"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

Schematic representation of PDCD10 protein with its domains and the main interactors.

<p>Mutations are reported.</p

Pedigrees of the 11 patient harbouring a <i>PDCD10</i>/CCM3 mutation.

<p>The arrow indicates the index case. Squares represent males; circles, females. A diagonal line through the symbol represents a deceased person.</p

1–3 MRI/TC scans from subjects

<p>: 1) 454CCM patient harbouring the <i>de novo</i> and novel mutation p.E54Rfs*22. A) T1 sagittal image at 16 months showing a cavernous malformation with recent bleeding in the pons; B) T1 axial image at 25 months showing increased size of the pontine cavernous malformation with compression on the mesencephalon, the cisterna interpeduncularis and the cisterna pontis. 2) 321CCM patient harbouring the mutation p.R35X. A) Imaging characteristics of the CCM lesion (in the white circle) located at the left anterior temporal lobe: at CT scan the lesion is inhomogeneous due to haemorrhagic components, B and D) the haemorrhagic component is hyperintense both in T1 and in T2 sequences, C) contrast enhancement is absent, E) and at GET2* the lesion is hypointense due to the paramagnetic characteristics of the haemosiderin ring and of the clotted lesion content. F) Finally, other two lesions can be detected at other sites (arrows) in the same patient. 3) 344CCM patient harbouring the novel mutation p.R54X. A) MRI showed a right cortical and subcortical parietal hemorrhagic CCM lesion (arrow) and other non-hemorrhagic CCM lesions at different sites: bilateral temporal polar (not shown), B) left superior temporal sulcus (arrow) and right parietal (arrowhead), left insular and fronto-insular (not shown), C) left frontal parasagittal (arrow), subcortical frontal with small areas of vacuolization and microcalcification, left posteromedial thalamic (not shown).</p

Patients' clinical features.

<p>Y = Yes; N = No; nr =  not reported; ni =  not investigated.</p><p>Patients' clinical features.</p

Details of Patients' mutation.

<p>Y =  Yes; N = No. Nomenclature according to HGVS.</p><p>Details of Patients' mutation.</p

Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: Findings from the nationwide FADOI-PRACTICE study

Background: Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy. Methods: PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy. Results: Among the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p &lt; 0.001), whereas median length of hospital stay was 16 (IQR = 13) vs 8 (IQR = 8) days (p &lt; 0.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days. Conclusions: Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2-3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples