S. R. Foley

ECMO – the clinician’s view

Background  Extra corporeal membrane oxygenation (ECMO) is a complex rescue therapy used to provide cardiac and/or respiratory support for critically ill patients who have failed maximal conventional medical management. ECMO is based on a modified cardiopulmonary bypass (CPB) circuit, and can provide cardiopulmonary support for up‐to several months. It can be used in a veno venous configuration for isolated respiratory failure, (VV‐ECMO), or in a veno arterial configuration (VA‐ECMO) where support is necessary for cardiac +/‐ respiratory failure. The ECMO circuit consists of five main components: large bore cannulae (access cannulae) for drainage of the venous system, and return cannulae to either the venous ( in VV‐ECMO) or arterial (in VA ECMO) system. An oxygenator, with a vast surface area of hollow filaments, allows addition of oxygen and removal of carbon dioxide; a centrifugal blood pump allows propulsion of blood through the circuit at upto 10 L/minute; a control module and a thermoregulatory unit, which allows for exact temperature control of the extra corporeal blood.

Improving the social cognitive deficits of schizophrenia: a community trial of Social Cognition and Interaction Training (SCIT).

Objective: Social Cognition and Interaction Training (SCIT) is a Cognitive and Behavioural Therapy (CBT) informed group therapy with an emerging evidence base in addressing the social cognitive deficits associated with schizophrenia. This paper evaluates the application of this therapy within a community public mental health setting in Australia. Method: A mixed methods approach to the evaluation was undertaken, including survey data and thematic analysis. Results: Considerable challenges were met in the trial of SCIT in this ‘real-world’ setting. The qualitative data suggested that at least a subset of participants viewed the program as valuable and relevant to their needs. Conclusions: Further research is required to realise the benefits of SCIT found in research settings, in the real world of public community psychiatric practice.

Red cell and albumin resuscitation following acute massive haemorrhage alters haemostasis

Background: Dengue is not endemic in Australia; rather in North Queensland, outbreaks occur seasonally. One of the largest epidemics in the last 50 years took place in 2008/2009, affecting a significant geographical area of North Queensland, with separate outbreaks in Cairns (and surrounding regions; DENV-2,3,4 08–09) and Townsville (DENV-1,3 09). Collectively, in these outbreaks there were more than 1000 confirmed clinical cases, with the majority of cases occurring in the Cairns region. Given the absence of an approved screening test, the strategy utilised by the Australian Red Cross Blood Service (Blood Service) for managing the risk of transfusion-transmitted dengue was exclusion of at risk donors. During this epidemic, supplementary questioning for all donors was implemented to determine exposure risk, and fresh components were not manufactured from at risk donors. Aims: This study aimed to estimate dengue fever viral exposure rates among Australian blood donors during this large epidemic. Methods: Samples were collected from blood donors during the 2008/2009 epidemic and 3 months after the last confirmed cased. Selected samples were tested for the presence of the dengue NS1 antigen with commercially available ELISA-based assay kits from PanBio. Results: Nineteen of 1020 donations collected in Cairns during the epidemic and selected for testing showed repeat reactivity towards the NS1 antigen, and one of 67 donations collected in Townsville during the epidemic and selected for testing showed repeat reactivity towards the NS1 antigen. Viral RNA was not detected in any of these NS1 reactive donations. Summary/conclusions: This study suggests recent dengue exposure in a self-declared asymptomatic population, and provides an understanding of the rate and dynamics of asymptomatic dengue infection in North Queensland during these recent outbreaks. Discordant results between NS1 and viral RNA detection needs further evaluation. Collectively, this study justifies the use of DENV management strategy during a DENV outbreak in north Queensland.