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To review delirium experience of family caregivers and healthcare staff and to summarize how to decrease the emotional strain of delirium care. Delirium is a source of stress for family caregivers and healthcare staff. Taking into account their experience can increase delirium detection and reduce care burden. Educational approaches based on acknowledgment of caregivers’ and nurses’ experience are needed to increase delirium awareness and reduce the burden associated with delirium care. To review the available literature regarding delirium experiences of family caregivers and healthcare staff, to discuss how caregivers and staff perception can increase delirium detection and to summarize how to address the needs of family caregivers and healthcare providers in delirium care. “State of the science” paper. High levels of caregiver stress are associated with delirium, although sources and features of burden differ according to background health status of patients, i.e. older subjects, with or without dementia, or terminal neoplastic disease. Family observation of cognitive changes is key for delirium detection, especially when dementia coexists, and is included in available delirium detection instruments. Healthcare staff experiences a high level of burden associated with delirium care, but often does not recognize delirium according to literature. An interprofessional healthcare staff education can improve attitudes towards delirium and increase delirium awareness, although intervention studies are still limited. Flexible visiting time is important to reduce family burden, although it needs appropriate staff training and work organization to avoid the risk of increased nurse burn-out. Delirium is a stressful event not only for patients but also for family caregivers and healthcare staff, especially nurses. Recording the observations of family members and healthcare staff can help in delirium detection. Staff education is crucial to reduce the burden of professional and family caregivers.

Background Cardiac pacing is the treatment of choice for cardioinhibitory carotid sinus syndrome (CSS), but syncope recurrence occurs in up to 20% of patients within 3 years. The present study aims at assessing incidence and identifying predictors of syncope recurrence in patients receiving pacing therapy for CSS. Methods The Syncope Clinics of two large regional hospitals in Northern Italy, both following European Syncope Guidelines, combined to perform this study. Retrospective analysis of 3127 consecutive patients undergoing carotid sinus massage (CSM) was performed 2004–2014. Ten-second supine and standing CSM was systematically assessed in patients aged >40 years with suspected reflex syncope as part of the initial evaluation. Syncope recurrence was investigated in those paced for CSS having >6 months' available follow-up. Data were collected from clinical records and patient interviews. Results CSS was diagnosed in 261 patients (8.3%). Pacemakers were implanted in 158, with follow-up data available in 112: 19 (17%) experienced 73 syncope recurrences during a mean follow-up of 89 ± 42 months, yielding an incidence of 0.5 episodes per patient/year. Prodrome, predisposing situations preceding syncope and chronic nitrate therapy were more frequent in patients reporting recurrence. Prodrome and predisposing situations remained independent predictors of post-implantation recurrence on multivariable analysis. Conclusions CSS is a frequent cause of syncope, if CSM is performed during the initial evaluation. Most patients treated by pacing remain asymptomatic during long-term follow-up. In those who have recurrence, its incidence is very low. Prodrome and predisposing situations are predictors of post-implantation recurrence, suggesting presence of hypotensive susceptibility.

Background/Objectives Delirium is underrecognized in clinical practice. The primary aim of the present multicenter study was to compare the ability of nurses to identify delirium features with a standardized assessment. The secondary aim was to identify predictors of missed or incorrect identifications of delirium by nurses. Design Point prevalence study in 120 wards across Italy. Setting “Delirium Day 2015.” Participants Inpatients aged 65 and older (N = 1,867). Measurements Participants and nurses were asked specific questions to investigate their perceptions of the presence of delirium features (acute cognitive change, inattention, cognitive fluctuations, impaired arousal). Delirium was identified according to the results of the Assessment Test for Delirium and Cognitive Impairment (4AT), completed by a physician. Comorbidities including dementia, disability, drug treatments, and delirium motor subtype according to the Delirium Motor Subtype Scale were recorded. Results Delirium was present in 429 subjects (23%) according to the 4AT. Cognitive fluctuations was the delirium feature that the nurses most often recognized. Nurses’ perceptions of acute cognitive change, cognitive fluctuations, or impaired arousal had 84% sensitivity and 81% specificity for delirium. The nonmotor subtype of delirium was less likely to be recognized (80%) than the hyperactive (97%), mixed (92%), and hypoactive (90%) subtypes. Incorrect perception of delirium was more frequent in subjects with dementia (specificity 64%). Conclusions The delirium feature that nurses were best able to recognize was cognitive fluctuations. The nonmotor subtype was associated with a lower recognition rate. Routine observation and registration of delirium features by nurses in clinical practice might be helpful to increase formal diagnosis of delirium.

To review the available literature regarding delirium experiences of family caregivers and healthcare staff, to discuss how caregivers and staff perception can increase delirium detection and to summarize how to address the needs of family caregivers and healthcare providers in delirium care."State of the science" paper.High levels of caregiver stress are associated with delirium, although sources and features of burden differ according to background health status of patients, i.e. older subjects, with or without dementia, or terminal neoplastic disease. Family observation of cognitive changes is key for delirium detection, especially when dementia coexists, and is included in available delirium detection instruments. Healthcare staff experiences a high level of burden associated with delirium care, but often does not recognize delirium according to literature. An interprofessional healthcare staff education can improve attitudes towards delirium and increase delirium awareness, although intervention studies are still limited. Flexible visiting time is important to reduce family burden, although it needs appropriate staff training and work organization to avoid the risk of increased nurse burn-out.Delirium is a stressful event not only for patients but also for family caregivers and healthcare staff, especially nurses. Recording the observations of family members and healthcare staff can help in delirium detection. Staff education is crucial to reduce the burden of professional and family caregivers.

Objectives Most elderly patients affected by reflex vasodepressor syncope take one or more hypotensive drugs. The role of these drugs in causing syncope has not yet been established. We hypothesised that recurrence of syncope and presyncope can be reduced by discontinuing/reducing vasoactive therapy without increasing the risk of cardiovascular and neurological events. Methods This randomised, parallel, prospective, trial was conducted from January 2014 to March 2016 in four general hospitals. Of 328 initially screened participants, 58 patients (mean (SD) age 74±11 years) affected by vasodepressor reflex syncope, which was reproduced by tilt testing (n=54) or carotid sinus massage (n=4), were randomised to stop/reduce vasoactive therapy or to continue it. Primary end point was recurrence of syncope, presyncope or adverse events (defined as stroke, cerebral transient ischaemic attacks, worsening heart failure, myocardial infarction). Results Of 58 patients who were randomised, 55 completed the trial. After 1 month, systolic blood pressure was significantly higher in the ‘stop/reduce’ group than in the ‘continue’ group, in both supine (141±13 mm Hg vs 128±14 mm Hg; p=0.004) and standing (133±13 mm Hg vs 122±15 mm Hg; p=0.02) positions. During a mean follow-up of 13±7 months, the primary combined end point occurred in seven ‘stop/reduce’ patients (23%): three had syncope, three had presyncope and one had heart failure. Conversely, it occurred in 13 ‘continue’ patients (54%): 10 had syncope, 2 had presyncope and 1 had cerebral transient ischaemic attack. The log-rank p value was 0.02 and the HR was 0.37 (95% CI 0.15 to 0.91). Conclusions Recurrence of syncope and presyncope can be reduced by discontinuing/reducing vasoactive therapy in most elderly patients affected by reflex vasodepressor syncope. Trial registration number NCT01509534; EudraCT2013-004364-63; Results.

To evaluate the characteristics of patients referred for dizziness to a Syncope Unit. This is a retrospective study. Of 491 patients referred to the Syncope Unit of Careggi Hospital in 2015, 198 (40.3%) who experienced dizziness alone or associated with a history of transient loss of consciousness were enrolled. All the patients underwent an initial evaluation according to the European Society of Cardiology guidelines on syncope. We compared the clinical characteristics and final diagnosis of patients referred for dizziness alone (n = 64) to those of patients with dizziness and history of transient loss of consciousness (n = 134). The study population had a mean age of 62 ± 20 years (range 16–96 years) and 101 (51%) were female. A final diagnosis of pre-syncope was made in about the 80% of the patients without a previous history of transient loss of consciousness. In this group, other diagnoses were benign paroxysmal positional vertigo (6.3%), transient ischemic attack (4.7%) or psychogenic dizziness (7.8%). Syncope was diagnosed in the 82.7% of the patients with dizziness and history of transient loss of consciousness. Dizziness was the main reason for referral to the Syncope Unit in almost one-third of the patients, in whom pre-syncope was the most frequent final diagnosis. Otological, neurological and psychiatric disorders should be also considered as differential diagnosis, highlighting the importance of a multidisciplinary approach.

Background " Unexplained syncope, no prodromes, and normal heart " has been described as a distinct clinical and biological entity. Objective The purpose of this study was to assess the mechanism of syncope. Methods In this prospective multicenter study, 58 patients presenting with unexplained syncope, no prodromes, and a normal heart received an implantable loop recorder (ILR) and were followed up until a diagnosis was established. Their outcomes were compared with those of 389 patients affected by reflex syncope with prodromes who received an ILR. Results During a mean observation period of 16 ± 13 months, a diagnostic event was documented by the ILR in 29 patients (50%); an asystolic pause of 11 ± 5 seconds (range 3.5–22 seconds) was present at the time of the diagnostic event in 19 patients (66%). Compared with patients affected by reflex syncope with prodromes, patients with unexplained syncope, no prodromes, and a normal heart more frequently had an asystolic syncope (66% vs 47%; P = .001), and this was more frequently due to idiopathic paroxysmal atrioventricular block (47% vs 21%; P = .04). Ten patients with asystolic pauses underwent cardiac pacing, and 8 patients underwent oral theophylline treatment. During the subsequent 17 ± 12 months of follow-up, syncope recurred in 1 patient on theophylline and presyncope occurred in 1 patient with pacemaker. Conclusion A long asystolic pause, frequently due to idiopathic paroxysmal atrioventricular block, played a role in the mechanism of syncope in two-thirds of patients who had electrocardiographic documentation of a diagnostic event. When a specific therapy was administered in patients with asystolic syncope, the short outcome was favorable.

To evaluate the diagnostic relevance of neuroautonomic evaluation in patients with unexplained falls compared to those with a syncope etiologically unexplained after initial evaluation. It is an observational study, comparing 298 patients with unexplained fall with 989 patients with unexplained syncope. Each patient underwent supine and upright blood pressure measurement, tilt testing (TT) and carotid sinus massage (CSM). Patients with unexplained falls were older (75.3 ± 11.1 vs. 63.2 ± 19.2 years, p

In cardio-inhibitory Carotid Sinus Syndrome (CI-CSS), syncopal recurrence is expected to occur in up to the 20% of patients after pacing therapy. The present study analyzes post-implantation syncopal recurrence in CI-CSS, to identify predictors of recurrence. We retrieved electronic records

Aims High hospitalization rates (39–58% in the literature) of patients admitted to Emergency Department (ED) for transient loss of consciousness (T-LOC) suspected for syncope are still an unresolved issue. The presence of an Observation Unit has reduced hospital admissions and the duration of hospitalization in controlled studies, and a Syncope Unit (SU) in the hospital may reduce hospitalization and increase the number of diagnoses in patients with T-LOC. We assessed the effect of a structured organization on hospitalization rate and outcome. Methods and results Consecutive patients referred to the ED for a T-LOC of a suspected syncopal nature as the main diagnosis were included. The ED physician was trained to choose between: hospital admission (directly or after short observation); discharge after short (

Les premiers ouvrages traitant de la methode Taylor arrivent en France au debut du XXe siecle. Cependant, une veritable attention envers l’application d’une nouvelle methode de travail fait son apparition a la fin du premier conflit mondial. Du point de vue theorique, cet interet se revele a travers la creation d’instituts de recherches techniques. Dans ce cadre, on peut analyser le caractere original de la Maison Michelin. L’interet de Michelin pour le taylorisme nait au cours des annees 1910. C’est Marcel Michelin qui, a l’issue de son voyage d’etudes aux Etats-Unis, initie la maison clermontoise aux principes d’organisation rationnelle du travail. Par ailleurs, les applications dans l’atelier commencent principalement apres la fin de la premiere guerre mondiale. La premiere introduction concerne la fabrication de masques a gaz pendant le conflit. A cote de la mise en œuvre dans les ateliers, la societe met en place une importante activite de propagande qui la conduit, en 1921, a fonder le Comite Michelin. Il s’agit d’un veritable outil de diffusion du systeme Taylor au sein des entreprises francaises. L’activite du comite s’arrete a la moitie des annees 1920. Mais Michelin continue a poursuivre son activite de propagande. La maison realise et publie un magazine qui traite de la methode Taylor et de ses applications dans les ateliers Michelin.