Aggressive Risk Assessment Research Articles

Influence of chronic congenital systemic disorder effects in orthodontic treatment

The orthodontic treatment of patients with medical disorders is becoming an increasing aspect of modern-day practice. Orthodontic treatment is no longer reserved for only healthy patients. With better management of serious medical problems, increased quality of life expectations, and greater ambulation, medically compromised individuals are now regular visitors to orthodontic practices. While orthodontic treatment has been historically considered to be completely noninvasive, specific orthodontic procedures may place some patients at risk for serious sequelae. Among the most common of these conditions are those associated with cardiovascular disease, bleeding disorder, respiratory disorder, neurological disorder, renal disease, musculoskeletal system, endocrine disorder, liver disease, allergies, and drug side effects. Aggressive risk assessment is the key factor in the identification and prevention of medically associated problems. Assessment and management of patients at risk for endocarditis, bleeding, and asthmatic attacks are discussed. The orthodontic treatment of patients with medical disorders is becoming an increasing aspect of modern-day practice. The influences of various systemic diseases on orthodontic treatment have been discussed and various recommendations to overcome the potential problems have been highlighted in this article.

Usefulness of Aggressive Behaviour Risk Assessment Tool for prospectively identifying violent patients in medical and surgical units

The aim of this study is to evaluate the usefulness of the Aggressive Behaviour Risk Assessment Tool for prospectively identifying violent patients in medical-surgical units. Although patient violence against nurses is a serious occupational hazard, there is a lack of simple screening tools with acceptable sensitivity and specificity for identifying potentially violent patients in medical-surgical units. A prospective cohort study involving patients admitted to six medical-surgical units at an acute care hospital was conducted from August 2009 to December 2009. Primary nurses completed the 17-item checklist within 24 hours of admission. A second identical checklist was completed by another nurse to assess the inter-rater reliability. Following a violent event or just prior to discharge, the violent event outcome section was completed to collect information about violent event, if any. A multivariate logistic regression model with backward elimination was used to select a set of parsimonious items that best predict violent behaviours. Fifty-six patients out of 2063 (2·7%) had one or more violent events. A parsimonious set of ten items were selected for the tool. Receiver Operating Characteristics analysis of Aggressive Behaviour Risk Assessment Tool showed that the area under the curve was 0·82 (95% Confidence Interval, 0·75-0·90). The sensitivity and specificity at the cut-off score of 1 were 70·9% and 89·3%, respectively. The Cohen's Kappa for inter-rater reliability was 0·647. The Aggressive Risk Assessment Tool is a simple, easy-to-use assessment tool with acceptable inter-rater reliability, sensitivity and specificity that may be useful for prospectively identifying violent patients in medical-surgical units.

The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients

Considerable research has attempted to delineate the demographic and clinical characteristics of high-risk psychiatric patients and identify salient modifiable aspects of aggression prone environments. Recently, there has also been increased interest in the development and testing of structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. Although some of these methods show acceptable predictive validity, their ability to inform day-to-day treatment and management decisions is limited. The current research was designed to identify existing and novel risk factors that would assist staff to identify and manage the risk for aggression in psychiatric inpatient populations. Results showed that assessments supported by structured risk measures were more accurate than unaided clinical judgements based only on nurses' clinical experience and knowledge of the patient alone. Seven test items emerged that were maximally effective at identifying acute psychiatric patients at risk for engaging in inpatient violence within 24 hours; these items have been combined in the development of the Dynamic Appraisal of Situational Aggression. Empirical analyses and clinical experience support the efficacy of the instrument in assisting clinical staff in the identification and management of inpatient aggression.

Assessing Risk for Aggression in a Forensic Psychiatric Hospital Using the Level of Service Inventory-Revised: Screening Version

The assessment of risk for aggression has become a central concern of many mental health services. Some structured schemes for guiding risk assessment, developed primarily to assess risk in psychiatric patients discharged from hospital and offenders being considered for release from prison, have recently been trialled in the inpatient setting. Against the background of some prior research demonstrating the potential benefits of structured assessment schemes, and some concerns about the practicality of these schemes for assessing risk in inpatients, the current research was initiated to assess the effectiveness of the Level of Service Inventory-Revised: Screening Version (LSI-R: SV) in the prediction of aggression within a forensic psychiatric hospital. Results showed that only a weak association between the LSI-R: SV total score and inpatient aggression existed. This is probably because the LSI-R: SV addresses more static variables and does not assess the clinical characteristics and recent hostility that is associated with aggression in psychiatric patients. The predictive validity of the LSI-R: SV in this context is therefore limited. There might be more effective schemes, some of which were designed specifically for the purpose of assessing inpatient aggression that should be used in preference to the LSI-R: SV.

Orthodontic management of selected medically compromised patients: Cardiac disease, bleeding disorders, and asthma

Orthodontic therapy is no longer reserved for only healthy patients. With better management of serious medical problems, increased quality of life expectations, and greater ambulation, medically compromised individuals are now regular visitors to orthodontic practices. While orthodontic therapy has been historically considered to be completely noninvasive, specific orthodontic procedures may place some patients at risk for serious sequelae. Among the most common of these conditions are those associated with cardiac disease, bleeding disorders and asthma. Aggressive risk assessment is the key factor in the identification and prevention of medically-associated problems. Assessment and management of patients at risk for endocarditis, bleeding and asthmatic attacks are discussed.

Pressure Ulcers: The Benefits and Costs of New Therapies

To the Editor. —Ferrell et al1are to be congratulated for a well-designed study that has added to the body of literature concerning the treatment of pressure ulcers. In developing a clinical practice guideline on pressure ulcers in adults,2the Agency for Health Care Policy and Research reviewed 13 clinical studies examining the effects of pressure-reducing devices on the incidence of pressure ulcers, only three of which were randomized controlled trials. They concluded that although there is evidence pressure-reducing devices can decrease the incidence of pressure ulcers, there is no evidence to suggest that one type of device is more effective than another. One problem with the present study is that it compares newer, high-cost, low-air-loss bed technology with a basic foam mattress. Other available devices include gel-foam mattresses, full-gel mattresses, and alternating air support mattresses. There are also important roles for aggressive risk assessment, education, and skin