Search

Purpose: The use of online focus groups to explore children and young people's (CYP) perspectives of inequalities in health and associated "sensitive" topics raises important ethical and methodological issues to consider. The purpose of the paper is to discuss lessons learnt from navigating the authors' way through some of the key challenges the authors encountered when researching inequalities in health with CYP through online focus groups. Design/methodology/approach: In the paper, the authors draw on reflections and notes from the fieldwork design, public involvement and engagement (PIE) activities and data collection for their research project. Findings: Collecting data online influenced the authors' ability to develop rapport and relationships with CYP and to provide effective support when discussing sensitive topics. The authors note that building activities to develop rapport with participants during recruitment and data collection and establishing clear support and safeguarding protocols helped navigate challenges of online approaches around effective and supportive participant engagement. Originality/value: The paper highlights that despite ethical and methodological challenges of conducting online focus groups with CYP on potentially sensitive topics, the adoption of practical steps and strategies before, during and following data collection can facilitate the safe participation of CYP and generate useful and valid data in meaningful and appropriate ways.

Despite health benefits gained from physical activity and sport participation, older adults are less likely to be active. This study investigates what influences 50- to 75-year-olds (N = 439) to initiate and maintain walking football, across gender, socioeconomic status, number of health conditions, and physical activity level. It also considers relationships between participant characteristics and influences, and intentions to play after a forced break (COVID-19). Results of a U.K. online cross-sectional survey found those with two or more health conditions rated social influences significantly higher in initiation and maintenance than participants with no health conditions. Multiple regression analysis found a positive walking football culture, and perceived use of maintenance resources contributed significantly to intentions to return to play after COVID-19 restrictions eased. Practitioners should consider providing opportunities for social connection, foster a positive walking football culture, and encourage players to utilize maintenance resources (e.g., scheduling sessions) in older adult walking football sessions. [ABSTRACT FROM AUTHOR]

Background: Underrepresented groups, including racial/ethnic minority groups and individuals with low socioeconomic status face complex barriers to engaging in community-based health initiatives. This research uses parkrun, an outdoor, mass-participation, weekly physical activity and volunteering initiative, to explore the engagement strategies ('outreach activities') that have been used to promote the inclusivity and diversity of parkrun events. Methods: Ten adult parkrun Ambassadors who fulfilled volunteer roles that involved promoting parkrun to underrepresented groups in the UK were interviewed. Interviews took place via telephone or video call in April-July 2021. Interview transcripts were analysed thematically. Results: Engagement strategies implemented by Ambassadors varied from opportunistic promotion within communities to strategic negotiations at higher decision-making levels. Approaches were characterised by a community-centred focus that ensured community networks and assets were utilised. Stories were considered valuable indicators of successful outreach. A common challenge to outreach for Ambassadors was limited personal and organisational capacity that impeded the widescale scope, reach and scalability of parkrun's engagement attempts. Conclusions: Parkrun Ambassadors have used a wide range of outreach activities at different levels of influence. A number of challenges to doing sustainable and effective outreach have been highlighted that need to be addressed. Working with and alongside communities where community-based health initiatives events take place to understand how to address inclusivity issues could contribute to greater participation by underrepresented groups. [ABSTRACT FROM AUTHOR]

Physical activity improves physical and mental well-being and reduces mortality risk. However, only a quarter of adults globally meet recommended physical activity levels for health. Two common initiatives in the UK are Couch-to-5k (an app-assisted 9-week walk/run programme) and parkrun (a free, weekly, timed 5-km walk/run). It is not known how these initiatives are linked, how Couch-to-5k parkrunners compare to parkrunners , and the extent to which this influences their parkrun performance. The aims were to compare the characteristics and motives and to compare physical activity levels, parkrun performance and the impact of parkrun between Couch-to-5k parkrunners and parkrunners. Three thousand two hundred and ninety six Couch-to-5k parkrunners were compared to 55,923 parkrunners to explore age, sex, ethnicity, employment status, neighbourhood deprivation, motives, physical activity levels, parkrun performance and the impact of parkrun. Couch-to-5k parkrunners were slightly older, more likely to be female and work part-time, but similar in ethnicity, and neighbourhood deprivation compared with other parkrunners. Couch-to-5k parkrunners had different motives for participation and reported high levels of physical activity at registration, which remained to the point of survey completion. This group had slower parkrun times but, when registered for a year, completed a similar number of runs (11) per year. Larger proportions of Couch-to-5k parkrunners perceived positive impacts compared with other parkrunners and 65% of Couch-to-5k parkrunners reported improvements to their lifestyle. parkrun appears to be an effective pathway for those on the Couch-to-5k programme, and the promising positive association between the two initiatives may be effective in assisting previously inactive participants to take part in weekly physical activity. [ABSTRACT FROM AUTHOR]

Lockdown restrictions imposed across the UK in response to the coronavirus disease 2019 (COVID-19) pandemic had a profound impact on many people's health and wellbeing. People were encouraged to be active, but population surveys suggest some groups found this easier than others. We explored the changes in health, wellbeing and physical activity levels among a sample in the UK who experienced the sudden loss of a weekly community-based physical activity opportunity, parkrun. A sample of UK parkrun participants responded to two surveys: pre-COVID-19 in January/February 2019 and during the COVID-19 pandemic in September 2020. Outcomes were happiness, life satisfaction, connections with others, physical health, mental health and physical activity. The sample was stratified by gender, age, deprivation status, physical activity and number of parkruns completed. Demographics were reported using descriptive statistics; distributions between sub-groups were compared using Chi-square tests while differences in outcomes were determined using the Mann–Whitney U test. Open text responses were also analysed. Happiness, life satisfaction, connections with others, physical health and mental health of 450 parkrun participants were negatively impacted for all sub-groups, although the impact was not experienced equally. Physical activity fell by 6% while happiness and life satisfaction fell by 12%. People experienced the worst negative impact on their connections with others. The COVID-19 pandemic negatively impacted the wellbeing of a greater proportion of females, younger adults, inactive people, those from higher deprivation areas, and those who had completed fewer parkruns. There is evidence that the wellbeing of those who were more active, and those more involved in a community-based physical activity initiative pre-pandemic, was less negatively affected during the COVID-19 lockdown. [ABSTRACT FROM AUTHOR]

Background: The UK National Health Service (NHS) is ideally placed to undertake research. The UK Government recently launched its vision of research within the NHS to improve research culture and activity amongst its staff. Currently, little is known about the research interest, capacity and culture of staff in one Health Board in South East Scotland and how their attitudes to research may have changed as a result of the SARS-CoV-2 pandemic. Methods: We used the validated Research Capacity and Culture tool in an online survey of staff working in one Health Board in South East Scotland to explore attitudes to research at the organisation, team and individual level together with involvement in, barriers to and motivators to engage in research. Questions included changes in attitude to research as a result of the pandemic. Staff were identified by professional group: nurses/midwives, medical/dental, allied health professionals (AHP), other therapeutic and administrative roles. Median scores and interquartile ranges were reported and differences between groups assessed using the Chi-square and Kruskal-Wallis tests with P < 0.05 accepted as statistical significance. Free-text entries were analysed using content analysis. Results: Replies were received from 503/9145 potential respondents (5.5% response), of these 278 (3.0% response) completed all sections of the questionnaire. Differences between groups were noted in the proportions of those with research as part of their role (P = 0.012) and in being research-active (P < 0.001). Respondents reported high scores for promoting evidence-based practice and for finding and critically reviewing literature. Low scores were returned for preparing reports and securing grants. Overall, medical and other therapeutic staff reported higher levels of practical skills compared with other groups. Principal barriers to research were pressure of clinical work and lack of time, backfill and funds. 171/503 (34%) had changed their attitude to research as a result of the pandemic with 92% of 205 respondents more likely to volunteer for a study themselves. Conclusion: We found a positive change in attitude to research arising from the SARS-CoV-2 pandemic. Research engagement may increase after addressing the barriers cited. The present results provide a baseline against which future initiatives introduced to increase research capability and capacity may be assessed. [ABSTRACT FROM AUTHOR]

Background: To support efforts to increase social prescribing and reduce levels of physical inactivity, parkrun UK and the Royal College of General Practitioners together developed the parkrun practice initiative to link general practices to local parkruns (free, weekly, timed, physical activity events). General practice staff are encouraged to take part in parkrun events themselves and to encourage patients to participate. Aim: To provide insights for primary care clinicians about parkrun participants (parkrunners), especially those with characteristics of patients who might be signposted to physical activity. Design and setting: Secondary analysis of an online survey of parkrunners in the UK. Method: Responders were ranked into 13 categories using mean parkrun finish time, allowing the following definitions: front runners; median runners; slower runners; runners/walkers; and walkers. Measures included demographics, health conditions, motives for first participating, and perceived impact on health and wellbeing. Results: The survey included 45 662 parkrunners. More than 9% of all participants and 45% of walkers were found to have at least one long-term health condition, including arthritis, obesity, depression, hypertension, chronic pain, anxiety, type 2 diabetes, and asthma. Walkers were less likely to be motivated by fitness or competition, and were more likely to be motivated by physical health. Despite these differences, perceived improvements to wellbeing were broadly similar for all parkrunners, regardless of their finishing time. Conclusion: Parkrunners are a diverse population in terms of their physical health. Information provided by this study could be combined with other research on the barriers to participation and successful brief interventions to help address the key issues of primary care clinicians' knowledge and confidence about social prescribing to increase patients' physical activity levels. [ABSTRACT FROM AUTHOR]

The article explores how the plan of the British government to abolish jury trials during the coronavirus disease 2019 (COVID-19) pandemic may affect the administration of criminal justice in Great Britain. Topics discussed include the condition of the British criminal justice system prior to the pandemic, the recorded decline in criminal legal aid expenditure, and the commitment expressed by Her Majesty's Courts and Tribunals Service (HMCTS) to reform and modernization.

The criminal law looks set to play a larger role in regulating healthcare. Until recently, health professionals only faced the prospect of criminal liability if it could be proved that their gross negligence resulted in the death of a patient. In such a case, the professional could face a charge of gross negligence manslaughter (GNM). Prosecutions for ‘medical manslaughter’ have generated concern among doctors worried about what is perceived as a rise in the number of doctors facing criminal prosecution and the impact prosecutions are having on healthcare practice. May more frequent resort to the criminal process damage rather than promote better health care? In seeking to try to answer this question, the first problem is that reliable data in this area about how many prosecutions are brought and how they fare are limited due to the way cases are recorded. What evidence does exist is often based on media reports or samples that are not representative. This paper will argue that, while the real risk of being prosecuted for medical manslaughter remains low, such fears should not be dismissed because, as Donald Berwick has argued, ‘fear is toxic’ – for health professionals and their patients. [ABSTRACT FROM AUTHOR]

The article offers information on the status of the legal representation of suspects and right of silence under the criminal justice system of Great Britain. It analyzes the long-term effects on the 20th anniversary of the changes to the due process rights under the Criminal Justice and Public Order Act 1994 (CJPOA). It determines the effectiveness of legal representation with relevance to the provisions of the lawyer—client relationship.

Despite the vast transitional justice scholarship relating to prisoner release, amnesties and prosecutions when conflicts end, there is a significant gap in practice and academic literature regarding wrongful convictions. Uniquely amongst post-conflict societies, Northern Ireland has a body for investigating miscarriages of justice, albeit one designed for 'ordinary' appeals. In the absence of a formal truth-recovery process, criminal appeals are becoming a proxy for addressing the role of the state during 'The Troubles,' as well as remedying individual injustices. This article examines the approach of the Northern Ireland Court of Appeal during the conflict. It charts the developments in its decision-making following the cease-fires and the establishment of the Criminal Cases Review Commission. It concludes that the current system is unsatisfactory as it ignores the effects of the conflict on the appeal process and offers no insights into the role of the Court during the conflict. Alternative models are suggested. [ABSTRACT FROM AUTHOR]

Northern peatlands are recognized as globally important stores of terrestrial carbon (C), yet we have limited understanding of how global changes, including land use, affect C cycling processes in these ecosystems. Making use of a long-term (>50 year old) peatland land management experiment in the UK, we investigated, using a CO pulse chase approach, how managed burning and grazing influenced the short-term uptake and cycling of C through the plant-soil system. We found that burning affected the composition and growth stage of the plant community, by substantially reducing the abundance of mature ericoid dwarf-shrubs. Burning also affected the structure of the soil microbial community, measured using phospholipid fatty acid analysis, by reducing fungal biomass. There was no difference in net ecosystem exchange of CO but burning was associated with an increase in photosynthetic uptake of CO and increased transfer of C to the soil microbial community relative to unburned areas. In contrast, grazing had no detectable effects on any measured C cycling process. Our study provides new insight into how changes in vegetation and soil microbial communities arising from managed burning affect peatland C cycling processes, by enhancing the uptake of photosynthetic C and the transfer of C belowground, whilst maintaining net ecosystem exchange of CO at pre-burn levels. [ABSTRACT FROM AUTHOR]

Purpose – A psychometrically validated measure is needed to evaluate outcomes in carers of people with mental health problems, including dementia. This study aims to develop and validate the Carer well-being and support questionnaire (CWS). Design/methodology/approach – Development and evaluation of the measure was conducted in three phases. The authors deconstructed an existing questionnaire (CUES-C) to produce a long version measure. This was trialed with carers to reduce the number of items and a preliminary evaluation of the psychometric properties of the remaining items was undertaken. A second field test was conducted with the item-reduced questionnaire measure to evaluate acceptability, reliability and validity. Findings – The CWS well-being scale shows moderate acceptability and good reliability and validity. The CWS support scale shows moderate acceptability and good reliability; validity testing for the support scale is limited by the lack of appropriate validating measures. Practical implications – The CWS is a reliable, valid measure of carer well-being and support, reflecting important aspects of carers' lives. Originality/value – This paper provides researchers and practitioners with a tool that can be used to measure and address areas of support for carers. This is important in assessing the effectiveness of new interventions and approaches. [ABSTRACT FROM AUTHOR]

Objective: The main objective of this study was to learn more about what increases or decreases the likelihood of patient conflict (such as verbal abuse, violence, and rule breaking) and containment (such as seclusion, manual restraint, and enforced medication) events in acute inpatient psychiatric wards. Methods: Line graphs that mapped the total conflict and containment scores over two years on 16 acute inpatient psychiatric wards in the United Kingdom (London) were matched with chronological events that were documented in 120 qualitative semistructured interviews with ward managers and consultant psychiatrists during the same two-year period. Conflict and containment scores were derived from the validated Patient-Staff Conflict Checklist-Shift Report, which was completed by nurses at the end of each shift to log the frequency of conflict behaviors of patients and the staff containment measures. Results: A total of 463 score transitions (upturns and downturns) were identified in the graphs. A total of 323 events were matched to these transitions. A thematic analysis of these events produced 40 themes, which were organized into four categories: patient centered, staff centered, practice or ward centered, or other themes. Thirteen themes were significantly associated with conflict and containment score transitions, 11 of which were staff centered. For example, negative staff morale and staffing change resulting in a negative impact significantly increased the likelihood that conflict and containment would occur, whereas report of positive staff practice significantly decreased the likelihood of such events occurring. Conclusions: The results support the theory that ward staff play a crucial role in influencing the likelihood that conflict or containment events will occur in inpatient psychiatric settings. [ABSTRACT FROM AUTHOR]

In the eighteenth century, the British were the most successful slavers in the Atlantic world. Their unexpected political conversion to anti-slavery in 1787-1833 proved to be a pivotal moment in the global history of slavery and abolition. In this article, we explore how the extraordinary growth of British towns and cities offered an environment in which opposition to slavery among a small, religious-based group of people would be transformed into a truly national campaign to end first the British slave trade and then slavery itself. To make sense of this complex relationship between anti-slavery sentiments and larger socio-economic transformation(s), we focus in particular upon the spread of religious dissent and non-conformity, upon the emergence and spread of business practices conducive to political mobilisation, and upon the ideological and religious appeal of anti-slavery arguments beyond the middle-class abolitionist leadership. [ABSTRACT FROM AUTHOR]

This article examines two contrasting proposals for the reform of criminal appeals: the government's recent proposal that the guilty should no longer have their convictions quashed on ‘technicalities’; and calls by campaigners for the Court of Appeal to consider innocence rather than the ‘safety of the conviction,’ together with their associated attempts to establish Innocence Projects in the UK. Despite the rhetorical power of ‘innocence’ as a campaigning tool, it is contended that to import such a standard into the legal system would be retrogressive and counter-productive, both as a safeguard against wrongful convictions and in protecting the integrity of the system. In order to be meaningful, due process protections must apply to all. The government's proposals attack this principle directly; innocence campaigners risk unwittingly assisting their endeavours. [ABSTRACT FROM AUTHOR]

Disclosure of unused material is essential to a fair trial, and non-disclosure has been a potent cause of miscarriages of justice. In England, Wales and Northern Ireland, however, recent legislation addressing this issue has prioritised the alleged problems that disclosure causes to the prosecution, rather than its demonstrable importance as a safeguard against wrongful convictions. Despite amendment by the Criminal Justice Act 2003, it is argued that the controversial disclosure provisions of the Criminal Procedure and Investigations Act 1996 cannot be made to work. This is a consequence of three fundamental defects in the statutory scheme: lack of consideration of the working cultures and practices of the key protagonists; the resulting inappropriate allocation of responsibilities; and insufficient recognition of the limited sanctions for disclosure failures that can be imposed fairly upon defendants under the current system. It has long been recognised that the effectiveness of due process reforms may be limited by police culture and the inadequate delivery of defence legal services. Drawing on new empirical data, this article suggests that it is equally important to consider the interplay between crime control legislation and occupational cultures. Legislative changes may otherwise reinforce poor practice and provoke injustice. [ABSTRACT FROM AUTHOR]

The Sexual Quality of Life-Female (SQOL-F) questionnaire has been developed to assess the impact of female sexual dysfunction (FSD) on a woman's sexual quality of life. SQOL-F items were developed through interviews with 82 women. Three data sets from women's health surveys in the United Kingdom and the United States generated data for scale validation. The SQOL-F showed good psycho-metric properties: convergent validity, discriminant validity, and test-retest reliability. The SQOL-F is a valid instrument for assessing the impact of FSD on quality of life and as an adjunct in evaluating FSD in clinical trials. The SQOL-F sensitivity to changes in sexual Junction needs confirmation. [ABSTRACT FROM AUTHOR]

Previous research shows that too often acute psychiatric inpatient care is neither safe nor therapeutic for patients. Earlier studies focused on promoting safety through good ward design, staff being able to anticipate and prevent violence, and use of medication. The current evidence base overwhelmingly reflects a staff perspective on risk management, and there is little evidence on how service users cope in this environment or about the strategies they employ to manage the risks they face or pose to others. This paper presents findings on this from two studies: (a) ethnographic research on three UK acute psychiatric wards, undertaken between 2000 and 2002, and (b) a content analysis of qualitative data from a 1999/2000 survey of psychiatric wards in England.Findings show that while some users perceive their ward to be comparatively safe—given the crisis they were in before being admitted—it is nonetheless a volatile environment in which risks are concentrated. Many risks, such as physical assault, are attributable to other patients. However, they are better understood as an outcome of the interplay between a range of interactional and contextual factors: for example, low staffing levels/minimal or poor surveillance may increase the risk of assault. Users were found to employ 10 strategies to manage risk on the ward, including actively avoiding risky situations/individuals, seeking staff protection, and getting discharged. Integral to these strategies are the risk assessments that patients make of one another.These findings shed light on how people cope while living in one of the most anxiety-inducing institutions of a ‘risk management society’. Service users routinely take an active role in making a safe environment for themselves, in part because they cannot rely on staff to do this for them. Future clinical practice guidelines should consider how to harness what users are already doing to manage risk. [Copyright &y& Elsevier]

Presents a review of recent developments in tissue engineering in Great Britain as of June 1, 2001. Background on the need to provide signals to cell populations to promote cell proliferation and differentiation; Potential medical benefits of engineering tissues; Challenges related to tissue engineering.

Investigates the negative impact on the quality of care in acute psychiatric wards in Great Britain. Evidence of violence, sexual harassment and substance misuse; Decline of nurse-patient relationship contact; Increase number of admission rates.

Reports on the perceptions and experiences of clinic staff and clients in exploring the processes involved in the delivery and receipt of counseling and support services in methadone treatment in Great Britain. Tensions that constrain the deployment of counseling services; Monitoring role; Role tensions of an interactional nature.

Background: The National Health Service (NHS) seems appropriately placed to be an exemplar employer in providing effective and proactive workplace health and wellbeing services for its staff. However, NHS staff sickness absence costs an estimated £2.4 billion. Evidence suggests staff health and wellbeing services delivered in the NHS can improve health, productivity and sickness absence and yet the adoption of these services remains a challenge, with few examples nationally. This research aimed to explore the perceptions of NHS senior leaders and health and wellbeing practitioners regarding barriers and facilitators to implementing workplace health and wellbeing services for staff in the NHS.Methods: Semi-structured interviews were conducted with NHS staff, consisting of four senior leaders, four heads of department and three health and wellbeing practitioners in one region of the UK. Interviews were transcribed verbatim and analysed using thematic analysis.Results: Themes describe the experience of delivering workplace health and wellbeing services in the NHS, and barriers and facilitators to implementation from senior decision makers. Barriers to implementation of services include; a busy and pressurised environment, financial constraints and reluctance to invest in staff health and wellbeing. Barriers to staff engagement were also reported and include difficulty of access to health and wellbeing services and lack of time. Initiating services were facilitated by financial incentives, a supportive organisational structure and culture that takes a preventative, rather than reactive, approach to staff health and wellbeing. Facilitators to implementing health and wellbeing services include a coherent, strategic approach to implementation, effective communication and advertisement, being creative and innovative with resources and conducting a needs analysis and evaluation before, during and after implementation.Conclusions: Barriers to the successful initiation and implementation of health and wellbeing services in the NHS are numerous and range from front-line logistical issues with implementation to high-level strategic and financial constraints. Adopting a strategic and needs-led approach to implementation and ensuring thorough staff engagement are amongst a number of factors that facilitate implementation and help overcome barriers to initiation of wellbeing programmes in the NHS. There is a need for a culture that supports staff health and wellbeing in the NHS. [ABSTRACT FROM AUTHOR]

Background: Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice.Method: We synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems.Results: We identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred.Conclusions: Our findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control. [ABSTRACT FROM AUTHOR]

Objectives: To describe the current provision of hospital-based liaison psychiatry services in England, and to determine different models of liaison service that are currently operating in England., Design: Cross-sectional observational study comprising an electronic survey followed by targeted telephone interviews., Setting: All 179 acute hospitals with an emergency department in England., Participants: 168 hospitals that had a liaison psychiatry service completed an electronic survey. Telephone interviews were conducted for 57 hospitals that reported specialist liaison services additional to provision for acute care., Measures: Data included the location, service structures and staffing, working practices, relations with other mental health service providers, policies such as response times and funding. Model 2-based clustering was used to characterise the services. Telephone interviews identified the range of additional liaison psychiatry services provided., Results: Most hospitals (141, 79%) reported a 7-day service responding to acute referrals from the emergency department and wards. However, under half of hospitals had 24 hours access to the service (78, 44%). One-third of hospitals (57, 32%) provided non-acute liaison work including outpatient clinics and links to specialist hospital services. 156 hospitals (87%) had a multidisciplinary service including a psychiatrist and mental health nurses. We derived a four-cluster model of liaison psychiatry using variables resulting from the electronic survey; the salient features of clusters were staffing numbers, especially nursing; provision of rapid response 24 hours 7-day acute services; offering outpatient and other non-acute work, and containing age-specific teams for older adults., Conclusions: This is the most comprehensive study to date of liaison psychiatry in England and demonstrates the wide availability of such services nationally. Although all services provide an acute assessment function, there is no uniformity about hours of coverage or expectation of response times. Most services were better characterised by the model we developed than by current classification systems for liaison psychiatry., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.)

Background: Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both., Objective: To test the efficacy of these interventions., Design: A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation. The main outcomes were rates of conflict and containment., Participants: Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals., Results: For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% CI 5.7-23.7%) [corrected] relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 23.2% (95% CI 9.9-35.5%). [corrected], Conclusions: Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment., Trial Registration: IRSCTN38001825., (Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.)

Sedation and mental clouding are of concern to people on antipsychotic medication and are implicated in social withdrawal but their severity may be underestimated by psychiatrists. Existing studies of communication about adverse effects of medication are based on reports made by doctors or patients. This study is based on audiotapes of 92 outpatient consultations in two UK mental health trusts involving nine consultant psychiatrists where antipsychotic medication was discussed. When interviewed, these doctors and their colleagues had expressed a commitment to 'patient-centred' practice as well as recording concerns about the difficulties involved in the discussion of medication side effects. The study focuses on the ways in which sedation and mental clouding are presented and engaged with. Analysis of audiotape transcripts showed that patients raise these issues more often than doctors, contrasting with other adverse effects (such as blood changes) where doctors are more frequently the initiators of discussion. Sleepiness is sometimes presented by both patients and doctors as a part of normal experience and therefore to be welcomed. When presented as troublesome, patients' reports were sometimes met by doctors offering no response, changing the subject, or disagreeing with the patient's interpretation of the experience. Equally, there were some attempts by doctors to engage with patients' troubles and seek solutions. These could be unsuccessful where they involved challenges to the patients' medication-taking rationale, or more successful where they involved sympathetic and supportive listening. We speculate that the capacity to avoid addressing these problems is linked to the informal conversational style of these consultations, which means that concerns raised by one party can remain unaddressed without offending conversational norms. Doctors in these consultations are able to exercise considerable discretion over whether to define reports of sedation and mental clouding as medication-related problems.