Healthcare Standards Research Articles

International accreditation of a pediatric hematology/oncology fellowship program in Guatemala: a quantitative assessment

PurposeHigh-quality graduate medical education programs are essential to expand the care available to children with cancer worldwide. The authors used the Education Program Assessment Tool (EPAT), a standardized tool for evaluating pediatric hematology/oncology (PHO) fellowship programs, to describe the impact of the Accreditation Council for Graduate Medical Education International (ACGME-I) accreditation process.MethodsThe EPAT is a comprehensive, validated tool for evaluating the elements of PHO fellowship programs. The authors used the EPAT in May 2018 and December 2023 to compare the pre-accreditation and post-accreditation status of the Unidad Nacional de Oncología Pediátrica (UNOP) PHO fellowship program.ResultsThe authors used the EPAT to identify program gaps and to prioritize interventions to meet ACGME-I accreditation standards. Before accreditation, the overall score of the UNOP PHO fellowship program was 77.2%. The highest score was for Hospital Infrastructure (86.4%) and the lowest score was for Research (63.0%). After accreditation, the overall score was 88.3%. Eight of the 10 EPAT domains had higher post-accreditation scores, with a significant improvement in domain scores overall (P < 0.0001) (Fig. 2). In alignment with the improvement workstreams, the Educational Infrastructure and Evaluation domains had the greatest increases in scores (27% and 25%, respectively). Research continued to have the lowest score (75.9%), but this was improved by 13%.ConclusionsThis study provides quantitative data on the enhancement of a PHO fellowship program in a middle-income country after the process ACGME-I accreditation based on the improvement of EPAT scores. Additional analyses and evaluation tools are needed to identify strategies optimize training approaches and to meet the evolving accreditation standards for health care around the world.

Nutritional Psychiatry: The Impact of Diet on Mental Health

Nutritional psychiatry is an emerging discipline exploring the intricate relationship between diet and mental health. This field emphasizes the role of dietary patterns, nutrients, and the gut-brain axis in influencing psychological well-being. Research highlights the benefits of specific nutrients, including omega-3 fatty acids, B vitamins, and magnesium, in alleviating symptoms of mood disorders such as depression and anxiety. The Mediterranean diet, rich in plant-based foods and healthy fats, is associated with improved mental health outcomes and reduced cognitive decline. Furthermore, the gut microbiome plays a pivotal role in the gut-brain axis, influencing mood and behavior through complex biochemical pathways. Clinical applications of nutritional psychiatry advocate personalized interventions, dietary assessments, and collaboration with registered dietitians. Despite significant advancements, broader policy reforms and interdisciplinary approaches are essential to integrate nutritional psychiatry into standard mental health care practices. This review underscores the transformative potential of diet as a therapeutic tool in mental health management and calls for continued research to solidify its role in psychiatric care. Keywords: Nutritional psychiatry, Mental health, Gut-brain axis, Mediterranean diet, Nutritional interventions.

Faculty-Led Action Research on Simulation-Based Learning: Enhancing Mental Health Nursing Competency in Undergraduate Education at a Public University in Oman.

Nursing programs provide holistic education in caring for people with various health conditions, including mental health conditions. This study aimed to explore the experience of faculty regarding planning and implementing mental health simulation as a method for enhancing the mental health nursing competency training of undergraduate students. The researchers have adopted an action research design under the qualitative paradigm to find answers to the research questions. A purposive sample of nine participants, including mental health nursing faculty and simulation unit staff working in a public university in Oman were included in the study. Ethical clearance was obtained from the institutional ethics committee. Data were collected through in-depth individual interviews with the faculty. Thematic analysis was done synchronously with the steps of action research through the process of coding, categorising and organising the data into meaningful themes. Member checking was done to ensure the transparency and correctness of the themes and subthemes. Seven themes were derived from thematic analysis of the transcripts, such as 'Need for creating innovative mental health nursing learning experiences for students', 'Perceived readiness for simulation', 'Experience in developing mental health simulation', 'Arrangement of resources', 'The zeal for implementing simulation', 'Challenges in the simulation experience', and 'Gaining momentum and confidence'. A conceptual framework for simulation in mental health nursing was developed by the authors based on the findings and by referring to existing models. Faculty can effectively plan and implement simulation experiences for their students. Simulation-based training can become an effective means to make the students more confident and competent in mental health nursing. Implementation of simulation-based teaching will enhance the quality of nursing education and, thereby, the standard of mental health care in clinical settings.

Impact of Funding Source on Long-Term Outcomes in Prostate Cancer: Analysis of a Large Public Database From Sao Paulo, Brazil.

We investigated the impact of the funding source (public v private) on the overall survival (OS) of men with prostate cancer in Brazil. We retrospectively analyzed patients with prostate cancer from a large hospital registry from the state of São Paulo, Brazil. Patients age 50-99 years diagnosed with prostate acinar adenocarcinoma or adenocarcinoma not otherwise specified (NOS) between January 2014 and December 2017 were eligible. Demographic and clinical features were analyzed alongside the funding source. On the basis of clinical characteristics at diagnosis (lymph node status, distant metastasis, prostate-specific antigen [PSA], and Gleason score), patients were categorized into low-risk, intermediate-risk, high-risk, and metastatic groups. Of 25,009 patients analyzed, 85% had a public funding source. These patients were slightly older, had greater proportion of adenocarcinoma NOS, and higher PSA levels and risk category. There was a significant difference in OS favoring patients with a private funding source (P < .0001). The estimated OS rates at 5 years were 76.2% (95% CI, 75.6 to 76.9) and 86.9% (95% CI, 85 to 88.7) for the public and private groups, respectively (P < .0001). The funding source was significantly associated with OS independent of age, educational level, and receipt of any treatment in the intermediate-risk (hazard ratio [HR], 2.28 [95% CI, 1.58 to 3.30]; P < .001) and high-risk (HR, 1.36 [95% CI, 1.02 to 1.80]; P = .04) groups, but not in the low-risk (HR, 0.85 [95% CI, 0.60 to 1.21]; P = .38) or metastatic groups (HR, 0.84 [95% CI, 0.64 to 1.11]; P = .23). The worse OS observed for patients with prostate cancer with a public source of funding underscores the need for actions directed to improve the standards of public health care in Brazil.

Proximity-based solutions for optimizing autism spectrum disorder treatment: integrating clinical and process data for personalized care.

Autism Spectrum Disorder (ASD) affects millions of individuals worldwide, presenting challenges in social communication, repetitive behaviors, and sensory processing. Despite its prevalence, diagnosis can be lengthy, and access to appropriate treatment varies greatly. This project utilizes the power of Artificial Intelligence (AI), particularly Machine Learning (ML) and Deep Learning (DL), to improve Autism Spectrum Disorder diagnosis and treatment. A central data hub, the Master Data Plan (MDP), will aggregate and analyze information from diverse sources, feeding AI algorithms that can identify risk factors for ASD, personalize treatment plans based on individual needs, and even predict potential relapses. Furthermore, the project incorporates a patient-facing chatbot to provide information and support. By integrating patient data, empowering individuals with ASD, and supporting healthcare professionals, this platform aims to transform care accessibility, personalize treatment approaches, and optimize the entire care journey. Rigorous data governance measures will ensure ethical and secure data management. This project will improve access to care, personalize treatments for better outcomes, shorten wait times, boost patient involvement, and raise ASD awareness, leading to better resource allocation. This project marks a transformative shift toward data-driven, patient-centred ASD care in Italy. This platform enhances treatment outcomes for individuals with ASD and provides a scalable model for integrating AI into mental health, establishing a new benchmark for personalized patient care. Through AI integration and collaborative efforts, it aims to redefine mental healthcare standards, enhancing the well-being for individuals with ASD.

Effect of precise health management combined with physical rehabilitation on bone biomarkers in senile osteoporosis patients

This study delves into the impact of precise health management coupled with physical rehabilitation on bone biomarkers in elderly patients with osteoporosis. Two hundred and forty individuals diagnosed with senile osteoporosis were randomly assigned to either the observation group (precision health management group, n = 120) or the control group (routine health management group, n = 120). Patients in the control group received standard health care, while those in the observation group received personalized health care along with physical therapy. Pain levels (assessed by VAS score), understanding of osteoporosis, confidence in managing osteoporosis, bone density, and biochemical markers of bone metabolism were compared between the groups at 6, 12, 18, and 24 months before and after the intervention. Following the intervention, the observation group exhibited significantly reduced VAS values and PTH levels at 6, 12, 18, and 24 months compared to the control group (P < 0.05). Additionally, scores on the Osteoporosis Knowledge Scale, Osteoporosis Self-Efficacy Scale, bone mineral density (BMD), ALP levels, and calcium levels were significantly higher in the observation group compared to the control group (P < 0.05). The integration of precise health monitoring with tailored physical therapy shows substantial efficacy in reducing pain among elderly individuals suffering from osteoporosis. Moreover, it empowers them in managing their health effectively, while also contributing to increased BMD and improved bone biomarker levels. This holistic approach merits recommendation for clinical implementation and warrants further investigation through rigorous study.

A Review on Cancer Diagnostic and Therapeutic Considerations in Dogs

Cancer presents a significant health concern in dogs, similar to its impact on humans, and stands as a primary contributor to canine mortality. The elevated incidence of cancer in dogs, relative to other domesticated animals, may be attributed to their intimate companionship with humans, advanced medical diagnostics, and elevated healthcare standards that have extended their lifespans beyond typical expectations, although accompanied by a heightened susceptibility to cancer. Effective diagnosis and treatment of canine cancer hinge upon a comprehensive understanding of tumor varieties, their underlying pathophysiology, and molecular alterations affecting genes and proteins. A range of diagnostic tools is employed for detecting cancer in dogs, encompassing blood profiles, cytological evaluations, histopathology, immunohistochemistry, and various imaging methods such as computed tomography, magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography. Additionally, molecular techniques play a crucial role. Therapeutic options for addressing canine cancer encompass chemotherapy, surgical procedures, and radiation therapy. Furthermore, promising developments including cancer vaccines and novel anti-cancer medications are currently undergoing clinical trials, aiming to enhance the management of cancer in dogs. This article provides an overview of both current and emerging diagnostic and treatment approaches, whether currently available or in the experimental stage, for effectively managing cancer in dogs.

Voices on academic accreditation: lived experiences of nurse educators, administrators, students, and alumni in nursing education

BackgroundAcademic accreditation is a pivotal process in nursing education, ensuring program quality, consistency, and graduate readiness for professional practice. Despite its significance, limited research explores the lived experiences and perspectives of stakeholders, including academic nurse educators, administrators, students, and alumni—engaged in accreditation.PurposeThis study aimed to explore the lived experiences, perceptions, and insights of nursing education stakeholders regarding the accreditation process, focusing on its impact on educational quality, program reputation, and professional preparation.MethodsA qualitative phenomenological approach was employed, using purposive sampling to recruit 54 participants from a Saudi nursing college, including academic nurse educators and administrators (n = 24), students (n = 20), and alumni (n = 10). Data were collected through semi-structured interviews.Thematic analysis identified key themes and subthemes associated with participants’ experiences of accreditation.FindingsSix main themes emerged: (1) knowledge and experience of accreditation; (2) importance and benefits of accreditation; (3) impact of accreditation; (4) preparation for professional practice; (5) challenges of accreditation; and (6) suggestions for improvement. Stakeholders across all groups recognized accreditation as essential for program quality and career readiness. Faculty and alumni emphasized the role of accreditation in enhancing program reputation and credibility, while students highlighted its influence on their learning experiences, though they expressed a desire for more engagement and transparency in the process. Faculty and administrators reported significant challenges, including administrative demands, time management, and resource allocation in maintaining accreditation standards.ConclusionThis study offers a comprehensive view of accreditation’s multi-dimensional impact from multiple stakeholder perspectives and experiences, reinforcing accreditation’s importance in promoting nursing education quality and alignment with healthcare standards. However, findings suggest a need for institutional support to manage accreditation demands effectively. Future research should investigate accreditation’s long-term impact through longitudinal and multi-site studies to broaden understanding and enhance the generalizability of findings in nursing education contexts worldwide.

Empowering Identity: A Multidisciplinary Investigation into The Psychological and Biomedical Effects of Gender Diversity on Sports Participation and Performance

The exploration of gender diversity, also termed as gender expansive and non-binary gender identities in different texts and contexts, is akin to navigating a complex, multifaceted emotional, identity-based, and biomedical landscape. Traditional gender binaries, deeply entrenched in both society and sports, impose restrictive boundaries that inhibit personal growth and authentic expression. However, the acknowledgment and understanding of gender diversity offer promising avenues for liberation and empowerment. This paper expands on the psychological and biomedical dimensions of gender diversity, underscoring its implications for sports participation and athletic performance. By recognizing the unique challenges encountered by gender-fluid individuals, we aim to illuminate pathways toward enhanced self-acceptance, inclusive participation, and improved mental health outcomes. This analysis also explores potential biomedical considerations, such as hormonal treatments and their impacts on physical performance and recovery, as well as the need for tailored healthcare standards for gender-diverse athletes.

Has the UK lost its position as a destination for world-leading clinical research? A comparative analysis of haematological cancer clinical trials performance before Brexit

ObjectivesTo understand the competitive position of the UK in comparison to Europe and the USA for haematological cancer clinical research.DesignUsing commercially available databases, clinical trial numbers, their effectiveness and publication...

Understanding how healthcare innovation is shaped by 5G technology: A comprehensive systematic review

5G technology is transforming healthcare by enhancing precision, efficiency, and connectivity in diagnostics, treatments, and remote monitoring. Its integration with AI and IoT is set to revolutionize healthcare standards. This study aims to establish the state of the art in research on 5G technology and its impact on healthcare innovation. A systematic review of 79 papers from digital libraries such as IEEE Xplore, Scopus, Springer, ScienceDirect, and ResearchGate was conducted, covering publications from 2018 to 2024. Among the reviewed papers, China and India emerge as leaders in 5G health-related publications. Scopus, Springer Link, and IEEE Xplore house the majority of first-quartile (Q1) papers, whereas Science Direct and other sources show a higher proportion in the second quartile (Q2) and lower rankings. The predominance of Q1 papers in Scopus, Springer Link, and IEEE Xplore underscores these platforms’ influence and recognition, reflecting significant advancements in both practice and theory, and highlighting the expanding application of 5G technology in healthcare.

Assessment of the Impact of Government Health Expenditure on Economic Growth in Nigeria

This study evaluates the impact of government health expenditure on economic growth in Nigeria between 1992 and 2021 using the ordinary least squares model which was used to perform the estimation for the variables that were determined to be stationary at first difference were evaluated for stationarity. According to the model’s estimated results, neither of the independent variables government capital or recurrent health spending has a discernible impact on Nigeria’s economic expansion. The independent variables were not significantly significant, this could be attributed to the lack of strength of indirect effects and the time lag between ongoing healthcare costs and the overall economy. Additionally, in Nigeria, poor machine quality, unfinished projects, and corrupt officials might be blamed for health expenditures, which decreased the standard of healthcare and general wellness. The study recommended that the government should put in place the facilities needed for people to use healthcare and to maximize wellbeing to improve health outcomes and the government should ensure efficiency and transparency of health expenditure, alongside increased investment in the health sector to stimulate sustainable economic growth in Nigeria.

ДУХОВНОСТЬ И ОКАЗАНИЕ МЕДИЦИНСКОЙ ПОМОЩИ

The paper analyses usefulness of spiritual health care provided by health care professionals as an important part of comprehensive health care. The contribution is written mainly from the point of view of the health care management and highlights the importance education plays in this process. It is intended for experts who are interested in spirituality as part of standard health care procedures and health care management, potentially for creators and teachers of medicine study programs.

Resilience and strength in healthcare standards

Resilience and strength in healthcare standards

Navigating ‘deterioration in mental state’ – from recognition to response in general hospitals to satisfy ‘National Standards’: a discussion paper

Background The Australian Commission on Safety and Quality in Health Care ‘National Standards’ require general hospitals to have systems for clinicians to recognise and respond to patients’ deteriorating mental state. The lack of an evidence-based operational definition and clear guidance challenges this requirement. Objective To review governance mechanisms and assessment processes for deteriorating mental state in a metropolitan general hospital and propose an organisational framework. Methods A qualitative document analysis using the READ approach systematically reviewed hospital committee reports, health district policies, and training programs to identify and synthesise key assessment points and processes. Findings The study mapped assessment points for recognising and responding to deteriorating mental state across patient journey stages. An organisational systems infographic provides a blueprint for meeting National Standards accreditation criteria. Conclusions Hospitals should establish comprehensive systems to observe, monitor, assess, and refer individuals with deteriorating mental state, involving multiple governance processes and frameworks. Impact statement Our paper maps governance and assessment processes to enhance deteriorating mental state recognition in general hospitals, aligning with National Standards. Plain English Summary General Hospital staff often need to recognise and respond to patients whose mental health is getting worse. This problem is serious because a worsening mental state can lead to harmful behaviours, such as self-harm or violence, and can result in poor healthcare experiences for patients. Our paper aimed to find ways to help hospital staff better identify and manage these situations. We looked at the systems and processes currently in place in hospitals to see how they could be used to meet national healthcare standards for mental health care. We created a detailed plan that hospitals can follow to improve their mental health responses. This plan includes steps for governance, assessment, and clinical pathways, ensuring that all parts of the hospital system work together to support patients with deteriorating mental states. Our findings suggest that using existing hospital processes, rather than creating new tools, can help staff more effectively recognise and respond to mental health issues. This approach not only meets accreditation requirements but also enhances patient safety and care quality. This paper provides valuable insights for healthcare practitioners and policymakers, showing that with the right systems in place, general hospitals can better manage mental health care, ultimately leading to better outcomes for patients.

Incentivizing Rural Work Preferences Among Specialist Physicians: Protocol for a Discrete Choice Experiment.

Retaining specialist physicians in rural parts of India poses a fundamental challenge, which affects the health care system's functionality and provision of standard health care services. There has been an acute shortfall of specialist physicians in the fields of medicine, pediatrics, obstetrics and gynecology, and surgery at rural community health centers. This necessitates urgent policy focus to address the shortages and design effective rural retention strategies. In this study, which uses a discrete choice experiment (DCE), individuals choose from multiple-choice preferences that resemble hypothetical job descriptions. DCEs are a quantitative approach to assessing several aspects of job selection. This study aims to develop a detailed plan of a DCE method used to determine specialist physicians' job choices. This protocol outlines the DCE method, which uses an exploratory sequential mixed methods research design to understand specialist physicians' preferences and design reward packages that would effectively motivate them to work in underserved regions. The qualitative phase of the study involved identifying job attributes and their corresponding levels for the DCE. We followed a meticulous process, which included reviewing relevant literature, performing qualitative pilot work, conducting in-depth individual interviews, and consulting with medical and health experts.The quantitative phase involved generating a D-efficient orthogonal fractional factorial design using Ngene software to create choice scenarios using the identified job factors and their corresponding levels. The generated choice scenarios were blocked into 6 versions in 6 blocks. The DCE wasundertaken among final-year postgraduate medical residents and specialist physicians from several health care facilities in Rajasthan. Various statistical models will be applied to explore the response variability and quantify the trade-offs that participants are willing to make for nonmonetary features as a substitute for adjustments in the monetary attribute. After the ethics committee's approval of the study, the qualitative data collection phase occurred from September to December 2021, while the quantitative phase took place from May to August 2022. Six attributes and 14 levels were identified and established through qualitative surveys. The experimental design resulted in 36 choice situations, which were grouped into 6 blocks. The preliminary investigation demonstrated that the instrument was valid and reliable. Statistical data analysis has been initiated, and the principal findings are expected to be disseminated in January 2025. The protocol provides a systematic framework to assess specialist physicians' preferences regarding working in rural health care centers. This research has the potential to substantially influence the future of rural health care by laying the foundation for understanding specialist physicians' choices, which will help design future incentive schemes, policy interventions, and research. DERR1-10.2196/59621.

The Effectiveness of Electronic Medical Records (RME) On Hospital Service Quality

This study investigates The Medical Record Department (MRD) plays a pivotal role in the hospital administration framework at Shri Balaji Hospital, ensuring the efficient management and organization of patient health data. As an essential component of healthcare delivery, the MRD is responsible for maintaining accurate, comprehensive, and up-to-date records for all patients treated at the facility. This includes not only clinical data such as diagnosis, treatment plans, and surgical histories, but also administrative information vital for billing, insurance, and regulatory compliance. At Shri Balaji Hospital, the MRD operates under strict protocols to guarantee the confidentiality and security of patient records in accordance with legal and ethical standards. The department is crucial for the coordination of multidisciplinary care, as it facilitates the timely and accurate sharing of medical information between healthcare professionals, thus ensuring continuity of care and improving patient outcomes. The MRD also plays a significant role in hospital operations by supporting functions such as audits, quality control, and risk management. It ensures that the hospital adheres to national healthcare standards, including those set by accrediting bodies and government regulations. In this regard, the department’s meticulous record-keeping supports the hospital’s efforts in continuous quality improvement and patient safety initiatives.

Analisis Pelayanan Pusat Kesehatan Masyarakat (PUSKESMAS) Panca Berdasarkan Prinsip Service Excellent

Community health centers (Puskesmas) have become one of the people's choices for treatment, medical examinations and so on. Panca Health Center is one of the Community Health Centers in Nagrak Village, District. Pacet, Bandung Regency, is an option for the people there who want to have a health check. Community health centers (Puskesmas) play an important role in providing primary health services for the community. In an effort to improve service quality, the application of the principle of excellent service is crucial. Service excellence is an approach that prioritizes customer satisfaction through providing services that exceed expectations. This research aims to evaluate the implementation of excellent service principles in Community Health Centers, focusing on aspects such as responsiveness, reliability, assurance, empathy and physical evidence. The research method used was a case study at the Community Health Center in Panca. Data was collected through interviews, interviews and direct observation. The research results show that Community Health Centers that apply the principle of excellent service are able to increase patient satisfaction, speed up response time, and improve the quality of communication between health workers and patients. In addition, factors such as continuous training for staff, improving physical facilities, and implementing a health information system also contribute to achieving service excellence. Researchers can conclude that implementing the principle of excellent service in Community Health Centers not only improves service quality, but also strengthens public trust in primary health services. Recommendations are provided to expand the application of these principles to achieve higher standards of health care on an equitable basis.

Improving implementation of needle and syringe programmes to expand, scale up, and sustain evidence-based prevention interventions for HIV and hepatitis C in prisons.

The 1990 resolution by the UN General Assembly committed member states to provide health-care equity for people in prison, who are included in the global goals to control HIV and eliminate hepatitis C virus (HCV) by 2030. WHO has set ambitious HCV elimination targets by including people who inject drugs (PWID), yet has not prioritised PWID who are incarcerated, a substantial population who have or are at risk for HCV infection. Human rights principles of health-care equity stipulate that "prisoners should enjoy the same standards of health care that are available in the community, without discrimination on the grounds of their legal status". Globally, only nine countries provide prison-based needle and syringe programmes (PNSPs), essential evidence-based interventions to holistically reduce the harms from drug use, of which only three countries extend reach to all prisons. Even where available, these services are accessed by few participants. PNSPs are recommended as an essential element of an effective HIV and HCV prevention strategy in prisons, and studies have shown that they are key to achieving HCV elimination in carceral settings. This Viewpoint, based primarily on unpublished data from key country-level stakeholders and expert opinion, highlights our perspective that implementation factors related to PNSP delivery in diverse settings likely contribute to low adoption and use of these services by PWID in prisons compared with in the community. However, successful expansion of these evidence-based interventions will depend on political commitment, national surveillance and monitoring programmes, and state-of-the-art implementation science methods, where inputs from multilevel stakeholders should guide improved implementation. Policy makers are urged to create and support opportunities to scale up PNSPs within countries where they exist and expand them to other countries where they are needed to solidify years of commitment towards the 2030 HCV elimination goals.

The revised remote area nurse model of consultation.

The aim of this revision was to update the Remote Area Nurse (RAN) Model of Consultation (MoC) and was prompted by publication of the National Rural and Remote Nursing Generalist Framework (2013-2018), shifts in RAN workforce patterns, community health patterns and technology use. Rural and remote residents face higher rates of hospitalisations, deaths and poorer access to health care with a significant burden of avoidable fatal conditions among Aboriginal and Torres Strait Islander peoples. Health care is mostly provided by RANs and Aboriginal and Torres Strait Islander Health Practitioners (ATSIHPs), addressing diverse health needs, a mobile population and navigating cross-cultural situations. Despite challenges such as clinician shortages, RANs manage a significant portion of non-emergency consultations. The RAN MoC was developed to ensure comprehensive, systematic and person-centred care and to mitigate risk to the client, the nurse and the health service. The 11 expert panel members, all authors, revised the RAN MoC through a series of Microsoft Teams meetings, one face-to-face meeting and an exchange of emails. The principles were reorganised under the four domains of the National Rural and Remote Nursing Generalist Framework and mapped against the National Safety and Quality Primary and Community Health Care Standards. The revised RAN MoC is designed to provide evidence based culturally informed care, standardise RAN consultation best practice and improve the health outcomes of their clients. With the increased turnover and number of nurses 'new' to remote, more innovative approaches to education and dissemination of the model is necessary.