Stabilisation and Referral Areas (SARA) are a unique model of Short Stay Psychiatry inpatient care. This protocol details the comprehensive evaluation of a new SARA service within the Royal Darwin Hospital located in remote and regional Australia. Located in the Northern Territory (NT) there are just 17 specialised mental health beds per 100,000 compared to the national average of 27 per 100,000. There have been no previous evaluations of SARA services in regional and remote Australian settings, therefore their acceptability and potential effects on consumer outcomes in these unique settings is unknown. This study protocol attempts to address this knowledge gap.A mixed method study with triangulation and including mirror methodology.A service evaluation protocol is proposed to be conducted over an initial 12 months period with a mirror image component to enable comparison of consumer outcomes prior to the service inception. The service evaluation is guided by the "Reach, Effectiveness, Adoption, Implementation and Maintenance" (RE-AIM) framework and utilized both qualitative and quantitative measures to comprehensively describe the service.Results will include both qualitative and quantitative data using the "R", "E" and "A" component (Reach, Effectiveness and Adoption) of the RE-AIM framework.Emergency departments (EDs) are not well suited to persons experiencing mental health crisis and efforts need to be made to improve the delivery of service as well as patient flow. Minimizing wait times in ED is paramount. SARA is an innovative model of care that may address some of these issues. Evaluating its performance across a range of measures is key to improving and progressing the service. The unique context of the service location which has a large First Nations population and its remote setting adds further weight to the need to understand this model within this geographical context.

The ability to provide culturally safe care is a core expectation of graduates from medical schools in Australia. Yet medical schools often struggle to meet this requirement. Recognising the need for curriculum redesign, this project created, delivered, and evaluated a program on providing culturally safe healthcare to First Nations peoples in the Northern Territory. The program was delivered to medical students enrolled in the Flinders University Northern Territory Medical Program over 9 weeks in 2022. To create the program, education theories including community of practice, constructivist principles, and transformative learning were drawn upon. The program also drew on training designed specifically for Northern Territory health staff, which used the podcast "Ask the Specialist: Larrakia, Tiwi and Yolngu stories to inspire better healthcare" to promote critical reflection on racism in healthcare. To evaluate the program, 177 surveys were collected weekly from students and seven students consented to pre- and post-program interviews. Written informed consent was obtained from these participants. Inductive narrative analysis, guided by critical theory and First Nations knowledges, was applied to data. Kirkpatrick's training evaluation model provided a framework to present results. On average, 81% of participants agreed or strongly agreed the program was valuable. Participants learnt to critically reflect on power dynamics and racism in healthcare and learnt skills regarding rapport building, communication and patient-centred care. The pilot demonstrated a successful framework for cultural safety education within medical school curricula which has potential for further adaptation and implementation.

As children hospitalised with community-acquired pneumonia (CAP) are at risk of persistent chest radiograph (CXR) abnormalities and respiratory sequelae, we investigated factors associated with incomplete CXR resolution at 4 weeks and 12 months post-discharge in children from populations at high-risk of chronic lung disease.Secondary analysis-multicentre, placebo-controlled, randomised controlled trial.324 children aged 3 months to ≤5 years hospitalised with radiographic-confirmed CAP were enrolled from seven hospitals in Australia, New Zealand and Malaysia. After 1-3 days of intravenous antibiotics, then 3 days of oral amoxicillin-clavulanate, they were randomised to extended (13-14 days) or standard (5-6 days) courses of antibiotics.CXRs were performed at admission, 4 weeks, and 12 months post-discharge and reviewed in a blinded manner.Radiographic changes of pneumonia at 4 weeks and 12 months post-discharge compared with admission CXRs.Among children with interpretable CXRs, incomplete resolution was seen in 42/253 (17%) at 4 weeks, and 29/212 (14%) at 12 months. Characteristics at admission associated with incomplete CXR resolution at 4 weeks were previous pneumonia hospitalisation (adjusted odds ratio [OR])=6.46, 95% confidence interval [CI] 2.21 to 18.85) and increasing age (OR=0.60 per-year, 95% CI 0.38 to 0.94). Continuing respiratory symptoms/signs at 4 weeks post-discharge was also associated with incomplete resolution (OR=5.63, 95% CI 2.38 to 13.32). At 12 months, previous pneumonia hospitalisation was associated with persistent incomplete CXR resolution (OR=4.03, 95 % CI 1.25 to 13.02).In high-risk settings, younger age, those with previous pneumonia hospitalisation, or ongoing respiratory symptoms/signs 4 weeks post-discharge from hospitalised CAP may be associated with incomplete CXR resolution. Consequently, follow-up imaging and monitoring may be warranted in these children.

This report represents a review of cryptococcosis in the Northern Territory from 1957 to 1975. There were 26 cases over a 19-year period; 25 of these were in full-blooded Aborigines. The disease occurred throughout the rural areas of the Territory as isolated cases. There were 24 cases of cryptococcal meningitis and only two with solitary lung involvement. The overall mortality was 50%. In all five untreated cases the disease was fatal. There were eight deaths among the 20 patients receiving chemotherapy, a mortality of 40%. Lung resection was performed in six cases of localized pulmonary cryptococcosis. The outcome for these was excellent.

PS5 Standard for Pharmacy Based Immunisation Programs

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