Internationally, seclusion practices continue to be the subject of intense clinical health service and academic scrutiny. Despite extensive efforts to reduce and eliminate this controversial practice, seclusion remains a clinical intervention widely used in contemporary mental health service settings. Early identification of people who are at risk for seclusion and the timely application of alternative evidence-based interventions are critical for reducing incidents of seclusion in real-world practice settings. This retrospective study aimed to determine the relationship between sociodemographic and clinical characteristics, and the use of seclusion for those mental health consumers for whom evidence-based seclusion-reduction initiatives had little impact. A 12-month centred moving average was fitted to seclusion data from a psychiatric inpatient unit over 2 years to determine stabilization in seclusion reduction. The number of consumers admitted was calculated from the point of stabilization for 1 year (n = 469). In this cohort, univariate analysis sought to compare the characteristics of those who were secluded and those who were not. A multivariate logistic regression model was undertaken to associate future seclusion based on significant independent variables. Of those people admitted, 88 (19%) were secluded. The majority of seclusions occurred in the first 5 days (70/88, 79%). Multivariate logistic regression indicated that three variables maintained their independent associative risk of seclusion: (i) age less than 35 years; (ii) assessment of risk of violence to others; and (iii) a history of seclusion. The implications of these findings for nursing practice are discussed.

The Cromer blood group system consists of 7 high incidence and 3 low incidence antigens that are carried on the complement regulatory glycoprotein called decay-accelerating factor (DAF; CD55). Despite laboratory results that would predict clinical significance, antibodies with specificities in the Cromer blood group system have not been reported to cause hemolytic disease of the newborn. It is possible that strong expression of DAF on the apical surface of antigen-positive fetally derived placental trophoblasts may absorb maternal antibodies that are directed to antigens in the Cromer blood group system. We studied two cases where strongly reactive anti-Cra and anti-Dra became undetectable during second and third trimesters of pregnancies.

The Cromer blood group system consists of 7 high incidence and 3 low incidence antigens that are carried on the complement regulatory glycoprotein called decay- accelerating factor (DAF; CD55). Despite laboratory results that would predict clinical significance, antibodies with specificities in the Cromer blood group system have not been reported to cause hemolytic disease of the newborn. It is possible that strong expression of DAF on the apical surface of antigen-positive fetally derived placental trophoblasts may absorb maternal antibodies that are directed to antigens in the Cromer blood group system. We studied two cases where strongly reactive anti-Cr^a and anti-Dr^a became undetectable during second and third trimesters of pregnancies.

TRM.31450 from the CAP Transfusion Checklist requires a laboratory using more than one method for a given analyte to compare those methods against each other at least twice a year. When developing a comparison protocol for antibody detection and identification, several variables must be taken into account, including availability of antibody positive plasma samples, reactivity in multiple media, antibody strength, and deterioration, any one of which may derail comparability of results. Our transfusion service developed a simple process using a commercial product. Antibody detection and identification are routinely performed by multiple methods: manual tube with no enhancement, LISS, PEG and column agglutination technique (CAT) or Gel. Polyclonal antibodies in the Quotient Competency Testing Kit (Newtown, PA) are validated by all of these methods before release. Moreover, use of the kit eliminated many variables related to the antibody positive sample. The Competency Testing Kit contains 10 plasma samples: nine antibody positive and one group AB antibody negative. We performed antibody screening on each test kit sample. Ortho Clinical Diagnostics (OCD) reagent RBCs (Raritan, NJ) were used for tube methods; OCD 0.8% reagent RBCs were used for the CAT method. Antibody identification was performed using CAT and OCD 0.8% panel cells. Reaction strength was graded 0-4+. The kit's antibody specificities included: Anti-D,-E,-c,-Jkb,-S,-Fya,-K. The identity of alloantibodies is provided to managers via website, so specificities were unavailable to the technologist, ensuring unbiased test performance. Each sample gave expected results in all methods used for antibody screening; reaction strength varied between methods by no more than two grades. Antibody identification matched specificities provided for all samples. Incorporating the Quotient Competency Testing Kit into our protocol simplified our challenges for comparison of methods required by CAP, providing a source of polyclonal antibodies, with specific, reliable reactivity, pre-validated by the company for use by multiple methods.