of diverse goals including geometry optimisation and generation of restraints.

Background: Protein tertiary structure prediction is a fundamental problem in computational biology and identifying the most native-like model from a set of predicted models is a key sub-problem. Consensus methods work well when the redundant models in the set are the most native-like, but fail when the most native-like model is unique. In contrast, structure-based methods score models independently and can be applied to model sets of any size and redundancy level. Additionally, structure-based methods have a variety of important applications including analogous fold recognition, refinement of sequence-structure alignments, and de novo prediction. The purpose of this work was to develop a structure-based model selection method based on predicted structural features that could be applied successfully to any set of models. Results: Here we introduce SELECTpro, a novel structure-based model selection method derived from an energy function comprising physical, statistical, and predicted structural terms. Novel and unique energy terms include predicted secondary structure, predicted solvent accessibility, predicted contact map, beta-strand pairing, and side-chain hydrogen bonding. SELECTpro participated in the new model quality assessment (QA) category in CASP7, submitting predictions for all 95 targets and achieved top results. The average difference in GDT-TS between models ranked first by SELECTpro and the most native-like model was 5.07. This GDT-TS difference was less than 1% of the GDT-TS of the most native-like model for 18 targets, and less than 10% for 66 targets. SELECTpro also ranked the single most native-like first for 15 targets, in the top five for 39 targets, and in the top ten for 53 targets, more often than any other method. Because the ranking metric is skewed by model redundancy and ignores poor models with a better ranking than the most native-like model, the BLUNDER metric is introduced to overcome these limitations. SELECTpro is also evaluated on a recent benchmark set of 16 small proteins with large decoy sets of 12500 to 20000 models for each protein, where it outperforms the benchmarked method (I-TASSER). Conclusion: SELECTpro is an effective model selection method that scores models independently and is appropriate for use on any model set. SELECTpro is available for download as a stand alone application at: http://www.igb.uci.edu/similar to baldig/selectpro.html. SELECTpro is also available as a public server at the same site.

Abstract Objective This study’s primary objective was to investigate the prevalence of physical and chemical restraint use in selected elderly hospitalized patients. Results This study was conducted in April 2014 in four major acute care hospitals. Trained data collectors assessed the use of physical and chemical restraint among all admitted elderly patients. There were 287 elderly patients (median age 64 years, 46% women). 32 patients were restrained. The overall prevalence of restraints was 11.1%, with physical restraint use alone at 3.2% and chemical restraints use alone at 7.3%. Restraint use varied by hospital type, with the highest at the private hospital (22.9%) and the lowest at the two university hospitals (

Objective: To map areas of discussion about use of seclusion and restraint in healthcare, as expressed in motifs posted on Twitter. Materials and method: We adopted a qualitative approach with an archival and cross-sectional observational design. 188 images from Twitter postings were analyzed. Results: Five categories were identified: Informative and educational messages; Equipment as artifacts; Spatiality; The restrained subjects; Sociopolitical connotations of restraint. Conclusions: Based on our results we conclude that Twitter included several aspects; the intention to educate others, show the spatiality in relation to restraint, imagining characterized by objects and persons, and a sociopolitical connotation. This in turn means that Twitter posts offer nurses a chance to engage in social marketing and connoting an ethical dimension to a person associated with measures used to exert power over others. This is because communication surrounding certain controversial issues in healthcare is free from hierarchies on Twitter. [ABSTRACT FROM AUTHOR]

Background: Physical restraints is one of the important responsibilities of nurses. Physical restraints are used by nurses in order to prevent patients from harming themselves and people around them but there are deaths and serious injuries due to physical restrictions. Aim: This research was carried out to determine the nurses' knowledge, attitudes and practices, with affecting factors, on the use of physical restraints. Methodology: The research is a descriptive, cross-sectional study. The research population consisted of 700 nurses. The sample consisted of 548 nurses who participated in the study voluntarily. Data were collected through the completion of a 'Personal Information Form' and a 'Levels of Knowledge, Attitudes, and Practices of Staff Regarding Physical Restraints Questionnaire'. The data were analyzed by percentage, arithmetic mean, ANOVA and t-test. Results: The nurses' knowledge average score relating to physical restraints was 7.8±1.8, the mean score for attitudes was 31.9±3.8 and mean score for practices was 37.2±3.8. A statistically significant difference was found between the hospitals and clinics where nurses work, and knowledge, attitude and practice scores relating to the use of physical restraints (p<0.05). Conclusions: Nurses have a good level of information on the use of the physical restraints, and they largely reflect a positive attitude towards applying this knowledge to the practice of physical restraints. However, the ratio of developing positive attitude was found to be lower than the mean scores of knowledge and practice. [ABSTRACT FROM AUTHOR]

Restraint and seclusion are measures to restrict the movement of a person. The predominant reason cited for the use of restraint in mental health settings is the safety of the staff and the patient in times of aggression and to control problem behaviors. However, there have been significant issues in terms of ethics, rights of the patient, and the harmful effects of restraint. Recently, there has been a move in Western countries to decrease its use by incorporating alternative methods and approaches. In India, the Mental Healthcare Act of 2017 advocates the use of least restrictive measures and alternatives to restraint in providing care and treatment for person with mental illness. In this context, approach to restraints is all the more relevant. This article looks to overview the types of restraints, complications of restraints, and the alternatives to restraint in diverse settings. [ABSTRACT FROM AUTHOR]

Background: Coercion and restraint practices in psychiatric care are common phenomena and often controversial and debatable ethical issue. Caregivers' attitude and perspective on coercion and restraint practices on psychiatric inpatients have received relatively less research attention till date. Aims: Caregivers' attitude and perspective on coercion and restraint practices on psychiatric inpatients. Methodology: This is a hospital-based, a descriptive, cross-sectional study. A total of 200 (n = 200) consecutive patient and their caregivers were chosen between June 2013 and September 2014 through computer-generated random numbers sampling technique. We used a semi-structured interview questionnaire to capture caregivers' attitude and perspective on coercion and restraint practices. Sociodemographic and coercion variable were analyzed using descriptive statistics. McNemar test was used to assess discrete variables. Results: The mean age was 43.8 (±14.9) years. About 67.5% of the caregivers were family members, 60.5% of them were male and 69.5% were from low-socioeconomic status. Caregivers used multiple methods were used to bring patients into the hospital. Threat (52.5%) was the most common method of coercion followed by persuasion (48.5%). Caregivers felt necessary and acceptable to use chemical restraint (82.5%), followed by physical restraint (71%) and electroconvulsive therapy (ECT) (56.5%) during acute and emergency psychiatric care to control imminent risk behavior of patients. Conclusion: Threat, persuasion and physical restraint were the common methods to bring patients to bring acutely disturbed patients to mental health care. Most patients caregivers felt the use of chemical restraint, physical restraint and ECT as necessary for acute and emergency care in patients with mental illness. [ABSTRACT FROM AUTHOR]