scholarly journals The reform of Italian forensic psychiatric hospitals and its impact on risk assessment and management

2018 ◽  
Author(s):  
Vittorio De Luca ◽  
Pieritalo Maria Pompili ◽  
Giovanna Paoletti ◽  
Valeria Bianchini ◽  
Federica Franchi ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Treatment Plan ◽  
Psychiatric Hospitals ◽  
Assessment Tools ◽  
Residential Home ◽  
Security Measures ◽  
Lazio Region ◽  
History Of ◽  
Forensic Psychiatric

Italy has a consolidated history of de-institutionalization, and it was the first country to completely dismantle psychiatric hospitals, in order to create small psychiatric inwards closer to the community (i.e. in general hospitals). Nevertheless, it took the nation nearly 40 years to end the process from the beginning of de-institutionalization, definitely closing all of the forensic hospitals, which was not addressed by the first Italian psychiatric reform. This paper describes the establishment of new facilities substituting old forensic hospitals, called Residences for the Execution of Security Measures (REMS), which are a paradigm shift in terms of community-based residential home, and are mainly focused on treatment and risk assessment, rather than custodial practices. The use of modern assessment tools, such as the Aggressive Incident Scale (AIS) and the Hamilton Anatomy of Risk Management (HARM), is crucial in order to point out the focus and consistent instruments of the treatment plan. A preliminary analysis of data from the first 2 years of activity, considering severely ill patients who have been treated for more than 12 months, is then described for two REMSs in the Lazio region, close to Rome. Encouraging results suggest that further research is needed in order to assess clinical elements responsible for a better outcome, and to detect follow-up measures of violence or criminal relapse after discharge.

scholarly journals Use of risk assessment instruments to predict violence in forensic psychiatric hospitals: a systematic review and meta-analysis

2018 ◽  
Vol 52 ◽  
pp. 47-53 ◽  
Author(s):  
Taanvi Ramesh ◽  
Artemis Igoumenou ◽  
Maria Vazquez Montes ◽  
Seena Fazel
Keyword(s):  
Risk Assessment ◽  
Performance Measures ◽  
Predictive Accuracy ◽  
Psychiatric Inpatient ◽  
Psychiatric Hospitals ◽  
Assessment Tools ◽  
Assessment Instruments ◽  
Predictive Values ◽  
Meta Regression ◽  
Forensic Psychiatric

AbstractBackground and Aims:Violent behaviour by forensic psychiatric inpatients is common. We aimed to systematically review the performance of structured risk assessment tools for violence in these settings.Methods:The nine most commonly used violence risk assessment instruments used in psychiatric hospitals were examined. A systematic search of five databases (CINAHL, Embase, Global Health, PsycINFO and PubMed) was conducted to identify studies examining the predictive accuracy of these tools in forensic psychiatric inpatient settings. Risk assessment instruments were separated into those designed for imminent (within 24 hours) violence prediction and those designed for longer-term prediction. A range of accuracy measures and descriptive variables were extracted. A quality assessment was performed for each eligible study using the QUADAS-2. Summary performance measures (sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, and area under the curve value) and HSROC curves were produced. In addition, meta-regression analyses investigated study and sample effects on tool performance.Results:Fifty-two eligible publications were identified, of which 43 provided information on tool accuracy in the form of AUC statistics. These provided data on 78 individual samples, with information on 6,840 patients. Of these, 35 samples (3,306 patients from 19 publications) provided data on all performance measures. The median AUC value for the wider group of 78 samples was higher for imminent tools (AUC 0.83; IQR: 0.71–0.85) compared with longer-term tools (AUC 0.68; IQR: 0.62-0.75). Other performance measures indicated variable accuracy for imminent and longer-term tools. Meta-regression indicated that no study or sample-related characteristics were associated with between-study differences in AUCs.Interpretation:The performance of current tools in predicting risk of violence beyond the first few days is variable, and the selection of which tool to use in clinical practice should consider accuracy estimates. For more imminent violence, however, there is evidence in support of brief scalable assessment tools.

Automated Risk Assessment in the Criminal Justice Process

Prejudice ◽  
2021 ◽  
pp. 135-154
Author(s):  
Endre Begby
Keyword(s):  
Risk Assessment ◽  
Criminal Justice ◽  
Assessment Tools ◽  
Data Set ◽  
Institutionalized Racism ◽  
Risk Assessment Tools ◽  
History Of ◽  
Justice Process ◽  
Criminal Justice Process ◽  
Algorithmic Bias

This chapter addresses recent concerns about “algorithmic bias,” specifically in the context of the criminal justice process. Starting from a recent controversy about the use of “automated risk assessment tools” in criminal sentencing and parole hearings, where evidence suggests that such tools effectively discriminate against minority defendants, this chapter argues that the problem here has nothing in particular to do with algorithm-assisted reasoning, nor is it in any clear sense a case of epistemic bias. Rather, given the data set that we are given to work with, there is reason to think that no improvement to our epistemic routines would deliver significantly better results. Instead, the bias is effectively encoded into the data set itself, via a long history of institutionalized racism. This suggests a different diagnosis of the problem: in deeply divided societies, there may just be no way to simultaneously satisfy our moral ideals and our epistemic ideals.

scholarly journals The views of public and clinician stakeholders on risk assessment tools for post-stroke dementia: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025586 ◽  
Author(s):  
Eugene Tang ◽  
Catherine Exley ◽  
Christopher Price ◽  
Blossom Stephan ◽  
Louise Robinson
Keyword(s):  
Risk Assessment ◽  
Qualitative Study ◽  
Secondary Care ◽  
Assessment Tools ◽  
Stroke Patients ◽  
Post Stroke ◽  
North East ◽  
Increased Risk ◽  
Diagnosis Of Dementia

ObjectiveStroke-survivors are at increased risk of future dementia. Assessment to identify those at high risk of developing a disease using predictive scores has been utilised in different areas of medicine. A number of risk assessment scores for dementia have been developed but none has been recommended for use clinically. The aim of this qualitative study was to assess the acceptability and feasibility of using a risk assessment tool to predict post-stroke dementia.DesignQualitative semi-structured interviews were conducted and analysed thematically. The patients and carers were offered interviews at around 6 (baseline) and 12 (follow-up) months post-stroke; clinicians were interviewed once.SettingThe study was conducted in the North-East of England with stroke patients, family carers and healthcare professionals in primary and secondary care.ParticipantsThirty-nine interviews were conducted (17 clinicians and 15 stroke patients and their carers at baseline. Twelve stroke patients and their carers were interviewed at follow-up, some interviews were conducted in pairs).ResultsBarriers and facilitators to risk assessment were discussed. For the patients and carers the focus for facilitators were based on the outcomes of risk assessment for example assistance with preparation, diagnosis and for reassurance. For clinicians, facilitators were focused on the process that is, familiarity in primary care, resource availability in secondary care and collaborative care. For barriers, both groups focused on the outcome including for example, the anxiety generated from a potential diagnosis of dementia. For the patients/carers a further barrier included concerns about how it may affect their recovery. For clinicians there were concerns about limited interventions and how it would be different from standard care.ConclusionsRisk assessment for dementia post-stroke presents challenges given the ramifications of a potential diagnosis of dementia. Attention needs to be given to how information is communicated and strategies developed to support the patients and carers if risk assessment is used.

scholarly journals Treatment of Atypical Bifid Mandibular Condyle Associated with Ankylosis of the Temporomandibular Joint

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Katheleen Miranda ◽  
André Sander Carneiro ◽  
Jennifer Tsi Gerber ◽  
Suyany Gabriely Weiss ◽  
Leandro Eduardo Klüppel ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Treatment Plan ◽  
Mandibular Condyle ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Lateral Deviation ◽  
Tmj Ankylosis ◽  
History Of ◽  
The Right

Introduction. The bifid mandibular condyle (BMC) is an unusual temporomandibular joint (TMJ) disorder with controversial etiology. The association of this entity with ankylosis is rare. Objective. The objective of the present study is to report a case of BMC with associated TMJ ankylosis in a patient with no history of trauma and/or infection. Case Report. A 17-year-old male patient sought care reporting pain on the right TMJ region and mastication difficulty due to a severe limitation of mouth opening. In the clinic and imaging examinations, a 15 mm mouth opening and BMC associated with ankylotic mass of the right TMJ were observed, besides a facial asymmetry with chin deviation to the right. The proposed treatment plan was condylectomy on the right side, bilateral coronectomy, and genioplasty, so the chin lateral deviation could be corrected, under general anesthesia. The patient remains under clinical and imaging follow-up of two years with functional stability and no signs of relapse of the ankylosis. Conclusion. The association of BMC with ankylosis is an atypical entity which must be diagnosed and treated early to prevent aesthetic and functional damages to the patient.

49 Falls and the Prediction of Fragility Fractures

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Celia Gregson
Keyword(s):  
Risk Assessment ◽  
Fracture Risk ◽  
Fragility Fractures ◽  
Fracture Risk Assessment ◽  
Assessment Tools ◽  
Health And Social Care ◽  
European Working ◽  
Risk Assessment Tools ◽  
History Of ◽  
Risk Factors For Falls

Abstract Fragility fractures carry high health and social care costs for patients, families, and health systems. Falls are a fundamental risk factor for sustaining a fragility fracture, and hence fracture risk assessment is an intrinsic component of any falls evaluation. I will review the relationship between falls and incident fracture and outline strategies for assessing fracture risk. I will review the different fracture risk assessment tools available, including FRAX. I will discuss approaches to fracture risk assessment in the context of falls. Sarcopenia is an important risk factors for falls. Recently the European Working Group on Sarcopenia in Older People (EWGSOP) updated their diagnostic criteria for sarcopenia, placing a greater emphasis on muscle strength and physical performance. Whilst measures of muscle mass may not add to the clinical prediction of fractures over an above a tool such as FRAX, I will discuss the value of tests of muscle function, impairment of which characterises sarcopenia, in the prediction of fracture risk. I will further present data on patient’s own perception of fracture risk and how this might be influenced by a history of falls.

Use of risk assessment tools for people with intellectual disability: The latest evidence

2016 ◽  
Vol 33 (S1) ◽  
pp. S38-S38 ◽  
Author(s):  
C. Morrissey
Keyword(s):  
Risk Assessment ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Outcome Measurement ◽  
Psychiatric Patients ◽  
Psychiatric Hospitals ◽  
Assessment Tools ◽  
High Rate ◽  
Lower Intelligence ◽  
The Uk

A relatively high proportion of people detained in forensic psychiatric hospitals have intellectual disabilities (up to 3000 people in the UK; Royal College of Psychiatrists, 2013), and people with intellectual disability are significantly over-represented among those psychiatric patients with long lengths of hospital stay (CQC, 2013; Vollm, 2015). People with mild to borderline intellectual disabilities are also prevalent in the UK prison system.Although the relationship between intelligence and offending is complex, lower intelligence is a known actuarial risk factor for offending behaviour. Studies, which have investigated the prediction of re-offending risk in populations with intellectual disability, have nevertheless found lower rates of recorded re-offending compared to those in mainstream forensic populations (e.g. Gray et al., 2010). The relatively high rate of ‘offending-like’ behaviour, which is not processed through the criminal justice system in people with intellectual disability makes risk prediction a more complex exercise with this group of people. It also makes outcomes measurement more difficult.This paper will give an overview of the current research evidence and clinical practice in the field of risk assessment, risk management and outcome measurement with offenders with intellectual disability. It will summarise the findings of a recent NIHR funded systematic review by the author, which pertains to this area, and will point to future developments in the field.Disclosure of interestThe author has not supplied his declaration of competing interest.

Comparing Predictive Validity of JSORRAT-II and MEGA♪ With Sexually Abusive Youth in Long-Term Residential Custody

2017 ◽  
Vol 62 (10) ◽  
pp. 2937-2953 ◽  
Author(s):  
Lucinda A. Lee Rasmussen
Keyword(s):  
Risk Assessment ◽  
Area Under The Curve ◽  
Assessment Tools ◽  
Sexual Recidivism ◽  
Residential Treatment Facility ◽  
Sexually Abusive ◽  
Risk Assessment Tools ◽  
Representative Samples

This 6-year prospective study is the first to compare two psychometrically sound risk assessment tools for sexually abusive youth: JSORRAT-II and MEGA♪. Cross-validated on representative samples of over 500 youth, these measures have cutoff scores, allowing for a more exact assessment of risk. Study sample consisted of 129 male adjudicated adolescents housed in a secured residential treatment facility for sexually abusive youth. Receiver operating characteristic (ROC) analysis showed that MEGA♪ Risk Scale was mildly predictive of sexual recidivism over a 6-year period (mean follow-up = 15.6 months)—area under the curve (AUC) = .67; 95% confidence interval [CI] = [0.52, 0.82]; p < .015. JSORRAT-II was not predictive (AUC = .57; 95% CI = [0.42, 0.72]; p < .297). The study contributes to scant literature on the most contemporary, statistically robust risk assessment tools for sexually abusive youth.

scholarly journals Apical Surgery: Therapeutic Option for Endodontic Failure

2018 ◽  
Vol 20 (3) ◽  
pp. 185
Author(s):  
Paulo Otávio Carmo Souza ◽  
Carolina Ferrari Piloni de Oliveira ◽  
Iussif Mamede-Neto ◽  
Amin De Macedo Mamede Sulaimen ◽  
Pedro Luís Alves de Lima ◽  
...  
Keyword(s):  
Root Canal ◽  
Therapeutic Option ◽  
Treatment Plan ◽  
Tomographic Images ◽  
Apical Surgery ◽  
Root Canal Retreatment ◽  
Periapical Granuloma ◽  
History Of ◽  
Endodontic Retreatment

AbstractThe aim of this study is present a surgical solution of the case of endodontic root canal failure caused by overfilling, with a history of endodontic retreatment and aesthetic rehabilitation with porcelain veneers. Patient C.F.P.L, 50 years old, female, was looking for treatment complaining of pain. Previous endodontic treatment was reported on tooth 11, and root canal retreatment after 6 months due to the persistence of painful symptomatology. Later, the patient carried out aesthetic rehabilitation with porcelain veneers, and approximately 6 months later the vitro pain related to the tooth 11 occurred again. Radiographic and tomographic images showed obturation of the root canal of the tooth 11 associated with diffuse hypodense area in the periapical region, with overextended endodontic material. The probable clinical diagnosis was symptomatic traumatic apical periodontitis, and apical surgery was proposed as treatment plan. After infiltrative anesthesia, a Newmann incision and split flap were performed, followed by osteotomy with micro-chisel and curettage of the lesion. An apicectomy was performed with Zecrya drill, followed by retro cavity with diamond ultrasonic tip and retrograde obturation with white MTA. After 2 years of follow-up bone neoformation and absence of symptomatology were observed, tooth in function and preservation of aesthetic rehabilitation harmony. Apical surgery is a therapeutic alternative with favorable prognosis for the treatment of endodontic failure, provided that it is correctly indicated and with a wellexecuted surgical protocol.Keywords: Apicectomy. Periapical Periodontitis. Periapical Granuloma. ResumoO objetivo deste estudo é apresentar a resolução cirúrgica de um caso de insucesso endodôntico ocasionado pela sobre obturação do canal radicular, com histórico de retratamento endodôntico e reabilitação estética com facetas cerâmicas. Paciente C.F.P.L, 50 anos, gênero feminino, procurou atendimento odontológico queixando-se de dor. Foi relatado tratamento endodôntico prévio no dente 11, e retratamento do canal radicular após 6 meses devido à persistência de sintomatologia dolorosa. Posteriormente, a paciente passou por reabilitação estética com facetas cerâmicas e, aproximadamente 6 meses após, houve o reaparecimento de dor espontânea relacionada ao dente 11. As imagens radiográficas e tomográficas revelaram obturação do canal radicular do dente 11 associado à área hipodensa difusa na região periapical, com extravasamento de material obturador. O diagnóstico clínico provável foi de periodontite apical sintomática traumática, e plano de tratamento proposto uma cirurgia parendodôntica. Posterior a anestesia infiltrativa, realizou-se incisão do tipo Newmann e retalho dividido, seguido de osteotomia com micro cinzel e curetagen da lesão. A apicectomia foi realizada com broca Zecrya, seguida da confecção da retrocavidade com ponta ultrassônica diamantada e obturação retrógrada com MTA branco. Após 2 anos de proservação foi observada neoformação óssea e ausência de sintomatologia, dente em função e preservação da harmonia da reabilitação estética. A cirurgia parendodôntica é uma alternativa terapêutica com prognóstico favorável para o tratamento do insucesso endodôntico, desde que corretamente indicada e com protocolo cirúrgico bem executado.Palavras-chave: Apicectomia. Periodontite Periapical. Granuloma Periapical.

Abstract TP75: Natural History of Incidental Small Paraclinoid Unruptured Aneurysm

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jeong Eun Kim ◽  
Jin Sue Jeon ◽  
Jun Hyong Ahn ◽  
Young-Je Son ◽  
Jae Seung Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Treatment Plan ◽  
Cumulative Survival ◽  
High Risk Factors ◽  
Significant Difference ◽  
History Of ◽  
Aneurysm Growth ◽  
Arterial Branch

Objective: The optimal consensus over treatment of incidental small paraclinoid unruptured intracranial aneurysm (UIA) remains controversial. The aim of this study was to reveal the natural history of small paraclinoid UIA with the goal of informing a treatment plan. Methods: A total of 344 patients harboring 364 paraclinoid UIA (≤5 mm) were retrospectively evaluated during the mean follow-up of 32±17.3 months from September 2001 to May 2011. Barami’s classification was used for categorizing aneurysm location. Univariate and multivariate analyses were used to determine the risk factors of aneurysm growth. The Kaplan-Meier product-limit estimator and generalized Wilcoxon tests were performed to assess the cumulative survival without aneurysm growth. Results: None of the aneurysm ruptures and 12 (3.3%) cases of aneurysm growth were observed during the follow up of 969.7 aneurysm-years. Aneurysm ≥ 4mm (hazard ratio [HR], 6.73; p=0.001) and hypertension (HR, 4.92; p=0.02) were associated with aneurysm growth. Other variables including female (p=0.18), age (p=0.24), arterial branch related location (p=0.47), multiplicity (p=0.11), and smoking (p=0.36) did not differ significantly. The multivariate analysis disclosed that aneurysm ≥4mm (HR, 4.78; p=0.01) and hypertension (HR, 4.20; p=0.03) were significant predictable factors for aneurysm growth. The cumulative survival without aneurysm growth reached a significant difference in aneurysms ≥4mm (p<0.001) and with hypertension (p=0.01). No statistical difference was observed between arterial branch related and unrelated groups (p=0.16). Conclusions: Incidental small paraclinoid UIA can be primarily treated conservatively. Patients with high risk factors including aneurysm ≥4 mm and hypertension must be monitored closely.

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