Issues for palliative care in rural Australia

A project funded by the Commonwealth Government's National Palliative Care Program examined rural (non remote) palliative care services in eight rural regions of Australia with the aim of identifying sound service delivery models. The research methodology included, development of a palliative care service baseline, postal survey of all services in the selected regions followed by field examinations, and section of four regions for in depth analysis using interviews and group sessions with medical practitioners, clinicians, former carers and service managers. The research established that patients and carers want palliative care services to first address symptom management and pain control. The service should then place experienced care as the next highest priority, in conjunction with the provision of family supports. Service models should aim to deliver services in the home or in environments which are home-like and located close to families. Research has demonstrated that even the smallest hospitals can incorporate a palliative care unit. Palliative care service planning in rural areas needs to make a distinction between the main provincial city in the region and the rural hinterland as different planning approaches will often apply. Palliative care teams should vary according to the nature of the service catchment. Particular attention should be given to the method of providing palliative care nursing expertise in a region. This project concluded that when active treatment is no longer beneficial, palliative services in rural regions are commonly of a high quality, although access to tertiary services remains as a limitation during the pre-palliative treatment phase.     

A profile of rural surgeons in Australia

Primary HIV infection is usually paucisymptomatic, although 30-40% of patients show a mononucleosic syndrome of variable intensity and different manifestations. An increasing number of heterosexual HIV infection in Spain, and the fact of more severe manifestations in this subset of patients make necessary a deeper understanding of this complex clinical picture. We report a case of heterosexual primary HIV infection in a female patient without any known risk factor. This care evolued in an exceptionally severe form with meningitis and pancreatitis, to the best of our knowledge, this is the first reported care of pancreatitis complicating primary HIV-1 infection.     

The provision of general surgical services in rural South Australia: a new model for rural surgery

BACKGROUND: Rural South Australia (SA), like other rural areas in Australia, faces a crisis in the medical workforce. It is also generally assumed that the same applies to rural surgical services but finding evidence to support this is scarce. METHODS: All hospitals situated outside the outer metropolitan area of SA were surveyed about surgical services (n = 57). Questions were asked about the frequency of emergency and elective theatre usage and which surgeons provided surgical services. RESULTS: Operating theatre facilities were in active use in 39 of the 57 hospitals studied. At the time of the study there were seven specialist general surgeons resident in rural SA. General practitioners continued to have a major input in the provision of surgical services, either by providing the general anaesthetic (34/39) or by performing the surgical procedures (26/39). CONCLUSIONS: The Department of Surgery at the University of Adelaide is instituting various measures to counter the rural surgical workforce problem and is developing a model that serves either the individual or the two-person surgical practice. Metropolitan teaching hospitals can play an important role in supporting current rural surgeons and can foster an increased commitment to the future of rural general surgery.     

A study of the educational and research priorities of registered nurses in rural Australia

This study set out to identify the educational and research priorities of registered nurses practising in rural and remote areas of Australia. It included two groups of participants, one which identified as rural and another which identified as remote. The findings for the rural cohort in the study are presented in this article. Research participants represented a national sample. The Delphi method was used to obtain the most reliable consensus of the nurse participants. In the final phase of the study, 13 high priorities were identified. Study findings highlight perceived needs for clinical nursing research and continuing education for nurses practising in rural Australia.     

Water quality and poultry production

Mineral and microbial content of water affects the performance of poultry. Because poultry production can adversely affect water quality, the Environmental Protection Agency monitors and regulates its impact. Management of nonpoint source water contamination is especially important. If properly managed, litter, a valuable secondary commodity associated with poultry production, can be used as fertilizer, food, or energy.     

The quality management journey: the progress of health facilities in Australia

Many facilities in Australia have taken the Total Quality Management (TQM) step. The objective of this study was to examine progress of adopted formal quality systems in health. Sixty per cent of organizations surveyed have adopted formal systems. Of these, Deming adherents are the most common, followed by eclectic choices. Only 35% considered the quality transition as reasonably easy. There was no relationship between accreditation and formal quality systems identified. The most common improvement techniques were: flow charts, histograms, and cause and effect diagrams. Quality practitioners are happy to use several tools exceptionally well rather than have many tools at their disposal. The greatest impediment to the adoption of quality was the lack of top management support. This study did not support the view that clinicians are not readily actively supporting quality initiatives. Total Quality Management is not a mature concept; however, Chief Executive Officers are assured that rewards will be realized over time.     

Maintenance of quality of life improvements in diverse rural older adults.

The maintenance of effects from home-delivered cognitive-behavioral therapy (CBT) was examined. One hundred thirty-four participants, predominantly African American and primarily rural, low-resource, and physically frail, were randomly assigned to either immediate or delayed CBT. The six-month follow-up assessments indicated that among those who remained in the study, participants evidenced significantly improved quality of life and reductions in psychological symptoms at follow-up, relative to pretreatment levels. Posttreatment gains were maintained at follow-up. These data suggest that treatment effects can be achieved and perhaps maintained with a disadvantaged sample of older adults and suggest that evidence-based treatments delivered through nontraditional means can have effects beyond posttreatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Improving quality of sexually transmitted disease case management in rural South Africa

OBJECTIVE: To measure quality of sexually transmitted disease (STD) syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial. SETTING: Ten rural primary care clinics, Hlabisa district, South Africa. DESIGN: Simulated patients (fieldworkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facilities were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surveillance was performed in all 10 clinics. RESULTS: A total of 9% of simulated patients were correctly managed (given correct drugs, plus condoms and partner notification cards), recommended drug treatment was given in only 41% of visits, and appropriate counselling was given in 48% of visits. Among patients leaving the clinic, although 39% waited over an hour to be seen and only 37% were consulted in private, all reported staff attitudes as satisfactory or good. Only six clinics had syndromic management protocols available, three reported intermittent drug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 week of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. CONCLUSIONS: Quality of STD case management was poor despite good staff knowledge and availability of most essential resources. An intervention comprising staff training and STD syndrome packets has been designed to improve quality of case management.     

New Insights into the Quality of Urban Storm Water in South Eastern Australia

Quantifying the quality of urban storm water is an important prerequisite to the effective management of urban runoff, which is recognized as the major nonpoint source of pollution in urban areas. Although data on urban storm-water quality are widely available, they are often based on relatively limited data sets, usually containing few samples per event and/or few events per catchment. This paper reports on a large scale monitoring of the key storm-water pollutants found in urban discharges during both wet and dry weather from seven urban catchments in South Eastern Australia. The catchments are all separately sewered (with wholly piped systems) with varying sizes and land uses. Using the same monitoring technique, between 16 and 52 pollutographs were captured at each site for total suspended solid (TSS), total phosphorus, and total nitrogen (TN), while event mean concentrations (EMCs) of heavy metals and major ions, as well as species of N and P, were recorded at a subset of sites. It was found that EMCs of TSS were around 50% less than have been typically reported in earlier literature. During wet weather, nutrients were similar to previously reported, as were most metals concentrations. However, zinc concentrations were significantly higher than previously reported. EMCs of TSS were higher during storm flows than in baseflow, while TN concentrations were consistently higher during baseflow. EMCs of all pollutants monitored were poor with simple hydrological parameters (e.g., event rainfall depth); however, event pollution loads correlated very well with the rainfall intensity to a power, summed over the event duration. It was not possible to distinguish an impact of land use on pollutant concentrations. The first-flush effect was found not to be significant at all sites except the smallest catchment with the simplest drainage layout (the roof of a large building). All these findings have significant implication for treatment strategies with the significantly lower than previously observed TSS requiring consideration in future modeling and treatment design.     

Ovine cysticercosis in the Albany region of Western Australia. 1. Survey of tapeworms of rural dogs

A survey of the cestode infections of 304 dogs from 134 properties in the Albany area of Western Australia was performed. Purgation was induced by oral administration of arecoline and the purge examined for cestodes. The cestodes found and their infection rates were: Dipylidium caninum 16.4%; Taenia spp 36.5%; T. ovis 8.9%; T. hydatigena 15.1%; T. pisiformis 15.1%; T. serialis 2.3%; Echinococcus granulosus 0.7%; Questionnaires completed on 133 of the 134 properties at the time the dogs were purged showed that:--73.6% of farmers were feeding raw sheep-meat and 24.8% were feeding raw offal to their dogs; dogs were treated on a regular basis with a cestocide on 23.3% of properties; dogs were allowed to roam on 21.8% of the properties and stray dogs were considered prevalent on 23.3% of properties. Suggestions for control of Cysticercus ovis are made based on an interpretation of the significance of these findings.     

农村公路养护管理质量综合评价指标体系构建研究

为构建一套科学的、适合江苏省农村公路建养一体化模式下的养护管理质量综合评价指标体系,本文通过资料查阅及专家咨询法初步构建农村公路养护管理质量综合评价指标体系框架,进一步联合使用德尔菲法与层次分析法进行指标筛选以及权重计算,形成了江苏省农村公路养护管理质量综合评价指标体系,包括一级指标8项,二级指标29项.其中一级指标包括机构管理、日常养护、安全生产、内业资料、养护材料、日常巡查、桥梁养护管理及合同信用评价八方面内容,权重系数分别为0.05,0.10,0.20,0.15,0.01,0.10,0.24,0.15,并在如皋建养一体化项 目中成功应用.该研究为建立农村公路养护管理质量评价指标体系提供了一定的理论依据,为推动"四好农路"建设提供了一定的科学参考.     

An inter district quality partnership: the experience of a large rural health service

The interleukin-2 receptor (IL-2R) gamma chain (gamma c chain) is shared by IL-4R, IL-7R, IL-9R, and IL-15R and plays an important role in regulation of the immune system. However, its regulation in monocytic cell lines has not been well clarified. We examined the expression and regulation of the IL-2R alpha, IL-2R beta, gamma c chain, IL-4R and IL-7R mRNA in a human monoblastic leukemia cell line, THP-1. Unstimulated THP-1 cells constitutively expressed a low level of gamma c chain and IL-4R mRNA. Phorbol myristate acetate (PMA) induced macrophage-like differentiation and up-regulated the gamma c chain mRNA expression in THP-1 cells. This effect of PMA was suppressed by the protein kinase inhibitors H-7 and staurosporine. PMA did not affect the expression of the other IL-R mRNAs examined. 1 alpha, 25(OH)2D3 and interferon-gamma also induced differentiation of THP-1 cells, but these reagents did not affect the expression of the IL-R mRNAs in THP-1 cells. These findings suggest that the expression of the gamma c chain mRNA is regulated by the PMA-dependent pathway and is not associated with that of the other IL-R mRNAs.     

Medicine in tropical Australia

In the unique environment of Australia's tropical north there are endemic diseases inherited from Gondwana, others introduced from the north and from Europe, and a wide range of particularly venomous animals. There is continuing disparity in morbidity and mortality between Aboriginal people and other Australians in tropical areas and elsewhere. This is being addressed by the National Aboriginal Health Strategy, which emphasises social, environmental and economic issues, as well as control and coordination of services by Aboriginal and Torres Strait Islander communities. While the re-introduction of malaria remains a potential threat, together with other infections, current diseases in tropical Australia are being better elucidated; melioidosis is now recognised as the commonest cause of fatal [corrected] community-acquired pneumonia in the Top End of the Northern Territory, and a new focus of scrub typhus has been found. Sexually transmitted diseases are an urgent issue, especially for Aboriginal communities, given the potential impact of the human immunodeficiency virus.     

Burkitt's lymphoma in Australia

An Australian case of Burkitt's lymphoma is reported. The clinical features of large ovarian masses and subsequent bone marrow invasion, as well as the results of investigations related to the Epstein-Barr virus, were more consistent with the American than the African type of Burkitt's lymphoma. After a good initial response to cyclophosphamide and vincristine, the tumour rapidly became resistant to these and other therapeutic measures and the patient died 10 months after diagnosis.