Risk factors for incident delirium in acute medical in-patients. A systematic review

Review question/objective
What risk factors are associated with incident delirium in adult patients during an acute medical hospitalisation?
More specifically, the objectives are to:
Identify and synthesise the best available evidence on the factors which are associated with delirium in adult patients admitted to acute medical facilities.

Types of participants
This review will consider studies that include adults (defined as 18 years and above) who were admitted to an acute medical setting (e.g. general medical units, stroke units, short stay units and neuromedical units) who were not delirious on admission (in order to differentiate incident delirium) but who developed incident delirium during hospitalisation

The review will exclude patients who were:
- critically ill and admitted to specialist unit e.g. ICU or CCU
- admitted for any type of surgery
- admitted for alcohol related reasons
- admitted to psychiatric facility
These patients will be excluded in order to determine factors that may be exclusive to the medical in patient setting.

Types of intervention(s)/phenomena of interest
This review will consider studies that evaluate any risk factors that may contribute to the development of delirium during in-patient hospitalisation. The review will look at factors present on admission (predisposing) and also factors that may occur during hospitalisation (precipitating) that contribute to incident delirium.

Types of outcomes
This review will consider studies that include the following outcome measures: the incidence of delirium as related to individual risk factors.

The pursuit of exclusion through zonal banning

In recent years, a growing emphasis has been placed on the use of zonal banning to address violence and anti-social behaviour associated with alcohol consumption. While we recognise the longer historical links between territory and crime, this article focuses on recent efforts to govern territory through new zonal regulations. Recent processes in Australia involve the conflation criminal law principles with processes of managing order in and around private spaces through new administrative approaches to alcohol-related law enforcement. The article outlines the nature of sub-sovereign ‘police laws’ and the extent to which they have been used based on Victorian data. We conclude by suggesting these developments need ongoing critical scrutiny given evidence of the ongoing expansion of proprietary-based principles in the management of urban disorder, and the potential for these developments to promote the increased use of surveillance technologies to exclude undesirable populations from the nighttime economies of Australian cities.

Does personality affect dietary intake?

The purpose of this review is to evaluate the evidence for an association between the Big Five dimensions of personality, dietary intake, and compliance to dietary recommendations. Poor diet is a known risk factor for overweight and obesity and associated chronic lifestyle diseases and it has been proposed that personality may be linked to dietary choices. Findings from cross-sectional surveys from different countries and cultures show a positive association between Openness and consumption of fruits and vegetables and between Conscientiousness and healthy eating. Although no evidence has been found that personality dimensions are associated with adherence to dietary recommendations over time, Conscientiousness is associated with a number of prosocial and health-promoting behaviors that include avoiding alcohol-related harm, binge-drinking, and smoking, and adherence to medication regimens. With emerging evidence of an association between higher Conscientiousness and lower obesity risk, the hypothesis that higher Conscientiousness may predict adoption of healthy dietary and other lifestyle recommendations appears to be supported.

Correlates and motives of pre-drinking with intoxication and harm around licensed venues in two cities

INTRODUCTION AND AIMS: The study investigates the prevalence of pre-drinking culture in the night-time economy (NTE) and its impact upon intoxication and alcohol-related harm and violence experienced by patrons. DESIGN AND METHODS: Cross-sectional surveys were conducted in and around licensed venues in Newcastle (NSW) and Geelong (Victoria) during peak trading hours (typically 9pm-1am). Participants completed a five minute structured interview which targeted: demographics, past and planned movements on the survey night, safety/experience of harm, and patron intoxication. 3949 people agreed to be interviewed, a response rate of 90.7%. Around half (54.9%) of interviewees were male and mean age was 24.4 years (SD = 5.8). RESULTS: 66.8% of participants reported pre-drinking prior to attending licensed venues. On a 1-10 scale measuring self-rated intoxication, pre-drinkers scored significantly higher compared to non pre-drinkers (P < 0.001). Compared to non-pre-drinkers, patrons who had consumed 6-10 standard pre-drinks were 1.5 times more likely to be involved in a violent incident in the past 12 months (OR = 1.50, 95%CI 1.03-2.19, P = 0.037) increasing to 1.8 times more likely for patrons who had 11-15 drinks (OR = 1.80, 95%CI 1.04-3.11 P = .036). Pre-drinking was also associated with both self-rated and observer-rated intoxication, as well as increased probability of illicit drug use. Amongst pre-drinkers, price was the most commonly reported motive for pre-drinking (51.8%). DISCUSSION AND CONCLUSIONS: 'Pre-drinking' was normal behaviour in the current sample and contributes significantly to the burden of harm and intoxication in the NTE. Price disparity between packaged vs. venue liquor is a key motivator for pre-drinking.

Helping someone with problem drinking: mental health first aid guidelines - a Delphi expert consensus study.

BACKGROUND: Alcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinker's social network can play an integral role in addressing hazardous (i.e., high-risk) or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them). This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence). METHODS: A systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians) individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. Participants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. Items that reached consensus on importance were retained and written into guidelines. RESULTS: The overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians), with 184 first aid strategies rated as essential or important by > or =80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency. CONCLUSION: The guidelines provide a consensus-based resource for community members seeking to help someone with a drinking problem. Improving community awareness and understanding of how to identify and support someone with a drinking problem may lead to earlier recognition of problem drinking and greater facilitation of professional help seeking.

The surveillance of social networking and the social value of privacy

This chapter argues that theories about privacy would benefit from embracing deliberative democratic theory on the grounds that it addresses harms to democracy, and widens our understandings of privacy infringements in social networking environments. We first explore how social networking services (SNS) have evolved through different phases and how they enable political deliberation. Subsequently, we discuss more traditional individualistic and intersubjective theories of privacy in relation to social networking and point out their limitations in identifying and redressing social networking-related harms. We then critique emerging claims concerning the social value of privacy in the context of the social Web. Here we point out how these theories might identify non-individualized harms, yet, at the same time, suffer important challenges in application. We conclude by arguing that deliberative democratic theory can add some critical insights into the privacy harms encountered on the contemporary “social Web” that are only imperfectly understood by individualistic and social conceptions of privacy.

The ones that turn up are the ones that are responsible : key stakeholders perspectives on liquor accords

INTRODUCTION AND AIMS: Liquor accords were introduced as an intervention to reduce alcohol-related harm in and around licensed venues. There have been very few evaluations of the accords, made all the more difficult given the multitude of measures that are often implemented under their banner. This study provides perspectives on the effectiveness of the liquor accords from key stakeholders who were involved in the strategy. DESIGN AND METHODS: In-depth interviews were conducted with 97 key stakeholders as part of a larger study, of which 46 spoke about the effectiveness of liquor accords. Responses were analysed using thematic analysis. RESULTS: Stakeholders reported the greatest benefit of liquor accords to be their ability to improve communication. Many stakeholders recognised the need for mandatory attendance and discussed whether the accords are a waste of time of resources. Stakeholders did not generally view liquor accords as effective means of reducing alcohol-related harm. DISCUSSION: There was a lack of positive feedback about liquor accords provided by stakeholders, indicating a clear need to better understand the role of liquor accords, and what they aim to achieve. Responsive regulation theory suggests that the dual roles of communication and intervention are confused, leading to some of the inherent problems with accords. CONCLUSIONS: The role and aims of liquor accords need to be clearly defined. The findings suggest that separating the communication and regulatory functions from accords will lead to a clearer role for accords, and interventions and regulation might be better placed in the hands of regulators and enforcement. [Curtis A, Miller P, Droste N, McFarlane E, Martino F, Palmer D. 'The ones that turn up are the ones that are responsible': Key stakeholders perspectives on liquor accords.

Privacy, surveillance, and the democratic potential of the social web

This chapter argues that theories about privacy would benefit from embracing deliberative democratic theory on the grounds that it addresses harms to democracy, and widens our understandings of privacy infringements in social networking environments. We fi rst explore how social networking services (SNS) have evolved through diff erent phases and how they enable political deliberation. Subsequently, we discuss more traditional individualistic and intersubjective theories of privacy in relation to social networking and point out their limitations in identifying and redressing social networking-related harms. We then critique emerging claims concerning the social value of privacy in the context of the social Web. Here we point out how these theories might identify non-individualized harms, yet, at the same time, suff er important challenges in application. We conclude by arguing that deliberative democratic theory can add some critical insights into the privacy harms encountered on the contemporary “social Web” that are only imperfectly understood by individualistic and social conceptions of privacy

Victoria’s banning notice provisions: parliamentary, procedural and individual vulnerabilities

Purpose Alcohol-related disorder in Australia’s night-time economy has precipitated an expanding regulatory and legislative framework. A key feature is the growth of police-imposed discretionary justice, one example of which are Victoria’s banning provisions. Banning notices are imposed on-the-spot, may be issued pre-emptively, but permit no right of independent appeal. However, there has been little analysis of the enactment, implementation or use of police-imposed banning provisions. The paper aims to discuss these issues.

Design/methodology/approach This paper draws upon a detailed examination of the record of parliamentary debate of the banning notice legislation to document how the provisions, and their embedded procedural vulnerabilities, were legitimised. In addition, an analysis of Victoria Police data informs consideration of the ongoing scrutiny of the police power to ban.

FindingsThe absolute discretion afforded to police officers, and a lack of effective oversight, has created the potential for the disproportionate and discriminatory implementation of Victoria’s banning notice powers. The findings highlight procedural vulnerabilities within the provisions, and concern regarding the particular risk of banning notices for vulnerable recipients.

Research limitations/implications The nature of Victoria’s banning provisions created the circumstances for their inequitable imposition, but public scrutiny of their use and effect is limited. Omissions and deficiencies in the published data restricts meaningful analysis of how banning works in practice.

Originality/value The research underpinning this paper was the first detailed examination of the implementation and ongoing scrutiny of Victoria’s banning notice provisions. The findings presented in this paper highlight key procedural vulnerabilities resulting from the passage of the legislation and the absence of effective oversight.

Upholding whose right? Discretionary police powers to punish, collective 'pre-victimisation and the dilution of individual rights

This article uses the example of Victoria’s alcohol-related banning notice provisions to explore the changing conception of balance within criminal justice processes. Despite the formalisation of individual rights within measures such as Victoria’s Charter of Human Rights and Responsibilities Act 2006, the discretionary power of the police to issue on-the-spot punishments in response to actual or potential criminal behaviour has increased steadily. A key driver, evident across the parliamentary debates of the banning legislation, is a presumed need to protect the broader community of potential victims. As a result, the individual rights of those accused (but not necessarily convicted) of undesirable behaviours are increasingly subordinated to the pre-emptive protection of the law-abiding majority. This shift embodies a largely unsubstantiated notion of collective pre-victimisation. Significantly, despite the expectations of Victoria’s Charter, measures such as banning notices have been enacted with insufficient evidence of the underlying collective risk, of their likely effectiveness and without meaningful ongoing scrutiny. The motto of Victoria Police – Uphold the Right –appears to belie a growing uncertainty over whose rights should be upheld and how.

A novel treatment resource for co-occurring symptoms

This paper describes the development of a novel integrative self-directed treatment tool which uses cognitive behavioural therapy techniques to reduce anxiety symptoms in patients presenting to treatment for alcohol-related problems. More specifically, the purpose of this paper is to explore patient and health practitioner perceptions of the booklet, in order to determine its suitability and utility in the context of existing alcohol treatment services. The extent of cross-informant agreement between patient and health practitioner responses is also examined. – This research utilises a cross-sectional qualitative research design using semi-structured interview methods with patients presenting to hospital for alcohol-related diseases/illnesses/accidents/injuries (n=15) and practitioners (n=10) working at inpatient, outpatient and residential substance treatment facilities. – The present study found that the majority of patients (80 per cent) and practitioners (90 per cent) expressed a motivation to utilise the proposed booklet, agreeing that the booklet was a practical, achievable and educational resource for patients suffering from co-occurring anxiety symptoms in substance abuse facilities. Participants outlined limitations of the resource, suggesting that the booklet would be most suitable for patients with moderate to high cognitive ability, who also exhibit a motivation to change alcohol consumption and have access to additional support. – Findings from the present study suggest that the booklet may be most effective in improving treatment accessibility and patient treatment seeking behaviours; rather than reducing practitioner-patient contact. – This paper focuses on the development and utility of a novel resource suitable for substance abuse treatment facilities. The findings and feedback produced from the present study can assist with modifications of the intervention and in improving the effectiveness of future trials.

The disparity between human rights policy and parliamentary practice in Australia : a Victorian case study

Over the past decade alcohol-related violence in and around licensed premises has given rise to significant legislative, regulatory and operational policing developments. In Australia, the State of Victoria introduced police-imposed banning notices as part of a range of provisions and new powers targeting alcohol-related disorderly behaviour. Banning notices exemplify a broader shift towards discretionary, pre-emptive, regulatory, summary justice which circumvents the criminal law, dilutes individual rights, and reconfigures expectations of balance in the administration of justice. The legal principles upon which banning notices are based and the way in which they were enacted by the Victorian Parliament challenge both the purpose and specific requirements of Victoria’s Charter of Human Rights and Responsibilities Act 2006. Detailed analysis of the application of the Charter compliance processes to the banning notice provisions point to a notable disparity between the expectations of formal human rights policy and the reality of substantive practice. The broader effect of such a disconnect is potentially significant, but has been largely opaque to meaningful scrutiny.

High rates of alcohol consumption and related harm at schoolies week : a portal study

To investigate alcohol consumption, substance use and risky and harmful behaviour among young people attending 'schoolies' week in Victoria.