AIMS:Investigate the perception of male accessibility to the fields of nursing practice by those studying or teaching nursing in England. DESIGN:Cross-sectional survey. METHODS:Online questionnaire with three closed-scale questions and two open-text questions designed to elicit perceptions on the accessibility of men to the fields of nursing practice. The questionnaire was distributed to the staff and students at 61 nursing schools in England. Inferential and descriptive statistics were used to analyse the closed questions data and inductive content analysis was used to analyse open-text questions data. RESULTS:Students (n = 52) and staff (n = 51) responded to the survey. Adult (Mdn = 6, IQR = 2) and mental health (Mdn = 6, IQR = 2) were perceived as the most accessible fields of nursing practice to men, and child (Mdn = 4, IQR = 2) the least. Specialised practice areas in acute and emergency (Mdn = 6, IQR = 2), education (Mdn = 6, IQR = 2), leadership (Mdn = 7, IQR = 1), prison services (Mdn = 7, IQR = 1), and research (Mdn = 7, IQR = 2) were rated the most accessible to men and neonatal care (Mdn = 3, IQR = 3) the least. Societal stereotyping and stigma were seen as barriers to men entering the nursing profession. The perception that nursing is a feminised profession persists and a distrust of men is associated with child nursing. Men were viewed as progressing to leadership roles with greater ease than women. CONCLUSION:Societal level stereotyping and stigma are perceived as prevalent in nursing practice areas considered less accessible to men entering the nursing profession. IMPACT:This study adds insight into the gendered nature of nursing and highlights the barriers to men entering a profession with a workforce crisis. REPORTING METHODS:STROBE cross-sectional studies guidelines. COREQ guidelines for content analysis. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

AimTo explore the lived experiences of nurses and patients co-producing evidence-based care for long-term conditions, and to understand how they make sense of this process within relational, emotional and organisational contexts.DesignA qualitative study using the Interpretative Phenomenological Approach.MethodsSemistructured interviews were conducted with 20 participants, comprising 11 registered nurses and 9 adult patients living with at least one Long-Term Condition. Participants were recruited from primary and secondary care settings across the Midlands, England. Data were collected between February and August 2023 and analysed using Interpretative Phenomenological Approach's iterative and inductive framework.ResultsFive experiential themes were identified: (1) weaving together different knowledges, (2) the relational foundations of co-production, (3) organisational pressures and misalignments, (4) shifting identities and power dynamics and (5) emotional and ethical complexity in co-producing care. Participants described co-production as a deeply relational and negotiated process, shaped by trust, vulnerability and shared decision-making.ConclusionCo-producing evidence-based care in Long-Term Condition management involves more than implementing guidelines. It is a relational, emotional and contextual practice that requires shared interpretation of evidence, deep listening and responsiveness to individual lives. Findings suggest a need to reframe evidence-based practice as a co-creative process grounded in relational ethics and contextual awareness.Impact and ImplicationsFindings emphasise the centrality of relational competence and organisational flexibility in enabling co-produced care. Findings call for educational and policy reforms that value emotional labour, professional humility and patient knowledge as essential to evidence-based nursing. Internationally, this work provides a grounded model for integrating person-centred approaches into chronic care delivery and policy.Contribution to the Wider Global Clinical CommunityThe study offers a relational model of evidence-based practice that moves beyond protocol-driven care to one shaped through dialogue, empathy and contextual negotiation, offering practical insights for transforming professional roles and health systems globally.Patient and Public InvolvementPatient representatives contributed to study design, development of interview guides and interpretation of findings to ensure alignment with lived experiences.Reporting MethodThis study follows the SRQR guideline.

POINTS OF INTERESTThis study explored the experiences of using digital technology by older and disabled people who were social distancing and shielding during the first period of lockdown over the Covid 19 Pandemic.The pandemic saw a greater need for support to use digital technologies as face-to-face social activities were limited.The biggest change in the use of digital technology and support requested from older and disabled people over the lockdown was the growth of video calling.Digital technologies were also used for entertainment like watching online videos, playing computer games, and listening to audiobooks and music.The study found older and disabled people used digital technologies to help them, but the increased use could be challenging and stressful.Both initial and ongoing digital support must be available to older and disabled people, and digital technology support workers need knowledge and experience of digital technology and disability to offer good support. This study explored the uses of digital technologies by older and disabled people who were social distancing and shielding during the early Covid-19 pandemic lockdowns. The study considers the benefits, difficulties, and technical support needs of these groups of people during this time. Using a case study methodology, in-depth interviews were undertaken with 11 older and disabled people recruited from a local digital support service, and their support workers. Five main themes were identified by the research team. These were: technology was a mixed blessing and caused frustration; technology use increased during lockdown; technology supported resilience and contributed to identity through 'stimulation, knowledge and friendship'; technology needs to be accessible, and support was required to facilitate technology use. Understanding these experiences will enable policymakers, commissioners, and providers to develop better and more responsive digital support for older and disabled people in the future.

In this commentary paper we reflect on our experiences of conducting two qualitative public health projects in Leicester UK around health inequalities and marginalised groups during the Covid 19 pandemic in 2020 and 2021. To contextualise the commentary, we first provide information about Leicester and how and why it was disproportionately affected by the pandemic, as well as describing the origins, aims, and methodologies of the two projects. In the second half, we describe and evaluate some of the adaptations we made to our studies and conclude with suggestions for future qualitative community health research as we adapt to the post-pandemic research landscape.

Abstract Background Physical activity (PA) interventions play a critical role in addressing obesity and its associated health risks. Understanding their long-term effectiveness, particularly across diverse economic contexts, is essential for designing sustainable and scalable strategies. This systematic review aimed to evaluate the long-term effectiveness of PA interventions implemented in low, middle, and high income countries (LMICs and HICs), identify key components contributing to their success. Methods Studies were included if they assessed PA interventions with follow-up periods of at least 12 months. A total of 27 studies from diverse countries met the inclusion criteria, encompassing 33 distinct strategies. Data were extracted on intervention components, follow-up duration, PA outcomes, and obesity-related measures. The studies were categorised by economic context, with a focus on comparing effectiveness across income groups. Results PA interventions demonstrated significant long-term effectiveness across all economic settings. In HICs, multicomponent interventions, such as those involving physician-led counselling, tailored exercise regimens, and fitness testing, were highly effective, showing improvements in weekly energy expenditure and physical fitness of up to 15%. Studies from MICs, like Mexico, highlighted the effectiveness of culturally tailored approaches, such as integrated care for older adults, in enhancing PA adherence despite resource constraints. LMICs, particularly China, leveraged culturally embedded and community-driven practices, such as tai chi and baduanjin, achieving comparable outcomes to HIC interventions in terms of PA adherence and fitness improvements. However, sustainability of intervention effects varied. Robust maintenance strategies, including booster sessions and ongoing support, contributed to stable long-term outcomes in studies from HICs. Conversely, LMIC interventions often lacked extended follow-up, limiting their ability to evaluate sustained effectiveness. The interventions were consistently associated with reductions in obesity-related risk factors, including BMI and metabolic health improvements. Conclusion This review highlights the effectiveness of culturally sensitive and resource-adapted PA interventions in sustaining long-term behaviour change and reducing obesity-related risks across economic contexts. Future research should prioritise consistent monitoring, extended follow-up, and the inclusion of underrepresented LMIC regions to enhance the global applicability and scalability of PA interventions. Addressing these gaps is crucial for combating obesity and promoting public health worldwide.

Background: Physical inactivity is a critical global health issue that contributes to increased morbidity and mortality rates worldwide. Regular physical activity (PA) benefits both physical and mental health, with particular importance for women, who face increased risks for chronic conditions associated with inactivity. This study examines barriers to and enablers of PA participation among women in coastal communities in East England, a population particularly affected by socioeconomic, environmental, and logistical challenges to maintaining active lifestyles. Methods: This study employed a mixed-methods convergent parallel design, integrating qualitative and quantitative data collected from 112 adult women recruited through local PA and weight loss programmes. Data collection utilised the International Physical Activity Questionnaire (IPAQ) and the Exercise Benefits and Barriers Scale (EBBS), alongside scenario-based and open-ended qualitative questions. The quantitative data were analysed via descriptive statistics and logistic regression in SPSS, whereas the thematic analysis of the qualitative data was conducted in NVivo. Results: Quantitative findings indicate that healthcare professionals (40%) are the primary source of PA information, with health benefits (36%) being the main motivator. Key barriers include family responsibilities (45%), low self-confidence (31%), and limited access to facilities (27%). Logistic regression revealed that women with family caregiving roles and existing health conditions were less likely to engage in PA. Qualitative data further highlight psychological and environmental barriers, alongside motivators such as medical advice, social support, and personal goals, which significantly impact PA participation. Conclusions: Women in coastal communities face unique socioenvironmental and psychological barriers to PA engagement. Effective interventions may need to incorporate multilevel, community-based approaches that address these specific challenges. This study highlights the potential for tailored interventions that leverage health advice, support networks, and culturally relevant programming to foster sustainable PA engagement among women in similar settings.

Background: Regular physical activity (PA) provides numerous health advantages, including lowering mortality rates and preventing obesity. Despite well-established guidelines advising 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA weekly, sedentary lifestyles remain prevalent, especially in industrialised nations. This systematic review examines the long-term effectiveness (12-24 months) of PA interventions aimed at reducing obesity risk among adults, with a particular focus on identifying strategies that promote sustained adherence. Methods: A comprehensive literature search was performed using multiple databases, including Cochrane Library, PubMed, and Embase, focusing on studies published between January 2004 and January 2024. The inclusion criteria focused on randomised controlled trials and similar designs targeting healthy adults, with interventions promoting sustained PA. Primary outcomes assessed were long-term PA adherence, reductions in obesity rates, and improvements in physical and metabolic health. Results: Twenty-one studies met the inclusion criteria, covering a range of intervention strategies. Most interventions featured structured PA programmes, often with personalised components and ongoing support. Several high-quality studies demonstrated long-term PA adherence, increased weekly energy expenditure, and improvements in fitness. However, adherence rates varied, with participants meeting recommended PA levels ranging from 4.6% to 81%. The meta-analysis showed a small to moderate positive effect of PA interventions on outcomes like PA levels and weight loss, with an effect size of 0.37 (CI: 0.25-0.50). Discussion: The results highlight the need for tailored, culturally sensitive interventions, particularly for vulnerable populations. Long-term PA adherence is stronger in older adults than middle-aged ones, but the sustainability of these effects remains unclear, warranting further research

Background Long COVID (LC) symptoms persist 12 weeks or more beyond the acute infection. To date, no standardised diagnostic or treatment pathways exist. However, a holistic approach has been recommended. This study explored participants’ experiences of a Long COVID–Optimal Health Programme (LC–OHP); a psychoeducational self-efficacy programme. Aim To explore perceptions and experiences of people with LC regarding the LC-OHP and identify suggestions to further improve the programme. Design & setting Qualitative study with patients with LC recruited through community settings. Method This study is part of a wider randomised controlled trial. Eligible participants were aged ≥18 years, have LC, and attended a minimum of five LC–OHP sessions plus a booster session. We interviewed those randomised to the intervention group. Interviews were conducted by an independent researcher and thematically analysed to identify common, emerging themes. Results Eleven participants were interviewed, mostly women from a White British ethnic group ( n = 10). Four main themes were identified, reflecting programme benefits and suggestions for improvement. The programme demonstrated potential for assisting patients in managing their LC, including physical health and mental wellbeing. Participants found the programme to be flexible and provided suggestions to adapting it for future users. Conclusion Findings support the acceptability of the LC–OHP to people living with LC. The programme has shown several benefits in supporting physical health and mental wellbeing. Suggestions made to further adapt the programme and improve its delivery will be considered for future trials.

Long COVID (LC) is a multisystem disease with symptoms lasting weeks or months beyond the acute COVID-19 infection. Several manifestations are reported by people with LC, including effects on mental health, with varying degrees of psychological distress and disturbances to daily activities. Research conducted to identify effective interventions to support mental health among people with LC has been limited by the breadth and scope of studies. This review aims to identify interventions being tested to support mental health of people with LC. A scoping review was conducted by searching five databases for articles published between January 2020 and early October 2022 to identify research evaluating interventions focused on improving mental health symptoms associated with LC. Results from all sources were checked for eligibility by two reviewers, and agreements were resolved by discussion. Gray literature and reference list of included studies and relevant reviews were scrutinised to identify any additional studies. Data extraction was conducted by one reviewer and checked by another reviewer for accuracy. Of the 940 studies identified, 17 were included, the design of which varied but included mainly case studies (n = 6) and clinical trials (n = 5). Several interventions were described, ranging from single interventions (e.g., pharmacologic) to more holistic, comprehensive suites of services (pharmacologic and non-pharmacologic). Several mental health outcomes were measured, mostly anxiety and depression. All included studies were reported to be associated with improvements in participants’ mental health outcomes. This scoping review identified studies reporting on a variety of interventions to support mental health among people with LC. Although positive changes were reported by all studies, some were case studies and thus their findings must be interpreted with caution. There is a need for more research to be conducted to identify the impact of interventions on mental health of people with LC.

Purpose “My Story” is based on a life story approach. This study aims to facilitate therapeutic alliances by providing a format for older and younger people to interact. Design/methodology/approach Three pairings were studied to explore the experiences of the older and younger person using “My Story”. The focus of the case studies was on how and if any therapeutic alliance emerged. Findings This study found that in the two of the pairings, “My Story” helped to create a bond and mutual benefit for the participants’ central to a therapeutic alliance. This led one of the pairings to develop into an intergenerational friendship and potentially help with loneliness. Research limitations/implications As this was an exploratory and small pilot, more cases and research are required to fully assess if “My Story” is a useful approach to develop intergenerational befriending. Practical implications Intergenerational befriending may be one solution that could help with loneliness and social isolation through forming a therapeutic alliance to make the befriending successful. Social implications Loneliness and social isolation for older people remain a problem. Originality/value An original pilot was undertaken to test the approach by bringing together older people identified as lonely by a voluntary sector provider and pairing these with a student volunteer. The students visited the older person over six weeks to discuss their life story and create an artefact based on the story for the older person.

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness and safety of interventions for hyperhidrosis.

BACKGROUND:Hyperhidrosis is a common skin condition characterized by excessive sweating, which can negatively impact on quality of life. It is under-researched compared with other conditions of similar prevalence.AIM:To generate a Top 10 list of research priorities for the treatment and management of hyperhidrosis, with equal input from people with hyperhidrosis and healthcare professionals (HCPs).METHODS:A priority setting partnership (PSP) was established and processes from the James Lind Alliance Handbook were followed. An online survey asked participants what questions they would like research to answer. These questions were grouped into 'indicative questions', which were ranked in a second survey of 45 indicative questions. The top 23 questions were then taken to a final workshop event attended by key stakeholders, and ranked to generate the Top 10 list of research priorities.RESULTS:There were 592 questions submitted by 268 respondents for the first survey. For the second survey, 286 participants ranked the indicative questions in order of priority. At the final workshop, the Top 10 list was generated. The top three priorities were: (i) Are there any safe and effective permanent solutions for hyperhidrosis? (ii) What is the most effective and safe oral treatment (drugs taken by mouth) for hyperhidrosis? and (iii) What are the most effective and safe ways to reduce sweating in particular areas of the body?CONCLUSIONS:There are many unanswered research questions that both people with hyperhidrosis and HCPs would like to see answered. The results from this PSP will help to ensure future research funding can be directed to these areas of priority.

This article is an exploratory study of perceptions in mental health nurses who are qualified to prescribe yet choose not to do so. In-depth semi-structured face-to-face interviews, field notes and analysis of documents were used to investigate the perceptions of the non–prescribing nurse prescriber. A mapping exercise was conducted to identify potential participants. Interview data analysis was based on the principles of descriptive phenomenology and the research was theoretically framed within concepts of power, structure/agency and culture. This study has contributed to understanding the views of non-prescribing mental health nurse prescribers on why they do not use their prescribing qualification. The findings from this study suggest that there are complex, interlocking factors: power and knowledge; culture; and structure and agency, which may enable or prevent mental health nurse prescribers from independently prescribing.

To explore the gendered nature of the nursing working force To consider current initiatives and programmes to encourage men to enter the nursing profession. To understand some of the barriers to recruiting men into the nursing profession.

AIM:To examine the UK pandemic preparedness in light of health expenditure, nursing workforce, and mortality rates in and relation to nursing leadership.BACKGROUND:The Global Health Security Index categorized the preparedness of 195 countries to face a biological threat on a variety of measures, producing an overall score. The United States of America and the United Kingdom were ranked 1st and 2nd most prepared in 2019.METHOD:A cross-nation comparison of the top 36 countries ranked by Global Health Security Index score using a variety of online sources, including key data about each nation's expenditure on health and the nursing workforce, and compared these with mortality data for COVID-19.RESULTS:The extent of a country's pandemic preparedness, expenditure on healthcare and magnitude of the nursing workforce does not appear to impact mortality rates at this stage of the pandemic which is something of a paradox.CONCLUSION:It is important that arrangements for dealing with future global pandemics involve a range of agencies and experts in the field, including nurse leaders.IMPLICATIONS FOR NURSING:To achieve the best outcomes for patients, nurse leaders should be involved in policy forums at all levels of government to ensure nurses can influence health policy.

The purpose of this editorial is to provide a rejoinder to an empirical research article: “Attitudes to Brexit: A survey of nursing and midwifery” that was published as an editorial online on 13 May 2018, in JAN, co-authored by McCrae and Jonathan (2019). We the authors, Andrew Clifton and David Banks did not read the article when it was first published. The article came to our attention on 23 May 2019, when a video of NM, an Editorial Board member of JAN, appeared online linking him to an incident at a Brexit Rally (https://tinyurl.com/y22sbf2t; accessed 24 June 2019). NM writes for Politicalite, the Bruges Group which was at the forefront for the campaign for the UK to leave the European Union (EU) and is a recent co-author on at least two occasions, with Roger Watson (Editor-in-Chief of JAN), on The Conservative Woman website. This is an organisation which claims to be part of a: ‘a counter-cultural offensive against the forces of leftism, feminism and modernism—against the anti-family, authoritarian identity politics and “equality and diversity” ideology sweeping through the country's institutions’. Why this rejoinder? On reading the McCrae and Portes article about nurses and midwifery students’ attitudes to Brexit we were surprised to see a full-blown empirical research paper masquerading as an editorial. We consider that the editorial lacked balance and there was no declaration of the political interests from either of the authors. The topic of the article is immaterial but given the backgrounds and affiliations of the authors more information and transparency about the publication process is surely required? We agree that the point of any editorial is to present an opinion, often controversial, to generate discourse and debate. We have no issues with Brexit or Remain issues being debated in JAN given the significant impact it has on our profession. We were however, surprised why this research article was accepted for publication as an editorial without undergoing peer-review? According to RW, “Editorials in journals regularly include empirical work at the editors” discretion’; well that is news to these two authors, with around 100 publications between us we have never submitted an empirical research article as an editorial to any journal, and after speaking to many senior academics in the UK, we are not alone. We then conducted a very quick and crude scope of the JAN archives for the last 5 years: Volume 75 to 71, which included 54 Issues to the current date (1 June 2019) to determine how many empirical research articles are classified as editorials. The answer is very few that we could find. Indeed, most editorial articles in JAN are unsurprisingly editorials in our understanding of the term. Here are a few random examples: (a) Do chief nurses need to be academically credible? (Volume 73, Issue 11). (b) Have research assessment exercises improved the quality of nursing research? (Volume 72, Issue 8). Both editorials were no more than two pages long, which was about the average length of most editorials that are generally included in JAN. The McCrae and Portes research article was nine pages; the longest so-called editorial we found. We believe it is disingenuous to publish empirical research as an editorial, as this means no peer review and quality control is at the whim of the Editor in Chief. Given the close relationship (“colleague and friend”) between RW and NM this brings into question the integrity and transparency of the publication process. RW has stated he is “the final arbiter of the content of @jadvnursing”, but we would draw readers’ attention to the problems of “club culture”, as described by Professor Ian Kennedy in the Bristol Inquiry (Dyer, 2001). If JAN continues publishing empirical research as editorials that is their prerogative, but the process should be more transparent. One step of ensuring this would be to involve more than one editor in the final decision, especially if a friend, colleague or fellow editor has submitted an article. All authors should publish a conflict (or potential conflict) of interest statement to reveal any important interests and affiliations including if any financial support was procured in undertaking their work. The history of nursing in the UK is underscored with a series of cabals, hidden networks and vested interests. If we want a candid and modern profession, we need more transparency and openness in all aspects of the profession, including academic publishing. We are grateful to Professor Roger Watson for giving us the opportunity to write this piece on JAN editorial policy. Dr Andrew Clifton works at De Montfort University as an Associate Professor of Nursing and is a member of the UK Labour Party. He voted remain in the 2016 referendum. Dr David Banks works at Queen Margaret University as a Lecturer of Nursing, and was a longstanding member of the UK Labour Party. This article is linked to Watson's Editorial paper. To view these article, visit https://doi.org/10.1111/jan.14159.

BACKGROUND Agitation has been reported in up to 90% of people with dementia. Agitation in people with dementia worsens carer burden, increases the risk of injury, and adds to the need for institutionalisation. Valproate preparations have been used in an attempt to control agitation in dementia, but their safety and efficacy have been questioned. OBJECTIVES To determine the efficacy and adverse effects of valproate preparations used to treat agitation in people with dementia, including the impact on carers. SEARCH METHODS We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 7 December 2017 using the terms: valproic OR valproate OR divalproex. ALOIS contains records from all major health care databases (the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources. SELECTION CRITERIA Randomised, placebo-controlled trials that assessed valproate preparations for agitation in people with dementia. DATA COLLECTION AND ANALYSIS Two review authors independently screened the retrieved studies against the inclusion criteria and extracted data and assessed methodological quality of the included studies. If necessary, we contacted trial authors to ask for additional data, including relevant subscales, or for other missing information. We pooled data in meta-analyses where possible. This is an update of a Cochrane Review last published in 2009. We found no new studies for inclusion. MAIN RESULTS The review included five studies with 430 participants. Studies varied in the preparations of valproate, mean doses (480 mg/day to 1000 mg/day), duration of treatment (three weeks to six weeks), and outcome measures used. The studies were generally well conducted although some methodological information was missing and one study was at high risk of attrition bias.The quality of evidence related to our primary efficacy outcome of agitation varied from moderate to very low. We found moderate-quality evidence from two studies that measured behaviour with the total Brief Psychiatric Rating Scale (BPRS) score (range 0 to 108) and with the BPRS agitation factor (range 0 to 18). They found that there was probably little or no effect of valproate treatment over six weeks (total BPRS: mean difference (MD) 0.23, 95% confidence interval (CI) -2.14 to 2.59; 202 participants, 2 studies; BPRS agitation factor: MD -0.67, 95% CI -1.49 to 0.15; 202 participants, 2 studies). Very low-quality evidence from three studies which measured agitation with the Cohen-Mansfield Agitation Index (CMAI) were consistent with a lack of effect of valproate treatment on agitation. There was variable quality evidence on other behaviour outcomes reported in single studies of no difference between groups or a benefit for the placebo group.Three studies, which measured cognitive function using the Mini-Mental State Examination (MMSE), found little or no effect of valproate over six weeks, but we were uncertain about this result because the quality of the evidence was very low. Two studies that assessed functional ability using the Physical Self-Maintenance Scale (PSMS) (range 6 to 30) found that there was probably slightly worse function in the valproate-treated group, which was of uncertain clinical importance (MD 1.19, 95% CI 0.40 to 1.98; 203 participants, 2 studies; moderate-quality evidence).Analysis of adverse effects and serious adverse events (SAE) indicated a higher incidence in valproate-treated participants. A meta-analysis of three studies showed that there may have been a higher rate of adverse effects among valproate-treated participants than among controls (odds ratio (OR) 2.02, 95% CI 1.30 to 3.14; 381 participants, 3 studies, low-quality evidence). Pooled analysis of the number of SAE for the two studies that reported such data indicated that participants treated with valproate preparations were more likely to experience SAEs (OR 4.77, 95% CI 1.00 to 22.74; 228 participants, 2 studies), but the very low quality of the data made it difficult to draw any firm conclusions regarding SAEs. Individual adverse events that were more frequent in the valproate-treated group included sedation, gastrointestinal symptoms (nausea, vomiting, and diarrhoea), and urinary tract infections. AUTHORS' CONCLUSIONS This updated review corroborates earlier findings that valproate preparations are probably ineffective in treating agitation in people with dementia, but are associated with a higher rate of adverse effects, and possibly of SAEs. On the basis of this evidence, valproate therapy cannot be recommended for management of agitation in dementia. Further research may not be justified, particularly in light of the increased risk of adverse effects in this often frail group of people. Research would be better focused on effective non-pharmacological interventions for this patient group, or, for those situations where medication may be needed, further investigation of how to use other medications as effectively and safely as possible.

Background Peer support provides the opportunity for peers with experiential knowledge of a mental illness to give emotional, appraisal and informational assistance to current service users, and is becoming an important recovery-oriented approach in healthcare for people with mental illness. Objectives To assess the effects of peer-support interventions for people with schizophrenia or other serious mental disorders, compared to standard care or other supportive or psychosocial interventions not from peers. Search methods We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials on 27 July 2016 and 4 July 2017. There were no limitations regarding language, date, document type or publication status. Selection criteria We selected all randomised controlled clinical studies involving people diagnosed with schizophrenia or other related serious mental illness that compared peer support to standard care or other psychosocial interventions and that did not involve ' peer' individual/ group(s). We included studies that met our inclusion criteria and reported useable data. Our primary outcomes were service use and global state (relapse). Data collection and analysis The authors of this review complied with the Cochrane recommended standard of conduct for data screening and collection. Two review authors independently screened the studies, extracted data and assessed the risk of bias of the included studies. Any disagreement was resolved by discussion until the authors reached a consensus. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary data, and the mean difference and its 95% CI for continuous data. We used a random-effects model for analyses. We assessed the quality of evidence and created a ' Summary of findings' table using the GRADE approach. Main results This review included 13 studies with 2479 participants. All included studies compared peer support in addition to standard care with standard care alone. We had significant concern regarding risk of bias of included studies as over half had an unclear risk of bias for the majority of the risk domains (i.e. random sequence generation, allocation concealment, blinding, attrition and selective reporting). Additional concerns regarding blinding of participants and outcome assessment, attrition and selective reporting were especially serious, as about a quarter of the included studies were at high risk of bias for these domains. All included studies provided useable data for analyses but only two trials provided useable data for two of our main outcomes of interest, and there were no data for one of our primary outcomes, relapse. Peer support appeared to have little or no effect on hospital admission at medium term (RR 0.44, 95% CI 0.11 to 1.75; participants = 19; studies = 1, very low- quality evidence) or all- cause death in the long term( RR 1.52, 95% CI 0.43 to 5.31; participants = 555; studies = 1, very low- quality evidence). There were no useable data for our other prespecified important outcomes: days in hospital, clinically important change in global state ( improvement), clinically important change in quality of life for peer supporter and service user, or increased cost to society. One trial compared peer support with clinician- led support but did not report any useable data for the above main outcomes. Authors' conclusions Currently, very limited data are available for the effects of peer support for people with schizophrenia. The risk of bias within trials is of concern and we were unable to use the majority of data reported in the included trials. In addition, the few that were available, were of very low quality. The current body of evidence is insufficient to either refute or support the use of peer- support interventions for people with schizophrenia and other mental illness.