"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 \ub1 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

Sustainable hotel strategy execution : a review and way forward

CITATION: Migale, H., Stimie, J. & Brent, A. 2019. Sustainable hotel strategy execution : a review and way forward. South African Journal of Industrial Engineering, 30(4):102-117, doi:10.7166/30-4-2025.The original publication is available at http://sajie.journals.ac.zaTourism, the third largest industry in the world, is worth US$ 1.4 trillion, and represents 10 per cent of the world’s GDP. Tourism is also responsible for five per cent of the world’s carbon dioxide emissions, of which hotels and other types of accommodation account for one per cent. In this context, a sustainable hotel strategy execution is essential for maintaining and improving our planet’s socio-economic and ecological balance. This systematic review lays the foundation for the development of a sustainable hotel strategy decision and execution support tool. Systems thinking and system dynamics allow the modelling of the interdependent elements of a complex hotel system, followed by a scenario simulation for proper strategy–analysis and strategy-decision. The execution of the chosen strategy can then be compared with the expected results. With a view to appraising the potential development of such a sustainable hotel strategy execution model for any tourism destination, a systematic literature review was carried out on existing sustainable strategy execution models and tools, as well as the existing use of systems thinking and system dynamics in the tourism and hotel sector.http://sajie.journals.ac.za/pub/article/view/2025Publisher's versio

The cortisol burden in elderly subjects with metabolic syndrome and its association with low-grade inflammation

Background: Elderly people are exposed to an increased load of stressful events and neuro-hormonal stimulation is a key finding in metabolic syndrome and its related disorders. Aims: To determine the role of cortisol in elderly subjects, with or without metabolic syndrome (MetS), by means of a national multicentre observational study, AGICO (AGIng and Cortisol). Methods: From 2012 to 2017, the AGICO study enrolled n.339 subjects (aged > 65), after obtaining their informed consent. The investigators assessed a cardio-metabolic panel (including electrocardiogram, carotid ultrasonography and echocardiography), the presence of MetS (on Adult Treatment Panel III criteria), a neurological examination (including brain imaging), and cortisol activity (using a consecutive collection of diurnal and nocturnal urine). Results: In the patients presenting with MetS, the standardized diurnal and nocturnal cortisol excretion rates were 210.7 \ub1 145.5 and 173.7 \ub1 118.1 (mean \ub1 standard deviation) \u3bcg/g creatinine/12 h; in those without MetS, the standardized diurnal and nocturnal cortisol excretion rates were 188.7 \ub1 92.7 and 144.1 \ub1 82.3 \u3bcg/g creatinine/12 h, respectively (nocturnal urinary cortisol in patients with MetS versus those without MetS p = 0.05, female patients with MetS vs female patients without MetS, p < 0.025). A significant positive correlation was found between the CRP levels and both the diurnal and nocturnal urinary cortisol levels with r = 0.187 (p < 0.025) and r = 0.411 (p < 0.00000001), respectively. Discussion: The elderly patients with MetS showed a trend towards increased standardized nocturnal cortisol excretions, with particular regard to the female subjects. Conclusion: The positive correlation between cortisol excretion and low-grade inflammation suggests a common mechanism driving both hormonal and inflammatory changes

Relations between Local Authorities and Public Utilities Companies

The development of public utilities (supply) has led to a change in needs, thereby influencing the functions that the local public administration is asked to perform. Globalisation has caused profound socio-political changes (just think of the formation of the European Union, the introduction of the single currency, the fall of some regimes) and has strongly influenced national and local goals. The development of the socio-political context and the development of new technologies have changed the meaning of public service, and local authorities (i.e. elected administrations) have been able to benefit from this discretional power, demonstrating their sensitivity to the matter as well as their vision