Part 1. Chemical and Physical Restraints in the Management of Mechanically Ventilated Patients in the ICU: Contributing Factors

Chemical and physical restraints are frequently used in the intensive care unit (ICU) to control agitated patients and to prevent self-harm and unplanned extubations. Published work relating to the numerous issues of the care and treatment strategies for these patients remains conflicting and unclear. Literature regarding sedation and chemical restraint reveals a trend towards management with lighter sedation, use of sedation assessment tools and sedation protocols. It remains unclear which treatment is best for agitated and delirious patients, and the evidence on the effect of sedation is conflicting. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. The purpose of this paper is to provide a summary of the existing literature on the use of physical and chemical restraints in the ICU setting. In Part 1 of this two-part paper, the evidence on chemical and physical restraints is explored with specific focus on definition of terms, unplanned

Part 2. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: A patient perspective

An important goal of the care for the mechanically ventilated patient is to minimize patient discomfort and anxiety. This is partly achieved by frequent use of chemical and physical restraints. The majority of patients in intensive care will receive some form of sedation. The goal and use of sedation has changed considerably over the past few decades with literature evidencing trends toward overall lighter sedation levels and daily interruption of sedation. Conversely, the use of physical restraint for the ventilated patient in ICU differs considerably between nations and continents. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. Recent literature suggests minimal use of physical restraint in the ICU, and that reduction programmes have been initiated. However, very few papers illuminate the patient's experience of physical and chemical restraints as a treatment strategy. In Part 1 of this two-part review, the evidence on chemical and physical restraints was explored with specific focus on definitions of terms, unplanned extubation, agitation, delirium as well as the impact of nurse–patient ratios in the ICU on these issues. This paper, Part 2, examines the evidence related to chemical and physical restraints from the mechanically ventilated patient's perspective.

Capital music : personal expression with a public display of song choice

Using information and communication technology devices in public urban places can help to create a personalised space. Looking at a mobile phone screen or listening to music on an MP3 player is a common practice avoiding direct contact with others e.g. whilst using public transport. However, such devices can also be utilised to explore how to build new meaningful connections with the urban space and the collocated people within. We present findings of work-in-progress on Capital Music, a mobile application enabling urban dwellers to listen to music songs as usual, but also allowing them to announce song titles and discover songs currently being listened to by other people in the vicinity. We study the ways that this tool can change or even enhance people’s experience of public urban spaces. Our first user study also found changes in choosing different songs. Anonymous social interactions based on users’ music selection are implemented in the first iteration of the prototype that we studied.

Music is a Wordless Knowing of Others : Resilience in Virtual Ensembles

Music making affects relationships with self and others by generating a sense of belonging to a culture or ideology (Bamford, 2006; Barovick, 2001; Dillon & Stewart, 2006; Fiske, 2000; Hallam, 2001). Whilst studies from arts education research present compelling examples of these relationships, others argue that they do not present sufficiently validated evidence of a causal link between music making experiences and cognitive or social change (Winner & Cooper, 2000; Winner & Hetland, 2000a, 2000b, 2001). I have suggested elsewhere that this disconnection between compelling evidence and observations of the effects of music making are in part due to the lack of rigor in research and the incapacity of many methods to capture these experiences in meaningful ways (Dillon, 2006). Part of the answer to these questions about rigor and causality lay in the creative use of new media technologies that capture the results of relationships in music artefacts. Crucially, it is the effective management of these artefacts within computer systems that allows researchers and practitioners to collect, organize, analyse and then theorise such music making experiences.

Voices of the Unheard

Adversity has the effect of eliciting talents, which, in prosperous circumstances, would have lain dormant. Horace - Roman lyric poet and satirist 65BC – 8 BC This quotation from Horace could well be the chorus to a medley of songs sung by people who face extraordinary adversity and have gained emotional resilience through music making. In this chapter we present three composition ventures that are stories or verses in a new song and whose chorus summarises the nature of the resilience factors present in the narratives. We are aware that words on a page like this can have the effect of filtering out the engaging nature of musical experience and reduce music to a critique or an evaluation of its aesthetic value. This disjuncture between language and the ephemeral, embodied experience is a problem for those who use these creative processes in therapeutic and salutogenic ways (Antonovsky, 1996) for public health. The notion of salutogenic health, put simply, delineates it from therapy in that the processes focus upon wellness rather than therapy. Whilst we include evidence from the fields of community music therapy (Pavlicevic, 2004; Leitschuh et al., 1991), neuroscience (Bittman et al., 2001) and community music (Bartleet et al., 2009) the framework for a salutogenic health outcome in community music is one which seeks to employ music practices and the qualities of music making that provide positive health benefit to communities –to enhance health and well being rather than the “treatment” of disorders. It is essentially a holistic and interdisciplinary study. Therapy and salutogenic health are not mutually exclusive as both depend upon the qualities of music experience to affect change. Collecting, analysing and presenting evidence of change in human behaviour that can be directly attributed to creative music making is a problem of evaluation.

Queensland Aborigines, multiple realities and the social sources of suffering. Part 2: Suicide, spirits and symbolism

This is the second part of a paper that explores a range of magico-religious experiences such as immaterial voices and visions, in terms of local cultural, moral and socio-political circumstances in an Aboriginal town in rural Queensland. This part of the paper explores the political and cultural symbolism and meaning of suicide. It charts the saliency of suicide amongst two groups of kin and cohorts and the social meaningfulness and problematic of the voices and visions in relation to suicide, to identity and family forms and to funerals and a heavily drinking lifestyle. I argue that voices and visions are used to reinterpret social experience and to establish meaning and that tragically suicide evokes connectivity rather than anomie and here cannot be understood merely as an individualistic act or evidence of individual pathology. Rather it is about transformation and crossing a threshold to join an enduring domain of Aboriginality. In this life world, where family is the highest social value and where a relational view of persons holds sway, the individualistic practice of psychiatric and other helping professions, is a considerable problem.

Songs of Resilience

The chapters of this book form a persuasive chorus of social practices that advocate the use of music to build a capacity for resilience in individuals and groups. As a whole they exemplify music projects that share common features aligned with an ecological view of reform in health, education and social work systems. Internationally renowned and early career academics have collaborated with practitioners to sing ‘Songs of Resilience’; some of which are narratives that report on the effects of music practices for a general population, and some are based on a specific approach, genre or service. Others are quite literally ‘songs’ that demonstrate aspects of resilience in action. The book makes the connection between music and resilience explicit by posing the following questions—Do music projects in education, health and social services build a measurable capacity for resilience amongst individuals? Can we replicate these projects’ outcomes to develop a capacity for resilience in diverse cultural groups? Does shared use of the term ‘resilience’ help to secure funding for innovative musical activities that provide tangible health, education and social outcomes?

A review of rationale for allocating costs and payments in producing and supplying public sector information PART A of 2 Parts – Chapters 1, 2 and 3) 13 March 2011 version

This work reviews the rationale and processes for raising revenue and allocating funds to perform information intensive activities that are pertinent to the work of democratic government. ‘Government of the people, by the people, for the people’ expresses an idea that democratic government has no higher authority than the people who agree to be bound by its rules. Democracy depends on continually learning how to develop understandings and agreements that can sustain voting majorities on which democratic law making and collective action depends. The objective expressed in constitutional terms is to deliver ‘peace, order and good government’. Meeting this objective requires a collective intellectual authority that can understand what is possible; and a collective moral authority to understand what ought to happen in practice. Facts of life determine that a society needs to retain its collective competence despite a continual turnover of its membership as people die but life goes on. Retaining this ‘collective competence’ in matters of self-government depends on each new generation: • acquiring a collective knowledge of how to produce goods and services needed to sustain a society and its capacity for self-government; • Learning how to defend society diplomatically and militarily in relation to external forces to prevent overthrow of its self-governing capacity; and • Learning how to defend society against divisive internal forces to preserve the authority of representative legislatures, allow peaceful dispute resolution and maintain social cohesion.

The Brisbane Cordon scheme : part A - preliminary investigation

It could be said that road congestion is one of the most significant problems within any modern metropolitan area. For several decades now, around the globe, congestion in metropolitan areas has been worsening for two main reasons. Firstly, road congestion has significantly increased due to a higher demand for road space because of growth in populations, economic activity and incomes (Hensher & Puckett, 2007). This factor, in conjunction with a significant lack of investment in new road and public transport infrastructure, has seen the road network capacities of cities exceeded by traffic volumes and thus, resulted in increased traffic congestion. This relentless increase in road traffic congestion has resulted in a dramatic increase in costs for both the road users and ultimately the metropolitan areas concerned (Bureau of Transport and Regional Economics, 2007). In response to this issue, several major cities around the world, including London, Stockholm and Singapore, have implemented congestion-charging schemes in order to combat the effects of road congestion. A congestion-charging scheme provides a mechanism for regulating traffic flows into the congested areas of a city, whilst simultaneously generating public revenue that can be used to improve both the public transport and road networks of the region. The aim of this paper was to assess the concept of congestion-charging, whilst reflecting on the experiences of various cities that have already implemented such systems. The findings from this paper have been used to inform the design of a congestion-charging scheme for the city of Brisbane in Australia in a supplementary study (Whitehead, Bunker, & Chung, 2011). The first section of this paper examines the background to road congestion; the theory behind different congestion-charging schemes; and the various technologies involved with the concept. The second section of this paper details the experiences, in relation to implementing a congestion-charging scheme, from the city of Stockholm in Sweden. This research has been crucial in forming a list of recommendations and lessons learnt for the design of a congestion-charging scheme in Australia. It is these recommendations that directly inform the proposed design of the Brisbane Cordon Scheme detailed in Whitehead et al. (2011).

The Brisbane Cordon scheme : part B - investigation into feasibility and effects

As detailed in Whitehead, Bunker and Chung (2011), a congestion-charging scheme provides a mechanism to combat congestion whilst simultaneously generating revenue to improve both the road and public transport networks. The aim of this paper is to assess the feasibility of implementing a congestion-charging scheme in the city of Brisbane in Australia and determine the potential effects of this initiative. In order to so, a congestion-charging scheme was designed for Brisbane and modelled using the Brisbane Strategic Transport Model with a base line year of 2026. This paper argues that the implementation of this initiative would prove to be effective in reducing the cities road congestion and increasing the overall sustainability of the region.

The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : Part 1 (New South Wales)

This is the first article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in New South Wales. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training medical professionals receive on issues such as advance directives and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in New South Wales.