Physical intervention: a review of the literature on its use, staff and patient views, and the impact of training

As a principal control measure, physical intervention is intended to be a skilled manual, or hands-on, method of physical restraint implemented by trained individuals, with the intention of controlling the aggressive patient, to restore safety in the clinical environment. Physical intervention is however a contentious practice. There have been reports in the literature of negative psychological views from staff and patients on the procedure. Although formal structured training was introduced in response to concerns around patient safety during restraint, concerns remain that PI is sometimes construed as a stand-alone violence prevention initiative. Its potential for misuse, and overuse, in corrupted cultures of care has emerged as a social policy issue. The following paper critically explores the literature on training in physical intervention in the United Kingdom.     

An evaluation of services for women with long-term mental health problems

This paper presents the results of an evaluation study of services for women with long-term mental health problems. The study, which was conducted in a long-term rehabilitation and community care service, examined the adequacy, accessibility, and responsiveness of services provided for women users; explored differences between the men and women using the service and those newly admitted to it; and explored the views and experiences of service providers and the women users themselves. The results of the study confirm and extend those of previous studies and suggest a number of service recommendations. The unevenness in attention to the needs of women across services needs to be addressed. Services should be more attractive to women. Agencies and facilities for women outside mental health services should be supported to ensure the they can accommodate women with long-term mental health problems, and the women themselves need to be offered the support necessary to ensure they have access to such facilities. Finally, efforts must be made to ensure that services both recognize the losses that women with long-term mental health problems have experienced and foster their continued hopes and aspirations for the future.     

Ethics and society: A survey of semen donation: phase II -- the view of the donors

This report presents the findings of phase II of the surveyof semen donation commissioned by the Human Fertilization andEmbryology Authority (HFEA), the purpose of which was to obtaininformation about the motivations and attitudes of semen donorsin comparison with a matched group of non-donors. A total of14 centres licensed by the HFEA to conduct donor inseminationparticipated in the investigation. At each centre, all men whoattended for their first or second appointment between 1st November1993 and 31st January 1994 were asked to complete a questionnaireabout the factors which prompted them to attend the centre andabout their knowledge of, and attitudes towards, semen donation.In spite of the recommendation by the HFEA that attempts shouldbe made to recruit as semen donors older men in stable relationshipswho already have children of their own and who wish to donatefor altruistic reasons, it remains the case that the large majorityof men in the UK who donate semen are young single studentswho are largely motivated by payment. Views on oocyte donationof women who had never donated oocytes were also obtained, andcompared with views on semen donation of a matched group ofmen who had never donated semen.     

The patient's perspective of commercial clinical trials

All drugs are tested on a large number of volunteers and patients prior to licensing by the Medical Controls Agency. Patients are often recruited while attending National Health Service (NHS) clinics. This paper reports a survey designed to ascertain patients' views of the desirability of such trials being undertaken in the NHS.

Patients have a sophisticated understanding of who benefits from commercial clinical trials. Nonetheless, those taking part in trials did feel the process had some personal benefit. The patients overwhelmingly supported such clinical trials being undertaken in the NHS and felt that they were likely to raise the overall quality of care.

The results can be used to influence the design of future patient information leaflets and the trial process.     

Coronal plane segmental flexibility in thoracic adolescent idiopathic scoliosis assessed by fulcrum-bending radiographs

Knowledge about segmental flexibility in adolescent idiopathic scoliosis is crucial for a better biomechanical understanding, particularly for the development of fusionless, growth-guiding techniques. Currently, there is lack of data in this field. The objective of this study was, therefore, to compute segmental flexibility indices (standing angle minus corrected angle/standing angle). We compared segmental disc angles in 76 preoperative sets of standing and fulcrum-bending radiographs of thoracic curves (paired, two-tailed t tests, p < 0.05). The mean standing Cobb angle was 59.7° (range 41.3°–95°) and the flexibility index of the curve was 48.6% (range 16.6–78.8%). The disc angles showed symmetric periapical distribution with significant decrease (all p values <0.0001) for every cephalad (+) and caudad (−) level change. The periapical levels +1 and −1 wedged at 8.3° and 8.7° (range 3.5°–14.8°), respectively. All angles were significantly smaller on the-bending views (p values <0.0001). We noted mean periapical flexibility indices of 46% (+1), 49% (−1), 57% (+2) and 81% (−2), which were significantly less (p < 0.001) than for the group of remote levels 105% (+3), 149% (−3), 231% (+4) and 300% (−4). The discal and bony wedging was 60 and 40%, respectively, and mean values 35° and 24° (p < 0.0001). Their relationship with the Cobb angle showed a moderate correlation (r = 0.56 and 0.45). Functional, radiographic analysis of idiopathic thoracic scoliosis revealed significant, homogenous segmental tethering confined to four periapical levels. Future research will aim at in vivo segmental measurements in three planes under defined load to provide in-depth data for novel therapeutic strategies.     

Perceived parental reactions to coming out,attachment, and romantic relationship views

Coming out as lesbian, gay, or bisexual (LGB) to one's parents can be a challenging experience and may lead to acceptance or rejection. Attachment theory can help predict parents' reactions to coming out and consequences for romantic attachment. In a cross-sectional study of 309 LGB individuals, we found that those who perceived their mother as accepting in childhood were more likely to have come out to her. Moreover, parents perceived as accepting and independence-encouraging in childhood were reported to react more positively to their child's sexual orientation. Mothers' positive reactions were associated with lower romantic attachment anxiety for men. The links between parent–child relationship quality and optimism and trust in romantic relationships were mediated by romantic attachment patterns. Findings support the contention that LGB pair bonds are attachment relationships, and underline the importance of prior parent–child relationships for predicting LGB individuals' experience of coming out and romantic relationships.