"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

Modeling heavy-ion fusion cross section data via a novel artificial intelligence approach

We perform a comprehensive analysis of complete fusion cross section data with the aim to derive, in a completely data-driven way, a model suitable to predict the integrated cross section of the fusion between light to medium mass nuclei at above barrier energies. To this end, we adopted a novel artificial intelligence approach, based on a hybridization of genetic programming and artificial neural networks, capable to derive an analytical model for the description of experimental data. The approach enables, for the first time, to perform a global search for computationally simple models over several variables and a considerable body of nuclear data. The derived phenomenological formula can serve to reproduce the trend of fusion cross section for a large variety of light to intermediate mass collision systems in an energy domain ranging approximately from the Coulomb barrier to the onset of multi-fragmentation phenomena

Can artificial intelligence simplify the screening of muscle mass loss?

Background: Sarcopenia is a risk factor for morbidity and preventable mortality in old age, with consequent high costs for the national health system. Its diagnosis requires costly radiological examinations, such as the DEXA, which complicate screening in medical centers with a high prevalence of sarcopenia. Objectives: Developing a nearly zero-cost screening tool to emulate the performance of DEXA in identifying patients with muscle mass loss. This can crucially help the early diagnosis of sarcopenia at large-scale, contributing to reduce its prevalence and related complications with timely treatments. Methods: We exploit cross-sectional data for about 14,500 patients and 38 non-laboratory variables from successive NHANES over 7 years (1999–2006). Data are analyzed through a state-of-the-art artificial intelligence approach based on decision trees. Results: A reduced number of anthropometric parameters allows to predict the outcome of DEXA with AUC between 0.92 and 0.94. The most complex model derived in this paper exploits 6 variables, related to the circumference of key corporal segments and to the evaluation of body fat. It achieves an optimal trade-off sensitivity of 0.89 and a specificity of 0.82. Restricting exclusively to variables related to lower limb, we obtain an even simpler tool with only slightly lower accuracy (AUC 0.88–0.90). Conclusions: Anthropometric data seem to contain the entire informative content of a more complex set of non-laboratory variables, including anamnestic and/or morbidity factors. Compared to previously published screening tools for muscle mass loss, the newly developed models are less complex and achieve a better accuracy. The new results might suggest a possible inversion of the standard diagnostic algorithm of sarcopenia. We conjecture a new diagnostic scheme, which requires a dedicated clinical validation that goes beyond the scope of the present study

Cataract standard set for outcome measures: An Italian tertiary referral centre experience

Purpose: Implementation of the International Consortium for Health Outcomes Measurements (ICHOM) standard for cataract surgery into clinical practice at an Italian tertiary referral centre. Methods: Prospective, observational, descriptive study consisting of the registry and analysis of cataract surgeries performed during a 6-month enrolment period at the University Eye Clinic of Trieste, Trieste, Italy. Outcomes were recorded and analysed according to the ICHOM Cataract Standard Set version 2.0.1. Records included clinician-reported outcome measures (CROMs) – visual outcome and complications – and patient-reported outcome measures (PROMs) – self-assessed vision with the Catquest-9SF questionnaire. Correlations between PROMs and CROMs were evaluated. A multiple linear regression was used for predicting the change in PROMs with surgery. Results: A total of 218 eyes (of 218 patients) were analysed. Postoperative corrected distance visual acuity (CDVA) was ⩾0.3 in 89.0% (194/218) of eyes. There was a statistically significant improvement of the post-operative Catquest-9SF global average score. (p 75 years old, and preoperative CDVA. Conclusions: Cataract surgery improves the functional vision, with some factors limiting the outcomes such as comorbidities. Self-perceived improvement in intermediate vision significantly influenced the improvement in self-assessed vision.This study has been supported by an unrestricted grant from Johnson & Johnson Vision to obtain the access to the ICHOM standard set for cataract surgery

Monitoring plasma vancomycin concentrations in a burned patient

This paper presents a case report of  therapeutic vancomycin monitoring through high performance liquid chromatography (HPLC-UV), as well as pharmacokinetic modelling in extensively burned patients. Data obtained from peak and trough levels indicated that the dosing schedule and type of intravenous infusion should be revised using  pharmacokinetics as a powerful monitoring tool

Nutrient consumption and chain tuning in diatoms exposed to storm-like turbulence

Current information on the response of phytoplankton to turbulence is linked to cell size and nutrient availability. Diatoms are considered to be favored by mixing as dissolved nutrients are more easily accessible for non-motile cells. We investigated how diatoms exploit microscale turbulence under nutrient repletion and depletion conditions. Here, we show that the chain-forming diatom Chaetoceros decipiens, continues to take up phosphorus and carbon even when silicon is depleted during turbulence. Our findings indicate that upon silica depletion, during turbulence, chain spectra of C. decipiens remained unchanged. We show here that longer chains are maintained during turbulence upon silica depletion whereas under still conditions, shorter chains are enriched. We interpret this as a sign of good physiological state leading to a delay of culture senescence. Our results show that C. decipiens senses and responds to turbulence both in nutrient repletion and depletion. This response is noteworthy due to the small size of the species. The coupling between turbulence and biological response that we depict here may have significant ecological implications. Considering the predicted increase of storms in Northern latitudes this response might modify community structure and succession. Our results partly corroborate Margalef's mandala and provide additional explanations for that conceptualization