The State of STEMI Care Across NSW: A Comparison of Rural, Regional, and Metropolitan Centres.

Background: At a global level, regional variation in the management of ST-elevation myocardial infarction (STEMI) is influenced by patient demographics and geography. Rural patients with STEMI are disadvantaged in reaching timely care owing to distance and limited ambulance and healthcare resources. Optimising models of STEMI care is key to overcoming the excess rural vs metropolitan cardiovascular morbidity and mortality.

Health service access and quality of care provided by the Western NSW Local Health District Virtual Rural Generalist Service: a retrospective analysis of linked administrative data.

Objective: To evaluate the quantity and quality of medical care provided by the Western NSW Local Health District Virtual Rural Generalist Service (VRGS).

Design: Retrospective cohort study; analysis of emergency department and administrative hospital data.

Setting: Twenty-nine rural or remote hospitals in the Western NSW Local Health District at which the VRGS was providing medical care in the emergency department (ED) and/or inpatient setting.

An economic evaluation of the Virtual Rural Generalist Service versus usual care in Western NSW Local Health District.

Objective: Evaluate the cost-effectiveness of the Virtual Rural Generalist Service (VRGS) model of care.

Design: A cost-consequence analysis of the VRGS model of care compared with usual care (treatment by local or locum [non-VRGS] doctors) from the perspective of the health care funder in 2022 prices.

Setting: Twenty-nine rural and remote hospitals in the Western NSW Local Health District where the VRGS has been in operation (VRGS sites).

'Imagine if we had an actual service ...': a qualitative exploration of abortion access challenges in Australian rural primary care.

Introduction: Rural populations in Australia rely upon local primary health care for medication abortion access. Yet little is known about how individual primary healthcare providers themselves negotiate the unique complexities of the rural health system to provide local abortion services.

Methods: To address this gap, we conducted qualitative, semi-structured interviews with primary healthcare providers in rural New South Wales (NSW).

Long-term patient-reported outcome measures (PROMs) after primary ventral or small midline incisional hernia repair.

Background: Ventral hernia repair is a common elective surgical procedure lacking strong evidence for specific operative approaches. This study aimed to evaluate the outcomes of primary suture repair or polypropylene sandwich mesh repair for ventral hernias. The main outcome measures were the rate of hernia recurrence, and evaluation of long-term complications and patient-reported outcomes.

The Murray-Darling Medical Schools Network Research Collaboration: protocol for a longitudinal, multi-university program of work to explore the effect of rurally based medical school programs in the Murray-Darling region.

Introduction: There is now strong evidence to support the positive impact of place-based medical education on the recruitment and retention of the rural health workforce in Australia. Much of this work, however, has been undertaken in the context of 'extended rural clinical placement' - students undertaking part of their medical degree in a rural location. Until recently, there were only a few places in Australia in which students could undertake the entirety of their medical degree in a rural area.

Effectiveness of an eHealth-Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial.

Objective: Our objective was to evaluate the effectiveness of a three-month physiotherapist-delivered eHealth physical activity program compared with usual care to improve function in adults with low back pain or knee osteoarthritis in rural Australia.

Methods: This was a parallel, two-group, pragmatic, superiority, randomized controlled trial involving three- and six-month posttreatment follow-ups. There was a total of 156 adults with chronic nonspecific low back pain (n = 97) or knee osteoarthritis (n = 59) from rural Australia.

Geographic variation in emergency department presentations among youth (10-24 years), New South Wales 2019: An epidemiological study.

Objective: To characterise ED presentations among youth in New South Wales (NSW) by geographic remoteness for 2019 and determine if intra-regional (inland vs coastal) variations exist.

Methods: A population-based, retrospective descriptive analysis of 2019 Emergency Department Data Collection registry data for state-wide emergency presentations to NSW public hospitals among NSW residents aged 10-24 years was undertaken. Local government areas of residence were classified as major city, coastal regional, inland regional or remote.

"Almost like it was really underground": a qualitative study of women's experiences locating services for unintended pregnancy in a rural Australian health system.

Rural women in Australia are more likely than urban women to experience unintended pregnancy, yet little is known about how this issue is managed in a rural health setting. To address this gap, we conducted in-depth interviews with 20 women from rural New South Wales (NSW) about their unintended pregnancy. Participants were asked about accessing healthcare services and what was uniquely rural about their experience.

What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales.

Background: Under the generalist model of health care in rural Australia, general practitioners (GPs) are often the first point of contact for women seeking health services for unintended pregnancy, including pregnancy decision-making support and options advice, antenatal or abortion care. Rural women are more likely to experience unintended pregnancy in Australia, yet little is known about how well local rural primary healthcare services currently meet their needs.

Methods: To address this gap, this qualitative study explores through in-depth semi-structured interviews, the experiences of 20 rural women managing an unintended pregnancy, and their expectations of, and satisfaction with, the quality of care they received.

Hepatitis C virus monitoring in inpatient psychiatry: Doctors' practice.

Objectives: Current guidelines recommend routine Hepatitis C virus (HCV) monitoring in people with serious mental illness. We sought to determine the rates at which doctors practising in inpatient psychiatry units monitor the HCV exposure risk and HCV infection status of their patients.

Methods: Electronic medical records (EMRs) of 50 short stay and 50 long stay mental health inpatients of a regional NSW hospital were retrospectively audited to determine the rates at which doctors screened for HCV and associated risk factors.

An intensive anatomy by whole-body dissection elective: A longitudinal study.

Whole body dissection, once a long-held method of learning and teaching in anatomy medical education, has largely been replaced by cost and time-reduced methods of teaching. This paper reports on a longitudinal study of student knowledge acquisition and retention, following six annual intensive eight-week elective anatomy by whole body dissection (AWBD) courses implemented between 2010 and 2015, utilizing a modified team-based learning (TBL) pedagogy. A total of 160 students completed the intensive full-time courses.

Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation.

Objective: To examine associations between extended medical graduates' rural clinical school (RCS) experience and geographic origins with practising in rural communities five and eight years after graduation.

Design, Participants: Cohort study of 2011 domestic medical graduates from ten Australian medical schools with rural clinical or regional medical schools.

Main Outcome Measures: Practice location types eight years after graduation (2019/2020) as recorded by the Australian Health Practitioner Regulation Agency, classified as rural or metropolitan according to the 2015 Modified Monash Model; changes in practice location type between postgraduate years 5 (2016/2017) and 8 (2019/2020).

'Empowering clinicians in smaller sites': A qualitative study of clinician's experiences with a rural Virtual Paediatric Feeding Clinic.

Objective: To explore the experiences of 'spoke site' allied health and child and family health clinicians in the provision of care through a pilot 'hub and spoke' model Virtual Paediatric Feeding Clinic (VPFC) outreach service.

Design: The study was qualitative, with data from virtual interview transcripts analysed using thematic analysis.

Setting: Orange Health Service ('hub site') and seven community health centres within the Western NSW Local Health District ('spoke sites').

An Exploration of Knowledge and Attitudes of Medical Students and Rheumatologists to Placebo and Nocebo Effects: Threshold Concepts in Clinical Practice.

Introduction: Understanding placebo and nocebo responses (context/meaning effects [CMEs]) is fundamental to physician agency. Specific instruction in CMEs is often lacking in medical education. Patient-practitioner interactions may challenge medical students' understanding of biomedical causality and the nexus between this, practical ethics and professionalism across various conceptual and applied aspects of CMEs.

Are people in the bush really physically active? A systematic review and meta-analysis of physical activity and sedentary behaviour in rural Australians populations.

Background: Physical inactivity is a major risk factor for non-communicable disease and premature mortality. People who live in rural settings are usually regarded as more physically active than those living in urban areas, however, direct comparisons between these populations are scarce. We aimed to summarise the prevalence of physical inactivity and sedentary behaviour in rural settings in Australia, compared to urban counterparts.

Bumpy and Smoother Pathways of Puberty Hormone Change: A Novel Way to Define Gonadal Hormone Trajectories in Adolescents.

Context: The study of gonadal hormone effects on adolescent wellbeing has been limited by logistical challenges. Urine hormone profiling offers new opportunities to understand the health and behavioral implications of puberty hormones.

Objective: To characterize pubertal change in urinary testosterone and estradiol among male and female adolescents, respectively.

Foot Length Growth as a Novel Marker of Early Puberty.

Foot growth is part of overall pubertal growth but its relation to other anthropometric and hormonal changes is unclear. Our objective was to determine how foot length changes relate to changes in other growth parameters (height and weight), Tanner stage, and serum hormones. Adolescents (n = 342) were recruited to a 3-year longitudinal cohort study, underwent annual anthropometric assessments (height, weight, and foot length), and provided self-rated Tanner staging.

Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes.

Introduction In large community-based studies of puberty, Tanner staging by a clinician is often not possible. We compared self-rated Tanner staging and other subjective ratings of pubertal development with serum hormone levels measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to reassess the utility of self-rated pubertal stage using highly sensitive and specific hormone analysis. Methods Adolescents and their parents enrolled in the Adolescent Rural Cohort study of Hormones and health, Education, environments and Relationships (ARCHER) answered annual survey questions on pubertal development.

The Australian Rural Clinical School (RCS) program supports rural medical workforce: evidence from a cross-sectional study of 12 RCSs.

Introduction: Many strategies have been implemented to address the shortage of medical practitioners in rural areas. One such strategy, the Rural Clinical School Program supporting 18 rural clinical schools (RCSs), represents a substantial financial investment by the Australian Government. This is the first collaborative RCS study summarising the rural work outcomes of multiple RCSs.