Literature / Littérature scientifique [CJRM

Literature / Littérature scientifique

CJRM 1999;4(2):108-9

Effect of real-time teleradiology on the practice of the emergency department physician in a rural setting: initial experience. Lee JK, Renner JB, Saunders BF, Stamford PP, Bickford TR, Johnston RE, et al. Acad Radiol 1998;5(8):533-8.

How about this tongue twister? Peter Piper picked a peck of pilot projects, how many pecks of pilot projects did Peter Piper pick before he got off his duff and did something?!

The rural literature is slowly (emphasis on slowly) developing a case for teleradiology. One might argue that the case has been proven, that the judge has gone home and that the defence is droning on in an empty courtroom. Unfortunately, in spite of accumulating evidence, interest and evolving technology, implementation of this idea remains patchy and half-hearted, both in Canada and in the United States (see also the paper by Campbell and Martel in this issue page 77).

In this article the authors document that a teleradiology link between a rural site and a university site was both used and useful. On a scale of 1 to 7, the participating physicians rated their satisfaction level at 5.4 and their comfort level (confidence in the result) at 5.6. Formal comparison of the teleinterpretation revealed no major discrepancies between the teleinterpretation and a later interpretation of the original hard copy. Of significant importance was the finding that "the teleradiology consultations led to changes in the emergency department physician's initial diagnosis in 27 of 90 cases." In addition the study documented a mean turnaround time for the consultation of 1.3 hours.

It's time people!

Rural childhood immunization. Rates and demographic characteristics. Lowery NE, Belansky ES, Siegel CD, Goodspeed JR, Harman CP, Steiner JF. J Fam Pract 1998;47(3):221-5.

It is commonly claimed that access to health services is poor in rural areas and that geographic barriers result in reduced access to, and participation in, programs of proven efficacy. Childhood immunization is an example of such a program. In this study the authors document that although childhood immunization rates are suboptimal in American rural areas, they are in fact no worse than rates in urban areas. They analysed 2 nationally representative surveys, the 1991 National Maternal and Infant Health Survey (NMIHS) and the 1993 National Health Interview Survey (NHIS). They found that "there were no significant differences in immunization rates between rural and urban children. In urban areas, immunization rates were 63.3% (NMIHS) and 65.5% (NHIS) compared with 63.0% (NMIHS) and 67.8% (NHIS) in rural areas." In both areas the factors associated with underimmunization were poverty, unemployment and low family education, among others. These findings, although of concern, leave room for optimism. Rural communities have every right to expect that preventive measures of this kind will not be denied their children by virtue of where they live.

Rural trauma care: role of the general surgeon. Bintz M, Cogbill TH, Bacon J. J Trauma 1996;41(3):462-4.

General surgeons in rural areas face significant practice challenges, not the least of which are those times when patients having major trauma present to their hospital. Although the frequency may be low, the acuity may be high — at least as high as in urban areas.

The authors of this study present the 7-year experience with trauma of a solo general surgeon at his rural Wisconsin hospital. Among the 43 308 patients who presented to the emergency department during this period, 84 patients with Injury Severity Scores ranging from 8 to 43 were selected for study. Of these, 4 died in the emergency department, 54 (64%) were transferred to a trauma centre and 26 (31%) were admitted to the local hospital. In reflecting on this experience the authors identified 4 central roles for the rural general surgeon in this setting: "(1) to coordinate trauma care in the community, including educational and organizational efforts; (2) to perform the necessary techniques in the ED to achieve optimal resuscitation and stabilization; (3) to rationally prioritize patients for transfer to a referral trauma centre based upon assessment of patient injuries and institutional capabilities; and (4) to provide definitive care for a subset of patients with no need for subspecialty intervention."

Needs assessment of rural and remote women travelling to the city for breast cancer treatment. Davis C, Girgis A, Williams P, Beeney L. Aust N Z J Public Health 1998; 22(5):525-7.

The authors studied the needs of 80 women from rural New South Wales and South Australia who had to travel to the city for breast cancer treatment. They documented that in 90% of cases the reason for travel was the unavailability of treatment closer to home. On average they spent 6.79 weeks away from home, 61% received no financial assistance and of those who did, 19% experienced difficulty in collecting it. Eighty-nine percent identified specific social and practical needs.

Rural women in other countries likely experience similar challenges and policy makers in Canadian jurisdictions might profitably study this area.