Regional NSW Research Articles

EP.17B.01 Timelines of Lung Cancer Pathway in Rural and Regional NSW; A Retrospective Study in Hunter New England LHD

EP.17B.01 Timelines of Lung Cancer Pathway in Rural and Regional NSW; A Retrospective Study in Hunter New England LHD

Age-Adjusted Rate of Transcatheter Aortic Valve Implantation is Lower for Patients Residing in Regional NSW: A Statewide Cohort Study in 3,562 Patients

Age-Adjusted Rate of Transcatheter Aortic Valve Implantation is Lower for Patients Residing in Regional NSW: A Statewide Cohort Study in 3,562 Patients

Trends in Acute Pulmonary Embolism Admissions and Mortality Across Metropolitan, Regional and Remote NSW from 2001–2021: A Retrospective Statewide Population-Linkage Cohort Study

Trends in Acute Pulmonary Embolism Admissions and Mortality Across Metropolitan, Regional and Remote NSW from 2001–2021: A Retrospective Statewide Population-Linkage Cohort Study

The seroprevalence of antibodies to Japanese encephalitis virus in five New South Wales towns at high risk of infection, 2022: a cross-sectional serosurvey.

To determine the proportion of people in New South Wales towns at high risk of Japanese encephalitis virus (JEV) infections during the 2022 outbreak; to identify risk factors for JEV infection. Cross-sectional serosurvey study of the seroprevalence of JEV-specific antibodies in NSW. Convenience sample of people (all ages) from five regional NSW towns deemed to be at high risk of JEV infections after first outbreak of Japanese encephalitis in southeastern Australia in early 2022 (Balranald, Corowa, Dubbo, Griffith, Temora), 21 June - 22 July 2022. Proportion of people seropositive for JEV total antibody, assayed by defined epitope-blocking enzyme-linked immunosorbent assay; prevalence odds ratios for exposure risk factors and protective behaviours. Eighty of 917 eligible participants (559 girls or women, 61%; 42 Aboriginal and Torres Strait Islander people, 4.6%; median age, 52 years [IQR, 37-62 years]) were seropositive for JEV-specific total antibody (8.7%); the median age of seropositive people was 61 years (IQR, 48-70 years). The seropositivity proportion was largest for people aged 65 years or more (30 of 192; weighted proportion, 13.7%) and larger for male than female participants (30 of 358, 10.6% v 50 of 559, 7.5%). Five of 42 samples from Aboriginal and Torres Strait Islander participants were seropositive (12%). We found mixed associations with a range of potential risk factors. We found evidence for a substantial number of JEV infections in five regional NSW towns during a single arbovirus season in 2022. Public health responses, including effective surveillance, vaccination against JEV, and mosquito management, are critical for controlling outbreaks. Promoting behaviours that reduce exposure to mosquitoes is a core component of prevention, particularly when the vaccine supply is limited.

SPARC - A multi-disciplinary team program for retroperitoneal sarcoma: the Royal Prince Alfred Hospital and Chris O'Brien Lifehouse Collaboration.

The Royal Prince Alfred Hospital (RPAH) and Chris O'Brien Lifehouse (COBLH) established a formal Sarcoma of the Pelvic and Abdominal Retroperitoneum Collaboration (SPARC) in November 2020. An established multidisciplinary team (MDT) with the aims to centralise patient referrals and treatment, establish database and research, coordinate surgical resections is critical in improving patient outcomes and quality of life. A prospective database was established in October 2021. Clinical, pathological and radiological data points were recorded for all patients since the inception of SPARC. Quality of Life questionnaires were included and follow-up planned regularly for 5 years. From November 2020 to Feb 2024, 294 new referrals were discussed at the MDT meeting. Majority were from the metropolitan area (182) followed by regional NSW (87), interstate (20) and five internationals. 141 operations were performed during this period compared to 119 operations from 2010 to November 2020 in RPAH. The inception of the SPARC program has resulted in exponential growth in operations, improving from the previous rate of 15 cases annually to 35. Liposarcomas followed by leiomyosarcomas are the most common types of sarcomas resected. The majority were extended resections (81.6%) and 22% were pelvic exenterations. Overall R0 rate is 54.6%, R1 38.3% and R2 1.4% (131 (92.9%) had R0/R1 resections. Overall complication rate is 35.5% with one in-hospital mortality. Success and expansion of a robust retroperitoneal sarcoma program requires a collaborative surgical approach, an MDT meeting, centralized referral process, and a research team in specialized tertiary institutions.

The Evolving Role of Aged Care Managers in Australia: A content analysis of aged care manager job descriptions

The Evolving Role of Aged Care Managers in Australia: A content analysis of aged care manager job descriptions

Price, social life and proximity influence food choices: Engaging young people as co-researcher collaborators to better understand their surrounding school food environments

Food environments around secondary schools are a strong influence on adolescents’ food purchasing habits1. We conducted a repeat cross-sectional study using Google Street View to examine school food environments in regional and metropolitan NSW, Australia over 17-years. Findings showed that unhealthful food outlets such as fast-food franchises, consistently dominated school food environments over 2007-2023. Increasing levels of poor nutrition among youth has been raised as a concern2 by the Health Advisory Panel for Youth at the University of Sydney [HAPYUS] - an established group of 16 adolescents aged 13-18 years residing in NSW3. To gain further insight into the study findings and how it may impact adolescents’ health, it is critical to include voices of adolescents in this research. The aim of this sub-study was to engage with members of our youth advisory group and conduct a consultation exercise on these study findings, drawing upon their lived experiences of school food environments. In Aug-2023, we engaged four youth advisors from HAPYUS. Study authors provided an overview of the study and its findings to the youth advisors via a Zoom call. Youth advisors formulated a 500-word statement on their perspectives and lived experiences of food environments surrounding their high schools over the subsequent 4 weeks. Adolescents agreed that physical proximity to unhealthy food outlets around schools was a key contributor to unhealthy eating habits however also recognised social and economic factors which play a significant role in shaping poor diets. The following quotes from their combined statement reflect social and economic concerns: i) “[We] observed on a daily basis young people were opting to travel to the closest food court for fast food, or in some extreme cases, even order fast food via a meal delivery app, to be delivered to the school - as opposed to choosing the closest outlet” ii) “Overpriced foods in schools with some drinks costing 2x more than a heavily discounted KFC meal, no meaningful difference between foods sold at canteens and those sold at fast food outlets - heavily processed, packaged snacks, pre-made reheated foods” iii) “Most unhealthy food outlets choose a location that is not only close to schools but also close to major shopping centres and food courts… ideal for an after-school social catchup as it appears to accommodate the needs of a large group of people.” Consultation findings revealed the importance of social and economic factors that must be analysed in addition to adolescents’ physical proximity to food outlets around their schools. Youth advisors call for governments to take immediate action to implement policies that ensure schools have cheap and healthy foods at canteens to mitigate against the purchase of foods from nearby unhealthy food outlets.

‘There seems to be some disparity then between our Syrian and Iraqi refugee children who seemed to have everything’: Constructing ‘good refugees’ and the ensuing equity issues in Australian schools

Abstract Australia took double the normal intake of refugees over 2015–17. On top of the usual humanitarian intake were refugees specifically from Syria and Iraq who were mostly Christian and were settled in metropolitan and regional NSW, Queensland, and Victoria. This article explores the responses of teachers in some of the schools where this cohort was settled. Using Critical Discourse Analysis, it argues that for the Australian population to accept this doubling of humanitarian migration it was important to ensure they were perceived as ‘good refugees’ in a discursive climate shaped by anti-Muslim, anti-refugee and anti-asylum seeker rhetoric. The insights provided in this article aim to support the educational needs and well-being of all refugee students by revealing how discursive positioning can lead to practices and processes of inclusion while simultaneously being exclusionary.

‘DANMM that’s good!’: evaluating the feasibility and acceptability of the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Programme across rural, regional and metropolitan NSW–a collaborative study protocol

IntroductionThis paper will describe the research protocol for the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Project, which will determine the feasibility and acceptability of a...

Exploration of Patient and Clinician Experience of Video Consultations in Community Palliative Care

ContextTelehealth video consultations (VCs) were implemented in the community palliative care team (CPCT) in a regional NSW health district, Australia, as a response to restrictions to the COVID-19 pandemic, using patient's device in the absence of a clinician. ObjectivesTo evaluate patient/carer and clinician satisfaction in using VCs for CPC consultations; to explore advantages and challenges of VCs. MethodsSelf-reported online questionnaires to community-dwelling patients under care of the CPCT; seeking patients/carers and clinician perspectives on the VCs from April to September 2020. ResultsOf 126 eSurveys completed, (85 clinicians; 41 patients/carers), 97% patient/carers and 97% clinicians indicated they were satisfied with VC. Overall, 93% clinicians agreed they provided same level of care compared to face-to-face review; 85% patients/carers agreed they received same level of care compared to face-to-face consultations and 98% agreed their issues were addressed. Of eSurvey responses 97% clinicians and 78% patients/carers indicated they would continue to use VCs in practice. Comments indicated dissatisfaction with lack of personal examination; some found technological issues to be barriers. Benefits discovered incidentally were empowering patient independence to live out their end-of-life desires while being treated/supported, improved service delivery, increased staff autonomy and upskilling staff. ConclusionUsers in this study perceived VCs to have a place in CPC consultations. Using patient device enabled patient freedom, improved timeliness of clinical assessment, and communication to complement face-to-face consults, while minimizing infection risk. Unexpected, but valuable benefits were revealed. Workable technology is paramount.

Sexual and Reproductive Health Service Access among Aboriginal and Torres Strait Islander Young People in Regional NSW, Australia

Owing to the historical and ongoing impacts of colonisation, there is a large health equity gap in sexual and reproductive health (SRH) outcomes between Aboriginal and Torres Strait Islander peoples and non‐Indigenous populations. Whilst qualitative research has identified the barriers and enablers to sexual healthcare engagement among young Aboriginal and Torres Strait Islander people in remote settings, little is known about the ways in which young people navigate sexual healthcare in a regional setting. This study aims to address this gap. Sixty‐five young (aged 15–29) Aboriginal and Torres Strait Islander people participated in semistructured interviews across three regional communities in New South Wales, Australia. The candidacy framework informed this analysis. A large proportion of participants expressed having agency and resources to attend health services for SRH needs (primarily STI testing and contraception). Women in particular described being supported by social networks to access SRH services. Male participants were less likely to identify their own candidacy for healthcare. Services that were culturally safe and had trustworthy, nonjudgemental staff and a feeling of community were easier to access (more permeable). Factors that decreased accessibility were confidentiality concerns, difficulty making appointments, and lack of visibility of services, or what they offer. Using the candidacy framework, this study identified the importance of culturally safe service provision, reducing barriers to accessing appointments and the provision of nonjudgemental care in engaging young Aboriginal and Torres Strait Islander people in SRH care. This study also highlighted the various strategies and actions that young Aboriginal and Torres Strait Islander people are already taking to protect their sexual health and that of their partners.

Clinicians’ Evaluation of Lung Cancer Clinical Quality Indicators and Comparative Performance Data in Practice

Objective. Lung cancer is commonly diagnosed and is the leading cause of cancer-related death, morbidity, and burden of disease globally. There is an ongoing need to ensure patients receive optimal evidence-based care and to identify and reduce unwarranted clinical variation to achieve best possible outcomes. The EnRICH program has developed evidence-based clinical quality indicators to measure processes and outcomes of lung cancer care, and a feedback dashboard to report comparative performance data, which highlight variation in both care and outcomes. The aims of this study were to evaluate the acceptability and utility of the quality indicators and feedback dashboard and identify benchmarks for performance monitoring and priorities for future quality improvement interventions to address observed clinical variation. Method. Clinicians from lung cancer multidisciplinary teams (MDTs) at six tertiary clinical sites across regional and metropolitan NSW were invited to participate in evaluation interviews. Interviews were conducted via videoconference and recorded with consent. Data were analysed thematically using framework methods. Results. Thirteen clinicians participated in interviews, with representation from each clinical site and specialty. All participants considered the quality indicators to be clinically meaningful. Three main themes were identified: (i) the importance of timely, local, quality data; (ii) implementable versus nonimplementable clinical practice changes; and (iii) the need for ongoing performance monitoring. Clinicians prioritised two areas of unwarranted clinical variation that could be immediately addressed through easily implementable quality improvement interventions to positively impact patient care: (i) a process to ensure that all stage III patients are discussed by a multidisciplinary team prior to commencing treatment; (ii) a referral pathway to palliative care within eight weeks for patients diagnosed with stage IV disease. The importance of lung cancer nurse specialists for improved care coordination was highlighted. Conclusion. Clinicians would like to continue to receive close-to-real-time quality data for ongoing performance monitoring to identify and address unwarranted clinical variation.

Refurbishment of a vacated office building to provide high-performance music teaching and performance facilities in regional NSW

In 2016, a Conservatorium of Music made a significant decision to move their music teaching and performance facilities, to a nearby vacated building situated 3km away. From the outset, the move presented the design team to deliver a state-of-the-art Conservatorium of Music, with several challenges due to the spatial and building constraints. Among the most notable of these challenges was the limited volume within the existing building which is an essential requirement for optimal music performance spaces. This paper outlines the users' expectations—which were gathered through an acoustic questionnaire, design process, details the specific challenges faced by the design team, and presents the design solutions devised to overcome these problems. The Conservatorium of Music opened in early 2023 and has been well received by users and audiences.

Australia's political engagement on health and climate change: the MJA-Lancet Countdown indicator and implications for the future.

Australia's political engagement on health and climate change: the MJA-Lancet Countdown indicator and implications for the future.

Retrospective audit on synovial fluid samples analysis over 5 years in two regional and a metropolitan microbiology laboratories

Introduction: Synovial fluid microscopic analysis is a highly specialised test requiring expert training to recognise distinct types of crystal morphology. It cannot be automated, and accuracy depends on experience. Methodology: In this 5-year retrospective study, we have evaluated 1,664 synovial fluid samples belonging to 1,294 patients. The microscopic exam was undertaken by two metropolitan and regional NSW microbiology laboratories. Results: Most (58%) of samples were from Emergency Departments. Most common samples were knee (59%), elbow (7%), ankle (7%), shoulder (6%), hip (5%), wrist (4%), followed by 1% each from fingers, toes, and bursae, while 9% samples were not specified. Crystals were present in 283/1664 (9%) of samples analysed. Uric acid (10%) was the most common analyte present followed by calcium pyrophosphate (5%), while 2% of analysed samples contained both crystal types. Conclusion: Data on synovial fluid crystal analysis provide some insights regarding aetiology of crystal arthropathies in the Nepean Blue Mountains Local Health District and Great-Western NSW area.

Adapting Fingerprints Within the NSW Police Force: An Historical Examination of the Geographical Barriers and Implications for Rural and Regional Policing

In the 1890s and 1900s, societies in Western nations, and in particular densely populated cities like London and Paris, became overtly concerned with the need to identify ‘habitual criminals’. In response, in 1903, NSW became the first Australian state to develop a designated fingerprint section or bureau within their police force, which, following international trends, was very much focused on metropolitan NSW. According to Cauchi and Knepper (2009), fingerprint technology as a form of criminal identification “was the mark of cosmopolitan police organization” (p. 74). Criminal identification was principally identified as a problem in the rapidly growing cities, and thus, fingerprinting resources were directed to those areas. As a result, for the first few decades of use, fingerprint identification in rural and regional areas was limited. For example, only officers in metropolitan NSW were trained in fingerprint identification and comparison methods, and police around regional NSW were expected to take finger-print exhibits to metropolitan areas for analysis. The limitations in technology available during the initial period of fingerprinting resulted in regional NSW police facing more barriers to the use of fingerprint identification technology than their metropolitan counterparts. To understand these barriers and the limitations of fingerprinting in rural areas, this paper explores the initial introduction of fingerprinting into the NSW Police system from 1903-1930, focusing upon the challenges and barriers experienced by regional police agencies in using what is now one of the most common forensic identification tools available to police worldwide.

A study of uropathogenic Escherichia coli from men in regional NSW (Australia) with special emphasis on antibiotic resistance

Background: Escherichia coli is an important uropathogen, responsible for most urinary tract infections (UTIs). Most studies on E. coli UTI pathogenesis have been in females, with limited studies on urinary isolates from men. Understanding UTI epidemiology in men is important in UTI management in this gender, including formulation of empirical treatment guidelines. Methods: We studied the distribution of 310 uropathogenic E. coli isolates from men by uro-clinical syndrome, hospitalisation status, age group, and antibiotic susceptibility. Results: Most of the E. coli isolates were from the outpatient setting (189, 61%), with the various age groups generally evenly distributed. In the inpatient setting, the 0-10 years age group was not represented, and the remaining 3 age groups were evenly represented (22-27%). Most of the isolates (74%) were from cystitis cases. For pyelonephritis isolates, the majority (65%) were confined to the 21-40 years age group, and the least in the 11-20 years age group (12%). Antibiotic (and multidrug) resistance was higher in pyelonephritis vs. cystitis isolates (73% vs. 58% ; P = 0.023, for multidrug resistance). Overall, antibiotic resistance differed significantly by age; highest in the 21-40 years age range (69%), and lowest in the 0-10 years group (39%). Likewise, ESBL production was highest in the 21-40 years age range (10%), and lowest in the 0-10 years age (0%). Conclusion: We documented a significant difference in the distribution of antibiotic resistance by age group amongst UPEC isolates from men in regional NSW, Australia, in the 0-60 years age group.

Hepatitis C virus monitoring in inpatient psychiatry: Doctors' practice.

Current guidelines recommend routine Hepatitis C virus (HCV) monitoring in people with serious mental illness. We sought to determine the rates at which doctors practising in inpatient psychiatry units monitor the HCV exposure risk and HCV infection status of their patients. Electronic medical records (EMRs) of 50 short stay and 50 long stay mental health inpatients of a regional NSW hospital were retrospectively audited to determine the rates at which doctors screened for HCV and associated risk factors. Chi-squared analysis and Fisher's exact test were performed to compare the two groups. Screening rates for HCV-associated risk factors varied according to the specific risk factor explored (prior incarceration 61%; intravenous drug use 55%; and tattoos/piercings 6%). Of 30 patients identified as having at least one HCV-associated risk factor, only 27% (n = 8) were tested for HCV during their admission, and the likelihood of testing was significantly higher in the long stay group. HCV infection status was documented for only one-third (34%) of patients. There is significant scope for improvement in assessing HCV status and exposure risk in this setting. Improved awareness among mental health professionals as to the higher incidence of HCV in this population could elicit more widespread monitoring.

Possible step-up in prevalence for Escherichia coli ST131 from fecal to clinical isolates: inferred virulence potential comparative studies within phylogenetic group B2

BackgroundEscherichia coli sequence type (ST)131 is an important urinary tract pathogen, and is responsible for considerable healthcare-associated problems and costs worldwide. A better understanding of the factors that contribute to its rapid worldwide spread may help in arresting its continual spread. We studied a large collection of fecal and urinary E. coli ST131 and E. coli non-ST131 phylogenetic group B2 isolates, from women, men and children, in regional NSW, Australia.ResultsWe found out that there was a step up in ST131 prevalence (and possibly in virulence) from fecal to clinical (urinary) isolates in general, and specifically among ciprofloxacin resistant isolates, in the 3 host groups. Furthermore, our results revealed that the inferred virulence potential of the ST131 isolates (as measured by VF gene scores) was much higher than that of non-ST131 phylogenetic group B2 isolates, and this was much more pronounced amongst the urinary isolates. This finding suggests presence of possible E. coli phylogenetic B2 subgroups with varying levels of virulence, with ST131 being much more virulent compared to others. A strong association between ST131 and fluoroquinolone (FQ) resistance was also demonstrated, suggesting that FQ use is related to ST131 emergence and spread. Specifically, about 77% of ST131 isolates from women and men, and 47% from children, were extended spectrum β- lactamase (ESBL) producers. Moreover, FQ resistant ST131 ESBL isolates on average harbored more VF genes than all other isolates.ConclusionsThe strong association between ST131 prevalence and FQ resistance amongst the studied isolates suggests that FQ use is related to ST131 emergence and spread. Furthermore, our results demonstrate that FQ resistance and a plurality of VF genes can exist together in ST131, something that has traditionally been regarded as being inversely related. This may partly contribute to the emergence and worldwide spread of ST131.

Supporting students with complex needs living in rural and regional New South Wales: is wraparound the answer?

Historically, students attending school in rural and regional New South Wales have experienced poorer outcomes than their peers attending metropolitan schools. The lack of coordinated support services for students with complex support needs compounds this issue. Wraparound models of support have been successful in improving outcomes for students with complex support needs, and the New South Wales government has prioritised the establishment of strong relationships between schools and communities to overcome the limitations of geographic isolation. The aim of the current study was to explore wraparound support for students with complex support needs attending schools in rural and regional New South Wales. A qualitative research approach was employed, and semi-structured interviews were conducted with key stakeholders to gain an in-depth understanding of current successes, barriers, and needs. The findings indicated that wraparound was most effective in rural and remote schools when school staff implemented bespoke approaches to wraparound, such as restorative practices. Resourcing was a barrier found to be central to all schools. Recommendations are provided to enhance the capacity of rural and regional NSW schools to provide wraparound support for students with complex support needs.