Delirium screening in intensive care: A life saving opportunity.

BACKGROUND: Delirium is described as 'acute brain failure' and constitutes a medical emergency which presents a hazard for people cared for in intensive care units. The Scottish intensive care society audit group recommend that all people cared for in intensive care units be screened for signs of delirium so that treatment and management of complications can be implemented at an early stage. CLINICAL IMPLICATION: There is inconsistent evidence about when and how the assessment of delirium is carried out by nursing staff in the intensive care setting. AIM: This narrative review explores the pathophysiology and current practices of delirium screening in intensive care. Consideration is given to the role of the nurse in detecting and managing delirium and some barriers to routine daily delirium screening are critically debated. CONCLUSION: It is argued that routine delirium screening is an essential element of safe, effective and person centred nursing care which has potential to reduce morbidity and mortality.

Hydration monitoring in the prevention of recurrent idiopathic urinary tract infections in pre-menopausal women.

OBJECTIVE: To assess whether the use of simple hydration monitoring can encourage adequate hydration and reduce urinary osmolality and the incidence of urinary tract infections (UTIs) in a population of susceptible pre-menopausal women with recurrent idiopathic urinary infections. SUBJECTS AND METHODS: The study included 28 pre-menopausal women who had at least two idiopathic UTIs in the previous 6 months. Urinary osmolality was assessed by the patients at each void by a simple hand-held probe, and the readings over 4 months compared. Monthly urine culture was compared between successive 4-month periods in which the probe was or was not used. RESULTS: The study was completed by 17 women. There was a significant shift towards urine of lower osmolality over the 4-month period using the probe (Pearson's chi 2 < 0.001). Significantly fewer urinary tract infections developed during the 4 months using the probe (McNemar's chi 2 = 0.046). CONCLUSIONS: The use of the osmolality probe encouraged the subject to maintain adequate hydration. The resulting augmentation of the natural urethral 'washout' mechanism led to lower osmolality urine and a reduction in the incidence of UTIs.

The significance of abdominal straining in men with lower urinary tract symptoms.

OBJECTIVE: To determine the relationship between the symptom of straining to void, the presence of objectively demonstrated abdominal straining and bladder outflow obstruction in men with lower urinary tract symptoms (LUTS), and to assess the effect of straining on flow rate in these men. PATIENTS AND METHODS: The presence of straining to void as a symptom was determined from a symptom questionnaire in 61 men presenting with LUTS. Objective evidence of straining to void was assessed by rectal pressure measurement and the presence of bladder outflow obstruction was determined by pressure-flow studies. The effect of straining on flow rate was assessed in a separate group of 58 men with LUTS, by comparing the maximum flow rate on non-strain and strain voids of similar volume. RESULTS: There was poor agreement between the complaint of straining and the presence of straining as measured by rectal pressure recording. Twelve of the 53 patients who claimed they never or occasionally strained to void in fact showed straining on each of four voids. There was no significant difference in the proportion of men who complained of straining in the obstructed and non-obstructed groups (P = 0.86). The probability of obstruction in those men with objective evidence of straining on all voids was 80% and in those who did not strain on all voids was 51%, but this difference was not statistically significant (P = 0.53). There was no clinically significant effect of straining on maximum flow rate in men with LUTS. CONCLUSION: As a symptom, straining is an uncommon complaint in men with benign prostatic hyperplasia (BPH), and the relationship between the symptom and objective evidence of its presence is poor. Both as a symptom and as an objectively measured voiding disorder, straining lacks sufficient sensitivity and specificity for it to be of value in the diagnosis of bladder outlet obstruction (BOO). Abdominal straining does not have a marked effect on flow rate in men with BPH. This study suggests that straining is an unreliable symptom of BOO, that it does not influence voiding function in elderly men and that its inclusion in symptom scores for BPH should be reconsidered.