Experiencia preliminar con el uso del soporte vital extracorpóreo como puente al trasplante pulmonar / Preliminary Experience of the Use of Extracorporeal Life Support as a Bridge to Lung Transplantation

Introducción: Diversos estudios han demostrado los beneficios del soporte vital extracorpóreo en pacientes críticos con patologías cardiorrespiratorias. El objetivo del presente trabajo consiste en evaluar la experiencia preliminar con el uso del soporte vital extracorpóreo en pacientes con enfermedad pulmonar avanzada, en lista de espera para trasplante pulmonar. Material y métodos: Se realizó un análisis retrospectivo y descriptivo de los pacientes que recibieron soporte vital extracorpóreo como puente al trasplante o a la candidatura para trasplante, entre agosto 2010 y julio 2015. Se analizaron los resultados según: exclusión de la lista de espera, candidatos a trasplante y trasplantes realizados. Se describen complicaciones y causas de mortalidad, tiempos de soporte vital extracorpóreo, asistencia respiratoria mecánica e internación post-trasplante. Se incluyeron 23 pacientes, edad promedio 36 ± 17 años, 61% mujeres. Los diagnósticos principales fueron fibrosis quística (34.8%), fibrosis pulmonar idiopática (30.4%) y fibrosis pulmonar secundaria (13.0%). Resultados: El tiempo medio con soporte vital extracorpóreo fue 14.4 ± 11.7 días; y se realizó veno-venoso en 14 pacientes, veno-arterial en 4, arterio-venoso 3 casos y veno-arterio-venoso en 2. Ocho pacientes no calificaron como candidatos al trasplante y se excluyeron de la lista de espera. Fueron aceptados como puente al trasplante 15 pacientes; 8 fallecieron bajo soporte vital extracorpóreo y 7 lograron ser trasplantados. Post trasplante, un paciente falleció y 6 fueron externados superando el año de supervivencia. Conclusión: En nuestra serie, el 46.7% de los candidatos lograron acceder al trasplante pulmonar bajo soporte vital extracorpóreo. La implementación de un programa de soporte vital extracorpóreo como puente al trasplante pulmonar efectivo requiere acceso a nuevas tecnologías y desarrollo de experiencia por parte del equipo.

Introduction: Several studies have demonstrated that the use of extracorporeal life support (ECLS) improves the recovery of critically ill patients with cardiorespiratory diseases. The purpose of this study was to evaluate a preliminary experience on the use of ECLS as a bridge to lung transplantation. Methods: We conducted a retrospective and descriptive analysis of patients who received ECLS as a bridge to lung transplantation between August 2010 and July 2015. ECLS results were analyzed according to the final status: excluded from the waiting list, confirmed transplant candidacy and transplanted patients. Complications and cause of mortality were evaluated, as well as the length of ECLS, time on mechanical ventilation, length of stay and survival. Twenty-three patients were included, mean age 36±17 years, 61% were female. The most common diagnoses were cystic fibrosis (34.8%), idiopathic pulmonary fibrosis (30.4%) and secondary pulmonary fibrosis (13.0%). Results: Mean time on ECLS was 14.4±11.7 days; veno-venous support was implemented in 14 patients, veno-arterial support in 4 cases, arterio-venous in 3, and veno-arterio-venous in 2. During ECLS, 8 patients did not qualify as candidates for transplantation. Fifteen patients were accepted as candidates for lung transplant, 8 of them died during ECLS, and 7 were transplanted. After transplant, one patient died and 6 were discharged from the hospital. Conclusion: The use of ECLS provided a successful bridge to lung transplantation in 46.7% of the patients. The implementation of an effective ECLS program requires of the conjunction between the technological advances and the development of the center's experience.

Preliminary Experience of the Use of Extracorporeal Life Support as a Bridge to Lung Transplantation

Introduction: Several studies have demonstrated the benefits of extracorporeal life support in critically ill patients with cardiorespiratory diseases. The purpose of this study was to evaluate the preliminary experience of the use of extracorporeal life support in patients with advanced pulmonary disease on the waiting list for lung transplantation. Materials and Methods: We conducted a retrospective and descriptive analysis of patients who received extracorporeal life support as a bridge to lung transplantation or to lung transplantation candidacy between August 2010 and July 2015. Results were analyzed according to: exclusion from the waiting list, transplant candidates and number of transplants performed. We described complications and causes of mortality, and duration of extracorporeal life support, mechanical respiratory assistance and post-transplant hospitalization. Twenty-three patients were included, with a mean age of 36 ± 17 years; 61% were female. The most common diagnoses were cystic fibrosis (34.8%), idiopathic pulmonary fibrosis (30.4%) and secondary pulmonary fibrosis (13.0%). Results: Mean time on extracorporeal life support was 14.4 ± 11.7 days; veno-venous support was implemented in 14 patients, veno-arterial support in 4 cases, arterio-venous in 3, and veno-arterio-venous in 2. Eight patients did not qualify as candidates for transplantation and were excluded from the waiting list. 15 patients were accepted as a bridge for lung transplant; 8 of them died while receiving extracorporeal life support, and 7 were transplanted. After the transplantation, one patient died and 6 were discharged from the hospital with more than one year survival. Conclusion: In our series, 46.7% of candidates had access to lung transplantation under extracorporeal life support. The implementation of an effective extracorporeal life support program as a bridge to lung transplantation requires the access to new technologies and the development of the Center's team experience.

Helping people with a mental illness obtain work: the Health Optimisation Program for Employment.

OBJECTIVE: Inclusion in work and education remains problematic for many people with a mental illness. We describe a structured programme - the Health Optimisation Program for Employment - that supported people with a mental illness to gain employment or commence studies. METHOD: Twenty hours of the Health Optimisation Program for Employment were delivered to 600 individuals. Participants were asked to complete an evaluation survey encompassing vocational status and ratings of self-efficacy. RESULTS: Of the 364 participants who completed the baseline assessment, 168 responded to the evaluation survey 6 months after the delivery of the Health Optimisation Program for Employment. Of these, 21.5% had started a new job, while a further 42.8% were either volunteering or studying. Satisfaction with the programme was high and self-efficacy ratings improved significantly over the short term only. CONCLUSIONS: The Health Optimisation Program for Employment requires further evaluation using rigorous scientific methodology but these initial results are encouraging in terms of vocational attainment for people with a mental illness, in the Australian context.

A randomized head to head trial of MoodSwings.net.au: an Internet based self-help program for bipolar disorder.

BACKGROUND: Adjunctive psychosocial interventions are efficacious in bipolar disorder, but their incorporation into routine management plans are often confounded by cost and access constraints. We report here a comparative evaluation of two online programs hosted on a single website (www.moodswings.net.au). A basic version, called MoodSwings (MS), contains psychoeducation material and asynchronous discussion boards; and a more interactive program, MoodSwings Plus (MS-Plus), combined the basic psychoeducation material and discussion boards with elements of Cognitive Behavioral Therapy. These programs were evaluated in a head-to-head study design. METHOD: Participants with Bipolar I or II disorder (n=156) were randomized to receive either MoodSwings or MoodSwings-Plus. Outcomes included mood symptoms, the occurrence of relapse, functionality, Locus of Control, social support, quality of life and medication adherence. RESULTS: Participants in both groups showed baseline to endpoint reductions in mood symptoms and improvements in functionality, quality of life and medication adherence. The MoodSwings-Plus group showed a greater number of within-group changes on symptoms and functioning in depression and mania, quality of life and social support, across both poles of the illness. MoodSwings-Plus was superior to MoodSwings in improvement on symptoms of mania scores at 12 months (p=0.02) but not on the incidence of recurrence. LIMITATIONS: The study did not have an attention control group and therefore could not demonstrate efficacy of the two active arms. There was notable (81%) attrition by 12 months from baseline. CONCLUSION: This study suggests that both CBT and psychoeducation delivered online may have utility in the management of bipolar disorder. They are feasible, readily accepted, and associated with improvement.

Development of an online intervention for bipolar disorder. www.moodswings.net.au.

We describe the development process and completed structure, of a self-help online intervention for bipolar disorder, known as MoodSwings ( www.moodswings.net.au) . The MoodSwings program was adapted as an Internet intervention from an efficacious and validated face-to-face, group-based psychosocial intervention. The adaptation was created by a psychologist, who had previously been involved with the validation of the face-to-face program, in collaboration with website designers. The project was conducted under the supervision of a team of clinician researchers. The website is available at no cost to registered participants. Self-help modules are accessed sequentially. Other features include a mood diary and a moderated discussion board. There has been an average of 1,475,135 hits on the site annually (2008 and 2009), with some 7400 unique visitors each year. A randomised controlled trial based on this program has been completed. Many people with bipolar disorder are accepting of the Internet as a source of treatment and, once engaged, show acceptable retention rates. The Internet appears to be a viable means of delivering psychosocial self-help strategies.

Controlled clinical trial of a self-management program for people with mental illness in an adult mental health service - the Optimal Health Program (OHP).

OBJECTIVE: The objective of this study was to evaluate the effect and cost-effectiveness of a self-management intervention, delivered as part of routine care in an adult mental health service. METHOD: In a community mental health setting, routine care was compared with routine care plus a nine-session intervention (the Optimal Health Program) using a non-randomised controlled design. Adult (18-65 years) consumers of mental health services in the Australian Capital Territory were eligible for participation. RESULTS: The Optimal Health Program was associated with significant improvements in health and social functioning as measured by the Health of the Nation Outcome Scale (average change relative to control: -3.17; 95% CI -4.49 to -1.84; P<0.001). In addition, there was a reduction in hospital admissions in the treatment group (percentage of time in hospital reduced from 3.20 to 0.82; P=0.07). This translated into a net cost saving of over AU$6000 per participant per year (uncertainty range AU$744 to AU$12656). CONCLUSIONS: This study shows promising results for incorporating a self-management program into routine care to improve the health and social functioning of mental health consumers in a cost-effective manner.

Group-based psychosocial intervention for bipolar disorder: randomised controlled trial.

BACKGROUND: Psychosocial interventions have the potential to enhance relapse prevention in bipolar disorder. AIMS: To evaluate a manualised group-based intervention for people with bipolar disorder in a naturalistic setting. METHOD: Eighty-four participants were randomised to receive the group-based intervention (a 12-week programme plus three booster sessions) or treatment as usual, and followed up with monthly telephone interviews (for 9 months post-intervention) and face-to-face interviews (at baseline, 3 months and 12 months). RESULTS: Participants who received the group-based intervention were significantly less likely to have a relapse of any type and spent less time unwell. There was a reduced rate of relapse in the treatment group for pooled relapses of any type (hazard ratio 0.43, 95% CI 0.20-0.95; t(343) = -2.09, P = 0.04). CONCLUSIONS: This study suggests that the group-based intervention reduces relapse risk in bipolar disorder.

The needs of parents with a mental illness who have young children: an Australian perspective on service delivery options.

BACKGROUND AND AIMS: This article discusses a collaborative approach to assisting parents with a mental illness who have children aged 5 years and under and explores themes found in the literature, focus groups with consumers and workshops with clinicians working with parents who have a mental illness. METHOD: Focus groups and workshops were held for consumers and clinicians. The workshops included information about a proposed group intervention and discussions about themes found in the literature review and previous focus groups. RESULTS: Using thematic analysis, the gaps identified in the focus groups and workshops were classified into five main categories--namely, interagency collaboration, a need for accessible support groups, a need for information and resources about mental illness, and parenting issues related to mental illness and independence. This information informed the development of a treatment package. CONCLUSION: The content of the proposed treatment package has been informed by the findings of the literature review, focus groups and workshops. The sessions focus on topics about parenting and managing mental health and consumers are actively involved at the outset in their own care and the care of their child. The intervention will be trailed in clinical settings to establish efficacy and effectiveness.

Pilot of group intervention for bipolar disorder.

Objective. This pilot study aimed to determine whether a group based psychosocial intervention reduced rates of relapse, improved function and quality of life in people with bipolar disorder. Method. Patients with a diagnosis of bipolar disorder, types I and II were recruited in the Geelong Region of Victoria. Patients were assessed at baseline for psychiatric status, mood episode, function, and medication adherence. They were randomly assigned to either the intervention arm, a 12-week, structured group-based therapy as an adjunct to treatment as usual or the control arm, which consisted of treatment as usual, plus weekly phone calls. Participants were then followed up for a period of 3 months and assessed by a researcher blinded to treatment and control interventions. Results. Functioning as measured by the Global Assessment of Functioning (GAF) was significantly improved in the intervention group (P=0.008). The social relationships subscale on the (WHOQoL-BREF) showed significant results (P<0.05 level). There was also a positive trend in reduction of relapses in the intervention group. Conclusion. The use of a group intervention for bipolar disorder as an adjunct to usual treatment has potential benefits, both in reduction of relapse and improvement in functionality, and may be a cost effective way of delivering psychosocial treatments.