Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study

Background: This study analyzes the effect of frailty and Post-Operative Delirium (POD) on the functional status at hospital discharge and at 4-month follow-up in patients with hip fracture (HF). Methods: Multicenter prospective observational study of older patients with HF admitted to 12 Italian Orthogeriatric centers (July 2019-August 2022). POD was assessed using the 4AT. A 26-item Frailty Index (FI) was created using data collected on admission. The outcome measures were Cumulated Ambulation Score (CAS) ≤ 2 at discharge and a telephone-administered CAS ≤ 2 after 4 months. Poisson regression models were used to assess the effect of frailty and POD on outcomes. Results: 984 patients (median age 84 years, IQR = 79–89) were recruited: 480 (48.7%) were frail at admission, 311 (31.6%) developed POD, and 158 (15.6%) had both frailty and POD. In a robust Poisson regression, frailty alone (Relative Risk, RR = 1.56, 95% Confidence Intervals, CI 1.19–2.04, p = 0.001) and its combination with POD (RR = 2.57, 95% CI 2.02–3.26, p < 0.001) were associated with poor functional status at discharge. At 4-month follow-up, the combination of frailty with POD (RR 3.65, 95% CI 1.85–7.2, p < 0.001) increased the risk of poor outcome more than frailty alone (RR 2.38, 95% CI 1.21–4.66, p < 0.001). Conclusions: POD development exacerbates the negative effect that frailty exerts on functional outcomes in HF patients

Antarctic coastal nanoplankton dynamics revealed by metabarcoding of desalination plant filters: Detection of short-term events and implications for routine monitoring

none11One of the main requirements of any sound biological monitoring is the availability of long term and, possibly, temporal data with a high resolution. This is often difficult to be achieved, especially in Antarctica, due to a variety of logistic constraints, which make continuous sampling and monitoring activities generally unfeasible. Here we focus on the 5 μm filters used in the desalination plant of the Italian research base “Mario Zucchelli” in the Terra Nova Bay area (Ross Sea, Antarctica) to evaluate intra-annual coastal nanoplankton dynamics. These filters, together with others of larger mesh sizes, are used to decrease the amount of organisms and debris in the input seawater before the desalination processes take place, hence automatically collect the plankton present in the water column around the desalination system intake. We have used a DNA metabarcoding approach to characterize the communities retained by filters' sets collected in January 2012 and 2013. Intra-annual dynamics were disclosed with an unprecedented detail, that would not have been possible by using standard sampling approaches, and highlighted the importance of extreme, stochastic events such as katabatic wind pulses, which triggered dramatic, short-term shifts in coastal nanoplankton composition. This method, by combining a cost-effective sampling and molecular techniques, may represent a viable solution for long-term monitoring programs focusing on Antarctic coastal communities.mixedCecchetto M., Di Cesare A., Eckert E., Fassio G., Fontaneto D., Moro I., Oliverio M., Sciuto K., Tassistro G., Vezzulli L., Schiaparelli S.Cecchetto, M.; Di Cesare, A.; Eckert, E.; Fassio, G.; Fontaneto, D.; Moro, I.; Oliverio, M.; Sciuto, K.; Tassistro, G.; Vezzulli, L.; Schiaparelli, S

Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients

Background: Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers. Methods: The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed 64 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected. Results: The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80\u201390), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23\u201362). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators (\u201cpre-surgical cognitive assessment\u201d, \u201cbone protection prescription\u201d, \u201cuse of urinary catheter\u201d and \u201cstart of physiotherapy\u201d), moderate in two indicators (\u201csurgery performed 64 48 h from fracture\u201d and \u201cdischarge toward rehabilitation\u201d and low in one (\u201cabsence of delirium on day following surgery\u201d). Comparison with international studies suggests very different ways of providing care to HF Italian patients. Conclusions: The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care

Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

426noreservedObjective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 “Delirium Day” project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P <.001), visual impairment (24.2% vs 15.7%; P <.01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2–2.1; P =.00] and in Model 2 (OR 1.4; CI 1.1–1.9; P =.02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6–1.2, P =.36; OR 1.1; CI 0.8–1.4; P =.42) or in Model 2 (OR 0.8, CI 0.6–1.2, P =.27; OR 1.1, CI 0.8–1.4, P =.63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.mixedMorandi A.; Inzitari M.; Udina C.; Gual N.; Mota M.; Tassistro E.; Andreano A.; Cherubini A.; Gentile S.; Mossello E.; Marengoni A.; Olive A.; Riba F.; Ruiz D.; de Jaime E.; Bellelli G.; Tarasconi A.; Sella M.; Auriemma S.; Paterno G.; Faggian G.; Lucarelli C.; De Grazia N.; Alberto C.; Margola A.; Porcella L.; Nardiello I.; Chimenti E.; Zeni M.; Giani A.; Famularo S.; Romairone E.; Minaglia C.; Ceccotti C.; Guerra G.; Mantovani G.; Monacelli F.; Candiani T.; Ballestrero A.; Santolini F.; Rosso M.; Bono V.; Sibilla S.; Dal Santo P.; Ceci M.; Barone P.; Schirinzi T.; Formenti A.; Nastasi G.; Isaia G.; Gonella D.; Battuello A.; Casson S.; Calvani D.; Boni F.; Ciaccio A.; Rosa R.; Sanna G.; Manfredini S.; Cortese L.; Rizzo M.; Prestano R.; Greco A.; Lauriola M.; Gelosa G.; Piras V.; Arena M.; Cosenza D.; Bellomo A.; LaMontagna M.; Gabbani L.; Lambertucci L.; Perego S.; Parati G.; Basile G.; Gallina V.; Pilone G.; Giudice C.; De F.; Pietrogrande L.; De B.; Mosca M.; Corazzin I.; Rossi P.; Nunziata V.; D'Amico F.; Grippa A.; Giardini S.; Barucci R.; Cossu A.; Fiorin L.; Distefano M.; Lunardelli M.; Brunori M.; Ruffini I.; Abraham E.; Varutti A.; Fabbro E.; Catalano A.; Martino G.; Leotta D.; Marchet A.; Dell'Aquila G.; Scrimieri A.; Davoli M.; Casella M.; Cartei A.; Polidori G.; Brischetto D.; Motta S.; Saponara R.; Perrone P.; Russo G.; Del D.; Car C.; Pirina T.; Franzoni S.; Cotroneo A.; Ghiggia F.; Volpi G.; Menichetti C.; Bo M.; Panico A.; Calogero P.; Corvalli G.; Mauri M.; Lupia E.; Manfredini R.; Fabbian F.; March A.; Pedrotti M.; Veronesi M.; Strocchi E.; Borghi C.; Bianchetti A.; Crucitti A.; DiFrancesco V.; Fontana G.; Bonanni L.; Barbone F.; Serrati C.; Ballardini G.; Simoncelli M.; Ceschia G.; Scarpa C.; Brugiolo R.; Fusco S.; Ciarambino T.; Biagini C.; Tonon E.; Porta M.; Venuti D.; DelSette M.; Poeta M.; Barbagallo G.; Trovato G.; Delitala A.; Arosio P.; Reggiani F.; Zuliani G.; Ortolani B.; Mussio E.; Girardi A.; Coin A.; Ruotolo G.; Castagna A.; Masina M.; Cimino R.; Pinciaroli A.; Tripodi G.; Cannistra U.; Cassadonte F.; Vatrano M.; Scaglione L.; Fogliacco P.; Muzzuilini C.; Romano F.; Padovani A.; Rozzini L.; Cagnin A.; Fragiacomo F.; Desideri G.; Liberatore E.; Bruni A.; Orsitto G.; Franco M.; Bonfrate L.; Bonetto M.; Pizio N.; Magnani G.; Cecchetti G.; Longo A.; Bubba V.; Marinan L.; Cotelli M.; Turla M.; Sessa M.; Abruzzi L.; Castoldi G.; LoVetere D.; Musacchio C.; Novello M.; Cavarape A.; Bini A.; Leonardi A.; Seneci F.; Grimaldi W.; Fimognari F.; Bambara V.; Saitta A.; Corica F.; Braga M.; Ettorre E.; Camellini C.; Bellelli G.; Annoni G.; Crescenzo A.; Noro G.; Turco R.; Ponzetto M.; Giuseppe L.; Mazzei B.; Maiuri G.; Costaggiu D.; Damato R.; Formilan M.; Patrizia G.; Gallucci M.; Paragona M.; Bini P.; Modica D.; Abati C.; Clerici M.; Barbera I.; NigroImperiale F.; Manni A.; Votino C.; Castiglioni C.; Di M.; Degl'Innocenti M.; Moscatelli G.; Guerini S.; Casini C.; Dini D.; D'Imporzano E.; DeNotariis S.; Bonometti F.; Paolillo C.; Riccardi A.; Tiozzo A.; DiBari M.; Vanni S.; Scarpa A.; Zara D.; Ranieri P.; Alessandro M.; Di F.; Pezzoni D.; Platto C.; D'Ambrosio V.; Ivaldi C.; Milia P.; DeSalvo F.; Solaro C.; Strazzacappa M.; Cazzadori M.; Confente S.; Grasso M.; Troisi E.; Guerini V.; Bernardini B.; Corsini C.; Boffelli S.; Filippi A.; Delpin K.; Faraci B.; Bertoletti E.; Vannucci M.; Tesi F.; Crippa P.; Malighetti A.; Bettini D.; Maltese F.; Abruzzese G.; Cosimo D.; Azzini M.; Colombo M.; Procino G.; Fascendini S.; Barocco F.; Del P.; Mazzone A.; Riva E.; Dell'Acqua D.; Cottino M.; Vezzadini G.; Avanzi S.; Brambilla C.; Orini S.; Sgrilli F.; Mello A.; Lombardi L.; Muti E.; Dijk B.; Fenu S.; Pes C.; Gareri P.; Passamonte M.; Rigo R.; Locusta L.; Caser L.; Rosso G.; Cesarini S.; Cozzi R.; Santini C.; Carbone P.; Cazzaniga I.; Lovati R.; Cantoni A.; Ranzani P.; Barra D.; Pompilio G.; Dimori S.; Cernesi S.; Ricco C.; Piazzolla F.; Capittini E.; Rota C.; Gottardi F.; Merla L.; Barelli A.; Millul A.; De G.; Morrone G.; Bigolari M.; Macchi M.; Zambon F.; Pizzorni C.; DiCasaleto G.; Menculini G.; Marcacci M.; Catanese G.; Sprini D.; DiCasalet T.; Bocci M.; Borga S.; Caironi P.; Cat C.; Cingolani E.; Avalli L.; Greco G.; Citerio G.; Gandini L.; Cornara G.; Lerda R.; Brazzi L.; Simeone F.; Caciorgna M.; Alampi D.; Francesconi S.; Beck E.; Antonini B.; Vettoretto K.; Meggiolaro M.; Garofalo E.; Notaro S.; Varutti R.; Bassi F.; Mistraletti G.; Marino A.; Rona R.; Rondelli E.; Riva I.; Scapigliati A.; Cortegiani A.; Vitale F.; Pistidda L.; D'Andrea R.; Querci L.; Gnesin P.; Todeschini M.; Lugano M.; Castelli G.; Ortolani M.; Cotoia A.; Maggiore S.; DiTizio L.; Graziani R.; Testa I.; Ferretti E.; Castioni C.; Lombardi F.; Caserta R.; Pasqua M.; Simoncini S.; Baccarini F.; Rispoli M.; Grossi F.; Cancelliere L.; Carnelli M.; Puccini F.; Biancofiore G.; Siniscalchi A.; Laici C.; Mossello E.; Torrini M.; Pasetti G.; Palmese S.; Oggioni R.; Mangani V.; Pini S.; Martelli M.; Rigo E.; Zuccala F.; Cherri A.; Spina R.; Calamai I.; Petrucci N.; Caicedo A.; Ferri F.; Gritti P.; Brienza N.; Fonnesu R.; Dessena M.; Fullin G.; Saggioro D.Morandi, A.; Inzitari, M.; Udina, C.; Gual, N.; Mota, M.; Tassistro, E.; Andreano, A.; Cherubini, A.; Gentile, S.; Mossello, E.; Marengoni, A.; Olive, A.; Riba, F.; Ruiz, D.; de Jaime, E.; Bellelli, G.; Tarasconi, A.; Sella, M.; Auriemma, S.; Paterno, G.; Faggian, G.; Lucarelli, C.; De Grazia, N.; Alberto, C.; Margola, A.; Porcella, L.; Nardiello, I.; Chimenti, E.; Zeni, M.; Giani, A.; Famularo, S.; Romairone, E.; Minaglia, C.; Ceccotti, C.; Guerra, G.; Mantovani, G.; Monacelli, F.; Candiani, T.; Ballestrero, A.; Santolini, F.; Rosso, M.; Bono, V.; Sibilla, S.; Dal Santo, P.; Ceci, M.; Barone, P.; Schirinzi, T.; Formenti, A.; Nastasi, G.; Isaia, G.; Gonella, D.; Battuello, A.; Casson, S.; Calvani, D.; Boni, F.; Ciaccio, A.; Rosa, R.; Sanna, G.; Manfredini, S.; Cortese, L.; Rizzo, M.; Prestano, R.; Greco, A.; Lauriola, M.; Gelosa, G.; Piras, V.; Arena, M.; Cosenza, D.; Bellomo, A.; Lamontagna, M.; Gabbani, L.; Lambertucci, L.; Perego, S.; Parati, G.; Basile, G.; Gallina, V.; Pilone, G.; Giudice, C.; De, F.; Pietrogrande, L.; De, B.; Mosca, M.; Corazzin, I.; Rossi, P.; Nunziata, V.; D'Amico, F.; Grippa, A.; Giardini, S.; Barucci, R.; Cossu, A.; Fiorin, L.; Distefano, M.; Lunardelli, M.; Brunori, M.; Ruffini, I.; Abraham, E.; Varutti, A.; Fabbro, E.; Catalano, A.; Martino, G.; Leotta, D.; Marchet, A.; Dell'Aquila, G.; Scrimieri, A.; Davoli, M.; Casella, M.; Cartei, A.; Polidori, G.; Brischetto, D.; Motta, S.; Saponara, R.; Perrone, P.; Russo, G.; Del, D.; Car, C.; Pirina, T.; Franzoni, S.; Cotroneo, A.; Ghiggia, F.; Volpi, G.; Menichetti, C.; Bo, M.; Panico, A.; Calogero, P.; Corvalli, G.; Mauri, M.; Lupia, E.; Manfredini, R.; Fabbian, F.; March, A.; Pedrotti, M.; Veronesi, M.; Strocchi, E.; Borghi, C.; Bianchetti, A.; Crucitti, A.; Difrancesco, V.; Fontana, G.; Bonanni, L.; Barbone, F.; Serrati, C.; Ballardini, G.; Simoncelli, M.; Ceschia, G.; Scarpa, C.; Brugiolo, R.; Fusco, S.; Ciarambino, T.; Biagini, C.; Tonon, E.; Porta, M.; Venuti, D.; Delsette, M.; Poeta, M.; Barbagallo, G.; Trovato, G.; Delitala, A.; Arosio, P.; Reggiani, F.; Zuliani, G.; Ortolani, B.; Mussio, E.; Girardi, A.; Coin, A.; Ruotolo, G.; Castagna, A.; Masina, M.; Cimino, R.; Pinciaroli, A.; Tripodi, G.; Cannistra, U.; Cassadonte, F.; Vatrano, M.; Scaglione, L.; Fogliacco, P.; Muzzuilini, C.; Romano, F.; Padovani, A.; Rozzini, L.; Cagnin, A.; Fragiacomo, F.; Desideri, G.; Liberatore, E.; Bruni, A.; Orsitto, G.; Franco, M.; Bonfrate, L.; Bonetto, M.; Pizio, N.; Magnani, G.; Cecchetti, G.; Longo, A.; Bubba, V.; Marinan, L.; Cotelli, M.; Turla, M.; Sessa, M.; Abruzzi, L.; Castoldi, G.; Lovetere, D.; Musacchio, C.; Novello, M.; Cavarape, A.; Bini, A.; Leonardi, A.; Seneci, F.; Grimaldi, W.; Fimognari, F.; Bambara, V.; Saitta, A.; Corica, F.; Braga, M.; Ettorre, E.; Camellini, C.; Bellelli, G.; Annoni, G.; Crescenzo, A.; Noro, G.; Turco, R.; Ponzetto, M.; Giuseppe, L.; Mazzei, B.; Maiuri, G.; Costaggiu, D.; Damato, R.; Formilan, M.; Patrizia, G.; Gallucci, M.; Paragona, M.; Bini, P.; Modica, D.; Abati, C.; Clerici, M.; Barbera, I.; Nigroimperiale, F.; Manni, A.; Votino, C.; Castiglioni, C.; Di, M.; Degl'Innocenti, M.; Moscatelli, G.; Guerini, S.; Casini, C.; Dini, D.; D'Imporzano, E.; Denotariis, S.; Bonometti, F.; Paolillo, C.; Riccardi, A.; Tiozzo, A.; Dibari, M.; Vanni, S.; Scarpa, A.; Zara, D.; Ranieri, P.; Alessandro, M.; Di, F.; Pezzoni, D.; Platto, C.; D'Ambrosio, V.; Ivaldi, C.; Milia, P.; Desalvo, F.; Solaro, C.; Strazzacappa, M.; Cazzadori, M.; Confente, S.; Grasso, M.; Troisi, E.; Guerini, V.; Bernardini, B.; Corsini, C.; Boffelli, S.; Filippi, A.; Delpin, K.; Faraci, B.; Bertoletti, E.; Vannucci, M.; Tesi, F.; Crippa, P.; Malighetti, A.; Bettini, D.; Maltese, F.; Abruzzese, G.; Cosimo, D.; Azzini, M.; Colombo, M.; Procino, G.; Fascendini, S.; Barocco, F.; Del, P.; Mazzone, A.; Riva, E.; Dell'Acqua, D.; Cottino, M.; Vezzadini, G.; Avanzi, S.; Brambilla, C.; Orini, S.; Sgrilli, F.; Mello, A.; Lombardi, L.; Muti, E.; Dijk, B.; Fenu, S.; Pes, C.; Gareri, P.; Passamonte, M.; Rigo, R.; Locusta, L.; Caser, L.; Rosso, G.; Cesarini, S.; Cozzi, R.; Santini, C.; Carbone, P.; Cazzaniga, I.; Lovati, R.; Cantoni, A.; Ranzani, P.; Barra, D.; Pompilio, G.; Dimori, S.; Cernesi, S.; Ricco, C.; Piazzolla, F.; Capittini, E.; Rota, C.; Gottardi, F.; Merla, L.; Barelli, A.; Millul, A.; De, G.; Morrone, G.; Bigolari, M.; Macchi, M.; Zambon, F.; Pizzorni, C.; Dicasaleto, G.; Menculini, G.; Marcacci, M.; Catanese, G.; Sprini, D.; Dicasalet, T.; Bocci, M.; Borga, S.; Caironi, P.; Cat, C.; Cingolani, E.; Avalli, L.; Greco, G.; Citerio, G.; Gandini, L.; Cornara, G.; Lerda, R.; Brazzi, L.; Simeone, F.; Caciorgna, M.; Alampi, D.; Francesconi, S.; Beck, E.; Antonini, B.; Vettoretto, K.; Meggiolaro, M.; Garofalo, E.; Notaro, S.; Varutti, R.; Bassi, F.; Mistraletti, G.; Marino, A.; Rona, R.; Rondelli, E.; Riva, I.; Scapigliati, A.; Cortegiani, A.; Vitale, F.; Pistidda, L.; D'Andrea, R.; Querci, L.; Gnesin, P.; Todeschini, M.; Lugano, M.; Castelli, G.; Ortolani, M.; Cotoia, A.; Maggiore, S.; Ditizio, L.; Graziani, R.; Testa, I.; Ferretti, E.; Castioni, C.; Lombardi, F.; Caserta, R.; Pasqua, M.; Simoncini, S.; Baccarini, F.; Rispoli, M.; Grossi, F.; Cancelliere, L.; Carnelli, M.; Puccini, F.; Biancofiore, G.; Siniscalchi, A.; Laici, C.; Mossello, E.; Torrini, M.; Pasetti, G.; Palmese, S.; Oggioni, R.; Mangani, V.; Pini, S.; Martelli, M.; Rigo, E.; Zuccala, F.; Cherri, A.; Spina, R.; Calamai, I.; Petrucci, N.; Caicedo, A.; Ferri, F.; Gritti, P.; Brienza, N.; Fonnesu, R.; Dessena, M.; Fullin, G.; Saggioro, D