The predictive validity of the Structured Assessment of Violence Risk in Youth in secondary educational settings.

Current developments in violence risk assessment warrant consideration for use within educational settings. Using a structured professional judgment (SPJ) model, the present study investigated the predictive validity of the Structured Assessment of Violence in Youth (SAVRY) within educational settings. The predictive accuracy of the SAVRY scales was assessed using a retrospective file review to gather data on 87 adolescents ranging in age from 12 to 18 years. Receiver-operating characteristic analyses were used to gauge the predictive accuracy. With an area under the curve of .72 (p = .001), the accuracy of the SAVRY total score in correctly identifying violent youth exceeds the accuracy of identifications based on chance predictions in this sample. Logistic regression analyses assessed the relative contribution of the SAVRY subscales, whereas the omnibus equation using all subscale scores correctly classified 82% of those adolescents who were nonviolent and 45% of those adolescents who were violent. These results build on previous research and provide support for the use of the SAVRY in educational settings for identification as well as directing intervention efforts. Practical implications and areas for future research are also discussed.

The efficacy of facilitated tucking for relieving procedural pain of endotracheal suctioning in very low birthweight infants.

PURPOSE: This study compared the efficacy of a behavioral pain reducing intervention (facilitated tucking) with standard neonatal intensive care unit (NICU) care for decreasing procedural pain (endotracheal suctioning) in very low birthweight (VLBW) infants. STUDY DESIGN AND METHODS: A prospective randomized crossover design with infants as their own controls were used. The sample consisted of 40 VLBW infants, 23-32 weeks gestation, and weighing 560-1498 g with tracheal intubation. The infants were observed twice during each endotracheal suctioning experience; one suctioning was done according to normal nursery routine; another was done using facilitated tucking (the caregiver "hand-swaddling" the infant by placing a hand on the infant's head and feet while providing flexion and containment). The Premature Infant Pain Profile (PIPP) measured the infant's pain response, and severity of illness of each infant was measured by the Score for Neonatal Acute Physiology (SNAP) and the NTISS (Neonatal Therapeutic Intervention Scoring System). Repeated measures analysis of variance (RMANOVA) determined the efficacy of facilitated tucking for reducing procedural pain (PIPP) and the effects of order of intervention vs. control. Regression analyses examined the relationship of gestational age, severity of illness, and number of painful procedures to the pain response. RESULTS: There was a significant difference between the PIPP scores for tucking and nontucking positions (p = 0.001) and a nonsignificant interaction with order (p = 0.64) as well as a nonsignificant main effect for order (p = 0.46). In the regression analyses, all predictors taken together did not significantly predict PIPP scores in the tucked position (p = 0.11) or nontucked position (p = 0.57). CLINICAL IMPLICATIONS: Facilitated tucking is a developmentally sensitive, nonpharmacological comfort measure that can relieve procedural pain in VLBW infants. Nurses need to be increasingly aware of infant pain during daily care taking, and to use validated pain assessment instruments. Further clinical research on individual pain assessment is needed for better understanding of the quality and significance of pain for each infant, and the factors that affect pain expression.