The use of mechanical restraint in critical care units: Characterisation, application standards and related factors. Results of a multicentre study.

OBJECTIVES: To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement. METHOD: Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals). RESULTS: A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = -.431) and in the subgroup of patients with ETT (r = -.521). CONCLUSIONS: Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.

Prevalence of scleroderma in Spain: an approach for estimating rare disease prevalence using a disease model.

PURPOSE: To estimate scleroderma prevalence in Spain. METHODS: As no data were available for Spain we used reported scleroderma incidence (Silman's study on UK and Alamanos' on Greece), scleroderma cause-specific mortality, obtained through the National Institute of Statistics (codes included in M34 of the International Classification of Diseases, 10th revision) in Spain and remission data. Estimates were applied to the Spanish population and to all-cause mortality for 2004, broken down by age group and gender. Estimators were assumed to follow a Poisson distribution. DisMod-II software was used for this purpose. RESULTS: Estimated prevalence was 0.23 and 0.71 cases per 10,000 people for men and women, respectively, based on UK incidence, and 0.28 and 2.58 cases per 10,000 people, respectively, based on Greek incidence. Estimated age at disease onset ranged from 50 to 58 years among men and from 52 to 55 among women, according to UK and Greek data, respectively. Mean duration of the disease was estimated to be in the range of 17-20 years for men and 19-20 for women. CONCLUSIONS: DisMod-II is useful for obtaining, modelling and confirming variability ranges of prevalence found in literature. It also provides information for orphan drug designation and for supporting public health decisions regarding rare diseases.

Autism, the big unkown.

Autism is a common disorder of childhood. Yet, it often remains unrecognized and undiagnosed until or after late preschool age because appropriate tools for routine developmental screening and screening specifically for autism have not been available. Paediatricians have an important role in early recognition and evaluation of autism spectrum disorders because they usually are the first point of contact for parents. It is important that paediatricians are able to recognize the signs and symptoms of autism spectrum disorders and have a strategy for assessing them systematically. But paediatricians have also a role in chronic management of these disorders. The objective of this paper is to show a general view of the autism spectrum disorders (ASD) state of knowledge nowadays as well to stress the need of early detection and treatment of these disorders in order to improve better evolution and prognosis.

[Review of ethical aspects in biomedical research. The experience of the Ethics Committee of the Center for Toxic Oil Syndrome and Rare Diseases [CISATER]]. / Revisión de los aspectos éticos en la investigación biomédica: la experiencia del Comité de Etica del Centro de Investigación sobre el Síndrome del Aceite Tóxico y Enfermedades Raras (CISATER).

This Field Note aims to make known the decisions taken by the Ethics Committee of the Instituto de Salud Carlos III for Toxic Oil Syndrome regarding the secondary use of research specimens in biological research when informed consent is lacking. This is a common concern in the field of biomedical research. After debating the ethical suitability of the secondary use of these samples, our main conclusion is that researchers conducting prospective studies should expressly solicit written informed consent from participants in the study about i) whether there will or could be any secondary use of the samples and, if so, ii) whether such secondary use would be conditional on the type of research.

[Work-related stress (demand-control-social support model) and health alterations: a review of the existing evidence]. / Estrés relacionado con el trabajo (modelo de demanda-control-apoyo social) y alteraciones en la salud: una revisión de la evidencia existente.

OBJECTIVE: To summarize the results obtained from epidemiological studies on the association of occupational stress and the development of illness in nurses or female population. METHODS: A descriptive review has been performed on studies published between 1979 and 2005 in which the Demand-Control-Social Support (DCS) model was used. Key words were focused on the DCS model and Occupational Health. The search was carried out using Medline (Pubmed), CINHAL, PsycINFO, and CUIDEN. RESULTS: A total of 36 articles were found. In 18 (50%) the study populations were nurses or workers in health areas. There is little evidence of the relationship between work-related stress and its repercussion on health. This could be justified because of the limited number of these longitudinal studies and the differences in the analysis of the model dimensions. CONCLUSIONS: The review of the literature does not offer consistent results. Longitudinal studies with longer follow-up periods that would make it possible to study the maintained effect of the exposure on health are needed.