Cognitive and Psychosocial Outcomes of Mechanically Ventilated Intensive Care Patients: Does an Experience of Delirium Make a Difference

Objective Delirium is common in intensive care patients and is associated with short- and long-term adverse outcomes. We investigated the long-term risk of cognitive impairment and post-traumatic stress disorder (PTSD) in intensive care patients with and without delirium. Methods We conducted a prospective cohort study in ICUs in two Australian university-affiliated hospitals. Patients were eligible if they were older than 18 years, mechanically ventilated for more than 24 hours and did not meet exclusion criteria. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Variables assessing cognitive function and PTSD symptoms were collected at ICU discharge, and both 6 and 12 following discharge: Mini Mental State Examination, Telephone Interview for Cognitive Status, Impact of Events Scale-Revised and Informant Questionnaire for Cognitive Decline (caregiver). Results 103 participants were included of which 36% developed delirium in ICU. Patients with delirium were sicker and had a longer duration of mechanical ventilation and ICU length of stay. After 12 months, 41/60 (68.3%) evaluable patients were cognitively impaired, with 11.6% displaying symptoms consistent with dementia. When evaluated by the patient’s caregiver, the patient’s cognitive function was found to be consistent with dementia in a larger proportion of patients (14/60, 23.3%). Delirium was associated with worse cognitive function at ICU discharge, but not with long-term cognitive function. IES-R scores, measuring PTSD symptoms, were significantly higher in patients who had 14 delirium compared to patients without delirium. In regression analysis, delirium was independently associated with cognitive function at ICU discharge and PTSD symptoms at 12 months. Conclusions Intensive care survivors have significant rates of long-term cognitive decline and PTSD symptoms. Delirium in ICU was independently associated with short-term but not long-term cognitive function, and with long-term PTSD symptoms

Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium

Abstract Objective Delirium is common in intensive care patients and is associated with short- and long-term adverse outcomes. We investigated the long-term risk of cognitive impairment and post-traumatic stress disorder (PTSD) in intensive care patients with and without delirium. Methods This is a prospective cohort study in ICUs in two Australian university-affiliated hospitals. Patients were eligible if they were older than 18 years, mechanically ventilated for more than 24 h and did not meet exclusion criteria. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Variables assessing cognitive function and PTSD symptoms were collected at ICU discharge, after 6 and 12 months: Mini-Mental State Examination, Telephone Interview for Cognitive Status, Impact of Events Scale-Revised and Informant Questionnaire for Cognitive Decline (caregiver). Results 103 participants were included of which 36% developed delirium in ICU. Patients with delirium were sicker and had longer duration of mechanical ventilation and ICU length of stay. After 12 months, 41/60 (68.3%) evaluable patients were cognitively impaired, with 11.6% representing the presence of symptoms consistent with dementia. When evaluated by the patient’s caregiver, the patient’s cognitive function was found to be severely impaired in a larger proportion of patients (14/60, 23.3%). Delirium was associated with worse cognitive function at ICU discharge, but not with long-term cognitive function. IES-R scores, measuring PTSD symptoms, were significantly higher in patients who had delirium compared to patients without delirium. In regression analysis, delirium was independently associated with cognitive function at ICU discharge and PTSD symptoms at 12 months. Conclusions Intensive care survivors have significant rates of long-term cognitive decline and PTSD symptoms. Delirium in ICU was independently associated with short-term but not long-term cognitive function, and with long-term PTSD symptoms. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001116415, 15/8/2016 retrospectively registered, https://www.anzctr.org.a

Do entrepreneurial characteristics affect the choice of strategy?

The purpose of this paper is first to define the entrepreneur and also to study certain strategies. Furthermore, we want to make a connection between the two. Revising various literature and articles on entrepreneurs and strategy was the first step of this dissertation. The next step was to create a matrix ourselves which was based on the literature and articles read. The idea with the matrix was to show that there might be a connection between the entrepreneur’s characteristics and the strategy that they implement. To test if our conclusions were accurate, we created three hypotheses that we tested with the help of our results obtained from the questionnaire from our study. In the course of the work we found that in some cases there are links between certain characteristics and certain strategies that we focused on in this dissertation. Trying to define the entrepreneur is not an easy task, different authors say different things. However, some adjectives were used more commonly in the sources we reviewed. This lead us too six characteristics and three strategies that we would be using when studying the entrepreneur. We also chose to limit the choice of our study to service organizations founded in the year 2000, which were still active and located in the area of Kristianstad. In practice it can be of value for small scale entrepreneurs to be aware of the fact that they themselves very well could be influencing their chosen strategies. If an entrepreneur is aware of this fact he or she might have a more open view to other suggestions and approaches. In the long run this insight could be valuable for their success and the growth of their company. The value of the paper is that it brings up an approach: the linkage of characteristics and strategy that we did not ourselves find in the existing literature