A novel computerized test for detecting and monitoring visual attentional deficits and delirium in the ICU

Objectives: Delirium in the ICU is associated with poor outcomes but is under-detected. Here we evaluated performance of a novel, graded test for objectively detecting inattention in delirium, implemented on a custom-built computerized device (Edinburgh Delirium Test Box–ICU). Design: A pilot study was conducted, followed by a prospective case-control study. Setting: Royal Infirmary of Edinburgh General ICU. Patients: A pilot study was conducted in an opportunistic sample of 20 patients. This was followed by a validation study in 30 selected patients with and without delirium (median age, 63 yr; range, 23–84) who were assessed with the Edinburgh Delirium Test Box–ICU on up to 5 separate days. Presence of delirium was assessed using the Confusion Assessment Method for the ICU. Measurements and Main Results: The Edinburgh Delirium Test Box–ICU involves a behavioral assessment and a computerized test of attention, requiring patients to count slowly presented lights. Thirty patients were assessed a total of 79 times (n = 31, 23, 15, 8, and 2 for subsequent assessments; 38% delirious). Edinburgh Delirium Test Box–ICU scores (range, 0–11) were lower for patients with delirium than those without at the first (median, 0 vs 9.5), second (median, 3.5 vs 9), and third (median, 0 vs 10.5) assessments (all p < 0.001). An Edinburgh Delirium Test Box–ICU score less than or equal to 5 was 100% sensitive and 92% specific to delirium across assessments. Longitudinally, participants’ Edinburgh Delirium Test Box–ICU performance was associated with delirium status. Conclusions: These findings suggest that the Edinburgh Delirium Test Box–ICU has diagnostic utility in detecting ICU delirium in patients with Richmond Agitation and Sedation Scale Score greater than –3. The Edinburgh Delirium Test Box–ICU has potential additional value in longitudinally tracking attentional deficits because it provides a range of scores and is sensitive to change

Investigating speech and language impairments in delirium: a preliminary case-control study

<div><p>Introduction</p><p>Language impairment is recognized as as part of the delirium syndrome, yet there is little neuropsychological research on the nature of this dysfunction. Here we hypothesized that patients with delirium show impairments in language formation, coherence and comprehension.</p><p>Methods</p><p>This was a case-control study in 45 hospitalized patients (aged 65–97 years) with delirium, dementia without delirium, or no cognitive impairment (N = 15 per group). DSM-5 criteria were used for delirium. Speech was elicited during (1) structured conversational questioning, and (2) the "Cookie Theft" picture description task. Language comprehension was assessed through standardized verbal and written commands. Interviews were audio-recorded and transcribed.</p><p>Results</p><p>Delirium and dementia groups scored lower on the conversational assessment than the control group (p<0.01, moderate effect sizes (r) of 0.48 and 0.51, resp.). In the Cookie Theft task, the average length of utterances (i.e. unit of speech), indicating language productivity and fluency, distinguished patients with delirium from those with dementia (p<0.01, r = 0.50) and no cognitive impairment (p<0.01, r = 0.55). Patients with delirium performed worse on written comprehension tests compared to cognitively unimpaired patients (p<0.01, r = 0.63), but not compared to the dementia group.</p><p>Conclusions</p><p>Production of spontaneous speech, word quantity, speech content and verbal and written language comprehension are impaired in delirious patients compared to cognitively unimpaired patients. Additionally, patients with delirium produced significantly less fluent speech than those with dementia. These findings have implications for how speech and language are evaluated in delirium assessments, and also for communication with patients with delirium. A study limitation was that the delirium group included patients with co-morbid dementia, which precludes drawing conclusions about the specific language profile of delirium.</p></div

The moral (im)possibilities of being an applied anthropologist in development : an exploration of the moral and ethical issues that arise in theory and practice

My broadest aim in this thesis is to explore some of the central ethical concerns of social anthropologists vis-a-vis the phenomena of development. In particular, what I want to bring out and examine is the dynamics of the 'moral experience' and 'moral force' of anthropologists in this area. I go about this by considering the historical unfolding of the anthropological conceptual and evaluative apprehension of planned social and economic change. On this basis, I also consider the nature of the critiques and contributions that social anthropology has generated. I also make an attempt to review the major conceptual moral controversies and agendas that are intrinsic to development from an anthropological perspective. Whilst the concepts and values that emanate from social anthropology are multi-faceted and many stranded, I believe that the anthropological standpoint is both distinctive and potentially counter hegemonic. I look specifically at the moral resources that can be unearthed from the emerging field of 'development ethics' which is largely articulated in terms of the maxims that are fundamental to Western moral and political traditions. I attempt to set out the terrain of the ethical deliberation of anthropologists involved in development in terms of some of the moral difficulties of Western society. I argue that Western moral reasoning, as a result of deep disagreements about the sources of value human life and society, tends to rely upon procedural, instrumental and coercive ethical frameworks. On this basis, one of my assertions is that communitarian arguments, whilst also being needed as a healthy antidote to the excesses of liberal individualism, also constitute a reflection of the aspirations of people(s), many of whom are beleaguered by the alienation, atomism and instrumentalism of modern society. The communitarian perspective also underpins a political commitment to supporting those besieged indigenous communities that struggle to defend their integrity in the face of the aggressive intrusions of the market mentality. This may involve supporting the maintenance of 'traditional' versions of moral reasoning, well being, and sociality (such as indigenous life-worlds), collective rights in the face of the fragmentary and individuating neo-liberal development policies, and to support the 'construction of new associative networks such as 'new social movements' that represent the aspirations, and embody the values, of marginalised and disempowered social groups

Trends in delirium coding rates in older hospital inpatients in England and Scotland: full population data comprising 7.7M patients per year show substantial increases between 2012 and 2020

Background: Little information is available on change in delirium coding rates over time in major healthcare systems. We examined trends in delirium discharge coding rates in older patients in hospital admissions to the National Health Service (NHS) in England and Scotland between 2012 and 2020. / Methods: Hospital administrative coding data were sourced from NHS Digital England and Public Health Scotland. We examined rates of delirium (F05 from ICD-10) in patients aged ≥70 years in 5 year and ≥90 age bands. / Results: There were approximately 7,000,000 discharges/year in England and 700,000/year in Scotland. Substantially increased delirium coding was observed for all age bands between 2012/2013 and 2019/2020 (p<0.001, Mann Kendall’s tau). In the ≥90 age band, there was a 4-fold increase between 2012 and 2020. / Conclusion: Delirium coding rates have shown large increases in the NHS in England and Scotland, likely reflecting several factors including policy initiatives, detection tool implementation and education