The Life Cycle Management and Intellectual Capital factors that influence sustainability integration in organisational processes

Following the suggestions of the UNEP/SETAC Life Cycle Initiative publications on Life Cycle Management (LCM) as a business management approach to improve sustainability performance, this research explored LCM as a promising research area that could help identify the factors that influence the integration of sustainability aspects into organisational processes. The initial research strategy was comprised of LCM literature analysis to explore LCM and identify potential factors that could direct the data collection. The analysis of the LCM literature shows that LCM is vaguely described. This research analysis puts into context the various LCM approaches through the introduction of the four LCM elements. The LCM elements were used as a frame to analyse the LCM cases found in the literature and identify the factors that influence integration of sustainability in organisational processes. The next stage of the research strategy was to conduct action research studies to explore in close proximity the integration of sustainability aspects in organisational processes. Two in depth action research studies were conducted, influenced by engaged scholarship. During Case A, the LCM elements were used in practice to influence the project whilst the LCM factors were observed in practice. Case A demonstrated the complexity of sustainability-related information integration in organisational processes and the division of information flows towards different organisational functions to inform their own decision. The analysis highlighted that developing knowledge is a key LCM factor that influences the application of LCM. As the importance of developing knowledge became apparent, a novel sustainability related intellectual capital (SrIC) framework was developed then used during Case B. This framework is shown to assist the sustainability professionals of Company B in enhancing the sustainability related intellectual capital of the company, which in turn led to more effective sustainability integration. This research used LCM as a ‘vehicle’ to explore the integration of sustainability aspects into organisational processes and hence contribute to the LCM literature with the four LCM elements framework of analysis, descriptions of the factors that influence the application of LCM, bringing a focus on the importance of developing knowledge for the effective application of LCM, and identifying the intellectual capital factors that influence the integration of sustainability aspects into organisational processes.EPSR

How to approach and treat viral infections in ICU patients.

Patients with severe viral infections are often hospitalized in intensive care units (ICUs) and recent studies underline the frequency of viral detection in ICU patients. Viral infections in the ICU often involve the respiratory or the central nervous system and can cause significant morbidity and mortality especially in immunocompromised patients. The mainstay of therapy of viral infections is supportive care and antiviral therapy when available. Increased understanding of the molecular mechanisms of viral infection has provided great potential for the discovery of new antiviral agents that target viral proteins or host proteins that regulate immunity and are involved in the viral life cycle. These novel treatments need to be further validated in animal and human randomized controlled studies

Remote Patient Monitoring for Patients with Heart Failure: Sex- and Race-based Disparities and Opportunities

Remote patient monitoring (RPM), within the larger context of telehealth expansion, has been established as an effective and safe means of care for patients with heart failure (HF) during the recent pandemic. Of the demographic groups, female patients and black patients are under-enrolled relative to disease distribution in clinical trials and are under-referred for RPM, including remote haemodynamic monitoring, cardiac implantable electronic devices (CIEDs), wearables and telehealth interventions. The sex- and race-based disparities are multifactorial: stringent clinical trial inclusion criteria, distrust of the medical establishment, poor access to healthcare, socioeconomic inequities, and lack of diversity in clinical trial leadership. Notwithstanding addressing the above factors, RPM has the unique potential to reduce disparities through a combination of implicit bias mitigation and earlier detection and intervention for HF disease progression in disadvantaged groups. This review describes the uptake of remote haemodynamic monitoring, CIEDs and telehealth in female patients and black patients with HF, and discusses aetiologies that may contribute to inequities and strategies to promote health equity

Duration of dual antiplatelet therapy after drug-eluting stent implantation: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is unclear, and its risks and benefits may vary according to DES generation. OBJECTIVES: The goal of this study was to evaluate the efficacy and safety of DAPT after DES implantation. METHODS: We included randomized controlled trials that tested different durations of DAPT after DES implantation: shorter dual antiplatelet therapy (S-DAPT) was defined as the per-protocol minimum duration of DAPT after the procedure, and longer dual antiplatelet therapy (L-DAPT) was defined as the per-protocol period of more prolonged DAPT. The primary efficacy and safety outcomes were definite/probable stent thrombosis and clinically significant bleeding (CSB), respectively. RESULTS: Ten randomized controlled trials (N = 32,135) were included. Compared with L-DAPT, S-DAPT had an overall higher rate of stent thrombosis (odds ratio [OR]: 1.71 [95% confidence interval (CI): 1.26 to 2.32]; p = 0.001). The effect of S-DAPT on stent thrombosis was attenuated with the use of second-generation DES (OR: 1.54 [95% CI: 0.96 to 2.47]) compared with the use of first-generation DES (OR: 3.94 [95% CI: 2.20 to 7.05]; p for interaction = 0.008). S-DAPT had an overall significantly lower risk of CSB (OR: 0.63 [95% CI: 0.52 to 0.75]; p < 0.001). Finally, a numerically lower all-cause mortality rate was observed with S-DAPT (OR: 0.87 [95% CI: 0.74 to 1.01]; p = 0.073). CONCLUSIONS: S-DAPT had overall lower rates of bleeding yet higher rates of stent thrombosis compared with L-DAPT; the latter effect was significantly attenuated with the use of second-generation DES, although the analysis may have been limited by the varying DAPT durations among studies. All-cause mortality was numerically higher with L-DAPT without reaching statistical significance. Prolonging DAPT requires careful assessment of the trade-off between ischemic and bleeding complications

Outcomes in Patients with Chronic Kidney Disease and End Stage Renal Disease and Durable Left Ventricular Assist Device: Insights from United States Renal Data System Database

BACKGROUND: There is paucity of data regarding durable LVAD outcomes in patients with chronic kidney disease (CKD) stage 3-5 and CKD stage 5 on dialysis (ESRD: end stage renal disease). METHODS: We conducted a retrospective study of Medicare beneficiaries with ESRD and 5% sample of CKD with LVAD (2006 to 2018) to determine one-year outcomes utilizing the United States Renal Data System (USRDS) database. The LVAD implantation, comorbidities and outcomes were identified using appropriate ICD-9 and ICD-10 codes. RESULTS: We identified 496 CKD and 95 ESRD patients who underwent LVAD implantation. The ESRD patients were younger (59 vs 66 years; p CONCLUSIONS: Patients with ESRD undergoing LVAD implantation had significantly higher index and 1-year mortality compared to CKD patients