Opinions of family caregivers on the use of physical restraints in Intensive care unit

*Aşiret, Güler Duru ( Aksaray, Yazar )Objective: This study aimed to determine the opinions of family caregivers on the use of physical restraints in patients admitted to intensive care units. Material and Methods: This descriptive study included the caregivers of 42 restrained patients admitted in Medical and Surgical Intensive Care Units of the Hacettepe University Adult Hospital between August 2012 and August 2013. Data was collected using a data collection form developed by researchers based on the literature. Descriptive statistical analyses and chi-square tests were used for data analysis. Results: The mean age of patients was 41.2 +/- 11.2; 52.4% of the patients were females. Among the caregivers, 61.9% were the patients' children. In this study, physical restraints were applied to the upper extremity alone and to both wrists and ankles in 90.5% and 9.5% of the patients, respectively. Among the relatives, 78.6% stated that they were informed of the physical restraining; 90.9% stated that the information provided was adequate. In addition, 85.7% of the relatives reported that physical restraint on the patient was necessary, 9.5% of the relatives stated that it was unnecessary, and 4.8% of the caregivers were ambivalent regarding the requirement of physical restraining. Only 8.6% of the patients suggested that their presence next to the patient in the intensive care unit may be a substitution for physical restraint. Informed consent for physical restraining was obtained from only 9.8% of the caregivers. Conclusion: Most of the caregivers were informed about physical restraining, and they thought that it was necessary; however, it was determined that informed consent was obtained from only a small percentage of caregivers...

Use of Mitoxantrone in Early Secondary Progressive Multiple Sclerosis: An Observational Study of 48 Patients with Clinical and MRI Outcomes

OBJECTIVE: To report the clinical follow-up, side effects, and magnetic resonance imaging (MRI) findings of mitoxantrone treatment in patients in the early phase of secondary progressive and exacerbating relapsing-remitting multiple sclerosis. METHODS: Patients that completed and/or were undergoing treatment between 2001 and 2008 were included in the study. All patients were definitive progressive multiple sclerosis patients and met ‘non-responder’ criteria for immunomodulatory the- rapy. They did not have active infection, cardiac disease, or any contraindication for immunosuppressive treatment. Baseline comp- lete blood count, liver function tests, and transthoracic echocardiography were performed. Mitoxantrone was given as induction the- rapy (1 dose per month for 3 months) and then as maintenance therapy (with 3 month periods, 12 mg/m2 until to the cumulative dose was reached). Patients were followed-up regularly for the appearance of any side effects. RESULTS: The study included 33 female and 15 male patients. Mean age was 36.6 ± 7.8 years, mean disease duration was 9.38 ± 4.8 years, mean expanded disease severity scale (EDSS) score was 5.8, and mean treatment duration was 11.16 ± 7.4 months. Fol- lowing the end of treatment, 17 patients were stabilized, 10 improved, and 14 progressed. There were no side effects observed du- ring or after treatment in 16 patients. Among the other 32 patients, the observed side effects were as follows: nausea (n= 18), per- manent leucopenia (n= 1), transient thrombocytopenia (n= 4), alopecia (n= 13), neutropenic fever (n= 1), and amenorrhea (n= 18). MRI follow-up was performed in a subgroup of patients and showed that the lesion loads were stabilized. CONCLUSION: We reported the efficacy, and clinical and MRI follow-up results of multiple sclerosis patients treated with mitoxantro- ne. Patient selection and therapy timing was very important for maximum efficacy. Patients that responded to mitoxantrone treat- ment benefited beginning with the induction phase and their disability was limited or improve