Transcending the Actuarial Versus Clinical Polemic in Assessing Risk for Violence

2002 ◽  
Vol 29 (5) ◽  
pp. 659-665 ◽  
Author(s):  
Christopher D. Webster ◽  
Stephen J. Hucker ◽  
Hy Bloom
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Risk Prediction ◽  
Statistical Data ◽  
Legal Framework ◽  
Violence Risk ◽  
Scientific Methods ◽  
Assessment Score ◽  
Dynamic Variables

Much energy has been expended over recent years in debating the relative merits of actuarial versus clinical approaches to violence risk prediction. Although it has gradually become apparent that scores based on more or less static factors obtainable from the record do indeed associate with outcome violence over years of follow-up, there is no reason to suppose that, at least potentially, dynamic variables do not hold as much or more promise when it comes to projections over weeks or months. Clinicians involved in release decision-making might wish to consider the following, in order of importance: (a) the legal framework within which the decision is being made, (b) the thoroughness with which scientific methods have been applied to the particular case at issue, (c) the precision of the individualized statement of violence risk being offered, (d) the steps which could be taken to reduce that risk, and (e) if available, the individual's violence risk assessment score in relation to already amassed pertinent statistical data.

scholarly journals Risk assessment in precapillary pulmonary hypertension: a comparative analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas Sonnweber ◽  
Eva-Maria Schneider ◽  
Manfred Nairz ◽  
Igor Theurl ◽  
Günter Weiss ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Hypertension ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Assessment Tool ◽  
Risk Models ◽  
Non Invasive

Abstract Background Risk stratification is essential to assess mortality risk and guide treatment in patients with precapillary pulmonary hypertension (PH). We herein compared the accuracy of different currently used PH risk stratification tools and evaluated the significance of particular risk parameters. Methods We conducted a retrospective longitudinal observational cohort study evaluating seven different risk assessment approaches according to the current PH guidelines. A comprehensive assessment including multi-parametric risk stratification was performed at baseline and 4 yearly follow-up time-points. Multi-step Cox hazard analysis was used to analyse and refine risk prediction. Results Various available risk models effectively predicted mortality in patients with precapillary pulmonary hypertension. Right-heart catheter parameters were not essential for risk prediction. Contrary, non-invasive follow-up re-evaluations significantly improved the accuracy of risk estimations. A lack of accuracy of various risk models was found in the intermediate- and high-risk classes. For these patients, an additional evaluation step including assessment of age and right atrium area improved risk prediction significantly. Discussion Currently used abbreviated versions of the ESC/ERS risk assessment tool, as well as the REVEAL 2.0 and REVEAL Lite 2 based risk stratification, lack accuracy to predict mortality in intermediate- and high-risk precapillary pulmonary hypertension patients. An expanded non-invasive evaluation improves mortality risk prediction in these individuals.

scholarly journals VIOLENCE RISK ASSESSMENT IN PSYCHIATRY - LITERATURE REVIEW AND PRACTICE COMPARISON BETWEEN LATVIA AND GERMANY

2021 ◽  
Vol 4 ◽  
pp. 357-367
Author(s):  
Karina Konstantinova ◽  
Alina Kuznecova
Keyword(s):  
Risk Assessment ◽  
Community Violence ◽  
Clinical Assessment ◽  
Assessment Tool ◽  
Legal Framework ◽  
Assessment Tools ◽  
Evidence Based ◽  
Violence Risk ◽  
Mentally Disordered Offenders ◽  
Violence Risk Assessment

Evidence-based future community violence risk assessment is a crucial issue in psychiatry. It is a cornerstone of safeguarding the rights of persons with mental health issues. Authors aimed to analyse the modern methods of risk assessment in psychiatry and the current practice and legal framework. Authors undertook a scoped review of the literature with search terms related to future community violence risk prediction for mentally disordered offenders in Latvian, English, German, and Russian languages. Main difficulties in future community violence risk assessment are demonstrated via Latvia’s court decisions analysis. Marked differences were identified: there are no standardized methods available/registered in Latvia, therefore risks assessment is performed via clinical assessment only. In Germany, the risk assessment is performed via structured evidence – based risk assessment tools and clinical assessment; nevertheless, the choice of the assessment tool remains challenging.  

scholarly journals Assessment of violence risk in 440 psychiatric patients in China: examining the feasibility and acceptability of a novel and scalable approach (FoVOx)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shaoling Zhong ◽  
◽  
Rongqin Yu ◽  
Robert Cornish ◽  
Xiaoping Wang ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Psychiatric Patients ◽  
Clinical Decision ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Risk Categories

Abstract Background Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service. Methods We followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool. Results The median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1–40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians’ assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future. Conclusions Clinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.

scholarly journals On the Diversity-Based Weighting Method for Risk Assessment and Decision-Making about Natural Hazards

Entropy ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 269 ◽  
Author(s):  
Pengyu Chen
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Natural Hazards ◽  
Strong Correlation ◽  
Statistical Data ◽  
Weighting Method ◽  
The Difference ◽  
Range Of Values ◽  
Weighting Methods ◽  
Coefficient Method

The entropy-weighting method (EWM) and variation coefficient method (VCM) are two typical diversity-based weighting methods, which are widely used in risk assessment and decision-making for natural hazards. However, for the attributes with a specific range of values (RV), the weights calculated by EWM and VCM (abbreviated as WE and WV) may be irrational. To solve this problem, a new indicator representing the dipartite degree is proposed, which is called the coefficient of dipartite degree (CDD), and the corresponding weighting method is called the dipartite coefficient method (DCM). Firstly, based on a large amount of statistical data, a comparison between the EWM and VCM is carried out. It is found that there is a strong correlation between the weights calculated by the EWM and VCM (abbreviated as WE and WV); however, in some cases the difference between WE and WV is big. Especially when the diversity of attributes is high, WE may be much larger than WV. Then, a comparison of the DCM, EWM and VCM is carried out based on two case studies. The results indicate that DCM is preferred for determining the weights of the attributes with a specific RV, and if the values of attributes are large enough, the EWM and VCM are both available. The EWM is more suitable for distinguishing the alternatives, but prudence is required when the diversity of an attribute is high. Finally, the applications of the diversity-based weighting method in natural hazards are discussed.

Surgery, Chemotherapy, and Radiotherapy for Gynaecological Cancer

2021 ◽  
pp. 356-364
Author(s):  
Konstantinos Pantazis ◽  
Ioannis Andronikidis ◽  
Lazaros Nikiforidis ◽  
Anne Floquet ◽  
Konstantinos Dinas
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Side Effects ◽  
High Risk ◽  
Complication Rates ◽  
Benefit Ratio ◽  
Oncology Treatment ◽  
Complications Of Surgery ◽  
All Treatment

Gynaecological oncology treatment yields no fewer complications and side effects than those met in any other oncology field. Patients and clinicians are highly alerted by the ominous diagnosis and sometimes seek for high risk, experimental, or even unproven therapies and are consequently prepared to accept high complication rates that would otherwise be unacceptable. Still, risk reduction remains a high priority. This is achieved by appropriate risk assessment, risk-to-benefit ratio balancing, treatment individualisation, close follow up through all treatment stages, and prompt patient informing and participation in decision making. The chapter aims to summarize the main complications of surgery, chemotherapy, and radiotherapy as well as the main ways to overcome them.

scholarly journals Violence risk prediction

2000 ◽  
Vol 177 (4) ◽  
pp. 303-311 ◽  
Author(s):  
M. Dolan ◽  
M. Doyle
Keyword(s):  
Risk Assessment ◽  
Risk Prediction ◽  
Assessment Tools ◽  
Current Status ◽  
Violence Risk ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Psychopathy Checklist ◽  
Violent Recidivism ◽  
Recent Developments

BackgroundViolence risk prediction is a priority issue for clinicians working with mentally disordered offenders.AimsTo review the current status of violence risk prediction research.MethodLiterature search (Medline). Key words: violence, risk prediction, mental disorder.ResultsSystematic/structured risk assessment approaches may enhance the accuracy of clinical prediction of violent outcomes. Data on the predictive validity of available clinical risk assessment tools are based largely on American and North American studies and further validation is required in British samples. The Psychopathy Checklist appears to be a key predictor of violent recidivism in a variety of settings.ConclusionsViolence risk prediction is an inexact science and as such will continue to provoke debate. Clinicians clearly need to be able to demonstrate the rationale behind their decisions on violence risk and much can be learned from recent developments in research on violence risk prediction.

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