To obtainconsensus from non-consultant hospital doctors and consultants indeveloping a eLearning module for teaching non-consultant hospital doctorsabout delirium

1) A questionnaire to assess knowledge regarding deliriumwas administered to Medical NCHDs and toPsychiatry NCHDs. A 50 minute teaching session was provided to the PsychiatryNCHDs, which included an existing e-learning module for undergraduateson delirium developed in University College Dublin(UCD). Followingthis feedback was obtained regarding the module and what changes would berequired for it to meet the training needs of non consultant hospital doctors.

2) In the first step of the DELPHIprocess, feedback from medical consultants was obtained in relation to thethemes and topics to be included in the delirium e-learning module.

•In the first iteration of the DELPHI process, both NCHDs and Consultants identified relevant learning outcomes for an eLearning module on delirium for postgraduate medical trainees.

The next iteration of the DELPHI process will refine the themespreviously identified in order to achieve consensus among the NCHD andconsultant groups surveyed. This will be the basis for the design of aneLearning module about delirium.

Lithium-treated patients with polyuria are at increased risk of lithium toxicity. We aimed to describe the clinical benefits and risks of different management strategies for polyuria in community lithium-treated patients.

This is a naturalistic, observational, prospective 12-month cohort study of lithium-treated patients with polyuria attending a community mental health service in Dublin, Ireland. When polyuria was detected, management changed in one of four ways: (a) no pharmacological change; (b) lithium dose decrease; (c) lithium substitution; or (d) addition of amiloride.

Thirty-four participants were diagnosed with polyuria and completed prospective data over 12 months. Mean 24-hour urine volume decreased from 4852 to 4344 ml (p = 0.038). Mean early morning urine osmolality decreased from 343 to 338 mOsm/kg (p = 0.823). Mean 24-hour urine volume decreased with each type of intervention but did not attain statistical significance for any individual intervention group. Mean early morning urine osmolality decreased in participants with no pharmacological change and increased in participants who received a change in medication but these changes did not attain statistical significance. Only participants who discontinued lithium demonstrated potentially clinically significant changes in urine volume (mean decrease 747 ml in 24 hours) and early morning urine osmolality (mean increase 31 mOsm/kg) although this was not definitively proven, possibly owing to power issues.

Managing polyuria by decreasing lithium dose does not appear to substantially improve objective measures of renal tubular dysfunction, whereas substituting lithium may do so. Studies with larger numbers and longer follow-up would clarify these relationships.