Australian Red Cross Research Articles

Determining the effect of vein visualization technology on donation success, vasovagal symptoms, anxiety and intention to re-donate in whole blood donors aged 18-30 years: A randomized controlled trial.

Vein visualization technology (VVT) devices use near-infrared light to assist location of peripheral veins. The current study investigated the impact of VVT on donor experience and collection success for young blood donors at the Australian Red Cross Blood Service. The study in donors aged 18 to 30 years used a two intervention to one control randomized trial design with 285 new and 587 returning donors recruited at two sites. Donors reported presyncopal symptoms, phlebotomy pain, anxiety and intentions to redonate along with other measures. Participating phlebotomists rated usefulness of the technology. Flow rates, collection volumes and other donation information were taken from routine data. No significant differences were found between control and intervention groups on presyncopal symptoms, phlebotomy pain, anxiety, intentions to redonate, flow rates, collection volumes or vasovagal reactions (all P's > 0·05). Phlebotomist ratings of VVT were significantly more positive when they had less than 5 years of experience (P < 0·01) or when the vein was not visible to the naked eye (P < 0·01). Results suggest that VVT does not improve the donation experience for younger blood donors. Staff reports indicate that VVT may have some utility for assisting with difficult phlebotomies.

One hundred years of annual reporting by the Australian Red Cross: Building public trust and approbation through emotive disclosures

Marking the centenary of the Australian Red Cross, this interpretive and historical case study spans the organization’s beginning in 1914 through to the present day. The overarching purpose is to reveal how one of Australia’s oldest and most important humanitarian organizations used accounting and related information in the discharge of accountability. More specifically, this longitudinal study examines the organization’s annual reporting practices over the course of a century, with particular focus on the emotive disclosures contained in the reports. A political economy of accounting theoretical framework guides the content analysis and the interpretation of the findings. The annual reports were found to be responsive to the changing institutional, social, economic and political environment and evidence the organization’s reliance upon emotive disclosures to discharge a broad scope accountability and build public trust and approbation.

Cytomegalovirus in Australian blood donors: seroepidemiology and seronegative red blood cell component inventories.

Cytomegalovirus (CMV) can lead to severe disease in high-risk subpopulations. To prevent transfusion-transmitted CMV in these patient groups, the Australian Red Cross Blood Service maintains inventories of CMV-seronegative fresh blood components. Donor demographic data and CMV seroscreening results for all blood donations and blood components issued in Australia between financial years (FYs) 2008/09 to 2012/13 inclusive were obtained. Population estimates were also extracted for the calculation of age-weighted seroprevalence estimates. Linear regression was used to model trends in red blood cell (RBC) component acquisition and demand. The estimated age-weighted seroprevalence of CMV in 20- to 69-year old Australians was 76.12 ± 0.13%, with higher seroprevalence in females and older age groups. Seroprevalence decreased over the study period, while the demand for CMV-seronegative RBC components increased. It was predicted that component acquisition may be insufficient by FY 2017/18 if current trends persist. These findings represent an evaluation of CMV seroepidemiology in Australia and form a basis to predict the future status of CMV-seronegative RBC component inventories. The results will serve to guide Blood Service operations and inform current international debate on CMV-safe blood components.

The role of the transfusion safety coordinator in Australia

Transfusion safety coordinators (TSCs) are an integral part of the transfusion process, which involves many interlinking chains of events and a multidisciplinary group of health professionals. In Australia, individual hospital‐based TSCs have been in place for several decades, with state‐based collaboratives commencing in 2002. The role has expanded across the country and currently there are 113 dedicated TSC positions and many more staff involved as blood/transfusion champions. There are also 12 transfusion nurse (TN) positions within the Australian Red Cross Blood Service. Over time both TSC and TN roles have evolved to meet the changes within the Australian blood sector. The primary focus of safety and appropriateness has now evolved to be more patient‐centred by incorporating patient blood management (PBM) initiatives. National PBM guidelines, statements, strategies, criteria and healthcare standards specifically focused on all aspects of transfusion have influenced this evolution. TSCs undertake diverse roles and activities that vary significantly between health services and within each jurisdiction. Effective communication and change management skills are integral to the success of the role. Conclusion: The TSCs are highly recognised within the transfusion team and the role continues to evolve with the changes in the Australian blood sector. The term Transfusion Safety Coordinators (TSCs) has been used to describe roles such as transfusion nurse/trainer/practitioner/safety officer/clinical nurse consultant and PBM nurses.

Donating blood for research: a potential method for enhancing customer satisfaction of permanently deferred blood donors.

Each year, a large number of individuals in Australia are deferred from donating blood. A deferral may have a negative impact on donor satisfaction and subsequent word-of-mouth communication. The Australian Red Cross Blood Service (the Blood Service) is, therefore, investigating options for managing service interactions with deferred donors to maintain positive relationships. While public research institutes in Australia have established independent research donor registries, other countries provide programmes allowing deferred donors to donate blood for research via blood collection agencies. This study examined attitudes towards donating blood for research use in a sample of permanently deferred Australian donors. Donors permanently deferred because of a risk of variant Creutzfeldt-Jakob disease (n=449) completed a postal survey that examined attitudes towards research donation. The majority of participants were interested in donating blood for research (96%), and joining a registry of research donors (93%). Participants preferred to donate for transfusion or clinical research, and were willing to travel large distances. Results indicated that positive attitudes towards the Blood Service would be extended if the opportunity to donate blood was provided. These findings indicate a desire for continued engagement with the Blood Service despite deferral. Donating blood for research is a potential way of maintaining positive relationships with permanently deferred donors which also benefits the health research community. Through maintaining positive relationships with deferred donors, positive word-of-mouth activity can be stimulated. Further work is needed to determine the feasibility of implementing research donation through the Blood Service in Australia.

Identification of genetic polymorphisms that predict responder/non-responder profiles to the RhD antigen.

Regular plasma donors who produce high titre anti-D immunoglobulin (Ig) are overseen by the Australian Red Cross Blood Service RhD Program. New donors to the program are immunised with small amounts of RhD-positive RBCs, whilst donors who have developed anti-D due to previous RhD-incompatible blood transfusion or pregnancy are boosted with RhD-positive RBCs to maintain a high level of serum anti-D Ig. A significant proportion of primarily immunised individuals do not respond to RhD immunisation and are therefore unnecessarily exposed to the risks involved in RBC sensitisation. We genotyped 184 anti-D donors for ∼9000 immunological and inflammatory genetic polymorphisms on an Affymetrix GeneChip, and validated the results with a High-Resolution Melt analysis assay. We built and validated a predictive logistic regression model using High Responder and Non-Responder anti-D donors that incorporated highly-associated polymorphisms and gender. High Responder and Non-Responder profiles in anti-D donors were significantly associated with a shortlist of 13 genetic polymorphisms and sex of the donor. The derivation of a logistic regression model showed an accuracy rate of 92.6% that was subsequently validated as 60.0% with an independent set of donor samples. This study has developed a logistic regression model and a genotyping assay that can predict the responder profiles of anti-D donors and could potentially be applied to new donors and transfusion-dependent patients in a clinical setting. Additionally, target polymorphisms identified in immunological genes could help to elucidate the immunomodulatory pathways regulating the immune response to the RhD antigen, and to other RBC antigens.

“There is no trace of him”: the Australian Red Cross, its Wounded and Missing Bureaux and the 1915 Gallipoli Campaign

One of the lesser known stories of the Gallipoli campaign was the significant support provided to the Australian Imperial Force by the array of voluntary patriotic funds. Mobilized from the beginning of the war and operating both on the Home Front and in Egypt, the large support network of individuals and organizations varied from sandbag funds, the provision of recreational equipment and hostel accommodation, to foodstuffs and medical supplies. This article focuses on the Australian Red Cross, formed on the outbreak of war in August 1914 as a branch of the British Red Cross Society. Its considerable contribution as a humanitarian organization concentrating on sick and wounded soldiers in war included Wounded and Missing Bureaux. Using the records of the South Australian Red Cross Information Bureau, this article explores the beginning of this programme and its efforts to trace missing soldiers from the Gallipoli campaign for family members and friends. Through this case study analysis, we find another lens with which to examine the effects of the Gallipoli campaign on the Home Front and explore the broader social and familial effects of the war more generally.

A long career in gastrointestinal oncology

John R Zalcberg speaks to Stella Bennett, Commissioning Editor: Professor John Zalcberg was the Director, Division of Cancer Medicine, at the Peter MacCallum Cancer Centre in Melbourne, Australia for 17 years. In 2014, he took up the position of Head of the Cancer Research Program in the School of Public Health and Preventive Medicine at Monash University where he is involved in setting up a number of national clinical quality registries in cancer. After earning a Bachelor of Medicine and a Bachelor of Surgery from the University of Melbourne he did a PhD in cancer immunology. He is immediate past Chair of the Board of the Australasian Gastrointestinal Trials Group after serving in this role for over 15 years. He is the current Co-Chair of the Cancer Drugs Alliance, an organization which advocates for improved access to new cancer drugs for patients and also the Chair of the Australian Clinical Trials Alliance. This organization is involved in advocating for embedding clinical research into routine clinical practice in order to improve the quality of healthcare delivery. He is also a Board Member of the Australian Red Cross Blood Service. A past Board Member of the NSW Cancer Institute, past President of the Clinical Oncological Society of Australia, and a past Member of the Consultative Council of the Victorian Cancer Agency, he has received a Medal of the Order of Australia Award, the 2011 Cancer Achievement Award from the Medical Oncology Group of Australia and the 2014 ‘Tom Reeve Award for Outstanding Contributions to Cancer Care’ from the Clinical Oncology Society of Australia. Professor Zalcberg’s clinical research interests include gastrointestinal cancer and healthcare outcomes. He was a Principal Investigator for the EORTC advanced GIST trial in Australia, remains active in numerous trials in gastrointestinal malignancies and continues an active clinical practice in gastrointestinal cancer. He has published more than 240 articles in peer-reviewed journals.

Assessing infectious threats – trick or threat?

BackgroundEffective surveillance for, and response to, emerging infectious disease (EID) agents is a pivotal component of blood safety risk management policy. The rate of emergence of new potential agents is increasing which demands a robust risk management strategy for rapidly assessing and ranking potential threats. This review discusses the general principles of threat assessment for EID agents.MethodsVarious schema for the management of the risk posed by EID agents have been proposed. Examples are the AABB ‘toolkit’ for EIDs which includes a framework for recognition, assessment and management of EID agents, and the Australian Red Cross Blood Service's EID management strategy. Both systems incorporate EID agent ‘templates’ to assist with ranking the threat level and formulating an appropriate response.ResultsThreats are primarily assessed based on three main criteria: prevalence in donor population, transmissibility by blood and the severity of clinical disease in recipients. Where the threat is deemed significant, quantitative risk assessment and cost‐effectiveness analysis for potential interventions can assist in defining the most appropriate mitigation strategy. Hepatitis E virus (HEV) is an excellent contemporary case study with transfusion–transmissibility now proven, but further studies required to define the extent of clinically significant disease in immunocompetent recipients.ConclusionsThe emergence of vCJD and subsequently West Nile virus underscored the importance of an effective EID risk management framework. However, not all EIDs necessarily pose a significant threat to blood safety, and therefore, an effective ranking system is required which we suggest should primarily assess prevalence, transmissibility and recipient disease outcome.

‘To reunite the dispersed family’: War, Displacement and Migration in the Tracing Files of the Australian Red Cross

The mass immigration of displaced persons (DPs) to Australia after the Second World War generated thousands of enquiries both to and from Australia of people searching for the fate of their family members. The Australian Red Cross tracing service often became the only means of communication for many families divided by the Cold War. This article examines the case files of Red Cross tracing enquiries for what they can reveal of the experiences of war, displacement and migration to Australia, and the reach of Cold War Europe in the everyday lives of migrants. These records also demonstrate the limits of the Red Cross goal of family reunion, for not all of those who were sought wished to be found.This article has been peer reviewed.

Business continuity in blood services: two case studies from events with potentially catastrophic effect on the national provision of blood components.

NHS Blood and Transplant (NHSBT) and the Australian Red Cross Blood Service (ARCBS) are national blood establishments providing blood components to England and North Wales, and Australia, respectively. In 2012, both services experienced potentially catastrophic challenges to key assets. NHSBT suffered a flood that closed the largest blood-manufacturing centre in Europe, whilst ARCBS experienced the failure of a data centre network switch that rendered the national blood management system inaccessible for 42 h. This paper describes both crisis events, including the immediate actions, recovery procedures and lessons learned. Both incidents triggered emergency response plans. These included hospital reprovisioning and recovery from the incident. Once normal services had been restored, both events were subjected to root cause analysis (RCA) and production of 'lessons learned' reports. In both scenarios, the key enablers of rapid recovery were established emergency plans, clear leadership and the support of a flexible workforce. Product issues to hospitals were unaffected, and there were no abnormal trends in hospital complaints. RCA identified the importance of risk mitigations that require co-operation with external organizations. Reviews of both events identified opportunities to enhance business resilience through prior identification of external risks and improvements to contingency plans, for example by implementing mass messaging to staff and other stakeholders. Blood establishment emergency plans tend to focus on responding to mass casualty events. However, consolidation of manufacturing to fewer sites combined with a reliance on national IT systems increases the impact of loss of function. Blood services should develop business continuity plans which include prevention of such losses, and the maintenance of services and disaster recovery.

The effect of caralluma fimbriata extract on metabolic parameters in high-fat fed wistar rats

The effect of caralluma fimbriata extract on metabolic parameters in high-fat fed wistar rats

Australian Red Cross leadership in the promotion of international humanitarian law

Editor's note: In this Opinion Note, Tim McCormack highlights the Australian experience of setting up and developing an IHL programme domestically as an example of how IHL can be disseminated and promoted at the national level. The Australian experience is a great success story and can serve as an example for others seeking to do the same.

Collaboration to improve evacuation centre operations in Queensland

Purpose – The purpose of this paper is to provide a case study of two organisations working in evacuation centres which overcame challenges to develop a constructive relationship, resulting in improved outcomes for disaster-affected people. A wide range of services for disaster-affected communities are provided as part of emergency sheltering. Collaboration between agencies providing services is essential, but sometimes challenging. Design/methodology/approach – A wide range of services for disaster-affected communities are provided as part of emergency sheltering. Collaboration between agencies providing services is essential, but sometimes challenging. The purpose of this paper is to provide a case study of two organisations working in evacuation centres which overcame challenges to develop a constructive relationship, resulting in improved outcomes for disaster-affected people. Findings – The Preferred Sheltering Practices provides an ongoing anchor for Australian Red Cross and Environmental Health Australia (EHA) (Queensland) Inc.’s relationship and has led to other tangible benefits such as involvement in each other’s events and trainings. The relationship has become embedded in each organisation’s day-to-day business ensuring the relationship’s sustainability beyond individual staff movements. Originality/value – This case study provides an example of how collaboration can be achieved between two organisations with seemingly different mandates to improve the response for disaster-affected communities.

Organisational Capacity for Engaging with Indigenous Australians

Community capacity building is a common goal for programmes and policies involving Indigenous peoples, but it relies heavily on organisational capacity to work effectively in intercultural settings. This paper reviews the organisational capacity of the senior leaders of Australian Red Cross and institutional efforts to build a culturally appropriate and respectful organisation. It reports results from a survey of the organisation’s leadership team and follow-up interviews undertaken in 2010, reviews the challenges facing the organisation in working with Aboriginal and Torres Strait Islander Australians, and considers institutional progress in building internal capacity to lead change in working with Aboriginal and Torres Strait Islander Australians. The paper concludes with discussion of wider implications of this research.

Can we manage blood inventory effectively?

AbstractBackground and ObjectivesIn Australia, we rely on voluntary, non‐remunerated donors to provide sufficient blood to meet patients’ needs. For fresh components, the Australian Red Cross Blood Service (Blood Service) is 100% self‐sufficient, with only rare phenotypes imported as required. Hospitals and pathology laboratories, as well as the Blood Service, are under increasing pressure from Government/s to improve value for money for blood and blood products, which is resulting in extra demands being placed on the Blood Service. There is also some pressure, in relation to lower age at issue for red cells, and a continuing trend to hold more Group O stock and less of the other groups, especially AB where demand is low. With a typically seasonal inventory pattern for red cells, the Blood Service has focussed on closer management of Blood Inventory. The Blood Service is fully funded by Australian Governments.AimThe aim of the inventory programme was to improve reliability of blood coming into the supply chain and therefore to improve reliability of delivery to customers. This is measured by average variance in the number of whole blood collection packs being receipted at the Blood Service processing centre. The aim was to reduce the variability in this metric, which would naturally lead to decreased inventory holding requirements, greater control and efficiency, and increased reliability and service to the customers. Order fulfilment is another measure used to demonstrate improvement.MethodsTo manage blood inventory effectively, the first step was to introduce a minimum and maximum inventory level, by blood type and by state. This provided a common and visible target to aim for. The bands were calculated by firstly setting a minimum inventory level using traditional supply chain safety stock calculations. The next step was to develop a 12‐week inventory forecast, using a number of planning assumptions. One of the core assumptions is the number of appointments booked in the lead up to a donation. To improve reliability, minimum targets were agreed at 3 months out (re‐booking time) through to 1 week out. A ‘traffic light’ style appointments portal was developed to provide improved visibility of appointment levels for each collection mode and by state.ResultsResults show that the quarterly standard deviation of blood coming in to the Blood Service inventory has improved from 1711 units to 1285 units in the last four financial years – a 25% reduction. In addition, order fulfilment has improved from 82% to 95%, demonstrating that, with improved planning systems and processes, it is possible to manage inventory effectively. The Blood Service in Australia set a goal to improve reliability of fresh components, in particular, red cells entering finished goods inventory, to improve order fulfilment and provide service excellence to customers. By implementing robust and disciplined planning and reporting systems, reliability has improved, demonstrating that there are methods available to improve the effectiveness of inventory management for blood components.

Meeting clinical demand for blood and blood products

BackgroundThe Australian Red Cross Blood Service (the Blood Service) is supported by circa 600 000 voluntary nonremunerated blood donors. The ongoing challenge is to influence donor behaviours to best match the collections received to the product demand.AimThe aim has been to develop a suite of tools and a framework of processes that result in a close alignment of supply and demand, ensuring that customer service and efficiency are balanced for optimal outcome.MethodsThe Blood Service implemented S&amp;OP in 2010, and this has been the basis for integrated, iterative planning that establishes a single set of monthly numbers that aim to align supply and demand. These plans are disaggregated to the lowest level of daily collection plans by blood type in order to drive or pull appointments only as needed to meet demand. Previously, collection targets were not ABO specific, so there was no assurance of correct proportions by ABO.ResultsThe average interval since last donation for returning donors by blood group has adjusted to better meet inventory targets. In January 2008, the gap between the lowest and highest average interval period was 33 days, and this has risen to 166 days by June 2013. This has resulted in more appropriate inventory holdings by ABO, enabling demand to be met and expiry to be reduced.Summary/ConclusionThe Blood Service has been effective in managing donation patterns at the blood group level, which has enabled the organization to improve performance in relation to meeting clinical demand for blood and blood products, especially red cells.

Shaping the Legend: The Role of the Australian Red Cross and Anzac

Established to assist the sick and wounded in war in August 1914, the Australian Red Cross became one of Australia's largest and most important voluntary organisations of the twentieth century. Both creations of World War I, the Anzac Legend and the Australian Red Cross appear at first glance to be the antithesis of each other. Yet the humanitarianism of the Australian Red Cross and the militarism of the Anzac Legend are inextricably linked and provide us with a unique perspective with which to evaluate the contested terrain of Anzac. Taking as its starting point the small booklet, Australia at the Dardanelles, 25 April 1915, sold as a fundraiser for the Australian Red Cross during Australia Day, 30 July 1915, this article examines the Australian Red Cross and its connections with the origins of the Anzac Legend during World War I.

Shaping the Legend: The Role of the Australian Red Cross and Anzac

Shaping the Legend: The Role of the Australian Red Cross and Anzac

Chagas disease in Australia and New Zealand: risks and needs for public health interventions

International migration has changed the global distribution of Chagas disease, with the emerging importance of non-endemic regions. We aimed at better documenting the Australia and New Zealand risk of Chagas disease and needs for interventions. We reviewed Chagas disease-related evidences, policies and practices in Australia and New Zealand and calculated the estimated prevalence. Australia hosts a rapidly growing population at risk and had 1928 infected residents in 2011; New Zealand had 98 in 2006. These figures underestimate the real situation, as they do not consider non-permanent residents. The only existing policy in both countries is the identification of blood donors with a history of or a risk of infection via questionnaire. There is no programme of detection and care of patients. The lifetime economic burden of disease for society is potentially very high. Chagas disease is an emerging health risk with potential high human and economic costs in Australia and New Zealand in the absence of public health attention. Implementing strategies to screen high-risk groups and prevent transmission should be considered. Moreover, migration between the Western Pacific and Chagas endemic regions and the presence of vectors means this risk applies in the whole region.