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1.
Sci Total Environ ; 931: 172825, 2024 Apr 29.
Article in English | MEDLINE | ID: mdl-38692311

ABSTRACT

Carbonaceous materials catalyze reductive dechlorination of chlorinated ethylenes (CEs) by iron(II) materials providing a new approach for the remediation of CE polluted groundwater. While most CEs are reduced via ß-elimination, vinyl chloride (VC), the most toxic and recalcitrant CE, degrades by hydrogenolysis. The significance of carbon catalysts for reduction of VC is well documented for iron(0) systems, but hardly investigated with iron(II) materials as reductants. In this study, a layered iron(II)­iron(III) hydroxide sulfate (green rust) was used as reductant for VC, with an N-doped graphene (NG), prepared by co-pyrolysis of graphene and urea, as catalyst. VC (80 µM) was completely reduced to ethylene within 336 h in the presence of 5 g Fe/L GR and 5 g/L NG pyrolyzed at 950 °C, following pseudo-first-order kinetics with a rate constant of 0.017 h-1. Dosing experiments demonstrated that dechlorination of VC takes place on the NG phase. Monitoring of hydrogen formation, cyclic voltammetry, and quenching experiments demonstrated that atomic hydrogen contributes significantly to the dehalogenation reaction, where NG is critical for formation of atomic hydrogen. CE competition experiments demonstrated the presence of specific VC reduction sites with hydrogenolysis being unaffected by concurrent ß-elimination reactions. The system exhibited excellent performance in natural groundwaters and in comparison with iron(0) systems. This study demonstrates that GR + NG is a promising system for remediation of VC contaminated groundwater, and the mechanistic part of the study can be used as a reference for subsequent studies.

2.
Sci Total Environ ; 921: 170658, 2024 Apr 15.
Article in English | MEDLINE | ID: mdl-38340825

ABSTRACT

Plants produce a diverse array of toxic compounds which may be released by precipitation, explaining their wide occurrence in surrounding soil and water. This study presents the first mechanistic model for describing the generation and environmental fate of a natural toxin, i.e. ptaquiloside (PTA), a carcinogenic phytotoxin produced by bracken fern (Pteridium aquilinum L. Kuhn). The newly adapted DAISY model was calibrated based on two-year monitoring performed in the period 2018-2019 in a Danish bracken population located in a forest glade. Several functions related to the fate of PTA were calibrated, covering processes from toxin generation in the canopy, wash off by precipitation and degradation in the soil. Model results show a good description of observed bracken biomass and PTA contents, supporting the assumption that toxin production can be explained by the production of new biomass. Model results show that only 4.4 % of the PTA produced in bracken is washed off by precipitation, from both canopy and litter. Model simulations showed that PTA degrades rapidly once in the soil, especially during summer due to the high soil temperatures. Leaching takes place in form of pulses directly connected to precipitation events, with maximum simulated concentrations up to 4.39 µg L-1 at 50 cm depth. Macropore transport is mainly responsible for the events with the highest PTA concentrations, contributing to 72 % of the total mass of PTA leached. Based on the results, we identify areas with high density of bracken, high precipitation during the summer and soils characterized by fast transport, as the most vulnerable to surface and groundwater pollution by phytotoxins.


Subject(s)
Pteridium , Sesquiterpenes , Pteridium/metabolism , Rhizosphere , Sesquiterpenes/metabolism , Indans , Soil
3.
Article in English | MEDLINE | ID: mdl-38348284

ABSTRACT

Delirium is common in hospitalised patients, and there is currently no specific treatment. Identifying and treating underlying somatic causes of delirium is the first priority once delirium is diagnosed. Several international guidelines provide clinicians with an evidence-based approach to screening, diagnosis and symptomatic treatment. However, current guidelines do not offer a structured approach to identification of underlying causes. A panel of 37 internationally recognised delirium experts from diverse medical backgrounds worked together in a modified Delphi approach via an online platform. Consensus was reached after five voting rounds. The final product of this project is a set of three delirium management algorithms (the Delirium Delphi Algorithms), one for ward patients, one for patients after cardiac surgery and one for patients in the intensive care unit.

4.
Pilot Feasibility Stud ; 9(1): 195, 2023 Dec 02.
Article in English | MEDLINE | ID: mdl-38042811

ABSTRACT

BACKGROUND: COVID-19 is a highly contagious disease where isolation of infected individuals is deemed warranted. If possible, home isolation is preferred over hospitalization. This implies a need for methods of observation that can ensure the safety of these patients. Preventive treatment methods that can both decrease the probability for development of critical disease and hopefully decrease the need for hospitalization would be an added benefit. This was a single-arm prospective pilot study performed to assess the feasibility of performing self-measurements of SpO2 and respiratory exercises in at-home isolated COVID-19 patients. METHOD: A total of 40 ambulant SARS-CoV-2-positive individuals in home isolation were followed up for a period of 14 days. At baseline, they were equipped with a pulse oximeter, PEF meter, a project diary to note all measurements, and simple instructions on how to perform respiratory exercises. No other contact was made, but participants were instructed to contact the hospital based on given criteria for blood oxygenation levels and dyspnea severity and to return study equipment and the project diary at the end of study. RESULTS: During the follow-up period, 35 participants (87.5%) recorded daily SpO2 measurements, and 12 (30%) adhered to daily respiratory exercises as instructed. Four participants (10%) were admitted to hospital during the follow-up period. Five participants terminated follow-up prematurely. CONCLUSIONS: Performing self-measurements of SpO2 during home isolation due to COVID-19 infection is feasible. The feasibility of performing respiratory exercises in ambulant patients is questionable and may require more motivational interventions to increase adherence. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04647747.

5.
Water Res ; 247: 120792, 2023 Dec 01.
Article in English | MEDLINE | ID: mdl-37925858

ABSTRACT

Phosphorus (P) losses from tile-drained agricultural fields may degrade surface water quality by accelerating eutrophication. Among the different edge-of-field technologies, compact filter systems using different filter materials have been identified as potentially effective solutions for removing P from drainage water before discharge downstream. This study investigated the long-term (>696 days) P removal efficiency of 5 different filter materials in a column setup, using artificial drainage water (pH 6). Filter materials included two iron-based granulates (calcinated diatomaceous earth (CDE), ferric hydroxide granules (CFH)), and three calcium-based granulates (seashells, limestone, calcinated silicate/calcium oxide (Filtralite-P)). Experiments were performed under variable flow rates (0.037 and 1.52 L h-1; hydraulic retention time of 26-43 min and 18-30 h) and inlet P concentrations (0.14 and 0.7 mg L-1). An overall analysis revealed that the Fe-based materials achieved higher P retention than Ca-based materials. In particular, CFH was capable of retaining 99 and 98 % of the high and low inlet P concentrations, respectively. Conversely, limestone retained only 25 % of the high P load. CDE performed moderately well, independently of the inlet P concentration. Filtralite-P and Seashells performed well at high inlet P concentration but relatively poorly at low P concentration. The sensitivity of filter material P removal efficiency to variations in P loading was generally lowest for CFH and highest for limestone.


Subject(s)
Bays , Phosphorus , Iron , Calcium Carbonate , Silicates
6.
Bioresour Technol ; 388: 129785, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37722544

ABSTRACT

In this study, cyanobacterial biochars (CBs) enriched/doped with non-metallic elements were prepared by pyrolysis of biomass amended with different N, S, and P containing compounds. Their catalytic reactivity was tested for persulfate oxidation of the antibiotic norfloxacin (NOR). N and S doping failed to improve CB catalytic reactivity, while P doping increased reactivity 5 times compared with un-doped biochar. Biochars produced with organic phosphorus dopants showed the highest reactivity. Post-acid-washing improved catalytic reactivity. In particular, 950 ℃ acid-washed triphenyl-phosphate doped CB showed the largest degradation rate and reached 79% NOR mineralization in 2 h. Main attributes for P-doped CBs high reactivity were large specific surface areas (up to 655 m2/g), high adsorption, high C-P-O content, graphitic P and non-radical degradation pathway (electron transfer). This study demonstrates a new way to reuse waste biomass by producing efficient P-doped metal-free biochars and presents a basic framework for designing carbon-based catalysts for organic pollutant degradation.


Subject(s)
Anti-Bacterial Agents , Cyanobacteria , Norfloxacin , Phosphorus , Charcoal
7.
Water Res ; 244: 120535, 2023 Oct 01.
Article in English | MEDLINE | ID: mdl-37660466

ABSTRACT

Vinyl chloride (VC) is a dominant carcinogenic residual in many aged chlorinated solvent plumes, and it remains a huge challenge to clean it up. Zerovalent iron (ZVI) is an effective reductant for many chlorinated compounds but shows low VC removal efficiency at field scale. Amendment of ZVI with a carbonaceous material may be used to both preconcentrate VC and facilitate redox reactions. In this study, nitrogen-doped graphene (NG) produced by a simple co-pyrolysis method using urea as nitrogen (N) source, was tested as a catalyst for VC reduction by nanoscale ZVI (nZVI). The extent of VC reduction to ethylene in the presence of 2 g/L of nZVI was less than 1% after 3 days, and barely improved with the addition of 4 g/L of graphene. In contrast, with amendment of nZVI with NG produced at pyrolysis temperature (PT) of 950 °C, the VC reduction extent increased more than 10-fold to 69%. The reactivity increased with NG PT increasing from 400 °C to an optimum at 950 °C, and it increased linearly with NG loadings. Interestingly, N dosage had little effect on reactivity if NG was produced at PT of 950 °C, while a positive correlation was observed for NG produced at PT of 600 °C. XPS and Raman analyses revealed that for NG produced at lower PT (<800 °C) mainly the content of pyridine-N-oxide (PNO) groups correlates with reactivity, while for NG produced at higher PT up to 950 °C, reactivity correlates mainly with N induced structural defects in graphene. The results of quenching and hydrogen yield experiments indicated that NG promote reduction of VC by storage of atomic hydrogen, thus increasing its availability for VC reduction, while likely also enabling electron transfer from nZVI to VC. Overall, these findings demonstrate effective chemical reduction of VC by a nZVI-NG composite, and they give insights into the effects of N doping on redox reactivity and hydrogen storage potential of carbonaceous materials.


Subject(s)
Graphite , Vinyl Chloride , Catalysis , Hydrogen , Iron , Nitrogen
9.
J Hazard Mater ; 459: 132067, 2023 10 05.
Article in English | MEDLINE | ID: mdl-37478594

ABSTRACT

Trace element polluted soils pose risks to human and environmental health. Biochar can decrease trace element bioavailability in soils, but their resulting ability to reduce soil toxicity may vary significantly depending on feedstocks used, pyrolysis conditions, and the target pollutants. Chromated copper arsenate (CCA) polluted sites are common, but only very few types of biochar have been tested for these sites. Hence, we tested fourteen well-characterized biochar materials for their ability to bind Cu and reduce toxicity in a CCA polluted soil in a 56-day experiment. Biochar (1%, wt/wt) increased plant (wheat, Triticum aestivum L.) shoot and root growth by 6-58% and 0-73%, reduced soil toxicity to Arthrobacter globiformis by 7-55%, decreased bioavailable Cu (Pseudomonas fluorescens bioreporter) by 5-65%, and decreased free Cu2+ ion activities by 27-89%. The A. globiformis solid-contact test constituted a sensitive ecotoxicological endpoint and deserves further attention for assessment of soil quality. Oil seed rape straw biochar generally performed better than other tested biochar materials. Biochar performance was positively correlated with its high cation exchange capacity, multiple surface functional groups, and high nitrogen and phosphorus content. Our results pave the way for future selection of feedstocks for creation of modified biochar materials with optimal performance in CCA polluted soil.


Subject(s)
Soil Pollutants , Trace Elements , Humans , Copper/toxicity , Biological Availability , Soil Pollutants/metabolism , Charcoal , Soil , Triticum/metabolism
11.
Argumentation ; 37(2): 253-267, 2023.
Article in English | MEDLINE | ID: mdl-36817945

ABSTRACT

This appearance condition of fallacies refers to the phenomenon of weak arguments, or moves in argumentation, appearing to be okay when really they aren't. Not all theorists agree that the appearance condition should be part of the conception of fallacies but this essay explores some of the consequences of including it. In particular, the differences between committing a fallacy, causing a fallacy and observing a fallacy are identified. The remainder of the paper is given over to discussing possible causes of mistakenly perceiving weak argumentation moves as okay. Among these are argument caused misperception, perspective caused misperception, discursive environment caused misperception and perceiver caused misperception. The discussion aims to be sufficiently general so that it can accommodate different models and standards of argumentation that make a place for fallacies.

13.
Ecotoxicol Environ Saf ; 242: 113939, 2022 Sep 01.
Article in English | MEDLINE | ID: mdl-35930836

ABSTRACT

The potential toxicity and ecological risks of rare-earth nanoparticles in the environment have become a concern due to their widespread application and inevitable releases. The integration of hydroponics experiments, partial least squares structural equation modeling (PLS-SEM), and Transmission Electron Microscopy (TEM) were utilized to investigate the physiological toxicity, uptake and translocation of yttrium oxide nanoparticles (Y2O3 NPs) under different hydroponic treatments (1, 5, 10, 20, 50 and 100 mg·L-1 of Y2O3 NPs, 19.2 mg·L-1 Y(NO3)3 and control) in tomato (Lycopersicon esculentum) seedlings. The results indicated that Y2O3 NPs had a phytotoxic effect on tomato seedlings' germination, morphology, physiology, and oxidative stress. The Y2O3 NPs and soluble YIII reduced the root elongation, bud elongation, root activity, chlorophyll, soluble protein content and superoxide dismutase and accelerated the proline and malondialdehyde in the plant with increasing concentrations. The phytotoxic effects of Y2O3 NPs on tomato seedlings had a higher phytotoxic effect than soluble YIII under the all treatments. The inhibition rates of different levels of Y2O3 NPs in shoot and root biomass ranged from 0.2% to 6.3% and 1.0-11.3%, respectively. The bioaccumulation and translocation factors were less than 1, which suggested that Y2O3 NPs significantly suppressed shoot and root biomass of tomato seedlings and easily bioaccumulated in the root. The observations were consistent with the process of concentration-dependent uptake and translocation factor and confirmed by TEM. Y2O3 NPs penetrate the epidermis, enter the cell wall, and exist in the intercellular space and cytoplasm of mesophyll cells of tomato seedlings by endocytic pathway. Moreover, PLS-SEM revealed that the concentration of NPs significantly negatively affects the morphology and physiology, leading to the change in biomass of plants. This study demonstrated the possible pathway of Y2O3 NPs in uptake, phytotoxicity and translocation of Y2O3 NPs in tomato seedlings.


Subject(s)
Nanoparticles , Solanum lycopersicum , Nanoparticles/toxicity , Oxides/pharmacology , Plant Roots/metabolism , Plants , Seedlings , Yttrium/metabolism
14.
J Neurol Sci ; 441: 120358, 2022 10 15.
Article in English | MEDLINE | ID: mdl-35969922

ABSTRACT

BACKGROUND: Optic nerve sheath (ONS) dilation indicates intracranial pressure elevation under clinical conditions but limited data exist with regard to the dynamics of sheath expansion. OBJECTIVE: To assess the time course of ONS widening and its stability under controlled pressure conditions in vitro. METHODS: Pre-defined pressure steps up to 65 mmHg were applied to the perineural space of ex-vivo human optic nerves (n = 16). Using ultrasound, the optic nerve sheath diameter (ONSD) was monitored over 500 s. Re-tests at low-pressure levels concluded each experimental series. RESULTS: In most cases, 50% of the total diameter-change were achieved within 50 s after pressure onset and 95% of the maximal diameter after 200 s. The diametric gains in each experiment were strongly correlated with the applied pressure levels (coefficient of variance 0,96) within preparations with variability of the transfer function across preparations. The time course of the dilation was found to follow an approximate natural logarithmic function (R2 = 0.93-0.99). The re-test condition revealed unchanged time course properties (5% significance level) despite starting regularly from a higher baseline-diameter after preceding exposures. CONCLUSIONS: ONS dilation commences rapidly after pressure exposure with a predictable time course over 3-4 min. Elasticity changes presumably affecting trabecular structures cause upward shifts of the optic nerve sheath pressure response. Clinically, ONSD shifts should be considered in serial measurements for increasing intracranial pressure monitoring, but relevant response delays are absent for lower or higher changes of intracranial pressure.


Subject(s)
Intracranial Hypertension , Intracranial Pressure , Dilatation/adverse effects , Humans , Intracranial Hypertension/etiology , Intracranial Pressure/physiology , Optic Nerve/diagnostic imaging , Ultrasonography
15.
J Hazard Mater ; 439: 129655, 2022 10 05.
Article in English | MEDLINE | ID: mdl-35901634

ABSTRACT

Peroxydisulfate (PDS) is a common oxidant for organic contaminant remediation. PDS is typically activated by metal catalysts to generate reactive radicals. Unfortunately, as radicals are non-selective and metal catalysts may cause secondary contamination, alternative selective non-radical pathways and non-metal catalysts need attention. Here we investigated PDS oxidation of commonly detected antibiotic Norfloxacin (NOR) using cyanobacterial nitrogen rich biochars (CBs) as catalysts. NOR was fully degraded by CB pyrolysed at 950 °C (CB950) within 120 min. CB950 caused threefold faster degradation than low pyrolysis temperature (PT) CBs and achieved a maximum surface area normalized rate constant of 4.38 × 10-2 min-1 m-2 L compared to widely used metal catalysts. CB950 maintained full reactivity after four repeated uses. High defluorination (82%) and mineralization (>82%) were observed for CB950/PDS. CBs were active over a broad pH range (3-10), but with twice as high rates under alkaline compared with neutral conditions. NOR is degraded by organic, •OH and SO4•- radicals in low PT CBs/PDS systems, where the presence of MnII promotes radical generation. Electron transfer reactions with radicals supplemented dominate high PT CBs/PDS systems. This study demonstrates high PT biochars from algal bloom biomass may find use as catalysts for organic contaminant oxidation.


Subject(s)
Anti-Bacterial Agents , Norfloxacin , Catalysis , Charcoal
16.
Micromachines (Basel) ; 13(4)2022 Mar 26.
Article in English | MEDLINE | ID: mdl-35457820

ABSTRACT

The metallization of plastics is an important industrial process. Plastics are metallized for both aesthetic and functional purposes. The unceasing pursuit towards the miniaturization and reduction in the part's size challenges the already complicated process of metallization. A rigorous research study uncovering the effects of miniaturization on the quality of metallized parts is missing at the state-of-the-art level. This study focuses on the quality of the deposited metal film based on geometrical dimensions and systematically characterizes the effects of miniaturization on the metallized micro-components. The experimental results presented in this paper reveal the hidden synergy among the metallization quality, part dimension, and process conditions used both for substrate fabrication and for metallization. The paper broadens the fundamental understanding about the interactions of various design, materials, and process parameters involved in the manufacturing process chain. The results and discussions presented in this paper will be valuable sources of information to deal with the integration of micrometallic structures on polymeric substrates for high precision applications.

17.
Sci Total Environ ; 834: 155283, 2022 Aug 15.
Article in English | MEDLINE | ID: mdl-35439507

ABSTRACT

Phytotoxins are produced in plants including agricultural crops. Lupins and other plants of the Fabaceae family produce toxic alkaloids. These alkaloids have been studied in food and feed, however, the environmental fate of alkaloids produced by cultivated lupins is largely unknown. Therefore, we conducted an agricultural field experiment to investigate the occurrence of indole and quinolizidine alkaloids in lupin plant tissues, soil, soil pore water and in drainage water. During the field experiment, alkaloids were regularly quantified (median concentrations) in lupin (13-8.7 × 103 ng/g dry weight (dw)), and topsoils at depth 0-5 cm (0.1-10 ng/g dw), and depth 15-30 cm (0.2-8.5 ng/g dw), soil pore water (0.2-7.5 ng/L) and drainage water samples (0.4-18 ng/L). Lupanine was the dominant alkaloid in all collected samples. Cumulative amounts of alkaloids emitted via drainage water were around 0.1-11 mg/ha for individual alkaloids over one growing season. The total cumulative amount of alkaloid in drainage water was 14 mg/ha, which is a very small amount compared to the mass of alkaloid in the lupin biomass (11 kg/ha) and soil (0.02 kg/ha). Nearly half of the alkaloids were exported in the drainage water during high flow events, indicating that alkaloids transport preferentially via macropores. These findings indicate that drainage from lupin cultivated areas contribute to surface water contamination. The environmental and ecotoxicological relevance of alkaloids as newly identified aquatic micropollutants in areas with agricultural activities have yet to be assessed.


Subject(s)
Alkaloids , Lupinus , Quinolizidines , Indoles , Soil , Water
18.
Neurocrit Care ; 37(1): 184-189, 2022 08.
Article in English | MEDLINE | ID: mdl-35237919

ABSTRACT

BACKGROUND: Meta-analyses show a variable relationship between optic nerve sheath diameter (ONSD) and the presence of raised intracranial pressure (ICP). Because optic nerve sheath (ONS) tissue can be deformed, it is possible that ONSD reflects not only the current ICP but also prior deforming biomechanical exposures. In this post hoc analysis of two published data sets, we characterize ONS Young's modulus (E, mechanical stress per unit of strain) and calculate threshold pressure for plastic deformation. METHODS: The authors of two previously published articles contributed primary data for these unique post hoc analyses. Human cadaveric ex vivo measurements of ONSD (n = 10) and luminal distending pressure (range 5 to 65 mm Hg) were used to calculate E and the threshold pressure for plastic deformation. Clinical in vivo measurements of ONSD and ICP during endotracheal tube suction from patients with traumatic brain injury (n = 15) were used to validate the ex vivo cadaveric findings. RESULTS: Ex vivo ONS estimate of E was 140 ± 1.3 mm Hg (mean ± standard error), with evidence of plastic deformation occurring with distending pressure at 45 mm Hg. Similar E (71 ± 10 mm Hg) was estimated in vivo with an average ICP of 34 ± 2 mm Hg. CONCLUSIONS: Ex vivo, ONS plastic deformation occurs at levels of pressure commonly seen in patients with raised ICP, leading to distortion of the ICP-ONSD relationship. This evidence of plastic deformation may illustrate why meta-analyses fail to identify a single threshold in ONSD associated with the presence of raised ICP. Future studies characterizing time-dependent viscous characteristics of the ONS will help determine the time course of ONS tissue biomechanical behavior.


Subject(s)
Intracranial Hypertension , Intracranial Pressure , Cadaver , Humans , Intracranial Hypertension/etiology , Intracranial Pressure/physiology , Optic Nerve/diagnostic imaging , Plastics , Ultrasonography
19.
Environ Pollut ; 299: 118911, 2022 Apr 15.
Article in English | MEDLINE | ID: mdl-35101556

ABSTRACT

The impact of land use type on the content of potentially toxic elements (PTEs) in the soils of the Qinghai-Tibet Plateau (QTP) and the associated ecological and human health risks has drawn great attention. Consequently, in this study, top- and subsurface soil samples were collected from areas with four different land uses (i.e., cropland, forest, grassland, and developed area) and the total contents of Cr, Cd, Cu, Pb and Zn were determined. Geostatistical analysis, self-organizing map (SOM), and positive matrix factorization (PMF), ecological risk assessment (ERA) and human health risk assessment (HRA) were applied and used to classify and identify the contamination sources and assess the potential risk. Partial least squares path modeling (PLS-PM) was applied to clarify the relationship of land use with PTE contents and risk. The PTE contents in all topsoil samples surpassed the respective background concentrations of China and corresponding subsurface concentrations. However, the ecological risk of all soil samples remained at a moderate or considerable level across the four land use types. Developed area and cropland showed a higher ecological risk than the other two land use types. Industrial discharges (32.8%), agricultural inputs (22.6%), natural sources (23.7%), and traffic emissions (20.9%) were the primary PTE sources in the tested soils, which indicate that anthropogenic activities have significantly affected soil PTE contents to a greater extent than other sources. Industrial discharge was the most prominent source of non-carcinogenic health risk, contributing 37.7% for adults and 35.2% for children of the total risk. The results of PLS-PM revealed that land use change associated with intensive human activities such as industrial activities and agricultural practices distinctly affected the PTE contents in soils of the Qinghai-Tibet Plateau.


Subject(s)
Metals, Heavy , Soil Pollutants , Adult , Child , China , Environmental Monitoring , Environmental Pollution/analysis , Humans , Metals, Heavy/analysis , Risk Assessment , Soil , Soil Pollutants/analysis
20.
J Neurol ; 269(7): 3735-3744, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35157137

ABSTRACT

BACKGROUND: Post-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management. METHODS: Multicentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison. Primary outcome was severity of POD, assessed with the Nursing Delirium Screening Scale (Nu-DESC). Secondary outcome parameters were POD incidence, duration, modified Rankin Scale (mRS), length of stay in SU and hospital, mortality, and others. RESULTS: Out of a total of 799 patients, 59.4% (n = 475) could be included with 9.5% (n = 45) being delirious. Implementation of a delirium-management led to reduced POD severity; Nu-DESC median: pre: 3.5 (interquartile range 2.6-4.7) vs. post 3.0 (2.2-4.0), albeit not significant (p = 0.154). Other outcome parameters were not meaningful different. In the post-period, delirium-management could be delivered to 75% (n = 18) of delirious patients, and only 24 (53.3%) of delirious patients required pharmacological treatments. Patients with a more severe stroke and POD remained on their disability levels, compared to similar affected, non-delirious patients who improved. CONCLUSIONS: Implementation of delirium-management on SU is feasible and can be delivered to most patients, but with limited effects. Nursing interventions as first choice could be delivered to the majority of patients, and only the half required pharmacological treatments. Delirium-management may lead to reduced severity of POD but had only partial effects on duration of POD or length of stay. POD hampers rehabilitation, especially in patients with more severe stroke. REGISTRY: DRKS, DRKS00021436. Registered 04/17/2020, www.drks.de/DRKS00021436 .


Subject(s)
Delirium , Stroke , Delirium/diagnosis , Delirium/epidemiology , Delirium/etiology , Humans , Incidence , Postoperative Complications/epidemiology , Prospective Studies , Quality Improvement , Registries , Risk Factors , Stroke/complications , Stroke/therapy
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