"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

Investigations with real time PCR assay on the trasmissibility of pear decline phytoplasma (PDP) with dormant buds.

A study was carried out to determine the possibility to transmit the PD agent through grafting with dormant buds collected from naturally infected trees, due to winter degeneration of the sieve tubes of the above ground part of pear trees. A real time PCR procedure for PDP detection was set up with a multiplex assay where host and pathogen DNA can be amplified simultaneously to distinguish between uninfected plant material and false negative results due to PCR inhibition. Real time pCR assays were performed on 92 seedlings of Pyrus communis (cv. A. fetel, Conference and William grafted on P. communis rootstocks) one year after grafting with dormant buds. resulted PD-positive after PCR analysis. No phytoplasmas were detected in the 92 grafted seedlings; the results suggested that in our conditions PDP is not trasnmissible with dormant buds to healthy trees

Investigations with real-time PCR assay on the transmissibility of pear decline phytoplasma (PDP) with dormant buds.

Pear decline is one of the most dangerous diseases of pear trees. A study was carried out to determine the possibility of transmitting the casual agent, pear decline phytoplasma (PDP), through grafting with dormant buds collected from naturally infected trees, due to winter degeneration of the sieve tubes of the above ground part of pear trees. A real time PCR procedure for PDP detection was set up with a multiplex assay where host and pathogen DNA could be amplified simultaneously to distinguish between uninfected plant material and false negatives due to PCR inhibition. Real-time PCR assays were performed on 92 seedlings of Pyrus communis one year after grafting with dormant buds resulted PD-positive after PCR analysis, from cvs. Abate Fetel, Conference and William, grafted on P. communis rootstock. Ten pear seedlings were also grafted with root samples from the above mentioned trees. No phytoplasmas were detected in the 92 grafted seedlings, on the contrary 6 plants on 10 tested positive after root grafting. The results suggested that in our conditions PDP is not transmissible with dormant buds to healthy trees

Left ventricular function and geometric patterns in elederly patients with hypertension.

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