A national survey of the mangement of delirium in UK intensive care units

Background: Delirium is an acute organ dysfunction common amongst patients treated in intensive care units. The associated morbidity and mortality are known to be substantial. Previous surveys have described which screening tools are used to diagnose delirium and which medications are used to treat delirium, but these data are not available for the United Kingdom. Aim: This survey aimed to describe the UK management of delirium by consultant intensivists. Additionally, knowledge and attitudes towards management of delirium were sought. The results will inform future research in this area. Methods: A national postal survey of members of the UK Intensive Care Society was performed. A concise two page questionnaire survey was sent, with a second round of surveys sent to non-respondents after 6 weeks. The questionnaire was in tick-box format. Results: Six hundred and eighty-one replies were received from 1308 questionnaires sent, giving a response rate of 52%. Twenty-five percent of respondents routinely screen for delirium, but of these only 55% use a screening tool validated for use in intensive care. The majority (80%) of those using a validated instrument used the Confusion Assessment Method for the Intensive Care Unit. Hyperactive delirium is treated pharmacologically by 95%; hypoactive delirium is treated pharmacologically by 25%, with haloperidol the most common agent used in both. Over 80% of respondents agreed that delirium prolongs mechanical ventilation and hospital stay and requires active treatment. Conclusions: This UK survey demonstrates screening for delirium is sporadic. Pharmacological treatment is usually with haloperidol in spite of the limited evidence to support this practice. Hypoactive delirium is infrequently treated pharmacologically.

Beyond the National Resource Privilege: towards an International Court of the Environment

The national resource privilege, which holds that states are allowed to control all the natural resources found in their territory, is a cornerstone of international politics. Supporters of the national resource privilege claim that without the privilege states would fail to be sovereign and self-determining entities which provide for the needs of their citizens. However, as this paper shows the case is not as simple as that. In fact, control over resources must be carefully unpacked. Doing so shows that states do not require full control over all resources found in their territory in order to be sovereign. Moreover, sovereignty and self-determination come with a set of responsibilities and duties attached. Based on these observations the paper will sketch the contours of an alternative resource governance scheme built around the idea of an International Court of the Environment.

Risk versus National Pride. Conflicting discourses over the construction of a High Voltage Power Station in the Athens Metropolitan Area for demands of the 2004 Olympics

This paper first explores the conflictual discourses employed by government agencies, citizens’ initiatives, and environmental organizations over the construction of a High Voltage Power Station (KYT) for demands of the 2004 Olympic Games, as presented in media reports and movement literature over a period of one year. Having in mind recent criticisms targeting the lack of empirical evidence in Ulrich Beck’s risk theorization, this exploration is of distinct importance. Secondly, it takes into account that both the defensive character of societal action and mistrust to expert authorities have been confirmed as prevalent characteristics of both the Greek and the general risk social context. The paper attempts to re-evaluate and/or complement existing perspectives of societal activism in general and environmental mobilizations in particular within the confines of the Greek social context. As a tentative conclusion, it is suggested that the risk perspective offers a novel prism for the examination of societal activism without confining it to the characteristics of individual national contexts.