Under-recognition of delirium is an international problem. For the early detection of delirium, a feasible and valid screening tool for healthcare professionals is needed. This study aimed to present a scientific reason for using the 4 ‘A’s Test (4AT) through a systematic review and meta-analysis of studies on the diagnostic test accuracy. We systematically searched articles in the EMBASE, MEDLINE, CINAHL, and PsycINFO databases and selected relevant articles on the basis of the predefined inclusion criteria. The quality of the included articles was evaluated using the Quality Assessment of the Diagnostic Accuracy Studies-2 tool. We estimated the pooled values of diagnostic test accuracy by employing the bivariate model and the hierarchical summary receiver operating characteristic (HSROC) model in data synthesis. A total of 3729 patients of 13 studies were included in the analysis. The pooled estimates of sensitivity and specificity of the 4AT were 81.5% (95% confidence interval: 70.7%, 89.0%) and 87.5% (79.5%, 92.7%), respectively. Given the 4AT’s evidence of accuracy and practicality, we suggest healthcare professionals to utilize this tool for routine screening of delirium. However, for detecting delirium in the dementia population, further work is required to evaluate the 4AT with other cut-off points or scoring methods in order for it to be more sensitive and specific.

Delirium is highly prevalent and leads to several bad outcomes for older long-term care (LTC) residents. For a more successful translation of delirium knowledge, Clinical Practice Guidelines (CPGs) tailored to LTC should be developed and applied based on the understanding of the barriers to implementation. This study was conducted to develop a CPG for delirium in LTC and to determine the barriers perceived by healthcare professionals related to the implementation of the CPG. We followed a structured, evidence- and theory-based procedure during the development process. After a systematic search, quality appraisal, and selection for eligible up-to-date CPGs for delirium, the recommendations applicable to the LTC were drafted, evaluated, and confirmed by an external group of experts. To evaluate the barriers to guideline uptake from the users’ perspectives, semi-structured interviews were conducted which resulted in four major themes: (1) a lack of resources, (2) a tendency to follow mindlines rather than guidelines, (3) passive attitudes, and (4) misunderstanding delirium care in LTC. To minimize adverse prognoses through prompt delirium care, the implementation of a CPG with an approach that comprehensively considers various barriers at the system, practice, healthcare professional, and patients/family levels is necessary.

Schools are an important place for children’s exposure to electromagnetic fields, which may cause adverse health effects. To better understand environmental extremely low-frequency magnetic fields (ELF-MFs) exposure among elementary school students, we measured numeric values of ELF-MFs in five classrooms at four schools during digital learning class hours. The measurement of ELF-MFs was taken with an EMDEX II field analyzer. Specifically, we examined the level of exposure to ELF-MFs for each student’s seating position in the classroom. The results showed that ELF-MFs exposure levels were lower than those in the International Commission on Non-Ionizing Radiation Protection guidelines; however, there were significant differences in the level of magnetic field exposure at each school and at each student’s seat. The exposure to ELF-MFs at students’ seat positions was mostly caused by electrical appliances, electronic wiring, and distribution boxes, but the exposure level decreased as the distance increased. Therefore, it is important to design safe and appropriate environments for digital learning in schools, such as proper seating arrangements, to avoid ELF-MFs exposure to students as much as possible. Future studies should measure ELF-MFs levels in other areas and investigate the effects of exposure to ELF-MFs during school hours on children’s health.