Regional Australian Centre Research Articles

PRISM study-Pre-natal iron deficiency screening and management within an Australian regional centre.

Current Australian guidelines differ in their recommendations on optimal iron deficiency anaemia screening and management during pregnancy. A more active approach to screening and treatment of iron deficiency in pregnancy has been beneficial within a tertiary population. However, this approach has not been evaluated within a regional healthcare setting. To evaluate the clinical impact of standardised screening and management for iron deficiency in pregnancy within a regional Australian centre. Single centre, retrospective cohort observational study that audited medical records pre and post implementation of standardised screening and management for antenatal iron deficiency. We compared rates of anaemia at birth, rates of peripartum blood transfusions and rates of peripartum iron infusions. There were 2773 participants with 1372 participants in the pre-implementation group and 1401 in the post-implementation group. Participant demographics were similar. Anaemia at admission for birth decreased from 35% to 30% (RR 0.87, 95% CI (0.75, 1.00), p 0.043) Fewer blood transfusions were required (16 (1.2%) pre-implementation, 6 (0.4%) post-implementation, RR 0.40, 95% CI(0.16, 0.99), p 0.048). Antenatal iron infusions increased from 12% to 18% of participants post implementation (RR 1.47, 95% CI(1.22, 1.76), p 〈0.001).We audited compliance with the guidelines and found improvements post implementation. This is the first study to show clinically useful and statistically significant reduction in rates of anaemia and blood transfusions, post implementation of routine ferritin screening and management within a regional Australian population. The results of this study suggest there is benefit to implementation of standardised ferritin screening and management packages in Australian antenatal care. It also encourages RANZCOG to review current recommendations on screening for iron deficiency anaemia during pregnancy.

Emergence delirium and caregiver anxiety: A non-existent link?

Emergence delirium (ED) is a common, transient uncooperative and disoriented state during the post-anaesthesia period. It is potentially dangerous for the child, and distressing for their caregivers and health staff. Numerous risk factors have been established, however the proposed link between increased preoperative caregiver anxiety and ED is yet to be demonstrated.This observational study aimed to determine the incidence of ED following tonsillectomy in Albury-Wodonga, a regional Australian centre, and establish whether there is a link between ED and caregiver anxiety.An ED incidence of 32.1% (95% CI 20.3–46.0%) was recorded. More significantly, no evidence of a link with caregiver anxiety could be detected. This result is contrary to expectation, and demonstrates the need for a further, much larger, investigation.

Experience and Outcomes of a Hybrid Reperfusion System of ST-Elevation Myocardial Infarction (STEMI) of a Regional Australian Centre.

While Primary Percutaneous Coronary Intervention (PCI) is the preferred method of managing STEMI, geographical barriers mean thrombolysis remains an important treatment modality in many regional Australian centres. In Coffs Harbour, Primary PCI for STEMI is offered during business hours, while thrombolysis, with rescue PCI if required, is the primary treatment strategy outside those times. We sought to describe our experience of managing STEMI using this hybrid reperfusion system in a regional Australian hospital.

774 30-day Safety and Effectiveness for Transcatheter Aortic Valve Implantation in a Regional Australian Centre

In the last 5 years, Australia has seen an exponential growth in the number of patients undergoing transcatheter aortic valve implantation (TAVI). Gold coast Hospital is a tertiary teaching regional hospital, which started TAVI service 2 years ago. In the current study we analysed the 30-day outcomes of the first 51 patients and compared it with the landmark Partner 2 trial. A prospective cohort analysis was performed on the first consecutive 51 patients who underwent TAVI (30 balloon-expandable and 21 self-expandable/ 3 subclavian and 48 femoral) at the GCUH and had completed 30 day clinical and imaging follow-up. Clinical characteristics and 30-day outcomes were compared with the landmark Partner 2 trial. Univariate analysis was performed to compare outcomes with the Partner 2 TAVI cohort. The average age of the patients was 82.2±7.3 years with 60% men. Two patients underwent emergency TAVI. The average STS score of 6.4±5.3 was slightly higher than the Partner 2 TAVI cohort (p=0.07). All patients had a successful TAVI as per the VARC definition with zero 30-day mortality. There was a significant improvement in the echo parameters at 30 days with only 4% of patients showing moderate + PVL. Only one vascular complication of pseudoaneurysm was noted. Other than the higher PPM rate most of the 30-day outcomes were similar or even better than Partner 2 TAVI cohort as shown in the figure 1. A successful TAVI program can be established in a regional centre by careful selection of patients.

Skilled Migrants and Negotiations: New Identities, Belonging, Home and Settlement

ABSTRACTIssues of identity, home and belonging underline most transnational and transmigrational experiences. Globally, there is increasing interest in issues related to the settlement of migrants; yet there is growing evidence on a quotidian basis that migrant settlement into a host country is not a smooth experience. Drawing on qualitative empirical work, involving a large cross section of ethnically diverse skilled migrants located in a regional Australian centre, this article explores the issue of settlement through considering how the concepts of identity, belonging, settlement and home are presented in narrative accounts from skilled migrants to Australia. Intersectional theoretical frameworks are used to explore migrants’ perceptions of identity, belonging and home in negotiating and realising their new settlement. This also helps highlight the differences in skilled and non-skilled experiences using visa status, gender, education, ethnicity and socio-economic status/class to conduct an intersectional analysis.

Prevalence of low anterior resection syndrome at a regional Australian centre.

With decreasing indication for abdominoperineal resection and an increase in sphincter preserving surgery, there is a growing population of patients who suffer from low anterior resection syndrome (LARS). The aim of this study is to use the LARS score to determine the prevalence of LARS at a regional centre in Australia and determine the effect of short- and long-course neoadjuvant therapy, anastomotic technique and interval from surgery will also be assessed. Patients who had undergone an anterior resection (high, low or ultralow) at a regional centre over an 11-year period were identified. Eligible patients were contacted to complete a LARS score questionnaire. Results were analysed to determine the rate of major LARS and possible causative roles of certain patient and treatment-related variables. A total of 64 of 76 patients (84%) returned completed questionnaires. The prevalence of major LARS was 37.5%. Short-course neoadjuvant therapy appeared to be more likely to be associated with major LARS compared to long course (odds ratio (OR) = 2.4, 95% confidence interval (CI) 0.37-15.3, P = 0.35); however, this did not reach statistical significance. Rates of major LARS appear to decrease slowly over time and J-pouch colonic anastomosis appears to be slightly protective against major LARS (OR = 0.7, 95% CI 0.12-3.9, P = 0.70); however, neither results were statistically significant. The rate of major LARS at this regional centre is 37.5%. Larger prospective multicentre studies are required to determine impact of variables such as type of neoadjuvant therapy, anastomotic techniques and progression of LARS over time.

Perinatal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Perinatal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Maternal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Maternal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Making sense of sound: Visceral sonic mapping as a research tool

This paper offers a contribution to ongoing discussions of the role of sound for producing geographical knowledge. It is argued that sound is an inherent component of critical research of emotions, society and space. Yet we note that there is a lack of practical advice as to how this might come about. In this paper we offer a methodological approach for the analysis of sound that we term visceral sonic mapping to help critical geographers progress enlivening geography through recent rethinking of ‘the body’. First, we provide a progress report to chart theoretical and methodological approaches to sound within geography and cognate disciplines. We then sketch a theoretical understanding of the visceral and our visceral sonic mapping. To demonstrate how this method might be productively put to use we draw on empirical material from a driving ethnography that was undertaken in a regional Australian centre from 2010 to 2011.

Teaching laparoscopic radical prostatectomy during the primary surgeon's early learning curve--analysis of our first 207 cases.

To assess the feasibility of introducing laparoscopic radical prostatectomy (LRP) training during the primary surgeon's early learning curve in a regional Australian centre. From a prospective single surgeon database perioperative, oncological and functional outcome data was collected from the first 207 consecutive patients who underwent LRP immediately after a 12-month LRP Fellowship in a high-volume centre by the primary surgeon (M.L.J.). A training case was defined as the successful completion of at least two of 10 steps by a training Fellow. Perioperative and oncological outcomes were compared in training and non-training cohorts and overall learning curve was assessed by comparing consecutive 50-patient cohorts. In all, 31% of cases were training cases with a median (range) of 7 (2-10) steps of 10 steps performed by the training Fellow. Operative times were significantly longer in training cases (mean 269 vs 209 min; P < 0.001). There was no statistically significant difference in perioperative outcomes of length of stay (2.7 vs 2.6 days), transfusion rates (3.1% vs 2.1%), major complication (Clavien >3a) rates (1.6% vs 2.1%) or positive surgical margins (PSMs: pT2 2.8% vs 15.3% and pT3 52.0% vs 45.1%) between training and non-training groups, respectively. Overall, there were two open conversions (1.0%). Despite the challenging learning curve, LRP training can be commenced safely with a stepwise modular approach, even when the primary surgeon is in their early learning curve. Perioperative outcomes including PSMs and major complications were unaffected by trainee involvement.

Radical nephrectomy and vena caval thrombectomy with the use of cardiopulmonary bypass

This study aimed to report on the experience of a single surgeon in a regional Australian centre with radical nephrectomy and vena caval thrombectomy with the use of cardiopulmonary bypass. Fifteen consecutive patients undergoing radical nephrectomy and vena caval thrombectomy with cardiopulmonary bypass over a 13-year period were identified. Retrospective analysis of prospectively collected data was used. Data were collected on intra-operative and pathological findings as well as post-operative complications. Oncological outcomes and long-term follow-up were analysed retrospectively in this study. All patients had a radical nephrectomy and vena caval thrombectomy with cardiopulmonary bypass. The median operating time was 336 min (mean 326.1 min), and median transfusion of packed red blood cells was 8 units (mean 6.9). The median bypass time was 107 min (mean 112.3 min), and the median circulation arrest time was 25 min (mean 25.3 min). Median length of hospital stay was 11 days (mean 14.5 days). Minor complications were seen in two patients and major complications seen in six, with one intra-operative death. Disease recurrence was seen in 1 of 14 patients who were considered completely resected at the time of operation. The overall 5-year survival rate was 84%. Median follow-up was 32 months (range 0-158). Median survival time was 135 months. Radical nephrectomy with caval thrombectomy with cardiopulmonary bypass can be performed in a regional centre with acceptable post-operative morbidity and mortality. Long-term survival is possible in some patients.

Laparoscopic Pyeloplasty: An Initial Experience From A Regional Centre In Rural Australia.

Open dismembered pyeloplasty is the current gold standard in the treatment of Pelviureteric Junction Obstruction (PUJO). However, laparoscopic pyeloplasty has been increasingly reported in the literature as a technique with equal efficacy. Additionally, laparoscopic surgery offers the advantage of being minimally invasive, which may result in less post-operative pain and shorter hospital stays. However, the availability of laparoscopic pyeloplasty is limited by the considerable learning curve required. We present our case series of 9 patients who underwent laparoscopic pyeloplasty at a regional centre. Average operating time was 159 minutes (117-192 mins) and median length of stay was 4 days (3-7 days). There were no conversions to an open procedure. There were no major complications noted. Additionally, 88.9% (8 out of 9) patients had complete alleviation of pain. Our case series represents the experience of a single urological surgeon working at a regional Australian centre and is comparable to that of other series in terms of mean operating times, conversion rates, median nights in hospital and success rates. Potential limitations include the low number of cases. Regardless, our series demonstrates that laparoscopic pyeloplasty is a safe and effective treatment in a regional centre.

Identity, uncertainty and responsibility: privileging place in a risk society

That young people today reside within social worlds of unprecedented ‘risk’ is a persuasive position. While such discourses have become increasingly pervasive, there has been little interest in exploring contemporary shifts within specific socio-geographic contexts: place has been largely invisible. This paper considers Ulrich Beck's ‘risk society’ theses as a framework for exploring the experiences of 85 young residents of a regional Australian centre. These young people's stories revealed complex and often contradictory, tensions in relation to identity, uncertainty and responsibility. Socio-geographic location was found to be a significant feature in the negotiation and repercussion of these young people's lives.

Attitudes to a Non-viable Community-owned Heritage Tourist Attraction

This paper reports on a study of community attitudes to a publicly owned heritage tourism attraction in a regional Australian centre. The attraction, an authentic reproduction of a 19th-century riverboat, was built as an Australian bicentennial project in 1988, with the aim of her becoming the region's primary tourism attraction. However, over the years it has proved to be a non-viable attraction, requiring an ongoing council subsidy of up to $A200,000 per year to keep it operational. The council is under strong pressure to divest itself of the vessel, which will mean its closure and likely removal from the community. The study found strong support for council retention and continued subsidisation of its operations. However, the study also raises questions about the efficacy of community involvement in the decision-making process. In this instance, emotional attachment to the attraction, rather than a rational assessment of its future, drives community attitudes.

Psychological symptoms in rural road trauma victims.

There is limited research into the psychological aftermath for people who have experienced road accidents, especially outside major cities. This study by postal survey used the General Health Questionnaire-28, the Impact of Events Scale, the Post-Traumatic Stress Disorder Interview, and the Late Effects of Accidental Injury Questionnaire to assess the psychological effects on a sample of 80 people who had attended a hospital in a regional Australian centre following road accidents. Results showed that there were marked effects on many people and that these had not always been diagnosed or treated.