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Barriers and enablers to accessing perinatal health services for rural Australian women: A qualitative exploration of rural health care providers perspectives 澳大利亚农村妇女获得围产期保健服务的障碍和促进因素:对农村医疗服务提供者观点的定性研究。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-06-04 DOI: 10.1111/ajr.13147
Fiona Faulks MMSc, Kristina Edvardsson PhD, Touran Shafiei PhD

Objective

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers.

Design

A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings.

Setting

Victoria, Australia.

Participants

Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023.

Results

Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models.

Conclusion

Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

目的从围产期保健服务提供者的角度,确定农村妇女在其社区内获得围产期保健服务时所感受到的障碍和促进因素:设计:采用反思性主题分析的定性描述性研究设计,使用社会生态框架来组织和阐述研究结果:环境:澳大利亚维多利亚州:对九名围产期医疗保健提供者进行了半结构化访谈,他们为农村社区的孕妇或新生儿母亲提供医疗保健服务。参与者于 2023 年在维多利亚州各地招募:结果:医疗服务提供者报告了农村妇女在其社区内获得围产期保健服务时面临的多层次障碍和促进因素。障碍包括妇女的个人情况、具有挑战性的专业关系、不公平的服务提供、服务和临床医生之间的无效合作以及政府的资助模式和政策。促进因素包括农村妇女的力量和韧性、农村社区内的社会资本、灵活的护理服务和创新实践、农村文化和护理模式的连续性:农村围产期保健服务提供者认为,农村妇女面临着多重障碍,这些障碍是由复杂的人际、组织、社区和政策因素造成或维持的,而这些因素是农村保健服务的内在因素。研究发现了一些可解决的因素,这些因素给农村妇女参与围产期保健造成了不必要的障碍。这些因素包括有关卫生系统、权利和期望的教育,围产期服务的公平分配,改善专业间关系和合作护理方法,以及基于公平的围产期服务供资模式(无论地理位置如何)。
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引用次数: 0
Development of a team-specific research strategy using a modified Delphi method in a regional public hospital dietetics department 在一家地区公立医院营养科采用改良德尔菲法制定针对团队的研究战略。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-06-01 DOI: 10.1111/ajr.13145
Rachel McMahon APD, Tilley Pain PhD, Felicity Dick APD, Susan Tench APD

Objective

Evaluate research capacity and culture among regional hospital dietitians, develop a team specific research strategy, and build research skills of novice researchers.

Methods

The Research Capacity in Context Tool was used to assess current research capacity and culture at organisational, team and individual levels. Results were analysed using descriptive statistics and content analysis of free text responses. A modified Delphi method gained consensus regarding research capacity building.

Design

Mixed method study.

Setting

Dietetics department of a regional tertiary hospital (Modified Monash Category 2).

Participants

All clinical dietitians currently employed within the hospital (n = 20) regardless of employment duration.

Main Outcome Measures

Self-rated response to research capacity and culture to produce a dietetics-specific research strategy.

Results

Fifteen dietitians (75%) completed the Research Capacity in Context Tool. The overall mean score was highest at an organisational level at 7.9 (IQR 2), and lowest at team and individual levels at 4.3 (IQR 2.7) and 4.9 (IQR 3.3) respectively. Common barriers to research included time, lack of skills, knowledge and support. Using the modified Delphi method 39 statements relating to research capacity building met consensus and informed the creation of a research strategy.

Conclusion

The results of the Research Capacity in Context Tool from this regional study reflect those reported in the literature at metropolitan sites. A dietetic-specific research strategy was developed to assist with increasing research capacity at a team and individual level in a regional setting. Evaluation of long-term outcomes post implementation will be the subject of further research.

目标评估地区医院营养师的研究能力和文化,制定针对团队的研究策略,培养新手研究人员的研究技能:方法:使用 "背景下的研究能力工具 "评估当前组织、团队和个人层面的研究能力和文化。使用描述性统计和自由文本回复内容分析对结果进行了分析。修改后的德尔菲法就研究能力建设达成了共识:设计:混合方法研究:研究地点:一家地区性三甲医院的营养科(经修改的莫纳什二类医院):主要结果测量:主要结果测量指标:对研究能力和文化的自我评价,以制定营养学研究策略:15名营养师(75%)完成了 "背景研究能力工具"。总体平均得分在组织层面最高,为 7.9 (IQR 2),在团队和个人层面最低,分别为 4.3 (IQR 2.7) 和 4.9 (IQR3.3)。研究的常见障碍包括时间、缺乏技能、知识和支持。采用修改后的德尔菲法,与研究能力建设有关的 39 项陈述达成了共识,并为制定研究战略提供了依据:结论:这项地区性研究的 "研究能力背景工具 "结果反映了大都市研究机构的文献报道。研究人员制定了一项针对营养学的研究战略,以帮助在地区环境中提高团队和个人的研究能力。对实施后长期成果的评估将是进一步研究的主题。
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引用次数: 0
Continuing professional development training needs of allied health professionals in regional and rural Victoria 维多利亚州地区和农村地区专职医疗人员的继续职业发展培训需求。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-05-30 DOI: 10.1111/ajr.13141
Michael Pang BPhysio, Alesha Sayner MPhysio, Kylie McKenzie PhD

Objective

The aim of the study was to identify continuing professional development (CPD) needs of allied health professionals (AHP) in regional and rural Victoria.

Design

This study was an online cross-sectional design conducted between December 2022 and February 2023.

Settings and Participants

AHPs employed at a large multi-site regional public health service providing acute, subacute, community and outpatient care in Victoria, Australia.

Main Outcome Measure(s)

The online questionnaire included four sections investigating satisfaction of CPD, prioritised topics for CPD, preference for CPD sourcing and perceived capabilities in delivering education. To investigate prioritised topics of CPD, a tool was adapted from the Hennessy Hicks Training Needs Analysis questionnaire to align with allied health (AH) career pathways. For organisational alignment, a second questionnaire was sent to AH managers.

Results

The response rate was 17% (53/316 AHPs) from members of 10 AH professions. The median years of clinical experience for participants was between 2 and 5 years. Participants with 6–10 years of clinical experience reported the lowest level of satisfaction. Research and education were identified as areas of highest training need. Self-perceived competence in education delivery was proportionately lower in areas of assessment, developing digital learning and constructive alignment.

Conclusion

CPD needs for AHPs in a regional and rural health service were shown to vary by career stage and weighted towards developing research and education delivery capabilities. Findings from this study may support public health sector and policy investment in CPD opportunities to support horizontal career progression opportunities, a balance of internal and externally sourced professional development and strategic investment in education delivery capabilities.

研究目的本研究旨在确定维多利亚州地区和农村地区专职医疗人员(AHP)的持续专业发展(CPD)需求:本研究采用在线横断面设计,在 2022 年 12 月至 2023 年 2 月期间进行:受雇于澳大利亚维多利亚州一家提供急性、亚急性、社区和门诊护理的大型多站点地区公共卫生服务机构的 AHP:在线调查问卷包括四个部分,分别调查持续专业发展的满意度、持续专业发展的优先主题、对持续专业发展来源的偏好以及在提供教育方面的感知能力。为了调查持续专业进修的优先主题,从 Hennessy Hicks 培训需求分析问卷中改编了一个工具,以便与专职医疗人员(AH)的职业发展路径保持一致。为了与组织保持一致,还向专职医疗管理人员发送了第二份调查问卷:来自 10 个专职医疗人员职业的 17%(53/316 名专职医疗人员)参与了问卷调查。参与者的临床经验年数中位数为 2 至 5 年。拥有 6-10 年临床经验的参与者的满意度最低。研究和教育被认为是最需要培训的领域。在评估、开发数字化学习和建设性调整方面,自我感觉的教育实施能力比例较低:结论:在一个地区和农村医疗卫生服务机构中,AHPs 的持续专业发展需求因职业阶段而异,并偏重于发展研究和教育实施能力。这项研究的结果可能会支持公共卫生部门和政策对持续专业发展机会的投资,以支持横向职业发展机会、内部和外部专业发展的平衡以及对教育交付能力的战略投资。
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引用次数: 0
Sustaining multidisciplinary teams in rural and remote primary care 在农村和偏远地区的初级保健中维持多学科团队。
IF 1.8 4区 医学 Q2 NURSING Pub Date : 2024-05-27 DOI: 10.1111/ajr.13144
Geoff Argus BSc (Hons), MPysch (Clin), GCert Public Health, MAPS, FCCLP, GAICD
<p>The health system in rural and remote Australia has been under significant strain for decades with rural and remote Australians continuing to face barriers in accessing and utilising appropriate primary health care due to a range of factors including geographic spread, low population density, infrastructure limitations and higher costs of delivering healthcare.<span><sup>1</sup></span> The global shortage of health care workers since the COVID-19 pandemic will likely further exacerbate the long-standing challenges for rural and remote Australian communities in attracting and retaining a suitably trained multidisciplinary primary care workforce with the appropriate mix of required skills.</p><p>Whilst the concept of multidisciplinary health care teams is well-established, there have been renewed calls for the implementation of sustainable multidisciplinary team-based models of primary care service delivery in rural and remote communities. There are several bodies of work in recent times that point towards the importance of needs-based multidisciplinary health workforce planning for effective and sustainable rural and remote primary care in Australia.</p><p>In 2023, the Office of the National Rural Health Commissioner released the <i>Ngayubah Gadan Consensus Statement: Rural and Remote Multidisciplinary Health Teams</i>,<span><sup>2</sup></span> which identifies key contextual areas for successful implementation and sustainability: Policy and Funding Context, Organisational Context, Multidisciplinary Team Context and Person and Community Context. The statement provides a framework for contextual considerations in the implementation and sustainability of multidisciplinary primary health care teams in rural and remote Australia. It makes clear that place-based solutions are required where service models are co-designed with the community to meet the specific ongoing health needs of the community.</p><p>The Innovative Models of Care (IMOC) Program administered by the Australia Department of Health and Aged Care<span><sup>3</sup></span> is attempting to address these issues by funding trials of multidisciplinary primary care models in rural and remote locations. This is an important initiative to showcase successful examples of rural and remote multidisciplinary models of primary care and determine the elements of success and challenge. A diversity of models and locations have thus far been funded, and it will be valuable to see over time a robust evaluation of these projects to inform future primary care reform.</p><p>The findings and outcomes of the <i>Unleashing the Potential of our Health Workforce—Scope of Practice Review</i><span><sup>4</sup></span> will be important in informing the future of rural and remote primary care. Identifying the appropriate mix of skills and capabilities of multidisciplinary primary care teams and clinicians working at their full scope of practice has been identified in the review. It is heartening to see the sugges
几十年来,澳大利亚农村和偏远地区的医疗系统一直承受着巨大的压力,由于地理位置分散、人口密度低、基础设施有限以及医疗保健服务成本较高等一系列因素,农村和偏远地区的澳大利亚人在获取和利用适当的初级医疗保健服务方面一直面临着障碍。自 COVID-19 大流行以来,全球医疗保健人员短缺,这很可能会进一步加剧澳大利亚农村和偏远社区在吸引和留住受过适当培训、具备所需技能的多学科初级医疗保健人员方面长期面临的挑战。虽然多学科医疗保健团队的概念已经确立,但人们再次呼吁在农村和偏远社区实施以多学科团队为基础的可持续初级医疗保健服务提供模式。近期有多项研究表明,基于需求的多学科医疗队伍规划对于澳大利亚农村和偏远地区有效和可持续的初级医疗服务非常重要:2023 年,全国农村卫生专员办公室发布了《Ngayubah Gadan 共识声明:农村和偏远地区多学科医疗团队》2 ,指出了成功实施和可持续发展的关键背景领域:该声明确定了成功实施和可持续发展的关键背景领域:政策和资金背景、组织背景、多学科团队背景以及个人和社区背景。该声明为澳大利亚农村和偏远地区多学科初级医疗团队的实施和可持续性提供了一个背景考虑框架。澳大利亚卫生与老年护理部(Department of Health and Aged Care)管理的 "创新护理模式计划"(Innovative Models of Care,IMOC)3 正试图通过资助农村和偏远地区的多学科初级保健模式试验来解决这些问题。这是一项重要举措,旨在展示农村和偏远地区多学科初级医疗模式的成功范例,并确定成功和挑战的要素。迄今为止,已有多种不同的模式和地点获得了资助,随着时间的推移,对这些项目进行有力的评估,为未来的初级医疗改革提供信息,将是非常有价值的。审查中确定了多学科初级医疗团队和临床医生在其全部执业范围内工作的技能和能力的适当组合。令人欣慰的是,有建议提出了一个技能和能力框架,该框架可能会确定农村和偏远社区所需的技能组合,特别是在技能可能由多个医疗专业共享的情况下。这对卫生工作者队伍的规划至关重要,以满足人口复杂的卫生需求。为了考虑以地方为基础的多学科初级卫生保健团队的适当组成,需要对相关社区当前和未来的卫生需求进行基于需求的分析,5 同时考虑满足人口需求所需的技能组合。对于在全部执业范围内工作的临床医生而言,各专业之间可能存在技能重叠,在建立适当的临床管理机制的情况下,可以进行技能共享。这就需要采取一种劳动力规划方法,首先考虑满足社区健康需求所需的技能组合,然后考虑能够在其执业范围内提供所需服务的各种医疗专业。6 为下一代卫生专业人员做好准备对于确保当代卫生工作者参与跨专业合作实践(ICP)至关重要。ICP 是一个有意识的过程,它超越了团队的跨学科组成,旨在创造一个包括接受护理者及其家人在内的高功能团队环境。7 多学科团队内的 ICP 是确保角色明确、共同决策、以人为本的护理、减少团队冲突和改善消费者结果的关键因素。
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引用次数: 0
Farm to bedside: Collaboration with local farmers to supply rural Australian hospital food 从农场到床边:与当地农民合作,供应澳大利亚农村医院食品。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-05-27 DOI: 10.1111/ajr.13142
Joshua G. Kovoor, Brandon Stretton, Luke Spajic, Genevieve Moseley, Harry Brown, Silas D. Nann, Alasdair Leslie, Aashray K. Gupta, Ammar Zaka, Yuchen Luo, Samuel Gluck, Matthew Marshall-Webb, Stephen Bacchi
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引用次数: 0
Does on-site computed tomography matter? A cross-sectional study of stroke patients’ door-to-scan-time in rural hospitals 现场计算机断层扫描重要吗?农村医院脑卒中患者门到扫描时间的横断面研究。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-05-20 DOI: 10.1111/ajr.13140
Nicholas Arnold GradDip, Kathryn Gough BMSc, Anthony Patsalou MD, Brendan Carrigan MBBS, William MacAskill PhD

Purpose

Many rural Australian hospitals lack on-site computed tomography (CT). These hospitals often refer patients to local off-site private radiology clinics or to central hospitals, challenging the achievement of time-sensitive scans. For stroke patients, timely access to CT affects treatment options. This study questions whether on-site CT matters in rural hospitals by investigating stroke patients’ door-to-scan-time (DTST) and CT scan sequence referrals.

Method

A retrospective chart audit was completed across four rural hospitals; two with on-site CT and two without. Adult emergency stroke presentations were randomly sampled. Comparisons between on-site and off-site CT hospitals were made for DTST and CT sequence referrals using Mann–Whitney U-tests and Fisher's exact tests.

Results

A total of 120 charts were audited (on-site CT, n = 60; off-site CT, n = 60). DTST was longer for off-site vs. on-site CT hospitals (median = 4.30 h vs. median = 0.70 h; U = 338, p < 0.001) regardless of whether presentations occurred in business hours or out of hours (p < 0.001). Off-site CT hospitals ordered less CT angiography or perfusion scanning (32% vs. 85%, p < 0.001).

Conclusions

Off-site CT hospital patients had longer DTST and received less angiography or perfusion scanning. These findings suggest that on-site CT matters to rural stroke patients by improving equitable access to CT and appropriate scan referrals.

目的:澳大利亚许多农村医院缺乏现场计算机断层扫描(CT)。这些医院通常会将病人转诊到当地的非现场私人放射诊所或中心医院,这给及时扫描带来了挑战。对于中风患者来说,能否及时获得 CT 会影响治疗方案。本研究通过调查脑卒中患者的门到扫描时间(DTST)和 CT 扫描顺序转诊情况,对农村医院现场 CT 是否重要提出质疑:方法:对四家农村医院进行了回顾性病历审计,其中两家医院有现场 CT,两家医院没有。随机抽取了成人急诊中风患者。使用 Mann-Whitney U 检验和费雪精确检验对现场和非现场 CT 医院的 DTST 和 CT 序列转诊进行比较:共审核了 120 份病历(现场 CT,n = 60;非现场 CT,n = 60)。与现场 CT 医院相比,非现场 CT 医院的 DTST 更长(中位数 = 4.30 小时,中位数 = 0.70 小时;U = 338,P 结论:非现场 CT 医院患者的 DTST 更长(中位数 = 4.30 小时,中位数 = 0.70 小时):非现场 CT 医院患者的 DTST 更长,接受血管造影或灌注扫描的时间更短。这些研究结果表明,现场 CT 对农村卒中患者很重要,因为它能改善公平的 CT 就诊机会和适当的扫描转诊。
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引用次数: 0
Rural and remote pharmacists’ perspectives of grey nomads with diabetes travelling in Australia 农村和偏远地区药剂师对在澳大利亚旅行的灰色游牧民族糖尿病患者的看法。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-05-20 DOI: 10.1111/ajr.13139
Anita De Bellis PhD, Christine McCloud PhD, Jane Giles CDE, Marc Apollloni Grad Dip Comm Prac Pharm, Wendy Abigail PhD, Pauline Hill PhD

Objective

The objective of the research was to explore rural and remote pharmacists’ experiences of encountering grey nomads with diabetes.

Design

A qualitative Interpretive Description design was used to explore and capture the experiences of rural and remote pharmacists interacting with grey nomads who had diabetes. Data from the interviews were analysed thematically.

Setting

The Pharmacy Guild of Australia was approached and through their membership rural and remote pharmacists were invited to participate in the research.

Participants

Nine rural and remote pharmacists who had encounters and provided services to grey nomads with diabetes responded to be interviewed.

Results

The analysed findings established four major themes including: the influence of rural and remote locations on services; common problems encountered by the pharmacists; preparation for travel by grey nomads with diabetes; and pharmacists’ preparedness to support grey nomads with diabetes.

Conclusion

The findings of this study identified that pharmacists needed remuneration for services provided to grey nomads with diabetes. Also, further development of the My Health record and telehealth to include pharmacists would be advantageous for grey nomads who have diabetes. Pharmacists stated there was a need for further education and a continuing professional development module specifically designed for pharmacists on diabetes self-management that moved beyond medications. A pre-travel checklist for grey nomads with diabetes travelling in rural and remote Australia would benefit all stakeholders through better preparation of travellers with diabetes to self-manage, thereby reducing the demand for health services including pharmacies.

研究目的研究目的是探索农村和偏远地区药剂师在遇到患有糖尿病的灰色游牧民族时的经验:设计: 采用定性解释性描述设计,探索并捕捉农村和偏远地区药剂师与患有糖尿病的灰色游牧民族互动的经验。对访谈数据进行了主题分析:联系澳大利亚药剂师协会,并通过其会员邀请农村和偏远地区的药剂师参与研究:九名接触过灰色游牧民族糖尿病患者并为其提供服务的农村和偏远地区药剂师接受了访谈:分析结果确定了四大主题,包括:农村和偏远地区对服务的影响;药剂师遇到的常见问题;灰色游牧民族糖尿病患者的旅行准备;以及药剂师为支持灰色游牧民族糖尿病患者所做的准备:本研究结果表明,药剂师为灰色游牧民族糖尿病患者提供服务需要报酬。此外,进一步发展 "我的健康记录 "和远程医疗,将药剂师纳入其中,对患有糖尿病的灰色游牧民也是有利的。药剂师表示,有必要开展进一步的教育,并专门为药剂师设计一个关于糖尿病自我管理的继续职业发展模块,而不仅仅是药物治疗。为在澳大利亚农村和偏远地区旅行的灰色游牧民族糖尿病患者制定一份旅行前清单,将使所有利益相关者受益,让糖尿病患者更好地做好自我管理的准备,从而减少对包括药房在内的医疗服务的需求。
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引用次数: 0
Antiarrhythmic preferences and outcomes post DC cardioversion for atrial fibrillation, an Australian rural perspective 从澳大利亚农村的角度看心房颤动直流电心脏复律术后的抗心律失常偏好和疗效。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-05-20 DOI: 10.1111/ajr.13138
Martin Thomas MD, James Elhindi BSc, Kanishka Kamaladasa FRACP, Tilak Sirisena FRACP

Introduction

Direct current cardioversion (DCCV) remains one of the recommended management strategies for symptomatic atrial fibrillation (AF). Antiarrhythmic drugs (AAD) are prescribed post procedure to maintain sinus rhythm (SR). Limited literature exists on the AAD prescribing practices and their efficacy, post-DCCV in rural Australia.

Objective

The primary aim was to determine the preferred AAD post-DCCV and the factors affecting AAD prescribing practices. The secondary aim was to assess the efficacy of the AAD in maintaining SR.

Design

A retrospective observational audit of patients with non-valvular AF who underwent successful elective DCCV for symptomatic AF, during 2015–2020 at a regional hospital in New South Wales (NSW) (Dubbo Base Hospital). Patients were followed up for a duration of 12 months post-DCCV.

Results

233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post-DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12 months post-DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p = 0.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices.

Conclusion

The study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12 months post-DCCV. Prescribing practices post-DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting.

简介:直流电心律转复术(DCCV)仍是症状性心房颤动(AF)的推荐治疗策略之一。术后处方抗心律失常药物(AAD)以维持窦性心律(SR)。有关澳大利亚农村地区 DCCV 术后抗心律失常药物处方及其疗效的文献有限:主要目的是确定 DCCV 术后首选的 AAD 药物以及影响 AAD 处方做法的因素。次要目的是评估 AAD 在维持 SR 方面的疗效:设计:对2015-2020年期间在新南威尔士州(NSW)一家地区医院(Dubbo基地医院)因症状性房颤成功接受选择性DCCV治疗的非瓣膜性房颤患者进行回顾性观察审计。患者在DCCV后接受了为期12个月的随访。结果:233名患者在研究期间成功接受了DCCV。胺碘酮是 DCCV 后首选的 AAD,其次是索他洛尔和非卡尼(分别为 36.5% vs. 27.8% vs. 1.3%)。35.2%的患者未获处方 AAD。胺碘酮和索他洛尔在 DCCV 后 12 个月维持 SR 方面的疗效相似但并不明显,均不优于未使用 AAD 的患者(房颤复发率分别为 61.5% vs. 68.2% vs. 71.6%,p = 0.37)。先兆脑血管意外(CVA)、肺部疾病、吸烟、曾使用地高辛、利尿剂和左心室(LV)功能障碍是影响AAD处方的因素:研究表明,胺碘酮、索他洛尔和无 AAD 在 DCCV 后 12 个月内维持 SR 的疗效相同。杜博基地医院在 DCCV 后的处方做法与观察到的国家趋势和指南有所不同。AAD处方需要采取多方面的方法,主要考虑的是安全优先于疗效,同时要注意在农村地区提供最佳医疗服务所面临的挑战。
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引用次数: 0
Building the workforce of tomorrow: The weighting of rural exposure in standardised curriculum vitae scoring criteria for entrance into Australian specialty training programs 培养未来的劳动力:澳大利亚专科培训项目入学标准化简历评分标准中农村经历的权重。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-05-08 DOI: 10.1111/ajr.13131
Thomas Muecke, Stephen Bacchi MBBS, PhD, Robert Casson MBBS, PhD, Weng Onn Chan MBBS

Objective

To determine the weighting of rural exposure within publicly available standardised curriculum vitae (CV) scoring criteria for trainee medical officer's applying into medical and surgical specialty training programs in Australia and New Zealand.

Methods/Design

An observational analysis of rural exposure point allocations within publicly available standardised CV scoring criteria for entrance into specialty training programs.

Setting

All Australian and New Zealand medical and surgical specialties training programs outlined by the Australian Health Practitioner Regulation Agency (AHPRA) who publish publicly available standardised CV scoring criteria for entrance into specialty training were included.

Results

Of the 14 specialty training programs that publish publicly available standardised CV scoring criteria, 8/14 allocate points towards rural exposure. While the allocation of points within this scoring domain varies between the eight training programs, the mean weighting of rural exposure is 13.7%.

Conclusions

The relative weighting of rural exposure varies between the eight specialty training programs who include rural exposure as a CV scoring criteria. The deliberate and strategic construction of CV scoring criteria and inclusion of rural exposure points is important to continue developing the Australian rural specialist workforce. Future development of standardised CV scoring criteria should continue to consider point allocation towards rural exposure and related activities to ensure that the requirements of rural Australian healthcare needs are met across medical and surgical specialties.

目的:确定在澳大利亚和新西兰申请进入内科和外科专科培训项目的见习医官的公开标准化简历(CV)评分标准中,农村经历所占的权重:在公开的专科培训项目入学标准化简历评分标准中,对农村接触点分配进行观察分析:澳大利亚卫生从业者监管局(AHPRA)列出的所有澳大利亚和新西兰内科和外科专科培训项目均包括在内,这些项目公布了公开的专科培训入学标准化CV评分标准:在 14 个公开发布标准化简历评分标准的专科培训项目中,有 8/14 个项目为农村经历分配分数。虽然这 8 个培训项目在这一评分范围内的分数分配各不相同,但农村经历的平均权重为 13.7%:结论:在将农村经历作为简历评分标准的八个专业培训项目中,农村经历的相对权重各不相同。深思熟虑、战略性地制定简历评分标准并将农村经历纳入其中,对于继续培养澳大利亚农村专科医生队伍非常重要。今后在制定标准化简历评分标准时,应继续考虑对农村经历和相关活动的分值分配,以确保满足澳大利亚农村医疗保健对内外科各专科的要求。
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引用次数: 0
Preparedness and training needs of a regional public mental health service to support people with intellectual disability 地区公共心理健康服务机构在支持智障人士方面的准备情况和培训需求。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-05-08 DOI: 10.1111/ajr.13130
Jo Spong PhD, Teresa Iacono PhD, Janelle Weise PhD, Julian Trollor MD, Lisa Spong MMHN, Tim Lenten MNSc

Objective

To explore the preparedness and training needs of a regional public mental health workforce to support people with intellectual disability and mental ill health.

Setting and Participants

Staff from a regional public mental health service in Victoria, Australia.

Design

A mixed-methods design comprised a survey, interviews and a focus group to collect data about staff attitudes, confidence, education and professional development regarding supporting people with intellectual disability and mental ill health. Descriptive and thematic analyses were used.

Results

Data from 31 survey respondents, seven interviews and one focus group were analysed. Survey descriptive analyses showed participants believed treating people with intellectual disability was part of their role but reported areas of low confidence along with insufficient education and training in intellectual disability mental health. Thematic analyses from interviews showed that underpinning confidence, education and training were the themes (1) need for flexibility, such as having more time and (2) solutions but with challenges, such as limited opportunity to upskill and availability of experts. A need for collaborative problem-solving where staff share skills and information to work towards person-centred solutions was a key theme from the focus group analysis.

Conclusion

Professional development in intellectual disability mental health is required for the regional public mental health workforce but needs to account for the challenges experienced and reflect how teams function. Exploration of described preparedness offered a possible learning approach informed by workforce members. Collaborative learning approaches to supporting people with intellectual disability and mental ill health are suggested.

目的探究地区公共精神卫生工作者在支持智障和精神疾病患者方面的准备情况和培训需求:澳大利亚维多利亚州地区公共精神健康服务机构的工作人员:设计:混合方法设计,包括调查、访谈和焦点小组,以收集有关员工在支持智障人士和精神疾病患者方面的态度、信心、教育和专业发展的数据。采用了描述性分析和主题分析:对来自 31 位调查对象、7 次访谈和 1 个焦点小组的数据进行了分析。调查描述性分析表明,参与者认为治疗智障人士是他们职责的一部分,但也报告了信心不足的领域,以及智障心理健康教育和培训不足的问题。访谈的主题分析表明,信心、教育和培训的基础是以下主题:(1)需要灵活性,例如有更多的时间;(2)解决方案,但面临挑战,例如提高技能的机会有限和专家的可用性。焦点小组分析中的一个关键主题是需要合作解决问题,即工作人员分享技能和信息,以实现以人为本的解决方案:结论:地区公共精神卫生工作者需要在智障精神卫生方面进行专业发展,但需要考虑到所经历 的挑战,并反映出团队是如何运作的。对所描述的准备情况的探索提供了一种可能的学习方法,该方法由工作团队成员提供信息。建议采用协作学习的方法为智障和精神疾病患者提供支持。
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引用次数: 0
期刊
Australian Journal of Rural Health
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