Dubbo Hospital

IntroductionWorkplace-based research training contributes to research capability and capacity in rural areas where access to university expertise is limited. Rural health complexities and the diverse approaches previously used to build research capacity have led to a lack of clarity about how to build research capacity within rural health services.MethodsUsing a critical realist foundation, we explored distributed workplace-based rural research training and synthesized five studies centered in rural New South Wales, Australia. Critical realism allowed the exploration of the structural supports and barriers for workplace-based research training activities and the ability of individuals to pursue research activities within rural health workplaces.ResultsThe component studies showed that distributed rural research training programs improve individual research capability by developing research skill, increasing research experience and facilitating research networks across sectors. Rural research activities are characterized by individual agency and partnering or relationships to access support and expertise. Structural barriers including a lack of operational planning for research and few ongoing research opportunities limit translation of capability into research capacity.DiscussionIndividual workplace-based research training is effective, but not sufficient to build and maintain research capacity. Structural supports such as organizational commitment and careful training design can maximize cooperative partnerships with education partners. Addressing both structural and individual factors is needed to build rural health research capacity and generate real-world health research to drive meaningful improvements in rural health.

The use of artificial intelligence (AI) and machine learning (ML) is increasingly widespread in radiation oncology. However, patient engagement to date has been poor. Respect for persons in the healthcare setting and the principle of informed consent requires recognition of patient perspectives. The aim of this study was to provide a baseline understanding of patient views about the use of AI/ML in the specific context of radiotherapy to contribute towards future governance of the technology. We developed a new questionnaire regarding AI/ML use in radiotherapy. Radiation oncology patients were surveyed from June to October 2024 at two public hospitals in Australia. Questions were on a five-point Likert scale and grouped into six topics. A free text item allowed participants to comment further. We analysed 474 completed questionnaires (474/811, 58 % completion rate). Most participants supported using AI/ML to help physicians with radiation oncology specific tasks (Median Score (MS) 4.3) and held positive views on the general benefits of AI/ML (MS 4.0). Patients also strongly expressed a preference to be aware and informed (MS 2.2). Significant uncertainty remained about whether AI/ML use would enable retention of the human touch and equity in care (MS 3.1). This is the largest questionnaire study to date of radiation oncology patients' perceptions of AI/ML, establishing a clear baseline. These results can inform future governance around AI/ML in radiotherapy. Actionable steps include informing patients of AI/ML use in their care and engaging physicians during development and regulation of the technology.

Amyloidosis is a rare disease involving the deposition of organised insoluble proteins in various body viscera, with the disease further classified into different subtypes. In exceedingly rare cases the literature has reported the presence of amyloid deposition in the gallbladder. We described the first documented case of wild-type transthyretin systemic amyloidosis involving the gallbladder, occurring in a 91-year-old female who presented with acute cholecystitis.

The relative electron density (RED) parameter is ubiquitous throughout radiotherapy for clinical dosimetry and treatment planning purposes as it provides a more accurate description of the relevant radiological properties over mass density alone. RED is in practice determined indirectly from calibrated CT Hounsfield Units (HU). While CT images provide useful 3D information, the spectral differences between CT and clinical LINAC beams may impact the validity of the CT-ED calibration, especially in the context of novel tissue-mimicking materials where deviations from biologically typical atomic number to atomic weight ratios 〈Z/A〉 occur and/or high-Z materials are present. A theoretical basis for determining material properties directly in a clinical beam spectrum via an electron-density equivalent pathlength (eEPL) method has been previously established. An experimental implementation of this approach is introduced whereby material-specific measured percentage depth dose curves (PDDs) are regressed to a PDD measured in a reference material (water), providing an inference of 〈Z/A〉, which when combined with the physical density provides a determination of RED. This method is validated over a range of tissue-mimicking materials and compared against the standard CT output, as well as compositional information obtained from the manufacturer's specifications. The measured PDD regression method shows consistent results against both manufacturer-provided and CT-derived values between 0.9 and 1.15 RED. Outside of this soft-tissue range a trend was observed whereby the 〈Z/A〉 determined becomes unrealistic indicating the method is no longer reporting RED alone and the assumptions around the eEPL model are constrained. Within the soft-tissue RED range of validity, the regression method provides a practical and robust characterisation for unknown materials in the clinical setting and may be used to improve on the CT derived RED where high Z material components are suspected.

Socioeconomic status and distance from hospital have been shown to be associated with poor surgical outcomes related to acute appendicitis. Indigenous populations experience greater socioeconomic disadvantages and poorer healthcare access than their non-Indigenous counterparts. This study aims to determine whether socioeconomic status and road distance from hospital are predictors of perforated appendicitis. It will also compare surgical outcomes of appendicitis between Indigenous and non-Indigenous populations. We performed a 5-year retrospective study of all patients who underwent appendicectomy for acute appendicitis at a large rural referral centre. Patients were identified using the hospital database for theatre events coded as appendicectomy. Regression modelling was used to determine if socioeconomic status and road distance from hospital were associated with perforated appendicitis. The outcomes of appendicitis between Indigenous and non-Indigenous populations were compared. Seven hundred and twenty-two patients were included in this study. The rate of perforated appendicitis was not significantly impacted by socioeconomic status (OR 0.993, 95% CI 0.98-1.006, P= 0.316) or road distance from hospital (OR=0.911, 95% CI 0.999-1.001, P= 0.911). Indigenous patients did not have a significantly higher rate of perforation compared to non-Indigenous patients (P= 0.849) despite having overall lower socioeconomic status (P= 0.005) and longer road distance from hospital (P= 0.025). Lower socioeconomic status and longer road distance from hospital were not associated with an increased risk of perforated appendicitis. Indigenous populations have poorer socioeconomic status and longer road distance to hospital but did not have higher rates of perforated appendicitis.

This paper describes the investments made, approaches taken and lessons learnt by three rural Australian academic health departments engaged in the delivery of the Health Career Academy Program (HCAP). The program seeks to address the under-representation of rural, remote and Aboriginal populations within Australia's health workforce. Significant resources are directed towards rural practice exposure for metropolitan health students to address workforce shortages. Fewer resources are directed towards health career strategies that focus on the earlier engagement of rural, remote and Aboriginal secondary school students, those in Years 7-10. Best practice career development principles highlight the importance of earlier engagement in the promotion of health career aspirations and in influencing secondary school student career intentions and uptake of health professions. This paper describes: delivery contexts; the theory and evidence that has informed the HCAP; program design, adaptability and scalability; program focus on priming the rural health career pipeline; program alignment to best practice career development principles; enablers and barriers confronted in program delivery, and lessons learnt to inform rural health workforce policy and resourcing. There is a need to invest in programs that seek to attract rural, remote and Aboriginal secondary school students to health professions if Australia is to develop a sustainable rural health workforce. A failure to invest earlier undermines opportunities to engage diverse and aspiring youth in Australia's health workforce. Program contributions, approaches and lessons learnt can inform the work of other agencies seeking to include these populations in health career initiatives.

3102 Background: Senaparib (or IMP4297) is a PARP inhibitor with a novel chemical structure. Preliminary data demonstrate senaparib has significant anti-tumor activity with good tolerability in some patients with advanced solid tumors. DNA damage caused by temozolomide, a non-classic oral alkylating agent, can sensitize tumors to the effects of PARP inhibitors. In a xenograft model, synergistic antitumor effect was observed with the combination of senaparib and temozolomide, supporting this trial (NCT04434482). Methods: This is a phase Ⅰb/Ⅱ dose-escalation and dose-expansion study. Patients with advanced solid tumors were enrolled for dose escalation to evaluate the safety, tolerability using a modified “3+3” design. Low dose temozolomide (20 to 30 mg, once daily, days 1 to 21) in combination with continuous senaparib (40 to 80 mg, once daily, days 1 to 28) of each 28-day cycle was evaluated. Dose expansion will establish anti-tumor activity and safety of the combination in patients with extensive stage small cell lung cancer (ES-SCLC). Results: A total of 14 patients were enrolled for dose escalation as follows: Cohort 1 (1 patient; senaparib 40 mg plus temozolomide 20 mg), Cohort 2 (3 patients; senaparib 60 mg plus temozolomide 20 mg), Cohort 3 (7 patients; senaparib 80 mg plus temozolomide 20 mg), Cohort 4 (3 patients; senaparib 80 mg plus temozolomide 30 mg). One DLT (Grade 4 thrombocytopenia) was observed in Cohorts 3 and 4. The MTD and RP2D were determined as: senaparib 80 mg plus temozolomide 20 mg. Anaemia, neutropenia and thrombocytopenia were the only Grade ≥3 TEAEs occurring in > 1 patient. All AEs were manageable, and no treatment related deaths were reported. The ORR was observed in 3 of 12 (25.0%) evaluable patients, including 2 confirmed PR and 1 unconfirmed PR. The DCR was 83.3% (10 of 12 evaluable patients). Two patients remain on treatment for more than 1 year. Conclusions: Preliminary results suggest that low dose temozolomide (D1-21 of a 28-day cycle) in combination with continuous senaparib is generally well tolerated with encouraging anti-tumor activity. Recruitment for dose expansion for ES-ECLC patients has commenced (Sep 2021). Clinical trial information: NCT04434482.