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Purpose/objectives To investigate sexual self-concept, sexual relationships, and sexual functioning, and the relationship between these and certain demographic variables of Irish women, following a diagnosis of gynecologic cancer. Design Descriptive, correlational. Setting Outpatient gynecologic oncology clinic in a large university hospital in Southern Ireland. Sample 106 women with a diagnosis of and treatment for various gynecologic cancers (cervical, ovarian, endometrial, and vulvar). Methods The Body Image Scale, Sexual Esteem Scale, and Sexual Self-Schema Scale were administered to women a minimum of six weeks postdiagnosis of any form of gynecologic cancer to measure sexual self-concept; the Intimate Relationships Scale to measure sexual relationships; and the Arizona Sexual Experiences Scale to measure sexual functioning. Main research variables Sexual self-concept, body image, sexual esteem, sexual self-schema, sexual relationships, and sexual functioning. Findings Participants reported negative changes in relation to their sexual self-concept, sexual relationships, and sexual functioning. Participants reported negative changes in relation to all stages of the sexual response cycle. Conclusions Gynecologic cancer has the potential to negatively affect a woman's sexual self-concept, sexual relationships, and sexual functioning. Sexuality is a multidimensional construct and must be measured in this way. Implications for nursing Healthcare professionals must use a holistic approach when providing information and support to patients with gynecologic cancer. Information must be provided to women on how cancer and its treatment has the potential to affect their sexual self-concept, sexual relationships, and sexual functioning, including information on how to overcome these alterations.

Purpose of the research The aim of this research was to explore participants’ qualitative perspectives on bowel symptom experiences and management strategies following sphincter saving surgery for rectal cancer. Methods and sample The data presented in this paper were gleaned from a semi-structured question that formed part of a larger multi-site quantitative correlational study. From a sample of 143 participants, a total of 77 (62.6%) males and 46 (37.3%) females provided qualitative comments. Participants were aged 30–70 years and over, had undergone sphincter saving surgery for rectal cancer in the past 3–42 months. Data were analysed using pre-determined semi-structured categories. Key results The study demonstrated the subjective nature of the bowel symptoms experienced. It also highlighted the bowel symptoms that were most problematic and the effect of these symptoms on participants’ daily lives. In addition, the self-care strategies that worked best for individual participants in the management of bowel symptoms were identified. Conclusions There is a need to educate patients on the short-term as well as the long-term bowel symptoms experienced following sphincter saving surgery for rectal cancer. Nurses have an important contribution to make in facilitating patients to choose from a range of self-care strategies to help them manage their bowel symptoms postoperatively.

A genetic association between NOTCH4 and schizophrenia has previously been proposed. Unsing all markers previously shown to be associated, we found no evidence for such in three independent family-based samples (n=519 parent-offspring trios), and a case-control sample derived from the same ethnic background as the original observation. These data strongly suggest that NOTCH4 is not a significant susceptibility allele for schizophrenia.

Aim. This paper presents the first phase of an all Ireland 2-year study between the University of Ulster and University College Cork, to determine the contextual indicators that enable or hinder person centred continence care and management in rehabilitation settings for older people. The primary outcome of the study was the development of a tool to enable practitioners to assess the practice context within which continence care is provided. The main focus of this paper is the value of understanding practice ‘context’ (culture, leadership and evaluation) and its impact to the provision of person centred continence care. Background. The literature highlights the effect of continence problems on the quality of life of older people. Incontinence is often seen by health care professionals and older people as an inevitable consequence of ageing and difficult to treat. Furthermore, health care professionals do not always have the necessary skills and knowledge of best practice in continence care and treatments. The Promoting Action on Research Implementation in Health Services (PARIHS) framework utilized in the study proposes that successful implementation of evidence in practice is dependent on the inter-relationship of three key elements; the nature of the evidence, the quality of the context and expert facilitation. Kitson et al. propose that for successful implementation, evidence needs to be robust, the context receptive to change and appropriate facilitation is needed. Consequently understanding practice ‘context’ and its impact on the provision of person centred continence care is of value. Methods. Case study methodology with several data collection methods was utilized to measure all aspects of ‘context’ as identified by the PARIHS framework. Methods include: Royal College of Physicians Audit Scheme, Staff Knowledge questionnaire, semi-structured observation of practice and multidisciplinary focus groups. Findings. The data were analysed in two stages. Stage 1 using both qualitative and quantitative (SPSS 12) methods. Stage 2 analysed all the data utilizing the characteristics of context from the PARIHS framework in order to identify the strong and weak characteristics of the context within which continence care was provided. Continence care and management in this study was found to be focused on continence containment rather than proactive management. The evidence suggests that the context (leadership, culture and evaluation) was weak and not conducive to person centred continence care and management. Conclusion. An analysis of the data using the context framework provided a picture of the context within the units and the identification of the specific contextual issues hindering and enabling the delivery of person centred continence care. This process has thus, added to our understanding of the importance of context to the provision of person-centred care.

Background. Bladder and bowel incontinence is a major health care problem, which adversely affects the lives of many individuals living at home or in health service facilities. Current approaches to continence care emphasize comfort, safety and reduction of risk, rather than detailed individualized assessment and management. The literature illustrates a gap between evidence and actual practice and emphasizes the context of care as being a key element for successful implementation of evidence based practice. Aims. To identify prevalence of bowel and bladder incontinence and its management, investigate continence knowledge and describe the professional practice environment within a rehabilitation unit for older people. Method. An integrated evaluation of continence prevalence, staff knowledge and the work environment was adopted. Results. Findings revealed a high incidence of incontinence (60% urinary, 3% faecal, 37% mixed) a lack of specific continence assessment and specific rationale for treatment decisions or continuation of care. The focus was on continence containment rather than on proactive management. Staff demonstrated a reasonable knowledge of incontinence causation and treatment as measured by the staff knowledge audit. The evaluation of the work environment indicated a low to moderate perception of control over practice (2.39), autonomy in practice (2.87), nurse doctor relationship (2.67) and organizational support (2.67).

A model of personhood for nursing in Ireland based on Celtic society, Irish language, Irish customs, and the Catholic religion is discussed. Concepts central to the model are presented bilingually as a means of capturing the essence of nursing care in an Irish context. The adequacy of the model is considered from the perspective of the following evaluative criteria: social utility, social congruence, and social significance.

Purpose of the research The aim of the study was to explore women’s Help Seeking Behaviour (HSB) for a self discovered breast symptom, in order to gain understanding of women’s experience of finding a breast symptom and how this influenced their HSB. In addition, the study sought to confirm the appropriateness of the “Help Seeking Behaviour & Influencing Factors” framework, for use in phase two of the study. Methods and sample A qualitative descriptive method was used involving semi-structured interviews with ten women, ranging in age from 25 to 55 years, who had discovered a breast symptom. Key Results Women’s HSB ranged from up to one month ( n = 6), one to three months ( n = 2) and over three months ( n = 2), following symptom discovery. The key variables linked to delayed help seeking were denial, fear, social factors and knowledge and beliefs. The study verified that the variables within the “Help Seeking Behaviour and Influencing Factors” framework act as both facilitators and barriers to women’s HSB. Thus, confirming the appropriateness of this framework for a larger quantitative study of women’s help seeking behaviour. Conclusions The study highlights that despite continued emphasis on early help seeking for breast cancer symptoms, delay is still prevalent amongst women. This reiterates the need for continued emphasis on the message of early detection for breast cancer symptoms. To this end, nurses have a significant role to play in educating women in both clinical and community settings, about breast cancer and early detection practices.

Aim: This is the second of a 2-part literature review, which aims to provide a summary of the research conducted into nurse prescribing and patients’ perspectives, the prescribing practice and benefits of prescribing. Background: Prescriptive authority for nurses was first introduced by America in 1969, followed later by the UK, Canada, New Zealand, Australia and Sweden. A review of research conducted internationally was performed to inform the development of prescribing policies and practice and to guide future research. Method: A number of electronic databases were searched in March 2009 and 155 results were retrieved. Forty-four studies satisfied the criteria for inclusion. Twenty-two of those studies are included in this part of the review. Findings: Sixteen studies reviewed were UK based, four from the USA and just two from Australia. Twentyone of the studies focused solely on primary/secondary care, with just one on the hospital setting alone. Twelve studies incorporated nurse prescribers’ views, while nine elicited patients’ views and one explored the views of the general public and nurse prescribing. Findings of studies relating to patients’ perspectives on prescribing were generally positive but methodologies in these studies were very diverse. Varied and context-specific evidence of the practices of nurse prescribers was presented in studies investigating this aspect of nurse prescribing. Conclusion: This review has demonstrated the diversity of research conducted in the area of patients’ perspectives on nurse prescribing, prescribing practices and benefits of nurse prescribing. It has identified areas that require further investigation which, in turn, will inform the future development of nurse and midwife prescribing.

Background: Prescriptive authority for nurses was first introduced by America in 1969, followed later by the UK, Canada, New Zealand, Australia and Sweden. A review of research conducted internationally was performed to inform the development of prescribing policies and practice and to guide future research. Aims: This article, the first of a 2-part literature review, aims to provide a summary of the research conducted in relation to nurse prescribing and confidence in prescribing, the impact of prescribing on relationships, and education for prescribing. Method: A number of electronic databases were searched in March 2009 and 155 results were retrieved. Forty-four studies satisfied the criteria for inclusion. Twenty-two of these studies are included in this part of the review. Findings: Seventeen studies were UK based, with USA, Australia and Sweden represented by a minority of studies. Seven studies addressed nurse prescribers’ confidence, while eight studies focused on the impact nurse prescribing has on interprofessional relationships. The final seven studies addresses the knowledge base and educational preparation of nurses for the prescribing role. Conclusion: This review has demonstrated the diversity of research conducted in the area of confidence in prescribing, interprofessional relationships and education. It has identified areas which require further investigation, which will inform the future development of nurse and midwife prescribing.

Psychologic variables such as attitudes and beliefs may account for patients choosing not to seek treatment for pain; however, there is a dearth of empirical research to support this contention. The aim of this study was to explore the help-seeking behavior, individual characteristics, attitudes, and beliefs of older adults with chronic pain in an Irish community setting. A descriptive correlational design was used. A convenience sample of 72 older adults with chronic pain were recruited through two primary care practices. The research instruments used were a demographic questionnaire, the Level of Expressed Need Questionnaire, which measured help-seeking behavior, the Pain Attitudes Questionnaire, and the Pain Beliefs Questionnaire. Results revealed that individual characteristics associated with help-seeking behavior were female gender, increasing age, higher education, living alone, and severe pain. High levels of stoicism were reported, indicating that participants were more likely to believe they had superior pain control and courage in the face of pain and were not willing to disclose their pain to others. These attitudes were significantly associated with lower levels of expressed need for treatment. Participants had moderate age-related beliefs about the origin of pain, but those who believed pain had an organic cause were more likely to seek help.

Postnatal depression (PND) is a significant public health issue, with variable prevalence and a dearth of research on risk and protective factors. This quantitative longitudinal study of 512 first-time mothers identified the prevalence of PND and examined the relationships between functional and structural social support at 6 and 12 weeks postpartum. The prevalence of PND was 13.2% at 6 weeks and 9.8% at 12 weeks. At 6 and 12 weeks, the only social support dimension independently associated with PND was total functional social support. At-birth formal structural support and emotional functional support were independently predictive of PND at 12 weeks.

Summary Aim To describe the lived experience of family members of patients in the intensive care unit. Background Admission of a critically ill relative to an intensive care unit causes anxiety and stress to family members. Nursing care is initially focused on maintaining the physiological stability of the patient and less on the needs and concerns of family members. Understanding how families make sense of this experience may help nurses focus on the delivery of family centred care. Methodology A phenomenological method was used to describe the lived experiences of family members of patients in an intensive care unit. In-depth interviews were conducted with six family members and analysed using qualitative thematic analysis. Results Four main themes emerged from the data: the need to know, making sense of it all, being there with them and caring and support. Family members needed honest information about the patient's progress and outcome to make the situation more bearable for them. Making sense of the situation was a continuous process which involved tracking and evaluating care given. Being with their relative sustained their family bond and was a way to demonstrate love and support. Caring reassurance provided by the nurses enabled a sense of security. Support was needed by family members to assist them in coping. Conclusion The research provided an insight into how family members viewed the impact of the admission and how they subsequently found ways of dealing with the situation. Relevance to clinical practice Using a holistic approach to nursing assessment and care delivery in intensive care necessitates that nurses interact with and care for family members of patients. Development of a philosophy of family centred care is necessary, with formal assessment of families to take place soon after admission and an appropriate plan of care drawn up at this time.

End stage renal disease and renal replacement therapies predispose individuals to a multitude of unwanted symptoms. Fatigue is one of the most frequently reported and disruptive symptoms experienced by patients with ESRD. Living with fatigue places added burdens on individuals and can impact negatively on quality of life. Nephrology nurses must ensure that patients'fatigue is managed effectively. Researching interventions to reduce fatigue among patients with ESRD should therefore become a priority. This article provides a review of research on the symptom of fatigue in individuals living with ESRD.

Aim: The aim of this paper is to present the strategies used in one newly established university School of Nursing and Midwifery in Southern Ireland to develop research capacity. Background: The case study was guided by an agreed strategic plan which included changing the research culture; providing focused and appropriate research training; mentoring of junior staff, employment of an external consultant; provision of funding for PhD progression; and institutional support at all levels. Conclusion: Success is profiled in relation to establishment of research themes, publications, research funding awarded, and numbers of students registered for PhDs. Challenges in further improving research productivity are also discussed.

IntroductionA family “constructs” an identity of its own derived from their assumptions about relationships and the social environment they live in. This identity transcends the individual while at the same time encourages individual differentiation. Family functioning is influenced from different factors like social context, qualitative characteristics, and from individual's medical or psychiatric condition.Aims and objectivesTo examined the effects of sociodemographic factors and individual psychopathology on the function of family in a non-clinical sample.MethodsCross-sectional study of participants and their families. The follow data collected:–demographics (age, gender, occupation, education);–description of the family (number of members, single parents family, adoption);–history of mental or physical illnesses;–Family Assessment Device (FAD);–Symptom Checklist-90 (SCL-90).ResultsThe sample constituted of 151 families, (453 individuals), in 48 families, 2 family members participated, in 56 families, 3 members participated, in 46 families 4 members participated and 1 family had 5 members participating. One hundred ninety-four (42.8%) were children and 259 (57.2%) were parents. The mean age of the children was 23.62 (SD: 6.35) and 68 (35%) were males. Mean age of the parents was 51.4 (SD: 8.2) and 117 (45.2%) were males. SCL-90 identified 183 participants as caseness. Multilevel analysis showed that individual psychopathology (caseness) was the only statistical significant factor for family dysfunctioning.ConclusionThere is strong association between family dysfunction and psychopathology of a member. Dysfunctional families need further psychiatric evaluation of the members. Cause-effect cannot be concluded from this cross-sectional study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe Family Assessment Device (FAD) is a self-report questionnaire, developed to assess the six dimensions of the McMaster Model of family functioning. It has been translated to the Greek language but never validated.Aims and objectivesTo evaluate the psychometric properties of the Greek version of FAD in a non-clinical sample.MethodsIn a sample of Greek families, FAD was administered together with the already validated Family Adaptability and Cohesion Evaluation Scale (FACES-III). In a subsample of 96 participants, the scales were administered again after 1 month.ResultsA sample of 453 participants (194 children and 259 parents) had completed both questionnaires (151 families). Mean age of children was 23.62 (SD: 6.35), 68 (35%) were males. Mean age of parents was 51.4 (SD: 8.2), 117 (45.2%) males. All subscales of FAD had significant correlation (concurrent validity) with FACES-III (n = 453, P < 0.001). Test-retest reliability range from 0.58 to 0.82 (n = 96, P < 0.001). Internal consistency (Cronbach's alpha) range from 0.47 to 0.94. A model with the 6 factors had a good statistical fit but not all the items were loading in the same components as from the theory assumed.ConclusionsThe Greek FAD has good psychometric properties, although its factor structure might differ from the original version. Further evaluation of the Greek version of FAD in other settings and in different samples especially clinical remains a task for future research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionTraditionally psychomotor subtypes have been investigated in patients with delirium in different settings and it has been found that those with hypoactive type is the largest proportion, often missed and with the worst outcomes.Aims and objectivesWe examined the psychomotor subtypes in an older age inpatients population, the effects that observed clinical variables have on psychomotor subtypes and their association with one year mortality.MethodsProspective study. Participants were assessed using the scales CAM, APACHE II, MoCA, Barthel Index and DRS-R98. Pre-existing dementia was diagnosed according to DSM-IV criteria. Psychomotor subtypes were evaluated using the two relevant items of DRS-R98. Mortality rates were investigated one year after admission day.ResultsThe sample consisted of 200 participants [mean age 81.1 ± 6.5; 50% female; pre-existing cognitive impairment in 126 (63%)]. Thirty-four (17%) were identified with delirium (CAM+). Motor subtypes of the entire sample was: none: 119 (59.5%), hypo: 37 (18.5%), mixed: 15 (7.5%) and hyper: 29 (14.5%). Hypoactive and mixed subtype were significantly more frequent to delirious patients than to those without delirium, and none subtype more often to those without delirium. There was no difference in the hyperactive subtype between those with and without delirium. Hypoactive subtype was significant associated with delirium and lower scores in MoCA (cognition), while mixed was associated mainly with delirium. Predictors for one-year mortality were lower MoCA scores and severity of illness.ConclusionsPsychomotor disturbances are not unique to delirium. Hypoactivity, this “silent epidemic” is also part of a deteriorated cognition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionNowadays “reflection” and “reflective practice” is nearly in every curriculum for psychiatric training. Trainees are asked to keep reflection diaries, journals, and participate in “reflection workshops”.AimsTo prove that reflection on or in action does not lead to learning.MethodsUsing epistemological notation.Results/proofsBecause sciences including psychiatry are approximate, evolving and inexact, the classical definition of propositional knowledge becomes: A knows that p if:– (a’) A believes that p is an approximate true;– (b’) p is approximate truth;– (c’) A has reason to claim that p is a better approximation than its rivals on available evidence.Condition (c’) implies that A is not possible at the same time to have two mutually contradictive approximate truths.In reflective learning we need to add two more conditions:– (d’) A knows the outcome of p;– (e’) A is satisfied in believing that p.In cases of reflection in-action, the (e’) remains even the outcome is not favourable. Similarly, in reflection on-action the condition (e’) remains unchanged since this happened in the past. This leads to controversy. Is p better or worse approximation of truth than its’ rival p’? However, p has passed rigorous and different scientific tests and has proved scientifically superior to its rival p’. Therefore subject A cannot change his knowledge despite the unfavourable outcome, but A can tests further the p. Within the former reflecting learning does not occur, within the latter “critical thinking” occurred.ConclusionsReflection does not lead to learning but critical thinking does.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionResearch has shown that approximately 67% of carers experience extreme mental tiredness, a decrease in their quality of life and a deterioration in their physical health since taking on a care-giving role.Aims and objectivesThis study aims to identify factors that influence carer burden and in doing so, identify the sub-populations of carers who are most susceptible to burden.MethodsIn northwest Ireland, 53 informal carers referred to the Carers Association, Sligo were contacted and met for a face-to-face interview. Measurements used included demographic data, the Neuropsychiatric Inventory, Zarit Burden Interview, Social Network Index and Brown's Locus of Control Scale.ResultsOf the 53 carers, 43 were females and 10 males (age range: 32–81 years, mean age of 64.5 years). Of the corresponding 53 patients, 21 were females and 32 males (age range: 17–92 years, mean age of 72.1 years). Multiple linear regression analysis showed that sex of carer, marital status and the patient's behavioural problems were statistically significant independent factors, which influenced carer burden (p < 0.01). Female sex and greater patient behavioural problems increased susceptibility to burden and being married increased resilience towards burden.ConclusionsThe ability to predict which carers are more susceptible to burden allows physicians to more quickly identify “higher risk” carers, facilitating routine check-ups by physicians and carer support services. Further research should explore why female and unmarried carers are more susceptible to burden and whether it is possible to tailor support services to their individual needs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionOutcome measurements in mental health services is beneficial in allowing healthcare providers in determining the effectiveness of their treatment plan. Health of the Nation Outcome Scale (HoNOS) and Global Assessment of Functioning (GAF) are two well-established instruments to measure patients’ outcome.Aims and objectivesTo measure the correlation of these two scales, and the feasibility of HoNOS.MethodsProspective longitudinal study of psychiatric outpatients attending a clinic in Sligo. Patients were assessed using HoNOS and GAF by trained doctors during the consultation. Feedback from doctors using HoNOS during the research was taken as a measure for feasibility.ResultsTotal of 441 HoNOS and 237 GAF completed on 280 patients (53.2% female, mean age 46.23; SD = 14.89). The correlation between HoNOS and GAF was (r = –0.696, P < 0.001). In reassessment, we found significant reduction in HoNOS score when comparing the first assessment with the second (t = 4.590, df = 110, P < 0.01) and the third (t = 2.876, df = 37, P < 0.01). Using a linear mixed-effects model, it was found that patients with diagnosis of schizophrenia, mood affective disorder, neurotic disorder, personality disorder and younger in age are more likely to improve during the follow-up compared to those with organic mental disorders, alcohol related problems and older age.ConclusionsHoNOS is a feasible scale and can be potentially used as an outcome measurement in the mental health services. Can help in deciding better management plan for patient and improvement of the service. HoNOs can also be used for comparison of outcomes between services in national and international level.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionBoth MMSE and MoCA are two widely used cognitive screening test. Comparison of the two tests has been done in specific populations (Parkinson) but not in general elderly psychiatric populations. In research, equating methodologies has been used to compare results among studies that use different scales, which measure the same construct.AimsTo explore their level of agreement within a particular clinical setting.Objectives(a) To find MoCA and MMSE agreement. (b) To derive a conversion formula between the two scales and test it in a random population of similar setting.MethodsProspective study of consecutive community dwelling older patients who attend outpatient clinic or day hospital. Both tests were administered from the same researcher the same day in random order.ResultsThe total sample (n = 135) was randomly divided in two. One from where the equating rule derived (n = 70) and a second (n = 65) in which the derived conversion was tested. Agreement of the two scales (Pearson's r) 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, we convert the MoCA scores to MMSE scores according to equating rule from the first sample and after we examined the agreement between the converted MMSE scores and the originals. The Pearson's r was 0.89 (n = 65, P < 0.001) and the CCC 0.88 (95% CI 0.82–0.92).ConclusionsAlthough the two scales overlap considerably, the agreement is modest. The conversion rule derived showed promising accuracy in this population but need further testing in other populations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

This article presents an overview of research on postnatal depression conducted with postnatal women only. Research spanning three areas is reviewed, namely, prevalence, mothers' experiences ,and treatments. The review shows prevalence rates varying from 4.4% to 73.7%, with the most recent systematic review suggesting a rate of 13%, indicating a serious clinical issue for nurses providing postnatal care to mothers. Mothers' experiences of living with postnatal depression exemplify such feelings as loneliness, anxiety, hopelessness, and loss of control at a time when expectations of joyousness are anticipated. Results of research on treatment options show limited success with antidepressant medications, some success with psychotherapeutic options, and the importance of social support for mothers with postnatal depression. Comparisons of studies are made from methodological perspectives, drawing on their strengths and limitations. Overall, this review highlights the high prevalence rates of postnatal depression, negative feelings exemplified by mothers' living with this condition, and the limited success of treatment options available to mothers. Postnatal depression is a significant clinical issue for nurses providing postnatal care for mothers and is underassessed, misunderstood, and very often poorly treated.

Non-adherence to medications is a prevalent and persistent healthcare problem, particularly for patients with a chronic disorder. Researchers have endeavoured to address poor adherence for the past five decades resulting in the accumulation of a vast body of literature. Despite the enormity of research conducted, interventions to date have neither been cost-effective nor predictably clinically effective in enhancing medication adherence. Though concerning, such contemporary information serves to refocus attention on the adequacy of knowledge regarding the factors influencing medication non-adherence. Although little consensus exists regarding the optimal categorisation of these influencing factors, increasingly, the broad and 'all encompassing' categorisation of intentional and unintentional factors is being used to account for patient medication-taking behaviours and actions. An extensive review of the related literature provides the basis for a critical discussion on the value and comprehensiveness of this current classification in guiding future adherence research and consequent clinical interventions. An appraisal of this categorisation is important if decisions regarding interventions are not to be made in a vacuum of insufficient understanding, which would result in the continued ineffective use and distribution of valuable resources to combat non-adherence.

Background: Schizophrenia shows substantial clinical heterogeneity. One common important clinical variable in presentation is the occurrence of episodes of major depression. Methods: We undertook analyses in an attempt to detect loci that influence susceptibility to, or modify the clinical expression of, schizophrenia according to the occurrence of episodes of major depression. We used a logistic regression framework in which lifetime presence/absence of major depression was entered as a covariate in the linkage analysis of our UK schizophrenia affected sibling pair series (168 affected sibling pairs typed for a 10 cM map of microsatellite markers). Results: Inclusion of presence/absence of depression as a covariate detected a genome wide significant linkage signal on chromosome 4q28.3 at 130.7 cM (LOD = 4.59; p = 0.038; increase in maximum LOD over univariate analysis (ILOD) = 3.62). Inclusion of the depression covariate also showed suggestive evidence of linkage on 20q11.21 (LOD = 4.10; expected to occur by chance 0.093 times per genome scan, ILOD = 2.83). Conclusions: Our findings identify loci that may harbour genes that play a role in susceptibility to, or modify the risk of, episodes of major depression in people with schizophrenia.

Some studies have reported associations between COMT and MAO genotypes and aggression, though results have been inconsistent. We examined the relationship between Overt aggression scale (OAS) scores, and both MAOA and MAOB polymorphisms in a well-powered sample of 346 subjects with schizophrenia. We also examined COMT in a Stage II replication sample of 150 individuals, and combined these results with our previously reported (Stage I) findings for COMT. We found no evidence of any associations between OAS ratings and any of the polymorphisms investigated under different genetic models. There was no evidence of epistatic interaction between MAOA and COMT on OAS scores. These results fail to support the theory that functional polymorphisms within the MAOA, MAOB, or COMT genes, as determinants of catecholamine enzymatic activity, are risk factors for aggressive behavior.

The aim of this research was to identify needs, perceptions and experiences of first-time mothers in the postnatal period. Data were collected through focus groups and in-depth interviews from a sample of 13 women, 61% were aged 20 years or less, from an urban city area in Southern Ireland. Through content analysis, key themes were identified relating to birth and hospitalization, support, motherhood and psychological issues. Attendance at antenatal classes was variable and perceptions of being unprepared for birth and motherhood prevailed. Participants appeared shocked at the amount of pain experienced during birth and had little rest during hospitalization. They received physical and emotional support and preparation for childcare from midwives. Breastfeeding, while promoted, by midwives was not acceptable. The 'maternal mother' was key in providing direct childcare, advice and emotional help, support for attendance at school and 'time out' to socialize. Support was reciprocal if the maternal mother had young children. Professional support by public health nurses was well-established. However, emphasis was perceived to be on 'baby's development'. Maternal depression, loneliness, living in homes with limited space and difficulty in 'letting go' of baby care to return to school or work were reported. Implications for antenatal preparation, national policies, motherhood, and the need for further research are discussed.

Introduction Delirium is a common neuropsychiatric disorder. The natural course is of an acute, fluctuating and often transient condition; however, accumulating evidence suggests delirium can be associated with incomplete recovery. Despite the growing body of relevant research, a lack of clarity exists regarding definition and outcomes. Objectives To clarify the definition of recovery of delirium used in the literature. Methods A Medline search was performed using relevant keywords. Studies were included if they were in English, provided any definition of recovery, and were longitudinal. Excluded articles were duplicated studies, case studies, review articles or articles related to alcohol, children, subsyndromal delirium only or those investigating core symptoms such as function. Results Fifty-six studies met the inclusion criteria. Only 2 studies used clinical criteria alone for the diagnosis of delirium, most studies used at least one validated scale, either categorical or continuous severity scales. A variety of 16 different terms were used to define the 'recovery of delirium”. The definitions of each term also varied. Studies using severity scales used either cut-off points or percentage reduction between assessments while others using dichotomous scales (yes/ no) defined as recovery one or more days of negative delirium as the end point. Conclusions An agreed terminology to define recovery in delirium is required. A distinction should also be made between symptomatic and overall recovery as well as between long and short term outcomes. It is proposed that cognition recovery may be used as outcome to identify recovery of delirium.

Introduction The role of APOE in Alzheimer’s disease and other dementias has been intensively investigated. However APOE in delirium has only recently been investigated in studies with small samples. There is evidence that APOE relates to delirium by one or more of the following pathophysiological mechanism: a) inhibition of inflammation in the CNS during acute illness, with release of inflammatory mediators, b) modification of inflammatory responses in an isoform-specific manner, c) by blocking both nicotine and acetylcholine receptors causing the anticholinergic effect which is assumed in delirium. Objectives A meta-analysis of the published pooled data seems timely to establish any relationship between APOE and delirium, and to determine further direction of research in this topic. Aims To find out if there is any direct relationship between the APOE epsilon 4 and the occurrence of delirium. Methods Pubmed, MEDLINE, EBSCOhost and Google Scholar have been searched with the relevant keywords, and from the references of relevant papers. Nine papers were found which examined the relationship between APOE and delirium. Data were extracted from 8 of them and were pooled for meta-analysis using random effects with R software. Results Data from 1762 participants showed no heterogeneity (Q=13.55, df:7, p=0.06). The possession of the APOE epsilon 4 allele has a small (OR:1.17, CI:0.77-1.80), non-significant (p=0.45) effect in the presence of delirium. Conclusions There is no association between APOE and the occurrence of delirium. Confirmation and clarification in larger studies could have important clinical implications for predicting prognosis and for treatment of delirium.

Introduction Delirium is associated with poor outcomes and high mortality. Current research shows conflicting results regarding mortality rates in patients with delirium. Aims The aim was to examine the hazard risk associated with delirium in elderly medically ill patients at 1 year follow-up, controlling for baseline risk factors and interaction effects. Methods This was a prospective, observational, longitudinal study carried out in the medical wards of Sligo Regional Hospital. All acute medical admissions of patients 70 years old and over were approached. Each patient was assessed twice weekly for 2 weeks or until discharge. The following scales were used: CAM, DRS-98R, MoCA, Barthel Index, APACHE II. Primary outcome was time of death during 1 year. Cox proportional hazards were estimated and compared across patients who had delirium during hospitalisation and those who did not. Results Two hundred patients agreed to take part in the study. The mean age of the studied sample was 81.13 (SD = 6.45; minimum 70 and maximum 100 years old) with 100 (50%) females. One hundred fifty four (77%) patients never developed delirium during hospitalization. Thirty four (17%) had delirium at admission and 12 (6%) developed prevalence delirium while inpatients. A total of 55 (27.5%) patients died during the one year follow-up. Significant risk factors for 1 year mortality were length of hospital staying, severity of illness (APACHE II), and cognition (MoCA). Conclusions Delirium was not found as an independent risk factor for 1 year mortality after controlling for other confounder variables.

Introduction Siblings’ relationships have been seen as determinants of emotional and personal development. Although Greece is assumed a country with strong family bonds there is not empirical research in this area. Similarly Ireland is traditionally viewed as a country with strong family values. Objectives In an attempt to conduct a comparative study of siblings’ relations the lack of a Greek valid instrument was obvious. The Sibling Relationship Questionnaire (SRQ) is a widely used scale which is a self reported measurement of this relationship. Aims Thus, in an attempt to employ an easily administered and valid measure, to assess sibling relationships, but also to be able to compare the results across countries the SRQ was the scale of choice. Methods Participants a random sample of 185 adolescents aged 13 to 18 years old. SRQ has been translated (forward and backwards) to Greek language. Concurrent validity, internal consistency, test-retest reliability and agreement between children-parents versions of the translated scale were investigated. Results The concurrent validity ranged from 0.29 to 0.68, the overall internal consistency (Cronbach's alpha) was equal to 0.86 and the test-retest reliability (Spearman's rho) ranged from 0.58 to 0.78. Agreement between children-parents versions was significant only when mothers do the rating. Conclusions Thus it seems that the translated Greek version of SRQ is a valid and reliable instrument to be used in the measurement of sibling relationships in Greek population, and can be used as a measurement for multinational clinical research and comparison with findings from other countries.

Introduction The recent DSM-5 criteria for delirium can lead to different rates of delirium and different case identification. Aims The aims of this study were to determine how the new DSM-5 criteria might differ from the previous DSM-IV in detecting rates of delirium in elderly medical inpatients and to investigate the agreement between different methods, including the DSM III, DSM III-R, DSM-IV and DSM-5 criteria. Methods Prospective, observational study of elderly patients aged 70+ admitted under the acute medical teams in a regional general hospital. Each participant was assessed within 3 days using the DSM-5, and DSM-IV criteria plus the DRS-R98, CAM and MoCA scales. Results The studied sample included 200 patients. The prevalence rates of delirium for each diagnostic system/scale were respectively for DSM-5 n=26 (13.0%), DSM-IV n=39 (19.5%), DRS-R98 n=27 (13.5%) and for CAM n=34 (17.0%). Using tetrachoric correlation coefficients the agreement between DSM-5 and DSM-IV was statistically significant (rho tetr =0.64, SE= 0.1, p Conclusions DSM-IV identifies more delirium cases compared to any other method and DSM-5 is the more restrictive. These classification systems identify different cases of delirium. This could have clinical, financial and research implications. However, both classification systems (and their antecedents) have significant agreement in the identification of the same concept (delirium). Clarity of diagnosis is required for classification but also has implications for prediction of outcomes, further research looking at outcomes could assist a more in depth evaluation of the DSM-5 criteria.

BackgroundEvidence exists for an association between aggression and schizophrenia. Although the aetiology of aggression is multifactorial, three studies have reported associations between polymorphisms of the catechol-O-methyltransferase (COMT) gene and aggression in schizophrenia.AimsTo replicate these findings in a larger sample using the Overt Aggression Scale (OAS).MethodA sample of 180 people with DSM–IV schizophrenia were rated for aggression using the OAS. Kruskal–Wallis and contingency table analyses were applied to the OAS results.ResultsThe high-activity homozygotes showed significantly higher scores of aggression, whereas the heterozygotes showed significantly lower scores. The odds ratio for aggression for the high-activity homozygotes was 2.07 (95% Cl=1.03–4.15), whereas that for the heterozygotes was 0.54 (95% CI=0. 30–1.00).ConclusionsThe high-activity COMT homozygote confers a higher risk of recorded aggression in schizophrenia. Heterozygotes had a significantly lower risk, which may represent an example of heterosis/heterozygote advantage.

For some time microcalcifications associated with breast lesions were considered to represent an epiphomenon, useful only as a radiological indicator of breast carcinoma. However, the data presented here shows that HA crystals are capable of exerting significant biological effects on surrounding cells. In this study we report that HA increases mitogenesis in both normal and malignant mammary cell lines. Particles of latex beads, of similar size and concentration to HA crystals, had no effect on mitogenesis. We have also shown that HA crystals stimulate mitogenesis of quiescent mammary cell lines in a concentration dependent fashion. HA crystals enhance the production of a variety of MMPs in normal and breast cancer cell lines alone or in co-culture. In addition our results suggest that exposure to HA crystals can cause a significant increase in PGE2 by induction of COX, which appears to be a critical factor in regulating the mitogenesis of those cells. Immunohistochemical staining of breast biopsies however did not show enhanced expression of MMP-1 or MMP-9 localised around the calcifications. COX-2 staining was occasionally upregulated in the proximity of a calcification and this finding warrants further study. Characterisation of the calcifications in the biopsies is necessary to help explain these finding. The data generated with the aid of this award supports our hypothesis that HA crystals may contribute to breast cancer progression by amplifying the pathological processes surrounding a lesion and underlie the importance of further studies of the pathological potential of microcalcifications consisting of HA crystals in breast oncology.

Neurotensin (NT) is an endogenous tridecapetide1 cleaved from a precursor proneurotensin/ proneuromedin protein. NT localises within dopaminergic neurones in the mesocortical, mesolimbic and nigrostriatal systems1-3 and it is now clear that NT can selectively modulate dopaminergic neurotransmission.2-9 These anatomical and functional connections have led to the hypothesis that NT dysfunction might contribute to the pathogenesis of neuropsychiatric disorders in which disordered dopaminergic neurotransmission is suspected, particularly schizophrenia.3 The latter hypothesis has been supported circumstantially by the observation that central administration of NT produces effects similar to those produced by the peripheral administration of atypical antipsychotics,10,11 and more directly by studies showing levels of NT in cerebral spinal fluid (CSF) is lower in schizophrenics than in controls.12,13 To allow such hypotheses to be tested, we used denaturing high performance liquid chromatography (DHPLC)14 to identify three sequence variants in the neurotensin gene (NTS) that might alter NT structure or expression. However, using a case-control study design and a novel genotyping system based upon a primer extension protocol and HPLC detection,15 we found no evidence to support the hypothesis that variation in the proneurotensin gene contributes to susceptibility to schizophrenia.

BACKGROUND: Long CAG repeats in the hKCa3 potassium channel gene have been associated with schizophrenia. We sought evidence for associations between this polymorphism and aspects of the schizophrenia phenotype. METHODS: Associations were investigated between CAG repeat length and gender, age of illness onset, and psychotic symptom dimensions in 203 unrelated individuals with DSM-IIIR schizophrenia. RESULTS: No association was found between CAG repeat length and gender or age of onset. Long CAG repeats were associated with higher negative symptom dimension scores. CONCLUSIONS: This study provides preliminary evidence that genetic liability to negative symptoms in schizophrenia may be partly mediated through the hKCa3 gene.

Introduction/Objectives Cognitive impairment during acute illness in older patients is acknowledged, although factors that underpin this condition are less well studied. Aims To investigated the relationship between cognitive recovery and a range of clinical and biological variables. Method Observational and longitudinal study. Participants were consecutive patients aged ≥70 years assessed within 3 days of their admission to elderly medical unit and re-assessed twice weekly with the DRS, CAM, MMSE, APACHE II, APS, Barthel index, frailty scale. Cytokines and APOE genotype were measured in a subsample. Results 142 patients were analysed [mean age 84.8±6.4; 47 (33%) male; 64, (45% with comorbid dementia]. 55 (39%) experienced cognitive improvement, of which 30 (54.5%) had delirium while 25 had non-delirious acute cognitive disorder. Using bivariate statistics, subjects with more severe acute illness, lower IGF-I levels and more severe delirium were more likely to experience ≥ 20% improvement in MMSE scores. When the criterion of cognitive improvement was a 3 point improvement in MMSE, those with more severe delirium, females and greater age were more likely to improve. Longitudinal analysis using any criterion of improvement indicated that improvement was significantly (p Conclusions Cognitive recovery during admission is not exclusively linked to delirium status, but reflects a range of factors. The character and relevance of non-delirious acute cognitive disorder warrants further study

Introduction The new version of DSM-5 provides nearly the same criteria as DSM-IV for delirium with an exception. The DSM-5 requires a disturbance in awareness while DSM-IV, a disturbance in consciousness. Objectives/ Aims Awareness is not the same as consciousness. In this study we examined the concordances between awareness and consciousness and the agreement between DSM-5 and DSM-IV. Methods All acute medical admissions 70 years and over. Exclusion criteria: terminal phase of illness, severe aphasia, intubated. Those included were assessed on Day 1, 3, 7, 10 of their admission. During the assessment each individual was tested with: MoCA, DRS-98R, CAM, RASS and the subscale of levels of consciousness and awareness of surroundings from RCDS; APACHE II, CAPE and BARTHEL index. Demographic data and a medication list were also recorded. Results 123 participants; Mean age: 81.3 SD (6.7) range 70-100 years old Females 60(48.9%) Delirium according CAM 21 (17.1%) Delirium 23 (18.7%) Subsyndromal delirium 28 (22.8%) No delirium 72 (58.5%) Previous cognitive decline: 76 (61.8%) RCDS (awareness and consciousness) Mean awareness: 0.4, SD (0.8) Mean consciousness 0.4 SD (0.8). Correlation (agreement) between awareness and consciousness Kendal's Tau =260, p=0.026 Using the awareness definition of delirium 8 participants with full awareness of surroundings have been indentified as delirious according to DRS 98, while using the consciousness definition 12 participants where indentify as delirious. Conclusion DSM-IV and DSM-5 detect two slightly distinct populations with delirium. Awareness and consciousness are not the same. DSM-5 is more restrictive in indentifying delirium.

Introduction Despite the increase of research and awareness in delirium it remains underdiagnosed, protean, difficult to manager and more difficult to comprehend. Objectives/Aims To find the clinical diagnosed rates of delirium, the possible aetiologies to describe treatment (psychotropics) and to investigate the reasons of referrals to Old age psychiatric team in relation to delirium in a general medical hospital. Methods Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during a 6 month time Results 156 files had a documentation of delirium (time prevalence 2%). Mean age of the sample was 82 years old (SD=7.2), 66 (42%) were male. 69 (44.2%) of the total sample had a previous history of dementia, 57 (36.5%) had a previous history of delirium. In 62 (40%) the cause was infection while in 4 no specific cause was indentified. 90 (58%) referred to liaison service but only in the 26 (28.9%) the reason for referral was’acute confusion’ or’delirium’ while in a majority of referrals the reason was one of the affective disorders and more often depression. There were not any significant differences between delirium subtypes and referrals (χ2=3.868, df:3, p=0.28). Examination of the amount of antipsychotics prescribed pre during and after delirium shows that there was a significant increase of antipsychotics during the delirium (χ2=17.512, df:8, p=0.025) decrease of z-medication, (χ2=20.114, df:4, p Conclusions Delirium is often misdiagnosed and unrecognized in hospital settings, however when is indentified the pharmacological management is rather optimal

Introduction Hyponatraemia is an important medical condition, relevant to all practitioners working in old age psychiatry. This has important clinical implications to ensure patients commenced on antidepressant medication are monitored for electrolyte imbalance. Aims & objectives To identify the incidence and key features of cases of hyponatraemia in consecutive referrals to a rural community Psychiatry of Old Age service (population 18,000 over 65) Methodology Naturalistic study design, routine referrals to the service were reviewed between 1/4/10 to 30/9/2011 and considered for inclusion. All hyponatraemia cases were identified and recorded at the MDT meeting. Clinical case notes and/or correspondence reviewed, data collected on demographics, psychiatric, medical diagnoses, psychotropic and general medication. Results 796 referrals reviewed, 22 cases of hyponatraemia identified, (2.8%), 15 case notes available for review, 4 review letters (include key information required), 3 casenotes were missing and 2 did not meet inclusion criteria as outside the period of study. Of the 17 included (12 female, 5 male), mean age was 82.1, all widowed/ single, 94% diagnosis of depression, 5 dual diagnoses, Mean MMSE 26/30. 100% on psychotropic medication, (87% antidepressants, 58% SSRI's). Mean medication number was 9. 6/17 (35%) cases of hyponatraemia were judged to be directly related to SSRI medication. Conclusion Hyponatraemia is an important clinical outcome that should be looked for in vulnerable populations with complex medical and psychiatric morbidity. Although many potential causes for hyponatraemia, SSRI antidepressants should be monitored with regular electrolytes in at risk patients (older age, polypharmacy, medical co-morbidity).

There has been considerable attention within the nursing research and education literature about creating a research culture. Yet, there is little attention to a culture of scholarship. Given the characteristics of nursing as a professional academic discipline, academic leaders should present a broad vision of scholarship and encourage a wide range of inquiry. Boyer's (1997) expanded definition of scholarship includes four dimensions: discovery, integration, application, and teaching. Discovery is best exemplified through traditional research methods, the discovery and dissemination of new knowledge in the discipline.

Background: Too little is currently known about the prevalence of and risk factors for depression and carer strain among informal carers of community-dwelling elderly mentally ill. This study seeks to assess the prevalence of depression, using the Geriatric Depression Scale-15 (GDS-15), the degree of carer burden/strain, and their risk factors among the primary informal carers of patients referred to our community-based old age psychiatry service.Methods: A cross-sectional study design was used, with the subjects comprising 100 primary informal carers of patients who live at home and were referred to our service. The main carer measures were the GDS-15 and an adapted version of Gilleard's Strain Scale. Patients were assessed the Clifton Assessment Procedure for the Elderly–Survey version, the GDS-15 and the Mini-mental State Examination.Results: Depression was found in 21% of the carers (a score of 5 or more on the GDS-15). The more problem behaviors identified and the greater the functional impairment of the patient, the higher the strain score deciles and the more likely the carer was to be depressed. Spouses were associated with lower carer strain scores. Patient diagnoses did not affect carer depression or carer strain.Conclusion: We found high levels of depression in the primary carers of community-dwelling patients attending an old age psychiatric service. The patients' behavior and their cognitive and functional ability conferred greater risk of carer depression or strain than their diagnosis. These risk factors may help identify carers at risk of strain and depression.