92 research outputs found
Prevalence and predictors of verbal aggression in a secure mental health service:use of the HCR-20
Despite evidence about the negative effects of verbal aggression in mental health wards there is little research about its prevalence or about the factors that predict the behaviour among inpatients. This study aimed to determine the prevalence of verbal aggression in a secure mental health service, and to examine the relationship of verbal aggression with risk factors for aggression in the risk assessment tool HCR-20 in order to establish whether, and with which factors, the behaviour can be predicted. Verbal aggression was measured using the Overt Aggression Scale (OAS) over a 3-month period across a heterogeneous patient group (nâ=â613). Over half the patients (nâ=â341, 56%) engaged in 1594 incidents of verbal aggression. The HCR-20 total, clinical, and risk management subscale scores predicted verbal aggression, though effect sizes were not large. Item-outcome analysis revealed that impulsivity, negative attitudes, and non-compliance with medication were the best predictors of verbal aggression and, therefore, should be targeted for intervention. There are key synergies between factors predicting verbal aggression and the core mental health nursing role. Nurses, therefore, are in a prime position to develop and implement interventions that may reduce verbal aggression in mental health inpatients
The utility of the Historical Clinical Risk -20 Scale as a predictor of outcomes in decisions to transfer patients from high to lower levels of security-A UK perspective
<p>Abstract</p> <p>Background</p> <p>Structured Professional Judgment (SPJ) approaches to violence risk assessment are increasingly being adopted into clinical practice in international forensic settings. The aim of this study was to examine the predictive validity of the Historical Clinical Risk -20 (HCR-20) violence risk assessment scale for outcome following transfers from high to medium security in a United Kingdom setting.</p> <p>Methods</p> <p>The sample was predominately male and mentally ill and the majority of cases were detained under the criminal section of the Mental Health Act (1986). The HCR-20 was rated based on detailed case file information on 72 cases transferred from high to medium security. Outcomes were examined, independent of risk score, and cases were classed as "success or failure" based on established criteria.</p> <p>Results</p> <p>The mean length of follow up was 6 years. The total HCR-20 score was a robust predictor of failure at lower levels of security and return to high security. The Clinical and Risk management items contributed most to predictive accuracy.</p> <p>Conclusions</p> <p>Although the HCR-20 was designed as a violence risk prediction tool our findings suggest it has potential utility in decisions to transfer patients from high to lower levels of security.</p
Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services
Pianisten Hans Roland Orgenius: Först uppÄtgÄende jazzstjÀrna sedan utkastad frÄn jazzens finrum
Den unge blinde Hans Roland Orgenius hade fÄtt en gedigen musikutbildning pÄ Blindinstitutet Tomteboda nÀr han vid 15 Ärs Älder beslöt att prova pÄ en karriÀr som jazzpianist. Efter skolan sökte han arbete pÄ Sveriges Radio, dÀr han fick anstÀllning som pianist för att spela i flera radioprogram, ofta tillsammans med sin nÄgot Àldre kamrat frÄn Tomteboda, Reinhold Svensson. Han började ocksÄ fÄ spelningar i Stockholmstrakten och blev mycket populÀr framför allt för sitt sÀtt att spela boogie-woogie. PÄ somrarna gjorde han turnéer pÄ landsbygden bl a med sÄngaren Chris Dane. Hans framgÄngar gav honom skivkontrakt, först med Sonora och sedan Columbia, och han spelade in flera 78-varvsskivor under Ären 1952-54. Vid turnéer i Frankrike och Tyskland 1953 och 1954, kom han i kontakt med mÄnga utlÀndska jazzstjÀrnor som Dizzy Gillespie, Charlie Parker och sÄngerskan Sarah Vaughan. NÀr jazzscenen förÀndrades vid ingÄngen till sextiotalet, fick mÄnga jazzmusiker svÄrigheter och en del slutade att spela. Orgenius kunde dock hÄlla sig kvar i branschen som turnerande musiker, men det blev inga flera skivinspelningar. och press och radio förlorade intresset för honom. Han fortsatte att turnera Àven i Norge och Finland och framhÀrdade med detta till 1981 dÄ han avslutade sin yrkeskarriÀr
High frequency properties of electrically conductive adhesive interconnections and multilayer substrates
Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders
Background: The assessment of risk of violence among mentally disordered
offenders has been a controversial but well-researched area in forensic
psychology and psychiatry during the last decades. The main focus of this
research has been on the predictive validity of various risk factors and
methods of combining risk factors to gain the highest possible predictive
accuracy. In the present thesis, risk assessment is defined more broadly
than predictive accuracy, and also includes process factors,
risk-management, and the communication and decision-making associated
with risk of violence. The overall aim of this thesis was to explore the
process of structured risk assessment in its naturalistic clinical
setting.
Method: Four different samples were across 5 studies. A guideline for
structured clinical risk assessment, Historical-Clinical-Risk assessment
(HCR-20), was used in the first 4 studies. The first study used a 6
raters x 6 patients design to establish inter-rater reliability and
validity of the HCR-20. 54 forensic patients were followed over time and
monitored for inpatient violence and violence after discharge during
three risk-management conditions in study 2. A sample of 40 nurses,
assessing the same 8 patients, was included in studies 3 and 4. Finally
study 5 included a sample of 88 decisionmakers, divided into 3 groups;
Clinicians, Criminal law professionals and Controls.
Results: The HCR-20 was found to have reasonable reliability and validity
in study 1. The main finding in study 2 was that the predictive accuracy
of the HCR-20 was influenced by the intensity of risk management (AUC .64
compared to .82). In study 3 it was found that structured clinical risk
assessment was not "immune" to emotional bias in the assessment process.
43% of the variance in risk-scores could be attributed to the assessors'
emotions towards the patient. The information utilised to make the
assessment, and how the assessor values it, also influenced the
assessments in study 4. Placing value on personal interaction was more
associated with inpatient violence than with recidivism. In study 5 we
found that the inclination of making release decisions was greatly
influenced (eta2=.58 ) by the prospect of making false negative error of
judgement.
Conclusions: Structured clinical risk assessments can be undertaken in a
reliable and valid way in forensic clinical settings. Attention needs to
be paid to factors that might influence the outcome of the assessments
and the risk-management decisions that are the consequence of risk
assessment. These factors can be emotional biases, evaluation of
different kinds of information that form the basis for the process. There
needs to be an awareness of other factors than probabilities that
influence decisions about risk. It is suggested that future descriptive,
as opposed to prescriptive, research is needed on the processes and
influences on risk assessments, as they are actually conducted by
clinicians in actual forensic, psychiatric and correctional settings, and
not by researchers or trained research assistants
Shrinking pleuritis with atelectasis : a clinical study on operated patients with reference to etiology, pathogenesis, radiology and immunology
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