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Understanding the enablers to implementing sustainable health and well-being programs for older adults in rural Australia: A scoping review 了解在澳大利亚农村地区为老年人实施可持续健康和福利计划的有利因素:范围审查。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-20 DOI: 10.1111/ajr.13111
Belinda Cash PhD, Michael Lawless PhD, Kristy Robson PhD, Shanna Fealy PhD, Denise Corboy PhD

Introduction

Supporting the health and well-being of older Australians necessitates the implementation of effective and sustainable community-based interventions. Rural settings, however, pose unique challenges to intervention implementation and sustainability, with limited research exploring strategies employed to overcome these complexities.

Objective

To identify enabling strategies that support the sustainable implementation of community-based health and well-being interventions for older adults in rural Australia.

Design

A scoping review, following methods by Arksey and O'Malley and enhanced by elements of the Joanna Briggs Institute methodology for scoping reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of seven databases was completed in April 2023. A thematic analysis was applied to provide a comprehensive and contextualised understanding of the phenomenon of interest.

Findings

Of 1277 records screened, 15 studies were identified and included for review. Five themes identified key enablers for rural implementation: (1) Co-designing for the local context; (2) Embedding local champions; (3) Leveraging existing local resources; (4) Maintaining impact beyond the end of the funded period and (5) Flexibility in funding models.

Discussion

The sustainable implementation of interventions requires active community involvement and consultation through all stages of program design and delivery to effectively meet the health and well-being needs of older rural-dwelling Australians.

Conclusion

Our findings advocate for clear implementation guidelines to support the design, delivery and adaptation of community-based programs that appropriately reflect the unique contextual needs and strengths of rural communities.

导言:要支持澳大利亚老年人的健康和福祉,就必须实施有效且可持续的社区干预措施。然而,农村环境给干预措施的实施和可持续性带来了独特的挑战,而探索克服这些复杂性的策略的研究却很有限:目标:确定支持澳大利亚农村地区老年人可持续实施社区健康与福利干预措施的有利策略:设计:按照Arksey和O'Malley的方法进行了范围界定综述,并借鉴了乔安娜-布里格斯研究所(Joanna Briggs Institute)的范围界定综述方法和范围界定综述系统性综述和Meta分析扩展首选报告项目(PRISMA-ScR)。2023 年 4 月完成了对七个数据库的电子检索。采用专题分析法对感兴趣的现象进行了全面和背景化的理解:在筛选出的 1277 条记录中,确定并纳入了 15 项研究进行审查。五个主题确定了农村实施的主要推动因素:(1)针对当地情况共同设计;(2)嵌入当地拥护者;(3)利用当地现有资源;(4)在资助期结束后保持影响;(5)资助模式的灵活性:讨论:干预措施的可持续实施需要社区积极参与,并在计划设计和实施的各个阶段进行磋商,以有效满足居住在农村的澳大利亚老年人的健康和福利需求:我们的研究结果主张制定明确的实施指南,以支持社区计划的设计、实施和调整,从而适当反映农村社区独特的背景需求和优势。
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引用次数: 0
A community-based modified sport program for rural community-dwelling older adults: A pilot study 针对居住在农村社区的老年人的社区改良体育计划:试点研究。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-20 DOI: 10.1111/ajr.13108
Jake Romein MClinExPhys, Gabrielle Hutchins BHlthSc (Nutr&Exerc), Ella Ottrey PhD, Scott Talpey PhD, Jaclyn Bishop PhD

Introduction

With Australiaʼs ageing population, especially in rural regions, promoting physical activity among older adults is crucial.

Objective

To identify factors influencing participation of older adults (60 years or over) from a rural community in a modified sport program and assess satisfaction with a pilot modified sport program informed by these findings.

Design

Insights and ideas from two focus groups exploring community perspectives on a modified sport program informed the development of a six-week pilot modified sport program delivered with the local fitness centre. Post-program surveys assessed participant satisfaction, willingness to continue, and likelihood of recommending the program to others.

Findings

Nine participants attended the focus groups, highlighting increased social connection, health management, and healthy ageing as key motivators. Joint and health concerns, cost, and time constraints emerged as main barriers. Preferences for the program included weekly sessions, alternating sports, indoor venues, and supporting modifications, but maintaining traditional rules.

Thirteen participants participated in the pilot modified sport program. There was strong program attendance (86%). All participants (13/13) rated their satisfaction as very satisfied. They were highly likely to recommend the program to others (8.5/10) and were interested in continuing modified sport after the pilot (7.7/10).

Discussion

This study demonstrates for the first time that modified sport is of interest to older people in the rural setting, and that delivering such a program is feasible in a small community. Rural communities implementing modified sport should consider the availability of suitable facilities and equipment, access to an engaging facilitator and participant cost.

Conclusion

Through a strong connection between the health service and community fitness centre, a modified sport program was developed and implemented, well-attended and enjoyed by participants in a rural community.

导言:随着澳大利亚人口老龄化的加剧,尤其是在农村地区,促进老年人的体育锻炼至关重要:目的:确定影响农村社区老年人(60 岁或以上)参与改良运动项目的因素,并根据这些结果评估改良运动试点项目的满意度:设计:两个焦点小组探讨了社区对改良运动项目的看法,其见解和想法为与当地健身中心合作开展为期六周的改良运动试点项目提供了依据。项目结束后的调查评估了参与者的满意度、继续参与的意愿以及向他人推荐该项目的可能性:九名参与者参加了焦点小组,他们强调增加社会联系、健康管理和健康老龄化是主要动机。关节和健康问题、费用和时间限制是主要障碍。对该计划的偏好包括每周一次的课程、交替运动、室内场地、支持修改,但保留传统规则。13 名参与者参加了改良运动试点项目。活动出勤率很高(86%)。所有参与者(13/13)的满意度都被评为 "非常满意"。他们极有可能向其他人推荐该项目(8.5/10),并有兴趣在试点项目结束后继续开展改良运动(7.7/10):讨论:本研究首次表明,农村地区的老年人对改良运动感兴趣,而且在小社区开展此类活动是可行的。农村社区在开展改良运动时,应考虑是否有合适的设施和设备、是否有吸引人的主持人以及参与者的费用:通过卫生服务机构和社区健身中心之间的紧密联系,一项改良运动计划得以开发和实施,并在农村社区得到了广泛的参与和参与者的喜爱。
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引用次数: 0
No shortcuts: False economy prevention during artificial intelligence implementation in rural Australian health care 没有捷径:澳大利亚农村医疗保健实施人工智能过程中的经济失误预防。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-20 DOI: 10.1111/ajr.13104
Joshua G. Kovoor MBBS, MS, Cansy Ittimani CA, Harry Godber LLB, BEc, Asith Herath BCom, BEc, Morgan Ovenden BEc, BFin, Christopher D. Ovenden MBBS, MS, Joseph N. Hewitt MBBS, MMed, Ammar Zaka MD, Mana Ittimani MBBS, FACEM, Matthew Marshall-Webb MBBS, FRACS, Aashray K. Gupta MBBS, MS, Brandon Stretton MBBS, MClinEd, Stephen Bacchi MBBS, PhD
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引用次数: 0
How the training pathways and capacity of rural physicians inform their scope of practice: A qualitative study examining the experiences of Australian and international medical graduates in South-East New South Wales, Australia 乡村医生的培训途径和能力如何影响其执业范围:对澳大利亚新南威尔士州东南部的澳大利亚和国际医学毕业生经历的定性研究。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-19 DOI: 10.1111/ajr.13105
Sarath Burgis-Kasthala PhD, Suzanne Bain-Donohue VCHAM, Ellen Tailby MMedRadSc, Kathryn Stonestreet MBA, Malcolm Moore FRACGP

Introduction

Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors’ professional journey engenders the skills required to practice rurally.

Objective

This paper analyses how rural general practitioners’ clinical pathway informs their scope of practice and future retention.

Design

Qualitative thematic analysis using semi-structured telephone interviews. Twenty-one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG).

Findings

AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates’ familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work-life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high-volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice.

Discussion

IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice.

Conclusion

Doctors’ scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to

导言:当前解决乡村医生短缺问题的战略重点是培养乡村全科医生。对医生的职业历程如何培养乡村执业所需的技能的研究有限:本文分析了乡村全科医生的临床路径如何影响其执业范围和未来的留任:设计:通过半结构化电话访谈进行定性专题分析。在过去 10 年中,21 名全科医生在澳大利亚 Murrumbidgee 和南新南威尔士州的当地卫生区任职。参与者包括 10 名澳大利亚医学毕业生(AMG)和 11 名国际医学毕业生(IMG):结果:澳大利亚医学毕业生和国际医学毕业生对比了他们进入农村执业的途径以及在农村工作的能力如何影响他们的执业范围。澳大利亚医学毕业生对农村地区的熟悉程度通过在农村临床学校等地的共同经历得到了巩固。矛盾的是,培训的流畅性限制了澳大利亚医学毕业生在无人监督的情况下获得的经验和信心。再加上注重工作与生活的平衡,这使得许多人只能提供主流的全科医疗服务,无法扩展其执业范围。国际医学毕业生介绍了他们的经验,这些经验往往是在工作量大的情况下在无人指导的情况下获得的。然而,由于缺乏专业机会,他们无法扩大自己的执业范围:讨论:IMG 和 AMG 在农村工作的动机和途径各不相同。这两类人都关注农村实践所需的技能和知识,其中包括机会和认可。培训的切入点应该是可变的,以便考虑到人生阶段、先前的技能发展和执业范围的扩展:医生的执业范围取决于他们进入农村执业的途径。澳大利亚医学毕业生在快速培训计划中可能无法获得足够的能力,从而无法自信地开展扩展的临床活动。而国际医学毕业生则缺乏机会和支持,无法在农村执业中发挥自己的专长。同时利用澳大利亚医学毕业生和国际医学毕业生的专业知识和承诺,可以协同解决劳动力短缺问题。
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引用次数: 0
Tranexamic acid versus oxytocin for primary postpartum Haemorrhage in the out-of-hospital setting: A systematic review with implications for rural practice 氨甲环酸与催产素治疗院外环境下的原发性产后出血:系统性综述对农村实践的影响。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-15 DOI: 10.1111/ajr.13103
Megan De Silva BHlthSc (Paramedicine), Gabrielle Mizzi BHlthSc (Paramedicine), Emily Potts BHlthSc (Paramedicine), Jayden Webb BHlthSc (Paramedicine), Elizabeth Thyer PhD, Navindhra Naidoo PhD

Introduction

Primary postpartum haemorrhage causes approximately 25% of global maternal deaths and accounts for significant maternal morbidity. While high certainty evidence demonstrates that tranexamic acid reduces comparative blood loss in postpartum haemorrhage in hospital settings, limited data exist on the specific pharmacological management of this condition in out-of-hospital settings, and the implications for rural communities.

Objective

To determine the efficacy of oxytocin compared to tranexamic acid in women suffering postpartum haemorrhage in the out-of-hospital environment.

Design

A systematic review comparing evidence containing patients with postpartum haemorrhage in the out-of-hospital and/or rural setting, in which oxytocin/tranexamic acid were used. Outcome measures were comparative blood loss/haemorrhagic shock, the need for further interventions and maternal/neonatal morbidity/mortality.

Findings

No randomised control trials have been conducted in an out-of-hospital environment in relation to oxytocin/tranexamic acid. In this setting, there is no difference in outcome measures when using oxytocin compared to no intervention, or oxytocin compared to standard care. Data are lacking on the effect of tranexamic acid on the same outcome measures.

Discussion

Rural and out-of-hospital management of postpartum haemorrhage is limited by resource availability and practitioner availability, capacity and experience. In-hospital evidence may lack transferability, therefore direct evidence on the efficacy of pharmacological management in these contexts is scant and requires redress.

Conclusion

There is no difference in blood loss, neonatal or maternal mortality or morbidity, or need for further interventions, when using oxytocin or TXA compared to no intervention, or compared to standard care, for PPH. Further studies are needed on the efficacy of these drugs, and alternate or co-drug therapies, for PPH in the out-of-hospital environment and rural clinical practice.

导言:原发性产后出血约占全球孕产妇死亡人数的 25%,也是孕产妇发病率的重要原因。尽管确凿证据表明,氨甲环酸可减少医院环境中产后出血的失血量,但有关院外环境中这种情况的具体药物治疗以及对农村社区的影响的数据却很有限:目的:确定催产素与氨甲环酸对医院外产后出血妇女的疗效比较:设计:一项系统性综述,比较医院外和/或农村地区产后出血患者使用催产素/氨甲环酸的证据。结果测量指标为比较失血量/失血性休克、是否需要进一步干预以及孕产妇/新生儿发病率/死亡率:没有在院外环境中进行过与催产素/氨甲环酸有关的随机对照试验。在这种情况下,使用催产素与不使用干预措施相比,或使用催产素与标准护理相比,在结果测量方面没有差异。关于氨甲环酸对相同结果指标的影响,目前还缺乏相关数据:讨论:农村和院外产后出血管理受到资源可用性、从业人员可用性、能力和经验的限制。院内证据可能缺乏可移植性,因此在这些情况下药物治疗疗效的直接证据很少,需要加以纠正:结论:在 PPH 的治疗中,使用催产素或 TXA 与不使用干预措施相比,或与标准护理相比,在失血量、新生儿或产妇死亡率或发病率或进一步干预的需求方面没有差异。在院外环境和农村临床实践中,还需要进一步研究这些药物以及替代或联合药物疗法对 PPH 的疗效。
{"title":"Tranexamic acid versus oxytocin for primary postpartum Haemorrhage in the out-of-hospital setting: A systematic review with implications for rural practice","authors":"Megan De Silva BHlthSc (Paramedicine),&nbsp;Gabrielle Mizzi BHlthSc (Paramedicine),&nbsp;Emily Potts BHlthSc (Paramedicine),&nbsp;Jayden Webb BHlthSc (Paramedicine),&nbsp;Elizabeth Thyer PhD,&nbsp;Navindhra Naidoo PhD","doi":"10.1111/ajr.13103","DOIUrl":"10.1111/ajr.13103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Primary postpartum haemorrhage causes approximately 25% of global maternal deaths and accounts for significant maternal morbidity. While high certainty evidence demonstrates that tranexamic acid reduces comparative blood loss in postpartum haemorrhage in hospital settings, limited data exist on the specific pharmacological management of this condition in out-of-hospital settings, and the implications for rural communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the efficacy of oxytocin compared to tranexamic acid in women suffering postpartum haemorrhage in the out-of-hospital environment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A systematic review comparing evidence containing patients with postpartum haemorrhage in the out-of-hospital and/or rural setting, in which oxytocin/tranexamic acid were used. Outcome measures were comparative blood loss/haemorrhagic shock, the need for further interventions and maternal/neonatal morbidity/mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>No randomised control trials have been conducted in an out-of-hospital environment in relation to oxytocin/tranexamic acid. In this setting, there is no difference in outcome measures when using oxytocin compared to no intervention, or oxytocin compared to standard care. Data are lacking on the effect of tranexamic acid on the same outcome measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Rural and out-of-hospital management of postpartum haemorrhage is limited by resource availability and practitioner availability, capacity and experience. In-hospital evidence may lack transferability, therefore direct evidence on the efficacy of pharmacological management in these contexts is scant and requires redress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is no difference in blood loss, neonatal or maternal mortality or morbidity, or need for further interventions, when using oxytocin or TXA compared to no intervention, or compared to standard care, for PPH. Further studies are needed on the efficacy of these drugs, and alternate or co-drug therapies, for PPH in the out-of-hospital environment and rural clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140141204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Scapular fractures: A regional and rural perspective 肩胛骨骨折:地区和农村视角。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-13 DOI: 10.1111/ajr.13100
Nordan Flaaten MD, Huissan Moslim MD, Eric Tang MBBS, Ruth Varrall MBBS

Introduction

Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective.

Objective

The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre.

Design

The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries.

Findings

One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma.

Discussion

A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world.

Conclusion

Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.

介绍:肩胛骨骨折(SFs)历来与严重创伤和多发性损伤有关。最近的研究表明,肩胛骨骨折的治疗效果有所改善。然而,人们从未从严格意义上的农村或澳大利亚角度对肩胛骨骨折进行过研究:该研究的目的是评估在澳大利亚一个地区性创伤中心,肩胛骨骨折与创伤评分、死亡率和其他常见相关损伤之间是否仍然存在关联:研究设计对一家地区医院在2012年至2021年期间收集到的急诊科创伤性肩胛骨骨折患者的前瞻性数据进行了检查。主要研究结果包括死亡率、受伤方式、ISS评分和相关损伤:105 名患者患有 SF。中位年龄为 49 岁,其中 93 人(89%)为男性。大多数骨折位于肩胛骨体(80%)。受伤的主要原因是摩托车事故(36%)、跌倒(24%)和机动车事故(22%)。两名患者因伤死亡(1.9%)。34%的患者为轻度创伤,36%为中度创伤,28%为重度创伤,1.9%为危重创伤。常见的相关损伤包括胸壁骨折、脊椎骨折、胸部损伤、脑损伤和腹部创伤:讨论:少数 SF 与严重或危重创伤相关,总体而言,SF 患者的死亡率较低。这些研究结果表明,来自地区的患者与来自世界其他地区城市中心的患者结果相似:鉴于这些结果,应考虑重新审查 SF 是否是严重创伤的可靠标志。
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引用次数: 0
Positive change in intent to practice rurally is strongly associated with nursing and allied health students of metropolitan origin after rural clinical placement 来自大都市的护理和专职医疗学生在农村临床实习后,其农村实习意向发生了积极变化。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-08 DOI: 10.1111/ajr.13099
Kristen M. Glenister PhD, Robyn McNeil MPH, Trish Thorpe MCB, Lisa Bourke PhD

Objective

To: (1) assess whether rural clinical placements influence change in intention to practice rurally for nursing and allied health students, (2) to assess whether residential origin (metropolitan or rural) or university location (metropolitan or non-metropolitan) influence this change, and (3) assess residential origin of health professionals practicing rurally after graduation.

Design

Cross-sectional survey (2014-2022) conducted in Northern/Northeastern Victoria and Grampians region by nursing and allied health students completing rural clinical placements. Survey explored student placement satisfaction, intention to practice rurally and demographic information, with a follow-up two years’ post-placement.

Findings

Experience of a rural placement increased students’ intention of practicing rurally. Importantly, 57% of metropolitan origin students studying at metropolitan campuses exhibited positive change. Logistic regression analysis suggested that after controlling for age, gender and satisfaction with placement and supervision, students of metropolitan origin at metropolitan campuses were 6.4 times more likely to report positive change in intent to practice rurally after placement than students of rural origin studying at non-metropolitan campuses.Follow-up data suggested that a substantial proportion of health professionals providing services in rural areas were of metropolitan origin.

Results

These findings concur that rural origin and rural training are important predictors of working rurally. Additionally, metropolitan students can change their intention to practice rurally after a rural placement.

Conclusions

This study supports strategies to enhance intention to practice rurally that are not restricted to rural origin students to build rural workforce.

目的目的:(1) 评估农村临床实习是否会影响护理和专职医疗学生的农村实习意向的变化,(2) 评估居住地(大都市或农村)或大学所在地(大都市或非大都市)是否会影响这种变化,(3) 评估毕业后在农村实习的医疗专业人员的居住地:设计:在维多利亚州北部/东北部和格兰皮恩斯地区对完成农村临床实习的护理和专职医疗学生进行横断面调查(2014-2022 年)。调查内容包括学生对实习的满意度、在农村实习的意向以及人口统计学信息,并在实习两年后进行跟踪调查:调查结果:农村实习经历增加了学生的农村实习意向。重要的是,57%在大都市校园学习的大都市出身的学生表现出了积极的变化。逻辑回归分析表明,在控制了年龄、性别以及对实习和监督的满意度后,在大都市校园学习的大都市籍学生在实习后报告在农村实习的意愿发生积极变化的可能性是在非大都市校园学习的农村籍学生的 6.4 倍:这些研究结果表明,农村出身和农村培训是在农村工作的重要预测因素。此外,大都市学生在农村实习后也会改变他们在农村实习的意向:本研究支持提高农村实习意向的策略,这些策略并不局限于农村出身的学生,而是要建立农村劳动力队伍。
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引用次数: 0
Perioperative knowledge, self-efficacy and clinical practices related to postoperative delirium care in older people across geographical regions in Australia 与澳大利亚不同地区老年人术后谵妄护理相关的围手术期知识、自我效能和临床实践。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-08 DOI: 10.1111/ajr.13097
Ezinne O. Igwe PhD, Jessica Nealon PhD, Pauline O'Shaughnessy PhD, Callum Ormonde MBBS, Victoria Traynor PhD

Introduction

In older people undergoing surgery, there is a lower tolerance for complications. This highlights the need for documented clinical practices on proper prevention, pre-screening and management of complications such as postoperative delirium (POD). Evidence-based clinical practice guidelines exist for delirium management; however, the management of delirium in clinical settings differs widely.

Objective

This study aims to develop an understanding of the knowledge, components of self-efficacy (confidence/competence), and clinical practice related to POD care among preoperative and recovery nurses across different types of geographical locations in Australia.

Design

A 27-item online survey was sent out to professional associations focused on perioperative care across Australia. The participants included practicing registered nurses specialising in perioperative care. The main outcome measures were Knowledge, confidence/competence and clinical practice relating to POD care in older patients.

Findings

Respondents were categorised into two groups—major cities and rural and remote. Mean age was 46.3 years for respondents in Australian major cities and 49.5 for the comparison group. There was a statistically significant difference between Australian major cities and ‘rural and remote’ in confidence in detecting hyperactive delirium, 25.2% versus 11.7% respectively as well as managing hyperactive delirium, 13.8% versus 1.7%, respectively. Similar results were also observed on hypoactive delirium. Respondents from both groups did not mirror the ideal situation in managing a hyperactive delirium.

Discussion

Results from this study are inconclusive and there is no clear-cut observation in clinical practice or knowledge between the two geographical categories in this study.

Conclusion

The absence of a distinct strategy with POD prevention highlights the need for a uniform approach and consensus on POD prevention and management in older people. This can be achieved by creating more awareness and education through professional development related to POD.

导言接受手术的老年人对并发症的耐受力较低。这凸显了对术后谵妄(POD)等并发症的正确预防、预检和管理的临床实践记录的必要性。目前已有基于证据的谵妄管理临床实践指南,但临床环境中对谵妄的管理却大相径庭:本研究旨在了解澳大利亚不同地理位置的术前和恢复期护士对 POD 护理的相关知识、自我效能(信心/能力)和临床实践:设计:向澳大利亚各地专注于围术期护理的专业协会发送了一份包含 27 个项目的在线调查。参与者包括专门从事围手术期护理的执业注册护士。主要结果指标为老年患者 POD 护理的相关知识、信心/能力和临床实践:受访者分为两组--大城市和农村及偏远地区。澳大利亚大城市受访者的平均年龄为 46.3 岁,对比组为 49.5 岁。澳大利亚大城市与 "农村和偏远地区 "的受访者在发现多动谵妄的信心方面存在显著差异(分别为 25.2% 对 11.7%),在处理多动谵妄的信心方面也存在显著差异(分别为 13.8% 对 1.7%)。在低能谵妄方面也观察到了类似的结果。两组受访者在处理多动谵妄时都没有反映出理想的情况:讨论:本研究的结果尚无定论,在临床实践或知识方面,本研究中的两个地域类别之间没有明显的差异:结论:缺乏预防 POD 的独特策略凸显了在老年人 POD 预防和管理方面采取统一方法和达成共识的必要性。要做到这一点,就必须通过与 POD 相关的专业发展,提高人们对 POD 的认识并加强教育。
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引用次数: 0
Young people's experiences of the Northern Rivers 2017 flood and its effects on their mental health 年轻人在 2017 年北部河流洪灾中的经历及其对心理健康的影响。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-03-08 DOI: 10.1111/ajr.13095
Michelle Luk, Jo Longman PhD

Objective

To explore young people's (YP) experiences of catastrophic flooding in the Northern Rivers area of northern NSW in 2017 and its effect on their mental health.

Design

Content analysis of free-text survey responses (written responses to open questions, rather than selecting a response option).

Setting

Northern Rivers NSW.

Participants

YP aged 16–25 years who were Northern Rivers residents at the time of the 2017 flood.

Results

YP found their flood experience to be novel and challenging. They expressed worry, distress, anxiety, and worsened pre-existing mental health issues as a result of the flood. YP reported a number of primary stressors (inadequate preparedness, warning and support during the flood) and secondary stressors (loss/damage of property and possessions, financial strain and disruptions to daily life) which potentially contributed to poor mental health. Some YP reported positive outcomes from their flood experience, notably increased community connectedness and personal resilience. However, they also expressed concern for the future, particularly potential reoccurrence of extreme floods as well as climate change. YP conveyed a desire for better community involvement to improve preparedness for future floods and a clear motivation to take action on climate change.

Conclusion

The flood was a challenging experience for YP which was commonly described as negatively affecting their mental health. Understanding what YP view as significant events or issues arising from their personal flood experience may help target support mechanisms and services to maintain their mental. More focus on community-based initiatives to improve disaster preparedness can support mental health in YP.

目的:探讨年轻人(YP)在 2017 年新南威尔士州北部北河地区灾难性洪灾中的经历及其对心理健康的影响:探讨年轻人(YP)在 2017 年新南威尔士州北部北河地区灾难性洪灾中的经历及其对心理健康的影响:对自由文本调查回复(对开放式问题的书面回复,而非选择一个回复选项)进行内容分析:新南威尔士州北部河流地区:参与者:2017 年洪灾发生时身为北部河流居民的 16-25 岁青年:结果:青年认为他们的洪灾经历既新奇又具有挑战性。他们对洪灾表示担忧、苦恼、焦虑,原有的心理健康问题也因洪灾而恶化。青年报告了一些主要压力源(洪灾期间准备不足、预警不足和支持不足)和次要压力源(财产和物品的损失/损坏、经济压力和对日常生活的干扰),这些都有可能导致心理健康状况不佳。一些青年报告说,他们从洪灾经历中获得了积极的结果,尤其是增强了社区联系和个人复原力。然而,他们也对未来表示担忧,特别是可能再次发生的特大洪灾以及气候变化。青年党表达了更好地参与社区活动的愿望,以提高对未来洪灾的防备能力,并表达了采取行动应对气候变化的明确动机:洪水对青少年来说是一次具有挑战性的经历,他们普遍认为洪水对他们的心理健康造成了负面影响。了解青年在个人洪灾经历中认为重要的事件或问题,有助于有针对性地提供支持机制和服务,以保持他们的精神健康。更多关注以社区为基础的措施,以改善备灾工作,可以为青少年的心理健康提供支持。
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引用次数: 0
Perioperative and anaesthetic considerations in rural patients on GLP-1 receptor agonists: An update 使用 GLP-1 受体激动剂的农村患者的围手术期和麻醉注意事项:更新。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2024-02-29 DOI: 10.1111/ajr.13096
Luke K. M. Chan MD
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引用次数: 0
期刊
Australian Journal of Rural Health
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