Delirium: guidelines for general hospitals.

OBJECTIVE: Delirium is highly prevalent in general hospitals but remains underrecognized and undertreated despite its association with increased morbidity, mortality, and health services utilization. To enhance its management, we developed guidelines covering all aspects, from risk factor identification to preventive, diagnostic, and therapeutic interventions in adult patients. METHODS: Guidelines, systematic reviews, randomized controlled trials (RCT), and cohort studies were systematically searched and evaluated. Based on a synthesis of retrieved high-quality documents, recommendation items were submitted to a multidisciplinary expert panel. Experts scored the appropriateness of recommendation items, using an evidence-based, explicit, multidisciplinary panel approach. Each recommendation was graded according to this process' results. RESULTS: Rated recommendations were mostly supported by a low level of evidence (1.3% RCT and systematic reviews, 14.3% nonrandomized trials vs. 84.4% observational studies or expert opinions). Nevertheless, 71.1% of recommendations were considered appropriate by the experts. Prevention of delirium and its nonpharmacological management should be fostered. Haloperidol remains the first-choice drug, whereas the role of atypical antipsychotics is still uncertain. CONCLUSIONS: While many topics addressed in these guidelines have not yet been adequately studied, an explicit panel and evidence-based approach allowed the proposal of comprehensive recommendations for the prevention and management of delirium in general hospitals.

Comentario general del crucero de evaluación del recurso merluza ejecutado en otoño de 1995 (Cr. BIC SNP-1, 9505-06)

Presenta las observaciones realizadas desde hace varios años, investigadas por el Instituto del Mar del Perú a través de su programa de seguimiento de pesqueras demersales y costeras, y de la evaluación directa de los stocks de peces de mar.

Comentario general sobre prospección de recursos pelágicos costeros y demersales costeros. E/E Huamanga 9611-12

Describe la actividad pesquera artesanal en el Perú, desarrollada hasta las 20 millas aproximadamente. En esta zona se captura una variedad de recursos hidrobiológicos que en su mayoría son destinados al consumo humano directo, considerando que el nivel de las capturas de la pesca artesanal representan el 43% de los detinados al consumo humano y de éstos el 100% son derivados al consumo fresco.

Comentario general sobre el desarrollo del crucero de evaluación del recurso merluza en invierno de 1996. Cr. BIC SNP-1 9607-08

Describe los aspectos metodológicos aplicados en el desarrollo del crucero de evaluación del recurso merluza en invierno de 1996, consistente en dos etapas: un rastreo acústico basado en un muestréo sistemático con lances de comprobación y una evaluación por área barrida propiamente dicha. Así mismo, presenta la estructura y nivel de la población de merluza, las condiciones oceanográficas y la estructura del subsistema demersal.

Comentario general del crucero de evaluación de biomasa desovante de anchoveta. BIC Humboldt 9608-09

Comenta los resultados más relevantes obtenidos durante el crucero realizado en agosto y setiembre de 1996, para estimar la biomasa desovante de la anchoveta (Engraulis ringens) de la zona norte centro del litoral, a través del método de producción de huevos (MPH). Teniendo como escenario un ambiente frío, con condiciones favorables para la dispersión de la anchoveta, se determinó una biomasa desovante de 4,02 millones de toneladas, magnitud inferior a la estimada en el año 1995. Se detectó una distribución estratificada de la anchoveta, ubicándose los juveniles hacia la costa, y los adultos lejos de ella. Estos últimos evidenciaron una gran avance en el proceso reproductivo, aunque la frecuencia de desove disminuyó comparándola con la de 1995. La producción de huevos también se redujo y la distribución de éstos no se presentó de la forma densa observada años atrás, cuando los adultos se distribuían principalmente dentro de las 30 a 60 millas de la costa.

Comentario general sobre crucero de evaluación de recursos pelágicos BIC SNP-1 9602-04

Presenta un comentario general sobre los principales resultados alcanzados durante el crucero 9602-04, de evaluación de los principales recursos pelágicos durante el verano 1996, documento basado en la información sobre la biomasa, distribución y concentración; aspectos biológicos de la anchoveta, sardina, jurel y caballa, además del medio ambiente marino.

How critical is timing for the diagnosis of influenza in general practice?

QUESTIONS UNDER STUDY: The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in the context of controlled studies with stringent inclusion criteria. There was a need to extend the evaluation of these predictors not only in the context of general practice but also according to the duration of symptoms and to the dynamics of the epidemic. PRINCIPLES: A prospective study conducted in the Medical Outpatient Clinic in the winter season 1999-2000. Patients with influenza-like syndrome were included, as long as the primary care physician envisaged the diagnosis of influenza. The physician administered a questionnaire, a throat swab was performed and a culture acquired to document the diagnosis of influenza. RESULTS: 201 patients were included in the study. 52% were culture positive for influenza. By univariate analysis, temperature >37.8 degrees C (OR 4.2; 95% CI 2.3-7.7), duration of symptoms <48 hours (OR 3.2; 1.8-5.7), cough (OR 3.2; 1-10.4) and myalgia (OR 2.8; 1.0-7.5) were associated with a diagnosis of influenza. In a multivariable logistic analysis, the best model predicting influenza was the association of a duration of symptom <48 hours, medical attendance at the beginning of the epidemic (weeks 49-50), fever >37.8 and cough, with a sensitivity of 79%, specificity of 69%, positive predictive value of 67%, negative predictive value of 73% and an area under the ROC curve of 0.74. CONCLUSIONS: Besides relevant symptoms and signs, the physician should also consider the duration of symptoms and the epidemiological context (start, peak or end of the epidemic) in his appraisal, since both parameters considerably modify the value of the clinical predictors when assessing the probability of a patient having influenza.

Serum 25-hydroxyvitamin D level and kidney function decline in a Swiss general adult population.

Molecular evidence suggests that levels of vitamin D are associated with kidney function loss. Still, population-based studies are limited and few have considered the potential confounding effect of baseline kidney function. This study evaluated the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline, and incidence of CKD and albuminuria. Baseline (2003-2006) and 5.5-year follow-up data from a Swiss adult general population were used to evaluate the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline (annual loss >3 ml/min per 1.73 m(2)), and incidence of CKD and albuminuria. Serum 25-hydroxyvitamin D was measured at baseline using liquid chromatography-tandem mass spectrometry. eGFR and albuminuria were collected at baseline and follow-up. Multivariate linear and logistic regression models were used considering potential confounding factors. Among the 4280 people included in the analysis, the mean±SD annual eGFR change was -0.57±1.78 ml/min per 1.73 m(2), and 287 (6.7%) participants presented rapid eGFR decline. Before adjustment for baseline eGFR, baseline 25-hydroxyvitamin D level was associated with both mean annual eGFR change and risk of rapid eGFR decline, independently of baseline albuminuria. Once adjusted for baseline eGFR, associations were no longer significant. For every 10 ng/ml higher baseline 25-hydroxyvitamin D, the adjusted mean annual eGFR change was -0.005 ml/min per 1.73 m(2) (95% confidence interval, -0.063 to 0.053; P=0.87) and the risk of rapid eGFR decline was null (odds ratio, 0.93; 95% confidence interval, 0.79 to 1.08; P=0.33). Baseline 25-hydroxyvitamin D level was not associated with incidence of CKD or albuminuria. The association of 25-hydroxyvitamin D with eGFR decline is confounded by baseline eGFR. Sufficient 25-hydroxyvitamin D levels do not seem to protect from eGFR decline independently from baseline eGFR.

Differential associations of personal and general just-world beliefs with the Five-Factor and HEXACO models of personality.

Recent literature evidences differential associations of personal and general just-world beliefs with constructs in the interpersonal domain. In line with this research, we examine the respective relationships of each just-world belief with the Five-Factor and the HEXACO models of personality in one representative sample of the working population of Switzerland and one sample of the general US population, respectively. One suppressor effect was observed in both samples: Neuroticism and emotionality was positively associated with general just-world belief, but only after controlling for personal just-world belief. In addition, agreeableness was positively and honesty-humility negatively associated with general just-world belief but unrelated to personal just-world belief. Conscientiousness was consistently unrelated to any of the just-world belief and extraversion and openness to experience revealed unstable coefficients across studies. We discuss these points in light of just-world theory and their implications for future research taking both dimensions into account.

Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

Karta öfver storfurstendömet Finland sammandragen, med stöd af de tillförlitligaste kartor uti general landtmäteri kontoret samt särskildte benäget meddelade upplysningar, uppå K. E. Holms förlag, af A. W. Eklund /

1 kartta :, vär. ;, lehti 88,7 x 58 cm

Karta öfver storfurstendömet Finland efter nya tillförlitliga källor och med särskildt begagnande af general stabens original-kartor utgiftven år 1860 af öfverste Georg Alfthan /

1 kartta :, vär. ;, 72,5 x 47,4 cm, lehti 83 x 58 cm

Kartor och beskrifningar öfver socknarne i Nylands län / upprättade å general landmäteri kontoret, lithografierade och utgifne till granskning och berigtigande år 1844.

1 kartasto ([35] s., [24] karttalehteä (7 taitettuina)) : 24 karttaa, vär. ; 56 cm