The use of recombinant activated factor VII for refractory bleeding post complex cardiothoracic surgery

We reviewed the outcome following use of recombinant activated factor VII (rVIIa) in patients with major bleeding post cardiothoracic surgery in our unit between January 2002 and July 2004. The unit consists of 16 cardiothoracic intensive care beds in a public metropolitan teaching hospital which serves as a referral centre for heart and lung transplant surgery Patients with refactory bleeding following cardiothoracic surgical procedures who were treated with rVIIa were identified. A total of 12 episodes of rVIIa use were recorded in ten patients, including three episodes with ventricular assist devices, and 5 heart and/or lung transplants. The median dose used was 85 mu g/kg. Chest tube drainage decreased in all patients following administration of rVIIa; median chest tube drainage decreased front 445 ml/h to 171 ml/h (P=0.03). Despite cessation of bleeding, mortality was high, when rVIIa was used after more than 24 hours. In six episodes, despite early rVIIa use (within six hours), continued bleeding necessitated return to theatre, where a surgical source of bleeding was found. In this small retrospective study, rVIIa significantly reduced bleeding that was refractory to standard blood product transfusion. In this series of patients., those that did not respond to rVIla early in the postoperative phase were found to have a surgical source of bleeding.

Teaching Australian cello music to Intermediate students: An exploratory study of motivation through repertoire

This paper explores the motivational aspects of repertoire for intermediate student cellists. Research into interest and intrinsic motivation related to the learning of instrumental music has been limited to date. As a cello teacher interested in including contemporary and Australian music in my students' studies I started to research availability of Australian repertoire for intermediate cellists and found that there was limited accessibility to such pedagogical material at this level. This study emerged as a way of providing useful information to composers. It investigates intrinsic motivation by questioning students and their teachers about which aspects of music repertoire are most likely to inspire students to practice more and strive for excellence. This paper presents the findings of the purpose-designed questionnaire distributed to cello teachers in Queensland. A similar set of questions has been prepared for student cellists and information gathering from students is still underway. Musical aspects investigated include technique and its development, style, harmony, tempo (speed), and rhythm. The questionnaire gathered information on the most frequently used teaching repertoire and teachers' experiences in teaching contemporary and Australian repertoire. This information was balanced with questions regarding the technical developmental requirements perceived necessary for intermediate students as well as other motivational aspects. It is hoped that information collated from this research will be of benefit in the selection of motivational repertoire for intermediate student cellists and especially in promoting the composition of Australian pieces for intermediate cellists.

The effect of music on monitoring a simulated anaesthetised patient with sonfication

The idea of sonifying anaesthetised patients’ vital signs is gaining acceptance, but some anaesthetists are concerned about additional noise in the operating theatre. We tested the effect of ambient music (jazz, classical and rock) on participants’ ability to monitor a simulated anaesthetised patient with sonification and visual monitors. Participants liked working with ambient music when workload was low. Participants preferred rock music, but reported working better with classical. Ambient music has less effect on participants’ ability to monitor the simulated patient than a distractor task does. We discuss practical implications of these findings.