Aims and objectives. The Forensic Early Warning Signs of Aggression Inventory (FESAI) was developed to assist nurses and patients in identifying early warning signs and constructing individual early detection plans (EDP) for the prevention of aggressive incidents. The aims of this research were as follows: First, to study the prevalence of early warning signs of aggression, measured with the FESAI, in a sample of forensic patients, and second, to explore whether there are any types of warning signs typical of diagnostic subgroups or offender subgroups. Background. Reconstructing patients’ changes in behaviour prior to aggressive incidents may contribute to identify early warning signs specific to the individual patient. The EDP comprises an early intervention strategy suggested by the patient and approved by the nurses. Implementation of EDP may enhance efficient risk assessment and management. Design. An explorative design was used to review existing records and to monitor frequencies of early warning signs. Methods. Early detection plans of 171 patients from two forensic hospital wards were examined. Frequency distributions were estimated by recording the early warning signs on the FESAI. Rank order correlation analyses were conducted to compare diagnostic subgroups and offender subgroups concerning types and frequencies of warning signs. Results. The FESAI categories with the highest frequency rank were the following: (1) anger, (2) social withdrawal, (3) superficial contact and (4) non-aggressive antisocial behaviour. There were no significant differences between subgroups of patients concerning the ranks of the four categories of early warning signs. Conclusion. The results suggest that the FESAI covers very well the wide variety of occurred warning signs reported in the EDPs. No group profiles of warning signs were found to be specific to diagnosis or offence type. Relevance to clinical practice. Applying the FESAI to develop individual EDPs appears to be a promising approach to enhance risk assessment and management.
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In the Netherlands an innovative programme for early detection of chronic obstructive pulmonary disease (COPD) in primary care among patients aged 40–70 years has been evaluated in both an effect study and a pilot implementation study. Health-care providers identified four obstacles for successful implementation of a COPD early detection programme. This Brief Communication describes the most important results of a qualitative study using in-depth interviews.
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A retrospective of the BUas contribution to the ALT-ER educational game project. The game's design and development was led by BUas, and the content with created in conjunction with other partners in the ALT-ER project. The game was a tool to facilitate conversations between young children and adults about topics that are of importance to their development. Unlike many educational games, the purpose was not to explicitly teach, instead it was to create a playful space in which children could explore and explain their experiences. This facilitated insights from the adults into the thoughts of the children and assisted in guiding their development. The core basis was to not replace the expertise of teachers, but instead to make their work easier. Design considerations for young children and adults were discussed.
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In recent years, the fight against terrorism and political violence has focused more on anticipating the threats that they pose. Therefore, early detection of ideas by local professionals has become an important part of the preventive approach in countering radicalization. Frontline workers who operate in the arteries of society are encouraged to identify processes toward violent behavior at an early stage. To date, however, little is known about how these professionals take on this screening task at their own discretion. Research from the Netherlands suggests that subjective assessment appears to exist. In this article, we argue that the absence of a clear norm for preliminary judgments affects prejudice or administrative arbitrariness, which may cause side effects due to unjustified profiling.
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“Early warning signs of aggression” refers to recurring changes in behaviors, thoughts, perceptions, and feelings of the patient that are considered to be precursors of aggressive behavior. The early recognition of these signs offers possibilities for early intervention and prevention of aggressive behaviors in forensic patients. The Forensic Early warning Signs of Aggression Inventory (FESAI) was developed to assist nurses and patients in identifying and monitoring these early warning signs of aggression.
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The early detection of breast-cancer-related lymphedema and referral for therapy has the potential to reduce lymphedema-related morbidity. Although research shows the benefits, a gap is observed between evidence and daily practice. We aimed to determine whether the early detection of lymphedema and referral for treatment is adequate following the current guidelines. Women with primary breast cancer treated with breast-conserving therapy or ablative treatment were included. Demographic-, general health-, tumor-, and treatment-related data were recorded. Bilateral arm volume measurements were performed preoperatively and 3, 6, 12, and 24 months post-surgery. A 5% or greater Relative Volume Change was considered the cutoff point for lymphedema and as an indication for therapy referral. After 24 months post-surgery, the main outcomes show that among the patients with early signs of lymphedema, based on a Relative Volume Change ≥5%, a nonreferral for therapy was noted in 83%. Additionally, we observed a significant improvement of the mean Relative Volume Change at 24 months within this group, which might implicate that nonreferral was an adequate choice and that watchful waiting is appropriate when lymphedema is detected within the first year post-surgery.
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This study evaluated the Toddler Oral Health Intervention (TOHI) for preventing early childhood caries (ECC) by 48 months. TOHI, an add-on to standard care in well-baby clinics (WBCs), aims to reduce ECC incidence and severity.
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Background: A patient decision aid (PtDA) can support shared decision making (SDM) in preference-sensitive care, with more than one clinically applicable treatment option. The development of a PtDA is a complex process, involving several steps, such as designing, developing and testing the draft with all the stakeholders, known as alpha testing. This is followed by testing in ‘real life’ situations, known as beta testing, and then finalising the definite version. Our aim was developing and alpha testing a PtDA for primary treatment of early stage breast cancer, ensuring that the tool is considered relevant, valid and feasible by patients and professionals. Methods: Our qualitative descriptive study applied various methods including face-to-face think-aloud interviews, a focus group and semi-structured telephone interviews. The study population consisted of breast cancer patients facing the choice between breast-conserving therapy with or without preceding neo-adjuvant chemotherapy and mastectomy, and professionals involved in breast cancer care in dedicated multidisciplinary breast cancer teams. Results: A PtDA was developed in four iterative test rounds, taking nearly 2 years, involving 26 patients and 26 professionals. While the research group initially opted for simplicity for the sake of implementation, the clinicians objected that the complexity of the decision could not be ignored. Other topics of concern were the conflicting views of professionals and patients regarding side effects, the amount of information and how to present it. Conclusion: The development was an extensive process, because the professionals rejected the simplifications proposed by the research group. This resulted in the development of a completely new draft PtDA, which took double the expected time and resources. The final version of the PtDA appeared to be well-appreciated by professionals and patients, although its acceptability will only be proven in actual practice (beta testing)
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Research into interprofessional collaboration (IPC) has predominantly focused on health care and special-ized care settings, but there is an increasing interest in interprofesssional ‘teams around the child’ in community-based settings. We conducted a realist synthesis of empirical studies into IPC between youth professionals, often in regular community settings, to explore barriers and facilitators of IPC. Included studies were coded with an elaborated scheme to chart the focus of studies and to identify moderators and context-mechanism-outcome configurations of IPC. Professional and normative integration was the main focus of the included studies. Most studies emphasized the challenges of IPC in practice, like unclear roles of self and others, lack of trust and inadequate communication. Other perceived barriers are exclud-ing others in the planning of interventions, taking ownership of plans (vs. sharing) and different modes of communication. Interprofessional education, co-location of staff, acting as a mediator in the team, organising formal and informal meetings, conflict resolutions, self-sacrifice, and conceptualizing practice were perceived as facilitators of IPC. Future IPC research into community-based settings should include all professional stakeholders and the children and their families to evaluate outcomes at both interprofes-sional and clinical level.
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