The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence

"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

Flower formation in vitro in a quantitative short-day tobacco: interrelation between photoperiod and infructescence development.

The flowering response of thin layers excised from branch internodes of Nicotiana tabacum cv. Maryland Catterton (quantitative short-day plant for induction) was studied under three photoperiodic treatments. The explants were excised from inflorescences bearing flowers only, flowers and green fruits, or from infructescences with green fruits only. The aim of the study was to investigate the post-inductive photoperiodic effects on in vitro flower bud formation in a quantitative short-day tobacco and the relation with infructescence development. Short days quantitatively enhanced the flower bud regeneration capacities of explants in all stages of development, both as number of explants induced to produce flowers and as mean number of flowers per explant. There was no significant difference in flower bud formation on explants of the first two stages, which produced much more flowers than those of the third stage. Observations in planta showed that, during the 20 days separating the second stage from the first stage, there was no significant difference in the number of floral buds and flowers present on the inflorescence; however, the branch internodes lengthened, as did the floral buds and flowers. During the 10 days leading to the third stage, the number of capsules did not change significantly, but a high rate of floral abscission occurred. The present results show that in Nicotiana tabacum cv. Maryland Catterton short day quantitatively controls not only the inductive step of the flowering process, but also affects the capacity to regenerate flower buds during the late post-inductive phases. The responsiveness to the photoperiodic signal decreases only when the plant exhibits only fruits

Endometriosi esterna: patologia di esclusivo interesse ginecologico? Il punto di vista del chirurgo generale

L’endometriosi esterna o extrauterina è la localizzazione in sede ectopica di tessuto endometriale funzionante. L’osservazione incidentale di casi asintomatici o paucisintomatici da parte del chirurgo generale è in aumento, grazie anche al diffondersi delle tecniche laparoscopiche. Per la sede in cui si localizza e le espressioni anatomo-patologiche che assume, è talora responsabile di un quadro clinico di puro interesse chirurgico; in tali casi, in considerazione della scarsità di sintomatolgia specifica, difficilmente viene inquadrata in fase preoperatoria, ponendo problemi di diagnostica differenziale nonché di strategia chirurgica ed imponendo, talora, un’attenta valutazione dell’estensione della demolizione chirurgica, trattandosi sovente di donne giovani che desiderano conservare la propria fertilità. Gli Autori presentano 7 casi giunti alla loro osservazione: un caso di endometriosi inguinale, una localizzazione ombelicale, tre casi parieto-cicatriziali, un caso a localizzazione intestinale, peraltro plurifocale e maligno ed emerso clinicamente con un quadro di addome acuto, ed infine un caso di pneumotorace catameniale con endometriosi diaframmatica. Tali casi rappresentano un vero catalogo delle possibili espressioni con le quali questa patologia può coinvolgere il chirurgo generale e gli Autori analizzano, alla luce anche di una revisione della letteratura, le implicazioni diagnostico-terapeutiche ad esse connesse. In particolare, prendendo spunto dalla loro esperienza, gli Autori pongono l’attenzione sui problemi posti, in caso di plurifocalità, dall’estensione della demolizione chirurgica e, in assoluto, sui rischi, da non sottovalutare, circa la possibile trasformazione maligna dell’epitelio endometriosico e la possibile endometriosi secondaria parieto-cicatriziale

SIMM: an integrated forecasting approach for the Mediterranean area

Many ‘high-impact’ meteorological, marine and hydrological events in the Mediterranean area are characterized by horizontal spatial scales of the order of 10–100 km. Such events are, sometimes, driven by complex dynamical processes involving planetary scale atmospheric flows. Several international programs (ALPEX, POEM, MAP, PYREX, MEDEX) have improved the understanding of some of these processes. However, because of the Mediterranean's geomorphological structure, characterized by mountain chains (e.g. the Alps), semi-enclosed sea basins and small river catchments, many problems remain. It is clear that such problems have to be faced in the context of analysis-prediction systems bridging the gap between global and local scales of motion. These systems should allow for an adequate representation of key dynamical processes at all the relevant scales of motion. The Hydro-Meteorological-Marine System (‘Sistema Idro-Meteo-Mare’, SIMM) is a first step in developing an integrated system, adequately covering all scales of motion from global to local. A short description of the system is presented, highlighting scientific concepts behind design choices. A summary of the results of verification tests is also illustrated, together with a general evaluation of the whole process in planning, developing and running SIMM in order to assist future updates of the system, currently under development. Copyright © 2007 Royal Meteorological Societ

Hydrogeology of continental southern Italy

This paper summarizes the results of a study focused on the hydrogeological characterization and recognition of groundwater resources in continental southern Italy, developed under the European INTERREG IIC Programme. The study reconstructed up-to-date scientific knowledge regarding aquifers, groundwater circulation schemes and groundwater resources exploitation in the administrative regions of southern Italy included in the Objective I (Molise, Campania, Basilicata, Puglia and Calabria). In this paper, the methodological approaches applied to synthesize and homogenize bibliographic data collected from the hydrogeological literature and to set a regional hydrogeological mapping are described. Results presented are three hydrogeological maps, 1:300,000 scale, showing hydrogeological units and groundwater flow schemes that are relevant in the regional hydrogeological context, and a brief description of principal types of aquifer and groundwater resources of continental southern Italy

Hydrogeology of continental southern Italy

This paper summarizes the results of a study focused on the hydrogeological characterization and recognition of groundwater resources in continental southern Italy, developed under the European INTERREG IIC Programme. The study reconstructed up-to-date scientific knowledge regarding aquifers, groundwater circulation schemes and groundwater resources exploitation in the administrative regions of southern Italy included in the Objective I (Molise, Campania, Basilicata, Puglia and Calabria). In this paper, the methodological approaches applied to synthesize and homogenize bibliographic data collected from the hydrogeological literature and to set a regional hydrogeological mapping are described. Results presented are three hydrogeological maps, 1:300,000 scale, showing hydrogeological units and groundwater flow schemes that are relevant in the regional hydrogeological context, and a brief description of principal types of aquifer and groundwater resources of continental southern Italy

Hydrogeology of continental southern Italy

<p>This paper summarizes the results of a study focused on the hydrogeological characterization and recognition of groundwater resources in continental southern Italy, developed under the European INTERREG IIC Programme. The study reconstructed up-to-date scientific knowledge regarding aquifers, groundwater circulation schemes and groundwater resources exploitation in the administrative regions of southern Italy included in the Objective I (Molise, Campania, Basilicata, Puglia and Calabria). In this paper, the methodological approaches applied to synthesize and homogenize bibliographic data collected from the hydrogeological literature and to set a regional hydrogeological mapping are described. Results presented are three hydrogeological maps, 1:300,000 scale, showing hydrogeological units and groundwater flow schemes that are relevant in the regional hydrogeological context, and a brief description of principal types of aquifer and groundwater resources of continental southern Italy.</p

"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