AN INTERNATIONAL JOURNAL OF TROPICAL & TRAVEL MEDICINE

ANNALS OF THE ACTM
AN INTERNATIONAL JOURNAL OF
TROPICAL & TRAVEL MEDICINE
ISSN 1448-4706
Volume 12 Supplement 1
IN THIS ISSUE
SUPPLEMENT 1
THE TOWNSVILLE HOSPITAL AND JAMES COOK UNIVERSITY,
SCHOOL OF MEDICINE AND DENTISTRY RESEARCH SYMPOSIUM
FRIDAY 14 OCTObER 2011
RObERT DOUgLAS AUDITORIUM,
THE TOWNSVILLE HOSPITAL, AUSTRALIA
• Editorial
• SympoSium program
• invitEd SpEakEr BiographiES
• kEynotE addrESS aBStract
• oral aBStractS
• poStEr aBStractS
• diScuSSion papEr
ACTM MEMBERSHIP APPLICATION
Official Journal of The Australasian College of Tropical Medicine
Volume 12 Supplement 1 October 2011
1 ANNALS OF THE ACTM
S1

Officers of The Australasian College of
Tropical Medicine
President
Associate Professor David Porter
Vice President
Dr Kym Daniell
Honorary Secretary
Dr Richard bradbury
Honorary Treasurer
Professor Peter A. Leggat
Immediate Past President
Associate Professor Tim Inglis
Council Members
Dr Vlas Efstathis, OAM, RFD, Associate Professor
John Frean, Dr Sue Heydon, Associate Professor
Wayne Melrose, Associate Professor geoff Quail,
Associate Professor Marc Shaw,
Professor Richard Speare
Chair, Faculty of Travel Medicine
Dr Jennifer Sisson
Chair, Faculty of Expedition and Wilderness Medicine
Associate Professor Marc Shaw
Chairs of Standing Committees
Dr Vlas Efstathis, OAM, RFD (Disaster Health)
Dr Richard S. bradbury (Medical Parasitology & Zoonoses)
Professor Derek R. Smith (Publications)
Dr Ken D. Winkel (Toxinology)
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ANNALS OF THE ACTM
Editor-in-Chief
Professor Derek R. Smith
Emeritus Editor-in-Chief
Emeritus Professor John M. goldsmid
Executive Editors
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Associate Professor John Frean
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Editor ACTM Bulletin
Professor Peter A. Leggat
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Pearn, AO, RFD, Dr Ken D. Winkel
ANNALS OF THE ACTM
AN INTERNATIONAL JOURNAL OF TROPICAL & TRAVEL MEDICINE
CONTENTS
SUPPLEMENT 1
THE TOWNSVILLE HOSPITAL AND JAMES COOK UNIVERSITY,
SCHOOL OF MEDICINE AND DENTISTRy RESEARCH SyMPOSIUM
FRIDAY 14 OCTOBER 2011
ROBERT DOUgLAS AUDITORIUM,
THE TOWNSVILLE HOSPITAL, AUSTRALIA
© Copyright 2011 ACTM
OCTOBER 2011
EDITORIAL S1
SyMPOSIUM PROgRAM S2
INVITED SPEAkER BIOgRAPHIES S3
kEyNOTE ADDRESS ABSTRACT S3-S4
ORAL ABSTRACTS S4-S7
POSTER ABSTRACTS S8-S12
DISCUSSION PAPER S13
MEMBERSHIP
ACTM MEMBERSHIP APPLICATION S15-S16
Cover photo: The Australian Institute of Tropical Medicine in 1916 (photo courtesy of James Cook University)
Material published in the Annals of the ACTM is covered by copyright and all rights are reserved, excluding “fair use”, as
permitted under copyright law. Permission to use any material published in the Annals of the ACTM should be obtained in
writing from the authors and Editorial board.

The Townsville Hospital and James
Cook University, School of Medicine
and Dentistry Research Symposium
Friday 14 October 2011 (12:30-4:00pm)
Robert Douglas Auditorium,
The Townsville Hospital
EDITORIAL
Fostering Research in Hospitals
Lynden J. Roberts
Director, Tropical Alliance for Clinical Excellence by Research (TRACER), Townsville Health
Service District, The Townsville Hospital, Townsville
Hospitals have long-provided a fertile environment for medical research.
Much of the knowledge base underpinning modern medicine was derived
from hospital-based research. That hospitals co-locate collections of the
sickest patients and enquiring clinical minds provides a ready explanation.
For reasons of efficiency, hospitals have also traditionally served as the
setting for medical student clinical training. For both of these reasons,
university medical faculties and research institutes have conventionally
sought to co-locate with large hospitals around the world. In Australia, this
model meant that a select group of “university teaching hospitals” evolved.
These delivered high concentrations of academically active clinicians
attached to the hospitals, and inevitably generated highly productive
research environments.
Much has changed. Research has become vastly more complex and
specialized requiring full-time research commitments, substantial funding,
and collaborating teams. The romantic idea that an astute clinician might
still make a major research discovery by isolated pottering in research,
without much time or resources, is unfortunately fanciful. Separately,
university medical schools have been increasingly providing clinical training
in community settings. this has been driven by the need to find sufficient
clinical resources to train students, but also out of a desire to improve the
breadth of clinical exposure during training, and with the realistic hope that
community-based training might encourage more people to choose to work
in those settings. Our own James Cook University has provided national
leadership in this area by demonstrating that this works. Lastly, hospitals
have been increasingly focused on optimizing the efficiency of the care they
provide. This has meant that clinical service demands consume an everincreasing
percentage of a clinician’s time. While all of these drivers of
change have sound underlying rationales, their combined effect has seen
the fading of academic life from modern Australian hospitals.
Yet, there remain two compelling reasons for fostering a culture of
research in hospitals. First, the hospitals traditional advantage of
clustering the sickest patients remains. When considering potential
impact, undertaking research on the sickest patients makes for a large
potential research yield and finding them all in one place makes the work
efficient. Second, and perhaps as important, a culture of research actually
underpins the quality of clinical care and of clinical education. Only a
research culture can deliver the enquiring minds with the skills to ask and
answer the contemporary health questions, to challenge dogma, and to
drive continuous improvements. Without a culture that teaches and applies
these skills, our hospitals become factories for the sick filled with ‘factory’
workers. this factory model might seem superficially appealing to generic
managers, but it fails to serve healthcare efficiently or effectively. rather,
we need hospitals to be flexible, adaptive and self-improving entities filled
with flexible, adaptive, and self-improving staff; only an organization-wide
culture of enquiring minds can deliver this. Although these advantages
of hospital-based research are compelling, our research attention must
Volume 12 Supplement 1
also embrace those long-neglected research areas of community health,
underserved populations, disease prevention, and the new problems of
chronic disease, workforce shortage and health services research to name
a few; but abandoning medical research in hospitals altogether represents
a sizeable opportunity lost.
There is some reason to be optimistic. There is growing recognition of
the importance of embedding research within integrated teaching hospital
environments. influential australian health leaders have pointed to the
high correlation between the quality of clinical care, education, and the
presence of research at the best institutions throughout the world and
have called for similar strategies here. 1;2 Our NHMRC in its strategic plan
2010-2012 has one of its objectives as “integrating the conduct of research
with high quality education of health professionals and with the care of
patients”. 3 Other countries are well ahead though. In fact, the USA has
been integrating patient care, research and education well ever since the
Flexner report laid out the strategy in 1910! In the UK, similar concerns to
those outlined above have driven major reforms of the NHS. These have
delivered substantial new funding targeting the clinical and translational
end of health research. Tellingly, the UK Health Minister has recently been
explicitly tasked with promoting research within the health portfolio. 4 All of
these authorities highlight the value of bringing research experiences into
training across the training spectrum and maintaining them throughout the
clinical working life.
Pleasingly, a local response is underway. The Townsville Health Service
District has established three streams of research activity in nursing,
allied health, and medical disciplines. To bolster the medical stream, the
District has recently appointed a Director of Clinical Research to lead a
new organization TRACER – the TRopical Alliance for Clinical Excellence
by Research. broadly, the aims of these three research streams are to lead
and support research within the District by building research capacity and
attracting resources, but they have a particular focus on research activities
that have visible ties to patient outcomes. The time is ripe for these
initiatives. This year’s NQ Clinical Research Symposium shows that there
is already a growing local base of research activity on which to build. Next
year the Symposium will form part of a multidisciplinary research week for
the District, which will come on the back of JCUs “Celebrating Research”
month of activities. I encourage you all to get involved and join the exciting
world of knowledge-making.
References
1. Penington Dg. Rediscovering university teaching hospitals for Australia. Med J Aust 2008; 189, 332-5.
2. Van Der Weyden Mb. The viability of Australia’s teaching hospitals. Med J Aust 2008; 189, 330-1.
3. Anderson W, good M. National Health and Medical Research Council Strategic Plan 2010-2012. Available online
at: http://www.nhmrc.gov.au/guidelines/publications/nh132 (Accessed: 13 September 2011)
4. Sanderson A. government response to the NHS Future Forum. Available online at: http://www.dh.gov.uk/prod_
consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127578.pdf (Accessed: 13 September 2011)
Acknowledgements
We would like to formally acknowledge all the members of the
2011 Organising Committee who kindly assisted in making this
year’s Symposium possible: Rebecca Evans, Jenine Lawlor, Lynden
Roberts, Shantae Ryle, Sabe Sabesan and Laura Simpson. We would
also like to acknowledge the assistance of the following members
of the Townsville Hospital Research Steering Committee, who have
graciously given their time: Peter Aitken, Rhys Edwards, John Evans,
Jeremy Furyk, Sarah Larkins, Richard Murray, Robert Norton, Carl
O’Kane, David Porter, John Reilly, Kunwarjit Sangla and Andrew White.
This special supplementary issue of the Annals of the Australasian
College of Tropical Medicine (AACTM) was edited by Derek R. Smith
and glenn Courtenay from the University of Newcastle, Ourimbah,
with graphic design undertaken by Jerry Liu from Jerry Liu Design &
Photography, brisbane. Thanks also to the AACTM Executive Editorial
board of John M. goldsmid, Peter A. Leggat and John Frean.
1 ANNALS OF THE ACTM
S1

SyMPOSIUM PROgRAM
The Townsville Hospital and James Cook University,
School of Medicine and Dentistry Research Symposium
Friday 14 October 2011 (12:30-4:00pm)
Robert Douglas Auditorium, The Townsville Hospital
TIME TOPIC SPEAkER
12:00 LUNCH
12:30 Welcome Address
12:35
Introduction and Overview
An epidemiological review of invasive Staphylococcus aureus infections in children of Far
North Queensland
Dr Andrew Johnson, CEO,
Townsville Health Service District
Dr Lynden Roberts, Chairperson,
2011 North Queensland Medical Research
Symposium
Ms Tiarna Ernst
12:40 injury and illness on the West coast trail: Still the graveyard of the pacific? Dr Jonathon Malo
12:45 Exposure to Coxiella burnetii in Townsville Dr Katie Eales
12:50
12:55
A study of outcome following Percutaneous Coronary Interventions (PCIs) in the Aboriginal
and Torres Strait Islanders (ATSIs) population of North Queensland
Maintaining intern learning in the ED despite a 50% increase in intern numbers: Can a
structured learning program be part of the answer?
Dr Akhlaq Khan
Dr Catriona Slater
1:00 Retinal vessels in low birth-weight babies Mr Leo Hartley
1:15
Diagnosing CT-negative spontaneous (non-traumatic) subarachnoid haemorrhage across
Australasia: Perceived versus actual practice
Dr Cassandra Farris
1:30 Keynote address: Then and now: 64 years a Surgeon Emeritus Professor Tom Reeve
2:15 AFTERNOON TEA
2:45 Intra- and inter-observer consistency in visual inspection for “xanthochromia” Ms Donna Rudd
2:55 Improving discharge summaries through education Dr Lesley Stainkey
3.00 glycaemic control post open heart surgery at the The Townsville Hospital Dr Ching-Siang Cheng
3:05
a longitudinal study of the career paths of the first James cook university medical school
graduates
Dr Aileen Traves
3:20 The Diabetic Host: Tropical paradise for a killer bug Dr Jodie Morris
3:35 Hospital access block - Exit block interaction Dr Paul goldstraw
3:50 bacteraemias in North Queensland Dr Robert Norton
4:05 Improving rural and indigenous cancer outcomes: A clinical research perspective Dr Sabe Sabesan
4:20 Closing Address
4.25
WINE AND CHEESE
AWARDINg OF PRIZES
Associate Professor Richard Murray, Dean
and Head of School, School of Medicine
and Dentistry, James Cook University
S2 ANNALS OF THE ACTM October 2011

INVITED SPEAkER BIOgRAPHIES
Volume 12 Supplement 1
Emeritus Professor Tom Reeve, AC, CBE.
Tom Reeve, AC, CbE, is an Emeritus Professor
in Surgery of the University of Sydney. Professor
Reeve graduated from the University in 1947 and
after working in Sydney entered general Practice in
Collinsville, North Queensland. In July 1950 he went
to Albany Medical College in upstate New York and
completed training in general and Thoracic Surgery.
Returning to Sydney in 1956, he worked as a Surgical
Research Fellow in the Unit of Clinical Investigation at Royal North Shore
hospital. in 1958 he became certified by the american Board of Surgery and
in 1967 became a Fellow of the Royal Australasian College of Surgeons. In
1961 he was appointed as a Senior Lecturer in the Department of Surgery,
The University of Sydney, based at Royal North Shore Hospital. He built on a
Thyroid Unit to develop a strong Endocrine Surgical Unit, which continues.
He also developed a strong association in the applied research activities of
the Ultrasonics Institute and became involved in clinical ultrasound during
its development for the study of the breast, thyroid and parathyroid glands,
working with Dr george Kossoff, the Institute’s Director and Dr Jack Jellins,
taking the modality into clinical practice. He was Chairman of Surgery at the
University from 1982 until 1988. He Chaired the Northern Sydney Health
Area from 1988-1996. He was awarded Commander of the Order of the british
Empire - for services to Medicine in 1973 and a Companion to The Order
of australia in 1994 ‘For service to medicine and to academic and clinical
surgery, particularly in the field of endocrinology’. on retirement, tom reeve
became President of the Royal Australasian College of Surgeons and has had
a role in best Practice and Quality activities at both a clinical and administrative
level. In 1993 he prepared a report “Quality Assurance and Utilisation
Review in Hospitals” for the Department of Health & Human Services.
He was appointed by the Australian Cancer Society (now known as Cancer
council australia) as Executive officer, australian cancer network in late
1993. He was Chair of the Working Party that developed “Clinical guidelines
for the Management of Early breast Cancer” for the NHMRC. These were the
first evidence-based cancer management guidelines produced in australia.
Professor Reeve developed a database in Thyroid and Parathyroid Surgery
commencing in 1957 and continues to the present. He is still active with a
number of young people in publishing papers in the thyroid field. he continues
to publish papers in refereed journals, including recent contributions
to papers on ‘Surgical trends in the management of thyroid lymphoma’ and
‘increasing incidence of thyroid cancer is due to increased pathologic detection’.
He holds honorary membership of the American Surgical Association,
kEyNOTE ADDRESS ABSTRACT
Then & Now: 64 Years a Surgeon
Emeritus Professor Tom Reeve, AC, CBE.
Professor of Surgery, University of Sydney
being a surgeon is a great privilege. being a surgeon for 64 years is an even
greater privilege. As a child, I saw Australia to be growing and beginning to
establish the institutions that are now an important part of our daily fabric. A
national parliament was opened. The nation survived a great and degrading
depression. It had distinguished itself in War. Nationhood had been achieved
in a demanding crucible and its achievements continue. Medical school was
still heavily dependent on Anatomy as the major subject in the curriculum.
The elements of history taking and clinical examination were the basis of
clinical medicine. Investigations were rather rudimentary as compared to
what is now available.
the Coller Society and the Alpha Omega Alpha (AΩA) Medical Honor Society.
He is an honorary MD of the University of Sydney and Honorary Fellow of
the American, Canadian, South African and Philippine Colleges of Surgeons.
He enjoys interacting with his colleagues, travel, reading and weekends in
the garden.
Dr Sabe Sabesan
Dr Sabe Sabesan, MbbS, FRACP, is the Director of
Medical Oncology at the Townsville Cancer Centre,
Townsville Hospital and the convenor of cancer education
at the School of Medicine and Dentistry at the
James Cook University. As a member of the Oncology
Education Committee of the Cancer Council of
Australia, he has contributed to the development of
ideal oncology curriculum for medical students and
published in the area of medical education. He was a member of the ANZ
Melanoma and Prostate Cancer guidelines Writing Committees and has written
chapters relating to medical therapies in both cancers. In his Queensland
Health role, he pioneered the largest teleoncology network in the country
for which his department was a finalist in the Qld premier’s award for Excellence
in Service Delivery in 2010. He has published, presented and conducted
workshops in the area of rural and indigenous health and telehealth.
SyMPOSIUM CHAIR
Dr Lynden J. Roberts
Dr Lynden J. Roberts, MbbS, PhD, FRACP, is the
newly appointed Director of Clinical Research for the
Townsville Health Service District. After graduating
with an MbbS from the University of Melbourne in
1994, he completed a PhD in Immunogenetics at the
Walter and Eliza Hall Institute of Medical Research in
2000. Currently Director of Rheumatology, his previous
appointments include Director of Physician
Training, and the Director of Internal Medicine at the Townsville Hospital,
and Senior Lecturer in the Department of Medicine, University of Melbourne.
dr roberts looks forward to helping raise the profile, quality and quantity of
clinical research in North Queensland.
Immediate postgraduate education was quite rudimentary and most specialisation
was begun in and from general practice. To move from a city hospital
to a country or regional area was commonplace and many doctors who later
became specialists commenced their progress along the training path in this
way. good understanding between the local community and doctors was
strong and patient expectations were less than they are now. Most graduates
who wanted to become highly specialised went to train in England. The odd
one chose to go the uSa only to find that their ambitions were overturned
by the Korean War which drained American hospitals of the young surgeons
and surgical trainees. Trainees in US teaching and regional hospitals were
well taught and expected to be involved in research activities - a feature being
considered in Australian programmes although the desirable extent is
still not determined.
3 ANNALS OF THE ACTM
S3

Returning to Australia allowed the study of some areas which would be different
today. Some matters came along unexpectedly at the time. Community
generosity allowed a surgeon to advance overseas to acquire training
in the use of cytotoxic drugs and their use in treatment before the arrival
of medical oncologists who quickly transformed the field. the compulsory
mass chest x-ray survey for detection of tuberculosis yielded signs of other
pathology than just in the chest and allowed a useful epidemiological study
into to other pathological processes. Opportunities also presented in the
field of diagnostic ultrasound which was materially advanced by members
of the Ultrasonics Institute. At the time, there was a strong realisation of the
important role played by training and the practiced management of professional
matters by strong mentors. Every young doctor can benefit from “an
experienced trusted adviser, counsellor and guide”.
ORAL ABSTRACTS
The Townsville Hospital and James Cook University,
School of Medicine and Dentistry Research Symposium
Friday 14 October 2011 (12:30-4:00pm)
Robert Douglas Auditorium, The Townsville Hospital
An Epidemiological Review of Invasive Staphylococcus aureus Infections
in Children of Far North Queensland
Tiarna Ernst
School of Medicine and Dentistry, James Cook University, Townsville
Aims: The objective of this study was to identify the prevalence of invasive
Staphylococcus aureus infections within Far north Queensland, australia;
in addition to obtaining epidemiological data of the patient demographics,
clinical consequences and severity of these infections. Methods: A
retrospective clinical record audit of all 172 paediatric patients admitted
to Cairns base Hospital between 1 st January 2000 and 31 st December 2009
with an invasive Staphylococcus aureus infection. High resolution melting
analysis was performed on a subsample population of 48 patients for
clonal complex (CC) identity and Panton Valentine Leukocidin (PVL) toxin
production. Results: The rate of admission to Cairns base Hospital with
an invasive S. aureus infection increased over the 10 year study period.
there was a significant increase in the proportion of infections caused by
ca-mrSa. indigenous children were significantly more likely to have a ca-
MRSA infection than non-indigenous children. On univariate analysis, PVL
positive infections were significantly more likely to have longer hospital
stay, higher C-reactive protein levels, severity scoring and ICU admission.
cc30 South West pacific was the most predominant clone. Five pvl positive
cc1 isolates were identified. Conclusion: ca-mrSa has significantly
contributed to an increase in paediatric invasive S. aureus infections within
Far North Queensland. There appears to be a heavy burden of invasive S.
aureus infections on the indigenous child population. A larger subsample is
required to confidently comment on the severity of pvl positive S. aureus
infections. There is observation of an increase in PVL positive CC emerging
within Far North Queensland.
Injury and Illness on the West Coast Trail: Still the graveyard of
the Pacific?
Jonathan A Malo¹ and Eiman Zargaran²
¹The Townsville Hospital, Townsville
²Parks Canada, Vancouver, Canada
Objective: To review the epidemiology of injuries, illnesses, and causes
of evacuations on the WCT and make recommendations for improving
One mentor in 1955 advised that a database be established in an area of
surgical speciality. He said, “Computers are coming - be ready”. Little did he
know that there would be a testing of personal interest and tenacity as there
would be no usable results for at least three years. However, a database in
Endocrine Surgical Procedures was commenced in 1957 and continues to
this day. It took 24 years before a single observation produced from the database
led to change in the world. Practice results are reported. The resultant
activities can be performed by trained surgeons in the cities and provinces.
Professionalism and attributes of clinical surgical researchers can be discussed.
Surgeons, however, need to carefully maintain their role in a highly
competitive research environment despite frequent criticism of their role.
participant safety. Methods: parks canada staff provided de-identified
public safety occurrence data within the WCT from 2005 to 2010. These
reports were retrospectively reviewed and the relevant data was extracted.
Only reports involving hikers during the May 1st to September 30th hiking
season were included. The two-proportion z-test was used to determine
statistical significance. Results: We reviewed 457 occurrence reports of
which 310 met inclusion criteria, corresponding to an incident rate of 1
per 104 hikers. this was significantly increased (p

and rainfall data was collected. Results: Serological evidence of exposure
to C. burnetii was demonstrated in 243 patients, including 92 patients with
confirmed acute disease. clustering of cases in suburbs of townsville
was demonstrated with a rate of 24.9 per 100,000 population in the most
affected area. A seasonal peak was found, with the greatest number of cases
observed in May. Conclusion: to our knowledge, this is the first study to
demonstrate an association between rainfall and the incidence of Q fever in
North Queensland. Townsville has historically been closely associated with
cattle farming and several old cattle grazing sites now lie within residential
zones. Furthermore, C. burnetii is known to commonly infect local wildlife
and tick populations. Possible reasons for the seasonal variation in acute
cases are discussed and further areas for research suggested.
A Study of Outcome following Percutaneous Coronary Interventions
(PCIs) in the Aboriginal and Torres Strait Islanders (ATSIs)
Population of North Queensland
Akhlaq Khan, Vishwanathan Venkatachalam, Raibhan Yadav and
Dinesh Sivananthan
Department of Cardiology, The Townsville Hospital, Townsville
Aim: A retrospective observational analysis of immediate, early & late
outcomes following PCIs in the ATSIs population of North Queensland.
Methods: 254 PCIs were performed on 190 ATSIs patients from May 2006
to February 2011. Details were obtained from the Townsville Hospital
Cardiology Database (Cardiobase) and hospital charts. The sample
population had a wide geographic distribution. Results: 195 hospitalization
with ischemic heart disease (IHD) comprised of 122 men (63%) and 73
women (37%). 234 urgent PCIs were performed on various coronary
arteries included 224 stent deployment (95.72%) and 10 angioplasties
(4.27%). 241 (94%) first pci procedure were performed in 132 men (55
%) & 109 women (45%) and 19 had repeat PCIs depending on the nature
of indication. 101 (53%) patients were followed up (men = 60 [51%] &
women = 41 [56%]) for an average period of 5 yrs at the Townsville hospital.
Overall immediate procedural success was (94.09%) and Immediate PCIrelated
complications were acute re-occlusion, residual thrombus, residual
stenosis, coronary artery dissection and VF arrest were 0.39%, 0.78%,
1.18%, 1.18% and 1.57% respectively. Late PCI-related complications
including early Instent thrombosis, subacute instent restenosis, late
Instent thrombosis and late instent restenosis was 0.52% for each
respectively. Overall M.A.C.C.E was 0.52% at 30 days, 6 months and at 1
year respectively. Conclusion: In 254 PCIs performed on ATSI population,
an excellent immediate procedural success rate was achieved with a low
rate of immediate, early & late PCI related-complications. Medication noncompliance
remained a significant challenging issue. however, the overall
M.A.C.C.E was low.
Maintaining Intern Learning in the ED despite a 50% Increase in
Intern Numbers: Can a Structured Learning Program be Part of the
Answer?
Catriona Slater, Michelle Lees and Jenine Lawlor
Post Graduate Medical Education Unit, The Townsville Hospital, Townsville
Introduction: the ‘more learning for interns in Emergency’ (moliE)
program was designed to provide targeted Emergency Medicine
education, while increasing the capacity of the Emergency Departments
to accommodate interns. Objective: To assess the effects of a structured
learning program on interns’ self-rated confidence in practical and
professional skills. Setting and Participants: The MoLIE program was
implemented in early 2010 in the Townsville Hospital ED, coinciding with
a 50% increase in intern numbers. it consisted of 8 hours of ‘off the floor’
consultant-led case-based teaching plus 2 to 4 shifts of additional ‘on
the floor’ consultant supervision per week. Methods: Data was collected
prospectively for 2 years from ED interns at the beginning and end of each
ED term, using a 25 item 5-point Likert scale questionnaire, addressing
interns’ self-reported confidence in practical and professional skills. the
Volume 12 Supplement 1
MoLIE program was implemented 1 year into the data collection period.
Summed likert Scores were calculated and the change in confidence in
both practical and professional skills was compared. Results: Interns
consistently reported an increase in confidence regarding their practical
and professional skills during a term in Emergency medicine. no significant
difference was found for the increase in confidence between the 2009 and
2010 cohorts of interns. Conclusion: The structure of the MoLIE program
has allowed for a significant increase in the capacity of the townsville
Hospital to accommodate interns, without compromising the educational
experience of an ED term, as perceived by the interns. We present the
MoLIE program as a viable model for accommodating the rapid expansion
in intern numbers in the ED.
Retinal Vessels in Low-Birth-Weight Infants
Yoga Kandasamy¹, Roger Smith¹, Ian Wright2 and Leo Hartley¹
¹Department of Neonatology, The Townsville Hospital, Townsville
²School of Medicine and Dentistry, James Cook University, Townsville
Aims: The purposes of this study were to determine the normal retinal
microvasculature measurements in human infants who are born at
term and to determine whether birth weight influences measurements
of retinal microvasculature. Study Design: Retinal arteriole and venule
measurements were obtained in a cohort of 24 infants who were born at
term. Digital images of both retinas were obtained using a digital retinal
camera after pupillary dilation. Results: In all, 24 newborn infants born at
term (12 females and 12 males) were analysed in this study. The measured
retinal arteriole diameters were 66.8–147.8 μm (mean, 94.2±19.6 μm), and
the venule diameters were 102.0-167.8 μm (mean, 135.2±19.1 μm). Seven
babies in the sample had low birth weight, while 17 babies were born
with normal weight. babies with lower birth weights had larger arteriole
(113.1±17.9 μm vs. 86.4±14.4 μm; p=0.0009) and venule diameters
(151.7±14.9 μm vs. 128.4±16.9 μm; p=0.0040). Conclusion: Retinal
venules and arterioles in low-birth-weight babies are larger compared
to those of normal-birth-weight babies. We postulate that the difference
observed in our study was due to in utero pathophysiological changes
that occurred in the cerebral circulation of growth-restricted foetuses.
Reprinted from the Journal of Perinatology (advance online publication, 2011: doi: 10.1038/
jp.2011.118). Full version available online at: http://www.nature.com/jp/journal/vaop/ncurrent/
full/jp2011118a.html
Diagnosing CT-negative Spontaneous (non-traumatic)
Subarachnoid Haemorrhage across Australasia: Perceived versus
Actual Practice
Cassandra Faris, Ryan Duell, Laurence Marshman, Jason McMilen,
Felix Ng, David Anderson and Eric guazzo
Department of Neurosurgery, The Townsville Hospital, Townsville
Aim: The diagnosis and management of spontaneous subarachnoid
haemorrhage (sSah) with normal plain ct findings is controversial.
Interventional risks may outweigh natural history risks for unruptured
aneurysms: proof of sSAH is therefore usually sought by LP. Unfortunately,
variation is possible in CSF sampling timing, CSF diagnostic criterion (DC)
definition, or cSF dc detection. We aim to document current laboratory
practice across australasia; the attitudes and knowledge of neurosurgical
registrars towards cSF-sSah diagnosis; and their familiarity with local
laboratory practice. Methods: N=51 laboratories (n=22 in neurosurgical
units) across Australasia were surveyed regarding their current practice in
dcdefinitionanddcdetectionmethodologywithcSF-sSahdiagnosis.n=55
neurosurgical registrars were then surveyed across each unit to document:
1) their knowledge and attitudes towards CSF-sSAH diagnosis, and 2) their
familiarity with local laboratory practice. Results: our results confirmed
maximal heterogeneity (both inter- and intra-state) in laboratory CSF-sSAH
diagnosis: in both dc definition (3/3 definitions practiced) and dc detection
methodology (6/6 methodologies practiced). there was also significant
5 ANNALS OF THE ACTM
S5

heterogeneity in knowledge and attitudes amongst neurosurgical registrars
towards cSF-sSah diagnosis (65% considered [un-recommended] ‘Xi’
the desired dc), significant heterogeneity in perceived sampling timing
(56% did not cite 12hrs) or sampling practicalities (1.8% considered these
irrelevant), whilst 84% incorrectly identified their own laboratory’s dc
definition and a further 42% incorrectly stated their own laboratory’s dc
detection methodology. Conclusion: CSF-sSAH diagnosis in CT-negative
patients in neurosurgical units across Australasia is currently confused:
both in principle, and in practice. National guidelines are required for CSF
dc definition, cSF dc laboratory detection methodology, and in the timing
and practicalities of CSF sampling.
Intra- and Inter-Observer Consistency in Visual Inspection for
‘Xanthochromia’
Ryan Duell¹, Cassandra Faris¹, Donna Rudd², Laurence Marshman¹,
David Anderson¹ and Eric guazzo¹
¹Department of Neurosurgery, The Townsville Hospital, Townsville
²Department of Physiology, James Cook University, Townsville
Aim: Where CT is negative after putative subarachnoid haemorrhage (SAH),
a lumbar puncture (LP) is usually performed. Whilst spectrophotometry to
measure cerebrospinal fluid (cSF) bilirubin is the currently recommended
diagnostic standard, some laboratories continue to perform visual
inspection to assess “xanthochromia” (viX) in the cSF supernatant.
However, to our knowledge, no study to date has demonstrated the intraand
inter-observer consistency of viX. We aim to demonstrate the intraand
inter-observer consistency of viX. Methods: A laboratory study was
devised to simulate viX analysis clinically. a series of tubes with mock
CSF containing increasing concentrations of added haemoglobin (0, 0.5,
1.0, 2.5, 5.0 and 6.0 g/L), bilirubin (0, 0.34, 1.0, 1.5, 3.0 and 6.0 umol/L)
and albumin (0.3 and 2.0 g/L), were subsequently mixed to simulate
varying degrees of blood, protein and bilirubin contamination from ‘clear’
through to ‘maximally contaminated’ in both cases. n=26 non-colourblind
observers (M11, F15) were then randomly assigned each known
mixture on two separate occasions: in two separate rooms of significantly
differing ambient luminosity (400-430 versus 950-1020lux). viX was
performed against a white background in all four circumstances. Results:
intra-observer viX consistency was poorer in males than in females.
intra-observer viX consistency was also poorer in lower than in higher
ambient luminosity. inter-observer viX consistency was significantly
poorer than intra-observer consistency. Inter-observer consistency was
also significantly poorer in lower ambient luminosity: especially regarding
‘orange’ hues. in general, with increased haemoglobin and bilirubin
concentrations, ‘red’ hues consumed ‘yellow’ hues. Conclusion: Even
excluding colour blindness (present in 8% males), both poor ambient
illumination and male sex appear to adversely affect viX consistency. viX
inconsistency is therefore clinically significant. viX should be abandoned
at a National level in favour of more objective analysis for CSF bilirubin.
Light in the Interior of a Tropical Hospital - Could This Affect Patients’
Circadian Rhythm?
Sandra Burton and Paul goldstraw
Dementia-Delirium Ward, Gerontology Services, The Townsville Hospital, Townsville
Introduction: The inner environment of buildings in the Tropics is a
balance between heat and ventilation, shade and light. This may result in
low internal light levels, below the required 2000 lux to maintain circadian
rhythm and mood. Patients with delirium and dementia easily lose that
rhythm. Night disorientation is a major problem in hospitals. Aim: This
study was undertaken to evaluate light levels inside a modern hospital in
the tropics as the first phase of a project on light and circadian rhythm
in at risk patient groups. Methods: Light level was measured in lux by a
TES Electrical Electronic Corporation Light Meter (model number 1330).
Recordings were taken during 12-1400 hours in the medical wards of TTH.
Results: The average lux level in single patient rooms of the Dementia-
Delirium ward was mean 267, the four bed room was 536 lux. The common
patient areas recorded an average of 90, with the dining room at 694 lux.
The future ward area recorded similar low levels. general Medical Ward 4
bed bays recorded 110-460, corridors and staff write-up areas 134 lux.
Conclusion: all ward areas had low levels of light; sufficiently low enough
to affect circadian rhythm of patients, particularly those at risk of poor
circadian entrainment. This is worthy of further study.
glycaemic Control Post Open Heart Surgery at the Townsville Hospital
Ching-Siang Cheng and Wei-Yan Tan
The Townsville Hospital, Townsville
Aim: The objective of the our study is to study and document the patterns
of blood glucose control post cardiac surgery at The Townsville Hospital,
and to contribute to the guidelines for blood glucose control for our
post cardiac surgical patients. Methods: Retrospective cohort study of
consecutive diabetic and non-diabetic patients undergoing open heart
surgery between January 2011 and July 2011 who survived for at least 24
hours postoperatively. Queensland health auslab defines the normal Bgl
range as 3.0 -7.8 mmol/L. Results: Of the 166 patients in this study, 9.1%
had type 2 diabetes at baseline. During hospitalisation, (median 10.9 days)
8 of these patients suffered a non-fatal stroke, myocardial infarction, septic
complication or died (termed “adverse outcomes”) 80.4% had optimal
glycaemic control (Bgl 3.0-7.8 mmol/l) on the first post-operative day,
and this decreased to only 65.8% at day 5 with optimal glycaemic control.
The majority of our patients had bgL within tight limits, with the highest
bgL in the cohort as 12.4mmol/L. There was no association between our
patients outside of the bgL limits and adverse outcomes (P=NS). This
was consistent with the findings of Estrada et al. who measured 30 day
mortality, infection rates (sternum, harvest site, sepsis, pneumonia,
urinary tract) and resource utilisation in a retrospective cohort of 1574
patients and found no association between hyperglycaemia and mortality
or infection rates, although their patients with hyperglycaemia experienced
longer hospital stays. Conclusion: Although the perioperative glycaemic
control in our cohort of patients was optimal, there remains opportunity for
improvement. Hyperglycaemia is physiologically associated with oxidative
stress in the myocardium, and hence the closure of any care gap leading to
hyperglycaemia is imperative.
A Longitudinal Study of the Career Paths of the First James Cook
University Medical School graduates
Aileen Traves¹ , ², Sarah Larkins², Tarun Sen gupta² and Richard Hays²
¹Tropical Medical Training, Townsville
²School of Medicine and Dentistry, James Cook University, Townsville
Aim: to collect information regarding the career paths of the first graduates
of the James cook university School of medicine during their first five
postgraduate years, including where postgraduate employment and
training has taken place, and what factors have influenced postgraduate
employment and training. Methods: A longitudinal mixed methods study
with data collection from the first cohort of graduates from the James
Cook University School of Medicine (n=58). Following ethics approval,
the quantitative data was collected via an online survey. A subgroup of
participants was interviewed to explore their experiences in more depth,
with a specific focus on those pursuing general practice careers. Survey
data was collated and analysed using simple bivariate descriptive statistics.
Interviews were transcribed in full and analysed with an iterative thematic
analysis. Results: Many graduates have worked in rural, remote, Indigenous
and tropical health related employment since graduation, with the majority
remaining in Queensland. While only 10% of the cohort indicated an
intention to work in general practice at the beginning of medical school,
nearly 40% of the graduates have undertaken general practice training.
there are many factors influencing career path decisions. more than
80% of graduates intend to participate in teaching during their careers,
and nearly 50% intend to participate in research. Conclusion: The focus
S6 ANNALS OF THE ACTM October 2011

on rural, remote, Indigenous and tropical health and strong promotion of
general practice throughout the James Cook University medical course
encouraged graduates to pursue careers in these fields.
The Diabetic Host: Tropical Paradise for a Killer Bug
Jodie Morris¹, Kelly Hodgson¹, Natasha Williams¹, Catherine Rush¹,
Brenda govan¹, Kunwarjit Sangla², Robert Norton³ and Natkunam
Ketheesan¹
¹Microbiology and Immunology, James Cook University, Townsville
²Department of Endocrinology, The Townsville Hospital, Townsville
³Pathology Queensland, The Townsville Hospital, Townsville
Aim: While there is increasing appreciation of immune dysfunction
associated with type 2 diabetes (T2D), relatively few studies have
investigated the implications of these alterations on subsequent hostpathogen
interactions following infection. We developed a whole blood
model of co-morbidity, together with an animal model to investigate early
host-pathogen interactions that contribute to the increased susceptibility of
individuals with T2D to gram negative infection. Methods: Peripheral blood
from individuals with T2D, with poor or well-controlled glycaemia, and
healthy non-diabetic (ND) individuals was stimulated with B. pseudomallei.
Oxidative burst, expression of pathogen recognition receptors (TLR2,
TLR4, CD14) and activation markers (CD11b, HLA-DR) were measured on
neutrophils and monocytes. plasma inflammatory cytokine (il-6, il-12p70,
TNF-α, MCP-1, IL-8, IL-1β, IL-10) concentrations were also determined. In
parallel, we developed a diet-induced model of T2D to investigate disease
progression following b. pseudomallei infection. Results: Differences were
observed in expression of TLR2, CD14 and CD11b on phagocytes and in IL-
12p70, MCP-1 and IL-8 plasma levels in blood from T2D and ND individuals
in response to B. pseudomallei. Similarly, increased expression of TNF-α,
IL-1 and IL-6 was observed following infection with b. pseudomallei in T2D
mice, compared to nd mice. this paralleled extensive neutrophil infiltration
and tissue damage at sites of infection in T2D mice and preceded mortality
within the first few days following infection. Conclusion: Early interactions
between B. pseudomallei and phagocytes are altered in hosts with T2D.
These changes contribute to impaired leukocyte migration and activation,
thus facilitating bacterial persistence and dissemination – a ticket to
paradise!
Bacteraemias in North Queensland: Trends, Susceptibilities and
Outcomes
Selina Porter¹, Natkunam Ketheesan¹ and Robert Norton²
¹School of Medicine and Dentistry, James Cook University, Townsville
²Pathology Queensland, The Townsville Hospital, Townsville
Aim: to determine the source, significance, trends and antibiotic
Make the move to
Queensland Health
Medical practitioners who possess medical registration with the
Medical Board of Australia (MBA), or are otherwise eligible for
registration with the Medical Board of Australia may apply through
the RMO2012 Recruitment Campaign.
For more information visit: http://www.health.qld.gov.au/rmo
Volume 12 Supplement 1
susceptibility patterns of bacteraemias seen in North Queensland over the
period 2000-2009. Methods: Analysis of data prospectively collected in the
Department of Microbiology, Townsville Hospital, relating to organisms
from blood cultures. Results: A total of 64,126 blood cultures were
collected over the period stated. Of these 8976 were positive and 61%
(5524) of these were significant clinically. this was equivalent to 4407
bacteraemic episodes (10.3/1000 admissions) Staphylococcus aureus,
Coagulase negative Staphylococci and E.coli were the commonest isolates.
There was a progressive increase in non multiresistant MRSA (nmMRSA)
and group b streptococci with a decrease in Streptococcus pneumoniae.
apart from a significant decrease in susceptibility of E.coli to gentamicin,
there were no other significant trends in antimicrobial susceptibilities.
Organisms unique to the region are Burkholderia pseudomallei, Brucella
suis and group A streptococcus. Conclusion: To date this is the largest
review of bacteraemias in australia and the first in this region. progressive
increases in nmMRSA and gp b streptococci were noted. a significant
decrease in S. pneumoniae is likely to be related to the introduction of
immunisation. Regional differences in causative organisms of bacteraemia
are also noted.
Hospital Access Block – Exit Block Interaction
Paul goldstraw, Desley Joyce, Yuwati Santoso and Cheryl White
Gerontology Services, The Townsville Hospital, Townsville
Introduction: Access block to TTH has focussed on beds and hospital
admission processes. The exit process to the community services post
hospital care has not been explored. Services are particularly required for
older people. Aim: To review exit block, the provision of community support
and to explore why people queue in hospital for home or nursing home
(NH) care. Methods: Data was reviewed on patients waiting for nursing
home placement (NHP), care decision making, Acute Care of the Elderly
(ACE), readmission to ACE and availability of Aged Care Packages (ACP) in
the community. Results: The NHP numbers peaked in 2009/10 at 29 and
30 respectively. A NH discharge analysis showed 45% had not received any
community support and carers stress occurred in 76% with rapid decision
making in 70%. Subsequent to ACE, there has been a maximum reduction
in the NH queue of up to 90%. ACE readmissions highlighted lack of family,
lack of ACP availability and that a stressed carer was twice as likely to opt
out of care. acp analysis 2010-2011 confirms significant delays at a cost
of 4447 bed days. Conclusion: geriatric Medicine in the Acute Care setting
reduces queuing for nh. lack of community services has significant
impact on the carer and the demand for hospital beds. A paradigm shift
in access concepts is required to include exit block focussing on subacute
and community services.
7 ANNALS OF THE ACTM
S7

POSTER ABSTRACTS
The Townsville Hospital and James Cook University,
School of Medicine and Dentistry Research Symposium
Friday 14 October 2011 (12:30-4:00pm)
Robert Douglas Auditorium, The Townsville Hospital
Calciphylaxis at The Townsville Hospital: An Emerging Concept
Usman Malabu¹, Darshan Shah², Valli Manickam², george Kan² and
Kunwarjit Sangla¹
¹Department of Endocrinology, The Townsville Hospital, Townsville
²Department of Renal Medicine, The Townsville Hospital, Townsville
Background: calciphylaxis is characterised by vascular calcification and
painful skin necrosis with high mortality of up to 80% (1). With the use of
multimodality and multidisciplinary care of the disease (2), it is not known
whether the course and prognosis will improve. Objectives: The aim of
the study was to review clinical cases and course of calciphylaxis at our
hospital. Methods: All patients admitted to the Townsville Hospital from
1 March 2006 to 28 February 2011 with diagnosis of calciphylaxis were
studied. Results: Seven patients were reviewed comprising 5 females and
2 males. All except one were Caucasians. Only one Australian aborigine
was recorded. Aetiology of the ESRF was diabetes in 4 subjects while
chronic glomerulonephritis and obstructive uropathy contributed one in
each. only one patient confirmed to have calciphylaxis had normal renal
function. All subjects received variable modalities of care including surgical
wound debridement, sodium thiosulphate, cinacalcet, pamidronate
infusion, hyperbaric oxygen and parathyroidectomy. Five of 7 patients
representing 71% died. The causes of death: sepsis in 3 whose wounds
failed to heal and acute myocardial infarction following completely healed
skin lesions in the other 2. Of the 2 surviving subjects, a male still has
partially healed ulcer on follow up as outpatient. The other, a female who
presented with normal renal function responded well to pamidronate
infusion. Conclusion: Calciphylaxis is not a rare syndrome at our centre,
occurring predominantly in subjects with ESRF and Caucasians with poor
outcome even after successful healing of the wounds. Deaths occurred
principally from sepsis and myocardial infarction. Further prospective
studies on a larger population are needed to verify our findings.
Tele-oncology for Indigenous Patients: The Perspectives of Patients,
Families and Health-workers
Jennifer Mooi¹, Lisa Whop², Patricia Verery² and Sabe Sabesan¹ , ³
¹Department of Medical Oncology, Townsville Cancer Centre, Townsville
² Health Systems and Epidemiology Division, Cancer Epidemiology, Menzies School of
Health Research, Darwin
³School of Medicine, James Cook University, Townsville
Aims: To describe the perspectives of Indigenous patients, their families
and rural health-workers on video-consultation and this tele-oncology
health service. Methods: Indigenous patients, their family members and
health-workers who were involved in video-consultations were invited to
participate in interviews using standardised questionnaires. These were
conducted face-to-face, via telephone or video-conference. Responses
from patients and families were recorded on a 5-point Likert Scale and
grouped under 4 themes. Interviews with health-workers consisted of
open-ended questions. Results: Of 23 Indigenous patients who had
participated in video-consultations between 2007 and 2011, 13 had
deceased at the time of this study, nine were interviewed and one could
not be contacted. Two family members and six health-workers were also
interviewed. Of the patients and family members interviewed, all (n=11,
100%) were satisfied with the quality of video-consultation [first theme];
able to establish satisfactory rapport with the specialist [second theme];
and reported benefits of video-consultation over face-to-face consultation
[third theme]. most (n=9, 82%) were highly satisfied with the care received
via tele-oncology in partnership with their local health-workers [fourth
theme]. Health-workers described overall positive experiences with videoconsultation
and felt empowered to be actively involved in providing cancer
care for Indigenous patients. All groups interviewed indicated an overall
preference for video-consultation over face-to-face consultation - reasons
quoted included reducing waiting time, cost, burden of travel and removal
from local supports for Indigenous patients. Conclusion: This study
suggests that tele-oncology is an acceptable model of care for Indigenous
patients, allowing partnership with local health-workers to provide quality
care for Indigenous cancer patients “at their door step”.
The Relationship between Blood Pressure and Aortic Dilation in
the Angiotensin II Mouse Model of AAA
Tammy Dougan, Sai-Wang Seto, Corey Moran, Catherine Rush, Lynn
Woodward and Jonathan golledge
Vascular Biology Unit, James Cook University, Townsville
Aim: Abdominal aortic aneurysm (AAA) is an abnormal ballooning of the
body’s main artery. Sudden aneurysm rupture is responsible for ~1000
deaths annually in Australia. The cause of AAA is poorly understood.
Angiotensin II (AngII), a potent mediator of increased blood pressure
(hypertension), contributes significantly to the development of vascular
disease in humans; however experimental data supporting the involvement
of angii-induced hypertension in aortic aneurysm remains conflicting.
The aim of the present study was to assess effect of blood pressure
on aneurysm formation in a mouse model of AAA. Methods: AAA was
induced in mice genetically prone to vascular disease (apoE-/-; n=55) via
subcutaneous infusion of angiotensin ii (angii; 1ug/kg/min) over 28 days.
blood pressure (tail-cuff) and suprarenal aortic diameter (ultrasound) was
determined at day 0 (baseline) then measured at 7-day intervals. Data were
analysed using parametric or non-parametric tests in accordance with
distribution of data, applying one-way analysis of variance (ANOVA) and
Spearman r-squared test. p value less than 0.05 was considered significant.
Results: Subcutaneous infusion of AngII over 28 days resulted in a timedependent
increase in both mean blood pressure (MbP) and suprarenal
aortic diameter (SRA). Mean maximum aortic diameter (MMD) and SRA
diameter measured from harvested aortas was positively correlated
with mean blood pressure measures at day 28 (r=0.3600; p=0.0111,
r=0.3545; p=0.0079 respectively. Conclusion: AngII-induced hypertension
contributes significantly to aaa formation in the apoE-/- mouse.
Central Nervous System Tuberculosis: a Disease of Papua New
guinea in North Queensland
Pascallina Ting and Robert Norton
Pathology Queensland, The Townsville Hospital, Townsville
Objective: to describe cases of confirmed central nervous system (cnS)
tuberculosis seen at the major tertiary referral centre of North Queensland
over a 10 year period. To compare the demographics of this group with
S8 ANNALS OF THE ACTM October 2011

previously reported Australian cases. Design: A retrospective case series
based study. Setting and participants: All cases of proven Mycobacterium
tuberculosis infection of the central nervous system presenting to the major
tertiary referral centre of North Queensland, between 2000 - 2010. Main
outcome measures: Differences in demographics and incidence of cases
in North Queensland compared with other published Australian studies.
Results: 5 cases of confirmed cnS tuberculosis were identified over the
10 year period with 2 deaths. All were from Papua New guinea with a
mean age of 7 years. Imaging and early microbiological diagnosis was
critical in making the diagnosis. HIV infection was not a contributing factor.
multidrug resistance was inferred or confirmed in 2 cases. Conclusion:
CNS tuberculosis is a disease being increasingly seen in North Queensland
among children from Papua New guinea. Anticipation of multidrug
resistance is important in the immediate management of suspected cases.
This will have important socio-political implications.
Position of Intramedullary Nail (Tri-gen and IMHS) Distal End in
Relation to the Distal Anterior Cortex and Distal Femur for Proximal
Third Femoral Fracture
Wei-Yan Tan and Rhys Edwards
Department of Orthopaedic Surgery, The Townsville Hospital, Townsville
Aim: The nail was designed with a 2.0m AP bow to minimize anterior
cortical impingement. This study was to determine the position of the most
distal end of the Intramedullary Nail in relation to the anterior cortex and the
blumensaat’s line. Methods: 64 post-operative lateral X-rays of proximal
third femur fractures that were treated with the IMHS or Tri-gen Nail
were identified. then the list of lateral femoral x-rays post intramedullary
nails insertion were obtained. The distance from the anterior cortex was
measured using the most distal screw insertion point as the reference
point. Then from this reference point, the distance to the anterior cortex
was measured using the measuring system on the Agfa Impax system.
The distance of the distal nail to the distal end of the femur was measured
using the tip of the IM nail to the blumensaat’s Line. Results: A frequency
distribution of the distance from nail to cortex was constructed and it
was found that in 27% of cases the nail was placed within 3mm of the
anterior cortex. In 14% of cases, the nail was within the 1mm of the cortex.
There was also a correlation between advanced age and anterior cortical
impingement. Conclusion: There was a concerning number of patients
whose distal end of the Tri-gen and IMHS nail was placed within the close
proximity to the anterior cortex.
Trends in Vitamin D levels in the Tropics
Fiona B Millard¹ , ² and Jey Chinnathambi²
¹Department of Psychiatry, School of Medicine and Dentistry, Townsville
²Tropical Medical Training, Townsville
Background: Vitamin D is produced by the skin in response to sunshine,
and we may assume that people living in the tropics have adequate levels.
This vitamin is important in keeping bones strong, supporting the immune
system and protecting the brain and nervous system. Aim: To measure
trends in vitamin D levels for people living in the tropics. Methods: Patients
attending their general practitioner were invited to have a blood test to
measure their vitamin D levels. Results were entered into SPSS software
with cases identified by consecutive numbers and assigned variables of age,
gender, date of test, vitamin D level, personal characteristics, occupation
and medical history. Results: Results indicated that vitamin D levels vary
with the seasons and weather patterns, with low levels more likely in spring
and after a long wet season. vitamin d deficiency where levels were less
than 50mmol/L was found in 20% of cases and low levels at 50-70mmol/L
in 50% of cases. People of all ages can have low vitamin D levels, with a
trend to low levels in those living or working indoors. Conclusion: Vitamin
D levels can be low in people living in the tropics and the prevalence of low
vitamin D levels suggests that testing should be encouraged in those at
risk and measures taken to correct the problem, minimizing the risk of this
deficiency contributing to future health problems.
Volume 12 Supplement 1
A Safety Survey of Nasogastric Feeding Tube Placement and Care
at the Townsville Hospital
Ching-Siang Cheng and Kristen Tuffin
The Townsville Hospital, Townsville
Aims: To determine the clinical practice at the Townsville Hospital with
regard to Nasogastric Tube (Ng tube) placement and the nursing care of
Ng tubes. Methods: this project was carried out in a two stages. the first
stage involved a review of the existing guidelines and recommendations
confirming ng tube placement and routine care afterwards. the second
stage involved a questionnaire targeting the current cohort of interns, and
random chart reviews in the month of July 2011 on ward patients with Ngtubes
in position. Results: The National Patient Safety Agency (NPSA) of
the uk recommended testing with ph indicator paper as the first line check,
with checking x-ray images as the second line test. No evidence supported
auscultation and bubbling to confirm correct ng tube placement. 43.5% of
the interns surveyed (n=23) have not yet checked an Ng tube placement
even after six months of internship. 39.1% checked placement about
once a month, with the remainder performing checks more often. 91.3%
stated a chest x-ray as the first-line for checking ng tube placement, while
8.7% listed ph indicator paper as the first line check. none considered
auscultation or bubbling as first line. Conclusion: Harm and even death
can result from feeding into the lungs from misplaced Ng tubes. Due to the
preventable nature of harm from misplaced Ng tubes, clinical audits such
as this study can identify shortfalls and trend data to show improvement in
clinical management of Ng tubes at the Townsville Hospital.
Perinatal Arterial Ischemic Stroke in Northern Queensland
Liza Edmonds¹, Yoga Kandasamy¹, Anthony LaMont² and Sara
O’Connor¹
¹Department of Neonatology, Women’s and Children’s Health Institute, The Townsville
Hospital, Townsville,
²Department of Radiology, The Townsville Hospital, Townsville
Aims: Perinatal arterial ischemic stroke is a relatively rare event in
the newborn period. Our aim was to review the occurrence of stroke,
presentation and associated risk factors in infants admitted to our tertiary
neonatal intensive care unit. Methods: infants were identified between
March 2002 and March 2011 by searching the inpatient database. Maternal
and neonatal hospital records were reviewed. All radiological imaging
was reviewed by a paediatric radiologist to confirm presence of arterial
stroke. Results: ten infants were identified as having had perinatal arterial
ischemic stroke. Strokes were left sided in 4, right sided in 3, cerebellum
in 1 and 2 were bilateral. Median birth weight was 2970g and median
gestation at birth was 36 weeks. Overall mortality was 30% and indigenous
infants made up 20% of the cohort. Pregnancy complications affected
80% of the mothers and 60% of the cases had foetal distress present
prior to delivery. Stroke presentations included 4 with seizures, 4 with
apnoea/sepsis presentation, 1 with thrombosis elsewhere and 1 without
symptoms. Retrieval was required for 5 of the infants. All infants had
risk factors for stroke identified. Conclusion: Perinatal arterial ischemic
stroke occurred within predominantly older gestation well grown infants
in keeping with other studies. a significant number needed retrieval to a
tertiary centre and the presentation features were variable. All infants had
identifiable risk factors on history and investigation with a broad range of
variables identified.
Case Study: Syndrome of Hypertension and Hyperkalemia with
Normal glomerular Filtration Rate
Nadarajah Mugunthan and Kunwarjit Sangla
Department of Endocrinology, The Townsville Hospital, Townsville
Introduction: Monogenic hypertension syndromes have become the
window to understand the new physiology of the nephron. All of these
syndromes converge around a single mechanism: the regulation of
9 ANNALS OF THE ACTM
S9

sodium ion transport within the distal nephron. Case Study: 26 year
old female presented with episodes of headache for three months. She
gave a history of hypertension from the age of 12 years which had been
attributed for “white coat hypertension”. On examination her height was
163cm with the weight of 72kgs. Her bP was 140-160/95-120. Her initial
blood test revealed normal serum sodium level with serum potassium
of 5.0-7.0mmol/l(N 3.5-5.1). Her serum bicarbonate level is 18mmol/l
(N 20-28). Her Serum creatinine, blood urea and egFR and thyroid
function tests were within normal range. Her renin level was low with
normal aldosterone levels. her chest Xray was normal. a diagnosis of
gordon Syndrome (Psudohypoaldosteronism type11) had been made
and she was treated with thiazide diuretic bendroflurozide 5mg daily.
Her symptoms, blood pressure and serum potassium normalized within
days. later genetic testing in a research lab confirmed mutation in the
family of serine-threonine kinases called With-No-lysine Kinases (WNK)
genes. Discussion: this case highlights finding of abnormal potassium
concentrations (low or high), alkalosis or acidosis, suppressed renin, and
normal or low aldosterone should prompt the consideration of one of the
rarer causes of hypertension. Further we discuss 1) Role of WNK kinases
and their role in the pathogenesis of gordon syndrome 2) Potential newer
therapeutic agents for hypertension to act on WNK kinases.
The Utility of Cerebrospinal Fluid Protein in the Microbiological
Assessment of Meningitis
Kevin Ostrowski¹, Kyle White¹, Torres Woolley², Samuel Maloney¹ , ³
and Robert Norton¹ , ³
¹The Townsville Hospital, Townsville
²School of Medicine and Dentistry, James Cook University, Townsville
³Microbiology Unit, Pathology Queensland, Townsville
Aim: the measurement of cerebrospinal fluid (cSF) protein is an essential
part of the microbiological examination of cSF. the definitive aetiologic
agent of meningitis is often not determined for some days after the lumbar
puncture while the CSF protein is available in the initial assessment. The
aim of this study was to look at the predictive value of the absolute CSF
protein value in correlating with specific aetiologic agents. We also sought
to find a relationship between cSF protein and cSF red cells and create
a correction factor for traumatic lumbar punctures. Methods: This was a
retrospective analysis of all CSFs taken at the Townsville Hospital during
the study period of 1998 to 2010. Results: A total of 4354 CSFs were
reviewed. Of these, there were 23 cases positive for bacterial meningitis
(both Neisseria meningitides) which had a CSF protein (mg/L), mean
and standard deviation, of 2028 (1744). 34 cases were positive for viral
meningitis with protein of 578 (245). In patients with a CSF protein

The data suggests that there should be a low threshold for vitamin D essays
in people over the age of 70 who present to the hospital in poor mobility.
the data confirms that people who are housebound and living in nursing
homes are a cohort that requires routine replacement.
Splenic Varices: A Poorly Recognised Phenomenon
Cassandra Faris¹, David Williams¹ and Enrico Roche²
¹Department of Anatomical Pathology, The Townsville Hospital, Townsville
²Department of Gastroenterology, The Townsville Hospital, Townsville
Aim: The most important cause of portal hypertension is cirrhosis. The main
consequences of portal hypertension are splenic congestion, including
splenomegaly, with or without hypersplenism, and also porto-systemic
shunting, anastomotic channels connecting the portal and systemic venous
systems opening up and becoming distended. The more well known of
such systems are the oesophageal tributaries of the azygous vein which
connect through the diaphragm with the portal system. When varicose,
these oesophageal tributaries are easily traumatised by the passage of
food, the result being bleeding into the gastrointestinal tract. We aim to
investigate the morbidity/mortality of splenic varices from a pathological
and gastroenterology view point and would like to comment on how they
may be treated clinically. Methods: Literature review, clinical perspective
on management of splenic varices in cases of portal hypertension and
case discussion including gross and microscopic findings of autopsy will
be used. Results: Splenic varices of the hilar area have been described
by radiologists in the literature, however, are not well known to morbid
pathologists and not usually managed clinically by gastroenterologists in
cases of portal hypertension secondary to cirrhosis. Conclusion: It appears
that splenic varices is not a topic debated widely in the literature amongst
gastroenterologists, morbid pathologists or radiologists given the low
threshold for clinical intervention and is an area requiring further research
given the cases which have been found of recent on autopsy secondary to
splenic variceal haemorrhage.
Researching the Use of Video Conferencing to Build Palliative
Care Capacity in North Queensland
Ofra Fried¹ and Robin Ray²
¹Palliative Care Unit, The Townsville Hospital, Townsville
²School of Medicine and Dentistry, James Cook University, Townsville
Aim: Using video conferencing technology to provide educational
opportunities for health and social care practitioners across north
Queensland, this project aims to build palliative care capacity in rural and
remote areas; enable palliative care patients to be more efficiently managed
locally and remain among their support networks in their communities to
the end of their life; evaluate the needs for palliative care education and
the use of videoconferencing for more effectively meeting these needs.
We will present the initial results of this project. Methods: A mixed
method approach is being used to implement and evaluate the video
conferences. Following an educational needs assessment, topics were
prioritised. after the first four video conferences, participants completed
an impact evaluation on-line survey including qualitative responses.
Further evaluation is planned during the life of the two-year project.
Results: The needs assessment reinforced the traditional palliative topics
but also highlighted new areas of concern. Participation in each video
conference averages 40 multidisciplinary practitioners from sites across
north Queensland. The process of video conferencing was convenient
for all especially for those in more remote areas and was rated as a very
useful learning tool. program content rated highly with each specific
topic meeting most participants learning and practice needs. Participants
reported increased confidence across all four topic areas presented to date.
Conclusion: Early results from this work in progress demonstrate a high
level of interest in increasing palliative care knowledge. Video conferencing
has proved a very useful tool for primary health providers across north
Queensland to access palliative care education and improve practice.
Volume 12 Supplement 1
Meta-Analysis of Associations Between Transforming growth Factor
Beta Polymorphisms and Coronary Heart Disease
Dylan Morris, Joseph Moxon, Erik Biros and Jonathan golledge
Vascular Biology Unit, James Cook University, Townsville
Aims: The genetic risk factors for coronary heart disease (CHD) are
incompletely understood. The aim of this study was to investigate the
association between common single nucleotide polymorphisms (SNPs)
in transforming growth factor (TgF)-β and CHD. Methods: We performed
a systematic review and subsequent meta-analysis of studies published
before 20th February 2011. Case-control studies assessing at least one
TgF-β SNP in CHD patients were included in the meta-analysis. The random
effects model was utilised to calculate odds ratios and confidence intervals
for each TgF-β SNP. Results: Eight studies examining the association
of TgF-β1 Snps with chd were identified. Six studies involving 5535
cases and 2970 controls reported common SNPs and were included in a
meta-analysis. Three SNPs in TgF-β1 were mildly associated with CHD:
rs1800469 (OR=1.13, 95% CI 1.02-1.25, p=0.024), rs1982073 (OR=1.15,
95% CI 1.03-1.28, p=0.016) and rs1800471 (OR=1.20, 95% CI 1.03-
1.40, p=0.017). Conclusion: This meta-analysis suggests that genetic
polymorphism in TgF-β1 influences the risk of developing chd.
A Systematic Review of Barriers to Early Career Medical Research
in the Australian Setting
Harris Eyre and Michael Stuart
School of Medicine and Dentistry, James Cook University, Townsville
Aim: Recent reports have raised concerns of a decline in the supply of
Australian clinician-scientists in the future. Involvement in undergraduate
and early postgraduate research has been shown to enhance interest in
this career path, and predicts a more successful academic career. There
are many barriers to early career medical research in the current Australian
setting including real, inbuilt issues in the delivery of medical training in
the healthcare system and issues. Methods: The authors systematically
reviewed national and international scientific literature and policies on the
subject from the last 15 years. Results: Available evidence consistently
demonstrates that medical students have significant interest in the
clinician-scientist career path; however, they have a narrow understanding
of what research entails. Interest has been reported to wane in the early
postgraduate years owing to a lack of structured opportunities for research
involvement, time factors, family and financial pressures. changes in the
training environment as a result of increased medical student numbers
may present several opportunities for enhancing the uptake of the clinicianscientist
career path. Conclusion: At present, the absence of longitudinal
studies limits our understanding of changing influences on the decision to
pursue a research career and at what point this decision is made. Further
studies of this type are required to better direct any programmes to boost
uptake of this career path.
How Do Contextual Issues Influence Social Accountability in Medical
Education?
Robyn Preston¹ , ³, Judy Taylor¹ , ², Sarah Larkins¹ and Jenni Judd³
¹James Cook University, Townsville
²Spencer Gulf Rural Health School, University of South Australia, Whyalla and University of
Adelaide, Adelaide
³Anton Breinl Centre, James Cook University, Townsville
Aims: To investigate the progress towards socially accountable medical
education in four medical schools in two countries. To analyse and
compare key contextual factors that influence the planning, implementation
and outcomes of socially accountable medical education within these
sites. Methods: A cross-national multiple case study design using mixed
methods: Background grey and peer reviewed literature; documents and
archival records from Schools and other Institutions, semi-structured
qualitative interviews; non-participant observation of a phenomenon at
11 ANNALS OF THE ACTM
S11

each School. Results: From the literature, a working definition of ‘context’
in my study will be conceptualised through bronfenbrennen’s ecological
approach. Key contextual factors that will be initially investigated include:
macro (historical context, policy environment, Fiscal environment);
Meso (Health system, Reference Population / the community, Workforce
issues); micro (leadership / governance, Student characteristics, Staff
/ Faculty characteristics, Extracurricular activities). Conclusion: This
research will demonstrate how progress towards social accountability
in medical education can be evaluated in different socio-cultural and
economic contexts; and give practical guidelines to medical schools, global
organisations, non-government organisations and departments/ministries
of health. Results may lead to the development of multi-site longitudinal
studies to investigate the outcomes of socially accountable medical
education in terms of graduate outcomes, cost effectiveness, quality and
access to care and ultimately health outcomes. This project may also
contribute the literature on case study methodologies in health services
research, particularly methods to analyse context and contextual issues.
The Implication for North Queensland Health Services of Aged
Care Package Accessibility
Robyn Russell, gillian Brunker, Margaret Boccalatte, Maria griffiths
and Paul goldstraw
Aged Care Assessment Services, Gerontology Services, The Townsville Hospital, Townsville
Aim: Aged Care Packages (ACP) are designed to provide care to older
people in the community. A recent study documented that 42% of older
people waiting in hospital for a nursing home had not received community
support. The accessibility to ACPs is unknown yet has individual and health
service implications. This study was undertaken to determine if such
delays existed and to what extent. Methods: When an ACP was approved,
demographic, functional details and date of approval were recorded. The
time taken to achieve access was determined by a weekly check with
providers. The study period was 12 consecutive months. Results: A total
of 285 ACPs were approved, of which only 12% (35) were accessed. Of
those 35, 63% (22) already had lower level services in place, 23% (8)
received less support than recommended. The waiting time ranged from 0
to 190 days. During the year 180 (63%) of the cohort were admitted to TTH
with 4447 bed days used, 23 (13%) died. Conclusion: The data suggests
a significant delay in access and not necessarily to the recommended
level. First time user access is poor with existing users having significantly
greater access. Whilst other factors may influence the acp uptake, the
mortality and morbidity of the cohort has implications for tertiary health
services.
Job Satisfaction among Rural and Remote general Practitioners:
A Comparative Study Between Canadian and Australian Doctors
Marco Viscomi
School of Medicine and Dentistry, James Cook University, Townsville
Background: Severe medical workforce shortages exist in both Australia
and canada, especially in the field of rural general practice. despite the
difficulty in recruiting and retaining doctors in these regions, there are
many gPs who continue to practice in these underserviced areas. Aim:
To determine what factors serve to attract and retain general practitioners
in rural and remote areas of both Australia and Canada. This enables
us to evaluate the efficacy of current undergraduate and postgraduate
medical training programs and determine if these differences can be
attributed to the employment of government policy initiatives. Methods:
Internet and paper-based surveys will collect demographic information
from all interested registered gP participants. A subset of participants will
complete a semi-structured, telephone interview, with discussions focused
around key general practice themes that aim to explore the strengths and
weaknesses of rural practice and the impact these factors have on the
doctor’s professional and personal life. Results: Preliminary survey results
from Canadian and Australian gPs have demonstrated that the majority
of rural gps are satisfied with their career choices, despite there being
difficulties in obtaining adequate collegial support. many participants have
indicated only partial satisfaction with family and personal life factors.
Conclusion: Discussion focusing on the level of satisfaction among active
rural gps can reveal the efficacy of current recruitment and retention
strategies, whilst providing the opportunity to raise ideas that could allow
improvements to be made in the future.
An Insight Into the Impact of Pre-emptive Nursing Home Decision
Making
Cheryl White
Gerontology Services, The Townsville Hospital, Townsville
Introduction: A recent study at TTH showed that clinical and system
processes of Nursing Home (NH) decision making for older people from
the facility were often pre-emptive. Seventy percent of NH decisions
were made on admission or within the first week. Aims: To increase
the awareness of health decision makers, highlight unfortunate decision
making with insights into the challenges faced when trying to reverse life
changing decisions. Methods: The cases of 2 people admitted to residential
aged care facilities (RACFs) from TTH who wished to reverse the decision
were analysed in depth. Results: A 76 year old male was deferred from a
previously recommended total knee replacement, due to his chronic leg
ulceration with bacterial colonisation, was admitted to Interim, awaiting
NH permanent placement. His house and contents were sold. Chronic
wound management produced healing. He subsequently purchased a unit
and was discharged. A 74 year old female placed in RACF from hospital
as high level care, two months later is almost totally independent. She is
currently negotiating her discharge and waiting for an aged care package.
Conclusion: The timing of decision making was precipitant and affects the
older person’s spiritual and psychosocial well being and thereby quality of
life. The case reports demonstrate that reversing the decisions is possible
but it is suggested that better access to gerontic subacute services and
education would reduce life impact errors.
S12 ANNALS OF THE ACTM October 2011

DISCUSSION PAPER
Improving Rural and Indigenous
Cancer Outcomes: A Clinical Research
Perspective
Sabe Sabesan
Director of Medical Oncology, Department of Medical Oncology, Townsville Cancer Centre,
Townsville; and School of Medicine and Dentistry, James Cook University, Townsville
Survival and quality of life among rural and indigenous patients after a cancer
diagnosis are inferior to metropolitan figures. reasons for this disparity are
many. 1 These include lack of access to health promotion services, primary
health care and tertiary services, shortage of health work force and lack of access
to cutting edge clinical trials to access new medical therapies; to name
a few. Distance, isolation, indigenous status, and socioeconomic factors are
additional correlates of poorer outcomes. Clinicians working with this disadvantaged
group have the responsibility and opportunity to help close the gap
by taking part in all three pillars of medicine; namely clinical medicine, clinical
research and medical education. In this abstract, we illustrate how clinical
departments might contribute to clinical research, using medical oncology
as an example. While it is established that rural and indigenous cancer patients
present with more advanced disease stages than their metropolitan
counterparts, 2 there are few prospective studies on the reasons for this late
stage presentation. The Townsville Cancer Centre (TCC) study on patterns of
care in lung and head and neck cancers will hopefully shed more light on this
issue in the near future.
One arm of the TCC’s strategy has been to build its clinical trials capacity.
Participation in clinical trials has become a standard of care for patients
with metastatic cancers since patients in these trials have better outcomes. 3
However, rates of participation are low among rural patients in Queensland
(Personal communication: Ms Heather Day, Cancer Council Queensland) and
centres with the capacity to conduct clinical trials are rare outside major cities.
Starting from nothing 5 years ago, the TCC now employs 7 clinical trial
nurses coordinating more than 35 multi centre trials between them. A survey
to examine the knowledge and attitudes towards clinical trials reported rural
patients were as willing to participate in clinical trials as their urban counterparts,
but convenience of travel and cost were concerns. As a result, some
trial budgets now have travel incentives at the TCC. 4 Under-treatment was
thought to be a reason for disparity in outcomes and audits in lymphoma,
colon cancer and breast cancers revealed that distance is not a contraindica-
Volume 12 Supplement 1
tion to intensive therapy. 5,6 These results are reassuring to the clinicians as
they demonstrate that intensive therapy can be safely given to rural patients.
Telemedicine has proven to be an effective tool for addressing access issues
in several scenarios. It aids immediate access to specialist services
and is particularly effective for indigenous communities. 7 The teleoncology
network in Townsville and Mt Isa health services districts has transformed
the rural cancer care in that all types of chemotherapy protocols are safely
given in Mt Isa. Ward rounds of admitted patients and urgent review of sick
patients have reduced the number of inter hospital transfers. This model of
care is accepted by indigenous and non indigenous patients and welcomed
by health workers, while maintaining cost effectiveness. 7,8 Using this model,
plans are underway to administer simple chemotherapeutic protocols, supervised
remotely by chemotherapy competent nurses from Townsville and
Mt Isa, in all other smaller centres to foster the concept of telenursing. The
flow on effect of improving access to mt isa is that we now have a comprehensive
chemotherapy centre in Mt Isa which is fully resourced to deal with
all types of chemotherapy protocols apart from high dose chemotherapy and
transplant protocols.
In conclusion, clinical research by clinicians has the potential to improve the
quality of services to the rural and indigenous sectors and hopefully contribute
to the “closing the gap” agenda.
References
Anton Breinl Centre for
Public Health & Tropical Medicine
1. Sabesan S, Piliouras P. Disparity in cancer survival between urban and rural patients: how can clinicians help
reduce it? Rural and Remote Health 2009: No.1146. Available online at: http://www.rrh.org.au/articles/subviewnew.asp?articleid=1146
(accessed: 13 September 2011)
2. Australian Institute of Health and Welfare (AIHW) and Australasian Association of Cancer Registries: Cancer
survival in Australia 1992-1997: geographic categories and socioeconomic status. Canberra: AIHW, 2003.
3. Institute of Medicine Website. A National Cancer Clinical Trials System for the 21st Century: Reinvigorating
the NCI Cooperative group Program. Available online at: http://www.iom.edu/Reports/2010/A-National-Cancer-
Clinical-Trials-System-for-the-21st-Century-Reinvigorating-the-NCI-Cooperative.aspx (Accessed: 13 September
2011)
4. Sabesan S, burgher b, buettner P, et al. Attitudes, knowledge and barriers to participation in cancer clinical trials
among rural and remote patients. Asia Pac J Clin Oncol 2011; 7: 27-33.
5. burgher b, Sabesan S. Assessing the safety of adjuvant chemotherapy for high risk breast cancer and sarcomas
among rural patients. Asia Pac J Clin Oncol 2009; 5 (Suppl. 2): a207.
6. Scott AP, Sabesan S, Morris ES. Distance from treating center is not a risk factor for excess mortality or morbidity
in patients receiving multiagent chemotherapy in North Queensland. Asia Pac J Clin Oncol 2009; 5 (Suppl.
2): A165.
7. Sabesan S, Simcox K, Marr I. Videoconferencing for medical oncology: acceptable model for patients and health
workers. Int Med J 2011 (Accepted Article) Available online at: http://onlinelibrary.wiley.com/doi/10.1111/j.1445-
5994.2011.02537.x/abstract (Accessed: 13 September 2011)
8. Thaker D, Sabesan S. Cost effective analysis of videolinked medical oncology clinics: Townsville experience. Asia
Pacific Journal of Clinical Oncology 2010; 6: 100-47.
The Anton Breinl Centre for Public Health and Tropical Medicine seeks to undertake high quality and relevant teaching, research and
training in population health, with a special focus on tropical Australia and our near neighbours.
Postgraduate study programs:
• Tropical Medicine • Public Health • Aeromedical Retrieval
• Biosecurity and Disease Control • International Health • Refugee and Disaster Health
• Rural, Remote and Indigenous Health
For further information:
• Travel Health and Diving Medicine
Phone: +61 7 4781 6107 Email: sphtm-studentofficer@jcu.edu.au
Visit: www.jcu.edu.au/phtmrs
13 ANNALS OF THE ACTM
33898_JCU1033_MAKADS
S13

Faculty of Medicine, Health and Molecular Sciences
Cohort Doctoral Studies Program
Focus your doctoral studies in a supportive environment
with mentoring, peer support and professional
development opportunities
• For professionals working in areas of medicine, nursing, health (including rehabilitation and sport
and exercise sciences), chemistry, and biomedical, molecular or veterinary sciences
• Join as part of a cohort and progress with this group
• Experienced academic mentor and peer support provided
• Supportive and nurturing environment - workshops, seminars, coursework, peer learning facilitation
and writing workshops
• Block mode where students attend campus for a one-week period each semester
• Electronic support for students outside of block teaching periods
• Bridging program available for students without research experience or qualifications
• Opportunities to undertake research related to your employment
einl Centre for
alth & Tropical Medicine
r Public Health and Tropical Medicine seeks to undertake high quality and relevant teaching, research and
lth, with a special focus on tropical Australia and our near neighbours.
rams:
Next program • Public commencing Health March 2012 with applications • Aeromedical due early January Retrieval 2012
ontrol • International Health • Refugee and Disaster Health
nous Health
• Travel Health and Diving Medicine
For further information, contact: Christine Teitzel.
Email: christine.teitzel1@jcu.edu.au Phone: 07 4781 6964
Fax: 07 4781 4901
mail: sphtm-studentofficer@jcu.edu.au
mrs
S14 ANNALS OF THE ACTM October 2011
33898_JCU1033_MAKADS

MEMBERSHIP
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Title: Dr Prof Mr Mrs Ms Rev Col Capt Other
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Return form to: ACTM Secretariat PO Box 123, Red Hill Qld 4059 AUST. P: +61 7 3872 2246 • F: +61 7 3856 4727 • E: actm@tropmed.org
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Volume 12 Supplement 1
Sept2011 - 889
15 ANNALS OF THE ACTM
S15

The Australasian College of Tropical Medicine
Types of Membership
The College has a range of membership options to suit
professionals, students, organisations and companies, and
other interested individuals.
Fellow
• Approved postgraduate academic qualification in tropical
medicine or an approved fellowship in a related professional
college or institute; AND
• Working, or have worked, a minimum of three years fulltime
or the equivalent part-time in tropical medicine; AND
• Made a significant contribution to tropical medicine.
Member
• Approved postgraduate academic qualification in tropical
medicine or an approved membership in a related
professional college or institute and working, or have
worked, a minimum of two years full-time or the equivalent
part-time in tropical medicine; OR
• Approved first degree and working, or have worked, a
minimum two years full-time or the equivalent part-time in
tropical medicine.
Associate Member
• Approved postgraduate academic qualifications in tropical
medicine or an approved fellowship or membership in a
related professional college or institute; OR
• Approved first degree or approved certificate, assoicate
diploma, diploma, or professional registration and working,
or have worked, a minimum one year full-time or the
equivalent part-time in tropical medicine
Affiliate Member
• Persons interested in tropical medicine.
• Full-time students undertaking a course of study in tropical
medicine or a related field at a recognised university or
institute.
Retired Member
• Persons who have ceased full-time employment because of
age or incapacity.
Life Member
• Fellow, Members, Associate Members and Affiliate Members
who have paid the prescribed life membership fee. This may
be paid for by installments, i.e. Pro-rata Life Membership.
Corporate / Sustaining Member
• Approved organisation or company. Annual membership
only applicable.
Purpose
The Australasian College of Tropical Medicine Inc is the
pre-eminent organisation in Australia and the region,
representing professional interests in tropical medicine and
promotes the highest ethical and professional standards
through education and information. It has both regional
and global interests with more than 400 members coming
from over 30 countries around the world and maintains
links to three international organisations working in
tropical medicine. Membership includes medical doctors,
scientists, academics, military personnel, consultants, and
other health professionals. Several committees and subgroups
within the College assist in organising local and
regional scientific meetings, as well as other professional
activities.
Mission
The College is committed to the development of tropical
medicine and is working with professionals to help
manage the global burden of tropical disease and injury
through networking research and development.
The aims of the college are to:
• Encourage continuing education and the exchange of
knowledge in tropical medicine;
• Collaborate with other organisations in conducting
activities of mutual concern, interest and direction in
tropical medicine;
• Promote research in tropical medicine;
• Strive for professionalism and competence among its
members and those specialising in and entering into
the field of tropical medicine; and
• Maintain in historical collection of items relevant to the
development of tropical medical in Australia.
History
The Australasian College of Tropical Medicine Inc (ACTM)
was founded at a meeting in Townsville, Australia on
29 May 1991. Membership now extends to all states of
Australia, and overseas. Membership includes many
eminent professionals working in various fields relating
to tropical medicine, such as parasitology, infectious
diseases and tropical veterinary science, reflecting the
broadest definition of tropical medicine. The College
was incorporated in Queensland in 1994. The original
secretariat was based at the Anton Breinl Centre, James
Cook University - in the building used for the Australian
Institute for Tropical Medicine established in 1910. A
Faculty of Travel Medicine was launched in 2001. Further
details on Faculty membership are available from the
ACTM Secretariat.
ACTM Secretariat PO Box 123, Red Hill Qld 4059 AUST. P: +61 7 3872 2246 • F: +61 7 3856 4727 • E: actm@tropmed.org
S16 ANNALS OF THE ACTM October 2011

ANNALS OF THE ACTM
AN INTERNATIONAL JOURNAL OF TROPICAL & TRAVEL MEDICINE
INSTRUCTIONS FOR AUTHORS
The format of the Annals of the ACTM will, in general, follow guidelines of the “Uniform requirements for
manuscripts submitted to biomedical journals” and published by the International Committee of Medical
Journal Editors (http://www.icmje.org/index.html).
The Annals will appear twice a year and will consider for publication, papers on a wide range of topics relating
to tropical and travel medicine. All papers will be refereed prior to acceptance for publication. Papers
will be included in one of the following categories:
a) Review Articles (5,000-10,000 words)
b) Research Articles (up to 5,000 words)
c) Case Reports (1,000-2,000 words)
d) Research Reports (1,000-2,000 words)
e) Letters (200-500 words)
Figures to be included: 1/4 page size = 250 words; 1/2 page size = 500 words etc. one page with images
is approximately 900 words, two pages with image is approximately 1,800 words. Manuscripts should be
double spaced and a short summary should be included at the beginning of the paper after the title and
author details. Title page with contributor names and addresses should be on a separate page. Each table
and figure should be on a separate page together with an appropriate caption, explanatory notes etc. any
acknowledgements should be included at the end of the paper before the references. Where appropriate,
authors must confirm in the paper that experimental procedures on humans and animals conformed to
accepted international ethical guidelines. references should be numbered consecutively in order of first
appearance in the text. For details of references, consult the “Uniform requirements for manuscripts submitted
to biomedical journals” available at http://www.icmje.org/index.html.
in the first instance, papers submitted for consideration should be sent to:
The Editorial Board
Annals of the Australasian College of Tropical Medicine
ACTM Secretariat
PO Box 123, Red Hill
Queensland 4059 Australia
Tel: + 61-7-3872-2246
Fax: +61-7-3856-4727
Email: actm@tropmed.org
Statements or opinions in papers published in the Annals of the ACTM are solely those of the authors and
not necessarily those of the Editorial board of The Australasian College of Tropical Medicine. The inclusion
of commercial advertising material in the Annals or the College. The College disclaims any responsibility
for any injury to persons or property resulting from publishing material or products referred to in articles
or advertisements. On acceptance of an article for publication in the Annals, copyright of the article is
automatically transferred to the ACTM.
© Copyright 2011 ACTM
Material published in the Annals of the ACTM is covered by copyright and all rights are reserved, excluding “fair use”, as
permitted under copyright law. Permission to use any material published in the Annals of the ACTM should be obtained in
writing from the authors and the Editorial board.
Volume 12 Supplement 1
17 ANNALS OF THE ACTM
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ANNALS OF THE ACTM
AN INTERNATIONAL JOURNAL OF TROPICAL & TRAVEL MEDICINE
© Copyright 2011 The Australasian College of Tropical Medicine