scholarly journals Short-term management of repeated self-harm in secure institutions

2011 ◽  
Vol 17 (6) ◽  
pp. 435-446 ◽  
Author(s):  
Jaydip Sarkar
Keyword(s):  
High Risk ◽  
Morbidity And Mortality ◽  
Pragmatic Approach ◽  
Short Term ◽  
Algorithmic Approach ◽  
Forensic Patients ◽  
Security Breaches ◽  
Self Harm ◽  
Harm To Others ◽  
Term Management

SummaryThe challenge of managing repeated self-harm and the high risk of morbidity and mortality are compounded in forensic patients, where there are additional risks of harm to others, absconding and security breaches. There is an urgent need for clinically sound, practice-based and theoretically grounded strategies for managing these associated risks. This is essential as available UK guidelines appear inadequate for this group of patients. This article promotes a pragmatic approach to assessing the risk of self-harm clinically to arrive at hierarchical risk judgements. It further suggests an algorithmic approach to managing these risks and provides testable strategies that can be adapted for use in various secure institutions.

scholarly journals IN THIS ISSUE

2006 ◽  
Vol 36 (12) ◽  
pp. 1659-1660
Author(s):  
CRAIG MORGAN
Keyword(s):  
Substance Use ◽  
Resource Utilization ◽  
Late Pregnancy ◽  
Psychiatric Diagnoses ◽  
Short Term ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Term Management

This issue contains three reviews, one on SSRI use in late pregnancy, one on dimensional approaches to psychiatric diagnoses, and one on resource utilization in the short-term management of deliberate self-harm (DSH). Other sets of papers examine various aspects of substance use and dependence, depression, and suicide, and two individual papers examine further topics.

Analyzing Language in Suicide Notes and Legacy Tokens

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 140-147 ◽  
Author(s):  
Michael J. Egnoto ◽  
Darrin J. Griffin
Keyword(s):  
Text Analysis ◽  
Low Cost ◽  
Computer Software ◽  
Student Writing ◽  
Computer Assisted ◽  
Automated Identification ◽  
Completed Suicide ◽  
Suicide Notes ◽  
Self Harm ◽  
Harm To Others

Abstract. Background: Identifying precursors that will aid in the discovery of individuals who may harm themselves or others has long been a focus of scholarly research. Aim: This work set out to determine if it is possible to use the legacy tokens of active shooters and notes left from individuals who completed suicide to uncover signals that foreshadow their behavior. Method: A total of 25 suicide notes and 21 legacy tokens were compared with a sample of over 20,000 student writings for a preliminary computer-assisted text analysis to determine what differences can be coded with existing computer software to better identify students who may commit self-harm or harm to others. Results: The results support that text analysis techniques with the Linguistic Inquiry and Word Count (LIWC) tool are effective for identifying suicidal or homicidal writings as distinct from each other and from a variety of student writings in an automated fashion. Conclusion: Findings indicate support for automated identification of writings that were associated with harm to self, harm to others, and various other student writing products. This work begins to uncover the viability or larger scale, low cost methods of automatic detection for individuals suffering from harmful ideation.

The Direct and Indirect Self-Harm Inventory (DISH): A new measure for assessing high-risk and self-harm behaviors among military veterans.

2017 ◽  
Vol 18 (3) ◽  
pp. 208-214 ◽  
Author(s):  
Jonathan D. Green ◽  
Christina Hatgis ◽  
Jaclyn C. Kearns ◽  
Matthew K. Nock ◽  
Brian P. Marx
Keyword(s):  
High Risk ◽  
Military Veterans ◽  
Self Harm

Short-term risk stratification using CADILLAC risk score in patients with ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Satou ◽  
H Kitahara ◽  
K Ishikawa ◽  
T Nakayama ◽  
Y Fujimoto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Adverse Events ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Short Term ◽  
Recurrent Myocardial Infarction ◽  
St Elevation

Abstract Background The recent reperfusion therapy for ST-elevation myocardial infarction (STEMI) has made the length of hospital stay shorter without adverse events. CADILLAC risk score is reportedly one of the risk scores predicting the long-term prognosis in STEMI patients. Purpose To invenstigate the usefulness of CADILLAC risk score for predicting short-term outcomes in STEMI patients. Methods Consecutive patients admitted to our university hospital and our medical center with STEMI (excluding shock, arrest case) who underwent primary PCI between January 2012 and April 2018 (n=387) were enrolled in this study. The patients were classified into 3 groups according to the CADILLAC risk score: low risk (n=176), intermediate risk (n=87), and high risk (n=124). Data on adverse events within 30 days after hospitalization, including in-hospital death, sustained ventricular arrhythmia, recurrent myocardial infarction, heart failure requiring intravenous treatment, stroke, or clinical hemorrhage, were collected. Results In the low risk group, adverse events within 30 days were significantly less observed, compared to the intermediate and high risk groups (n=13, 7.4% vs. n=13, 14.9% vs. n=58, 46.8%, p<0.001). In particular, all adverse events occurred within 3 days in the low risk group, although adverse events, such as heart failure (n=4), recurrent myocardial infarction (n=1), stroke (n=1), and gastrointestinal bleeding (n=1), were substantially observed after day 4 of hospitalization in the intermediate and high risk groups. Conclusions In STEMI patients with low CADILLAC risk score, better short-term prognosis was observed compared to the intermediate and high risk groups, and all adverse events occurred within 3 days of hospitalization, suggesting that discharge at day 4 might be safe in this study population. CADILLAC risk score may help stratify patient risk for short-term prognosis and adjust management of STEMI patients. Initial event occurrence timing Funding Acknowledgement Type of funding source: None

Doing More With Less: Pragmatic Implementation of Vancomycin Area-Under-the-Curve (AUC) Monitoring

2021 ◽  
pp. 089719002110272
Author(s):  
Joanne Huang ◽  
Jeannie D. Chan ◽  
Thu Nguyen ◽  
Rupali Jain ◽  
Zahra Kassamali Escobar
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Therapeutic Drug Monitoring ◽  
Paradigm Shift ◽  
Area Under The Curve ◽  
Cost Effective ◽  
Practical Method ◽  
Therapeutic Drug ◽  
Short Term ◽  
Quality Improvement Process

Universal area-under-the-curve (AUC) guided vancomycin therapeutic drug monitoring (TDM) is resource-intensive, cost-prohibitive, and presents a paradigm shift that leaves institutions with the quandary of defining the preferred and most practical method for TDM. We report a step-by-step quality improvement process using 4 plan-do-study-act (PDSA) cycles to provide a framework for development of a hybrid model of trough and AUC-based vancomycin monitoring. We found trough-based monitoring a pragmatic strategy as a first-tier approach when anticipated use is short-term. AUC-guided monitoring was most impactful and cost-effective when reserved for patients with high-risk for nephrotoxicity. We encourage others to consider quality improvement tools to locally adopt AUC-based monitoring.

scholarly journals Benefit and Harm of Extended Dual Antiplatelet Therapy After PCI in high-risk TWILIGHT-like patients with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
HY Wang ◽  
R Zhang ◽  
ZX Cai ◽  
KF Dou
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Cardiovascular Death ◽  
Secondary Outcome ◽  
Short Term ◽  
Bleeding Events ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the benefits and risks of extended-term (>12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI. Methods All consecutive patients fulfilling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identified from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were defined by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome. Results Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT > 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction > 0.05). Conclusion Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.

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