Examining the relationship between risk assessment and risk management in mental health

Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others.     

急性有机磷农药中毒治疗概况

提高急性有机磷农药中毒的抢救成活率仍然是严峻的问题，本文就抗胆碱能药及胆碱酯酶复能剂的合理应用和治疗进展进行讨论。     

急性百草枯中毒的治疗进展

百草枯（paraquat,1,1-二甲基-4,4-联吡啶阳离子盐）,是目前应用最广泛的触灭型除草剂之一,动物属中等毒性,但对人的毒性却较高,成人估计致死量40mg／kg。百草枯中毒后可造成多个系统或器官损害,肺部最为严重,病死率极高,致病机制复杂且尚未完全明确,     

急性重度有机磷农药中毒患者死亡危险因素分析

目的：探讨急性重度有机磷农药中毒死亡的危险因素。方法回顾性分析急性重度有机磷农药中毒44例患者的临床资料,对各项危险因素进行统计分析,比较患者的病死率。结果44例急性重度有机磷农药中毒患者住院期间病死率22.7%(10/44),其中急性生理学及慢性健康状况评分(APACHE)≥20分和<20分、年龄≥60岁和<60岁、合并低血压和未合并低血压、合并低氧血症和未合并低氧血症、合并代谢性酸中毒和未合并代谢性酸中毒的患者病死率比较,差异均有统计学意义(P <0.05或<0.01)。结论 APACHEⅡ分值、高龄、低血压、低氧血症、代谢性酸中毒可能是急性重度有机磷农药中毒患者死亡的危险因素,在临床中可以用于评估患者病情严重程度与死亡风险。     

Deconstructing risk assessment and management in mental health nursing

RATIONALE: Risk assessment and management have a taken a central position in the delivery of contemporary mental health services. However, these concepts are generally taken-for-granted as necessary and unavoidable aspects of mental health nursing practice. This deconstructive analysis explores some of the assumptions and values that underpin these concepts. AIMS: The aims of the study were to provide a deconstructive analysis of the concepts of risk and risk management, and to explore the historical context of mental disorder and the concept of risk, the clinical context of risk assessment and management, the cultural, political and economic context of risk, and the impact on mental health nursing and consumers of mental health services. DESIGN: This paper takes a deconstructive approach to the exploration of the historical, clinical, cultural, political and economic context of the concept of risk and its assessment and management. This is undertaken by providing a critical review of the history of mental illness and its relationship to risk, examination of government policy on clinical risk management, analysis of a risk assessment model and a discussion of the political and economic factors that have influenced the use of risk assessment and management in clinical practice. FINDINGS: The concept of risk and its assessment and management have been employed in the delivery of mental health services as a form of contemporary governance. One consequence of this has been the positioning of social concerns over clinical judgement. The process employed to assess and manage risk could be regarded as a process of codification, commodification and aggregation. In the mental health care setting this can mean attempting to control the actions and behaviours of consumers and clinicians to best meet the fiscal needs of the organization. CONCLUSION: The mental health nursing profession needs to examine carefully its socially mandated role as guardians of those who pose a risk to others to ensure that its practice represents its espoused therapeutic responsibilities.     

急性速眠新中毒1例

Summary This paper reported a case of acute intoxication of sumianxin. The patients mainly manifested con- vulsions accompanied with disturbance of consciousness, Blood gas analysis show hypoxemia. The route of intoxica- tion,clinical manifestations,diagnosis and treatment were analyzed. Acute intoxication of sumianxin had following clinical features：sumianxin is a animal compound anesthesia agents, the drug-delivery way is intramuscular injec- tion. The side effect of the drug is cardiovascular and respiratory system dysfunction. Suxingling is the specific an- tidote. This case study shows naloxone has some effect on sumianxin poisoning.     

序贯器官衰竭评分对急性中毒病情及预后的评价

目的 评估急性中毒患者器官衰竭情况,研究序贯器官衰竭评分(SOFA)与急性中毒患者预后的关系.方法 回顾性分析2006年6月至2007年6月中国医科大学附属一院急诊ICU收治的76例急性中毒患者的临床资料,收集其入院即刻及入院后48 h的心率、血压、血氧饱和度、血气、血常规、肝功能、肾功能、心肌酶谱、血糖值及神志状态,并记录各时间段应用的血管活性药物的剂量,对其进行分段SOFA评分(人院即刻和入院后48 h),比较存活组与死亡组不同时间点的SOFA评分是否存在差异,评估SOFA评分与预后的关系.结果 入院即刻累计SOFA评分(s0FAu)在死亡组与存活组中差异无统计学意义(P=0.26),48 h累计s0FA评分(soFA48)及两者之差(ΔSOFA)在两组中差异具有统计学意义(P<0.01).Logistic回归分析结果显示48 h SOFA评分中的肾脏及神经系统的评分是急性中毒患者预后的独立危险因素(P值分别为0.003和0.012),Speannan秩相关分析结果提示ALT、CK-MB、WBC、BE值及血糖值(BG)与SOFA48有相关性(P<0.05).结论 SOFA评分与急性中毒患者预后呈相关趋势,而动态观察SOFA评分的变化对评价病情严重程度及判断预后具有重要意义.     

急性有机磷中毒的急诊急救护理

目的探讨急性有机磷中毒急诊急救的综合护理,寻求提高抢救成功的对策,降低死亡率。方法对本院急诊科2002年1月至2007年3月收治的92例急性有机磷中毒患者的临床资料进行回顾分析,对中毒途径、中毒程序、服药量、中毒至就诊时间及各种处理措施等因素进行分析。结果早期彻底洗胃,合理维持阿托品化和应用呼吸机是有效的处理措施。全组治愈87例（94．6％）,死亡5例（5．4％）。呼吸循环衰竭、阿托品中毒为主要死亡原因。结论有效的护理措施、预防并及时处理并发症和辅助方法的恰当选用是提高存活率的关键。     

Violence risk assessment: combining actuarial and clinical information to structure clinical judgements for the formulation and management of risk

Throughout history most societies have assumed a link between mental disorder and violence to others. In recent times there has been increasing concern in the United Kingdom over law and order, specifically the risk of violence, and these issues are now high on the political and mental health agenda. Nurses and staff working in National Health Service Mental Health Service Trusts are the groups most at risk of violence. Many clinical decisions are based on risk. Mental health nurses play a pivotal role in the assessment and management of risk and it is argued that they need to adopt a clear structured approach to violence risk assessment and management, which is evidence-based. The advantages of clinical and actuarial approaches to risk assessment are briefly reviewed and a structured clinical judgement approach is proposed that combines these approaches. A method of linking the assessment process with the management plan via a risk formulation is discussed.     

风险管理在临床护理质量管理中的运用

护理部将医院风险管理的理念运用于护理质量管理 ,建立风险管理的组织架构 ,对风险事件进行明确的定义和分类 ,改进风险呈报系统 ,并开展风险评估和预警。管理者的观念转变了 ,受到了护士的欢迎 ,提高了管理质量     

Designing reasonable accommodation of the workplace: a new methodology based on risk assessment

If working tasks are carried out in inadequate conditions, workers with functional limitations may, over time, risk developing further disabilities. While several validated risk assessment methods exist for able-bodied workers, few studies have been carried out for workers with disabilities. This article, which reports the findings of a Study funded by the Italian Ministry of Labour, proposes a general methodology for the technical and organisational re-design of a worksite, based on risk assessment and irrespective of any worker disability. To this end, a sample of 16 disabled workers, composed of people with either mild or severe motor disabilities, was recruited. Their jobs include business administration (5), computer programmer (1), housewife (1), mechanical worker (2), textile worker (1), bus driver (1), nurse (2), electrical worker (1), teacher (1), warehouseman (1). By using a mix of risk assessment methods and the International Classification of Functioning (ICF) taxonomy, their worksites were re-designed in view of a reasonable accommodation, and prospective evaluation was carried out to check whether the new design would eliminate the risks. In one case – a man with congenital malformations who works as a help-desk operator for technical assistance in the Information and Communication Technology (ICT) department of a big organisation – the accommodation was actually carried out within the time span of the study, thus making it possible to confirm the hypotheses raised in the prospective assessment.     

Systematic approach to community risk assessment and management

A move from institutional to community health care means that health service staff are increasingly requested to visit patients in their own homes. This undertaking is not without risk, particularly where the patient or the locality is unknown. There are no nationally available guidelines for formally assessing potential risk to a health worker before the home visit. A protocol for risk assessment and a safety schedule before making a home visit was therefore developed and is described in this article. The difficulties in carrying out a comprehensive risk assessment are outlined. Several ways in which the assessment of risk before home visits could be made more effective are suggested.     

Cardiovascular risk assessment tools: A scoping review

ObjectivesThe objective of this review was to describe cardiovascular risk (CVR) assessment methods and to identify evidence-based practice recommendations when dealing with population at risk of developing cardiovascular diseases.Review methods and data sourcesA literature review following the Arksey and O'Malley scoping review methodology was conducted. By using appropriate key terms, literature searches were conducted in PubMed, SciELO, Cochrane Library, Dialnet, ENFISPO, Medigraphic, ScienceDirect, Cuiden, and Lilacs databases. A complementary search on websites related to the area of interest was conducted. Articles published in English or Spanish in peer-review journals between 2010 and 2017. Critical appraisal for methodological quality was conducted. Data was extracted using ad-hoc tables and qualitatively synthesized.ResultsAfter eliminating duplicates, 55 325 records remained, and 1432 records were selected for screening. Out of these, 88 full-text articles were selected for eligibility criteria, and finally, 67 studies were selected for this review, and 25 studies were selected for evidence synthesis. In total, 23 CVR assessment tools have been identified, pioneered by the Framingham study. Qualitative findings were grouped into four thematic areas: assessment tools and scores, CVR indicators, comparative models, and evidence-based recommendations.ConclusionsIt is necessary to adapt the instruments to the epidemiological reality of the population. The most appropriate way to estimate CVR is to choose the assessment tool that best suits individual conditions, accompanied by a comprehensive assessment of the patient. More research is required to determine a single, adequate, and reliable tool.     

有机磷中毒合并呼吸衰竭的危险因素分析

目的分析探讨急性有机磷中毒（AOPP）患者并发呼吸衰竭的危险因素。方法对2000年以来我科收治的AOPP患者2 132例进行回顾性分析,其中合并呼吸衰竭患者207例（呼吸衰竭组）,随机抽取未发生呼吸衰竭的患者186例（对照组）,对血浆胆碱酯酶活力（AchE）等11项可能相关的危险因素采用logistic多变量逐步前向回归法分析发生呼吸衰竭的独立危险因素。结果 11项可能的相关危险因素中有6项指标差异有统计学意义（P〈0.05）,包括血乳酸（Lac）水平（OR=5.19,95%CI=3.14-10.37）、屈颈抬头无力（OR=12.14,95%CI=9.64-18.35）、AchE活力（OR=12.65,95%CI=9.51-19.96）、中毒至开始治疗时间（OR=8.38,95%CI=6.12-11.36）、肌酸激酶（CK）水平（OR=9.81,95%CI=6.58-13.31）、急性生理及慢性健康状况Ⅱ（APACHEⅡ）评分（OR=7.04,95%CI=4.93-11.30）。结论 AOPP患者易并发呼吸衰竭,AchE活力、屈颈抬头无力、CK水平、中毒至治疗开始时间、APACHEⅡ评分、血Lac水平是AOPP发生呼吸衰竭的独立危险因素。     

急性中毒诊治热点与关注

急性中毒是我国常见急症,呈现发病率高、毒物种类多、区域差异大、季节变化明显等特点。多数急性中毒缺乏规范的诊治方案,导致急性中毒救治困难、病死率高,社会危害大。本文主要阐述有机磷中毒、敌草快中毒、毒蕈中毒、甲醇中毒、海洋生物毒素中毒等近几年常见急性中毒诊治过程中存在的问题,旨在提高我国急性中毒救治水平,造福患者。     

Caprini 2005风险评估模型在脑卒中急性期患者中的应用价值评价

目的 评价Caprini 2005风险评估模型对脑卒中急性期深静脉血栓形成（DVT）的诊断价值与临床可操作性。方法 采用前瞻性研究,选取2018年11月至2019年11月期间于苏州大学附属第一医院就诊的489例脑卒中急性期患者,以彩色多普勒超声检查作为DVT诊断金标准,应用Caprini 2005风险评估模型对患者进行风险评估。结果 Caprini 2005风险评估模型的ROC曲线下面积（AUC）为0.761（95%CI: 0.720 0.798,P<0.01）,当临界值取11分时,对应的最佳灵敏度与特异度为78.87%和66.51%。该模型的条目利用率为60.0%,存在16条评估条目利用率为0。结论 Caprini 2005风险评估模型的诊断价值中等,但临床可操作性不佳,其危险分层的最佳临界值与评估条目需适当调整。