Although the sample sizes were too small to allow definite conclusions, the results suggest that when services are able to provide interventions preferred by patients, those patients are more likely to be satisfied with treatment. This pilot study provides some evidence that women's crisis houses are as effective as traditional psychiatric wards, and may be more cost-effective.

Summary Various antiplatelet and anticoagulation options are available for stroke prevention in patients with atrial fibrillation (AF). Currently, it is unclear whether these agents differ in their propensity to cause major gastrointestinal bleeding (MGIB). To our knowledge, no systematic evaluation of MGIB rates from randomised controlled trials (RCTs) of pharmacological stroke prevention in patients with AF has been conducted. Two independent investigators conducted systematic literature searches in MEDLINE and CENTRAL from the earliest possible date through November 2010. To be included, RCTs had to evaluate an adult population with AF or flutter and report data on the incidence of MGIB. Peto’s odds ratios (ORs) with associated 95% confidence intervals (CIs) were calculated for all possible pair‐wise comparisons of pharmacological stroke prevention alternatives. A total of 16 unique trials (n = 42,983) met inclusion criteria. The reported incidence of MGIB in placebo or control arms of identified trials was as high as 1.5%. Upon pair‐wise meta‐analysis of different pharmacological strategies, adjusted‐dose vitamin K antagonists (VKAs) were found to be associated with a higher odds of MGIB compared with placebo/control (OR 3.21, 95% CI 1.32–7.82) and aspirin (or triflusal or indobufen) (OR 1.92, 95% CI 1.08–3.41). The addition of aspirin (or triflusal) to an adjusted‐dose VKA resulted in greater odds of MGIB compared with aspirin alone (OR 4.72, 95% CI 1.35–16.49) and adjusted‐dose VKA alone (OR 2.66, 95% CI 1.05–6.74). While aspirin increased the odds of MBIG by 3.23‐fold compared with placebo/control, this finding did not reach statistical significance. The combination of aspirin and clopidogrel increased patients’ odds of MGIB compared with aspirin alone (OR 1.93, 95% CI 1.46–2.56). Dabigatran was associated with a 30% increased odds of MGIB compared with adjusted‐dose VKA (OR 1.30, 95% CI 1.06–1.59); however, ximelagatran was not. Low‐intensity VKA therapy, alone or in combination with aspirin, was not associated with increased odds of MGIB compared with any (active‐) comparator. The MGIB is a concern for patients with AF receiving pharmacological stroke prevention. Current RCT data suggest that dabigatran and adjusted‐dose VKA therapy are associated with the highest odds of MGIB. Aspirin was not found to increase patients’ odds of MGIB; however, this finding may be the result of type 2 error. Dual therapy resulting from the addition of an antiplatelet agent was typically associated with further increased odds of MGIB compared with monotherapy.

The primary aim of this study was to examine women's experiences of inpatient psychiatric services. A secondary aim was to use the emerging themes in service planning and to develop an evaluation tool. Focus groups and individual interviews with women in receipt of psychiatric services in Croydon were used. The findings suggest continuity with both negative and positive aspects of institutional care described before the policy of community care was introduced. The attempts to 'normalize' institutional care by desegregating wards appear rather to have compounded problems faced by women. Women were clear about what they felt they wanted and needed. Women are dissatisfied about many aspects of care aside from the problems associated specifically with mixed sex wards. This suggests that sexual segregation of wards alone is a necessary but an insufficient measure to improve inpatient care. The findings can inform development of a women-only service in Croydon and of a tool to evaluate it.

background Borderline personality disorder (BPD) is characterised by severe instability in emotions, identity, relationships and impulsive behaviour. One contributing factor to BPD is deficient mentalizing-our ability to understand the mental states of others and ourselves. Psychotherapies can be effective at reducing symptoms of BPD but effects are small. Innovative ways of enhancing existing therapies are therefore essential. Objective In a mixed-methods, feasibility and acceptability study, we adjuncted conventional mentalization-based treatment (MBT) for BPD with avatar software (avatar-MBT). We wanted to test whether the enhanced visual narrative afforded by the software would facilitate therapy. Methods We used proprietary avatar software in four group MBT sessions. We collected data on uptake (n=15), dropout (n=4) and self-report measures (n=11) of mentalization and mood and conducted qualitative interviews to assess attitudes and beliefs (n=9). Findings Thematic analysis revealed five themes on the usefulness of avatar-MBT, including facilitating perspective taking, expression, emotional distancing, the big picture and group participation. The sixth theme suggested avatar-MBT is best placed within a group setting. There was no deterioration in symptoms as monitored by self-report measures. conclusions Qualitative data suggest that avatar-MBT is acceptable to patients with BPD who described it as enhancing conventional MBT and expressed a wish to continue using it. However, controlled trials are required to assess efficacy. clinical implications Results suggest that avatar-MBT may be a viable option to enhance existing BPD treatment. Furthermore, we provide initial evidence that it is feasible to implement a digital adjunct within a group therapy setting. bAckgrOund Borderline personality disorder (BPD) is a mental disorder characterised by severe instability in emotions, identity, relationships and impulsive behaviour.1 The condition occurs globally, with a lifetime community prevalence of up to 6%.2 Functional impairment is an enduring feature of the disorder, and people with BPD are at significantly increased risk of suicide, which affects up to 10% of individuals.3 Psychotherapies are effective in producing symptomatic remission, although a recent systematic review concluded that effect sizes are relatively small and unstable at follow-up.