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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
Prevalence of technology and connectivity issues in general practices in rural New South Wales and their impact on staff capability to perform their job 新南威尔士州农村地区普通诊所的技术和连接问题及其对员工工作能力的影响。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-05-05 DOI: 10.1111/ajr.13129
Margot Leeson-Smith B.HSc, Louise Geddes PhD, Heath Johnson B.Communication (Hons), Sabrina Pit PhD, Robyn Ramsden PhD

Objective

To identify the technology and connectivity issues in rural and remote general practices, and the factors independently associated with these issues that negatively impact staff's capability to perform their job.

Methods

An annual cross-sectional survey of rural and remote general practice managers. Dependent variables included demographic data, practice size, geographic location, connection type and frequency of connectivity issues. Descriptive statistics are presented, and bivariate logistic regression was undertaken to determine factors independently associated with connectivity issues that negatively impact staff's capability to perform their job.

Participants

One hundred sixty-eight general practice managers from rural and remote New South Wales.

Results

The majority of respondents (87%, n = 146) indicated that technology and connectivity issues had impacted staff's capability to perform their job. Internet problems were the most frequently reported issue (36%, n = 61). In bivariate analysis, practices that had a total clinical staff headcount between 5 and 7 (OR 0.27; 95% CI 0.10–0.67; p = 0.005) or between 8 and 11 (OR 0.39; 95% CI 0.16–0.95; p = 0.038) were significantly less likely to report technology and connectivity issues that negatively impact staff's capability to perform their job, compared with practices with a total clinical headcount of less than five.

Conclusions

Technology and connectivity issues persist in rural and remote general practices. This is the first study to demonstrate that technology and connectivity issues impact on rural staff's capability to perform their job. Furthermore, smaller practices face more technology and connectivity issues that negatively impact staff's capability to do their job than larger practices. Further research is required to find solutions to address these challenges.

目的确定农村和偏远地区全科诊所的技术和连接问题,以及与这些问题独立相关、对员工工作能力产生负面影响的因素:方法:对农村和偏远地区全科医生管理人员进行年度横截面调查。因变量包括人口统计学数据、诊所规模、地理位置、连接类型和出现连接问题的频率。调查提供了描述性统计数字,并进行了双变量逻辑回归,以确定与对员工工作能力产生负面影响的连接问题独立相关的因素:来自新南威尔士州农村和偏远地区的 168 名全科诊所经理:大多数受访者(87%,n = 146)表示,技术和连接问题影响了员工的工作能力。互联网问题是最常报告的问题(36%,n = 61)。在双变量分析中,与临床人员总数少于 5 人的医疗机构相比,临床人员总数在 5-7 人之间(OR 0.27;95% CI 0.10-0.67;p = 0.005)或 8-11 人之间(OR 0.39;95% CI 0.16-0.95;p = 0.038)的医疗机构报告技术和连接问题对员工工作能力产生负面影响的可能性要小得多:结论:在农村和偏远地区的全科医疗机构中,技术和连接问题依然存在。这是首次有研究表明,技术和连接问题会影响农村员工的工作能力。此外,与规模较大的诊所相比,规模较小的诊所面临更多的技术和连接问题,这些问题对员工的工作能力产生了负面影响。要找到应对这些挑战的解决方案,还需要进一步的研究。
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引用次数: 0
Implementation of a day-stay joint replacement pathway in an Australian regional public hospital: A descriptive study 在澳大利亚一家地区公立医院实施日间留院关节置换路径:描述性研究。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-04-30 DOI: 10.1111/ajr.13127
Amanda Tutty BASc (Physio)(Hons), Sam Martin FRACS (Orth), Corey Scholes PhD, Michel Genon FRACS (Orth), Jane Linton BASc (Physio), Simon Davidson BPhys (Hons), Christopher Williams PhD

Objective

To describe the implementation, feasibility and safety of a day-stay joint replacement pathway in a regional public hospital in Australia.

Method

Over a 12-month pilot period, a prospective descriptive analysis of consecutive patients undergoing total knee and hip arthroplasty was conducted. The number of eligible day-stay patients, proportion of successful same-day discharges and reasons for same-day failure to discharge were recorded. Outcome measures captured for all joint replacements across this period included length of stay (LoS), patient reported outcomes, complications and patient satisfaction. The implementation pathway as well as patient and staff identified success factors derived from interviews were outlined.

Results

Forty-one/246 (17%) patients booked for joint replacement surgery were eligible for day-stay and 21/41 (51%) achieved a successful same-day discharge. Unsuccessful same-day discharges were due to time of surgery too late in the day (7/20), no longer meeting same-day discharge criteria (11/20) and declined discharge same-day (2/20). Over the implementation period 65% (162/246) of all patients were discharged with a LoS of 2 days or less. Patient satisfaction for the day-stay pathway was high. Complication rates and patient-reported outcomes were equivalent across LoS groups.

Conclusion

The day-stay joint replacement surgery pathway was feasible to implement, safe and acceptable to patients. Day-stay pathways have potential patient and system-level efficiency benefits.

目的描述在澳大利亚一家地区性公立医院开展的日间留院关节置换术的实施情况、可行性和安全性:在为期 12 个月的试点期间,对连续接受全膝关节和髋关节置换术的患者进行了前瞻性描述性分析。对符合条件的日间留院患者人数、当天成功出院的比例以及当天未能出院的原因进行了记录。在此期间采集的所有关节置换术的疗效指标包括住院时间(LoS)、患者报告的疗效、并发症和患者满意度。此外,还概述了实施路径以及访谈中患者和员工发现的成功因素:41/246(17%)名预约关节置换手术的患者符合日间留院条件,21/41(51%)名患者成功实现了当日出院。当日出院不成功的原因包括手术时间太晚(7/20)、不再符合当日出院标准(11/20)和拒绝当日出院(2/20)。在实施期间,65% 的患者(162/246)在 2 天或更短时间内出院。患者对日间留院路径的满意度很高。各LoS组的并发症发生率和患者报告结果相当:结论:日间留院关节置换手术路径的实施是可行的、安全的,也是患者可以接受的。日间留院路径具有潜在的患者和系统层面的效率优势。
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引用次数: 0
Prevalence and factors associated with mental health status in Parkinson's disease: Data from the 45 and Up Study 帕金森病患者精神健康状况的患病率和相关因素:来自 "45岁及以上研究 "的数据。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-04-29 DOI: 10.1111/ajr.13125
Peter S. Micalos PhD, Patricia A. Logan PhD, Marguerite Bramble PhD, Alfred Wong PhD

Introduction

Parkinson’s disease (PD) is associated with a range of non-motor symptomologies such as anxiety and depression.

Objective

The purpose of this research was to investigate the prevalence and factors associated with mental health status in persons with PD.

Design

This retrospective data linkage study analysed a subset of data from the Sax Institute’s 45 and Up Study based in the population of the state of New South Wales (NSW), Australia. Data was analysed between 2005-2009 of persons who self-identified with PD. Secure data access was provided through the Sax Institute’s Secure Unified Research Environment (SURE). Participants were aged 45+ years of age and living in NSW, Australia. Regression analysis was performed on psychological distress (K10), previous diagnosis of anxiety, and/or depression, with independent variables for locality, demographic, health, medical, and sociocultural factors.

Findings

A total of 1676 persons self-identified with PD from the 45 and Up Study Wave 1 baseline and were linked to the 2010 Social, Economic and Environmental Factors (SEEF) survey dataset. Mental health manifestations are common in PD with 29% and 32% reporting a previous medical diagnosis of anxiety and depression, respectively. Rural locality was associated with an increased likelihood of psychological distress, anxiety, and depression compared to metropolitan locality.

Discussion

Mental health status in PD was associated with living in rural areas, medical service access, female gender, ageing, physical mobility, Australian born, social interactions, and in a coupled relationship.

Conclusion

Further research is required on the longitudinal impact of these associations on mental health in PD.

简介:帕金森病(PD)与焦虑和抑郁等一系列非运动症状有关:帕金森病(PD)与焦虑和抑郁等一系列非运动症状有关:本研究旨在调查帕金森病患者精神健康状况的患病率和相关因素:这项回顾性数据关联研究分析了澳大利亚新南威尔士州(NSW)萨克斯研究所 "45岁及以上研究"(45 and Up Study)的部分数据。研究分析了 2005-2009 年间自认为患有帕金森病的人的数据。通过萨克斯研究所的安全统一研究环境 (SURE) 对数据进行了安全访问。参与者年龄在 45 岁以上,居住在澳大利亚新南威尔士州。对心理困扰(K10)、既往焦虑和/或抑郁诊断进行了回归分析,并对地区、人口、健康、医疗和社会文化因素进行了自变量分析:在 "45岁及以上研究 "第一波基线调查中,共有1676人自我认定患有帕金森病,并与2010年社会、经济和环境因素(SEEF)调查数据集进行了关联。精神健康表现在帕金森病中很常见,分别有29%和32%的患者曾被医学诊断为焦虑症和抑郁症。与大都市相比,农村地区出现心理困扰、焦虑和抑郁的可能性更大:讨论:帕金森病患者的心理健康状况与居住在农村地区、获得医疗服务的机会、女性性别、年龄、身体活动能力、澳大利亚出生、社会交往以及夫妻关系有关:结论:需要进一步研究这些关联对帕金森病患者心理健康的纵向影响。
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引用次数: 0
RuralHealthConnect: A network for evidence, innovation and action 农村健康连接:证据、创新和行动网络
IF 1.8 4区 医学 Q2 NURSING Pub Date : 2024-04-22 DOI: 10.1111/ajr.13118
Susi Tegen MBA, BA, DipEd, FAICD, FGIA, GCCM, GCRL
<p>Federal and state governments invest millions of dollars to support the rural health sector to address the myriad of challenges not adequately addressed by the usual funding mechanisms, tools and levers. Rural clinicians, communities, researchers and entities that deliver care in rural Australia currently do not have access to what can learned, trends that are identified and what could be adapted in other communities.</p><p>The National Rural Health Alliance (the Alliance) and the <i>Australian Journal of Rural Health</i> (AJRH), with input from the National Rural Health Commissioner, have developed a proposal to address the challenge of inadequate evidence and information sharing and to promote capacity building, adaptation and innovation in rural health care and investment in education and training. The proposal combines the expertise and reach of all three entities and will draw together key rural health stakeholders in a steering committee.</p><p>With investment, the proposal aims to address the lack of information shared and learning from government funded research and programs that addresses declining medical and health workforce shortages, models of care, health care access discrepancies and health outcomes in rural areas compared with urban centres. Many initiatives have been implemented over past decade or are currently being trialled to achieve these goals, such as Innovative Models of Care (IMOC), Primary care Rural Integrated Multidisciplinary Models (PRIMM), as well as initiatives funded through the Medical Research Futures Fund (MRFF), the National Health and Medical Research Council (NHMRC) and other bodies. These projects include rural research initiatives, multidisciplinary models of care, various workforce or distribution programs, community-led initiatives, actions by specific professions, quality improvement activities and innovative models of delivery and care.</p><p>Although funding may impact a particular community or individual, there is currently a lack of sharing information about what is being learned, what works, why and what challenges have arisen. Indeed, often individuals or communities are not aware of the array of projects that have been or are funded or where these communities or fund holders are located. This lack of communication means that other rural communities, who may be experiencing similar problems, often do not have access to the findings, lessons and emerging trends. There is insufficient cross-pollination of ideas to build capacity, increase adoption and ensure scale-up for maximum utility and impact on health outcomes.</p><p>Up to now, isolated researchers, policy-makers in government, managers, service users, service providers, not-for-profits, local governments, primary health networks (PHNs), workforce agencies, community members and entities that support communities have not been able to benefit from high-quality, multidimensional synthesise and analysis of what has been learned. This has hamp
联邦政府和州政府投入了数百万澳元支持农村卫生部门应对各种挑战,但通常的资助机制、工具和杠杆无法充分应对这些挑战。全国农村健康联盟(National Rural Health Alliance,简称联盟)和《澳大利亚农村健康杂志》(Australian Journal of Rural Health,简称 AJRH)在全国农村健康专员(National Rural Health Commissioner)的建议下,制定了一项提案,以应对证据和信息共享不足的挑战,并促进农村医疗保健的能力建设、调整和创新,以及对教育和培训的投资。通过投资,该提案旨在解决政府资助的研究和计划缺乏信息共享和学习的问题,这些研究和计划旨在解决农村地区与城市中心地区相比不断下降的医疗卫生劳动力短缺问题、医疗模式问题、医疗服务差异问题以及医疗成果问题。为实现这些目标,过去十年间已实施或正在试行许多举措,如创新护理模式(IMOC)、农村综合多学科初级护理模式(PRIMM),以及由未来医学研究基金(MRFF)、国家健康与医学研究委员会(NHMRC)和其他机构资助的举措。这些项目包括农村研究倡议、多学科护理模式、各种劳动力或分配计划、社区主导的倡议、特定专业的行动、质量改进活动以及创新的交付和护理模式。虽然资金可能会对特定社区或个人产生影响,但目前缺乏有关正在学习什么、什么有效、为什么以及出现了什么挑战的信息共享。事实上,个人或社区往往不知道有哪些项目已经或正在获得资助,也不知道这些社区或资助方位于何处。这种缺乏交流的情况意味着,可能遇到类似问题的其他农村社区往往无法获得相关的研究成果、经验教训和新趋势。迄今为止,孤立的研究人员、政府决策者、管理人员、服务使用者、服务提供者、非营利组织、地方政府、初级卫生网络(PHNs)、劳动力机构、社区成员和支持社区的实体都无法从对所学知识进行的高质量、多维度的综合与分析中获益。这阻碍了修订和制定政策和指导方针、调整模式和方法以及影响供资优先次序以反映新趋势从而产生最佳影响的努力。这一挑战限制了澳大利亚及其他地区创新型农村医疗保健和教育/培训投资的有效性和效率。社区、非营利组织、研究人员和其他利益相关者(包括公共卫生网络、劳动力机构和地方政府)并不了解许多以往项目的潜在经验教训。交流想法、做法、资源、框架和成果可以促进循证学习,对于转化工作(包括扩大项目规模)至关重要,尤其是在各项举措越来越多地由社区驱动、以地方为基础并具有参与性的情况下。然而,从服务和教育举措中汲取的宝贵经验并没有得到充分的转化,也没有在适当的时间框架内出版,或应用于特定环境之外,以改善未来的农村医疗实践和教育。当务之急是最大限度地提高政府、社区和农村医疗利益相关者在农村医疗保健方面的投资价值,分享所学到的知识,综合并确定政策和实践方面的证据,确定趋势和学习机会,同时提高各地区的能力和认识。RuralHealthConnect 旨在改善多种信息来源的访问、连接、相关性和影响,为农村医疗服务提供者、资助者、劳动力机构、政府部门、非政府组织、大学和社区成员的行动提供证据。
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引用次数: 0
Editorial: Navigating low-value care in regional, rural and remote Australia 社论:澳大利亚地区、农村和偏远地区的低价值医疗导航
IF 1.8 4区 医学 Q2 NURSING Pub Date : 2024-04-22 DOI: 10.1111/ajr.13123
Rae Thomas BEd, Grad Dip Couns Psych, PhD, Vinay Gangathimmaiah MBBS, MPH, FACEM, Marlow Coates FACRRM, FRACGP-RG, FRACMA, JCCA/DRGA, Michelle Guppy MBBS, FRACGP, MPH
<p>Occasions of low-value care (LVC) are those that confer little or no benefit to the patient or where harm (including lost treatment opportunity and financial cost) exceeds likely benefit.<span><sup>1</sup></span> While it is easy to conceptualise health care as either low or high value, the reality is that ‘value’ is conferred on a continuum and within a context. Some health care activities are widely acknowledged as low value (e.g., cranial CT in patients without meeting clinical decision criteria<span><sup>2</sup></span> and MRIs for low back pain<span><sup>3</sup></span>). However, much health care is conducted in the ‘grey zone’<span><sup>4, 5</sup></span> where the ‘value’ of health care is context dependent.</p><p>In regional, rural and remote Australia, the provision of health care is characterised by challenges distinct from our urban counterparts. Limited access to services, high rates of multimorbidity, and a maldistributed and inconstant workforce are some of the contextual factors in our ‘grey zone’.</p><p>From the perspectives of regional (Townsville), rural (New England) and remote (Thursday Island) health services, we describe how the contexts of our clinical environments guide our clinical decisions and challenge notions of what is, and what is not, LVC.</p><p>Townsville University Hospital is a tertiary referral centre in regional North Queensland supporting the health care needs of 700 000 people.<span><sup>6</sup></span> Amidst a national context of emergency department overcrowding<span><sup>7, 8</sup></span> the Townsville University Hospital Emergency Department (TUH-ED) cared for 99 748 people in 2024. The challenges of providing care in this time-, space-, staff- and information-constrained setting can lead to LVC.<span><sup>9</sup></span> Similar to metropolitan settings, we have identified that approximately a third of urine cultures, coagulation studies, blood cultures and cranial CT scans conducted within the TUH-ED setting, may be seen as low value.<span><sup>10, 11</sup></span> Recent semi-structured interviews with TUH-ED clinicians identified LVC is fuelled by perceptions of efficiency further compounded by clinician beliefs about consequences and capabilities of care provision (unpublished data). This array of systemic and individual factors is shaping clinician behaviour and contributing to the persistence of LVC at TUH-ED.</p><p>The New England region of NSW has a population of 160 000 spread over a wide geographic area with regional and rural towns of MM3-6 in size. Like many rural health services, there is an increasing reliance on a locum rather than a local workforce. In many locations, it is difficult to even attract a locum workforce, so emergency care is provided via telehealth support. Since telehealth specialists cannot physically examine patients, the ordering CT scans of all body parts has increased. It is likely that clinical skill variability, concern for patient outcomes and the desire for a cli
如果患者的 CRP 偏高,而客观上身体状况良好,只是表现出一些轻微的疾病征兆,那么临床医生就会根据全州范围的败血症路径(Sepsis Pathways)13 对可能的重症患者采取相应的措施。在这些偏远地区,复杂或严重疾病的检测前概率相对较高,而诊断工具有限,因此对于消费者和临床医生来说,原本被视为低血容量的检测变得非常有价值。在地区、农村和偏远地区,要找到诊断检查的 "最佳点 "14 ,在过度使用和使用不足之间取得平衡,同时为处于有效治疗 "灰色地带 "的患者寻求最佳的健康结果,5 就需要了解具体情况。我们的医疗系统在应对不断增长的人口、日益减少的资源和距离的限制方面面临着巨大的挑战。一些诊断测试的检测前概率要高于大都市地区的相同测试。我们能否及时采取干预措施取决于一些现实情况,例如能否获得航空医疗检索、是否需要协调病理取件与相关运输设施(渡轮、快递等)的关系、工作人员对病人的熟悉程度,以及普遍存在的设施资源不足的现实情况。在这些情况下,临床医生和社区的参与对于确定当地的 LVC 案例以及驱动因素、做法和行为至关重要。临床医生和社区的参与对于了解干预措施的优先事项和机会也至关重要,以实现有效和可持续地消除低消费量:构思;写作--原稿;写作--审阅和编辑。Vinay Gangathimmaiah:构思;写作--原稿;写作--审阅和编辑。马洛-科茨构思;写作--原稿;写作--审阅和编辑。米歇尔-古比Michelle Guppy 教授是《澳大利亚农村卫生杂志》的副编辑和编辑委员会成员。其他作者声明无利益冲突。
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引用次数: 0
The burden of Finke Desert race-related trauma: A 10-year retrospective descriptive analysis 芬克沙漠种族相关创伤的负担:10 年回顾性描述分析。
IF 1.9 4区 医学 Q2 NURSING Pub Date : 2024-04-20 DOI: 10.1111/ajr.13124
Matthew G. Cehic MD, Casey Knight MBBS, David Morris MD, James Van Essen MD, Nitin Bither MS (Orthopaedic Surgery), Kanishka Williams FRACS (Orthopaedic Surgery)

Introduction

The Finke Desert Race is an annual motorsport race (motorbikes, cars and buggies) held in Alice Springs resulting in a significant major trauma burden. This imposes unique challenges in one of the world's most remote healthcare settings.

Objectives

To quantify the volume and characteristics of Finke Desert Race-related trauma presenting to the Alice Springs Hospital.

Design

A retrospective descriptive study was undertaken to review all patients presenting to the Alice Springs Hospital with Finke Desert Race-related trauma over a 10-year period. Information collected included demographic data, injury characteristics, patient disposition and required management.

Findings

Over the 9 years the event was held, 325 patients were admitted to the Alice Springs Hospital. Patients were almost exclusively male (98.8%), with a mean age of 34.75 and residing outside of Alice Springs (82.2%). There were a total of 460 distinct injuries with the clavicle, spine and ribs the three most commonly injured sites. A total of 129 operations were required, of which 19 required retrieval to an interstate centre.

Discussion

Alice Springs is one of the most remote and geographically isolated centres on Earth. This rurality poses unique challenges when trying to coordinate medical and retrieval services, exacerbated for a concentrated, yet highly resource intensive event such as Finke. It has far reaching impacts, placing additional stresses on all aspects of healthcare provision.

Conclusion

This review has quantified the trauma burden of the event for the first time, enabling local and interstate stakeholders' ability to plan an adequate and sustainable response while also enabling the future effectiveness evaluation of recent safety reforms.

简介芬克沙漠赛是每年在爱丽斯泉举行的赛车比赛(摩托车、汽车和越野车),造成了严重的创伤。我们开展了一项回顾性描述性研究,对爱丽斯泉医院在 10 年间收治的所有因芬克沙漠赛而受到创伤的患者进行了回顾。收集的信息包括人口统计学数据、损伤特征、患者处置和所需治疗。研究结果在赛事举办的 9 年间,爱丽斯泉医院共收治了 325 名患者。患者几乎全部为男性(98.8%),平均年龄为 34.75 岁,居住在爱丽斯泉以外的地区(82.2%)。共有 460 例不同程度的受伤,锁骨、脊柱和肋骨是最常见的三个受伤部位。总共需要进行 129 次手术,其中 19 次需要送往州际中心。这种偏远的地理位置给医疗和救援服务的协调工作带来了独特的挑战,而对于像芬克这样集中且资源高度密集的事件来说,这种挑战就更加严峻了。此次审查首次量化了该事件造成的创伤负担,使当地和州际利益相关者有能力规划适当且可持续的应对措施,同时也有助于对近期安全改革的未来效果进行评估。
{"title":"The burden of Finke Desert race-related trauma: A 10-year retrospective descriptive analysis","authors":"Matthew G. Cehic MD,&nbsp;Casey Knight MBBS,&nbsp;David Morris MD,&nbsp;James Van Essen MD,&nbsp;Nitin Bither MS (Orthopaedic Surgery),&nbsp;Kanishka Williams FRACS (Orthopaedic Surgery)","doi":"10.1111/ajr.13124","DOIUrl":"10.1111/ajr.13124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Finke Desert Race is an annual motorsport race (motorbikes, cars and buggies) held in Alice Springs resulting in a significant major trauma burden. This imposes unique challenges in one of the world's most remote healthcare settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To quantify the volume and characteristics of Finke Desert Race-related trauma presenting to the Alice Springs Hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective descriptive study was undertaken to review all patients presenting to the Alice Springs Hospital with Finke Desert Race-related trauma over a 10-year period. Information collected included demographic data, injury characteristics, patient disposition and required management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Over the 9 years the event was held, 325 patients were admitted to the Alice Springs Hospital. Patients were almost exclusively male (98.8%), with a mean age of 34.75 and residing outside of Alice Springs (82.2%). There were a total of 460 distinct injuries with the clavicle, spine and ribs the three most commonly injured sites. A total of 129 operations were required, of which 19 required retrieval to an interstate centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Alice Springs is one of the most remote and geographically isolated centres on Earth. This rurality poses unique challenges when trying to coordinate medical and retrieval services, exacerbated for a concentrated, yet highly resource intensive event such as Finke. It has far reaching impacts, placing additional stresses on all aspects of healthcare provision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review has quantified the trauma burden of the event for the first time, enabling local and interstate stakeholders' ability to plan an adequate and sustainable response while also enabling the future effectiveness evaluation of recent safety reforms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"684-692"},"PeriodicalIF":1.9,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140680816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Health equity in clinical trials for regional, rural and First nations communities: Need for networked clinical trial system, through a values and purpose-aligned system culture 地区、农村和原住民社区临床试验的健康公平性:需要通过价值观和目标一致的系统文化,建立网络化的临床试验系统。
IF 1.8 4区 医学 Q2 NURSING Pub Date : 2024-04-17 DOI: 10.1111/ajr.13122
Sabe Sabesan FRACP, Melanie Poxton B Nursing
<p>Clinical trials are essential components of health practice and are vital to developing new therapies, advancing interventions, improving service delivery and enhancing models of care.<span><sup>1</sup></span> For patients, participation in clinical trials improves outcomes in many disease areas and reduces variation in practice, due to strict monitoring requirements. For health practitioners, clinical trials present an opportunity to be at the cutting edge of best practice. For services, clinical trials improve standard procedures. For health systems, industry sponsored trials are an additional source of revenue that could be reinvested to build clinical trial units. Reports suggest that there is significant return on investment in this sector.<span><sup>2</sup></span></p><p>For these and other reasons, the new National Clinical Trial Governance Framework has called for clinical trials to be included as a routine aspect of clinical practice.<span><sup>3</sup></span> In the cancer care sector, which serves a significant number of patients with incurable diseases, international guidelines recommend clinical trials as the first option.<span><sup>4</sup></span> This means, to be aligned with international best practice, every cancer service should be offering clinical trials to all cancer patients regardless of postcode, at least for patients with incurable diseases.</p><p>Australia and many Western countries have invested significant resources to build clinical trial capabilities and enable engagement in local and international trials. However, people in regional, rural and First nations communities continue to have limited access to trials close to home.<span><sup>5, 6</sup></span> As a result, they must endure substantial travel, major costs and inconvenience, and often, must relocate to metropolitan centres or pass up the opportunity to participate. This is a key challenge highlighted by the accompanying commentary (Walsh et al.)<span><sup>7</sup></span> and specifically emphasised in the accompanying research paper (McPhee et al.).<span><sup>7, 8</sup></span> Alarmingly, an MJA study recently described particularly poor representation of First nations communities in trials (exemplified in trials of parenting programs).<span><sup>9</sup></span></p><p>Many of the challenges and barriers to health services in regional, rural and First nations communities are apparent (or even more pronounced) in the case of clinical trials. Workforce shortages and turn over at all levels, limited skills and awareness among staff of the potential benefit of trials, and inadequate investment in infrastructure are common. This constrains such sites from attracting sponsors and hosting clinical trials as stand-alone sites. Beyond this, system cultural issues within rural and First nations services may stifle participation, or the economic imperatives of metropolitan trial units and their sponsors may overrule.</p><p>In the light of the above, it is not unreasonable
临床试验是医疗实践的重要组成部分,对于开发新的疗法、推进干预措施、改善服务提供和加强护理模式至关重要。1 对患者而言,由于严格的监测要求,参与临床试验可改善许多疾病领域的治疗效果,并减少实践中的差异。对医疗从业人员来说,临床试验提供了一个站在最佳实践前沿的机会。对医疗服务机构来说,临床试验可以改进标准程序。对于医疗系统来说,行业赞助的试验是一个额外的收入来源,可用于再投资,建立临床试验单位。有报告显示,在这一领域的投资回报率很高。2 出于上述原因和其他原因,新的《国家临床试验管理框架》呼吁将临床试验作为临床实践的一个常规方面。3 在癌症治疗领域,有大量的不治之症患者,国际指南建议将临床试验作为首选。这意味着,为了与国际最佳实践接轨,每家癌症治疗机构都应为所有癌症患者提供临床试验服务,而不论其邮政编码如何,至少对于无法治愈的疾病患者而言是如此。澳大利亚和许多西方国家都投入了大量资源来建设临床试验能力,使患者能够参与本地和国际试验。5, 6 因此,他们必须忍受长途跋涉、高昂的费用和不便,而且往往必须搬迁到大都市中心,否则就会放弃参与试验的机会。这是随附的评论(Walsh 等人)7 中强调的一个主要挑战,随附的研究论文(McPhee 等人)也特别强调了这一点。各级人员短缺和更替、工作人员技能有限、对试验潜在益处的认识不足、基础设施投资不足,这些都是普遍存在的问题。这就限制了这些试验点吸引赞助商并作为独立试验点开展临床试验。除此之外,农村和原住民医疗服务机构内部的系统文化问题可能会阻碍试验的参与,或者大都市试验单位及其赞助商的经济要求可能会压倒一切。综上所述,我们可以得出这样的结论:大多数地区、农村、偏远地区和原住民医疗服务机构都无法作为独立的临床试验机构发挥作用。作为一种替代方案,政府审查和政府战略计划,包括国家卫生与医学研究中心等机构,都主张采用分散试验访问的网络化方法。例如,为了在系统层面建立分散的临床试验,联邦政府通过医学研究未来基金(MRFF)资助各州和地区建立了由昆士兰州卫生部门牵头的澳大利亚远程试验计划(Australian Teletrial Program),同样,新南威尔士州和澳大利亚首都领地政府也于 2019 年建立了地区、农村和偏远地区试验计划。这两项计划的总价值达 1 亿澳元,采用澳大拉西亚 Teletrial 模式(最初由澳大利亚临床肿瘤学会的农村和地区小组设计)作为机制,将较大和较小的试验点连接起来,形成试验集群。这样,全国各地的小型中心就有可能提供某些或所有方面的试验。(这种模式的操作细节可参见《全国试验简编》(National Teletrials Compendium; https://www.health.gov.au/resources/collections/the-national-teletrials-compendium)。这些计划旨在建立有利的基础设施、制定监管流程并进行能力建设,以创建一个可行的网络化分散试验系统。同样,PARTNER 计划旨在建设地区和农村初级保健实践的试验能力 (https://partnernetwork.com.au/)。此类计划利用各州/地区的地区临床试验协调中心 (RCCC) 来帮助临床医生熟悉必要的审批流程。在过去两年中,一些试验是通过远程试验模式进行的。我们现在有一项 1 亿美元的计划,旨在改善区域、农村、偏远地区和原住民社区的试验机会。
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引用次数: 0
Differences in cancer clinical trial activity and trial characteristics at metropolitan and rural trial sites in Victoria, Australia 澳大利亚维多利亚州大都市和农村试验点癌症临床试验活动和试验特征的差异。
IF 1.8 4区 医学 Q2 NURSING Pub Date : 2024-04-17 DOI: 10.1111/ajr.13102
Narelle J. McPhee MND, Michael Leach PhD, Claire E. Nightingale PhD, Samuel J. Harris MBBS, Eva Segelov PhD, Eli Ristevski PhD

Objective

Cancer clinical trials (CCTs) provide access to emerging therapies and extra clinical care. We aimed to describe the volume and characteristics of CCTs available across Victoria, Australia, and identify factors associated with rural trial location.

Methods

Quantitative analysis of secondary data from Cancer Council Victoria's Clinical Trials Management Scheme dataset.

Design

A cross-sectional study design was used.

Setting

CCTs were available Victoria-wide in 2018.

Participants

There were 1669 CCTs and 5909 CCT participants.

Main Outcome Measures

Rural CCT location was assessed as a binary variable with categories of ‘yes’ (modified Monash [MM] categories 2–7) and ‘no’ (MM category 1). MM categories were determined from postcodes. The highest (‘least rural’) MM category was used for postcodes with multiple MM categories.

Results

Of 1669 CCTs, 168 (10.1%) were conducted in rural areas. Of 5909 CCT participants, 315 (5.3%) participated in rural CCTs. There were 526 CCTs (31.5%) with 1907 (32.3%) newly enrolled participants. Of 1892 newly enrolled participants with postcode data, 488 (25.8%) were rural residents. Of them, 368 (75.4%) participated in metropolitan CCTs. In a multivariable logistic regression analysis for all 1669 CCTs, odds of a rural rather than metropolitan CCT location were significantly (p-value <0.05) lower for early-phase than late-phase trials and non-solid than solid tumour trials but significantly (p-value <0.05) higher for non-industry than industry-sponsored trials.

Conclusions

In Victoria, 10% of CCTs are at rural sites. Most rural-residing CCT participants travel to metropolitan sites, where there are more late-phase, non-solid-tumour and industry-sponsored trials. Approaches to increase the volume and variety of rural CCTs should be considered.

目的癌症临床试验(CCT)为患者提供了获得新兴疗法和额外临床护理的机会。我们旨在描述澳大利亚维多利亚州的CCT数量和特点,并确定与农村试验地点相关的因素。方法对维多利亚州癌症委员会临床试验管理计划数据集的二手数据进行定性分析。主要结局测量农村CCT位置作为二元变量进行评估,分为 "是"(修改后的莫纳什[MM]类别2-7)和 "否"(MM类别1)两类。MM类别是根据邮编确定的。结果 在 1669 次 CCT 中,168 次(10.1%)在农村地区进行。在 5909 名 CCT 参与者中,315 人(5.3%)参加了农村 CCT。共有 526 次 CCT(31.5%),其中有 1907 名(32.3%)新注册的参与者。在 1892 名有邮政编码数据的新注册参与者中,有 488 人(25.8%)是农村居民。其中,368 人(75.4%)参加了大都市的 CCT。在对所有1669个CCT进行的多变量逻辑回归分析中,CCT地点在农村而非大都市的几率在早期试验中显著低于晚期试验,在非实体瘤试验中显著低于实体瘤试验,但在非工业赞助的试验中显著高于工业赞助的试验(P值<0.05)。在维多利亚州,10%的CCT在农村地区进行。大多数居住在农村地区的CCT参与者前往大都市地区,因为那里有更多的晚期非实体肿瘤试验和行业赞助的试验。应考虑采取各种方法,增加农村 CCT 的数量和种类。
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引用次数: 0
期刊
Australian Journal of Rural Health
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