Services In Remote Locations Research Articles

Evaluating the impact of pharmacy-led telemedicine services on access to oncology care in rural areas

This review paper explores the impact of pharmacy-led telemedicine services on enhancing access to oncology care in rural areas. With the increasing prevalence of cancer and the challenges associated with delivering specialized oncology services in remote locations, telemedicine has emerged as a vital tool for bridging the healthcare gap. The paper highlights the significant role of pharmacists in managing complex medication regimens, improving patient adherence, and providing essential support through telemedicine platforms. Key findings indicate that telemedicine improves patient access to care and enhances patient and provider satisfaction, leading to better treatment outcomes. The review also discusses the implications for healthcare policy and practice, emphasizing the need for investment in telemedicine infrastructure and pharmacists' integration into this care model. Future research directions are proposed to evaluate the long-term effectiveness of these services and explore advanced telemedicine technologies. The potential of telemedicine to transform rural healthcare access and outcomes is vast, offering a promising solution to address the disparities in oncology care. Keywords: Telemedicine, Oncology Care, Rural Healthcare, Pharmacy-Led Services, Patient Access, Healthcare Disparities.

An Analysis of Profitability of Sarva Haryana Gramin Bank

The most significant measure of financial performance is profitability. The degree of efficiency, productivity, and cost-effectiveness is selected through the bank's profit, which may be viewed as a composite index of its performance in numerous areas of operation. This study evaluates Sarva Haryana Gramin Bank's (SHGB) profitability performance. It is a banking establishment with operations in several Haryana areas. It was established to offer financial and banking services in remote locations. This research report examines the Sarva Haryana Government Bank's profitability performance. The secondary data used in this study were gathered from a variety of sources, including the RBI Bulletin, the Sarva Haryana Gramin Bank's annual reports, the Annual Reports of NABARD, and numerous research articles. The study's fiscal years of 2017–18 through 2022–2023 are covered. It has assessed the management performance of the bank using statistical tools such as computed annual growth rate and ratio analysis to assess Sarva Haryana Gramin Bank's profitability.

Performance analysis of a hybrid optical amplifier based 480-Gbps DWDM-FSO system under the effect of different atmospheric conditions

Free space optical (FSO) systems offer a desirable and affordable way of providing communication services in remote locations. They provide secure wireless transmission without the requirement for licensing and with lower implementation costs. However, due to the impact of atmospheric turbulences on the effectiveness of FSO systems, their implementation faces significant challenges. Dense wavelength division multiplexing (DWDM) has shown promise in addressing the growing bandwidth needs in optical networks. This paper introduces a hybrid optical amplifier based system, combining DWDM and FSO technology. Energy conservation in such a system involves optimizing various aspects to reduce power consumption while maintaining or improving performance. The proposed DWDM-FSO system operates at a rate of 480 Gbps and consists of 12 channels, each capable of transmitting data at 40 Gbps. The system's performance is evaluated and compared by determining the Q-factor and bit error rate (BER) for both the cases when hybrid amplifier is employed and with no hybrid amplifier within the C-band, specifically focusing on wavelengths around 1550 nm. Moreover, the length of the FSO link is increased to assess the corresponding Q-factor and BER. Resultantly, the maximum distance for the FSO link is determined, ensuring that it remains within acceptable Q-factor and BER thresholds. Furthermore, the FSO system's effectiveness is assessed and compared across various atmospheric conditions. The findings reveal that, in clear weather conditions, the FSO system achieves a maximum distance of 510 meters while maintaining satisfactory Q-factor and BER values when not utilizing a hybrid amplifier. However, by integrating a hybrid amplifier, the system's reach significantly extends to 1700 m under clear weather conditions, still maintaining acceptable Q-factor and BER values.

Pockets of promise: exploring innovation and complexity of remote ECEC service delivery in Australia

IntroductionThe existing funding architectures for early childhood education and care (ECEC) services in Australia are incompatible with the needs of remote and First Nations communities. The Australian system relies on a market-based model for ECEC – characterized by demand-led funding mechanisms where funding flows to users to choose what service to use. This model is not viable or sustainable in remote and First Nations communities. In this paper, we ask what we can learn from alternative models of ECEC that serve remote, largely Indigenous communities.MethodsThis research is based on interviews with 10 key stakeholders. Potential participants were identified using three selection criteria which established their expertise in relation to: advocacy and experience in delivering ECEC services in remote locations (evident in relevant parliamentary reviews and inquiries), in-depth knowledge about First Nations perspectives about ECEC models, and broader understandings of the ECEC system in Australia. Three themes were explored in the interviews: (1) funding context (including impact of recent changes to Budget Based Funding, and role of philanthropy in the ECEC sector); (2) Quality and regulatory context (including workforce challenges and cultural considerations); and (3) Future research (including research gaps, opportunities, and considerations). The study design and analysis of data was guided by policy studies frameworks that advocate for collaboration and coordination among researchers and stakeholders in order to address complex problems.ResultsAnalysis of the interviews illuminated the complex structural and cultural elements shaping the design of, and access to, ECEC in remote communities. Stakeholders argued that the ECEC system should be universal in that it delivers services that meet the needs of young children and their families. This requires the development of a definition of ‘universality’ that enables communities to define their own ECEC needs and the types of services best suited to meet those needs. Stakeholders’ views about the importance of community-led design and delivery highlighted the need to align structural and cultural aspects of quality standards and workforce needs, and also to strengthen consultation with First Nations organisations to better understand community-specific solutions.DiscussionThe paper outlines the complexities and nuances of ECEC service delivery in remote communities. The findings are intended to foster discussion about current initiatives, challenges, and futures possibilities for ECEC in remote communities in Australia. These findings concur with other research that argues for community led service delivery and for stronger equity-based partnerships between First Nations and non-First Nations researchers and organizations.

\u2018Grey nomad\u2019 travellers\u2019 use of remote health services in Australia: a qualitative enquiry of hospital managers\u2019 perspectives

BackgroundFor more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as ‘Grey Nomads’. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the ‘baby boomer’ generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946–1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may “burden” already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers.MethodsThe aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads.In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues.ResultsThese nursing managers described a strong service and community ethos. They regarded travellers’ healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers.ConclusionParticipants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia’s national transition to electronic health records including a patient—held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs.

Review in IoT for Healthcare in Our Life Engineering

Over the previous decade, significant research has been conducted in the field of healthcare services and their technological advancement. To be more precise, the Internet of Things (IoT) has demonstrated potential for connecting numerous medical devices, sensors, and healthcare professionals in order to deliver high-quality medical services in remote locations. This has resulted in an increase in patient safety, a decrease in healthcare expenses, an increase in the healthcare services’ accessibility, and an increase in the industry’s healthcare operational efficiency. This paper provides an overview of the possible healthcare uses of Internet of Things (IoT)-based technologies. The evolution of the HIoT application has been discussed in this article in terms of enabling technology, services of healthcare, and applications for resolving different healthcare challenges. Additionally, effort difficulties and drawbacks with the HIoT system are explored. In summary, this study provides a complete source of information on the many applications of HIoT together the purpose is to help future academics who are interested in working in the field and making advances gain knowledge into the issue.

PP165 Bridging The Gap Of Health Services During The COVID-19 Pandemic Through Telemedicine

IntroductionHealth care for patients with chronic pathologies was scarce and limited worldwide during the COVID-19 pandemic. The challenge for clinical and biomedical engineers is to develop a bridging system to maintain the basic health services for chronic pathologies. Populations living in low-income countries did not have access to basic health services during the pandemic and depended on the scarce resources of their emergency health system. There were also equity issues between urban and rural populations. In this context, telemedicine tools should be directed toward maintaining the basic health services for patients with chronic pathologies. This study evaluated the results of a telemedicine system in remote public hospitals in Paraguay to show how health care for patients with chronic pathologies has been maintained by providing access to tertiary level diagnostic services by specialists.MethodsThis descriptive study evaluated the results of using telemedicine between 2014 and 2020 for diagnosis in remote public hospitals to bridge the gap in providing basic health services for patients with chronic pathologies during the COVID-19 pandemic.ResultsA total of 620,289 telediagnoses were performed in 67 hospitals. The 399,806 electrocardiogram diagnoses performed in 61 hospitals were normal (62%) or showed unspecified arrhythmias (13%) and sinus bradycardia (10%). The 207,597 teletomography tests performed in 12 hospitals were performed on the head because of motorcycle accidents and cerebrovascular diseases (54%), on the chest (14%), and other anatomical regions. The 12,867 electroencephalograms performed in 19 hospitals were for the antecedents of seizure (54%), evolutionary controls (14%), and headache (12%). The 19 ultrasound studies corresponded to prenatal controls.ConclusionsAlthough the telemedicine tool implemented in public health to bridge the gap in basic health services for patients with chronic pathologies during the COVID-19 pandemic offered better equity in the provision of services in remote locations, a widespread use assessment should be undertaken before this tool is adopted.

Parent perceptions of minimally invasive dental treatment of Australian Aboriginal pre-school children in rural and remote communities.

Aboriginal* children in rural and remote communities in Australia have a higher burden of dental decay and poorer access to dental services than their non-Aboriginal counterparts. In the Kimberley region of Western Australia (WA), Aboriginal children experience six times the rate of untreated dental decay of non-Aboriginal children. Access to dental care is challenged by the availability and appropriate delivery of services in remote locations. This study elicited the experiences and perceptions of parents and carers who participated in a project that tested the minimally invasive atraumatic restorative treatment and the Hall technique approaches (ART-HT) to manage early childhood dental caries among Australian Aboriginal preschool children. The core study design was a stepped-wedge, cluster-community-randomised controlled trial. Consenting communities in the Kimberley region of WA were randomised into early and delayed intervention groups. Children were clinically examined at study commencement; the early intervention group was offered dental treatment using the ART-HT approach, and the delayed group was advised to seek dental care from their usual service provider. At the 12-month follow-up, children in both groups were re-examined and offered care using the minimally invasive model of care, and parents and carers were invited to take part in focus group or one-to-one interviews. Semistructured interviews, guided by the yarning approach, were conducted with consenting parents and carers in community locations of convenience to participants. The same open-ended questions were asked of all participants, and the interviews were audio-recorded with permission and transcribed by an independent agency. Thematic analysis was undertaken, the transcripts were coded by NVivo software, and emergent themes were identified and developed. One-to-one interviews were conducted with 29 parents and carers (10 from five test communities; 19 from eight control communities). Interview participants consisted of 3 males and 26 females. Following thematic analysis, three main themes (and subthemes) were identified: (1) access to care (barriers, service availability, impact on family due to lack of access); (2) experience of care (cultural safety, child-centred care, comprehensiveness of care); (3) community engagement (service information, engagement, oral health education). Structural and system factors as well as geography were identified as barriers by parents and carers in accessing timely and affordable dental care in culturally safe environments; parents and carers also identified the impacts from lack of access to care. They valued comprehensive care delivered within community, underpinned by child- and family-centred care. Of equal importance was the holistic approach adopted through the building of community engagement and trusting relationships. A high level of satisfaction was reported by parents and carers with their experience of dental care for their children with the minimally invasive approach. Satisfaction was expressed around ease of accessing services delivered in a child- and family-centred manner, and that were well supported by appropriate engagement between service providers, communities and families. The findings from this study suggest a minimally invasive dental care model can be considered effective and culturally acceptable and should be considered in delivering oral health services for young children in rural and remote locations. * The term Aboriginal is inclusive of Aboriginal and Torres Strait Islander peoples.

The Brief Review on Telemedicine: New Dream in Developing Countries

: In the new modern world, technology has a remarkable role in human life and affects all aspects of it. Indeed, the need for rapid counteractions, especially in medical requirements, can lead to interesting innovations. Telemedicine was disregarded for being an unwieldy, unreliable, and unaffordable technology. Rapidly evolving telecommunications and information technologies have provided a solid foundation for telemedicine as a feasible, dependable, and useful technology. Telemedicine has been conceived as an integrated system of healthcare delivery that employs telecommunications and computer technology as a substitute for face-to-face contact between provider and client. It has the potential for ameliorating seemingly intractable problems in healthcare such as limited access to care among segments in the population, especially the geographically disadvantaged, uneven quality of care, and cost of inflation. Its true merit has yet to be determined by systematic empirical studies. In another survey, the authors defined telemedicine as a branch of e-health, which works by communication networks and delivers healthcare and medical educations from remote locations. The main aim of telemedicine is to overcome the improper distribution of human and fundamental resources. Telemedicine could be considered from the viewpoint of two basic conditions: (1) as an alternative way for emergency services in remote locations and (2) it is a better option rather than conventional health services; for example, teleradiology for rural hospitals. It can result in appropriate availability of health services and acceptable efficiency. However, this aspect of medicine was considered in the late 1990, and then, developing countries have a long way for research about it.

Unlocking the Potential of Fintechs for Financial Inclusion: A Delphi-Based Approach

The financial sector is experiencing an accelerated process of transformation shaped by fintechs, which opens an important window of opportunity to increase financial inclusion in emerging markets, such as Brazil, with high financial exclusion. Thus, this article investigates, through a Delphi approach involving fintech professionals, the potential of fintechs to enable financial inclusion in emerging markets, using Brazil as a proxy. The analysis carried out identified three domains related to fintechs that have the potential to impact financial inclusion: (i) fintechs can serve niches of people without a bank account in the traditional financial market, (ii) fintechs can reduce costs for clients through increased competition, and (iii) fintechs can offer financial services in remote locations, far from traditional financial institutions. Thus, with the objective of developing a public agenda of financial inclusion through fintechs, the article proposes four lines of public policies: (i) expansion and modernization of mobile and internet infrastructure, (ii) improvement of the population’s financial and digital education, (iii) implementation of a trustworthy environment for the fintech clients, and (iv) development and enforcement of an effective legal and regulatory framework for fintechs. These policies, if implemented, can benefit people excluded from the financial system around the world.

Disproportionate CH4 Sink Strength from an Endemic, Sub-Alpine Australian Soil Microbial Community.

Soil-to-atmosphere methane (CH4) fluxes are dependent on opposing microbial processes of production and consumption. Here we use a soil–vegetation gradient in an Australian sub-alpine ecosystem to examine links between composition of soil microbial communities, and the fluxes of greenhouse gases they regulate. For each soil/vegetation type (forest, grassland, and bog), we measured carbon dioxide (CO2) and CH4 fluxes and their production/consumption at 5 cm intervals to a depth of 30 cm. All soils were sources of CO2, ranging from 49 to 93 mg CO2 m−2 h−1. Forest soils were strong net sinks for CH4, at rates of up to −413 µg CH4 m−2 h−1. Grassland soils varied, with some soils acting as sources and some as sinks, but overall averaged −97 µg CH4 m−2 h−1. Bog soils were net sources of CH4 (+340 µg CH4 m−2 h−1). Methanotrophs were dominated by USCα in forest and grassland soils, and Candidatus Methylomirabilis in the bog soils. Methylocystis were also detected at relatively low abundance in all soils. Our study suggests that there is a disproportionately large contribution of these ecosystems to the global soil CH4 sink, which highlights our dependence on soil ecosystem services in remote locations driven by unique populations of soil microbes. It is paramount to explore and understand these remote, hard-to-reach ecosystems to better understand biogeochemical cycles that underpin global sustainability.

Sustaining oral health services in remote and Indigenous communities: a review of 10 years experience in Western Australia

In line with findings throughout Australia, rural, remote and Indigenous Western Australians suffer from a higher burden of oral disease and have less access to dental practitioners and care than their urban and non-Indigenous counterparts. With workforce projections indicating an increase in the shortage of dental practitioners, especially in rural and remote areas, the Centre for Rural and Remote Oral Health (CRROH) in Western Australia set out to establish a sustainable programme to service such increasingly disadvantaged populations. Via the vertical integration of education, service and research CRROH pioneered a sustainable model to deliver much needed oral health services to some of Western Australia's most remote areas, while primarily focused on addressing the oral health needs of Indigenous Australians. One of the key lessons from the programme has been the development of a strong clinical governance framework and a support network to sustain services in remote locations. This study offers one way to provide and sustain dental care for those most in need, yet largely left out.

Reducing 30-Day All-Cause Rehospitalizations: A Pharmacist-Led Telehealth Service.

BACKGROUND: Use of skilled nursing facilities (SNFs) has grown as an intermediary step for patients unready to discharge to lower acuity care settings. Discharge planning from SNFs has become a critical component of the care continuum and may impact patient outcomes and facility payment status. Currently, the discharge process does not include a pharmacist-led comprehensive medication review.<br/> OBJECTIVES: To determine the impact of a pharmacistdriven discharge consultation service on 30-day allcause rehospitalization. Secondary outcomes included hospital readmission diagnosis, discharge consultation times, number of pharmacist interventions, and patient satisfaction.<br/> METHODS: The institutional review board approved this prospective cohort with a historical control pilot study to evaluate patients discharging from SNFs. Patients who provided informed consent were enrolled to participate in a video consultation service at the time of discharge. The primary outcome measured was 30-day hospital readmission rate postdischarge compared with one year prior.<br/> RESULTS: One hundred ninety-six counseling sessions were performed at three facilities. The average time per discharge was 15.4 ± 3.3 minutes, average number of medications was 15.5 ± 6.2, and average Charlson Comorbidity Index was 5.6 ± 2.2. Patient readmission data were tracked by diagnosis and reported by facility.<br/> CONCLUSION: A positive correlation between reduced readmission rates and participation in consultation service were observed. Second, positive patient satisfaction surveys indicated patients value medication education. The use of a pharmacist-led telehealth service like the one described in this study may lead to a reduction in facility readmission penalties and improve patient access to pharmacist services in remote locations.

VP28 Building A Virtual Diagnosis Network Through A Telemedicine Platform

IntroductionAdvances in information and communication technology (ICT) and health technology have enhanced healthcare for many countries around the world. The challenge for low income setting countries is to build a telemedicine platform to enhance the community hospital diagnosis response capacity. Populations living in remote areas did not have access to specialist care and quality diagnostic services and thus depended on the low response capacity of their local health system. There were subsequent equity issues between urban and rural populations. In this context the virtual telediagnosis network should be directed towards developing better equity in the provision of services in remote locations without access to specialists. The usability of a telemedicine platform to enhance the virtual diagnosis network of community hospitals in rural areas of Paraguay was investigated.MethodsThis descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute (IICS-UNA) and the University of the Basque Country (UPV / EHU) to evaluate the utility of a telemedicine platform to enhance the virtual diagnosis network of community hospitals. For this purpose, the results obtained by the virtual telediagnosis network implemented in sixty public countryside community hospitals were analyzed.ResultsA total of 427,026 remote diagnoses were performed between January 2014 and October 2018 in sixty community hospitals. Of the total, 35.76 percent (152,703) corresponded to tomography studies, 62.55 percent (267,100) to electrocardiography (EKG), 1.68 percent (7,204) to electroencephalography (EEG) and 0.01 percent (19) to ultrasound. There were no significant differences between the remote and the face-to-face diagnosis. With the remote diagnosis a reduction of the cost was obtained, that supposes an important benefit for each citizen of the sixty communities.ConclusionsThe results show that the virtual diagnosis network based on a telemedicine platform can enhance significantly the community hospital diagnostic services, maximizing professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out its countrywide implementation, a contextualization with the regional epidemiological profile must be performed.

PP05 Developing Equity In Remote Locations Through Telediagnosis

Introduction:Clinical background: Until recently, populations living in remote areas did not have access to specialist care and quality diagnostic services and thus depended on the low response capacity of their local health system. Subsequently, there were equity issues between urban and rural populations. Therefore it was considered telediagnosis applications should be directed towards developing better equity in the provision of services in remote locations without access to specialists. This study has evaluated the results of a new telemedicine system in remote public hospitals in Paraguay, in order to show how the response capacity of the local integrated health service delivery networks has been improved by providing access to tertiary level diagnostic services by specialists. Objective: This study aims to evaluate the utility of telemedicine as a tool for developing better equity in the provision of services in remote locations.Methods:This was a descriptive study, where the results of using telemedicine for diagnosis in remote public hospitals were evaluated as a tool to improve access to diagnostic services countrywide between 2014–2017. For these purposes, type and frequency of pathology diagnosed was determined.Results:A total of 311,562 telediagnoses were performed in fifty-seven hospitals. The 191,435 electrocardiogram diagnosis performed in the fifty-five hospitals were mainly normal (62.1%), unspecified arrhythmias (12.5%), and sinus bradycardia (10.4%). Also 115,924 teletomography tests were performed in twelve hospitals, where 54.4 percent corresponded to head as a consequence of accidents (motorcycles) and cerebrovascular diseases, 13.8 percent to chest, and the rest the other anatomical regions. Regarding the 4,184 electroencephalogram tests performed, antecedents of seizure (54.3%), evolutionary controls (14.0%), and headache (11.5%), were mainly diagnosed. The nineteen ultrasound studies corresponded to prenatal controls.Conclusions:Despite the results of the telediagnosis implemented in the public health to develop better equity in the provision of services in remote locations, a widespread use-assessment should be analyzed before this tool is adopted.

Role of Social Media as Communication Channel for Veterinary Extension Workers

A study was conducted to assess the role of social media networks for effective digital communication among the veterinary extension workers. The study involved assessing the role and constraints of a social media group named as veterinary technical forum in the context of enhancing quality health service to the livestock by active networking with other experts of the world. It is concluded that the most important role of social media was the commonality of interest which could be achieved in sharing of knowledge. Lack of broadband services in remote locations was considered as the major constraints in adopting social media as a communication channel for veterinary extension works.

Primary Mental Health Care Services in Ethiopia: Experiences, Opportunities and Challenges from East African Country

It is estimated that about 25 million Ethiopians some form of mental disturbance , while but 10 per cent receive any sort of treatment, and fewer than 1 per cent receive specialist care. Psychiatrists are a particularly scarce resource in Ethiopia; in population of over 101 million, there are only 63 psychiatrists, yielding a ratio of 0.65 psychiatrists to 1 million people. Most of the psychiatrists are concentrated within the large cities and consequently treatment gap exists as a high proportion of Ethiopians sleep in rural areas (more than 80 percent of the populations of the country sleep in rural areas) and thus haven't any access to psychological state services. As far back because the 1970s, the planet Health Organization (WHO) recommended that psychiatry be rooted in medical care in order to reduce the treatment gap for psychological state disorders. Community model of psychological state care in Ethiopia impediments to psychological state care services in our communities include the uneven distribution of psychological state resources, problems of accessing services in remote locations, and social acceptability in reference to ignorance and belief systems. Families have to make out-of-pocket payments for these services thanks to the nonavailability of social support systems. on the NationalHealth Insurance Scheme (NHIS), there's limited coverage for mentalhealth care.

Industrial paramedics, out on site but not out of mind

Australian natural resource exploration and production companies are employing paramedics to provide emergency medical response, primary health care, injury prevention, and health promotion services in remote locations nationally and internationally. Although Australian paramedic practice has steadily evolved to include increasingly complex medical interventions in the prehospital setting, paramedics are not yet registered health professionals, and in many states and territories their title is not protected. Similarly, tertiary-level education is becoming the entry to practice standard for traditional ambulance paramedics; however, certificate- and diploma-level paramedic courses remain an acceptable pathway to private and industrial paramedic jobs. To ensure acceptable patient safety standards are maintained and to protect all related stakeholders, the role, skills, training, and professional capacity of industrial paramedics must be defined. The study objective was to explore the published literature for a definition for the discipline of industrial paramedicine. A comprehensive systematic analysis was conducted using the EBSCOhost (health), MEDLINE, SCOPUS, and CINAHL electronic databases. The primary search terms "remote", "offshore", "mining", and "oil" were combined with the secondary search terms "paramedic" and "emergency medical services". An initial search using the combined two-term sets identified 870 citations. After application of the inclusion and exclusion criteria to a title and abstract review, 69 citations met the criteria including those discovered by searching the reference lists. Of these, nine citations were excluded because full-text papers could not be found and eight citations were excluded based on review of the full article. The result was 40 articles that discuss the role of paramedics in the remote or offshore environment (ROP) and 12 articles that discuss the provision of emergency medical services in the mining or oil and gas sectors (MOEMS). There is no single definition or comprehensive role description for industrial paramedic practice within the literature. Worldwide, there is little high-quality published evidence to adequately reflect all aspects of industrial paramedic practice. However, based on the literature available, this definition is offered: 'An industrial paramedic is an advanced clinical practitioner in paramedicine with an expanded scope of practice. The industrial paramedic provides emergency response, primary health care, chronic disease management, injury prevention, health promotion, medical referral, and repatriation coordination at remote mining sites, offshore installations, and other isolated industry settings. The industrial paramedic is resourceful, adaptable, and comfortable working independently. Industrial paramedics practice on site with limited resources, remotely located from tertiary care, and use telemedicine to consult with other health professionals as required. Industrial paramedics are experts at rapidly assessing, prioritising, and establishing control in their unpredictable workspace to reduce risks and create an environment conducive to quality patient care. The industrial paramedic preferably holds a specialised tertiary qualification and is committed to maintaining their clinical competency through continuing professional development.' Further research is required to validate, refute, or expand this proposed definition.

Northern Lights: Access to Electricity in Canada's Northern and Remote Communities

Access to energy in many of the world?s remote communities is still restricted; these locations only have access to simple and inexpensive local energy sources, such as biomass for cooking and kerosene lamps or candles for lighting. The World Bank and the International Energy Agency (IEA) perceive this energy deficit as a major obstacle to achieving community economic development as well as to obtaining adequate access to health services and clean water. Electricity is a flexible, modern source of energy that is considered to be one of the principal driving forces that stimulate community development and access to basic services in remote locations. Governments, private institutions, and nongovernmental organizations have gradually recognized these energy needs and have established electrification programs at the national and regional levels that aim at the gradual electrification of remote locations.

Quality improvement through teleradiology: Opportunities and challenges

Teleradiology is rapidly establishing its presence as an effective solution to the problem of provision of radiological services in remote locations. Although significant effort has been put into the development and establishment of quality assurance (QA) processes required for the implementation and conduct of this new technology, little attention has been given to the possible use of teleradiology in enhancing quality and safety of radiological practice, and as an alternative to conventional quality improvement (QI) initiatives. This paper critically evaluates teleradiology from the point of view of its potential use in QA/QI and considers its possible advantages as well as limitations. Considering the unique features of teleradiology such as remote access that can be simultaneous at multiple sites, rapid transfer of information and computerized data storage as well as good reproducibility and reliability of data, the authors argue that teleradiology represents an ideal tool which can not only be equivalent to other methods of QA in radiology but in some instances may be superior to them.