"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Pourquoi l'inégalité devant la loi ?

Forschungen zum Therma Ungleichheit vor dem Gesetz haben gezeigt, daß Variablen wie soziale Schicht und Rasse das Ergebnis des Strafprozeses beeinflussen. So erhalten im allgemeinen Schwarze und Mitglieder der Arbeiterschicht eine strengere Behandlung als Weiße und Agehörige dominanter Schichten. Schwierig war bislang zu erklären, auf welche Art und Weise diese Variablen funktionieren. Das in Turin durchgeführte Forschungsprojekt sollte dazu beitragen, diese Lücke auszufullen. Dazu wurden 1993 hundert Strafprozesse vor einem Gericht der ersten Instanz in Turin von zwei Beobachtern unabhängig voneinander aufgenommen und analysiert. Sowohl « blue-collar » als auch « white-collar-crime » wurde in die Betrachtung einbezogen. Die direkte Beobachtung hat es erlaub, einige Mechanismen zu rekonstruieren, die zu einer Ungleichbehandlung führen. Das Hauptaugenmerk richete sich auf die sozialen und personalen Merkmale der Beschuldigten (Beruf , Kleidung, Verhalten während des Prozesses, usw.) sowie auf die Qualität der Verteidigung. Besonders dieser Faktor erwies sich als direkt verkniipft mit der sozialen Schicht und der Art des Delikts. Auf der Basis der quan- titativen und qualitativen Daten ergibt sich als Ergebnis, daß die Macht, einen Anwalt des Vertrauens erhalten zu können, ein strategischer Faktor ist. Da analytische Modell mit den drei Variablen soziale Schicht, Delikttyp und Qualität der Verteidigung kann in 80% der Fälle das Ergebnis des Prozeses voraussagen.Most research on the issue of equality before the law has shown that variables such as social class and ethnicity - just to mention a few - influence the outcome of the penal process. Thus, for example, criminal cases where Blacks or working class people are involved, systematically receive a harsher treatment than cases where Whites or members of the ruling class are prosecuted. What has been difficult to explain is how those variables act. The investigation carried out in Torino represents an attempt to fill this gap. During 1993 one hundred criminal processes taking place at a lower Court (pretura) in Torino have been observed and recorded by two independent observers. Both white and blue collar crimes have been taken into consideration. Direct observation has made possible to reconstruct some of the mechanisms producing inequality of treatment. In particular the attention has been placed on the social and individual characteristics of the prosecuted (including profession, clothing, language, behavior during the hearings, etc.), and the quality of the defence. The latter showed to be clearly related to both social class and type of crime. The overall conclusion, supported by both qualitative and quantitative data, is that a factor which is strategic as to the outcome of the process is the access to a private attorney. The analytical model based on the variables of social class, type of crime and type of defence predicts the outcome of the process in 80% of the cases.Bestaande onderzoeken rond het thema van de ongelijkheid voor de wet hebben aan- getoond dat variabelen zoals sociale klasse en ras het resultaat van strafprocessen beinv- loeden. Zo ondergaan zwarten en leden van de arbeidersklasse over het algemeen een strengere behandeling dan verdachte blanken of zij die behoren tot de dominante klassen. Moeilijk te verklaren was wel de «manier» waaroop deze variabelen spelen. Het gevoerde onderzoek in Turijn heeft deze lacune trachten op te vullen. Honderd processen die in 1993 plaats vonden voor een rechtbank van eerste aanleg in Turijn werden bestu- deerd en geregistreerd door twee onafhankelijke waarnemers. Zowel de «blue collar» cri- minaliteit als de «white collar» criminaliteit werden in overweging genomen. De directe observatie Het toe enkele mechanismen bloot te leggen die de ongelijkheid van behandeling veroorzaken. De aandacht spitste zich voornamelijk toe op de sociale en persoonlijke karakteristieken van de verdachten (beroep, manier van kleden en spreken, gedrag tij- dens het procès, enz.) en de kwaliteit van de verdediging. Deze laaste factor blijkt nauw verbonden te zijn met sociale klasse en het tape van overtreding. Op basis van kwantitatieve en kwalitatieve gegevens werd geconcludeerd dat het kun- nen verwerden van een vertrouwenwekkende advokaat een factor van strategisch belang is. Het analytisch model op basis van de drie variabelen sociale klasse, type van overtreding en kwaliteit van de verdediging voorziet het resultaat van het procès in 80% van de gevallen.Cottino Amedeo, Fischer Maria-Grazia. Pourquoi l'inégalité devant la loi ?. In: Déviance et société. 1996 - Vol. 20 - N°3. pp. 199-214

Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study

Objective To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. Methods This is a point prevalence study nested in the â\u80\u9cDelirium Day 2015â\u80\u9d, which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS). A multinomial logistic regression was used to determine the factors associated with delirium subtypes. Results Of 429 patients with delirium, the DMSS was completed in 275 (64%), classifying 21.5% of the patients with hyperactive delirium, 38.5% with hypoactive, 27.3% with mixed and 12.7% with the non-motor subtype. The 4-AT score was higher in the hyperactive subtype, similar in the hypoactive, mixed subtypes, while it was lowest in the non-motor subtype. Dementia was associated with all three delirium motor subtypes (hyperactive, OR 3.3, 95% CI: 1.2-8.7; hypoactive, OR 2.8, 95% CI: 1.2-6.5; mixed OR 2.6, 95% CI: 1.1-6.2). Atypical antipsychotics were associated with hypoactive delirium (OR 0.23, 95% CI: 0.1-0.7), while intravenous lines were associated with mixed delirium (OR 2.9, 95% CI: 1.2-6.9). Conclusions The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium