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/
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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.
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.
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.
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.
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