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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]

Objective This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. Design This paper was performed on a prospective, self-report cross-sectional on-line survey. Setting The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. Participants Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. Interventions None. Main outcome measures Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor-Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale - Nursing Work Index Revised. Results Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. Conclusions The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further. [ABSTRACT FROM AUTHOR]

Aim Facilities in retirement villages form a supportive environment for older residents. The purpose of this paper is to investigate the provision of these facilities in retirement villages, which are regarded as a viable accommodation option for the increasing ageing population in Australia. Methods A content analysis of facilities in 124 retirement villages operated by 22 developers in Queensland and South Australia was conducted. Results The most widely provided facilities are community centres, libraries, barbeque facilities, hairdressers/salons and billiards/snooker/pool tables. Commercial operators provide more facilities than not-for-profit organisations, and larger retirement villages normally have more facilities due to the economies of scale involved. Conclusions The results of the study provide a useful reference for providing facilities within retirement villages that may support the quality lifestyles of older residents. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. Methods: This mixed‐method study (survey and semi‐structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. Results: This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two‐thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'. Conclusion: This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial. [ABSTRACT FROM AUTHOR]

Objective: To investigate student supervisor experiences of supervising students on clinical placements since the onset of the COVID‐19 pandemic. Background: Studies on the impact of COVID‐19 on student clinical placements have focused largely on student reports and have been specific to individual professions or topic areas. There is a need to investigate student supervisor experiences. This study was conducted in Queensland (Australia) in four regional and rural public health services and four corresponding primary health networks. Methods: The anonymous, mixed methods online survey, consisting of 35 questions, was administered to student supervisors from allied health, medicine, nursing and midwifery between May and August 2021. Numerical data were analysed descriptively using chi‐square tests. Free‐text comments were analysed using content analysis. Results: Complete datasets were available for 167 respondents. Overall trends indicated perceived significant disruptions to student learning and support, plus mental health and well‐being concerns for both students and supervisors. Extensive mask wearing was noted to be a barrier to building rapport, learning and teaching. Some positive impacts of the pandemic on student learning were also noted. Conclusions: This study has highlighted the perceived impact of the pandemic on supervisors' mental health, and on the mental health, learning and work readiness of students. This study provides evidence of the pandemic impacts on student clinical placements from a supervisor point of view. Findings can assist in future‐proofing clinical education and ensuring that students continue to receive learning experiences of benefit to them, meeting curriculum requirements, in the event of another pandemic. [ABSTRACT FROM AUTHOR]

Background: Peripartum antibiotics are commonly administered. Little is known of the attitudes of pregnant women toward peripartum antibiotics. Aim: We aimed to assess the awareness of and attitudes toward peripartum antibiotic use in Australian women. Materials and Methods: We surveyed post‐partum women at three hospitals over six months. Women reported if they received antibiotics 48 h either side of delivery and responded to statements assessing attitudes to peripartum antibiotic use. Administered antibiotics were recorded. We reported the proportion receiving antibiotics and the proportion aware of receiving them. Participants responded on five‐point Likert scales and selected side effects of concern. Results: Participants responding were 248 of 299 (83%, Royal Brisbane and Women's Hospital), 56 of 106 (53%, Caboolture Hospital) and 17 (Redcliffe Hospital, denominator not recorded). Of 183 (57%) receiving antibiotics, 134 (73%) received them pre‐delivery only, 18 (10%) post‐delivery only and 31 (17%) pre‐ and post‐delivery. Pre‐delivery, the most common indication was pre‐incisional prophylaxis for caesarean delivery (93 of 160 responses, 58%). Seventy‐nine (51%, 156 responses) of those receiving pre‐delivery antibiotics were aware. Of 49 women receiving post‐delivery antibiotics, 36 (73%) were aware. Most agreed they were worried that pre‐delivery antibiotics would affect their baby (198, 62%) and 160 (50%) were concerned about effects on their own microbiome. Most (204, 65%) agreed they would rather not take antibiotics while breastfeeding. Conclusion: Many women were unaware of receiving pre‐delivery antibiotics. Most had concerns about side effects. Improved communication regarding peripartum antibiotic use would improve patient‐centred care. [ABSTRACT FROM AUTHOR]

Aims: Early childhood anaemia, usually attributed to iron deficiency, is associated with persistent detrimental effects on child development. This study investigates the association of anaemia between age six and 23 months with indicators of childhood development at school‐age among children of remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Methods: The triennial Australian Early Development Census (AEDC) encompasses five domains of early childhood development—physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school‐based), communication skills and general knowledge. AEDC 2012 and 2015 assessments were linked with health information for children and their mothers from remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Results: AEDC assessments were available for 250 children who had measurements of haemoglobin recorded at age 6 to 23 months. More children who had had early childhood anaemia (n = 66/143, 46.2%, [37.9%, 54.4%]) were developmentally vulnerable on two or more domains compared to those who had not been anaemic (n = 25/107, 23.4% [15.2%, 31.5%], P <.001). Multivariable analysis confirmed that early childhood anaemia more than doubled the risk of developmental vulnerability (OR 2.2 [1.1, 4.3] P =.020) at school age. Conclusions: Early childhood anaemia is a risk factor for developmental vulnerability at school‐age in this setting. Interventions combining nutrition promotion and multi‐micronutrient food fortification, are effective in prevention of early childhood anaemia. Such interventions could also improve early childhood development and subsequent educational achievement. [ABSTRACT FROM AUTHOR]

Aim Three years following a state-wide Nutrition Care Process Terminology ( NCPT) implementation project, the present study aimed to (i) assess changes in NCPT knowledge and attitudes, (ii) identify implementation barriers and enablers and (iii) seek managers' opinions post-implementation. Methods Pre-implementation and three years post-implementation, all Queensland Government hospitals state-wide were invited to repeat a validated NCPT survey. Additionally, a separate survey sought dietetic managers' opinions regarding NCPT's use and acceptance, usefulness for patient care, role in service planning and continued use. Results A total of 238 dietitians completed the survey in 2011 and 82 dietitians in 2014. Use of diagnostic statement in the previous six months improved ( P < 0.001). Perceptions of NCPT's importance ( P < 0.020) and benefits of incorporating NCPT into practice ( P = 0.029) increased. Time to complete NCPT documentation ( P < 0.013) and access to mentors decreased ( P < 0.001). Other areas including enhanced attitudes, familiarity, confidence, views, knowledge and incorporation into practice were sustained ( P > 0.05). Key elements in sustaining NCPT implementation over three years included ongoing management support, workshops/tutorials, discussion and mentor and peer support. The most valued resources were pocket guides, ongoing workshops/tutorials and mentor support. Dietetic managers held many positive NCPT views, however, opinions differed around the usefulness of service planning, safer practice, improving patient care and facilitating communication. Some managers would not support NCPT unless it was recommended for practice. Conclusions Immediate improvements following the NCPT implementation project were sustained over three years. Moving forward, a professional focus on continuing to incorporate NCPT into standard practice will provide structure for process and outcomes assessment. [ABSTRACT FROM AUTHOR]

Aim: A standardised tool was needed to measure a generalist dietitian's confidence about working with clients experiencing psychological issues in order to effectively evaluate mental health ‐ related professional development activities. The aim of this study was to develop, pilot and validate a robust instrument that measures a generalist dietitian's professional confidence for working with clients experiencing psychological issues. Methods: The Dietetic Confidence Scale (DCS) was developed. Two cross ‐ sectional samples of practicing dietitians (n = 185; 458) from various settings and locations were recruited. Study 1: principal components analysis (PCA) helped refine scale items and derive a model, which was then validated using confirmatory factor analysis (CFA, Study 2). Cronbach's alpha estimated scale reliability. Correlations assessed associations between factors. Results: Study 1: A 13 ‐ item, two ‐ factor solution accounted for 69.1% of the total variance. Total Cronbach's α = 0.92. Dietetic confidence was associated with: (i) Confidence using the Nutrition Care Process and (ii) Confidence Advocating for Self care and Client care. Study 2: The CFA supported the proposed scale and model. A Good Fit Index of 0.95 indicated a strong fit. Item ‐ factor correlations ranged from r = 0.50 to 0.91. The final scale showed good reliability (α = 0.93). Conclusions: This is the first self ‐ efficacy scale for dietetic practitioners subjected to PCA and CFA using two independent samples. The DCS is a psychometrically robust instrument with strong internal consistency. It can be used to measure dietetic confidence about working with clients experiencing psychological issues and to highlight areas where additional support or training may be needed. Further validity and reliability testing is needed to enhance scale generalisability and use. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage ( SAH), use of diagnostic tests, emergency department ( ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal-referral and city-regional hospitals were examined. Methods A prospective cross-sectional study was conducted over 4 weeks in September 2014. All patients ≥ 18 years presenting to one of 29 public and five private hospital EDs across the state with an acute headache were included. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend to about 90% of all ED presentations statewide. The treating doctor collected clinical information at the time of the ED visit including the characteristics of the headache and investigations performed. A study coordinator retrieved results of investigations, ED discharge diagnoses, and disposition from state databases. Variations in presentation, investigations, and diagnosis between city-regional and principal-referral hospitals were examined. Results There were 847 headache presentations. Median (range) age was 39 (18-92) years, 62% were female, and 31% arrived by ambulance. Headache peaked instantly in 18% and ≤ 1 hour in 44%. It was 'worst ever' in 37%, 10/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale score was < 15 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the ED was found in 6.5%. A computed tomography ( CT) head scan was performed in 38% (318/841, 95% CI = 35% to 41%) and an lumbar puncture in 4.7% (39/832, 95% CI = 3.4% to 6.3%). There were 18 SAH, six intraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and two bacterial meningitis. Migraine was diagnosed in 23% and 'primary headache not further specified' in 45%. CT head scans were more likely to be performed in principal-referral hospitals (41%) compared to city-regional hospitals (33%). The headache in patients presenting to the latter was less likely to be instantly peaking or associated with activity, but was no less severe in intensity and was more frequently accompanied by nausea and vomiting. Their diagnosis was more likely to be a benign primary headache. Variations in CT scanning could thus be due to differences in the case mix. The median (interquartile range) ED length of stay was 3.1 (2.2 to 4.5) hours. Patients was discharged from the ED or admitted to the ED short-stay unit prior to discharge in 57 and 23% of cases, respectively. Conclusions The majority of patients had a benign diagnosis, with intracranial hemorrhage and bacterial meningitis accounting for only 3% of the diagnoses. There are variations in the proportion of patients receiving CT head scans between city-regional and principal-referral hospitals. As 38% of headache presentations overall underwent CT scanning, there is scope to rationalize diagnostic testing to rule out life-threatening conditions. [ABSTRACT FROM AUTHOR]

Aim Nutrition is important for pressure ulcer prevention. This randomised control pilot study assessed the feasibility of conducting a larger trial to test the effectiveness of a patient-centred intervention for improving the dietary intakes of patients at risk of pressure ulcer in hospital. Methods A 3-day intervention targeting patients at risk of pressure ulcer was developed, based on three main foundations: patient education, patient participation and guided goal setting. The intervention was piloted in three wards in a metropolitan hospital in Queensland, Australia. Participants were randomised into control or intervention groups and had their oral intakes monitored. A subset of intervention patients was interviewed on their perceptions of the intervention. Feasibility was tested against three criteria: ≥75% recruitment; ≥80% retention; and ≥80% intervention fidelity. Secondary outcomes related to effects on energy and protein intakes. Results Eighty patients participated in the study and 66 were included in final analysis. The recruitment rate was 82%, retention rate was 88%, and 100% of intervention patients received the intervention. Patients viewed the intervention as motivating and met significantly more of their estimated energy and protein requirements over time. Conclusion This pilot study indicates that the intervention is feasible and acceptable by patients at risk of pressure ulcer. A larger trial is needed to confirm the effectiveness of the intervention in the clinical setting. [ABSTRACT FROM AUTHOR]

Aim: Information on attitudes and knowledge of practising dietitians regarding the Nutrition Care Process (NCP) and International Dietetics and Nutrition Terminology (IDNT) would be useful to inform effective implementation. The present study aimed to: (i) explore dietitians' expectations, perceptions and anticipated benefits of NCP/IDNT pre and post implementation; (ii) identify perceived implementation barriers and enablers; and (iii) develop and assess a train ‐ the ‐ trainer NCP/IDNT implementation approach. Methods: All Queensland Government State hospitals from metropolitan, regional and remote areas were included in the study. Dietitian champions (n = 17) attended one face ‐ to ‐ face, train ‐ the ‐ trainer day, then led 14 one ‐ hour educational sessions to 279 district dietitians tailored to local situations, facilities and resources. NCP/IDNT were embedded into local processes and chart audits completed. Pre ‐ /post ‐ implementation surveys were completed by 86 dietitians. Results: Pre ‐ implementation results showed positive attitudes regarding the value of NCP/IDNT (mean 1.89, SD 0.67, 1 = strongly agree, 5 = strongly disagree). Dietitians identified management support; practice, tutorials and workshops; mentor support; and follow up audits as important for successful implementation. Most attendees (81%) completed ≥10/13 tutorials and 86% (415/480) of audited charts included Nutritional Diagnosis statements. Post ‐ implementation familiarity, confidence and knowledge of NCPT (Nutrition Care Process Terminology) significantly improved (P < 0.001). Conclusions: Prior to implementation, respondents viewed the NCP/IDNT as applicable to their practice areas. The train ‐ the ‐ trainer program with frequent teleconference and email support was effective in improving knowledge, confidence, preparedness for implementing NCPT and charting behaviour. Although training was positively received and has achieved good results, dietitians identified the need for ongoing training and support to further increase confidence following implementation. [ABSTRACT FROM AUTHOR]

Objective. The aims of this study were to determine the prevalence of erosion in a birth cohort at 24, 36, and 48 months and to investigate risk factors for erosion. Methods. One hundred and fifty-four children from a birth cohort were followed at 24, 36, and 48 months of age. Results. Of the 154 children examined, 0% (0/ 154), 7% (11/154), and 28% (40/154) had erosion detected for the first time at 24, 36, and 48 months, respectively (P < 0.001). A cumulative total of 51 (33%) children and 256 (8%) teeth had erosion by the age of 48 months. There were no significant associations between erosive lesions first detected at 36 months and oral hygiene behaviour, medical conditions, or dietary habits reported at the 24- or 36-month examinations (all P > 0.05). In contrast, erosive lesion first detected at 48 months was positively associated with the use of a feeding bottle reported at the 36-month examination (P = 0.026). Conclusions. The prevalence of dental erosion in young children increased with age, with clinically detectable lesions forming between 24 and 36 months of age. Erosive lesions first detected at 48 months were positively associated with the use of a feeding bottle reported at 36 months. [ABSTRACT FROM AUTHOR]

Aim: The benefits of Transition Care Programs (TCPs) for patients with cognitive impairment are not well established. This study aimed to investigate the impact of TCP on patients according to their cognitive status. Methods: In this prospective cohort study, 351 patients were comprehensively assessed at TCP admission using the interRAI Home Care instrument and divided into two groups based on scores on the Cognitive Performance Scale. Results: Of 346 patients assessed for cognition, 242 (69.9%) were considered cognitively intact, and 104 (30.1%) were classified as cognitively impaired (Cognitive Performance Scale ⩾ 2). There were no significant differences in TCP outcomes between the two groups, including community living at six months (P = 0.1), hospital readmission rates (P = 0.6), or achievement of TCP goals (P = 0.3). Conclusions: Cognitively intact and cognitively impaired patients have similar outcomes post-TCP. Older patients should not be refused Transition Care based on the presence of cognitive impairment. [ABSTRACT FROM AUTHOR]

Objectives This study's objective was to determine whether tuition in medical documentation enhanced the ability of emergency medicine interns to produce effective medical records. Methods The study adopted a case control design, using a retrospective document audit methodology, following an education intervention during the ' More Learning for Interns in Emergency' ( MoLIE) programme. It was conducted in a tertiary hospital that supports five 10 week rotations of 12 interns each year ( n = 60). Controls were drawn from records written in March 2012 and cases from March 2013. A total of 250 medical records written by interns were audited, 125 from each year. Results Three categories of documentation were investigated: patient characteristics, clinical impressions and management plan using a purpose-designed score sheet. Three individual items (differential diagnosis [ DDX], Support and Impressions [ Impress]) showed significant improvement. The proportion of excellent scores for DDX increased by 50% from 40.8% to 61.6%. A χ2 test for independence (with Yates continuity correction) indicated a significant association between the intervention and subsequent score ( X2[1, n = 250] = 10.006, P < 0.001, phi −0.208). For Impress, a 48% increase in excellent scores was seen (39.2% to 58.4%). A χ2 test for independence indicated a significant association between the intervention and subsequent score ( X2[2, n = 250] = 11.249, P = 0.004, Cramer's V 0.212). The variable Support also improved ( X2[2, n = 250] = 8.297, P = 0.012, Cramer's V 0.189) with the number of excellent scores increasing from 37.6% to 48.0%. Conclusion The study demonstrated that documentation of clinical notes by interns can be enhanced by formal tuition. [ABSTRACT FROM AUTHOR]