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"documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Med Clin. 2023;160:224-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Stress cardiomyopathy and euglycemic ketoacidosis in a patient treated with sodium-glucose cotransporter type 2" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "225" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miocardiopatía de estrés y cetoacidosis euglucémica en una paciente tratada con inhibidores del cotransportador sodio-glucosa tipo 2" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Martín Negreira Caamaño, Ariana Gonzálvez García, Luis Javier Yuste Domínguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Martín" "apellidos" => "Negreira Caamaño" ] 1 => array:2 [ "nombre" => "Ariana" "apellidos" => "Gonzálvez García" ] 2 => array:2 [ "nombre" => "Luis Javier" "apellidos" => "Yuste Domínguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S002577532200536X" "doi" => "10.1016/j.medcli.2022.09.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577532200536X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623000542?idApp=UINPBA00004N" "url" => "/23870206/0000016000000005/v1_202303052139/S2387020623000542/v1_202303052139/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Physical restraints in hospitalized patients" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "225" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Luis Angel Sánchez-Muñoz" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Luis Angel" "apellidos" => "Sánchez-Muñoz" "email" => array:1 [ 0 => "lsanchezmunoz@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Contención física en pacientes hospitalizados" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">García Andreu and Díez-Manglano<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>'s insightful editorial underlines the need to improve the use of restraints in hospitalised patients both in terms of the appropriateness of their indication (avoiding overuse) and in the procedure for performing them (non-standardisation), given the possible consequences for the patient.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to reduce the use of restraints it is important to promote preventive rather than reactive actions. If we know that 20% of hospitalised patients over the age of 70 can develop delirium (6 times more common in patients with dementia) and that it is preventable in 30–40% of cases, preventive measures can be applied to reduce its incidence and, therefore, reduce the prescription of restraints<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. Basic measures such as assessing the risk of delirium on admission, pain treatment, infection control, adequate nutrition and hydration (adapted diet, supplements, help with intake if necessary), prevention of constipation, early mobilisation (avoiding unnecessary probes, tubes and IV drips, encouraging the use of the toilet, avoiding nappies in continent patients), favouring nocturnal rest, reviewing and reconciling medication and adapting the environment (reorientation, auditory and visual aids if necessary, family assistance, lighting, calendar, clock, photographs, cognitively stimulating activities) decrease the risk of delirium and the need for restraints<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. This preventive strategy has been promoted by the Choosing Wisely initiative<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The absence of regulatory legislation or evidence-based guidelines for the use of restraints makes the ethical aspects of their use even more important. The current movement to reduce and adapt the use of restraints underlines that care must not only consider health, but also autonomy and individual preferences as an asset to be protected. This entails accepting a certain degree of risk, which must be associated with protocols for falls management, rational use of drugs, etc.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the hospital setting is outside the scope of the recent instruction of the State Attorney General's Office on the use of mechanical or pharmacological means of restraint<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>, based on its reading there are areas for improvement that we can probably transfer to our centres: Is physical restraint applied under medical prescription and informed consent obtained from the patient or, where appropriate, the patient's legal representative. Are generic orders used ("mechanical restraint if required") when it should be assessed on an individual basis. Does the centre have a protocol for the use of restraints that includes indications, procedure, observation and monitoring guidelines? Is the measure applied to each patient documented, specifying indication, use, type of restraint, duration and monitoring?</p><p id="par0025" class="elsevierStylePara elsevierViewall">To conclude, it is preferable to enhance preventive measures aimed at reducing the need for physical restraint. This should be the last resort (after having tried verbal and pharmacological restraint) and should be applied as sparingly as possible and for the time strictly necessary, in a standardised and monitored manner.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">No funding has been received.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author declares no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medidas de sujeción en el paciente agitado, ¿seguridad o peligro?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.M. García-Andreu" 1 => "J. Díez-Manglano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2022.05.018" "Revista" => array:2 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2022 Sep 2" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Think delirium: Preventing delirium amongst older people in our care. Tips and strategies from the Older Persons’ Mental Health Think Delirium Prevention Project" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Gee" 1 => "J. Bergman" 2 => "T. Hawkes" 3 => "M. Croucher" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016" "editorial" => "Canterbury District Health Board" "editorialLocalizacion" => "Christchurch, New Zealand" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://edu.cdhb.health.nz/Hospitals-Services/Health-Professionals/think-delirium/Documents/Think-Delirium-236949.pdf" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Choosing Wisely . Ten things physicians and patients should question, [Accessed 26 September 2022]. Available in: <a target="_blank" href="https://www.choosingwisely.org/wp-content/uploads/2015/02/AGS-Choosing-Wisely-List.pdf">https://www.choosingwisely.org/wp-content/uploads/2015/02/AGS-Choosing-Wisely-List.pdf</a> American Geriatrics Society." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio Fiscal. Instrucción 1/2022, de 19 de enero, de la Fiscalía General del Estado, sobre el uso de medios de contención mecánicos o farmacológicos en unidades psiquiátricas o de salud mental y centros residenciales y/o sociosanitarios de personas mayores y/o con discapacidad. BOE núm. 36, de 11 de febrero de 2022. pp. 18260-79." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000005/v1_202303052139/S2387020623000530/v1_202303052139/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000005/v1_202303052139/S2387020623000530/v1_202303052139/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623000530?idApp=UINPBA00004N" ]
