Restraint Effectiveness Research Articles

Frontal Crash Testing of a Class V Lift Truck

Abstract Counterbalanced, center control, high-lift trucks with a sit-down, non-elevating operator position are required to have a restraint system. The restraint system is intended to restrain the operator in the normal operating position and assist in reducing the risk of entrapment of the operator between the truck and the ground in the event of a tip-over. This is typically accomplished through the use of a two-point lap belt. This type of restraint also provides a degree of protection in the event of a collision between the lift truck and another object. Lift trucks operate in relatively low-speed environments, and many are limited to a maximum speed of 8 mph through a limiting device or by job site regulations. Though the speeds are low, lift trucks can operate in close proximity to other lift trucks and stationary rigid structures, creating the potential for collisions. The standards governing lift truck restraints do not mandate impact testing or injury criteria. This paper describes instrumented frontal impact and sled testing with a peak acceleration of 51 g performed on a Class V lift truck using an anthropomorphic test device (ATD) to test the effectiveness of lift truck restraints in this scenario. The results of this testing showed ATD injury metrics within automotive safety standards.

Antikorozivna svojstva leka ropinirol (ERN sistem) sa isteklim rokom trajanja kao inhibitora za meki čelik u 1M HCl

Ropinirole is utilized to forestall sickness and spewing brought about by disease chemotherapy and radiation treatment. It works by hindering serotonin, a characteristic substance in the body that causes queasiness and retching. After lapse, they can be utilized as consumption added substances or inhibitors. The consumption obstruction activity of terminated Ropinirole drug (ERN) on the erosion of mild steel in 1M HCl medium has been assessed by the weight reduction strategy. The weight reduction estimations showed that erosion restraint effectiveness expanded with expanding the convergence of the inhibitor, with greatest security productivity at 0.001 M. The temperature influences the pace of erosion; at high temperatures, the consumption restraint effectiveness diminishes, and erosion is noticed. The robotic parts of consumption obstruction have been concentrated by the potentiodynamic polarization method and electrochemical impedance spectroscopy (EIS). The potentiodynamic polarization strategy uncovers that the inhibitor framework capabilities as a cathodic kind of inhibitor, controlling cathodic responses. An inhibitor can decrease corrosion current due to inhibited reaction rate and increase Linear polarization resistance due to the formation of a barrier on the electrode surface. time., since, within the sight of an inhibitor framework, the charge moves opposition esteem increments and the twofold layer capacitance esteem diminishes. The surface morphology of repressed gentle steel was dissected by filtering electron microscopy (SEM). The natural constituents on the gentle steel surface have been portrayed by energy dispersive X-beam spectroscopy (EDAX). The harshness of the gentle steel surface in cleaned MS, clear MS, and inhibitor frameworks has been described by nuclear power microscopy (AFM). The outcomes have obviously shown that ERN has a repressing limit with regards to decreasing the erosion of gentle steel submerged in hydrochloric corrosive medium.

Investigating influence of external restraint on welding distortion in LAHS steel thin-plate structures by means of integrated computational approach

In order to ensure the dimensional accuracy during welding assembly, external restraints are often used to control welding-induced distortion. The objective of this study is to investigate the effectiveness of external restraints on the reduction of welding distortion in low alloy high strength (LAHS) steel thin-plate panel structures with different plate thickness by means of an integrated computational approach. In the current study, the total deformation of LAHS steel thin-plate welded structure was computed by a two-step integrated computational approach which combines the thermal elastic plastic finite element method (FEM) with the elastic FEM based on inherent strain theory. In the integrated computational approach, the thermal elastic plastic FEM was employed to obtain the inherent deformations of each typical joint involved in the thin-plate welded structure at the first step, and then the elastic FEM based on the inherent strain theory was used to estimate the total deformation of the whole thin-plate welded structure. Firstly, the integrated computational approach was used to simulate the buckling distortion in a thin-plate panel structure, and the corresponding experiment was carried out to verify its computational accuracy. Then, two finite element models with plate thickness of 5 and 12 mm were established to clarify the effectiveness of external restraint on the reduction of welding distortion of the thin-plate welded structures. The simulated results suggest that external restraint could not effectively prevent the occurrence of buckling distortion for the thin-plate structure with 5 mm thickness, while it can reduce the out-of-plane deformation to a large extent for the thin-plate welded structure with 12 mm thickness.

Protocol for the adaptation of clinical practice guidelines for the management of physical restraints in critically ill patients.

The effectiveness of physical restraints (PRs) in the prevention of unplanned extubation has been increasingly questioned, and several countries have developed clinical practice guidelines for reducing the use of PRs. However, some countries, including China, have failed to establish their guidelines, and the adaptation of existing guidelines to local circumstances may be an attractive alternative. Following the guideline definition of Institute of Medicine, the guideline will be adapted following the CAN-IMPLEMENT©. Guideline scope and clinical questions will be established based on an integrative review, retrospective study, and stakeholder interviews. The guideline's quality will be assessed by the Appraisal of Guidelines for Research and Evaluation II and Appraisal of Guidelines Research and Evaluation-Recommendations Excellence. A systematic review and meta-analysis will be evaluated by A Measurement Tool to Assess Systematic Reviews. The guidelines will meet the criteria of the RIGHT-Ad@pt Checklist. This study describes the proposed protocol for adapting clinical practice guidelines on PRs in critically ill patients. We believe the guideline will help health professionals, especially critical care nurses, deliver safe, high-quality patient care by reducing the implementation of PRs in China. The guideline has been registered at the International Practice Guidelines Registry Platform (http://www.guidelinesregistry.org/). The registration number is IPGRP-2019CN094, registration date 27-Dec-2019.

Evaluation of Gloriosa superba seeds extract as corrosion inhibition for low carbon steel in sulfuric acidic medium: A combined experimental and computational studies

Various concentrations of Gloriosa superba seeds extract were utilized for low carbon steel (LCS) within the sight of a destructive solution (0.5 M sulfuric corrosive) utilizing electrochemical techniques (Tafel and EIS) followed by weight loss method. The condition of mixed adsorption to LCS is confirmed by potentiodynamic polarization. G. superba demonstrated a corrosion restraint effectiveness of 93.84% at 700 mg/L. SEM and AFM were utilized to recognize the formation of a surrounding protective layer on LCS to shield it from corrosive media. The inhibitor adsorption was shown by noticeable spectroscopic strategies. The FT-IR system affirmed the presence of various utilitarian gatherings and heteroatoms in the inhibitor. Adsorption of inhibitory atoms on the LCS followed the Langmuir adsorption isotherm. Hypothetical exploration has demonstrated a significant relationship. All the outcomes ensure that G. superba makes a defensive layer to reduce the corrosion process.

Age Differences in Occupant Motion during Simulated In-Vehicle Swerving Maneuvers.

Background: With active safety and automated vehicle features becoming more available, unanticipated pre-crash vehicle maneuvers, such as evasive swerving, may become more common, and they may influence the resulting effectiveness of occupant restraints, and consequently may affect injury risks associated with crashes. Therefore, the objective of this study was to quantify the influence of age on key occupant kinematic, kinetic, and muscular responses during evasive swerving in on-road testing. Methods: Seat belt-restrained children (10–12 years old), teens (13–17 years old), and adults (21–33 years old) experienced two evasive swerving maneuvers in a recent model sedan on a test track. Kinematics, muscle activity, and seat belt load distribution were determined and analyzed. Results: Compared to teens and adults, children showed greater head and trunk motion (p < 0.03), but similar muscle activation in the into-the-belt direction of swerving. In the out–of-the-belt direction, children showed head and trunk motion more similar to teens and adults (p < 0.02), but with greater muscle activation. Conclusions: Children showed different neuromuscular control of head and trunk motion compared to older occupants. This study highlights differences in the relationship between kinematics and muscle activation across age groups, and provides new validation data for active human body models across the age range.

Frontal crash seat belt restraint effectiveness and comfort accessories used by older occupants

Objective: Around a quarter of older occupants use some type of comfort or orthopedic aftermarket accessory on the vehicle seat while traveling in a vehicle. The aim of this study was to investigate the effect of comfort accessories on the performance of the seat belt restraint system in a frontal crash in terms of potential injury implications for older occupants.Methods: Eight frontal sled tests (43 km/h, 32 g) were carried out on a deceleration sled fitted with a three-point lap-sash seat belt and a front passenger seat from a common Australian passenger car for each test. A 5th percentile Hybrid III anthropometric test device (ATD) was positioned in the seat and measurements were recorded for head center of gravity acceleration, chest acceleration, neck forces and moments and sternal deflection. Tests were carried out in a baseline condition and with seven comfort accessories. Each comfort accessory was inserted between the ATD and vehicle seat as it is intended to be used, with the ATD otherwise positioned as close as possible to the baseline test position.Results: Initial distance between the seat belt anchor and ATD hip was associated with a statistically significant decrease in Head Injury Criterion and increase in sternal deflection. Submarining was related to the ATD torso recline angle and angle of the lap belt from the seat belt anchor.Conclusions: Accessories placed between the seat back and the lumbar region of an occupant have the potential to increase the risk of submarining due to a change in posture and should be avoided if such a change in posture when seated with an accessory is excessive. Sitting on seat cushions resulted in the greatest increase in seat belt anchor to hip distances and hence largest increase in sternal deflection. Given the fragility, frailty and particular importance of chest injuries among older vehicle occupants, further investigation is needed to determine whether these changes in ATD sternal deflection observed with seat cushion use results in injury threshold limits being exceeded and whether pretensioners and load limiters would ameliorate these effects without causing other negative changes in occupant response or kinematics.

Effects of child restraint misuse on dynamic performance

Objective: Estimates of child restraint misuse rates in the United States range from 49% to 95%, but not all misuse modes have similar consequences in terms of restraint effectiveness. A series of laboratory sled tests was conducted to determine the effects of common misuses and combinations of misuses, including loose harness, loose installation, incorrect installation angle, incorrect belt path, loose/no tether, and incorrect harness clip usage.Methods: Three commercial convertible child restraint models were loaded with the Hybrid III 3-year-old anthropomorphic test device (ATD) and secured by either LATCH or seat belt on a modified FMVSS No. 213 bench. Tests were conducted in forward-facing (FF) and rear-facing (RF) modes. The response variables included ATD accelerations, excursions, and restraint kinematics. Belt/LATCH loads, tether loads, ATD kinematics, and restraint structural response data were also documented. A fractional factorial test design on 8 factors was used to define an initial series of 32 tests. The first series also included 4 tests of correct CRS, 2 forward facing and 2 rearward facing. The analysis of those data determined the selection of conditions for the remaining 20 tests to focus on factors and interactions of high interest and significance.Results: In the RF condition, misrouting the LATCH belt or seat belt through the incorrect belt path was the only misuse that significantly affected outcomes of interest and was associated with high levels of undesirable CRS rotation. In FF tests, loose installation and tether misuse had large adverse effects on 3 of 4 key response variables.Conclusion: The study provides strong evidence for prioritizing tight restraint installation and proper tether use for FF restraints. In particular, use of the tether helped offset the adverse effects of loose installation or loose harness. Because the results show that performance of a RF child restraint system (CRS) installation is less affected by user error, they also provide support for extended RF restraint use. In addition, packaging convertible child restraints with the LATCH belt routed through the RF belt path could help prevent the most consequential RF CRS misuse.

Radiotherapy-customized head immobilization masks: from modeling and analysis to 3D printing

Immobilization devices may be a valuable aid to ensure the improved effectiveness of radiotherapy treatments where constraining the movements of specific anatomical segments is crucial. This need is also present in other situations, specifically when the superposition of various medical images is required for fine identification and characterization of some pathologies. Because of their structural characteristics, existing head immobilization systems may be claustrophobic and very uncomfortable for patients, during both the modeling and usage stages. Because of this, it is important to minimize all the discomforts related to the mask to alleviate patients’ distress and to simultaneously guarantee and maximize the restraint effectiveness of the mask. In the present work, various head immobilization mask models are proposed based on geometrical information extracted from computerized tomography images and from 3D laser scanning point clouds. These models also consider the corresponding connection to a radiotherapy table, as this connection is easily altered to accommodate various manufacturers’ solutions. A set of materials used in the radiotherapy field is considered to allow the assessment of the stiffness and strength of the masks when submitted to typical loadings.

USE OF SYZYGIUM AROMATICUM EXTRACT AS GREEN CORROSION INHIBITOR FOR MILD STEEL IN 0.5M H2SO4

The corrosion hindrance impact of Syzygium aromaticum fruit extract has been analyzed on mild steel (MS) corrosion in 0.5[Formula: see text]M H2SO4 by utilizing weight reduction estimations, potentiodynamic polarization estimations and electrochemical impedance spectroscopy (EIS) procedures. This Eugenol- and Eugenol-acetate-containing extract diminishes the corrosion rate of MS in acidic medium. The greatest corrosion restraint effectiveness was observed at 500[Formula: see text]mg/L inhibitor concentration in 0.5[Formula: see text]M H2SO4. The adsorption of Syzygium aromaticum extract on the surface of MS has been analyzed by utilizing atomic force microscopy (AFM), scanning electron microscopy (SEM) study and spectroscopic strategies.

Effect of automated versus manual emergency braking on rear seat adult and pediatric occupant precrash motion

Objective: Emergency braking can potentially generate precrash occupant motion that may influence the effectiveness of restraints in the subsequent crash, particularly for rear-seated occupants who may be less aware of the impending crash. With the advent of automated emergency braking (AEB), the mechanism by which braking is achieved is changing, potentially altering precrash occupant motion. Further, due to anatomical and biomechanical differences across ages, kinematic differences between AEB and manual emergency braking (MEB) may vary between child and adult occupants. Therefore, the objective of this study was to quantify differences in rear-seated adult and pediatric kinematics and muscle activity during AEB and MEB scenarios.Methods: Vehicle maneuvers were performed in a recent model year sedan traveling at 50 km/h. MEB (acceleration ∼1 g) was achieved by the driver pressing the brake pedal with maximum effort. AEB (acceleration ∼0.8 g) was triggered by the vehicle system. Inertial and Global Positioning System data were collected. Seventeen male participants aged 10–33 were restrained in the rear right passenger seat and experienced each maneuver twice. The subjects’ kinematics were recorded with an 8-camera 3D motion capture system. Electromyography (EMG) recorded muscle activity. Head and trunk displacements, raw and normalized by seated height, and peak head and trunk velocity were compared across age and between maneuvers. Mean EMG was calculated to interpret kinematic findings.Results: Head and trunk displacement and peak velocity were greater in MEB than in AEB in both raw and normalized data (P ≤ .01). No effect of age was observed (P ≥ .21). Peak head and trunk velocities were greater in repetition 1 than in repetition 2 (P ≤ .006) in MEB but not in AEB. Sternocleidomastoid (SCM) mean EMG was greater in MEB compared to AEB, and muscle activity increased in repetition 2 in MEB.Conclusions: Across all ages, head and trunk excursions were greater in MEB than AEB, despite increased muscle activity in MEB. This observation may suggest an ineffective attempt to brace the head or a startle reflex. The increased excursion in MEB compared to AEB may be attributed to differences in the acceleration pulses between the 2 scenarios. These results suggest that AEB systems can use specific deceleration profiles that have potential to reduce occupant motion across diverse age groups compared to sudden maximum emergency braking applied manually.

Effectiveness of child restraints and booster legislation in Israel

96 countries in the world have enacted child restraints and booster legislation (CRBL). Yet, findings regarding the effectiveness of CRBLs are mixed. The current study is the first to examine the association between Israel's CRBL, implemented in November 2004, and the traffic injury and fatality rates among children aged 0-9 years. We extend on previous studies by accounting for risk exposure and by comparing populations of children affected by the legislation to those who were not. We used an interrupted time series design of kilometre driven-based traffic injury rates for children aged 0-4 years and children aged 5-9 years using childred aged 10-14 years as a comparison group. We estimated the effects of Israel's CRBL using monthly injury and fatality count data from the Israeli Central Bureau of Statistics. The sample includes all child vehicle occupants injured and killed in crashes in Israel between January 2003 and December 2011. Children aged 0-4 years experienced a 5.17% yearly reduction in traffic injury rate (incidence rate ratio (IRR): 0.94(95% CI 0.92 to 0.96); p=0.000), and the injury rate for children aged 5-9 years was associated with a 4.10% yearly reduction (IRR: 0.95(95% CI 0.93 to 0.98); p=0.001). The comprehensive CRBL implemented in Israel was associated with a 6.3% (95% CI -7.2% to5.5%; p=0.001) reduction in traffic injuries and fatalities for children aged 0-9 years. This is the first study comparing traffic injury rates per kilometre driven for motor vehicle-occupant children before and after the implementation of the CRBL in Israel.

Evaluation of kinematics and injuries to restrained occupants in far-side crashes using full-scale vehicle and human body models

ABSTRACTObjective: The objective of the current study was to perform a parametric study with different impact objects, impact locations, and impact speeds by analyzing occupant kinematics and injury estimations using a whole-vehicle and whole-body finite element–human body model (FE-HBM). To confirm the HBM responses, the biofidelity of the model was validated using data from postmortem human surrogate (PMHS) sled tests.Methods: The biofidelity of the model was validated using data from sled experiments and correlational analysis (CORA). Full-scale simulations were performed using a restrained Global Human Body Model Consortium (GHBMC) model seated on a 2001 Ford Taurus model using a far-side lateral impact condition. The driver seat was placed in the center position to represent a nominal initial impact condition. A 3-point seat belt with pretensioner and retractor was used to restrain the GHBMC model. A parametric study was performed using 12 simulations by varying impact locations, impacting object, and impact speed using the full-scale models. In all 12 simulations, the principal direction of force (PDOF) was selected as 90°. The impacting objects were a 10-in.-diameter rigid vertical pole and a movable deformable barrier. The impact location of the pole was at the C-pillar in the first case, at the B-pillar in the second case, and, finally, at the A-pillar in the third case. The vehicle and the GHBMC models were defined an initial velocity of 35 km/h (high speed) and 15 km/h (low speed). Excursion of the head center of gravity (CG), T6, and pelvis were measured from the simulations. In addition, injury risk estimations were performed on head, rib cage, lungs, kidneys, liver, spleen, and pelvis.Results: The average CORA rating was 0.7. The shoulder belt slipped in B- and C-pillar impacts but somewhat engaged in the A-pillar case. In the B-pillar case, the head contacted the intruding struck-side structures, indicating higher risk of injury. Occupant kinematics depended on interaction with restraints and internal structures—especially the passenger seat. Risk analysis indicated that the head had the highest risk of sustaining an injury in the B-pillar case compared to the other 2 cases. Higher lap belt load (3.4 kN) may correspond to the Abbreviated Injury Scale (AIS) 2 pelvic injury observed in the B-pillar case. Risk of injury to other soft anatomical structures varied with impact configuration and restraint interaction.Conclusion: The average CORA rating was 0.7. In general, the results indicated that the high-speed impacts against the pole resulted in severe injuries, higher excursions followed by low-speed pole, high-speed moving deformable barrier (MDB), and low-speed MDB impacts. The vehicle and occupant kinematics varied with different impact setups and the latter kinematics were likely influenced by restraint effectiveness. Increased restraint engagement increased the injury risk to the corresponding anatomic structure, whereas ineffective restraint engagement increased the occupant excursion, resulting in a direct impact to the struck-side interior structures.

Obesity and trauma mortality: Sizing up the risks in motor vehicle crashes

Protective effects of safety devices in obese motorists in motor vehicle collisions (MVC) remain unclear. Aim of our study is to assess the association between morbid obesity and mortality in MVC, and to determine the efficacy of protective devices. We hypothesised that patients with morbid obesity will be at greater risk of death after MVC. A retrospective analysis of MVC patients (age ≥16 y.o.) was performed using the National Trauma Data Bank from 2007 to 2010. Patients with recorded comorbidity of morbid obesity (BMI≥40) were identified. Patients dead on arrival, with isolated traumatic brain injury, or incomplete data were excluded. The primary outcome was in-hospital mortality. Multivariate logistic regression was performed. Our sample of 214,306 MVC occupants included 10,260 (4.8%) morbidly obese patients. Mortality risk was greatest among occupants with morbid obesity (ORcrude 1.74 [1.54-1.98]). After adjusting for patient demographics, safety device and physiological severity, odds of death was 1.52 [1.33-1.74] times greater in motorists with morbid obesity. Motorists with morbid obesity were at greater risk of death if no restraint (OR 1.84 [1.47-2.31]), seatbelt only (OR 1.48 [1.17-1.86]), or both seatbelt and airbag were present (OR 1.49 [1.13-1.97]). No significant differences in the odds of death exist between drivers with morbid obesity and non-morbidly obese drivers with only airbag deployment (OR 0.99 [0.65-1.51]). Motorists with morbid obesity are at greater risk of MVC. Regardless of safety device use, occupants with morbid obesity remained at greater risk of death. Further research examining the effectiveness of vehicle restraints in drivers with morbid obesity is warranted.

Finite Element Approach to Identify the Potential of Improved Heavy-Truck Crashworthiness and Occupant Protection in Frontal Impacts

Interior crash protection has not yet received adequate attention for heavy trucks, as such protection did for automobiles. The goal of this pilot project was to determine the nature of truck crashes that would remain after full deployment of advanced collision avoidance technologies and to assess the crashes with respect to truck driver injury and prevention. Heavy-truck occupant safety was analyzed according to injury pattern and severity to help identify and characterize heavy-truck crashes to define opportunities for improved truck crashworthiness and reduce truck driver fatalities and injuries. A finite element (FE) model combining heavy-truck cabin structure, interior components, dummy, and passive restraint systems was developed to simulate a head-on crash into a rigid barrier at 35 mph, the impact conditions used with the NHTSA new car assessment program test. This crash also represented an impact condition that was overrepresented in real-world crash data and for which there was room for improvement in occupant safety. A full FE tractor semitrailer model was employed to collect the crash pulse resulting on the truck cab as outcome of the computer simulation, which was then applied to defined locations of the FE cab model. Acceleration data were collected from impact of different parts of the dummy with interior components of the occupant compartment to assist in the calculation of body injury levels. The researchers developed a comparative risk study to evaluate the effectiveness of passive safety restraints, which would lead to preliminary guidance on the effectiveness of the use of such occupant injury mitigation systems.

O-135 Safety Aspects In Neonatal Transport And Retreival: A National Reference Survey

Background and aim The use of these safety measures during neonatal transport may reduce stress and improve physiological stability. There is no UK. national guidance for the use of specific measures such as restraints and ear defenders. As part of a quality improvement initiative we sought to benchmark these current safety practices by neonatal transport teams in the UK. Methods We surveyed all institutions undertaking neonatal transport in the UK. A questionnaire was devised and sent by email to the lead doctor and nurse of all 25 teams. We asked teams whether they used the safety measures in question and if so the specific type. We provided a section for open comment. An additional follow-up phone call was performed to complete or clarify information. Results Twentyfour (96%) of teams responded; 21/24 (88%) used some form of restraint within transport. Three types of restraint are currently used within the U. K. Comments were provided regarding infection control and the safety effectiveness of restraints. Thirteen (54%) respondents did not use ear defenders of any kind in any situation. In teams using ear defenders, 6/11 (55%) used them in all situations and 2/11 (18%) used them specifically for MRI and air transport. Respondents described difficulty in securing the defenders and concerns with effectiveness. Conclusion These results show that within the UK there is a variation in neonatal transport safety practices, specifically in the use of restraints and ear defenders. This information will allow development and improvement of safe and secure transport practice.

Influences of Initial Forward Speed, Ground Stiffness on Seat-Belt Restraint Effectiveness in Rollover of Engineering Vehicle

A simulation model of a certain wheel loader is established to assess the restraint effectiveness of seat belts in 90° rollover accident along slope. The restraint effectiveness of seat belts for 95th percentile human body models are simulated which wearing lap belt, three-point belt and harness at a certain speed, and the influences of initial velocity and ground stiffness are analyzed. The results show that under a certain forward speed and same ground stiffness, wearing the harness can make the operator completely restrained in the operators seat comparing with the other belts, the head excursion is smallest, and it can reduce the risk of the head striking hazardous features of the cab interior. Under the same restraint system, the dummy's injury risk is inconsistent with change of initial speed. The harness can all provide the best restraint for the operator under different forward speeds and ground stiffness.

The effectiveness of physical restraints in reducing falls among adults in acute care hospitals and nursing homes: a systematic review.

Physical restraint was introduced as the primary measure to maintain patient safety in preventing falls. However, physical restraints may lead to complications such as functional loss, immobility, delirium, pressure sore, and even falls or injuries. Despite all these negative effects and many alternatives that are available, physical restraint is still commonly used in hospitals and nursing homes. Hence, it is crucial to understand the effectiveness of physical restraints in protecting adult patients from falling. The overall objective was to examine the effectiveness of physical restraints in reducing falls among adults in acute care hospitals and nursing homes. This review considered quantitative designs, including randomised controlled trials, quasi-experimental studies, cohort studies, case control studies and case series/reports.The participants of this review were male and female adult patients aged 18 years or over who are on authorized physical restraints in acute care hospitals and nursing homes.This review focused on studies that investigated physical restraint as an intervention for reducing falls among adults in acute care hospitals and nursing homes.The outcomes of interest were the number of individuals receiving restraints who fall, or the rate or number of falls in acute hospitals and nursing homes. A three-step search strategy was utilised in this review. An initial limited search of MEDLINE and CINAHL was undertaken, followed by a second search using all identified keywords and index terms across all included databases. Thirdly, the reference list of all identified reports and articles was searched for additional studies. All searches were limited to English Language studies and there was no limit in the timeframe. The quality of the included studies was subjected to assessment by two independent reviewers using the standardised critical appraisal tools from the Joanna-Briggs Institute from the JBI-MAStARI (Joanna Briggs Institute-Meta-Analysis of Statistics Assessment and Review Instrument). Data was extracted from included papers using the standardised extraction tool from the JBI MASTARI. Due to the heterogeneous nature of the study methods, the findings of this review are presented in a narrative summary. Nine studies were included in the review. The majority of the findings showed that physical restraints were not associated with the reduction in falls and decreased restraint use did not contribute to more falls. From the overall results, physical restraints are not effective in reducing falls or injuries among adults in acute care hospitals and nursing homes.National standards and application guides for physical restraints are recommended. The use of physical restraints should be assessed by trained staff based on individualised need and consideration of patient's autonomy and integrity. The awareness of appropriate physical restraint usage should be enhanced among the healthcare professionals.Large multicentre research to determine the risk and benefit ratio of physical restraints and to examine the effectiveness of alternative measures, different number of bedrails, intermittent restraint use and restraint reduction programs are needed respectively.

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patientsin psychiatric settings. However, little is known about their utilization and effectiveness in pediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilization in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1,000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies, an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2 to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures. Otherwise, seclusion episodes reduced by 74.7%, including a 32.4% shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behavior, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.

Use of physical restraints in adult ICU patients to prevent patient-initiated device removal: a systematic review.

Review Question/Objective The aim of the systematic review is to present the best available evidence on the use of physical restraint to prevent patient-initiated device removal in adult ICUs patients. The review question is: what is the effectiveness of physical restraints on prevention of patient-initiated device removal in adult ICU patients? Inclusion Criteria Types of Participants All adult (>18 years old) ICU patients: - with all types of devices (for example -but not limited to- endotracheal tube, IABP, lung drainage, CVC, indwelling bladder catheter, arterial catheter, feeding tube, etc) - with any kind of pathology, at any degree of severity and any kind of co-morbidity. Types of interventions Physical restraints intended as any kind of device, material, or equipment that is attached (not only “adjacent”: bed rails in ICU cannot be considered physical restraints) to a person’s body and deliberately prevents the person’s free bodily movement. - All types of sedation at any dosage are accepted in light of the current sedation trends including daily wakening protocols and a patient’s activity level scored as calm and cooperative - Patient treated with neuromuscular blocking agent (NMBAs) are excluded from this systematic review; neuromuscular blocking drugs block neuromuscular transmission at the neuromuscular junction, causing paralysis of the affected skeletal muscles. Their use in ICUs is usually limited to patients affected by severe acute respiratory distress syndrome (ARDS) because they require a deep sedation and could be implicated in lung atelectasis, ICU-acquired myopathies and prolonged duration of mechanical ventilation. Patients treated with NMBAs can’t make any movement -restrained or not- and they are not subjected to self-removal of therapeutic devices. Comparison Any other strategy (for example -but not limited to- surveillance by family members/volunteers, direct nurse observation, environmental factor, effective communication) Types of outcomes - Frequency of patient-initiated device removal. - Complications related to patient-initiated device removal (for example -but not limited to- bleeding/haemorrhage, respiratory failure/failure, delay in therapy, pneumothorax, urinary retention, aspiration, hypotension, ect) - Complications related to the use of physical restraints in terms of direct injury (for example -but not limited to- lacerations, bruising, development of pressure sores, ischaemia, nerve compression, etc)