The reality of practice development for nurses working in an inpatient service for people with severe and enduring mental health problems.

Nursing practice development is a growing priority for the British National Health Service. However, the nature of practice development remains poorly articulated. Despite the growing number of papers on practice development in nursing, there is insufficient guidance in the literature for the practical day-to-day management of the role, particularly in the inpatient environment. This paper explores the tensions experienced by practitioners engaged in practice development within a service for people mainly with a diagnosis of psychosis. The entrenched culture of the environment is described, which was resistant to change therefore did not easily embrace practice development. Within such a culture it is important to balance effective management with team development and support. Although this balance is essential for positive change, it is the maintenance of the balance that often leads to the tensions experienced by practice development practitioners. The paper describes numerous tensions including the competing agendas, influencing 'hearts and minds' rather than forcing change and working where people are at. Each tension is explored alongside possible survival strategies. The material presented aims to be realistic and although it may not be generalizable to other settings and staff groups, the authors hope to stimulate debate about similar or contrasting experiences of practice development.

Interventions with family caregivers for people with dementia: efficacy problems and potential solution.

Family members are increasingly caring for relatives with dementia at home. It is well recognized that this is a stressful experience for carers. Treatment approaches that aim to alleviate this stress were introduced in the 1970s and later research began to evaluate their efficacy. Early studies using subjective ratings of satisfaction and usefulness demonstrated encouraging results. However, later studies using standardized measures of distress and burden, have not been able to demonstrate efficacy in a convincing way. There have been some positive significant changes; however, most findings have been poor, inconsistent and equivocal. This may be accounted for by the poor methodological rigour diluting the positive potential benefits of interventions for carers. This paper suggests that in order for the efficacy research to evolve, there needs to be a change in direction. It is vital that instead of repeating 'more of the same' studies, researchers need to prioritize the use of theoretically driven interventions and research design. This factor alone could provide the framework to influence the methodological issues that potentially dilute the demonstration of treatment efficacy. Without clearer evidence from research, guidance for practitioners about treatment for carers is ambiguous.

The second locus for autosomal recessive primary microcephaly (MCPH2) maps to chromosome 19q13.1-13.2.

Primary microcephaly is a clinical diagnosis made when an individual has a head circumference of greater than 3 standard deviations below the age and sex matched population mean, mental retardation but without other associated malformations and no apparent aetiology. The majority of cases of primary microcephaly exhibit an autosomal recessive mode of inheritance. We now demonstrate the genetic heterogeneity of this condition with the identification of a second primary microcephaly locus (MCPH2) on chromosome 19q13.1-13.2 in two multi-affected consanguineous families. The minimum critical region containing the MCPH2 locus is defined by the polymorphic markers D19S416 and D19S420 spanning a region of approximately 7.6 cM.