Use of physical restraints in rehabilitation settings: staff knowledge, attitudes and predictors.

AIM: This paper reports a study examining the knowledge, attitudes and practices of staff with regard to the use of restraints in rehabilitative settings, and quantifying the direct and indirect effects of the factors that influenced these practices. BACKGROUND: Nursing staff hold many misconceptions that support the continued use of physical restraints as a desirable technique in clinical settings to control clients. A number of previous studies measuring the knowledge, attitudes and/or practices of nursing staff towards the use of restraints have been conducted in acute, elder care, or psychiatric settings. However, not many have examined the predictors of staff practices when restraints are applied. In the study reported here, physical restraint was defined as any manual method or physical/mechanical device, material or equipment attached to a client's body so that their free movement was restricted. METHODS: A questionnaire was administered to 168 nursing staff in two rehabilitation centres in Hong Kong. The data were collected in 2002-2003 and the response rate was 80%. FINDINGS: Inadequate knowledge and negative attitudes on the use of restraints were found among staff. Most believed that good alternatives to restraints are not available, or they underestimated the physical and psychological impact of restraints on clients. Path analysis indicated that staff attitudes and their clinical experiences had positive direct effects on restraint use. In addition, level of knowledge and clinical experience had a positive indirect effect on practice by influencing attitudes. CONCLUSION: These data could serve as a basis for re-educating nursing staff on the subject. Staff with more clinical experience could give appropriate guidance to other members of staff on decisions to apply restraints. More effective alternative interventions to restraining clients should be explored. Once the gaps in knowledge are closed, more positive attitudes among staff towards the use of restraints can be cultivated, thus leading to a higher standard of nursing practice.

The cytotoxic and genotoxic potential of 5-aminolevulinic acid on lymphocytes: a comet assay study.

BACKGROUND: 5-aminolevulinic acid (ALA) and its hexylester (ALA-H) are the drugs currently used in photodynamic therapy (PDT). The side effect, especially the long-term side effect of these drugs is a problem of concern in this field, which has not been clearly understood yet. PURPOSE: The normal lymphocytes and nasopharyngeal carcinoma (NPC) cells were used as the cell models to evaluate the side effects of ALA or ALA-H in the absence of light or under sub-lethal doses of light. METHODS: The cytotoxic and DNA-damaging effects of ALA or ALA-H on lymphocytes and NPC cells were studied by means of the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and the alkaline comet assay. ALA at 0.75 mM concentration and ALA-H at 10-microM concentrations were selected in the studies. This is because under these concentrations, ALA- or ALA-H-mediated PDT can destroy most NPC cells in vitro. The intracellular distributions of the protoporphyrin IX (PpIX), induced by the ALA or ALA-H, were measured by the confocal laser scanning microscope to provide more information for understanding the DNA damage. RESULTS: The incubation of 0.75 mM ALA or 10 microM ALA-H alone (without light) did not cause DNA damage as well as the considerable cytotoxic effect on NPC cells. However, after ALA (0.75 mM) incubation and without light irradiation, the serious cytotoxicity and remarkable DNA damage were found in lymphocytes. When the lymphocytes were incubated with ALA-H (10 microM) alone (in the absence of light), no DNA damage could be detected and a slight cytotoxic effect was found. Both ALA and ALA-H induced PpIX in the lymphocytes. The fluorescence images of PpIX intracellular localization demonstrated that the PpIX diffused into the nuclear region in ALA-(0.75 mM)-incubated lymphocytes but not existed in the nucleus of ALA-H(10 microM)- incubated lymphocytes, providing an explanation for the facts that ALA (0.75 mM) induced the DNA damage while ALA-H (10 microM) did not. CONCLUSION: These results suggested that the genotoxic potential of lymphocytes seems high for ALA (0.75 mM) and could be excluded for ALA-H (10 microM).

Behavioural, emotional and family functioning of hospitalized children in China and Hong Kong.

PURPOSE: This study examined behavioural and emotional problems, social competence and family functioning of hospitalized Chinese children in Hong Kong and the Chinese Mainland. METHOD: A sample of 210 hospitalized children (ages 2-11 years) and their families participated in the study. The families were from a cross-section of geographical areas in Hong Kong (two hospitals) and the Chinese Mainland (five hospitals). Parents completed an age-appropriate Chinese version of the Child Behaviour Checklist and the Family Assessment Device. Multiple regression models were used to examine predictors of children's behaviour problems. RESULTS: Behavioural patterns appeared to be specific to the developmental stage. Children had greater problems when their families demonstrated poorer affective involvement. Hospitalized children on the Chinese Mainland experienced more internalizing and externalizing behaviour problems than those in Hong Kong. Sick children, according to their parents, however, demonstrate some resiliency based on social and academic competency factors. CONCLUSIONS: Hospitalized Chinese children manifest behavioural, emotional and family problems that vary by region, the child's development and gender. Problems predominantly of an internalizing nature characterized this group. The findings support the need for culturally appropriate behavioural assessments and interventions with hospitalized children.

The psychometric properties of Chinese pain intensity verbal rating scale.

BACKGROUND: This study investigates the validity and reliability of the Chinese pain intensity verbal rating scale (C-PIVRS). METHODS: This is a correlational comparative study. Fifty Chinese adults were recruited by convenience. A pain source generator (precision pain source, PPS-3) was used to produce four levels of mechanical pain stimuli (350, 550, 750 and 950 g). The pain stimuli were applied to subjects' interphalangeal joints in random sequences to stimulate sensation of pain. The subjects then rated their pain intensity using both the C-PIVRS and the visual analog scale (VAS) for each stimulus. The pain scores obtained from the C-PIVRS were compared with the VAS for satisfactory level of reliability and validity. Test and re-test were applied to verify consistency between the two pain scales. RESULTS: The test/re-test correlation coefficients between the two pain scales were r = 0.92 (P < 0.001) and r = 0.91 (P < 0.001), respectively. This showed a good positive correlation. The intra-class correlation (ICC) ranged from 0.78 to 0.90, which indicated good reliability. In the factor analysis, a single factor emerged in each analysis. The first eigen values of each matrix were 3.42, 3.24, 3.17 and 3.29 for each level of pain stimulation. This indicated that both pain scales were assessing the same pain dimension. CONCLUSIONS: The two pain scales have a comparable level of reliability and validity for assessing pain intensity in Chinese adults.

The long-term effects of auricular therapy using magnetic pearls on elderly with insomnia.

OBJECTIVE: To examine the long-term effect of auricular therapy using magnetic pearls administered for the elderly suffering from insomnia. DESIGN: A follow-up study after a randomized controlled trial. SETTINGS: Four hostels for the elderly in Hong Kong. INTERVENTIONS: This paper focuses on reporting the long-term effect of auricular therapy using magnetic pearls in the experimental group of a randomized controlled study. Fifteen volunteer participants were followed up at 1-, 3-, and 6-month intervals after a 3-week treatment course. OUTCOME MEASURES: Objective sleep parameters using actigraphic monitoring were collected at different intervals of time after the therapy. RESULTS: Results of RANOVA demonstrate that there was a significant difference of nocturnal sleep time (F(2.30,29.90)=3.63, P<0.05) and marginally differences of sleep efficiency (F(4,52)=2.52, P=0.05) at baseline, immediately after the therapy, and at the three time intervals at 1, 3 and 6 months. The results illustrate that the mean nocturnal sleep time (F=4.95, P=0.30, R(2)=0.91) and the mean sleep efficiency (F=13.50, P=0.19, R(2)=0.96) also remained constant over the 6-month follow up period. The results of least square polynomial regression analysis also illustrate that the mean NST (F=4.95, P=0.30, R(2)=0.91) and the mean sleep efficiency (F=13.50, P=0.19, R(2)=0.96) remained constant over the 6-month follow up period. CONCLUSION: The results of this follow up study indicate that auricular therapy using magnetic pearls could have a long-term effect, at least within the observed period of time, on improving the quality as well as the quantity of sleep among the elderly.

Prevalence and related risk factors of areca quid chewing among junior high students in eastern Taiwan.

Areca quid chewing is a serious problem in eastern Taiwan. The prevalence and related risk factors of areca quid chewing among junior high students were studied. Group 1 consisted of 896 non-aboriginal students and group 2 of 565 aboriginal students. The students were asked to fill out a questionnaire anonymously. Among the non-aboriginal students, 2.2% were found as current areca quid chewers, 16.4% had tried but not become regular users, and 2.2% had used it regularly and quit, whereas 9.7% of aboriginal students were current chewers, and 32.7% had tried it but had not become regular users, and 7.4% had used it regularly and quit. The prevalence of areca chewing is significantly different between boys and girls in the non-aboriginal group. A logistic regression analysis indicated that a non-aboriginal student who is a male, grows areca at home, is a tobacco smoker, an alcohol drinker, and has family members and close friends as chewers is more likely to chew areca quid than others. Aboriginal students who are chewers are likely to grow areca at home, are tobacco smokers and alcohol drinkers, and have family members and close friends as chewers. Based on the findings of the study, the need for a health promotion program was identified. Areca quid is not only detrimental to people's health, but also to the environment in which people live.