A survey of public sector information resource management in Australia

The concept of Information Resource Management (IRM) was introduced in the mid-1970?s bythe United States federal government as part of its attempt to reduce the paperwork burden on the general public. Since then, the concept of IRM has evolved and taken on many meanings and diverse interpretations ranging from technical perspectives to ?Information Management perspectives. These diverse interpretations, at least in the Australian context, have held back the successful implementation of IRM in practice. As part of a larger program of research on IRM, a survey of IS/IT executives in some national and state public sector organisations was conducted.Despite the existence of a number of state and federal government policy documents relating to IRM, the survey revealed a lack of penetration of IRM in Australian public sector organisations, a pattern of mixed success and even a lack of awareness of IRM. Factors involved in the success or failure of IRM included awareness of IRM, existence of a CIO role, top-level (CEO) endorsement and strategic planning

In Vitro Validation of the Affinity NT Oxygenator Arterial Outlet Temperatures

During cardiopulmonary bypass, the rates of cooling and rewarming and the maximum temperatures attained are implicated in patient morbidity. Thus, accurate oxygenator arterial outlet temperature measurements are needed. The purpose of this study was to determine the accuracy of the arterial outlet temperature probe on the “Affinity NT” membrane oxygenator in measuring perfusate temperatures. An in vitro circuit was used. Crystalloid solution was recirculated through an Affinity NT membrane oxygenator and, to simulate the patient, a second oxygenator. Water was recirculated through the heat exchanger of the second oxygenator via a reservoir. A myocardial temperature probe was inserted in-line 4 cm distal to the Affinity NT oxygenator arterial outlet temperature probe and was considered to measure the actual temperature of the perfusate. Temperatures were simultaneously recorded from the in-line probe, arterial outlet probe, and reservoir every second. Twenty-seven trials were run using random combinations of three Affinity NT oxygenators and three in-line probes. Each trial entailed cooling an initially normothermic reservoir to 28°C and then rewarming it to normothermia again. The arterial outlet temperature probe on the Affinity NT membrane oxygenator underestimated the perfusate temperatures during early rewarming (bias of 0.72°C; precision of ±1.15°C) and late rewarming (bias of 0.52°C; precision of ±0.97°C). An overestimation of the perfusate temperatures occurred during early cooling (bias of −0.57°C; precision of ±1.37°C). Only during the late cooling phase was the arterial outlet temperature probe accurate (bias of −0.02°C; precision of ±0.3°C). The perfusionist should be aware of the temperature probe monitoring characteristics of the oxygenator to safely perfuse the patient

Microbubble Transmission during Cardiotomy Infusion of a Hardshell Venous Reservoir with Integrated Cardiotomy versus a Softshell Venous Reservoir with Separated Cardiotomy: An In Vitro Comparison

An important mechanism for postoperative cognitive impairment after cardiac surgery using cardiopulmonary bypass (CPB) is microemboli. One component of the CPB circuit—the cardiotomy—is a major source of gaseous microemboli because it aspirates significant volumes of air with blood from the operative field and intracardiac chambers. Cardiotomies are either integrated within an open hardshell venous reservoir (IC-HSVR) or are a separate canister attached to a softshell collapsible venous reservoir bag (SC-SSVR). The purpose of this study was to compare the Medtronic IC-HSVR (Affinity NT CVR) with Medtronic’s SC-SSVR (CB 1351, CBMVR 1600) in terms of relative microbubble transmission during cardiotomy infusion. A recirculating in vitro circuit primed with blood was used to compare the two cardiotomy-reservoir systems with the venous reservoir in the SC-SSVR further assessed in a fully closed or partially open state (SC-SSVR-closed; SC-SSVR-open). Microbubbles were detected using a GAMPT BC100 Doppler system in the outflow line of the venous reservoir. Measurements were taken before (baseline) and after aerated prime was pumped into the cardiotomy while altering pump flow rates (3 L/min; 5 L/min) and reservoir prime volumes (400 mL; 900 mL). Infusing cardiotomy blood into the venous reservoir was associated with an increase in microbubbles and bubble volume transmitted by both cardiotomy-reservoir systems with the magnitude rising with reduced prime volumes. The effect was markedly greater with the IC-HSVR. The IC-HSVR also transmitted larger bubbles, particularly with reduced prime volumes. There was no significant difference in microbubble transmission seen between the SC-SSVR-closed and SC-SSVR-open. The SC-SSVR transmits fewer microbubbles than the IC-HSVR during cardiotomy infusion and should be considered as the preferential system. Because both cardiotomy-reservoir systems transmitted microbubbles during cardiotomy infusion, particularly at the lower venous reservoir volume, it is important to use strategies to minimize cardiotomy microbubble infusion

Air Transmission Comparison of the Affinity Fusion Oxygenator with an Integrated Arterial Filter to the Affinity NT Oxygenator with a Separate Arterial Filter

Arterial filters used in the extracorporeal circuit (ECC) have been shown to minimize cerebral injury by capturing particulate matter and microbubbles. We clinically use the Affinity NT oxygenator with an Affinity arterial filter attached (“Affinity system”). The new Affinity Fusion oxygenator (“Fusion”) incorporates integrated arterial filtering. Our aim was to determine if the Fusion oxygenator was as safe as the Affinity system in terms of relative microbubble transmission of introduced air. A recirculating in vitro circuit primed with blood was used to compare the Fusion with the Affinity system. Microbubbles were detected using a GAMPT BC100 Doppler in the oxygenator–arterial filter outflow line. Measurements were taken 1 minute before and 3 minutes after bolusing 30 mL air proximal to the venous reservoir while altering pump flow rates (3 L/min; 5 L/min). Both the Fusion and Affinity system transmitted microbubbles during air injection. Microbubble volume transmitted at 5 L/min pump flow was significantly greater than at 3 L/min in both systems. The Fusion tended to transmit fewer bubbles, less bubble volume, and smaller sized bubbles than the Affinity system. Under the parameters of this in vitro study, the Affinity Fusion oxygenator with an integrated arterial filter is as safe as the Affinity NT oxygenator with a separate arterial filter in terms of microbubble transmission. However, more research is needed to confirm this study’s findings and generalizability to the clinical environment. As both oxygenator–arterial filter systems transmitted microbubbles during air introduction, it is important to develop strategies to minimize microbubble entry into the ECC