The publication of this work resulted in a public outcry in the 1900's that began an inquiry into the state of U.S. mental health care and psychiatric services. It contributed significantly to the mental hygiene movement and to establish the National Committee for Mental Hygiene

Seclusion as a concept is poorly understood and this is reflected in the literature on the topic, particularly from nursing authors. This has led to an emotionally charged altercation rather than academic debate, both within the literature and at conferences. But why bother learning about seclusion at all, particularly as it is used less and less within mental health? We would point out to those sceptical about the value of this book that seclusion is not only of interest as an intervention per se, but is valuable in reflecting a shifting ethos within care. For some reason, seclusion has been neglected; we believe that one reason is that it impinges upon widely held myths and beliefs within psychiatric practice. Questioning about seclusion uncovers uncomfortable facts and assumptions concerning the values underpinning today's mental health care approaches. Such uncomfortable questioning is often avoided for safer research pursuits. Also, we hold that this book is necessary in examining issues pertaining to seclusion practice. There is a gap within nursing knowledge in so far as seclusion is concerned, as our chapter on education upholds. Yet inquiries and litigation have highlighted the fact that seclusion practice must be more clearly understood as an intervention. At present, such understanding is erratic and far from useful in providing a higher standard of care. Practitioners need to make informed decisions regarding seclu sion, and this book aims to provide the necessary information on which to base these decisions.

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.