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Objective This paper contributes to the literature on relocation for specialist care by providing findings on specific issues impacting on rural farmers and property owners who have to travel to the metropolitan area for specialist care for a haematological malignancy. Design and setting This paper uses descriptive qualitative research based on 45 interviews with patients with haematology in Queensland. The interviews were audio-recorded, transcribed verbatim, coded and thematically analysed. Results In addition to issues of distance, farmers and rural property owners who have to relocate for specialist care must deal with problems associated with the lack of opportunity to take absence from the property because of the inescapable pressure of daily farm and property responsibilities and the high cost of, or lack of opportunity to, outsource daily maintenance. Further concerns include the cost of relocation in the context of continuing drought, serious problems sustaining the travel and time away required, and the lack of choice for some but to deal with treatment alone. Conclusion In recent years there has been considerable progress with regard to overcoming the distance barrier for rural and remote patients with cancer through innovative clinical models using technology and telemedicine. However, there has been limited uptake of such models for patients with haematology. The present findings indicate that from the perspective of rural farmers and property owners there are important reasons why the use of innovative strategies should be fostered and expanded. [ABSTRACT FROM AUTHOR]

Objective Previous Australian studies have suggested poorer survival of patients with colorectal cancer in remote areas. To date no studies have assessed the geographic disparity in patients with metastatic disease. This retrospective cohort study looks at geographic differences in the surgical care and survival of patients with metastatic colorectal disease. The paper utilises data from the South Australian Clinical Registry for Metastatic Colorectal Cancer ( SACRMCC). Design, participants, interventions and main outcome measures Data on patients' socio-economic status, primary and metastatic tumour characteristics, treatment and survival was extracted from the SACRMCC database. A binomial model analysis was used to identify geographical differences in the surgical treatment of patients and a Cox proportional hazards model was used to identify any geographic differences in survival. Results The findings showed no differences in the diagnosis of liver metastases or provision of liver surgery between geographic areas, however there was a reduced likelihood of liver surgery with increasing age. The median overall survival rate, from the date of diagnosis of metastatic disease, was 20.0 months and the distribution by geographic remoteness was 19.1 months, 20.2 months, 22.0 months and 20.4 months in Major Cities, Inner Regional, Outer Regional and Remote areas respectively. This was not statistically significant. Conclusion Overall, there was no evidence of a geographical disparity in the diagnosis, surgical treatment or survival in metastatic colorectal cancer. This may be due to the shift toward centralising surgical care in South Australia. Nevertheless, there remains a need to improve the uptake of surgical care in the growing elderly population. [ABSTRACT FROM AUTHOR]

Objective This paper identified barriers which prevent rural health care providers from utilising rt- PA in acute ischaemic stroke and proposes possible support mechanisms to increase its utilisation. Methods This descriptive study uses data from anonymous surveys distributed to health care providers involved in acute stroke patient care in three rural hospitals with rt- PA pathways. Saturation sampling was used. Surveys gathered self assessed ratings of experience, practice environment, attitudes, existing support, barriers and possible enablers regarding rt- PA use in acute stroke. Results Physicians reported the strongest barriers to the use of rt- PA in acute stroke as pre-hospital delays (91%), risk of intracerebral haemorrhage ( ICH) (73%) and clinical diagnostic uncertainty (60%). They reported high levels of confidence in the support received from their stroke units (90%). Nurses identified a poor level of stroke education and knowledge on rt- PA utilisation in acute stroke. A third of nurses could correctly list six different stroke signs. The risk of ICH following rt- PA administration in stroke was also a significant barrier for nurses. Response rate from physicians was 26% (10/38) and 19% (13/69) for nurses. Conclusions To reduce barriers to rt- PA utilisation in rural facilities physicians require education on the calculated risk of ICH as well as exposure and experience to improve their ability to confidently diagnose stroke patients who are eligible for rt- PA treatment. Education for nurses on symptoms of stroke and rt- PA utilisation and administration is recommended. [ABSTRACT FROM AUTHOR]

Objective To obtain information about aged care services in rural New South Wales public hospitals, and to describe key operational aspects of their service delivery models. Design A mixed methods design was used to combine data collected from: (i) a survey of public hospitals and (ii) qualitative site visits in a sample of eleven rural sites. Setting Rural public hospitals in NSW, Australia. Participants Qualitative data were collected from multidisciplinary clinicians, managers and community service providers who participated in site visits in 2010 and from surveys of NSW public hospitals in 2009/10 about aged care and dementia services. Results Survey and site visit findings demonstrated that rural hospitals have fewer secure beds for managing patients with disturbed behaviour due to dementia and delirium and fewer speciality aged care staff than metropolitan hospitals. Site visit participants also described how secure environments can aid care for people with dementia even in the absence of clinical specialists. Conclusion The care of people with dementia in rural hospitals is constrained by access to specialist aged care staff and the physical environment of the hospital. Clinicians are adept at maximising resources to manage diagnosis and transitions for people with dementia. Further understanding of how key operational aspects of clinical leadership and environmental modifications impact on a range of patient outcomes would be valuable. [ABSTRACT FROM AUTHOR]

Objective: This pilot study explored the outcomes of clinical psychology trainees delivering treatments via videoconferencing. Design: A noncurrent, multiple baseline across subjects and settings. Setting: University outpatient psychology clinic. Participants: Six clients (two men and four women) with an anxiety or depressive disorder were randomly assigned to received six sessions of individual therapy (either via videoconferencing or face to face) from a male or female clinical psychology trainee. Main outcome measures: Participants provided daily ratings (0-10) of subjective distress/well-being via text messaging, and at pre-, post-, and 1 month follow-up of treatment, completed the Depression Anxiety Stress Scales and the Outcome Questionnaire-45. Along with the trainees, participants also provided feedback on the therapy experience. Results: The subjective well-being of all participants improved, and all videoconferencing participants showed a statistically and clinically significant reduction in symptomology and gains in general life functioning. Feedback comments were positive. Conclusions: This study suggests that there is value in clinical psychology trainees gaining experience in the delivery of treatments via videoconferencing. Further study is needed to demonstrate the potential for university clinics to deliver mental health services, via this modality, to rural and remote areas. [ABSTRACT FROM AUTHOR]