Critical care nurses in the United Kingdom have become increasingly concerned about the use, potential abuse and risks associated with physical restraint of patients. Restraint in critical care is not only confined to physical restraint but can also encompass chemical and psychological methods. There are concerns regarding the legal and ethical issues relating to the (ab)use of physical restraint techniques in critical care. The aim of this article was to present the British Association of Critical Care Nurses (BACCN) position statement on the use of restraint in adult critical care units and to provide supporting evidence to assist clinical staff in managing this process.

Objectives: The Glasgow Coma Scale (GCS) is routinely used to assess patients following head injury or other acute neurological events. The aims of this project were: to assess and evaluate registered nurses' baseline knowledge of the three behavioural responses that make up the assessment tool; to review the recording of GCS in neuroscience areas compared with non-specialist units; and to ascertain when the GCS is taught during nurse training and the background experience of the lecturers who teach it. Methods: Sixty questionnaires were used across six clinical areas: neurosurgery, neuro-intensive care, neuromedicine, general medicine, accident and emergency, and general intensive care. Observational studies compared nurses' performance, recording and documentation of GCS observations in each of these units. The unpublished standards for making GCS observations, written by the Neuroscience Nursing Benchmarking Group, were used to identify questions for examination in the audit. Results: Several areas for improvement were identified; including the use and application of painful stimulus. The use of sternal rubbing and nail bed compression continues to be common practice. Data collected also suggested a lack of knowledge of the patho-physiology underpinning the three components that make up the scale. Problems were evident in the record keeping, with very few examples of documentation within nursing records of the separate components of the GCS. Finally, the questionnaires returned from the universities revealed that students were introduced to the assessment tool during the first year of training, normally by lecturers with a critical care or accident and emergency clinical background. Conclusions: The data demonstrated wide variation in GCS scoring across all specialties. While the benchmarking standards are applied in neuroscience wards, the guidelines are not widely available for use in other units. It is pertinent to consider whether access to a clear and comprehensive protocol would help remove some of the ambiguities and ensure a more consistent approach to assessment. Novel approaches to education are required to maintain knowledge and skills in this area of practice. Documentation needs to improve and include the results from component parts of the scale. Instruction on the performance of GCS observations, if taught in the first year of training, should be re-examined, linking theory to practice prior to qualifying. The findings from this study will provide a useful basis for future research using more precise methods.

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The present activity in the Antarctic provided a stimulus for a study of the diet of sledge dogs. Observations made and results obtained in the Antarctic, together with cognate laboratory studies carried out in Britain, are here described. Experiments were made in Britain on dogs of various breeds, and in the Antarctic on huskies. The established sledging ration was found to be inadequate, so a product, pemmican, manufactured and supplied as blocks of I lb. to expeditions over the past 26 years was specially investigated. I n consequence, a new diet of a completely different composition has been devised; large quantities of it were shipped to the Antarctic for the first time in the autumn of 1956.Britain maintains several permanent bases in the Antarctic and the largest of them is at Hope Bay, 63' S., 57' W., where one of us (R. J. F. T.) spent the years of 1954 and 1955. At that time the complement at the base consisted of twelve men and about seventy-five dogs. The dogs, while at the base, received on alternate days 6-8 lb. of seal meat, most of which was muscle, fat and bone, but liver and heart were given occasionally. Most of the seal used as food was Lobodon carcinophagus and there is considerable evidence, backed by 12 years of practical experience, to show that such a diet of seal is almost, if not completely, adequate.On journeys, however, a concentrated, dehydrated ration must be provided, since on a loaded sledge about 50 yo of the weight may be food for the dog team. The ration has consisted, for the last quarter century, of dog pemmican, usually in the form of I lb. blocks. Dog pemmican was first used by H. G. Watkins in 1930 (Watkins, 1932), and it has been manufactured and supplied for every expedition since then. It may be, therefore, that there has been variation in composition over that period. All the work here recorded, however, deals with a single sample received in bulk from the manufacturers and, therefore, presumably of a reasonably constant composition.There have been complaints in the past that dog pemmican is inadequate as a sledging ration, but, until recently, there has been little factual evidence. It was known that the condition of the dogs deteriorated, with loss of weight and almost constant I Nutr. 13, IDownloaded from https://www.cambridge.org/core.

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