Factors Associated With Physical Restraints in a Psychiatric Unit in Japan: a Retrospective Study.

OBJECTIVE: To identify factors associated with the use and duration of physical restraint (PR) in a psychiatric unit in Japan. METHODS: Medical records of 1308 patients admitted first time to the psychiatric emergency unit of Showa University Northern Yokohama Hospital between 1 January 2014 and 31 December 2021 were retrospectively reviewed. Data collected included patient age, sex, outpatient treatment, living arrangements, disability pension status, diagnosis (based on ICD-10), and psychotropic medication use at admission (chlorpromazine equivalent dose, imipramine equivalent dose, diazepam equivalent dose, and number of mood stabilisers administered). Logistic regression analysis and multiple regression analysis were used to identify factors associated with the use and duration of PR, respectively. RESULTS: Of 1308 patients, 399 (30.5%) were subjected to PR and 909 (69.5%) were not. Among the 399 patients subjected to PR, 54 were excluded from the multiple regression analysis for duration of PR as they remained subject to PR on the day of discharge. The remaining 345 patients were subject to PR for a median of 10 days. PR utilisation was associated with male sex (odds ratio [OR] = 1.420), treatment at our hospital (OR = 0.260), treatment at other hospitals (OR = 0.645), F3 diagnosis (depression) [OR = 0.290], F4-9 diagnosis (OR = 0.309), and imipramine equivalent dose at admission (unit OR = 0.994). The log-transformed duration of PR was independently associated with the age group of 50 to 69 years (ß = 0.248), the age group of ≥70 years (ß = 0.274), receiving a disability pension (ß = 0.153), an F1 diagnosis (ß = -0.187), an F4-9 diagnosis (ß = -0.182), chlorpromazine equivalent dose at admission (ß = 0.0004), and number of mood stabilisers administered at admission (ß = -0.270). CONCLUSION: Identifying factors associated with the use and duration of PR may lead to reduction in the use and duration of PR.

Samarium(III)-propylenediaminetetraacetate complex: A water-soluble chiral shift reagent for use in high-field NMR

Samarium(III)-(R)- or (S)-propylenediaminetetraacetate complex resolved the enantiomer signals of alpha-amino acids on high-field (1)H and (13)C NMR with remarkably less line broadening than was previously reported for the Eu(III) complex of the same ligand. A widely observed regularity between the absolute configuration of enantiomers and the relative shift of their NMR signals is useful for the assignment of absolute configuration.

Characterization of very virulent Marek's disease viruses isolated in Japan.

Pathogenicity of two isolates of Marek's disease virus (MDV), MS1 and MS2, from chickens was examined in two genetically different strains of chickens, MD-susceptible P-2 chickens and less susceptible PDL-1 chickens. The isolates induced an early mortality syndrome unassociated with lymphoproliferative lesions in P-2 chickens. There were no significant differences in pathogenicity between our isolates and the Md/5 strain of very virulent MDV (vvMDV) in both P-2 and PDL-1 chickens. Protective indices of turkey herpes virus (HVT) vaccine against challenge with MS1 or MS2 in P-2 chickens were 54% and 28%, respectively, whereas HVT gave more than 80% protection in PDL-1 chickens. These results indicate that the two isolates could be classified as vvMDV. In contrast, a bivalent vaccine composed of HVT and serotype 2 MDV, and CVI988 vaccine gave good protection against challenge with the isolates in P-2 chickens; however, the best protection was given by the CBI988 vaccine. This is the first report of isolation of vvMDV in Japan.

[Hospice care and the treatment of cancer pain].

The history of hospice care in Great Britain was first introduced, and the pioneer work carried out by the founder of the modern hospice care, Dame Cicely Saunders was briefly described. The first duty of the hospice to patients with terminal cancer is to eliminate physical pain, especially intractable severe pain, which may deteriorate the quality of the patient's life. For this purpose, morphine and its derivatives should be the panacea of choice, although it is of importance to initially determine the appropriate, i.e. completely analgesic level combined with euphoria and anxiolysis, then to maintain this level continuously without somnolence or other dysphoric effects. The dose differs quite markedly according to each patient and the severity of pain. To maintain the level of analgesia, the oral use of morphine at four-hour internals is required, or continuous hypodermic administration by means of a syringe driver is quite ideal. In Japan, the use of diamorphine (heroin) is strictly forbidden, and therefore, a non-narcotic and potent analgesic morphine antagonists, e.g. buprenorphine (Lepetan) has been used by continuous hypodermic administration with a syringe driver by Umeda et al. of Kyoto University Hospital, at a dose of 4-8 micrograms/kg of body weight/day with favorable results. Hospice care should now be considered to be a new concept of medical treatment or a new medical field which must include not only the patient himself with incurable malignant disease but also his family or relatives in considering the target of treatment and care, in order to improve the quality of the patient's life even though shortened by the malignancy.