A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

Objective: This review examines nature and effectiveness of interventions to reduce the use of mechanical restraint and seclusion among adult psychiatric inpatients. Method: Electronic searches were conducted to locate post-1960 empirical studies of restraint and seclusion reduction in English. A total of 36 studies were identified, mostly from the USA. Analysis was conducted using a structured data extraction tool. Results: The majority of studies reported reduced levels or mechanical restraint and/or seclusion, but the standard of evidence was poor. There were no randomised trials. Most were retrospective studies of official records before and after the intervention was introduced, with varying follow-up periods. The interventions were diverse, but tended to include one or more of the following: new restraint and/or seclusion policies, staffing changes, staff training, review procedures and crisis management initiatives. The research was unable to address which of these elements was most effective. There was also evidence that some improved outcomes were achieved by substituting restraint or seclusion for each other or for alternatives forms of containment (medication in particular). Nurses’ attitudes, skills and approach to patient care were absent from the literature. Conclusions: Interventions probably can reduce the use of restraint and seclusion, but better designed research is required to demonstrate their effectiveness conclusively. More attention should also be paid to understanding how interventions work, particularly from the perspective of nursing staff. This is essential to the successful implementation of restraint and seclusion interventions across different psychiatric settings and treatment populations

Resting-state EEG spectral and fractal features in dementia with Lewy bodies with and without visual hallucinations

Objective: Complex visual hallucinations (VH) are a core feature of dementia with Lewy bodies (DLB), though they may not occur in all patients. Power spectral density (PSD) analysis of resting-state EEG (rs-EEG) shows associations between some frequency bands (e.g., theta), individual alpha frequency (IAF) and VH. However, new tools that improve early differential diagnosis and symptom-based stratification with higher sensitivity and specificity, even within the DLB population, are desirable. We aimed to assess differences in rs-EEG data between DLB patients with VH (DLB-VH+) and without VH (DLB-VH-), comparing innovative non-linear approaches with more traditional linear ones. Methods: We retrospectively analyzed rs-EEG recordings of DLB-VH+, DLB-VH-, Alzheimer's disease patients and age-matched healthy controls. EEG was analyzed using the nonlinear Higuchi's Fractal Dimension (FD) measure, and the results were compared with those of entropy and standard linear methods based on PSD and IAF. Results: Only the FD measure could discriminate between DLB-VH+ and DLB-VH-. Conclusions: In conclusion, rs-EEG differences between DLB-VH+ and DLB-VH- are better characterized by FD analysis than by a more traditional power spectrum approach. Significance: This suggests that the presence of complex VH is associated with less complex brain dynamics at rest, as reflected by the FD measure

FOXE1 (forkhead box E1 (thyroid transcription factor 2))

Review on FOXE1 (forkhead box E1 (thyroid transcription factor 2)), with data on DNA, on the protein encoded, and where the gene is implicated

Diabetes-Related Autoantibodies in Children With Acute Lymphoblastic Leukemia

[No abstract available

The role of affective temperaments in self-care and medication adherence among individuals with bipolar disorder: a moderation analysis

Background Affective temperament, defined as the fundamental predisposition from which normal affective states originate or as the constitutional core of personality, play a crucial role in mood disorders, particularly bipolar disorders. Understanding the relationship between temperaments, treatment adherence, and self-care is crucial for effective management and improved clinical results.Objectives This study aims to (1) assess the correlation between affective temperaments and treatment adherence, (2) investigate the relationship between affective temperaments and self-care abilities, (3) identify predictors of treatment adherence, and (4) explore the moderating effect of self-care on the relationship between treatment adherence and depressive temperament in individuals with bipolar disorder.Methods A cross-sectional study was conducted with 231 individuals diagnosed with bipolar disorder (BD) type I (N=160) and type II (N=71). The participants were evaluated using the following psychometric tools: Temperament Evaluation of Memphis, Pisa, and San Diego (TEMPS) to assess affective temperaments, Personal and Social Performance Scale (PSP) to evaluate social functioning and self-care abilities, and Morisky Medication Adherence Scale (MMAS) to measure treatment adherence. The study involved statistical analyses to examine correlations, identify predictors, and explore moderating effects.Results The findings revealed significant correlations between affective temperaments and both treatment adherence and self-care abilities. Specifically, hyperthymic temperament was positively associated with higher treatment adherence, whereas cyclothymic and depressive temperaments were linked to lower adherence. Self-care abilities were found to mediate the relationship between depressive temperament and treatment adherence, suggesting that improved self-care can enhance adherence in individuals with depressive temperament.Conclusions Affective temperaments significantly influence treatment adherence and self-care abilities in individuals with bipolar disorder. The mediating role of self-care highlights the importance of developing targeted interventions to improve self-care practices, thereby enhancing treatment adherence and overall well-being. Personalized treatment strategies based on temperament assessments could lead to better clinical outcomes and quality of life for individuals with bipolar disorder

Time perception in cerebellar and basal ganglia stroke patients

The neural mechanisms underlying time perception remain elusive. Although the cerebellum (CE) and basal ganglia (BG) are considered fundamental, evidence primarily stems from studies on neurodegenerative diseases, where progressive and widespread damage complicates linking deficits to specific brain structures. In contrast, brain stroke affects focal areas suddenly, allowing for the assessment of immediate functional consequences. Here, we compared patients with acute stroke in the CE and BG to age-matched healthy controls (HC) on both explicit (time bisection, free and 1-second finger tapping) and implicit (rhythmic, temporal orienting) timing tasks. Concerning explicit timing, both CE and BG patients were faster than HC in their free finger tapping, while BG lesions showed greater variability than HC in the 1-second tapping. Similarly, performance on the bisection task suggested deficits more related to cognitive complaints in stroke than specific temporal dysfunction. In implicit timing tasks, BG patients, like HC, effectively used information provided by the rhythm and the temporal orienting cues to anticipate the target onset, whereas CE patients failed and showed longer reaction times. Therefore, before compensatory mechanisms can take effect, acute CE damage might hinder implicit timing, whereas BG lesions could disrupt explicit temporal representation when processed alongside other cognitive functions

The Added Value of Controlling Nutritional Status (Conut) Score for Preoperative Counselling on Significant Early Loss of Renal Function After Radical Nephrectomy for Renal Cell Carcinoma

Background and objectives: We aimed at evaluating the impact of Controlling Nutritional Status (CONUT) score on clinically significant decline in estimated glomerular filtration rate (eGFR) in patients with non-metastatic Clear Cell Renal Cell Carcinoma (ccRCC) undergoing radical nephrectomy (RN). Materials and methods: We retrospectively analyzed a multi-institutional cohort of 140 patients with ccRCC who underwent RN between 2016 and 2018 at three Urological Centers. The CONUT score was calculated with an algorithm including serum albumin, total lymphocyte count, and cholesterol. Clinical and pathologic features were analyzed using Fisher's exact test for categorical variables and a Mann-Whitney U test for continuous variables. To define the independent predictors of clinically significant eGFR decline, univariable (UVA) and multivariable (MVA) binomial logistic regression analyses were performed in order to assess the Odds Ratio (OR) with 95% Confidence Intervals (CIs). Results: The optimal cut-off value to discriminate between a low and high CONUT score was assessed by calculating the ROC curve. The area under the curve (AUC) was 0.67 (95%CI 0.59-0.78) with the most appropriate cut-off value at 2 points. Overall, 46 patients (32.9%) had a high CONUT score (>2). Statistically significant variables associated with eGFR decline at 24 months were age ≥ 70 (OR 2.01; 95%CI 1.17-3.09; p 0.05), stage II-III chronic kidney disease (CKD) (OR 6.05; 95%CI 1.79-28.3; p 0.001), and a high CONUT score (OR 3.98; 95%CI 1.58-10.4; p 0.004). Conclusions: The CONUT score is a low-time-consuming, cost-effective, and promising tool able to preoperatively screen patients at risk of developing CKD after a RN

Data-driven approach for highlighting priority areas for protection in marine areas beyond national jurisdiction

One of the aims of the United Nations (UN) negotiations on the conservation and sustainable use of marine biodiversity in areas beyond national jurisdiction (ABNJ) is to develop a legal process for the establishment of area-based management tools, including marine protected areas, in ABNJ. Here we use a conservation planning algorithm to integrate 55 global data layers on ABNJ species diversity, habitat heterogeneity, benthic features, productivity, and fishing as a means for highlighting priority regions in ABNJ to be considered for spatial protection. We also include information on forecasted species distributions under climate change. We found that parameterizing the planning algorithm to protect at least 30% of these key ABNJ conservation features, while avoiding areas of high fishing effort, yielded a solution that highlights 52,545,634 km2 (23.7%) of ABNJ as high priority regions for protection. Instructing the planning model to avoid ABNJ areas with high fishing effort resulted in relatively minor shifts in the planning solution, when compared to a separate model that did not consider fishing effort. Integrating information on climate change had a similarly minor influence on the planning solution, suggesting that climate-informed ABNJ protected areas may be able to protect biodiversity now and in the future. This globally standardized, data-driven process for identifying priority ABNJ regions for protection serves as a valuable complement to other expert-driven processes underway to highlight ecologically or biologically significant ABNJ regions. Both the outputs and methods exhibited in this analysis can additively inform UN decision-making concerning establishment of ABNJ protected areas