Remote Australia Online

Pregnancy can be a stressful time for many women. Australian Indigenous women of childbearing age (18–44 years) have been found to experience high or very high rates of psychological distress. However, few studies have examined the burden of or any associations between stressful life events, social disadvantage and psychological distress for pregnant Indigenous women in Australia.

This paper provides techniques for engagement and data collection in researching with Aboriginal Australian cultures, acknowledging significant differences in forms of communication and usage of Information Systems to the mainstream Australian culture. An approach to trust in relationships is developed by interpreting cultural aspects arising from the diverse relationships to technology developed by Aboriginal users. This work uses the existing Honeycomb model for social media development as a base framework for collaborative web systems and online knowledge sharing in the Indigenous domain. We present a series of product development research projects based in universities in NSW Australia, in particular user experience studies, to explain the relationship between the researchers and users and the products that are created in terms of the model. Some concepts and processes fundamental to engagement with Aboriginal Australian communities in the supply of appropriate information sharing technology are discussed in this context. For if Aboriginal people are to engage in IS development, we are sharing the knowledge or the culture that is embedded in the technology which can have detrimental effects. Either we are asking them to enter the culture that created the technology, that is assimilate, or we use engagement in design to change that technology to suit the culture.

Social media and mobile phones are a global phenomenon and remote communities in North East Arnhem Land have been drawn into the adoption of these emergent technologies. This study of youth and emergent technology is grounded in a traditional Aboriginal context; a remote community with limited access to resources and employment opportunities. It is important to take into account that this community still practised Aboriginal culture, law, discipline, sorcery, traditional medicine and demand sharing as part of their social life. This ethnography spanned the duration of three years, applied a series of in-depth interviews which were followed up throughout the fieldwork. The informants and interview participant’s contributions were triangulated with informal discussions and interactions with youth, socio-historical narratives of technology appropriation and relevant findings from key Indigenous academics. The engagement with young people, generally a hard-to-reach population, was carried out within a respectful relationship dictated by Yolngu kinship laws. All interviews and interactions were undertaken in several locations in the town of Nhulunbuy and the communities of Yirrkala and Birritjimi making the environment and space accessible and relevant to Aboriginal participants and intellectuals especially the young people. The key study questions were to: • Understand the role of mobile phones and social media in a remote Aboriginal community and how they were used as a combination between the traditional and contemporary (i.e. The Yirrkala Bark Petition); • Analyse the attitudes towards mobile phones and social media in the community, particularly amongst young people; • Describe how these new objects (mobile phones and social media) belong in the Yirritja and Dhuwa moieties, and the kinship system; • Analyse the use of sorcery or ‘accusations and suspicions of sorcery’ in the Yolngu online social life. The ethnography is a story of youth and their struggles, as a result of disproportionate access to economic resources and opportunities. Their partial resistance to the dominant culture, some traditional and cultural norms, including powerful individuals and families in the community, whilst striving to be part of contemporary global youth culture contributed to their expressed feelings of frustration and lack of hope for the future.

AIMS: To explore the in vitro ability of alpha haemolytic streptococcus (AHS) and lactobacilli (LBs), from Indigenous Australian children, to inhibit the growth of respiratory pathogens (Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis), also from Indigenous Australian children. METHODS AND RESULTS: The bacterial interference of 91 isolates, from Indigenous Australian children both with and without otitis media (OM) or rhinorrhoea, was investigated using agar overlay and cell-free supernatant. Promising isolates underwent whole genome sequencing to investigate upper respiratory tract tropism, antibiotic resistance and virulence. Antibiotic susceptibility was examined for ampicillin, amoxicillin +clavulanic acid and azithromycin. Differences in the strength of bacterial inferences in relation to OM was examined using a case series of three healthy and three children with OM. LBs readily inhibited the growth of pathogens. AHS were less effective, although several isolates inhibited S. pneumoniae. One L. rhamnosus had genes coding for pili to adhere to epithelial cells. We detected antibiotic resistance genes coding for antibiotic efflux pump and ribosomal protection protein. LBs were susceptible to antimicrobials in vitro. Screening for virulence detected genes encoding for two putative capsule proteins. Healthy children had AHS and LB that were more potent inhibitors of respiratory pathogens in vitro than children with OM. CONCLUSIONS: L. rhamnosus from remote Indigenous Australian children are potent inhibitors of respiratory pathogens in vitro. SIGNIFICANCE AND IMPACT OF STUDY: Respiratory/ear disease are endemic in Indigenous Australians. There is an urgent call for more effective treatment/prevention; beneficial microbes have not been explored. L. rhamnosus investigated in this study are potent inhibitors of respiratory pathogens in vitro and require further investigation.

INTRODUCTION: Emergency department (ED) utilisation continues to increase, particularly for primary care presentations that do not require high level ED services. The reasons for this are complex, and research has focused on patient perspectives in choosing where to seek care rather than those of ED and general practitioner (GP) providers. This study aimed to address this gap by exploring the views of ED and GP providers regarding ED utilisation for primary care type health conditions in a small, remote Australian city with perhaps unique population demographics and service configuration. METHODS: Service providers from the ED and general practice clinics were invited to participate in focus groups and semi-structured interviews exploring their views on ED utilisation for primary-care-type health presentations. The data were analysed using thematic content analysis. RESULTS: In total, 24 healthcare providers (five GPs, seven ED practitioners, seven community nurse navigators, four Aboriginal and Torres Strait Islander Health Workers and one Indigenous Liaison Officer) participated in focus groups discussion and interviews. The analysis identified three themes: access and logistic barriers, rational decision-making and self-perceived urgency. While there was some overlap in the healthcare providers' perceptions, there were also strong differences between ED and GP groups. In particular, the ED group believed that GP services are less accessible for urgent appointments, whereas GPs believed that such arrangements were in place. Both groups agreed on the need for clear communication between the ED and general practice. CONCLUSION: ED and GP providers demonstrate similarities and differences in understanding patients' reasons for choosing which service to access. The differences may stem from ED providers' focus on offering a rapid resolution of acute presentations and GP providers' focus on offering comprehensive and continuing care. Effective communication between general practice and the ED services and clearer referral pathways may help in reducing ED utilisation for less urgent primary-care-type problems.

Perceived readiness for practice can help mitigate the stress and uncertainty associated with transitioning from university into the workforce. This study aimed to identify factors influencing the readiness for clinical practice among final-year medical, dental, and pharmacy students at an Australian regional university.

This report documents a hydrogeological data review and assessment for Numbulwar and the surrounding region covering an area of ~40 km2. The area encompasses two key hydrogeological units: (i) the Quaternary Coastal Deposits and (ii) the Cretaceous Beds. Sand aquifers hosted in the Coastal Deposits are currently exploited for community water supplies, whereas sandstone aquifers hosted in Cretaceous Beds have only had historical investigations. The assessment considered data in the context of: (i) understanding the potential sustainability of the current water source and (ii) identifying and prioritising technical works and infrastructure requirements to underpin long-term water security. An integrated interpretation of data has proved invaluable for: (i) refining the existing hydrogeological conceptual model for the sand aquifers; (ii) evaluating the ability of the current borefield in the sand aquifers for meeting community water demand and (iii) evaluating opportunities, risks and technical requirements for expanding development of the current aquifers or further exploring and developing the Cretaceous sandstone aquifers.

The purpose of this rapid evidence check was to identify virtual care modalities that are safe and effective in the delivery of end of life and palliative care. Thirty-three peer reviewed articles which were either review articles or interventional/evaluative studies presenting comparative data were identified through PubMed, Google, and Google Scholar searches. Extracted data was synthesized narratively and outcomes were categorised separately for patients, healthcare providers, caregivers and health system. Included studies reported on a wide range of virtual care modalities, including video consultation, mobile apps, videos, websites, telephone support, email and alert messages. Generally, studies reported similar or favourable quality of life outcomes to face-to-face palliative care, especially when virtual care was used as a supplement rather than a substitute for face-to-face care. Positive attitudes for perceived usefulness and helpfulness were reported by patients, caregivers and healthcare providers. Challenges identified related to technology limitations, trust, ethical concerns, administrative burden and evidence gaps. Overall, most studies found virtual care modalities to be safe and effective in end of life and palliative care with no detrimental adverse outcomes, when used as a supplement to face-to-face care.

We aim to report the co-design of the implementation strategy of a telehealth-enabled cardiac rehabilitation model of care in rural and remote areas of Australia. The goal of this model of care is to increase cardiac rehabilitation attendance and completion by country patients with cardiovascular diseases.We hypothesise that a model of care co-designed with stakeholders will address patients? needs and preferences and increase participation. We applied the Model for Large Scale Knowledge Translation and engaged with patients, clinicians and health service managers across six local health networks in rural South Australia. They informed the design of a web-based cardiac rehabilitation programme and the delivery of the expanded telehealth service.The stakeholders defined face-to-face, telephone, web-based or combinations as choices of mode of delivery to patients referred to cardiac rehabilitation. A case-managed programme supported by a web portal with an interface for patients and clinicians was considered more appropriate to the local context than a self-managed programme. A business model was developed to enable the sustainability of cardiac rehabilitation clinical assessments through primary care. The impact of the model of care on cardiac rehabilitation attendance/completion, clinical outcomes, patient-reported outcomes and patient-reported experiences and cost-effectiveness will be tested in a 12-month follow-up study.

Point-of-care (POC) testing has proven to be a life-changing and transformational technology for patients with acute, chronic, and infectious diseases who live in regional and remote Australia. This technology facilitates patient-centred test results, of equivalent laboratory quality, that are rapidly available to inform clinical and public health decisions with immediate impact on case management. Traditionally, POC testing in high-middle income countries has been most widely used in tertiary or acute care settings to provide rapid diagnostic results for emergency departments, intensive care units, operating theatres and outpatient clinics. However, in low-middle income countries, POC tests are commonly used during antenatal and perinatal care for infectious disease detection, such as Human immunodeficiency virus (HIV) or syphilis, where laboratory services are too expensive, inaccessible, or non-existent. Similarly, the application of POC testing in primary care settings in Australia offers improved healthcare benefits to geographically isolated regional and remote communities, where access to laboratory-based pathology testing is poor and the burden of disease is high. Evidence-based data from research in established primary care POC testing networks for acute chronic, and infectious disease is used to describe the clinical, cultural, and economic effectiveness of POC technologies. Innovative solutions to address current barriers to the uptake of POC testing in primary care settings, which include clinical and cultural governance, high staff turnover, operator training and competency, device connectivity, quality testing, sustainable funding strategies, and the need for regulatory requirements are also discussed. POC testing can provide practical and resourceful opportunities to revolutionise the delivery of pathology services in rural and remote primary care sectors, where the clinical and community need for this technology is greatest. However, several barriers to the scale-up and sustainability of POC testing networks in these settings still exist, and the full potential of POC testing cannot be realised until these limitations are addressed and resolved.

Many rural communities in New South Wales (NSW), Australia, have poor-quality water supplies. The lack of a palatable alternative increases the risk of the high consumption of sugar-sweetened beverages, a significant contributor to adverse health outcomes. This disproportionately effects Aboriginal people living in these towns, who are also profoundly affected by the social determinants of health. Therefore, examining health inequalities linked to water access is important. This study investigated the availability of drinking water fountains in rural and remote communities in NSW. Telephone interviewer-assisted surveys were conducted with 32 representatives from local government councils or Local Aboriginal Land Councils in NSW from communities with a population of <5000 and an Aboriginal population of at least 3%. The results were analysed descriptively. Towns and communities with a higher population of Aboriginal people and lower median weekly income were less likely to have access to free refrigerated and filtered water within the community or at local schools compared with towns and communities with a lower Aboriginal population and higher median weekly income. The availability of free, clean and refrigerated water in rural and remote communities is critical to reducing the consumption of sugar-sweetened beverages and the promotion of water as the preferred drink.

Many theories of language acquisition struggle to account for the morphological complexity and diversity of the world’s languages. This book examines the acquisition of complex morphology of Murrinhpatha, a polysynthetic language of Northern Australia. It considers semi-naturalistic data from five children (1;9-6;1) collected over a two-year period. Analysis of the Murrinhpatha data is focused on the acquisition of polysynthetic verb constructions, large irregular inflectional paradigms, and bipartite stem verbs, which all pose interesting challenges to the learner, as well as to theories of language acquisition. The book argues that morphological complexity, which broadly includes factors such as transparency, predictability/regularity, richness, type/token frequency and productivity, must become central to our understanding of morphological acquisition. It seeks to understand how acquisition is impacted by differences in morphological systems and by the ways in which children and their interlocutors use these systems.

Objective: To assess the accessibility, availability and utilisation of a comprehensive range of community-based healthcare services for Aboriginal people and describe contributing factors to providing effective healthcare services from the provider perspective. Setting: A remote community in New South Wales, Australia. Participants: Aboriginal and non-Aboriginal health and education professionals performing various roles in healthcare provision in the community. Design: Case study. Methodology: The study was co-designed with the community. A mixed-methods methodology was utilised. Data were gathered through structured interviews. Descriptive statistics were used to analyse the availability of 40 health services in the community, whilst quotations from the qualitative research were used to provide context for the quantitative findings. Results: Service availability was mapped for 40 primary, specialised, and allied health services. Three key themes emerged from the analysis: (1) there are instances of both underservicing and overservicing which give insight into systemic barriers to interagency cooperation; (2) nurses, community health workers, Aboriginal health workers, teachers, and administration staff have an invaluable role in healthcare and improving patient access to health services and could be better supported through further funding and opportunities for specialised training; and (3) visiting and telehealth services are critical components of the system that must be linked to existing community-led primary care services. Conclusion: The study identified factors influencing service availability, accessibility and interagency cooperation in remote healthcare services and systems that can be used to guide future service and system planning and resourcing.

CONTEXT: Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners. ISSUES: FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities. LESSONS LEARNED: Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.

Despite a lengthy and successful history of Indigenous multilingual/multiliteracy education and English as an Additional Language or Dialect programmes in Australia's Northern Territory, these programmes have virtually disappeared. The current denuded offerings in school instruction are a consequence of locally nuanced manifestations of neoliberal global developments. This paper uses Roberts and Mahtani's (2010) market orientation to race to examine the localised expression of global neoliberal influences in Northern Territory remote Indigenous contexts.

Objective Women with threatened preterm labor in remote Australia often require tocolysis in the prevention of in-flight birth during air medical retrieval. However, debate exists over the tocolytic choice. Methods A retrospective analysis was undertaken on data containing women who required air medical retrieval for threatened preterm labor within Western Australia between the years 2013 and 2018. Results A total number of 236 air medical retrievals were deemed suitable for inclusion; 141 received nifedipine, and 95 women received salbutamol + nifedipine. Tocolytic efficaciousness was reported in 151 cases, proportionally more (P < .05) from the women who received salbutamol + nifedipine (n = 68, 71.6%) compared with the women who received nifedipine only (n = 83, 58.9%). Those receiving salbutamol + nifedipine were more likely to suffer maternal tachycardia (n = 87 [91.6%] vs. n = 62 [44.0%]), fetal tachycardia (n = 26 [27.4%] vs. n = 13 [9.2%]), nausea (n = 17 [17.9] vs. n = 5 [3.55%]), and vomiting (n = 12 [12.6%] vs. n = 2 [1.4%]). Three women who received salbutamol + nifedipine had serious side effects including echocardiographic changes, chest pain, and metabolic and lactic acidosis. Conclusion Salbutamol + nifedipine tocolysis was proven to be more effective than nifedipine only. Although salbutamol + nifedipine had increased temporary side effects, most were nonsevere and managed in-flight.

Background. Aboriginal leaders invited us to examine the frequency and reasons for emergency department (ED) presentations by children in remote Western Australia, where Prenatal Alcohol Exposure (PAE) is common. Methods. ED presentations (2007-11 inclusive) were examined for all children born in the Fitzroy Valley in 2002-03. Results. ED data for 127/134 (94.7%) children (95% Aboriginal) showed 1058 presentations over 5-years. Most (81%) had at least 1 presentation (median 9.0, range 1-50). Common presentations included: screening/follow-up/social reasons (16.0%), injury (15.1%), diseases of the ear (14.9%), skin (13.8%), respiratory tract (13.4%), and infectious and parasitic diseases (9.8%). PAE and higher presentations rates were associated. Commonly associated socio-economic factors were household over-crowding, financial and food insecurity. Conclusion. Children in very remote Fitzroy Crossing communities have high rates of preventable ED presentations, especially those with PAE. Support for culturally appropriate preventative programs and improved access to primary health services need to be provided in remote Australia.

The aim of this thesis was to examine whether utilising a collective impact model of design, implementation and evaluation improves effectiveness and efficiency of health care services for Aboriginal Australians. Background: Colonisation had a devastating impact on the culture, health, population and wellbeing of Aboriginal Australians. The impacts of colonisation are complex, long standing, entrenched and wide ranging. Collective Impact is a structured five-stage and three-phase process which facilitates community engagement in resolving highly complex or wicked problems. The purpose of this research is to determine the efficacy of utilising collective impact in the design, implementation and evaluation of health care services for Aboriginal people in Australia. Methods: Mixed methods are utilised in this research including: systematic reviews; interviewer assisted surveys; semi-structured interviews; and retrospective comparison of two data sets. The data is analysed descriptively and thematically; and the retrospective comparative data is analysed quantitatively. Results and discussion: Quantitative and qualitative evidence is provided in this research to support the finding that collective impact is efficacious in engaging Aboriginal people in the design, implementation and evaluation of health care services intended for them. The collective impact approach is demonstrated to result in successful, well designed programs and increase the efficacy of health services. Conclusions: Collective impact is a suitable tool for health care policy makers, managers and funders to utilise to expedite progress with improving health outcomes for Aboriginal Australians. Key words Aboriginal, health outcomes, collective impact, service design, workforce development, program evaluation.

The study aims to explore the role of mental health care in remote Aboriginal health services in the Kimberley region of Western Australia and provide a more nuanced understanding of the patients presenting for care, their needs, and the clinical response. Little is currently known about primary health care presentations for mental health, suicide, and self-harm for remote dwelling Aboriginal residents of the Kimberley region, despite high rates of psychological distress, self-harm, and suicide across the area. This study was progressed through a retrospective, cross-sectional audit of the electronic medical records system used by three remote clinics to explore the interactions recorded by the clinics about a patient’s mental health. In addition, an in-depth file review was conducted on a stratified purposive sample of 30 patients identified through the audit. Mental ill-health and psychological distress were found to be prominent within clinical presentations. Psychosocial factors were frequently identified in relation to a patient’s mental health presentation. Optimizing patients’ recovery and wellness through service improvements, including an enhanced mental health model of care, is an important next step.

I welcome the opportunity to make a submission in response to the Northern Territory Government’s ‘NT Strategic Water Plan – Directions Paper’. I note that the Housing for Health Incubator made a submission to the former ‘Northern Territory Water Regulatory Reform’ process on 30 March 2019. That submission, which I co-authored with Dr Kirsty Howey, made the following recommendations. 1. Securing a safe and potable public water supply for all residents of the NT should be an explicit and primary aim of the proposed reforms 2. The NTG should legislate for uniform minimum water quality standards and water utility service provision across the NT 3. The NTG should amend the Water Act to include a power to specifically reserve water for future drinking water supply security and to ensure it is of adequate quality 4. The NTG should legislate for a right to potable and adequate drinking water for all residents The above recommendations remain relevant and necessary in 2022. Since that time, Dr Howey and I have published peer reviewed research on water law and governance regimes in the Northern Territory. Rather than describe in detail the findings of that research, I have attached the following publications as appendices to this submission, noting key pages: • Housing for Health Incubator. 2020. ‘Safe drinking water in the Northern Territory – Fact Sheet, November 2020.’ • Grealy, Liam and Howey, Kirsty. 2020. ‘Securing Supply: Governing drinking water in the Northern Territory.’ Australian Geographer. 51(3): 341-360. (Especially pages 343-349) • Howey, Kirsty and Grealy, Liam. 2021. ‘Drinking water security: The neglected dimension of Australian water reform.’ Australasian Journal of Water Resources. 25(2): 111-120. (Especially pages 116-119) In terms of the proposed directions for water security listed within the current Directions Paper, this research is most directly relevant to: 1. Water governance is contemporary and coordinated, and 2. Drinking water is safe. It is important that the consultation exercise initiated by this Directions Paper leads to significant reform in Northern Territory water governance. This must involve meaningful collaboration with Traditional Owners and their representative institutions. In order to ensure that NT residents’ water security is guaranteed, I consider it necessary that the following actions are pursued: 1. Legislate a Safe Drinking Water Act 2. Establish an independent water regulator 3. Develop a pricing regime for commercial water use

Objective: To develop an artificial intelligence image classification algorithm to triage otoscopic images from rural and remote Australian Aboriginal and Torres Strait Islander children. Study Design: Retrospective observational study. Setting: Tertiary referral center. Patients: Rural and remote Aboriginal and Torres Strait Islander children who underwent tele-otology ear health screening in the Northern Territory, Australia between 2010 and 2018. Intervention(s): Otoscopic images were labeled by otolaryngologists to classify the ground truth. Deep and transfer learning methods were used to develop an image classification algorithm. Main Outcome Measures: Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, area under the curve (AUC) of the resultant algorithm compared with the ground truth. Results: Six thousand five hundred twenty seven images were used (5927 images for training and 600 for testing). The algorithm achieved an accuracy of 99.3% for acute otitis media, 96.3% for chronic otitis media, 77.8% for otitis media with effusion (OME), and 98.2% to classify wax/obstructed canal. To differentiate between multiple diagnoses, the algorithm achieved 74.4 to 92.8% accuracy and an AUC of 0.963 to 0.997. The most common incorrect classification pattern was OME misclassified as normal tympanic membranes. Conclusions: The paucity of access to tertiary otolaryngology care for rural and remote Aboriginal and Torres Strait Islander communities may contribute to an under-identification of ear disease. Computer vision image classification algorithms can accurately classify ear disease from otoscopic images of Indigenous Australian children. In the future, a validated algorithm may integrate with existing telemedicine initiatives to support effective triage and facilitate early treatment and referral.

OBJECTIVES: Using echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town. DESIGN: Prospective, cross-sectional echocardiographic screening study; results compared with data from the NT rheumatic heart disease register. SETTING, PARTICIPANTS: People aged 5-20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018. INTERVENTION: Echocardiographic screening for RHD by an expert cardiologist or cardiac sonographer. MAIN OUTCOME MEASURES: Definite or borderline RHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosing ARF. RESULTS: The screening participation rate was 72%. The median age of the 613 participants was 11 years (interquartile range, 8-14 years); 298 (49%) were girls or women, and 592 (97%) were Aboriginal Australians. Definite RHD was detected in 32 screened participants (5.2%), including 20 not previously diagnosed with RHD; in five new cases, RHD was classified as severe, and three of the participants involved required cardiac surgery. Borderline RHD was diagnosed in 17 participants (2.8%). According to NT RHD register data at the end of the study period, 88 of 849 people in Maningrida and the surrounding homelands aged 5-20 years (10%) were receiving secondary prophylaxis following diagnoses of definite RHD or definite or probable ARF. CONCLUSION: Passive case finding for ARF and RHD is inadequate in some remote Australian communities with a very high burden of RHD, placing children and young people with undetected RHD at great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.

Introduction Radiographers working in remote Far North Queensland (FNQ), Australia, need to possess unique skills sets in order to provide culturally safe practice to predominantly Indigenous communities. Due to the lack of onsite radiologists in FNQ, radiographers need to provide preliminary findings to referring practitioners including sonographic findings. The accuracy of such findings has not been evaluated to date. The objective of this study was to compare the level of agreement and recommendations for further investigations of FNQ radiographers to teleradiologists? reports. As radiographic findings are not recorded or stored as part of routine practice, only sonographic findings were included in the study. Methods Consecutive de-identified ultrasound cases were extracted between January and March 2019 inclusively by an independent investigator. The researcher scored the ultrasound cases between 1 and 4 according to levels of agreement between sonographic findings and teleradiologists? reports, and recommendations between radiographers and teleradiologists were also compared using frequency analysis. Results Five-hundred and thirty-two ultrasound cases were included for this study. Of those, 517 (97.2%) were in complete agreement and 15 (2.8%) reported minor discrepancies. There were no moderate or major discrepancies suggesting an overall accuracy rate of 100% as the radiographer/sonographer findings were in close agreement with the teleradiologists? reports. There was complete agreement regarding further clinical recommendations in 453 (85%) cases. The discrepancy in the remaining 15% of cases did not lead to any adverse or changed patient management. Conclusions This study supports existing evidence about the accuracy and timely communication of sonographic findings to radiologists and other health care professionals, in keeping with the Medical Radiation Practice Board of Australia expectations. It is likely that radiographer comments on plain radiographic images are equally as reliable, but this remains to be explored.

This Topical Issues paper identifies remote Indigenous housing as a structural gap in the nation’s overarching housing policies. The paper reproduces a submission to the current Productivity Commission review of the National Housing and Homelessness Agreement (NHHA) which argues for a much stronger focus to be placed upon remote Indigenous housing in the renewal of the NHHA scheduled for 2023. The submission outlines the extent and systemic underpinnings of the substantial Indigenous housing shortfall in remote Australia, and assesses the adequacy of current policy frameworks to meet that need and thus mitigate ongoing adverse social, health and economic consequences. In particular, the submission argues that the national housing target in the National Agreement on Closing the Gap is, in its current form, an inadequate mechanism to address remote housing need. The submission makes a number of specific recommendations designed to ensure that remote Indigenous housing needs are effectively addressed going forward.

Objective To address access to cardiac rehabilitation (CR) for people in R poorly defined referral pathways; lack of guidelines; inadequate understanding of holistic, multidisciplinary CR by health staff, community participants and leaders; limited centre-based CR services; lack of awareness, or acceptance of telephone support services. Conclusion To address barriers identified for CR in R&R areas, health care systems' revision, including development of referral pathways to local health professionals, CR guidelines and in-service education, is required to developing a model of care that focuses on self-management and education: Heart: Road to Health.