Objective: The objective of this study is to determine if there are differences in outcome for patients diagnosed with multiple myeloma in a rural setting compared to a metropolitan setting and which factors influence these outcomes.
Design: Retrospective cohort study.
Setting: Illawarra Shoalhaven Local Health District.
Participants: A total of 391 patients diagnosed with multiple myeloma between 2000 and 2022.
Main outcome measures: Treatment and survival outcomes of these patients.
Results: Patients being treated in a rural cancer care centre had lower overall survival compared to those treated at a metropolitan cancer care centre (median OS = 44.4 months vs. 80.2 months, p = 0.002), despite access to similar treatments by the same group of haematologists. There was a significantly higher rate of upfront autologous transplantation (38% vs. 20%, p = 0.001) and higher rate of inclusion in clinical trials (16% vs. 7%, p = 0.021) in patients treated at a metropolitan cancer care centre compared to the rural cancer care centre.
Conclusions: Multiple myeloma patients treated at a rural centre had shorter survival compared to patients treated at a metropolitan centre, and this may be related to lower rates of autologous transplantation and inclusion in clinical trials.
Introduction: Indigenous children may be at higher risk of being misdiagnosed with speech-language difficulties due to Eurocentric practices in health care and education. The use of conventional speech pathology assessment practices contributes to inappropriate disorder identification, further stigmatising a vulnerable population. Few resources are available for speech pathologists, which examine the cultural and linguistic relevance of assessments for this population.
Objective: To provide important features for speech pathologists to account for when building assessment plans for Indigenous children.
Design: This comprehensive scoping literature review was completed using the Arksey and O'Malley 6-step methodological framework, including the optional consultation exercise, and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. To be included, studies needed to have been published since 2000, discuss speech-language assessments and involve a significant proportion of Indigenous participants under 7 years old.
Findings: Three features were extracted from 32 studies that discussed First Nations, Métis, Inuit, Native American, Aboriginal and Torres Strait Islander communities: using a battery of resources including alternative approaches, ensuring authenticity and cultural relevance, and considering a child's linguistic characteristics.
Conclusion: While there remains a need to adapt according to a specific child's reality, this study provides a guideline for all allied health clinicians when they are building their culturally and linguistically relevant assessment plans.
The predicted rise in weather-related disasters indicates that many Australian children and their families will be affected by these events in the future. Play therapy, an emerging profession in Australia, may provide valuable support to children exposed to these events.
A scoping review was designed to map the existing literature and the role of the play therapist in supporting children (aged 3–12 years) and families following natural disasters, and to formulate a model to guide play therapists in the future.
A systematic search of the literature was performed and a total of 25 articles were identified as relevant to the role of the play therapist in response to natural disasters.
Play therapists must be mindful of the different phases of natural disaster response and how their role may vary across these phases. In the early stages post-disaster, a play therapist may be involved in psychoeducation, facilitating therapeutic play and community involvement. More formal clinical play therapy interventions that focus on the individual child or family are better suited to the latter stages of disaster response. There is a need for further research into the impact of natural disasters on children and families and interventions that aid mental health and well-being, especially for children who may be more vulnerable and potentially overlooked in the wake of such disasters. Further research is also needed into the effectiveness of play therapy as a post-disaster intervention for children.
Objective: To identify barriers and facilitators contributing to the successful implementation of the allied health assistant role in private disability practice to better meet population needs.
Design: A qualitative case study.
Setting: This study was completed with staff working in private disability practices in a regional context in the Northern Territory.
Participants: Eight participants were interviewed, including three allied health assistants, three allied health professionals, and two managers with allied health backgrounds.
Results: More barriers were reported than facilitators, with four key themes identified. Financial risk was a barrier when employing allied health assistants. This risk was mediated by providing part-time employment or having allied health assistants in dual roles. Reduced confidence from allied health professionals and assistants to complete delegation work was the second barrier. A facilitator was increasing allied health assistants' task variation, which participants reported increased retention. Finally, a positive working relationship between allied health professionals and assistants facilitates delegation.
Conclusion: This research offers private disability providers insight into the realities of employing an allied health assistant. It also suggests that formal training programs for both allied health assistants and professionals require increased focus on delegation in the private disability sector. On a government level, a review of the NDIS price guide for allied health assistant rates is needed if private providers are to better meet the requirements for NDIS participants in regional areas.
To explore the impact of COVID-19 pandemic disruptions on general practice trainees interdependent learning, from the perspectives of trainees and the whole of the practice team.
Four rural general practices in Queensland that continued to supervise registrars, junior doctors and medical students through the pandemic.
Twenty-three members of the general practice teams, including general practitioners, practice managers, receptionists, practice nurses, registrars, junior doctors and medical students.
Audio-recorded semi-structured interviews were conducted with all participants following an initial survey. Thematic analysis and the theory of interdependent learning were used to understand how supervision and training was both disrupted and sustained during the pandemic period. Reporting is informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.
Learning affordances were transformed by the rapid implementation of physical distancing and other infection control measures. Telehealth consultations and remote working impacted on the interdependent relationship between the work environment, supervision team and trainees.
Practice staff identified new ways of working that arose through this period, including changes to practice team roles and the supervisory dynamic that enabled patient care and trainee learning to continue. Social connectedness was important to the trainees and the implications for future training need to be further evaluated.
Introduction: Western Australia (WA) spans a large, sparsely-populated area of Australia, presenting a challenge for the provision of Emergency Medical Service (EMS), particularly for time-critical emergencies such as out-of-hospital cardiac arrest (OHCA).
Objective: To assess the impact of rurality on the epidemiology, incidence and survival of OHCA in WA.
Methods: We conducted a retrospective cohort study of EMS-attended OHCA in WA from 2015 to 2022. Incidence was calculated on all OHCAs, but the study cohort for the multivariable regression analysis of rurality on survival outcomes consisted of OHCAs of medical aetiology with EMS resuscitation attempted. Rurality was categorised into four categories, derived from the Australian Standard Geographic Classification - Remoteness Areas.
Results: The age-standardised incidence of EMS-attended OHCA per 100 000 population increased with increasing remoteness: Major Cities = 104.9, Inner Regional = 123.3, Outer Regional = 138.0 and Remote = 103.9. Compared to Major Cities, the adjusted odds for return of spontaneous circulation (ROSC) at hospital were lower in Inner Regional (aOR = 0.71, 95%CI 0.53-0.95), Outer Regional (aOR = 0.62, 95%CI 0.45-0.86) and Remote areas (aOR = 0.52, 95%CI 0.35-0.77) but there was no statistically significant difference for 30-day survival. Relative to Major Cities, Regional and Remote areas had longer response times, shorter transport-to-hospital times, and higher rates of bystander CPR and automated external defibrillator use.
Conclusions: Out-of-hospital cardiac arrest in rural areas had lower odds of ROSC at hospital compared to metropolitan areas, despite adjustment for known prognostic covariates. Despite WA's highly sparse regional population, these differences in ROSC are consistent with those reported in other international studies.
Identify barriers and enablers for remote Tasmanians participating in bowel cancer screening through the National Bowel Cancer Screening Program.
A small remote Tasmanian community.
Tasmanian remote community members aged 50 years and over.
A qualitative study conducted 16 semi-structured interviews. Two researchers conducted in-person and telephone interviews. Questions were directed by an interview guide developed using the Theoretical Domains Framework for behaviour change and Behaviour Change Wheel. Two researchers analysed data using directed content analysis with a flexible inductive approach.
Four themes related to barriers and enablers to completing the National Bowel Cancer Screening Program screening kit in remote Tasmania. Themes included the subject of screening, physical screening kit, the process and outcome of the kit. Several barrier and enabler sub-themes overlapped or were linked, as many enablers mitigated barriers. For example, social influences, awareness level, steps in completing screening, and planning and timing to screen. Social support and discussing screening with others were key enablers, whereas lack of these were barriers. For remote communities, taking the kit to the post office was a barrier from often knowing the post officer. A bowel bus providing screening and information support services may reduce the travel burden of follow-up diagnostic tests and support low-literacy individuals to screen.
Barriers and enablers exist within each stage of the screening process, from what influences an individual decision to screen, through to the outcome. To improve screening rates in rural/remote Tasmania, barriers and enablers to screening must be considered.
Objective: Globally, most doctors train and work in metropolitan areas but a key strategy for developing the rural health workforce is expanding rural training. The aim of this study was to describe the scope and quality of learning along with skill acquisition of GP trainees based in regional, rural, and remote settings.
Setting: Regional, rural and remote settings in Queensland Australia excluding Brisbane.
Participants: Thirty-seven general practice trainees who had undertaken their first community placement were recruited from regional, rural and remote learning settings within Queensland.
Design: Qualitative descriptive methodology based on constructionist epistemology was employed which allowed for the exploration of current GP trainees' experiences. Trainees were interviewed and data were thematically analysed as to the scope and quality of learning by the setting of training. Learning experiences were then mapped against the Dreyfus and Dreyfus model to explore skill acquisition.
Results: In terms of the scope and quality of learning, rural and remote trainees mainly focused on the diverse and unique (sometimes challenging) experiences their setting offered compared with regionally based trainees. Mapping of the trainee comments to the Dreyfus model of skill acquisition demonstrated that regardless of setting, equivalent learning occurred by GP trainees.
Conclusions: This exploratory study provides evidence that rural and remote learning may provide a more diverse and challenging experience. It suggests an equivalence of quality of education and skill acquisition across settings rural, regional and remote. This suggests that the training distribution policies may not disadvantage GP trainees and the scope and quality of more remote learning may increase uptake of remote placements.
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