Factors associated with the use of mechanical restraint in disability services

Background: Mechanical restraint refers to the use of materials or devices to restrict the behaviours of a person with a disability, where the restraint is neither for therapeutic purposes or required by law. The inappropriate use of mechanical restraint is recognised in legislation and policy as a violation of people’s human rights, and a risk to their health and wellbeing. Understanding who is at risk of mechanical restraint may assist service providers to better support people with a disability.

Method: State-wide data collected between July 2012 to June 2013 were sourced. Odds ratios were used to describe the associations between individual characteristics and whether an individual was subjected to mechanical restraint.

Results: Individuals with certain characteristics, such as the presence of a hearing, physical, neurological, communication or visual impairment, and autism spectrum disorder had an increased likelihood of being mechanically restrained.

Conclusion: Initiatives to reduce mechanical restraint should pay particular attention to the support needs of those with sensory impairments and complex communication support needs including those with autism spectrum disorder and those with a physical impairment.     

Systemic photodynamic therapy in folliculitis decalvans

Folliculitis decalvans (FD) is classified as a primary neutrophilic cicatricial alopecia, and is estimated to account for approximately 10% of all cases of primary cicatricial alopecia.[] The role of dysfunctional immune activity and the presence of bacteria, particularly Staphylococcus aureus, appear pivotal. We describe a 26‐year‐old man with a 4‐year history of FD that was recalcitrant to numerous systemic and topical therapies, whose disease was virtually cleared during a follow‐up of 25 months following a course of treatment with systemic photodynamic therapy (PDT) using ultraviolet light (100–140 J/cm²) with porfimer sodium 1 mg/kg as monotherapy. This is the first report of the use of systemic PDT as a treatment for FD. Systemic PDT has potent antibacterial effects with little or no resistance. In addition, systemic PDT provides local immunomodulation and improved scar healing. Significant adverse effects following systemic PDT with appropriate aftercare are rare. This case demonstrates that systemic PDT is a useful therapy option in the treatment of recalcitrant FD.     

Exploring psychotic symptoms: a comparison of motor related neuronal activation during and after acute psychosis

ABSTRACT: BACKGROUND: Delusions and hallucinations are classic positive symptoms of schizophrenia. A contemporary cognitive theory called the 'forward output model' suggests that the misattribution of self-generated actions may underlie some of these types of symptoms, such as delusions of control [EN DASH] the experience of self-generated action being controlled by an external agency. In order to examine the validity of this suggestion, we performed a longitudinal functional magnetic resonance imaging (fMRI) study examining neuronal activation associated with motor movement during acute psychosis. METHODS: We studied brain activation using fMRI during a motor task in 11 patients with schizophrenia and 9 healthy controls. The patient group was tested at two time points separated by 6[EN DASH]8 weeks. RESULTS: At initial testing, the patient group had a mean Positive and Negative Syndrome Scale score of 56.3, and showed significantly increased activation within the left inferior parietal lobe (IPL) compared to controls. Patients reported significantly decreased positive symptoms at 6[EN DASH]8 week followup and IPL activation had returned to normal. Our results demonstrate that first-rank positive symptoms are associated with hyperactivation in the secondary somatosensory cortex (IPL). CONCLUSIONS: These findings lend further credence to the theory that a dysfunction in the sensory feedback system located in the IPL, and which is thought to underlie our sense of agency, may contribute to the aetiology of delusions of control.     

Bleeding duodenal ulcer

Basal gastric acid output was analyzed prospectively in 110 patients with endoscopically documented duodenal ulcer disease to determine the frequency of gastric acid hypersecretion in patients with bleeding versus nonbleeding ulcers. Thirty-eight patients with stigmata of an actively or recently bleeding duodenal ulcer had a mean basal output of 12.6±8.9 meq/hr. In comparison, 72 patients with nonbleeding duodenal ulcers (and no history of prior bleeding) had a significantly lower mean basal acid output of 8.7±7.5 meq/hr (P<0.05). Twenty-four of the 38 patients (63%) with bleeding and 28 of the 72 (39%) with nonbleeding duodenal ulcers had gastric acid hypersecretion, defined as a basal acid output of greater than 10.0 meq/hr. There was a statistically significant association between bleeding duodenal ulcer and acid hypersecretion (P=0.01). All 110 patients were treated with standard doses of H₂-receptor antagonists for eight weeks. In that time, 87 patients healed and 23 patients (14 with prior bleeding and nine with nonbleeding duodenal ulcers) remained unhealed. Significantly more patients who had bled had nonhealing duodenal ulcers (P=0.004). Irrespective of bleeding history, all 23 patients with nonhealing duodenal ulcers at eight weeks had basal acid outputs of greater than 10.0 meq/hr (range 10.1–49.1 meq/hr). These 23 patients with nonhealing duodenal ulcers were treated with increased doses of ranitidine (mean 690 mg/day, range 600–1200 mg/day) for up to eight additional weeks. All were observed to have complete endoscopic healing documented within that period. These results suggest that bleeding duodenal ulcers are often associated with gastric acid hypersecretion and that these ulcers are less likely to heal after eight weeks of standard dose H₂-receptor antagonist therapy. Similarly, nonbleeding duodenal ulcers associated with gastric acid hypersecretion are also less likely to heal after standard doses of antisecretory therapy.     

Arrhythmias, haemodynamic changes and extent of myocardial damage during coronary ligation in rabbits anaesthetized with halothane, alpha chloralose or pentobarbitone

We investigated the incidence of ventricular arrhythmias, extent of myocardial infarction and alteration in haemodynamic parameters during 30 minutes of coronary arterial occlusion in rabbits anaesthetized with halothane, alpha chloralose and pentobarbitone. Ventricular tachycardia and fibrillation occurred in 10 of 15 given halothane and in 11 of 15 animals given alpha chloralose while of 15 animals given pentobarbitone, 5 developed tachycardia and 8 had fibrillation. Following ligation, blood pressure promptly fell in each group to 71-76% of control values at 1 minute and remained low throughout the occlusion period. This was most marked in the group receiving halothane which had significantly lower pressures at 30 minutes than those anaesthetized with alpha chloralose or pentobarbitone (P less than 0.01 in each case). Those receiving halothane also recovered less on reperfusion. Heart rate remained stable with pentobarbitone anaesthesia during coronary occlusion and reperfusion, but promptly declined in the first minute of occlusion in the groups given halothane and alpha-chloralose and then remained low throughout occlusion, especially in the group given alpha-chloralose (P less than 0.001 vs pentobarbitone and P less than 0.01 vs halothane). The extent of myocardial damage was measured from nitroblue tetrazolium-stained sections and expressed as a percentage of the zone at risk, which was obtained in five hearts following 90 minutes coronary ligation. Values were 44.0% with pentobarbitone, 54.0% with alpha chloralose (P less than 0.01 vs pentobarbitone) and 62.1% with halothane (P less than 0.001 vs pentobarbitone). Thus, the choice of anaesthetic employed during experimental myocardial ischaemia may have significant effects on the incidence of ventricular tachycardia, haemodynamic changes and extent of necrosis observed.(ABSTRACT TRUNCATED AT 250 WORDS)