"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

Histochemical fiber types characteristics in the normal and the persistent levator ani muscle of the rat

Morphological features of the persistent levator ani (LA) muscle of the female rat normally undergoing involution but maintained by application of testosterone propionate to newborn animals were compared with that of the normal LA muscle of untreated male rat. The two muscles differ in number and size of muscle fibers. Using histochemical methods for "myofibrillar" adenosine triphosphatase (ATPase), mitochondrial \u3b1-glycerophosphate dehydrogenase (\u3b1-GPDH) and succinic dehydrogenase (SDH) the distribution of these enzymes in individual muscle fiber types was studied. ATPase and \u3b1-GPDH activities show a homogenously positive reaction in the muscle fibers of the male rat, whereas a small portion of fibers with low activity is found in the persistent muscle of female rat. The most pronounced difference concerns SDH activity, i.e. two kinds of fibre types are barely discernible with prolonged incubation in LA muscle of male rat, but three basic fibre types (white, intermediate and red) are clearly distinguished in LA muscle of the female rat. The results are discussed in relation to neural and hormonal influences on histochemical features in cross-striated muscle

Estimated glomerular filtration rate (eGFR) come fattore predittivo indipendente di mortalità a lungo termine in pazienti asintomatici sottoposti a TEA carotidea

INTRODUZIONE/SCOPO DELLO STUDIO Recenti linee guida per il trattamento chirurgico della stenosi carotidea sintomatica raccomandano l'esclusione dei pazienti con un\u2019aspettativa di vita minore di 3-5 anni. Scopo di questo studio \ue8 verificare come l\u2019insufficienza renale cronica, valutata attraverso la estimated Glomerular Filtration Rate (eGFR), possa incidere sulla sopravvivenza a lungo termine nei pazienti asintomatici sottoposti a tromboendoarterectomia (TEA) carotidea. MATERIALE E METODI Da gennaio 2002 a luglio 2013, 653 pazienti asintomatici sono stati sottoposti a TEA carotidea. I pazienti in terapia emodialitica (0,6%) sono stati esclusi. Per il calcolo dell\u2019eGFR \ue8 stata utilizzata la modification of Diet in Renal Disease (MDRD) formula. I pazienti sono stati suddivisi in cinque gruppi: gruppo A (eGFR 6590 mL/min/1.73m2) gruppo B (eGFR 89-60 mL/min/1.73m2). Sono state calcolate le curve di sopravvivenza secondo Kaplan-Meyer per ogni gruppo di pazienti.) e gruppo E (eGFR <15 mL/min/1.73m2 RISULTATI Quattrocentoventisette uomini (65,7%) e 222 donne (34,3%) sono stati sottoposti a TEA carotidea. L\u2019et\ue0 media era di 74 anni (range 47-93). Il tasso cumulativo di stroke/morte a 30 giorni dall\u2019intervento per l\u2019intera popolazione era 1.23%. I pazienti sono stati seguiti per un periodo medio di 56 mesi (IQR 27-84). La sopravvivenza a 5 anni dall\u2019intervento era 85% (gruppo A 96%, gruppo B 87%, gruppo C 80%, gruppo D 40%, gruppo E 0%; P< .0001). L\u2019analisi univariata ha evidenziato come la diminuzione di eGFR sia un fattore di rischio per mortalit\ue0 postoperatoria (RR 0,97; IC95% 0,96-0,98; P<.0001). Il modello ottenuto nell\u2019analisi multivariata combinando l\u2019eGFR con l\u2019et\ue0 (RR 1,11; IC95% 1,07-1,14; P<.0001) ha evidenziato come il valore di quest\u2019ultimo sia sostanzialmente immodificato dopo tale correzione (RR 0,98; IC95% 0,97-1,00), risultando sostanzialmente significativo (P=0,0513) gruppo C (eGFR 59-30 mL/min/1.73m2) DISCUSSIONI/CONCLUSIONI Pazienti con funzionalit\ue0 renale compromessa presentano una mortalit\ue0 postoperatoria a lungo termine significativamente aumentata. Il valore di eGFR, in pazienti portatori di stenosi carotidea asintomatica, risulta un parametro utile nella selezione dei pazienti candidabili alla TEA

Combined administration of growth hormone-releasing hormone and clonidine restores defective growth hormone secretion in old dogs

We have studied in old dogs the effects of short-term administration of growth hormone (GH)-releasing hormone (GHRH) alone or co-administered with clonidine (CLO), an alpha2-adrenergic agonist, on the GH secretory pattern (cluster analysis), and GH responsiveness to an acute GHRH or GHRH + CLO challenge and plasma somatomedin C (SMC) levels. Dogs were given either GHRH alone twice daily for 10 days (treatment 1) or combined GHRH + CLO both given twice daily (treatment 2) or GHRH + CLO given once daily (treatment 3). Animals were sampled from 09.00 to 15.00 h, at 10-min intervals, both before and 14 h after treatments. At the end of the 6-hour sampling period, dogs were challenged with simultaneous administration of GHRH and CLO, while they were tested with GHRH alone on the morning of the following day. In dogs undergoing treatment 1, acute administration of GHRH or GHRH + CLO elicited mean GH peak responses higher than before treatment, but none of the GH secretory indices were modified during the 6-hour sampling period, except for the increase in mean GH peak amplitude. In dogs undergoing treatment 2, acute administration of GHRH elicited a mean GH peak response higher than that before treatment, whereas administration of GHRH + CLO induced a mean GH peak response not different from that elicited by GHRH + CLO before treatment or by GHRH alone after treatment. However, this treatment significantly augmented the frequency of spontaneous bursts of GH secretion, the mean GH peak amplitude and the total peak area. In dogs undergoing treatment 3, acute administration of GHRH alone or GHRH + CLO elicited a mean GH peak response higher than that elicited by the same drugs before treatment. Moreover, there was an increase of GH peak frequency, mean GH peak amplitude and total peak area, even higher than after treatment 2. Plasma SMC levels rose significantly after all treatments, treatment 3 being the most effective in this instance. These data demonstrate that: (1) both a hypothalamic and a pituitary component play a role in the defective GH secretion in old dogs; (2) GH hypofunction is not an irreversible event, since GH secretion may be restored by pharmacological means acting at both the pituitary and the hypothalamic level, and (3) CLO given only once daily was more effective than CLO given twice daily, perhaps due to the property of this drug to down-regulate at high doses hypothalamic alpha2-adrenoceptors

An in vitro methodology for evaluating the mechanical properties of aortic vascular prostheses

The main problem in the replacement of pathological segments of the aorta with vascular prostheses consists of matching the fluid admittance of the host artery and the graft. This mismatch results from the different compliance between natural and prosthetic vessels and from the plastic dilatation of the prosthesis diameter that occurs after implantation. An experimental procedure was set up for evaluating the mechanical properties of aortic vascular prostheses. An MTS 858 MiniBionix testing machine was equipped with a purposely designed testing apparatus, which allows loading a ring-shaped prosthesis specimen with forces that can be related easily to the transmural pressure acting on the prostheses in vivo. The reference pressure waveforms are simulated from a lumped parameter model of the cardiovascular system. Preliminary tests on 3 different (woven, warp knitted, and carbon-coated warp knitted fabric) aortic prostheses point out a good reproducibility of the results. The fabric strongly affects the circumferential elasticity and the dimensional stability of the graft. Simulation of hypertension promotes larger diameter dilatation and reduction in compliance. Agreement between in vitro and clinical diameter measurements has been assessed for 8 prosthesis samples and found to be adequate. This method is thus a potentially useful means for preclinical evaluation of compliance of vascular prostheses for the purpose of matching to native vessels