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In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.
To conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.
A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.
Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.
A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.
Declaration of interest
K.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
The United States Department of Defense Law of War Manual: Commentary and Critique provides an irreplaceable resource for any politician, international expert, or military practitioner who wishes to understand the approach taken by the American military in the complex range of modern conflicts. Readers will understand the strengths and weaknesses of US legal and policy pronouncements and the reasons behind the modern American way of war, whether US forces deploy alone or in coalitions. This book provides unprecedented and precise analysis of the US approach to the most pressing problems in modern wars, including controversies surrounding use of human shields, fighting in urban areas, the use of cyberwar and modern weaponry, expanding understanding of human rights, and the rise of ISIS. This group of authors, including academics and military practitioners, provides a wealth of expertise that demystifies overlapping threads of law and policy amidst the world's seemingly intractable conflicts.
Reforestation in the Inland Northwest, including northeastern Oregon, USA, is often limited by a dry climate and soil moisture availability during the summer months. Reduction of competing vegetative cover in forest plantations is a common method for retaining available soil moisture. Several spring and summer site preparation (applied prior to planting) herbicide treatments were evaluated to determine their efficacy in reducing competing cover, thus retaining soil moisture, on three sites in northeastern Oregon. Results varied by site, year, and season of application. In general, sulfometuron (0.14 kg ai ha–1 alone and in various mixtures), imazapyr (0.42 ae kg ha–1), and hexazinone (1.68 kg ai ha–1) resulted in 3 to 17% cover of forbs and grasses in the first-year when applied in spring. Sulfometuron+glyphosate (2.2 kg ha–1) consistently reduced grasses and forbs for the first year when applied in summer, but forbs recovered in the second year on two of three sites. Aminopyralid (0.12 kg ae ha–1)+sulfometuron applied in summer also led to comparable control of forb cover. In the second year after treatment, forb cover in treated plots was similar to levels in nontreated plots, and some species of forbs had increased relative to nontreated plots. Imazapyr (0.21 and 0.42 kg ha–1) at either rate, spring or summer 2007, or at lower rate (0.14 kg ha–1) with glyphosate in summer, provided the best control of shrubs, of which snowberry was the dominant species. Total vegetative cover was similar across all treatments seven and eight years after application, and differences in vegetation were related to site rather than treatment. In the first year after treatment, rates of soil moisture depletion in the 0- to 23-cm depth were correlated with vegetative cover, particularly late season soil moisture, suggesting increased water availability for tree seedling growth.
Globally, the Series 2 – Series 3 boundary of the Cambrian System coincides with a major carbon isotope excursion, sea-level changes and trilobite extinctions. Here we examine the sedimentology, sequence stratigraphy and carbon isotope record of this interval in the Cambrian strata (Durness Group) of NW Scotland. Carbonate carbon isotope data from the lower part of the Durness Group (Ghrudaidh Formation) show that the shallow-marine, Laurentian margin carbonates record two linked sea-level and carbon isotopic events. Whilst the carbon isotope excursions are not as pronounced as those expressed elsewhere, correlation with global records (Sauk I – Sauk II boundary and Olenellus biostratigraphic constraint) identifies them as representing the local expression of the ROECE and DICE. The upper part of the ROECE is recorded in the basal Ghrudaidh Formation whilst the DICE is seen around 30m above the base of this unit. Both carbon isotope excursions co-occur with surfaces interpreted to record regressive–transgressive events that produced amalgamated sequence boundaries and ravinement/flooding surfaces overlain by conglomerates of reworked intraclasts. The ROECE has been linked with redlichiid and olenellid trilobite extinctions, but in NW Scotland, Olenellus is found after the negative peak of the carbon isotope excursion but before sequence boundary formation.