[Joint study of seclusion, mechanical restraint and chemical restraint: Pilot study in three French psychiatric hospitals]. / Étudier conjointement l'isolement, la contention mécanique et la contention chimique : étude pilote dans trois établissements psychiatriques français.

Psychiatric wards that only exceptionally use isolation and mechanical restraint may be suspected of using "chemical restraint". However, in the case of these services, the hypothesis of a reduction in the general level of restraint can also be formulated. Prior to a comprehensive study to test these hypotheses, the current research aims to assess indicators which define high levels of the use of these measures and a relevant sample. The study was conducted in three facilities with 254 hospitalized patients over a week. Five per cent experienced isolation, 2% mechanical restraint, and 13% received high doses of medication (including "as needed" treatments). These figures are below literature data and national averages. Variances exist among centers, with one showing higher percentages for all three measures. While confirming the feasibility of studying these measures together, the study suggests the need for longer observations and continuous evaluation of prescription practices to better reflect yearly isolation and restraint trends. Future studies should involve more centers and include case studies for a nuanced understanding of administration practices in relation to prescriptions.

["Zero heavy restraint" objective]. / Objectif "zéro contention forte".

When caring for a patient with an intellectual disability, restraint is often an ambush. At the Institut Jérôme Lejeune, the nursing team has put in place a series of measures designed to help both patient and caregiver, whether in managing the pain induced by care or the apprehension it provokes. After a year's implementation, the number of heavy restraints has fallen significantly.

[PLAID-Care: Research into the reduced use of coercion in France]. / PLAID-Care : une recherche sur le moindre recours à la coercition en France.

The use of coercion is a common practice in psychiatry despite its deleterious effects and insufficient evidence of benefits. It is so deeply rooted that the mention of establishments that make little use of it arouses a form of incredulity. However, the history of psychiatry and the international literature provide numerous examples of a psychiatry that is hardly coercive and numerous experiences of a reduction in the use of seclusion and/or restraint in psychiatric facilities. Today, in France, there are also less coercive establishments, which, for example, do not use mechanical restraint, have all their units open, or have reduced their use of seclusion and restraint. With regard to the stated policy objectives of reducing the use of coercion, it is surprising that most of these facilities receive little attention. PLAID-Care research aims to contribute to the visibility and analysis of these institutions and the factors involved in the reduced use of coercion. While these factors have already been identified in the international literature, the research is based on the multiplication of disciplinary perspectives (nursing, sociology, anthropology, geography) and the mobilization of a multi-level analytical framework that allows us to embrace their multiplicity and better understand their articulation. The originality of the research also lies in its historical dimension, which allows us to understand, on the scale of an institution, how a policy and practices aiming at the least recourse emerge and are consolidated. The project timeline is divided in three tasks: firstly, an inventory of "low-coercion" facilities in France; secondly, we will select and research four traditionally "low-coercion" facilities in France; thirdly we will focus on recently emerged "low-coercion" practices. PLAID-Care aims to revitalize French research on this theme which to date has been relatively lagging behind the numerous international studies. It will bring together and articulate the knowledge, tools and forms of organization and collaboration that contribute to making a policy of lesser use of coercion operational.

[Restraint in geriatrics: France's backwardness]. / Contention en gériatrie : le retard de la France.

In the absence of legal provisions, passive physical restraint methods in geriatrics were defined at the start of this century, accompanied by recommendations relating to their use. Despite the frequency of these measures of restraint, there are few French publications on this subject. It seems that this practice varies according to the geriatric establishments and prevails in hospital more than in nursing home. The most widespread method is the dual barrier on the bed, as well as in hospital than in nursing home. To this should be added restraint provided by the premises themselves, intended to secure access to a facility, found in 90% of residences for the dependent elderly, and also medication. Passive physical restraint, mainly implemented to prevent falls, has however clearly shown its deleterious effects, particularly in the USA where it is thought to be responsible for 1/1000 deaths in nursing homes, although when it is absent there appears to be no increased risk of falls. Medication-based restraint is more readily used to sedate in case of disruptive behaviors (agitation, aggressiveness) although no clear data is available to date. Restraint provided by the premises themselves, used preventively in case of wandering and straying, is nevertheless a deprivation of freedom, and seems to concern the majority of geriatric facilities today. In the absence of legislation to regulate these practices, the present authors discuss the need for ethical reflection before the implementation of measures of restraint, whatever their nature, and they propose certain ideas on possible methods for passive physical restraint: raising awareness among caregivers and family members who often call for these measures, the existence of alternative measures, and the delaying of implementation as long as possible and/or sequentially.

[Isolation and mechanical restraint in psychiatry]. / Isolement et contention mécanique en psychiatrie.

Since 2016, there has been a succession of legal texts aimed at framing the use of seclusion and mechanical restraint in psychiatric services. These legal evolutions are not without consequence on the practice of caregivers. We propose here a practical summary of this issue.

[Isolation and restraint in psychiatry: practice and feedback from professional experiences]. / Isolement et contention en psychiatrie : pratique et retours d'expériences professionnelles.

A psychiatric nurse since 2013, who became a clinical psychologist in 2022, I have had the opportunity, on numerous occasions, to use isolation and therapeutic restraint as part of my nursing practice, mainly in a closed psychiatric admissions service. These therapeutic tools, specific to psychiatry, are used in a very specific theoretical and legislative framework. Their use always leads to reflection, both individually and as a team. Indeed, their use must remain the last therapeutic bulwark to be used because it can be experienced with difficulty or even in a traumatic way by the patient, which can damage the relationship of trust with the carers. Thus, it is important that this practice be supervised and discussed with the patient and the team in order to be as appropriate as possible.

[Isolation and restraint in units for difficult patients and in psychiatric intensive care units]. / Isolement et contention en unités pour malades difficiles et en unités de soins intensifs psychiatriques.

The units for difficult patients (UMD) and the intensive psychiatric care units (Usip) are psychiatric services that are not successively sectorized, created to meet the needs of intensive care in a closed environment and sometimes of a forensic nature. These two systems are used to care for patients whose clinical condition often makes it too complex to maintain them in sector psychiatric units, and many of their operating rules differ. This is not the case for seclusion and restraint measures and the application of the law governing these measures.

[Geriatric restraints as a last resort]. / Contentions en gériatrie, dernier recours.

Relying on the remaining abilities of elderly people at home, in hospital or in residential care facilities for the dependent elderly, allows them to maintain their autonomy and avoid restraints. If geriatric caregivers observe an elderly person who is agitated, at risk of falling, or putting themselves in danger, they suggest strategies to calm the person. As a last resort, physicians may prescribe an appropriate restraint. This is a deprivation of liberty. The multidisciplinary evaluation every twenty-four hours of this care is based on the principle of beneficence by re-evaluating the prescribed device.

Enabling Energy Harvesting-Based Wi-Fi System for an e-Health Application: A MAC Layer Perspective.

The adverse impacts of using conventional batteries in the Internet of Things (IoT) devices, such as cost-effective maintenance, numerous battery replacements, and environmental hazards, have led to an interest in integrating energy harvesting technology into IoT devices to extend their lifetime and sustainably effectively. However, this requires improvements in different IoT protocol stack layers, especially in the MAC layer, due to its high level of energy consumption. These improvements are essential in critical applications such as IoT medical devices. In this paper, we simulated a dense solar-based energy harvesting Wi-Fi network in an e-Health environment, introducing a new algorithm for energy consumption mitigation while maintaining the required Quality of Service (QoS) for e-Health. In compliance with the upcoming Wi-Fi amendment 802.11be, the Access Point (AP) coordination-based optimization technique is proposed, where an AP can request dynamic resource rescheduling along with its nearby APs, to reduce the network energy consumption through adjustments within the standard MAC protocol. This paper shows that the proposed algorithm, alongside using solar energy harvesting technology, increases the energy efficiency by more than 40% while maintaining the e-Health QoS requirements. We believe this research will open new opportunities in IoT energy harvesting integration, especially in QoS-restricted environments.

An optimal monotone contention resolution scheme for bipartite matchings via a polyhedral viewpoint.

Relaxation and rounding approaches became a standard and extremely versatile tool for constrained submodular function maximization. One of the most common rounding techniques in this context are contention resolution schemes. Such schemes round a fractional point by first rounding each coordinate independently, and then dropping some elements to reach a feasible set. Also the second step, where elements are dropped, is typically randomized. This leads to an additional source of randomization within the procedure, which can complicate the analysis. We suggest a different, polyhedral viewpoint to design contention resolution schemes, which avoids to deal explicitly with the randomization in the second step. This is achieved by focusing on the marginals of a dropping procedure. Apart from avoiding one source of randomization, our viewpoint allows for employing polyhedral techniques. Both can significantly simplify the construction and analysis of contention resolution schemes. We show how, through our framework, one can obtain an optimal monotone contention resolution scheme for bipartite matchings, which has a balancedness of 0.4762. So far, only very few results are known about optimality of monotone contention resolution schemes. Our contention resolution scheme for the bipartite case also improves the lower bound on the correlation gap for bipartite matchings. Furthermore, we derive a monotone contention resolution scheme for matchings that significantly improves over the previously best one. More precisely, we obtain a balancedness of 0.4326, improving on a prior 0.1997-balanced scheme. At the same time, our scheme implies that the currently best lower bound on the correlation gap for matchings is not tight. Our results lead to improved approximation factors for various constrained submodular function maximization problems over a combination of matching constraints with further constraints.

Joint Optimization of Multi-Hop Broadcast Protocol and MAC Protocol in Vehicular Ad Hoc Networks.

Beacon messages and emergency messages in vehicular ad hoc networks (VANETs) require a lower delay and higher reliability. The optimal MAC protocol can effectively reduce data collision in VANETs communication, thus minimizing delay and improving reliability. In this paper, we propose a Q-learning MAC protocol based on detecting the number of two-hop neighbors. The number of two-hop neighbors in highway scenarios is calculated with very little overhead using the beacon messages and neighbor locations to reduce the impact of hidden nodes. Vehicle nodes are regarded as agents, using Q-learning and beacon messages to train the near-optimal contention window value of the MAC layer under different vehicle densities to reduce the collision probability of beacon messages. Furthermore, based on the contention window value after training, a multi-hop broadcast protocol combined with contention window adjustment for emergency messages in highway scenarios is proposed to reduce forwarding delay and improve forwarding reliability. We use the trained contention window value and the state information of neighboring vehicles to assign an appropriate forwarding waiting time to the forwarding node. Simulation experiments are conducted to evaluate the proposed MAC protocol and multi-hop broadcast protocol and compare them with other related protocols. The results show that our proposed protocols outperform the other related protocols on several different evaluation metrics.

[Attitude of psychiatrists and psychiatry residents in Lebanon towards restraint and informed consent]. / Attitude des psychiatres et internes en psychiatrie au Liban vis-à-vis de la contention et du consentement éclairé.

OBJECTIVES: Psychiatry differs from the rest of medical specialties by the unique character of its pathologies, which makes ethical reflection difficult, including the collection of informed consent and the use of restraint and the seclusion-room. This reflection can be affected by subjectivity and a variety of influences, hence the interest of studying the attitude of psychiatrists and residents in psychiatry in Lebanon with regard to restraint and informed consent. METHODS: We collected data using an anonymous questionnaire that we sent as a Google form to Lebanese psychiatrists and psychiatry residents by email and phone messages. The descriptive analysis was done using Microsoft Excel software, and the analytical analysis was done using the SPSS software and the following statistical tests: independent-sample test and the Mann Whitney U test. RESULTS: Forty people responded, including 19 men and 21 women (16 psychiatric interns, 15 university psychiatrists and 9 non-university psychiatrists). Concerning the questions related to the use of restraint, 70% did not find that it is being commonly used in hospital practice. However, 92.5% would use it to counter the patient's dangerousness and 60% to help deliver treatment. 57.5% did not find the repeated usage of restraint as a dehumanization of care, but the majority (70%) agreed with the need for temporal limitation of any form of restraint. As for the ability to consent, 90% considered a patient in a psychotic state as unfit to consent. CONCLUSIONS: Restraint is considered uncommon by psychiatrists and psychiatric residents in Lebanon and must remain an option of last resort with efforts being made upstream in order to avoid situations where the use of restraint becomes mandatory. Post critical thinking is paramount, and restraint should never respond to a lack of manpower or a security goal. Informed consent is one of the most important guarantors of the principle of autonomy, and must be sought in each patient, individually. Finally, no significant difference was found between the subgroups, which would therefore become a single population. Ethical reflection would therefore be directly linked to the population. Mental illnesses are becoming more common and an important source of morbidity worldwide. It is our role to ensure the dignity of the mentally ill. The introduction of the Psychiatric Nurse Diploma, an increase in the relational approach to the training of psychiatrists in Lebanon, and an increase in the number of health care teams may help to maximize the ability of capacity.

[Freedom and constraint of the ambulatory patient]. / Liberté et contrainte du patient qui déambule.

The use of physical, as well as chemical, restraints is subject to a medical prescription. It is a medical decision, most often fortunately made as a team. Responsibilities are involved when it is implemented. It is necessary to know them, as well as it is essential to know the alternatives. A study of the caring perception of restraint of hospitalized patients with neurocognitive disorders and excessive ambulation has been carried out. Thus, an ethical approach would make it possible to adopt a fairer approach taking into account the notions of individual and collective freedom, safety and risk.

[Physical restraint of the adult patient with uncontrollable agitation]. / Contention physique du patient adulte présentant une agitation incontrôlable.

In the context of psychiatric emergencies, it is important to distinguish between so-called controllable agitation and uncontrollable agitation. In this context, physical restraint of the adult patient is sometimes necessary, but remain an exceptional measure. Restraints must be applied rapidly and in a protocolised manner. It should be used sparingly in the elderly patient. Physical restraint is a medical prescription that must be accompanied by chemical restraint.

A Smart Band for Automatic Supervision of Restrained Patients in a Hospital Environment.

Mechanical contention (MC) is a restrictive, vital but controversial measure, prescribed in the majority of EU countries to handle patients with psycho-motor agitation that do not respond to other types of intervention, with an imminent risk of physical violence and aggression involved. This last resort approach implies risks for the somatic health of the contained individual that go from trauma injuries to, in some extreme cases, sudden death. Despite these risks, somatic supervision and the monitoring of patients under MC is limited, being periodically and manually carried out by nursing personnel with portable equipment. In this context, ensuring continuous monitoring using fully automated equipment is an uncovered yet urgent need. There are several devices already in the market capable of monitoring vital signs, but they are not specifically designed for these type of patients and they can be expensive and/or difficult to integrate with other systems from a software perspective. The work described in this paper gives answers to these necessities with the introduction of a low-cost system, targeted at psychiatric patients, for the acquisition and wireless transmission in real-time of physiological parameters, making use of micro-controllers for collecting and processing sensor data, and WiFi technology to upload the information to the server where a patient's profile with all the relevant vital parameters resides. In addition to data collection and processing, an application aimed at use by nursing staff has also been developed to raise alerts in case any critical condition is detected.

A Novel Energy-Efficient Contention-Based MAC Protocol Used for OA-UWSN.

A hybrid optical-acoustic underwater wireless sensor network (OA-UWSN) was proposed to solve the problem of high-speed transmission of real-time video and images in marine information detection. This paper proposes a novel energy-efficient contention-based media access control (MAC) protocol (OA-CMAC) for the OA-UWSN. Based on optical-acoustic fusion technology, our proposed OA-CMAC combines the postponed access mechanism in carrier sense multiple access with collision avoidance (CSMA/CA) and multiplexing-based spatial division multiple access (SDMA) technology to achieve high-speed and real-time data transmission. The protocol first performs an acoustic handshake to obtain the location information of a transceiver node, ensuring that the channel is idle. Otherwise, it performs postponed access and waits for the next time slot to contend for the channel again. Then, an optical handshake is performed to detect whether the channel condition satisfies the optical transmission, and beam alignment is performed at the same time. Finally, the nodes transmit data using optical communication. If the channel conditions do not meet the requirements for optical communication, a small amount of data with high priority is transmitted through acoustic communication. An evaluation of the proposed MAC protocol was performed with OMNeT++ simulations. The results showed that when the optical handshaking success ratio was greater than 50%, compared to the O-A handshake protocol in the literature, our protocol could result in doubled throughput. Due to the low energy consumption of optical communication, the node's lifetime is 30% longer than that of pure acoustic communication, greatly reducing the network operation cost. Therefore, it is suitable for large-scale underwater sensor networks with high loads.

A Contention-Based Hop-By-Hop Bidirectional Congestion Control Algorithm for Ad-Hoc Networks.

Existing hop-by-hop congestion control algorithms are mainly divided into two categories: those improving the sending rate and those suppressing the receiving rate. However, these congestion control algorithms have problems with validity and limitations. It is likely that the network will be paralyzed due to the unreasonable method of mitigating congestion. In this paper, we present a contention-based hop-by-hop bidirectional congestion control algorithm (HBCC). This algorithm uses the congestion detection method with queue length as a parameter. By detecting the queue length of the current node and the next hop node, the congestion conditions can be divided into the following four categories: 0-0, 0-1, 1-0, 1-1 (0 means no congestion, 1 means congestion). When at least one of the two nodes is congested, the HBCC algorithm adaptively adjusts the contention window of the current node, which can change the priority of the current node to access the channel. In this way, the buffer queue length of the congested node is reduced. When the congestion condition is 1-1, the hop-by-hop priority congestion control (HPCC) method proposed in this paper is used. This algorithm adaptively changes the adjustment degree of the current node competition window and improves the priority of congestion processing of the next hop node. The NS2 simulation shows that by using the HBCC algorithm, when compared with distributed coordination function (DCF) without congestion control, the proposed unidirectional congestion control algorithms hop-by-hop receiving-based congestion control (HRCC) and hop-by-hop sending-based congestion control (HSCC), and the existing congestion control algorithm congestion alleviation-MAC (CA-MAC), the average saturation throughput increased by approximately 90%, 62%, 12%, and 62%, respectively, and the buffer overflow loss ratio reduced by approximately 80%, 79%, 44%, and 79%.

[Seclusion and restraint: From prescription to decision]. / Isolement et contention : de la prescription à la décision.

Psychiatric care has always included patients in crisis who are potentially dangerous or agitated. Faced with the many issues they may encounter, the therapeutic relationship has always been prioritized over all other considerations. However, the practice of seclusion and restraint has been steadily increasing in the past few decades. Their use is becoming customary rather than exceptional and consequently fosters less thought by the care teams. In the Healthcare System Modernization Act of January 26th, 2016, the lawmakers sought to underline the freedom-destroying nature of these practices and the necessity of their regulation. This law represents a fundamental change in the nature of seclusion and restraint. What was but a simple prescription becomes a conscious decision of depriving someone of her or his freedom and must only be considered as a last resort. The changes in the Law and the recent changes in the recommendations for clinical practice by the French National Institute of Health invite reflection. Many questions remain about the origins of violence, the reasons for the increasing use of seclusion and restraint measures, and the alternatives that have been developed. Many theories suggest that the less stressful and constrained an environment is, the more empowered the patient will be. He is an actor in his own care and is considered a full active participant. The Law is reconciled with caregivers initiating a reflection on the benefits of these measures regarding the violation of fundamental freedoms. Reflection on psychiatric care and the quality of its management must be the focus when caring for patients in crisis.

Preliminary Biochemical Description of Brain Oxidative Stress Status in Irritable Bowel Syndrome Contention-Stress Rat Model.

Background and objectives: Oxidative stress and inflammation have been implicated in the etiology of irritable bowel syndrome (IBS), a common gastrointestinal functional disease. This study aimed to further characterize the contention-stress rat model by exploring a possible correlation between oxidative stress markers measured in brain tissues with behavioral components of the aforementioned model. Thus, it is hereby proposed a possible IBS animal model relevant to pharmacological and complementary medicine studies. Materials and Methods: Wild-type male Wistar rats (n = 5/group) were chronically exposed to 6-hour/day contention, consisting of isolating the animals in small, vital space-granting plastic devices, for seven consecutive days. Following contention exposure, temporal lobes were extracted and subjected to biochemical analyses to assess oxidative stress-status parameters. Results: Our results show increased brain oxidative stress in contention-stress rat model: decreased superoxide dismutase and glutathione peroxidase activities and increased malondialdehyde production in the IBS group, as compared to the control group. Furthermore, the biochemical ratios which are used to evaluate the effectiveness of an antioxidant system on oxidative stress could be described in this model. Conclusions: The correlations between the behavioral patterns and biochemical oxidative stress features could suggest that this may be a complex model, which can successfully mimic IBS symptomatology further providing evidence of a strong connection between the digestive system, enteric nervous system, and the central nervous system.

[Reduction of restraint, an innovative program]. / Réduction de la contention, un programme innovant.

The German group Peter Janssen initiated a 2-year common program to reduce restraint use in 12 retirement homes. This article relates the different steps of this program: diagnosis, analysis of caregivers' representations of bedrails, action plan, results, limits, and prospects.