scholarly journals Selecting a risk assessment tool to use in practice:a 10-point guide

2017 ◽  
Vol 21 (2) ◽  
pp. 41-43 ◽  
Author(s):  
Seena Fazel ◽  
Achim Wolf
Keyword(s):  
Risk Assessment ◽  
Assessment Tool ◽  
External Validation ◽  
Assessment Tools ◽  
Prognostic Models ◽  
Violence Risk ◽  
Risk Assessment Tools ◽  
Research Findings ◽  
Clinical Algorithms ◽  
Key Questions

With the increase in the number of risk assessment tools and clinical algorithms in many areas of science and medicine, this Perspective article provides an overview of research findings that can assist in informing the choice of an instrument for practical use. We take the example of violence risk assessment tools in criminal justice and forensic psychiatry, where there are more than 200 such instruments and their use is typically mandated. We outline 10 key questions that researchers, clinicians and other professionals should ask when deciding what tool to use, which are also relevant for public policy and commissioners of services. These questions are based on two elements: research underpinning the external validation, and derivation or development of a particular instrument. We also recommend some guidelines for reporting drawn from consensus guidelines for research in prognostic models.

scholarly journals Novel Approach to Inpatient Fall Risk Prediction and Its Cross-Site Validation Using Time-Variant Data (Preprint)

2018 ◽  
Author(s):  
Insook Cho ◽  
Eun-Hee Boo ◽  
Eunja Chung ◽  
David W. Bates ◽  
Patricia Dykes
Keyword(s):  
Risk Assessment ◽  
Error Rate ◽  
Fall Risk ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Fall Risk Assessment ◽  
C Statistic ◽  
Risk Assessment Tools ◽  
Hospital Days ◽  
Cross Site

BACKGROUND Electronic medical records (EMRs) contain a considerable amount of information about patients. The rapid adoption of EMRs and the integration of nursing data into clinical repositories have made large quantities of clinical data available for both clinical practice and research. OBJECTIVE In this study, we aimed to investigate whether readily available longitudinal EMR data including nursing records could be utilized to compute the risk of inpatient falls and to assess their accuracy compared with existing fall risk assessment tools. METHODS We used 2 study cohorts from 2 tertiary hospitals, located near Seoul, South Korea, with different EMR systems. The modeling cohort included 14,307 admissions (122,179 hospital days), and the validation cohort comprised 21,172 admissions (175,592 hospital days) from each of 6 nursing units. A probabilistic Bayesian network model was used, and patient data were divided into windows with a length of 24 hours. In addition, data on existing fall risk assessment tools, nursing processes, Korean Patient Classification System groups, and medications and administration data were used as model parameters. Model evaluation metrics were averaged using 10-fold cross-validation. RESULTS The initial model showed an error rate of 11.7% and a spherical payoff of 0.91 with a c-statistic of 0.96, which represent far superior performance compared with that for the existing fall risk assessment tool (c-statistic=0.69). The cross-site validation revealed an error rate of 4.87% and a spherical payoff of 0.96 with a c-statistic of 0.99 compared with a c-statistic of 0.65 for the existing fall risk assessment tool. The calibration curves for the model displayed more reliable results than those for the fall risk assessment tools alone. In addition, nursing intervention data showed potential contributions to reducing the variance in the fall rate as did the risk factors of individual patients. CONCLUSIONS A risk prediction model that considers longitudinal EMR data including nursing interventions can improve the ability to identify individual patients likely to fall.

Factors Predicting Desistance From Reoffending: A Validation Study of the SAPROF in Sexual Offenders

2016 ◽  
Vol 62 (3) ◽  
pp. 697-716 ◽  
Author(s):  
Dahlnym Yoon ◽  
Daniel Turner ◽  
Verena Klein ◽  
Martin Rettenberger ◽  
Reinhard Eher ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Sexual Offenders ◽  
Interrater Reliability ◽  
Predictive Accuracy ◽  
Negative Relationship ◽  
Incremental Validity ◽  
Assessment Tools ◽  
Violence Risk ◽  
Limited Extent ◽  
Risk Assessment Tools

The present study aims at validating the German version of the Structured Assessment of PROtective Factors (SAPROF) for violence risk in a representative sample of incarcerated adult male sexual offenders. Sexual offenders ( n = 450) were rated retrospectively with the SAPROF using the database of the Federal Evaluation Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System. Interrater reliability and predictive validity of the SAPROF scores concerning desistance from recidivism were calculated. Concurrent and incremental validity were tested using the combination of the SAPROF and the Sexual Violence Risk–20 (SVR-20). Interrater reliability was moderate to excellent, and predictive accuracy for various types of recidivism was rather small to moderate. There was a clear negative relationship between the SAPROF and the SVR-20 risk factors. Whereas the SAPROF revealed itself as a significant predictor for various recidivism categories, it did not add any predictive value beyond the SVR-20. Although the SAPROF itself can predict desistance from recidivism, it seems to contribute to the risk assessment in convicted sexual offenders only to a limited extent, once customary risk assessment tools have been applied. Implications for clinical use and further studies are discussed.

scholarly journals VIOLENCE RISK ASSESSMENT IN PSYCHIATRY - LITERATURE REVIEW AND PRACTICE COMPARISON BETWEEN LATVIA AND GERMANY

2021 ◽  
Vol 4 ◽  
pp. 357-367
Author(s):  
Karina Konstantinova ◽  
Alina Kuznecova
Keyword(s):  
Risk Assessment ◽  
Community Violence ◽  
Clinical Assessment ◽  
Assessment Tool ◽  
Legal Framework ◽  
Assessment Tools ◽  
Evidence Based ◽  
Violence Risk ◽  
Mentally Disordered Offenders ◽  
Violence Risk Assessment

Evidence-based future community violence risk assessment is a crucial issue in psychiatry. It is a cornerstone of safeguarding the rights of persons with mental health issues. Authors aimed to analyse the modern methods of risk assessment in psychiatry and the current practice and legal framework. Authors undertook a scoped review of the literature with search terms related to future community violence risk prediction for mentally disordered offenders in Latvian, English, German, and Russian languages. Main difficulties in future community violence risk assessment are demonstrated via Latvia’s court decisions analysis. Marked differences were identified: there are no standardized methods available/registered in Latvia, therefore risks assessment is performed via clinical assessment only. In Germany, the risk assessment is performed via structured evidence – based risk assessment tools and clinical assessment; nevertheless, the choice of the assessment tool remains challenging.  

scholarly journals Clinicians’ Perceptions of the Implementation of the Structured Assessment of Protective Factors for Violence Risk (SAPROF) on an Inpatient Forensic Unit

2019 ◽  
Author(s):  
Tom Domjancic ◽  
Treena Wilkie ◽  
Shaheen Darani ◽  
Brittney Williams ◽  
Bandhana Maheru ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Protective Factors ◽  
Assessment Tool ◽  
Point Of View ◽  
Assessment Tools ◽  
Violence Risk ◽  
Exploratory Research ◽  
Structured Interviews ◽  
Consensus Scoring ◽  
Additional Value

The Structured Assessment of PROtective Factors for Violence Risk (SAPROF) is an assessment tool that examines protective factors when assessing for violence risk. There is limited research on clinicians’ perceptions of the use and implementation of risk assessment tools, and this study aimed to examine the experiences of clinicians using the SAPROF in a low secure forensic rehabilitation inpatient unit in Canada. An exploratory research design was used, and five clinicians participated in semi-structured interviews. Data was analyzed using a thematic approach and three central themes were identified: understanding of the patient from a strengths-based point of view, providing clinicians with a focus on how to help the patient, and bringing in opportunities to collaborate as a team. The findings highlight the additional value of the SAPROF as tool in helping forensic teams to adopt strengths based approaches to risk assessment, enhancing treatment planning and inter-professional collaboration.   Keywords: strengths, risk assessment, SAPROF, consensus scoring, recovery

scholarly journals Validation of HIV Risk Screening Tool to Identify Infected Adults and Adolescents >14 years at Community Level

2021 ◽  
Author(s):  
Kesetebirhan Delele Yirdaw ◽  
Justin Mandala
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Hiv Risk ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Hiv Test ◽  
Risk Assessment Tools ◽  
Hiv Risk Assessment ◽  
Sensitivity Specificity ◽  
Conventional Risk Factors

Abstract Background There are a number of risk factors being used to identify undiagnosed HIV infected adults. As the number of undiagnosed people gets lesser and lesser, it is important to know if existing risk factors and risk assessment tools are valid for use. In this study, we validate existing HIV risk assessment tools and see if they are worth using for HIV case finding among adults who remain undiagnosed. Methods The Tanzania and Zambia Population-Based HIV Impact Assessment (PHIA) household surveys were conducted during 2016. We used adult interview and HIV datasets to assess validity of different HIV risk assessment tools. We first included 12 risk factors (being divorced, separated or widowed (DSW); having an HIV+ spouse; having one of the following within 12 months of the survey: paid work, slept away from home for at least a month, had multiple sexual partners, paid for sex, had sexually transmitted infection (STI), being a tuberculosis (TB) suspect, being very sick for at least 3 months; had ever sold sex; diagnosed with cervical cancer; and had TB disease into a risk assessment tool and assessed its validity by comparing it against HIV test result. Sensitivity, specificity and predictive value of the tool were assessed against the HIV test result. A receiver operator characteristic (ROC) analysis was conducted to determine a suitable cut-off score in order to have a tool with better sensitivity, specificity, and PPV. ROC comparison statistics was used to statistically test equality between AUC (area under the curve) of the different scores. ROC comparison statistics was also used to determine which risk assessment tool was better compared to the tool that contained all risk factors. Results Of 14,820 study participants, 57.8% were men, and had a median age of 30 (IQR: 21-24). HIV prevalence was 2.3% (95% confidence interval (CI): 2.0-2.6). For the tool containing all risk factors, HIV prevalence was 1.0% when none of the risk factors were positive (Score 0) compared to 3.2% when at least one factor (Score ≥1) was present and 8.0% when ≥4 risk factors were present. Sensitivity, specificity, PPV, and NPV were 82.3% (78.6%-85.9%), 41.9% (41.1%-42.7%), 3.2% (2.8%-3.6%), and 99.0% (98.8%-99.3%), respectively. The use of a tool containing conventional risk factors (all except those related with working and sleeping away) was found to have higher AUC compared to the use of all risk factors (p value <0.001), with corresponding sensitivity, specificity, PPV, and NPV of 63.5% (58.9%-68.1%), 66.2% (65.5%-67.0%), 4.2% (3.6%-4.8%), and 98.7% (98.5%-98.9%), respectively. Conclusion Use of a screening tool containing conventional risk factors improved HIV testing yield compared to doing universal testing. Prioritizing people who fulfil multiple risk factors should be explored further to improve HIV testing yield.

scholarly journals Urban Security and Counterterrorism: An Approach to Proportionality

2021 ◽  
Vol 14 (3) ◽  
pp. 70-85
Author(s):  
Tegg Westbrook ◽  
Thomas Schive
Keyword(s):  
Risk Assessment ◽  
Urban Design ◽  
Assessment Tool ◽  
Dead Reckoning ◽  
Assessment Tools ◽  
Risk Assessments ◽  
Design Strategies ◽  
Risk Assessment Tools ◽  
Urban Security ◽  
Security Returns

As cities and crowded areas increasingly become targets of terrorist plots and attacks, there is ample demand for risk assessment tools that consider proportional measures that reduce the threat, vulnerability, and possible impacts, whilst providing ‘security returns’ for those investments. There is a risk in this process of over- or under-fortifying places based on practitioners’ subjective biases, experiences, dead reckoning and conflicting agendas. Currently, risk assessments rely on qualitative tools that do not consider proportionality that removes these inherent biases. Critiquing well-known urban design strategies and national risk assessments, this article therefore seeks to develop a supplementary assessment tool – an equation for proportionality – that is more objective and is created to help practitioners make good choices, in particular on: (1) reducing the threat, (2) vulnerability, (3) impact, (4) accepting risk, and (5) measuring a security measure’s ability to deter, delay or stop an attack. It concludes that while no assessment is truly objective, the equation works to remove as much subjectivity as possible when assessing proportional urban security.

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