Restraint Protocols Research Articles

A Collaborative Stakeholder Approach for Reducing the Use of Custodial Restraints in Hospitalized Patients.

In hospitals across the country, most patients admitted from jails or prisons receive their care in custodial restraints regardless of clinical concerns or public safety risk. Blanket restraint protocols are deemed necessary for public safety; however, the indiscriminate use of custodial restraints causes harm to patients physically, mentally, and through propagation of prejudice. Hospitals and correctional officials must create policies that allow for a case-by-case analysis of patients to develop an individualized custodial restraint plan that will balance public safety and patient care needs. In this Viewpoint, we recommend a collaborative stakeholder approach to address this needed public policy evolution. Now is the time for health care professionals, correctional and hospital administrators, those with lived incarceration experience, and community members to work together to create policies on custodial restraints that support patient healing and reduce physical harm, emotional distress, and prejudice while optimizing staff and public safety.

Echocardiography of turquoise-fronted parrots (Amazona aestiva, Linnaeus, 1758) subjected to physical orpharmacological restraint protocols

The tranquilizers can influence the preload and the afterload and alter echocardiographic parameters in parrots since echocardiography in these animals invariably depends on pharmacological containment. This study aimed to determine the echocardiographic parameters of turquoise-fronted parrots (Amazona aestiva) under physical and pharmacological restraint using midazolam and a combination of midazolam and ketamine and evaluate these drugs as facilitators of echocardiography. Echocardiographic examinations were performed on 10 healthy parrots using three restraint protocols at 30-day washout: midazolam 1.5 mg/kg IM (PM protocol), midazolam 0.2 mg/kg with ketamine 25 mg/kg IM (PMK protocol), and physical (PRP protocol). Apical images were obtained using the horizontal ventromedian approach using B-mode. Sedation scores and duration of exams were determined. In the PMK protocol, it was observed that Vmax-Ao (p = 0.0052), Ao-Grad (p = 0.0110), LVLd (p = 0.0219), LALd (p = 0.0304), IVSs (p = 0.0219) and IVSd (p = 0.0156) was lower than the PRP protocol and equal to PM protocol. However, cardiac debit was lower than the PM protocol (p = 0.0417) and equal to the PRP protocol. The A-wave velocity was greater than the E-wave velocity in 80% of the birds, while 20% showed E-wave velocity greater than the A wave velocity in the PMK and PM protocols. PMK protocol showed a higher level of sedation without resistance to manipulation. In parrots, ketamine and midazolam alter echocardiographic parameters dependent on preload and afterload, but midazolam causes minor changes. In addition, pharmacological restraint facilitates echocardiography without altering the examination time.

Advanced assisted reproduction technologies in endangered mammalian species.

A new synergistic approach of classical conservation strategies combined with advanced assisted reproduction technologies (aART) allows for protection and rescue of endangered keystone species at the brink of extinction, which can help to safeguard complex ecosystems. Reproduction biology and management in mammal species is not only challenging in regards to their diverging sizes, anatomy, and often unknown physiology; it also requires customized training or chemical restraint protocols for safe handling. Besides these general challenges, there are several new assisted reproduction techniques (ART) specifically tailored to critically endangered mammals. The current portfolio of ART in these mammalian taxa is ranging from sexual cycle characterization and manipulation, semen collection and cryopreservation, artificial insemination, biobanking of living cells, oocyte collection, invitro fertilization (IVF), and embryo production, embryo transfer as well as stem cell-derived invitro gametogenesis for generating gametes in culture. The article covers advanced assisted reproduction technologies (aART), success and challenges, as well as ethical implications.

Comparison of four chemical restraint protocols in pacas

Discussions about different anesthetic techniques designed for wild rodents, particularly neotropical species, are scarce in the literature. However, chemical restraint is required for management and medical procedures in these animals, due to their susceptibility to stress and their behavioral characteristics. This research evaluated quality and duration of chemical restraint of pacas (Cuniculus paca) using low doses of ketamine in association with xylazine (Group 1), xylazine and midazolam (Group 2), butorphanol and midazolam (Group 3), and azaperone and midazolam (Group 4). All doses were calculated by interspecific allometric scaling. In Group 1, recovery was disturbed and the moment of incapacity of manipulation occurred early. In Groups 2, 3 and 4, the duration of chemical restraint was higher. The best chemical restraint quality occurred in Group 2 (ketamine, xylazine and midazolam). Midazolam provided an extremely calm recovery, and afforded animals’ manipulation for prolonged time, even and after return of normal ambulation.

99 seconds to Midnight: A Case for Institutionalizing Nuclear Risk Reduction Measures in South Asia

South Asian nuclear tests in summer of 1998, heralded a new chapter in the pervasive & deeply rooted sub-continental cold war, bringing forth the sobering realization that given geographical proximity and an inherent risk of tension escalation, there is a need to implement safeguards against incidental or accidental nuclear weapons usage, as well as avoidance of brinksmanship. Resultantly, Lahore MoU of 1999, and later the comprehensive dialogue process (2004), were positive steps initiated to institutionalize nuclear restraint measures. However, given the checkered history of bilateral relations, after making initial progression, this critical track like all other tracks of dialogue also faced a setback. Further exacerbated by populist ultra nationalist rhetoric and anti-Pakistan hate mongering of the Saffron regime in India under Narendra Modi. The recent Indian missile incident, trivialized as a mere accident is latest in the series of such episodes, that breaches mutual nuclear restraint protocols, as such actions carry the risk of inadvertent war under the nuclear shadow. Given the nature of relations between the two neighbours, these “accidents” can very well be misperceived or considered an intentional and deliberate misadventure, which can lead not only to tension escalation, but a nuclear crisis with grim consequences. This paper would appraise the often overlooked yet established nuclear restraint protocols between the two countries, seeking the fundamental question, whether after quarter of century, the South Asia neighbours fully understand the consequence of using nuclear weapons as elements of political currency. Can this incident be used as a positive turning point in helping usher a viable risk reduction regime between the two adversaries or the region is destined to gradually slide up the escalation ladder to an eventual catastrophe.

Intranasal oxygen reverses hypoxaemia in immobilised free-ranging capybaras (Hydrochoerus hydrochaeris).

Capybara (Hydrochoerus hydrochaeris) is the main host of tick-borne pathogens causing Brazilian spotted fever; therefore, controlling its population is essential, and this may require chemical restraint. We assessed the impact of chemical restraint protocols on the partial pressure of arterial oxygen (PaO2) and other blood variables in 36 capybaras and the effect of different flows of nasal oxygen (O2) supplementation. The capybaras were hand-injected with dexmedetomidine (5 μg/kg) and midazolam (0.1 mg/kg) and butorphanol (0.2 mg/kg) (DMB, n = 18) or methadone (0.1 mg/kg) (DMM, n = 18). One-third of the animals were maintained in ambient air throughout the procedure, and one-third were administered intranasal 2 L/min O2 after 30 min whereas the other third were administered 5 L/min O2. Arterial blood gases, acid-base status, and electrolytes were assessed 30 and 60 min after drug injection. The DMB and DMM groups did not vary based on any of the evaluated variables. All animals developed hypoxaemia (PaO2 44 [30; 73] mmHg, SaO2 81 [62; 93] %) 30 min before O2 supplementation. Intranasal O2 at 2 L/min improved PaO2 (63 [49; 97] mmHg and SaO2 [92 [85; 98] %), but 9 of 12 capybaras remained hypoxaemic. A higher O2 flow of 5 L/min was efficient in treating hypoxaemia (PaO2 188 [146; 414] mmHg, SaO2 100 [99; 100] %) in all the 12 animals that received it. Both drug protocols induced hypoxaemia, which could be treated with intranasal oxygen supplementation.

Determinants of mechanical restraint in an acute psychiatric care unit.

BACKGROUNDDespite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential.AIMTo determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR.METHODSDescriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration.RESULTSOf the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05). CONCLUSIONThe presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.

Drug-Loading Capacity of PAMAM Dendrimers Encapsulating Quercetin Molecules: A Molecular Dynamics Study with the 2016H66 Force Field.

The complexation of quercetin molecules with poly(amidoamine) (PAMAM) dendrimers of generation 0-3 was studied by molecular dynamics simulations. Three main points were addressed: (i) the effect of starting from different initial structures; (ii) the performance of the 2016H66 force field (recently validated in the context of dendrimer simulations) in predicting the experimental drug(quercetin)-loading capacity of PAMAM dendrimers; and (iii) the stability of quercetin-PAMAM complexes and their interactions. Initial structures generated by different restraint protocols led to faster convergence compared to initial structures generated by randomly placing the drug molecules in the simulation box. The simulations yielded meta-stable complexes where the loading numbers have converged to average values and were compared to experimentally obtained values. Once the first meta-stable state was reached, the drug-dendrimer complexes did not deviate significantly throughout the simulation. They were characterized in terms of structural properties, such as the radius of gyration and radial distribution functions. The results suggest that quercetin molecules interact mostly with the internal dendrimer monomers rather than to their surface.

Factors influencing critical care nurses’ intentions to use physical restraints adopting the theory of planned behaviour: A cross-sectional multicentre study

BackgroundStudies addressing critical care nurses' practices regarding physical restraints have focused on individual nurses' knowledge and attitudes but lack the understanding of other social influences that could affect nurses’ intentions to use them. ObjectiveThe objective of this study was to determine critical care nurses’ attitudes, subjective norms, perceived behavioural control, and intentions to use physical restraints in intubated patients and the relationship between them and sociodemographic, professional, and contextual factors using a survey approach. MethodsA cross-sectional, multicentre study was conducted in a convenience sample of 12 intensive care units from eight hospitals in Spain (n = 354). The Physical Restraint-Theory of Planned Behaviour questionnaire and a researcher-developed survey were used to collect structural and clinical data from each unit. Multilevel model analysis was used. ResultsCritical care nurses showed a moderate level of intention to use physical restraints 12.52 (standard deviation = 3.81) [3–21]. More than a half (52%) agreed restraints were safe. The highest perceived barrier against physical restraint use was patient cooperation. Although nurses did not feel that others expected them to use restraints, they did not perceive high levels of disapproval of such practice. Nurses who had received previous training on restraints and who worked in units with a flexible family visitation policy, an informed consent form for restraint use, analgosedation and restraint protocols, and nurse-driven analgosedation management reported lower levels of intention to use restraints. Working in smaller units (beta −1.81; 95% confidence interval [CI]: −0.18, −3.44) and working in units with a consent form for restraint use (beta −4.82; 95% CI: −2.80, −6.85) were the variables with the highest impact on nurses’ intentions to use restraints. ConclusionsCritical care nurses’ intentions to use physical restraints are moderate and are influenced by intrapersonal, patient, and contextual factors. Nurses who work in units with organisational policies and alternatives to restraints demonstrated lower levels of intention to use them.

COMPARISON OF SUBCUTANEOUS ADMINISTRATION OF ALFAXALONE-MIDAZOLAM-DEXMEDETOMIDINE WITH KETAMINE-MIDAZOLAM-DEXMEDETOMIDINE FOR CHEMICAL RESTRAINT IN JUVENILE BLUE POISON DART FROGS (DENDROBATES TINCTORIUS AZUREUS).

Blue poison dart frogs (Dendrobates tinctorius azureus) are commonly maintained in zoological institutions and are becoming popular in the pet trade industry. Sedation or light anesthesia is required for safe and effective handling of this species. In this study, the sedative effects of subcutaneously administered alfaxalone-midazolam-dexmedetomidine (AMD) (20, 40, 5 mg/kg, respectively) and ketamine-midazolam-dexmedetomidine (KMD) (100, 40, 5 mg/kg, respectively) were compared in a prospective, randomized, blinded, crossover study in juvenile blue poison dart frogs (n = 10). Both protocols were partially reversed 45 min after administration of either protocol with subcutaneously administered flumazenil (0.05 mg/kg) and atipamezole (50 mg/kg). Heart rate, pulmonic respiratory rate, various reflexes, and behavioral parameters were monitored after drug administration. Both protocols resulted in rapid loss of righting reflex [median (range): AMD, 5 min (5-5 min); KMD, 5 min (5-10 min)]. Time to complete recovery was similar with both protocols (mean ± SD: AMD, 97.5 ± 11.4 min; KMD, 96.5 ± 25.4 min). The AMD protocol resulted in pulmonic respiratory depression, whereas no significant difference in heart rate was found between the two protocols. All frogs were observed eating within 24 hr of chemical restraint. Gastric prolapses occurred in four frogs (AMD 3, KMD 1) that were easily reduced with a cotton-tip application. No other adverse reactions were observed. The results of this study provide two different subcutaneous chemical restraint protocols in juvenile blue poison dart frogs.

Influência de diferentes protocolos de contenção nosvalores do eletrocardiograma de macacos-da-noite (Aotus azarae infulatus)

RESUMO: Macacos-da-noite são muito susceptíveis ao estresse e por isso a contenção química ou física deve ser cuidadosamente avaliada antes de qualquer procedimento. Protocolos anestésicos podem alterar alguns parâmetros fisiológicos, sendo o eletrocardiograma (ECG) um exame muito utilizado para avaliação do ritmo e da frequência cardíaca. O objetivo deste estudo foi avaliar a influência de quatro diferentes protocolos de contenção sobre o ECG realizado em Aotus azarae infulatus. Para isso foram utilizados 10 animais, machos, adultos, submetidos à contenção com a associação tiletamina/zolazepam (TZ), isoflurano (ISO), associação cetamina e midazolam (CET) e contenção física (CF). Não foram observadas diferenças nos parâmetros de ondas e complexos obtidos no ECG em todos os grupos testados, no entanto, durante a avaliação do traçado os animais do grupo CF apresentaram uma quantidade maior de alterações. Concluiu-se que os protocolos de contenção utilizados não alteraram os valores do ECG e que não foi possível considerar o grupo CF como controle devido causar mais alterações do que todos os protocolos testados.

Evaluation of blood pressure in feline night monkeys (Aotus azarae infulatus) under different restraint protocols.

Feline night monkeys are very susceptible to stress when handled, and because of that, the use of anesthetic and physical restraint methods should be carefully evaluated. To ensure a safer anesthesia to the animals the present study aimed to observe the influence of four restraint protocols in the blood pressure of Aotus azarae infulatus. Blood pressure was obtained from 10 animals subjected to restraining protocols using tiletamine and zolazepam, isoflurane, ketamine and midazolam, and physical restraint and results were evaluated to determine their effect on this exam. Among the restraint protocols tested, the anesthetic isoflurane promoted lower blood pressure values and no differences were observed between values measured in both arms in all groups. The results of our study suggest that all restraint protocols tested significantly alter blood pressure in this species of primates.

Allometric scaling for chemical restraint in greater Rheas (Rhea americana) with Tiletamine and Zolazepam

BackgroundChemical restraint is of great importance in the clinical practice of wildlife animals. In such, interspecific allometric scaling proposes pharmacological doses to a wide range of species, based on previously known doses for domestic animals and the target animal’s body mass. The objective was to compare chemical restraint responses in the greater rhea (Rhea americana) with conventional doses of tiletamine/zolazepam, found in the literature for the species, and with doses calculated through interspecific allometric scaling extrapolation. From the Federal University of Piauí, six adult greater rheas (Rhea americana), three males and three females, were randomly selected to be subjects in this research. All six animals were submitted to two chemical restraint protocols with tiletamine and zolazepam, per intramuscular injection in the hind limb. The first protocol was composed of doses found on the literature for the species, while the second protocol used doses calculated by interspecific allometric scaling, with the domestic dog as model animal. Heart and respiratory rates, body temperature, eyelid reflex, digital pinch and metatarsal reflex were registered along with latency and ambulation times.ResultsThe use of interspecific allometric scaling for chemical restraint with the combination tiletamine and zolazepam showed satisfying results, with great similarity to results obtained with conventional doses in Greater rheas.ConclusionsLiterature on chemical restraint and use of tiletamine and zolazepam in rheas is scarce. Chemical restraint is of extreme importance on these animals, due to their aggressive nature and low level of domesticity. This research may further establish the interspecific allometric scaling method as a viable tool for the veterinary physician in formulating anesthetic and chemical restraint protocols for wildlife animals.

Evaluation of rebound tonometry in red-eared slider turtles (Trachemys scripta elegans).

To evaluate feasibility and accuracy of intraocular pressure (IOP) measurement by rebound tonometry in adult red-eared slider turtles and determine the effects of manual and chemical restraint on IOP. Seventeen adult red-eared slider turtles. Intraocular pressure was measured with TonoLab® and TonoVet® tonometers in conscious, unrestrained turtles. To evaluate the effects of manual restraint, turtles were restrained by digital pressure on the rostral head or proximal neck. The effect of two chemical restraint protocols (dexmedetomidine, ketamine, midazolam [DKM] and dexmedetomidine, ketamine [DK] subcutaneously) on IOP was evaluated. Triplicate TonoLab® and TonoVet® readings were compared with direct manometry in three ex vivo turtle eyes. TonoLab® correlated better with manometry at IOPs < 45 mmHg than TonoVet® (linear regression slopes of 0.89 and 0.30, respectively). Mean (±SD) IOP in unrestrained conscious turtles was significantly lower (P < 0.01) with TonoLab® (10.02 ± 0.66 mmHg) than with TonoVet® (11.32 ± 1.57 mmHg). Manual neck restraint caused a significant increase in IOP (+6.31 ± 5.59 mmHg), while manual rostral head restraint did not. Both chemical restraint protocols significantly reduced IOP (DKM: −1.0 ± 0.76 mmHg; DK: −1.79 ± 1.17) compared with measurements in conscious unrestrained turtles. Chemical and manual neck restraint affected IOP. Rostral head restraint had no significant effect on IOP and is, therefore, recommended as the appropriate restraint technique in red-eared slider turtles. TonoLab® measurements estimated actual IOP more accurately, within physiologic range, than measurements obtained using the TonoVet®.

Quantitative Assessment of the Canine Pupillary Light Reflex

To develop instrumentation and methods for thorough quantitative assessment of the pupillary light reflex (PLR) in dogs under varying stimulus conditions. The PLR was recorded in normal Dachshunds using a custom system allowing full user control over stimulus intensity, color, and duration. Chemical restraint protocols were compared to determine which protocol provided for optimal baseline stability of pupil size and appropriate eye positioning. A series of white light stimuli of increasing intensity was used to elicit pupil constriction. Pupil images were concurrently recorded using continuous infrared illumination and an infrared-sensitive camera. The PLR was also recorded in response to blue and red stimuli. With injectable chemical restraint alone, spontaneous fluctuations in pupil size occurred independent of light stimulation, and spontaneous eye movements made it difficult to fully visualize the pupil. Combined injectable chemical and inhalation restraint provided a steady baseline pupil size throughout PLR assessment and allowed for stable positioning of the eye using a conjunctival stay suture. Robust PLRs were elicited with all light colors. PLR constriction amplitude increased with increasing flash intensity and ranged from 5% to 70%. A recording system and protocol have been developed to reliably quantify the canine PLR. The techniques and instrumentation will be useful for objective quantitative assessment of the PLR in dogs and other species in research applications and may be useful in clinical veterinary ophthalmology and neurology if PLR abnormalities detected with these procedures can be associated with specific diseases.

Characteristics of Psychiatric Inpatients Who Experienced Restraint and Those Who Did Not: A Case-Control Study

Use of restraint in acute psychiatric wards is highly controversial. Knowledge is limited about the characteristics of patients who are restrained and the predictors of use of restraint. This study examined whether restrained patients differed from nonrestrained patients in demographic, clinical, and medicolegal variables and to what extent the variables predicted use of restraint. A two-year retrospective case-control design was used. The sample comprised all restrained patients (N=375) and a randomly selected control group of nonrestrained patients (N=374) from three catchment-area-based acute psychiatric wards in Norway. Data sources were restraint protocols and electronic patient files. The restrained patients were significantly younger and more likely to be men, to reside outside the wards' catchment areas, and to have an immigrant background. Restrained patients also had more admissions and longer inpatient stays than nonrestrained patients and were more likely to be involuntarily referred and to have one or more of the following ICD-10 diagnoses: a substance use disorder, schizophrenia or a related psychotic disorder, and bipolar disorder. Binary logistic regression analyses, adjusting for age, gender, immigrant background, and catchment area, indicated that the number of admissions, length of stay, legal basis for referral, and diagnosis each independently predicted the use of restraint. No interactions were found. Use of restraint was predicted by multiple admissions, long inpatient stays, involuntary admission, and serious mental illness. Identifying patients at risk may inform the development of alternatives to restraint for these patients.

Characteristics of Psychiatric Inpatients Who Experienced Restraint and Those Who Did Not: A Case-Control Study

Objective: Use of restraint in acute psychiatric wards is highly controversial. Knowledge is limited about the characteristics of patients who are restrained and the predictors of use of restraint. This study examined whether restrained patients differed from nonrestrained patients in demographic, clinical, and medicolegal variables and to what extent the variables predicted use of restraint. Methods: A two-year retrospective case-control design was used. The sample comprised all restrained patients (N=375) and a randomly selected control group of nonrestrained patients (N=374) from three catchment-area-based acute psychiatric wards in Norway. Data sources were restraint protocols and electronic patient files. Results: The restrained patients were significantly younger and more likely to be men, to reside outside the wards' catchment areas, and to have an immigrant background. Restrained patients also had more admissions and longer inpatient stays than nonrestrained patients and were more likely to be involuntarily referred and to have one or more of the following ICD-10 diagnoses: a substance use disorder, schizophrenia or a related psychotic disorder, and bipolar disorder. Binary logistic regression analyses, adjusting for age, gender, immigrant background, and catchment area, indicated that the number of admissions, length of stay, legal basis for referral, and diagnosis each independently predicted the use of restraint. No interactions were found. Conclusions: Use of restraint was predicted by multiple admissions, long inpatient stays, involuntary admission, and serious mental illness. Identifying patients at risk may inform the development of alternatives to restraint for these patients. (Psychiatric Services 62:492–497, 2011)

Association between patients’ gender, age and immigrant background and use of restraint—A 2-year retrospective study at a department of emergency psychiatry

The study aimed to determine rates and types of patient restraint, and their relationship to age, gender and immigrant background. The study retrospectively examined routinely collected data and data from restraint protocols in a department of acute psychiatry over a 2-year period. Each patient is only counted once in this period, controlling for readmission. Of 960 admitted patients, 14% were exposed to the use of restraints. The rate was significantly higher among patients with immigrant background, especially in the younger age groups. Most commonly used were mechanical restraint alone for native-born patients and a combination of mechanical and pharmacological restraints for patients with immigrant background. The use of restraints decreased when patients reached 60 years. Both patients’ age and immigrant background seem to have an impact on the use of restraint.

Glucocorticoid receptor blockade in the dorsal hindbrain attenuates body weight gain in response to chronic restraint stress

Chronic stress can elevate endogenous glucocorticoid levels. The current experiments were performed to test the hypothesis that dorsal hindbrain (DHB) glucocorticoid receptors (GRs) contribute to the effects of glucocorticoids on responses to chronic restraint stress. Small pellets of the GR antagonist Mifepristone (Mif) or silastic (sham pellet) were implanted on the DHB of adult male borderline hypertensive rats (BHRs). Rats were then subjected to chronic daily restraint stress by placing each rat in a clear Plexiglas tube for either 1 hour (h)/day (d) for 14 d or 2 h/d for 26 d, on most days. Two additional non-stressed control groups (DHB sham and DHB Mif) were weighed daily for 14 d. On day 10 or 22 of treatment, indwelling arterial catheters were implanted to measure baseline mean arterial pressure (MAP) and heart rate (HR). In DHB sham-treated rats, chronic restraint stress tended to increase body weight gain, with this effect reaching significance on day 7 (P=0.03) of treatment. DHB Mif treatment reduced body weight gain during chronic stress (P<0.01 for both restraint protocols). For example, on day 7 of treatment weight gain in chronically stressed rats (1 h/d) was 31 ± 3 g in DHB sham rats and 1 ± 6 g in DHB Mif rats, while unstressed DHB sham and DHB Mif rats gained 16 ± 4 g and 17 ± 4 g, respectively. Baseline MAP was not significantly reduced by DHB Mif. However, in the chronically stressed rats HR was decreased in the DHB Mif (305 ± 2 bpm, P<0.01) relative to the DHB sham group (HR=348 ± 8 bpm). We conclude that blockade of DHB GRs attenuates weight gain in chronically stressed BHRs. Supported by NIH Grant HL-076807

Improving patient care through implementation of nurse-driven restraint protocols.

Nationally, much attention has been placed on the indiscriminate application and abuse of restraint usage. This was the impetus for health care institutions across the country to relook at the policy, practices, and procedures regarding restraints. Our health care system made changes to our restraint policy, practice guidelines, and procedures in an effort to assure protection of the patients' health and safety while preserving their dignity, rights, and well-being. The mission was to pursue a restraint-appropriate environment by restraining only those patients who were assessed as being at risk of harming self and to protect the patient or others from injury. Our overall goal was to reduce restraint usage. This article describes the current policies, practice guidelines, and procedures for identifying clinically appropriate and adequately justified situations for restraint usage. The focus is on implementation of nurse-driven restraint protocols to improve patient care. All efforts directed at improvements in restraint usage and management of a patient in restraints has reduced our overall numbers of patients in restraints as well as significantly reduced risk of incidence for patients in restraints.