Workplace Violence: Practical Considerations for Mental Health Professionals in Consultation, Assessment, and Management of Risk

Workplace predatory violence has been the focus of increased study over the past 30 years, leading to a more sophisticated understanding of the factors that contribute to it, and important considerations for its assessment and management. Risk assessment professionals involved in workplace violence consultations should be mindful of issues specific to the workplace context and the principles of threat assessment to provide a more precise opinion of risk, to inform and enhance critical decisions regarding the employment status of the individual of concern, security measures, possible treatment options, and other management responses, while being mindful of the employee's certain rights.

Workplace assessment of targeted violence risk: the development and reliability of the WAVR-21

This study describes the development of the WAVR-21, a structured professional judgment guide for the assessment of workplace targeted violence, and presents initial interrater reliability results. The 21-item instrument codes both static and dynamic risk factors and change, if any, over time. Five critical items or red flag indicators assess violent motives, ideation, intent, weapons skill, and pre-attack planning. Additional items assess the contribution of mental disorder, negative personality factors, situational factors, and a protective factor. Eleven raters each rated 12 randomly assigned cases from actual files of workplace threat scenarios. Summary interrater reliability correlation coefficients (ICCs) for overall presence of risk factors, risk of violence, and seriousness of the violent act were in the fair to good range, similar to other structured professional judgment instruments. A subgroup of psychologists who were coders produced an ICC of 0.76 for overall presence of risk factors. Some of the individual items had poor reliability for both clinical and statistical reasons. The WAVR-21 appears to improve the structuring and organizing of empirically based risk-relevant data and may enhance communication and decision making.

Determination of vascular-endothelial growth factor levels in serum from tumor-bearing BALB/c mice treated with photodynamic therapy

MATERIAL/METHODS

We implanted a malignant tumour, BFS1 fibrosarcoma, into BALB/c mice and then treated them using a new photosensitizer, hydroxygallium (III) phthalocyanine tetrasulfonic acid tetrasodium salt, BON-6. The administration of this compound was followed by light irradiation using a halogen lamp at 680 nm. VEGF concentrations were measured in sera from the mice and compared to the time of tumor growth.

RESULTS

BON-6 was found to be effective in PDT. This feature was accompanied by low levels of VEGF after BON-6+PDT, and also prolongation of the time of survival of treated animals. The mice which received BON-6+PDT survived 83.8 days (SD 10.23). The mean survival time in control groups did not exceed 35 days. Additionally, measurement of tumor size showed total regression in single cases after BON-6+PDT.

CONCLUSIONS

PDT, by decreasing VEGF serum levels, may influence the capability of tumor tissue to form new vessels.

Determination of basic fibroblast growth factor levels in serum of tumor-bearing BALB/c mice treated with photodynamic therapy

In the present study we have checked whether photodynamic therapy (PDT) may influence concentration of basic Fibroblast Growth Factor (bFGF) in in vivo conditions. We have implanted malignant tumor, i.e. BFS1 fibrosarcoma into BALB/c mice and have them treated using well established photosensitizer, hematoporphyrin derivative and new compound, hydroxygallium (III) phthalocyanine tetrasulfonic acid tetrasodium salt, BON-6. The administration of those compounds was followed by light irradiation using a halogen lamp at proper wavelengths. Our results indicate that in vivo photodynamic therapy may cause a significant decrease in bFGF concentration and this phenomenon is accompanied by prolongation of survival of treated animals.

Community service-learning in an undergraduate psychiatric mental health nursing course

This article reports the outcomes of a descriptive study of service-learning undertaken in a Psychiatric and Mental Health Nursing Course at Virginia Commonwealth University. Following a review of the service-learning (S-L) literature, study questions are presented. The S-L intervention is presented, as are characteristics of learners and sites where S-L was conducted. Gains for all stakeholders and lessons learned are reported.

Acute systemic blood pressure elevation in obstructive and nonobstructive breath hold in primates

Phasic blood pressure (BP) response during obstructive apnea (OA) in human sleep has been previously described as consisting of a slow incremental increase in BP to the point of apnea termination followed by a rapid rise and then fall in BP at the resumption of respiration. This rise in BP has been attributed to postapneic augmentation of cardiac output resulting after release of the marked negative intrathoracic pressure (NIP) of obstructed inspiration. Via an endotracheal tube, we created obstructed and nonobstructed breath hold (apnea) in chloralose-anesthesized baboons consisting of fixed-duration (30, 45, and 60 s) single OAs (mechanical obstruction) and nonobstructive (paralysis, ventilator cessation) apneas of matched duration and arterial desaturation. Systemic BP was measured before apnea (T0), during the last 5 s of apnea (T1), and during the first 5 s after resumption of respiration (T2). Despite wide fluctuations in NIP and BP during the T0 to T1 phase of OA, BP elevation in OA and nonobstructive apnea at T0, T1, or T2 did not differ for any duration apnea. At the release of obstruction, when resolution of NIP changes could theoretically increase cardiac output and accentuate BP, there was no difference in T1 and T2 pressures between the two conditions. We conclude that in this anesthesized animal model, mechanical (NIP) changes do not play a major role in overall maximum BP response to OA. Because of physiological differences between natural sleep in humans and the anesthetized state in animals, care must be taken in extrapolating these results to human sleep apnea.

Effect of cardiac output reduction on rate of desaturation in obstructive apnea

The nadir of SaO2 during an obstructive apnea is dependent upon the apnea's duration and the rate of fall of saturation (dSaO2/dt). We postulated that a low Q, such as in patients with congestive heart failure with sleep apnea, or a reduction in Q, as seen in some humans during obstructive sleep apnea, might steepen dSaO2/dt. The mechanism postulated was lowering of SvO2 with increased pulmonary capillary blood oxygen uptake and faster depletion of alveolar oxygen. This study examines dSaO2/dt following the onset of apnea in eight spontaneously breathing adult baboons. Nonrepetitive obstructive apneas (30, 45, and 60 seconds) were created by clamping an indwelling cuffed endotracheal tube at the end of expiration. Following baseline measurements, the animals were given a bolus of a rapid-acting beta-adrenergic blocker followed by continuous infusion to reduce cardiac output and to limit the cardiovascular response to obstructive asphyxia. Fiberoptic catheters were used for continuous monitoring of SaO2, SvO2, and cardiac output. Esophageal pressure and relative thoracic gas volume (Respitrace) were monitored to insure equivalence of lung volume at the onset of apnea. Beta-adrenergic blockade reduced resting Q by a mean of 25 percent. The blocked vs unblocked dSaO2/dt was 0.73 vs 0.72 percent/s, 0.76 vs 0.73 percent/s, and 0.70 vs 0.71 percent/s for 30-second, 45-second, and 60-second apneas, respectively. Thus, mean dSaO2/dt for all durations of apneas was unaffected by beta-adrenergic blockade. We concluded that dSaO2/dt is not influenced by limited Q preceding or induced by obstructive asphyxia.

Porphyrin sensitizers in tumour phototherapy. Novel sensitizers of the chlorin and bacteriochlorin class with amphiphilic properties

The requirements for activity in a tumour-photosensitizing drug are outlined. A series of metallo tetrasulphonatophthalocyanines are shown to be inactive in an in vivo assay of tumour photosensitization; however, some less water-soluble compounds (hydroxylated derivatives of octaethylchlorin and octaethylbacteriochlorin) are shown to possess promising activity.

Violence and trauma response

This chapter is intended to assist managers and occupational physicians in assessing the impact of violence-induced trauma in the workplace, and in determining the most appropriate responses for both employee and corporate welfare. Among the topics covered are the dimensions of violence in the workplace, the phases of the trauma experience, the objective and subjective experience of employee-victims, and the dynamic interplay and organizational trauma.

Antipyrine kinetics following partial blood exchange with Fluosol-DA in the rat

The effects of partial blood exchange with Fluosol-DA on hepatic microsomal oxidative metabolism have been studied in the rat. Antipyrine clearance (Cl) was used as an in-vivo measure of the activity of the mixed function oxidase system. Rats were partially exchanged with Fluosol-DA and dosed with antipyrine at selected time intervals following exchange. No change in antipyrine Cl was observed at 0.5 h, but there was a statistically significant decrease at 24 h and then an increase by more than 50% relative to control at 48 and 72 h. These data indicate that the effects of Fluosol-DA on hepatic function are time-dependent and that Fluosol-DA has the potential both to inhibit and to enhance hepatic metabolism. The possibility of altered hepatic metabolism should be considered when patients transfused with Fluosol-DA are given drugs primarily metabolized by the mixed function oxidase system.

Tryptophan metabolism in depressive illness

[Methylene-14C]-L-tryptophan was administered intravenously to five patients suffering from severe depression before and after clinical recovery, and to six control subjects; all subjects were tested while on a standard diet. [14C]-5-Hydroxyindoleacetic acid and [14C]-indoleacetic acid were isolated from urine during the following 48 hours and purified to constant specific radioactivity (SA). From the SA and the determination of the total excretion of the two acids their percentage conversion from labelled tryptophan was estimated. There was no consistent difference found, in patients before and after recovery, or between patients and controls, in the conversion of tryptophan to these indole acids. In another series of 11 depressive patients and 11 controls, plasma total (acid-soluble) tryptophan was measured at frequent intervals up to three hours after intravenous administration of a loading dose (1 g) of L-tryptophan. The height of the curves of plasma tryptophan throughout the three hour period was greater than in the depressive patients, even after they had recovered, than in the controls. It is concluded that the apparent volume of distribution of tryptophan is reduced in depressive individuals. This is consistent with other findings of increased protein-binding of plasma tryptophan and reduced CSF tryptophan levels in depressive patients.