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Objective: To assess the cost-effectiveness of a structured education pulmonary rehabilitation programme (SEPRP) for chronic obstructive pulmonary disease (COPD) relative to usual practice in primary care. The programme consisted of group-based sessions delivered jointly by practice nurses and physiotherapists over 8 weeks. Design: Cost-effectiveness and cost-utility analysis alongside a cluster randomised controlled trial. Setting: 32 general practices in Ireland. Participants 350 adults with COPD, 69% of whom were moderately affected. Interventions: Intervention arm (n=178) received a 2 h group-based SEPRP session per week over 8 weeks delivered jointly by a practice nurse and physiotherapist at the practice surgery or nearby venue. The control arm (n=172) received the usual practice in primary care. Main outcome measures: Incremental costs, Chronic Respiratory Questionnaire (CRQ) scores, quality-adjusted life years (QALYs) gained estimated using the generic EQ5D instrument, and expected cost-effectiveness at 22 weeks trial follow-up. Results: The intervention was associated with an increase of €944 (95% CIs 489 to 1400) in mean healthcare cost and €261 (95% CIs 226 to 296) in mean patient cost. The intervention was associated with a mean improvement of 1.11 (95% CIs 0.35 to 1.87) in CRQ Total score and 0.002 (95% CIs -0.006 to 0.011) in QALYs gained. These translated into incremental cost-effectiveness ratios of €850 per unit increase in CRQ Total score and €472 000 per additional QALY gained. The probability of the intervention being cost-effective at respective threshold values of €5000, €15 000, €25 000, €35 000 and €45 000 was 0.980, 0.992, 0.994, 0.994 and 0.994 in the CRQ Total score analysis compared to 0.000, 0.001, 0.001, 0.003 and 0.007 in the QALYs gained analysis. Conclusions: While analysis suggests that SEPRP was cost-effective if society is willing to pay at least €850 per one-point increase in disease-specific CRQ, no evidence exists when effectiveness was measured in QALYS gained. Trial Registration: Current Controlled Trials ISRCTN52 403 063. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the factors that impact on students' implementation of clinical skills in the practice setting. This was a part of a larger exploration into the role of the Clinical Skills Laboratory in preparing student nurses for clinical practice. Background It is already known that students can experience reality shock on clinical placement and that staff support is crucial for their adaptation to the environment. This process is similar to socialisation theory whereby the newcomer adapts to the workplace. Design A multiple case study design ( n = 5) was used. Methods Data were collected using semi-structured interviews ( n = 43) and non-participant observation of students implementing skills in clinical practice. Results Findings revealed the factors that could facilitate students' implementation of clinical skills were as follows: provision of learning opportunities, staff support and supervision, and students' confidence. Factors that hindered students were reality shock, 'the gap' in how skills were taught in the higher education institutions and the clinical setting, and missed learning opportunities. Support from peers in the clinical area and having previous experience of working as a health care assistant, or similar, were the factors that could either positively or negatively impact on students. Conclusions Students need to be adequately prepared for the real-life clinical environment. Understanding, through socialisation theory, how students adapt to the workplace can facilitate this process. Facilitating students' learning includes supporting them, developing their confidence and ensuring that they have prior exposure to undertaking clinical skills. Relevance to practice Staff working with students in clinical practice can help facilitate students' learning and implementing of clinical skills through an understanding of how students adapt and 'fit in' to their working environment. [ABSTRACT FROM AUTHOR]

Aim To provide an overview of interpretive phenomenology. Background Phenomenology is a philosophy and a research approach. As a research approach, it is used extensively in nursing and 'interpretive' phenomenology is becoming increasingly popular. Data sources Online and manual searches of relevant books and electronic databases were undertaken. Review methods Literature review on papers on phenomenology, research and nursing (written in English) was undertaken. Discussion A brief outline of the origins of the concept, and the influence of 'descriptive' phenomenology on the development of interpretive phenomenology is provided. Its aim, origins and philosophical basis, including the core concepts of dasein, fore-structure/pre-understanding, world view existential themes and the hermeneutic circle, are described and the influence of these concepts in phenomenological nursing research is illustrated. Conclusion This paper will assist readers when deciding whether interpretive phenomenology is appropriate for their research projects. Implications for research/practice This paper adds to the discussion on interpretive phenomenology and helps inform readers of its use as a research methodology. [ABSTRACT FROM AUTHOR]

Aim To report a case study that identifies how leadership is enacted by advanced practitioners in nursing and midwifery and differentiates between clinical and professional leadership in advanced practice. Background A national evaluation of advanced practitioners in nursing and midwifery was commissioned to inform policy makers' decision-making about future developments in Ireland. Leadership is a key aspect of the advanced practitioner role. However, leadership in the advanced practice context is under researched and lacks empirical evidence on how advanced practitioners enact their clinical and professional leadership function in practice. Design A multiple case study methodology was used to identify the leadership activities of advanced practitioners. Methods Purposive sampling of advanced practitioners in nursing and midwifery across various specialities and health regions in Ireland was employed. Data sources included non-participant observation of advanced practitioners, interviews with key stakeholders, and documentary evidence including audits, policies, and guidelines. Collectively these data were used to identify the leadership activities of advanced practitioners in practice. The study was conducted between December 2008-December 2010. Results Seven key activities that indicated clinical leadership and three key activities for professional leadership at advanced practice level were identified. Conclusions The leadership activities identified provide greater clarity in distinguishing between professional and clinical leadership and in specifying the nature and scope of leadership activities. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand the meaning of chronic obstructive pulmonary disease (COPD) for people and their response to this disease. Background COPD is a major cause of disability and death. The symptoms of COPD have the potential to impact on every aspect of a person's day-to-day life. To date most published qualitative studies have focused on the 'experience' of breathlessness and its impact on the person. Few studies have sought to 'understand' the meaning of COPD to people and their response to this disease. This study aimed to address this gap. Design Straussian grounded theory guided study design. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems they encounter. Methods Data were collected through semi-structured interviews with 26 people with COPD. Study participants were recruited from general practices on the western seaboard of Ireland. Results Two interrelated categories were identified as contributing to 'co-existing with COPD': 'hiding' and 'battling'. 'Co-existing with COPD' was conceptualised as the core category. The potential to 'co-exist' with COPD was influenced by mediating factors. Conclusion The Theory of Co-existing with COPD was generated from the data. This theory explains the delicate balance people with COPD maintain to 'co-exist with COPD'. 'Controlled co-existence' enables the person to feel in control and live life to the optimum. This is a fragile balance however and the unpredictability of COPD can tip the person into 'strained co-existence' or 'uncontrolled co-existence'. Relevance to clinical practice Understanding the experience of living with COPD and the balances involved in 'co-existing with COPD' can help health professionals provide more focused and empowered client care. Enabling people to achieve 'controlled co-existence' with COPD challenges health professionals to educate people with COPD on how to effectively manage their disease. [ABSTRACT FROM AUTHOR]

A variety of terms are used to describe advanced practice nursing roles internationally. This has resulted in confusion in terminology around these roles. The aim of this concept analysis was to clarify what is meant by advanced practice nursing internationally, what attributes signify advanced practice nursing and what are its antecedents, consequences, references and related terms. Rodgers's evolutionary method of concept analysis was used. Data sources included Medline, CINAHL, Applied Social Sciences Index and Abstracts ( ASSIA), Cochrane Library, Science Direct, SCOPUS, Web of Science, Dissertation Abstracts and DARE as well as relevant nursing texts and professional organization websites. The analysis reveals that there are many different articulations of the advanced practice nursing role outlined in the literature. This variety in terminology hinders developments in advanced practice nursing roles. Consensus on advanced practice nursing definitions, terminology, educational requirements and regulatory approaches is integral to the implementation of the advanced practice nursing role internationally. [ABSTRACT FROM AUTHOR]

Aim To provide examples of a qualitative multiple case study to illustrate the specific strategies that can be used to ensure the credibility, dependability, confirmability and transferability of a study. Background There is increasing recognition of the valuable contribution qualitative research can make to nursing knowledge. However, it is important that the research is conducted in a rigorous manner and that this is demonstrated in the final research report. Data sources A multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Multiple sources of evidence were collected: semi-structured interviews (n=58), non-participant observations at five sites and documentary sources. Discussion Strategies to ensure the rigour of this research were prolonged engagement and persistent observation, triangulation, peer debriefing, member checking, audit trail, reflexivity, and thick descriptions. Practical examples of how these strategies can be implemented are provided to guide researchers interested in conducting rigorous case study research. Conclusion While the flexible nature of qualitative research should be embraced, strategies to ensure rigour must be in place. [ABSTRACT FROM AUTHOR]

Aim To provide an explanation of the research methodologies and strategies available. Background There are numerous research methodologies and strategies. The literature is ambiguous in relation to research terminology and this often leads to confusion about which methodology or strategy to adopt. Data sources A review of the most up-to-date literature. Discussion The most commonly adopted methodologies and strategies are discuss Conclusion Part 1 (Welford et al 2011) of this two-part paper explained the research paradigms and the rationales for choosing particular paradigms. Part 2 provides an explanation of the methodologies and strategies available to the researcher. Implications for practice/research This paper will be particularly useful for novice researchers or doctoral students. [ABSTRACT FROM AUTHOR]

dowling m, murphy k, cooney a & casey d (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 476-487 A concept analysis of empowerment in chronic illness from the perspective of the nurse and the client living with chronic obstructive pulmonary disease Aims. To explicate a model of empowerment appropriate to clients living with a chronic illness, in particular chronic obstructive pulmonary disease. Background. Empowerment is a concept central to nursing practice and is viewed from a variety of perspectives in nursing literature. Empowerment shapes how those living with a chronic illness view their illness and approach their involvement in self-care. This concept analysis was conducted as part of the literature review to inform the development of the Pulmonary Rehabilitation in Nurse-led Community Environments trial. Design. Review of the literature on empowerment, with particular focus on empowerment in chronic illness. Methods. A search of electronic databases to March 2010 for literature related to 'empowerment' was conducted. Papers included in the review had reference to 'empowerment' in the abstract. The literature was then organised following guidance on the structure for concept analysis proposed by Norris (1982, Concept Clarification in Nursing) and Rodgers ( Journal of Advanced Nursing, 1989). Results. Empowerment in chronic illness is a process with both the nurse and client contributing to its evolvement. The nurse must feel empowered, communicate effectively and surrender control in the empowerment process. The client must be motivated to change and possess specific competencies to engage in the empowerment process. Both the nurse and client experience a transformation when empowered. Conclusion. Despite identification of the characteristics, antecedents and consequences of empowerment in chronic illness, empowerment remains an evolving concept, with evident immaturity revealed in its competing definitions. Relevance to clinical practice. This concept analysis provides nurses with an understanding of what patient attributes contribute to empowerment in chronic illness and how nurses on an individual level can influence the empowerment process for patients, through effective communication, surrendering control and focusing on goals. [ABSTRACT FROM AUTHOR]

Aim In this paper, the choice of classic grounded theory will be discussed and justified in the context of the first author's PhD research. Background The methodological discussion takes place within the context of PhD research entitled: Development of a stakeholder-led framework for a structured education programme that will prepare nurses and healthcare assistants to deliver a psychosocial intervention for people with dementia. There is a lack of research and limited understanding of the effect of psychosocial interventions on people with dementia. The first author thought classic grounded theory a suitable research methodology to investigate as it is held to be ideal for areas of research where there is little understanding of the social processes at work. Data sources The literature relating to the practical application of classic grounded theory is illustrated using examples relating to four key grounded theory components: Theory development: using constant comparison and memoing. Methodological rigour. Emergence of a core category. Inclusion of self and engagement with participants. Discussion Following discussion of the choice and application of classic grounded theory, this paper explores the need for researchers to visit and understand the various grounded theory options. Conclusion This paper argues that researchers new to grounded theory must be familiar with and understand the various options. The researchers will then be able to apply the methodologies they choose consistently and critically. Doing so will allow them to develop theory rigorously and they will ultimately be able to better defend their final methodological destinations. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore key stakeholders and direct care managers' perspectives on the current provision of end-of-life care for older people in acute and long-stay care settings in Ireland and to construct a model of these. Although the literature reveals a number of factors that impact on end-of-life care, no study has examined staff perceptions concerning the provision of good end-of-life care for older people in an Irish context. Grounded theory was used. Semi-structured interviews were employed to collect data between 2007-2008. A purposive sample of 33 staff involved in the delivery of end-of-life care to older people working in six sites were selected. Factors that influence provision of end-of-life care in Ireland were identified. The core category was 'dying well'. The potential to 'die well' was influenced by three factors, namely philosophy, culture and organisation of care, knowing the person and physical environment and resources. People are living longer consequently acute and long-stay care setting will increasingly become places where older people die. This study identified the factors that influence the provision of good end-of-life care for older people. Mobilising resources to ensure that these factors are considered is crucial to ensuring that regardless of where older people die in Ireland, they will receive the highest standard of care that nurses can provide. Understanding the factors that influence the provision of end-of-life care in acute and long-stay facilities in Ireland can help health professionals give more focused support and ensure that influencing factors are addressed so that older people at end-of-life receive quality end-of-life care. [ABSTRACT FROM AUTHOR]

Aim The decision to use grounded theory is not an easy one and this article aims to illustrate and explore the methodological complexity and decision-making process. It explores the decision making of one researcher in the first two years of a grounded theory PhD study looking at the psychosocial training needs of nurses and healthcare assistants working with people with dementia in residential care. It aims to map out three different approaches to grounded theory: classic, Straussian and constructivist. Background In nursing research, grounded theory is often referred to but it is not always well understood. This confusion is due in part to the history of grounded theory methodology, which is one of development and divergent approaches. Common elements across grounded theory approaches are briefly outlined, along with the key differences of the divergent approaches. Data sources Methodological literature pertaining to the three chosen grounded theory approaches is considered and presented to illustrate the options and support the choice made. Discussion The process of deciding on classical grounded theory as the version best suited to this research is presented. The methodological and personal factors that directed the decision are outlined. The relative strengths of Straussian and constructivist grounded theories are reviewed. Conclusion All three grounded theory approaches considered offer the researcher a structured, rigorous methodology, but researchers need to understand their choices and make those choices based on a range of methodological and personal factors. In the second article, the final methodological decision will be outlined and its research application described. [ABSTRACT FROM AUTHOR]

Aim This article aims to provide clear explanations of the research approaches available for nursing research. Background There are numerous research approaches available to the nurse researcher. There is also some ambiguity in the literature in relation to research terminology and this often leads to confusion about which approach to adopt. Data sources A review of the available and most up-to-date literature. Discussion The most commonly adopted approaches in nursing research are described and discussed. Conclusion This article explains the research paradigms and the rationales for choosing particular paradigms while part two will provide an explanation of the methodological options available to the researcher. A table is included that summarises the key information related to each paradigm. Implications for practice/research These articles will be particularly useful for the novice researcher or for the doctoral student. [ABSTRACT FROM AUTHOR]

The aim of this study was to understand the experience of participants in the Dose Adjustment for Normal Eating programme and to identify factors that influence participants' implementation of the self-management guidelines. The literature revealed that structured education programmes, such as Dose Adjustment for Normal Eating programme, have many positive outcomes for people with Type 1 diabetes including: a decrease in HbA1c levels, reductions in hypoglycaemic events, reduction in hospital admissions and increased and sustained quality of life. Few researchers, however, have gathered participants' perspectives on the impact of participation in a Dose Adjustment for Normal Eating programme on self-management capacity. A grounded theory design focused on description guided by Corbin and Strauss was used. Data collection and analysis were concurrent using the constant comparative technique. Over 24 months, 2006-2008, interviews were undertaken with 40 participants who had completed a Dose Adjustment for Normal Eating programme in one of five study sites across Ireland. Purposive sampling was used, initially, with theoretical relational sampling towards the end of the interviews as concepts emerged. The interviews lasted from 30-60 minutes and were transcribed verbatim. Five factors that influenced participants' self-management of their diabetes following dose adjustment for normal eating were identified. These were knowledge, support, motivation, relationship shift and empowerment, and these were all related to the core category, 'Being in Control'. Understanding the factors that influence self-management in Ireland is important as it broadens prior knowledge and confirms the factors that are important to facilitate self-management. Understanding the factors that influence the implementation of dose adjustment for normal eating principles can help health professionals give more focused and empowering care to persons with diabetes. Using the persons' experience and expertise is essential as it can help them develop their internal resources. [ABSTRACT FROM AUTHOR]

This article examines the many ethical challenges that are specific to qualitative research. These challenges concern the issues of informed consent procedures, the researcher-participant relationship, risk-benefit ratio, confidentiality and the dual role of the nurse-researcher. Each challenge will be examined and practical examples of how it was dealt with, using examples from a multiple case study, will be described. [ABSTRACT FROM AUTHOR]

Aims and objectives. To undertake a concept analysis (CA) of residential autonomy to identify its attributes. To reveal the antecedents and consequences of autonomy for older people in residential care and thus enable this concept to be operationalised. Background. Globally, there is an ageing population. This population and their families demand that services offer choice and recognise the older individual in care relationships. Design. Concept analysis. Methods. Using the same search terms, findings from a literature search in 2007 and from a follow-up search in 2009 were used to conduct the CA. Rodgers (1989) framework was used to develop a model case of autonomy for older people in residential care. The attributes, antecedents, consequences and references were delineated. Results. Six attributes of autonomy for older people in residential care were delineated. (1) Residents are involved in decision making while their capacity is encouraged and maintained. (2) Residents delegate their care needs based on the right to self-determination and this can be achieved through (3) negotiated care planning, which is encouraged through open and respectful communication and (4) including families or significant others when the resident is cognitively impaired. (5) The residential unit operates a culture and atmosphere of flexibility within an ethos of maintaining resident dignity. (6) Meaningful relationships are enabled by the presence of regular and motivated staff, and these relationships enhance the residents’ opportunities to be autonomous. Conclusions. A CA framework is useful in trying to understand a term in its context and thus make it operational. Relevance to clinical practice. This CA is the first step required for further research on this aspect of care. This is essential in informing this nursing specialty. The attributes, antecedents and consequences can now be used to operationalise the concept in practice. [ABSTRACT FROM AUTHOR]

Objective To assess the effects of premedication with buprenorphine on the characteristics of anaesthesia induced with ketamine/medetomidine. Study design Prospective crossover laboratory study. Animals Six female New Zealand White rabbits. Methods Rabbits received, on occasions separated by 7 days, either buprenorphine (0.03 mg kg−1) or saline subcutaneously (SC) as premedication, followed 1 hour later by SC ketamine (15 mg kg−1) and medetomidine (0.25 mg kg−1) (K/M). At pre-determined time points reflex responses and cardiopulmonary parameters were recorded and arterial blood samples taken for analysis. Total sleep time was the duration of loss of the righting reflex. Duration of surgical anaesthesia was the time of suppression of the ear pinch and pedal withdrawal reflexes. Wilcoxon signed-ranks tests were used to compare data before ( T0) and 10 minutes after ( T10) injection with K/M. Results All animals lost all three reflex responses within 10 minutes of injection of K/M. The duration of loss of these reflexes significantly increased in animals that received buprenorphine. At induction, animals that had received buprenorphine tended to have a lower respiration rate but there were no significant differences in arterial PCO2, PO2 or pH between treatments. Hypoxaemia [median PaO2 < 6.0 kPa (45 mmHg)] developed in both treatments at T10 but there was no significant difference between treatments. Mean arterial pressure (MAP) was lower at T10 in animals that had received buprenorphine. Conclusion and clinical relevance Premedication with buprenorphine significantly increased the duration of anaesthesia induced by K/M, with no significant depression of respiration further to the control treatment within the first 10 minutes of anaesthesia. The MAP decreased but this was not reflected in a difference in other physiological parameters. These data show that premedication with buprenorphine, before K/M anaesthesia in the rabbit, has few negative effects and may provide beneficial analgesia. [ABSTRACT FROM AUTHOR]

Service learning is a teaching tool that facilitates students’ ability to link theory to practice while simultaneously providing a needed service to the community. This paper describes Irish nursing students’ experiences of a service learning placement undertaken in a developing country. The students complete 30 h of theoretical content, which includes lectures and workshops on such topics as personal safety, health, and human rights, as well as the preparation of students for the emotional impact of the experience. All the content is underpinned by a commitment to developing reciprocal relationships with the service learning communities. To explore these students’ experiences, a descriptive qualitative study was conducted. The data were collected using interviews and were analyzed by thematic analysis. Four main themes were identified: developing cultural sensitivity, caring for people in different cultures, learning/knowing more, and the potential impact on nursing practice. The findings suggest that the students are more culturally aware and are becoming more responsible citizens. [ABSTRACT FROM AUTHOR]

Anesthetic protocols for behavioral neuroscience experiments are evolving as new anesthetics are developed and surgical procedures are refined to improve animal welfare. We tested whether neurotoxic dorsal hippocampal lesions produced under two different anesthetic protocols would have different behavioral and/or histo-pathological effects. Rats were anesthetized with either propofol, an intravenous anesthetic, or isoflurane, a gaseous anesthetic, and multiple injections of an excitotoxin ( N-methyl- D-aspartate) were stereotaxically placed in the dorsal hippocampus bilaterally. Intraoperative physiological parameters were similar in the two surgical groups, as were the volumes of the lesions, although the profile of postoperative impairment in a spatial learning task differed between the lesion groups depending on the anesthetic regimen used. These results show that the choice of anesthetic protocol is a critical variable in designing behavioral neuroscience experiments using neurosurgical procedures. This factor should be considered carefully in experimental design and in cross-study comparisons of lesion effects on behavior. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Aim. The aim of this research was to determine the factors that facilitate or hinder high quality nursing care for older people in long-term care settings in Ireland. Background. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors which have an impact on care have been identified, it is difficult to determine key factors from current research. Method. This was a mixed method study, which involved qualitative and quantitative approaches. A self-response questionnaire was generated from data gathered by interview and analysis of literature. Information was collected from 498 nurses working in long-term care settings within a Health Board. A 68% response rate was achieved. Factor analysis was used to identify facilitating and hindering factors of quality care for older people. Results. Nine factors where identified six facilitating factors of quality and three hindering factors of quality care. The six factors, which facilitate quality, were: an ethos of promoting independence and autonomy; a homelike social environment; person centred, holistic care; knowledgeable, skilled staff; knowing the person and adequate multidisciplinary resources. The three factors which hindered quality care; these were: a lack of time and patient choice, resistance to change and bound by routine. Conclusions. The findings of this research provide nurses with a clear set of facilitating and hindering factors of quality care for older people and reveal some of the complexities and challenges of providing this care. Relevance to clinical practice. Long-term care is the home of many older people and attention within these environments to the facilitating and hindering factors of quality is required. It is hoped that the factors generated in this study add to understanding in relation to quality care and the factors that influence this. [ABSTRACT FROM AUTHOR]

Aim. The aim of this research was to explore nurses’ perceptions of the attributes of quality care and the factors that facilitate or hinder high-quality nursing care in long-term care. Background. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research. Method. The study was a qualitative exploration of nurses’ perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen. Findings. The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted. Conclusion. There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers. Relevance to practice. This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long-term care. [ABSTRACT FROM AUTHOR]

Summary: The aim of this study was to investigate nurses’ and midwives’ current knowledge of osteoporosis and assessed their education and training needs. A quantitative, descriptive survey was conducted using a questionnaire on a stratified, random sample of 128 nurses and midwives in the North West of Ireland. A generally high level of knowledge about certain risk factors was found. The main deficit of knowledge and lifestyle factors in this study was that of exercise and bone health. A link was, however, established between age and knowledge scores and a more significant link was established between years of qualification and knowledge. Midwives were found to have a high knowledge level. Nurses and midwives received their information from media sources, as opposed to a formal education session. Almost all of the respondents identified a need for further education on osteoporosis. [Copyright &y& Elsevier]

Background: A dementia diagnosis can lead to a decline in cognitive, social, and physical health, but people with dementia can live meaningful lives and participate actively in society with psychosocial support. This single-arm, non-randomised feasibility study explored the feasibility and acceptability of a Comprehensive REsilience-building psychoSocial intervenTion (CREST) for people with dementia, their caregivers, General Practitioners (GPs), and the public. Methods: Nine people with dementia and their primary caregivers living in the community (n = 9 dyads) completed the CREST intervention which had three components (cognitive stimulation therapy [CST], physical exercise, and dementia education). Quantitative secondary outcomes were assessed at baseline and following the 15-week intervention; qualitative interviews were conducted during and post-intervention. All study components were assessed against pre-defined criteria, to determine the feasibility of conducting a future definitive trial. Results: Recruitment of people with dementia and their caregiver was a significant challenge and led to considerable delays to the onset and conduct of the intervention. Only 13% of eligible GP practices agreed to assist in recruitment and achieved a 6% enrolment rate; a community-based recruitment strategy proved more effective, yielding a 29% enrolment rate. However, once recruited, participants maintained high attendance and adherence to the content of each component with average adherence rates of 98% for CST, exercise sessions and caregiver education. Adherence to secondary exercise measures was lower, with home exercise diary completion at 37% and Fitbit wear adherence at 80% during the day and 67% at night. The people with dementia felt their concentration and fitness had improved over the 15-week intervention and particularly enjoyed the social aspects (e.g. group classes, exercising with partners from the community). Caregivers felt they had better knowledge and understanding following their education component and reported that the social aspects (interacting and sharing experiences with each other) were important. Overall, participants reported that the three components of the intervention were feasible and acceptable. In addition, the quantitative measures and health economic tools employed were feasible. However, the secondary elements of the exercise component (recording home exercise diaries and Fitbit use) were not considered feasible. Overall, pre-defined criteria for progression to a definitive intervention were fulfilled in terms of acceptability, retention and fidelity but not recruitment. Conclusion: While overall, the CREST intervention was feasible and acceptable to participants, significant difficulties with recruitment of people with dementia and their caregiver through GP practices impacted the viability of delivering the intervention. Recruitment through community-based groups proved a more feasible option and further work is needed to overcome barriers to recruiting this cohort before a larger-scale trial can be conducted. Trial registration: ISRCTN25294519. [ABSTRACT FROM AUTHOR]