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Research spanning 30 years has highlighted discharge planning as a complex area of practice. Discharge co-ordinators are part of the support provided to improve the patient's journey from acute to community settings. The aim of this study was to explore and describe the role of discharge co-ordinators in a healthcare setting. Using an exploratory descriptive research design a convenience sample of discharge co-ordinator nurses (n=6) across a variety of acute care settings in the Republic of Ireland, were interviewed. Thematic analysis revealed that the role of the discharge co-ordinators was multifaceted and a number of factors affected their role. Recommendations for practice include improved discharge planning processes and education.

It is well established that pharmacotherapy is fundamental to disease and symptom management. Adherence to medication regimens is therefore essential for improved patient health outcomes. In reality, however, many patients experience difficulty with medication taking resulting in suboptimal adherence. Given the consequences of this pervasive problem, non-adherence is increasingly recognized as one of the leading challenges that professionals face in contemporary health care. As health-care professionals, nurses have an important role in combating this problem. This paper therefore examines the literature surrounding medication adherence for the purposes of enhancing professional knowledge and practice in this area. Specifically, the impact of poor adherence from the patient's, health-care professional and health-care system perspective is detailed to highlight the significance of this issue. The underlying philosophical attributes of adherence and the interchangeable concepts of compliance and concordance are explored, with the implications of the meanings attributed to these concepts for nursing practice and research considered.

Summary of findings Theresultsofthisstudyidentifytheprofessionalpracticeenvironments for Irish nursing and the organizationalstructures and processes in large acute hospitals inIreland. Staff-nurses had a moderately positive per-ception of relationships between doctors and nurses,nurse autonomy, control over practice settings andorganizational support. The findings of this study alsoindicate that there were differences in the characteristicsof the nursing practice environment offered in the11 band-one hospitals. The slightly higher scores indoctor–nurse relationships and nurse autonomy arereflective of the close working relationship most Irishclinicalnurseshavewithmedicalcolleagues.Theeffectofthe recent change to degree level education for entry topracticemayhavehadaneffectinpromotingautonomy.The levels reported may also be a result of samplecharacteristics.The research identifies differences between the pro-fessional practice environment in Irish and Americanhospitals when comparison was made with the researchpublished by Aiken and Havens (2000a,b) – the mostnotable difference being for control over the practicesetting which attained the lowest score in the Irishstudy. These results may be an indicator of the reluct-ance of Irish nurses to take control over practice, lack ofencouragement from senior managers or disempower-ing policies.This study identifies a substantial difference in theperceptions of staff-nurses and DONs on several issues:nurse autonomy, control over practice, nurse–doctorrelationships, organizational support and involvementof staff-nurses in decision-making (see Figure 3).These results together with the finding that organ-izational support was perceived as low by nurses isworrying as supports are vital if nursing is to progress asa practice discipline. The findings, however, are similarto those of Aiken et al. (2002) where nurses from five

Public health nurses (PHNs) in Ireland are involved with all children and their families for health screening and health education. Nurse/client relationships with vulnerable families are important, yet there is evidence that they are not participatory. Participation in the context of this study implied PHN/client consensus in relation to the needs identified and provided, in conjunction with mutual satisfaction with the level of interpersonal involvement and responses. The primary purpose of this pilot study was to determine similarities in perceptions on participation between nurses and mothers of vulnerable families (n = 44 dyads). A cross-sectional quantitative design was used to investigate the needs identified and provided, as well as satisfaction with the level of involvement and response, from the perspective of both sides of the dyad. There were more similarities than differences in perception found in the dyads, indicating participatory relationships.

This literature review aims to (a) provide a summary of the research conducted in the Irish nurse/midwifery education field, (b) identify key recommendations from the research reviewed and (c) examine the policy, theory and methodological implications of the research conducted. The electronic databases of CINAHL (EBSCO host 1982-2006) and PubMed (1950-2006) were searched for the relevant literature. Sixty-one studies satisfied the criteria for inclusion which were based on; quality of research design, sampling, data analysis, scientific merit, and authorship (registered nurse/midwife who conducted research in the Republic of Ireland). Findings demonstrated diversity in relation to aims, methods and results highlighting a need to formulate a collaborative research agenda in nurse and midwifery education.

The role of apolipoprotein E (APOE) in Alzheimer's disease and other dementias has been investigated intensively. However, the relationship between APOE and delirium has only recently been explored in studies that have included relatively small samples. A meta-analysis of the published pooled data is timely to explore the relationship between APOE and delirium and to inform further research in this topic. PubMed, EBSCOhost, Google Scholar, Scopus, all EBM Reviews (OVID) and the Cochrane Database of Systematic Reviews were searched with relevant keywords and from the references of relevant papers. Ten papers were found that examined the relationship between APOE and delirium. Data were extracted from eight of them and pooled for meta-analysis using random effects with R software. Data from 1762 participants, of whom 479 (27.2%) were diagnosed with delirium, showed low heterogeneity (Q=13.11, d.f.=7, P=0.07; I=44.86%). The possession of the APOE e4 allele has a small (log odds ratio: 0.18, 95% confidence interval: 0.23-0.59), nonsignificant (P=0.38) effect on the presence of delirium. No publication bias was identified. The metapower of the pooled data was low (α=0.05, power=0.65). On analysing the studies to date, it seems that there is no association between APOE and the occurrence of delirium. We suggest that further studies are needed with greater number of patients to clarify any association as well as to examine for other patterns of association including relevance for subgroups of patients who develop delirium and for effects on the phenotype of delirium and the outcomes.

AIM To explore the agreement between the mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA) within community dwelling older patients attending an old age psychiatry service and to derive and test a conversion formula between the two scales. METHODS Prospective study of consecutive patients attending outpatient services. Both tests were administered by the same researcher on the same day in random order. RESULTS The total sample (n = 135) was randomly divided into two groups. One to derive a conversion rule (n = 70), and a second (n = 65) in which this rule was tested. The agreement (Pearson's r) of MMSE and MoCA was 0.86 (P < 0.001), and Lin's concordance correlation coefficient (CCC) was 0.57 (95% CI: 0.45-0.66). In the second sample MoCA scores were converted to MMSE scores according to a conversion rule from the first sample which achieved agreement with the original MMSE scores of 0.89 (Pearson's r, P < 0.001) and CCC of 0.88 (95% CI: 0.82-0.92). CONCLUSION Although the two scales overlap considerably, the agreement is modest. The conversion rule derived herein demonstrated promising accuracy and warrants further testing in other populations.

Background: Incontinence of both bladder and bowel is a major health care problem and adversely affects the lives of many people living at home or in health service facilities. The prevalence and severity of incontinence is a global concern that has, in recent years, prompted investigation across several countries. Current approaches to continence care indicate an emphasis on safety and reduction of risk, rather than on detailed individualised assessment and management. Aim: To show approaches to assessment, diagnosis, and management of urinary and faecal incontinence in two rehabilitation settings for older people in Ireland. The study forms part of a larger 2-year case study to identify the determinants of practice “context” that enable or hinder proactive approaches to promoting continence and the treatment of incontinence in rehabilitation settings for older people. Method: The Royal College of Physicians Audit Scheme was used to record the assessment and management of urinary and faecal incontinence. This scheme also includes questions regarding resources available to enable effective continence management. Over 6 months, 220 patients who suffered from incontinence participated in two study sites: a 78-bed rehabilitation unit in Northern Ireland and an 80-bed rehabilitation unit in Southern Ireland. Results: Findings indicated that 60% of incontinent patients had urinary incontinence, 3% faecal incontinence, and 37% mixed urinary and faecal incontinence; however, a specific continence assessment and specific rationale for treatment decisions or continuation of care were lacking. The focus was on continence containment rather than on proactive management. The examination of resources available for continence promotion and management showed that even though guidelines for continence management were available to staff in one unit, there was a dearth of appropriate education or support for staff in continence care. Implications for Practice: Because incontinence remains an issue for older people and the clinical implications of sustained incontinence are multifaceted, strategies should focus on the development of practice towards evidence-based multidisciplinary approaches to continence promotion and management.

Aim. To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning. Background. Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing. Method. A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire. Results. Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status. Conclusion. The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing. Relevance to clinical practice. Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary.

Aims. The primary aim of this study was to describe the unintentional and intentional aspects of non-adherence in patients diagnosed with hypertension. A secondary aim was to examine the relationships between medication adherence and purposeful actions (intentional non-adherence), patterned behaviours (unintentional non-adherence) and demographic questionnaire variables. Background. Non-adherence to medications continues to be a significant health-care issue, the extent and consequences of which have been well documented. Despite considerable research over the past five decades, little progress has been made in solving this healthcare problem. Recent literature indicates that this lack of progress can be attributed to the fact that past research has concentrated solely upon either the unintentional or the intentional aspects of non-adherence, instead of addressing both facets simultaneously. Methods. A quantitative, descriptive, correlation research design was employed using Johnson's (2002) Medication Adherence Model as a theoretical framework. A convenience sample of 73 participants with hypertension, attending the outpatients’ clinics of two university hospitals was recruited. Data were collected by means of a researcher administered questionnaire and analysed using the Statistical Package for Social Sciences. Results. High levels of medication adherence with a mean adherence score of 4·75 (maximum 5) were reported. Low and medium levels of purposeful actions and medium and high levels of patterned behaviours towards medication taking were found. Correlational analyses did not demonstrate statistically significant associations. Conclusions. Both the intentional and unintentional dimensions of medication-taking are simultaneously considered by patients to varying levels when adhering to therapeutic regimens. This is an important research area for nurses as it facilitates an increased understanding of non-adherence and, in so doing, aids the uncovering of more effective interventions aimed at sustaining lifelong pharmacotherapy. Relevance to clinical practice. By acknowledging a broader approach to patient medication-taking, nurses will be able more effectively to assess and intervene in non-adherent behaviours and actions.

Background Turnover in nursing and midwifery has recently become a problem in the Republic of Ireland and Irish health-care managers are constantly challenged to retain qualified nurses. The literature suggests that intention to stay or leave employment is the final step in the decision-making process. It is, therefore, reasonable to suggest that understanding ‘intent to stay or leave’ might facilitate nurse managers in introducing of appropriate retention strategies. Aim The aim of this study was to investigate registered nurses ‘intent to stay or leave’ employment. Methods A cross-sectional quantitative design was utilized. A questionnaire was designed and these were randomly distributed to 352 registered nurses at 10 hospital sites throughout the Republic of Ireland. Results Almost 60% of the sample, comprising of young, female, college educated nurses, expressed an intent to leave their current post. The most statistically significant predictors of intent to leave were ‘kinship responsibilities’ (P

This column presents an analysis of McCormack's conceptual framework for person-centered practice with older people as a theoretical basis for the delivery of care of older adults in an Irish context. The evaluative process is guided by the framework proposed by Fawcett (2000) for the analysis and evaluation of conceptual models of nursing. The historical evolution, philosophical claims, and an overview of the content of the model are addressed. The following criteria are then applied: logical congruence, the generation of the theory, the credibility of the model, and the contribution of the model to the discipline of nursing.

Self-neglect is a significant international public health issue. Estimates suggest that there may be over one million cases per year in the United States. Aging populations will put more people at risk of self-neglect. This chapter presents background literature, self-neglect definitions and policy context, risk factors, and a brief overview of research on perspectives of self-neglect from both clients and community health and social care professionals. A case study is presented from the perspective of an individual and is used to explore ethical issues therein. A person-centered assessment within a multidisciplinary team approach is required for building a therapeutic relationship with clients. Capacity is a central issue in the management of responses to self-neglect. Ethical considerations of importance for community health and social care professionals include beneficence and nonmaleficence, autonomy and capacity, and respect for people's rights and dignity. A model of ethical justification is presented to explain dilemmas, challenges, and actions. Competence of professionals, multidisciplinary team working, informed consent, privacy, confidentiality, and best interest are also critical considerations. Effective decision making by an interdisciplinary team of professionals needs to be person-centered and give due consideration to the best interest of self-neglecting clients. The purpose of this chapter is to provide an in-depth discussion and examination of ethical issues and challenges relating to self-neglecting clients.

Aim Impaired attention is a core diagnostic feature for delirium. The present study examined the discriminating properties for patients with delirium versus those with dementia and/or no neurocognitive disorder of four objective tests of attention: digit span, vigilance “A” test, serial 7s subtraction and months of the year backwards together with global clinical subjective rating of attention. Methods This as a prospective study of older patients admitted consecutively in a general hospital. Participants were assessed using the Confusion Assessment Method, Delirium Rating Scale–98 Revised and Montreal Cognitive Assessment scales, and months of the year backwards. Pre-existing dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Results The sample consisted of 200 participants (mean age 81.1 ± 6.5 years; 50% women; pre-existing cognitive impairment in 126 [63%]). A total of 34 (17%) were identified with delirium (Confusion Assessment Method +). The five approaches to assessing attention had statistically significant correlations (P

Self-neglect (SN) is a global phenomenon, largely hidden, poorly defined, and a serious public health issue. It can be intentional or unintentional and depends on the individual's capacity. Creating a safe living environment for self-neglecting adults can present complex ethical challenges. The purpose of this research was to develop and evaluate the psychometric properties of an instrument to measure professional's perceptions of self-neglect. A descriptive cross-sectional design was used in this two-stage study. Stage 1 involved the generation of an item pool (90 items), face and content validity; and pilot testing of the instrument. In stage 2, the questionnaire was posted to a national sample of community health and social care professionals (n=566) across Ireland, with a 60% response (n=339). Exploratory factor analysis (EFA) was conducted using scale development guidelines to identify scales and subscales of the instrument. Construct validity was established using EFA. The result was a 37-item SN instrument, composed of five factors: environment, social networks, emotional and behavioural liability, health avoidance, and self-determinism which explained 55.6% of the total variance. Factor loadings were ≥0.40 for all items on each of the five subscales. Cronbach's alpha (α) for four subscales ranged from 0.83 to 0.89 and one subscale was 0.69. The SN-37 can be used not only to measure SN, but also to develop interventions in practice. Further testing of the SN-37 in primary care settings with diverse populations is recommended.

This article presents an overview of the first phase of a study to determine the contextual indicators that enable or hinder evidence-based continence care and management. The main focus of the article is to provide an insight into the value of understanding practice 'context' and its impact on the provision of person-centred continence care.

Background Cardiovascular disease accounts for 39% of all deaths in Ireland each year. Many of these deaths are due to acute myocardial infarction (AMI). The diagnosis of AMI has major implications for individuals in terms of health and social gain, health related quality of life and living and adapting to a chronic illness. The diagnosis requires lifestyle changes such as changes to diet, smoking habit, physical activity, and stress management. Aims The aim of this descriptive qualitative study was to explore patients' perspectives of making lifestyle changes following AMI. Methods Using a descriptive qualitative approach, ten participants were interviewed 6 weeks following discharge about their experiences. Data were collected using in depth interviews and analysed using thematic analysis. Research findings Four themes emerged: lifestyle warning signs, taking responsibility for lifestyle changes, professional support and looking forward to the future. The findings offer insight into the everyday realities, which patients experience regarding lifestyle changes particularly in relation to smoking cessation and stress management. The difficulties encountered by participants 6 weeks following discharge reflect the implementation of too many life style changes at once as well as the lack of professional help in the community to support participants in their endeavours to make lifestyle changes. In addition, overprotection by family members was a source of frustration and aggravation for participants. Conclusion The study highlights the need for the development of primary care services and cardiac rehabilitation programmes to support patients as well as providing information to families to reduce anxiety and fear.

A paucity of research is available on patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer. Most research undertaken to date on patients' bowel symptoms following surgery for rectal cancer has been largely atheoretical. The purpose of this paper is to describe the process of choosing a theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer. As a result of a thorough literature review, we determined that the Symptom Management Theory provided the most comprehensive framework to guide our research.

We undertook a genomewide linkage study in a total of 353 affected sib pairs (ASPs) with schizophrenia. Our sample consisted of 179 ASPs from the United Kingdom, 134 from Sweden, and 40 from the United States. We typed 372 microsatellite markers at approximately 10-cM intervals. Our strongest finding was a LOD score of 3.87 on chromosome 10q25.3-q26.3, with positive results being contributed by all three samples and a LOD-1 interval of 15 cM. This finding achieved genomewide significance (P.05), on the basis of simulation studies. We also found two regions, 17p11.2-q25.1 (maximum LOD score [MLS] = 3.35) and 22q11 (MLS = 2.29), in which the evidence for linkage was highly suggestive. Linkage to all of these regions has been supported by other studies. Moreover, we found strong evidence for linkage (genomewide P.02) to 17p11.2-q25.1 in a single pedigree with schizophrenia. In our view, the evidence is now sufficiently compelling to undertake detailed mapping studies of these three regions.

It became apparent in 1998 that there was a significant shortage of nurses and midwives in the Republic of Ireland. Because of the lack of data on the reasons for this, a national study was commissioned to estimate the turnover rate among registered nurses and to identify the underlying reasons for the loss of so many trained staff to the profession. Both quantitative and qualitative methodologies were used. Participants were drawn from 128 health service agencies, and 1,921 questionnaires were completed over a one-year period by nurses and midwives leaving the service. Telephone interviews were also conducted with 140 participants. The results indicate a mean turnover rate of 12%, with considerable variations across services. Reasons for leaving included wanting to pursue other employment in nursing (35%), travel abroad (21%) and a desire to undertake further study (12%). It appeared that a considerable number of nurses would have been retained if retention strategies focusing on promotion of greater autonomy, professional development, managerial support, or improved professional practice environments had been introduced.

Drawings can be used as an important tool to measure children's perception and emotions. Using a qualitative design, we asked a group of 24 school children (10 boys and 14 girls) aged 11-12 to draw their impressions of psychiatrists. In the majority of drawings, psychiatrists were portrayed as a friendly or kind figure. The art work was analysed by the coordinator of the Arts Initiative in Mental Health, Niamh O'Connor. Psychiatrists were portrayed positively by this group of young people. This reflects a strong influence of the media on children's perception.

The purpose of this survey was to improve nursing care of patients with peripheral intravenous catheters (PVCs), focusing on assessment of the PVC site for infection. The survey was conducted in 20 wards by an infection control nurse (ICN), recording data on assessment, site infection and removal/resiting of PVCs. Nursing staff were interviewed on assessment of the PVC site and nursing interventions were recorded. A total of 554 PVCs in 397 patients were surveyed of which 28 (5%) had site infection. There was no related bloodstream infection (BSI). Overall, PVCs were assessed 450 (81%) times by nurses. Malfunction was reported 95 (17%) times, pain 28 (5%) times and pyrexia 10 (2%) times. Characteristics that showed significant difference between 28 infected and 526 non-infected PVCs included when nurses assessed PVCs as infected, and nurses' intervention for PVCs inserted for 1–3 days’ duration. Other characteristics were resiting PVCs when associated with malfunction and also resiting because of pain. The involvement of the ICN was likely to have contributed to the low infection rate. While not conclusive this survey identified characteristics between infected and non-infected PVCs that may have been associated with this low infection rate, namely, nurses’ overall intervention in PVC care and assessment that is focused on identifying infection, and resiting for malfunction and pain. These are simple assessment and intervention measures that should not require the assignment of a dedicated ICN, but which are within the capabilities of all healthcare workers entrusted with PVC care.

This is a case report highlighting the impact of low sodium levels on one’s mental status. For the first time in the literature, we see two discrete episodes of catatonia associated with hyponatraemia occurring in the same patient. On both occasions, his serum sodium levels were depleted; he became profoundly psychotic with catatonic symptoms. Recovery, with complete resolution of all symptoms, was associated with normalisation of these levels. This case exemplifies the profound effect that electrolyte imbalances, in particular sodium depletion can have on a patient’s mental status and is for the first time, we see this effect on two temporally unrelated occasions in the same patient.

IntroductionStudies of the association between blood BDNF levels and delirium are very few and have yielded mixed results.ObjectivesTo investigate the blood BDNF levels in the occurrence and recovery of delirium.MethodsProspective, longitudinal study. Participants were assessed twice weekly with MoCA, DRS-R98, APACHE-II. BDNF levels of the same were estimated with ELISA method. Delirium has been define as per DRS-98R (cut-off > 16) and recovery of delirium as at least two consequently assessments without delirium prior to discharge.ResultsNo differences in the levels of BDNF between those with delirium and those who never developed it. Excluding those who never developed delirium (n = 140), we analysed the effects of BDNF and the other variables on delirium resolution and recovery. Of the 58 remained with delirium in the subsequently observations (max = 8) some of them continue to be delirious until discharge or death (n = 39) while others recovered (n = 19). BDNF levels and MoCA scores were significantly associated with both delirium cases who became non-delirious (resolution) during the assessments and with overall recovery. BDNF (Wald χ2 = 11.652, df: 1 P = .001), for resolution. For recovery Wald χ2 = 7.155; df: 1, P = .007. No significant association was found for the other variables (APACHE-II, history of dementia, age or gender)ConclusionsBDNF do not have a direct effect in the occurrence of delirium but for those delirious of whom the levels are increased during the hospitalisation they are more likely to recover from delirium.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPsychological resilience is defined as an individual's ability to adapt to stress and adversity. People with psychotic illness often experience high levels of distress and difficulties adapting.AimsTo assess the relationship between the resilience of people with psychotic illnesses and their quality of life.MethodologyOutpatients from multiple settings attending Sligo-Leitrim Mental Health Services, aged 18+ years old with a diagnosis of either schizophrenia, bipolar affective disorder or schizoaffective disorder were approached by their treating teams and invited to participate. Other inclusion criteria were having a family member. Drug induced psychoses or no family member were exclusion criteria. The scales used were the Resilience Appraisal Scale and the schizophrenia Quality of Life Scale. This study is part of a larger study looking at family factors and psychosis.ResultsThe study sample was 58 enrolled but only 49 participants completed the 2 assessments, of these 33 were males (67.3%). Data was analysed using SPSS 21. Pearson's correlation coefficient for resilience and quality of life was 0.503, P < 0.001. This shows that higher resilience is associated with better quality of life amongst people with psychotic illnesses. These results could have useful clinical implications. If we can intervene to therapeutically increase resilience, we can eventually improve the quality of life of people with psychoses.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Delirium is associated with poor outcomes. Previous research in delirium and mortality gave rather inconclusive results. This study aims to find out the rates of mortality at 1 year and the factors associated with it in a cohort of hospitalized older patients.Prospective, observational, longitudinal study. All acute medical admissions 70 years of age and above were approached within 72 h of admission. Exclusion criteria are as follows: severe aphasia; intubation; severe sensory problems; and non-English speakers. Patients eligible for inclusion were assessed four times, twice weekly during admission. Delirium was defined using the Confusion Assessment Method.Two hundred patients were recruited. The mean age was 81.13 years (SD = 6.45; minimum 70 and maximum 100 years old), of which 100 (50%) participants were women. One hundred fifty-four (77%) patients never developed delirium during hospitalization. The overall rate of delirium was 23%. A total of 55 (27.5%) patients died during the 1-year follow-up. Although at 1-year follow-up, more people with delirium died (χ(2) = 9.873, df:1, p = 0.002), survival analysis after controlling for other variables showed that mortality was independent of delirium and that severity of illness, longer hospital stay and cognition were significant risk factors for mortality.Although the sample size precludes drawing any definite conclusion, the findings of this study suggest that delirium is not an important risk factor for subsequent mortality. Perhaps delirium and cognitive impairment share common pathophysiological pathways that are related to mortality and in which the currently used methods cannot detect.

Giant cell arteritis (GCA) is pathologically characterized by dysfunctional angiogenesis and inflammatory cell infiltration. Acute-phase serum amyloid A (A-SAA) is an acute-phase reactant, but is also produced at sites of inflammation and may contribute to vascular inflammation in atherosclerosis. This study was undertaken to examine the effect of A-SAA on proinflammatory pathways and angiogenesis in GCA, using a novel ex vivo temporal artery tissue explant model.Serum A-SAA levels were measured by enzyme-linked immunosorbent assay (ELISA). Temporal artery explants and peripheral blood mononuclear cell (PBMC) cultures were established from patients with GCA. Temporal artery explant morphology, viability, and spontaneous release of proinflammatory mediators following 24-hour culture were assessed by hematoxylin and eosin, calcein viability staining, and ELISA. Temporal artery explants and PBMC cultures were stimulated with A-SAA (10 μg/ml), and interleukin-6 (IL-6), IL-8, vascular endothelial growth factor, Ang2, and matrix metalloproteinase 2 (MMP-2)/MMP-9 were quantified by ELISA and gelatin zymography. The effect of conditioned medium from temporal artery explants on angiogenesis was assessed using endothelial cell Matrigel tube-formation assays. Temporal artery explants were also embedded in Matrigel, and myofibroblast outgrowth was assessed.Serum A-SAA levels were significantly higher in GCA patients versus healthy controls (P0.0001). Intact tissue morphology, cell viability, and spontaneous cytokine secretion were demonstrated in temporal artery explants. A-SAA treatment induced a significant increase in the levels of IL-6 and IL-8 from temporal artery explants (P0.05) and IL-8 from PBMCs (P0.05) compared to basal conditions. Conditioned medium from A-SAA-treated explants significantly induced angiogenic tube formation (P0.05 versus basal controls). Finally, A-SAA induced myofibroblast outgrowth and MMP-9 activation.Our findings demonstrate a functional role for A-SAA in regulating temporal artery inflammation, angiogenesis, and invasion, all key processes in the pathogenesis of GCA.

We used a new self-report measure, the Kings Schizotypy Questionnaire (KSQ; Williams, M. The psychometric assessment of schizotypal personality. PhD thesis. Institute of Psychiatry, University of London, 1993), to investigate schizotypy as a quantitative measure of familial liability to schizophrenia. The KSQ was administered to 135 DSM-IV schizophrenia probands, 153 of their healthy first-degree relatives, and 267 control subjects. We found that the questionnaire clearly differentiated schizophrenic from non-schizophrenic individuals, but failed to differentiate the relatives from controls. Possible reasons for this include defensive responding among relatives, self-selection bias among relatives, differences in data collection methods, and the possibility that positive aspects of schizotypy may not be closely related to familial liability to schizophrenia.

Introduction The prevalence of ADHD in adult population has been estimated at 2.5%. Higher rates (23.9%) have been reported among adult mental health service (AMHS) users. Aims To estimate the prevalence of ADHD among adult MH users in west county Ireland. Methods All consecutive patients attending any of 5 Sligo/Leitrim AMHS were invited to participate. Participants completed the Adult ADHD Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS). Clinical notes were reviewed to identify those with preexisting ADHD diagnosis. Exclusion criteria applied were: age: less 18 or above 65, illiterate, non-English speaking patients. Results From 792 attending the clinics, n = 59 (47 aged above 65, 10 severe learning difficulties and 2 non-English speaking) were excluded. Ninety-three (11.7%) decline to participate, giving a total of n = 640 (87% eligible response rate). Mean age was 41.27 (SD: 12.8), and 336 (52.5%) were females. Three had diagnosis of ADHD. Two hundred and thirteen (33.8%) met criteria on the WURS for childhood onset ADHD and 238 (37.5%) participants met caseness on the ASRS. Applying more stringent criteria of scoring on both scales, suggested 125 (19.5%) with unrecognised ADHD. Conclusions While recall bias (WURS) and the possibility of overlapping symptoms with other major psychiatric disorders in adulthood need to be considered, the use of both screening reduces these confounders and suggests a very high rate of ADHD. Given the low number previously identified, this becomes a clinical priority, both to offset the negative trajectories associated with untreated ADHD, but also to effect optimal treatments in comorbid conditions.

Neurobehavioral symptoms are not uncommon after a traumatic brain injury. However, psychiatric syndromes per se have rarely been studied in patients with such an injury. The purpose of this study was to evaluate the type and extent of psychiatric syndromes in patients with traumatic brain injury.One hundred ninety-six hospitalized adults were studied 1 year after a traumatic brain injury with the use of a two-stage psychiatric diagnostic procedure. Psychiatric diagnoses were made according to ICD-10 criteria on the basis of data from the Schedules for Clinical Assessment in Neuropsychiatry interview.Of 164 patients interviewed, 30 (18.3%) had an ICD-10 diagnosis of a psychiatric illness. Among the 120 patients who were 18-64 years old, 21.7% had a psychiatric illness, compared with 16.4% in a study of the general population. A depressive illness was present in 13.9% of the traumatic brain injury patients, compared with 2.1% of the general population, and panic disorder was present in 9.0%, compared with 0.8% of the general population.In comparison with the general population, a higher proportion of adult patients had developed psychiatric illnesses 1 year after a traumatic brain injury; the rates of depressive episode and panic disorder were significantly higher in the study group. A history of psychiatric illness, an unfavorable global outcome according to the Glasgow Outcome Scale, a lower score on the Mini-Mental State examination, and fewer years of formal education seemed to be important risk factors in the development of a psychiatric illness. Compensation claims, however, were not associated with the rate of psychiatric illness.

A recent study has suggested that a polymorphism in the hKCa3 potassium channel may be associated with raised susceptibility to schizophrenia. Despite its modest statistical significance, the study is intriguing for two reasons. First, hKCa3 contains a polymorphic CAG repeat in its coding sequence, with large repeats more common in schizophrenics compared with controls. This is interesting in view of several repeat expansion detection (RED) studies that have reported an excess of large CAG repeats in psychotic probands. Second, the hKCa3 gene is a functional candidate gene because studies of antipsychotic and psychotogenic compounds suggest that glutamatergic systems modulated by SKCa channels may be important in schizophrenia pathogenesis. In the light of the above, we have tested the hypothesis of an association between schizophrenia and the hKCa3 CAG repeat polymorphism using a case control study design. Under the same model of analysis as the earlier study, schizophrenic probands had a higher frequency of alleles with greater than 19 repeats than controls (chi 2 = 2.820, P = 0.047, 1-tail). Our data therefore provide modest support for the hypothesis that polymorphism in the hKCa3 gene may contribute to susceptibility to schizophrenia.

To explore relatives' involvement in the care of older adults admitted to residential settings.A qualitative approach using semi-structured interviews was adopted. Data were analysed using content thematic analysis.Content thematic analysis revealed that participants experienced a change in role when their relatives were admitted to residential care. Three major themes emerged: family involvement, family-centred care, and communication. The importance of communicating with staff was emphasised by relatives.The transition from home to residential care is a challenging time for residents and families. Nurses need to communicate with families and adopt a collaborative, integrated approach to care.

The study sought to assess opinions and attitudes of general practitioners (GPs) in Ireland towards fitness to drive (FTD) assessment in people older than 65 years old as well as to gather information on current assessment practices.A postal-based cross-sectional survey was carried out with 603 GP practices randomly selected using the Irish College of General Practitioners database.Response rate was 42.6%. The prevalence of GPs not confident in assessing FTD was less than 15% with 81% reporting the need for more education on assessing FTD, and 82% identifying that mandatory reporting of unsafe drivers posed a conflict of interest. Only 37% of GPs always/often used the Irish Road Safety Authority handbook when assessing FTD with 14% not aware of its existence. Of responders, 89% were of the opinion that a clinical assessment tool would be of benefit in assessing FTD.Our study highlights the need for education and training for Irish GPs on FTD assessment in the older people patient population.

This study aims to assess whether educational programmes for caregivers of individuals with dementia living in the community are effective on caregiver burden, quality of life (QoL), depression and transitions to long stay care compared with usual care.MEDLINE, EMBASE, PsycINFO, CINAHL, AgeLine, CENTRAL and ERIC were searched with no restrictions on language or publication status in February 2013. Randomised controlled trials (RCTs) were eligible. Participants were informal caregivers undertaking day to day care of an individual with dementia living in the community. Interventions were educational programmes aimed at teaching skills relevant to dementia caring. Two authors independently assessed studies for eligibility, assessed risk of bias and extracted data.We screened 1390 citations and included seven RCTs with 764 participants. Meta-analysis of five trials showed a moderate effect on carer burden (Standardised Mean Difference (SMD) = -0.52; 95% confidence interval (CI) -0.79 to -0.26; I(2) = 40%). Meta-analysis of two trials showed a small effect on depression (SMD = -0.37; 95% CI -0.65 to -0.09; I(2) = 0%). There was no effect on number of transitions to long stay care (relative risk 1.29; 95% CI 0.80 to 2.08). Effect on QoL was not estimable as studies varied in reporting of sub-domains and constructs within scales.Educational programmes have a moderate effect on caregiver burden and a small effect on depression. Evidence of an effect on QoL and transitions to long stay care remains unclear.

Despite the increase in research on delirium, it remains underdiagnosed and difficult to manage, and the outcome is poor especially in older people. To identify the clinically diagnosed rates of delirium, the possible aetiologies, to describe treatment, number and type of psychotropic medication used and to investigate the reasons for referral to a liaison psychiatric team. Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during an 18-month period. One hundred and fifty-six files had a documentation of delirium (time prevalence 2 %). Mean age of the sample was 82 years (SD = 7.2), 66 (42 %) were male. Sixty-nine (44.2 %) of the total sample had a previous history of dementia, and 57 (36.5 %) had a previous history of delirium. In 67 (43.2 %) samples, the cause was infection, while in 4, no specific cause was identified. Ninety (58 %) were referred to the liaison service, but only in 26 (28.9 %), the reason for referral was “acute confusion” or “delirium”. In a majority of referrals, the reason was an affective disorder more often depression. There were no significant differences between delirium subtypes and referrals (χ 2 = 3.868, df 3, p = 0.28). Examination of the amount of antipsychotics prescribed before, during and after delirium shows that there was a significant increase in use during the delirium (χ 2 = 17.512, df 8, p = 0.025) and decrease in z-hypnotics medication (zopiclone/zolpidem), (χ 2 = 20.114, df 4, p

To investigate older people's perceptions of a planned relocation from one long-term care facility in an older building to another modern setting almost 10km away.A qualitative descriptive design was used. Semi-structured interviews were conducted with eight residents. Manifest content analysis was used to analyse the data.Three major themes were identified: information required, desirability and continuity. Emerging subthemes were also described and these included aspects of knowing and relationship issues.By understanding residents' perspectives a more person-centred approach can be taken to reduce the negative impact of the transition from one care setting to another.

Background Depression is the most common mental health problem among young people, particularly university students, with prevalence rates as high as 48% reported. This population however, is reluctant to seek professional help. Online interventions may be particularly appealing to students, with evidence suggesting that they use the Internet for mental health support. While there are many mental health resources on the Internet few focus specifically on the needs of young people and few have been evaluated. This research aimed to develop and pilot test an online peer support intervention for students experiencing depressive symptoms. Methods A depression support Web site ( www.losetheblues.ie ) was designed specifically for 18–24 year old students. The study used a mixed method, involving quantitative descriptive, pre- and post-test and qualitative descriptive designs. Data were collected using the Centre for Epidemiological Studies Depression Scale (CES-D), a background questionnaire and online forum posts. Results The sample consisted of 117 university students with self-reported depressive symptoms. Results from participants in the pre- and post-test element of the study, showed no statistical significance. The forum posts revealed that the participants' main difficulties were loneliness and perceived lack of socialization skills. The Web site provided a place for sharing, offering and receiving emotional and informational support. Conclusion Developing health care interventions in an online environment presents unique challenges to the research process, however they have the potential to provide mental health care that is accessible and affordable.

To explore the role dimensions, competence and professional development needs of practice nurses in Ireland from both the general practitioner's and practice nurse's perspective and highlight any agreement/disagreement between the professions.Economic pressure on healthcare delivery is promoting a re-evaluation of professional roles and boundaries. This coupled with a primary care sector that is evolving prompted an investigation into the role dimensions and competence of the practice nurse. There is a lack of empirical data comparing the general practitioner's and practice nurse's perspective on the current role of the nurse, clinical competence (existing and required), strategic direction for the role and continuing professional development.A descriptive cross-sectional survey design was used.A random sample of general practitioners (n = 414) and a purposeful sample of practice nurses (n = 451) participated. Data from each profession were analysed and comparisons drawn.General practitioners and practice nurses agree (±5%) that the nursing role is centred on immunisation, direct clinical care and elements of chronic disease management. However, in some areas such as preconceptual advice, family planning, advice on menopause, continence promotion and research, there was a 30% difference between the general practitioners perceptions of the nurse's involvement and the practice nurse's actual involvement in the role. Perceived competency differed in a number of areas with nurses more likely to indicate competency in health promotion activities. Both disciplines acknowledged that only a minority of practice nurses were competent in audit, research and dealing with 'problems with living' (relationship breakdown, addiction and parenting).There is some congruence of opinion among practice nurses and general practitioners in Ireland regarding the current role of the practice nurse. Divergent opinions on the nurses' involvement in a particular aspect of the role may be due to the general practitioners underestimating the nurse's involvement in the role. Training is required in the areas of audit, research and 'problems with living'.This research provides data for role clarity and evidence-based role development for practice nurses within the context of evolving primary care services. It also indicates how general practitioners perceive the nursing role.

Background Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids. Objectives This study aims to advance understanding about the contribution facilitation can make to implementing research findings into practice via: extending current knowledge of facilitation as a process for translating research evidence into practice; evaluating the feasibility, effectiveness, and cost-effectiveness of two different models of facilitation in promoting the uptake of research evidence on continence management; assessing the impact of contextual factors on the processes and outcomes of implementation; and implementing a pro-active knowledge transfer and dissemination strategy to diffuse study findings to a wide policy and practice community. Setting and sample Four European countries, each with six long-term nursing care sites (total 24 sites) for people aged 60 years and over with documented urinary incontinence Methods and design Pragmatic randomised controlled trial with three arms (standard dissemination and two different programmes of facilitation), with embedded process and economic evaluation. The primary outcome is compliance with the continence recommendations. Secondary outcomes include proportion of residents with incontinence, incidence of incontinence-related dermatitis, urinary tract infections, and quality of life. Outcomes are assessed at baseline, then at 6, 12, 18, and 24 months after the start of the facilitation interventions. Detailed contextual and process data are collected throughout, using interviews with staff, residents and next of kin, observations, assessment of context using the Alberta Context Tool, and documentary evidence. A realistic evaluation framework is used to develop explanatory theory about what works for whom in what circumstances. Trial registration Current Controlled Trials ISRCTN11598502.

The primary aim of this article is to identify the self-care strategies that patients use to manage bowel symptoms experienced following sphincter-saving surgery for rectal cancer. Comparisons will be made with self-care strategies used by patients to manage chronic fecal incontinence and the bowel symptoms associated with other chronic bowel diseases, such as irritable bowel syndrome and inflammatory bowel disease. Published studies and conceptual literature from 2000-2010 were the data sources. Three major themes emerged from the literature reflecting the self-care strategies used by patients to manage bowel symptoms: functional self-care strategies (e.g., taking medication), social activity-related self-care strategies (e.g., planning social events), and alternative self-care strategies (e.g., complementary therapies). An analysis of studies highlighted that, through the process of trial and error, patients learned the strategies that were most effective in the management of their bowel symptoms. Knowledge of such strategies will be beneficial to healthcare professionals when educating patients about effective management of bowel symptoms following sphincter-saving surgery.

There are more people living with chronic pain than cardiovascular disease and cancer combined. Many people with chronic pain do not seek help from health professionals and suffer in silence for many years. Untreated chronic pain can lead to increased disability, increased risk of fall, depression, sleep deprivation, reduced quality of life and social isolation. The aim of this review is to determine the factors associated with help-seeking for chronic pain in an effort to highlight potential reasons why help may or may not be sought. A total of 23 studies were included in the review. On the whole the review has demonstrated that the most significant demographic and clinical factors associated with help-seeking were increasing age, female gender, pain severity and disability. Psychosocial factors included past help seeking, outcome expectancy, age-related beliefs, social cost and social influence. While the evidence presented appears promising, some conflicting results were found and methodological limitations were noted. Further research needs to examine the underlying determinants of help-seeking behaviour for chronic pain underpinned by theory. The information derived from such research will augment the development of a complex nursing intervention to improve help-seeking for chronic pain.