Remote Queensland Research Articles

Rapid evidence assessment of student-assisted assessment and brief intervention clinics: Addressing the gaps in rural and remote health care.

With high disease and disability burden in rural and remote regions, student-assisted clinics can be an effective workforce development tool to meet community health needs and workforce shortages. This research sought to identify the conditions under which student-assisted clinics can be successfully utilised as a workforce development strategy, with specific application to remote Queensland, Australia. A rapid review of the international literature in English was conducted. This was the most appropriate type of review because the results of the review were time-sensitive, with the student-assisted clinic model being trialled in Queensland soon. A mixed methods design was applied, with the search strategy piloted with one database. Eleven studies met the inclusion criteria. Seven reported data on participant experiences, including consumers, students, services/clinics, and educators/supervisors/health professionals. Each of the studies operationalised student-assisted clinics through practice models (university-driven learning need), service delivery models (service driven need addressed through a student workforce), community need models (student delivered services primarily addressing a community health need), and blended models (practice need and community need). Some studies reported concerns about fragmentation of services, referral pathways and issues with follow-up, while others reported concerns about sustainable funding. All models reported successful outcomes when focused on service or consumer health outcomes, or student learning outcomes. Student-assisted clinics make an important contribution to the development of the rural and remote health workforce. Student-assisted clinics can complement and extend existing services, supporting workforce development in an overstretched health system impacted by an ongoing pandemic.

Nasal high flow therapy in remote hospitals: guideline development using a modified Delphi technique.

In remote Australian hospitals there are no onsite paediatric intensive care units (PICUs), increasing the reliance on aeromedical retrieval to access tertiary care. Nasal high flow (NHF) therapy is an oxygen therapy used in tertiary hospitals to treat paediatric patients with respiratory conditions. In rural and remote Queensland, Australia, the use of NHF therapy is inconsistent and there are no guidelines on how this therapy should be implemented in practice. Therefore, three remote hospitals within the Torres Strait and Cape York commenced a project to improve consistent and equitable access to NHF therapy. Implementing NHF therapy in remote hospitals may improve health and social outcomes for children with acute respiratory distress. A clinical guideline for the use of NHF therapy in the three participating remote hospitals was published on 28 October 2021. This study aimed to develop a clinical guideline for the use of NHF therapy in three remote hospitals. A modified Delphi technique was used to develop the guideline. Remote medicine and nursing clinicians at the three study sites, retrieval experts, a receiving tertiary-based paediatrician, PICU specialists and NHF therapy experts made up the expert panel of participants. These experts participated in an iterative round table discussion to develop remote-specific guidelines for the use of NHF therapy. Prior to the meeting, panellists were provided with an executive summary of the current literature on NHF therapy implementation with key questions for consideration. Participants were able to add relevant issues ad hoc. A final guideline representing the panellists' recommendations was submitted to the Torres and Cape Health Service for ratification. Remote-specific decisions on the following topics were produced: environment of care, nasogastric tube usage, timings of chest X-ray, automatic approvals to arrange courier services for pathology, medication use, staff training; staff ratios, observations regimes, both tertiary and local medical consultation frequency and the experience level of the medical officer required to attend to these consultations, location of the on-call medical officer, documentation, escalation of care considerations and disposition of the patient in relation to retrievals. Decisions were made to mitigate two highly representative remote factors: delays in the workplace practices, such as time to arrange treatment locally and delays in retrievals; and burden of the lack of access to services, such as lack of access to trained staff, staffing levels on-shift, adequate oxygen and equipment/consumable supplies. The aim was to develop a clinical guideline that was contextualised to the remote hospital. This outcome was achieved by using a modified Delphi technique, with a panel of experts providing the decision-making for the guideline. Consistency and safety were addressed by reducing delays in workplace practices; examples were time to arrange treatment locally and mitigate delays in an unknown time to retrievals, access to trained staff, staffing levels, and communication between remote and tertiary teams.

P034 An economic evaluation comparing the provision of sleep disorder services via a regional hub-and-spoke model of care to standard care in a metropolitan tertiary hospital

Abstract Introduction A new hub-and-spoke model of care (New-MOC) was introduced in a very remote Queensland region for the management of Obstructive Sleep Apnoea. Standard Care required travel and admission to a major metropolitan hospital. The aims were to increase access to services and ensure the New-MOC was cost-effective for sustainability. Method A cost-utility evaluation was performed from the health service perspective. Administrative and clinical data was collected in the 2-years prior and 1-year post implementation of the New-MOC to compare costs and outcomes. Base-case was modelled using decision tree analysis for a hypothetical cohort of 100 patients over a time horizon that captured 12-months of treatment. One-way sensitivity analyses were performed to evaluate uncertainty of inputs in which a) all costs were adjusted to upper bound b) set up costs were added and c) QALYs were reduced in the New-MOC. Results Under base-case the New-MOC was dominant and projected to save $226,511 of health service costs over 1.2 years and result 0.488 QALYs gained compared Standard Care. The New-MOC remained cost effective under all scenarios modelled. Discussion Whilst the New-MOC was cost effective, primary source data was only available up to diagnosis and therefore modelling relied on assumption around outcomes. Follow-up of patients in relation to treatment compliance would improve the accuracy of the model as would applying a lifetime horizon to capture all outcomes for a chronic condition. However, sufficient evidence exists to support the New-MOC as cost saving and cost-effective. Acknowledgement supported by a Metro North LINK Grant

Less than idyllic: Crime specialization in rural and remote Queensland, Australia

Rural areas have long been considered bastions of community safety and cohesion. However, recent research in rural criminology has demonstrated the heterogeneity of crime and safety in rural areas. In areas like Australia and Canada, crime rates in rural communities often surpass those of their urban counterparts. However, many have critiqued this as a denominator effect, emphasizing that a small number of events will produce a higher rate of crime when the population is low. In 2014, Carleton and colleagues examined crime in British Columbia, Canada and found that, by using the location quotient, a measure of crime specialization, rural areas indeed specialized in violent crime, but urban areas specialized in property crime. The current study replicates and extends this strategy in Queensland, Australia, to determine if these findings are representative in the international context, examining these differences across five diverse area types (highly accessible, accessible, moderately accessible, remote, and very remote), and then determining specifically which types of crimes are driving violent and property crime specialization. In addition, this study also explores social disorder, as it accounts for a large proportion of police activity. As such, this study offers a more extensive and specified understanding of crime patterns along the rural/urban divide.

Delivering Care to Regional and Remote Queensland: Development of a Web-Based Clinical Tool to Plan and Manage Cardiac Outreach Through the Queensland Cardiac Outcomes Registry

Delivering Care to Regional and Remote Queensland: Development of a Web-Based Clinical Tool to Plan and Manage Cardiac Outreach Through the Queensland Cardiac Outcomes Registry

CONNECTING IN CAPE YORK: EXPLORING DIGITAL INCLUSION AND ACCESS FOR LOW INCOME INDIGENOUS FAMILIES

Our presentation will discuss how our team of Indigenous and non-Indigenous developed a unique Indigenous research methodology to increase understanding of the digital inclusion challenges faced by low income Indigenous families living on Mornington Island, a remote Aboriginal community in remote Queensland, Australia. We discuss our methodology and findings of how low income Mornington Island Aboriginal families use the internet to access government and social services, education, e-health and e-commerce. This project employs Indigenous methodologies including yarning, participant photography, and co-design workshops to inform policies, practices and programs. Our results are interpreted within the growing body of decolonizing methodologies and Indigenous research, methods and methodologies. Informed by Martin’s (2009) Relatedness Theory, our data is considered through Aboriginal ways of being, doing and knowing, with Aboriginal axiology, epistemology and ontology forming a window through which we observe, analyse and interpret data. In this presentation, we will discuss how we as a blended research team: • facilitated Indigenous involvement in the research (starting with the development of the research concept and design) • engaged strongly with with Indigenous research and literature, both academic and community-based to interpret data and findings • engaged with and developed Indigenous methodologies to ensure the effectiveness and appropriateness of this research and • represented Indigenous authors and voices in analysis and communication of research results

Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross-sectional study.

To compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community. Three cross-sectional screening surveys, 2019-2021, complemented by laboratory pathology testing. Small community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists. Children aged 1-14 years; opportunistic screening of people aged 15 years or more. Prevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein. During the three surveys, 73 examinations of 58 children aged 1-4 years, 309 of 171 aged 5-9 years, and 142 of 105 aged 10-14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation-follicular were identified in 5-9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10-14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15 years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1-9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies. Despite the prevalence of clinical signs consistent with trachomatous inflammation-follicular among 5-9-year-old children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.

The quality of life of regional and remote cancer caregivers in Australia.

ObjectiveThis study compares the well‐being of rural caregivers with that of the general population and explores the potential drivers of poorer outcomes.MethodPatient–caregiver dyads (n = 241) residing in regional or remote Queensland, Australia, reported on QoL, chronic illness, caregiver burden, depression, anxiety and stress. Caregiver outcomes were compared with population norms and patient outcomes. Multiple regressions were conducted to identify factors associated with poorer caregiver outcomes.ResultsCaregivers reported lower mental health‐related QoL (M = 0.436, 95% CI = 0.410–0.462) in comparison with age‐matched population norms (M = 0.556, 95% CI = 0.532–0.580). No differences existed between caregiver and population norms for anxiety, stress and depression. Caregiver chronic illness and higher burden were associated with poorer mental and physical QoL, depression, anxiety and stress (η 2s ranging from 0.03 to 0.30). These associations were slightly stronger for male caregivers when compared with female caregivers (η 2s ranging from 0.03 to 0.08).ConclusionIt is vital that efforts are made to improve rural caregivers' mental and emotional well‐being. Interventions that support caregivers with chronic conditions reduce caregiver burden and take into consideration the unique experience of male caregivers will go some way to addressing this. Future research is needed to identify other drivers of health outcomes in this group.

Access to imaging investigation and neurosurgical care is delayed in regional Queensland for paediatric primary brain tumours

Central nervous system tumours are the leading oncology cause of paediatric mortality. The aim of this research was to identify stages within the diagnostic process of a primary paediatric brain tumour that could be improved resulting in better outcomes. MethodsThe electronic medical records of Queensland Children’s Hospital patients with central nervous system tumours between the 17/12/2014 till 11/12/2019 were retrospectively accessed. Time intervals of symptom onset to first medical review,location, time till medical imaging,subspecialty or neurosurgical review, timing of surgery, diagnosis and mortality status were recorded then analysed. ResultsA total of 168 patients were included. Mean age to 7.5, 65% male, with pilocytic astrocytoma representing 31%. 71.4% of the population were from a major city as determined by Remoteness Area classification, ABS, with 19% inner regional and 9.5% being outer regional and remote. The average time from first medical review to diagnostic imaging was significantly different when comparing remoteness classification (p = 0.044). There was also a statistically significant difference in the duration of time from medical imaging to specialist review comparing major city and outer regional/remote (p = 0.016) and inner regional versus outer regional/remote areas (p = 0.026). ConclusionsDelays in imaging in outer regional and remote Queensland are contributing to a delay in diagnosis and intervention in paediatric brain tumours. Service provision for neurosurgery in outer regional and remote Queensland is currently on par with inner regional and city areas. Suspicion of paediatric brain tumours is needed with clear referral pathways for general practitioners to access diagnostic imaging.

Delivering inflammatory bowel disease care across distance.

BackgroundInflammatory bowel disease (IBD) patients living in regional or remote Queensland are often disadvantaged by limited access to IBD specialist care. Telehealth clinics could potentially address this disparity and improve patient outcomes.AimWe report the impact of the Royal Brisbane and Women's Hospital (RBWH) IBD telehealth clinics from March 2011 to December 2017, including patient satisfaction and healthcare activity.MethodsPatient satisfaction surveys were collected prospectively between March 2011 and March 2012. Healthcare activity was assessed through occasions of service (OOS), number of enrolled patients on biologics and IBD related admissions to RBWH.ResultsOverall, 3764 OOS were completed including 576 new patient and 3188 follow‐up visits. Mean age at first telehealth visit was 44 years (range: 16–87 years). The IBD telehealth clinics were well accepted with 99% of the first 153 patients surveyed choosing to continue with telehealth and 94% rated the telehealth experience as very good or excellent. The net number of patients under active review increased from 125 patients in 2011 to 345 patients in 2017. Enrolled patients on biologics also increased from 9 patients in 2011 to 63 patients in 2017. There was an initial dip in annual IBD related admissions to RBWH in 2011 but these have progressively increased over time although the average length of inpatient stay annually has remained stable.ConclusionThe RBWH IBD telehealth clinics have shown that telemedicine is well received and can be used successfully to deliver IBD specialist care to patients living in regional or remote areas.

\u2018Grey nomad\u2019 travellers\u2019 use of remote health services in Australia: a qualitative enquiry of hospital managers\u2019 perspectives

BackgroundFor more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as ‘Grey Nomads’. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the ‘baby boomer’ generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946–1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may “burden” already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers.MethodsThe aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads.In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues.ResultsThese nursing managers described a strong service and community ethos. They regarded travellers’ healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers.ConclusionParticipants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia’s national transition to electronic health records including a patient—held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs.

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.

The Experiences of Young People Living With Cancer in Regional and Remote Australia: A Qualitative Study

ABSTRACT There is limited qualitative research specifically exploring the experiences of young people living with cancer in nonmetropolitan Australia. This article reports on an in-depth qualitative study exploring young people’s experiences of diagnosis, treatment, and postcancer care and support, focusing on the impact of living in regional and remote Queensland, Australia. Thematically coded data from in-depth interviews were managed using NVivo 12 qualitative software. Connections with place, knowledge, people, support, lifestyle, and peers were key themes. Travelling for treatment interrupted these connections, with participants desiring treatment closer to home. Preventive social work in metropolitan and nonmetropolitan areas that supports maintaining connections for young patients from regional and remote areas is recommended. Further research, including the impact on young Aboriginal and Torres Strait Islander people with cancer and on the role of social workers, will inform improvements in social work practice. IMPLICATIONS Recognising the importance of connections for young people living with cancer from regional and remote areas can inform social work psychosocial assessments in metropolitan and nonmetropolitan settings, assisting social workers to respond appropriately to information young people share and supporting these valued connections. Enhancing preventive social work care with young people living with cancer from regional and remote areas will involve direct, regular communication at diagnosis and during and after cancer treatment using appropriate age-specific interventions.

P037 Indigenous Australians’ conceptualisation of sleep health differs from western interpretations

Abstract Purpose Despite a significant burden of poor sleep, Aboriginal and Torres Strait Islander peoples’ (Indigenous Australians) conceptualisation of sleep health is poorly understood. This research explored Indigenous Australians’ understanding and interpretation of sleep health and how that affects their health. Methods Indigenous people from remote Queensland were invited to participate in focus group discussions exploring their understanding of sleep health, the link between dreaming and sleep, and perceived implications of poor sleep. Participants were also asked to complete an adapted pictorial Epworth Sleepiness Scale (ESS). Descriptive statistics were used to summarise ESS data and participants’ demographic data. Thematic analysis was used to analyse focus group data. Results A total of 29 Indigenous Australians (82% females), median age 39 years (Interquartile range 26–51 years) from various geographical areas within North West Queensland participated in focus group discussions (n=6). The following themes emerged from the data: interconnection among sleep, emotional and physical health; challenges and successes in obtaining healthy sleep; the impact of dreams on waking life; and lack of support from health services in managing sleep issues. Scores from the modified pictorial scale indicate 24% of the participants had excessive daytime sleepiness (ESS score>10 points). Conclusion Indigenous Australians’ conceptualisation of sleep health is different from the western interpretation of sleep health. In particular, the connection between dreams and sleep is not adequately captured in current tools and resources to promote sleep health. This will limit effective prevention and management of sleep issues in Indigenous communities.

The Supportive Care Needs of Regional and Remote Cancer Caregivers

Objective: As cancer survival rates continue to increase, so will the demand for care from family and friends, particularly in more isolated settings. This study aims to examine the needs of cancer caregivers in regional and remote Australia. Methods: A total of 239 informal (i.e., non-professional) cancer caregivers (e.g., family/friends) from regional and remote Queensland, Australia, completed the Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C). The frequencies of individuals reporting specific needs were calculated. Logistic regression analyses assessed the association between unmet needs and demographic characteristics and cancer type. Results: The most frequently endorsed needs were lodging near hospital (77%), information about the disease (74%), and tests and treatment (74%). The most frequent unmet needs were treatment near home (37%), help with economic burden (32%), and concerns about the person being cared for (32%). Younger and female caregivers were significantly more likely to report unmet needs overall (OR = 2.12; OR = 0.58), and unmet healthcare staff needs (OR = 0.35; OR = 1.99, respectively). Unmet family and social support needs were also significantly more likely among younger caregivers (OR = 0.35). Caregivers of breast cancer patients (OR = 0.43) and older caregivers (OR = 0.53) were significantly less likely to report unmet health and psychology needs. Proportions of participants reporting needs were largely similar across demographic groups and cancer type with some exceptions. Conclusions: Caregiver health, practical issues associated with travel, and emotional strain are all areas where regional and remote caregivers require more support. Caregivers’ age and gender, time since diagnosis and patient cancer type should be considered when determining the most appropriate supportive care.

Determinants and Follow-up of Lung Function Data from a Predominantly First Nations Cohort of Adults Referred to Specialist Respiratory Outreach Clinics in Regional and Remote Queensland.

Northern Territory (NT)-based clinical service data suggest substantial lung function impairment amongst First Nations adults as young as 18-40years. Our objectives were to describe the burden of disease and lung function of adults living in regional-remote Queensland, identify determinants of lung function, and evaluate the impact of a specialist respiratory outreach service on lung function. Retrospective 8-year cohort study (February 2012-March 2020) of 1113 First Nations Australian adults (and 648 non-First Nations adults) referred to respiratory outreach clinics in regional-remote Queensland. In the combined cohort, the forced expiratory volume in 1s (FEV1) was clinically abnormal for 54% of First Nations patients (51% of non-First Nations patients), forced vital capacity (FVC) for 46% (36%), FEV1/FVC% for 30% (36%), and gas diffusing capacity (DLCO) for 44% (37%). A respiratory diagnosis was assigned by a respiratory physician in 78% of First Nations (76% non-First Nations) patients. Smoking, household smoke exposure, underweight BMI, and respiratory disease were associated with reduced lung function. In the 40% of patients (709/1765) followed up, FEV1 and FVC significantly improved (mean change: zFEV1 = 0.15 [95% CI 0.10-0.20]; zFVC = 0.25 [0.20, 0.31]), and FEV1/FVC% significantly reduced (mean = - 0.10 [95%CI - 0.07 to - 0.03]), with no significant change in DLCO. Patients with COPD had lower FEV1 improvement, whilst underweight and obese patients had lower FVC improvement. Regional-remote First Nations adult Queenslanders have higher lung function than previously reported, with no lung function decline observed at follow-up visit, including for those with respiratory disease.

Performance ‘Training’ in the Dirt: facilitating belonging in a regional community musical theatre event

Community-engaged theatre projects are host to a complex dynamic set of tensions, particularly when volunteers from a specific community are partnered with visiting professional/industry artists or ‘systems convenors’. These tensions are given nuance in regional Australia, where community-engaged projects frequently utilise metropolitan-based artists to facilitate creation with local partipants, implicitly indicating that ‘regional’ may be conflated with ‘amateur’. The authors seek to interrogate the tensions at the heart of creating genuine rapport through the ‘training’ of un-trained participants in community-engaged projects. This paper focuses on one such project by the Queensland Music Festival, The Power Within (2017), built in collaboration with the Isaac Shire Council in central Queensland. In particular, the paper draws on the experience of one adolescent in the process: Sam, who credits The Power Within as beneficial in establishing his emerging personal identity. In this, the authors draw upon the work of Orr and Shreeve (2018) to demonstrate the relationship between personal and community identity. Further elucidation is gained through the work of Margaret Archer and Pierre Bourdieu to explore the deeply reflexive nature of face-to-face training in the unique environment of remote Central Queensland. This reveals the nuances at the crucible of atypical, informal and imposed training that can operate within community-engaged theatre projects in regional Queensland. Ultimately, for Sam, the key learnings from the project assisted in the establishment of himself as a professional make-up artist, an outcome entirely unpredicted by the creative leadership team tasked with collaborating with him. The authors posit it is this unpredictability that renders the training within community-engaged arts projects unique and bespoke.

Divided loyalties

St Joseph’s Nudgee College is an Irish Christian Brothers boys’ boarding school in Brisbane. It was established in 1891 to provide the children of Irish Catholics living in regional and remote Queensland and northern New South Wales with access to an education that would act as a vehicle for socio-economic advancement. The first decades of the college’s existence were nevertheless defined by two competing, sometimes contradictory imperatives. An often-belligerent determination to retain an Irish identity existed side by side with an awareness that a ‘ghetto mentality’ would hinder the socio-economic advancement of Queensland’s Catholics. The balancing act that this necessitated was particularly evident in the College’s mixed reaction to the outbreak of war in 1914 and the subsequent reticence to celebrate Anzac Day between 1916 and 1939. This article explores the College’s response through its Annuals (Year Books) and places it in the context of the Australian Irish Catholic experience of war and commemoration.

Abstract P482: Outcome of Endovascular Thrombectomy for Ultra-Long Aeromedical Transfers: The Experience of 1 Hub and 11 Spoke Sites Covering More Than 1.8 Million Km 2

Background: Local endovascular services for acute stroke in rural and remote regions remain a significant challenge despite higher rates of stroke in these regions. Aim: We present time metrics, logistical, safety and outcome data on large vessel occlusion (LVO) patients receiving endovascular thrombectomy (EVT) that were aeromedically transferred from rural and remote “spoke” sites to the Gold Coast University Hospital (GCUH) “hub”. Methods: This is a retrospective observational study utilizing prospectively collected stroke database from December 2018 to March 2020. Aeromedical transfers from ten rural and remote Queensland sites and one northern New South Wales site were included, covering more than 1.853 million km 2 catchment. Results: 20 out of 26 transferred patients underwent EVT over this period. Mean distance was 1380.5 km, median time of ictus to re-canalization was 928 minutes and TICI 2b-3 was achieved in 90% of the patients. One out of 20 patients (5%) had symptomatic ICH (sICH), and 9 out of 20 (45%) achieved functional independence (mRS 0-2) at 90 days; similar to the recent pivotal trials. Conclusions: Our 12-center network experience confirms real world reproducibility of trial results including ultra-long transfers and supports such transfers at other centers worldwide.

Are National Cancer Control Indicators for patient experiences being met in regional and remote Australia? A cross-sectional study of cancer survivors who travelled for treatment

ObjectiveTo examine the health services experience of patients with cancer from regional and remote Australia using the Australian National Cancer Control Indicators (NCCI) guidelines as an assessment framework.DesignCross-sectional.SettingQueensland non-for-profit cancer...