"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

Sulphuric acid burned women in Bangladesh: a social and medical problem

In August-September 1998 an Italian medical team, composed of a plastic surgeon, an anaesthesiologist, an infectious diseases specialist and a psychologist, assisted by a local non-government organization (Narripokkho), studied a cohort of Bangladeshi women injured by sulphuric acid. The goals of the mission were: (1) recognition of the magnitude of the phenomenon of acid being intentionally thrown at women; (2) evaluation of the type and severity of burns; (3) preparation of a tentative schedule of surgical treatment of the lesions; (4) organization of local facilities; (5) training of doctors and nurses

Un caso di xantogranuloma giovanile in una donna di 59 anni: problemi di diagnosi differenziale

Gli AA. presentano un caso di xantogranuloma, precedentemente diagnosticato daltri specialisti come epitelioma basocellulare. L’approccio terapeutico si è limitato all’effettuazione di un check up completo, che ha escluso l’associazione della lesione con una patologia sistemica attiva. L’interesse del caso è legato alla possibilità che nell’adulto lo xantogranuloma imiti il basaliom

Degradazione per Via Biologica di Reflui a Componenti Tossiche Prodotti da una Industria Farmaceutica

Il lavoro presenta l’indagine sperimentale condotta per rilevare la capacità di adattamento della biomassa dell’impianto di depurazione di una industria farmaceutica a seguito della variazione delle caratteristiche del liquame influente, e la possibilità di degradazione, per via biologica, delle componenti tossiche presenti nel refluo. Attraverso prove in scala pilota vengono evidenziati gli effetti causati dall’arrivo di tali componenti su di un impianto di ossidazione a fanghi attivi a regime, e vengono individuati gli interventi da apportare per garantire il raggiungimento degli standard richiesti nell’effluente. I risultati ottenuti vengono estesi all’impianto a scala reale di cui vengono illustrati i rendimenti depurativi in termini di abbattimento del carico inquinante