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Objective: The prevalence and effects of delirium in very old individuals aged ≥80 years have not yet been systematically evaluated. Therefore, this large single-center study of the one-year prevalence of delirium in 3,076 patients in 27 medical departments of the University Hospital of Zurich was conducted. Methods: Patient scores on the Delirium Observation Screening scale, Intensive Care Delirium Screening Checklist, Diagnostic and Statistical Manual, 5th edition, and electronic Patient Assessment–Acute Care (nursing tool) resulted in the inclusion of 3,076 individuals in 27 departments. The prevalence rates were determined by simple logistic regressions, odds ratios (ORs), and confidence intervals. Results: Of the 3,076 patients, 1,285 (41.8%) developed delirium. The prevalence rates in the 27 departments ranged from 15% in rheumatology (OR = 0.30) to 73% in intensive care (OR = 5.25). Delirious patients were more likely to have been admitted from long-term care facilities (OR = 2.26) or because of emergencies (OR = 2.24). The length of their hospital stay was twice as long as that for other patients. Some died before discharge (OR = 24.88), and others were discharged to nursing homes (OR = 2.96) or assisted living facilities (OR = 2.2). Conclusion: This is the largest study to date regarding the prevalence of delirium in patients aged ≥80 years and the medical characteristics of these patients. Almost two out of five patients developed delirium, with a high risk of loss of independence and mortality. [ABSTRACT FROM AUTHOR]

This article explores the engagement of the Pakistani Jamaʿat-i Islami (JI) with the Iranian Revolution. I argue that the Islamist JI was drawn to the events because it reflected a core concern and signature idea of Abu 'l-Aʿla Maududi, namely to establish the sovereignty of God (hakimiyya) on earth. My analysis of various travelogues and JI publications from the 1980s demonstrates that JI observers were deeply familiar with internal revolutionary dynamics and Iran's Shiʿi identity. The prospect of seeing a proper Islamic system in action, with potentially global consequences for their cause, initially crowded out any sectarian concerns for the JI. At the same time, certain JI leaders began to voice criticism of what they perceived as rash revolutionary policies that differed from Maududi's careful, irenic understanding of a proper Islamic revolution. They also took note of sectarian messages that damaged Iran's ecumenical outreach. It was, however, the more general geopolitical climate in the Middle East and South Asia which forced the JI to publicly downplay its ties with Iran. By the late 1980s, being accused of harbouring affinities for the 'deviant Islam' of Shiʿism was a charge that had to be avoided at all costs in Pakistan and beyond. [ABSTRACT FROM AUTHOR]

Background: The general in-hospital mortality and interrelationship with delirium are vastly understudied. Therefore, this study aimed to assess the rates of in-hospital mortality and terminal delirium.Method: In this prospective cohort study of 28,860 patients from 37 services including 718 in-hospital deaths, mortality rates and prevalence of terminal delirium were determined with simple logistic regressions and their respective odds ratios (ORs).Results: Although overall in-hospital mortality was low (2.5%), substantial variance between services became apparent: Across intensive care services the rate was 10.8% with a 5.8-fold increased risk, across medical services rates were 4.4% and 2.4-fold, whereas at the opposite end, across surgical services rates were 0.7% and 87% reduction, respectively. The highest in-hospital mortality rate occurred on the palliative care services (27.3%, OR 19.45). The general prevalence of terminal delirium was 90.7% and ranged from 83.2% to 100%. Only across intensive care services (98.1%, OR 7.48), specifically medical intensive care (98.1%, OR 7.48) and regular medical services (95.8%, OR 4.12) rates of terminal delirium were increased. In contrast, across medical services (86.4%, OR 0.32) and in particular oncology (73.9%, OR 0.25), pulmonology (72%, OR 0.31) and cardiology (63.2%, OR 0.4) rates were decreased. For the remaining services, rates of terminal delirium were the same.Significance Of Results: Although in-hospital mortality was low, the interrelationship with delirium was vast: most patients were delirious at the end of life. The implications of terminal delirium merit further studies. [ABSTRACT FROM AUTHOR]

This article draws on a wide range of Shiʽi periodicals and monographs from the 1950s until the present day to investigate debates on the status of Sayyids in Pakistan. I argue that the discussion by reformist and traditionalist Shiʽi scholars (ʽulama) and popular preachers has remained remarkably stable over this time period. Both 'camps' have avoided talking about any theological or miracle-working role of the Prophet's kin. This phenomenon is remarkable, given the fact that Sayyids share their pedigree with the Shiʽi Imams, who are credited with superhuman qualities. Instead, Shiʽi reformists and traditionalists have discussed Sayyids predominantly as a specific legal category. They are merely entitled to a distinct treatment as far as their claims to charity, patterns of marriage, and deference in daily life is concerned. I hold that this reductionist and largely legalising reading of Sayyids has to do with the intense competition over religious authority in post-Partition Pakistan. For both traditionalist and reformist Shiʽi authors, ʽulama, and preachers, there was no room to acknowledge Sayyids as potential further competitors in their efforts to convince the Shiʽi public about the proper 'orthodoxy' of their specific views. [ABSTRACT FROM AUTHOR]

This paper seeks to illuminate the intellectual impact of the Iranian Revolution of 1979 among Pakistani Shiʻas by focusing on Sayyid ʻArif Husain al-Husaini, the dominating Shiʻi leader of the 1980s. In particular, I am interested in exploring how al-Husaini adapted hallmark themes of the Iranian revolutionary message, such as Muslim unity or political leadership of the religious scholars (ʻulama), to the specific circumstances of Pakistan. Crucial for such processes of translation was not only pressure from the Pakistani state but rather internal challenges and divisions among the Shiʻi community. While al-Husaini could draw on a strong, indigenous tradition of political mobilisation, his revolutionary ʻthird waveʼ of Shiʻi thought sat uncomfortably between Lucknow-educated traditionalists and Najaf-trained reformers who shied away from getting entangled in these novel forms of politics. By drawing on biographical accounts and al-Husaini's speeches in Urdu, I trace how his revolutionary rhetoric had to accommodate thorny local issues such as sectarianism, South Asian mourning traditions or the lack of an established Shiʻi clerical hierarchy in Pakistan. [ABSTRACT FROM PUBLISHER]

This paper adds to the growing literature on transnational Shi'ism which has so far mostly focused on social history and political contestations. By tracing the thought, transnational legacy, and ultimate failure of the reformist Shi'i scholar, Muhammad al-Khalisi (d. 1963), I argue for the crucial importance of local contexts and ideas for the genesis of Islamic modernist projects. In his native Iraq, al-Khalisi not only distinguished himself as a guerrilla fighter and political activist but also was shaped by prevailing notions about the compatibility of Islam and science. Exiled to Iran for his opposition to the British from 1922 to 1949, he encountered there specific medicalizing discourses on modernity. This exposure and his experience as a practitioner of medicine in the Iranian countryside led al-Khalisi to identify medicine as the master key to unlocking the secrets of the divine law, the sharī'a: his major work on Islamic law singles out human health as God's supreme concern. Back in Iraq during the 1950s, al-Khalisi's medical-scientific vision of modernity was finally complemented with an uncompromising call for intra-Muslim unity. This stance led to furious attacks against al-Khalisi which continue unabated in contemporary Pakistan where his name has become a term of abuse. [ABSTRACT FROM PUBLISHER]

Objective: Nursing instruments have the potential for daily screening of delirium; however, they have not yet been evaluated. Therefore, after assessing the functional domains of the electronic Patient Assessment - Acute Care (ePA-AC), this study evaluates the cognitive and associated domains., Methods: In this prospective cohort study in the intensive care unit, 277 patients were assessed and 118 patients were delirious. The impacts of delirium on the cognitive domains, consciousness and cognition, communication and interaction, in addition to respiration, pain, and wounds were determined with simple logistic regressions and their respective odds ratios (ORs)., Results: Delirium was associated with substantial impairment throughout the evaluated domains. Delirious patients were somnolent (OR 6), their orientation (OR 8.2-10.6) and ability to acquire knowledge (OR 5.5-11.6) were substantially impaired, they lost the competence to manage daily routines (OR 8.2-22.4), and their attention was compromised (OR 12.8). In addition, these patients received psychotropics (OR 3.8), were visually impaired (OR 1.8), unable to communicate their needs (OR 5.6-7.6), displayed reduced self-initiated activities (OR 6.5-6.9) and challenging behaviors (OR 6.2), as well as sleep-wake disturbances (OR 2.2-5), Furthermore, delirium was associated with mechanical ventilation, abdominal/thoracic injuries or operations (OR 4.2-4.4), and sensory perception impairment (OR 3.9-5.8)., Significance of Results: Delirium caused substantial impairment in cognitive and associated domains. In addition to the previously described functional impairments, these findings will aid the implementation of nursing instruments in delirium screening.

Objective: Nursing assessments have been recommended for the daily screening for delirium; however, the utility of individual items have not yet been tested. In a first step in establishing the potential of the electronic Patient Assessment-Acute Care (ePA-AC) as such, the impact of delirium on the functional domains was assessed., Method: In this prospective observational cohort study, 277 patients were assessed and 118 patients were delirious. The impact of delirium on functional domains of the ePA-AC related to self-initiated activity, nutrition, and elimination was determined with simple logistic regressions., Results: Patients with delirium were older, sicker, were more commonly sedated during the assessment, stayed longer in the intensive care unit (ICU) and floors, and less commonly discharged home. A general pattern was the loss of abilities and full functioning equivalent to global impairment. For self-initiated mobility, in and out of the bed sizable limitations were noted and substantial inability to transfer caused friction and shearing. Similarly, any exhaustion and fatigue were associated with delirium. For self-initiated grooming and dressing, the impairment was greater in the upper body. Within the nutritional domain, delirium affected self-initiated eating and drinking, the amount of food and fluids, energy and nutrient, as well as parenteral nutrition requirement. In delirious patients, the fluid demand was rather increased than decreased, tube feeding more often required and dysphagia occurred. For the elimination domain, urination was not affected - of note, most patients were catheterized, whereas abilities to initiate or control defecation were affected., Significance of Results: Delirium was associated with sizable impairment in the level of functioning. These impairments could guide supportive interventions for delirious patients and perspectively implement nursing instruments for delirium screening.