Sunshine Coast Hospital and Health Service (Queensland Health)

Introduction Breast cancer is the most commonly diagnosed cancer among women worldwide. Survivors often experience physical and psychological effects arising from breast cancer and its treatment, which can last months and years, adversely impacting quality of life. As the number of early breast cancer survivors increases, models of specialist-led follow-up care in hospital settings are not sustainable and evidence suggests that they may not meet survivors’ needs. Nurse-enabled, shared-care, follow-up models between cancer specialist and primary care teams have potential to address this need. Methods and analysis The proposed research is a multicentre, prospective, pragmatic, stepped-wedge cluster-randomised trial designed to test the effectiveness and implementation of IBIS-Survivorship, a follow-up care model for patients with early breast cancer who have completed primary treatment. The IBIS-Survivorship intervention involves a nurse-led consultation, development of a Survivorship Care Plan and case-conferencing between a breast care nurse and the patient’s primary care provider. This study seeks to recruit 1079 breast cancer survivors across six cancer centres (clusters) in Australia. Health-related quality of life at 12 months assessed by the Functional Assessment of Cancer Therapy - Breast Cancer questionnaire will be the primary endpoint, along with a range of patient-reported outcomes, safety indicators and cost-effectiveness measures as secondary endpoints. General and generalised linear mixed models will be used to assess the effectiveness of the intervention versus usual care. Implementation and process outcomes will be assessed using the Reach Effectiveness Adoption Implementation Maintenance framework. Ethics and dissemination Ethical approval was provided by the Metro South Hospital and Health Service Human Research Ethics Committee (HREC/2020/QMS/59892) and reciprocally across the other five trial sites under National Mutual Acceptance arrangements. Results will be disseminated through peer-reviewed academic journal publications and presentations at national and international conferences. Trial registration Australia and New Zealand Clinical Trials Registry (ANZCTR) Trial ID: ACTRN12621000188831.

Background Household food insecurity is a critical concern for ultra-poor families in low- and middle-income countries like Bangladesh, particularly those with members who have disabilities. The COVID-19 pandemic has worsened this situation. Objective This study aimed to assess the impact of microfinance-based livelihood programs on food insecurity in ultra-poor families with members affected by cerebral palsy in Bangladesh. Methods Data were extracted from the SUPPORT CP trial for 251 children with cerebral palsy. The Household Food Insecurity Access Scale score was the outcome variable. The explanatory variable was the intervention type, dividing the sample into 3 arms: Arm C (care as usual), Arm B (Community-Based Rehabilitation [CBR]), and Arm A (CBR with the integrated microfinance-based livelihood program [IMCBR]). Both linear regression and the Generalized Estimating Equations model were used to determine the association of outcome variable with explanatory variables adjusting for covariates. Results We found a consistent level of household food insecurity across each time point, with a significant increase in the midline during the peak of COVID-19 pandemic in 2020. However, following the end of the COVID-19 pandemic, both Arms A and B, where interventions were provided, reported a significant decline in food insecurity. Notably, Arm A, where IMCBR was provided, exhibited the fastest decrease in food insecurity followed by Arm B, where only CBR was provided, compared to Arm C. Conclusion Microfinance programs can reduce food insecurity among families of children with cerebral palsy in Bangladesh, especially during crises like COVID-19, underscoring the need to integrate them with tailored disability rehabilitation services.

Background Cardiovascular disease and Type 2 diabetes are two serious chronic health conditions that impact patients, families, and health services. Patients who experience both conditions can struggle to access relevant programmes to guide and educate them on successful self-management. Peer support has been proven to assist patients in managing these dual conditions, but the experience of using an online platform has not been previously explored. Aim To understand the experience of using a theory-based, peer-support, self-management website for people with cardiovascular and diabetes conditions in an Australian regional health service. Design An exploratory qualitative study was undertaken. Our study is reported according to COREQ guidelines. Methods Data were collected via online, semi-structured interviews approximately one week after participants were asked to engage with the website. Interviews were conducted to focus on the user experience, feasibility and usefulness of accessing the website, and how it helped support development of self-management skills. Interview data were transcribed from audio recordings into text files, thematic analysis was conducted for evolving themes. Results Fifteen participants agreed to be interviewed for the study. Findings revealed that participants found the website useful for providing relevant, comprehensive, and reliable online health information to help them manage their comorbidities. Participants appreciated the opportunity to share their experiences with others, and some expressed their interest in becoming peer supporters, to help others who might be trying to manage similar comorbidities. Conclusion Users’ experience of the peer-support, web-based programme was positive overall and supported the physical and emotional well-being of the participants, who were trying to manage two complex chronic health conditions. Considerations for further development are reported on.

Central venous access devices (CVADs) play a vital role in the administration of anti-cancer therapy; however, skin injuries surrounding insertion sites can develop, resulting in pain and device failure. This review aimed to synthesise and critically appraise studies describing skin injuries related to CVADs in children being treated for cancer. This integrative literature review follows established methodology by Whittemore and Knafl’s (2005) guidelines. Studies were included if they had paediatric participants (from birth to 18 years), being treated for a solid or haematological cancer, where the study outcomes measured skin integrity at the CVAD sites. Three databases (MEDLINE, Embase and CINAHL) yielded 613 articles, with six studies meeting the inclusion criteria. Exit site infection ranged from 2.35 per 1000 catheter days to 0 per 1000 catheter days. The rate of skin injury and complications are observed to be as high as 16% for exit site infection and 11% for dermatitis. Infection is an important outcome, but not the sole outcome to consider during CVAD site observation. Often a lack of knowledge and awareness of skin injury can cause device complications and failure which has a negative impact on paediatric cancer patients.

Purpose: An open Hartmann (OH) procedure generally remains the standard of care for several emergent colorectal conditions. There is a perception that the laparoscopic approach is limited to large subspecialist centers. This study aimed to investigate the outcomes of these emergency procedures in a non-subspecialized regional center. Methods: We conducted a retrospective cohort analysis on patients who underwent an emergency Hartmann procedure between 2019 and 2023 within a general surgery unit at a regionally located tertiary-level Australian hospital. Patients were classified as having undergone either OH or laparoscopic Hartmann (LH) procedures. Our primary outcome of interest was length of hospital stay (LOS). Secondary outcomes included time to return of gut function, morbidity, and reversal. Differences between the OH and LH groups were assessed descriptively and using confounder-adjusted regression. Results: We identified 115 patients (83 underwent OH, 32 underwent LH) during the study period. The adjusted estimated mean LOS for patients undergoing an OH procedure was 15.8 days (95% confidence interval [CI], 13.7-17.9) compared to 9.6 days (95% CI, 7.4-11.9) for patients undergoing an LH procedure. The mean time taken for the return of gut function was estimated to be 34% longer following an OH procedure compared to an LH procedure (adjusted incidence rate ratio, 1.34 days; 95% CI, 1.00-1.81). Morbidity was similar between groups. The LH group had higher rates of laparoscopic reversal (91.7% vs. 33.3%). Conclusion: The expected benefits of laparoscopic surgery may extend to the emergency colorectal setting and LH procedures can be performed safely in a non-subspecialized center.

Introduction There is a lack of indicators to guide quality improvement activities in virtual emergency medicine internationally. We developed quality indicators for use across a collaboration of four metropolitan virtual ED (VED) settings in four Australian states. The services deliver ED care directly to patients, in consultation with paramedics, and as virtual care coordination. Methods The model of care and use of potential indicators at each site were described using interviews and combined with literature review to develop a set of 27 candidate benchmarking indicators. These were refined using a three-stage Delphi study conducted between November 2022 and May 2023. The first stage used a survey to assess the indicators’ feasibility and importance, synonyms and draft definitions. These results were fed back to participants for refinement during discussions and written review of revised indicators and definitions across two subsequent stages. Results A definition for VED care was proposed: ‘An episode of care between patients and/or care providers, occurring remotely, using any form of communication or information technologies, for conditions that would otherwise result in a physical presentation for emergency care.’ Across Delphi rounds 1 and 2, some proposed indicators were removed, and new types of indicators were added. In rounds 2 and 3, 24 and 23 indicators, respectively, were reviewed, and the final indicator set comprised 16 indicators. The majority (15) were readily mapped to the six Institute of Medicine Domains of Quality (efficient (n=2), effective (n=5), equitable (n=2), patient centred (n=2), safe (n=2) and timely (n=2)) and all 16 mapped to the National Quality Forum’s telehealth quality indicators (access to care (n=2), effectiveness (n=8), experience (n=4), financial impact/cost (n=2)). Conclusion There is enthusiasm for a national benchmarking collaborative across four Australian VED services and states. An identified set of 16 indicators and definitions can be further validated with consumers and piloted.

Objectives To describe quantitative studies of sport or physical recreation for children and young people with physical disability and evaluate effects on health-related outcomes. Design Systematic review with meta-analysis of randomised controlled trials. Data sources Six databases searched from inception to December 2023. Eligibility criteria Quantitative studies evaluating sports or physical recreation among children and young people≤18 years with physical disability. Results 77 studies (n=2584) were included in the review, with 11 randomised controlled trials included in meta-analyses. Pre–post measurement design, health condition cerebral palsy and intervention of dance were most common. Meta-analysis could not be performed for participation outcomes because there were only two eligible trials. Sport and physical recreation had a small positive impact on activity limitations (nine trials, n=271, standardised mean difference (SMD) 0.30, 95% CI 0.02 to 0.57, p=0.018, low certainty evidence) and a medium positive impact on physical impairment (seven trials, n=216, SMD 0.63, 95% CI 0.08 to 1.18, p=0.025, very low certainty evidence) compared with control. No effect was found on quality of life (three trials, n=133, SMD −0.02, 95% CI −0.42 to 0.38, p=0.917, moderate certainty evidence) or cognitive or behavioural impairment (four trials, n=124, SMD 0.54, 95% CI −0.29 to 1.36, p=0.202, very low certainty evidence). A small number of mild adverse events were reported. Conclusion Sport and physical recreation likely improve activity and physical impairment outcomes for children and young people with physical disability. More research assessing participation outcomes and evaluation of existing sport and recreation programmes in the community is indicated. PROSPERO Registration Number CRD42020159283

The impact of the COVID-19 pandemic on the wellbeing of 26,555 Dutch children and adolescents (ages 8–18, 50% female, 89% with parents born in the Netherlands) was investigated using three cohorts: a general population twin sample (NTR), a general population sample (KLIK), and a clinical sample (DREAMS). Data were collected in seven waves between 2020 and 2023. Linear mixed models were employed to examine changes in wellbeing, twin models were used to estimate genetic and environmental contributions, and a psychometric model was employed to explore potential rater bias. A 6.5% drop in wellbeing was observed at the onset of the pandemic in the NTR sample, followed by partial recovery but not a return to pre-pandemic levels. Mean wellbeing scores were consistently lower in the clinical cohort (DREAMS), which also showed different effects of age, gender, and parental educational attainment compared to the two general population samples (NTR and KLIK). Increased disagreement between fathers’ and mothers’ ratings during lockdown was also identified. Genetic factors were found to account for 26–28% of the variance in wellbeing during the pandemic, and 34–35% before and after. Shared environmental factors were higher during the lockdown period (60–62%) compared to before and after the lockdown (45–49%), indicating the key role of family and home environment in that period. Multi-rater analyses suggested that part of this increase in shared environmental variance likely reflects rater bias rather than true environmental influences. These findings highlight that children in psychiatric care may face additional challenges compared to their peers and emphasize the importance of multi-rater assessments. Results suggest that both genetic predispositions and environmental disruptions should be considered when developing strategies to support child wellbeing during crises.

Background Obstructive sleep apnoea (OSA) is associated with increasing body mass index (BMI) and affects up to 15% of pregnant women. OSA in pregnancy can be associated with adverse maternal and neonatal outcomes. Continuous positive airway pressure (CPAP) may be an effective treatment for OSA during pregnancy. Aim To examine the feasibility and acceptability of screening women with a BMI ≥ 35 kg/m² for OSA in pregnancy, followed by randomisation to treatment with CPAP or no CPAP for women diagnosed with moderate to severe OSA. Methods This study was a single-centre, two-stage pilot study. Firstly, all consenting participants were screened for OSA and then, only if diagnosed with moderate to severe OSA (AHI ≥ 15), randomised to CPAP or no CPAP. The feasibility of the OSA screening was determined by recruitment rates. A priori criteria of > 20% recruitment to the sleep study were considered feasible. The acceptability of the sleep study was examined using the completion rate and reasons for withdrawal prior to the sleep study. The acceptability of CPAP randomisation was assessed by completion rates for women randomised, adherence to CPAP, reasons for withdrawal, and the review of quality-of-life measures over the course of pregnancy. Results Ninety-six women with a BMI ≥ 35 kg/m² before 26 completed weeks of pregnancy were invited to participate from the Sunshine Coast University Hospital and Health Service. Overall, 36 women enrolled, giving a recruitment rate of 37%. A total of 75% (n = 26) of recruited women completed OSA screening (clinical history, questionnaires, and formal sleep study). Subsequently, six (6%) of invited women had an apnoea hypopnoea index (AHI) ≥ 15/h and were diagnosed with moderate to severe OSA and underwent randomisation to receive treatment with CPAP (n = 4) or no CPAP (n = 1) until birth. One woman withdrew after randomisation to treatment. Nine women withdrew prior to full completion of OSA screening and one following an inconclusive sleep study. Women who had a sleep study found it acceptable, and in women randomised to CPAP, adherence averaged 4.86 h/night. Quality-of-life measures were similar when measured over two time points in pregnancy. Discussion A definitive trial screening women for OSA and subsequent randomisation to treatment or no treatment may be feasible. Future trials should be resourced to expand inclusion criteria, improve accessibility for participants, evaluate clinical and cost-effectiveness, and investigate partial treatment effects. Trial registration ACTRN, ACTRN12621001523897. Registered 9 September 2021 — retrospectively registered, https://www.anzctr.org.au/Trial/Update/Step8_Update.aspx?id=382640.

Objective To describe interpreter services provided to international migrants in the emergency department (ED). Methods This observational study used health service data pertaining to all patient presentations made to two public EDs between 2019 and 2021. Results In total, 4560 patients required an interpreter. An 18‐month subset data showed that an interpreter was requested for 47 of the 2509 patients in the ED. Thirty‐eight patients received the service. Conclusions This study has identified a significant gap between interpreter service requirements and utilisation. Further research is recommended to explore the barriers and decision‐making process of interpreter service utilisation in the ED.

Objectives. The value of engaging health service users and their families (consumers) in research is increasingly being recognised in planning and evaluating health services to meet diverse needs. This project aimed to co-design a strategic consumer involvement framework and implementation plan for a public Australian hospital and health service. Methods. A co-design approach was used to adopt a framework and develop an implementation plan across five stages: (1) an initial consultation with key stakeholders, (2) a survey of health service staff about involving consumers in research at the health service, (3) three group sessions using Nominal Group Technique with health service consumers and staff that explored barriers and solutions to involving consumers, (4) data synthesis, and (5) a workshop of key stakeholders to develop and refine the implementation plan. Three consumer partners contributed to protocol development, research design, data analysis, and manuscript writing. Results. Survey and group session data highlighted a need for governance, infrastructure, capacity building, and leadership and culture within the organisation to support the involvement of consumers in research at the health service. These aligned with the South Australian Health and Medical Research Institute (SAHMRI) Framework domains. Implementation strategies were adjusted on the basis of insights from the local context to facilitate adoption within the health service. Conclusions. By better supporting consumers and researchers to work together in health service research, organisations can enhance the relevance, quality, and impact of their research efforts. This project provides a valuable blueprint for developing a local, contextualised approach to promoting effective consumer–researcher relationships in Australian public health services.

Background Automated insulin delivery (AID) systems, which integrate continuous glucose monitoring (CGM) with automated insulin dosing, have emerged as a transformative therapy. However, real‐world data on AID effectiveness, particularly in regional Australia, remain limited. Methods We conducted a retrospective audit across three Australian hospital sites—Logan (metropolitan), Mackay and Townsville (regional)—to evaluate the impact of AID therapy in adults with Type 1 Diabetes Mellitus (T1DM). Data on demographics, comorbidities, CGM metrics and clinical outcomes were extracted from medical records and device platforms. The primary outcome was change in HbA1c and CGM time‐in‐range (TIR; 3.9–10 mmol/L) at follow‐up. Follow‐up data were recorded up to 12 months following AID commencement. Secondary outcomes included changes in body weight, glycaemic variability and predictors of HbA1c reduction. Results The study consisted of 158 people living with T1DM who were initiated on AID. Following AID initiation, mean TIR improved from 53.4% (SD 21.1%) to 70.0% (SD 14.6%) (p < 0.0001), and time in hyperglycaemia (>13.9 mmol/L) declined from 18.7% (SD 19.4%) to 8.4% (SD 9.31%) (p < 0.0001). The mean HbA1c significantly decreased from 8.62% (SD 1.70) at baseline to 7.34% (SD 1.31) at follow‐up across the entire study cohort (p < 0.0001), with 42.7% achieving <7% and 64.1% achieving <7.5% at follow‐up. Multivariable regression identified higher baseline HbA1c (p < 0.0001) as a significant predictor of HbA1c reduction. Improvements were consistent across AID system types and geographical settings. Conclusions AID therapy significantly improves glycaemic control in adults with T1DM in both regional and metropolitan Australia. Our findings support the real‐world effectiveness of AID systems and highlight their potential to bridge care gaps across diverse settings.

Background and aim In 2020, the Gold Coast University Hospital emergency department (ED) established a Medical Commander role; a medical leadership position with a focus on optimising patient flow. The objective of this study was to understand how the role executes leadership tasks to promote patient flow and its impact on staff working in and with the ED. Methods A multimethod case study approach combined data from documents, observations staff interviews and surveys across a breadth of stakeholders. Data were deductively themed and triangulated through the analytical framework of Path-Goal leadership theory to provide a comprehensive analysis of the Medical Commander role functions and impact. Results The Medical Commander role dynamically exhibits a combination of directive, supportive and participative leadership behaviours to enact and deliver patient flow leadership across a breadth of stakeholders. Path-Goal theory illuminates the environmental and personnel characteristics that have contributed to the role’s perceived successes in patient flow and employee motivation. In addition, the application of this theory identifies several crucial enablers, including role characteristics (ie, clinical and service seniority, division-wide oversight and absence of clinical load) that support the dynamic use of leadership behaviours observed in this study and their effect on staff morale and patient flow. Conclusions As rising demand and complexity increase the risks associated with delays to patient care coordination and flow, the senior-level oversight and enabling leadership behaviours provided by the Medical Commander role represent a viable and effective intervention to manage these gaps.

Background People with disabilities have the same need for contraception as the general population. However, their access to modern contraceptive methods is largely underexplored in low‐ and middle‐income countries. Objective This study aimed to explore the prevalence of modern contraception use among reproductive‐aged (15–49 years) persons with disabilities in low‐ and middle‐income countries and identify the key determinants. Methods In June 2024, we conducted a systematic search across six databases including PubMed, Web of Science, Embase, Global Health, Medline and Scopus to identify studies on disability and modern contraception in low‐ and middle‐income countries. The search terms included a combination of Medical Subject Headings (MeSH) terms and keywords related to disability, modern contraception and low‐ and middle‐income countries integrated using the Boolean operators (AND, OR). All studies published between January 2015 and June 2024, in English, and conducted in low‐ and middle‐income countries were included. The primary outcomes were the prevalence of modern contraception use and its determinants among persons with any disability. Summary estimates were calculated using meta‐analysis with a fixed effects model for lower heterogeneity. Random effects meta‐analysis was used for mid‐level heterogeneity (50%–74%) and high‐level heterogeneity (75%–100%). Results A total of 18 studies from low‐ and middle‐income countries were included, with 11 included in the meta‐analysis. The pooled prevalence of modern contraception use among persons with disabilities was 31.4% (95% CI: 26.5, 36.2). Significant heterogeneity was observed across respondent characteristics (I² = 94.55%). Five factors were significantly associated with higher contraception use: being aged over 25 years, having some level of education, being in a higher wealth quintile, having adequate knowledge of family planning and being in a formal marital relationship. Conclusion This study reveals a significantly lower prevalence of modern contraception use among persons with disabilities in low‐ and middle‐income countries compared to the general population. Improving access to education, addressing social norms and strengthening healthcare systems may contribute to increasing access to contraception and uptake among persons with disabilities in low‐ and middle‐income countries.

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections, especially in infants and young children globally. Despite its impact, RSV testing and epidemiological data remain limited, particularly in regional Australia. Central Queensland, with its subtropical climate, provides a unique setting in which to study RSV trends, testing patterns, and associated hospital burden. Methods: This study used hospital-based data to analyse RSV-related hospitalisations and testing from Central Queensland. Data were collected retrospectively between 2018 and 2021 and prospectively between 2022 and 2023. Eligible cases included individuals presenting to or admitted at any hospitals in Central Queensland with laboratory-confirmed RSV or RSV-related diagnoses based on ICD-10-AM codes. The analysis focused on RSV-related hospital admissions and hospitalisation outcomes. Incidence rate ratios (IRR) for hospitalisation rates between the two periods were calculated. Results: Between 2018 and 2023, there were 1,279 RSV-related hospitalisations, with 53.2% of cases being male. Infants under 12 months accounted for the highest proportion of admissions (38.4%). RSV-related hospitalisations peaked during the prospective study period, rising from 123 in 2018 to 357 in 2023. The hospitalisation rate among infants was significantly higher in the prospective study period compared to the retrospective study period (IRR: 2.2; 95% confidence interval [95% CI]: 1.8–2.6; p < 0.001). The Indigenous population had a significantly higher hospitalisation rate than the non-Indigenous population over the whole study period (IRR: 3.1; 95% CI: 2.7–3.6; p < 0.001). The median length of stay was two days, with 20.6% of those hospitalised requiring ventilation, 2.2% needing intensive care unit (ICU) support, and 0.9% of hospitalisations resulting in death. Mortality was highest among those aged 60 years and above (91.7%). Although infants under 12 months had the lowest RSV testing rates (9.8%), they had the highest test positivity rate (16.4%). Conclusions: RSV admissions have been under-reported due to limited testing. Increased awareness and widespread testing during prospective surveillance revealed a significant rise in RSV-related admissions. These findings underscore the need for enhanced RSV testing, improved resource allocation, and expanded immunisation efforts to effectively manage the burden of RSV.

Objectives To explore and describe patients' expectations, perceptions and experiences of having a pelvic examination (PV) in the emergency department (ED) and to describe ED clinicians' attitudes and perceptions regarding PVs. Methods A mixed methods study using questionnaires and semi‐structured interviews with patients and clinicians at two EDs in the same health service (tertiary ED and urban district ED) between May 2023 and February 2024. Quantitative data are reported descriptively using means and proportions. A qualitative descriptive approach and thematic analysis were used to develop themes from interviews and gather granular insights from participants' first‐hand experiences. Results Clinicians completed 84 questionnaires and nine interviews. Patients completed 63 questionnaires and eight interviews. Quantitative and qualitative data were merged to form four themes: (1) the variable clinical utility of the PV in ED, (2) lack of ED clinician confidence and training, (3) bedside manner as primary influence on patient experience, and (4) the inadequate ED setting for performing intimate exams. Conclusions The utility of PVs in ED remains ambiguous and it is vital to avoid unnecessary invasive exams. However, urgent PVs will sometimes be needed and participants have made actionable suggestions to improve the clinical care delivered when performing PVs in ED. The four themes can inform future strategies to advance clinicians' training, confidence and skill level when performing PVs. This will lead to overall enhanced patient experience and satisfaction and reduce downstream negative consequences of having an inadequate PV experience in ED.