Unlock the doors:Aggressive behaviour and seclusion on closed psychiatric wards

Seclusion of patients on psychiatric wards is a controversial intervention with serious safety issues for patients. Nurses have an important role in the decision to use seclusion when encountering aggressive behaviour. The aim of this thesis is to improve knowledge about the influence of nurses on the incidence of aggressive behaviour and the use of seclusion, in order to use that knowledge to prevent such events in the future. Patients and nurses share views on the factual cause of aggressive behaviour, but their perception of the severity differ. The attitude of nurses towards seclusion changed over the last decades from a therapeutic paradigm to a safety paradigm. In our study, teams with majority of male nurses were associated with less seclusion and aggressive behaviour. Teams with high scores on personality trait openness were associated with less seclusion and teams with high scores on personality trait extraversion were associated with patients’ aggression. There are no golden solutions to improve safety of psychiatric wards, but increased attention of development of nursing skills seems as an important step forward. By providing optimal nursing care, vulnerable patients on psychiatric wards receive the care they deserve

Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards

PURPOSE: Estimate the effect of nursing, shift, and patient characteristics on patients' aggression. DESIGN AND METHODS: Follow‐up study on a closed psychiatric ward was performed to estimate the effect of nursing team characteristics and patient characteristics on the incidence of aggression. FINDINGS: The incidence of aggression (n = 802 in sample) was lower in teams with >75% male nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive. PRACTICE IMPLICATIONS: These findings could stimulate support for nurses to prevent aggression

Cross-classified multilevel models improved standard error estimates of covariates in clinical outcomes – a simulation study

Objective: To compare estimates of effect and variability resulting from standard linear regression analysis and hierarchical multilevel analysis with cross-classified multilevel analysis under various scenarios. Study design and setting: We performed a simulation study based on a data structure from an observational study in clinical mental health care. We used a Markov chain Monte Carlo approach to simulate 18 scenarios, varying sample sizes, cluster sizes, effect sizes and between group variances. For each scenario, we performed standard linear regression, multilevel regression with random intercept on patient level, multilevel regression with random intercept on nursing team level and cross-classified multilevel analysis. Results: Applying cross-classified multilevel analyses had negligible influence on the effect estimates. However, ignoring cross-classification led to underestimation of the standard errors of the covariates at the two cross-classified levels and to invalidly narrow confidence intervals. This may lead to incorrect statistical inference. Varying sample size, cluster size, effect size and variance had no meaningful influence on these findings. Conclusion: In case of cross-classified data structures, the use of a cross-classified multilevel model helps estimating valid precision of effects, and thereby, support correct inferences

Differential Expression of Cadherin-2 and Cadherin-4 in the Developing and Adult Zebrafish Visual System

Cadherins are homophilic cell adhesion molecules that control development of a variety of tissues and maintenance of adult structures. Although cadherins have been implicated in the development of the brain, including the visual system, in several vertebrate species, little is known of their role in zebrafish. In this study, we examined distribution of cadherin-2 (Cdh2, N-cadherin) in the visual system of developing and adult zebrafish using both immunocytochemical and in situ hybridization methods, and we compared Cdh2 distribution to that of the previously reported and closely related cadherin-4 (Cdh4, R-cadherin). As in other vertebrates, in zebrafish embryos Cdh2 was widely expressed in the early nervous system, but its expression became more restricted as development proceeded. Cdh4 was not detectable until later in development, at about the time when the first ganglion cells are generated. Cdh2 and Cdh4 were expressed in distinct regions of developing visual structures, including the lens. We hypothesize that the differential expression of these two cadherins in developing zebrafish visual structures reflects functionally different roles in the development of the vertebrate visual system

Foot-and-Mouth Disease Virus 3C Protease Induces Fragmentation of the Golgi Compartment and Blocks Intra-Golgi Transport

Picornavirus infection can cause Golgi fragmentation and impose a block in the secretory pathway which reduces expression of major histocompatibility antigens at the plasma membrane and slows secretion of proinflammatory cytokines. In this study, we show that Golgi fragmentation and a block in secretion are induced by expression of foot-and-mouth disease virus (FMDV) 3C(pro) and that this requires the protease activity of 3C(pro). 3C(pro) caused fragmentation of early, medial, and late Golgi compartments, but the most marked effect was on early Golgi compartments, indicated by redistribution of ERGIC53 and membrin. Golgi fragments were dispersed in the cytoplasm and were able to receive a model membrane protein exported from the endoplasmic reticulum (ER). Golgi fragments were, however, unable to transfer the protein to the plasma membrane, indicating a block in intra-Golgi transport. Golgi fragmentation was coincident with a loss of microtubule organization resulting from an inhibition of microtubule regrowth from the centrosome. Inhibition of microtubule regrowth also required 3C(pro) protease activity. The loss of microtubule organization induced by 3C(pro) caused Golgi fragmentation, but loss of microtubule organization does not block intra-Golgi transport. It is likely that the block of intra-Golgi transport is imposed by separate actions of 3C(pro), possibly through degradation of proteins required for intra-Golgi transport