Remote Australia Online

Q fever is considered one of the most important zoonoses in Australia. Whilst ruminants are the primary reservoirs for Coxiella burnetii, and the major source of human infection, human cases have also been reported following contact with pet dogs and cats. This study aimed to estimate the prevalence of seropositivity to, and bacterial shedding of, C. burnetii by pet dogs and cats in a region with a high human Q fever incidence and explore risk factors for C. burnetii exposure. Samples (serum, whole blood, reproductive tissue, reproductive swabs) and questionnaires (completed by the pet's owner) were collected from dogs and cats from eight communities across remote New South Wales (NSW), Australia. Overall 86/330 dogs (26.1%, 95% CI 21.3-30.8%) and 19/145 cats (13.1%, 95% CI 7.6-18.6%) were seropositive to C. burnetii. Seroprevalence varied significantly between communities and was highest in communities within 150km of a 2015 human Q fever outbreak. Feeding raw kangaroo was identified as a risk factor for seropositivity (adjusted OR 3.37, 95% CI 1.21-9.43). Coxiella burnetii DNA was not detected from any dog or cat whole blood, reproductive tissues or vaginal/preputial swabs using qPCR targeting the IS1111 and com1 genes. Our findings suggest that companion animals are frequently exposed to C. burnetii in western NSW. Geographical variation in C. burnetii seroprevalence amongst companion animals – which corresponds with a human Q fever outbreak – suggests a shared environmental source of infection is likely with important consequences for public and animal health. The lack of detection of C. burnetii DNA from healthy companion animals suggests that pet dogs and cats are not an important reservoir for human Q fever infection outside a narrow periparturient window.

Data on 33 Aboriginal children with rheumatic heart disease who attended the Royal Darwin Hospital over a four-year period were examined. Mitral-valve incompetence was the most-common valvular lesion that occurred as a result of rheumatic heart disease and was present in 30 children. Mitral stenosis was present in 17 children and was accompanied by incompetence in all cases; it was present by the age of 13 years in more than half the children. Five children died in the period of the study and four of these had mitral stenosis as part of their valvular abnormality. Rheumatic heart disease is a significant cause of morbidity and mortality in Aboriginal children in the Northern Territory. (Med J Aust 1989; 150: 503-505)

Introduction: Many Aboriginal and Torres Strait Islander Australian adolescents from remote communities attend boarding schools, requiring integrated healthcare between home and schools. This study explored students’ health status, healthcare service use and satisfaction. Methodology: A two-phased mixed-methods explanatory design was implemented. 32 Indigenous primary and 188 secondary boarding school students were asked their health status, psychological distress, use of healthcare services in community and boarding school, and service satisfaction. Results were fed back to students, parents and community members, and education and healthcare staff to elicit further explanation and interpretation. Results: In the previous year, 75% of primary and 81% of secondary boarding school students had visited a doctor. More than 90% were satisfied with healthcare services used. Despite 27.1% reporting high psychological distress, students did not perceive distress as reducing their overall health, nor was distress associated with mental healthcare service use. Discussion: Despite high levels of service use and satisfaction, this study highlighted the need for improved healthcare integration for Indigenous adolescents between school-based and remote community services. Further research is needed to identify students’ expectations and models for healthcare integration. Conclusion: With resourcing, schools could play a greater role in facilitating access to healthcare.

A social marketing campaign promoting hand-washing with soap was implemented to reduce the high burden of infection experienced by Australian Aboriginal children living in remote communities. Epidemiological evidence of effect and other evidence were used to identify the hygiene intervention and health promotion approach for the project. We drew on the findings of: (i) a systematic literature review to identify the intervention for which there is strong effect in similar populations and contexts; and (ii) a narrative literature review to determine our health promotion approach. This process provided practitioners with confidence and understanding so they could address a complex problem in a politically and otherwise sensitive context.

Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning.Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations.Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions.Conclusions The availability and application of a specific ‘fit-for-purpose’ access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities.What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making.What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is demonstrated using a case study to hypothetically model changes in rural PHC workforce supply.What are the implications for practitioners? The Index of Access has significant potential for identifying how rural and remote primary health care access inequities can be addressed. This critically important information can assist health service planners, for example those working in primary health networks, to determine where and how much redistribution of PHC services is needed to correct existing inequities.

Over the decade from 1971 to 1980, there was a decline in Western Australia in the number of Aboriginal infants and children admitted to hospital with infections. The most marked change occurred in admissions for gastroenteritis and other infections in the Kimberley region in the far north of the State. Despite this decline, there is still a very wide gap between the rate of admission to hospital for infectious diseases of Aboriginal and that of non-Aboriginal infants and children. The decline reported here is considered to reflect improvements in health status caused by several interrelating factors, including improvement in the general standard of living, housing and hygiene, and the provision of comprehensive, community-based health programmes. Environmental contamination is still a major factor causing ill health in Australian Aboriginal communities.

CONTEXT: Tuberculosis (TB) is a serious infectious disease with high rates of morbidity and mortality if left untreated. In Australia, TB has been virtually eradicated in non-Indigenous Australian-born populations but in remote Aboriginal and/or Torres Strait Islander communities TB presents a rare but significant public health issue. Remote health services are most likely to encounter patients with suspected and confirmed TB diagnosis but may be unprepared for supporting someone with this disease and the complexities of balancing public health risk with patient autonomy. ISSUE: This case study will outline the process for diagnosis and treatment of a TB patient in a remote Cape York community. This case involved significant delay in diagnosis and required several strategies to achieve successful disease eradication. The process of treatment, however, had a significant effect on the patient's physical health, and social and emotional wellbeing. LESSONS LEARNED: This case highlights the importance of early collaboration between medical, nursing, Indigenous health worker and allied health services and the importance of technology such as electronic information records to support opportunistic access to diagnostic services and treatment. The enactment of the TB protocol should include discussions about the consequences of any restrictions of movement, employment or social/community roles. Identifying alternative opportunities to engage in meaningful roles may reduce the impact the disease has on a patient's quality of life.

OBJECTIVE: To describe, from a patient perspective, factors leading to suboptimal management of individuals with rheumatic fever (RF) and rheumatic heart disease (RHD) among members of the Kimberley population. METHOD: Qualitative in-depth semistructured and repeated interviews of seven Kimberley patients, or parents of children, with rheumatic fever and/or rheumatic heart disease, during 1998. RESULTS: Participants showed variable levels of understanding about RF/RHD, often relating to the need for secondary prophylaxis. Compliance with medication was closely linked with positive patient-staff interactions. From the perspective of health care, living in a remote location was frequently described as a negative influence. Participants desire more accessible and culturally appropriate opportunities for learning about their disease. CONCLUSIONS: Participants focused on issues closely related to effective and ineffective management of RF/RHD. The lessons learned are indicators for health staff attempting to improve the quality of management that people receive.

Aboriginal children in northern Australia have high rates of rheumatic fever and rheumatic heart disease, which are chronic conditions because of the need for long-term treatment and monitoring. This article critically reviews the literature on transition to adult care for children with chronic conditions and considers applicability to the care of these children. The review was merged with findings from a focussed ethnography conducted in four remote Aboriginal communities with young people who have these conditions. Transition care aims to support adolescents on a healthcare trajectory to facilitate best long-term health and personal outcomes. Characteristics of the two medical conditions, the children and their local health services in northern Australia were generalised and merged with principles from the transition care literature, including policies governing transition clinics in urban locations. In this setting, the challenge is to transition Aboriginal children safely through to adulthood without rheumatic heart damage rather than to a separate health service on reaching adulthood. Recommended tailoring of transition care involves engaging and valuing local navigators who can address language and cultural barriers to provide a sustainable alternative to transition coordinators in mainstream programs. This has potential to improve care without further burdening overstretched clinical resources.

OBJECTIVE: To explore young Aboriginal people's and clinicians' experiences of injection pain for the 10 years of penicillin injections children are prescribed to prevent rheumatic fever recurrences. METHODS: Aboriginal children on the penicillin regimen and clinicians were purposively recruited from four remote sites in Australia. Semi-structured interviews and participant observations were conducted. Views were synthesised and thematically analysed. RESULTS: A total of 29 Aboriginal children and 59 clinicians were interviewed. Sixteen participants appeared to become accustomed to the injection pain, eight did not find pain an issue, and five found injection pain difficult. A further five believed the injections made them unwell. Patients expressed varying abilities to negotiate with clinicians about the use of pain reduction measures. Clinicians revealed good knowledge of pain reduction measures, but offered them inconsistently. All clinicians found administering the injections distressing. CONCLUSION: Repeated painful procedures in children necessitate well-planned and child-focused care. Current practices are not in line with guidance from the Royal Australasian College of Physicians about effects of repeated painful procedures on children. Initiating the long-term injection regimen for rheumatic fever is a special event requiring expert input. A newly reported finding of a subset of young people feeling unwell after receiving the injection requires further investigation. Implications for public health: Improvement of local and jurisdictional guidelines on use of pain reduction measures for children who have been prescribed repeated painful injections for rheumatic fever is needed.

Objective: The aim of this review is to explore the multifaceted roles of registered nursing practice in rural and remote areas of Australia. Background: People in rural and remote Australia have less access to healthcare than their metropolitan counterparts. They are also burdened with higher rates of chronic disease and premature mortality. These areas also have less doctors and allied health professionals than metropolitan areas, with the core workforce being registered nurses. One strategy to address the health workforce disparities, is to promote registered nurses to work to their full scope and in advanced generalist roles. An understanding of the current roles of the registered nurse is therefore required to assist in determining how their scope could be extended, and to inform appropriate educational planning. Study design and methods: An integrative review of literature was used to obtain articles from online databases relevant to nursing from 1995 to 2017. Data was quality appraised, extracted, and thematically analysed. Results: Registered nurses in rural and remote Australia work in diverse contexts that have a major influence on the roles they undertake. They are already required to be multi-skilled and to practice at an advanced level, including undertaking some aspects of the health professional role traditionally the domain of medical practitioners. These registered nurses often feel unprepared for the breadth and complexity of this role. Discussion: To enable registered nurses to be adequately prepared for rural and remote practice, educational programs need to be flexible, accessible and affordable. The registered nurse’s existing experience and expertise should be recognised, and educational pathways structured to enable the nurse to expand their practice according to the context in which they work and the needs of the community. Conclusion: Registered nurses in rural and remote areas function as advanced generalists. Greater understanding of these roles is necessary to inform the development of ‘fit for purpose’ educational models. Implications for research, policy and practice: Future research is needed to focus on evaluation of existing models of rural and remote nursing practice and in particular the role of the nurse as doctor substitute. The findings of this study highlight the potential expanded contribution of registered nurses in these areas, which is an important factor for consideration by policy makers. In practice, supportive frameworks are required to ensure registered nurses are able to function to their full capacity in their unique context. What is already known about the topic? – People living in rural and remote areas are subjected to inequities in respect of health and access to healthcare services. – Registered nurses working in rural and remote areas are essential for addressing healthcare needs that would otherwise be unmet. – Nurses practicing in these areas require an advanced skills-set in order to function effectively in their role. What this paper adds. – This paper examines the multifaceted role of the registered nurse working in rural and remote areas of Australia as described in the literature. – Four main themes were identified: roles shaped by context; doctor substitute; multi-skilled and advanced practice; and feeling unprepared. – Understanding the complexity of the registered nurse role in rural and remote areas enables the development of policy, practice and educational approaches to support nurses in functioning to their full capacity.

Issue addressed: Good nutrition, physical activity and adequate sleep are essential for the healthy growth and development of young children. Due to complex cultural, historical, social factors, Aboriginal and Torres Strait Islander children face additional challenges to optimal health, particularly in remote areas of Australia. ?Learning, Eating, Active Play and Sleep? (LEAPS) was a Queensland-wide professional development program designed to support early childhood education and care (ECEC) educators to implement and reinforce healthy nutrition and physical activity in their services. This article describes the adaptation, implementation, and evaluation of LEAPS for remote ECEC settings in Cape York. Methods An Aboriginal and Torres Strait Islander Reference Group was commissioned to provide advice about the appropriateness of the existing program for Aboriginal and Torres Strait Islander ECEC settings. Based on the advice of the Reference Group, the program was adapted for use in Cape York and was evaluated using the RE-AIM framework and a combination of data sources. Quantitative data provided information about changes to participant knowledge and confidence regarding nutrition and physical activity and in-depth interviews allowed further insights into enablers and challenges for successful program implementation. Conclusion A tailored LEAPS program increased participants? knowledge and confidence regarding nutrition and physical activity in ECEC settings. The importance of community consultation, building relationships and face-to-face delivery of training were highlighted as key enablers. The evaluation identified a number of challenges relating to competing priorities, limited support for ongoing implementation and adoption of improved practices. So what? Poor nutrition and growth in children in remote Aboriginal and Torres Strait Islander communities indicates the need for the ongoing commitment to and investment in nutrition and physical activity across a range of community settings. To achieve success, this requires a dedicated preventative health workforce supporting evidence-informed, coordinated programs driven by community priorities and developed via community development approaches.

Indigenous Knowledge, the Library and Information Service Sector, and Protocols

Objective To establish a program for the prevention of rheumatic fever and rheumatic heart disease In a semi-Isolated Aboriginal community in far north Queensland and to test its efficacy. Design A prevalence study of acute rheumatic fever and chronic rheumatic heart disease was conducted In the community in 1985 and subjects with possible acute rheumatic fever were assessed. A prophylactic antibiotic program was instituted. Records were kept of the prevalence of acute rheumatic fever for six years after the 1985 survey. A second survey of the community was held in 1991 to detect chronic rheumatic carditis resulting from undetected acute rheumatic fever. Setting The Yarrabah Aboriginal community in north Queensland (latitude 17°S). The program was conducted by the Yarrabah Health Team, a part of the North Queensland Aboriginal Health Division. Participants The whole Yarrabah community (population 1250) was invited to participate. In 1985, after the completion of an educational program, 89% of the community cooperated in the survey. There was no educational program before the 1991 survey and the compliance rate was much lower. Importantly, however, 87% of the vulnerable group (4?16 year olds) were examined. Interventions After the 1985 survey, all community members aged 4?16 years had throat swabs taken three times each year. Those with swabs showing Group A streptococci were treated; their contacts were also swabbed and treated if Group A streptococci were found. Results: Before the institution of the swabbing program there were four new cases of acute rheumatic fever each year in the Yarrabah community. In the six years after the program was introduced only one case of acute rheumatic fever occurred. This was at a time when swabbing had temporarily lapsed for a three-month period. Conclusions These results support the use of a prophylactic antibiotic program in Aboriginal communities as a cost effective and efficient method for the prevention of rheumatic fever. The cooperation of the community is an integral part of Its success and this can be obtained by community education.

Fungal kerion is a hypersensitivity reaction to a scalp dermatophyte which gains access to the hair shaft following physical trauma. However, precipitating injuries are rarely reported. We report the case of a 4-year-old girl who presented with non-healing scalp lesions following a deep dermal forehead scald caused by hot water. The third degree burn was epithelialized with two autologous split skin grafts from a donor thigh site. The grafts were complicated by early bacterial infection treated with intravenous antibiotics. The child returned to her remote community and was lost to follow up. Three months later, fungal kerion at the same site as the burn was clinically diagnosed and confirmed with culture of Trichophyton tonsurans from plucked hair samples. Her condition improved after treatment with oral terbinafine and co-trimoxazole (for suspected bacterial co-infection). Clinical recognition of fungal kerion following a deep burn injury as a trauma mechanism is presented to facilitate early recognition in other children with similar risk factors.

Objective: To determine the burden of hospitalised, radiologically confirmed pneumonia (World Health Organization protocol) in Northern Territory Indigenous children. Design, setting and participants: Historical, observational study of all hospital admissions for any diagnosis of NT resident Indigenous children, aged between ≥ 29 days and < 5 years, 1 April 1997 to 31 March 2005. Intervention: All chest radiographs taken during these admissions, regardless of diagnosis, were assessed for pneumonia in accordance with the WHO protocol. Main outcome measure: The primary outcome was endpoint consolidation (dense fluffy consolidation [alveolar infiltrate] of a portion of a lobe or the entire lung) present on a chest radiograph within 3 days of hospitalisation. Results: We analysed data on 24 115 hospitalised episodes of care for 9492 children and 13 683 chest radiographs. The average annual cumulative incidence of endpoint consolidation was 26.6 per 1000 population per year (95% CI, 25.3–27.9); 57.5 per 1000 per year in infants aged 1–11 months, 38.3 per 1000 per year in those aged 12–23 months, and 13.3 per 1000 per year in those aged 24–59 months. In all age groups, rates of endpoint consolidation in children in the arid southern region of NT were about twice that of children in the tropical northern region. Conclusion: The rates of severe pneumonia in hospitalised NT Indigenous children are among the highest reported in the world. Reducing this unacceptable burden of disease should be a national health priority.

Objective: To describe the epidemiology of acute lower respiratory infection (ALRI) and bronchiectasis in Northern Territory Indigenous infants hospitalised in the first year of life. Design: A historical cohort study constructed from the NT Hospital Discharge Dataset and the NT Immunisation Register. Participants and setting: All NT resident Indigenous infants, born 1 January 1999 to 31 December 2004, admitted to NT public hospitals and followed up to 12 months of age. Main outcome measures: Incidence of ALRI and bronchiectasis (ICD-10-AM codes) and radiologically confirmed pneumonia (World Health Organization protocol). Results: Data on 9295 infants, 8498 child-years of observation and 15 948 hospitalised episodes of care were analysed. ALRI incidence was 426.7 episodes per 1000 child-years (95% CI, 416.2–437.2). Incidence rates were two times higher (relative risk, 2.12; 95% CI, 1.98–2.27) for infants in Central Australia compared with those in the Top End. The median age at first admission for an ALRI was 4.6 months (interquartile range, 2.6–7.3). Bronchiolitis accounted for most of the disease burden, with a rate of 227 per 1000 child-years. The incidence of first diagnosis of bronchiectasis was 1.18 per 1000 child-years (95% CI, 0.60–2.16). One or more key comorbidities were present in 1445 of the 3227 (44.8%) episodes of care for ALRI. Conclusions: Rates of ALRI and bronchiectasis in NT Indigenous infants are excessive, with early onset, frequent repeat episodes, and a high prevalence of comorbidities. These high rates of disease demand urgent attention.

Eight adult Aboriginal people residing in a remote community in the north-west of Australia participated in this research. The data were collected from an ?inside? perspective and, as culturally appropriate, through informal interviews (yarning) and ongoing conversations. These data were recorded as field notes and audio files which were transcribed and used to formulate case studies. Because the authors are not Aboriginal people, the voices of the participants were used to tell their personal stories and experiences. The findings indicate that each identified as Aboriginal and according to their language group. They recognized their wide-ranging linguistic repertoire which included Aboriginal English (AE), Kriol and, to various degrees, traditional languages. They believed they were more connected to their culture because of their Aboriginal dialects and languages. Their language use was fluid and they engaged in translanguaging. Not all claimed to be proficient in Standard Australian English and some described feeling ?shame? when speaking this and their Aboriginal language varieties. They also reported experiences with linguicism and racism, even in their own community because of their language use and because of the color of their skin. Our findings suggest a key role for education in providing support for multilingual Aboriginal people.

As part of the teacher education program at Edith Cowan University, a small group of student teachers experience teaching practice in remote Aboriginal communities. In this paper, student teacher perceptions of their experiences on such a practice are presented to illustrate the influence of the practice on their views about teaching Aboriginal children. Through an investigation of journals written during the practice, it is apparent that students had considerable difficulty adapting their teaching to the context in which they were working, particularly in relation to the different cultural and social demands of the situation.

This project focuses upon the Pitjantjatjara-, Yankunytjatjara-, and Ngaanyatjarra-speaking communities in Central Australia, located in the region known as the NPY Lands. This target group forms a large part of the cross border region of South Australia, Northern Territory and Western Australia as defined by the Justice Departments in the three contributing jurisdictions in the context of the Cross-Border Justice Project. The lead agency is the South Australian Department of Correctional Services.

Background: Health system strengthening is needed to improve delivery of secondary prophylaxis against rheumatic heart disease. Methods and Results: We undertook a stepped-wedge, randomized trial in northern Australia. Five pairs of Indigenous community clinics entered the study at 3-month steps. Study phases comprised a 12 month baseline phase, 3 month transition phase, 12 month intensive phase and a 3- to 12-month maintenance phase. Clinics received a multicomponent intervention supporting activities to improve penicillin delivery, aligned with the chronic care model, with continuous quality-improvement feedback on adherence. The primary outcome was the proportion receiving ≥80% of scheduled penicillin injections. Secondary outcomes included “days at risk” of acute rheumatic fever recurrence related to late penicillin and acute rheumatic fever recurrence rates. Overall, 304 patients requiring prophylaxis were eligible. The proportion receiving ≥80% of scheduled injections during baseline was 141 of 304 (46%)—higher than anticipated. No effect attributable to the study was evident: in the intensive phase, 126 of 304 (41%) received ≥80% of scheduled injections (odds ratio compared with baseline: 0.78; 95% confidence interval, 0.54–1.11). There was modest improvement in the maintenance phase among high-adhering patients (43% received ≥90% of injections versus 30% [baseline] and 28% [intensive], P<0.001). Also, the proportion of days at risk in the whole cohort decreased in the maintenance phase (0.28 versus 0.32 [baseline] and 0.34 [intensive], P=0.001). Acute rheumatic fever recurrence rates did not differ between study sites during the intensive phase and the whole jurisdiction (3.0 versus 3.5 recurrences per 100 patient-years, P=0.65). Conclusions: This strategy did not improve adherence to rheumatic heart disease secondary prophylaxis within the study time frame. Longer term primary care strengthening strategies are needed.

Objective: To evaluate the impact of a comprehensive primary health care service model on key health performance indicators in a remote region of Australia. Design and setting: A cross-sectional 6-year retrospective evaluation of the results of a health service partnership between an Aboriginal community controlled health service, a hospital and a community health service in north-west Western Australia. Intervention: Integration of health promotion, health assessments and chronic disease management with an acute primary health care service as a result of the formal partnership. Main outcome measures: Cross-sectional data on use and outcomes of health care from 1 July 2006 to 30 June 2012 are reported in accordance with national key performance indicators. Results: There were increases in occasions of service (from 21 218 to 33 753), most notably in primary health care services provided to very remote outlying communities (from 863 to 11 338). Health assessment uptake increased from 13% of the eligible population to 61%, leading to 73% of those identified with diabetes being placed on a care plan. Quality-of-care indicators (glycated haemoglobin checks and proportion of people with diabetics receiving antihypertensives) showed improvements over the 6-year study period, and there was also a downward trend in mortality. Conclusions: This study demonstrates that strengthening primary health care services by addressing key enablers and sustainability requirements can translate into population health gains consistent with the goals underpinning the National Health Care Reform and Closing the Gap policies, and may potentially reduce health inequity for remote-living Aboriginal Australians.

This paper builds upon the evolving methodological perspective of a rural standpoint (Roberts, 2014b), and its related method of strategic eclecticism (Roberts and Green, 2013), to reanalyse existing data behind a previously published paper by Drummond, Halsey and van Breda (2012). It does this through an examination of the role of the rural in the Australian curriculum, drawing upon work that raises the lack of recognition of rurality in the curriculum as an important social justice issue (Roberts, 2014a; Roberts, 2015; Roberts & Downes, 2016). Through the reanalysis the paper illustrates that the rural educators who responded to the initial study had a concern for local places, and a perspective that an Australian Curriculum has the potential to marginalise local knowledges, and rural and remote schools more generally. Furthermore the re-analysis shows that age, time teaching in a rural or remote setting, distance from a major centre and jurisdiction of the school all influence respondents' views in distinct ways. Consequently this paper illustrates the utility of re-analysing previous research reports, the use of a rural standpoint in research, and that rural educators have specific rural-related concerns regarding the Australian Curriculum that are largely unaddressed.

Technology transfer from university research to industry is an issue that universities are addressing regularly through many avenues. This paper examines a novel approach by Monash University which involves teams of students working in conjunction with industry to achieve realistic outcomes for issues challenging industry. As an example, the paper uses the problem of the blinding eye disease trachoma, in remote communities in Australia. Trachoma is widely regarded as a public health issue, but teams of students at Monash under the auspices of the Monash Industry Team Initiative (MITI), assisted by industry have devised an engineering solution, in the form of a mobile Interactive Face Washing trailer, to encourage facial cleanliness amongst children, as a preventative measure to stave off serious consequences of trachoma. The teams also took into account cultural aspects that could encourage the use of the device.

Objective: To evaluate the experiences of a group of rural and remote nurses in providing palliative care and to discuss the implications of this evaluation for the development and implementation of professional support strategies. Design: Semi-structured survey comprising 23 items measuring perceptions of the nature of rural and remote practice, the provision of palliative care in these settings and the appropriateness of various professional development strategies; as well as 12 open-ended questions to obtain qualitative descriptions relating to key concepts in rural and remote practice. Setting: Rural and remote communities in the Southern zone of Queensland Health. Subjects: Thirty-one registered and enrolled nurses, all female, who attended a two-day professional development workshop. Main outcome measures: Identification of characteristics of, barriers against and strategies to support the practice of palliative care in rural and remote communities. Results: High levels of agreement with key statements relating to issues evident in contemporary literature regarding rural and remote nursing practice; qualitative descriptions show congruence with key statements. Conclusions: This evaluation demonstrated congruence between the challenges faced by this group of nurses and those reported in the literature. These nurses identified the importance of peer networking as an integral part of their work, which enhanced their potential as rural and remote palliative care providers. What is already known: The issues faced by nurses in rural and remote communities have been described in previous studies. For the most part, these had not specifically targeted the practice of palliative care in this setting. It was not clear whether the practice of palliative care brought distinct challenges to nurses. What this paper adds: This paper adds to the growing body of knowledge about the professional development needs of nurses in rural and remote communities in relation to the practice of palliative care. It suggests that the nurses surveyed in this study share many challenges in common with nurses practising rural and remote settings. Palliative care is understood to be an integral part of practice, despite the infrequency of palliative care clients and the diverse roles they carry out. Barriers to professional development related to geographical and professional isolation are shared in common. An imperative emerges to identify professional development strategies that are directly relevant to rural and remote settings, to improve access to professional development resources and to promote sustainable peer support networks.