Biomedical subjects

Tom Mason

Publications and source records attributed to Tom Mason.

8 recordsLinked to original sources

PubMed2006

Assessment of risk and special observations in mental health practice: a comparison of forensic and non-forensic settings.

The use of special observations in psychiatric practice may be employed as an alternative to more restrictive methods such as the use of seclusion and restraint. From the literature, special observations are used for a complex array of signs and symptoms (and risk behaviours) which include suicidal intent, self-injurious behaviour, hallucinatory experiences, and absconding. This paper reports on research into the use of special observations in both forensic and non-forensic psychiatric settings. A comparative approach was adopted to establish if the perceived risk factors leading to the adoption of special observations were similar in both settings. Three groups of nursing staff were requested to assess 30 patients who were placed on special observations. Before this, nurses were requested to rate the risk factors in terms of their severity on a 7-point Likert scale. The rank-ordering analysis revealed a similarity of identified risk factors and anova (one-way, unrelated) and the Jonckheere Trend Test revealed that there were significant differences between the scores in the forensic and the non-forensic settings. The statistical differences existed for risk factors relating to harm to self and others but not for psychiatric symptomatology.

Analysis of Variance↗

PubMed2006

Dangerous severe personality disorder in the United Kingdom.

For years, the UK government has struggled to find the best way to manage people with severe personality disorder. The debate continues and includes concerns by the forensic psychiatric nurses who work with these patients.

Antisocial Personality Disorder↗

PubMed2003

Pre-admission nursing assessment in a Welsh medium secure unit (1991-2000): Part 1--an analysis of practice and cost.

Pre-admission nursing assessment is a widely accepted practice in forensic mental health services, yet has never been described or evaluated. The costs and merits of this practice have not hitherto been the subject of systematic investigation. This article describes the practice of pre-admission assessments and details a method for estimating the cost of forensic nursing assessments in terms of the investment of nursing time. The method was then employed to evaluate the cost of nursing assessments to a Welsh medium secure unit over a 9-year period. The results showed that the demand for, and location, of pre-admission nursing assessment varied considerably over 9 years. Assessments were expensive in the demands that they placed on the resources of the nursing department. Due to the high investment costs, evidence is required to support such practice.

Costs and Cost Analysis↗

PubMed2003

Pre-admission nursing assessment in a Welsh Medium Secure Unit (1991-2000): Part 2--comparison of traditional nursing assessment with the HCR-20 risk assessment tool.

Pre-admission forensic nursing assessment is a tradition that has no research evidence base, little documentary support and is an expensive drain on nursing resources from clinical environments. Such an expensive practice warrants some evaluation of the quality of these nursing assessments. This study assessed the quality of nursing risk assessments through comparison with the HCR-20, a well-established and widely validated violence risk assessment instrument. There was a high degree of correspondence between nurse assessments and the contents of the HCR-20. The results offer support for forensic nurses' abilities to develop effective measures and practices based upon nursing knowledge and experience where no formal evidence base previously existed.

Forensic Psychiatry↗

PubMed2002

Towards a 'forensic lens' model of multidisciplinary training.

This paper reports on research undertaken to identify if common areas of multidisciplinary training exist in the literature. The literature that specifically focused on training issues in forensic practice (mental health) was located and reviewed by coding analysis. Thirteen common areas were identified and approximately 250 content items were acknowledged. A 'forensic lens' model was established to provide a framework in which multidisciplinary training could be located. Further research is promulgated to establish the actual importance of each training area for specific forensic disciplinary groups.

Clinical Competence↗

PubMed2002

The influence of evil on forensic clinical practice.

As the medicalization of criminal behaviour expands through forensic psychiatric practice it is reliant upon a therapeutic ideology based on clinical assessment and effective application of treatment strategies. When such criminal offenses are particularly heinous the perpetrators are often referred to as evil by non-professional accounts. However, the extent to which the concept of evil affects the perceptions of mental health professionals working with such offenders is little understood. This paper reports on research conducted in a high-security psychiatric hospital in the North-west of England and examines the construction of care plans in relation to a number of mentally disordered offenders who are considered by a group of mental health professionals as evil. Thematic analysis of mental health professionals' discourse pertaining to the care plans revealed a complex motivational and rational structuring of evil that dictated the switch from medical ideological discourse to lay notions of badness. From this, an Airaksinen model was constructed to display the types of evil manifestations.

Attitude of Health Personnel↗

PubMed2002

Osteopenia in adults with a history of juvenile rheumatoid arthritis. A population based study.

OBJECTIVE: To determine the extent of osteopenia in a population based cohort of adults with a history of juvenile rheumatoid arthritis (JRA). METHODS: The Rochester Epidemiology Project database was used to identify all cases of JRA diagnosed among Rochester, Minnesota residents under the age of 16 years between January 1, 1960, and December 31, 1993. Thirty-two of the 57 adult patients in this population based cohort (ages 19-53 years, mean 35) participated in this study. Average length of followup from the time of diagnosis was 27.1 years (median 26.9, range 7.7-39.1). Dual energy x-ray absorptiometry scans were used to assess bone density of the lumbar spine, hip, distal one-third radius, and whole body. In addition, a number of variables that influence bone mass were analyzed. RESULTS: Although many participants had T scores within the normal range (T score > -1) at all measured sites, 41% (n = 13) were osteopenic (T score < or = -1) at either the lumbar spine or femoral neck. Twenty-eight percent (n = 9) had T scores < or = -1 in the lumbar spine (p = 0.058 relative to expected). Thirty-two percent (n = 10) had T scores < or = -1 in the femoral neck (p = 0.012 relative to expected). Several variables were significantly (p < 0.05) associated with low bone density in this cohort of adults with a history of JRA, including: (1) revised Steinbrocker functional class > or = 2 during adolescence, indicating poorer physical functioning; (2) lack of participation in organized sports during adolescence (a surrogate measure of physical activity); (3) tobacco use during adolescence; and (4) lower calcium intake during adolescence. CONCLUSION: Although many adults with a history of JRA have normal bone density, a substantial subset are osteopenic, placing them at increased risk of fractures later in life. This observation is particularly striking given the predominance of patients with pauciarticular JRA in this population based group. We identified several variables associated with osteopenia in this cohort. Further work is needed to identify those patients with JRA who may benefit from aggressive therapy targeted at preventing the longterm morbidity associated with osteopenia.

Absorptiometry, Photon↗

PubMed2002

Frequency of abnormal hand and wrist radiographs at time of diagnosis of polyarticular juvenile rheumatoid arthritis.

OBJECTIVE: To determine the frequency of radiographic abnormalities in hand/wrist radiographs of children with newly diagnosed polyarticular juvenile rheumatoid arthritis (polyJRA) because radiographs of small joints are an important tool in assessing outcomes in RA and there are clinical similarities between RA and polyJRA. METHODS: A medical record review was performed to identify cases of polyJRA seen at Mayo Clinic from January 1, 1994, to December 31, 2001. Hand/wrist radiographs, obtained at the time of diagnosis, were reviewed by 3 radiologists with attention to periarticular osteopenia, joint space narrowing (JSN), or erosion. At least 2 radiologists had to independently identify abnormal findings on the same radiograph. The relative carpal length (RCL), judged by Poznanski's method, was also determined. RESULTS: From the review of 159 medical records, 60 cases of newly diagnosed polyJRA were identified. Twenty-five of these had hand/wrist radiographs at diagnosis; 18 sets were available for this study. Of those, 2/3 were female, 6% (1/18) had subcutaneous nodules, 7% (1/14) had elevated levels of serum rheumatoid factor, and 44% (7/16) had elevated serum levels of antinuclear antibodies. Median age at diagnosis was 10.2 years, median duration of hand/wrist symptoms at diagnosis was 10 months, and median number of joints with either swelling, pain on range of motion (ROM), or limited ROM was 14.5. Sixty-one percent of radiographs taken at the time of diagnosis of polyJRA were abnormal. While 44% had periarticular osteopenia, 28% had either erosions or JSN. Six (33%) had RCL > 2 SD below the mean for age. Five (83%) of those with RCL, > 2 SD below the mean for age, had periarticular osteopenia, JSN, or erosion. CONCLUSION: We conclude the frequency of abnormal hand/wrist radiographs is very high very early in the course of polyJRA. More studies are needed to determine to what extent these radiographic abnormalities correlate with clinical outcomes.

Antibodies, Antinuclear↗