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Adaptive pacing (AP) is a self-management technique which seeks to balance energy and rest in individuals with chronic health conditions. Adaptive pacing can help people with myalgic encephalomyelitis/chronic fatigue syndrome learn how to manage their energy expenditure thereby reducing their risk of post-exertional malaise (PEM) and other symptoms. Given some symptom similarity, AP also has rehabilitation potential for people experiencing disability from long COVID. The purpose of this study was to explore patient experiences of an AP intervention (the "PaceMe" app) to determine its value for individuals experiencing long COVID. Twenty-five participants each took part in two narrative interviews (at intervention start point and at 3-6 months). Data were analyzed using narrative thematic analysis. Our analysis identified 4 themes relating to key benefits of the PaceMe app: (1) PEM management, (2) Support, (3) Validation, and (4) Control and Agency. By illuminating the critical facts and centring patient voices, these findings contribute a better understanding of the experiences and needs of those with long COVID and highlight the value of a digital health intervention as a vital component of rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: Dietitians have a central role in eating disorder (ED) treatment, however few studies exist investigating therapeutic aspects of dietetic care and factors influencing the dietitian‐patient relationship. To address the gap, this study aimed to use a qualitative description approach to explore the experiences of delivering and receiving dietetic care in ED treatment in the UK. Method: Semi‐structured interviews were conducted with 6 specialist ED dietitians and focus groups with 11 recovered ED patients. Interviews were transcribed and inductive thematic analysis was performed to identify key themes describing the data. Results: Six key themes were generated: (1) Building trust, (2) Appropriate timing, (3) Adapting, (4) Dietitians as experts, (5) Boundaries, and (6) Difficult relationships. Participants highlighted the importance of building trust and considering nutritional risk and readiness in treatment approach. Patients expressed a desire for dietitians to have experience in EDs, facilitating understanding of their illness. However, dietitians identified the nature of EDs making their role challenging at times. Discussion: This study described various factors affecting dietetic care in EDs and provided a valuable insight into patients' perceptions of treatment. The findings support advancements in ED dietitians' knowledge and understanding, helping to enhance quality of care. Highlights: A trusting and collaborative dietitian‐patient relationship is considered important in supporting success of eating disorder (ED) treatment, however this relationship can take time to developExperience in eating disorders can facilitate dietitians to have greater understanding of the illness, including awareness of detrimental phrases or approaches, and appropriate boundaries to implementAdapting treatment approach based on stage of illness and individual values is perceived to support management of nutritional risk and development of an identity beyond the ED [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Co‐production aims to value service user voices and is increasingly used in healthcare.Less is known about how co‐production in nursing education is experienced by service users. What the paper adds to existing knowledge?: This paper shares the experience of one service user who teaches student nurses in a UK university.For the first author, the paper highlights that co‐producing nurse education has been valuable and rewarding for both a service user and students. What are the implications for practice?: Co‐production has the potential to benefit student nurses, including challenging their perceptions of 'difficult' patients. To achieve this, teaching sessions must be equally produced and delivered. By employing and including service users, universities have the potential to improve experiences for students and service users alike. Introduction: Co‐production is increasingly used in health care but there is less attention to a co‐produced mental health nurse education. Aim: This article sought to explore the co‐production experiences of a service user who teaches mental health nurses, alongside the benefits of this to nurse education. Methods: The article is a lived experience narrative co‐written with a nursing lecturer. Thesis: Co‐produced mental health nurse education challenges students' perceptions towards self‐harm and encourages empathy and understanding of service user distress. Implications for Practice: Co‐production has many benefits to nurse education including a positive student experience, and validation of the service user experience to support meaningful recovery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between training load and subjective wellness in English Premier League goalkeepers (GKs) and examine potential positional differences in subjective wellness. Methods: A total of 34 players (GK = 7, outfield = 27) completed a daily subjective wellness questionnaire assessing sleep quality, sleep hours, fatigue, mood, soreness, and total wellness over two and a half seasons. Ten-Hertz GPS devices were worn during training to calculate previous-day and 7-day total distance, player load, total dives, total dive load, average time to feet, and high, medium, and low jumps. Results: All previous 7-day training loads were associated with all wellness markers (r =.073 to.278, P <.05). However, associations between previous 7-day dive load and mood, average time to feet, and both sleep quality and quantity, and between low jumps and sleep quality, were not significant. For previous-day metrics, total distance was associated with all wellness markers (r =.097 to.165, P <.05). In addition, player load and high jump were associated with fatigue, soreness, and wellness (r =.096 to.189, P <.05). Total dives and soreness were also related (r =.098, P <.05), and relationships were evident between average time to feet, medium jumps, and all wellness markers excluding sleep quality (r =.114 to.185, P <.05). No positional differences in subjective wellness occurred (P >.05). Conclusion: Some GK GPS variables are associated with subjective wellness, which could inform training-load prescription to maximize recovery and performance. In addition, GKs are no more vulnerable to poorer subjective wellness when compared with outfield players. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the psychological and relational processes of a service user reflective group on a medium secure forensic ward. The group was conceptualised by the service as a component of the therapeutic offer contributing to the patients' journey towards recovery and this study aimed to explore whether the group was being experienced as beneficial, by service users and staff, in relation to recovery concepts. Design/methodology/approach: Qualitative data were collected using semi-structured interviews from 10 participants who had experience of an existing service user reflective group on a medium secure forensic ward. Participants in the study were patients who attended the group (6) and staff members who facilitated the group (4). The data collected were analysed using constructivist grounded theory methodology. Findings: Results formed a flexible, cyclical model based on five key categories: "Group Identity", "Linking Self with Others", "The Changing Self", "Living Visibly in a System" and "Moving On." Practical implications: Findings indicate that service user reflective groups in forensic inpatient settings can contribute to increased interpersonal effectiveness and personal recovery. Originality/value: The role of service user reflective groups in secure recovery has not been explored empirically to date, although they are a suggested intervention to enhance relational security and to aid therapeutic progress within a secure recovery framework. This study aimed to begin to address this gap in research and understanding. [ABSTRACT FROM AUTHOR]

Risk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient's perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patient risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as "ontological insecurity of inattentiveness". This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients' experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views. It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital. [ABSTRACT FROM AUTHOR]

Gendered understandings of housing transitions amongst women and especially amongst those in substance use disorder recovery are under-researched. To address this gap, this study explores the multifaceted challenges and pathways to housing stability amongst women in substance use disorder recovery in the UK. Through qualitative analysis of life course interviews with 15 women in recovery, it becomes evident that housing insecurity, instability, and frequent transitions are common experiences. The women in the sample faced housing instability, ranging from temporary supported accommodations to homelessness. Notably, escaping negative relationships with male partners emerged as a primary cause of homelessness among these women. What this article highlights, which has not been found elsewhere to date, is that housing transitions are essentially a social process for women in recovery. This study highlights the social dimension of housing transitions. The potency of social capital and social networks in determining housing stability and security amongst women is emphasised as they exchange negative forms of social capital for positive forms of social capital. Recommendations stemming from this study include the need for drug recovery and housing policies to integrate gender-specific strategies to adequately support women in recovery. Further, they need to adopt a broader perspective, emphasizing the importance of fostering positive social connections and networks when considering housing options for individuals in recovery. For women who have spent a long time in supported residential and therapeutic environments, there is a need to develop a scaffolded support system to help women transition to independent living. The utilisation of recovery capital (and CHIME) as frameworks may provide a basis upon which to map out holistic and sustainable pathways to housing stability and security for women in recovery due to their acknowledgement of interconnected and related life domains that produce change and transformation. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic lockdown restrictions posed unique challenges for people living with eating disorders (EDs), particularly relating to social isolation and changes in treatment access. However, less is known about the experience of lockdown for people 'in recovery' from EDs or disordered eating (DE) (i.e., with an ED/DE history). This study explored: (i) how people with a self-reported ED/DE history responded to and managed the experience of lockdown, specifically in relation to their recovery, and (ii) coping strategies for the management of recovery. Semi-structured interviews were conducted between June and August 2020 with 20 adults with a self-reported ED/DE history living in the UK. Data were analysed using inductive thematic analysis within a critical realist framework. Three overarching themes were identified: (1) Seeking safety and stability during a pandemic, (2) Lockdown prompting realisations about recovery, and (3) Exploring self-compassion as a more adaptive approach. While most participants experienced a resurgence in ED symptoms during lockdown, many reflected on the successful management of these as reinforcing their recovery. These findings have important implications for understanding ED recovery, in addition to informing interventions to better promote recovery during the COVID-19 pandemic and beyond. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To appreciate the importance of effective management of service users’ discharge from inpatient settings • To understand the factors that can enhance service users’ experience of transition from inpatient rehabilitation settings to the community • To learn about what elements of the discharge process could be improved to enhance service users’ experience. Discharge from inpatient rehabilitation settings can be a stressful experience for service users and mismanagement of the transition process can have negative outcomes, such as early readmission. This service evaluation explored the experience of people transitioning from inpatient rehabilitation settings to the community to identify what works well in the rehabilitation pathway discharge process and areas for improvement. Eight service users participated. All eight completed a bespoke questionnaire, six of whom took part in a subsequent semi-structured interview. Findings suggest that, overall, participants had a positive experience of transition, particularly in relation to practical and emotional support from inpatient and community rehabilitation services. Areas identified for improvement include increased involvement of family and carers during the discharge process and greater clarity about the role of the various professionals and teams involved in service users’ care once they are discharged to the community. [ABSTRACT FROM AUTHOR]

The recovery movement has facilitated a move from a palliative approach to care, to one that emphasises the possibility and likelihood of recovery. This study aimed to explore people's experience of community mental health services, and to explore any changes that have occurred over-time. A qualitative study was conducted using Interpretative Phenomenological Analysis. Seven individuals who have experience of psychosis and who have been involved with services for 5 years or more, were recruited from community mental health teams in the UK. Interviews were conducted via the telephone using a semi-structured approach. Individuals reported a mixed experience of services. Four super-ordinate themes were identified; 1) Grateful for connection; 2) Hesitant about being dissatisfied; 3) The unequal distribution of power; and 4) An enduring vulnerability. Service-users benefited from a secure and connected relationship with professionals. They were less comfortable about criticising services but did describe some elements of care that were oppressive and isolating. Furthermore, the balance of power continues to favour professionals, with a more equal relationship required if we are to facilitate recovery and empower service-users. [ABSTRACT FROM AUTHOR]

This article draws upon research conducted as part of an officially sponsored evaluation into one part of a recovery programme, put in place following a mass shooting event in the Plymouth city district of Keyham, in the UK, in the summer of 2021. It discusses the contribution made by a dedicated community policing team, focusing on its reception by the local community and aspects of its constitution and operational practices that may be regarded as critical success factors. More critically, the article questions whether this part of the recovery programme was as much about the recovery of the reputation and standing of the local police as it was about the recovery of a putative vulnerable community. [ABSTRACT FROM AUTHOR]

Objective: Admissions to hospitals for people with anorexia nervosa (AN) often last over 2 months, during which significant time is often spent with other patients, but there is little qualitative research on the impact on recovery of the inter‐patient relationships. Our aim was to conduct qualitative interviews with people with a history of inpatient treatment for AN, focusing on the impact of interactions and relationships between patients during hospital admission on recovery, including short‐term and long‐term effects. Method: We conducted nine semi‐structured, one‐to‐one interviews, specifically exploring the helpful and unhelpful aspects of inter‐patient relationships during inpatient treatment for AN. No type of relationship was either included or excluded. Participants were recruited as volunteers in response to an online advertisement; all who met the eligibility criteria were selected. Interviews were transcribed and analyzed using thematic analysis. Results: Thematic analysis identified five themes: (1) comparison and justification, (2) learnt unhelpful behaviors, (3) dealing with distress, (4) compassion, and (5) role‐modeling. All participants expressed conflicting feelings about their relationships with other patients, but generally described developing more resilience to negative effects as they got closer to recovery. Positive effects, such as compassion, appeared to hold significance long term in participants' recovered lives. Discussion: The detailed exploration of themes in this study provides a deeper understanding of inter‐patient relationships during inpatient treatment for AN. This could aid clinical decision‐making when choosing appropriate treatment settings for individual patients as well as informing clinical practice in hospital. Public Significance: This study closely examines the effect on recovery of relationships with other patients during hospital treatment for AN, a severe eating disorder. Findings might help hospital staff to understand the feelings of those they look after and develop ways to protect patients from the negative effects of peer relationships and enhance the positive ones, to support recovery in hospital. [ABSTRACT FROM AUTHOR]

Background: Previous research has demonstrated that remissions from alcohol use disorders can occur without accessing treatment. The current study explored the prevalence of such untreated remissions in the UK and further, examined the extent to which people who resolved an alcohol use disorder regarded themselves as ever, or currently, being in recovery. Methods: Participants were recruited using the Prolific online platform. Participants who met criteria for lifetime alcohol dependence (ICD-10) were asked about their drinking at its heaviest, use of treatment services, whether they identified as being in recovery, and their current alcohol consumption (to identify those who were abstinent or drinking in a moderate fashion). Results: A total of 3,994 participants completed surveys to identify 166 participants with lifetime alcohol dependence who were currently abstinent (n = 67) or drinking in a moderate fashion (n = 99). Participants who were currently abstinent were more likely to have accessed treatment than those who were currently moderate drinkers (44.4% versus 16.0%; Fischer's exact test = 0.001). Further, those who were abstinent were heavier drinkers prior to remission [Mean (SD) drinks per week = 53.6 (31.7) versus 29.1 (21.7); t-test = 5.6, 118.7 df, p <.001] and were more likely to have ever identified themselves as 'in recovery' (51.5% versus 18.9%; Fischer's exact test = 0.001) than current moderate drinkers. Conclusions: While participants with an abstinent remission were more likely than those currently drinking in a moderate fashion to have accessed treatment and to identify as being 'in recovery,' the majority of participants reduced their drinking without treatment (and did not regard themselves as in recovery). [ABSTRACT FROM AUTHOR]

Background: In 2019, coronavirus disease 2019 (COVID‐19) broke out worldwide, leading to a pandemic. Studies have shown that COVID‐19 patients in intensive care units (ICUs) require more nursing care than other patients. ICU nurses who care for patients with COVID‐19 have shown signs of psychological and physical strain. Aim: The aim of this study was to illuminate ICU nurses' experiences of caring for patients with COVID‐19 in ICUs during the first wave of the pandemic. Study Design: A qualitative, descriptive and inductive approach was used. A total of 70 blog posts from 13 bloggers in the United States, Great Britain, Finland and Sweden were analysed using qualitative inductive manifest content analysis. Results: The results reveal an overall theme: 'An overturned existence under extreme conditions'. Furthermore, three categories—'the virus caused changes in work and private lives', 'unreasonable demands', and to hold on to caring ideals thanks to the support of others'—and seven subcategories were identified. Conclusions: Caring for patients with COVID‐19 during the first wave of the pandemic was demanding because of a lack of knowledge about the disease and the severity of the illness. This led to ICU nurses experiencing extreme conditions that affected various aspects of their lives. Support from colleagues and teamwork were revealed to be particularly important for how nurses dealt with the demands of working during a pandemic, as was sufficient recovery time between work shifts. Relevance to Clinical Practice: Work in ICUs was challenging and demanding, even before the pandemic. This study contributes to an understanding of the complex work environment that existed in hospitals during the first wave of the COVID‐19 pandemic. The knowledge obtained from this study can be used to revise working conditions and identify health interventions for ICU nurses. [ABSTRACT FROM AUTHOR]

Identity has been empirically established as a recovery process from serious mental illness (SMI) yet is often overlooked within intervention evaluations. Community arts presents one such intervention with emerging evidence illustrating the potential for recovery to occur within this context. However, research indicates numerous mechanisms may be involved in the identity recovery process, making it difficult to determine what works, for whom and in what context. The current review aimed to generate new theories to explain how, why and in what context community arts enable the identity change recovery process for individuals with SMI. A realist review was conducted between January and September 2021, with 22 articles and reports reviewed and synthesised to develop a theory. A safe and empowering intervention context was found to be vital to activate three key mechanism pathways: (a) feeling in control of SMI through coping; (b) achieving acceptance through connectedness and (c) overcoming personal challenges. The outcome was the development of positive self‐awareness, which enables individuals to redefine identity beyond SMI through both social and personal identities. Novel insights are presented through theory development, utilising the Social Identity Approach to Health and Transformative Learning Theory to conceptualise the findings through a multi‐theoretical lens. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Introduction: Concerns have been raised that consumption of no‐ and low‐alcohol drinks by those who are in recovery could lead to a relapse to past drinking behaviours. However, little is known regarding how individuals use these products to substitute alcohol and support their sobriety. Methods: This article draws on an ethnographic study of women's experiences of recovery within online sobriety communities in which semi‐structured interviews were conducted with 25 UK‐based women. The dataset was analysed and coded from a pragmatist feminist standpoint using a grounded theoretical approach to specifically address the research question: 'How do women in recovery navigate the protective and risk factors associated with no‐ and low‐alcohol drinks through practices of consumption?' Results: Women in recovery navigate no‐ and low‐alcohol drinks as potential harm‐reduction tools and relapse triggers by engaging in nuanced practices of substitution. Contrasting examples include direct substitution and temporary avoidance in early recovery. Discussion and Conclusions: Substitution practices are informed by the temporality of participants' recovery journeys, the social situation, and the products. Participants selectively replicate and resist their former drinking practices to balance their perceived harm‐reduction benefits and relapse triggers of no‐ and low‐alcohol drinks. Important considerations are raised for those in recovery who may want to use no‐ and low‐alcohol drinks as a harm reduction tool, and for recovery modalities that promote them. It concludes with calls for more clarity regarding the definition and labelling of no‐ and low‐alcohol drinks, and for a greater understanding of their use across different recovery cultures. [ABSTRACT FROM AUTHOR]

There is a significant diversity in approach to 'resilience' in the context of mental health recovery following experiences of psychosis, varying from clinically measurable outcomes to a personal trait within a recovery 'journey'. Given the contested nature of resilience within mental health literature, this study aimed to complete a scoping review to synthesise understandings of resilience by individuals with experiences of psychosis. Drawing on the holistic and person-centred principles that underpin social work approaches to mental distress, these perspectives are considered in the statutory, policy and critical contexts of British social work, establishing learning for practice. A meta-synthesis of qualitative studies was completed, drawing on searches of five databases (Social Care Online, APA PsychInfo, Cinahl, Medline and Web of Science), identifying twelve relevant papers. A thematic analysis identified three overarching themes (personal, social and professional factors) and eight associated sub-themes (personal responsibility, use of experience, coping strategies, peer support, social relationships, contribution, relationships with professionals and structured support). The study identifies systemic and life-course approaches as empowering service user engagements with psychosis, recovery and resilience, suggesting that the social work profession is well placed to engage with resilience enhancement in the context of mental health recovery. [ABSTRACT FROM AUTHOR]

Background: The concept of recovery has increasingly become an organizing paradigm in the addiction field in the past 20 years, but definitions of the term vary amongst interested groups (e.g. researchers, clinicians, policy makers or people with lived experience). Although professional groups have started to form a consensus, people with lived experience of alcohol or drug (AOD) problems use the term in a different way, leading to confusion in policy making in the UK. Greater knowledge about the prevalence and correlates of adopting a recovery identity amongst those who have overcome an AOD problem would inform clinical, public health, and policy communication efforts. Methods: We conducted a cross-sectional nationally representative survey of individuals resolving a significant AOD problem (n = 1,373). Weighted analyses estimated prevalence and tested correlates of label adoption. Qualitative analyses summarized reasons for adopting or not adopting a recovery identity. Results: The proportion of individuals currently identifying as being in recovery was 52.4%, never in recovery 28.6%, and no longer in recovery 19.0%. Predictors of identifying as being in recovery included current abstinence from AOD, formal treatment, recovery support service or mutual-help participation, and history of being diagnosed with AOD or other psychiatric disorders. Qualitative analyses found themes around not adopting a recovery identity related to low AOD problem severity, viewing the problem as resolved, or having little difficulty in stopping. Conclusions: Despite increasing use of the recovery label and concept in clinical and policy contexts, many resolving AOD problems do not identify in this manner. These are most likely to be individuals with less significant histories of impairment secondary to AOD and who have not engaged with formal or informal treatment systems. The understanding of the term recovery in this UK population did not completely align with abstinence from alcohol or drugs. [ABSTRACT FROM AUTHOR]

Objectives: Self‐harm rates and clinical presentations differ by ethnicity. South Asian women are at risk of self‐harm. Previous research suggested investigating individuals' experiences with self‐harm with qualitative studies in developing self‐harm prevention strategies. This research aims to explore self‐harm experiences among South Asians in the United Kingdom. Design: Qualitative study. Methods: Participants were recruited via third‐sector organizations and online platforms. Semi‐structured interviews were conducted with 11 South Asian individuals with a history of self‐harm living in the United Kingdom. The data were analysed based on a reflective thematic analysis approach. Results: Results revealed four main themes: (1) reasons for self‐harm; (2) recovery journey; (3) culture and mental health; and (4) the transition to suicidal thoughts and behaviours. Reasons for self‐harm included negative life circumstances, social life difficulties, challenges faced during COVID‐19 and mental health problems. Participants described their recovery journey by acknowledging the role of professional help, self‐care, psychoeducation and personal growth, improving social relationships, and faith and spirituality. Cultural factors included generational differences and stigma. Culturally adapted psychological interventions were perceived as promising. The reported transition from self‐harm to suicidal behaviours was linked to experiencing major stressful life events and the use of severe methods of self‐harm. Conclusions: The findings suggest that socio‐cultural factors impact mental health and recovery processes among South Asians. Mental health services should consider improving culturally sensitive clinical practices in responding to self‐harm among South Asian communities. [ABSTRACT FROM AUTHOR]

Health precautions implemented by the United Kingdom (UK) government to limit the spread of the Coronavirus Disease 2019 (COVID-19) led to the closure of many well-being support services in 2020. This created a need to re-think how impactful recovery support courses can be provided. One such service was that of the five-day Multi Activity Course (MAC) which was redesigned in accordance with national health guidelines to allow continued access for Wounded, Injured and Sick (WIS) military personnel to the service; the positive impacts of which are well established. This study investigated the influence of the newly developed Reduced numbers MAC (R-MAC) on the WIS participants lives during and for 12 months after attending. The R-MAC led to comparable impacts for participants well-being, at a time in which people's mental well-being was often being adversely affected. The positive mental well-being of the 261 participants improved by 33% throughout the course and remained 14% higher for the 37 participants who provided data six months after attending. Key facets of the experience that were most impactful for the participants were (i) shared experience with other veterans, (ii) discussing issues in a safe environment while receiving support from the staff and (iii) developing knowledge around self-help/personal development. Adapting to the challenging circumstances and developing the R-MAC mitigated against the already adverse impact of the COVID-19 pandemic for the WIS participants. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive analytic therapy (CAT) is used within UK mental health settings as a treatment for transdiagnostic complex psychological presentations. However, it is not routinely offered by the NHS Talking Therapies, for anxiety and depression (NHS Talking Therapies) programme which provides psychological treatments for common mental health difficulties. We aimed to evaluate the outcomes of providing CAT treatment to patients presenting with depression and/or anxiety, within the context of relational difficulties, adverse childhood experience or difficulty managing emotions, returning for further psychological treatment within NHS Talking Therapies. Methods: This was a pragmatic, real‐world evaluation, involving routinely collected self‐report measures of depression and anxiety, to examine the treatment outcomes of NHS Talking Therapies patients offered CAT over an 18‐month period. Quantitative validated measures of depression and anxiety were administered at the beginning and end of CAT treatment, and at follow up. Within‐group change in depression and anxiety scores were examined statistically, and rates of reliable improvement and recovery calculated. Results: Statistically significant decreases in depression and anxiety scores were observed during the CAT active treatment phase. The recovery rate was 46.4%, and 71.4% of patients showed a reliable improvement post‐treatment. Positive outcomes continued to be observed at follow‐up, with a recovery rate of 50% and a reliable improvement rate of 79.4%. Conclusions: CAT shows promise as a treatment option for NHS Talking Therapies patients re‐presenting with depression and/or anxiety. More research is required to determine if CAT should be offered more widely within NHS Talking Therapies services. [ABSTRACT FROM AUTHOR]

The impact of crises on firm performance has been studied widely. This paper explores the relationship between firms' reaction to COVID-19 (in employment) and the adoption of digital technologies, taking into account their productivity, digitalisation level and high-growth episodes before the crisis. We match the EIB Group Survey of Investment and Investment Finance with ORBIS database for 27 EU Member States and the United Kingdom. We find that firms with higher productivity levels are less prone to decrease the number of employees in the short and long term due to the pandemic. High-growth enterprises are less likely to expect a reduction in the number of employees in the long term. Moreover, firms in highly digitalised sectors have a lower probability to reduce the number of employees. Finally, our results suggest that COVID-19 leads firms to increase their use of digital technologies, especially those that were already more digitalised. [ABSTRACT FROM AUTHOR]

Those who experience parental domestic abuse in childhood are affected in multiple ways, but existing research uses a narrow lens, relying on psychotherapeutic and neuroscientific understandings. This article uses a dialogical theory to explore women's recovery stories. Interviews were conducted with 10 women in England and a voice-centered narrative analysis was used. This article attends to gendered, psychotherapeutic, and neoliberal narrative resources that shaped participants' stories. It concludes that recoveries after domestic abuse in childhood can be considered as dynamic processes that are individual, as well as shaped by social, political, and relational contexts that shape storytelling practices. [ABSTRACT FROM AUTHOR]

Background: Establishing and maintaining healthy social connections and relationships are important in encouraging a sense of belonging that can help mid-life and older aged women in recovery from illicit drug use. This paper contributes to an under-researched area of substance use recovery among women in mid-life and older age by asking what influence social relationships have on their sense of self as they age into recovery from illicit drugs. Methods: In-depth qualitative interviews were undertaken with 19 women in the United Kingdom who self-identified as 'in recovery' from illicit drug use. The interviews were transcribed verbatim and analyzed using Braun and Clarke's thematic analysis techniques. The study received ethical approval from the University of Glasgow. Results: As their drug use progressed, the women experienced feelings of estrangement and separation from others. Entering and maintaining a healthy recovery from drug use required the women to break their connections to people considered disruptive or challenging. Creating and setting boundaries enabled some of the women to gain a sense of control over their relationships and recovery. Positive reinforcement from others was pivotal to the process of the women's self-acceptance, contributing to better self-concepts that helped them maintain their recovery. Discussion: This investigation into substance use recovery among women in midlife and older age offers new insights into the relationship challenges they face. It offers suggestions for further research that could support the development of family support programs for mid-life and older age women in active drug use or recovery. [ABSTRACT FROM AUTHOR]

Purpose: In 2019, the world was hit by a life threatening severe acute respiratory syndrome causing a global pandemic; Coronavirus disease (COVID-19). In the UK, a nationwide "lockdown" of public isolation and reduced social contact followed. The experience of COVID-19 and the lockdown for forensic secure mental health patients is yet to be understood. This study aims to explore this phenomenon from the patients' perspective. Design/methodology/approach: A qualitative approach was taken. Semi-structured interviews were carried out with six patients from a low secure unit in the UK, between November 2020 and March 2021. Findings: Interpretive phenomenological analysis generated three superordinate themes from the data, providing insight into patients' experience: "treading water"; how they managed: "learning to swim"; and what was helpful during this time: "in the same boat". Practical implications: Further consideration should be given to creating a sense of safety in wards, along with ways to continue to address the power imbalance. Interestingly, social connection may be cultivated from within the hospital setting and would benefit from further research. Originality/value: To the best of the authors' knowledge, this is the first study to explore secure patients' experience of COVID-19 from the patients' perspective, within a population often neglected within recovery research. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: It is known that people with a diagnosis of borderline personality disorder often experience crises in their mental wellbeing.There is little evidence about the approaches of mental health nurses in community‐based crisis teams when working with people with a diagnosis of BPD. What the paper adds to the existing knowledge?: This paper highlights that limited resources, work‐patterns and issues of stigma present challenges to delivering recovery‐oriented care.The paper highlights that nurses typically try to navigate the challenges to continue to provide individualized care, though their self‐assessment is that this is with mixed success. What are the implications for practice?: The findings suggest that support is needed to develop brief interventions specific to teams working with people with a diagnosis of BPD who are at a point of crisis. Introduction: People with a diagnosis of borderline personality disorder (BPD) are often in contact with mental health services at a point of crisis, and in the UK, this includes Crisis Resolution Home Treatment teams (CRHTT). There is a drive for services to be recovery orientated; however, there is little evidence about the degree to which community services achieve this for people with a diagnosis of BPD when in crisis. Research Aim: To understand the perceptions held by CRHTT clinicians about their provision of recovery‐orientated acute care, for people with a diagnosis of BPD. Method: From a purposive sample of a single CRHTT, seven registered mental health nurses were interviewed and Braun and Clarke's thematic analysis framework was used to interpret the data. Results: Five themes emerged: person‐centred care; the timing is wrong; inconsistent staffing; the risks are too great; and BPD as a label. Discussion: The results demonstrate tensions between a drive to deliver person‐centred care and a range of challenges that inhibit this, with the possibility of reframing a recovery approach as "recovery‐ready". Implications for Practice: A whole‐system approach is required to enable a consistent recovery‐oriented approach, but research is also needed for brief interventions specific to this context. [ABSTRACT FROM AUTHOR]

To investigate the effect of home and away game travel on risk of concussion across different levels of rugby union. Exploration study across school, university, and professional rugby teams. Retrospective analysis of concussion incidence and symptomology of surveillance data and prospective data collection for potential concussions via surveys. Data was collected from school rugby teams (n = 344 matches, over 2 years), a university rugby (n = 6 matches), and a professional rugby team (n = 64 matches, over two seasons). School level rugby had an increased prevalence of concussions in away matches (p = 0.02). Likewise, there was a significant increase (p < 0.05) in concussions at away matches in university rugby. In addition, the professional rug by team had significant differences in recovery times and symptoms with away fixtures, including longer recovery times (p < 0.01), more initial symptoms (p < 0.01), as well as greater and more severe symptoms at 48 hours (p < 0.05). This research highlights an increased prevalence of concussion in school and university-aged rugby players away from home, as well as increased symptoms, symptom severity, and recovery times in professional rugby players. [ABSTRACT FROM AUTHOR]

Introduction: Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control and demographic characteristics. Methods: In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics. Results: In April 2020, monthly requests dropped to 7.9–18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7–86.9% of 2019 levels. During April–June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4–63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April–June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April–June 2020; trend test p < 0.001) and two subsequent periods (July–September and October–December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group. Conclusion: Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59–86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality. [ABSTRACT FROM AUTHOR]

Background: Despite enhanced recovery programmes, length of stay is variable following robotic assisted radical cystectomy (RARC). The aim of this study was to assess the impact socioeconomic deprivation on recovery following RARC. Methods: The prospectively maintained RARC databases at two tertiary referral hospitals were reviewed from 2015 to 2017. Demographic, histological, and outcome data including length of stay (LOS), operation time and blood loss were recorded. The Index of Multiple Deprivation, was chosen as a deprivation index as this is used by the UK government to direct funding and resources to regions, towns and postal codes by assessing a number of indicators. Results: During the study period, 340 consecutive patients underwent RARC. Deprivation deciles were significantly higher in site 1 patients (7.9 in site 1 vs 6.6 in site 2, p < 0.001) implying that these patients are more likely to have higher incomes, levels of education and improved living environments. The mean operating time was longer in the site 1 cohort (397 vs 366 min, p > 0.001) with a reduced mean blood loss volume (252 and 484 mL, p < 0.001). There was a significant difference in mean LOS (6.2 days in site 1 vs 10.6 days in site 2, p < 0.001). On multivariable analysis, a higher deprivation decile did not predict LOS (OR = 1, 95% CI = 0.9–1.1, p = 0.407). Sex and operation site were however significantly associated with LOS (p = 0.006 and <0.001). Conclusion: Recovery following RARC was independent of socioeconomic status when comparing two hospitals with diverse catchment areas in the UK. [ABSTRACT FROM AUTHOR]

The aim of the article is to show the problematic issues of the BREEAM certification system, when assessing historic buildings from Poland and Great Britain. The research hypothesis is to analyse the disparities in the results of BREEAM for historic buildings, and to examine whether the criteria are adequate for a reliable assessment of the degree of sustainability in their adaptation. The first part of the article outlines the idea of sustainability and presents methods for assessing the degree of sustainability of buildings, and the main assumptions for BREEAM adaptation projects. Research methodology includes quantitative and qualitative research. The study involved statistical analysis. The scheme for adaptation projects was discussed. The second part of the study included a case study of four certified historic buildings from Poland and Great Britain. The results showed excessive generalisation and the favouring of individual categories of the BREEAM scheme. The authors pointed to disproportions and inconsistencies in the assessment of the degree of sustainability of objects, with regards to sustainability sectors. The possible exemplary solutions were presented, which include the modification of the BREEAM document, to assess in a more proper way the level of sustainable use of the architectural cultural heritage. [ABSTRACT FROM AUTHOR]

Background: The current emphasis among addiction treatment providers is to use person-first language, such as "a person with a substance use disorder," as a way to reduce stigma around addiction and resulting barriers to treatment. This study considers how individuals recovering from substance use feel about the terms "alcoholic" and "addict," particularly how they self-identify and whether they believe the terms carry stigma. Method: Thirty-five individuals were interviewed, recruited primarily, but not exclusively, from 12-step meetings (Alcoholics Anonymous, Narcotics Anonymous), from 3 locations throughout a rural New England state. Interviews were transcribed and coded in Atlas Ti qualitative analysis software, and a content analysis of text coded with "stigma" was conducted. Results: Some comments reflected a belief that the terms "addict" and "alcoholic" carry a stigma. However, more comments rejected the notion of these being stigmatized terms; or acknowledged the stigma but reflected the subject's lack of internalizing of any stigma. Comments reflected other themes including a sense of pride, identity and ownership when self-identifying as an addict or alcoholic. Several comments suggested that person-first language is part of a larger movement to "soften everything," without changing the underlying condition (addiction). The findings may reflect the fact that subjects were recruited from 12-step programs, where the convention is to self-identity using the terms "alcoholic" and/or "addict." Conclusions: Some individuals seeking treatment for addiction may prefer self-identifying using old-school terminology (addict, alcoholic) rather than person-first language, for a variety of reasons (eg, they do not internalize the stigma of such terms). [ABSTRACT FROM AUTHOR]

Background: The positive and negative effects of interacting with web-based content on mental health, and especially self-harm, are well documented. Lived experience stories are one such type of static web-based content, frequently published on health care or third-sector organization websites, as well as social media and blogs, as a form of support for those seeking help via the web. Objective: This study aimed to increase understanding about how people who self-harm engage with and evaluate web-based lived experience stories. Methods: Overall, 4 web-based focus groups were conducted with 13 people with recent self-harm experience (aged 16-40 years). In total, 3 example lived experience stories were read aloud to participants, who were then asked to share their reactions to the stories. Participants were also encouraged to reflect on stories previously encountered on the web. Data were analyzed thematically. Results: Overall, 5 themes were generated: stories of recovery from self-harm and their emotional impact, impact on self-help and help-seeking behaviors, identifying with the narrator, authenticity, and language and stereotyping. Conclusions: Lived experience stories published on the web can provide a valuable form of support for those experiencing self-harm. They can be motivating and empowering for the reader, and they have the potential to distract readers from urges to self-harm. However, these effects may be moderated by age, and narratives of recovery may demoralize older readers. Our findings have implications for organizations publishing lived experience content and for community guidelines and moderators of web-based forums in which users share their stories. These include the need to consider the narrator's age and the relatability and authenticity of their journey and the need to avoid using stigmatizing language. [ABSTRACT FROM AUTHOR]

Purpose: To understand the patient journey to Lumbar Spinal Fusion Surgery (LSFS) and patients' experiences of surgery. Methods: Qualitative study using interpretive phenomenological analysis. Adult participants following LSFS were recruited from 4 UK clinical sites using purposive sampling to ensure representation of key features (e.g. age). Semi-structured interviews informed by a piloted topic guide developed from the literature were audio-recorded and transcribed verbatim. Framework analysis for individual interviews and then across participants (deductive and inductive) identified emerging themes. Trustworthiness of data analyses was enhanced using multiple strategies (e.g. attention to negative cases). Results: Four emerging themes from n = 31 patients' narratives were identified: decision for surgery, coping strategies, barriers to recovery and recovery after surgery. Decision for surgery and recovery after surgery themes are distinguished by the point of surgery. However, barriers to recovery and coping strategies are key to the whole patient journey encompassing long journeys to surgery and their initial journey after surgery. The themes of coping strategies and barriers to recovery were inter-related and perceived by participants as parallel concepts. The 4 multifactorial themes interacted with each other and shaped the process of an individual patient's recovery. Factors such as sporadic interventions prior to surgery, time-consuming wait for diagnosis and surgery and lack of information regarding recovery strongly influenced perceptions of outcome. Conclusion: Patient driven data enables insights to inform research regarding surgery/rehabilitation through depth of understanding of the patient journey. Awareness of factors important to patients is important; ensuring that patient-driven data informs research and patient care. [ABSTRACT FROM AUTHOR]

Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. Discussions regarding housing and support often lack a thorough consideration of individual experiences, with a reliance on quantitative surveys. The question remains how to assure that supported accommodations actually are supportive of the residents' ongoing recovery process. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. Semi‐structured interviews were conducted with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents: (1) support from care staff which was readily available; (2), a sense of community and daily activity offered by the residence and on‐site activities; and (3) the experience of supported living as a stepping‐stone in an ongoing recovery process. Findings indicate the power of comprehensive care with supportive staff, peer‐relations, autonomy and fostering hope in empowering individuals in their ongoing recovery. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic brought substantial changes in clinical practice in Obstetrics and Gynaecology (O and G). Redeployment of staff and restrictions in elective services raised training concerns. We sought to assess the impact on subspecialty training, to identify issues to help mitigate the impact. We conducted cross-sectional anonymous electronic surveys of UK subspecialty trainees at three time points: June 2020, February 2021, September 2021. Surveys were analysed by descriptive statistics and thematic analysis of free-text responses. Response rates ranged from 30% to 40%, with higher response rates from urogynaecology trainees. Up to 72% reported an impact on training, most notable in gynaecological subspecialties, and particularly urogynaecology, which persisted over time. More than a third anticipated needing extra time to complete training. This raises serious future workforce and patient care concerns. Clinical recovery should consider training needs as essential when re-establishing services. Subspecialty trainees may need additional time to achieve competencies required of future consultants. What is already known on the subject? Covid-19 led to dramatic changes in clinical practice in Obstetrics and Gynaecology. Previous studies on training in O and G during the pandemic in the UK and internationally highlighted issues from redeployment, trainee absence, and changes in service provision, that had potential to severely impact training. What do the results of this study add? Subspecialty training in Obstetrics and Gynaecology has been affected by the pandemic. Urogynaecology was worst affected and continues to be affected over the course of the pandemic. What are the implications of these findings for clinical practice and/or further research? Covid-19 recovery plans need to incorporate training requirements. Extended training due to the pandemic may affect consultant workforce numbers and thus service provision in tertiary care. [ABSTRACT FROM AUTHOR]

The purpose of the current review is to synthesize the evidence of patients' perspectives of recovery after hip fracture across the care continuum. A systematic search was conducted, focusing on qualitative data from hip fracture patients. Screening, quality appraisal, and a subset of articles for extraction were completed in duplicate. Themes were generated using a thematic synthesis of data from original studies. Fourteen high-quality qualitative studies were included. Four review themes were identified: recovery as participation, feelings of vulnerability, driving recovery, and reliance on support. Patients considered recovery as a return to pre-fracture activities or "normal" enabling independence. Feelings of vulnerability were observed irrespective of the time since hip fracture and only diminished when recovery of function and activities enabled participation in valued activities, e.g., outdoor mobility. Participants expressed a desire to engage in recovery with realistic expectations and the benefits of meaningful feedback reported. While reliance on healthcare professionals decreased towards a later stage of recovery, reliance on social support persisted until recovery was perceived to have been achieved. Patient perspectives highlighted hip fracture as a major life event requiring health professional and social support to overcome feelings of vulnerability and enable active engagement in recovery. Rehabilitation professionals should ensure expectations and goals are set early in the recovery process. Rehabilitation professionals should ensure goals set with patients are tailored to the individual's pre-fracture activities or "normal" promoting independence. Rehabilitation professionals should monitor goals ensuring they are providing support, motivation, and managing expectations across the care continuum. Rehabilitation professionals should address patients' feelings of vulnerability, particularly in the absence of social support, and ensure appropriate ongoing input to maximize recovery. [ABSTRACT FROM AUTHOR]

Background: Early aerobic exercise is associated with improved outcomes following recovery from sport-related concussion (SRC) and is now recommended in guidance for clinicians managing athletes return-to-play., Objectives: To explore student-athlete experiences of a novel early aerobic exercise intervention., Design: Qualitative study using semi-structured interviews., Setting: Loughborough University, UK., Participants: Ten rugby union university aged student-athletes (6 men) that had been medically diagnosed with an SRC sustained playing rugby., Results: Three themes divided into eight supporting subthemes were generated. Main findings were: 1) Experience: despite some apprehension over the novel approach, most had a positive experience, 2) Adherence: Participants suggested reasonably good overall adherence to the prescribed exercises but intrinsic and extrinsic factors for non-adherence were identified, 3) Outcomes: the intervention was perceived to help rehabilitation, improve confidence, support retention of athletic identity and, for some, influenced more cautious attitudes toward brain health., Conclusions: The novel early exercise intervention was reasonably well received and adhered to. Unintended benefits included supporting retainment of athletic identity and encouraging precautious health behaviours. As early exercise protocols are refined, these findings will help inform the design and delivery of future interventions, particularly in relation to intensity and diversity of exercises and supporting education., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Within traditional drug and alcohol (D&A) treatment services, the majority of those accessing support are of white ethnicity, with only a small percentage of people from the British South Asian (BSA) and Muslim community engaging in treatment services. This paper aims to explore perceived barriers to accessing traditional D&A services within the British South Asian and Muslim communities, based on qualitative data from interviews with family members and a practitioner. Qualitative data were obtained via 11 semi-structured interviews involving a practitioner (n = 1), and family and friends (n = 10) of those with historic and current D&A use in the community. Reflexive thematic analysis revealed four themes: (1) awareness of drug and alcohol use in the community, (2) drug and alcohol use as a taboo topic and the impact of admitting use, (3) knowledge of services for treatment, (4) how to increase awareness and accessibility of treatment. There was an increasing awareness of D&A use in the BSA and Muslim community. Despite this, limited conversations and misconceptions around D&A use and recovery led to those using D&A and their family members feeling stigmatised within their community and unable to seek support. This paper concludes by recommending increased communication between the BSA and Muslim communities and D&A treatment services to ensure accessibility of treatment by improving cultural competency.

Purpose: This review aimed to characterise and map: (1) what type of evidence and what dominant study characteristics are available regarding acquired brain injury (ABI) survivors' experience of occupation and activity in hospital? (2) How are occupation and activity conceptualised in the literature? (3) How are ABI survivors experiencing occupation and activity while in hospital? (4) What factors create barriers or opportunities for engagement in occupations or activity in hospital? (5) Are there any knowledge gaps identified?, Materials and Methods: A scoping review was conducted examining literature published between 2017 and 2022. Relevant studies were systematically retrieved from electronic databases., Results: Thirty-four publications were included. There were more quantitative studies ( n  = 18). Much of the research has been conducted outside of the UK. The populations studied were principally stroke ( n  = 22). The concept of activity rather than occupation predominates. Patients spend their time alone and inactive. Structural and contextual barriers for engaging in activity are identified. Qualitative study designs exclude ABI survivors with communication or cognitive impairment., Conclusions: There is a paucity of research with ABI survivors in hospitals in the UK. Alternative methodological approaches such as ethnography would ensure those with communication or cognitive impairment are not excluded from research. Implications for rehabilitationRehabilitation professionals, especially occupational therapists, need to lead acquired brain injury (ABI) research in acute hospital settings in the UK.Conceptualisation of meaningful activity and occupation needs a clearer focus in ABI research.Qualitative studies frequently exclude participants with cognitive or communication impairments so methodologies that are more inclusive and representative of brain injury survivors are needed.

A life course approach recognizes the role of turning points in adding twists and turns in individuals' addiction recovery processes. The notion of certain key life events that trigger turning point experiences offers a valuable theoretical construct for understanding processes of change. The current study aimed to identify turning points and assess the role of contextual dynamics in generating long-term changes, based on lived experiences of persons in drug addiction recovery. A qualitative research design was applied using a Lifeline Interview Method (LIM), allowing a retrospective lens to elicit recovery narratives. Purposive sampling was utilized to compose a heterogeneous group of thirty persons in self-defined drug addiction recovery in Flanders (Belgium). An interpretative phenomenological approach was adopted during a thematic analysis, grounding the research claims in respondents' lived experiences. Key moments of change that were reported by participants are: (1) adverse drug-induced experiences; (2) becoming a parent; (3) 'hitting rock bottom'; (4) (dis)engagement of social networks and environments; and (5) addiction treatment. The findings illustrate the role of contextual dynamics that can facilitate (or hamper) experiencing these life events as turning points toward change. This study contradicts the notion of a single event or turning point causing abrupt changes in individuals' addiction trajectories. Contextual dynamics and meaning-making processes simultaneously influence whether specific life events can facilitate change. Treatment providers, researchers, and policymakers should take into account the process-based, situational, and relational nature of recovery. [ABSTRACT FROM AUTHOR]

Background Kidney disease registries typically report populations incident to kidney replacement therapy (KRT) after excluding reversible disease. Registry-based audit and quality assurance is thus based on populations depleted of those with the highest early mortality. It is now mandatory for UK kidney units to report all recipients of dialysis, both acute and chronic. This work presents 90-day survival and recovery outcomes for all reported adults. Methods Seventy adult centres reporting to the UK Renal Registry were included. Those assessed as underreporting death and recovery were excluded. Survival was evaluated using a Kaplan–Meier estimator. Cox regression was used to describe hazard ratios (HRs) for age, sex and acute/chronic dialysis coding on day 1. Analysis of all-cause 90-day mortality with recovery as a competing risk is presented. Results Twenty-four centres were assessed as underreporting, with rates of death/recovery below the 99.7th centile. Of 5784 dialysis starters in the remaining 46 centres, 2163 (37.4%) were coded as receiving acute dialysis on day 1. Ninety days after starting, 3860 (66.7%) of all starters were receiving KRT, 1157 (20.0%) were alive having stopped, 716 (12.4%) were dead and 51 (0.9%) were lost to follow-up. Mortality was higher among those coded as receiving acute dialysis on day 1 (HR 4.88, P < 0.001). The sub-HR for recovery among those coded as receiving acute compared with chronic dialysis was 56.14 (P < 0.001). Conclusions Death and recovery rates are substantially higher than reported in conventional incident populations. This work highlights a vulnerable subgroup of patients largely overlooked by most national quality assurance systems. [ABSTRACT FROM AUTHOR]

Few adventurous training courses have been formally designed to assist military personnel in their recovery and/or transition into civilian life by supporting psychological health and well-being. This study examines, for the first time, the longitudinal effects of a five-day Multi Activity Course (MAC) on the mental well-being of serving but wounded, injured, and/or sick (WIS) UK armed forces personnel. The MAC is delivered using a participant-centered approach to encourage engagement in adaptive sports, adventurous activities, and personal development coaching sessions. This work extends previous research showing powerful short-term well-being benefits. Measures of positive well-being and psychological need satisfaction were provided by participants before and after attending the course, as well as two weeks, three months, six months and 12 months later. Self-reported well-being measures of psychological need satisfaction and positive mental well-being improved significantly throughout the course. These remained significantly higher at six and 12 months after the course, respectively. [ABSTRACT FROM AUTHOR]

Recent years have seen a renewed interest in integrating creative activities into statutory mental health practice in high‐income countries. In this article, we offer an exploratory analysis of an arts project delivered within UK mental health services, Creativity for Enablement and Wellbeing (CREW). Drawing on data collected for a process evaluation of the project, we suggest that conceptualising CREW as liminal and liminoid provides a helpful way to articulate the processes, atmospheres, relationships, and practices of the project. Through this theoretical lens, we identify CREW as a mode of engagement comprising looseness, possibility and collectivity, all brought together through a unique community event, the showcase. We explore CREW's mode of engagement through three themes: 'carving out a liminal space', 'looseness and experimentation,' and 'from liminal to liminoid'. Implications for service delivery are discussed, focussing on how CREW managed to create a transformative space of liminoid possibility rather than a recovery journey delineated by service‐defined imperatives. [ABSTRACT FROM AUTHOR]

Background: Health-related research on women who use drugs (WWUD) tends to focus on reproductive and sexual health and treatment. Missing from the picture is an exploration of mid-life and older women's bodily experiences of transitioning from long-term substance use into recovery. While there are a growing number of studies that explore the intersection of drug use and ageing, the gaps in analysis lie in the intersections between drug use, recovery, ageing, gender, and the body. Methods: In-depth qualitative interviews were undertaken with 19 women in the UK who self-identified as "in recovery" from illicit drug use. The interviews were transcribed verbatim and analysed using Braun and Clarke's thematic analysis techniques. The study received ethical approval from the University of Glasgow. Results: Key findings from the interviews relate to the women's personal sense of power in relation to current and future health status, the challenges they endured in terms of ageing in recovery and transitioning through the reproductive life cycle, and the somatic effects of trauma on women's recovery. The findings demonstrate that health in recovery involves more than abstinence from drugs. Discussion: Moving from the body in active drug use to the body in recovery is not without its challenges for mid-life and older women. New sensations and feelings—physical and mental—must be re-interpreted in light of their ageing and drug-free bodies. This study reveals some of the substantive sex-based differences that older women in active drug use and recovery experience. This has important implications for healthcare and treatment for women in drug services and women with histories of drug use more generally. [ABSTRACT FROM AUTHOR]

Summary: Additional physiotherapy in the first postoperative week was associated with fewer days to discharge after hip fracture surgery. A 7-day physiotherapy service in the first postoperative week should be considered as a new key performance indicator in evaluating the quality of care for patients admitted with a hip fracture. Introduction : To examine the association between physiotherapy in the first week after hip fracture surgery and discharge from acute hospital. Methods: We linked data from the UK Physiotherapy Hip Fracture Sprint Audit to hospital records for 5395 patients with hip fracture in May and June 2017. We estimated the association between the number of days patients received physiotherapy in the first postoperative week; its overall duration (< 2 h, ≥ 2 h; 30-min increment) and type (mobilisation alone, mobilisation and exercise) and the cumulative probability of discharge from acute hospital over 30 days, using proportional odds regression adjusted for confounders and the competing risk of death. Results: The crude and adjusted odds ratios of discharge were 1.24 (95% CI 1.19–1.30) and 1.26 (95% CI 1.19–1.33) for an additional day of physiotherapy, 1.34 (95% CI 1.18–1.52) and 1.33 (95% CI 1.12–1.57) for ≥ 2 versus < 2 h physiotherapy, and 1.11 (95% CI 1.08–1.15) and 1.10 (95% CI 1.05–1.15) for an additional 30-min of physiotherapy. Physiotherapy type was not associated with discharge. Conclusion: We report an association between physiotherapy and discharge after hip fracture. An average UK hospital admitting 375 patients annually may save 456 bed-days if current provision increased so all patients with hip fracture received physiotherapy on 6–7 days in the first postoperative week. A 7-day physiotherapy service totalling at least 2 h in the first postoperative week may be considered a key performance indicator of acute care quality after hip fracture. [ABSTRACT FROM AUTHOR]

To explore older adult's perceptions of early rehabilitation and recovery after hip fracture, as a complement to the UK standards for acute physiotherapy after hip fracture. In-depth semi-structured interviews with 15 adults aged 60 years or more in hospital after hip fracture surgery. A thematic analysis approach with interpretation informed by Bury's biographical disruption theoretical framework. Participants voiced the importance of self-determination, professional support, meaningful feedback, and social capital after hip fracture. Collaborative working with staff was required for meeting the UK standards. Participants voiced anxieties about their hip fracture when considered in conjunction with their age and co-existing conditions, anticipating a disruption to their previous physical and social activities. This new, more dependent, life situation was not acceptable to participants. This study suggests hip fracture alone, was not perceived as a biographical disruption by older adults although it is presented as a potential tipping point in the loss of independence, contributing to the wider disruption of advancing age and co-existing conditions. For successful implementation of the UK standards, goal setting should consider patients in the wider context of their advancing age and co-existing conditions to empower them to define a fresh narrative of self. Hip fracture was perceived as a potential tipping point in the loss of independence, contributing to the wider disruption of advancing age and co-existing conditions. Participants expressed uncertainty over their ability to recover their previous identity in the absence of professional support and/or social capital. Healthcare professionals need to educate and empower older adults to take charge of their own recovery. For successful implementation of the UK standards for acute physiotherapy, there is a need to contextualize goal setting to empower patients to define a fresh narrative of self. [ABSTRACT FROM AUTHOR]

Objective: Cervical cancer is predominantly a cancer of younger women, and improvements in oncological outcomes have led to an increase in cervical cancer survivors living with the long‐term effects of treatment. Understanding the recovery process after treatment is essential to increase awareness of the short‐ and long‐term needs of survivors. The aim of this study was to qualitatively explore the recovery process and return to daily activity of cervical cancers survivors from a biopsychosocial perspective. Methods: Participants were 21 women treated for cervical cancer between the ages of 18 and 60 years, living in the United Kingdom. Interviews were undertaken face to face and via the telephone using a semi‐structured interview schedule. Results: Data analysis revealed themes which represented participants' experience and perceptions of treatment as a paradox; emotional needs after treatment; and a journey of adversarial growth. A key finding from this analysis was the nuanced experiences between treatment modalities, with physical changes perceived to be more disruptive following radical treatments, whilst psychological repercussions were significant regardless of treatment type. Conclusion: This study provides novel insight into the varied recovery experiences of those treated with surgery and/or chemoradiotherapy for cervical cancer, which can be used to improve the survivorship experience. [ABSTRACT FROM AUTHOR]

In 2019, the employment rate among 25‐ to 64‐year‐olds in the UK reached 80 per cent – the highest on record, and considerably higher than the 76 per cent rate recorded shortly before the Great Recession. In this paper, we investigate the growth in employment between the eve of the Great Recession and the eve of COVID‐19 across several dimensions. We analyse which sectors, demographic groups and regions accounted for the rise. We also investigate how job 'quality' – in both financial and non‐financial terms – has changed. We find that almost all demographic groups and regions saw a rise in employment, especially those with low pre‐existing employment rates and those near the bottom of the income distribution. Hourly pay growth was very weak over the period, with the median actually slightly falling. Other indicators of job quality show a more mixed picture: employees seem to have greater appreciation of their work and firm, but perceive less security and flexibility in their job. [ABSTRACT FROM AUTHOR]

Background: Depression is a common mental disorder, yet it shows low remission rates. The available evidence on personality traits as factors associated with the course of depression has common methodological limitations. Identifying personality traits linked with depression can improve understanding of the course of illness. Therefore, we aimed to investigate personality traits that are associated with the course of depression over 18 months., Methods: longitudinal data of 2366 Adult Psychiatric Morbidity Survey respondents were analysed. Assessments were applied at two-time points (baseline) and follow-up (about 18 months later). We assessed the total score on the screening questionnaire from the Structured Clinical Interview (SCID-II) for the dependent, obsessive-compulsive, and borderline personalities. Depression was measured using the revised Clinical Interview Schedule (CIS-R) version., Results: An increase of one score on the borderline personality scale at baseline increased the odds of experiencing persistent depression by 1.50 times (OR = 1.50, 95 % CI [1.22-1.86]), depression onset by 1.30 times (OR = 1.30, 95 % CI [1.14-1.50]), and recovery by 1.52 times (OR = 1.52, 95 % CI [1.35-1.70]), comparing to no depression group. Elevated scores of dependent personality traits significantly predicted depression persistence (OR = 1.95, 95 % CI [1.52-2.49]). An increase of one score on the obsessive-compulsive personality scale increases the odds of depression onset by 1.21 times (OR = 1.21, 95 % CI [1.04-1.39])., Limitations: The APMS survey defined depression statuses in a limited sense, which may affect the generalisability of these results., Conclusion: The present study confirms previous findings and contributes evidence suggesting that personality dysfunctions worsen depression outcomes., Competing Interests: Declaration of competing interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)