Analysis of patient physical restraints usage in a Swiss emergency service

Introduction: Emergency services (ES) are often faced with agitated,confused or aggressive patients. Such situations may require physicalrestraint. The prevalence of these measures is poorly documented,concerning 1 to 10% of patients admitted in the ES. The indications forrestraint, the context and the related complications are poorly studied.The emergency service and the security service of our hospital havedocumented physical restraint for several years, using specific protocolsintegrated into the medical records. The study evaluated the magnitudeof the problem, the patient characteristics, and degree of adherence tothe restraint protocol.Methods: Retrospective study of physical restraint used on adultpatients in the ES in 2009. The study included analysis of medical anddemographic characteristics, indications justifying restraint and qualityof restraint documentation. Patients were identified from computerizedES and security service records. The data were supplemented byexamination of patients' medical records.Results: In 2009, according to the security service, 390 patients (1%)were physically restrained in the ES. The ES computerized systemidentified only 196 patients. Most patients were male (62%). The medianage was 40 years (15-98 years; P90 = 80 years). 63 % of the situationsoccurred between 18h00 and 6h00, and most frequently on Saturday(19%). Substance or alcohol abuse was present in 48.7% of cases andacute psychiatric crisis was mentioned in 16.7%. In most cases,restraint was motivated by extreme agitation or auto / hetero-aggressiveviolence. Most patients (68 %) were restrained with upper limb andabdominal restraints. More than three anatomic restraints werenecessary in 52 % of the patients. Intervention of security guards wasrequired in 77% of the cases. 61 restraint protocols (31 %) were missingand 57% of the records were incomplete. In many cases, the protocolsdid not include the signature of the physician (22%) or of the nurse(43.8%). Medical records analysis did not allow reliable estimation ofthe number of restraint-induced complications.Conclusions: Physical restraint is most often motivated by majoragitation and/or secondary to substance abuse. Caregivers regularlycall security guards for help. Restraint documentation is often missing orincomplete, requiring major improvement in education and prescription.

HIERFSTAT, a package for R to compute and test hierarchical F-statistics

The package HIERFSTAT for the statistical software R, created by the R Development Core Team, allows the estimate of hierarchical F-statistics from a hierarchy with any numbers of levels. In addition, it allows testing the statistical significance of population differentiation for these different levels, using a generalized likelihood-ratio test. The package HIERFSTAT is available at http://www.unil.ch/popgen/softwares/hierfstat.htm.

Iowa Public Library Statistics, July 2005-June 2006

The 2005-2006 (FY06) edition of Iowa Public Library Statistics includes information on income, expenditures, collections, circulation, and other measures, including staff. Each section is arranged by size code, then alphabetically by city. The totals and percentiles for each size code grouping are given immediately following the alphabetical listings. Totals for all reporting libraries are given at the end of each section. There are 542 libraries included in this publication; 10 did not report. The Table of Cities and Size Codes lists the libraries alphabetically and gives their size codes. The table allows a user of this publication to locate information about a specific library. The following table lists the size code designations, the population range in each size code, the number of libraries reporting in each size code, and the total population of the reporting libraries in each size code. The total population of the 542 libraries is 2,243,396. Population data is used to determine per capita figures used throughout the publication.

Iowa Public Library Statistics, July 2006-June 2007

The 2006-2007 (FY07) edition of Iowa Public Library Statistics includes information on income, expenditures, collections, circulation, and other measures, including staff. Each section is arranged by size code, then alphabetically by city. The totals and percentiles for each size code grouping are given immediately following the alphabetical listings. Totals and medians for all reporting libraries are given at the end of each section. There are 543 libraries included in this publication; 530 submitted a report. The table of size codes (page 6) lists the libraries alphabetically. The libraries in each section of the publication are listed by size code, then alphabetically by city. The following table lists the size code designations, the population range in each size code, the number of libraries reporting in each size code, and the total population of the reporting libraries in each size code. The total population served by the 543 libraries is 2,248,279. Population data is used to determine per capita figures throughout the publication.

Analyse des besoins du système de prise en charge des addictions en Suisse: Module 1 : revue de littérature

Le but de cette étude est d'explorer et de définir, par une analyse des besoins, si l'offre actuelle en services dans le domaine des addictions est encore adaptée à la situation épidémiologique actuelle des addictions, à l'évolution des types de comportements liés à la dépendance et aux besoins des clients. Il s'agit en particulier de répondre aux questions suivantes: Existe-t-il actuellement des besoins en traitement pour lesquels il n'existe aucune offre appropriée ? Quels groupes ne sont pas ou sont insuffisamment atteints par l'offre existante? A quels genres de problèmes liés à la dépendance et à quels nouveaux besoins des clients les structures oeuvrant dans le domaine de la dépendance sont-elles confrontées? Quels sont les besoins d'adaptation du système de prise en charge nécessaires concernant soit les groupes-cibles de services, soit les types d'offres - en particulier le besoin en nouveaux concepts/modèles de prise en charge pour répondre à l'évolution des besoins? Comment ces structures font-elles face à l'accroissement de l'usage de multiples substances (multi-consommation)?

Iowa Public Library Statistics, July 2007-June 2008

The 2007-2008 (FY08) edition of Iowa Public Library Statistics includes information on income, expenditures, collections, circulation, and other measures, including staff. Each section is arranged by size code, then alphabetically by city. The totals and percentiles for each size code grouping are given immediately following the alphabetical listings. Totals and medians for all reporting libraries are given at the end of each section. There are 543 libraries included in this publication; 522 submitted a report. The table of size codes (page 6) lists the libraries alphabetically. The following table lists the size code designations, the population range in each size code, the number of libraries reporting in each size code, and the total population of the reporting libraries in each sizecode. The total population served by the 543 libraries is 2,248,279. Population data is used to determine per capita figures throughout the publication.

Iowa Public Library Statistics Pocket Digest, 2008

The information in this digest comes from the FY08 Iowa Annual Public Library Survey. It reflects the activities of 522 of the 543 public libraries in Iowa. Full details may be found at http://www.statelibraryofiowa.org/ld/statistics. Information for the national rankings on pages 3 to 4 comes from Public Libraries in the United States: Fiscal Year 2006 by the Institute of Museum and Library Services, Washington D.C., December 2008. http://harvester.census.gov/imls/pubs/pls/pub_detail.asp?id=121#