Prevalence and risk factors of delirium in the intensive care unit: An observational study.

BACKGROUND: Several risk factors, such as age, alcohol abuse, dementia, and severe illness, can contribute to the development of delirium. However, limited information is available in the literature regarding the risk of delirium among surgical, trauma, neurological, and medical intensive care patients. AIM: To describe the prevalence of risk factors associated with delirium in intensive care units. DESIGN: This study used an observational design. METHODS: We enrolled 165 patients hospitalized in two intensive care units in Italy. Patients were first evaluated using the Prediction of Delirium model and were subsequently evaluated using the Intensive Care Delirium Screening Checklist; evaluation lasted a maximum of 5 days for each admitted patient after sedation. A logistic regression model was used to identify the prevalence and risk factors of delirium. RESULTS: The average age of the patients was 57.6 (SD = 18.3) years, and the patients were predominantly male (65.0%). The majority of patients had been subjected to trauma (38.8%); 37.6% had undergone general surgical interventions, and 23.6% had undergone medical interventions. Delirium occurred in 55.8% of the 165 patients. The risk of delirium was independently associated with coma (odds ratio = 10.6; 95% confidence interval, 3.08-39.9) and the Acute Physiology and Chronic Health Evaluation II score (odds ratio = 4.27; 95% confidence interval, 1.58-11.53). CONCLUSIONS: This study confirmed that coma and the Acute Physiology and Chronic Health Evaluation II score were non-modifiable risk factors for delirium. Further studies could categorize the different types of coma. Proper delirium management could limit the impact on the recovery of these patients, their autonomy, and their reintegration into the social and professional world. RELEVANCE TO CLINICAL PRACTICE: Delirium increases intensive care unit and hospital length of stay. Early identification and risk factor assessment by critical care nurses are considered the key factors in the treatment of delirium.

[Emergency nurses and workplace violence: a cross-sectional study in Campania, South Italy]. / Gli infermieri di pronto soccorso e la violenza sul luogo di lavoro: un'indagine trasversale nel contesto campano.

AIM: To determine the characteristics of workplace violence towards emergency nurses in Campania, South Italy. INTRODUCTION: In Italy, workplace violence is a severe and widespread problem. A national survey describes that, working in South Italy significantly increases the probability of being exposed. However, available data in Campania workplace violence towards nurse emergency department (ED) is lacking. METHOD: We used a cross-sectional design, in two emergency department. Between April and May 2019, we distributed a questionnaire (QIN16VIPs). Three types of violence have been investigated: verbal/physical violence, verbal violence and physical violence. The data were analyzed using procedures of descriptive statistics. RESULTS: A total of 83 questionnaires (response rate 92.3%), 48.2% of emergency nurses experienced verbal violence, 21.7% both verbal and physical violence and only 28.9% denied having experienced either. Nurses feeling at risk in emergency setting were more exposed to workplace violence (p=0.001). Anxiety (p=0.023) and anger (p=0.001) were perceived feeling with significant repercussions on the degree of evidence working in ED (p=0.043) and on trust in management (p=0.001). CONCLUSIONS: Workplace violence turns out to be a serious and widespread problem that generates negative feelings in the attacked subject that affect the personal and work dimension. The promotion of simple and anonymous reporting systems would help nurses to be more aware of the importance of reporting the event, which is still in deficit today, thus preventing a true and proper estimate of the phenomenon. Future research should be focused for preventive measures could be drawn up to reduce the problem.

Dressings and Securement Devices of Peripheral Arterial Catheters in Intensive Care Units and Operating Theaters: A Systematic Review.

BACKGROUND: Hemodynamic monitoring, implemented by the placement of peripheral arterial catheters (PACs), is a characterizing aspect of the intensive care units. Peripheral arterial catheters can continually detect blood pressure and quickly conduct blood sampling. The use of PACs is generally considered safe, without serious complications. Currently, only 25% of the implanted catheters are actually subject to complications, including accidental removal, dislocation, occlusion, and infection. All of these complications arise from inadequate catheter stabilization at the level of the skin. This study aimed to summarize and describe the effectiveness and characteristics of dressings and securement devices for catheter stabilization. METHODS: A systematic review of literature from the following databases was conducted: MEDLINE, CINAHL, Cochrane, EMBASE, and OvidSP. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to guide article selection and reporting. RESULTS: Herein 626 articles were referred, with 5 directly related to the topic under discussion. We found 3 studies that describe PAC failure and 4 about dislodgement. We described 6 types of dressings or securement devices and classified them into 3 categories for classifying PAC dressings or securement devices. These were detected and grouped as adhesive tissues, sutureless devices, and transparent polyurethane dressings. CONCLUSIONS: Current research indicates that transparent polyurethane dressings offer the most effective catheter stabilization, but adhesive tissues may constitute a valid alternative. However, there are limited high-quality studies about effective dressings and securement devices for PACs.

Estudo multicêntrico para avaliaçäo da efetividade e tolerabilidade da gatifloxacina em pacientes idosos com infecçäo no trato respiratório adquirida na comunidade no Brasil / Multicenter study for the evaliation of effectiveness and tolerability of gatifloxacin in elderly patients with community-acquired respiratory tract infection in Brazil

A infecçäo do trato respiratório é um dos grandes problemas de saúde pública em pessoas acima de 65 anos de idade.0 processo do envelhecimento acarreta modificaçöes orgânicas favoráveis a estes processos infecciosos e o surgimento de cepas bacterianas resistentes aos antibióticos mais utilizados, dificultando a abordagem terapêutica. Gatifloxacina é uma nova fluoroquinolona de amplo espectro, que tem excelente atividade contra os patógenos bacterianos mais prevalentes causadores de infecçäo do trato respiratório: Streptococcus pneumonfae, incluindo as cepas resistentes à penicilina e Haemophilus influenzae, inclusive aqueles que säo resistentes aos antibióticos beta-lactâmicos, além de ter atividade também sobre os patógenos atípicos. Um estudo aberto, prospectivo, multicêntrico, avaliou a efetividade, a tolerabilidade e segurança da gatifloxacina, na dose de 400 mg tomada uma vez ao dia (durante 7 a 14 dias) em infecçöes do trato respiratório. Participaram do estudo médicos voluntários. Foram incluídos 791 pacientes ambulatoriais com idade acima de 65 anos e com pneumonia adquirida na comunidade (PAC) (n=358), exacerbaçäo bacteriana aguda de bronquite crônica (EBABC) (n=314) e sinusite bacteriana aguda (n=119). A taxa global de cura ou melhora foi de 95,7 por cento, a incidência de recaída e falha do tratamento foi baixa, 0,25 por cento e 2,02 por cento, respectivamente. Os eventos adversos ocorreram em 11,3 por cento dos pacientes e os mais comuns foram relacionados ao trato gastrintestinal: dispepsia (2,0 por cento) e náuseas (1,6 por cento), geralmente leves e autolimitados. Gatifloxacina tomada na dose de 400 mg via oral uma vez ao dia é efetiva e segura para os pacientes idosos ambulatoriais com infecçäo bacteriana do trato respiratório: PAC, EABC e sinusite aguda.