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Objective: Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state‐wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined. Methods: Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository. Design: Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis). Setting: All people diagnosed with HNC in Queensland, Australia. Participants: The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner‐regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015. Main Outcome Measures: This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co‐morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post‐acute outcomes (readmission rates, causes of readmission and 2‐year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed. Results: Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2‐year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment. Conclusions: This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy in haemodialysis patients can not only manifest as the continued prescribing of unnecessary medications but also has the potential to increase medication‐related hospital admissions, morbidity, and mortality. A validated deprescribing algorithm has recently been developed, specifically targeted at dialysis patients. This paper audits the experience of implementing this algorithm in Australian dialysis settings. Aim: The aim of this paper was to evaluate the usefulness and applicability of the pharmacist‐led Toronto deprescribing tool in Australian haemodialysis settings. Method: The pharmacist‐led deprescribing algorithm was implemented across two metropolitan sites and one rural site. The audit focused on five medications that could potentially be deprescribed in the target patient group (diuretics, alpha blockers, statins, proton pump inhibitors [PPIs], and quinine). Between 1 and 12 months later, a reaudit was conducted, with patients followed up to confirm if medications remained deprescribed. Results: Two hundred and eleven patients across three sites were reviewed. Application of the algorithm resulted in 168 medications deemed appropriate to deprescribe. Of these 168 medications, 56 (33%) were initially deprescribed, with 50 medications (30%) remaining deprescribed on reaudit. The deprescribing rates varied between the three different services, with initial deprescribing rates ranging from 18% to 61%. After follow‐up, deprescribing changes across target medications were fairly static, with only a small number of patients restarting either their diuretic or PPI. Conclusion: The pharmacist‐led deprescribing algorithm resulted in substantial deprescribing across the three sites. Deprescribing rates varied between the sites due to differences in the team model that the pharmacist worked within and the method of the rollout. Further studies should draw on aspects such as finding enablers to overcome prescriber and patient concerns about deprescribing and the aspects of which team models lead to higher rates of successful deprescribing. [ABSTRACT FROM AUTHOR]

Background: Whilst dysphagia is a commonly reported complication of stroke, it has received relatively little attention in the literature for patients following non‐traumatic subarachnoid haemorrhage (SAH). Aims: To investigate dysphagia incidence, risk factors, clinical progression and recovery in patients following non‐traumatic SAH. Methods & Procedures: A prospective cohort study of 49 patients admitted to a tertiary neurosurgical referral unit with non‐traumatic SAH over a 12‐month period was conducted. Swallowing function was assessed by a speech–language pathologist within 72 h of medical stability and monitored throughout the acute inpatient admission. Outcomes & Results: Dysphagia incidence was 16.33% (n = 8/49). Risk factors associated with dysphagia included; Glasgow Coma Scale (GCS) score on admission, need for intensive care unit (ICU) admission, length of ICU stay, need for intubation and ventilation, and hydrocephalus. Participants with dysphagia were admitted to hospital 1.9 times longer than those without dysphagia (p < 0.05) and were more likely to be transferred to another inpatient facility for ongoing care (p < 0.05). Dysphagia remained present at hospital discharge for over half (62.5%) of participants who developed this complication. Conclusions & Implications: Care pathways for patients admitted to hospital with non‐traumatic SAH should include early screening for dysphagia risk. Further research using a larger prospective cohort is required to validate dysphagia incidence and risk factors in this patient cohort. What this paper addsWhat is already known on this subjectDysphagia is a negative complication following non‐traumatic SAH, and can occur as a result of primary injury or secondary to treatment complications (e.g., intubation and ventilation, surgical intervention). However, limited evidence regarding its incidence, risk factors, clinical progression and recovery in a prospective cohort exists.What this paper adds to existing knowledgeThis study is the first to examine prospectively patients with non‐traumatic SAH within 72 h of medical stability. It identifies dysphagia incidence, risk factors, clinical characteristics and recovery during the acute hospital admission for this patient cohort.What are the potential or actual clinical implications of this work?Early and regular screening for dysphagia in the presence of associated risk factors is essential for patients admitted with non‐traumatic SAH. Speech–language pathologist resources in the neurocritical care context should be available to support the assessment and management of dysphagia in this cohort. [ABSTRACT FROM AUTHOR]

Accessible Summary: In the past 30 years, many people with (intellectual) learning disabilities have been moved out of large "institutions" and into their own home in their local communityThese people are now often between 30 and 50 years oldWe asked people with learning disabilities aged between 30 and 50 and who are living in their local community what things, including work, that they enjoyed doingWe asked people with learning disabilities aged between 30 and 50 and who are living in their local community whether they felt that they could make decisions about their lifeWe found out the things that make their life good, and also what might stop people enjoying their lifeWe learnt that people with learning disabilities should receive more support to assist them before they retireWe learnt that people with learning disabilities still need more support and choice around who they live with Background: This study investigated perceived quality of life (QoL) of community‐dwelling middle‐aged adults (30–50 years) with an intellectual disability and/or developmental disability living in rural or urban areas in New South Wales and Queensland, Australia. The specific aim of the current paper was to provide a descriptive evidence base of QoL and its specific domains by various key demographic characteristics of middle‐aged individuals. This cohort is likely to have either experienced or reached adulthood during and after large‐scale deinstitutionalisation in Australia. Methods and procedures: A cross‐sectional design was utilised, based on the QoL‐Q survey, testing domains of satisfaction; Competence/Productivity; Empowerment/Independence; and social belonging/community integration. The survey included demographic questions and was distributed to participants through disability support agencies across two states. The final sample included 291 respondents. Results: The overall QoL‐Q scores ranged from 3.0 to 29.5 (Mean = 20.4, SD, 4.1), with considerable variation in mean scores both across and within domains. The two demographic areas that showed greatest predictive value for QoL were work status and accommodation issues. The loss of agency and control in choice of co‐residents influenced perceived QoL for empowerment and independence domain of QoL‐Q. Conclusions: The findings highlight QoL issues associated with policy decisions and support programmes for middle‐aged adults. The two key recommendations arising from the project are that future planning for post‐retirement or reduced working hours needs to commence at a much younger age than currently expected, and more attention needs to focus on facilitating individual decision‐making and choice within shared accommodation options. [ABSTRACT FROM AUTHOR]

Objective To examine urban-rural differences and individual risk factors for a late stage of breast cancer at diagnosis in Australian women. Design Individual-level longitudinal data were linked with cancer registry data from New South Wales (New South Wales Cancer Registry linked by the Centre for Health Record Linkage (CHeReL)), Queensland (Queensland Cancer Registry) and Victoria (The Cancer Council Victoria). Setting Participants were drawn from the Australian Longitudinal Study on Women's Health 1946-1951 cohort (n = 13 715). Participants The sample included 195 women identified from the linked cancer registry data with a breast cancer diagnosis. Interventions Rural or urban residence was measured using Accessibility/Remoteness Index of Australia Plus (ARIA+). Individual characteristics and socio-demographic variables examined included survey year, menopausal status, country of birth, education and marital status. Main outcome measures A late stage of breast cancer at diagnosis was defined based on the TNM Classification of Malignant Tumours. Results A late stage of breast cancer diagnosis was observed in 36% of women residing in urban areas and 40% of women residing in rural areas. After adjusting for individual characteristics, we found that obesity was the strongest risk factor for a late stage of breast cancer at diagnosis. Conclusions Given that women are becoming increasingly obese, and that the rate of obesity is higher in the Australian rural population, this paper provides further evidence for targeting interventions for obesity, particularly in rural Australia, as a public health priority. [ABSTRACT FROM AUTHOR]