He did what? Well that wasn't handed over! Communicating risk in mental health

Mental health inpatient units are dynamic, complex environments that provide care for patients with heterogeneous ages, diagnoses and levels of acuity. These environments commonly expose clinicians and patients to many potential risks. Despite extensive research into risk assessment, prediction and management, no study has investigated how risk information is communicated at handover in acute mental health settings. Given the pivotal role handover plays in informing risk management, this evidence gap is significant. This paper reports on a study that investigated the practices of communicating risk at handover in an Australian acute mental health inpatient unit. The aim of this research was to identify the frequency and type of risk information communicated between nursing shifts, and the methods by which this communication was performed. A secondary aim was to identify effective and ineffective risk communication practices. This study involved an observational design method using a 14-item Clinical Audit Tool derived from handover principles outlined by World Health Organization. Five hundred occasions of patient handover were observed. Few risk information items were observed to be communicated in any method. Risk communication practice was inconsistent, and a key recommendation from the study is the use of standardized handover tools that ensures risk information is adequately reported.

Identifying the core competencies of mental health telephone triage

Aims and objectives. The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage.
Background. Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice.
Design. An observational design was employed to address the research aims.
Methods. Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011.
Results. The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation.
Conclusions. The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. Relevance to clinical practice. The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment.

Debating the evidence : oral contraceptives containing drospirenone and risk of blood clots

Skepticism is an essential quality in science. We doubt, re-examine and demand the highest quality of evidence. However, sometimes this puts us in an awkward situation. How much evidence do we need before we act? This dilemma is a constant problem in drug safety. Treatment decisions are always a balance of risks and benefits and there may be a paucity of evidence about rare or very rare adverse events.

Safeguarding Australia from cyber-terrorism : a SCADA risk framework

Terrorist groups are currently using information and communication technologies (ICTs) to orchestrate their conventional attacks. More recently, terrorists have been developing a new form of capability within the cyber-arena to coordinate cyber-based attacks. This chapter identifies that cyber-terrorism capabilities are an integral, imperative, yet under-researched component in establishing, and enhancing cyber-terrorism risk assessment models for SCADA systems. This chapter examines a cyber-terrorism SCADA risk framework that has been adopted and validated by SCADA industry practitioners. The chapter proposes a high level managerial framework, which is designed to measure and protect SCADA systems from the threat of cyber-terrorism within Australia. The findings and results of an industry focus group are presented in support of the developed framework for SCADA industry acceptance.

Moral antecedents of smoking behavior and risk beliefs among overseas Asian students

Instead of focusing on the misconduct of multinational cigarette manufacturers, this research project broadens the discussion of cigarette consumption by focusing on the moral antecedent variables that shape young adults' smoking behavior and risk beliefs. It especially challenges current wisdom among anti-smoking advocates that by increasing consumer knowledge of the medical risks associated with smoking will lead to significant reductions in young adult smoking prevalence rates. Empirical results of this study suggest that although increasing smoking risk knowledge does not significantly reduce Asian students' smoking behavior, increasing their risk assessment beliefs does produce the desirable public policy effect of reducing current smoking. Furthermore, only among rules-driven individuals does an increase in no harm scores significantly reduce student smoking risk assessment beliefs. Thus, current anti-smoking advertising campaigns among overseas Asian students may be more effective if they attempt to change these students' smoking risks assessment beliefs especially if they are targeted to rules-driven student market segments.

Spontaneous judgements of health related-risk

In health psychology, individuals’ judgements about health risks have almost exclusively been investigated by explicitly soliciting such judgements. Five novel methodologies were used to examine risk judgements that are made spontaneously, without prompting. The findings suggest that spontaneous risk judgements can differ in important ways from researcher solicited ones.

Attributable risk analysis reveals potential healthcare savings from increased consumption of dairy products.

With rising burdens of obesity and chronic disease, the role of diet as a modifiable risk factor is of increasing public health interest. There is a growing body of evidence that low consumption of dairy products is associated with elevated risk of chronic metabolic and cardiovascular disorders. Surveys also suggest that dairy product consumption falls well below recommended targets for much of the population in many countries, including the USA, UK, and Australia. We reviewed the scientific literature on the health effects of dairy product consumption (both positive and negative) and used the best available evidence to estimate the direct healthcare expenditure and burden of disease [disability-adjusted life years (DALY)] attributable to low consumption of dairy products in Australia. We implemented a novel technique for estimating population attributable risk developed for application in nutrition and other areas in which exposure to risk is a continuous variable. We found that in the 2010-2011 financial year, AUD$2.0 billion (USD$2.1 billion, €1.6 billion, or ∼1.7% of direct healthcare expenditure) and the loss of 75,012 DALY were attributable to low dairy product consumption. In sensitivity analyses, varying core assumptions yielded corresponding estimates of AUD$1.1-3.8 billion (0.9-3.3%) and 38,299-151,061 DALY lost. The estimated healthcare cost attributable to low dairy product consumption is comparable with total spending on public health in Australia (AUD$2.0 billion in 2009-2010). These findings justify the development and evaluation of cost-effective interventions that use dairy products as a vector for reducing the costs of diet-related disease.

Modification of the National Inpatient Medication Chart improves venous thromboembolism prophylaxis rates in high-risk medical patients

Background : Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality in Australia. While there is well-established evidence for the use of VTE prophylaxis in hospital inpatients, adherence to such guidelines is poor. Aim : The aim of the present study is to assess the impact of education and system change on improving rates of VTE prophylaxis in hospital inpatients. Methods : We performed four consecutive audits of inpatient medical records of a regional hospital service over 2 years. The audits aimed to test the impact of serial interventions at increasing the appropriate use of VTE prophylaxis (based on risk assessment). The interventions were (i) staff education and (ii) a process change that mandated a prophylaxis decision by modifying the National Inpatient Medication Chart with ‘VTE avoidance’ preprinted in the first medication box. Results : Our results from the baseline study showed that of the 236 medical inpatients reviewed, 80% were at high risk of VTE. Of this high-risk cohort, 34.9% (confidence interval (CI) 28–42%) had appropriate prophylaxis decisions. Post the education intervention, 43.2% (CI 37–49%) of the high-risk cohort received appropriate VTE prophylaxis, an improvement of 8.3% (CI −1% to 18%) from baseline. With the subsequent introduction of a process change, 82.1% (CI 66–92%) of the high-risk cohort received appropriate prophylaxis, an improvement of 47.2% and 38.8% (CI 24–54%) when compared with baseline and education respectively. Retention rates at 11 months postsystem change were 73% (CI 55–86%). Conclusions : This study therefore concluded that while education has an impact on rates of appropriate VTE prophylaxis, it is system change that has the most marked and sustained effect.

International sex offender registration laws : research and evaluation issues based on a review of current scientific literature

In many jurisdictions, anyone convicted of a sexual offense is required to register with police, often for life. Nine different countries have now implemented sex offender registries in an attempt to protect the public from the perceived threat posed by sexual offenders. Yet such laws have been criticized as being overly inclusive, tying up limited law enforcement resources to track many offenders who pose little risk of sexual reoffending. This paper considers the available research evidence relevant to the effectiveness of such laws for the deterrence of sexual offending and the investigation of sex crimes. It is concluded that significant gaps persist in our knowledge of whether existing laws effectively reduce sexual offending or reoffending and that large-scale, well-designed studies of the impact of sex offender registration on rates of offending, the collateral consequences to offenders and their families, and the costs of such laws are needed.

Assessing pressure injury risk and prevention using the Braden mobility subscale

 Getting a pressure injury or ulcer whilst in hospital may cause debilitating physical effects, pain or even death. This research found that assessment of mobility alone compares well with the more commonly used and more complex risk assessment scales when used to identify person's risk for developing a pressure sore.

FRAX (Aus) and falls risk: Association in men and women

Purpose: The WHO fracture risk prediction tool (FRAX®) utilises clinical risk factors to estimate the probability of fracture over a 10-year period. Although falls increase fracture risk, they have not been incorporated into FRAX. It is currently unclear if FRAX captures falls risk and whether addition of falls would improve fracture prediction. We aimed to investigate the association of falls risk and Australian-specific FRAX. Methods: Clinical risk factors were documented for 735 men and 602 women (age 40-90. yr) assessed at follow-up (2006-2010 and 2000-2003, respectively) of the Geelong Osteoporosis Study. FRAX scores with and without BMD were calculated. A falls risk score was determined at the time of BMD assessment and self-reported incident falls were documented from questionnaires returned one year later. Multivariable analyses were performed to determine: (i) cross-sectional association between FRAX scores and falls risk score (Elderly Falls Screening Test, EFST) and (ii) prospective relationship between FRAX and time to a fall. Results: There was an association between FRAX (hip with BMD) and EFST scores (. β=. 0.07, p<. 0.001). After adjustment for sex and age, the relationship became non-significant (. β=. 0.00, p=. 0.79). The risk of incident falls increased with increasing FRAX (hip with BMD) score (unadjusted HR 1.04, 95% CI 1.02, 1.07). After adjustment for age and sex, the relationship became non-significant (1.01, 95% CI 0.97, 1.05). Conclusions: There is a weak positive correlation between FRAX and falls risk score, that is likely explained by the inclusion of age and sex in the FRAX model. These data suggest that FRAX score may not be a robust surrogate for falls risk and that inclusion of falls in fracture risk assessment should be further explored.

Towards consistency, rigour and compatibility of risk assessments for ecosystems and ecological communities

Ecosystem-level conservation is increasingly important at global, national and local levels. Many jurisdictions have developed and apply their own protocols for assessing the threat status of ecosystems, often independently, leading to inconsistencies between and within countries which are problematic for cross-jurisdictional environmental reporting. Australia is a good example of these historic legacies, with different risk assessment methods applied nationally and in most states. The newly developed criteria for the International Union for the Conservation of Nature (IUCN) Red List of Ecosystems (RLE) provide a framework to compare and contrast apparently divergent protocols. We critically reviewed the Australian protocols and compared them with the IUCN RLE, based on the following components of a risk assessment protocol: (i) categories of threat; (ii) assessment units; (iii) underlying concepts and definitions; (iv) assessment criteria; (v) uncertainty methods; and (vi) assessment outcomes. Despite some differences in specific objectives, criteria and their expression, the protocols were structurally similar, included broadly similar types of criteria, and produced assessment outcomes that were generally concordant. Alignment with the IUCN RLE would not require extensive changes to existing protocols, but would improve consistency, rigour and robustness in ecosystem risk assessment across jurisdictions. To achieve this, we recommend: (i) more quantitative assessments of functional change; (ii) separation of management and policy considerations from risk assessment; and (iii) cross-referencing of assessment units in different jurisdictions. We argue that the focus on processes and ecological function, rather than only patterns, is key to robust risk assessment. © 2014 The Authors.

An integrated framework for suicide risk prediction

Suicide is a major concern in society. Despite of great attention paid by the community with very substantive medico-legal implications, there has been no satisfying method that can reliably predict the future attempted or completed suicide. We present an integrated machine learning framework to tackle this challenge. Our proposed framework consists of a novel feature extraction scheme, an embedded feature selection process, a set of risk classifiers and finally, a risk calibration procedure. For temporal feature extraction, we cast the patient’s clinical history into a temporal image to which a bank of one-side filters are applied. The responses are then partly transformed into mid-level features and then selected in 1-norm framework under the extreme value theory. A set of probabilistic ordinal risk classifiers are then applied to compute the risk probabilities and further re-rank the features. Finally, the predicted risks are calibrated. Together with our Australian partner, we perform comprehensive study on data collected for the mental health cohort, and the experiments validate that our proposed framework outperforms risk assessment instruments by medical practitioners.