Juliet Hounsome

Cognitive skills behavior programs for offenders in the community: A reconviction analysis

This study presents the findings of an evaluation of the effect on reconviction of three general offending behavior programs involving adult male offenders in the English and Welsh Probation Service. Using a quasi-experimental design controlling for population factors, there was no difference in the reconviction rates of offenders allocated to programs and a comparison group. Offenders who completed a program had a lower rate of reconviction compared to the nonstarter, noncompleter, and comparison groups. A range of explanations for this “completion effect” is discussed, particularly with regard to the emerging literature on readiness to change.

Offending behaviour programmes in the community: The effects on reconviction of three programmes with adult male offenders

Purpose. This study presents the findings of an evaluation of the effect on reconviction of three general offending behaviour programmes in the English and Welsh Probation Service with adult male offenders. Method. The study employed a quasi-experimental design comparing the reconviction rates of three groups: offenders who were allocated to and completed a programme, offenders allocated to a programme but failed to complete, and a comparison group. Results. The main finding from the analyses indicated that, controlling for salient population factors, the offenders who had completed a programme had a lower rate of reconviction as compared with non-completers and comparison groups. Additionally, the non-completers had a higher rate of reconviction than the comparison group. Conclusions. The findings are discussed in light of the extant literature and a range of explanations is presented. Research suggests that offenders typically show distinctive social cognitive styles, including impulsivity and problematic social perspective-taking, and experience difficulties in solving interpersonal problems in socially appropriate ways (for a review, see Antonowicz & Ross, 2005). Therefore, offending behaviour programmes attempt to reduce reoffending by changing offenders’ behaviour through cognitive skills training. This approach to reducing reoffending is supported by the results of metaanalytic reviews of offender treatment, in which interventions based on cognitivebehavioural principles have been shown to be effective in reducing the rates of reoffending (e.g. Andrews et al., 1990; Lipsey, 1992; Lipton, Pearson, Cleland, & Yee, 2002). These meta-analyses have shown interventions to have an average effect size

Rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin's lymphoma.

This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of rituximab for the first-line treatment of stage III/IV follicular non-Hodgkins lymphoma (FNHL) based upon the manufacturers submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The manufacturers scope restricts the intervention to rituximab in combination with CVP (cyclophosphamide, vincristine and prednisolone) (R-CVP); the only comparator used was CVP alone. The evidence from the one included randomised controlled trial (RCT) suggests that the addition of rituximab to a CVP chemotherapy regimen has a positive effect on the outcomes of time to treatment failure, disease progression, overall tumour response, duration of response and time to new lymphoma treatment in patients with stage III/IV FNHL compared with CVP alone. Adverse events were comparable between the two arms. This study was confirmed as the only relevant RCT. The economic analyses provided by the manufacturer were modelled using a three-state Markov model with with the health states being defined as progression-free survival (PFS), progressed (in which patients have relapsed) and death (which is an absorbing state). The model generated results for a cohort of patients with an initial age of 53 and makes no distinction between men and women. The model is basic in design, with several serious design flaws and key parameter values that are probably incompatible. Attempting to rectify the identified errors and limitations of the model did not increase the incremental cost-effectiveness ratio (ICER) above 30,000 pounds. Although the cost-effectiveness results obtained appear to be compelling in support of R-CVP compared with CVP for the trial population the results may not be so convincing for a more representative population. The results of the ERG analysis on the impact of age suggest that ICERs increase steadily with age, as the proportion of PFS that can be converted to overall survival (OS) is diminished by rising mortality rates in the general population. For the most extreme scenario (no OS gain) the ICER appears to remain below 30,000 pounds per QALY gained. On balance the evidence indicates that R-CVP is more cost-effective than CVP. The guidance issued by NICE in July 2006 as a result of the STA states that rituximab within its licensed indication (in combination with cyclophosphamide, vincristine and prednisolone) is recommended as an option for the treatment of symptomatic stage III/IV follicular non-Hodgkins lymphoma in previously untreated patients.

Aggression replacement training with adult male offenders within community settings: a reconviction analysis

This study presents the findings of an evaluation of the Aggression Replacement Training programme as regards the reconviction of male violent offenders within the English and Welsh Probation Service. This study employed a quasi-experimental design which utilised one-to-one matching on key criminogenic variables between an experimental group and a comparison group. The experimental group comprised convicted violent offenders who had been allocated to the programme by probation staff, while the comparison group was sampled from a larger pool of individuals who had been convicted of a violent offence and had subsequently received a community sentence but were not allocated to the programme. Outcome data were analysed using both the ‘intention to treat’ and ‘treatment received’ methodologies. The latter methodology allowed comparison of the naturally occurring groups of completers and non-completers with their matched comparisons and each other. The phi effect size correlations indicated a 13.3% decrease in reconviction in the experimental group as compared to the matched comparison group. Additionally, programme non-completers were more likely to be reconvicted than their matched comparisons and programme completers. These findings are discussed in the light of the extant literature, and different interpretations are considered.

The Importance of Appropriate Allocation to Offending Behavior Programs

This study examined the impact on reconviction of appropriate allocation to three general offending behavior programs involving adult male offenders in the English and Welsh Probation Service. Appropriate allocation was defined by level of risk for reconviction. There were three allocation groups: too low, appropriate, and too high. Using a quasi-experimental design, the reconviction rates of offenders who were allocated to and completed a program, offenders allocated to a program who failed to start, and a comparison group were compared. It was found that the appropriateness of allocation affected reconviction independently of treatment group. Furthermore, in line with the risk principle, there was an interaction between treatment group and the appropriateness of allocation.

Allocation to offending behavior programs in the english and welsh probation service

The Probation Service of England and Wales delivers three offending behavior programs designed for offenders who have committed any offense. One of the selection criteria for these programs states that offenders should have a medium-high risk of reoffending rather than low or very high risk. This article examines the appropriateness of offender allocation by risk level to these three programs in the Probation Service. There was significant variation in allocation performance by Probation Area and program. Appropriateness of allocation was associated with program completion. Very high—risk offenders were more likely to not start a program that they had been allocated to and more likely to not complete a program once they had started. Appropriateness of allocation also affected reconviction independently of program completion status.

The Structured Assessment of Violence Risk in Adults with Intellectual Disability: A Systematic Review.

BACKGROUND While structured professional judgement approaches to assessing and managing the risk of violence have been extensively examined in mental health/forensic settings, the application of the findings to people with an intellectual disability is less extensively researched and reviewed. This review aimed to assess whether risk assessment tools have adequate predictive validity for violence in adults with an intellectual disability. METHODS Standard systematic review methodology was used to identify and synthesize appropriate studies. RESULTS A total of 14 studies were identified as meeting the inclusion criteria. These studies assessed the predictive validity of 18 different risk assessment tools, mainly in forensic settings. All studies concluded that the tools assessed were successful in predicting violence. Studies were generally of a high quality. CONCLUSIONS There is good quality evidence that risk assessment tools are valid for people with intellectual disability who offend but further research is required to validate tools for use with people with intellectual disability who offend.

A systematic review of information format and timing before scheduled adult surgery for peri-operative anxiety

We included 34 trials with 3742 participants, identified through 6 database and supplementary searches (to May 2017): 29 were randomised; 4 were quasi‐randomised and 1 was cluster‐randomised. Disparate measurements and outcomes precluded meta‐analyses. Blinding was attempted in only 6 out of 34 (18%) trials. A multimedia format, alone or in combination with text or verbal formats, was studied in 20/34 (59%) trials: pre‐operative anxiety was unaffected in 10 out of 14 trials and reduced by the multimedia format in three; postoperative anxiety was unaffected in four out of five trials in which formats were compared. Multimedia formats increased knowledge more than text, which in turn increased knowledge more than verbal formats. Other outcomes were unaffected by information format. The timing of information did not affect pre‐operative anxiety, postoperative pain or length of stay. In conclusion, the effects of pre‐operative information on peri‐operative anxiety and other outcomes were affected little by format or timing.

A systematic review of the diagnostic accuracy of automated tests for cognitive impairment

The aim of this review is to determine whether automated computerised tests accurately identify patients with progressive cognitive impairment and, if so, to investigate their role in monitoring disease progression and/or response to treatment.

Nitrous oxide‐based vs. nitrous oxide‐free general anaesthesia and accidental awareness in surgical patients: an abridged Cochrane systematic review

Accidental awareness during general anaesthesia can arise from a failure to deliver sufficient anaesthetic agent, or from a patients resistance to an expected sufficient dose of such an agent. Awareness is ‘explicit’ if the patient is subsequently able to recall the event. We conducted a systematic review into the effect of nitrous oxide used as part of a general anaesthetic on the risk of accidental awareness in people over the age of five years undergoing general anaesthesia for surgery. We included 15 randomised controlled trials, 14 of which, representing a total of 3439 participants, were included in our primary analysis of the frequency of accidental awareness events. The awareness incidence rate was rare within these studies, and all were considered underpowered with respect to this outcome. The risk of bias across all studies was judged to be high, and 76% of studies failed adequately to conceal participant allocation. We considered the available evidence to be of very poor quality. There were a total of three accidental awareness events reported in two studies, one of which reported that the awareness was the result of a kink in a propofol intravenous line. There were insufficient data to conduct a meta‐ or sub‐group analysis and there was insufficient evidence to draw outcome‐related conclusions. We can, however, recommend that future studies focus on potentially high‐risk groups such as obstetric or cardiac surgery patients, or those receiving neuromuscular blocking drugs or total intravenous anaesthesia.