Effect of intravenous beta-2 agonist treatment on clinical outcomes in acute respiratory distress syndrome (BALTI-2): a multicentre, randomised controlled trial

BACKGROUND:
In a previous randomised controlled phase 2 trial, intravenous infusion of salbutamol for up to 7 days in patients with acute respiratory distress syndrome (ARDS) reduced extravascular lung water and plateau airway pressure. We assessed the effects of this intervention on mortality in patients with ARDS.
METHODS:
We did a multicentre, placebo-controlled, parallel-group, randomised trial at 46 UK intensive-care units between December, 2006, and March, 2010. Intubated and mechanically ventilated patients (aged =16 years) within 72 h of ARDS onset were randomly assigned to receive either salbutamol (15 µg/kg ideal bodyweight per h) or placebo for up to 7 days. Randomisation was done by a central telephone or web-based randomisation service with minmisation by centre, pressure of arterial oxygen to fractional inspired oxygen concentration (PaO(2)/F(I)O(2)) ratio, and age. All participants, caregivers, and investigators were masked to group allocation. The primary outcome was death within 28 days of randomisation. Analysis was by intention-to-treat. This trial is registered, ISRCTN38366450 and EudraCT number 2006-002647-86.
FINDINGS:
We randomly assigned 162 patients to the salbutamol group and 164 to the placebo group. One patient in each group withdrew consent. Recruitment was stopped after the second interim analysis because of safety concerns. Salbutamol increased 28-day mortality (55 [34%] of 161 patients died in the salbutamol group vs 38 (23%) of 163 in the placebo group; risk ratio [RR] 1·47, 95% CI 1·03-2·08).
INTERPRETATION:
Treatment with intravenous salbutamol early in the course of ARDS was poorly tolerated. Treatment is unlikely to be beneficial, and could worsen outcomes. Routine use of ß-2 agonist treatment in ventilated patients with this disorder cannot be recommended.

Profiling: a Strategy for Successful Volunteer Recruitment in Credit Unions

Credit unions are non-profit financial organisations that provide financial services to their members. They are located in 97 countries across the world. All credit unions are governed by a volunteer board and many are reliant on volunteers for all their labour requirements. However, recruiting volunteers is a problem. The literature on recruitment issues in volunteering in general, suggests that the not-for-profit sector looks to the private sector for guidance on recruitment policies and approaches. One such approach which is considered in this paper is ‘market segmentation’ wherein the potential volunteer body is profiled to determine if an individual is likely to volunteer and if they are, to identify the type of role they are most likely to be attracted to. Prior literature on volunteering in non-profit organisations suggests that certain types of individual (dominant individuals) are more likely to volunteer. This paper investigates whether this dominant status profile is evident amongst volunteers in credit unions in Northern Ireland (NI). The study finds that people with dominant characteristics are more likely to be attracted to volunteering to the board of directors and individuals who have less dominant traits overall should be offered more social/participative type roles. This information can be used by credit union governing boards for volunteer recruitment, retention and management purposes.