This is a repository copy of Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S0140-6736(18)32521-2 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ ReuseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Implications of all the available evidenceDespite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.

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Using meta-analytic approaches, we examined whether interventions for women offenders are effective in reducing recidivism, as well as whether gender-informed and gender-neutral interventions differ in their effectiveness. Across 38 effect sizes reflecting 37 studies and nearly 22,000 women offenders, women who participated in correctional interventions had 22% to 35% greater odds of community success than non-participants. In other words, correctional interventions for women are at least as effective as the published rates for men. Across all 38 effect sizes, gender-informed and gender-neutral interventions were equally effective; however, when analyses were limited to 18 effect sizes associated with studies of higher methodological quality, gender-informed interventions were significantly more likely to be associated with reductions in recidivism. These findings support recent research indicating that women and girls are more likely to respond well to gender-informed approaches if their backgrounds and pathways to offending are associated with gendered issues.

These results underscore the challenge posed to Canadian federal corrections in providing the necessary mental health services to assist in the management and rehabilitation of a significant percentage of the offender population with mental health needs.

Results of outcome evaluations of the domestic violence (DV) programs are not encouraging. Overall, the most optimistic conclusion is that these programs have only a modest impact on reducing repeat partner violence. Recently, there are calls for DV programs to "grow up," adapt a paradigm shift, shed ideology, and determine how the maximum impact can be realized from work to reduce intimate partner violence (IPV). The following review examines why program results are so unconvincing and proposes a comprehensive framework to advance the field. Specifically, it recommends that applying the risk-need-responsivity (RNR) principles of effective corrections could substantially improve treatment results. Using this framework, the article identifies selected risk assessment tools to screen offenders into appropriate levels of service (the risk principle) and provides an extensive review of the literature on appropriate targets for change (the need principle). Problems with substance use (particularly alcohol abuse), emotion management, self-regulation, and attitudes supportive of partner abuse have substantial empirical support as factors related to IPV. There is weaker but promising support for targeting the impact of association with peers who are supportive of abuse of women, poor communication skills, and motivation to change abusive behavior patterns. Responsivity could be enhanced through incorporation of motivational interviewing techniques, the processes of change identified in the Transtheoretical Model, solution-focused and strength-based approaches, and attention to identity programs and practice Applying Effective Corrections Principles 495 change and cultural issues. In addition, the review describes strategies to insure ongoing program integrity, a key factor in implementing effective interventions.

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Background:There is recent evidence to suggest that sustaining a traumatic brain injury (TBI) increases risk of criminal justice system involvement, including incarceration. The objective of this study was to explore the association between TBI and risk of incarceration among men and women in Ontario. Methods:We identified a cohort of 1.418 million young adults (aged 18-28 yr) on July 1, 1997, living in Ontario, Canada, from administrative health records; they were followed to Dec. 31, 2011. History of TBI was obtained from emergency and hospital records, and incarceration history was obtained from the Correctional Service of Canada records. We estimated the hazard of incarceration using Cox proportional hazard models, adjusting for relevant sociodemographic characteristics and medical history.Results: There were 3531 incarcerations over 18 297 508 person-years of follow-up. The incidence of incarceration was higher among participants with prior TBI compared with those without a prior TBI. In fully adjusted models, men and women who had sustained a TBI were about 2.5 times more likely to be incarcerated than men and women who had not sustained a TBI.Interpretation: Traumatic brain injury was associated with an increased risk of incarceration among men and women in Ontario. Our research highlights the importance of designing primary, secondary and tertiary prevention strategies to mitigate risk of TBI and incarceration in the population. Abstract ResearchResearch CMAJ OPEN CMAJ OPEN, 4(4) E747

This study presents data on male perpetrators of domestic violence (DV) in the Correctional Service of Canada (CSC) using two samples: (a) a snapshot of all male offenders in CSC who had been assessed for DV (n = 15,166) and (b) a cumulative sample of male offenders in CSC from 2002-2010 who had been assessed as moderate or high risk for further DV (n = 4,261) DV offenders were compared to a cohort sample of non-DV offenders (n = 4,261). Analyses were disaggregated for Aboriginal and non-Aboriginal offenders. Results indicated that 40% of the federal male population had a suspected history of DV and were therefore screened in for in-depth DV risk assessment. Of these, 45% were assessed as moderate or high risk for future DV. DV offenders had higher risk and criminogenic need ratings, more learning disabilities, more mental health problems, and more extensive criminal histories than those without DV histories. Aboriginal DV offenders had high levels of alcohol dependence, suggesting a need for substance abuse treatment as part of DV programming. Most federal offenders with DV histories would be described as belonging to the Antisocial/Generalized Aggressive typology and, therefore, adhering to the Risk-Need-Responsivity principles of the effective correctional literature, cognitive-behavioral treatment that focuses on teaching skills of self-management, and changing attitudes supporting relationship violence would be recommended.