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

ObjectiveSensory 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.DesignCross-sectional study nested in the 2017 “Delirium Day” project.Setting and ParticipantsPatients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy.MethodsDelirium 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).ResultsA 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 implicationsOur 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.     

An integrated approach to determine sediment quality in areas above CO2 injection and storage in agreement with the requirements of the international conventions on the protection of the marine environment

The urgent need to reduce the greenhouse emissions to the atmosphere has leaded to study new systems to capture and store carbon dioxide (CO₂). The sequestration of CO₂ in marine geological formations is one of these systems proposed at the international level to effectively reduce the concentration of atmospheric CO₂. Although permanent containment is expected, it is necessary to determine the risk of leakage to the marine environment. The integrated model for the evaluation of the environmental quality of the marine environment will contribute to determine the potential environmental pathways and effects that are relevant to the consideration of the potential consequences of the leakage of CO₂ and incidental associated substances from the geological formations to the marine environment. In addition, this model will satisfy the requirements for a safe CO₂ storage in sub-seabed geological formations set in the international conventions on the protection of the marine environment (1992 OSPAR Convention and 1996 London Protocol). The objective of this paper is to show how to adapt classical methodologies based on a weight-of-evidence approach to establish the impact of CO₂ leaks in the sediment quality. It is described how the classical methods should modify their application when acidification occurs related to CO₂ leaks being the main potential impact in these areas.     

Comparative studies of Metarhizium anisopliae and Tolypocladium cylindrosporum as pathogens of mosquito larvae

Mosquito fungal pathogens, Metarhizium anisopliae and Tolypocladium cylindrosporum, were compared with regard to virulence against the larvae of Aedes aegypti, Anopheles stephensi and Culex pipiens. Culex pipiens larvae were much more susceptible to M. anisopliae conidia than An. stephensi or Ae. aegypti. But Ae. aegypti and Cx. pipiens larvae were equally susceptible to T. cylindrosporum propagules which weakly attack An. stephensi. Using a high concentration conidial suspension (10(7) sp/ml) of M. anisopliae no. 139, Ae. aegypti larvae were killed immediately within 1.1 days, before intrahemocoelian invasion; but at lower concentrations (10(6) and 10(5) sp/ml), typical mycosis occurred. However, T. cylindrosporum no. 3 blastospores were much more pathogenic to Ae. aegypti larvae than conidia. Conidial suspension of 10(7) spores/ml killed 68% fourth-instar larvae, relative to the 96% invaded by blastospores under the same conditions. Presoaked conidia virulence appeared still intermediate between conidia and blastospores. At low temperatures, 15 degrees C, virulence of M. anisopliae highly decreased, while at the same temperature, T. cylindrosporum blastospores were still virulent.     

When terror is routine: how Israeli nurses cope with multi-casualty terror

The wave of terror that has befallen the Israeli civilian population over the past two years, striking deep into the heart of towns and cities all over the country, presents a unique challenge for the health care system in general and nursing in particular. This article has a two-fold purpose: (a) to describe discussions that took place with four focus groups consisting of emergency room nurses who had recently cared for victims of terror, and (b) to delineate recommendations for policy enhancement based upon these discussions. Qualitative analysis of the data collected from focus group discussions revealed four stages of personal and professional involvement, each one eliciting a specific response from the nurses: call up to report for duty, waiting for casualties to arrive, caring for the victims, and closure of the event. Nurses identified numerous hardships and great anxiety along with a strong sense of professional fulfillment. Recommendations for policy include: incorporating stress management and debriefing skills in post-basic ER training, designing workshops and drills in trauma care for non-ER nurses who float into the ER in the wake of a multi-casualty act of terror, and developing leadership seminars for head nurses in the ER departments.     

State involvement in professional nursing development in Israel: promotive or restrictive

This article describes the role of the Israeli Ministry of Health's Nursing Division in regulating the development of the nursing profession and the nursing care provided. First, factors influencing professional nursing in Israel and the development of the Ministry of Health's Nursing Division are presented. Then, examples of the Nursing Division's influence on nursing practice, the process of statutory authorization used to facilitate this influence, and future Nursing Division initiatives are discussed. The article concludes by noting that, on balance, ministerial (governmental) involvement strengthens the nursing profession and the quality of nursing care provided, yet may also restrict nurses' private concerns.     

The wandering central venous catheter

A subclavian central venous catheter wandered spontaneously between the superior caval and the internal jugular veins. The case supports the routine of regular X-ray checks for catheter position.     

4-Bromo-2,5-dimethoxyphenethylamine (2C-B): presence in the recreational drug market in Spain, pattern of use and subjective effects

4-Bromo-2,5-dimethoxyphenethylamine (2C-B) is a psychoactive analogue of mescaline that is becoming increasingly popular as a rave and club drug. We investigated its presence in the illicit drug market in Spain, its pattern of use and profile of subjective effects. Drug material was analysed for 2C-B and information on pattern of use and subjective effects was obtained from recreational users. Scores were statistically compared with previously collected data on psychostimulants (d-amphetamine), entactogens (MDMA) and psychedelics (ayahuasca and Salvia divinorum). The percentage of samples containing 2C-B doubled between 2006 and 2009, evolved from powder to tablet form and showed low falsification rates. Respondents reported taking 2C-B orally in doses of about 20 mg. Subjective effects involved perceptual modifications analogous to those observed after ayahuasca and salvia but absent after amphetamine and MDMA. Pleasure and sociability effects did not differ from those after MDMA and incapacitation was lower than for the psychedelics used as comparators. In conclusion, we found 2C-B is consistently present in the illicit drug market in Spain. While it elicits perceptual modifications that are analogous to other psychedelics, the lower impairment and higher pleasurable effects make it comparable with entactogens.