Keynote Speakers Dr Peter Lazzarini Keynote Speaker Monday 28 October 2019 12:00pm Principal Research Fellow with Queensland Health and Queensland University of Technology After practicing for more than 12 years as a clinical podiatrist managing patients with foot disease at Queensland Health, he began his research career in 2011 and completed his PhD on the burden of foot disease in inpatient populations at QUT in 2016.

Dr Lazzarini’s research interests are in the epidemiology and treatment of foot disease (ulcers, infections and ischaemia) and he is particularly motivated by research that prevents foot disease hospitalisation and amputation. He has an emerging international track record in foot disease research with more than 55 papers in peer-reviewed journals, more than $3.5 million in grant funding, 15 higher degree students supervised, and his research has been translated into 7 national policy or practice improvements. Dr Lazzarini was recently awarded a four-year National Health and Medical Research Council of Australia Early Career Fellowship in 2018 to investigate the incidence and predictors of foot disease hospitalisation in Australia.

Over the years he has also served on many (inter)national diabetic foot disease, diabetes, wound and podiatry committees and he is currently the founding co-chair of Diabetic Foot Australia (Australian peak body) and secretary for the International Working Group of the Diabetic Foot (IWGDF, international peak body) Pressure Offloading Guideline

Workshop: Monday 28 October 8:00am – 11:00am Diabetic foot disease is a silent leading cause of the global hospitalisation, amputation and disability burdens. Yet, research shows these burdens are readily reducible when we use the research.

Diabetic foot disease typically includes diabetic foot ulcers, infections and ischaemia and is precipitated by diabetic peripheral neuropathy and arterial disease.

In this three-hour workshop we will utilise new international research and clinical guidelines to explore the following diabetic foot disease topics:

1. Global and national burdens

2. Global and national strategies

1. 3. Guideline-based principles for patient assessment

3. Guideline-based principles for patient management

4. Tools, tests and technologies for the future

Professor James Elliott Keynote Speaker Tuesday 29 October 2019 12:00pm Prof Elliott completed his PhD at the University of Queensland, Australia (UQ) in 2007 and a post-doctoral fellowship (2010) at UQ’s CCRE-Spine.

The primary focus of his interdisciplinary laboratory is to quantify altered spinal cord anatomy and whole-body skeletal muscle degeneration as potential markers of recovery following head/neck trauma. His work has resulted in external recognition as a global expert in neck pain (broadly) and whiplash injuries (more specifically).

He is currently a Professor of Allied Health in the Faculty of Health Sciences at the University of Sydney and the Northern Sydney Local Health District. Prior to this, Dr Elliott was an Associate Professor in the Feinberg School of Medicine at Northwestern University in Chicago, USA, where he remains an adjunct Professor and the Principal Investigator of the Neuromuscular Imaging Research Laboratory.

Workshop: Tuesday 29 October 2019 8:00am – 11:00am

Assessment/Prediction/Management of the Patient with Head/Neck Disorders This innovative participatory workshop provides participants the opportunity to learn, apply, and interpret new research and clinical knowledge to optimise outcomes of traumatic and non-traumatic neck pain such as whiplash-associated disorder and idiopathic neck pain.

By the end of this three-hour workshop, course participants will be able to:

1. Describe and apply a new framework for pain assessment using a 'radar plot' as an approach to structure and interpret assessment findings

2. Critically discuss the value and caveats of diagnostic imaging for patients with traumatic neck pain.

3. Identify and describe risk factors for chronicity in patients with acute traumatic neck pain.

Professor Sue Kildea Keynote Speaker Wednesday 30 October 2019 12:00pm Prof Sue Kildea is the co-director of the Molly Wardaguga Research Centre at Charles Darwin University. She is an internationally renowned midwifery and health services researcher with collaborative projects across Australia, Canada, Sweden and the UK. Sue has been invited to work as a technical advisor for the World Health Organisation, UNFPA and other organisations in Mongolia, Geneva, Jordan, Viet Nam, Canada, New Zealand, Japan and Indonesia.

She has a strong clinical background and has long advocated for the return of birthing services to rural and remote areas and the primary care setting. She has received a Human Rights Reconciliation award (2004), the Aurora Award for Outstanding Contribution to Remote Area Health (2012) and in 2018, she received Research Australia’s Health Services Research Award.

Associate Professor Yvette Roe Keynote Speaker Wednesday 30 October 2019 12:00pm Assoc Prof Roe is a Njikena Jawuru woman from the West Kimberley region, Western Australia. Assoc Prof Roe has more than 25 years’ experience working in the Indigenous health sector and she was awarded her PhD, University of South Australia in November 2015. She is the Co-Director of the Molly Wardaguga Research Centre, Charles Darwin University.

As an Aboriginal scholar, Assoc Prof Roe’s research and priority has been to identifying opportunities to improve health outcomes for Aboriginal and Torres Strait Islander peoples by delivering and evaluating services that are client, family and community focused. Assoc Prof Roe has diverse interests across a number of disciplines such as public health, sociology, and research methods. She is one of the few Aboriginal researchers currently developing and applying Indigenous critical realist evaluation to assess the impact of health interventions in Indigenous communities. The focus of her work is to unpack the multiple components of a complex intervention to ascertain what works for who, in what circumstances, in what respects and in what duration.

Workshop: Wednesday 30 October 2019 8:00am – 11:00 Health Services Research Using the RISE Framework to redesign maternity services for the best start in life for Aboriginal and Torres Strait Islander families In this workshop Yvette and Sue will describe a framework their team has developed to assist in driving maternity services reform for the best start in life for Aboriginal and Torres Strait Islander families.

The RISE Framework has four pillars to drive reform: 1. Redesign the health service; 2. Invest in the workforce; 3. Strengthen families; and, 4. Embed Aboriginal and/or Torres Strait Islander community governance and control.

We present the evidence base for each pillar and practical examples Participants will have time to explore how it can be adapted to their local situation in this interactive workshop

Program - Monday 28 October 2019 Time Topic Speaker

11:00 Lunch Starts Serving in Robert Douglas Auditorium Foyer – All Welcome

11:30 Opening remarks and acknowledgement of country

12:00 Keynote Speaker Dr Peter Lazzarini BAppSc(Pod), PhD

13:00 Human-robot interactions: a novel way to improve health literacy in preventing influenza Christine McIntosh

13:15 Three-dimensional printing as an imaging method to improve the inter- and intra-observer agreement of the Neer classification system for proximal humeral fractures

Hannah Bougher

13:30 The fetal renal parenchyma: Evaluation of a novel ultrasound measurement to assess kidney development Sonja Brennan

13:45 Prospective Randomized Placebo-controlled Double-blind Clinical study of Dexamethasone with Surgery for Chronic Subdural Haematoma. Interim analysis

Kristy Mebberson

14:00 Developing the multi-professional clinical academic workforce in Australia and New Zealand: a scoping review Alexandra Edelman

14:15 BREAK

14:30 Can ieMR-compatible tablets improve the workflow for physiotherapy student clinical educators in a digital hospital? Damian Coe

14:45 Long-term conditions in administrative staff: Expanding the health service picture Kathy Wright

15:00 Rhetoric and reality: experiences and drivers of Aboriginal and Torres Strait Islander Health Workers’ practice in far north Queensland

Stephanie Topp

15:15 Medical student preparedness to manage end-of-life care. - Aran Sandrasegaran Aran Sandrasegaran

15:30 The efficacy of an Octenidine decolonisation protocol in reducing Staphylococcus Aureus carriage in patients undergoing Total Joint Arthroplasty

Tristan Symonds

15:45 Break

16:00 Panel: Research and workforce in a dispersed population

Abstracts – Monday 28th October Human-robot interactions: a novel way to improve health literacy in preventing influenza Christine McIntosh C. McIntosh1, W. Smyth 2,3, A. Elvin1, M. Birks3 C. Nagle2,3 1 Short Stay Unit, Townsville Hospital, Townsville, Queensland, Australia 2 Townsville Institute of Health Research and Innovation, Townsville Hospital and Health Service, Townsville, Queensland, Australia 3 Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia Background: Vaccination health literacy is known to be low, which poses a public health issue. With emerging and disruptive artificial intelligence technology, social humanoid robots may be useful in addressing this concern. Method: The study explored the impact of a social humanoid robot (‘Pepper’) on individuals’ knowledge and attitudes towards influenza vaccination. Pepper provided information and posed questions on preventing influenza using a pre/post-test approach. Analysis used descriptive statistics to summarise data and McNemar’s test for paired pre/post-test data. Results: A total of 995 individuals participated, including 528 visitors, 207 patients, 100 staff and 30 students; 130 did not identify their role. Two-thirds were vaccinated against influenza; only 6% disagreed that vaccination was important (reduced to 3.9% post-test). The most common reason for not being vaccinated was ‘feeling fit and healthy’ (46%). There was a statistically significant (all p<0.05) increase in correct responses (pre/post): the best way to avoid influenza (45.3%, 90%), survival time of the virus outside the body (23.9%, 85.5%), and recommended time of hand washing (45.7%, 91.1%). Almost all participants (99.2%) enjoyed interacting with Pepper. Conclusions: The novelty of a social robot encouraged participation and likely contributed to the knowledge gains. More research is required to investigate if knowledge gain is sustained and if behaviour change results from interactions with the robot. The participants were generally positive towards influenza vaccination both before and after interacting with the robot. Further research into interactions between the robot and those with strong anti-vaccination views may be of value.

Three-dimensional printing as an imaging method to improve the inter- and intra-observer agreement of the Neer classification system for proximal humeral fractures. Hannah Bougher Bougher H1, Heal C1, Na HS2, Smith J2, Buttner P1, Forrestal D3, Banks J1. 1 James Cook University, Mackay, Queensland, Australia. 2 Mackay Base Hospital, Mackay, Queensland, Australia. 3 Queensland University of Technology, Brisbane, Queensland, Australia. Background: Inter- and intra-observer agreement for proximal humeral fracture (PHF) classification increases from radiographs (x-ray) to two-dimensional (2D) computed tomography (CT) to three-dimensional (3D) CT, although remains suboptimal. CT appears to increase agreement further when observers are less experienced. 3D models (models) increase inter-observer agreement for distal humeral and coronoid fracture characteristic identification. This study aimed to determine model’s impact on the inter and inter-observer agreement of the Neer classification system. The primary hypothesis was that models would improve inter-observer agreement over x-ray. Secondary hypotheses were that models would improve agreement: 1) over 2D and 3D CT and 2) further in less experienced surgeons. Method: Fourteen orthopaedic surgeons (seven registrars and seven consultants), classified thirty PHFs from a state-wide database. Observers examined x-rays, 2D CTs, 3D CTs and models separately, recording their classification on individual fixed response surveys. This was repeated three-eight weeks later. Kappa and percentage agreement quantified inter- and intra-observer agreement. Results: Models produced significantly higher inter-observer observer agreement than alternative imaging, with agreement increasing from x-ray to 2D CT to 3D CT to models. Models improve inter-observer agreement marginally more for registrars than for consultants. Intra-observer agreement increased from 3D CT to 2D CT to x-ray to models. Conclusions: The primary and secondary hypothesis were affirmed. Models should be used when available for PHF classification, particularly for surgically managed or complex fractures. Future studies should compare models to x-ray and CT and examine agreement by fracture complexity and observer experience.

The fetal renal parenchyma: Evaluation of a novel ultrasound measurement to assess kidney development Sonja Brennan Sonja Brennan1, David Watson2, Donna Rudd3, Michal Schneider4, Yogavijayan Kandasamy5,6 1Ultrasound Dept, Townsville Hospital, Townsville, Australia 2Obstetrics & Gynaecology, Townsville Hospital, Townsville, Australia 3College of Public Health, Medical & Veterinary Sciences, James Cook University (JCU), Townsville, Australia 4Medical Imaging & Radiation Sciences, Monash University, Melbourne, Australia 5Dept of Neonatology, Townsville Hospital, Townsville, Australia 6Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Newcastle, Australia Background: Abnormal fetal growth can adversely impact renal development and is associated with increased risks of hypertension and chronic kidney disease later in life. We hypothesise that the fetal renal parenchymal thickness could be used to evaluate kidney development and provide a non-invasive, indirect estimate of fetal nephron number. This study uses ultrasound to assess fetal renal parenchymal growth to determine if it is affected by abnormal fetal growth. Methods: A longitudinal, observational study was conducted at the Townsville Hospital between May 2017 to December 2018. Mixed risk women with an accurately dated, singleton pregnancy underwent a pregnancy ultrasound scan at least every four weeks between 16 and 40 weeks gestation. Renal parenchymal thickness, renal volume, fetal growth biometries, amniotic fluid, renal artery Doppler and other Dopplers indices were assessed in appropriately grown, growth restricted and large for gestational age fetuses. Results: 155 participants were recruited (7 were excluded due to fetal abnormalities). Mixed-effects modelling was used to create a reference graph for normal fetal renal parenchymal growth. In growth restricted fetuses the renal parenchymal thickness was found to be significantly reduced when compared to appropriately grown fetuses (at 32 weeks p= <0.001, d=0.58). Conclusions: Measurement of the renal parenchymal thickness is an innovative method to evaluate fetal kidney development. It may be useful for the diagnosis of renal parenchymal pathologies and identifying infants at risk of kidney disease. Fetal growth restriction adversely affects renal parenchymal growth. Evaluating the fetal renal parenchyma may lead to early diagnosis of abnormal renal development.

Prospective Randomized Placebo-controlled Double-blind Clinical study of Dexamethasone with Surgery for Chronic Subdural Haematoma: Interim analysis Kristy Mebberson Kristy Mebberson1, Piers Thomas1, 2, Paul Mitchell1, Kelvin Robertson3, Michael Colditz1, Laurence Marshman1, 2, Eric Gauzzo1, David Anderson1, Sarin Kuruvath1, 2 1 Department of Neurosurgery, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Townsville, QLD 4814, Australia 2School of Medicine and Dentistry, James Cook University, Douglas, Townsville 4810, Queensland, Australia 3Department of Pharmacy, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Townsville, QLD 4814, Australia. Background: Most chronic subdural haematomas (CSDH) are successfully treated with burr hole aspiration and continuous drainage for 48-72hrs. However, CSDH recurrences occur with a frequency 5-30%, potentially prolonging length of stay (LOS). The only adjuvant factor proven to decrease CSDH recurrences is post-operative drainage. One non-randomised study compared dexamethasone (DX) as an adjunct to surgery: whilst a null effect was observed, the ‘surgery-alone’ group consisted of only n=13. We aimed to assess the effect of DX on recurrences, LOS and modified Rankin Score (mRS) after CSDH surgery. Method: Participants were fully informed and consented. Concealed block randomisation was performed by a trial pharmacist. Participants were allocated in a 1:1 ratio to either placebo or a reducing DX regime over 2 weeks. Manufacturing and preparation of the medication was performed by an external Good Manufacturing Practice accredited facility. All patients underwent CSDH evacuation and received levetiracetam 500mg twice daily and ranitidine 150mg daily. LOS and morbidity were calculated using a Mann-Whitney test, recurrences with a Fisher’s exact test (Prism). Results: Interim analysis was performed at n=47. Recurrences were not observed with DX, but were with placebo (0/23 [0%] v 5/24 [20.83%], P=0.049). There was no significant between-group differences in LOS (11.3 v 18.9 days, P=0.58), mRS (2.1 v 2.4, P=0.37) or post-operative morbidity (8 v 5, P=0.29). Conclusions: This is the first registered placebo-controlled study to investigate the effects of DX on outcome after CSDH surgery. Interim analysis suggest that adjuvant DX management is safe and may significantly decrease recurrences.

Developing the multi-professional clinical academic workforce in Australia and New Zealand: a scoping review Alexandra Edelman Alexandra Edelman1,2, Robin Gauld3, Pavel Ovseiko4, Richard Murray1 1James Cook University, Townsville, Australia 2Townsville Hospital and Health Service, Townsville, Australia 3University of Otago, Dunedin, New Zealand 4University of Oxford, Oxford, United Kingdom Background: In Australia and New Zealand (ANZ), clinical academics are an important part of the workforce needed to deliver social and economic returns from health and medical research investment. This review aims to examine the extent and nature of the evidence addressing the development of the multi-professional clinical academic workforce in ANZ and to synthesise policy-relevant findings. Method: The review adopts a scoping review design. Searches were undertaken in Medline (Ovid), Scopus, and CINAHL, with reference lists and websites searched for additional literature. Papers eligible for inclusion were those published in English in 2000-2018 that reported results of empirical studies focussed on developing the research functions of the clinical workforce. Results were reported narratively using a labour market policy framework. Results: A total of 43 studies representing a diverse range of health professions and study designs were included; two represented the New Zealand context. Clinical academic workforce development was framed as a policy strategy to improve productivity and performance of the broader health workforce. Findings relevant to maldistribution suggest that production and retention policies should target populations and geographies where research-capable clinicians are most likely to be needed. Conclusions: The review findings offer evidence-based policy recommendations on how to invest in, and provide an enabling environment for, research engagement and skills development of interested or already research-active clinicians. Lessons from rural and primary health care research capacity building programs in Australia could help to inform policy aimed at New Zealand, Maori and Pacific Island health workforce development.

Can ieMR-compatible tablets improve the workflow for physiotherapy student clinical educators in a digital hospital? Damian Coe Coe, D.1

1Townsville Hospital and Health Service, Townsville, Australia

Background: The aim was to examine whether use of an ieMR-compatible tablet by physiotherapy clinical educator supervising multiple students within collaborative placement models increased the amount of face to face supervision delivered to students performing clinical care. Method: The study was completed as a multi-site clinical education quality activity. A frequency task log was developed to record the number of patient histories, objective examination, and interventions completed by students with the educator present. Supervision data were collected for placement blocks with and without the tablet at three facilities. A focus group exploring use of tablets within clinical education was also completed. Results: Use of a tablet did not meaningfully alter the total volume of face to face supervision provided by clinical educators to students on clinical placement. Infection control precautions, variable connectivity to hospital wi-fi, and desire to keep hands free to assist students with patient care were identified as barriers to using the tablet. The educators found the tablet useful for accessing the medical record, verifying student clinical handovers, and performing data entry into the online system for assessment of student placement performance. Conclusions: The educators supported use of a tablet within collaborative placement models from the perspective of having protected access to a portable workstation within clinical environments where there is competition with other professions for workstations. Future designs could utilise phenomenology observation alongside time measurement using wearable sensors to further understand the volume and types of interactions that are occurring between clinical educators and students on placement.

Long-term conditions in administrative staff: Expanding the health service picture Kathy Wright Wright, K1, Verney, K1, Brennan, D2, Smyth, W3,4, Lindsay, D4, Lindsay, D5

1Health, Safety and Wellness, Townsville Hospital and Health Service, Townsville, Australia 2Allied Health Governance, Townsville Hospital and Health Service, Townsville, Australia 3Townsville Institute of Health Research and Innovation, Townsville Hospital and Health Service, Townsville, Australia 4Centre for Nursing and Midwifery Research, James Cook University, Townsville, Australia 5College of Public Health, Medical and Veterinary Sciences Background: This study investigated the self-reported long-term conditions affecting the administration workforce of a regional Australian health service, and their self-management of these conditions. Comparisons are drawn with previous studies with the health service’s nurses, midwives, medical and allied health staff. Method: Using a cross-sectional survey design, a link to an electronic questionnaire was emailed to all administration staff employed in 2018 across the health service. Results: Half of the 328 respondents reported having at least one long-term condition. Of these, 136 (81.4%) nominated one main condition and described the management strategies used. Musculoskeletal conditions were the most commonly nominated category (59.6%), followed by mental health conditions (10.3%). Respondents with musculoskeletal conditions were statistically more likely to have a co-existing mental health long-term condition, X2(1) = 95.64, p<0.001. There was also a statistically significant association between respondents reporting a mental health condition and being overweight, X2(1) = 54.27, p< 0.05. There were no significant relationships between sedentary work practices and aspects of long-term conditions. Conclusions: This is the first study of self-reported long-term conditions among administration staff within an Australian health service. The type of self-reported long-term conditions and management strategies were essentially similar to the previous studies involving the health service’s nurses, midwives, medical and allied health, although administrative staff more readily disclosed their condition to their colleagues and their supervisors compared to the other health professionals. Taken together, the findings from these studies can be used to design targeted workplace intervention strategies to complement personal approaches.

Rhetoric and reality: experiences and drivers of Aboriginal and Torres Strait Islander Health Workers’ practice in far north Queensland. Stephanie Topp Stephanie M Topp1, Veronica Graham1, Rachel Cummins1, Josslyn Tully, 2 Sean Taylor,1,3

1 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia 2 Torres and Cape Hospital and Health Service, Cairns, Australia 3 Top End Health Service, Darwin, Australia Objectives: Australian federal and state-based health policy frequently places Aboriginal and Torres Strait Islander Health Workers (A&TSIHW) at the centre of efforts to ‘close the gap’ between Indigenous and non-Indigenous health outcomes. Yet little is known about whether governance arrangements for A&TSIHW actually support this vision. This study examined the governance arrangements that guide and influence A&TSIHW work practices in far north Queensland. Methods: Using a case-based qualitative design, we conducted interviews in the Cape York and Torres Strait regions with 50 state-employed A&TSIHW, 17 non-Indigenous health providers, 7 Indigenous community members. Data collection and analysis were guided by institutional governance theories that recognise both formal and informal relationships, rules and norms as drivers. Results: A&TSIHWs were viewed by most as critical to effective delivery of remote-area Indigenous health services. However, confusion exists regarding the nature and scope of A&TSIHWs’ role, which spans managerial, clinical, health promotion and cultural brokerage duties. A key contributor to the confusion is the current career structure, within which there is no A&TSIHW-specific employment stream, resulting in A&TSIHWs’ appointment under generic ‘operational’ or ‘administrative’ roles. Key relational contributors include the strong curative orientation of the broader health system, which deprioritises and implicitly devalues primary and preventive-focused activity that forms the basis of much A&TISHWs’ work. Within a risk-averse organisational environment, these factors disempower A&TSIHWs whose capabilities are under-utilised. Implications: Rule-based and relational factors are inhibiting A&TSIHWs’ contribution to Indigenous health outcomes. Improved role clarity and flexibility to accommodate A&TSHW strengths are urgently needed.

Exploratory sequential study of medical student preparedness to manage end-of-life care

Aran Sandasegaran James Cook University

Introduction: End of life care (EoLC) is essential to many branches of healthcare and yet EoLC education has been reported in the literature to be limited in medical schools. Aims: to explore the impact of the James Cook University (JCU) medical student curriculum on medical students’ preparedness for discussing EoLC with palliative patients. Methods: This study used a mixed method, exploratory sequential study design with year four, five and six medical students invited using purposive sampling to participate in semi-structured focus groups and then a survey. Focus group were recorded; transcribed and the data was analysed using NVivo 11 software. The data was coded and themes generated by consensus process to develop a 15 question survey consisting of single-answer, 5-point Likert scale and extended response questions. Survey analysis was carried out using IBM SPSS version 23 statistical software to perform frequency, bivariate and multivariate analysis relating to the EoLC curriculum, the JCU palliative care rotation and medical student preparedness for EoLC. Results: Three year-level focus groups were conducted with medical students. Three major themes emerged from the data: (1.) challenges of EoLC placement experiences (2.) medical student preparedness for EoLC and (3.) curriculum deficiencies. Focus group and survey analysis identified key student preferences and predictors of student preparedness for EoLC. Discussion: This study demonstrated the need for a cohesive curriculum of academic teaching integrated with practical interventions, such as workshops covering core competencies and followed by placement experiences including a comprehensive palliative care rotation.

The efficacy of an Octenidine decolonisation protocol in reducing Staphylococcus Aureus carriage in patients undergoing Total Joint Arthroplasty Tristan Symonds Dr Tristan Symonds, Andrea Grant, Hannah Brien, Dr Ben Parkinson Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Australia Background: Prosthetic joint infections are responsible for a high morbidity and economic cost in patients undergoing total joint arthroplasty. Staphylococcus aureus (S. Aureus) is a key modifiable risk factor in the reduction of surgical site infections (SSI). Evidence suggests that decolonization of S. aureus carriers reduces the risk of SSI. Octenidine is an antiseptic active against gram-positive and gram-negative bacteria. The aim of this study is to establish the eradication rate of S. aureus in patients undergoing total joint arthroplasty using an Octenidine wash protocol prior to surgery. Method: Patients undergoing total joint arthroplasty (TJA) at the Cairns Private Hospital during a five-month trial period had pre-operative nasal swabs to screen for S. Aureus pre and post Octenidine treatment. All patients underwent a body wash and nasal gel protocol for five days using Octenidine. The primary outcome was to determine decolonization rates in patients following the wash. Results: A total of 183 patients met inclusion criteria into this study. At the first swab 151 (82.5%) patients had normal regional flora and 32 (17.5%) were positive for S. Aureus. Of these 32 patients 30 (93.75%) were negative for MRSA and 2 (6.25%) had non-multiresistant MRSA. The decolonization rate for patients with S. Aureus was 76.6%. It was unsuccessful in clearing the two patients with nmMRSA. Conclusion: Octenidine is effective in reducing S. Aureus colonization in patients undergoing total joint arthroplasty. Further studies are required to compare it to mupirocin and determine its efficacy as an alternative for use in a decolonization protocol.

Program - Tuesday 29 October 2019

Time Topic Speaker

11:00 Lunch Starts Serving in Robert Douglas Auditorium Foyer – All Welcome

12:00 Keynote Speaker Prof James Elliott PT, PhD, FAPTA

13:00 Exploring the Microbiome of Preterm Infants at the Townsville Hospital Jacob Westaway

13:15 Attempts at piquing the interest of undergraduate nursing students in research: Four steps forward, three steps back Alan Ramsay

13:30 Cohort Study Examining the Association Between Blood Pressure and Cardiovascular Events in Patients with Peripheral Artery Disease

Diana Thomas Manapurathe

13:45 Enablers and Barriers to Diabetes Self-Management Mary Adu

14:00 Primary prevention Implantable Cardiac Defibrillators: A Townsville District Perspective Nathan Engstrom

14:15 BREAK

14:30 Long term use of low-dose aspirin does not reduce deaths contributed to by severe infection: results from the Aspirin to Inhibit SEPSIS (ANTISEPSIS) trial

Damon Eisen

14:45 Community acquired Acinetobacter pneumonia Stephanie Hendry

15:00 Using positive psychology interventions to improve outcomes after mild to moderate brain injury: the ORBIT-RCT Maria Hennessy

15:15 Systemic Inflammatory Response Differs in Indigenous and Non-Indigenous Patients After Cardiac Surgery in Australia And New Zealand

Siva Senthuran

15:30 Predictors of future research interest among allied health professionals at a regional tertiary hospital Tilley Pain

Abstracts – Tuesday 29th October Exploring the Microbiome of Preterm Infants at the Townsville Hospital Jacob Westaway Jacob Westaway1, Dr Roger Huerliman2, Dr Yoga Kandasamy3, Dr Tiffany Kosche4, Dr Robert Norton5, Dr David Watson6, Dr Donna Rudd7 1James Cook University, Cairns, Australia 2James Cook University, Townsville, Australia 3Townsville Hospital and Health Service, Townsville, Australia 4James Cook University, Townsville, Australia 5Pathology Queensland, Townsville, Australia 6Townsville Hospital and Health Service, Townsville, Australia 7James Cook University, Townsville, Australia

Background: The gut microbiome plays a critical role in the healthy development, immunity and metabolism of infants. Preterm birth disrupts this development and potentially leads to the development of acute and chronic disease. This project explored the microbiome of preterm infants admitted to the Neonatal Intensive Care Unit (NICU) before and after probiotic administration. Better understanding this dynamic microbiome could provide significant short- and long-term health benefits for these infants. Methods: Infants (<32 weeks and >32 weeks) were recruited from the THHS NICU or Special Care Nursery (SPCN) (Oct – Dec 2017) and a faecal sample collected on admission and just prior to discharge. 16S rRNA analysis was performed on the extracted DNA using the Illumina MiSeq system to understand variation of gut flora between infants and over time. Bioinformatics and statistical analysis were performed using R and Calypso. Results: 109 infants were recruited, and 164 samples collected. A significant (<0.05) increase in richness from admission to discharge in NICU infants was observed, with many differentially abundant taxa at all levels of taxonomy. The most significant being greater abundance of Staphylococcus (admission samples), and Bifidobacterium (discharge samples). Furthermore, and unexpectedly, significantly higher alpha diversity and Bifidobacterium was observed in NICU infants compared to SPCN infants. Conclusion: Preterm birth is often associated with a gut microbiome with low diversity and low relative abundance of Bifidobacterium and the presence of potential pathogens. This greater abundance of Bifidobacterium and alpha diversity could be due to the probiotic administration, used as a standard of care within the THHS NICU.

Attempts at piquing the interest of undergraduate nursing students in research: Four steps forwards, threes steps back. Alan Ramsay Alan Ramsay1, DR Kristin Wicking2, DR Karen Yates1, 1James Cook University, CAIRNS, Australia 2James Cook University, TOWNSVILLE, Australia Background: Nursing research teaching is seen as central to nurse education and practice, but the impact of exposure to research teaching on students’ attitudes towards research remains unclear. The aims of this study were to explore the attitudes towards research of undergraduate nursing students, before and after exposure to research teaching. A further aim of this study was to better understand students’ attitudes towards research, to inform future teaching strategies. Method: This descriptive quasi-experimental, longitudinal study used pre-semester and post-semester data collected by means of an online questionnaire. The Attitudes Towards Nursing Research Scale measured student attitudes via 18 Likert items that assessed four domains: Research Abilities, Usefulness of Research, Personal Interest in Research and Using Research in Clinical Practice. Results: There were no statistically significant changes in the overall Attitude Towards Research Scale. Individual item analysis did show statistically significant changes in two items: Understanding of research terminology increased (p = 0.001), but Intention to conduct research decreased (p =0.035), sample size 64. Conclusions: This study generated evidence on attitudes of nursing students toward research before and after their exposure to a research subject. Research teaching may be insufficient to effect a change in student nurses’ attitudes towards research.

Cohort Study Examining the Association Between Blood Pressure and Cardiovascular Events in Patients with Peripheral Artery Disease Diana Thomas Manapurathe Diana Thomas Manapurathe1, Joseph Vaughan Moxon1,2, Smriti Murali Krishna1,2, Sophie Rowbotham1,3,4, Frank Quigley5, Jason Jenkins4, Michael Bourke1,6, Bernard Bourke6, Rhondda E Jones7, Jonathan Golledge1,2,8. 1 Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. 2 The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia. 3 School of Medicine, University of Queensland, Brisbane, 4 Department of Vascular and Endovascular Surgery, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia. 5 Department of Vascular and Endovascular Surgery, Mater Hospital, Townsville, Australia. 6 Gosford Vascular Services, Gosford, NSW, Australia.

7 Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia. 8 The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia. Background: Hypertension is an important risk factor for cardiovascular events in patients with peripheral artery disease; however, optimal blood pressure targets for these patients are poorly defined. This study investigated the association between systolic blood pressure (SBP) and cardiovascular events in a prospectively recruited patient cohort with peripheral artery disease. Methods and Results: A total of 2773 patients were included and were grouped according to SBP at recruitment (≤120 mm Hg, n=604; 121–140 mm Hg, n=1065; and >140 mm Hg, n=1104). Adjusted Cox proportional hazards analyses suggested that patients with SBP ≤120 mm Hg were at greater risk of having a major cardiovascular event (myocardial infarction, stroke, or cardiovascular death) than patients with SBP of 121–140 mm Hg (adjusted hazard ratio, 1.36; 95% CI, 1.08–1.72; P=0.009). Patients with SBP >140 mm Hg had an adjusted hazard ratio of 1.23 (95% CI, 1.00–1.51; P=0.051) of major cardiovascular events compared with patients with SBP of 121–140 mm Hg. These findings were similar in sensitivity analyses only including patients receiving antihypertensive medications or focused on patients with a minimum of 3 months of follow-up. Conclusions: This cohort study suggests that patients with peripheral artery disease and SBP ≤120 mm Hg are at increased risk of major cardiovascular events. The findings suggest caution in intensive SBP lowering in this patient group.

Enablers and Barriers to Diabetes Self-Management Mary Adu Adu MD1*, Malabu UH2, Aduli AEO3, Aduli BMA4 1College of Medicine and Dentistry, James Cook University, Townsville, Australia 2College of Medicine and Dentistry, James Cook University, Townsville, Australia 3College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia 4College of Medicine and Dentistry, James Cook University, Townsville, Australia Background: Decision-making processes for diabetes self-management are influenced by factors which could either serve as enablers or barriers, thus impacting ability to engage in self-management. The study aimed to explore these factors as information gathered could provide health professionals with valuable insights to achieving better health outcomes with patients. Method: International online survey and telephone interviews were conducted on patients to inquire about enabling factors and barriers to diabetes self-management. Surveys were analysed using descriptive and inferential statistics. Interviews were analysed using inductive thematic analysis. Results: A total of 217 respondents with type 1 diabetes (38.25%) or type 2 diabetes (61.8%), from 4 continents (Australia, Europe, Asia and America) participated in the survey while 16 participants of these subset were interviewed. Major enablers of diabetes self-management include: the will to prevent the development of diabetes complications and the use of health technologies. Issues regarding: (i) limited skills for: managing stress and diabetes, exercise planning to avoid hypoglycemia and interpreting blood glucose pattern levels (ii) diabetes distress (iii) varying expectations of care and (iv) financial constraints limited patients’ effective self-management of diabetes. Conclusions: This study presents in-depth understanding of the experiences of diabetes patients and provides useful insights to health professionals on how to better support diabetes patients. Educational reinforcement could be employed as an intervention to alleviate identified gaps in management skills and provide motivational support to overcome diabetes distress. Furthermore, improved approaches that address varying expectations of care and financial burden are essential for enhancing diabetes self-management.

Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective Nathan Engstrom Nathan Engstrom1, Professor Geoffrey Dobson2, Dr Hayley Letson3, Dr Kevin Ng4 1The Townsville Hospital/ Cardiac Investigations & James Cook University (College of Medicine and Dentistry), Townsville, Australia 2James Cook University (College of Dentistry and Medicine), Townsville, Australia 3 James Cook University (College of Dentistry and Medicine), Townsville, Australia 4 Cairns and Hinterland Hospital/ Cardiac Electrophysiologist, Townsville, Australia Background: Implantable cardiac defibrillators (ICD) are lifesaving devices used to treat ventricular arrhythmias that cause sudden cardiac death. Patients may receive a primary prevention device for ischaemic (ICM) or non-ischaemic (NICM) cardiomyopathies with a left-ventricular ejection fraction (LVEF) ≤35%. LVEF alone may be insufficient for identifying appropriate patients. The aim of this study was to describe primary prevention patients, risk factors and ICD follow up, within the Townsville

Hospital District. Method: The retrospective cohort study included 82 patients implanted between 01/01/2008-31/12/2015. Data was collected from medical records and Cardiobase. Statistical analysis compared the total population and ICM and NICM groups. Analysis included Kaplan Meier survival with log rank test, Cox proportional hazard regression for predictors of mortality, and binary logistic regression for predictors of ventricular arrhythmias. Statistical significance was set at p<0.05 Results: The main risk factors were hypercholesterolemia (70.7%, p<0.05), hypertension (47.6%, p<0.05), and obesity (41.5%). Severe obstructive sleep apnoea was found exclusively in the NICM group (23.7%, p=0.001). Total mortality over the 4.8-yr follow up period was 30.5%. Twenty-eight percent of patients received ICD shocks, but only 16% were appropriate for ventricular arrhythmias. Patients receiving 2 incidences of inappropriate therapy were 18-times more likely to die (p=0.013). Three cardiac arrests were prevented by the ICD. Conclusions: LVEF is a poor predictor of ventricular arrhythmias in primary prevention patients. New selection criteria are needed to risk stratify these patients and should consider hypercholesterolemia, hypertension and obesity. Mortality risk also needs to be considered closely before ICD implantation

Long term use of low-dose aspirin does not reduce deaths contributed to by severe infection: results from the Aspirin To Inhibit SEPSIS (ANTISEPSIS) trial. Damon Eisen Damon Eisen 1, 2 Karin Leder2 Robyn Woods2 Jessica Lockery2 Sarah McGuiness2 Rory Wolfe2 David Pilcher2,3 Mark Nelson2 Chris Reid2 John McNeil2 Emma McBryde4 1 Townsville Hospital and Health Service 2 School Public Health and Preventive Medicine, Monash University 3 Alfred Hospital 4 Australian Institute of Tropical Health and Medicine, JCU Background. A simple, community-based preventive strategy would make a considerable contribution to reducing the burden of sepsis. Low-dose aspirin may be able to improve sepsis outcomes as suggested by experimental models and retrospective clinical data. Methods. ANTISEPSIS was performed as a sub-study of ASPREE, a randomised controlled trial of low-dose aspirin in healthy elderly participants conducted in Australia and the US. ANTISEPSIS studied the cohort of Australian participants. Teams of clinical specialist investigators, blinded to the intervention, assessed potential sepsis events to determine if they satisfied ANTISEPSIS’s primary endpoint of death contributed to by sepsis or secondary endpoint of hospitalisation contributed to by sepsis. Results. A total of 16,703 participants aged 70 years and over at trial entry were followed-up for a median of 4.7 years. Two hundred and three deaths and 413 hospitalisations not resulting in death were adjudicated as being contributed to by sepsis. These events were most commonly due to pneumonia and urinary tract infections. Overall, Escherichia coli was the commonest pathogen detected. Adjusted analysis showed no significant difference in deaths contributed to by sepsis between the study groups (hazards ratio 1.04, 95% confidence interval 0.79 – 1.37). No significant differences in hospitalisation (1.18; 0.95 – 1.47) and a composite of death and hospitalisation contributed to by sepsis (1.14; 0.95 – 1.35) were demonstrated. Conclusions. Low-dose aspirin treatment did not reduce deaths or hospitalisations contributed to by sepsis in community dwelling over 70-year-olds.

Community Acquired Acinetobacter Pneumonia: An Epidemiological Study from Northern Australia Stephanie Hendry Hendry S¹, Adegboye O², McBryde E², Davis J3, Elliott J4,5, Currie B3, Eisen D1,2 ¹Townsville Hospital, Queensland, ²Australia Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland 3Menzies School of Health Research, 4Cochrane Australia, 5Monash University Background: Community acquired Acinetobacter pneumonia (CAAP) is a fulminant cause of pneumonia within tropical Australia yet there is limited data to describe this entity. Established risk factors are indigenous background, hazardous alcohol use, smoking, chronic lung disease and diabetes. The 90-day mortality rate varies between 11- 60%. Method: A linked hospital administrative dataset including information on 5521 episodes of community acquired pneumonia was used to identify episodes of CAAP at Townsville Hospital during an eleven-year period to end 2016. Cases of CAAP required microbiologically confirmed Acinetobacter species isolated from blood and respiratory

specimens. Information on these cases were combined with CAAP data from Royal Darwin Hospital. CAAP cases were compared with age and sex matched pneumococcal pneumonia controls (1:2). Results: A total of 67 cases of CAAP were available for analysis (33 Townsville, 41 RDH) of which 56 had bacteremia. Previously described risk factors were present in all cases, including 47% patients identified as indigenous. 38% of cases required ICU care and the 30-day mortality was 15%. Independent predictors for ICU were indigenous status and excessive alcohol use. Other comorbidities and the presence of bacteremia were not. Overall, CAAP was the only independent risk factor to predict ICU admission (OR 13) and more likely to result in death (OR 17) compared to pneumococcal pneumonia. Conclusion: CAAP is a more lethal disease when compared to the most common cause of pneumonia, pneumococcal pneumonia. It is over represented within the indigenous population who are more likely to have severe disease.

Using positive psychology interventions to improve outcomes after mild to moderate brain injury: the ORBIT-RCT Maria Hennessy Maria Hennessy Townsville Hospital and Health Service

Background: Traumatic brain injury (TBI) survivors are often at risk of developing mental health problems such as anxiety and depression. This study examined the efficacy of a positive psychology gratitude intervention (What Went Well – WWW) in improving mental health after TBI. Method: Individuals with mild to moderate TBI were consecutively recruited from Emergency Department admissions at The Townsville Hospital. 43 participants were randomly assigned into one of three treatment arms: treatment as usual (TAU), bibliotherapy, and gratitude intervention. They were assessed at three time points: Baseline, Time 1 (2 weeks), Time 2 (3 months). Participants completed the following measures: Mini-International Neuropsychiatric Interview, Rivermead Post-Concussion symptoms Questionnaire (RPQ), Quality of Life After Brain Injury scale, Depression Anxiety Stress Scale, Gratitude Questionnaire, and the Optimism, Life Satisfaction and Positive Emotions subscales from the Comprehensive Inventory of Thriving (CIT). Results: A 2x3 split-plot analysis of variance (SPANOVA) with time (baseline and Time 1) and treatment group revealed significant Time x Group interactions for two measures: the RPQ3 (𝐹𝐹2,21= 4.411, p = .025, 𝜂𝜂𝑃𝑃2= 0.296), and the CIT Optimism scale (𝐹𝐹2,21= 3.750, p = .031, 𝜂𝜂𝑃𝑃2= 0.263). Post-hoc analyses revealed superior efficacy of the bibliotherapy and WWW interventions for reducing post-concussive symptoms, as well as WWW for increasing optimism. Conclusions: Integrating brief, low-cost interventions such as bibliotherapy or positive psychology interventions may be beneficial in the acute management of mild to moderate TBI. Future research should consider the timing of interventions, along with focussed efforts to reduce attrition rates.

Systemic Inflammatory Response Differs in Indigenous and Non-Indigenous Patients After Cardiac Surgery In Australia And New Zealand. Siva Senthuran Siva Senthuran Townsville Hospital and Health Service

Introduction: Indigenous populations in Australia and New Zealand have been reported to have higher markers of inflammation and worse outcomes after cardiac surgery than the non-indigenous. Aims: We aimed to determine if indigenous status was independently associated with the systemic inflammatory response syndrome (SIRS) after admission to the intensive care unit (ICU) following cardiac surgery in Australia and New Zealand and its relationship with clinical outcomes. Methods: Patients listed in the Australian and New Zealand Intensive Care Society Adult Patient Database over 16 years of age, who underwent coronary artery bypass and/or valvular surgery from January 2010 to December 2016, were analysed. Primary outcome was the development of SIRS within the first 24 hours of ICU admission. Univariable and multivariable analyses were undertaken to determine if indigenous status was an independent risk factor for SIRS in the first 24 hours after ICU admission. Secondary outcomes included ICU and hospital mortality, lengths of stay and readmission to ICU. Results: Indigenous patients accounted for 4,336/84,469 (5.1%) of those studied. They were younger, and more commonly had chronic renal failure, diabetes and obesity and had higher ICU mortality. Indigenous patients had a

higher prevalence of post-operative SIRS (55.1% vs 47.8%, P<0.001). The association between indigenous status and SIRS persisted after adjusting for confounders (OR 1.11 [95% CI 1.03-1.19], P=0.007). Conclusion: Indigenous status was associated with increased risk of SIRS in ICU after cardiac surgery. This study suggests race and associated factors may affect patients’ inflammatory response to cardiac surgery.

Predictors of future research interest among allied health professionals at a regional tertiary hospital Tilley Pain Tilley Pain1, 2, Malindu Fernando1,2,3, Daniel Lindsay2 1Townsville Hospital and Health Service, Townsville, Qld 2James Cook University, Townsville, Qld 3Queensland University of Technology, Brisbane, Qld Background: Allied health professionals (AHPs) are core service providers in acute health care. AHP’s career trajectory may be via graduate education in clinical, management or research higher degrees. However, little is known of AHP graduate education and future research aspirations. This study calculates predictors of future research activity of AHPs at a regional Australian hospital. Method: A cross sectional electronic survey was sent to all AHPs working for the Townsville Hospital Health Service (THHS). The survey collected information about past, current and future education and research motivating factors. Data was analysed using SPSS (Version 24 IBM Corp, USA) Univariate binomial logistic regression analyses were then performed with future research interest as the outcome variable. Results: Most AHPs (56%) indicated they were interested in research in the future. The significant predictors of an increased likelihood of future research interest in our study cohort were prior Masters or PhD qualification (OR:4; 95%CI: 1.1-15.6), attending research education (OR: 2.9; 95%CI:1.3-6.6) , having a research topic (OR:4.9; 95%CI:1.9-13.9) and prior qualitative research experience (OR:2.4; 95%CI:1.1-5.5). Conclusions: The predictive factors for future research activity imply a desire to conduct research. AHPs in clinical roles within HHSs have the potential to derive research questions from ground level clinical practice. Therefore, universities, HHSs and policy makers could exploit these predictive factors and strengthen their focus on supporting AHP’s research education at the level of developing research questions. Research education aimed at developing a research question from a clinical problem is likely to substantially increase AHP research activity.

Program - Wednesday 30 October 2019 Time Topic Speaker

11:00 Lunch Starts Serving in Robert Douglas Auditorium Foyer – All Welcome

12:00 Keynote Speaker Prof Sue Kildea & A/Prof Yvette Roe

13:00 ATSIHLAC and Research Dallas Leon

13:30 Thiamine levels post cardiopulmonary bypass Adam Holyoak

13:45

A North Queensland PICU's perspective on optimal serum Vancomycin trough levels in critically ill children with complex infections: Are we reaching recommended therapeutic serum Vancomycin plasma concentration targets

Celeste Barrington

14:00 Vitamin D deficiency in multiple myeloma patients in tropical Australia

Vibooshini Ganeshalingam

14:15 BREAK

14:30 Crikey! Is crocodile meat fair dinkum? Fish cross-allergy - from sharks and barras to crocs and chicken Thimo Ruethers

14:45 Neonatal nurses' perceptions of using live streaming video cameras to view infants in a regional NICU

Michelle Evans & Michelle Baxter

15:00 Why are doctors not referring their Aboriginal and Torres Strait Islander patients to a pain clinic Matthew Bryant

15:15 Epidemiological analysis of association between lagged meteorological variables and pneumonia in wet-dry tropical North Australia, 2006 to 2016

Oyelola Adegboye

15:30 Organization development for malaria elimination Peter Case

15:45 BREAK

16:00 Panel Discussion: Research in Partnership with First Nations Peoples

Abstracts – Wednesday 30th October 2019 Thiamine levels post cardiopulmonary bypass Adam Holyoak Odelli AL1, Holyoak AL2, Yadav S2, Page SM2 1John Hunter Hospital, New Lambton Heights, Australia 2The Townsville Hospital, Douglas, Australia Background: Significantly higher morbidity and mortality is associated with the occurrence of post-operative hyperlactataemia following cardiopulmonary bypass (CPB). Thiamine is an important cofactor in aerobic metabolism and low levels can result in increased lactate production. Although thiamine kinetics in patients undergoing cardiac surgery is complex and poorly understood, supplementation may result in decreased lactate production. We sought to examine the effect of CPB on blood thiamine levels, and whether there was any relationship with post-operative blood lactate levels. Method: Single centre, prospective, analytic observational study of patients over 18 undergoing elective cardiac surgery requiring CPB. Preadmission and immediate post-operative thiamine levels were taken, along with 4 hourly post-operative blood lactate measurements. Primary outcome measure was a comparison of pre- and post-CPB thiamine levels, and secondary outcome measure was to examine any correlation between post-operative thiamine and lactate levels. Results: 82 patients were recruited, with 78 being included for analysis. Mean sample age was 61 (30-84, SD=11.55), with the majority being female (69%) and undergoing coronary artery bypass procedures. Post-operative lactate levels (mean=1.77nmol/g Hb, SD=0.53) were significantly higher than pre-operative (mean=1.36nmol/g Hb, SD=0.31) (p<0.001). There was no statistically significant association found between post-operative thiamine and lactate levels. Conclusions: Unexpectedly, blood thiamine levels were found to rise immediately following CPB. This may be explained by an artificial elevation in levels due to decreased metabolic demand occurring as the result of therapeutic hypothermia instituted while undergoing CPB, or due to other mechanisms associated with CPB resulting in altered pyruvate dehydrogenase activity.

A North Queensland PICU's perspective on optimal serum Vancomycin trough levels in critically ill children with complex infections: Are we reaching recommended therapeutic serum Vancomycin plasma concentration targets Celeste Barrington Celeste Barrington MD, BN, Registered Nurse PICU1 , Joshua Nicholls BMedSci, MBBS Paediatric Trainee1 Dr Arjun Chavan MBBS, DCh, FCPS, MD, CCT (Paeds/PICU), UK, FCICM PG Dip. Technology & Education in Simulation, London Staff Specialist in Paediatric Intensive Care & Donate Life (Paediatrics)1

1The Townsville Hospital, Townsville, Australia Background: Prevention of subtherapeutic resistance to Vancomycin is a national and global priority. Current guidelines recommend therapeutic serum Vancomycin plasma concentration (SPVC) levels of 15-20mg/ml in serious infection. Paediatric studies are limited and existing dose models are extrapolated from adult regimens and the implications of higher SPVCs in children is largely unknown. This quality initiative evaluated use of Vancomycin in critically ill children to determine the effectiveness of reaching SPVCs in the initial 48 hours of treatment. Methods: A single center retrospective chart review of children aged 1 month to 16 years admitted to the Pediatric Intensive Care Unit (PICU) and prescribed vancomycin therapy for ≥ 24 hours over 2 years. Results: The median serum Vancomycin plasma concentration (SVPC) fell below the therapeutic target of 15-20mg/ml for all dosing regimens currently implemented.Laboratory confirmed Methicillin Resistant Staphylococcus Aureus (MRSA) cases was 28%(17/60) with 70.58%(12/17) of these children being of Aboriginal or Torres Strait Islander (ATSI) ethnicity. 8.33%(5/60) had no levels at all and 54.54%(30/55) never reached therapeutic target ranges. 20%(11/55) reached therapeutic targets in <48 hours and 23.6%(13/55) reached therapeutic targets in >48 hours. Conclusion: Therapeutic target SPVCs in initial 48 hours of treatment were only reached in 20% of cases and >50% never achieved target SPVCs of 15-20mg/ml. Further prospective investigation is warranted to examine if Area under curve (AUC) and minimum inhibitory concentration (MIC) are better markers of efficacy and if pharmacokinetic (PK) dosing models can more safely predict and monitor Vancomycin dosing

in critically unwell children.

Vitamin D deficiency in Multiple Myeloma patients in Tropical Australia Vibooshini Ganeshalingam Vibooshini Ganeshalingam1, Karthik Nath2, Barbara Ewart2, Elizabeth Heyer2, Kerrianne Watt1, Andrew Birchley2, John Casey2, Hock Choong Lai2, Edward Morris2, Georgina Hodges2 1James Cook University, College of Medicine and Dentistry, Townsville, Australia 2Townsville Hospital, Department of Haematology and Bone Marrow Transplantation, Townsville, Australia Background: The role of vitamin D in the pathogenesis, prevalence and prognosis of multiple myeloma remains poorly investigated. It therefore remains infrequently assessed in the routine workup of myeloma patients. We characterised the prevalence of vitamin D deficiency in patients with myeloma in North Queensland. We then expanded upon this and tested for the impact of vitamin D status on clinical outcomes. Given the paucity of vitamin D studies in myeloma, these findings may have practice changing implications and aid in designing future clinical trials. Method: This was a cross-sectional study performed at The Townsville Hospital. Patients on active therapy for myeloma underwent testing of serum 25-hydroxyvitamin D (25(OH)D). Information on disease stage, skeletal morbidity, peripheral neuropathy, sunlight exposure, sunscreen use and vitamin D supplementation were collected from medical records and patient questionnaires. Results: A total of 41 patients were included (median age 69 years; 66% male). With a median disease duration of 38 months, 27% were vitamin D deficient. Patients with vitamin D deficiency had higher rates of peripheral neuropathy compared to their non-vitamin D counterparts (73% vs. 33%, P = 0.03). Although those with vitamin D deficiency had more skeletal morbidity, this was not statistically significant (73% vs 50%, P = 0.19). Reduced 25(OH)D was associated with a poor performance status (P = 0.003). Conclusions: We have shown a relatively high prevalence of vitamin D deficiency in myeloma patients in the sunshine heavy region of North Queensland. Furthermore, we demonstrate an association between vitamin D deficiency and peripheral neuropathy. Prospective interventional studies are required to determine the impact of vitamin D repletion.

Crikey! Is crocodile meat fair dinkum? Fish cross-allergy - from sharks and barras to crocs and chicken Thimo Ruethers Thimo Ruethers1,2,3,4, Aya C. Taki1,2,3,4, Roni Nugraha1,3,4,5, Trúc T. Cao1, Thu T. K. Le1,3,4, Shaymaviswanathan Karnaneedi1,2,3,4, Sandip D. Kamath1,2,3,4, Elecia B. Johnston1,3,4, Martina Koeberl6, Tanja Kalic7, Nicholas A. Williamson8, Shuai Nie8, Michael Leeming8, Sam Mehr2,9,10, Dianne E. Campbell2,9,11, Andreas L. Lopata1,2,3,4 1Molecular Allergy Research Laboratory, James Cook University, Townsville, Australia 2Centre for Food and Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia 3Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia 4Centre for Sustainable Tropical Fisheries and Aquaculture, James Cook University, Townsville, Australia 5Department of Aquatic Product Technology, Bogor Agricultural University, Bogor, Indonesia 6Technical Development and Innovation Group, National Measurement Institute, Melbourne, Australia 7Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria 8Bio21 Mass Spectrometry and Proteomics Facility, The Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne; 9Children’s Hospital at Westmead, Allergy & Immunology, Westmead, Australia 10Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Australia 11Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia Background: Seafood, including fish and shellfish, is the most common trigger of fatal anaphylaxis to foods in the world’s allergy capital, Australia. Diagnosis and management of life-long fish allergy are hampered by knowledge gaps. We sought to improve current practice by evaluating diagnostic methods and characterise the allergenicity of edible vertebrates. Method: The world’s largest cohort of paediatric fish-allergic patients was recruited (n=80). Patients’ in vivo reactivity to seven fish species and crocodile was evaluated by skin prick testing (SPT). SPT preparations (n=26), as well as raw and heated protein extracts from 66 fish and 10 other vertebrates, were evaluated for their comprehensive allergen repertoire and patients’ serum IgE reactivity by immunoblotting and advanced mass spectrometric analyses. Results: The allergen amount in SPT preparations varied greatly and in some, the major

allergens were absent. Eight novel fish allergens were identified, registered with the World Health Organisation, and now complement the previously reported 5. The allergenicity of fish and other vertebrates was species- and patient-specific. Most cartilaginous fish seem to be hypoallergenic. However, over half of the patients were sensitised to crocodile meat, making it a dangerous alternative to fish. Conclusions: Generally, the highest allergenicity was observed for bony fish, followed by amphibians, reptiles, cartilaginous fish, birds, and higher vertebrates. This previously undiscovered cross-reactivity between bony fish and other vertebrates can be explained by molecular evolutionary ancestry. Currently, we are developing component-resolved in vitro tests for a wide variety of species. This will allow safe, reliable management and liberate patients’ diet.

Neonatal nurses’ perceptions of using live streaming video cameras to view infants in a regional NICU Michelle Evans & Michelle Baxter Evans ML1, Baxter M 1, Kandasamy Y1, Kilcullen M2, Vandervalk S2, Kanagasingam Y3, Vignarajan J3 1The Townsville Hospital, Townsville, Australia 2James Cook University, Townsville, Australia 3CSIRO/Australian E Health Research , Floreat , WA

Background: Family Centred Care (FCC) is the delivery of health care based on partnerships between patients, families and health care professionals involved in the care of the infant and family. FCC is considered the gold standard for providing neonatal care. Hospital services have introduced live streaming video cameras into the Neonatal units with the aim of reducing distress and enhancing bonding and attachment between infants and parents during hospitalisation. However, there is a paucity of research exploring the impact of using live streaming video cameras in the neonatal context. The aim of this study was to understand staff perceptions of using a live streaming video camera in a neonatal context. Method: All Neonatal intensive care unit (NICU) nursing staff (n=43) were invited to complete two surveys about their perceptions of using cameras in the NICU – prior to installation of cameras in the NICU (T1) and six months after installation (T2). 15 (35%) nurses completed the first survey (T1) and 18 (42%) nurses completed the follow-up survey (T2). Discussion: The current study identified staff perceptions of using cameras in the NICU. While staff reported benefits for parents, concerns regarding increased workload and difficulties in using the technology were reported. For this technology to be implemented confidently by nurses as standard care, it will be important to address these concerns. Conclusion: Working in collaboration with nurses who have experience with the cameras in clinical practice is key to finding effective solutions for implementing live web streaming cameras into standard care.

Why are doctors not referring their Aboriginal and Torres Strait Islander patients to a pain clinic? Matthew Bryant Dr Matthew Bryant FANZCA, FFPMANZCA, FRACGP, FACRRM, Grad Dip Rural GP, MBBS Director, North Queensland Persistent Pain Management Service, The Townsville Hospital Aim: To identify the barriers to referral to the Pain Management Clinic, as perceived by doctors with a significant Aboriginal and Torres Strait Islander patient case load. Background: Chronic pain is a very common and disabling condition. Australian Aboriginal people have worse health outcomes compared with other Australians, and we are failing to Close the Gap. Research at the intersection of Aboriginal Health and pain management in Australia is sparse, with varying research methodologies, levels of research rigour and cultural safety, study populations and clinical settings. Findings are heterogeneous and at times conflicting. Cultural and communication barriers impede patient assessment and management. The prevalence of chronic pain is high. The degree to which pain contributes to disability is at opposites in different studies, with more recent studies suggesting chronic pain is profoundly disabling for Aboriginal people. Methods: Following extensive stakeholder engagement, a study protocol was submitted for ethics and governance approval. A semi-structured interview guide was developed. Doctors with a majority Aboriginal and Torres Strait Islander case load were enrolled via purposive sampling from across North Queensland. Interviews were transcribed verbatim and coded into themes by constant comparative analysis using NVivo software. Results: Most doctors utilised a biomedical approach to pain management. Allied health pain management was limited by cost and availability. Access to pain management medical education at undergraduate and postgraduate levels was poor. Tertiary service related barriers were common. Of note, doctors in the Torres Strait report that Torres Strait Islander patients do not seek assistance from health staff for chronic pain.

Conclusion: There is very little published research considering Australian Aboriginal people and pain management and none involving Torres Strait Islanders. No Australian Faculty of Pain Medicine fellow has published research on this topic. Gaps in the literature are significant in number and scope. This study adds information regarding the barriers as perceived by referring doctors. Further research is needed to guide acute and chronic pain management for Aboriginal and Torres Strait Islander peoples.

Epidemiological analysis of association between lagged meteorological variables and pneumonia in wet-dry tropical North Australia, 2006 to 2016 Oyelola Adegboye Oyelola A. Adegboye, PhD1*, Emma S. McBryde, PhD 1, Damon P. Eisen, MD 1, 2 1Australian Institute of Tropical Health and Medicine, James Cook University, Discovery Drive Douglas, QLD, Australia 4814 2Townsville Hospital and Health Service, Angus Smith Drive, Douglas, QLD, Australia 4814 Background: Pneumonia accounts for 1.5% of all overnight hospital admission in Australia. This study is based on a large cohort of inpatients that were hospitalized due to pneumonia between 2006 and 2016. Cases were identified using the ICD10-AM codes J10.0* - J18.0*. Method: We investigated the nonlinear and delay effect of weather (temperature and rainfall) on pneumonia. A time-varying distributed lag nonlinear model was used to estimate the burden of the disease attributable to varying weather-lag-pneumonia relationships and identify vulnerable groups. Results: The relative risk (logRR) associated with temperature was immediate and highest in late winter at the lowest temperature of 16oC (logRR=1.13, 95% CI: 0.59, 1.66). The cumulative effect over the lag range zero to eight weeks revealed two peaks for low (12 mm, logRR=0.73, 95% CI: 0.32, 1.13) and moderately high rainfall (51 mm) with logRR of 1.15 (95% CI: 0.10, 2.20). A substantial number, 22.50% (95% empirical CI: 1.83, 34.68), of pneumonia cases were attributable to temperature (mostly due to moderate low temperatures). Females and Indigenous (Aboriginal and Torres Strait Islander) patients were particularly vulnerable to the impact of temperature-related pneumonia. Conclusions: We highlighted the delayed effects and magnitude of burden of pneumonia that is associated with low temperature and rainfall. Between 2012 and 2013, 8.2% of the total hospital admissions in Australia were potentially preventable hospitalizations. The findings in this study can inform a better understanding of the health implications and burden associated with pneumonia to support discussion-making in healthcare and establish a strategy for prevention and control of the disease among vulnerable groups.

Organization Development for Malaria Elimination Peter Case Peter Case1, 2 1College of Business, Law & Governance; James Cook University, Townsville, Australia 2Bristol Business School; University of the West of England, Bristol Background: Research conducted by the author in malaria zones has had a significant impact on healthcare service delivery. Backed by the Bill and Melinda Gates Foundation-funded Malaria Elimination Initiative, the work has introduced a new approach to tackling malaria in Vietnam, Zimbabwe, Eswatini and Namibia. Implementing his Organization Development for Malaria Elimination tool has led to quantitative improvements in malaria health care indicators and also resulted in many qualitative benefits. Method: Participatory Action Research (PAR) and reproduction of ‘system-in-the-room’ methods are used to identify, analyse, and resolve context-specific operational challenges in resource-poor environments. Through a series of workshops held across a given malaria season, healthcare professionals and community members are able to meet to communicate the challenges they face when tackling malaria. This approach has been trialled in Vietnam, Zimbabwe and Eswatini (2014-18) and has led to development of a process intervention tool, Organization Development for Malaria Elimination (ODME), that involves collective identification of challenges, priorities and work programs. Work is on-going in Zimbabwe and Namibia (2018-2020), in collaboration with UCSF’s MEI and supported by the BMGF. Conclusions: The author has introduced an ODME training program for senior clinical staff and administrators in Zimbabwe, some of whom have been commissioned to assist with intervention delivery in other parts of Africa and regions of the world. The author is in discussion with WHO on means by which the approach can be systematically up-scaled.

POSTERS Topic Author

Analysis of Linked Hospital Administrative Data Shows High A Long-Term Mortality Rate of An Inpatient Cohort in Far North Queensland Damon Eisen

Reducing discharges against medical advice: A deadly nursing initiative Norma Lane

The pulling power of Pepper: An exploratory study of a social humanoid robot in an acute health setting Wendy Smyth

Systematic review of stability data pertaining to antibiotics used for extended infusions in Outpatient Parenteral Antimicrobial Therapy (OPAT) in warmer climates.

Stephen Perks

ThermieVA-Does it work? Kav Pather

Parents' perceptions of using live streaming video cameras to view infants in a regional NICU

Michelle Evans & Michelle Baxter

Maternity service organisational interventions that aim to reduce caesarean section: A systematic review and meta-analyses Cate Nagle

Technology: Improving women's experience in birthing? Sari Holland

Fibrinogen replacement in trauma patients: Effect on anticoagulant proteins antithrombin, protein C and protein S. Allie Ross

Successfully tacking access to care issues: delivery of an online persistent pain self-management program in a tertiary hospital setting

Alison Beeden & Shereen Gilmore

Choice of spirometry reference equations has a significant impact on lung function testing outcomes for adults from Papua New Guinea Suzy Munns

Behind the stats - what do students and clinical educators do? Mark Gooding

Mathematical model of tuberculosis transmission in Bangladesh Md Abdul Kuddus

Prescribing the perfect prescription; Pharmacist-led education for final year medical students Sophie Mokrzecki

Relationship between handgrip strength and lung function in health and unhealth adults: a systematic review Nnamdi Mgbemena

Smoking and Biomass Fuel but not Betel Nut use increase the probability of obstructive airway conditions in adults from National Capital District, PNG Suzy Munns

Experiences of an Occupational Therapy Led Paediatric Burns Telehealth Clinic: family and clinician’s experiences Lauren Matheson

Utility of Positron Emission Tomography Imaging in the Diagnosis of Chronic Q fever- A Review of the Literature Pirathaban Sivabalan

Topic Author Serum IgE reactivity to commonly consumed seafood products among seafood allergic subjects in North Queensland, Australia. Thu Le

One step closer to reducing ovary-reactions to menstruation! Parinda Shah

Identifying the complete allergen repertoire of prawns for better management of prawn allergy, the most common food allergy among adults

Shayma V. Kamaneedi

Administration of immune checkpoint inhibitors at rural towns using the teleoncology model of care - Evaluation of safety at a regional cancer centre

Sebastian Kang Wen Zhi

Acute Q fever and the full blood count: A North Queensland review Adam Walsh

Can datalinkage help identify standards of care and outcomes of emergency laparotomy at The Townsville Hospital? - A pilot study Louise Rafter

Occupational Therapists' involvement in reducing restraint and seclusion in adult acute mental health inpatient units: an Australian survey

Luciana Theodoro de Freitas

Building a bridge from the swamp to the ivory tower Clare Heal

Exercise interventions following total hip arthroplasty and their effects on self-reported physical function and pain: A systematic review Wilson Tang

The Effects of Functional Electrical Stimulation (FES) Cycling on Muscle Spasticity in Individuals with Spinal Cord Injury: A Systematic Review Stephanie Couper

Dogs as medicine: Shedding light on the use of psychiatric assistance dogs Janice K. F. Lloyd

Incidence and Outcomes of Inpatient Hypoglycemia at the Townsville Hospital: A Retrospective Chart Audit Oliver Hayes

Success! Facilitating renal patients in the tropics with central venous lines to maintain the integrity of their dressings while attending to personal hygiene Kim Quayle

Antibiotic stewardship in skin infections: a cross-sectional analysis of GP registrar’s management of impetigo Hilary Gorges

Detection of tympanic membrane retraction conditions using non-invasive technique: Wideband tympanometry Venkatesh Aithal

Topical antibiotics for wounds healing by primary intention Clare Heal

Risk Factors, Morbidity and Mortality Associated with Airway Foreign Body Inhalation (AFBI) in Children: A Queensland Experience Lua Saylany

Experience with Definity Use in Townsville Hospital Sonali Basu

Effect of Housing Conditions and Route of Administration in Inducing Peanut Allergy in Mice Kunal Pratap

A comparison of lower-limb major amputation rates and outcomes for Indigenous and non-Indigenous people in North Queensland Australia during 2000-2015.

Tejas P. Singh

Poster Abstracts Analysis of Linked Hospital Administrative Data Shows High A Long-Term Mortality Rate of An Inpatient Cohort in Far North Queensland. Damon Eisen Eisen DP 1,2, Harings M 1 McBryde ES 3 Vasanthankumar L 1 Adegboye O 3 1 The Townsville Hospital 2 James Cook University 3 Australian Institute of Tropical Health and Medicine Background: Linked hospital administrative data can be used to describe associations that predict disease outcomes including long-term mortality. Methods: A retrospective cohort study of Townsville Hospital inpatients discharged with an ICD10-AM code for an infectious disease between 1/1/2006 and 31/12/2016 was undertaken. This utilised linked anonymised data from; the Queensland Admitted Patient Data Collection, Emergency Department Information Services, Pathology Queensland, pharmacy dispensing data, notifiable conditions and the National Death Registry. The most common infectious diseases diagnoses and selected conditions of interest are described. Age/sex-adjusted mortality was compared with the Queensland population and predictors of death were measured. Results: The database has linked information on; 41,367 patients with 378,487 admissions and 1,869,239 diagnostic/procedure codes. Nearly 15% of the cohort identify as Aboriginal or Torres Strait Islanders. Invasive staphylococcal, pneumococcal and Group A streptococcal infections and influenza were common in this cohort. The commonest comorbidities were; smoking (43.95%), chronic renal disease (17.93%), diabetes (16.71%), cancer (13.59%) chronic and pulmonary disease (12.42%). Mortality over the eleven-year period was 20%. Compared with the Queensland population the age and sex adjusted mortality ratio for this cohort was 5.26 greater. Aboriginal and Torres Strait Islander people had a 16.6% greater risk of dying than non-indigenous patients. Conclusions: This database reutilising administrative information describes a cohort from a single tropical Australian hospital of in-patients with infectious diseases. A high eleven-year mortality rate is described in this population that is associated with indigenous status and numerous comorbidities.

Reducing discharges against medical advice: A deadly nursing initiative Norma Lane Lane, N1, Smyth, W2,3, Nagle, C2,3

1 Professional Nursing and Midwifery Services, Townsville Hospital and Health Service, Townsville, Queensland, Australia 2 Townsville Institute of Health Research and Innovation, Townsville Hospital and Health Service, Townsville, Queensland, Australia 3 Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia Background: Discharge against medical advice (DAMA) is an indicator for monitoring progress toward the Closing the Gap policy. Aboriginal and/or Torres Strait Islanders are 3.5 times more likely to DAMA than non-Indigenous patients. Innovation: In 2017, a model of care was established which included a dedicated Clinical Nurse Consultant (CNC) – Indigenous Health position, whose responsibilities include:

Connecting with Indigenous patients identified as being at risk of DAMA; Providing leadership and mentorship to nurses and midwives, particularly in relation to understanding cultural needs in relation to the patient’s journey through the healthcare system; Engaging with Indigenous Liaison Officers and community stakeholders. Results:

This model has achieved a decreasing average in DAMA from 3.5% prior to its inception to an average of 1.6% for January 2018 – March 2019 period. An essential component of the model is the CNC’s face-to-face interaction with patients, family and health professionals. The underpinning philosophy of the model is “person first, business second”. For Indigenous peoples it is important to establish an understanding of family and of country to build trust and credibility, and to listen to the person’s story and the real issues that are prompting the person to DAMA. Conclusions: Many Indigenous patients have complex concerns, and the CNC’s skills and knowledge are invaluable to preventing DAMA. Sustained Indigenous nursing leadership is needed to continue success with DAMA. It is essential to maintain efforts and allocate resources to work with Indigenous patients towards the ultimate goal for care always being culturally safe, so that everyone feels comfortable in hospital.

The pulling power of Pepper: An exploratory study of a social humanoid robot in an acute health setting Wendy Smyth Smyth, W1,2, McIntosh, C3, Elvin, A3, Nagle, C1,2, Birks, M2 1 Townsville Institute of Health Research and Innovation, Townsville Hospital and Health Service, Townsville, Queensland, Australia 2 Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia 3 Short Stay Unit, Townsville Hospital, Townsville, Queensland, Australia

Background: Technology needs to enhance the roles of healthcare providers while meeting patients’ needs. This study was the first to be conducted in an Australian hospital setting studying a robot as an information provider. Methods: Using an exploratory descriptive design, the acceptability and usability of a robot in the clinical setting was evaluated. Interactions of patients, visitors and healthcare staff with the robot were observed over a one-month period and participants were invited to complete a questionnaire. The social humanoid robot called “Pepper” was programmed to provide basic information about the hospital, patients’ rights and health. Results: Eighty-six patients, 78 visitors, and 350 staff were observed. Non-verbal behaviours were overwhelmingly positive; the most frequent observation was ‘smiling’. Gender and other human-like attributes were sometimes assigned to the robot. Negative comments about the robot included “freaks me out”, “creepy”, “too weird for me”. However, positive comments such as “awesome”, “unreal”, “amazing” were more frequent. All responses to the Social Attributes Scale component of the questionnaire completed by 96 participants were positive. No-one associated ‘dangerous’ or ‘aggressive’ with robot technology. ‘Interactive’, ‘happy’, ‘responsive’ and ‘knowledgeable’ were all associated with a robot. Conclusions: This study found that a social humanoid robot in a concierge role was well received in a busy acute hospital unit, eliciting positive emotions while providing hospital and health information that was perceived as accessible and reliable. Survey results reinforced the potential roles that such robots could play in similar settings, including improved efficiency and support for hospital staff.

Systematic review of stability data pertaining to antibiotics used for extended infusions in Outpatient Parenteral Antimicrobial Therapy (OPAT) in warmer climates. Stephen Perks Perks SJ1,2, Lanskey C1, Robinson N1, Pain TG1,2, Franklin R TG2 1The Townsville Hospital, Townsville, Australia 2ICollege of Public Health Medical and Veterinary Sciences – James Cook University, Townsville, Australia Aim: To determine if there is sufficient stability data to confirm appropriate prescribing of antibiotics commonly used in OPAT in warmer climate. Method: Four databases were systematically searched using the terms ‘beta-lactams’, or ‘antibiotics’, or ‘anti-bacterial agents’ and ‘drug stability’ or drug storage’ for studies specific to drug stability published between 1966 and Feb 2018. The search strategy initially identified 2879 potential articles. After title and abstract review, the full-texts of 137 potential articles were assessed, with 46 articles matching the inclusion and exclusion criteria included in this review. Results: A large volume of stability data is available for the selected drugs. Stability data at temperatures higher than 25oC was available for several of the medications, however few drugs demonstrated stability in warmer climates of 34oC or higher. Sequential data profiling the drug for an extended period in solution under refrigeration prior to the runout period at the higher temperature is also lacking. Conclusions: There is insufficient stability data of antibiotic use in warmer climates. Studies to verify the stability and appropriate use of many antibiotics used in OPAT at standard room temperature and in warmer climates are urgently required. Several drugs in current use in the OPAT setting are lacking stability data. This study was limited by including only peer reviewed articles. There may be further grey literature supporting the stability of some of the drugs mentioned. Further research in this field is needed to develop structured evidence-based guidelines.

Assessing efficacy of transcutaneous temperature-controlled radiofrequency therapy in improving symptoms of vaginal laxity, sexual satisfaction, vaginal dryness and urinary incontinence. Kav Pather Kav Pather MBBS, BBiomedSc, BPubHealth (Paramedic), Grad Cert (Critical Care) Ajay Rane1, Jay Iyer2, Sapna Dilgir3, Thomas Currie4 1 Dept of Obstetrics and Gynaecology, James Cook University; Director of Urogynaecology, The Townsville Hospital, Australia 2 James Cook University; Consultant Obstetrician & Gynaecologist, Pelvic Floor Surgeon, The Townsville Hospital, Australia 3 James Cook University; Consultant Obstetrician & Gynaecologist, The Townsville Hospital, Australia 4 James Cook University, Townsville, Australia

Background: Transcutaneous radiofrequency devices have enjoyed increasing popularity among the cosmetic industry. Recently their application has been extended for vaginal use, where it is proposed that the “tightening” and “rejuvenation” functions of the device may be applicable to vaginal mucosa and labial tissues. Use of this device is becoming increasingly prevalent despite minimal research in this area. The aim of this article is to assess the efficacy of a transcutaneous, monopolar, radiofrequency device in improving vaginal laxity, sexual satisfaction, climax ability, vaginal moisture, urinary stress incontinence, stream control and urinary urge incontinence. Methods: a prospective cohort of 100 women aged between 52 and 68 years of age were identified as having symptoms outlined. Each candidate was offered a course of transvaginal, monopolar, radiofrequency therapy consisting of three treatments spaced at four-week intervals. A pre-treatment Likert questionnaire was completed prior to each of the three treatments, and four-weeks post-third treatment. Digital photographs were taken throughout to correlate patient evaluation with visible improvement. Results: Improvements in patient satisfaction were reported for symptoms of vaginal laxity (25.5% improvement), sexual satisfaction (22.2%), climax ability (52.5%), vaginal moisture (63.9%), urinary stress incontinence (11.1%) and urge urinary incontinence (16.7%). The study suggests transvaginal radiofrequency therapy may worsen stream control (14.8% worse). Digital photography shows improvement of labial tissues in respect to tissue atrophy. Conclusion: Consistent efficacy of transvaginal radiofrequency therapy has been demonstrated. Stream control may be worsened by use of the device. Further studies are warranted to assess the placebo effect.

Parent’s perceptions of using live streaming video cameras to view infants in a regional NICU Michelle Evans and Michelle Baxter Evans ML1, Baxter M1, Kandasamy Y1, Kilcullen M2, Vandervalk S2, Kanagasingam Y3, Vignarajan J3 1The Townsville Hospital, Townsville, Australia 2James Cook University, Townsville, Australia 3CSIRO/Australian E Health Research, Floreat , WA Background: Family Centred Care (FCC) is the delivery of health care based on partnerships between patients, families and health care professionals involved in the care of the infant and family. Hospital services have introduced live streaming video cameras into the Neonatal units with the aim of reducing distress and enhancing bonding and attachment between infants and parents during hospitalisation. However, there is a paucity of research exploring the impact of using live streaming video cameras in the neonatal context. The aim of this study was to understand parent’s perceptions of using a live streaming video camera in a neonatal context. Method: Families of a very low birth weight baby (VLBW, birth weight < 1500g) admitted to the Neonatal Intensive Care Unit (NICU) were eligible to participate in the study. Parents of neonates with a terminal diagnosis, or under the care of the Department of Child Safety were excluded from the study. Parents were invited to complete attachment, bonding and mood scales at admission (T1) 1 (T2) and 2 (T3) weeks and three months after enrolment (T4). Results: Overwhelmingly, parents reported positive experiences and a reduction in stress and anxiety when using the webcam in the NICU. In contrast, using the webcams increased anxiety when there was poor connectivity and when cameras were not replaced on the cots if removed. Conclusion: Overwhelmingly, parents reported positive experiences when using the webcam in the NICU. Family-centred care could be enhanced with the development of a guideline before implementing live streaming cameras into the NICU.

Organisational interventions to reduce caesarean section: A systematic review and meta-analyses Cate Nagle Chapman A1, 2, Nagle C3, 4, Bick D5, Lindberg R6, Kent B7, Calache J1, 2, Hutchinson AM1, 2 1School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia 2Monash Health, Clayton, VIC, Australia 3Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia 4Townsville Hospital and Health Service, Townsville, Queensland, Australia 5Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK 6Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia 7Faculty of Health and Human Sciences, University of Plymouth, Plymouth, Devon, UK Background: With the continued increase in caesarean section globally, it is timely to conduct a systematic review of organisational interventions specifically designed to decrease caesarean section rates. An organisational intervention “…involves a change in the structure or delivery of health care … a change in who delivers health care, how care is organised, or where care is delivered…” Cochrane EPOC group. Method: This review was conducted in line with the PRISMA statement and was prospectively registered with PROSPERO. Cochrane CENTRAL, CINAHL, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS databases were searched from 1/1/1980 to 31/12/2017. The search was restricted to peer reviewed journal articles. Fifteen studies met the selection criteria. Results: Compared with women allocated to usual care, women allocated to midwife-led models of care implemented across pregnancy, labour and birth, and the postnatal period were, on average, less likely to experience CS (overall) (average RR 0.83, 95% CI 0.73 to 0.96), planned CS (average RR 0.75, 95% CI 0.61 to 0.93), and episiotomy (average RR 0.84, 95% CI 0.74 to 0.95). Audit and feedback, and a hospital policy of mandatory second opinion for CS, were identified as interventions that have potential to reduce CS rates. Conclusions: The adoption of midwife-led models of care within healthcare organisations, particularly for women classified as low-risk, is recommended. Additional studies that utilise either audit and feedback, or a hospital policy of mandatory second opinion for CS, are required to facilitate the measurement of intervention effects within future reviews.

Technology: Improving women’s experience in Birthing? Sari Holland Holland, S1, Taylor, R2, Hadland, M3, Smyth, W4,5, Nagle, C4,5 1 Birth Suite, Townsville Hospital, Townsville, Australia 2 Midwifery Services, Townsville Hospital, Townsville, Australia 3 Midwifery Group Practice, Townsville, Australia 4 Townsville Institute of Health Research and Innovation, Townsville Hospital and Health Service, Townsville, Australia 5 Centre for Nursing and Midwifery Research, James Cook University, Townsville, Australia

Background: The environment a woman labours in has an impact on her birth experience, birth outcomes and breastfeeding success. Labouring in a safe, supportive homelike environment and using non-pharmacological strategies can be effective. The Immersive Sensory Experience (ISE) is a ceiling-mounted projector that the woman uses during labour to create an environment that suits her individual needs, by selecting images, videos and/or music. The ISE will be installed and evaluated in one of the birth suites. Method: A three-phase study consisting of a quasi-experimental study and two qualitative exploratory studies will be employed to evaluate outcomes. Women will be recruited from the Midwifery Group Practice (MGP) all-risk model of care during the antenatal period. When in labour, participating women will choose a picture or video (along with musical preferences) which will be projected onto the birth suite wall. The women’s birth outcomes will be compared to women who laboured and birthed in a traditional birth suite (where the ISE was not installed). Postnatally, 24 women participants will be interviewed by telephone to explore their experiences of the ISE. The MGP midwives will also be interviewed to explore their experiences of the ISE. Results: Recruitment is anticipated to commence in August 2019. This presentation will discuss the evidence underpinning ISE, demonstrate ISE and include initial data analysis. Conclusions: ISE is a proof of concept study exploring how the use of technology to create a calming birth environment effects birth outcomes and maternal satisfaction.

Fibrinogen replacement in trauma patients: Effect on anticoagulant proteins antithrombin, protein C and protein S Ailie Ross Ailie Ross1 and Donna Rudd2 1 Pathology Queensland ,2 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville Background: Fibrinogen replacement in severe trauma has been shown to improve patient outcomes. Hypofibrinogenaemia is a side effect of severe trauma and fibrinogen replacement has become an important target for treatment. Increasingly, major haemorrhage protocols replace fresh frozen plasma and cryoprecipitate with fibrinogen concentrate, largely due to convenience and speed. Method: This study investigated the plasma levels of anticoagulant proteins following trauma in patients randomly assigned to receive either fibrinogen concentrate or cryoprecipitate. Antithrombin, protein C and protein S levels were assessed prior to fibrinogen replacement, on admission to and 6, 12, 24 and 72 hours post admission. Levels of anticoagulant proteins were low at presentation for all patients who met the clinical requirements for fibrinogen replacement. Results: Following treatment, the cryoprecipitate group demonstrated rapid recovery, with plasma levels of anticoagulant proteins returning to the normal range by 24 hours. Significant differences were seen in Protein S concentrations between the treatment groups at 12 hours post ICU admission. Conclusions: This may suggest that fibrinogen replacement products have different effects on anticoagulant protein levels post trauma. Disruptions to this balance may cause consequences for recovering patients. As fibrinogen concentrate use increases, anticoagulant protein function and risk of thromboembolic events in the longer term needs to be considered. Thromboembolic events occurred in 27% of patients, demonstrating that post treatment complications are common in this cohort. The implications of this are unclear, there may be a role for combined fibrinogen replacement therapy in major haemorrhage protocols, these results suggest more research is required.

Successfully tackling access to care issues: delivery of an online persistent pain self-management program in a tertiary hospital setting Alison Beeden Alison Beeden1, Dr Blake Dear2, Shereen Gilmore1, 1The Townsville Hospital and Health Service, Townsville, Australia 2Macquarie University, Sydney, Australia Background: Persistent pain affects 1 in 5 Australians; however, access to care has been difficult for many to obtain. As a result, research into internet-based pain management programs has proliferated, with results comparable to those of traditional face-to-face programs. It is unknown whether tertiary pain management services can employ these programs. The purpose of this research is to examine the effectiveness of The Online Pain Course in patients of the North Queensland Persistent Pain Management Service (NQPPMS). The results will inform us about how much these patients will benefit from this course and how best to administer it. Method: A single-group uncontrolled design with 1 group (treatment) is currently employed in a regional pain management setting. Participants are recruited from accepted patient referrals and includes people 18y+. A battery of psychometrics are administered to assess outcomes at treatment end and 3month follow-up; and mixed linear models analysis is employed. Results: This trial is ongoing; preliminary results for 79 participants indicate a significant improvement in depression and anxiety, as well as small to medium improvements in disability and self-efficacy, with results sustained at 3months follow-up. Qualitative feedback indicates high acceptability and satisfaction with the treatment. Conclusions: The initial results suggest that The Online Pain Course is acceptable and efficacious for a clinical sample of people living with persistent pain, effectively addresses barriers to access for some, and is cost effective for the health service. Further analysis will determine for whom it is most effective, and whether rural and remote patients are utilising this treatment.

Choice of spirometry reference equations has a significant impact on lung function testing outcomes for adults from Papua New Guinea Suzy Munns Munns SL1, Taufa S2 1College Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia 2School of Medicine, University of Papua New Guinea, Port Moresby, Papua New Guinea Background: Spirometry, an important component of lung function testing, assists in disease diagnosis and severity classification. Measured lung function is compared to that predicted from reference equations. Reference equations are ideally developed from a large sample of healthy, lifetime non-smokers from the relevant population. There are no spirometry reference equations validated for use in PNG. The aim of this study was to investigate which available spirometry reference equations are best matched to non-smoking adults from PNG and thus should be used in clinical lung function testing. Method: Spirometry was completed with 218 healthy, non-smoking adults from Port Moresby, PNG. Measured results were compared to those predicted by the NHANES III ethnicity corrected Caucasian reference equation and to all 5 ethnic equations of GLI 2012. Model best fit was determined by the z scores for FEV1, FVC and FER, with best fit defined as mean=0, SD=1. The impact of model choice on lung function classification and severity rating was determined by Cohen’s kappa and Krippendorff’s alpha scores respectively. Results: The currently used NHANES III ethnicity corrected Caucasian reference equation was not well matched to PNG adult sample. The best match was GLI 2012 “Black”, rather than the recommended GLI “Other”. Altering reference equations had significant impacts on both lung disease classification and severity, particularly related to vital capacity measurements. Conclusions: PNG population based reference equations need to be developed for accurate lung disease classification via spirometry. We recommend the use of GLI “Black” reference equations until these can be developed.

Behind the stats – what do students and clinical educators do? Mark Gooding Gooding, M1, Shardlow, K2, Stoikov, S2,3, 1Townsville Hospital and Health Service, Townsville, Australia 2Metro South Hospital and Health Service, Brisbane, Australia 3Australian Catholic University, Brisbane, Australia Background: Education of health professional students within clinical settings is essential in developing competent, effective and safe clinicians. Clinical educators (CEs) have dual roles while supervising students: 1) delivering health services; 2) concurrent student supervision and support. The team gained an understanding of these roles by analysing how CEs and students spend their time during student placements. Method: Data collection tools were developed to identify daily clinical and non-clinical activities. The tools were completed by 53 physiotherapy CEs and 165 physiotherapy students in five Queensland Hospitals. Data were collected over four, five-week placement blocks in four areas of clinical practice. Results: Students spent 51% of placement time providing clinical care and 49% of time in non-clinical activities - self-directed learning (18%); feedback (7%); tutorials (7%); work-shadowing (4%). Analysis revealed a decrease over the placement in non-clinical activities with a concomitant increase in clinical care. CEs spent 75% of placement time educating students, with the remainder in clinical care (15%), clinical services management (9%) and training staff (1%). Of the time spent educating students: 80% was supervising students clinical care; 8% formal feedback; 12% other education activities. Conclusions: Physiotherapy students and CEs spent significant amounts of time engaged in activities that support service delivery and best practice clinical learning. This presentation will explore the breakdown of these activities, including how time commitments changed throughout the duration of placement. Implications for practice including staff resourcing, structuring of allied health student placements and student contribution to health service delivery will also be discussed.

Mathematical model of tuberculosis transmission in Bangladesh Md Abdul Kuddus Md Abdul Kuddus1, 2, 3* 1Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 2College of Medicine and Dentistry, James Cook University, Townsville, QLD 3Department of Mathematics, University of Rajshahi, Rajshahi-6205, Bangladesh Background: Tuberculosis (TB) is an airborne, potentially fatal, infectious disease that causes millions of deaths worldwide each year. Alarmingly, several strains of the causative agent, Mycobacterium tuberculosis (MTB)– including drug-susceptible (DS) and drug-resistant variants – already circulate throughout most developing and developed countries, particularly in Bangladesh, with extensively and totally drug-resistant strains starting to emerge. Method: In this study we develop a two-strain TB model including DS and multi-drug resistant (MDR) strains and performed a rigorous analytical analysis of the system properties and solutions. Results: Results show that resistance to drugs increase with increase in drug use, that is, active tuberculosis treatment results in a reduction of drug sensitive and increase in MDR TB because of amplification. Both analytic results and numerical simulations suggest that if the both basic reproduction numbers max[R0s, R0m] < 1, the disease free equilibrium is asymptotically stable, which means that the disease naturally dies out. Furthermore, if R0m > max [R0s, 1], then DS TB dies out but MDR TB persist in the population and if R0s > max [R0m, 1] the both DS TB and MDR TB persist in the population. Conclusions: This study will help National TB control program in Bangladesh to mitigate DS TB and MDR TB.

Prescribing the Perfect Prescription; Pharmacist-led education for final year medical students Sophie Mokrzecki Sophie Mokrzecki1, 2, Dr Tilley Pain1, 2, Mr Stephen Perks 1, 2 1James Cook University, College of Public Health, Medical & Vet Sciences 2The Townsville Hospital, Townsville, Australia Background: Prescribing is an unavoidable task for all doctors. If performed poorly this can lead to patient harm and increase cost to the health sector. We propose pharmacists are well placed to provide education to final year medical students. Aim: Assess if a pharmacist-led education session on prescription writing for final year medical students improves the quality and safety of prescribing skills. Method: Participants and intervention: Randomised controlled trial using pre- and post-test assessment on final year medical students. Students were randomised into two groups - tutorial group (TG) and non-tutorial group (NTG). TG received an education session by a clinical pharmacist and pharmacy educator using case-based learning. NTG received no additional education. Following the pre-test, students completed a three-week tertiary hospital placement on the medical wards. Students completed the post-test after the placement. Student assessment: Schedule 4 (S4, prescription only), Schedule 8 (S8, controlled drug), S4 streamline (S4SL), and Mixed case (S4 and S8) prescriptions were assessed. Results: There were no significant differences at baseline for the groups scores or proportion of passes. Statistical analysis demonstrated the TG significantly improved their overall score from pre- to post-test (p=0.012) whereas the NTG overall score significantly decreased (p=0.004). The number of cases passed overall was significantly more in the TG than NTG (p<0.001). Conclusions: Education by a clinical pharmacist improved the prescribing skills of final year medical students in this study. Students learning from peers on placement as their primary form of education decreased prescribing skills. We propose pharmacist education on prescription writing should become a fixed component of university curriculums.

Relationship between handgrip strength and lung function in healthy and unhealthy adults: a systematic review. Nnamdi Mgbemena Mgbemena NC1, Jones A1, Leicht AS1. 1College of Healthcare Sciences, James Cook University, Townsville, Australia. Background: Handgrip strength (HGS) is a functional test that has been directly associated with lung function in healthy populations, however, inconsistent findings have been reported for unhealthy populations. The aim of this review was to identify the relationship between HGS and lung function in both healthy and unhealthy adults. Results would support the applicability of HGS as a simple tool for lung function assessment by practitioners, especially in rural/remote Australia, where spirometry resources and training may be lacking. Method: A systematic review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Six databases were searched and studies were included based on multiple selection criteria. Reported values of HGS and lung function (forced expiratory volume in one second, forced vital capacity and peak expiratory flow rate), as well as the strength of their relationship were retrieved. Results: Twenty-five studies met the inclusion criteria with 10 and 15 studies including healthy and unhealthy populations, respectively. Despite heterogeneous equipment and protocols utilised during HGS and lung function assessments, significant positive relationships were reported for healthy populations. In contrast, the observed relationships between HGS and lung function for unhealthy populations was contradictory and inconclusive. Conclusions: An easy-to-use and inexpensive tool like HGS could be a simple indicator of poor lung function in healthy adults with its pertinent use in unhealthy populations to be substantiated. Future longitudinal studies using valid, reliable equipment, with well-defined assessment protocols, will confirm the relationship between HGS and lung function for unhealthy adults.

Choice of spirometry reference equations has a significant impact on lung function testing outcomes for adults from Papua New Guinea Suzy Munns Munns SL1, Taufa S2 1College Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia 2School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea Background: Spirometry, an important component of lung function testing, assists in disease diagnosis and severity classification. Measured lung function is compared to that predicted from reference equations. Reference equations are ideally developed from a large sample of healthy, lifetime non-smokers from the relevant population. There are no spirometry reference equations validated for use in PNG. The aim of this study was to investigate which available spirometry reference equations are best matched to non-smoking adults from PNG and thus should be used in clinical lung function testing. Method: Spirometry was completed with 218 healthy, non-smoking adults from Port Moresby, PNG. Measured results were compared to those predicted by the NHANES III ethnicity corrected Caucasian reference equation and to all 5 ethnic equations of GLI 2012. Model best fit was determined by the z scores for FEV1, FVC and FER, with best fit defined as mean=0, SD=1. The impact of model choice on lung function classification and severity rating was determined by Cohen’s kappa and Krippendorff’s alpha scores respectively. Results: The currently used NHANES III ethnicity corrected Caucasian reference equation was not well matched to PNG adult sample. The best match was GLI 2012 “Black”, rather than the recommended GLI “Other”. Altering reference equations had significant impacts on both lung disease classification and severity, particularly related to vital capacity measurements. Conclusions: PNG population based reference equations need to be developed for accurate lung disease classification via spirometry. We recommend the use of GLI “Black” reference equations until these can be developed.

Experiences of an Occupational Therapy Led Paediatric Burns Telehealth Clinic: family and clinician’s experiences. Lauren Matheson Debra Phillips1, Lauren Matheson1, Dr Tilley Pain1,2, Dr Gail Kingston1,2 1The Townsville Hospital, Townsville, Australia 2James Cook University, Townsville, Australia

Background: Post burn injury, rural and remote children are geographically disadvantaged compared to metropolitan children in Australia. Specialist services to rehabilitate children following burn injury are located in metropolitan tertiary referral hospitals. The Townsville Hospital established the Occupational Therapy Led Paediatric Burns Telehealth Clinic (OTPBTC) to reduce rural disadvantage. It is an expanded scope model for the occupational therapist who substitutes for the Paediatric Surgeon to monitor children undergoing active burn rehabilitation. Aim: The aim of this research is to explore the experiences had by families and clinicians utilizing the OTPBTC. Method: This interpretive phenomenological qualitative study explored family’s and clinician’s experiences with OTPBTC. (HREC/17/QTHS/221). Results: Four major themes were derived through thematic analysis: continuity of care; family centred care; technology; and building rural capacity. Families value accessing health care services close to home to reduce time off work and school and minimise disruption to day to day life. Families and clinicians highlighted their confidence in the occupational therapist’s ability to manage the child’s rehabilitation and act as the sole point of contact. Rural clinicians benefitted from specialist advice and gained knowledge for their own skill development. Conclusions: This research demonstrates the value families place on receiving care close to home and the role telehealth and expanded scope allied health positions play in supporting this. Success of this local study suggests this model of care can be implemented in other health services across Australia and in other clinical areas.

Utility of Positron Emission Tomography Imaging in the Diagnosis of Chronic Q fever- A Review of the Literature Pirathaban Sivabalan Sivabalan P1,3, Visvalingam R2, Norton R1, 3 1Townsville Hospital, Townsville, Australia 2Logan Hospital, Brisbane, Australia 3James Cook University, Townsville, Australia

Purpose: Diagnosing chronic Q fever is a challenging clinical problem as it is difficult to culture the pathogen. Diagnosis therefore usually relies on serology and/or the detection of DNA from blood or tissue samples. Positron emission tomography/computed tomography (PET/CT) is an imaging technique that identifies tissues with increased metabolism and can identify a focus of infection. Our aim was to review the literature on the use of PET/CT to assist in the diagnosis of chronic Q fever. Methods and Materials: A literature search was conducted in PubMed and Google Scholar to ascertain publications on the radiological diagnosis of chronic Q fever. We used the terms “Positron Emission Tomography” and “PET CT” in combination with subheadings “chronic Q fever” or “Coxiella burnetii”. 231 articles were initially attained. After exclusion criteria, 28 articles were included. Results: Majority of literature found were case studies. Of the 20 case reports, nine were cases where the focus of infection was in a vascular prosthesis, four were cases of native vascular infection and three were cases of osteoarticular infection. The remaining four case reports used PET/CT to screen for infection but no focus was found. Four retrospective studies looked at patients who had a PET/CT in proven chronic Q fever, which revealed that PET/CT was of assistance in 50-80% of cases. Conclusion: PET/CT is a clinically useful tool in the diagnosis of chronic Q fever. Literature suggests its most valuable implementation is in detecting both native and prosthetic vascular infections

Serum IgE reactivity to commonly consumed seafood products among seafood allergic subjects in North Queensland, Australia Thu Le Thu Le1,2,3, Aya C. Taki1,2,3, Anthony Leicht4, Kenji Doma4, Darlene Wallace5, Sandip D. Kamath1,2,3, Elecia Johnston1,2,3, Dianne E. Campbell6,7,8 and Andreas L. Lopata1,2,3 1Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia 2Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia 3Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia 4Sport and Exercise Science, James Cook University, Townsville, Queensland, Australia 5School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia 6Centre for Food and Allergy Research, Murdoch Children’s Research Institute, Parkville, Australia 7Department of Allergy and Immunology, The Children’s Hospital at Westmead, Westmead, Australia 8Discipline of Paediatrics and Child Health, University of Sydney, Westmead, Australia Background: Seafood allergy is often lifelong and potentially life-threatening. Despite its high prevalence, there is limited information about the accountability of allergens to allergic reactions in Australia. This study investigated IgE antibody reactivity against 15 shellfish and 13 fish species to identify putative allergenic sources to develop better diagnostics. Method: Forty seafood allergic subjects and 28 healthy controls were recruited in the Townsville and Cairns region. The clinical history of allergic reactions was recorded, and sera collected for IgE screening by immunoblotting. The IgE recognition between extracts and allergens was compared using the Friedman test. Results: The majority of subjects presented with clinical food allergy: acute onset and oral allergy syndrome and/or skin problems. Only two subjects (5%) reacted to all fish and shellfish. Shellfish allergic group (28/40) showed stronger IgE binding to mite than to shellfish (p < .0001). This group also demonstrated higher IgE reactivity to prawn heated extract and the allergen hemocyanin than tropomyosin (p < .0001). 57% of shellfish allergic subject reacted to fish parvalbumin whilst all fish allergic subjects (4/4) had sIgE to prawn and crab tropomyosin. Of all participants, tropomyosin from Anisakis and parvalbumin from basa fish showed the strongest IgE reactivity. Conclusions: Mite exposure seems to be the primary sensitizer for shellfish allergy in this cohort. Cross-reactivity was observed among subjects with shellfish allergy reacting to fish allergens and vice versa. Tropomyosin is the major allergen responsible for cross-reactivity, but contributions of other allergens are possible and needs to be further investigated.

One step closer to reducing ovary-reactions to menstruation! Parinda Shah Shah P1, Rane A1, Dilgir S1, Woolley T1 1James Cook University, Townsville, Australia Background: Several studies have highlighted that to prevent misconceptions regarding menstruation and reduce social stigma, it is important that we promote education on this subject.1-5 Currently, there is minimal literature assessing medical students’ knowledge, attitudes and practices regarding menstruation. A baseline study, such as this one, can help identify gaps in the medical curriculum and from student feedback, strategies to create a better menstrual education program which provides a holistic understanding of this topic can be suggested.3 Research Question: Knowledge, attitudes and practices (KAP) regarding menstruation of final year medical students and the strategies used to teach this topic at James Cook University (JCU). Method: A mixed quantitative and pseudo-qualitative approach was utilised in a convergent parallel fashion. An online survey consisting of open and closed-ended questions was distributed to all Year 6 students enrolled in the JCU MBBS program in 2019. The quantitative data was manually coded into dummy variables and analysed using SPSS release 23 for Windows. The qualitative data was analysed using priori content analysis. Results: Sample size: 185 students

• 113 (Female), 72 (Male) • 125 (18-24yo), 58 (25-34yo), 2 (35-44yo).

Results: • University was a major source of knowledge for male students. • 81.5% agreed that studying medicine improved their understanding of menstruation. • 36.9% stated the JCU MBBS program could be improved

Conclusions: The content taught in medical school increased student understanding of menstruation and allowed students to feel more comfortable discussing this topic. However, there is a need for more education on the cultural differences regarding menstruation during medical school.

Identifying the complete allergen repertoire of prawns for better management of prawn allergy, the most common food allergy among adults Shayma V Karnaneedi Shayma V. Karnaneedi1-6, Roni Nugraha1,3,6,8, Elecia B. Johnston1,3,4,6, Sandip D. Kamath1-4,6, Thimo Ruethers1-4,6, Aya C. Taki1-4,6, Roger S. Huerlimann5,6, Nick Wade5,7, Dean Jerry5,6, Andreas L. Lopata1-4,6 1Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia 2Centre for Food and Allergy Research, Murdoch Children’s Research Institute, Melbourne, Australia 3Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia 4Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia 5ARC Research Hub for Advanced Prawn Breeding, James Cook University, Townsville, Queensland, Australia 6Centre for Sustainable Tropical Fisheries and Aquaculture, James Cook University, Townsville, Queensland, Australia 7Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Australia 8Department of Aquatic Product Technology, Bogor Agricultural University, Bogor, Indonesia Background: Shellfish allergy affects over 2% of the world’s population, mostly persists for life and is the highest cause of food-related anaphylactic deaths in Australia. The diagnosis of shellfish allergy, in particular prawn allergy, is however often challenging due to similar allergens in inhalant sources including dust mites. Despite the clinical importance, the complete allergen range of prawns remains unclear. This project aims to identify the whole repertoire of prawn allergens by utilising bioinformatics tools and advanced transcriptomic analyses. Method: The transcriptomes of five prawn species (whiteleg, black tiger, king, endeavour, and banana prawn) were assembled de novo and were subsequently quality verified. The transcriptomes were analysed for all known and unreported prawn allergens by amino acid sequence alignment with 2,172 different allergens. Further homology analyses were conducted and their relative abundance determined. Results: All seven known prawn allergens were identified but importantly, the transcriptomic analyses revealed up to 40 yet unreported allergens in different prawn species. This includes heat-shock protein, alpha-tubulin, chymotrypsin, cyclophilin, beta-enolase, aldolase-A, and glyceraldehyde-3-phosphate-dehydrogenase. These prawn allergens are very similar to well-known allergen sources, including dust mites and cockroaches. Conclusion: The identification of previously unreported allergens in prawns enables their molecular characterisation and the evaluation of their clinical allergenicity and relevance. This study revealed the immunological reason underpinning the frequently reported cross-sensitisation to dust mite in shellfish-allergic individuals. This first transcriptomic analyses of allergens in a major food source provides the fundamental knowledge required to develop specific diagnostics for optimal management of patients.

Administration of immune checkpoint inhibitors at rural towns using the teleoncology model of care - Evaluation of safety at a regional cancer centre. Sebastian Kang Sebastian Kang1, Amy Brown2, Sabe Sabesan3, Abhishek Joshi4 1,2,3,4 Townsville Cancer Centre, Douglas, Australia Background: The Teleoncology model of care provides oncology specialist review and chemotherapy administration via telehealth systems to patients who live in rural and regional towns. This study evaluated the safety of administering immune checkpoint inhibitors (CPIs) and monitoring for immune related adverse events (irAEs) using this system by comparing its patient toxicity related mortality and morbidity outcomes to a tertiary cancer centre. Method: All patients who received CPI treatment via the Townsville Teleoncology Network (TTN) or directly at the Townsville Cancer Centre (TCC) between January 2015 and April 2019 were extracted from electronic records. Patient demographics, treatment details, irAE hospitalisation and mortality rates were recorded in a chart audit. Results: 28 patients received a total of 331 cycles of CPIs through the TTN while 142 patients received a total of 1697 cycles directly at the TCC. There were no significant differences in all demographic characteristics between both groups, including tumour profile and indigenous status. There were no statistically significant differences between the rates of high grade irAE across multiple systems (p>0.05) and rate of hospital admissions (11% (TTN) vs 7% (TCC), p=0.312) with a median duration of 7 days (range 1-25) for TTN patients and 4 (2-17) for TCC patients. There were no irAE related deaths in both groups. Conclusions: The Teleoncology model of care allows safe administration of CPIs and monitoring for iAREs at rural and regional towns comparable to that of a tertiary centre, thereby minimising the need for long distance travel and its inconveniences for patients.

Acute Q fever and the full blood count: A North Queensland review

Adam Walsh Adam Walsh1, Jane Royal2, Joel Wight3, Robert Norton4 1Queensland Health, Townsville Hospital, Townsville, Australia 2Queensland Health, Townsville Hospital, Townsville, Australia 3Queensland Health, Townsville Hospital, Townsville, Australia 4Queensland Health, Townsville Hospital , Townsville, Australia Background: Q fever is a worldwide-occurring zoonotic infection caused by Coxiella burnetii, resulting in acute or chronic disease. The manifestations of acute Q fever are not limited to the typical flu-like illness with pneumonia or hepatitis but also include neurological, osteoarticular, genitourinary, gastrointestinal, endocrine and haematological complications. Previous studies estimate a varying leucocyte count (unremarkable in 90%) and thrombocytopenia in 25% of patients with acute Q fever. Less commonly reported haematological manifestations of Q fever include haemolytic anaemia, antiphospholipid antibodies and an association with Non-Hodgkin Lymphoma. The aim of this study was to assess all acute Q fever cases at our institution for haematological manifestations, report severity of cytopenias and to determine if there is a correlation between cytopenias and clinical severity. Method: A retrospective cohort study was conducted for all patients presenting to The Townsville Hospital and diagnosed with acute Q fever between 1997 and 2019. Results: 97 patients (76.3% male; median age 52 years) with acute Q fever were identified at our institution based on predefined serology results. 61% developed thrombocytopenia (platelets <400x109/L) during their presentation. Based on CTCAE thrombocytopenia definitions; 6% developed grade 4, 10% grade 3, 19% grade 2 and 25% grade 1 thrombocytopenia. 70% of patients developed lymphopenia (lymphocyte count <1x109/L). Other haematological manifestations in our cohort include positive antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies) and one case of haemophagocytic lymphohistiocytosis. Conclusions: Our findings demonstrate thrombocytopenia and lymphopenia are much more prevalent in patients presenting to the Townsville hospital with acute Q fever than previously reported studies.

Can datalinkage help identify standards of care and outcomes of emergency laparotomy at The Townsville Hospital? - A pilot study Louise Rafter Louise Rafter, Rachael Payne, Siva Senthuran, Donald Cameron, Alexander Kippin 1Townsville Hospital and Health Service, Townsville, Australia Background: Emergency laparotomy (EL) carries high morbidity, mortality and financial burden on the public health system. The Australia New Zealand Emergency Laparotomy Audit (ANZELA) ) aims to prospectively assess standards of care and outcomes to drive quality improvement. This study assessed the reliability of data linkage to provide baseline data for quality improvement at a regional tertiary hospital. Method: 1727 operated patients between July 2015 and December 2017 were screened by ICD10 codes categorised as “include” “exclude” or “neutral” chosen by a general surgeon. Serial 3 and 6 month datasets involving 619 case records were manually reviewed to derive, refine and validate the algorithm to identify “emergency” and “laparotomy” cases. Deterministic linkage across administrative, clinical and imaging databases was used to identify standards of care. Results: There were 348 EL patients. The algorithm was 93%% sensitive and 92% specific in identifying EL patients. Mean hospitalization was 17 days. Mean hospital mortality was 5.75%. Only 84% of patients booked for emergency surgery within 1h underwent surgery within that timeframe. For the 60% of patients not admitted to ICU, their hospital mortality was <1%. Mortality for those admitted to ICU was 14%. Proportion of those aged over 70 seen by a geriatrician was 14%. 81% of patients had a CT scan within 5 days before surgery was and of these, 63% were reported preoperatively. Conclusions: Despite limitations, datalinkage can provide useful baseline information on patient care for future audits and be an enduring data source for quality improvement initiatives.

Occupational Therapists' involvement in reducing restraint and seclusion in adult acute mental health inpatient units: an Australian survey Luciana Theodoro de Freitas Luciana Theodoro de Freitas 1, Tilley Pain 1 and Justin Scanlan 2 1 Townsville Hospital and Health Service; 2 University of Sydney Background: Restraint and Seclusion (R&S) are still widely used amongst psychiatric services around the world including Australia despite efforts to reduce them. Emerging evidence suggests sensory modulation interventions improve consumers’ self-regulation and can support reductions in the use of R&S. Although Occupational Therapists (OTs) have taken the lead internationally in the implementation of these interventions, there was limited evidence that Australian OTs were using this approach. This project explored OT’ practices in supporting the multidisciplinary team in acute inpatient units to reduce R&S based on the Six Core Strategies (6CS) as international best practice. Method: This study used a cross-sectional survey approach disseminated by Occupational Therapy Australia Association. IBM SPSS statistics package was used to analyse the data. Open-ended responses were grouped into themes using principles of thematic analysis. Results: A total of 33 OTs participated in the study. The responses were organised according to each of the 6CS. As would be expected from the current literature, OTs’ involvement was predominantly focused on supporting the implementation of sensory approaches in their workplaces. These results suggest that, apart from advocating for sensory approaches, the role of OTs in implementing the 6CS to support the multidisciplinary team in reducing or eliminating R&S is relatively limited. Conclusions: OTs in Australia are contributing to minimise R&S practices by implementing sensory approaches. Further research is required to explore the change of focus on the discipline scope of practice and their full involvement in the 6CS to support the multidisciplinary team towards zero seclusion practices.

Bridging the gap from the swamp to the Ivory Tower – conducting randomised controlled trials in general practice Clare Heal Dr Clare Heal James Cook University Background: Primary care research is underfunded. Few randomised controlled trials (RCTs) are conducted in a primary care setting. However, it is important that clinical practice be informed by adequate primary care evidence so general practitioners (GPs) have tools and guidelines applicable to the patients they see. Objective: To describe and reflect on the experience of conducting five RCTs between 2003 and 2018 in a rural general practice setting with minimal funding, in North Queensland. Method: We sought to identify describe enabling factors and barriers to conducting practice based randomised controlled trials. Findings/Results: Enabling factors include using grassroots research questions, co-creating projects with GPs and engaging practice nurses. Barriers include negotiating ethics applications and insufficient funding. Recommendations to reduce study costs include compensating practice nurses rather than GP time. Conclusions: The findings are designed to encourage grassroots GPs to consider participating in pragmatic, feasible projects. The success of the projects was underpinned by the fact that they were established by a group of GPs who had interesting questions that were relevant to their clinical practice and not answered by current evidence.

Exercise interventions following total hip arthroplasty and their effects on self-reported physical function and pain: A systematic review Wilson Tang Wilson Tang 1, Carol Flavell 1, Kenji Doma1, Andrea Grant 2 1 James Cook University, Townsville, Queensland 2 Orthopaedic Research Institute of Queensland, Townsville, Queensland Background: Previous reviews which have investigated exercise interventions following total hip arthroplasty (THA) highlight issues with inter-study comparability owing to heterogeneity of outcome measures. No previous reviews have focused on self-reported function and post-operative pain intensity. Therefore, this study aims to systematically review research exploring the effects of exercise interventions specific to self-reported functional outcomes and pain intensities following THA. This study will guide evidence-based exercise prescription to maximise self-perceived physical function. Method: An electronic database search of CINAHL, Informit, Medline, PEDro, Scopus and SportDiscus was conducted. Literature was selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Randomised controlled trials, which were reported in English, exploring physical exercise interventions initiated post-THA, which utilised self-reported outcomes of physical function and pain intensity, were screened for. Studies were selected and appraised using the PEDro scale by two independent reviewers. Results: Twenty-one studies were identified for review. Study quality ranged from fair to excellent. Inter-study heterogeneity pertaining to exercise duration, intervention period, and outcome measures, existed. The exercises interventions, and exercise progressions of progressive resistance training, hydrotherapy, gait-retraining, task-based training, and upper-limb training were poorly reported. Significant between-group differences in self-reported function and pain were observed in nine studies, favouring the exercise intervention group. Conclusion: Exercise program implementation and duration were inconsistent. Furthermore, self-reported functional outcome measures used lacked homogeneity. Thus, evidence to determine which exercise is most beneficial to maximise self-perceived function and pain is insufficient. Future studies should evaluate exercise interventions using homogenous intervention durations and frequencies.

The Effects of Functional Electrical Stimulation (FES) Cycling on Muscle Spasticity in Individuals with Spinal Cord Injury: A Systematic Review Stephanie Couper Stephanie Couper1, Moira Smith1. 1James Cook University, Townsville, Australia. Background: Spasticity is a common secondary impairment following spinal cord injury (SCI) and can have a severe impact on function and daily life. One non-invasive approach in the treatment of spasticity is functional electrical stimulation (FES) cycling. Whilst FES cycling is currently used in rehabilitation with individuals with SCI, there are no specific guidelines on the use of FES cycling for spasticity treatment. The objective of this systematic review was to evaluate the effects of FES cycling on muscle spasticity in individuals with SCI and provide recommendations for use. Method: Database searches of CINHL, PEDro, PubMed and Scopus were conducted to identify relevant studies published up to October 2018 for this systematic review. Studies that included a FES cycling intervention, an outcome measure of spasticity and were full-text English articles were included. Two independent reviewers extracted the data and appraised the literature via the Crowe Critical Appraisal Tool (CCAT). Results: Eleven studies were deemed eligible for this review with a total of 174 participants aged 15-67 years old. Nine of the 11 studies had positive objective outcomes and two studies had positive subjective outcomes on spasticity, following FES cycling. Only six studies used statistical analysis for reporting results. CCAT scores ranged from 19/40 to 35/40. Conclusion: There is some evidence to suggest FES cycling may be effective in reducing muscle spasticity in SCI, however study quality is variable. Randomised control trials are required in conjunction with standardisation of FES parameters to determine more definitive conclusions on this treatment’s effectiveness and development of practice guidelines.

Dogs as medicine: Shedding light on the use of psychiatric assistance dogs Janice Lloyd Janice Lloyd1, Laura Johnston2, Julia Lewis2 1Discipline of Veterinary Sciences, James Cook University, Townsville, QLD, Australia 2Independent Researcher, Sydney, NSW, Australia A psychiatric assistance dog (PAD) is a service dog that is trained to assist its handler (owner) who has been diagnosed with a mental health condition such as PTSD, depression, anxiety, or bipolar disorder. Little is known about the population of people who own PADs, the type of dogs used or the functions they provide. One third (n = 199) of PAD owners registered with the charity ‘mindDog’ (that assists people procure, train and certify PADs) participated in an online survey to explore these matters. Results show that owners have differing mental health diagnoses, and their dogs performed different tasks to support them in daily life. PAD usage decreased (46%), increased (30%) or did not change (24%) participants' use of psychiatric or other healthcare services. Decrease in service use was mainly due to reduced suicide attempts, and less requirement for hospitalisation and medication; increased use was mainly due to enhanced ability to attend appointments. Results also suggest that successful person-dog teams do not require the dog to have been bred, raised and trained for the role by assistance/service dog provider organisations. These findings will inform clients and medical professionals, who play a pivotal role regarding their patients’ application for a mindDog, about how dogs may be of assistance.

Incidence and Outcomes of Inpatient Hypoglycemia at The Townsville Hospital: A Retrospective Chart Audit Oliver Hayes Hayes OG1, Ryan A1, Adegboye O2,3 Vangaveti VN2, Jhamb S2, Robertson K1, Sangla KS1,2, Malabu UH1,2,3 1The Townsville Hospital, Townsville, Australia 2James Cook University, Townsville, Australia 3Australian Institute of Tropical Health and Medicine, Townsville, Australia Background: Studies have shown Caucasian patients with inpatient hypoglycaemia are associated with increase in length of stay (LOS), mortality and cost. But there are no similar studies on indigenous Australians diabetic patients despite having higher prevalence of diabetes and its complications. The aim of the study was to evaluate pattern and outcomes of diabetic inpatient hypoglycemia among Aboriginal and Torres Strait Islander (ATSI) compared to Australian Caucasian patients. Method: A retrospective audit of diabetic patients aged >18 years admitted at The Townsville Hospital medical and surgical wards was analysed for a period between 1st April 2015 and 31st March 2016. The database contains clinical information at the time of admission and initial discharge and readmission within 4 weeks thereafter. Results: 1618 (of total 6027) patients were admitted with diabetes representing 23.7% of the total ward admissions of which 484 (29.9%) had inpatient hypoglycaemia. Of the data analysed ATSI origin with inpatient hypoglycaemia was associated with longer length of stay (LOS) (HR=2.072, 95%CI: 1.219-3.485) while severe hypoglycaemia (<2.8 mmol/L) in both ATSI and non-ATSI was significantly associated with longer LOS (HR: 1.878, 95CI%: 1.123-3.128). Conclusions: We reported high rate of inpatient hypoglycemia in our study population. Indigenous Australian diabetic patients with inpatient hypoglycemia had significantly longer LOS compared to non-Indigenous Caucasian counterparts. Over all our results are significant for promoting awareness of the effect of ethnic background on inpatient hypoglycemia risk. Further prospective studies on a larger population are needed to confirm our findings.

Success! Facilitating renal patients in the tropics with central venous lines to maintain the integrity of their dressings while attending to personal hygiene Kim Quayle Quayle, K1, Smyth, W2, 3, McArdle, J1, Hughes, K1, Wicking, K3, Nagle, C2, 3 1Townsville Renal Service, Townsville Hospital and Health Service, Queensland, Australia 2Townsville Institute of Health Research and Innovation, Townsville Hospital and Health Service, Queensland, Australia 3Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia Background: A randomised controlled trial found different central venous catheter (CVC) exit-site dressings only stayed intact two-thirds of the time in the tropics. We explored two options to assist patients undergoing haemodialysis via CVCs to maintain the integrity of their exit site dressings while managing their daily hygiene needs as they preferred. Method: A three-phase study was undertaken. The options provided were bath wipes, and a waterproof dressing cover. Data were collected by questionnaires, interviews, dressing audits, and case studies. Results: Phase 1: Nurses (37) considered both options acceptable and feasible, but expressed some practical concerns related to their use. Phase 2: Participants (27) with CVCs discussed their hygiene preferences and the difficulties they encountered with keeping dressings dry. They were enthusiastic about the proposed options. Phase 3: Participants appreciated being able to shower without wetting their CVC dressings; individuals modified the use and application of the waterproof cover to meet their body shape and CVC site. Although the waterproof covering was most popular and most frequently used, participants who tried the bath wipes were happy with them. Intactness of the dressings was 85% during the trial; there were no CVC infections during the study. Conclusions: These options filled an unmet need and promoted patients’ hygiene and dignity. Funding for ongoing provision of the products needs to be considered. However, monitoring of their use in a non-research environment will be required (for example, to guard against complacency). Other interventions that further increase patient participation in their care warrant investigation.

Antibiotic stewardship in skin infections: a cross-sectional analysis of GP registrar’s management of impetigo Hilary Gorges H Gorges1, C Heal1, M Van Driel2, A Tapley3, J Davis⁴, A Davey3, E Holliday⁵, J Ball⁶, N Najib3, N Spike⁷, K Fitzgerald⁸, P Magin3⁵ 1College of Medicine and Dentistry, James Cook University, Mackay, Australia 2Faculty of Medicine, University of Queensland, Brisbane, Australia 3GP Synergy, Liverpool, Australia ⁴ Menzies School of Health Research, Darwin, Australia ⁵School of Medicine and Public Health, University of Newcastle, Newcastle, Australia ⁶Hunter Medical Research Institute, New Lambton Heights, Australia ⁷Department of General Practice, University of Melbourne, Melbourne, Australia ⁸General Practice Training Tasmania, Hobart, Australia Background: Impetigo is a childhood common skin infection. Guidelines recommend antibiotics for all cases with severity guiding topical or oral therapy. Antimicrobial resistance from misuse is a serious global threat to public health. Our aim was to establish the prevalence and associations of systemic antibiotic prescription for impetigo by general practice registrars. Method: Design: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing multi-site cohort study of Australian registrars’ in-consultation clinical practice across five Australian states. Participants: Registrars participating in ReCEnT from 2010-2017. Outcome measures: Management of impetigo with systemic antibiotics. Results: 1741 registrars (response rate 96%) provided data from 384,731 problems identified in 246,434 consultations. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed topical antibiotics; 306/683 (44.8%) systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01). Conclusions: Australian registrars prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.

Detection of tympanic membrane retraction conditions using non-invasive technique: Wideband tympanometry. Venkatesh Aithal Venkatesh Aithal 1,2, Sreedevi Aithal1,2, Joseph Kei 2, Shane Anderson 3 1Audiology Department, Townsville Hospital and Health Service. Douglas, Australia. 2Hearing Research Unit for Children, University of Queensland, Australia. 3ENT Department, Townsville Hospital and Health Service, Douglas, Australia. Background: Although 226Hz tympanometry is the standard test to assess tympanic membrane conditions, it is not sensitive to measure tympanic membrane retraction pockets (RPs) that often develop into dangerous cholesteatoma. Hence an alternate test is required to improve the detection of RPs. The aim of the present study was to investigate the effect of different types of tympanic membrane retraction on wideband tympanometry (WBT). Method: Wide band absorbance at 0 daPa (WBA0 ) and at tympanometric peak pressure (WBATPP ) were obtained from 16 ears with attic retractions (AR), 17 ears with mesotympanic retractions (MR), 43 ears with Eustachian Tube Dysfunction (ETD) without effusion. The results were compared with 49 healthy ears. Results: Mean WBA0 was reduced when compared to WBATPP for AR, MR and ETD. WBA0 and WBATPP were similar up to 2.5 kHz for AR and MR. Both WBA0 and WBATPP were reduced in MR compared to AR from 3-6 kHz. WBA0 was significantly lower than WBATPP at 0.25-1 kHz for AR, and 0.25-2 kHz for ETD. Difference between WBATPP and WBA0 was highest for ETD and lowest for MR. With AR, tympanometry showed type “A” in 7 ears. “B” in 3 ears and “C” in 6 ears whereas MR showed type “A” in 5 ears, “B” in 9 ears and “C” in 3 ears. ETD showed type “C” in all ears. Conclusions: WBT showed differential absorbance patterns for retraction conditions and recommended to use at the clinic. However, 226 Hz tympanometry did not show distinctive patterns.

Topical antibiotics for wounds healing by primary intention: a systematic review and meta-analysis. Clare Heal Presenting Heal CF1, 1JCU Mackay

Background: Judicious prescribing of antibiotics is vital. Topical antibiotics have some advantages over oral use. Surgical-site infections (SSIs) increase patient morbidity and costs. Method: The aim of the systematic review and meta-analysis was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. Results: Fourteen RCTs with 6466 participants met inclusion criteria. Pooling of eight trials (5427 participants) showed topical antibiotics reduced risk of SSI compared with no topical antibiotic (risk ratio (RR) 0.61, 95 per cent c.i. 0.42 to 0.87; moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic (RR 3.94, 0.46 to 34.00; very low-quality evidence). Pooling five trials (1299 participants) indicated that topical antibiotics probably reduce risk of SSI compared with topical antiseptics (RR 0.49, 0.30 to 0.80; moderate-quality evidence); 43 fewer SSIs per 1000 patients treated. Pooling two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents (RR 0.97, 0.52 to 1.82; very low-quality evidence). Conclusions: Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis. They should be used with caution.

Risk Factors, Morbidity and Mortality Associated with Airway Foreign Body Inhalation (AFBI) in Children: A Queensland Experience Lua Saylany Lua Saylany1, Dr. Susan Gorton PhD1, Dr. Venkat Vangaveti1, Dr. Ramaa Puvvadi MBBS 2 1James Cook University, Townsville, Australia 2The Townsville Hospital, Townsville, Australia Background: AFBI is a common cause of respiratory emergency in children. Accurate diagnosis is a problem resulting in increased morbidity. Due to poor diagnostic sensitivity of clinical assessment negative bronchoscopies are expected in the management of suspected AFBI. Limited studies address predictors of morbidity and morbidity associated with bronchoscopy. Method: Retrospective analysis of electronic medical records for patients who underwent bronchoscopy for suspected AFBI. Data was analyzed using multivariate binary logistic regression to evaluate the pre-bronchoscopy, bronchoscopy, and post-bronchoscopy factors. Results: 150 patients (92M, 58F) underwent bronchoscopy with median age 22 months. Airway foreign body was found in 58% of the patients. 20% of patients had a witnessed choking event. Multivariate analysis demonstrated that wheeze on auscultation (OR6.0[CI95%1.7-21], p<0.01), reduced air entry on auscultation (OR6.0[CI95%1.7-21],p<0.001), collapse/consolidation (OR5.2[CI95%1.7-16],p<0.01), hyperinflation/air trapping (OR4.4[CI95% 1.3-14],p<0.05), and radiopaque findings (OR6.0[CI95% 2.5-14],p<0.01) on chest X-ray were significant findings indicative of positive bronchoscopy. 77 patients (51.3%) had both rigid and flexible bronchoscopy. 41 patients had bronchoalveolar lavage. 20 patients had desaturation >2 minutes under general anaesthetic. 22 patients were admitted to PICU. 25 patients were given post-bronchoscopy steroids. 12 patients had follow-up bronchoscopies. There were 3 deaths, all had positive bronchoscopies. Conclusions: Positive bronchoscopy is associated with several complications, namely increased anaesthetic time and PICU admissions. Clinical findings (wheeze and reduced air entry), and radiological findings (consolidation/collapse, hyperinflation/air trapping, radiopacity), in combination with choking history, have high risk of predicting presence of foreign body. While choking alone is a low risk of finding a positive foreign body.

Experience with Definity Use in Townsville Hospital Sonali Basu Dr Kyi Win1 Dr Sonali Basu2 Dr Suranga Weerasooriya 3 1 Cardiology advance trainee, Townsville Hospital, Queensland Health, Australia 2 BPT Registrar, Townsville Hospital, Queensland Health, Australia 3 Cardiologist consultant, Townsville Hospital, Queensland Health, Australia

Introduction: The use of Ultrasound Enhancing Agents (UEAs) has become integral in Echocardiography. Of the 3 UEAs available in the market, Cardiac Investigation Unit (CIU) in Townsville Hospital uses Definity. The indications are delineation of LV endocardial border but off label clinical applications are also very useful in clinical echocardiography. Only contraindication is hypersensitivity to perflutren. Methods: Aim of our study is to demonstrate the indications, effectiveness of Definity in echocardiography in a local population. This is an audit done in CIU 2017-2018. Results: 202 echocardiograms were examined. The demographics revealed that 73% of the patients were male; median age was 62. Transthoracic echocardiograms were majority (79%), with stress echo (20%) and trans-oesophageal echo (1%). 46% were outpatients and the rest inpatients [CCU (24%), Wards (10%), ICU (2%), and others (16%)]. Indications were enhancing endocardial definition (80%), quantification of LV ejection fraction and LV volume (59%), assess LV apex (24%), exclude intra-cardiac masses (12%), and Doppler enhancement (2.5%). The success rates were 95%, 96%, 98%, 90% and 69% respectively. Clinical implications showed no change in management (79%), medication change (9%), procedural change (7%), change in both (2%) and inadequate imaging (3%). Only 1 patient had complication as back pain. Conclusion: Use of Definity in our Echo Lab has shown to be very effective in multiple clinical applications, avoiding other down-stream investigations without causing major complications. It also helps in clinic decision making leading to changes in management in 18% of the cases.

Effect of Housing Conditions and Route of Administration in Inducing Peanut Allergy in Mice. Kunal Pratap Pratap K.1,2,3, Taki A. C.1,2, Harnandez S. M.1, Lopata A. L.1,2,3, Kamath S. D.1,2,3 1Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia 2Centre for Molecular Therapeutics, James Cook University, Townsville, Australia 3Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia Background: Previous studies have reported that specific housing conditions of mice can either inhibit or exaggerate the induced disease response because of the macro-environment of the holding facility. In addition, the route of sensitization plays a significant role in inducing food allergy. The aim of this study was to investigate the effect of housing conditions on manifestation of food allergy in Balb/c mice using intraperitoneal and oral induction routes. Method: 5 groups (n=6) of female Balb/c mice 6-8 weeks old were maintained in a specific-pathogen-free (SPF) facility as well as a conventional facility for two weeks after weaning. Mice were subsequently sensitised with peanut extract in PBS using two different routes, oral and intraperitoneal. Alum (intraperitoneal) and Cholera toxin (oral) were used as adjuvants in this study. Three sensitisations and two challenges were performed at one-week interval. Clinical symptoms were scored, and temperature was recorded. Cytokine analysis was performed in supernatant collected from activated splenocytes. Results: The allergy scores were significantly different between the facilities. Peanut specific IgG and IgG1 antibody levels were significantly increased in the alum induced peanut allergy group in both SPF and conventional facility. Peanut specific IgG2a however demonstrated increased levels in the conventional facility only. Importantly, a significant decrease in body temperature was detected in the conventional facility after both challenges, in contrast to the SPF facility. Increased levels of IL-4, IL-5 and IL-13 expression was observed in supernatant of activated splenocytes from the SPF facility in allergy induced groups. Conclusions: This study indicates that changes in housing condition of experimental mice can significantly affects the induction of food allergy depending on route of induction.

A comparison of lower-limb major amputation rates and outcomes for Indigenous and non-Indigenous people in North Queensland Australia during 2000-2015 Tejas Singh Tejas P. Singh1,2, Joseph V. Moxon1,3, Michael T. Meehan3, Rhondda E. Jones3, Yvonne Cadet-James4, Jonathan Golledge1,2,3 1Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia 2The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia 3The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia 4Indigenous Centre, James Cook University, Townsville, Queensland, Australia Background: This study aimed to estimate the incidence of major amputations for Indigenous and Non-Indigenous Australians in North Queensland, Australia, examine trends in incidence over time and investigate clinical outcomes. Methods: This was a retrospective study of patients who underwent a non-traumatic major amputation (above the ankle) at the main tertiary hospital in North Queensland (The Townsville Hospital) between 2000 and 2015. Age-standardised major amputation rates (per 100,000) and incidence rate ratios (IRR) were calculated using census data to define the at-risk population. Clinical characteristics of patient groups were compared using Pearson’s χ2 and Mann-Whitney U tests. The independent contributions of age, Indigenous status and diabetes to amputation risk were estimated using generalised logistic regression models (GLMs). Kaplan-Meier survival and Cox-proportional hazard analyses estimated the incidence of and risk factors for all-cause mortality. Results: The annual incidence of major amputations in North Queensland generally increased over time and were greater than previously reported national estimates. Diabetes-related major amputation rates were approximately 4-times greater in Indigenous than non-Indigenous Australians (IRR 4.42, 95% CI [3.38-5.87]). Indigenous patients undergoing a major amputation were younger (p<0.001), more likely to be females (p=0.002), have diabetes (p<0.001) and end-stage renal disease (p=0.003) than non-Indigenous patients. Indigenous patients were at 2-fold greater risk of all-cause mortality during follow-up compared to non-Indigenous patients, although this association was lost after adjusting for other risk factors (hazard ratio 1.24 95% CI, [0.82-1.89]); p=0.314). Conclusion: The burden of major amputations is increasing in North Queensland and is greater in Indigenous people.