Units In Denmark Research Articles

The combined diagnosis of allergic and irritant contact dermatitis in a retrospective cohort of 1000 consecutive patients with occupational contact dermatitis.

The diagnosis of combined allergic and irritant contact dermatitis is an accepted subdiagnosis for hand dermatitis, and it is often considered in a patient with contact dermatitis, a positive and relevant patch test result, and wet work exposure. We therefore hypothesize that it is arbitrary for wet work exposure to be taken into consideration in a patient with newly diagnosed relevant contact allergy. Furthermore, an overestimation of the diagnosis will probably occur if the criteria for wet work exposure are applied correctly, as many occupations have an element of wet work. To find the statistically expected number of combined allergic and irritant contact dermatitis cases in 1000 patients, and to evaluate the diagnostic criteria for the diagnosis. One thousand consecutive patients with occupational contact dermatitis from a hospital unit in Denmark were assessed. The expected number of cases with the diagnosis of combined allergic and irritant contact dermatitis was 0.33%, as compared with the observed number of 6.4%. Females occupied in wet occupations were often diagnosed with combined allergic and irritant contact dermatitis (p < 0.005). The diagnosis of combined allergic and irritant contact dermatitis should be used critically to avoid misclassification, and possible criteria for the diagnosis are proposed.

Estimating The Organ Donor Potential in Non-Intensive Care Units in Denmark: A Retrospective Analysis of Potential Organ Donors in The Central Denmark Region.

The aim of this study was to assess unexploited organ donor potential consisting of patients dying in non-intensive care units (ICU), of cerebral catastrophes, and without medical contraindications for organ donation. The cohort was identified by the Danish Cause of Death Registry. Data were collected on patients who died within 48 hours from admission, by one of the known etiologies that cause brain death, in non-ICU wards in The Central Denmark Region, from January 2008 till December 2010. Incidence of conditions compatible with imminent brain death was assessed by a medical records review of patients who had had computed tomography scan of the cerebrum (CTC). After retrospectively reviewing a total of 287 medical records, excluding cases not consistent with imminent brain death and with absolute contraindications for donation, the pool of identified possible donors after brain death (DBD) consisted of 87 persons. The mean age was 77.1 years (36-96 years). 71.3% of the deaths were due to cerebral hemorrhage, 21.7% died of subarachnoid hemorrhage, 6.9% of cerebral infarction and 1.1% due to a benign cerebral neoplasm. The main comorbidities of the identified DBDs were hypertension (60%), heart diseases (41%), lung diseases (16%), diabetes (13.8%) and kidney diseases (2.3%). Each case was then evaluated by a transplant coordinator (TC) with respect to medical suitability to organ donation. Of the 87 possible DBDs, the TC identified 9 eligible donors, in 30 cases it was not possible to assess eligibility because of missing information, in 5 cases permission was refused by relatives, and 43 had medical contraindications precluding organ donation. An unexploited DBD donor potential was identified during a 3 year period in a region with population of about 1.3 MIO, of which, in at least 9 cases, neither absolute nor relative medical contraindications were found. However, in those 9 cases, no information on consent was available.

Information to Coming BMT Patients - Creating a Web Site

As transplant coordinators we have the first contact with all Bone Marrow Transplant (BMT) patients referred to our unit. Our experience is that the patients have a lot of questions concerning transplant. Initial information about BMT is given at a different hospital, by physicians and nurses not specialized in BMT. Purpose To identify what information is given to the patient from diagnosis until being admitted to the transplant unit. What information is needed from patient, doctors and nurses’ perspective and how it should be given? To prepare the participants for an interview, we created a semi structured questionnaire and emailed it to eight doctors and nurses at five referring hematology units in Denmark. All agreed to participate. Seven interviews were carried out over the phone and one in person. Questionnaires were handed out to eight patients who received their transplant during September and October 2012. All agreed to participate. Patients were interviewed in person at the hospital. Two focus group interviews were conducted among nurses in the in- and outpatient BMT-clinic. All participants stated that they would like more information about time range from diagnosis to the time of transplant. Neither staff from referring hematology units nor patients had the full view of time from HLA typing is performed to the time of transplant. The patients stated that lack of time frame made them and their family frustrated since there are economic, work related, and social arrangements to take care of before transplant. Their idea was that information could be carried out as a small pamphlet. All patients and staff from referring units asked for more visual information; video with patients going through transplant and pictures of the transplant unit. Some asked for a list with links to national and international web pages about BMT and a list with frequently asked question (FAQ). Patients suggested that staff from the transplant unit should go to referring hematology units to teach staff. Contact to the Danish Cancer Society has been established and a video production has started. Video will be ready in early 2014 and will be posted on the Danish Cancer Society’s web site and a link will be present on the hospital web page. A time line with information about the deferent processes has been created and is posted on the hospital web page together with links to books about transplant, which can be downloaded. Links to relevant national and international web pages has been posted. List with FAQ has been developed and posted on the web page. To introduce the new part of the hospital website to doctors and nurses at referring hematology units. To post the website so current and future patients will get to know it. To post pictures of the BMT unit on the hospital website. Future project is to arrange visit/meetings with referring hematology units, teaching staff.

Study protocol: rehabilitation including social and physical activity and education in children and teenagers with cancer (RESPECT)

BackgroundDuring cancer treatment children have reduced contact with their social network of friends, and have limited participation in education, sports, and leisure activities. During and following cancer treatment, children describe school related problems, reduced physical fitness, and problems related to interaction with peers.Methods/designThe RESPECT study is a nationwide population-based prospective, controlled, mixed-methods intervention study looking at children aged 6-18 years newly diagnosed with cancer in eastern Denmark (n = 120) and a matched control group in western Denmark (n = 120). RESPECT includes Danish-speaking children diagnosed with cancer and treated at pediatric oncology units in Denmark. Primary endpoints are the level of educational achievement one year after the cessation of first-line cancer therapy, and the value of VO2max one year after the cessation of first-line cancer therapy. Secondary endpoints are quality of life measured by validated questionnaires and interviews, and physical performance. RESPECT includes a multimodal intervention program, including ambassador-facilitated educational, physical, and social interventions. The educational intervention includes an educational program aimed at the child with cancer, the child’s schoolteachers and classmates, and the child’s parents. Children with cancer will each have two ambassadors assigned from their class. The ambassadors visit the child with cancer at the hospital at alternating 2-week intervals and participate in the intervention program. The physical and social intervention examines the effect of early, structured, individualized, and continuous physical activity from diagnosis throughout the treatment period. The patients are tested at diagnosis, at 3 and 6 months after diagnosis, and one year after the cessation of treatment. The study is powered to quantify the impact of the combined educational, physical, and social intervention programs.DiscussionRESPECT is the first population-based study to examine the effect of early rehabilitation for children with cancer, and to use healthy classmates as ambassadors to facilitate the normalization of social life in the hospital. For children with cancer, RESPECT contributes to expanding knowledge on rehabilitation that can also facilitate rehabilitation of other children undergoing hospitalization for long-term illness.Trial registrationClinical Trials.gov: file. NCT01772849 and NCT01772862

Effects on Presenteeism and Absenteeism From a 1-Year Workplace Randomized Controlled Trial Among Health Care Workers

It is unknown whether workplace interventions successfully improving health outcomes can also provide concurrent improvements in presenteeism and absenteeism. A 1-year cluster randomized controlled trial was conducted on 144 employees at a care unit in Denmark. The intervention consisted of calorie-limited diet, physical exercise, and cognitive behavioral training during working hours 1 hour per week. The reference group was offered presentations about healthy lifestyle. Absenteeism and presenteeism (productivity, workability, and sickness absence) were recorded at baseline and after 3 and 12 months of intervention. In intention-to-treat analysis, a significant effect of the intervention was found for productivity after 3 months. Nevertheless, after 12 months no significant effects on absenteeism or presenteeism were found. This study suggests that a worksite intervention, despite successfully reducing overweight, does not induce lasting improvements on absenteeism or presenteeism.

How is nursing care for stroke patients organised? Nurses' views on best practices

To describe staff nurses' and charge nurses' perceptions of how to organise stroke care. Many elements are important for high quality care and stroke patients' ability to regain pre-stroke capacities. Among them is how nursing care is organised. Research on the organisation of nursing care in stroke units is sparse. A qualitative descriptive study was conducted in four inpatient stroke units in Denmark using semi-structured interviews with charge nurses and focus groups with staff nurses. Data were analysed using conventional content analysis. Data from the two groups were analysed 8months apart. Five themes emerged: nursing staff competencies focused on high quality care (29%); focus on organising continuity of care (26%); strong culture of collaboration no matter the work environment (19%); staff committed to their patients (13%); continuity of care maintained during hospital discharge transitions (13%). Organisation of care to maintain continuity is important for high quality care and includes assigning patients permanent designated nurses who are responsible for interdisciplinary care coordination. Other important elements include nurses' competencies, collaboration, commitment and resources. To improve quality care, the nurse managers should implement processes that strengthen continuity across the care spectrum and among all disciplines.

Assessment of the physical–chemical stability of cytotoxic drug preparations: a national project

In recent years there has been a growing wish for national collaboration with respect to the production of cytotoxic drug preparations in order to increase efficiency and standardisation to meet...

Higher Stroke Unit Volume Associated With Improved Quality of Early Stroke Care and Reduced Length of Stay

Specialized stroke unit care improves outcome among patients with stroke, but it is unclear whether there are any scale advantages in costs and clinical outcome from treating a larger number of patients. We examined whether the case volume in stroke units was associated with quality of early stroke care, mortality, and hospital bed-day use. In a nationwide population-based cohort study, we identified 63 995 patients admitted to stroke units in Denmark between 2003 and 2009. Data on exposure, outcome, and covariates were collected prospectively. Comparisons were clustered within stroke units and adjusted for patient and hospital characteristics. Patients in high-volume stroke units overall had a better prognostic profile than patients in low-volume stroke units. Patients in high-volume stroke units also received more processes of care in the early phase of stroke compared with patients in low-volume stroke units (unadjusted difference, 9.84 percentage points; 95% CI, 3.98-15.70). High stroke unit volume was associated with shorter length of the initial hospital stay (adjusted ratio, 0.49; 95% CI, 0.41-0.59) and reduced bed-day use in the first year after stroke (adjusted ratio, 0.79; 95% CI, 0.70-0.87). No association between volume and mortality was found. Patients admitted to high-volume stroke units received a higher quality of early stroke care and spent fewer days in the hospital compared with patients in low-volume units. We observed no association between volume and mortality.

HCR-20 violence risk assessments as a guide for treating and managing violence risk in a forensic psychiatric setting

Over the past decades there has been a vast development in the research into risk factors for violence and the development of risk assessment instruments. One instrument that has been given special attention is the HCR-20 violence risk assessment scheme. However, little attention has been paid to the clinical applicability of this tool, i.e. how does this assessment scheme perform when utilized in clinical practice as a tool to guide intervention and management in order to alleviate risk of violent behaviour? The present study was a true prospective study into the utilization of the HCR-20 as a clinical routine. Data on forensic psychiatric patients (n = 81) from a forensic unit in Denmark are presented. As part of a clinical routine all patients were assessed for risk of future violence utilizing the structured professional judgement model, the HCR-20. Outcome measures were aggressive episodes during hospitalization and new convictions post discharge. The predictive validity of the HCR-20 was lower compared with previous findings. It is argued that this does not necessarily indicate poor predictive accuracy of the HCR-20. Rather, it may indicate that the HCR-20 is suitable for guiding risk management in order to prevent violent behaviour.

Skin‐to‐skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices

To investigate the application of skin-to-skin care (SSC) in the Nordic countries, the existence of guidelines for SSC and the attitudes of neonatal staff towards SSC. One questionnaire was distributed at unit level and one at staff level in all Nordic neonatal intensive care units (n = 109). The unit questionnaire was answered by 95 (87%) units and the staff questionnaire by 1446 staff members (72%). All units offered SSC to various degrees, but guidelines only existed at 47% of them. Units in Denmark, Norway and Sweden seemed to use SSC earlier, longer and in more medically complicated situations than units in Finland and Iceland. Seventy-seven per cent of the units had private rooms where parents and infants could stay together, still the physical environment of the units limited the use of SSC. Medical risks were considered the main barrier for further implementation of SSC, while general development and early interaction were the most frequently mentioned benefits. Skin-to-skin care is implemented in all Nordic neonatal units, but offered to various degrees, to various populations and to varying extents. Danish, Norwegian and Swedish units are offering SSC more extensively than units in Finland and Iceland.

Freestanding midwifery units versus obstetric units: does the effect of place of birth differ with level of social disadvantage?

BackgroundSocial inequity in perinatal and maternal health is a well-documented health problem even in countries with a high level of social equality. We aimed to study whether the effect of birthplace on perinatal and maternal morbidity, birth interventions and use of pain relief among low risk women intending to give birth in two freestanding midwifery units (FMU) versus two obstetric units in Denmark differed by level of social disadvantage.MethodsThe study was designed as a cohort study with a matched control group. It included 839 low-risk women intending to give birth in an FMU, who were prospectively and individually matched on nine selected obstetric/socio-economic factors to 839 low-risk women intending OU birth. Educational level was chosen as a proxy for social position. Analysis was by intention-to-treat.ResultsWomen intending to give birth in an FMU had a significantly higher likelihood of uncomplicated, spontaneous birth with good outcomes for mother and infant compared to women intending to give birth in an OU. The likelihood of intact perineum, use of upright position for birth and water birth was also higher. No difference was found in perinatal morbidity or third/fourth degree tears, while birth interventions including caesarean section and epidural analgesia were significantly less frequent among women intending to give birth in an FMU. In our sample of healthy low-risk women with spontaneous onset of labour at term after an uncomplicated pregnancy, the positive results of intending to give birth in an FMU as compared to an OU were found to hold for both women with post-secondary education and the potentially vulnerable group of FMU women without post-secondary education. In all cases, women without post-secondary education intending to give birth in an FMU had comparable and, in some respects, more favourable outcomes when compared to women with the same level of education intending to give birth in an OU. In this sample of low-risk women, we found that the effect of intended place on birth outcomes did not differ with women’s level of education.ConclusionFMU care appears to offer important benefits for birthing women with no additional risk to the infant. Both for women with and without post-secondary education, intending to give birth in an FMU significantly increased the likelihood of a spontaneous, uncomplicated birth with good outcomes for mother and infant compared to women intending to give birth in an OU. All women should be provided with adequate information about different care models and supported in making an informed decision about the place of birth.

Commentary: Preventing adolescent suicide: is proactive screening for mental disorders the answer? – reflections on Christiansen and Larsen (2011)

Commentary: Preventing adolescent suicide: is proactive screening for mental disorders the answer? – reflections on Christiansen and Larsen (2011)

Constructing the illness narrative: A grounded theory exploring patientsʼ and relativesʼ use of intensive care diaries

After a stay in the intensive care unit, patients risk experiencing delusional memories, memory loss, and symptoms of posttraumatic stress. Since the 1990s, diaries have been kept for intensive care unit patients to help fill in memory gaps, aid psychosocial recovery, and improve health-related quality of life. More insight is needed into the application of diaries. The aim of our study was to explore how patients and relatives use diaries in the context of the illness trajectory. Qualitative multicentered design using in-depth semistructured interview technique. A nine-bed general intensive care unit and a 13-bed thoracic surgical intensive care unit in Denmark. A sample of 19 patients at 6-12 months postintensive care unit discharge and 13 relatives (n = 32). Intensive care diaries and handover 1 or 3 months postintensive care unit discharge. Grounded theory method was used to explore the use of diaries as a psychosocial process of recovery involving patients and relatives. Data were managed by NVivo software. The core category was "constructing the illness narrative," which was a process of narration embedded in our emerging theory of psychosocial recovery after critical illness. The main categories within the patient perspective were information acquisition and gaining insight, and the main categories within the relative perspective were supporting the patient, supporting oneself, and negotiating access. Intensive care diaries are useful to patients as well as their relatives. Patients need to construct their illness narrative, and diaries are among the sources they use. The patients' project was to combine various sources of information in a process of information acquisition, narration, and evolving insight progressing toward recovery. The relatives supported the patients' project and also supported themselves by using the diary to uphold their own healing process. We recommend intensive care diaries as a low-technology, low-cost rehabilitative intervention for patients and relatives to help bridge the span from intensive care to recovery.

Quality of Care and Patient Outcome in Stroke Units

Specialized stroke unit care improves outcome in stroke patients. However, it is uncertain whether the units should be placed in a neurological or non-neurological (eg, internal medicine or geriatric) setting. To assess whether stroke unit setting (neurological/non-neurological) is associated with quality of care and outcome among patients with stroke, and whether these associations depend on the severity of comorbidity. In a nationwide population-based follow-up study, we identified 45,521 patients admitted to stroke units in Denmark between 2003 and 2008. Outcomes were quality of care (whether patients received evidence-based processes of acute stroke care), mortality, length of stay, and readmission. Charlson comorbidity index was used to assess comorbidity, and comparisons were adjusted for patient and hospital characteristics. Patients admitted to stroke units in neurological settings had higher odds for early antiplatelet therapy (odds ratio, 1.68; 95% confidence interval, 1.10-2.56) and early computed tomographic scan or magnetic resonance imaging (odds ratio, 1.77; 95% confidence interval, 1.29-2.45) compared with patients in non-neurological settings. No other differences were found when studying quality of care and patient outcomes. However, patients with moderate comorbidity admitted to stroke units in neurological settings had higher odds for 1-year mortality, but comparisons across strata of comorbidity were not statistical significant. Except for early antiplatelet therapy and early computed tomographic scan or magnetic resonance imaging, the medical setting was not associated with differences in processes of acute stroke care and patient outcome. No medical setting related differences were found according to comorbidity, although indications of a worse outcome in patients with moderate comorbidity in neurological settings warrant further investigation.

Measuring and improving quality in obstetrics – the implementation of national indicators in Denmark

From September 2010, all births in Denmark will be monitored from a quality perspective with the Danish National Indicator Project in order to document and develop the quality of the care provided during delivery. We describe the process of selecting the indicators based on relevance, scientific evidence, usefulness and applicability, acceptability and patient safety. Eight indicators were selected covering different aspects of delivery: anesthesia/pain relief; continuous support for women in the delivery room; lacerations, 3rd or 4th degree; acute cesarean section; post-partum hemorrhage; establishment of skin-to-skin contact between mother and newborn infant; severe fetal hypoxia; delivery of a healthy child after uncomplicated delivery. Registration will be mandatory for all delivery units in Denmark. Subsequently, the clinical units will receive feedback in the form of real-time monthly and quarterly standard reports including unadjusted results that may be used for the unit's own internal monitoring and development of quality.

Psychopathy as a Risk Factor for Violent Recidivism: Investigating the Psychopathy Checklist Screening Version (PCL:SV) and the Comprehensive Assessment of Psychopathic Personality (CAPP) in a Forensic Psychiatric Setting

A robust relationship has been established between psychopathy and violence, and psychopathy is considered essential in the process of violence risk assessment. This study presents data on a patient sample from a forensic psychiatric unit in Denmark. All patients were assessed for psychopathy using the Psychopathy Checklist Screening Version (PCL:SV) and the Comprehensive Assessment of Psychopathic Personality (CAPP). After a follow-up period of 5.7 years, recidivism outcomes were obtained from the Danish National Crime Register. Both psychopathy measures were related to a more severe and versatile criminal career as well as to violent recidivism. Overall, the predictive accuracy of violent recidivism of the two measures was good, and no significant difference was found in terms of predictability. The newly developed CAPP could be a promising clinical risk management tool in terms of its comprehensiveness. Its validity needs to be further explored, but at least its ability to predict violence similar to the PCL:SV is supported by the present study.

Fitness consultations in routine care of patients with type 2 diabetes in general practice: an 18-month non-randomised intervention study

BackgroundIncreasing physical activity is a cornerstone in the treatment of type 2 diabetes and in general practice it is a challenge to achieve long-term adherence to this life style change. The aim of this study was to investigate in a non-randomised design whether the introduction of motivational interviewing combined with fitness tests in the type 2 diabetes care programme was followed by a change in cardio-respiratory fitness expressed by VO2max, muscle strength of upper and lower extremities, haemoglobin A1c (HbA1c) and HDL-cholesterol.MethodsUncontrolled 18-month intervention study with follow-up and effect assessment every 3 months in a primary care unit in Denmark with six general practitioners (GPs). Of 354 eligible patients with type 2 diabetes, 127 (35.9%) were included. Maximum work capacity was tested on a cycle ergometer and converted to VO2max. Muscle strength was measured with an arm curl test and a chair stand test. The results were used in a subsequent motivational interview conducted by one of the GPs. Patients were encouraged to engage in lifestyle exercise and simple home-based self-managed exercise programmes. Data were analysed with mixed models.ResultsAt end of study, 102 (80.3%) participants remained in the intervention. Over 18 months, VO2max increased 2.5% (p = 0.032) while increases of 33.2% (p < 0.001) and 34.1% (p < 0.001) were registered for the arm curl test and chair stand test, respectively. HDL-cholesterol increased 8.6% (p < 0.001), but HbA1c remained unchanged (p = 0.57) on a low level (6.8%). Patients without cardiovascular disease or pain from function limitation increased their VO2max by 5.2% (p < 0.0001) and 7.9% (p = 0.0008), respectively.ConclusionsIn this 18-month study, participants who had repeated fitness consultations, including physical testing and motivational interviewing to improve physical activity, improved VO2max, muscle strength, and lipid profile. Our results indicate that physical testing combined with motivational interviewing is feasible in a primary health care setting. Here, a fitness consultation tailored to the individual patient, his/her comorbidities and conditions in the local area can be incorporated into the diabetes programme to improve patients' muscle strength and cardio-respiratory fitness.

Quantitative landscape dynamics in Denmark through the last three millennia based on the Landscape Reconstruction Algorithm approach

This paper explores the spatial and temporal land-cover variability within the main cultural landscape units in Denmark during the last 3,000 years. Quantitative estimates of the cover of trees, grasses, Cerealia and Calluna around nine Danish lakes were obtained using the recently developed Landscape Reconstruction Algorithm (LRA) (Sugita 2007a, b). The performance of the approach was evaluated by comparing reconstructed vegetation based on a.d. 1800 pollen spectra to land cover from historical maps of the same period. Although the model tended to overestimate grassland cover by 10–20%, the reconstructed vegetation was much more similar to the observed than the uncorrected pollen proportions. The LRA was then applied to 3,000 year long pollen records to reconstruct the vegetation development around each of the nine sites. The results support earlier conclusions regarding the relative stability of woodland, agrarian and heathland dominated landscapes in Denmark (Odgaard and Rasmussen 2000), with the distribution of the main landscape types determined by topography and soil characteristics. The present study indicates that the transition zones between agricultural and forest dominated landscapes were the most dynamic, acting as buffer zones where most of the expansions and contractions of agricultural activities took place. The quantitative vegetation reconstructions underline the importance of farming and especially pastoral activities in shaping the Danish landscapes throughout the study period.

The importance of early anti‐social behaviour among men with a schizophrenia spectrum disorder in a specialist forensic psychiatry hospital unit in Denmark

People with a major mental disorder are at increased risk of committing crimes, especially violent crimes, compared with the general population. Sub-groups have been identified based on age of onset of anti-social or violent behaviour. Mentally disordered offenders with early onset anti-social behaviour tend to have a lifelong pattern of it, but in a clinical setting, are they easily identifiable as a distinct sub-group? Our main aim was to establish whether distinct groups of early and later onset offenders can be identified from the standard clinical record of men with schizophrenia spectrum disorders selected for hospital treatment after conviction for a serious crime, and to test the hypothesis that even in such a clinically selected group, early onset offending would be associated with subsequent persistent and versatile offending. A retrospective case file review of all 83 men with a schizophrenia spectrum disorder in a complete 2-year discharge cohort from one specialist secure forensic hospital unit (2001-2002). A sub-group of patients with early onset anti-social behaviour was confirmed. Prior to this specialist hospitalisation, this group had sustained significantly more criminal convictions and were more criminally versatile than their late onset peers. The recognition of clinically meaningful sub-groups among hospitalised offender patients seems straightforward, and may be useful in the development of more specifically focused intervention and in making sense of more longer-term outcomes.

Risk Assessment: The Value of Structured Professional Judgments

International research suggests that using formalized risk assessment methods may improve the predictive validity of professionals’ predictions of risk of future violence. This study presents data on forensic psychiatric patients discharged from a forensic unit in Denmark in year 2001–2002 (n =107). All patients were assessed for risk of future violence utilizing a structured professional judgment model: the HCR-20 violence risk assessment scheme. After a follow-up period of 5.6 years, recidivism outcome were obtained from the Danish National Crime Register. Overall, the predictive validity of the HCR-20 was good. The structured final risk judgment had the highest predictive accuracy of violent recidivism and was superior to the HCR-20 used in an actuarial manner. At the individual item level, a higher number of the dynamic items were significantly predictive of violent recidivism compared to static items. In sum, the findings support the use of structured professional judgment models of risk assessment and in particular the HCR-20 violence risk assessment scheme. Findings regarding the importance of the (clinical) structured final risk judgment and the individual dynamic items strengthen the use of this scheme in clinical practice.