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East London NHS Foundation Trust (ELFT) is a major provider of mental healthcare and community health services. Quality improvement (QI) has become central to its organisational policy and goals for which it has received national and international attention.

This piece reflects on the Trust's transformation and its approach. It provides many examples and discusses several of the associated challenges in building and sustaining QI momentum. It is the result of a range of perspectives from staff involved in planning and building large-scale QI capability. It contextualises QI's current status in UK mental healthcare.

Several key factors were identified: board-led commitment to organisational transformation; investment in training and resources to support staff motivation; clear and realistic project goals in line with the service's over-arching strategic direction; support for service users and staff at all levels to get involved to address issues that matter to them; and, finally, placement of a high value on service user and staff qualitative feedback.

Building QI capability represents a significant challenge faced by all large healthcare providers. Sharing experiences of change can assist other organisations achieve the necessary buy-in and support the planning process.

Achieving and sustaining lasting organisational change in healthcare is challenging. This article provides a background on QI at ELFT and reflects on the pathway to its present position at the forefront of the application of QI within healthcare.

The study of arms control and disarmament is a subject of renewed interest in the United States. The attention of academicians, politicians, and average citizens, focused by a fear of nuclear holocaust, has turned to questions of how best to seek peace and safety in the nuclear age. Courses and programs devoted to arms control and disarmament and methods of achieving peaceful resolution of conflicts in today's world are offered at all educational levels, and the general public, aware of the necessity of being well‐informed on such an important topic, is looking for ways to obtain factual and reliable information to help sort out the conflicting claims of political spokespeople. Such material does exist and should be available to researchers, professors, students, and citizens, so that they can form opinions and attempt to influence policy on the basis of a sound understanding.

In August 1977, the Division for Library Services awarded Library Services and Construction Act Title III funding to a proposal submitted by Denise B. Erwin, Director of the Instructional Materials Center, School of Education, University of Wisconsin‐Madison, for a planning grant to identify and document the need for “Cooperative Media Review Centers” in the State of Wisconsin. This grant provided money for an eight month period to conduct the study and, based on the findings, to submit a report which would include a plan for the development and implementation of such an evaluation program. This proposal was based on work done previously, nationwide in scope and widely reported in the library press.

At the recent conference of the British Medical Association, Dr. Langdon‐Down, of South Middlesex, submitted the report of the Ethical Committee on behalf of the Council, upon the ethics of indirect advertising by the medical profession. The report mentioned a number of restrictions which it was thought advisable to impose as regards advertising by members of the profession. It was stated that in discussions in the Press on matters of public importance relating to the medical questions it was not necessary that the names of the medical writers or informants should be given. The newspapers, it was contended, could give the necessary assurance to their readers as to the professional standing of the authority quoted without mentioning names.—Dr. Fothergill moved that certain recommendations in the report be referred back for reconsideration, including that which related to medical men not attaching their signatures to letters and communications they sent to the Press on medical subjects. On that latter point he suggested that before the report was issued the council should approach the Press Association to get their views on the question. What the Press required was not the advertising of an inferior practitioner. What they desired was to get an adequate medical opinion. The Press said: “If you allow a doctor to go to the Church Congress and talk openly there of birth control, should you not allow that same doctor to put into the public Press a letter over his signature?”—Dr. Lyndon hoped the representative body would not be led away by Dr. Fothergill. The question of having a conference with the Press was brought before the council, who were all against it.—Sir Jenner Verrall said he did not think what was suggested would be a substitute for the indirect advertising complained of.—Dr. Bishop Harman expressed agreement with the contention that it was the name that really mattered in these contributions to the Press. An eminent medical man wrote to The Times a brilliant letter on an important medical subject, and signed himself “Veritas.” It never caused a ripple on the water. They thought it was a gas mantle or something, and there was no punch behind it. Three things mattered—what you say, how it is said, and who says it, and the last is the only thing that really matters.—The report was adopted with the exception of that part relating to medical men's names being attached to letters and communications sent to the Press. That section of the report was referred back for consideration, with the object of seeing how far it was possible to depart from anonymity.

Uses the term “McJob” to convey that working either full‐time or part‐time at McDonald’s is one of the most common occupations in the 1990s. Defines a McJob as a job requiring little training, usually in the service sector. Investigates the low‐skill workplace through six case studies and a survey consisting of personal interviews with the individuals in Fredericton, Canada. Reveals a large number of incompetent, morally bankrupt and illegal labour practices, particularly as low‐skill workers have minimal recourse to legal processes. Indicates that conventional employment law simply does not extend to low‐skill employment and that part‐time and minimum wage employees, as well as being denied legal rights, are completely at the whim of the employer. Proposes an Ombudsman should operate independently of government, ranking employers according to their treatment of employees, publicizing offences and unfair practices, to shame bad employers and act as an impetus for change.

The case of a woman with a history of offending and prolonged imprisonment is given. The purpose of this paper is to explore the complex interplay between diagnoses of autistic spectrum disorder (ASD), personality disorder and gender dysphoria. A discussion on useful and less useful treatment approaches follows, given the unusual and complex clinical presentation.

This is a case report with a summary of the background to this under-researched area.

The way in which the diagnostic picture clarified over time is explained. The difficulties in accurately diagnosing are put forward and strategies to address this are suggested. Successful treatment of unusual clinical problems may require highly individualised care within generic services.

The authors know of no similar case reports in the published literature. The clinical associations between ASDs, personality disorders and gender dysphoria, in forensic mental health populations, appears to be unexplored in the literature.

THE 31st annual meeting of the Library Association passed off very comfortably at Brighton, and if nothing particularly momentous occurred affecting librarianship, everybody enjoyed the various entertainments and the breezy weather. Brighton certainly deserved the title to breeziness which it claims, because it was stormy nearly every night or early morning during the run of the Conference, and members must be congratulated on the lucky manner in which it was found possible to dodge the showers.

It is not proposed here to treat the sheaf catalogue from a controversial point of view, and to enter into a detailed examination of the respective advantages and disadvantages of this as compared with other forms of catalogues. Many are alive to the merits of the sheaf catalogue, either as the only means of displaying and indexing the contents of a library, or as an addition to some already existing means, and it is for the use of these that the following practical notes on the making of a sheaf catalogue are submitted.