A rural doctor's telehealth training program during the COVID-19 pandemic.

INTRODUCTION: In Australia, remote consultations have been used as an adjunct to traditional healthcare delivery during the COVID-19 pandemic using telephone and video techniques with an increase in the use of telephone consultations, and to a lesser extent video consultations, for management of patient conditions, assessment, treatment, monitoring and diagnosis. METHODS: To establish the needs of rural doctors for training in the provision of remote consultations, an online survey of members of the Australian College of Rural and Remote Medicine was undertaken. Subsequently an online scenario-based training program was designed to improve the competencies of members in providing these consultations. The outcomes of this program were analysed using pre- and post-intervention surveys, and qualitative analysis of session recordings. RESULTS: The program improved trainee confidence and competence in providing safe, quality remote consultations, particularly when using video technologies. Competencies in communication, history taking, physical online examination, clinical management and professionalism improved. Trainees adapted their practice because they were then able to manage potential issues, were more aware of the capabilities of telehealth technologies and could assist a health professional, such as a nurse or Aboriginal Health Worker (with the patient) to do an examination. Concerns remained about set-up time, technical quality, privacy, interaction with and examination of patients, and how to assess the severity of conditions. CONCLUSION: The outcomes of the program showed significant improvement in the levels of confidence and competencies required for providing remote consultations using telehealth services. A need remains to improve virtual interactions with patients, and to acquire better technology and financial support for remote consultations. In an environment where government is asking whether remote consultations are appropriate and clinically effective, these findings provide guidance from a professional group of experienced rural practitioners.

Preferred Place of Death-A Study of 2 Specialist Community Palliative Care Services in Australia.

Choice and preference are fundamental to person-centered care and supporting personal choice at the end of life should be a priority. This study analyzed the relationship between a person's preferred place of death and other individual variables that might influence their actual place of death by examining the activity of 2 specialist community palliative care services in Australia. This was a cross-sectional study of 2353 people who died between 01 August 2016-31 August 2018; 81% died in their preferred place. Sex, type of life-limiting illness, and length of time in care were the only variables significantly related to dying in one's preferred place. Women were more likely to die in their preferred place than men (84% v 78%) and people with a non-cancer diagnosis were 7% more likely to die in their preferred place than those with cancer, particularly when that place was their private residence (74% v 60%) or Residential Aged Care Facility (98% v 89%). Someone in care for 0-7 days had 4.2 times greater odds of dying in their preferred place (OR = 4.18, 2.20-7.94), and after 21 days in care, people had 4.6 greater odds of having a preference to die in a hospital (OR = 4.63, 3.58-5.99). Both community palliative care services have capacity and a model of care that is responsive to choice. These findings align with known referral patterns and disease trajectories and demonstrate that it is possible to support the majority of people in the care of community palliative care services to die in their preferred place.

Guinea pig GnRH: localization and physiological activity reveal that it, not mammalian GnRH, is the major neuroendocrine form in guinea pigs.

The isolation of GnRH cDNA from guinea pig hypothalamus predicted a novel form of GnRH with two unique amino acid substitutions relative to all known forms of this essential decapeptide. The predicted substitution at amino acid 2 in guinea pig (gp) GnRH was particularly intriguing because of the proposed importance of position 2 for binding and activation of the GnRH receptor. In the present study, gpGnRH was synthesized, and a specific antibody was generated and used to assess translation of the gpGnRH transcript. The localization of intensely labeled gpGnRH-positive cell bodies and processes in tissue sections through the preoptic area and hypothalamus argue that gpGnRH is the major neuroendocrine form of GnRH in guinea pigs. Guinea pig GnRH stimulated LH release in guinea pigs and increased LH output from guinea pig pituitary fragments, thus demonstrating biological activity in this species. In contrast, gpGnRH demonstrated little ability to stimulate LH release in rats, a species known to possess the highly conserved mammalian GnRH receptor. These findings suggest that: (1) the amino acid substitutions in gpGnRH impede binding to and/or activation of the mammalian GnRH receptor, and (2) the unique amino acid substitutions in gpGnRH are accompanied by changes in the guinea pig GnRH receptor.