Death in hospital following ICU discharge : insights from the LUNG SAFE study

Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure : an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Проблеми та перспективи розвитку нейромаркетингу: дослідження для Бангладеш

For improving marketing effectiveness, the producers and entrepreneurs today want to understand how human psychology and emotions influencing on decision making. In this instance, the concept of neuromarketing offers a chance to get accurate, factual data about the buying habits of target markets. This study has been intended to explore the challenges, prospects, limitation and potentiality of practising neuromarketing in the context of Bangladesh as a cutting-edge marketing issue with the purpose of providing corresponding recommendations. The status and future prediction of neuromarketing have been exposed through qualitative and quantitative analysis. The finding of the study has been supported by collecting data from 55 customers and 65 marketers as the respondents. The key findings of this study are quite impressive and prospective regarding the level of awareness, interest, acknowledgement and conviction towards practising neuromarketing in the context in Bangladesh. The contribution of this study can be breakthrough and pave the way for neuromarketing in Bangladesh. The findings of this study will be helpful for the marketing policy makers and govt agencies to introduce this new method of marketing tools in Bangladesh. Finally, some policy guidelines were provided based on findings and analysis. In that way, marketers have to promote initiatives to familiarize the devices of the neuromarketing, have to engage the educated customers to share their experiences while designing the marketing strategies and plans. The important conclusion that the education is one of the most important factors affecting the adoption of the neuromarketing practice. On the other hand, marketers should take initiatives to overcome some misconceptions regarding the harmful for the brain activity devices of the neurology.Сучасні тенденції розвитку інформаційних технологій обумовлюють необхідність використання нових сучасних маркетингових інструментів з метою підвищення ефективності проведення рекламних кампаній організації. При цьому необхідно враховувати, як психологія споживачів та їх емоції впливають на процес прийняття рішень щодо вибору товару. Авторами зазначається актуальність використання концепції нейромаркетингу, яка дає змогу отримати фактичні дані про споживчі вподобання групи споживачів цільового ринку. Метою дослідження є вчення проблем, перспектив, обмежень та потенціалу використання нейромаркетингу як найбільш сучасного маркетингового підходу з метою надання відповідних рекомендацій для компаній з урахуванням особливостей ринкового середовища Бангладешу. Автором узагальнено основні бар’єри та обмеження розвитку нейромаркетингу в Бангладеші як в країні, що розвивається. Використання якісного та кількісного аналізу дозволило автору визначити стан, місце та перспективи використання нейромаркетингу у бізнес-середовищі Бангладешу. У рамках дослідження було проаналізовано дані 120 респондентів (55 клієнтів і 65 маркетологів). Результати дослідження свідчать, що проведення нейромаректингових кампаній вимагає наявності як кваліфікованих спеціалістів-маркетологів, так і готових сприймати інформацію споживачів. Тому автор наголошує, що освіта є одним із ключових факторів, що впливає на поширення концепції нейромаркетингу в Бангладеші. Окрім цього, автор рекомендує проведення маркетологами ініціативних просвітницьких програм в локальних спільнотах щодо безпечності пристроїв та технологій нейромаркетингу з метою зменшення стереотипного мислення щодо їх шкідливості та небезпечності для функціонування організму людини

Effectiveness of Integrated Management Packages Against Pod Borer Complex on Mungbean

Experiment was carried out in the farmer’s field at Sonakhali, Barguna sadar, Barguna district of Bangladesh during January to April 2018 to evaluate the effectiveness of different IPM packages against pod borer complex of mungbean. Results revealed that the lowest number of pod borer (1.33/m2), the highest percent (93.56%) pod borer reduction over control, lowest pod damaged (5.33/m2), highest percent (87.70%) pod damaged reduction over control at 65 DAS were recorded in Package 5 (Bioneem plus 1% EC @ 1 mL/l of water + sex pheromone trap) treated plots. The highest yield (1,416 kg/ha), percent yield increase over control (40.26%), highest net return come (Tk. 23,146/ha) and highest marginal benefit cost ratio (4.35) were obtained from Package 3 (Sex pheromone trap + white sticky trap) treated plots followed by Package 5 (1,319 kg/ha and 27.33%) and the lowest yield (1,010 kg/ha) from untreated control. From this experiment Package 3 (Sex pheromone trap + White sticky trap) was found to be the best integrated management package for the suppression of pod borer complex and produced maximum yield of mungbean. Integration of IPM components revealed that installation of sex pheromone trap along with white sticky trap (package 3) was found to be the best IPM package for the management pod borer complex producing maximum yield and providing highest marginal benefit cost ratio of mungbean

Withholding and withdrawal of life-sustaining treatments in intensive care Units in Asia

10.1001/jamainternmed.2014.7386JAMA Internal Medicine1753363-37

Death in hospital following ICU discharge : insights from the LUNG SAFE study

Altres ajuts: Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); Science Foundation Ireland Future Research Leaders Award; European Society of Intensive Care Medicine (ESICM), Brussels; St Michael's Hospital, Toronto; University of Milan-Bicocca, Monza, Italy.Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073