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Objective To examine the association between residential remoteness and stage of cancer at diagnosis, treatment uptake, and survival within the Australian Indigenous population. Design Systematic review and matched retrospective cohort study. Setting Australia. Participants Systematic review: published papers that included a comparison of cancer stage at diagnosis, treatment uptake, mortality and/or survival for Indigenous people across remoteness categories were identified (n = 181). Fifteen papers (13 studies) were included in the review. Original analyses: new analyses were conducted using data from the Queensland Indigenous Cancer Study (QICS) comparing cancer stage at diagnosis, treatment uptake, and survival for Indigenous cancer patients living in rural/remote areas (n = 627, 66%) and urban areas (n = 329, 34%). Main Outcome Measures Systematic review: Papers were included if there were related to stage of disease at diagnosis, treatment, mortality and survival of cancer. Restrictions were not placed on the outcome measures reported (e.g. standardised mortality ratios versus crude mortality rates). Original analyses: Odds ratios (OR, 95%CI) were used to compare stage of disease and treatment uptake between the two remoteness groups. Treatment uptake (treated/not treated) was analysed using logistic regression analysis. Survival was analysed using Cox proportional hazards regression. The final multivariate models included stage of cancer at diagnosis and area-level socioeconomic status (SEIFA). Results Existing evidence of variation in cancer outcomes for Indigenous people in remote compared with metropolitan areas is limited. While no previous studies have reported on differences in cancer stage and treatment uptake by remoteness within the Indigenous population, the available evidence suggests Indigenous cancer patients are less likely to survive their cancer the further they live from urban centres. New analysis of QICS data indicates that Indigenous cancer patients in rural/remote Queensland were less likely to be diagnosed with localised disease and less likely to receive treatment for their cancer compared to their urban counterparts. Conclusion More research is needed to fully understand geographic differentials in cancer outcomes within the Indigenous population. Knowing how geographical location interacts with Indigenous status can help to identify ways of improving cancer outcomes for Indigenous Australians. [ABSTRACT FROM AUTHOR]

The article talks about rural generalism in rural medical practice, focusing on a paper on rural generalist training delivered at the National General Practice Education and Training Conference in Queensland, Australia. The paper defined a rural generalist as a rural medical practitioner permitted to serve in hospital-based and community-based medical practice.

Objective: The aim of this study was to determine the incidence, characteristics and in‐hospital mortality of non‐ventilator‐associated hospital‐acquired pneumonia (NV‐HAP) in a regional (Modified Monash Model 2) Australian hospital. Methods: All cases with NV‐HAP were obtained from the Business Analysis and Decision Support (BADS) Unit between 1st January 2013 and 31st December 2018. Medical records were reviewed, and data pertaining to incidence, characteristics (age and gender), length of stay, co‐morbidities (measured using the Charlson Comorbidity Index) and in‐hospital mortality were extracted. Incidence rate was calculated as a proportion of NV‐HAP cases per 1000 bed‐days. Design: A retrospective study design was used to review all cases of NV‐HAP between 1 January 2013 and 31 December 2018 at a single regional Australian hospital. Using the Modified Monash Model (MMM), our regional setting is classified as a regional centre (MMM‐2). Setting: Rockhampton Hospital, Australia. Participants: Patient cases. Main outcome measures: Incidence rate, Incidence proportion, mortality. Results: A total of 501 cases were identified with an incidence rate of 0.98 cases per 1000 bed‐days over the study period 2013–2018. Cases with NV‐HAP had a median age of 78.2 years (interquartile range 18.8), a median length of stay of 13.0 days (interquartile range 12.0) and a median Charlson Comorbidity Index score of 3.0 out of 39 (interquartile range 3.0), and a greater proportion was male (n = 297, 57%). The in‐hospital mortality rate for NV‐HAP cases was 18.9%. Conclusion: This study revealed an overall incidence rate of 0.98 cases per 1000 bed‐days from 2013 to 2018 in a regional Australian hospital. In addition, this study provided the descriptive characteristics for patients with NV‐HAP at our regional hospital. [ABSTRACT FROM AUTHOR]

Objective(s): The objective of the study was to validate a clinical aid to guide the assessment and management of a patient's listed beta‐lactam antibiotic allergy for use in rural areas of Australia. Design: Rural generalists, pharmacists and junior doctors completed an online assessment of eight patient case studies using the tool. Setting: The study was conducted in the Southern Downs, QLD. Participants: Twenty‐seven rural generalists, nine pharmacists and eight junior doctors. Main outcome measures: The sensitivity of the selected allergy phenotype and management option for each case study was calculated by profession and overall. Hazardous responses were reported by management category and profession. Results: The sensitivity overall for phenotype selection was 82.4% (95% CI, 78.0–86.2) and for management 88.1% (95% CI, 84.2–91.2). The sensitivity for phenotype selection was lower for junior doctors than other professions 73.4% (95% CI, 60.9–83.7), but did not reach statistical significance (p = 0.08). A total of 10/308 responses for management recommended the least restrictive option of direct delabelling or oral challenge, where the correct answer was skin prick testing or referral to an allergist. Conclusion(s): With further education the tool could be a key component of increased antimicrobial stewardship in rural areas in Australia. [ABSTRACT FROM AUTHOR]

Objective: To define characteristics of vehicle crashes occurring on rural private property in north Queensland with an exploration of associated risk factors. Design: Descriptive analysis of private property crash data collected by the Rural and Remote Road Safety Study. Setting: Rural and remote north Queensland. Participants: A total of 305 vehicle controllers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash. Main outcome measure: A structured questionnaire completed by participants covering crash details, lifestyle and demographic characteristics, driving history, medical history, alcohol and drug use and attitudes to road use. Results: Overall, 27.9% of interviewees crashed on private property, with the highest proportion of private road crashes occurring in the North West Statistical Division (45%). Risk factors shown to be associated with private property crashes included male sex, riding off-road motorcycle or all-terrain vehicle, first-time driving at that site, lack of licence for vehicle type, recreational use and not wearing a helmet or seatbelt. Conclusions: Considerable trauma results from vehicle crashes on rural private property. These crashes are not included in most crash data sets, which are limited to public road crashes. Legislation and regulations applicable to private property vehicle use are largely focused on workplace health and safety, yet work-related crashes represent a minority of private property crashes in north Queensland. [ABSTRACT FROM AUTHOR]

Objective: To ascertain differences in the working lives of geographically dispersed nurses. Design: Cross-sectional. Setting: Registered, enrolled and assistants-in-nursing members of the Queensland Nurses' Union employed in nursing in Queensland, Australia. Participants: A total of 3000 members of the Union, equally stratified by sector (public, private, aged care). Among them, 1192 responded and 1039 supplied postcodes matching the Australian Standard Geographical Classification. Main outcome measures: Statistically significant differences in working lives of nurses employed in different geographical locations. Results: Nurses in outer regional/remote/very remote localities are more likely to be employed as permanent full-time staff and self-report higher levels of work stress. These levels could be explained by: lack of replacement staff for leave, longer working and on call hours and lack of support for new staff. Distance remains a major barrier to accessing continuing professional education. However, outer regional/remote/very remote nurses were more likely to be provided employer support for professional education. Inner regional nurses were more likely to work part time, would work more hours if offered and were more likely to have taken a break from nursing as a result of family commitments. Conclusion: The data confirm that current policies are not addressing the differences in the working lives of geographically dispersed nurses. Policies addressing orientation, mentoring and workloads should be implemented to address these issues. [ABSTRACT FROM AUTHOR]

Objective: The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice. Design: Self-report questionnaires and semistructured in-depth telephone interviews. Participants: Graduates (n = 15) from the first cohort of occupational therapists from James Cook University, Queensland. Main outcome measure: The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice. Results: Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice. Conclusions: Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements. [ABSTRACT FROM AUTHOR]

Objective: Since 1994, as part of the Health Careers in the Bush program, Queensland Health has run residential workshops to provide secondary school students from rural and remote areas with information about health careers. This study reports on the influence of the program on tertiary course selection. Design: Self-administered mail survey and telephone interviews. Setting: Secondary schools. Participants: Past students who had in year 10 attended residential career workshops run by Queensland Health. Main outcome measures: Tertiary courses; self-reported influence of the workshop program on raising awareness and course selection. Results: Over 90% of participants reported that the workshops had a major impact on their course and career selection. The workshops provided exposure to a wide variety of health-related disciplines, enabling students to be better informed about their course and career plans within the industry. Half of the students changed their course as a result of attending a workshop, and 83% enrolled in a health-related course. The 17% who did not enrol in a health-related course also recognised the value of the workshop program. Conclusion: The workshop program raised awareness of health professions and offered valuable information to rural students about a wide range of health careers. Results suggest that provision of such information in a residential-workshop format contributed significantly to tertiary course selection of rural and remote students. The benefit to the health industry from these workshops has been substantial in relation to the small amount of funds invested. [ABSTRACT FROM AUTHOR]

Objective: Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state-wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined., Methods: Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository., Design: Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis)., Setting: All people diagnosed with HNC in Queensland, Australia., Participants: The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner-regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015., Main Outcome Measures: This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co-morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post-acute outcomes (readmission rates, causes of readmission and 2-year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed., Results: Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2-year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment., Conclusions: This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Knowledge of the history of remote-area nursing in Australia is necessary if we are to truly understand the processes that have dictated the boundaries and reality of the scope of practice for today's RANs (remote-area nurses). This paper briefly explores and discusses the social context and history of remote-area nursing in Australia and, in particular, Queensland during the 19th century.