Allied Health Research Symposium - Australasian College of ...

ANNALS OF THE ACTM 

AN INTERNATIONAL JOURNAL OF 

TROPICAL & TRAVEL MEDICINE 

ISSN 1448-4706 

Volume 13 Issue 2 

IN THIS ISSUE 

SYMPOSIUM EDITION 

TOWNSVILLE HEALTH RESEARCH WEEK 

MONDAY 8 OCTOBER – FRIDAY 12 OCTOBER, 2012 

ROBERT DOUGLAS AUDITORIUM, 

THE TOWNSVILLE HOSPITAL, AUSTRALIA 

• Editorial 

• rEsEarch WEEk ovErviEW 

• spEakEr BiographiEs 

• oral aBstracts 

• postEr aBstracts 

• aWard announcEmEnt 

Official Journal of The Australasian College of Tropical Medicine 

Volume 13 Issue 2 July 2012 

1 ANNALS OF THE ACTM 

1

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) 

Secretariat 

ACTM Secretariat, PO Box 123, 

Red Hill QLD 4059 AUSTRALIA 

Tel: +61-7-3872-2246 

Fax: +61-7-3856-4727 

Email: actm@tropmed.org 

Website: http://www.tropmed.org 

Editorial Board 


Editor-in-Chief 

Professor Derek R. Smith 

Emeritus Editor-in-Chief 

Emeritus Professor John M. Goldsmid 

Executive Editors 


Associate Professor John Frean 

ACTM BULLETIN 

Editor ACTM Bulletin 


Sub-Editor 

Associate Professor Arun Menon 

Board Members and Review Panel 

Dr Irmgard Bauer, Emeritus Professor Roderick SF 

Campbell, AM, Professor David Durrheim, Associate 

Professor John Frean, Dr Michael Humble, Associate 

Professor Tim Inglis, Professor Justin La Brooy, 

Professor Ahmed Latif, Dr Alan Mills, Professor John H. 

Pearn, AO, RFD, Dr Ken D. Winkel 


AN INTERNATIONAL JOURNAL OF TROPICAL & TRAVEL MEDICINE 

CONTENTS 

SYMPOSIUM EDITION 

TOWNSVILLE HEALTH RESEARCH WEEK 

MONDAY 8 OCTOBER – FRIDAY 12 OCTOBER, 2012 

ROBERT DOUGLAS AUDITORIUM, 

THE TOWNSVILLE HOSPITAL, AUSTRALIA 

JULY 2012 

Editorial 17 

Research Week Overview 18 

Speaker Biographies 19-21 

ALLIED HEALTH RESEARCH SYMPOSIUM 

Program 22 

Oral Abstracts 23-25 

Poster Abstracts 26-27 

NURSING RESEARCH SYMPOSIUM 

Program 27 


Poster Abstracts 30 

MEDICAL RESEARCH SYMPOSIUM 

Program 30-31 


Poster Abstracts 34-40 

Award Announcement 40 

Cover photo: The Australian Institute of Tropical Medicine in 1916 (photo courtesy of James Cook University) 

© Copyright 2012 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 Editorial board.

The Townsville Health Research Week 

Monday, 8 October – Friday, 12 October, 2012 

Robert Douglas Auditorium, 

The Townsville Hospital 

EDITORIAL 

A Vision for Building Research 

Capacity in the Tropical North 

Professor David Plummer, AM 

Professor in Health Practitioner Research Capacity Development, Townsville Health Service 

& James Cook University and Adjunct Professor, Public Health, University of Texas, Houston 

Associate Professor Lynden Roberts 

Director of Clinical Research, Townsville Hospital & Health Service Head of Medicine 

Discipline, Townsville, Queensland and Associate Professor, James Cook University 

Professor Linda Shields 

Professor of Nursing, Tropical Health Research Unit, Townsville Health Service & James 

Cook University and Honorary Professor, Medical School, University of Queensland 

Tropical Australia covers a vast area, is relatively sparsely populated and 

the population faces a surprising range of unique health problems: social, 

cultural, remote, Indigenous, service-related, bio-security and tropical 

diseases to name a few. The north shares key international borders: to the 

northwest is Indonesia, to the north is Papua New Guinea, and to the east 

are the south pacific island nations and territories. indeed, our closest 

international border with Papua New Guinea marks one of the biggest 

health disparities on earth. In 2011, the UNDP Human Development Index 

for Australia ranked 2 nd to Norway and while PNG ranked 153. 1 

Townsville is the biggest city, not only in northern Queensland but in all 

of tropical Australia and is home to the Townsville Hospital, the largest 

tropical hospital in the country. Adjacent to the Townsville Hospital is the 

principal campus of the James Cook University, including the main campus 

of the Faculty of Medicine, Health and Molecular Sciences. The James Cook 

University is a university of considerable international standing and is well 

known for its teaching and its biological research. In short, Townsville’s 

health infrastructure is exceptionally well placed to take advantage of the 

unique circumstances of the northern, tropical geography. 

To respond to the challenges of the tropical north and to take advantage of 

the unprecedented opportunities in tropical health care, a highly developed 

workforce is essential. In particular, with rapid technological developments 

and the special challenges of tropic health practice, health professionals of 

all disciplines must be skilled in evidence-based practice to an international 

standard and which accommodates the unique features of the tropics. To 

be fully engaged in evidence-based practice, health workers need to be able 

to access and read the relevant research literature and to stay up-to-date. 

Fortunately, in the internet age, accessing the literature has never been 

easier. Both the university and Queensland Health have excellent libraries 

and exceptional professional library support. 

While there is ready access to the health research literature, such literature 

is highly technical and research is moving quickly: reading the literature, 

interpreting it and translating it into world-class practice demands highly 

developed skills. Quality and innovation in health care depends very much 

on the workforce being highly ‘research literate’. Given the diversity of 

health care - from psychiatry, to social work, to laboratory diagnostics, 

to community practice, to Indigenous health, to neurosurgery, to health 

promotion, to name a few - it is clear that ‘evidence’ will take many 

forms and be the product of a diverse array of research methods. So, 

to be research literate and to be able to critically analyse the evidence, 


health professionals need a broad working knowledge of a range of 

methodological approaches. It is no longer possible to declare that one 

is purely ‘quantitative’ or entirely ‘qualitative’ in research orientation. 

This would mean that one is semi-literate and able to meaningfully read 

only some of the literature. Moreover, intellectual openness and capacity 

building are the keys to a thriving research and health care culture. Thus a 

vital strategic step for developing health care in the north (and elsewhere) 

is to develop wide research literacy and capacity. 

A recent internal workforce survey of health practitioners right across 

northern Queensland gave us some clues: the survey had a respectable 

response rate of 55%; 86% of respondents replied ‘yes’ or ‘maybe’ 

when asked whether they were interested in doing higher education in 

the future (40% ‘yes’; 46% ‘maybe’). When asked about research, 66% 

of respondents wanted to undertake research as part of their higher 

degree (14% exclusively; 52% in combination with coursework). Finally, 

and perhaps most tellingly, more than 80% of those surveyed expressed 

a desire to conduct health research as part of their job in the future. In 

short, there is a keen interest among northern health practitioners to 

engage in research. Moreover, the diversity of the respondents and the 

wide range of interests once again reinforce the need for any research 

capacity development strategy to be broad-based, multi-disciplinary and to 

accommodate a range of methodologies. 

Of course, developing research capacity requires money and here lies the 

‘catch-22’. For health professionals to attract funding they will need some 

essential supporting infrastructure and a research track record before most 

grant schemes will consider them. The system almost seems set-up for the 

rich to get richer and for the gap to widen. It is vital that we do not let this 

situation strangle the development of research in the north. Fortunately, 

there are ways of kick-starting a track record, which will open the way 

to the big, competitive grants. First, aspiring researchers can associate 

themselves with experienced researchers who already have a track record. 

Of course, this depends on how available such people are and whether 

their research relates to the questions in which the new researchers are 

interested. A second way is for some small pump priming funding to be 

specifically targeted to help people to start to establish a track record. We 

strongly endorse both options. 

As we have seen, North Queensland has excellent health and academic 

infrastructure and the Townsville Hospital is the largest in tropical Australia. 

However, there is one key part of the jigsaw puzzle that is still missing. If 

a hospital of this size was in a capital city, there would have already been 

a well developed, thriving research institute associated with the hospital/ 

university complex which would have been operating for a considerable 

period of time: think Garvan, Baker, Walter & Eliza Hall (WEHI) to name but 

three. Indeed, just over 100 years ago such an institute was established 

in Townsville. It was called the Australian Institute of Tropical Medicine 

and has the distinction of being the first institute for medical research in 

the country, antedating the WEHI by 6 years. 2 What happened to it? It 

was moved to the University of Sydney, a non-tropical university in a nontropical 

capital city. 

To conclude, the 2012 Townsville Health Research Week is a hugely 

important milestone. For the first time, the ‘three pillars’ of health research 

- medical, nursing and midwifery, and allied health - have come together 

in a week-long event to present their work, to support each other, to 

collaborate, to explore across methodological boundaries, and above all to 

demonstrate that there is a critical mass of researchers in the north so that 

research will thrive. We are witnessing a ‘coming of age’ in the north and 

the north can no longer do without a thriving health research institute like 

those that are commonplace in the capital cities. We take this opportunity 

to call for the final part of the jigsaw to be put in place. the time is now! 

References 

1. United Nations Development Programme. Human Development Report 2011. New York (NY): United Nations 

Development Programme (US); 2011. 185 p. 

2. Douglas RA. Dr Anton Breinl and the Australian Institute of Tropical Medicine. Med J Aust 1977; 1; 713-716. 


17

OVERVIEW OF THE TOWNSVILLE HEALTH RESEARCH WEEK 


Robert Douglas Auditorium, The Townsville Hospital 

FRIDAY 

12 OCTOBER 

THURSDAY 

11 OCTOBER 

WEDNESDAY 

10 OCTOBER 

TUESDAY 

9 OCTOBER 

MONDAY 

8 OCTOBER 

DATE 

Research Breakfast 

– Including Trivia Contest 

Endeavour Room - JCU Halls 

of Residence 

Breakfast 

7:00 am to 9:00 am 

Workshop 

“Research in Indigenous 

Settings” 

by Professor Yvonne 

Cadet-James 

Workshop 

“Writing for Publication” 

by Dr Liz Tynan 

Workshop 

“Effective Literature Searching 

and EndNote” 

by Bronia Renison 

Workshop 

“Effective Literature Searching 

and EndNote” 

by Bronia Renison 

Workshop 

“Roadmap to Grant 

Applications” by Jasper Taylor 

Morning Session 

9:00 am to 11:30 am 

9-11 am Tutorial Room 3, 

JCU Clinical School 

(first floor, tth) 

9-11:30 am, EG065 

(ground floor, tth) 

9-11:30 am, EG065 


9-11 am, EGO62 


Locations as indicated 

9-11:30 am, EG062 


“Getting Published” 

by Dr Martin Van Der Weyden 

at 45-002 on JCU Campus 

Lunch 

12:00 pm to 12:30 pm 

Lunch 

provided by Betty Blue and the 

Lemon Tart 

Lunch 


Lemon Tart 

Research Week Official 

Opening 

with lunch provided by Betty 

Blue and the Lemon Tart 

Lunch (RDA) 


Lemon Tart 

Food served in the 

Robert Douglas 

Auditorium (RDA) foyer 

18 ANNALS OF THE ACTM July 2012 

Lunch 

provided by Michel’s 

Closing Session 

Best Presentations of the 

Week – Awarding of the Best 

Overall Presentation Prize 

12:30-1:30 

The Great Debate: 

“Health research 

– we’re different up here!” 

Affirmative Team: 

Carl O’Kane, Anne Swinbourne, 

Clare Newton 

Negative Team: 

Sabe Sabesan, Robyn Adams, 

Brendan Porter 

Afternoon Session 

12:30 pm to 4:30 pm 

Medical Research 

Symposium 

(see pages 30-31) 

Nursing Research 


(see page 27) 

Allied Health Research 


(see page 22) 

Announcement of the 

Professor Ian Frazer 

Humanitarian Award 

All events held in 

the Robert Douglas 

Auditorium at The 

Townsville Hospital 

Wine and Cheese Wine and Cheese Wine and Cheese 

Evening Session 

4:30 pm to 6:00 pm

THE GREAT DEBATE 

Health Research – We’re Different up Here! 

debaters for the affirmative 

Dr Carl O’Kane 

Carl J. O’Kane studied Medicine at the University of N.S.W and completed 

his junior years at Royal North Shore Hospital in Sydney and Port Macquarie 

Hospital on the Mid NSW coast. He took a year off to complete a diploma in 

boogie boarding and worked in England for a spell. He fell into Emergency 

Medicine training in Gosford and completed it in Townsville where he stayed 

on in a consultant role. he misses his surfing but enjoys movies and teaching 

and intends to maybe do further study when his Xbox breaks again. 

Dr Anne Swinbourne 

Anne Swinbourne is a Senior Lecturer in Psychology at James Cook University. 

Her interest in health research in North Queensland stems from her 

appointment in 2001 as a senior research and Evaluation officer at the then 

Tropical Population Health Unit. It took some time for her to accept that the 

health data she was presented with was real and not a series of typographical 

errors. a firm believer that we are different up here, anne looks forward to 

putting this motion forward at the Debate. 

Ms Clare Newton 

Clare Newton is a Nurse Educator in ICU at The Townsville Hospital and 

Subject Coordinator for Intensive Care Course at JCU. With 20 years nursing 

experience, she says she is still looking for her real career. Given her involvement 

with health research, maybe she’ll find it! involved in the previous great 

Debate on the winning team, she is hoping to also be a part of this year’s to 

gain the title of reigning champ!! this led clare to thoughts of rocky for a 

minute, but then she became concerned she was showing her age!! 

Debaters for the Negative 

Associate Professor Sabe Sabesan 

Sabe Sabesan is the director of the department of medical oncology at the 

Townsville Cancer Centre, Townsville Hospital, Queensland and the Clinical 

Dean of the Townsville Clinical School, the School of Medicine and Dentistry 

at the James Cook University, Townsville. In his Queensland Health role, he 

pioneered a large teleoncology network in North Queensland servicing 19 

rural centres 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 

teleoncology. 

Ms Robyn Adams 

Robyn Adams has been a long term advocate for rural and regional allied 

health professionals. A past national President of Services for Australian Rural 

and Remote Allied Health (SARRAH) and allied health representative to 

the National Rural Health Alliance, Robyn has worked in public, private, aged 

care and academic sectors. Currently the Executive Director Allied Health, 

Townsville Hospital and Health Service, Robyn is undertaking doctoral studies 

at James Cook University. 

Mr Brendan Porter 

Brendan Porter was born in Portadown, County Armagh, Northern Ireland. 

He attended Armagh Christian Brothers primary and grammar schools before 

moving to Armagh College of Further Education. Brendan commenced 

training as a nurse at Purdysburn hospital in Belfast. Working as a mental 

health nurse he moved to St Luke’s hospital in Armagh and then commenced 

training as a Nurse for people with an intellectual disability. He married Ro- 


berta in 1985 and they have one daughter, Victoria. In 1998 they moved to 

Townsville to work at the Townsville General Hospital. Brendan has been a 

member of Rotary International for 15 years and in 2009/2010 was District 

Governor for Rotary District 9550, an area covering 1.5 million sq kilometres. 

During this time he lead Rotarians to give and do more to the 5 Rotary Charities 

The Rotary Foundation, Polio Plus, Australian Rotary Health, Rotary Australia 

World community Service and Rotary Oceania Medical Aid for Children. 

In 2012 he will head the International Charity Rotary Australia Medical Aid for 

Children. He was a member of the Queensland Cancer Fund team that raised 

$7 million to build the palliative care unit. He has two commendations from 

Queensland Health, was the 2006 Queensland Cancer Fund charity Nurse of 

the Year and was awarded the Fundraising Institute of Australia’s award for 

the largest fundraiser for a non-government project in Queensland. 

Adjudicators 

Mr Aussie Lanphier 

Aussie Lanphier is the North Queensland Director 

of the Lions Medical Research Foundation of 

Queensland, the sponsor of the Ian Frazer Humanitarian 

award. in 2002 aussie held the office of governor 

of Lions Q2 District covering Northern Queensland 

and New Guinea and is the current President of the 

Northern Suburbs Lions Club in Townsville. Aussie, 

his wife Toni, and their family have a distinguished 

record of community service recognised by numerous awards and citations 

over the years. In his 28 years as a Lion he has held many Zone and District 

offices and arranged numerous fund raising events for health research and 

other worthy causes. With a background in business, sales and marketing together 

with a love of good wine and company, Aussie is a generous, popular 

and well respected member of the local community. 

Professor Gracelyn Smallwood 

Gracelyn Smallwood is a Birrigubba, Kalkadoon and 

South-Sea Islander woman born in Townsville in 

1951. She has been advocating against the racism 

and violation of human rights against her people for 

the past 45 years and prior to this her parents for 

50 years and her grandparents for another 50 years 

before that. In 1973, she became a registered nurse; 

in 1993, she became the first indigenous australian 

to receive a Master of Science in Public Health (JCU), and in 2011, she completed 

her PhD Thesis Human Rights and First Australians Well-being. Her 

many accomplishments include: helping to found the Townsville Aboriginal 

and Islander Health service in 1974 and being awarded the Queensland Aboriginal 

of the Year in 1986, and an Order of Australia in 1992 for service to 

public health, particularly hiv-aids education. in 1994 she became the first 

woman, first indigenous person and first non-paediatrician to receive the 

Henry Kemp Memorial Award at the International Society for Prevention of 

Child Abuse and Neglect, and in 2007 she received the peer- and community 

judged Deadly Award for Outstanding Lifetime Achievement in Indigenous 

Health, which she considers one of her greatest achievements. From 2007- 

2011 she held a part-time role as Special Advisor to the Vice Chancellor on 

Indigenous Matters at James Cook University trying to improve the relationship 

between JCU and the Indigenous community. About her life’s work to 

date, she says, “I have dealt with almost every disease, both nationally and 

internationally, however I have never been able to come to terms with the 

ugly disease of racism.” 


19

WORKSHOPS 

Dr Martin Van Der Weyden 

Martin Van Der Weyden was the Editor of The Medical 

Journal of Australia from 1995 to 2011 and Chief 

Executive of the Australasian Medical Publishing 

Company from 1996 to 2009. A graduate of Sydney 

University Martin has had a varied and distinguished 

career in academic and clinical medicine and hospital 

administration. On completion of his prevocational training at Sydney Hospital 

he was appointed as a Research Fellow in Clinical Haematology at Monash 

Medical School at The Alfred Hospital in Melbourne and subsequently he was 

a Merck Sharpe & Dohme International Fellow in Clinical Pharmacology and a 





Monday, 8 October, 9-11 am, Room EG062 

(Ground Floor, The Townsville Hospital) 

Roadmap to Grant Applications 

Mr Jasper Taylor 

Director, Research Services, James Cook University 

this workshop aims to assist participants to find funding opportunities 

and to identify those with aims, objectives and selection criteria that best 

fit the field of research and applicant level. it will cover the preparation 

necessary for success in applying and, most importantly, the skills that are 

required and the methodology to adopt in order to write a good application 

– “grantsmanship”. 

Tuesday, 9 October, 9-11:30 am, Room EG065 


Wednesday, 10 October, 9-11:30 am, Room EG065 


Effective Literature Searching and EndNote 

Ms Bronia Renison 

Director Library Services, Townsville Hospital and Health Service 

This workshop will take place in a computer training room so the skills being 

taught can be practiced in real time. In the “Effective Literature Searching” 

portion of the talk we will cover methods for correctly framing your 

search question, including: PICO, how to choose the right place to start 

searching, the use of Boolean operators and how to quickly find a single citation. 

She will also demonstrate use of OVID, including Medline, PsycInfo, 

Embase and CINAHL Ebsco (nursing & allied health), among others. The 

“Introduction to EndNote” will include how to create an EndNote library, 

how to add references (manually and via importation), how to insert citations 

into a Word document, and will review installation and the various 

versions of EndNote. 

National Science Foundation Fellow at Duke University Medical Centre, North 

Carolina. On return to Monash Medical School at Alfred Hospital Melbourne 

he was appointed as an NHMRC Research Fellow and, subsequently, Associate 

Professor of Medicine and Professor of Haematology. At the Alfred, he 

was a senior visiting physician and head of the Haematology Services. Not 

satisfied with these challenges he was recruited into administration as chief 

of Investigative Medicine before joining The Medical Journal of Australia. Dr 

Van Der Weyden was awarded the Sussman Prize for Medical Research by 

the Royal Australasian College of Physicians in 1981. He is a member of the 

International Committee of Medical Journal Editors (ICMJE) and a Director 

of the World Association of Medical Editors (WAME). He has published in 

excess of 200 peer reviewed articles. 

Tuesday, 9 October, 12 pm, Room 45-002 (James Cook 

University Campus, Townsville) 

Getting Published 


Emeritus editor, Medical Journal of Australia 

The reasons why individuals publish are many. In an abstract sense these 

may include various combinations of the desire to: inform, interpret, criticize, 

influence and reform. alternatively, publication may also be driven 

by the desire for: academic advancement, obtaining research funding, 

communicating new findings or adding to the existing body of knowledge. 

Finally, there may even be pressure from departmental heads. Whatever 

its rationale, a paper will not see the light of day unless it successfully negotiates 

the editorial trail. Firstly, it must gain approval from selected peer 

reviewers as to its scientific merit and relevance and in due course pass editorial 

scrutiny. While the raison d’etre of editors may well differ in general 

and specialist journals, it is ultimately the editor who makes the final decision 

for acceptance or rejection. In each stage of the process the quality 

of communication is critical and should meet the framework advanced by 

Bradford Hill, the eminent British epidemiologist, who asked: What did you 

do? Why did you do it? What did you find? What does it mean? answers to 

these questions form the basis of the IMRD (Introduction, Method, Results 

and discussion) structure of all scientific papers. Before writing any scientific 

paper it is wise to consult previous issues of the selected journal to get 

a feel for the in-house style and consult instructions for authors. Above all, 

transparency and brevity are paramount. Finally, it is useful to show the 

paper to colleagues for their critical comments before submission. 

Thursday, 11 October, 9-11:30 am, Tutorial Room 3 (JCU 

Clinical School, First Floor, The Townsville Hospital) 

Writing for Publication 

Dr Liz Tynan 

Co-ordinator Research Student Academic Support, JCU Graduate Research School 

Scientists and academics do not just “do” science, they must write science 

as well. It stands to reason, then, that writing research is not only 

science-based, it is language-based. Good data are not enough – the language 

you use must ensure clear and persuasive transmission of ideas. 

This workshop will provide some guidance and strategies for writing effective 

academic publications using strong and effective language. We will 

examine the processes of producing a research article, focusing mainly 

on the IMRAD (Introduction, Methods, Results and Discussion) structure, 

and will give some thought to how scientific concepts can be made clear 

through critical thinking and robust writing skills. We will also think about 

how to construct an effective article title and abstract. 

20 ANNALS OF THE ACTM July 2012

Friday, 12 October, 9-11:30 am, Room EG062 (Ground 

Floor, The Townsville Hospital) 

Research in Indigenous Settings 

Professor Yvonne Cadet-James 

Chair Indigenous Australian Studies, School of Indigenous Australian Studies, James Cook 

University 

The aim of this workshop is to provide participants with an understanding 

of research protocols which ensure that research undertaken in an Indigenous 

context is of high quality, ethical, meaningful, and appropriate 

INVITED SPEAKERS 





Allied Health Research Symposium 

Professor Nick Graves 

Professor of Health Economics, Queensland University of Technology and Adjunct Associate 

Professor, University of Queensland 

Nicholas Graves is Professor of Health Economics with a joint appointment 

in the Institute of Biomedical and Health Innovation, School 

of Public Health, Queensland University of Technology and the Centre 

for Healthcare Related Infection Control and Surveillance, Queensland 

Health, Australia. His applied research brings economics to the study of 

health-care. He has a programme of research that uses Bayesian methods 

for the synthesis of diverse sources of data that are subsequently 

used to inform parameters in decision models that address questions 

about the value of competing investments in health care sector alternatives. 

He supervises PhD students, teaches economics to post-graduate 

students and has made research contributions of international significance 

publishing in Nature, BMJ, AIDS, Health Economics, Lancet Infectious 

Diseases, The Journal of Infectious Diseases and Emerging 

Infectious Diseases. Professor Graves will be presenting the talk “Using 

Research to Improve Health Services.” Much useful information is 

available for decision making in public health and health services. There 

are times when the research data show a new service is good value for 

money yet it remains unfunded. Other times services with high costs and 

low benefits are chosen for funding. often health services return similar 

health benefits per unit of cost and it is important to present the results 

of cost-effectiveness studies in a way that is intuitive for decision makers 

with the uncertainties in the decision quantified, and even show the economic 

value of collecting more information to reduce uncertainty. Some 

generic reasons for seemingly irrational decisions in health services are 

discussed. 

Nursing Research Symposium 

Professor Linda Shields 

Professor of Nursing - Tropical Health, Tropical Health Research Unit for Nursing and Midwifery 

Practice, James Cook University & Townsville Health Service District 


with a focus on building capacity and contributing to improving outcomes 

for Aboriginal and Torres Strait Islander Peoples. By participating in this 

workshop participants will gain: (1) An overview of the history of Indigenous 

people in Australia and its impact on Indigenous people’s perception 

of research due to previous and ongoing research practice by some 

researchers; (2) An insight into kinship systems, roles and responsibilities, 

obligations and commitments and the importance of such information in 

relation to group and community engagement throughout the research 

process; (3) An introduction to cross cultural communication issues and 

key principles of effective communication; (4) Knowledge about existing 

protocols and the opportunity to examine these as they apply throughout 

the research process. 

Linda Shields is Professor of Tropical Health Nursing at James Cook University 

and Townsville Health District in Queensland and is an Honorary 

Professor in the Department of Paediatrics and Child Health at The University 

of Queensland. her research interests include the influence of a tropical 

environment on nursing and health outcomes across the life span; the 

care of children in health services, in particular family-centred care, and the 

history of nursing and ethical issues surrounding nursing such as nurses’ 

roles in the euthanasia programmes of the Third Reich. She holds a Doctor 

of medicine from the university of Queensland, the first nurse in australia 

to attain a Higher Doctorate. In August 2012, she was one of three Australians 

inducted into the International Nurse Researcher Hall of Fame of 

Sigma Theta Tau International, the international honour society for nurses. 

Professor Shields will be presenting the talk “Why do nurses and midwives 

do research?” Until the 1980s, few nurses and midwives had the knowledge, 

skills or opportunity to undertake independent research projects. 

Since the move to university education, a thriving research community 

has evolved. She will discuss how nurses became involved in research, 

and some of the important and exciting research that has been done by 

nurses and midwives. Tropical North Queensland has a vibrant research 

culture, with interesting and relevant output, demonstrating that nurses 

and midwives here can and conduct some of the most important translatable 

research in Australia. 

Medical Research Symposium 


Emeritus Editor, The Medical Journal of Australia 

Martin Van Der Weyden was a renowned clinical and academic haematologist 

prior to his role as Chief Editor of the Medical Journal of Australia for 

15 years, before retiring in 2011. Combining a pragmatic, passionate, and 

provocative style, he has made a substantial contribution to raising the 

quality and profile of australian health research. dr van der Weyden will be 

presenting the talk “A Career Sustained by Scholarships” in which he will 

reflect on his journey from a boy growing up in the suburbs of Wollongong 

to his position as the Editor of The Medical Journal of Australia. (MJA) He 

will talk about what led him along an often non-linear path, which included 

stop-offs in Sydney, Melbourne, and the United States, bridging the worlds 

of clinical academia and basic scientific research, before becoming the editor 

of the MJA. He will share with us the lessons he learned throughout 

his interesting career, with a special focus on the many variables shaping 

the decisions he made - including the scholarships assisting his pathway 

beyond traditional medical boundaries to the crucial of role of mentors and 

the desire to do something challenging. Martin will also comment on the 

expectation that researchers adhere to the dictum driving much research, 

namely: Publish or Perish. Indeed, throughout his career, Martin was to 

publish 190 peer-reviewed papers, 122 editorials and 108 commentaries 

entitled: “From the editor’s desk.” 


21

ALLIED HEALTH RESEARCH SYMPOSIUM PROGRAM 

Tuesday, 9 October, 2012 

12:30-4.30 pm (lunch from 12 pm) 


TIME TOPIC SPEAKERS 

12:00 Lunch 

12:30 Introduction and Overview Ms Robyn Adams 

12:35 Essential Medicines Safety Information for Allied Health Professionals Ms Carla Scuderi 

12:40 Climate Change and Secondary Lymphoedema Associate Professor Sue Gordon 

12:45 Body Mass Index Predicts Pelvic Adiposity in Prostate Cancer Patients Mrs Amy Brown 

12:50 Sexual Reconstruction after the Loss of Manhood: The Men’s Tales Professor Matthew Yau 

1:05 

1:20 

Renal Parenchymal Thickness as a Measure of Renal Growth in Low 

Birth Weight versus Normal Birth Weight Infants 

chronic low Back pain: diagnostic classification, intervention and 

Outcome 

Mrs Sonja Brennan 

Miss Carol Flavell 

1:35 Keynote Address: Using Research to Improve Health Services Professor Nick Graves 

2:15 AFTERNOON TEA 

2:45 North Queensland Physiotherapists Experience and Needs Ms Yvonne Kane 

2.50 

Factors Impacting Rural and Regional Physiotherapy Service Provision: 

Preliminary Perspectives from Beyond the 23 Parallel 

Ms Robyn Adams 

2:55 Perceptions of Allied Health Notes on Patient Continuity of Care Ms Rebecca Smith 

3.00 

3:15 

3:30 

3:45 

Sweep Frequency Impedance (SFI) Measurements: Development of 

Normative Data Sets for Healthy Neonates 

Intergenerational Mentoring: Promoting the Psychosocial Wellbeing of 

Older Men and Teenage Boys Through Meaningful Occupation 

Human Papillomavirus Status of Oropharyngeal Cancer: A Predictor of 

Tolerance to Radiotherapy? 

Assessment of Needs of Early Life Service Providers in the Townsville 

Health Service District: Are We Doing Enough? 

Mr Venkatesh Aithal 

Dr Reinie Cordier 

Dr Nathan Wilson 

Ms Sarah Deacon 

Ms Rebecca Capper 

Ms Kristen Payne 

Ms Joanna Boyle 

4:00 A Sweet Bridge Between Two Countries: Call to UN's 2011 Challenge Mrs Achamma Joseph 

4:05 

Acknowledgements 

WINE AND CHEESE 

AWARDING OF PRIZES 

a great many people have contributed to the allied health research symposium, and we would specifically like to thank: robyn adams, venkatesh 

Aithal, Daryl Brennan, Amy Brown, Jennifer Croker, Gail Kingston, Tara MacDonald, Tilley Pain, Ish Patel, David Plummer, Bronia Renison, Kelvin 

Robertson, Alexandra Ryan, Wendy Smyth, and Matthew Yau. We would also like to thank our Keynote Speaker Professor Nick Graves. 


ORAL ABSTRACTS 






Essential Medicines Safety Information for Allied Health Professionals 

Carla Scuderi 

Pharmacy Department, The Townsville Hospital & Medication Services Queensland, Townsville, 

Queensland 

Background / Aims: Medicines are the largest single intervention provided 

to patients in hospital. Adverse effects of medicines may decrease the 

ability of patients to participate in interventions, specifically allied health 

Professional’s (AHP) interventions, impacting on the quality of care and 

length of hospital stay. AHPs receive education about medicines as part 

of their undergraduate degree but receive little formal professional education 

on medication after graduation. Pharmacists are well placed to provide 

education to other AHPs about the nature of medication and medication 

issues which may benefit individual professions in the performance of their 

duties. This study aimed to formulate a pilot interdisciplinary workshop 

addressing essential medicines safety information for AHPs. Methods: A 

series of scoping interviews were conducted which moulded the content of 

the workshops into 5 clinical topics and a case study. AHP knowledge was 

assessed using a pre and post workshop quiz and using a certainty based 

scoring scheme. Results: A pilot 2 hour workshop was held was held with 

thirty-three attendees from six different disciplines. A global trend towards 

more correct answers and an increased certainty the AHPs were correct, 

was observed between the pre and post quiz. Overall, 93% of responses 

indicated the workshop content was useful, informative and provided skills 

which would be able to be taken back to the workplace. Conclusion: Due to 

the increasing number of medicines and complexity of patients this style of 

workshop should be further developed to provide specific skills and knowledge 

to Allied Health Professionals regarding medicines. 

Sexual Reconstruction after the “Loss of Manhood”: The Men’s 

Tales 

Matthew Yau 

School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, 

Townsville, Queensland 

Background / Aims: sexuality contributes significantly to the development 

of individual’s identity, self-esteem and relationships. Research indicates 

that males tend to incorporate their sexual potency to define identity, selfesteem 

and “manhood.” Physical disabilities that impact on one’s sexual 

functioning can affect man’s perception of self and relationship with others. 

Methods: The study adopted a qualitative approach to collect narrative 

tales of seven adult males with an acquired physical disability through 

semi-structured interviews that focused on courtship, intimate relationship 

and perceived sexual potency before and after the injury, attempts made 

to reconstruct own sexuality, and experience with health professionals in 

addressing sexual concerns. Thematic analysis was conducted on the data. 

Results: All informants expressed that the desires for sexual satisfaction 

and intimacy did not diminish after the injury and that sexual concerns 

were inadequately or not addressed by health professionals. Major themes 

identified include: loss of manhood and its consequences, partner’s role 

change from lover to carer, unspeakable desires and pathway to sexual 

reconstruction. Conclusion: Sexuality is often neglected by health profes- 


sionals in the rehabilitation process. Findings in the study provide insights 

to the experiences of men with acquired physical disability in the journal 

of sexual recovery. 

Renal Parenchymal Thickness as a Measure of Renal Growth in 

Low Birth Weight versus Normal Birth Weight Infants 

Sonja Brennan and Yoga Kandasamy 

Departments of Medical Imaging and Neonatology, The Townsville Hospital, Townsville, 

Queensland 

Background / Aims: Low birth weight (LBW, < 2500 g) infants have smaller 

kidneys and therefore a reduced number of glomeruli and nephrons. Renal 

ultrasound remains the primary technique for assessing renal volume. 

Renal volume (RV) is obtained by acquiring three measurements and then 

using a formula to estimate the volume. In contrast, measurement of the 

renal parenchymal thickness, with ultrasound, is a single measurement of 

the kidney. We carried out a study to determine whether renal parenchymal 

thickness can be used to detect any differences in renal growth between 

LBW and normal birth weight (NBW, 2500-4500g) infants. Methods: This 

study was conducted over a 12-month period from August 2010 in the 

Departments of Medical Imaging and Neonatology, Townsville Hospital. 

Only infants born full-term without urinary tract symptoms or underlying 

renal problems were included. these infants were then classified according 

to birth weight as LBW or NBW. Results: Thirty-eight infants were evaluated 

(11 LBW and 27 NBW). The mean RV and mean renal parenchymal 

thickness in lBW infants are significantly lower than they are in nBW infants. 

there was no significant difference in renal length between lBW and 

nBW infants. Furthermore, there were no significant differences between 

each kidney’s right and left renal length, parenchymal thickness and volume. 

Renal parenchymal thickness is found to be closely correlated with 

an increase in RV (p < 0.0001). Conclusion: The mean renal parenchymal 

thickness in lBW infants is significantly lower than in nBW infants. renal 

parenchymal thickness is a single, easily performed measurement that 

may be a more useful and accurate approach to monitoring renal growth. 

Chronic Low Back Pain: Diagnostic Classification, Intervention and 

Outcome 

Carol Flavell 1 , Laurence Marshman 2 , Susan Gordon 1 and Kerrianne 

Watt 1 

1Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, 

Queensland 

2The Pain Clinic, The Townsville Hospital, Townsville, Queensland 

Background / Aims: This research consists of three interconnected and 

sequential studies. Preliminary data from study two will be presented. This 

study aims to evaluate a physiotherapy diagnostic classification system 

for chronic low back pain (CLBP), against a gold standard of anaesthetic 

spinal injection. Methods: Volunteer participants (n=30), diagnosed with 

CLBP were recruited. A physiotherapist and a neurosurgeon examined and 

classified all subjects. the physiotherapist and neurosurgeon were blinded 

to each other’s examination findings. spinal injection was conducted by 

the neurosurgeon. Immediately following spinal injection subjects were 

re-examined, and post injection pain levels were determined. Data from 

participants whose physiotherapy classification matched the diagnosis of 

the neurosurgeon was analysed to identify significant differences in pain 

levels. Results: subjects showed significant improvement (p < 0.001), in 

before and after spinal injection measures of Visual Analogue Scale (VAS) 

and Numerical Pain Scale (NPS). In addition greater than 50% of participants 

reported 80-100% reduction in NPS and VAS. Conclusion: The preliminary 

results suggest that this physiotherapy classification protocol is 

a valid tool, and has implications for the role of physiotherapists in the 

classification of chronic low back pain prior to spinal injection and potential 

to improve physiotherapy interventions for patients with chronic low back 

pain. 


23

North Queensland Physiotherapists’ Experience and Needs 

Tilley Pain 1 , Yvonne Kane 4 , Desley Harvey 2 , Alison Pighills 3 and 

David Plummer 1 

1 Health Practitioner Research Fellow, Queensland Health, Townsville, Queensland 

2 Health Practitioner Research Fellow, Queensland Health, Cairns, Queensland 

3 Health Practitioner Research Fellow, Queensland Health, Mackay, Queensland 

4 Department of Physiotherapy, The Townsville Hospital, Townsville, Queensland 

Background / Aims: Building research capacity includes developing consumers 

and producers of research. Allied health professionals, part of the 

Health Practitioner (HP) stream within Queensland Health, are the subjects 

of a state-wide research capacity building initiative. Physiotherapists 

in northern Queensland were surveyed to ascertain their experience and 

perceptions of research. They were also questioned about their requirements 

to enable them to participate in research. The aim of this work was 

to provide research training and resources to physiotherapists and other 

allied health staff in northern Queensland. Methods: A cross-sectional 

survey was sent to all Queensland Health HPs from northern Queensland 

between May and June 2011 using the online tool, Survey Monkey. The 

survey consisted of 53 questions including closed and open-ended questions. 

The focus of the questions was to determine HPs’ research experience 

and needs. Closed questions were 5 point Likert scale which was analysed 

using descriptive statistics and comparisons using chi squared tests. 

Ethics approval was obtained (HREC/11/QTHS/93). Results: Over 50% of 

physiotherapists had limited experience in writing proposals, ethics applications, 

grants, reports or articles for peer reviewed journals. Conversely, 

greater than 50% indicated they need a lot or moderate support in generating 

research ideas, both qualitative and quantitative methods and writing 

proposals, ethics and papers for publication. Forty percent of physiotherapists 

are interested in doing a higher degree but only 5% by research only. 

Conclusion: Most physiotherapists are not actively involved in research. 

However, they are interested in implementing Evidence Based Practice by 

appraising literature or updating guidelines. 

Factors Impacting Rural and Regional Physiotherapy Service 

Provision: Preliminary Perspectives from Beyond the 23 Parallel 

Robyn Adams 1,2 , Lorraine Sheppard 2,3 , Anne Jones 2 and Sophie 

Lefmann 3 

1Allied Health Planning and Support, Townsville Hospital and Health Service, Townsville, 

Queensland 

2School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook 

University, Queensland 

3School of Health Sciences, University of South Australia, Adelaide, South Australia 

Background / Aims: Variable access to services such as physiotherapy 

in rural and regional areas has been suggested as one consequence of 

workforce shortages and maldistribution. Improving access to health services 

in rural areas is a national health priority. Gaining insight into factors 

influencing service provision may inform our understanding of access 

to services such as physiotherapy. The pilot study aims include obtaining 

stakeholder perspectives of factors influencing rural physiotherapy service 

provision. Methods: A systems theory-case study heuristic provided the 

research framework. An interpretivist approach within a qualitative research 

paradigm supported understanding of stakeholder perspectives. 

Data collection included surveys and semi structured interviews of participants 

from a rural and regional Queensland site. An iterative approach 

to data analysis for open ended survey questions and interview responses 

occurred. Results: nine participant responses provide field observations of 

the complex system of health. observations on factors influencing service 

provision include: fluctuating budgets, targeted funding, limited staffing 

numbers, challenging demand management, limited professional development 

and support, and challenging recruitment of experienced staff to rural 

areas. Observations impacting on the clinician included decreased clinical 

effectiveness and job satisfaction and increased stress. Service limitations, 

gaps and inconsistencies were also suggested, as were a mismatch between 

funded services and clinical priorities and restricted long term planning. 

Conclusion: obtaining insight into factors influencing the provision 

of services such as physiotherapy in rural and regional areas may complement 

the ‘who’, ‘what’ and ‘where’ of existing statistical data to inform 

future rural and regional health planning. Participant perspectives provide 

valuable field observations of complex systems. 

Perceptions of Allied Health Notes on Patient Continuity of Care 

Tilley Pain, Jemma Thomson, Sandra Froyland, Rebecca Smith, 

Janet Askern and Leanne Bell 

The Townsville Hospital, Townsville, Queensland 

Background / Aims: Notes written in the health record are a primary conduit 

for the exchange of clinical information and are thus essential for the 

continuing care of the in-patient. Readers of the health record include a 

number of specific health professionals who all contribute to the management, 

care and recovery of the patient. This study investigated what health 

professionals are looking for in allied health notes to inform the decisions 

they make for patient continuity of care. Methods: This is a qualitative 

study using focus groups to obtain the perception of medical, nursing, 

and allied health staff who work on the medical wards. The focus groups 

were recorded and transcribed verbatim and nonverbal communication 

was noted by an observer. Iterative thematic analysis was performed by 

all of the researchers to code and identify themes from the transcripts. 

Major themes were discussed and compared to the literature. Results: 

participants identified various ways allied health notes contributed to their 

care, with primary themes including 1) obtaining background information, 

2) ensuring patient safety, and 3) informing their own decision making 

process. The notes were read mostly when a referral had been made for 

a particular discipline’s involvement or intervention and were commonly 

associated with patient discharge. The layout and format of allied health 

notes was identified as enhancing their usefulness to other health professionals. 

Conclusion: It was concluded that health professionals read allied 

health notes chiefly to find information on patient progress and to plan the 

next course of action for the patient. 

Sweep Frequency Impedance (SFI) Measurements: Development 

of Normative Data Sets for Healthy Neonates 

Venkatesh Aithal 1 , Joseph Kei 2 , Carlie Driscoll 2 , Andrew Swanston 3 

and Katrina Roberts 4 

1 Audiology Department, Townsville Hospital and Health Service, Townsville, Queensland 

2School of Health and Rehabilitation Sciences, Audiology, University of Queensland, Brisbane, 

Queensland 

3 ENT Department, Townsville Hospital and Health Service, Townsville, Queensland 

4Institute of Women’s and Children’s Services, Townsville Hospital and Health Service, 


Background / Aims: The majority of false positive referrals during newborn 

hearing screening are due to transient middle ear dysfunction which alters 

the acoustic properties of the middle ear. The current screening technologies 

(automated auditory brainstem response (AABR), otoacoustic emissions 

(OAE)) do not distinguish between hearing loss due to transient 

middle ear dysfunction and permanent hearing loss. Although sweep frequency 

impedance (SFI) testing is reported to hold promise for middle ear 

assessment in neonates, there is a scarcity of normative data in this population. 

The present study aimed to develop normative SFI data in healthy 

neonates. Methods: A total of 100 full term healthy neonates (58 males, 42 

females) who passed all three tests namely, AABR, OAE and high frequency 

tympanometry (HFT) were enrolled in the study. Mean age at the time of 

testing was 43.9 hr (range 8 to 103 hours). Results: Two resonances of 

outer/middle ear were observed with high resonance frequency (RF) being 

approximately 4 times that of low RF. The 90% range for low RF ranged 

from 209 to 420 Hz and high RF ranged from 834 to 1539 Hz. Volume 

displacements of ear drum (#8710;SPL) ranged from 3.4 dB SPL to 13 


dB SPL at low RF and from 1.4 to 8.2 dB SPL at high RF. ANOVA results 

showed no significant gender or ear effects or their interactions for rF and 

measured #8710;SPL. Conclusion: The normative data sets developed for 

RF and #8710;SPL will further the understanding of acoustic properties of 

middle ear function in neonates. It will also assist in classifying middle ear 

status as normal or abnormal. 

Intergenerational Mentoring: Promoting the Psychosocial 

Wellbeing of Older Men and Teenage Boys through Meaningful 

Occupation 

Reinie Cordier 1 , Nathan J Wilson 2 and Ms Lisa Wilson-Whatley 3 

1School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, 


2 Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales 

3City of Canada Bay, Sydney, New South Wales 

Background / Aims: Many teenage boys who are at risk of social dysfunction 

often have few, if any, positive male role models. Their future participation 

in society as healthy, active and productive members of society is 

uncertain. Nine teenage boys, aged between 14-16 years and at risk of exclusion 

at school, participated in a weekly shared construction project with 

older male mentors aged between 60-75 years at the local men’s shed over 

1 school term. This research aimed to explore the older men’s perception 

of the project. Methods: Data were collected from pre- and post-project 

individual interviews with 6 of the mentors, 1 post-project focus group 

with 6 mentors and the project co-ordinator. Data were analysed using the 

constant comparative method of grounded theory; themes were developed 

individually and then collectively by all authors. Results: The men reported 

that values and respect were important, but often overlooked, commodities 

in modern society. The process of mentorship proved one of reciprocity 

in sharing their life experiences. The teenage boys appeared to positively 

respond over the life of the project with enhanced self-esteem a notable 

outcome. Importantly, joint engagement in meaningful occupation served 

as the conduit for males to connect socially. Conclusion: Our analysis suggests 

that through participation in grassroots initiatives, such as men’s 

sheds, that the psychosocial wellbeing of older and younger males can be 

enhanced. these findings have implications for national male health policy, 

particularly for health service delivery of males in rural and remote areas, 

retired males, and males who are socially isolated. 

Human Papillomavirus Status of Oropharyngeal Cancer: A 

Predictor of Tolerance to Radiotherapy? 

Rebecca Capper, Sarah Deacon and Kristen Payne 

Townsville Cancer Centre, The Townsville Hospital, Townsville, Queensland 

Background / Aims: Human Papillomavirus (HPV) is changing the face of 

oropharyngeal cancer. the rise in detection rates has redefined the role 

of oncology allied health professionals with a shift to increased clinical 

workload demand. HPV P16 positive oropharyngeal cancer patients treated 

at the Townsville Cancer Centre within the last 18 months were noted to 

show greater deterioration during radiotherapy; a disparity to their favourable 

long term prognosis evidenced within current literature. Methods: 

A retrospective chart audit was conducted on 46 oropharyngeal cancer 

patients treated with radical radiotherapy. Data was collated regarding demographics, 

diagnosis, treatment, weight, feeding intervention, hospital 

admission and radiation side effects. Comparisons were made between 

HPV P16 positive (P16+) and HPV P16 negative (P16-) cancer groups. 

Results: P16+ cancers represented 54% of the population. Comparison of 

total body weight loss between P16+ (10%) and P16- (5%) cancer groups 

was statistically significant (p

POSTER ABSTRACTS 





Exploring Empathy with Social Work Students through the Use 

of Real Life Vignettes: Implications for Effective Client / Patient- 

Centred Care 

Susan Gair 

School of Arts and Social Sciences, James Cook University, Townsville, Queensland 

Background / Aims: The promotion of empathic, non-judgmental care and 

helping is very familiar discourse in health and allied health education and 

training, including social work. The medical, health and allied health literature 

identifies that empathy is a vital ingredient in effective clinical intervention, 

but that empathy can be diminished rather than increased during the 

course of professional training programs, and that in-group preferences in 

empathy might exist. The primary aim of classroom-based research undertaken 

in 2009 and 2011 was to explore the concept of empathy with social 

work students through the use of selected, real life vignettes Methods: 

reflective, critical and phenomenological thinking (deep, reflective ways 

of understanding) informed these projects in order that students could 

identify and explain their empathic responses. Results: The research has 

provided some evidence that for these students, personal value judgments 

may influence their ability to enact empathy, particularly in cross-cultural 

contexts. these findings suggest that social work educators need to engage 

more proactively with students around concepts of empathy, in order to 

transform their conceptual understanding of empathy and non-judgmental 

helping, into a mastery of a deeper, felt and enacted empathy for effective 

client/patient-centred engagement. Conclusion: these findings have implications 

beyond social work education and practice, to the education and 

practice arena of many health and allied health professionals. 

Normative Wideband Reflectance in Healthy Australian Newborns 

Sreedevi Aithal1,2 , Venkatesh Aithal1 , Joseph Kei2 , Carlie Driscoll2 , 

Andrew Swanston3 , Katrina Roberts4 , Marissa Edmondson4 , Jewelie- 

Ann Wright4 and Rowena Lyons4 1 Audiology Department, The Townsville Hospital, Townsville, Queensland 

2Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University 

of Queensland 

3ENT Department, The Townsville Hospital, Townsville, Queensland 

4Institute of Women’s and Children’s Services, Townsville Hospital and Health Service, 


Background / Aims: to date, normative wideband reflectance data has 

been described in neonates who have passed a distortion product otoacoustic 

emission test. However, distortion product otoacoustic emission 

is not sensitive to subtle middle ear pathology and hence not an ideal gold 

standard. The objective of this study was to establish normative wideband 

reflectance data in healthy neonates with normal middle ear function who 

pass a battery of tests. Methods: Wideband reflectance was measured 

in 66 healthy neonates who passed a battery of tests that included high 

frequency (1000 hz) tympanometry, acoustic stapedial reflex, transient 

evoked otoacoustic emissions and distortion product otoacoustic emissions. 

Results: The analysis of variance (ANOVA) results showed that there 

was no significant difference between ears and genders. reflectance varied 

significantly across the frequencies. the median reflectance reached a 

minimum of 0.21-0.24 at 1-2 kHz, but increased to 0.45-0.59 below 1 kHz 

and 0.24-0.52 above 2 kHz. Conclusion: the normative reflectance data 

established in the present study were in agreement with, but marginally 

smaller than, those of previous normative studies, except for the Keefe et 

al. (2000) study. The use of a test battery approach had ruled out minor 

middle ear dysfunctions and ensured normal middle ear function as indicted 

by the slight reduction of reflectance across most frequencies. these 

norms can be applied to determine the middle ear status of neonates using 

test performance measures. 

The Role of TNF-alpha in Cognitive Decline 

Marielou Camara1,2 , Catharine Jawahar1 , Emily Jaehne1 , Helen Anscomb3 

and Bernhard Baune1,2 1Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia 

2Psychiatric Neuroscience, James Cook University, Townsville, Queensland 

3Discipline of Anatomy, James Cook University, Townsville, Queensland 

Background / Aims: Cognitive dysfunction is an essential symptom of a 

number of inflammatory conditions including depression, alzheimer’s disease 

(AD) and rheumatoid arthritis (RA). This impairment in cognition has 

been linked to increased levels of pro-inflammatory cytokines, particularly 

TNF-α, although the exact mechanisms are yet to be fully elucidated. A 

clear understanding of the cellular and immune mechanisms that contribute 

to cognition will allow development of effective strategies that enhance 

the treatment of cognitive deficits that reduce productive ageing, quality 

of life and functional independence. Methods: The study used genetically 

modified 3 month old mice (n=14 per strain) in tnF-/-, tnF-r1-/- and tnF- 

R2-/- , as well as wild type control mice. The mice were subject to a behavioural 

battery incorporating the Barnes Maze and Novel Object Recognition 

test (NORT) to measure cognition like behaviour and Elevated Zero Maze 

to assess anxiety. Results: Impaired spatial learning on the Barnes Maze 

was noted in TNF-/-, TNF-R1-/- and TNF-R2-/- mice. TNF-/- and TNF-R1-/mice 

also demonstrated significantly impaired retention memory in the 

NOR task, when compared to WT mice (p

using direct photolysis. Conclusion: Thus, photolytic and photocatalytic 

treatments are efficient to degrade naproxen in water. 

Pre-Analytical Pathology 

David Porter, Ruth Yimsung, Neil Silvester, Judy Cardillo and Andrew 

Wade 

Pathology Queensland, Townsville Hospital and Health Services, Townsville, Queensland 

Background / Aims: Pathology testing is divided into the pre-analytical, analytical 

and post-analytical phases. The pre-analytical component is where 

most errors occur and is where we are focusing our attention. The analytical 

phase is very well controlled through quality assurance and accreditation 

audits and the post-analytical phase has improved with electronic 

reporting and online result availability. The aim of this poster is to describe 

the measurement and subsequent management of pre-analytical errors in 

NURSING RESEARCH SYMPOSIUM PROGRAM 

Wednesday, 10 October, 2012 12:30-4.30 pm (lunch from 12 pm) 



cooperation with key staff at one major tertiary referral hospital, and two 

smaller rural health facilities. Methods: Pre-analytical errors detected on 

samples received at the Pathology Queensland Townsville Laboratory were 

registered on the laboratory information system (Auslab). This information 

was analysed and discussed with clinical staff to identify common root 

causes and to design interventions aimed at reducing these errors. Results: 

We showed by providing accurate feedback, resources were best allocated 

to reducing the commonest cause of errors, focusing on those with 

the highest risk to the patient. It was observed we could reduce the overall 

pre-analytical error rate with a few simple interventions. Conclusion: Preanalytical 

error is a well-recognised though poorly managed problem affecting 

patient care and incurring unnecessary costs. This poster describes 

how we measured baseline error rates and the effectiveness of various interventions 

to reduce pre analytical error at three local health care facilities. 


12:00 LUNCH 

12:30 

1:30 

1:45 

2:00 

2:15 

Nursing Grand Rounds 

Healing Touch for Older Women: Using an RCT to Test a Complementary Therapy 

Use of Audits to Evaluate Clinical Practice: Re-Testing for Chlamydia at a Regional 

Sexual Health Service 2002 to 2011 

A Pilot Project to Improve Access to Chemotherapy for Rural Patients: The 

Townsville Tele-Nursing Model 

What are the Legal, Ethical and Professional Implications of the Use of Web 2.0 

Technologies by Nurses and Nursing Students? 

When do new mothers present for assistance with Breastfeeding difficulties and 

How do They Know Where to go? 


2:35 

2:50 

3:05 

Concordance of Temperature Measurements in the Preterm and Term Neonate Using 

Three Thermometers 

The Use of PRN Medication in an Adult Acute 

Mental Health Inpatient Unit 

The Positive and Negative Outcomes of the Buttonhole Cannulation Technique 

Compared to the Rope-Ladder Cannulation Technique: A Partial Replication Study 

Mrs Kristin Wicking 

Dr Monika Buhrer-Skinner 

Mrs Sandra Roberts 

Ms Carolina Bunhian 

Mrs Jean Shephard 

Mrs Jacqueline Smith 

Mr Colin Livesey 

Dr Wendy Smyth 

3:20 Cold Therapy Following Orthopaedic Surgery: The Literature Mrs Kerryn Royce 

3:25 

Looking in the Bowl: An Analysis of the Townsville Catchment Area National Bowel 

Cancer Screening Program Data 

Mrs Helen Britton 

3:30 Keynote Address: Why Do Nurses and Midwives Do Research? Professor Linda Shields 

3:40 




a great many people have contributed to the nursing research symposium, and we would specifically like to thank: gail abernethy, david lindsay, 

David Plummer, Bronia Renison and Wendy Smyth. We would also like to thank our Grand Rounds presenter, Mrs Kristin Wicking, and our Keynote 

Speaker, Professor Linda Shields. 


27



Wednesday, 10 October, 2012 




Use of Audits to Evaluate Clinical Practice: Re-Testing for Chlamydia 

at a Regional Sexual Health Service 2002 to 2011 

Monika Buhrer-Skinner 1,2 , Petra Buettner 1 , Natasha Miller 2 , Arun 

Menon 2 and Chama Kaoma 3 

1Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, 


2Townsville Sexual Health Service, The Townsville Hospital and Health Service, Townsville, 

Queensland 

3School of Medicine and Dentistry, James Cook University, Townsville, Queensland 

Background / Aims: Chlamydia trachomatis (Chlamydia) is the most commonly 

notified sexually transmissible infection in australia. re-infection 

rates between 10% and over 25% have been reported from Australia and 

internationally. Re-infections with Chlamydia are associated with a high 

risk of reproductive health morbidity. Re-testing presents a promising 

strategy to reduce the risk of re-infections. The aim of this presentation is 

to describe the effects of different interventions targeted at increasing retesting 

rates for Chlamydia. Methods: Re-testing and re-infection status for 

all positive Chlamydia cases attending a Queensland-based regional sexual 

health clinic between 2002 and 2011 were ascertained using clinical audits. 

95% confidence intervals (95%ci) were calculated. Results: At the time 

of the baseline audit (2003 to 2004) the re-testing rate for Chlamydia was 

2/283 (0.71%; 95%CI; 0.09%-2.53%), with one person re-testing positive. 

The introduction of a home-sampling kit which can be mailed to clients in 

2008 resulted in re-testing rates of 57/228 (25%; 95%CI; 19.5%-31.14%) 

of which 10 tested positive (17.54%; 95%CI; 8.75%-29.91%) for that year. 

In 2009 a reminder system was established, staff education conducted, and 

all positive cases were advised to re-test during their clinical consultation, 

resulting in re-testing rates of 323/665 (48.57%; 95%CI; 44.71%-52.44%) 

between 2009 and 2011. The re-infection rate in these re-tested clients 

was 71/323 (21.98%; 95%CI; 17.59%-26.90%). Conclusion: Re-infection 

rates reported from this Queensland-based regional sexual health service 

were high and comparable to those found in other parts of Australia and 

internationally. Interventions such as staff and patient education, homesampling 

kits and reminders can improve re-testing rates and case finding. 

What are the Legal, Ethical and Professional Implications of the 

Use of Web 2.0 Technologies by Nurses and Nursing Students? 

Carolina Bunhian 

School of Nursing, Midwifery and Nutrition, James Cook University, Townsville, Queensland 

Background / Aims: Web 2.0 technology is potentially both favourable and 

detrimental to the nursing profession. As the number of nurses/students 

disciplined or dismissed due to social media posts is increasing, this study 

is timely and socially relevant. The aim is to promote awareness of the need 

for social media policies, and to generate a draft policy that is legally, ethically 

and professionally defensible as a guide for the development of future 

policies. Methods: This study uses critical policy analysis to examine ten 

social media policies from overseas and Australia, informed by a comprehensive 

evidence-based literature review. These satisfy the criteria adopted 

in the modified six-step Basic policy analysis and planning process of 

Patton, Sawicki and Clark. Results: A literature review was conducted 

which identified strengths, weaknesses, and legal, ethical and professional 

implications of the use of Web 2.0 by nurses/students. It was found that 

Web 2.0 is prone to misuse and that nurses/students need guidance on 

how to use the technology within the parameters of the nursing discipline. 

The review also found that there are few policies explicitly guiding the use 

of Web 2.0 in Australian universities or healthcare institutions. Conclusion: 

Web 2.0 increases opportunities for nurses and others to further the interests 

of their discipline and to enhance learning but is open to inadvertent 

or deliberate abuse or misuse. Nurses and students, and those working in 

educational institutions, need to be educated about these issues and appropriate 

social media policies developed which allow for rapid modification 

in order to keep pace with technological change. 

When do New Mothers Present for Assistance with Breastfeeding 

Difficulties and How do They Know Where to go? 

Jean Shephard 

Child, Youth and Family Health Services, The Townsville Hospital and Health Service, 


Background / Aims: i am an international Board-certified lactation consultant 

working with women and children in the community setting. I was 

interested in some baseline information on how soon new mothers would 

seek advice and information for breastfeeding concerns and how they found 

out where to get professional assistance. Methods: Over a six-month period 

during 2010-2011, I gathered information from mothers face-to-face 

on their first presentation at our lactation clinic in kirwan. this period included 

Christmas and Cyclone Yasi which may have impacted on numbers 

due to closure of the clinic at the time. The data collected included babies’ 

age, the reason for the visit, place of birth and who referred the mothers to 

our clinic. Responses were stored on a spreadsheet. Results: The greatest 

number of mothers was seen between one and three weeks post birth, with 

the highest number attending at two weeks. The most common presenting 

problem experienced by new mothers was around attaching babe to the 

breast. These mothers were informed of our lactation clinic largely by the 

hospital midwifery care program. a gap was identified, with very small 

numbers being referred from the general practitioner or family and friends. 

Conclusion: the findings reinforced that it is vital that new mothers are 

well informed early about where to get help with their breastfeeding difficulties. 

nursing staff are taking the opportunity to inform mothers during 

those early home visits. there is an opportunity to create a poster or flyer 

for community organisations, hospital and general practitioner settings. 

Concordance of Temperature Measurements in the Preterm and 

Term Neonate Using Three Thermometers 

Jackie Smith 1 , Kim Usher 2 , Gary Alcock 1 and Petra Buettner 3 

1 Neonatal Unit, The Townsville Hospital, Townsville, Queensland 

2 School of Nursing, Midwifery and Nutrition, James Cook University, Townsville, Queensland 

3Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, 


Background / Aims: Measuring temperature is an essential part of nursing 

care. It has been widely accepted as an indication of a patient’s clinical 

condition. Methods: A comparative design was used to evaluate the level of 

agreement between each thermometer in preterm and term infants, ranging 

from 24 weeks gestation to post term. Results: A total of 238 infants 

were enrolled in the study: 52 infants of less than 28 weeks gestation, 112 

of 29 to 36 weeks, 69 infants of more than 36 weeks. In general, BD Digital 

Thermometer and SureTemp ® Plus 692 measurements were in closer 

agreement than the BD Digital Thermometer and the Genius 2 tympanic 

thermometer. The mean difference between the BD Digital Thermometer 

and the SureTemp ® Plus 692 measurements was -0.185 (2SD: -0.561 to 

0.91). The mean difference between the BD Digital Thermometer and 

Genius 2 was -0.368 (2SD: -1.078 to 0.342). The BD Digital Thermometer 

and SureTemp ® plus 692 showed a negative but nonsignificant (r= 

-0.07; p=0.273) correlation between the differences and the averages of 


the measurements. The correlation of the differences and the averages 

of the BD Digital Thermometer and Genius 2 measurements was also 

negative and significant (r= -0.53; p

POSTER ABSTRACTS 


Wednesday, 10 October, 2012 



Recruiting for Lifestyle Modification Programs in the Workplace 

Julie Twomey and Tracy Cheffins 

Townsville-Mackay Medicare Local, Queensland 

Background / Aims: lifestyle modification programs (lmp) to prevent type 

2 diabetes mellitus were funded by the Department of Health and Ageing 

for people aged 40-49 years, on referral from a general practitioner (GP). 

Divisions of General Practice were funded to overcome barriers and improve 

participation in LMP. Methods: Workplaces within the Townsville GP 

Network region were approached to participate in a diabetes risk screening 

program, linked to the LMP in the area. Trained LMP facilitators assessed 

workers individually using the AUSDRISK screening tool. The age restrictions 

were removed, but high risk people were still required to attend a 

GP for referral to the LMP. Workers were shown the evidence for lifestyle 

change, and provided with paperwork to assist the referral process. Factors 

affecting recruitment and completion were explored. Results: Four 

workplaces participated, with 79 workers completing the screening tool 

(age range 18-60 years). Twenty were found to be at high risk and advised 

to see their GP for further assessment and referral to a LMP. Eight chose 

to continue with the referral process and completed the program. Conclusion: 

Results showed increased participation could be gained from: identifying 

a contact person in each workplace to assist worker participation; 

MEDICAL RESEARCH SYMPOSIUM PROGRAM 

Thursday, 11 October, 2012 12:30-4.30 pm (lunch from 12 pm) 


simplification of forms to improve referral procedures; and giving more 

information to potential LMP clients. Removing age restrictions and the requirement 

for a GP referral into the LMP resulted in improved participation. 

Don’t Burn the Baby: Advice from Australian Nurses Recommending 

Therapeutic Sun Exposure During Infancy 

Simone Harrison and Jane Nikles 

Skin Cancer Research Group, School of Public Health and Tropical Medicine, James Cook 

University, Townsville, Queensland 

Background / Aims: To investigate inappropriate nursing advice advocating 

therapeutic sun exposure post-partum and during the first year 

of life. Methods: Questionnaires were completed by 363 nurses (57.2% 

response) responsible for the care of post-partum women in 11 maternity 

hospitals in Queensland (QLD) and the Australian Capital Territory 

(ACT). Results: A high proportion of nurses reported holding risky beliefs 

about the therapeutic benefits of sun exposure, including the treatment 

of: cracked nipples (QLD 41%, ACT 66%), neonatal jaundice (QLD 50%, 

ACT 75%), nappy rash (QLD 23%, ACT 17%) and acne (QLD 12%, ACT 

30%) and made recommendations consistent with their beliefs. Relatively 

few nurses stipulated sunning through glass or specified exposure time 

limits. Approximately 40% of respondents thought people generally looked 

healthier with a suntan, and 79% [95% CI: 74.4% - 82.8%] of these respondents 

also had one or more risky beliefs about therapeutic sun exposure. 

Nursing staff in obstetric and post-natal wards working in public 

hospitals in Queensland were significantly more likely than nursing staff 

in private hospitals in Queensland to have one or more risky beliefs about 

therapeutic sun exposure (p=0.008). However, being born in Queensland 

was borderline (p=0.08) protective against having one or more risky beliefs 

about therapeutic sun exposure. Conclusion: As mothers are likely to intentionally 

expose their babies or themselves to sunlight if advised to do so 

by nursing staff, professional education is needed to change the beliefs and 

practices of those who make such recommendations, which could increase 

children’s future risk of skin cancer. 


12:00 LUNCH 

12:30 Introduction and Overview Associate Professor Lynden Roberts 

12:35 

Factors influencing prescription of anti-Emetic medications in the 

Management of Nausea and Vomiting in the Emergency Department 

Setting 

Dr Joseph England 

12:40 The Increasing Incidence of Gonococcal Arthritis in North Queensland Dr Gemma Robertson 

12:45 

12:50 

12:55 

1:00 

1:15 

can Wideband reflectance be used as an adjunct tool during newborn 

Screening? 

The Equation of Care: The Queuing of Patients with Dementia in an 

Acute Hospital 

Low Birth Weight Term Admissions to a Tertiary Perinatal Centre in 

Northern Queensland: A 10 Year Review 

The Association of Visceral Adiposity with Abdominal Aortic Aneurysm 

Presence and Growth 

Risk Factors for Wound Infection after Minor Surgery in General 

Practice 

Mrs Sreedevi Aithal 

Ms Cheryl White 

Dr Philline Peppermint Tanchi 

Mr Oliver Cronin 

Associate Professor Clare Heal 




1:30 

Efficacy of oral antibiotic prophylaxis at reducing infections Following 

"High Risk" Skin Lesion Excision: A Double-Blind Placebo Controlled 

Trial 

Mr Samuel Smith 

1:45 Keynote Address: A Career Sustained by Scholarships Dr Martin Van Der Weyden 


3:00 

3:05 

3:10 

The Effect of Building a New Emergency Department with Increased Bed 

Capacity on Emergency Department Access Block 

Clinical Audit of Children with Empyema and Parapneumonic Effusion 

Admitted to a Major Referral Centre in North Queensland 

Using the Dutch Resident Educational Climate Test to Assess the 

Learning Climate of Interns at the Townsville Hospital 

Dr Nitin Vaswani 

Dr Vana Sabesan 

Dr Hilary Taylor-Evans 

Associate Professor Ralph Pinnock 

3:15 Cannabis Withdrawal among Indigenous Detainees and Inmates Mrs Bernadette Rogerson 

3:20 

3:35 

3:50 

4:05 

Effect of using Standardised Queensland Statewide Diabetic 

Ketoacidosis Management Protocol 

Long term Outcomes of Autologous Peripheral Blood Stem cell 

Transplantation at The Townsville Hospital 

Hip Fracture Management at a Tertiary Hospital: A Retrospective Study 

Pre- and Post-Establishment of an Orthogeriatric Unit 

Sex and the City: A Community Screen in Response to a Syphilis 

Outbreak in regional Australia 

Dr Ben Tisdell 

Dr Caroline McNamara 

Dr Luke Eggleston 

Dr Tamara Ryan 

4:20 Wrap Up Associate Professor Lynden Roberts 

4:25 




a great many people have contributed to the medical research symposium, and we would specifically like to thank: rhys Edwards, rebecca Evans, 

Jeremy Furyk, Usman Malabu, Lawrence Marshman, Robert Norton, Carl O’Kane, Sarah Larkins, Peter Leggat, Ralph Pinnock, David Plummer, David 

Porter, Juergen Reichardt, John Reilly, Linda Shields, Alex Tan, Andrew White and Richard White. We would also like to thank our Keynote Speaker Dr 

Martin Van Der Weyden. 


Medical Research Symposium 

Thursday, 11 October, 2012 



The Increasing Incidence of Gonococcal Arthritis in North 

Queensland 

Gemma Robertson 1 , Kayley Baxter 2 , Robert Norton 1 , Lynden Roberts 3 , 

Amy Jennison 3 , Helen V. Smith 3 and Brett Heron 3 

1 Pathology Queensland, Townsville, Queensland 

2 The Townsville Hospital, Townsville, Queensland 

3 Department of Rheumatology, The Townsville Hospital, Townsville, Queensland 

4 Forensic and Scientific Services, Coopers Plains, Queensland 

Background / Aims: Gonococcal septic arthritis is an uncommon joint infection 

caused by the gram negative coccus Neisseria gonorrhoeae. From 

2001-2012, the townsville hospital has seen a significant increase in the 

incidence of this illness. We have reviewed the rates of gonococcal arthritis 

both in our catchment area and nationally. The isolates have also been sequenced 

in order to determine the relatedness, if any, between the isolates. 

Methods: The joint aspirates were sent to Brisbane for sequencing using 

NG-MAST. Analysis of the incidence of all gonococcal infections from 2001 

to 2012 in the Townsville catchment area was performed using the extended 

enquiries algorithm in AUSLAB. Rates of infection were compared to 

annual data obtained by the Australian Gonococcal Surveillance Program 

(AGSP). Results: The AGSP reported 12 cases of DGI across Queensland 

in 2010. Ten episodes of gonococcal arthritis were diagnosed from March 

2011-march 2012 in the townsville catchment area, representing a significant 

increase in cases, while the number of positive genital isolates gradually 

rose over the same period of time. Analysis of the gene targets porA 

and tbpB shows that more than 90% of the isolates are unrelated. Conclusion: 

the available data suggests a significant increase in the incidence of 

gonococcal arthritis in Townsville over the past year, in concert with a rise 

in genital gonococcal infection. While the use of PCR for N. gonorrhoeae is 

not yet validated for use on joint aspirates, it is important that clinicians are 

aware of this organism as a cause of septic arthritis. 


31

Can Wideband Reflectance Be Used as an Adjunct Tool During 

Newborn Screening? 

Sreedevi Aithal 1,2 , Joseph Kei 2 , Carlie Driscoll 2 , Asaduzzaman Khan 2 

and Andrew Swanston 3 

1 Audiology Department, The Townsville Hospital, Townsville, Queensland 

2Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University 

of Queensland 

3ENT Department, The Townsville Hospital, Townsville, Queensland 

Background / Aims: The two technologies used in universal newborn 

hearing screening (UNHS) are not sensitive for middle ear function. False 

positive referrals, due to transient middle ear dysfunction, continue to be 

an issue with UNHS. The standard tests of middle ear function used with 

children and adults are not suited for neonates. Hence, the search is on for 

a valid test that can be used along with newborn hearing screening to reduce 

false positives. Wideband reflectance (WBr) is a new technology that 

holds promise as a test of middle ear function. The aims of the study were 

to compare the test performance of wideband reflectance with a battery of 

tests to determine if it is a valid test of middle ear function in infants. Methods: 

A battery of four tests was used as the gold standard to determine 

the middle ear status of 108 neonates (91 passed, 17 failed). A pass in all 

the tests was considered a pass and a fail in all the tests was considered 

a fail. Wideband reflectance was performed immediately following the battery 

of tests. Performance of WBR was compared with the battery of tests. 

Results: reflectance was high for fail condition indicating an inefficient 

conducive pathway. the aroc (0.89-0.91), hit rate (0.88-0.94), efficiency 

index (0.88-0.89) and Negative predictive value (0.98-0.99) were high in 

the mid frequency range (1-2 kHz). Conclusion: WBR test had good performance 

in classifying UNHS test battery outcomes. It has the potential to 

be used as a valid test along with UNHS screening to reduce false positive 

referrals. 

The Equation of Care: The Queuing of Patients with Dementia in 

an Acute Hospital 

Cheryl White, Helen Murray, Desley Joyce and Paul Goldstraw 

Gerontology Services, The Townsville Hospital, Townsville, Queensland 

Background / Aims: Queuing for care in acute public hospitals is a recognised 

phenomenon as patients compete for care. Demand outstrips the 

supply of residential care and aged care packages. An unrecognised factor 

in this equation is the provision of Geriatric Medical and Psychogeriatric 

Services. To explore this, a review of patients waiting for care during a 2 

year development period of services was undertaken. Methods: An audit of 

the Gerontology Service database for 2009-10 and 2011-12 compared the 

number of patients, with and without dementia, queuing for care and the 

time spent waiting. Queuing time (QT) is expressed in days and as a queue 

time patient (Q/P) ratio. Results: The number queuing has reduced from 

216 to 180 p.a. (17%). The dementia cohort increased by 12% with an increased 

QT from 1231 to 2342 days and Q/P ratio from 36 to 47. Whereas, 

the general care cohort reduced by 22%, the QT reduced from 5368 to 

1287 days and Q/P ratio from 29 to 13 ( p30mm) 

and controls were patients with intermittent claudication but no AAA (infrarenal 

aortic diameter

for the year prior to the opening of the new ED (19 July 2010 to 18 July 

2011) and the year after the opening (19 July 2011 to 18 July 2012) was 

retrieved from the emergency departments information system (EDIS). Access 

block was defined according to the australian council on healthcare 

Standards (ACHS) and the Australasian College of Emergency Medicine 

(ACEM) as the percentage of all patients admitted, transferred or dying in 

the ED where their total time exceeds eight hours and compared across 

the two time periods. Secondary comparisons examined performance on 

the recently implemented 4-hour National Emergency Access Target for 

the two time periods. Results: More patients attended the ED during the 

2011/2012 period than during 2010/2011 (N=57,585 vs. N=51,815). There 

was an overall decrease in the proportion of patients experiencing access 

block from 55.1% to 48.8% (p

Admissions prior to 01/01/2010 served as the control group. Groups were 

compared on total dose and duration of iv insulin, total amount of iv fluid, 

average BGL reduction, mean time taken for normalisation of serum bicarbonate, 

length of hospitalisation, incidence of hypokalaemia and incidence 

of hypoglycaemia. Results: 35 admissions (n=35) in the protocol group, 

and 36 admissions (n=36) in the control group were analysed. The protocol 

group had shorter mean time to normalise serum bicarbonate (15.1hr 

for protocol vs. 24.6hr for control, P=0.01), and mean length of hospitalisation 

(37.9hr vs. 49.2hr, P=0.01). Incidence of hypokalaemia (28.6% vs. 

52.8%, P=0.038) and hypoglycaemia (8.6% vs. 28%, P=0.036) was also 

lower in the protocol group compared with the control group. Conclusion: 

Using the standardised Queensland statewide DKA protocol improved several 

clinical outcomes in acute management of DKA. 

Long term Outcomes of Autologous Peripheral Blood Stem Cell 

Transplantation at The Townsville Hospital 

Caroline McNamara 1 , Georgina Hodges 2 , Andrew McCutchan 1 , Joanne 

Kanakis 1 , Edward Morris 1 , Hock Choong Lai 1 and Ian Irving 1 

1Department of Haematology and Bone Marrow Transplantation, The Townsville Hospital, 


2Pathology Queensland, The Royal Brisbane and Women’s Hospital, Herston, Queensland 

Background / Aims: To evaluate the safety and outcomes of autologous peripheral 

blood stem cell transplants (PBSCT) performed at The Townsville 

Hospital. Methods: A retrospective chart review on all patients who have 

undergone an autologous PBSCT at The Townsville Hospital between July 

1998 and June 2012. Overall survival was calculated using Kaplan-Meier 

estimates. Results: two hundred and fifty-one (251) patients have undergone 

271 autologous PBSCT at The Townsville Hospital from July 1998 

until June 2012. Ten year overall survival for acute myeloid leukaemia, 

Hodgkin lymphoma, non Hodgkin lymphoma and multiple myeloma was 

57%, 54%, 50% and 30% respectively. Overall transplant related mortality 

(trm) was 3% (9/270) and in the last five years trm was 1% (1/97). 

specifically in the last two years (July 2010 until June 2012), there have 

been 50 autologous PBSCT in 49 patients with no deaths secondary to 

TRM. Conclusion: The data demonstrates that having designated cancer 

centres acting as regional hubs is a safe and feasible way of delivering 

highly specialised and best practice care to rural and regional residents. 

this approach helps combat deficiencies in cancer services in rural and 

regional Australia. 

Hip Fracture Management at a Tertiary Hospital: A Retrospective 

Study Pre- and Post-establishment of an Orthogeriatric Unit 

Kelly Wright and Luke Eggleston 

Gerontology Services and Orthopaedic Surgery, The Townsville Hospital, Townsville, 

Queensland 

Background / Aims: There has been a worldwide trend to manage hip fractures 

with the input of an orthogeriatric service. This study was undertaken 

to evaluate the impact of the services at The Townsville Hospital, 

Queensland, Australia. Methods: A retrospective audit of patients aged 

over 70 years old admitted to Townsville Tertiary Hospital with a fragility 

hip fracture during June November 2009 (pre- orthogeriatric service[pre]) 

and 2011 (post- orthogeriatric service[post]). Access to discharge summaries, 

pathology and pharmaceutical databases was gained for the audit. 

Results: 127 patients were identified (63 in 2009 and 64 in 2011). Both 

groups had similar demographics. the post group were significantly more 

likely to receive a complete osteoporotic workup (11% vs. 88%, p value 

with any intervention, in order to influence and improve the effective use of 

pathology the law of enthalpy needs to be followed. Energy and resources 

need to be expended in order for positive change to be sustained. Our work 

proves the ongoing success of improvement strategies attained through 

committed clinical teamwork, respect and cooperation. 

Point of Care Testing Field Trial in Mount Isa Using the SD Bioline 

Syphilis 3.0 

Gemma Robertson 1 , Arun Menon 2 , Samantha Hornsby 1 , Glenda Gilmore 

1 , Robert Norton 1 and Karen Thompson 3 

1 Pathology Queensland, Townsville, Queensland 

2 Townsville Sexual Health Services, Townsville, Queensland 

3Pathology Queensland, Mount Isa, Queensland 

Background / Aims: Syphilis is a sexually transmitted illness (STI) caused 

by the spirochaete Treponema pallidum subsp. pallidum. Effective treatment 

relies on intramuscular injection with benzathine penicillin, but there 

are often impediments to appropriate follow-up once the laboratory provides 

a positive diagnosis. Point-of-care testing (PoCT) offers an alternative 

that allows for diagnosis and treatment in a single visit. Methods: A 

field trial was performed using the sd Bioline syphilis 3.0 rapid lateral 

flow assay on 238 patients recruited during the mount isa Youth health 

Screen. The tests were performed on serum obtained on site and then 

repeated in The Townsville Hospital microbiology laboratory. The results 

were compared to enzyme immunoassay (EIA), Treponema pallidum particle 

agglutination (TPPA) and rapid plasma reagin (RPR) performed on the 

same samples. Results: Of 238 specimens, 27 were positive by the gold 

standard of EIA. 22 of the 27 were positive by the SD Bioline rapid test and 

no false positives were recorded. The sensitivity of the test is 81.5%, while 

the specificity is 100%. Conclusion: poct offers a significant advantage 

in the management of syphilis as it allows patients to be diagnosed and 

treated in a single visit. This is especially useful in regional and remote 

areas where access to health care can be problematic and provision of 

laboratory results may be delayed. The low sensitivity of this test currently 

precludes its use as a single diagnostic agent; however, further testing on 

a larger number of positive isolates may improve the results. 

Five Years of Teleoncology in North Queensland: A Sustainable 

Rural Cancer Care Model 

Sabe Sabesan and Abhishek Joshi 

Department of Medical Oncology, Townsville Cancer Centre, The Townsville Hospital, 

Townsville, Queensland and School of Medicine and Dentistry, James Cook University, 


Background / Aims: The Townsville Cancer Centre (TCC) has been delivering 

its medical oncology services closer to home for patients from 19 rural 

centres via teleoncology since 2007. patients are satisfied with this model 

of care. Our aim is to describe the services extended to rural patients and 

the resource improvements enjoyed by rural hospitals as a result of teleoncology 

over this period. Methods: Data for patients treated via teleoncology 

from 1st April 2007 to 31st March 2012 was extracted from the oncology 

information system of TCC. Demographic details and type of services provided 

are presented descriptively. Results: A total of 170 patients were 

seen in 800 consultations over 60 months. Median age was 58y (20-89), 

males 46% and females 54%. 25 patients were from remote indigenous 

communities. Most common cancer types were breast (37%), colorectal 

(21%) and lung (22%). A total of 87 patients receiving chemotherapy in 

Mt Isa and Proserpine were supervised remotely from Townsville via V/C 

with curative intent in 30% and palliative intent in the rest. Examples of 

chemotherapy regimens included TAC, BEP, methotrexate and ifosfamide 

infusion. 26 patients were seen urgently and appropriate treatment initiated 

within 24 hours in Mt Isa, thus avoiding inter hospital transfer. 6 admitted 

patients were seen on regular ward rounds. Severe toxicities included one 

death from pneumonia, one stroke and one resuscitated cardiac arrest. By 

improving the resources in Mt Isa hospital to accommodate these services, 

the numbers of oncology specific medical and allied health practitioners 


and the service capability have improved. Conclusion: The teleoncology 

model can enhance rural service capabilities and health resources so that 

comprehensive medical oncology services can be sustainably provided to 

rural areas by remote supervision. 

Safety of Chemotherapy Delivery under the Townsville Tele-Oncology 

Model 

Bryan Chan 1 and Sabe Sabesan 1,2 

1 Department of Medical Oncology, Townsville Cancer Centre, Townsville, Queensland 


Background / Aims: rural communities face significant challenges getting 

access to oncology care. To overcome this, the Townsville Cancer 

Centre utilises a model of shared care to deliver oncology services to rural 

communities. We assessed the safety of this model at our largest site, the 

Mount Isa Hospital. Methods: A retrospective audit was conducted on all 

referrals to the Mount Isa oncology unit between September 2006 and May 

2012. Patients not receiving chemotherapy or supervised by others were 

excluded. Results: A total of 83 patients received 1076 cycles of chemotherapy. 

Treatment intent was either adjuvant (37%) or palliative (63%). 

The median age was 57 years and 26% were Indigenous. The most common 

malignancies were breast (26%), lung (24%) and colorectal (19%). 

Grade 3 or 4 adverse effects (AE) were recorded in 43 cycles (4%) and 

commonly included: haematological (61%), neuropathic (7%) and gastrointestinal 

(5%). There was one death after completion of gemcitabine for 

metastatic pancreatic cancer. There were 41 hospitalisations (4%), reasons 

included: febrile neutropenia (25%), palliation (22%) and grade 3 or 4 

AE (18%). The median dose intensity achieved for adjuvant treatment was 

100% for breast, 93% for colorectal and 89% for other malignancies. The 

full intended dose was delivered in 87% of cycles. Conclusion: The adverse 

effects and dose intensities achieved was similar to that seen in the literature. 

these findings suggest that the townsville tele-oncology model is a 

safe and effective way to provide oncology services to rural communities. 

Perceived Barriers to Optimal Lung Cancer Care in North 

Queensland: A Qualitative Study 

Shivanshan Pathmanathan 1 , Jillian Mathiesson 2 , Dilanka De Silva 2 

and Sabe Sabesan 1,2 

1 Department of Medical Oncology, Townsville Cancer Centre, Townsville, Queensland 


Background / Aims: The mortality of cancer patients living in rural areas 

is higher. The aim of this study is to evaluate patients’ views on barriers 

to lung cancer diagnosis and management, in particular those of rural 

patients in North Queensland. Methods: As part of a patterns of care lung 

cancer study, patients’ views on barriers were explored in a qualitative 

study using semi-structured interviews lasting up to 30 minutes. Patients 

from urban and rural areas were recruited from Townsville, Cairns, Mackay 

and Mt Isa hospitals after informed consent. Transcripts of the interviews 

were coded and summarised under several themes. rurality was defined 

as per standard guidelines. Results: Of the 250 patients approached, a total 

of 230 patients consented to interviews; 86 from Townsville and Cairns, 

and 144 from rural areas. Main themes relating to patients’ perceived barriers 

included the following: delayed presentations to general practitioners 

or referral to the appropriate specialists, other priorities (work, family), 

delays investigating, financial constraints, lack of social support and environmental 

hazards (floods, cyclones). predominant themes for perceived 

barriers to management in rural patients included financial constraints, difficulty 

travelling to tertiary centres, and responsibilities (work or family). 

In the urban group, main themes included: patient not opting for management, 

other medical conditions delaying management, and responsibilities 

(work). Conclusion: significant modifiable barriers to lung cancer diagnosis 

and management remain in both urban and rural communities. Rural 

cancer patient have additional barriers of financial difficulty and difficulty 

travelling to tertiary centres. New models of care are needed to address 

rural barriers. 


35

A Single Centre Experience of Seven Day Consecutive 5Azacitidine 

(Vidaza) Usage in Patients with Relapsed Acute Myeloid Leukaemia 

(AML) Post an Autologous or Allogeneic Peripheral Blood 

Stem Cell Transplant (PBSCT) 

Caroline McNamara, Ian Irving, Edward Morris, Emily Wenta, Joanne 

Kanakis and Hock Choong Lai 

Department of Haematology and Bone Marrow Transplantation, The Townsville Hospital, 


Background / Aims: Patients with AML who relapse after an autologous 

or allogeneic PBSCT have a dire prognosis. Furthermore, there are no recognisable 

therapies for this group. 5azacitidine is a pyrimidine analogue 

and currently has pharmaceutical Benefits scheme (pBs) approval for 

low blast count (20-30%) AML and high risk myelodysplastic syndrome. 

Our aim is to evaluate the safety, feasibility and outcomes of seven day 

consecutive 5azacitidine usage in patients with relapsed AML post an autologous 

or allogeneic PBSCT. Methods: A retrospective chart review of 

all patients with relapsed AML treated with 5azacitidine at The Townsville 

Hospital (TTH) between March 2009 and June 2012. Overall survival was 

calculated using Kaplan-Meier estimates. Results: 5azacitidine (75 mg/ 

m2/day for 7 days every 28 day cycle sc) was prescribed to five patients 

with relapsed AML post an autologous or allogeneic PBSCT. The median 

age was 51 years (range: 24-61yrs) and 60% (3 patients) were female. 

Three patients received concurrent donor lymphocyte infusion (DLI) and 

one patient received everolimus. Patients received a median of 5 months 

(range: 4-6 months) of therapy with all patients progressing and dying 

of their disease. No patient discontinued 5azacitadine due to toxicity. The 

median overall survival was 145 days. Conclusion: 5azacitadine has shown 

disease stability which is a major advance in the treatment of relapsed AML 

post a transplant. Although the responses are not durable, 5azacitadine 

may provide a bridge to more definitive therapy. 

A Granulin Growth Factor Secreted by the Carcinogenic Liver Fluke, 

Opisthorchis Viverrini, and the Role it Plays in Carcinogenesis 

Michael J. Smout 1 , Thewarach Laha 2 , Jason Mulvenna 1 , Javier Sotillo 

1 and Alex Loukas 1 

1Centre for Biodiscovery and Molecular Development of Therapeutics and the Queensland 

Tropical Health Alliance, James Cook University, Townsville, Queensland 

2Department of Parasitology, Khon Kaen University, Khon Kaen, Thailand 

Background / Aims: the human liver fluke, opisthorchis viverrini, infects 

millions of people throughout South-East-Asia and is a major cause of 

cholangiocarcinoma (bile duct cancer). The mechanisms by which the 

parasite causes cancer are multi-factorial, but one process is the secretion 

of mitogenic parasite proteins into the bile ducts, driving cell hyperproliferation 

and creating a tumorigenic environment. Using proteomics 

we identified the secreted ov-grn-1, a homologue of the human growth 

factor granulin, that likely plays a pivotal role in the development of liver 

cancer in infected people. Previously we demonstrated the potent nanomolar 

growth activity on human bile duct cells. We aim to characterise the 

role of Ov-GRN-1 in human carcinogenesis. Methods: Recombinant bacterial 

expression of Ov-GRN-1 is used to produce protein for wounding and 

other experiments. RNAi is used to suppress parasite expression. Human 

cells labeled with iTRAQ tags are used for proteomic comparisons of treatments. 

Balb/c mice and cell monolayers are used for wounding studies. 

Results: 1) Parasite Ov-GRN-1 expression can be suppressed with RNAi 

and suppressed parasites are being used to investigate host pathenogenicity 

changes. 2) There are striking changes in protein expression evident 

after bile-duct cell exposure to Ov-GRN-1. Remarkably, and in support of 

our hypothesis, many of these upregulated proteins were associated with 

cell growth and cancer, whereas the downregulated proteins were associated 

with tumour/proliferation suppression. 3) Ov-GRN-1 induces wound 

closure. Conclusion: our novel findings improve understanding of hostparasite 

interactions, such as cell proliferation and wound healing, which 

will lead to the development of such a devastating form of cancer. 

Immune biomarkers in depression: an update for clinicians 

Michael Stuart1 , Harris Eyre1,2 , Zoltan Sarnyai3 and Bernhard Baune1,4 1 School of Medicine and Dentistry, James Cook University, Townsville, Queensland 

2 Queensland Health, Townsville, Queensland 

3School of Veterinary and Biomedical Sciences, James Cook University, Townsville, 

Queensland 

4University of Adelaide, Adelaide, South Australia 

Background / Aims: Immune dysfunction is heavily implicated in the pathogenesis 

and pathophysiology of depression. From this knowledge, various 

immune factors such as cytokines and inflammatory proteins have been 

intensively investigated in the last decade as potential biomarkers with limited 

success. More recently aspects of the adaptive immune system have 

also been investigated. progress in the field of neuroimmunology has also 

begun to elucidate the mechanisms by which dysfunction in these systems 

may contribute to the classical neurobiological disturbances associated 

with these. We will review the evidence for the utility of immune biomarkers 

in depression, discuss the mechanisms by which they may contribute 

to this illness, and implications for the development of novel therapeutic 

approaches. Methods: We systematically reviewed the PubMed, Cochrane 

Library, and PsycINFO databases for literature published online. The following 

limits were applied: English, published in last 20 years. Results: 

Data from human biomarker, neuroimaging, genetic and post-mortem 

studies are presented. The majority of literature is concerned with cytokine 

and inflammatory biomarkers, while factors such as immune cells and 

chemokines have been largely neglected. In immunogenetic and serum 

biomarker studies the cytokines TNF-alpha, IL-1beta, and IL-6 are most 

strongly implicated. There is also good evidence from these studies for 

the involvement of other inflammatory proteins including crp. We discuss 

strengths and weaknesses of this data, and highlight areas of opportunity 

for future research. Conclusion: Further research is required to explore the 

role of immune biomarkers in depression diagnosis and treatment. 

Causes of Multiple Sclerosis: A Functional Genomics Approach 

Margaret Jordan1 , Judith Field2 , Grace Foo3 , Laura J. Johnson2 , Louise 

Laverick3 , Melissa Gresle3 , Jac Charlesworth4 , Jim Stankovich5 , 

Helmut Butzkueven *3 and Alan Baxter *1 

1 Comparative Genomics Centre, James Cook University, Townsville, Queensland 

2 The Florey Neuroscience Institutes, Melbourne, Victoria 

3 The Department of Medicine, University of Melbourne, Melbourne, Victoria 

4 The Menzies Research Institute, Hobart, Tasmania 

5 The Walter and Eliza Hall Research Institute, Melbourne, Victoria 

*joint last authors 

Background / Aims: Multiple Sclerosis (MS) is the most common disabling 

neurological disease affecting young adults in Western Society. To 

date, 55 strongly associated single nucleotide polymorphisms have been 

discovered. We now need to identify causal genes. While T cells as targets 

for therapeutic intervention have rarely proven useful, there is strong 

clinical and in vitro data identifying nk cell deficiencies in patients, and 

key roles for monocytes in myelin and axon destruction and autoantigen 

presentation. Methods: RNA extracted from magnetic bead sorted monocytes 

and NK cells, of healthy controls (HC) and untreated patients with 

relapsing remitting MS (RRMS), was labelled and hybridised to Affymetrix 

Human Gene 1.0 ST arrays. Expression values were standardized across 

chips using RMA and quantile normalization as implemented in GenePattern. 

genes were ranked by expression difference significance by mann 

Whitney U test and ANOVA. Results: To date, we have analysed monocytes 

of 30 patients and 39 HC, and NK cells from 25 patients and 32 HC. Expression 

differences of those genes adjacent to MS associated risk SNPs lying 

between 110kb upstream and 40kb downstream of a candidate gene were 

considered. We have identified three genes worthy of further analysis on 

this basis: RGS1, HHEX and THEMIS. Conclusion: To test the relevance of 

these candidates to central nervous system (CNS) autoimmunity, we aim 

to mimic phenotypes associated with these expression quantitative trait 

loci (eQtl) in in vitro cultures of purified nk cells and monocytes, and in 


vivo in a mouse model of MS - experimental autoimmune encephalomyelitis 

(EAE). 

Neurological Melioidosis in The Townsville Hospital from 1995 to 

2011 

Martin Deuble, Chloe Aquilina and Robert Norton 

Department of Microbiology, The Townsville Hospital, Townsville, Queensland 

Background / Aims: We reviewed admissions to the Townsville Hospital 

with confirmed neurological melioidosis from 1995 to 2011. Methods: A 

retrospective chart review was conducted including all patients admitted to 

the Townsville Hospital between 1995 and 2011 that were proven to have 

positive cultures for B. pseudomallei with significant neurological involvement. 

Results: Between 1995 and 2011, there were 13 confirmed cases of 

Neurological Melioidosis presenting to the Townsville Hospital. Of these, 

10 charts were available for review. significant presenting features were 

fever, headache and ataxia. Four patients died during their admission and 

an additional four patients had significant neurological long term sequelae. 

Two patients fully recovered. CSF analysis revealed elevated protein counts 

with pleocytosis and sterile cultures. Conclusion: Neurological Melioidosis 

is uncommon. however, it is important due to its significant mortality 

and morbidity. The clinical presentations of Neurological Melioidosis at the 

Townsville Hospital are largely consistent with those in the Northern Territory. 

Acquired Brain Injury in Children at The Townsville Hospital: One 

Year’s Experience in Paediatric Rehabilitation 

Li Jun Thean, Jessica Ciantar, Rebecca Watson-Brown and Andrew 

White 

Institute of Women’s and Children’s Services, The Townsville Hospital, Townsville, 

Queensland 

Background / Aims: Acquired brain injury in children can lead to long term 

difficulties including impaired motor and sensory function; cognitive effects 

on language, memory, or executive function; and effects on socialisation 

and behaviour. The Townsville Hospital is without resident paediatric 

rehabilitation subspecialists but has a full range of paediatric allied health 

staff and sees a large number of cases. Methods: A retrospective chart 

review was conducted on all children aged 0-16 referred to the paediatric 

rehabilitation team for acquired brain injury between January 2011 and 

January 2012. Data described includes demographics, mechanism of injury, 

severity of injury, treatment received and outcomes of the patients at 

time of discharge or last contact. Results: 31 cases were managed in this 

period. Average age was 10 years (range:11 months - 15 years). There 

were 21 males, 10 females, and 7 indigenous patients including one from 

Papua New Guinea. 15 cases lived locally, 8 live in the health district and 8 

live more distantly. Mechanisms of injury seen: 9 falls, 5 cerebrovascular 

events, 4 pedestrian v car, 3 motor vehicular collisions, 3 motorbike collisions, 

2 pushbike collisions, 3 other blunt trauma, 2 infective and inflammatory 

pathology. 29% required ICU with stay averaging 5 days (range: 

1-18). The average time of inpatient rehabilitation was 15 days (range: 

1-169). 26% received outpatient intensive rehabilitation averaging 71 days 

(range: 13-148). Issues addressed were cognitive, physical, psychological 

and family. Conclusion: Acquired brain injury in children requires a skilled, 

multidisciplinary team. There are unique challenges in a regional centre 

without dedicated funding for the service and limited resources. 

Differentiating Between ADEM and Cerebral Melioidosis: Clinical 

and Radiological Findings, A Case Series 

Anne Miller and Andrew V. White 

Department of Paediatrics, The Townsville Hospital, Townsville, Queensland and James 

Cook University, Townsville, Queensland 

Background / Aims: Melioidosis is a serious infectious disease localised 

to Northern Australia and parts of South East Asia. Cerebral melioidosis 

can present with a number of different neurological signs and symptoms, 

and can be difficult to differentiate from acute disseminated Encephalo- 


myopathy (ADEM), particularly in its early stages. We sought to review 

the clinical and radiological signs of children with both conditions in order 

to determine features of differentiation. Methods: A retrospective audit of 

charts from January 2000 until December 2011 was performed, looking 

at children admitted to the Townsville hospital over this time. Clinical and 

radiological features were collated, described and compared. Results: Ten 

cases of ADEM, three cases of cerebral melioidosis and two uncertain cases 

were identified. six boys versus nine girls were included. three of the 

children with ADEM and one of the children with cerebral melioidosis were 

Indigenous. Five of the ADEM cases and 2 of the melioidosis cases were 

from rural or remote areas. There was one death from melioidosis. There 

were overlaps of clinical symptoms and lab results including cell count 

and protein on CSF. MRI in the melioidosis cases showed more extensive 

involvement, more oedema and ring enhancing lesions. 2 of the melioidosis 

cases occurred in the wet season but one presented in September. 

Conclusion: Cerebral melioidosis and ADEM have a broad range of clinical 

presenting features. In a child presenting with neurological symptoms, 

especially during the wet season in North Queensland, cerebral melioidosis 

should be considered. 

An Audit of Childhood Constipation at The Townsville Hospital 

Angela Clarke, Mark Yates and David Newsom 

Department of Paediatrics, The Townsville Hospital, Townsville, Queensland 

Background / Aims: Our aim was to compare current management of 

childhood constipation with national and international standards. Methods: 

retrospective review of fifty children (8 weeks) in 12%, and alternative diagnosis, 

e.g. bezoar, in 10%. Rates of symptom documentation included: stool 

frequency 72%, diet/fluid intake 67%, stool consistency 56%, pain 35%, 

faecal incontinence 11% and locomotor symptoms 7%. Examination of the 

abdomen was documented in 99%, perianal 35%, PR 14%, neuromuscular 

13%, spine 1%, and gluteal examination in zero. Blood tests were ordered 

for 24%, abdominal x-ray 28% and ultrasound 4%. Twenty one percent 

(21%) were admitted. Treatments included lactulose 26%, macrogols 

19%, parachoc 18%, senna 11%, coloxyl 10% and colon lightly 8%. Enemas 

were used in 28% without sufficient trial of oral medication. Conclusion: 

1. Overuse of PR examination, blood tests, imaging and enemas was 

observed. 2. Treatment with oral macrogols was not routinely practiced. 3. 

An evidenced based guideline and patient handout for childhood constipation 

is suggested. 

Evaluation of a Novel Australian Regional Paediatric Rheumatology 

Service 

Joanna Toscianczuk, Anya Gordon, Janelle Kent, Bianca Coviello, 

Neil Archer and Lynden Roberts 

Department of Rheumatology, The Townsville Hospital, Townsville, Queensland 

Background / Aims: There is a shortage of paediatric rheumatology services 

in Australia, especially in regional and rural locations. Demand for 

such services far exceeds available supply. A new model of care for North 

Queensland paediatric rheumatology services was established in 2010 to 

replace the need for children to travel to capital cities. Methods: Referrals 

to the service were accepted from general practitioners and paediatricians. 

Children were assessed and managed by a musculoskeletal team including 

a paediatric occupational therapist, a paediatric physiotherapist, an adult 

rheumatologist, and a paediatrician at The Townsville Hospital (Kirwan 

Campus). Children were also seen by rheumatologist outreach services 

to Mt Isa and Palm Island. Clinical and administrative data was routinely 


37

collected. A retrospective audit of all patients seen in the service was performed. 

Results: Of the 59 children seen in the service between 2010 and 

June 2012, complete data was available for 36. Of these, 67% had Juvenile 

idiopathic arthritis. other diagnoses included non-inflammatory musculoskeletal 

pain (25%), juvenile SLE (8%), and dermatomyositis (6%). 

Chronic immunosuppressive medication was used in 39% of the cohort, 

and biologics in 11%. Intra-articular corticosteroid injections were given at 

least once in 25% of children. Distance travelled ranged from 2 to 590 km, 

with an average distance of 78km travelled (excluding outreach services 

to Mt. Isa and Palm Island). Conclusion: The model of care described in 

the study provided specialist paediatric rheumatology services using an 

evidence based model of care. Children and families were relieved of the 

burden of travelling to capital cities for care. 

Rescue Therapy in Ulcerative Colitis: A Regional Queensland Experience 

Enoka Gonsalkorala and Enrico Roche 

Department of Gastroenterology, The Townsville Hospital, Townsville, Queensland 

Background / Aims: infliximab is established therapy for steroid refractory 

Crohn’s disease but is not subsidised for treatment of refractory Ulcerative 

Colitis (UC). Cyclosporine is subsidised for treatment of refractory UC. Recent 

data suggests infliximab and cyclosporine may be equally efficacious 

at achieving short term remission and avoidance of urgent colectomy. 

Studies have however shown that more complications are associated with 

cyclosporine compared with infliximab. Experience in regional australian 

centres with these two medications is unknown. We aimed to review the 

demographics, disease severity, type of rescue therapy, complications 

and outcomes of patients with severe UC refractory to steroid therapy. 

Methods: A retrospective chart review was performed of patients with 

UC treated with rescue therapy for refractory disease at The Townsville 

Hospital. Results: seven patients were included in the study. infliximab 

therapy was given at week zero, two and six at 5mg/kg. Cyclosporine therapy 

was administered at 2mg/kg infusion as an inpatient and changed to 

oral therapy at 5mg/kg upon discharge. three patients received infliximab 

alone, one patient received cyclosporine alone and three patients received 

both. to date none of the patients treated with infliximab or cyclosporine 

as monotherapy have required colectomy. Three patients treated with both 

therapies received cyclosporine first followed by infliximab. two subsequently 

proceeded to surgery. One patient had an anaphylactoid reaction 

to cyclosporine leading to immediate cessation of treatment and switch to 

infliximab. Conclusion: In this small group patients who received cyclosporine 

were more likely to need rescue with infliximab. Both patients who 

proceeded to colectomy were initially treated with cyclosporine. The one 

major adverse event was associated with cyclosporine use. 

Preliminary Observations of Hat Wearing in Brisbane Schools 

Simone Harrison and Jane Nikles 

Skin Cancer Research Group School of Public Health and Tropical Medicine, James Cook 

University, Townsville, Queensland 

Background / Aims: Queensland is the Australian state with highest incidence 

of melanoma, however, only 50% of primary schools in Queensland 

are SunSmart. Although the SunSmart program has been very successful 

overall, data on actual implementation of the program are scarce. Though 

no hat no play is commonly found in SunSmart policies, anecdotal evidence 

shows that this guideline could be better implemented. This study 

aims to document the proportions of children and adults at schools observed 

actually wearing hats. Methods: On 6 separate days from April to 

June 2012, 2 trained volunteer observers drove to a convenience sample of 

71 schools in Western Brisbane and conducted observations from the road 

for time periods ranging from 1 to 20 minutes during the following: walking 

into school grounds, before school, late arrivals, morning tea, lunch 

break, PE lesson, outdoor lesson, in the school yard, excursion, and at the 

bus stop. Results: Of the 71 schools, 57.7% were public schools. 94.4% 

were co-educational. 90.1% were primary only and 4.2 % were secondary 

only. 71.5% of children, 33.5% of adults and 15% of siblings were wearing 

hats overall and 71.6%, 45.9% and 20% of siblings were wearing a hat of 

some kind. Conclusion: According to this preliminary data, implementation 

of hat wearing policies in Brisbane schools could be improved. Adult 

role modelling of hat wearing and of using hats on students’ siblings is an 

area where more public health education is needed. Further observational 

studies are needed. 

Impact of the SunSmart Early Childhood Program in Queensland 

Simone Harrison, Vicki Saunders and Jane Nikles 

Skin Cancer Research Group School of Public Health, Tropical Medicine and Rehabilitation 

Sciences, James Cook University, Townsville, Queensland 

Background / Aims: There are few studies of sun protection practices in 

early childhood settings. This study was conducted to provide baseline 

data about the sun-protection knowledge and practices in early childhood 

centres (ECCs) in Queensland 18 months after implementing the SunSmart 

Early Childhood Centre Program, to see whether the program made an 

appreciable difference to reported sun-protection knowledge and practice 

in SunSmart/participating centres compared to non-SunSmart centres. 

Methods: A statewide survey conducted in 2002 explored sun-protection 

knowledge, practices and policy of directors/senior teachers of 1383 early 

childhood services in Queensland (56.5% response). Results: Kindergarten/preschools 

and commercial/private centres had the highest uptake of 

SunSmart status, and an inner regional location was associated with the 

highest proportion of SunSmart status. SunSmart status appears to have 

significantly improved the following: 1. children’s reported overall median 

sun protection practices scores; 2. Children reported hat-wearing and tendency 

to play in the shade more than 80% of the time; 3. Presence of 

rules/guidelines about suitable clothing; 4. Sun-protection mainly taught 

through a combination of formal and informal methods; 5. Early childhood 

service directors/coordinators attendance at in-service training about sunprotection 

in previous 12 months; 6. Percentage of staff who had attended 

a sun-protection in-service; 7. Proportion of ECCs that had developed and 

implemented a current (written) sun-protection policy. Conclusion: The 

beneficial effect was mainly on policy, curriculum and inservice attendance 

rather than sun-protection practices and knowledge. This survey shows 

that further work is required to protect children from future skin cancer. 

Variation in Emergency Department Presentations during a Major 

Sporting Event: The Effect of the State of Origin Broadcasts on Our 

House 

Jeremy Furyk, Jenine Lawlor, Richard Franklin, Carl O’Kane, Colin 

Banks and Peter Aitken 

Queensland Health and James Cook University School of Public Health and Tropical Medicine, 


Background / Aims: This study examines variation in patient presentations 

to the Townsville Hospital Emergency Department (TTH ED) during 

the State of Origin series. Methods: This study was a retrospective 

audit of data on ED presentations obtained from Emergency Department 

Information System (EDIS). The number of presentations during the State 

of Origin game days during the 2005 to 2012 series was compared with 

control days matched for year, seasonality and day of the week. Variations 

in hourly presentation rates before, during and after the game were also 

examined. These comparisons were then examined for sex differences. 

Results: Patients presenting on 24 game days (N=3582) and 80 control 

days (N=12647) were included for analysis. There was an average of 8.84 

fewer patients presenting to ED on game days at 149.25 patients compared 

to 158.09 patients on control days (p=0.035). When the data was examined 

for hourly attendance from 6pm to midnight, presentation averages began 

to diverge significantly from 7:00 pm (p=0.03). the reduction in hourly 

presentations was most marked during State of Origin kick off, from 8:00 

to 9:00 pm (p

for future events. Results also reveal the possibility that the populace of 

Townsville are avid supporters of Origin. 

Effective Triage System in Endocrinology 

Rajeswari Radha Krishnan, Vasanth Shenoy and Kunwarjit Sangla 

Department of Endocrinology, The Townsville Hospital, Townsville, Queensland 

Background / Aims: to assess efficacy and benefits of a unified consultantled 

triage system in private endocrinology and diabetes clinics at TTH in 

2012. Methods: Retrospective review from Hibiscus data of category (cat) 

1 waitlists, referral processing and discharges over 2 months (June–July 

2012) compared to a similar period in 2011. Results: The cat 1 waitlist for 

endocrinology bulk billed private clinics has reduced from 77 to 29 over 

this period compared to an increase from 43 to 79 patients in 2011. The 

wait lists for diabetes bulk billed private clinics has remained stable (54 

to 50) over these two months similar to 2011 with better utilisation of the 

satellite facilities. Of the total cat 1 referrals over 2 months in 2012, just 

over 35% were booked straightaway, being marginally better than the 30% 

in 2011, whilst 65% were waitlisted for future review. 46 of the 248 total 

referrals (23/136 endocrinology, 23/127 diabetes), were either booked for 

investigations prior to clinic appointments or provided with a community 

management strategy to be implemented by GP. Registrars were also 

asked to see interesting cases with an independent, but supervised plan as 

additional walk in bookings. 13% patients were discharged from the service 

in 2011 as compared to 10% patients in 2012. Conclusion: Efficient 

consultant triaging can effectively reduce the clinical wait lists and facilitate 

timely assessment of adequately worked up cases. This system also provides 

feedback and support to the referring GPs for managing waitlisted 

patients and serves to enhance registrar training. 

Severe Hypertriglyceridaemia: A North Queensland Experience 

Moe Thuzar, Connor O’Neill, Vasant Shenoy, Usman Malabu and 

Kunwarjit Sangla 

Department of Endocrinology and Diabetes, The Townsville Hospital, Townsville, Queensland 

Background / Aims: Hypertriglyceridaemia (HTG) is a component of the 

metabolic syndrome and therefore very commonly seen in association with 

type 2 diabetes mellitus. Severe HTG can lead to acute pancreatitis and 

is more likely to be triggered when serum triglyceride (TG) level exceed 

10mmol/L. There is a paucity of clear treatment guidelines for this presentation. 

Methods: We reviewed 5 cases of severe HTG, 4 of whom presented 

with pancreatitis to the Townsville Hospital from 2010-mid 2012. The management 

and clinical course of these cases and available literature will be 

reviewed. Results: All were male, overweight type 2 diabetic patients with 

age range 39-48 years. Four patients were Caucasians and one was a Torres 

Strait Islander (TSI). The serum TG level at time of presentation was 

around 100 mmol/L in all cases. Lipid electrophoresis revealed Frederickson 

type III hyperlipidaemia in 2 cases, type V in 2 cases. The four subjects 

were homozygous for apolipoprotein E3. Family history of hyperlipidaemia 

was negative except in one patient. Patients were managed with variable 

treatment modalities that included a combination of nil per oral (NPO), 

insulin, heparin, and lipid lowering medications. Serum triglyceride level 

in the first 24 hours decreased more rapidly in those patients who were 

managed with NPO and IV insulin compared to those who were not. Treatment 

was uncomplicated in all except one patient who subsequently developed 

a pancreatic pseudocyst. Conclusion: Combination of NPO and IV 

insulin seems to be an important treatment strategy in acute management 

of severe hypertriglyceridaemia. larger studies are needed to confirm our 

finding. 

The Educational Opportunity of a Gerontology Interdisciplinary 

Student Team 

Paul Goldstraw 1,3 , Holger Jansen 3 , Chris Barrett 2 , Kerrie Gilboy 1 , Riri 

Santoso 1 , Sharee NanTie 2 and Karen Rowan 2 

1 Gerontology Services, The Townsville Hospital, Townsville, Queensland 

2 Social Work Department, The Townsville Hospital, Townsville, Queensland 



Background / Aims: The population is ageing yet not all health disciplines 

include gerontology principles in their curricula. Moreover, interdisciplinary 

team work is core function of health services for older people yet 

team skills are acquired after graduation. A Gerontology interdisciplinary 

student team (GIST) experience could provide a positive learning by responsibility 

opportunity for gerontic education and team skills. A review 

of the literature failed to produce reports on the training in these skills in 

a single programme. A pilot programme was undertaken to evaluate the 

logistics and the learning experience of a student interdisciplinary team 

mirror managing patients of the TTH Gerontology Services. Methods: A 

volunteer interdisciplinary student team was formed from the JCU Schools 

of Medicine, Physiotherapy, Occupational Therapy and Social Work. Mock 

records were kept and team meetings were managed after initial facilitation 

by the team. At the end of 4 days the treating and student teams met to 

discuss treatment, variances and expected outcomes. Attitudes towards 

older people and professional/educational outcomes of the project were 

recorded before and after. Results: logistics proved difficult with differing 

rotation times and durations. The mean Team-SkillScale-Score increased 

by 18.6% while the student with the lowest initial score increased by 

61.5%. Attitudes-Towards-Health-Care-Teams-Scores as well as Geriatric- 

Attitudes-Scale-Scores remained high over the course of the project with 

one student increasing in the Geriatric-Attitudes-Scale-Score by 17%. Conclusion: 

The potential advantages of a GIST learning option outweigh the 

logistical problems. A more formal study to evaluate the concept in greater 

depth is proposed. 

The Prevalence of Geriatric Functional Syndromes in Older People 

Admitted to an Acute North Queensland Hospital 

Paul Goldstraw and Apurva Shanker 

Geriatric Medicine, Townsville Clinical School, James Cook University, Townsville, 

Queensland 

Background / Aims: The Geriatric Functional Syndromes (GFS) are symptom 

complexes associated with decrease in function that affect many older 

people. Irrespective of aetiology, GFS are associated with a poor outcome 

and increased lengths of stay (LOS). Geriatric Evaluation and Management 

(GEM) may alter this outcome. This audit was undertaken as part of establishing 

a GEM service at TTH to understand service demand and GFS 

profile of potential patients. Methods: A chart review was undertaken during 

3 separate weeks in February, March and August 2012, to evaluate the 

number of patients aged over 75 yrs admitted to the medical wards, the 

los and gFs profile. gFs are defined as more than 3 falls per year, incontinence, 

Mini Mental State Exam < 23/30, delirium, assistance for activities 

of daily living (As-ADL) and to walk 3 metres (As-Walk); carer stress; 

more 5 drugs. Results: The > 75 years cohort (n=119) represented 36% 

of the medical ward patients and the majority (90%) had a GFS. The most 

prevalent GFS were >5drugs (83%), As-ADL (50%), carer stress (43%) 

and As-Walk (25%). The cohort mean LOS was 55 days, with no difference 

between the presence or number of GFS. Only 28% returned home 

compared to 70% if no GFS. Conclusion: GFS were common in the older 

patients. There was no correlation with LOS but they were long. The longer 

LOS were associated with falls. Home was less likely if GFS were present. 

The GEM service could target by age, length of stay presence of GFS. 

Fractional Flow Reserve: Do Patients Need to Stay Overnight? 

Navin P. Sinhal, Raibhan R. Yadav, Sugeet Baveja and Ryan G. 

Schrale 

Department of Cardiology, The Townsville Hospital, Townsville, Queensland 

Background / Aims: measurement of fractional flow reserve (FFr) to guide 

percutaneous coronary intervention has demonstrated improved safety 

and efficacy. there are no guidelines for optimal timing of discharge. our 

current practice is admission overnight for monitoring. Methods: We retrospectively 

reviewed the medical records for patients who underwent FFR 

at the townsville hospital from august 2009 to June 2012. We specifi- 


39

cally evaluated patients with FFR >0.8, i.e. functionally non-obstructive stenosis, 

potentially suitable for same-day discharge. Results: 117 patients 

underwent a FFR examination in the study period, of which 76 (65%) had 

FFR > 0.8. Of these 76, 61% were male, 26% diabetic and 39% smokers, 

47% had previous PCI and 8% prior CABG. 37% underwent FFR as an 

overnight-stay procedure, with the remainder being hospital inpatients. 9% 

were discharged on the same day due to operator preference. 9% underwent 

procedure via radial approach. There were no deaths or myocardial 

infarction within 1 month. 52 patients had troponin measured post-procedure, 

of which 18 were elevated, troponin >0.04µg/L (range 0.05-0.7, 


The Townsville Health Research Week 2012 Symposium Edition 

AWARD 

Lions Medical Research Foundation Professor 

Ian Frazer Humanitarian Award 

Professor Rick Speare 

The Lions Medical Research Foundation is a community 

based, not for profit organization dedicated 

to long term medical research funding to successfully 

improve the standard of health for all Australians 

and people throughout the world. The Lions 

Medical Research Foundation is committed to 

raising funds for medical research to improve the 

quality of life for present and future generations. 

The Foundation has a 48 year history in providing 

seed funding to early career medical researchers. The Foundation is supported 

by the Lions community and the greater community in general. The 

Award is named after Professor Ian Frazer in recognition of his research 

into Cervical Cancer over many years and assistance to the Lions Medical 

Research Foundation. The Award may be given for outstanding humanitarian 

services to the community or support of medical research. Membership of 

Lions Clubs International is not a prerequisite. 

The recipient of the Northern Suburbs Lions Club Professor Ian Frazer 

Humanitarian Award, presented in conjunction with the Townsville Health 

Research Week is Professor Rick Speare. Rick is well known and highly 

regarded in the medical, veterinary, university, hospital, public health and 

general community and is currently Professor of Public health and Tropical 

Medicine at James Cook University. He is also Director, Tropical Health 

Solutions Pty Ltd. 

median 0.085µg/l). only five had a confirmed “new” rise in troponin, as 

in total 60 patients did not have pre-procedure troponins measured. No 

patient reported chest pain or recorded ECG changes. No patient required 

further coronary intervention during index hospital procedure. One patient 

had groin haematoma, 2 had a vasovagal event requiring fluid resuscitation. 

Conclusion: FFR is relatively a safe procedure but the rate of positive 

troponins seen was surprisingly high. Possible causes include pre-existing 

unsuspected troponin elevation, lab false positive assay, or peri-procedural 

myocardial injury. This requires further study. 

We would like to formally acknowledge all members of the 2012 Organising Committee who kindly assisted in making this Townsville Health Research 

Week possible: Robyn Adams, Daryl Brennan, Rebecca Evans, Elizabeth LaMont, Jenine Lawlor, Sarah Larkins, David Lindsay, Tilley Pain, Belinda Parisi, 

David Plummer, Bronia Renison, Lynden Roberts, Daphne Rodgers, Shantae Ryle, Linda Shields, and Wendy Smyth. This symposium edition of the 

Annals of the Australasian College of Tropical Medicine was compiled and edited by Dr Elizabeth G. LaMont from James Cook University and Professor 

Derek R. Smith from the University of Newcastle. 

Friday, 12 October, 2012 


Rick was awarded a Bachelor of Veterinary Science with 1st Class Honours in 

1970 and Medical Bachelor and Bachelor of Surgery with 1st Class Honours 

in 1975. His PhD dissertation “Studies on the taxonomy of Strongyloides 

(Nematoda: Strongyloididae)” was awarded at the Graduate School of Tropical 

Veterinary Science James Cook University on 23 May, 1987. Among his 

many achievements, he has made major contributions to research in the 

control of lymphatic filariasis, intestinal parasites, scabies and head lice and 

more recently he has worked on using hookworm as therapy for autoimmune 

disease and in emerging infectious diseases, particularly those emerging 

in wildlife. He led the team which has been internationally recognised for 

the identification of factors causing the global decline in frog populations. 

Rick has conducted applied research for 34 years in both human and veterinary 

fields with a particular focus on control of communicable diseases. his 

described his aim with research as being to improve the health of humans 

and animals by undertaking relevant research and ensuring that the message 

is delivered clearly to the target audience. He has particularly aimed to 

generate new evidence to assist in making better decisions to improve the 

health of human and animal populations in the tropics. He has done research 

in Australia, Papua New Guinea, Solomon Islands, Tuvalu, New Zealand, Malawi, 

and South Africa. 




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 2012 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. 



41 i



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