Cairns Hospital Research Articles

Amifostine and rituximab in refractory immune thrombocytopaenia: A case series.

Management of refractory immune thrombocytopaenia (ITP) can be challenging. Amifostine, a thiophosphate prodrug, induces megakaryocyte maturation. In 2010, Fan et al. published results for 21 Chinese splenectomized patients, aged 13-92, with steroid-refractory ITP. Nineteen patients (15 patients aged >18 years) achieved remission 2months post-amifostine. This is the first publication utilizing amifostine and rituximab in refractory ITP. At the Cairns Hospital in Australia, we identified five patients treated with amifostine and rituximab for refractory ITP. Amifostine IV 400 mg once daily was administered 5 days/week for 5 weeks as tolerated. Rituximab was administered concurrently with/preceding amifostine based on clinician preference. Data were obtained through medical records and follow-up serology up to 5 years post-amifostine was available. Three cases demonstrated durable responses up to 5 years' follow-up. One patient initially achieved remission but relapsed 1-year post-amifostine. One patient who did not have a splenectomy prior to amifostine did not respond. Three out of five patients achieved durable responses with amifostine and rituximab. Although there is confounding by rituximab, given its established low durable response rate, it is likely that the excellent long-term responses achieved were a result of amifostine. Clinical trials with larger patient cohorts and further investigation are required to confirm the efficacy and mechanism of amifostine in ITP.

Rural patients highly satisfied with gynaecological oncology care via telehealth.

Introduction of telehealth for gynaecological oncology consultations aims to improve access to specialised care for rural and remote Queensland women with gynaecological malignancies. This survey examines patient satisfaction with gynaecological oncology consultations via telehealth after introduction of the service in Far North Queensland in 2017. Patients who accessed the gynaecological oncology telehealth service at Cairns Hospital from January 2019 to June 2020 were invited to participate in the study. Demographic details and results of a satisfaction survey were investigated. The questionnaire included 16 statements measured on a five-point Likert scale and three open-ended questions, which were coded into related responses and predominant themes developed. Fifty-three patients completed the study. The mean satisfaction score across all questions was 90.5% (standard deviation 8.7%). The lowest overall patient score was 77.5% and the highest was 100%. Themes emerging from the open questions were emotions experienced by women, communication, relationship building and acceptability of the service. Patients were highly satisfied with the telehealth service. Our findings encourage further development and research into telehealth care models for surgical disciplines such as gynaecological oncology.

Chest Pain Admissions During the Covid-19 Pandemic

Cairns Hospital in Far North Queensland has a catchment area of approximately 14, 900 square kilometres. The prevalence of cardiovascular disease in Far North Queensland is higher than that of the rest of Australia. The first case of COVID-19 in Australia was on 25 January 2020 and on 22 March 2020, the Australian Government issued strict social distancing restrictions along with the “stay home stay safe campaign.” We assessed the impact of COVID-19 and the public health campaign on cardiac admissions to the Cairns Hospital.

S3142 Adherence to Seattle Biopsy Protocol in Patients With Long Segment Barrett’s Esophagus at Cairns Hospital, Australia

S3142 Adherence to Seattle Biopsy Protocol in Patients With Long Segment Barrett’s Esophagus at Cairns Hospital, Australia

S3144 Prevalence, Clinicopathological Evaluation and Management Strategy of Benign Esophageal Strictures at Cairns Hospital, Australia

S3144 Prevalence, Clinicopathological Evaluation and Management Strategy of Benign Esophageal Strictures at Cairns Hospital, Australia

Epidemiology of severe ocular trauma following the implementation of alcohol restrictions in Far North Queensland.

Indigenous communities of Far North Queensland (FNQ) have one of the highest incidences of alcohol-related ocular trauma globally. To review the epidemiology of closed- and open-globe trauma admitted to Cairns Hospital from FNQ health districts following the implementation of alcohol restrictions in Indigenous communities. Retrospective study of cases from January 2014 to December 2018. A total of 142 cases identified from ICD-10 clinical-coding data. Records were reviewed to determine demographics, clinical details and outcomes. Annual incidence by demography and ethnicity (Indigenous vs non-indigenous). Estimated annual incidence was 10.4/100 000 population (open-globe: 3.6/100 000, closed-globe: 6.8/100 000 population). Incidence rate ratio was 2.8× higher in Indigenous (22.8/100 000 population) compared to non-indigenous populations. Injury from assault was 8.2× higher in the Indigenous population. Alcohol was involved in 76% of assaults. Paediatric injuries comprised 20.4% of the cohort, with Indigenous children over-represented (44.8% of children). Visual acuity (VA) at presentation ranged from -0.08 logMAR to no-perception of light (NPL), with 41.8% poorer than +1.00 logMAR. Final VA ranged from -0.18 logMAR to NPL. Mean final VA was significantly better for closed- than open-globe injuries (+0.43 vs +1.01 logMAR). Ruptures had the poorest outcomes (mean +1.65 logMAR). The overall incidence of severe ocular trauma in FNQ has decreased compared to that reported from 1995 to 2002. The extremely high incidence observed in the Indigenous communities of Cape York has decreased dramatically since the introduction of Alcohol Management Plans. Nevertheless, the Indigenous population still experiences significantly higher rates of severe ocular trauma, particularly from assault.

Lupus nephritis in Indigenous Australians: a single-centre study.

The incidence, presentation and outcomes of lupus nephritis (LN) vary with geography, ethnicity, socioeconomic status and gender. There are relatively few data on LN in the non-Caucasian populations in Australia. To describe the clinical presentation, histological features, natural history, and outcomes of a historical cohort of Aboriginal and Torres Strait Islanders people in Far North Queensland with biopsy-proven LN. This is a retrospective observational study, and the study was conducted in Cairns and Hinterland Hospital and Health Service, Queensland, Australia. The study included Aboriginal and Torres Strait Islander patients with biopsy-proven LN treated between 1990 and 2013. The main outcome measures were renal replacement therapy and overall patient survival. Aboriginal and Torres Strait Islander people represented a substantial proportion (n = 16/40, 40%) of all patients diagnosed with LN during the observation period. The frequency of nephrotic range proteinuria (n = 11/14, 78.5%), estimated glomerular filtration rate <60 mL/min/1.73 m2 (n = 6/14, 42.8%) and proliferative LN (n = 13/16, 81.25%) was high at the time of presentation. Despite use of multiple immunosuppressive agents, the overall rate of remission was poor (n = 4/14, 28.5%) and incidence of end-stage kidney disease (n = 4/14, 28.5%) and death (n = 5/16, 31.25%) was high. The clinical presentation of LN in Aboriginal and Torres Strait Islanders in Far North Queensland is severe and the response to standard immunosuppressive therapy is unsatisfactory. Larger prospective multi-centre studies are required to better understand ethnic disparities in prognosis and response to immunosuppressive therapy in this specific population.

Characteristics and preventability of obstetric intensive care unit admissions in Far North Queensland.

The rarity of maternal deaths in developed countries has increased interest in auditing cases of severe maternal morbidity or maternal 'near miss'. The assessment and preventability of cases of maternal 'near misses' are important in improving the provision of maternity care. To describe the epidemiology and determine aspects of preventability in care among women admitted to an obstetric intensive care unit (ICU) in Far North Queensland. A retrospective observational study of pregnant and postpartum patients admitted to the Cairns Hospital ICU between 1 January 2013 and 31 December 2017 was undertaken. Cases of severe maternal morbidity were identified using the World Health Organization (WHO) 'near miss' criteria and reviewed to determine reasons for admission to ICU and ascertain aspects of preventability in the care provided. Sixty-nine out of 12081 (0.6%) women admitted for obstetric care were transferred to the ICU with 31 cases fulfilling WHO 'near miss' criteria. The most common direct obstetric-related diagnosis for ICU admission was hypertensive disease of pregnancy and obstetric haemorrhage. Indirect obstetric causes contributed to approximately 40% of ICU admissions. Among the 31 cases of WHO 'near miss', ten cases were deemed preventable with the most common reason for preventability related to lack of recognition of high-risk clinical status. Maternal 'near miss' and rates of obstetric admission to the ICU at Cairns Hospital are reassuringly low. Nevertheless, one-third of women with 'near miss' required improvements in the provision of care, emphasising the need for continued audit and improvement of clinical practice.

Mortality within 30 days of receiving checkpoint inhibitor immunotherapy: An Australian multicenter review.

e19182 Background: Mortality within 30 days of chemotherapy is recognised as an important quality assurance measure. There is limited data regarding mortality within 30 days of immunotherapy and whether the same standards should apply. In contrast to chemotherapy, immunotherapy has a favourable toxicity profile and a higher chance of durable responses. We assess 3 years of data from two regional cancer centres in Queensland, Australia. Methods: Retrospective review of patients treated with checkpoint inhibitor immunotherapy at Cairns Hospital and Gold Cold University Hospital between June 2016 and June 2019. Results: 533 patients received immunotherapy and 59 (11.1%) died within 30 days of treatment. 25 patients died within 30 days of their first treatment (4.7%). Anti-PD-L1/PD-1 was more common than anti-CTLA-4 and combination treatment (84.7% v 1.7% v 13.6%). Median age was 65 years (range 37 – 87). Most patients were treated for non-small cell lung cancer (51%) and melanoma (36%). Poor prognostic features were prevalent: ECOG 3-4 (30%), brain metastases (34%), 3 sites of metastases (59%), and raised LDH (80%). Grade 3+ toxicity was uncommon (3.4%) and there were no treatment-related mortalities. Most patients died due to progressive disease. 67% died in hospital and 25% received acute treatment within 48 hours of their death. Most patients were known to palliative care (85%). Resuscitation plans were documented in 55% before their final treatment. Discussion regarding very poor prognosis was documented in 44%. Conclusions: Thirty-day mortality rates were similar to published data relating to chemotherapy and mortality within 30 days of initiating therapy was low. While there were few significant immune-related toxicities, a quarter of patients received acute treatment within 48 hours of their death. Most patients had documented resuscitation plans and were known to palliative care.

Administration of immune checkpoint inhibitors using teleoncology model of care in Far North Queensland: A multicenter review of safety outcomes.

2084 Background: The Teleoncology model of care, as developed and implemented across health services in Far North Queensland (Australia), improves access to specialist oncology services, including telehealth supervised administration of Oncology drugs for patients in rural/remote towns. There is limited published data regarding the safety of checkpoint inhibitor immunotherapy when it is administered via Teleoncology. Aim: Evaluate safety of immunotherapy administration via Teleoncology, including immune-related adverse events (irAE), treatment delays, hospital admissions and interhospital transfers, in comparison to a retrospective control population. Methods: Retrospective review of all patients treated with immunotherapy via Teleoncology as part of Cairns and Hinterland Hospital and Health Service (CHHHS) and the Townsville Teleoncology Network (TTN) between January 2015 and April 2019. A retrospective cohort treated at Townsville Cancer Centre over the same time period was used as a control group. Results: Fifty-one patients received a total of 624 cycles of immunotherapy (all single agent anti-PD-1/L-1) via Teleoncology. The control population included 142 patients who received 1697 cycles of immunotherapy. Baseline characteristics were well matched between groups. Compared to the control population, patients treated via telehealth did not have statistically significant differences in the rate of Grade 3+ irAE (13.7% v 8%), hospital admissions (13.7% v 7.4%) or protocol suspensions due to immune toxicity (16% v 10%). One patient with Grade 3+ irAE required interhospital transfer for investigation and management, which occurred within 24 hours of presentation to hospital. There were no treatment-related mortalities in either group. Conclusions: Checkpoint inhibitor immunotherapy can safely be delivered using the Teleoncology model of care in rural and remote centres. The incidence of toxicity for single agent immunotherapy was predictably low and not significantly different between groups, however the numbers in this retrospective study were small. The time to recognition and management of immune mediated toxicity in rural and remote centres is an important factor that was not assessed in this study and will be considered in future work.

P188 Aboriginal and Torres Strait Australians have significantly worse coronary disease, risk factors and 4 year outcomes compared with non-indigenous Australians

Abstract Introduction The Aboriginal and Torres Strait Islander (ATSI) population in Australia appear to present with coronary disease more frequently, have worse risk factors, worse coronary disease and poorer outcomes, however there is limited data available on this population. The ATSI population represent 8% of the Cairns total population. We undertook to compare these findings and four-year outcomes in ATSI versus non-indigenous patients aged &amp;lt; 50 years old undergoing coronary angiography. Methods We collected data on all patients aged &amp;lt; 50 years old, who underwent coronary angiography at Cairns Hospital over a two-year period (2014-2016), from the Queensland Coronary Outcomes Registry. Data of patient risk factors and 4 year outcomes were collected using electronic hospital medical records and electronic discharge summaries available on all Queensland patients. Patients residing outside Queensland were excluded. Results From 2014-2016, a total of 555 patients &amp;lt; 50 years old underwent coronary angiography. The average age was 43. 322 (58.0%) patients were male and 233 (42.0%) were female. 271 patients (48.8%) identified as ATSI. Coronary risk factors - 42.4% of ATSI patients had diabetes vs 13.7 in the non-indigenous group, 58.7% of ATSI patients vs 43.7% had hyperlipidaemia, 61.3% of ATSI patients vs 39.8% were current smokers, 65.3% of ATSI patients vs 42.3% were hypertensive, and 64.2% of ATSI patients vs 50.4% had a family history of premature coronary artery disease. This demonstrates significantly higher incidence of cardiac risk factors in ATSI patients (combined risk factors P = 0.00086). When comparing coronary artery disease, as demonstrated by coronary angiography, the ATSI group had significantly more abnormal coronary angiograms - 74.5% compared to the non-indigenous group 42.3% (P = 0.000006). There was not a statistically significant difference between the severity of coronary artery disease between the two populations who had coronary disease, however, the ATSI population demonstrated a higher incidence of triple vessel disease. ATSI patients were more likely to have repeat coronary angiography 11% vs 4%. In the four-year follow up period, 18.5% of the ATSI population had at least one major adverse cardiac event (MACE), whereas in the non-indigenous group 7.0% had at least one MACE. There was not a statistically significant difference between all cause mortality between the two populations. Conclusion We have shown that Aboriginal and Torres Strait Islanders Australians are more likely to have coronary angiography at a younger age. That Aboriginal and Torres Strait Islanders Australians have a significantly higher incidence of cardiac risk factors, higher incidence of coronary artery disease, and more major cardiac events after undergoing coronary angiography compared to non-indigenous patients. The all cause mortality in this young population was not significantly different.

205 Clinical Audit on the Management of Patients Presenting to Emergency Department With Atrial Fibrillation at a Regional Hospital

Atrial fibrillation (AF) is the commonest arrhythmia and is a significant public health and emergency department (ED) burden. Although the mainstay of AF treatment is rate or rhythm control and anticoagulation, there is substantial variation in AF management in ED. We assessed the management of AF in patients presenting to Cairns Hospital ED over a 1 year period by conducting a retrospective audit. There were 374 presentations with AF from 1/10/2018 to 30/9/2019. 237 were randomly selected for audit. This included first diagnosed AF (30 %), paroxysmal AF (47 %), persistent/permanent AF (23%). In terms of AF management, 122 (51.3%) of patients received rate control and 116 (48.3%) received rhythm control. Of the cases considered for rhythm control - 58 patients received pharmacological treatment and 48 received electrical cardioversion. Only 12 patients (5%) were referred for electrophysiology follow-up. 67.6% of patients had a CHA2DS2VASc score of ≥2, of which 72.0% were appropriately anticoagulated. 10.1% of anticoagulated patients received warfarin while 87.3% received NOACs. Adjunct therapies - IV Magnesium was prescribed in >2/3 of all patients. Although Cairns ED is compliant to anticoagulation guidelines, AF management by rate or rhythm control is almost 50/50% and the use of IV Magnesium (not evidence-based) is used in >2/3. This audit highlights the need for guidelines for appropriate and consistent management and ongoing care of AF patients treated in ED.

Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality.

Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies-including protective ventilation and early renal replacement therapy (RRT)-have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach. All cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients' demographics, presentation, management and clinical course were examined. The 55 patients' median (interquartile range (IQR)) age was 47 (32-62) years and their median (IQR) APACHE III score was 67 (48-105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175-3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities. In patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes.

Electronic intravenous N-acetyl cysteine ordering tool: A retrospective review.

To examine if the electronic N-acetyl cysteine (NAC) order reduced prescribing errors. This was a retrospective chart review of all patients presenting over 2 years to Cairns Hospital ED with a discharge diagnosis of 'paracetamol overdose'. Data were collected for any patient who received i.v. NAC. Any error, and a description of the error such as dose, volume of fluid, time of infusion and incorrect patient weight was recorded. There were 172 presentations with paracetamol poisoning with 86 receiving i.v. NAC. In the 75 (87%) where the electronic NAC order was used, there were no errors in dose of NAC, volume of i.v. fluid and length of time of infusion. In the 11 presentations where the manual NAC order was used, there were multiple errors identified. The use of this electronic NAC order removed errors in NAC prescription and should be considered for prescribing and administering i.v. NAC.

Severe Respiratory Syncytial Virus Infection in Hospitalized Children Less Than 3 Years of Age in a Temperate and Tropical Climate.

Respiratory syncytial virus (RSV) infection is a frequent cause of hospitalization in infants younger than 3 years of age. We aimed to determine the factors associated with severe RSV disease. Retrospective medical review of children up to 3 years of age admitted for laboratory-proven RSV infection between January 1, 2013, and December 31, 2014, was conducted at the Women's and Children's Hospital, Adelaide, South Australia, and the Paediatric Department at Cairns Hospital, Cairns, North Queensland. Severity of infection was determined using the validated Brisbane RSV Infection Severity Score. Four-hundred ninety-six children (383 at Women's and Children's Hospital and 113 at Cairns Hospital) were included in the study, with 76, 323 and 97 patients identified as having mild, moderate or severe disease, respectively. Decreasing age [odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.90-0.99, P = 0.020), and being Indigenous, increased (OR = 2.6; 95% CI = 1.4-4.9, P = 0.002) the risk of severe RSV infection in hospitalized children. Underlying respiratory (P = 0.029, OR = 2.5; 95% CI = 1.1-5.8) or cardiac (OR = 2.7; 95% CI = 1.1-6.4, P = 0.024) conditions, as well as the presence of tachypnoea on admission (OR = 2.2; 95% CI = 1.2-4.1, P = 0.009), were also independent predictors of severe RSV infection. Seasonal variation in hospitalization was observed between temperate and tropical climates but was not associated with disease severity. Young infants, Indigenous patients and children with underlying respiratory and cardiac disease should be observed closely for signs of deterioration. Infants with tachypnoea on admission should be continuously monitored.

Use of fetal fibronectin testing in women transferred for threatened preterm labour in remote far north Queensland.

Threatened preterm labour is a common reason for medical transfer from remote communities; however, many transferred women do not deliver preterm. A tool for prediction of preterm birth such as fetal fibronectin may reduce transfers and related social and economic costs. To review the use of fetal fibronectin testing in women transferred for threatened preterm labour from Cape York to Cairns Hospital between 2011 and 2015 and determine the role testing could play in reducing transfers and associated costs. Records from the Royal Flying Doctor Service and Cairns Hospital were accessed. Women transferred solely for threatened preterm labour were included in the study. Fetal fibronectin testing, hospital admission, outpatient stays and birth outcome data were collated and analysed. Costs were assigned using the National Hospital Cost Data Collection, round 19. Forty-seven women were included in the study; however, only 20 underwent fetal fibronectin testing. Transfer of 30 women who had either a negative test or were not tested but delivered at term resulted in 41 inpatient nights and 443 excess outpatient nights, costing an estimated AU$57408. Aeromedical transfers were estimated to cost a further $151500. Adherence to clinical guidelines and greater availability and use of fetal fibronectin testing in Cape York have the potential to reduce aeromedical transfers for threatened preterm labour. Substantial inpatient and excess outpatient stays could be avoided with associated reduction in health system and social costs. Strategies to improve adherence to guidelines and increase access to testing are required.

Socio-economic composition of low-acuity paediatric presentation at a regional hospital emergency department.

Despite increasing rates of emergency department (ED) utilisation, little is known about low-acuity presentations in children ≤5 years. The aims of the study were to estimate the proportion and cost of low-acuity presentations in children ≤5 years presenting to the ED and to determine the relative effect of socio-economic status (SES) on paediatric low-acuity presentations at the ED. This is a retrospective observational study of children ≤5 years presenting to the Cairns Hospital ED over 4 years. A multivariate logistic regression model was used to assess the association between SES and low-acuity presentations. Cost of low-acuity presentations was calculated based on triage score and admission status, using costs obtained from the National Hospital Cost Data Collection. A total of 23 086 children were included in the study, of whom 56.7% were male (mean age = 1.85 ± 1.63 years). Approximately one-third of ED visits were low-acuity presentations (32.4%), and low-acuity presentations increased progressively with SES. In multivariate analysis, children from families with very high SES were twice as likely to have a low-acuity presentation (odds ratio 2.17; 95% confidence interval, 1.66-2.85). Low-acuity ED presentations cost the health-care system in excess of A$895 000-A$1 110 000 per year. These findings demonstrate that a significant proportion of paediatric ED visits are of low acuity and that these visits yield a substantial cost to the health system. Further research is required regarding care givers' rationale and potentially other reasons underlying these low-acuity ED presentations.

Medical students and midwives – How do they view each other?

Medical students from James Cook University who had completed their rotation in obstetrics, and midwives working in Cairns Hospital who had undertaken supervision of medical students in the birth suite, were invited to complete anonymous questionnaires on their views of their respective roles in the birth suite. Several issues were identified including increased medical and midwifery student numbers, and lack of communication between midwives and medical students. Increased cooperation and communication between medical and midwifery education providers is urgently needed to improve both student groups' learning experiences.

Enhancing perinatal and infant mental health through an innovative integrated and collaborative partnership

This paper reports on the outcomes of an intensive collaborative community-based perinatal and infant mental health (PIMH) Day Program designed to improve the emotional-social wellbeing of mothers with a moderate to severe mental illness and attachment to their infant. Coordinated by the Queensland Centre for Perinatal and Infant Mental Health, Child and Youth Mental Health, Children’s Health Queensland Hospital and Health Service, the program was delivered in 2016 to twenty six mother-infant dyads through an interagency partnership between adult mental health, child and youth mental health and community child health across two Hospital and Health Service sites in Queensland, Australia. The study resulted from recommendations of a pilot project conducted in Brisbane in 2009 . An infant’s developmental outcomes are predicated by their earliest attachment to their caregivers . It is estimated 40% to 60% of children whose parent has a mental illness are at risk to their mental wellbeing. With more than 16% of Australian women and 10% of fathers developing a perinatal mental illness, there is an identified gap in both the availability and flexibility of services to this vulnerable population. Evidence suggests that service delivery to perinatal mothers with complex mental health issues is typically ‘siloed’ and that treating maternal mental health alone does not improve outcomes for infants. The unique feature of the PIMH Day Program is the collaboration of three separate health services delivering one program to mothers and infants together. Cairns and Hinterland Hospital and Health Service (HHS) and Townsville HHS are two large regional cities located in north Queensland. Clinicians from adult mental health, child and youth mental health and child health from each HHS delivered three (3) six week (one day per week) perinatal and infant mental health programs between May to November 2016 through a collaborative and integrative methodology. Multidisciplinary clinicians from the three services worked together to deliver the program using a dedicated program manual. The intervention resulted in statistically significant improvements in pre-post quantitative measures relating to mother’s emotional-social wellbeing and infant attachment, positive feedback from self-report surveys on program elements, and engagement in post referral pathways. Clinicians reported high level satisfaction with the collaborative process, resource sharing and transfer of knowledge and skills. They support the intervention as a sustainable, effective and efficient model of service. The findings support the premise that interagency collaboration between health services brings about improved mental health outcomes for mothers with a mental illness and enhanced understanding and sensitivity to their infants. The study resulted in statistically significant results in both sites supporting the results of the 2009 study. This program demonstrates that collaboration, partnerships and integration across service boundaries and professional disciplines offers a promising opportunity to deliver a service that supports parenting and an infant’s emotional-social development. The Day Program translates across settings while building workforce capacity in perinatal and infant mental health.

Structural Heart Interventions in Far North Queensland: Feasibility and Safety in a Regional Centre

Background: With advancements in device technology and procedural techniques, structural heart intervention is becoming increasingly common. However, this has been largely limited to metropolitan centres, usually with on-site surgical backup. This study sought to assess the safety and outcomes of structural heart interventions at Cairns Hospital.