The empirical evidence base for the use of the HCR-20: A narrative review of study designs and transferability of results to clinical practice

Utilization of the Fordham Risk Screening Tool for violence risk assessment in an emergency department

BACKGROUND

Violence is a critical problem in the emergency department (ED) and patients experiencing mental health crises are at greater violence risk; however, tools appropriate for assessing violence risk in the ED are limited. Our goal was to evaluate the utility of the Fordham Risk Screening Tool (FRST) in reliability assessing violence risk in adult ED patients with acute mental health crises through evaluation of test characteristics compared to a reference standard.

METHODS

We evaluated performance of the FRST when used with a convenience sample of ED patients undergoing acute psychiatric evaluation. Participants underwent assessment with the FRST and an established reference standard, the Historical Clinical Risk Management-20, Version 3 (HCR-20 V3). Diagnostic performance was assessed through evaluation of test characteristics and area under the receiver operating characteristic curve (AUROC). Psychometric assessments examined the measurement properties of the FRST.

RESULTS

A total of 105 participants were enrolled. In comparison to the reference standard, the AUROC for the predictive ability of the FRST was 0.88 (standard error 0.39, 95% confidence interval [CI] 0.81-0.96). Sensitivity was 84% (95% CI 69%-94%) while specificity was 93% (95% CI 83%-98%). The positive predictive value was 87% (95% CI 73%-94%) and negative predictive value was 91% (95% CI 83%-86%). Psychometric analyses provided reliability and validity evidence for the FRST when used in the ED setting.

CONCLUSIONS

These findings support the potential utility of the FRST when used to assess violence risk in adult ED patients experiencing a mental health crisis. Future research with more diverse populations and ED settings is warranted.

Construction of hybridization chain reaction induced optical signal directed change of photonic crystals-DNA hydrogel sensor and its visual determination for aflatoxin B1

Herein, we have introduced hybridization chain reaction (HCR) into the photonic crystals (PhCs) hydrogel, for the first time, realizing HCR for inducing the change of the optical signal of PhCs hydrogel and using this hydrogel as a sensor for determination of the aflatoxin B1 (AFB1). By using specific sequences as the cross-linker, the extension of the cross-linker by HCR drives the swelling of the hydrogel, and the optical property of 2D PhCs array converts this swelling into a change of the Debye diffraction ring. Moreover, by further selecting the aptamer to construct the cross-linker, the hydrogel is also endowed with a unique capability for AFB1, making the hydrogel a novel sensor based on the signal amplification strategy. The results show that the designed hairpin DNAs can effectively trigger the HCR and cause the swelling of hydrogel, and the hydrogel sensor has a good determination performance and high specific recognition for AFB1.

Perspective: Coping with Covid-19: An isolation risk assessment and management guideline for healthcare staff

The mental health consequences of pandemic isolation have been well documented extending from psychological conditions such as anxiety and depression to increased falls risk, medication errors and delirium. Whilst risk factors associated with isolation are known, there remains a gap in the guidance for healthcare staff on how to assess for these risks and develop effective management plans. Using a structured professional judgement (SPJ) approach and the author's recent experience providing consultation and leadership to clinical staff working with at-risk patients during the pandemic, an isolation risk assessment and management guideline was developed. SPJ is an evidenced-based analytical method used to understand and mitigate risk that was primarily developed for the assessment and management of aggression and violence. This paper discusses an evidenced-based process used to develop the guideline and the application of its use from the author's clinical experience.

Care Pathways, Health Service Use Patterns and Opportunities for Justice Involvement Prevention Among Forensic Mental Health Clients

OBJECTIVES

The objective of the present study is to describe the patterns of health service use and of prescription claims in the year preceding an offense leading to a verdict of not criminally responsible on account of a mental disorder (NCRMD).

METHODS

Provincial health administrative databases were used to identify medical services, hospitalizations, and ambulatory prescription claims among 1,014 individuals found NCRMD in Québec. Contacts in the year preceding the offense were analyzed using descriptive analyses and latent class analysis.

RESULTS

Overall, 71.4% of subjects were in contact with services for mental health reasons within a year of their NCRMD offense. Among those that received services and not hospitalized for psychiatric reasons at the time of the offense, 20.7% committed the NCRMD offense within a week of the most recent mental health contact. Among those that had at least one prescription claim for an antipsychotic, 45.8% were not taking any antipsychotic at the time of the offense. Latent class analysis provided a multidimensional representation of mental health service use and showed that 58.4% of subjects had no or very rare contact with services.

CONCLUSIONS

Many forensic patients are likely to have experienced service disruption or discontinuity while in the community, for reasons that may relate to perceived need for care, to service organization, or to the acceptability, availability, and accessibility of services. Given the serious impact of the "forensic" label on the lives of service users, not to mention the increased pressure on resources, the considerable economic costs, and the impact on victims, there is reason to advocate for a greater involvement of mental and physical health service providers in early prevention of violence, which requires reorganizing resources to share the forensic knowledge upstream, before an offense is committed.

Risk assessment in clinical practice: a framework for decision-making in real-world complex systems

Risk assessment in clinical practice is often characterised as a process of analysing information so as to make a judgement about the likelihood of harmful behaviour occurring in the future. However, this characterisation is brought into question when the evidence does not support the current use of risk assessment approaches to predict, or provide probability estimates of, future behaviour in a way that is usable in single instances arising in individual cases. This article sets out a broader and more clinically applicable description of risk assessment which takes account of the wider influences on how this clinical activity takes place. In so doing, it provides a framework to guide clinicians, researchers and authors of practice guidance who are interested in improving approaches to risk assessment.