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OBJECTIVES: There is little data evaluating procedural skills in current rural pediatric practices. In order to prepare a cadre of pediatricians to work in rural settings, we require an understanding of the unique procedural skills needed by rural pediatric providers. Our objective was to determine how often pediatricians performed various procedural skills, determine the importance of these skills to current practice, and how they differ between rural and urban pediatric providers. METHODS: A survey evaluating pediatrician utilization of the 13 required Accreditation Council Graduate Medical Education procedural skills in current practice was developed and distributed to pediatric providers in New Mexico. Descriptive statistics were used to profile participants and describe survey responses. Chi-square tests were used to evaluate differences by urban setting or IHS. Fisher's exact test was employed to assess differences if cell sizes were less than five. All p-values were two sided with alpha=.05. Benjamini-Hochberg method was used to control for type 1 errors. RESULTS: Fifty-two of 216 pediatric providers responded. The majority surveyed performed each of the 13 procedures less than monthly but competency in many of these procedures is important. Thirty-two respondents submitted free-text responses recommending competence with tracheostomy changes, gastrostomy-tube changes/cares, and circumcision. CONCLUSION: Majority of surveyed pediatricians performed the required procedures less than monthly but deemed several procedures to be important. Rural pediatricians recommended specific procedural skills needed in rural practice. All trainees receive procedural skills training. However, trainees interested in rural practice may need additional training in specific skills different than their non-rural counterparts. [ABSTRACT FROM AUTHOR]

In 2023, a Diploma of Rural Generalist Anaesthesia (DipRGA) was implemented across Australia. Developed collaboratively by the Australian and New Zealand College of Anaesthetists (ANZCA), the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP), the 12-month qualification is completed during or following ACRRM or RACGP Rural Generalist Fellowship training. Focused on the needs of rural and remote communities for elective and emergency surgery, maternity care, resuscitative care for medical illness or injury, and stabilisation for retrieval, the DipRGA supports rural generalist anaesthetists working within collaborative teams in geographically isolated settings. The goal is a graduate who can anaesthetise American Society of Anesthesiologists physical status class 1, 2 and stable 3 patients for elective surgery, provide obstetric anaesthesia and analgesia, anaesthetise paediatric patients and undertake advanced crisis care within their scope of practice. Crucially, they also recognise both limitations of their skills and local resources available when considering whether to provide care, defer, refer or transfer patients. DipRGA curriculum design commenced by adapting the ANZCA specialist training curriculum with consideration of the training approach of both the ACRRM and the RACGP, particularly the rural and remote context. Curriculum content is addressed in seven entrustable professional activities supported by workplace-based assessments and multisource feedback. Trainees are supervised by rural generalist anaesthetists and specialist anaesthetists, and complete flexible learning activities to accommodate geographical dispersion. Standardised summative assessments include an early test of knowledge and an examination, adapted from the ACRRM structured assessment using multiple patient scenarios. [ABSTRACT FROM AUTHOR]

Introduction: We highlight the utility of telemedicine and telementoring for the management of orthopaedic emergencies using a case of forearm compartment syndrome following a penetrating trauma in a northern Inuit community in Nunavik, Quebec, Canada.Methods& Results: As in many cases of compartment syndrome in rural settings, the patient was at a high risk of developing irreversible complications. A prompt diagnosis followed by an emergency decompressive fasciotomy was warranted. Using telemedicine and telementoring guidance, the diagnosis of compartment syndrome was made, and the patient's volar compartment was successfully decompressed by a local emergency physician in a timely manner. Subsequently, the patient was able to be safely transferred to a level 1 trauma centre for further surgical management. This included a second-look operative exploration, irrigation and debridement, completion of volar fasciotomy and ulnar nerve decompression. No complications were seen.Discussion: Our experience highlights two important clinical implications. First, telemedicine can be successfully implemented to facilitate clinical diagnosis of surgical emergencies in the rural setting. Second, telementoring can effectively allow surgeons to guide physicians remotely to perform emergency decompressive fasciotomy, which can help salvage the affected limb and significantly decrease the risk of debilitating complications. [ABSTRACT FROM AUTHOR]

Background: Antibiotics are commonly prescribed for uncomplicated urinary tract infection (UTI) and acute otitis media (AOM) and may be unnecessary at times. The aim of this study was to evaluate prescribing practices for UTIs and AOM in a rural ambulatory care setting and to identify areas for improvement. Methods: In a single-center, retrospective review conducted at a rural clinic, patients diagnosed with uncomplicated UTI and AOM were included. Patients were identified by International Classification of Diseases, Tenth (ICD-10) codes, and data were collected for visits between January 1, 2017, and December 31, 2017. The primary outcome was to assess adherence of antimicrobial prescribing to current treatment guidelines. Results: Of the 76 patients identified, 28 met inclusion criteria. Of the 28 patients, 75% received an agent recommended first line in the treatment guidelines, and 18 of the 21 received a recommended dose. Only 17% of patients were prescribed an appropriate duration of treatment. Conclusion: Opportunities exist for antimicrobial stewardship interventions for uncomplicated UTIs and AOM. Prescribers are not consistently adhering to guidelines in regard to antibiotic choice, dose, or duration. Additional education and stewardship interventions are crucial considering the increased prevalence of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Objective: Rural areas in Ontario have fewer psychiatrists, making access to specialist mental health care challenging. Our objective was to characterise psychiatrists delivering and patients receiving telepsychiatry in Ontario and to determine the number of patients who accessed a psychiatrist via telepsychiatry following discharge from psychiatric hospitalisation.Method: We conducted a serial panel study to evaluate the characteristics of psychiatrists providing telepsychiatry from April 2007 to March 2013. In addition, we conducted a cross-sectional study for fiscal year 2012-2013 to examine telepsychiatry patient characteristics and create an in-need patient cohort of individuals with a recent psychiatric hospitalisation that assessed if they had follow-up with a psychiatrist in person or through telepsychiatry within 1 year of discharge.Results: In fiscal year 2012-2013, a total of 3801 people had 5635 telepsychiatry visits, and 7% ( n = 138) of Ontario psychiatrists provided telepsychiatry. Of the 48,381 people identified as in need of psychiatric care, 60% saw a local psychiatrist, 39% saw no psychiatrist, and less than 1% saw a psychiatrist through telepsychiatry only or telepsychiatry in addition to local psychiatry within a year. Three northern regions had more than 50% of in-need patients fail to access psychiatry within 1 year.Conclusions: Currently, relatively few patients and psychiatrists use telepsychiatry. In addition, patients scarcely access telepsychiatry for posthospitalisation follow-up. This study, which serves as a preliminary baseline for telepsychiatry in Ontario, demonstrates that telepsychiatry has not evolved systematically to address need and highlights the importance of system-level planning when implementing telepsychiatry to optimise access to care. [ABSTRACT FROM AUTHOR]

Community paramedicine programs are beginning to flourish across the nation, and the need to provide demonstration or pilot programs is essential to providing a consistent and high-level standard for this model of care. While the overarching goals are to align with the Triple Aim, piloting a community paramedicine program also allows each community to develop and implement a program tailored to the healthcare needs of their specific community. A successful program builds the evidence base that can then be used to create legislative change necessary to financially sustain this model of care across the healthcare delivery system. This article provides a discussion of the healthcare needs of people living in rural areas and of the ways in which community paramedicine can address some of those needs. This article begins with a discussion of legislative authorization and characteristics of the Maine community paramedicine pilot program, the general strategies for implementation, and lessons learned from these programs. A case study of a Maine community paramedicine program provides an example of key implementation strategies along with structural and operation functions of the program that may be useful for other community paramedicine pilot sites looking to implement a community-based health care program. [ABSTRACT FROM AUTHOR]

Telemedicine consultations in remote intensive care units (ICUs) overseas were found to be effective in reducing mortality and hospital length of stay (LOS). In Australia, there were anecdotal reports of these clinical outcomes. This retrospective before and after study assessed the improvement in patient outcomes with the implementation of a telemedicine program in a regional high dependency unit. Daily virtual consultations were conducted between the rural facility and the intensivists at the regional centre. A total of 525 patients received intensive care support between 2010 and 2015. Hospital and High Dependency Unit mortality showed no evidence of significant differences between the telemedicine group and the baseline (relative risk 1.02, 95% confidence interval [CI] 0.99-1.06, P=0.25 and relative risk 1.00, 95% CI 0.98-1.03, P=0.67 respectively). The hospital LOS was lower in the baseline group by 1.5 days. There was no significant difference in High Dependency Unit LOS. To adjust for the covariates in LOS, log linear regression analysis was performed. The telemedicine intervention, Acute Physiology and Chronic Health Evaluation II scores and inter-hospital transfers were found to contribute significantly to hospital LOS. The most important result of the study was that the proportion of inter-hospital transfers was lower in the telemedicine group (relative risk 0.88, 95% CI 0.80-0.98, P=0.03) compared to baseline. This means that critically ill patients in our regional centre can continue to receive specialist care remotely through tele-ICU consultations thus avoiding the need for patient transport. However, further study is needed to establish the benefits and risks of telemedicine intervention in ICUs in Australia. [ABSTRACT FROM AUTHOR]

Dynamic assessment of the effective surgical workforce recommends 27,300 general surgeons in 2030; 2,525 more than are presently being trained. Rural shortages are already critical and there has been insufficient preparation for this need. A literature review of the factors influencing the choice of rural practice was performed. A systematic search was conducted of PubMed and the Web of Science to identify applicable studies in rural practice, surgical training, and rural general surgery. These articles were reviewed to identify the pertinent reports. The articles chosen for review are directed to four main objectives: 1) description of the challenges of rural practice, 2) factors associated with the choice of rural practice, 3) interventions to increase interest and preparation for rural practice, and 4) present successful rural surgical practice models. There is limited research on the factors influencing surgeons in the selection of rural surgery. The family practice literature suggests that physicians are primed for rural living through early experience, with reinforcement during medical school and residency, and retained through community involvement, and personal and professional satisfaction. However, more research into the factors drawing surgeons specifically to rural surgery, and keeping them in the community, is needed. [ABSTRACT FROM AUTHOR]

The present study, framed as critical action research, aimed at contributing to the improvement of training emergency teams in primary care. The first author was a participating observer in local simulation sessions performed by 10 different teams. Leadership practice as interaction was analysed in three types of communicative spaces: in the review and debriefing sessions; in the author group; and in focus groups involving local stakeholders. The teams practiced both designated and distributed leadership in the course of the various training sessions. During the simulation sessions, the teams remained aware of the physicians’ formal responsibility for decisions concerning diagnosis and medication. Shifts in leadership modes coincided with situational changes requiring particular competencies. Distribution of leadership and teamwork dynamics were informed by simple, yet fundamental principles: strong commitment to the task at hand even though ‘unreal’; responsibility for the patient’s life and health; responsibility for the colleagues’ functioning and well-being; and a perception of calmness as an indicator of good teamwork. A rising awareness with regard to leadership practice as interaction was facilitated by critical application of theory and engaged participation of local personnel in several analytical phases. [ABSTRACT FROM PUBLISHER]

The Indian Systems of Medicine and Homoeopathy (ISM&H) were given an independent identity in the Ministry of Health and Family Welfare in 1995 by creating a separate Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November 2003. Mainstreaming of AYUSH implies integration of infrastructure, manpower and medicines of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) to strengthen the public health care delivery and strengthen the AYUSH systems at grass root level by establishing a linkage between modern medicine and AYUSH systems in a collaborative way. Mainstreaming of AYUSH is a policy commitment of government of India and it received momentum by the launch of National Rural Health Mission (NRHM) in April, 2005. The present study was done in two villages of district Yamunanagar, Haryana on the sample of 25 which consisted professional allopathic doctors, traditional healers and village respondents to know their awareness and attitudes regarding AYUSH. In the present study it was found that the potential barriers that emerge are the lack of awareness about the government's AYUSH scheme and for successful implication it is required that awareness at grass root level should be promoted. [ABSTRACT FROM AUTHOR]

This article documented the Australian community pharmacists' brand substitution practices using identical alternatives (pseudo-generics) and the patients' acceptability. A national mail survey was conducted among 500 Australian community pharmacies from different geographical areas in year 2008. The data of the first 25 original PBS prescription items dispensed on one working day and eligible for generic substitution were collected from each pharmacy. Brand substitution which involved identical alternatives of the originator medicines were identified based on the manufacturers' information stated in the Schedule of Pharmaceutical Benefits Scheme (PBS). Responses were received from 82 pharmacies for a response rate of 16.4%. The pharmacists offered brand substitution for 96.4% of the prescription items which eligible for substitution. About 10% of the substitution recommendations were involved switching of originator medicine to its pseudo-generic alternatives. A total of 10.1% of the pseudo-generic substitution recommendations were declined by the patients. This resulted in an average of AUD$4.44 per item of unnecessary extra-costs paid by the patients for purchasing the originator medicines. This indicated that the existence of pseudo-generics in the PBS market can negatively affect the consumers' welfare in terms of unnecessary extra expenditures for originator medicines that have cheaper identical alternative brands. [ABSTRACT FROM PUBLISHER]

Objectives: To explore whether a group programme for community-dwelling chronic stroke survivors and their carers is feasible in rural settings; to measure the impact of the programme on health-related quality of life and functional performance; and to determine if any benefits gained are maintained. Design: Randomized, assessor blind, cross-over, controlled trial. Setting: Rural outpatient. Subjects: Twenty-five community-dwelling, chronic stroke survivors and 17 carers of participant stroke survivors. Intervention: The intervention group undertook a once-a-week, seven-week group programme combining physical activity, education, self-management principles and a 'healthy options' morning tea. At completion, the control group crossed over to receive the intervention. Main measures: Stroke Impact Scale (stroke survivors), Health Impact Scale (carers), Six Minute Walk Test, Timed Up and Go, Caregiver Strain Index. Results: There were insufficient participants for results to reach statistical significance. However between-group trends favoured the intervention group in the majority of outcome measures for stroke survivors and carers. The majority of measures remained above baseline at 12 weeks post programme for stroke survivor participants. The programme was well attended. Of the seven sessions all participants attended four or more and 88% attended six or seven sessions. Conclusions: This novel programme incorporating physical activity, education and social interaction proved feasible to undertake by a stroke-specific multidisciplinary team in three rural Australian settings. This programme may improve and maintain health-related quality of life and physical functioning for chronic stroke survivors and their carers and warrants further investigation. [ABSTRACT FROM AUTHOR]

The purpose of this descriptive correlational secondary data analysis is to describe the relationship between job satisfaction and accountability among registered nurses with clinical responsibilities employed by a rural health care network in the Midwest. The response rate from the primary study is 39%, with 337 RN respondents. The sample for this secondary analysis is 299. The instruments used to measure accountability and job satisfaction are the Specht and Ramler Accountability Index-Individual Referent and the McCloskey-Mueller Satisfaction Scale (MMSS). The results indicate that accountability is perceived to be relatively high and job satisfaction is moderate. Accountability and job satisfaction are significantly correlated at a moderate level. The correlations between the subscales of the MMSS and accountability are all statistically significant but low. The subscales with the highest correlations (e.g., control and responsibility, praise and recognition, professional opportunities, scheduling) provide direction for nurse administrators about important target areas for improvement. [ABSTRACT FROM AUTHOR]

Choosing a doctorGive me a doctor partridge-plump,Short in the leg and broad in the rump,An endomorph with gentle handsWho’ll never make absurd demandsThat I abandon all my vicesNor pull a long face in a crisis,But with a twinkle in his eyeWill tell me that I have to die.W. H. Auden [ABSTRACT FROM PUBLISHER]

Dent W, Spiss HK, Helbok R, Matuja WBP, Scheunemann S&Schmutzhard E. Prevalence of migraine in a rural area in South Tanzania: a door-to-door survey. Cephalalgia 2004. London. ISSN 0333-1024We set out to assess the prevalence during the previous year of migraine in a rural area surrounding the Mnero Diocesan Hospital in Southern-Tanzania. A door-to-door survey from August until December 1999 using a questionnaire based on the criteria of the International Headache Society (IHS), including 1047 households with 3351 persons, was done, consisting of a screening dialogue with a representative family member followed by a face-to-face interview with the affected subject. Of the 3351 participants (female 1876; male 1475; age > 10 years), 23.1% had suffered from headache during the past year; overall prevalence of migraine was 5.0% (female 7.0%; male 2.6%); 1.4% reported migraine without aura (female 1.8%; male 0.9%); and 3.6% reported migraine with aura (female 5.2%, male 1.6%). The peak prevalence was found in female persons in the fourth (11.1%), in male persons in the third decade of life (3.8%). Compared with other African surveys, the prevalence rate of migraine headache in South Tanzania is slightly higher than among Ethiopian and Zimbabwean Africans. [ABSTRACT FROM AUTHOR]

We studied two rural telemedicine projects in the state of Michigan: one that enjoyed success and steady growth in activity, and one that experienced frustration and a lack of clinical utilization. Multiple data collection strategies were employed during study periods, which lasted approximately one year. Both projects enjoyed a grassroots approach and had dedicated project coordinators. However, the more successful project benefited from resources and expertise not available to the less successful project. In addition, the more successful project possessed a more formalized organizational structure for the telemedicine application. A comparison of the two projects leads to a simple conclusion. Telemedicine programmes are positioned within larger health organizations and do not operate in a vacuum. It is crucial that the organization in which it is intended to launch telemedicine is examined carefully first. Each organization operates within a larger environment, which is often constrained by fiscal, geographical and personnel factors. All these will affect the introduction of telemedicine. [ABSTRACT FROM AUTHOR]

This research evaluates the effect of case management on the utilization of substance abuse, medical, and mental health services by substance abuse treatment clients subsequent to initiating residential treatment. The study also evaluates whether the proximity of the case manager to the treatment facility and use of a telecommunication system are related to case management effectiveness. Clients were randomly assigned to one of four conditions. Three conditions received case management according to the Iowa Case Management model and differed according to the location of the case manager and use of a telecommunication system. A fourth condition received standard treatment services. Clients provided feedback regarding service use for 12 months. Results indicated that when case managers were located at the treatment facility, they had an impact on clients' use of substance abuse treatment and medical services. Clients who were assigned to case managers located at the treatment facility used more treatment aftercare and medical services after admission to residential treatment than clients who received standard treatment. These effects were not found for clients assigned to case managers not located at the facility. Case management was not related to the use of mental health services subsequent to treatment. [ABSTRACT FROM AUTHOR]

Focuses on the trend of physicians who are dropping the practice of obstetrics and the increasing reluctance of those who remain in practice to serve women who receive Medicaid assistance. Some of the factors that physicians perceive as barriers to providing care to low-income women.

The article discusses the factors to consider in extending clinical services for exceptional children in rural areas in the U.S. There are two aspects considered to be essential in providing clinical services which include (1) the location and diagnosis of exceptional children, and (2) the need for the recommendation regarding the placement of those children in special classes. It must be put into reality that the success of clinical programs depends on the adequacy of clinical services, for those who deal with special education. The State of Pennsylvania, nevertheless, provides the most thorough pattern of clinical services to rural areas. Other States as well provide similar but limited services.

The University of Alberta uses videoconferencing to link physicians in interactive continuing health education. We examined evaluations of 29 videoconferences for rural practitioners during the programme year September 2003–May 2004. The evaluation form, completed by participants following the presentation, used both quantitative and qualitative methods of data collection. The average attendance for the videoconference sessions was 40 people. A total of 593 evaluations were collected (response rate 51%). The audience were very satisfied with the programme and felt that the sessions were relevant to their practice. The interactive discussion component was rated very highly. Most respondents stated that they would change their practice based on the information discussed. It is clear from our survey that videoconferencing is useful in overcoming the barriers of distance and that small physician numbers create a positive environment for adult learning. [ABSTRACT FROM AUTHOR]

Provides information on the development of a rural public health research agenda which aimed to create opportunities for public health researchers to address issues of geographic health disparities and ultimately improve the health status of U.S. citizens in the rural areas. Topics highlighted by the steering group; Sample of priority research questions identified through the process; Details of the cross-cutting themes which emerged from the research agenda setting meeting.

Background: Medical education can help alleviate the chronic undersupply of physicians to rural communities. Providing students with early rural clinical experiences may allow the gaining of necessary knowledge and skills to practice and live rurally, as well as the desire to do so. Purpose: This study aims to provide a detailed understanding of Remote and Rural Community Placements (RRCPs) which occur in the second year of a Doctor of Medicine programme. Methodology/Approach: Using a thematic analysis approach, we examined the experiences of students and preceptors in the RRCP. Data were collected using semi-structured interviews and focus groups. Findings/Conclusions: Students valued RRCPs as a formative clinical experience and preceptors gained professionally from participating. The RRCPs enhanced students regard for, and knowledge of, rural medicine. Yet, contrary to the stated aims of the placement, students spent very little time in activities outside of the clinic, neither learning about the community nor about the life of a physician as a community member. Implications: Medical educators should recognise that students and preceptors will inevitably place different value on the different sociocultural and perceptual aspects of placements, namely clinical and non-clinical. As such, the curriculum should draw clearly articulated links between each. [ABSTRACT FROM AUTHOR]

The author comments on the article "Meeting the Increasing Demands for Rural General Surgeons" by Mary C. McCarthy et al. He maintains that the characteristics of his upbringing and education were contrary to predicting a career as a rural surgeon. He emphasizes that because of the mission of the Advisory Council on Rural Surgery (ACRS), all patients receive care from trusted surgeons who practice with skill in safe and optimal environments.

The author comments on an article by Dr. Don Nakayama on rural pediatric surgery. She discusses the importance of the concept of multidisciplinary regionalization of care as raised by Nakayama. She also cites several important issues tackled by Nakayama including the challenges faced by the medical community at rural hospitals and the disparity in care.

The article offers news briefs related to health. The British Medical Association (BMA) restated the supervision on treating oneself, family and friends. The setting up of rural forum, which is open for people interested in rural medicine as well as to the Royal College of General Practitioners (RCGP) members. The alterations in the law concerning to the notification of disease to public health that become effective on January1, 2010 in Scotland while on April 6, 2010 in England and Wales.

The author comments on the article "Meeting the Increasing Demands for Rural General Surgeons" by Mary C. McCarthy et al. He says that in the early decades of the 21st century, those who live close to the care hub are provided with highly accessible and great quality surgical care while those living closer to the rim of the hub system face access issues and potential quality issues.

Suggests the creation of a rural surgery specialty in the U.S. Obstacles facing rural surgeons; Benefits of modern transportation and communication for surgeons practicing in a remote area; Suggestions for training surgeons.

The article reports on the first performance of appendectomy in North America by Canadian rural doctor Abraham Groves on May 10, 1883 in Fergus, Ontario. The patient was a 12-year-old boy. Groves performed the operation on the kitchen table of a farmhouse. He practiced absolute cleanliness, using rubber gloves and boiling his instruments. The boy's father administered the anesthetic. Groves had performed about 6,000 appendectomies by 1924.

Reports on plans for the expansion of a rural medicine research center at Wisconsin's Marshfield Clinic, which is committed to the medical needs of 62 million Americans who live in rural areas. The Laird Center; Proposal for a bank of genetic materials; More.

A letter to the editor is presented in response to the article concerning community medicine in the November 1982 issue.