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The purpose of this paper was to investigate the impact of specific carbohydrate restriction (polysaccharides and disaccharides) in the form of the specific carbohydrate diet (SCD) in treating irritable bowel syndrome (IBS).

A female patient diagnosed with diarrhea predominant IBS was assigned to the SCD for six months. The diet occurred in phases and was advanced based on the individual’s tolerance level under the guidance of a registered dietitian. Quality of life was measured by a pre- and post-IBS severity score questionnaire. Gastrointestinal symptoms were measured by self-assessment of IBS symptoms using a seven-point Likert-like scale, with −3 = substantially worse to +3 = substantially better. Probiotics were consumed throughout the duration of the study.

The quality of life severity score significantly improved from a severity of 315 (with 500 being the most severe) to 15. The initial symptoms from the first day on the diet compared to the total period for bloating, abdominal pain/discomfort, flatulence/wind, diarrhea, bowel urgency, stool consistency, stool frequency, energy levels, incomplete evacuation and abdominal rumbling were improved significantly (p < 0.0005). The SCD diet significantly improved the quality of life and IBS symptoms in a female patient with IBS-diarrhea.

This study is the first of its kind to evaluate the efficacy of the SCD to treat IBS. The SCD should be considered a therapeutic option to treating IBS after fermentable carbohydrate restriction.

Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the purpose of this paper is to gain more insight into patterns of violent behavior, so that adequate preventive measures can be taken.

Data on inpatient violence in a Dutch forensic psychiatric hospital between 2008 and 2014 were extracted from hospital files on 503 patients.

More than half of all the patients (n=276, 54.9 percent) displayed verbal aggression on at least one occasion, whereas 27.2 percent of all patients (n=137) exhibited one or more incidents of physical violence. Female patients were responsible for more physically violent episodes than male patients. Patients admitted with a civil court order exhibited more violent behavior than patients with a criminal court order. Violent patients with a civil commitment had a significantly longer length of stay than non-violent patients with a civil commitment. More violence was found to take place on the earlier days of the week.

This study points at important differences between groups of forensic inpatients in frequency and type of inpatient violent behavior and in temporal factors. Interventions aimed at reducing the number of violent incidents should take these differences into account. Further research is necessary to gain more insight into the background of inpatient violence.

Service industries, contrary to popular opinion, can have a high level of investment in automation and technology, but most attention focuses on back office technology. Investigates the use of automation in the customer contact environment in order to examine the role of technology in front office design. Concludes that the use of technology by the customer remains limited by the opportunities to train the customer to use the technology, which restricts the degree of complexity of the technology; and by other limitations such as the need for the provision of customer “reward” for appropriate use of the technology.

There is mixed evidence regarding the efficacy of low-intensity integrated care interventions in reducing the use of emergency services and costs of care. The purpose of this paper is to examine the effects of a low-intensity intervention formulated for older adults and delivered in an urban medical center serving low-income individuals.

The intervention included an initial evaluation of stress, psychiatric symptomatology and health habits; potential referrals for lifestyle management and psychiatric treatment; and training for physicians about the impact of lifestyle change in older adults. Participants included older adults (at or above 50 years of age) seen as outpatients in an urban medical center serving a low-income community (n=945). Participants were entered into the intervention at any point during this two-year period. Mixed models analyses examined all visits for all enrolled individuals over a two-year period, comparing visits before the individual received the initial intervention evaluation to those received after this evaluation. Outcomes included total health care costs incurred, average cost per visit, and emergency department (ED) usage within the facility.

The intervention was associated with reduced likelihood of emergency department use and reduced costs per visit following the intervention. These effects were seen across all participants.

Limitations of the study include the lack of control group.

This program is easy to disseminate and could improve the quality of care and costs.

This study is among the few available to document a decrease in medical costs, as well as decreased ED utilization following a low-intensity integrated care intervention.

A 2 × 2 full factorial between subjects experimental design was used to examine how three elements of the health care experience (patients’ freedom to choose a physician; patients receiving their preferred physician; health care outcome) impacted on patient satisfaction with health care service. All constructs with corresponding measurements were discussed, and their relationships with satisfaction were examined. Hypotheses were developed and tested for each relationship using a pencil and paper scenario of a patient’s first time service encounter at a health clinic. Results of the experiment indicated that given an undesirable health outcome, allowing patients a choice of physicians favorably raised patient satisfaction levels. Further, patients who were treated by a physician whom they preferred rated the health care experience more positively than did patients who received non‐preferred physicians.

The purpose of this paper is to develop an understanding of the experience of secure care from the patients’ perspective.

A systematic review of qualitative literature was conducted. The data was sourced from the electronic databases: PsychINFO, CINAHL, Medline and the Web of Science Core Collection using pre-defined search terms. A total of 17 studies, conducted in various countries worldwide and covering high, medium and low secure inpatient settings, were included for review. The analysis involved integrating findings from across the literature and was guided by thematic synthesis.

A total of eight themes were generated from the data, three of which provided an understanding of the experience of forensic secure care, and the remaining five themes provided an understanding of the factors which may influence the experience of secure care.

Developing understanding of patient experience can lead to service improvements, potentially impacting patients’ motivation and engagement and thus reducing admission times, potential recalls and recidivism.

To the best of the authors’ knowledge, this is the first systematic review to date to exclusively explore the broad topic of the patient experience of secure mental health care.

The purpose of this paper is to describe the evolution of legislation relevant to people with intellectual disabilities (IDs) since the Scottish Parliament came into being in 1999; this will be particularly relevant to practitioners working with people with IDs within mental health and forensic mental health services.

A descriptive review of the relevant legislation, setting this out in the chronological order in which the legislation was enacted.

The paper demonstrates that legislative reform is a dynamic and evolving process, responsive to social, political and legal agendas.

The paper is limited to a description of the relevant legislation in only one part of the UK (Scotland).

A helpful summary of the relevant legislation is provided which should be of particular value to readers/practitioners from outwith Scotland.

The paper provides an up to date account of the legislative reform in Scotland during the period 1999-2015.

Forensic mental health services play an important role in providing treatment and accommodation for people diverted from prison or the courts who require secure and specialist mental health treatment. There are more than 3,500 people in medium and high‐secure hospitals who have been directed there by the courts or prison system, and nearly 1,000 new admissions are received each year. Yet, the facts and figures relating to these services are patchy and not widely published. This paper builds on an earlier statistical briefing produced by the Sainsbury Centre for Mental Health in 2007, and seeks to provide an up‐to‐date and improved understanding of this area of service provision by presenting the most recent data and figures.

The three aims of the study reported were to investigate the functions of self‐harm in a population of patients detained in the Peaks Unit at Rampton hospital, to investigate the context and nature of this behaviour and to examine how staff respond to incidents of self‐harm. The findings indicate that there may be some functions of self‐harm specific to this population in addition to those found in other settings, namely expression of aggression and revenge. The context and nature of incidents were similar to those found in other secure settings. A range of staff responses were observed, and indicated high demand on staff time and resources. Limitations of the methods are discussed, with proposals for future research.

The purpose of this paper is to present an evocative story “Resisting the Ban” which illustrates the ethical and pragmatic issues that nurses face when contending with smoking ban policies in inpatient psychiatric settings.

The creative story “Resisting the Ban” was developed based on an organisational auto-ethnographic approach. The story was crafted through employing creative writing techniques and through framing and critiquing memories via several theoretical frames.

The story illustrates how smoking ban policies have created pragmatic and ethical issues on wards. The work practices of nurses have changed as have their relationships with patients. The liberties of involuntary patients have also been infringed.

This approach can illuminate links between acts of resistance and issues associated with public policies.

The effects of smoking bans need to be considered more carefully particularly in relation to their effects on workers and patients. The social meaning of the smoking bans needs closer investigation. Policy needs to be recrafted so that it better addresses the liberties of involuntary patients. Also ward nurses need to be able to carry out their roles in a manner which is consistent with their values.

Public policies, such as smoking bans, can produce negative consequences maligning relationships, practices and cultures. Critical auto-ethnography provides a means of understanding issues that have resulted from problematic policies.

Scholarly work conducted on the relationship between everyday resistance in workplaces and public policies is rare. This study offers new “insider” insights into the negative effects of a smoking ban policy in psychiatric inpatient settings.