Rural: Journals & articles

Aim: Rural hospitals in New Zealand provide broad generalist clinical services, including procedural sedation and analgesia (PSA). This study was designed to explore patterns of procedural sedation use including indications, equipment, medications, logistical and medical staff support available by rural hospitals, and whether current professional guidelines support rural sedation practice.

Methods: Through the New Zealand Rural Hospital Research Network, 17 rural hospitals were enrolled in an online survey during February 2018. The electronic survey consisted of 31 questions, regarding general information, staffing level and procedural sedation practice. Further questions sought information on clinical documentation and training guidelines.

Results: Most participating sites represented larger rural hospitals and were distributed equally throughout New Zealand. All performed procedural sedation. The distance of rural hospitals to their referral hospitals varied, with the closest being 65 km and the furthest at 326 km away. This study found that staffing and equipment available for rural procedural sedation varied, with the majority of rural hospitals having access to only one doctor out of hours, and only half having access to two doctors within daytime hours. A majority of the respondents felt that a minimum safe level for procedural sedation in their rural hospital required only a single doctor. Procedural sedation is frequently performed in rural hospitals in New Zealand, with the majority of respondents performing PSA at least once a week or more. Ketamine is the preferred PSA agent. A wide variety of procedures are undertaken including orthopaedic and injury treatments, abscess incision and drainage, and cardioversions. Patient transfer to another centre for the purpose of PSA is infrequent, occurring a few times a month or less for all hospitals.

Conclusion: This exploratory survey of rural hospital PSA practice demonstrated that PSA is a commonly performed procedure for a variety of indications. Staffing, equipment and techniques available for rural PSA vary according to institution. There is no current professional framework that suitably defines minimum standards for rural PSA practice, and specific training resources are limited. Providing procedural sedation and analgesia is an essential rural hospital service which is patient and whānau (Māori-language word for extended family) centred, saves patient transfers, and should be supported by a safe, pragmatic and realistic framework of tools, recommendations and training for rural practitioners.

The report is based on prospectively collected data for 311 patients treated for stages 1 to 3 colorectal cancer by four surgeons in the 110-bed Mount Gambier Hospital, between 1 February 2006 and 31 January 2020. Of these patients, the median age was 71 years (spanning from 63 to 78 years) and 55% were men.

Overall five‐year survival in this study of 79% exceeded the most recent reported value for Australia (2011–2015: 69.9%), and contrasts with a Californian study which found that rural residence was associated with poorer cancer‐specific mortality.

Published data on outcomes beyond 10 years after colorectal cancer surgery are limited, but the overall 10‐year survival rate of 45% stated in the new report is similar to the figures reported by an earlier study in Fremantle (44%).

King Island residents needing care are forced to deal with the Patient Travel Assistance Scheme (PTAS) — a federally-funded and state-run service to partially fund the travel expenses of people forced to leave their homes in rural and regional Tasmania for health services. But the PTAS program is often impractical and has residents jumping through hoops.

Abstract
Background: Reasons for elective surgery cancellations and their impact vary from one institution to another. Cancellations have emotional and financial implications for patients and their families. Our service has a particularly broad and geographically diverse patient population, hence we sought to examine these impacts in our service.

Methods: We identified families with procedural cancellations and administered a telephone questionnaire. Survey items included the reason for and timing of cancellation, how the family was informed, the mode of transport and distance travelled to the hospital, associated leave from work, expenses, whether the child was required to fast, missed school, as well as the child's and parent's emotional responses to the cancellation, along with overall parental satisfaction with how the cancellation was handled.

Results: During our study period a total of 7870 procedures were booked. 6734 (86%) of these were completed and 1136 (14%) were cancelled, with 6% cancelled on the day of surgery. In 750 (66%) of these cancellations, families were successfully contacted by telephone and agreed to participate. Of these 305 (41%) cancellations were family-initiated and 444 (59%) were hospital-initiated, with these hospital-initiated cancellations occurring closer to scheduled surgery. The most common cause of cancellation was that the child could not undergo the procedure due to illness (22%) or being unable attend the hospital (14%). The greatest disruption to families and children occurred when procedures were cancelled late, particularly when the cancellation occurred on the day of the planned procedure.

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Abstract
Alcohol misuse is a disproportionately large contributor to morbidity and mortality in the Northern Territory. A number of alcohol harm minimisation policies have been implemented in recent years. The effect of these on intensive care unit (ICU) admissions has not been fully explored. A retrospective before-after cross-sectional study was conducted at the Alice Springs Hospital ICU between 1 October 2017 and 30 September 2019. The primary outcome was the proportion of admissions in which alcohol misuse was a contributing factor in the 12 months before (pre-reforms phase) versus the 12 months following (post-reforms phase) implementation of alcohol legislation reforms. Secondary outcomes were measures of critical care resource use (length of stay, need for and duration of mechanical ventilation). After exclusions, 1323 ICU admissions were analysed. There was a reduction in the proportion of admissions associated with alcohol misuse between the pre-reforms and post-reforms phases (18.8% versus 11.7%, P < 0.01). This was true for both acute (10.6% versus 3.6%, P < 0.01) and chronic misuse (13.3% versus 9.6%, P = 0.03). Rates of mechanical ventilation were unchanged during the post-reforms phase (18.3% versus 14.7%). Admissions with a primary diagnosis of trauma were lower (10.5% versus 4.7%, P < 0.01). This study demonstrated a reduction in ICU admissions associated with alcohol misuse following the implementation of new alcohol harm minimisation policies. This apparent reduction in alcohol-related harm is suggestive of the effectiveness of the Northern Territory's integrated alcohol harm reduction framework.

The Australian and New Zealand Journal of Public Health (ANZJPH) is concerned with public health issues. The research reported includes formal epidemiological inquiries into the correlates and causes of diseases and health-related behaviour, analyses of public policy affecting health and disease, and detailed studies of the cultures and social structures within which health and illness exist. The Journal is multidisciplinary and aims to publish methodologically sound research from any of the academic disciplines that constitute public health.

The Australian Journal of Rural Health (AJRH) is a multidisciplinary refereed journal published on behalf of NRHA by John Wiley and Sons Australia Ltd.

Rural and Remote Health is a not-for-profit (Australasian), open-access, online-only, peer-reviewed academic publication. It aims to further rural and remote health education, research and practice. The primary purpose of the Journal is to publish and so provide an international knowledge-base of peer-reviewed material from rural health practitioners (medical, nursing and allied health professionals and health workers), educators, researchers and policy makers.