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Tamwoy N, Rosas S, Davis S, Farthing A, Houghton C, Johnston H, Maloney C, Samulkiewicz N, Seaton J, Tuxworth G, Bat M. Co-design with aboriginal and torres strait islander communities: A journey. Aust J Rural Health 2022; 30:816-822. [PMID: 36037400 DOI: 10.1111/ajr.12918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/11/2022] [Accepted: 08/08/2022] [Indexed: 12/25/2022] Open
Abstract
AIM This paper explores the principles of co-design with Aboriginal and Torres Strait Islander communities by reflecting on the literature, learning from experiences of allied health professionals, and considering how co-design can be applied in rural and remote allied health practice. CONTEXT This paper has been authored by a working group from Services for Rural and Remote Allied Health (SARRAH). SARRAH is a member-based allied health organisation, working to improve health outcomes for rural and remote Australians. SARRAH has been representing and supporting allied health professionals in rural and remote Australia for over 20 years, with a member base that includes students, practitioners, programme managers, policy makers and academics. As a non-Indigenous organisation, SARRAH works in partnership and receives guidance from the peak organisation, Indigenous Allied Health Australia (IAHA). APPROACH Over a period of 3 months, a group of eleven SARRAH members and staff came together to review available literature, seek member perspectives and share their experiences and understandings of co-design. Working group discussions were grounded in the knowledge and experiences shared by two Aboriginal and Torres Strait Islander group members. CONCLUSION This paper proposes that successful co-design with Aboriginal and Torres Strait Islander communities places legitimate value on different knowledge systems, is built on strong and trusting relationships, promotes inclusive involvement and requires authentic partnerships. Using these principles, SARRAH will engage with members and stakeholders to influence meaningful change in allied health practice in rural and remote Australia.
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Affiliation(s)
| | | | - Scott Davis
- The Cairns Institute (JCU), Smithfield, Qld, Australia
| | | | | | - Hannah Johnston
- Community Allied Health Team, NT Health, Casuarina, NT, Australia
| | | | | | - Jack Seaton
- James Cook University, Townsville, Qld, Australia
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Jessup B, Hoang H, Podubinski T, Obamiro K, Bourke L, Hellwege B, Jatrana S, Heaney S, Farthing A, Sheepway L, Rasiah R. 'I can't go, I can't afford it': Financial concern amongst health students undertaking rural and remote placements during COVID-19. Aust J Rural Health 2022; 30:238-251. [PMID: 35229400 PMCID: PMC9111257 DOI: 10.1111/ajr.12855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/06/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION As the coronavirus pandemic unfolded during 2020, widespread financial uncertainty emerged amongst university students across the globe. What is not yet clear is how Australian health students were financially impacted during the initial stages of the pandemic and whether this influenced their ability to undertake planned rural or remote placements. OBJECTIVE To examine (a) financial concern amongst health students during COVID-19, (b) the financial implications of changes to planned rural or remote placements and (c) the impact of these factors on students' ability to undertake placements during the pandemic. DESIGN Mixed-methods design involving an online survey (n = 1210) and semi-structured interviews (n = 29). Nursing, medical and allied health students with a planned University Department of Rural Health-facilitated rural or remote placement between February and October 2020 were invited to participate. FINDINGS 54.6% of surveyed students reported financial concern during COVID-19. Financial concern correlated with both changes in financial position and employment, with 36.6% of students reporting a reduction in income and 43.1% of students reporting a reduction in, or cessation of regular employment. Placement changes yielded a range of financial implications. Cancelled placements saved some students travel and accommodation costs, but left others out of pocket if these expenses were prepaid. Placements that went ahead often incurred increased accommodation costs due to limited availability. Financial concern and/or financial implications of placement changes ultimately prevented some students from undertaking their rural or remote placement as planned. DISCUSSION Many nursing, allied health and medical students expressed financial concern during COVID-19, associated with a loss of regular employment and income. Placement changes also presented unforeseen financial burden for students. These factors ultimately prevented some students from undertaking their planned rural or remote placement. CONCLUSION Universities need to consider how best to align financially burdensome placements with the personal circumstances of students during periods of economic uncertainty.
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Affiliation(s)
- Belinda Jessup
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Ha Hoang
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Tegan Podubinski
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Kehinde Obamiro
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Lisa Bourke
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Barbara Hellwege
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Santosh Jatrana
- JCU Murtupini Centre for Rural and Remote HealthJames Cook UniversityMount IsaQueenslandAustralia
| | - Susan Heaney
- The University of Newcastle Department of Rural HealthThe University of NewcastlePort MacquarieNew South WalesAustralia
| | - Annie Farthing
- Centre for Remote HealthFlinders UniversityAlice SpringsNorthern TerritoryAustralia
| | - Lyndal Sheepway
- La Trobe Rural Health SchoolLa Trobe UniversityWodongaVictoriaAustralia
| | - Rohan Rasiah
- Western Australian Centre for Rural HealthThe University of Western AustraliaKarrathaWestern AustraliaAustralia
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Hoang H, Jessup B, Obamiro K, Bourke L, Hellwege B, Podubinski T, Heaney S, Sheepway L, Farthing A, Rasiah R, Fitzroy R, Jatrana S, Argus G, Knight S. Impact of COVID-19 on rural and remote student placements in Australia: A national study. Aust J Rural Health 2022; 30:197-207. [PMID: 35103353 DOI: 10.1111/ajr.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/04/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate students' perceptions of the impact of coronavirus SARS-CoV-2 on rural and remote placements facilitated by 16 University Departments of Rural Health in Australia in 2020. DESIGN A mixed-method design comprising an online survey and semi-structured interviews. SETTING Australia. PARTICIPANTS Allied health, nursing and medical students with a planned University Departments of Rural Health-facilitated rural or remote placement between February and October 2020. INTERVENTION A planned rural or remote placement in 2020 facilitated by a University Departments of Rural Health, regardless of placement outcome. MAIN OUTCOME MEASURES Questionnaire included placement outcome (completed or not), discipline of study (nursing, allied health, medicine), and Likert measures of impact to placement (including supervision, placement tasks, location, accommodation, client contact and student learning) and placement experience (overall, support, supervision, university support). Semi-structured interviews asked about placement planning, outcome, decisions, experience and student perceptions. RESULTS While coronavirus SARS-CoV-2 reportedly impacted on the majority of planned placements, most students (80%) were able to complete their University Departments of Rural Health-facilitated placement in some form and were satisfied with their placement experience. Common placement changes included changes to tasks, setting, supervisors and location. Allied health students were significantly more likely to indicate that their placement had been impacted and also felt more supported by supervisors and universities than nursing students. Interview participants expressed concerns regarding the potential impact of cancelled and adapted placements on graduation and future employment. CONCLUSIONS The coronavirus SARS-CoV-2 pandemic was reported to impact the majority of University Departments of Rural Health-facilitated rural and remote placements in 2020. Fortunately, most students were able to continue to undertake a rural or remote placement in some form and were largely satisfied with their placement experience. Students were concerned about their lack of clinical learning and graduating on time with adequate clinical competence.
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Affiliation(s)
- Ha Hoang
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Belinda Jessup
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Barbara Hellwege
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Tegan Podubinski
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Susan Heaney
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle Department of Rural Health, Port Macquarie, NSW, Australia
| | - Lyndal Sheepway
- La Trobe Rural Health School, La Trobe University, Wodonga, Vic., Australia
| | - Annie Farthing
- Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Rohan Rasiah
- Western Australian Centre for Rural Health, The University of Western Australia, Karratha, WA, Australia
| | - Robyn Fitzroy
- Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Santosh Jatrana
- JCU Murtupini Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Geoff Argus
- Southern Queensland Rural Health, Cranley, QLD, Australia
| | - Sabina Knight
- JCU Murtupini Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
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Campbell N, Farthing A, Lenthall S, Moore L, Anderson J, Witt S, Rissel C. Workplace locations of allied health and nursing graduates who undertook a placement in the Northern Territory of Australia from 2016 to 2019: An observational cohort study. Aust J Rural Health 2021; 29:947-957. [PMID: 34490936 DOI: 10.1111/ajr.12784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of the study is to determine the current work locations of allied health professionals and nurses who undertook a student placement in the Northern Territory of Australia from 2016-2019. DESIGN An observational cohort study was conducted in October 2020, with students emailed a link to an on-line survey, plus two reminders. SETTING Primary health care in the Northern Territory of Australia. PARTICIPANTS All allied health and nursing students who undertook a student learning placement in the Northern Territory from 2016-2019 (n = 1936). MAIN OUTCOME MEASURES Practicing nurses and allied health professionals were asked about their work history and locations (coded using the Modified Monash Model of remoteness and population size). RESULTS The response rate was 14.2% (275/1936 students). Most respondents reported that their placement positively influenced them to consider working: in a rural or remote location (76%), in the Northern Territory (81%), and with marginalised or under-served populations (74%). Of the respondents, 224 had graduated and 203 were currently working in their health profession. A total of 31.4% of respondents reported that they had worked in a remote or rural location after graduation. CONCLUSIONS The student placement had a positive effect on the likelihood of students working in a rural or remote location. A focus on recruiting students with a remote upbringing/background and offering longer placements would likely be successful in helping build the health professional workforce in remote locations.
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Affiliation(s)
| | - Annie Farthing
- Flinders NT, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Sue Lenthall
- Flinders NT, Flinders University, Katherine, NT, Australia
| | | | - Jessie Anderson
- Flinders NT, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
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Campbell N, Moore L, Farthing A, Anderson J, Witt S, Lenthall S, Petrovic E, Lyons C, Rissel C. Characteristics of nursing and allied health student placements in the Northern Territory over time (2017-2019) and placement satisfaction. Aust J Rural Health 2021; 29:354-362. [PMID: 34133041 DOI: 10.1111/ajr.12713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/26/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Assess nursing and allied health student satisfaction with their remote Northern Territory integrated learning placement and consideration of future rural/remote work Describe the characteristics of these students Examine changes in student characteristics over time. DESIGN A cross-sectional survey of students and a review of student placement data. SETTING Northern Territory, Australia. PARTICIPANTS Former students having a work integrated learning placement of more than 1 week in the Northern Territory from 2017 to 2019. MAIN OUTCOME MEASURE(S) Agreement with the statements 'This placement has encouraged me to consider living and working in a rural or remote location after I graduate' and 'Overall, I was satisfied with my placement.' The administrative record review examined student numbers, and placement length over time. RESULTS A total of 341 students responded to the online survey. Overall satisfaction with the placement was very high (93%), and 84% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. High-quality clinical supervision and educational resources were associated with overall placement satisfaction. Overall placement satisfaction, prior interest in working remotely and satisfaction with educational resources were associated with consideration of working remotely. The number of students having a placement increased by 29% in 2017 to 2019. The number of placement weeks also increased (35%). CONCLUSIONS The number/placement time of nursing and allied health students has increased in the NT. Satisfaction with remote work integrated learning placements is an the important pathway to growing a local health professional workforce in remote and rural settings.
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Affiliation(s)
- Narelle Campbell
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
| | - Leigh Moore
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
| | - Annie Farthing
- Flinders Northern Territory, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Jessie Anderson
- Flinders Northern Territory, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Susan Witt
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
| | - Sue Lenthall
- Flinders Northern Territory, Flinders University, Katherine, NT, Australia
| | - Erica Petrovic
- Flinders Northern Territory, Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Chloe Lyons
- Flinders Northern Territory, Flinders University, Gove District Hospital, Nhulunbuy, NT, Australia
| | - Chris Rissel
- Flinders Northern Territory, Flinders University, Tiwi, NT, Australia
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Moore L, Farthing A, Lenthall S, Rissel C. Perspectives of supervisors of allied health and nursing students undertaking work-integrated learning placements in the Northern Territory: The view from here. Aust J Rural Health 2021; 29:259-260. [PMID: 33838062 DOI: 10.1111/ajr.12698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Leigh Moore
- Flinders NT, Royal Darwin Hospital Campus, Tiwi, NT, Australia
| | - Annie Farthing
- Flinders NT, Royal Darwin Hospital Campus, Tiwi, NT, Australia
| | - Sue Lenthall
- Flinders NT, Royal Darwin Hospital Campus, Tiwi, NT, Australia
| | - Chris Rissel
- Flinders NT, Royal Darwin Hospital Campus, Tiwi, NT, Australia
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7
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Waller S, Walker L, Farthing A, Brown L, Moran M. Understanding the elements of a quality rural/remote interprofessional education activity: A rough guide. Aust J Rural Health 2021; 29:294-300. [PMID: 33838064 DOI: 10.1111/ajr.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS To offer a rough guide to a quality rural/remote interprofessional educational activity. CONTEXT Australian remote and rural interprofessional undergraduate placements offered in Modified Monash Model 3-6 locations. APPROACH Biggs' triple P framework from the interprofessional educational literature and Allport's contact hypothesis are used to describe map, and explore the educational dimensions and positive elements, of a quality rural/remote interprofessional educational activity. CONCLUSION Delivery of a quality interprofessional educational activity requires attention to all dimensions of the activity with acknowledgement of the value of the remote or rural contexts. Interprofessional learning requires constructive alignment and positive contact conditions to ensure a quality and sustained experience.
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Affiliation(s)
- Susan Waller
- Monash Rural Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Bendigo, Vic., Australia
| | - Lorraine Walker
- School of Nursing and Midwifery, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Vic., Australia
| | - Annie Farthing
- Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Leanne Brown
- Department of Rural Health, University of Newcastle, Tamworth, NSW, Australia
| | - Monica Moran
- Western Australian Centre for Rural Health, Faculty of Medicine and Health Sciences, University of Western Australia, Geraldton, WA, Australia
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Campbell N, Farthing A, Witt S, Anderson J, Lenthall S, Moore L, Rissel C. Health Professional Student Placements and Workforce Location Outcomes: Protocol of an Observational Cohort Study. JMIR Res Protoc 2021; 10:e21832. [PMID: 33443482 PMCID: PMC7843200 DOI: 10.2196/21832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background The successful recruitment and retention of health professionals to rural and remote areas of Australia is a health policy priority. Nursing or allied health professional students’ learning placements in the Northern Territory (NT) of Australia, most of which is considered remote, may influence rural or remote work location decisions. Objective The aim of this study is to determine where allied health professionals and nurses who have had a student placement in the NT of Australia end up practicing. Methods This research is an observational cohort study, with data collection occurring at baseline and then repeated annually over 10 years (ie, 2017-2018 to 2029). The baseline data collection includes a demographic profile of allied health and nursing students and their evaluations of their NT placements using a nationally consistent questionnaire (ie, the Student Satisfaction Survey). The Work Location Survey, which will be administered annually, will track work location and the influences on work location decisions. Results This study will generate unique data on the remote and rural work locations of nursing and allied health professional students who had a placement in the NT of Australia. It will be able to determine what are the most important characteristics of those who take up remote and rural employment, even if outside of the NT, and to identify barriers to remote employment. Conclusions This study will add knowledge to the literature regarding rates of allied health and nursing professionals working in remote or rural settings following remote or rural learning placements. The results will be of interest to government and remote health workforce planners. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000797976; https://www.anzctr.org.au/ACTRN12620000797976.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/21832
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Affiliation(s)
| | - Annie Farthing
- Flinders University, Northern Territory, Alice Springs, Australia
| | - Susan Witt
- Flinders University, Northern Territory, Adelaide, Australia
| | - Jessie Anderson
- Flinders University, Northern Territory, Adelaide, Australia
| | - Sue Lenthall
- Flinders University, Northern Territory, Katherine, Australia
| | - Leigh Moore
- Flinders University, Northern Territory, Darwin, Australia
| | - Chris Rissel
- Flinders University, Northern Territory, Darwin, Australia
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Farthing A. The Mirena coil is a suitable treatment of early-stage endometrial cancer in obese women: AGAINST: Please follow the manufacturer's advice. BJOG 2020; 127:1000. [PMID: 32350997 DOI: 10.1111/1471-0528.16223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A Farthing
- West London Gynaecological Cancer Service, Queen Charlotte's Hospital, London, UK
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10
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Smith T, Cross M, Waller S, Chambers H, Farthing A, Barraclough F, Pit SW, Sutton K, Muyambi K, King S, Anderson J. Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements. J Multidiscip Healthc 2018; 11:85-97. [PMID: 29430183 PMCID: PMC5797464 DOI: 10.2147/jmdh.s150623] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students' future rural practice intentions. METHODS Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. RESULTS The core concept identified from the thematic analysis was "ruralization of students' horizons," a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, "preparation and support," "rural or remote health experience," and "rural lifestyle and socialization," each of which includes multiple subthemes. From the content analysis, factors that promoted students' rural practice intentions were having a "positive" practice experience, interactions with "supportive staff," and interactions with the "community" in general. It was apparent that "difficulties," eg, with "accommodation," "Internet" access, "transport," and "financial" support, negatively impacted students' placement experience and rural practice intentions. CONCLUSIONS The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.
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Affiliation(s)
- Tony Smith
- Department of Rural Health, University of Newcastle, Taree, NSW
| | - Merylin Cross
- Centre for Rural Health, University of Tasmania, Launceston, TAS
| | - Susan Waller
- Department of Rural Health, Monash University, Moe, VIC
| | | | - Annie Farthing
- Centre for Remote Health, Flinders University, Alice Springs, NT
| | | | - Sabrina W Pit
- University Centre for Rural Health, University of Western Sydney, Lismore, NSW, NSW
| | - Keith Sutton
- Department of Rural Health, Monash University, Moe, VIC
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla, SA
| | - Stephanie King
- Centre for Rural and Remote Health, James Cook University, Mt Isa, QLD, Australia
| | - Jessie Anderson
- Centre for Remote Health, Flinders University, Alice Springs, NT
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Smith T, Sutton K, Pit S, Muyambi K, Terry D, Farthing A, Courtney C, Cross M. Health professional students' rural placement satisfaction and rural practice intentions: A national cross-sectional survey. Aust J Rural Health 2017; 26:26-32. [PMID: 28815895 DOI: 10.1111/ajr.12375] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to profile students undertaking placements at University Departments of Rural Health (UDRHs) and investigate factors affecting students' satisfaction and intention to enter rural practice. DESIGN Cross-sectional survey comprising 21 core questions used by all UDRHs. SETTING Eleven UDRHs across Australia that support students' placements in regional, rural and remote locations. PARTICIPANTS Medical, nursing and allied health students who participated in UDRH placements between July 2014 and November 2015 and completed the questionnaire. MAIN OUTCOME MEASURES Key dependent variables were placement satisfaction and rural practice intention. Descriptive variables were age, gender, Aboriginal or Torres Strait Islander (ATSI) background, location of placement, healthcare discipline, year of study and type and length of placement. RESULTS A total of 3328 students responded. The sample was predominantly female (79%), the mean age was 26.0 years and 1.8% identified as ATSI. Most placements (69%) were >2 but ≤12 weeks, 80% were in Modified Monash 3, 4 or 5 geographical locations. Public hospitals and community health made up 63% of placements. Students satisfied with their placement had 2.33 higher odds of rural practice intention. Those satisfied with Indigenous cultural training, workplace supervision, access to education resources and accommodation had higher odds of overall satisfaction and post-placement rural practice intention. CONCLUSIONS The majority of students were highly satisfied with their placement and the support provided by rural clinicians and the UDRHs. UDRHs are well placed to provide health professional students with highly satisfactory placements that foster rural practice intention.
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Affiliation(s)
- Tony Smith
- Department of Rural Health, University of Newcastle, Taree, New South Wales, Australia
| | - Keith Sutton
- Department of Rural Health, Monash University, Moe, Victoria, Australia
| | - Sabrina Pit
- University Centre for Rural Health, University of Western Sydney, Lismore, New South Wales, Australia
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla, South Australia, Australia
| | - Daniel Terry
- Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia
| | - Annie Farthing
- Centre for Remote Health, Flinders University, Alice Springs, Northern Territory, Australia
| | - Claire Courtney
- Western Australia Centre for Rural Health, Geraldton, Western Australia, Australia
| | - Merylin Cross
- Centre for Rural Health, University of Tasmania, Launceston, Australia
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12
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Lindeman M, Mackell P, Lin X, Farthing A, Jensen H, Meredith M, Haralambous B. Role of art centres for Aboriginal Australians living with dementia in remote communities. Australas J Ageing 2017. [DOI: 10.1111/ajag.12443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Melissa Lindeman
- Flinders NT; Flinders University and Charles Darwin University; Alice Springs Northern Territory Australia
| | - Paulene Mackell
- National Ageing Research Institute Ltd, Health Promotion Division; Melbourne Victoria Australia
| | - Xiaoping Lin
- National Ageing Research Institute Ltd, Health Promotion Division; Melbourne Victoria Australia
| | - Annie Farthing
- Centre for Remote Health; a Joint Centre for Flinders University; Alice Springs Northern Territory Australia
- Charles Darwin University; Darwin Northern Territory Australia
| | - Heather Jensen
- Centre for Remote Health; a Joint Centre for Flinders University; Alice Springs Northern Territory Australia
- Charles Darwin University; Darwin Northern Territory Australia
| | - Maree Meredith
- Centre for Remote Health; a Joint Centre for Flinders University; Alice Springs Northern Territory Australia
- Charles Darwin University; Darwin Northern Territory Australia
| | - Betty Haralambous
- National Ageing Research Institute Ltd, Health Promotion Division; Melbourne Victoria Australia
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13
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Borley J, Wilhelm-Benartzi C, Yazbek J, Williamson R, Bharwani N, Stewart V, Carson I, Hird E, McIndoe A, Farthing A, Blagden S, Ghaem-Maghami S. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG 2015; 122:843-849. [PMID: 25132394 DOI: 10.1111/1471-0528.12992] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer. DESIGN Two-phase retrospective cohort study. SETTING West London Gynaecological Cancer Centre, UK. POPULATION Women with stage 3 or 4, ovarian, fallopian or primary peritoneal cancer undergoing cytoreductive surgery. METHODS Preoperative CT images were reviewed by experienced radiologists to assess the presence or absence of disease at predetermined sites. Multivariable stepwise logistic regression models determined sites of disease which were significantly associated with surgical outcomes in the test (n = 111) and validation (n = 70) sets. MAIN OUTCOME MEASURES Sensitivity and specificity of CT in predicting surgical outcome. RESULTS Stepwise logistic regression identified that the presence of lung metastasis, pleural effusion, deposits on the large-bowel mesentery and small-bowel mesentery, and infrarenal para-aortic nodes were associated with debulking status. Logistic regression determined a surgical predictive score which was able to significantly predict suboptimal debulking (n = 94, P = 0.0001) with an area under the curve (AUC) of 0.749 (95% confidence interval [95% CI]: 0.652, 0.846) and a sensitivity of 69.2%, specificity of 71.4%, positive predictive value of 75.0% and negative predictive value of 65.2%. These results remained significant in a recent validation set. There was a significant difference in residual disease volume in the test and validation sets (P < 0.001) in keeping with improved optimal debulking rates. CONCLUSIONS The presence of disease at some sites on preoperative CT scan is significantly associated with suboptimal debulking and may be an indication for a change in surgical planning.
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Affiliation(s)
- J Borley
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - J Yazbek
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - R Williamson
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - N Bharwani
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - V Stewart
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - I Carson
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - E Hird
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - A McIndoe
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - A Farthing
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - S Blagden
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - S Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
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Kyrgiou M, Horwell DH, Farthing A. Laparoscopic radical abdominal trachelectomy for the management of stage IB1 cervical cancer at 14 weeks' gestation: case report and review of the literature. BJOG 2015; 122:1138-43. [PMID: 25832461 DOI: 10.1111/1471-0528.13392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/27/2022]
Affiliation(s)
- M Kyrgiou
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK.,West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea - Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK
| | | | - A Farthing
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK.,West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea - Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK
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Saso S, Chatterjee J, Pai P, Farthing A, Ghaem-Maghami S. Training the trainees: an evaluation exercise using the TLH and BSO model. J OBSTET GYNAECOL 2013; 33:548-52. [PMID: 23919847 DOI: 10.3109/01443615.2013.807784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our aim was to evaluate surgical training in gynaecological oncology by assessing the time required by a trainee to complete a single laparoscopic gynaecologic-oncological operation. A total of 135 patients with a BMI < 40 kg/m2, diagnosed with endometrial cancer, underwent a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (TLH and BSO). Patients in Group I (n = 78) were operated on by a consultant gynaecological oncology surgeon and in Group II (n = 57) by sub-specialist trainees (SSTs). The mean patient age and BMI was 63.5 years and 29.6 kg/m2, respectively, in Group I and 64.5 years and 29.9 kg/m2, respectively, in Group II. Median operating times for Groups I and II were 58 and 90 min, respectively (p < 0.05). Furthermore, significant improvement was noted when comparing the average operating time between the first and second half of SST training. Even experienced gynaecological trainees take significantly longer to perform a reproducible laparoscopic operation. At the completion of training, an SST demonstrates improvement with respect to operation duration but is still not as fast as the trainer.
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Affiliation(s)
- S Saso
- Division of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, UK.
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16
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Borley J, Yazbek J, Farthing A. Supporting the wider use of laparoscopy in the treatment of ovarian masses. J OBSTET GYNAECOL 2013; 33:434-7. [PMID: 23815190 DOI: 10.3109/01443615.2013.783004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with ovarian masses which have a moderate risk of malignancy are frequently treated by open laparotomy, despite the Royal College of Obstetricians and Gynaecologists (RCOG) guidance indicating that laparoscopic oophorectomy may be performed in selected cases. The reluctance to perform laparoscopic surgery in these cases is normally due to the perception that survival is affected if the mass is subsequently diagnosed as being malignant, the risk of rupture impacting on FIGO stage and the need for additional staging surgery. However, there is no good evidence to support these views. Preoperative diagnosis of ovarian masses is limited and thus a significant number of patients are subjected to open surgery, where they may have benefitted from the advantages of laparoscopic surgery. We argue that in the absence of a definitive preoperative test, there are advantages to the laparoscopic approach in patients who have a moderate risk of malignancy and further high level evidence should be encouraged in this field.
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Affiliation(s)
- J Borley
- Imperial College NHS Trust, London, UK
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Farthing A, Chatterjee J, Joglekar-Pai P, Dorney E, Ghaem-Maghami S. Total laparoscopic hysterectomy for early stage endometrial cancer in obese and morbidly obese women. J OBSTET GYNAECOL 2012; 32:580-4. [DOI: 10.3109/01443615.2012.693990] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Saso S, Ghaem-Maghami S, Chatterjee J, Naji O, Farthing A, Mason P, McIndoe A, Hird V, Ungar L, Del Priore G, Smith JR. Abdominal radical trachelectomy in West London. BJOG 2011; 119:187-93. [DOI: 10.1111/j.1471-0528.2011.03213.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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19
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Lavery S, Ng C, Kyrgiou M, Farthing A. Gestational surrogacy after intra-operative oocyte collection in a hysterectomised woman diagnosed with endometrial cancer. BJOG 2011; 118:1669-71. [PMID: 21967041 DOI: 10.1111/j.1471-0528.2011.03145.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- S Lavery
- Reproductive Medicine Unit, Hammersmith Hospital, London, UK
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20
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Smith JR, Ghaem-Maghami S, McIndoe A, Farthing A, Mason P, Ungar L, Del Priore G. Fertility-sparing surgery for young women with early-stage cervical cancer. BJOG 2011; 118:377-8; author reply 378-9. [PMID: 21226829 DOI: 10.1111/j.1471-0528.2010.02796.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fulwell L, Taylor-Clarke M, Chatterjee J, Mason P, McIndoe A, Smith R, Farthing A, Ghaem-Maghami S. P1013 Morbidity and mortality associated with the use of inferior vena caval filters prior to major gynaecological oncology surgery in patients with venous thromboembolism: experience at the Hammersmith Hospital, London, UK. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aggarwal R, Tully A, Grantcharov T, Larsen CR, Miskry T, Farthing A, Darzi A. Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG 2007; 113:1382-7. [PMID: 17081183 DOI: 10.1111/j.1471-0528.2006.01148.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess the first commercially available virtual reality (VR) simulator to incorporate procedural modules for training of inexperienced gynaecological surgeons to perform laparoscopic salpingectomy for ectopic pregnancy. DESIGN Prospective cohort study. SETTING Departments of surgery and gynaecology in central London teaching hospitals. SAMPLE Thirty gynaecological surgeons were recruited to the study, and were divided into novice (<10 laparoscopic procedures), intermediate (20-50) and experienced (>100) groups. METHODS All subjects were orientated to the VR simulator with a basic skills task, followed by performing ten repetitions of the virtual ectopic pregnancy module, in a distributed manner. MAIN OUTCOME MEASURES Operative performance was assessed by the time taken to perform surgery, blood loss and total instrument path length. RESULTS There were significant differences between the groups at the second repetition of the ectopic module for time taken (median 551.1 versus 401.2 versus 249.2 seconds, P = 0.001), total blood loss (median 304.2 versus 187.4 versus 123.3 ml, P = 0.031) and total instrument path length (median 17.8 versus 8.3 versus 6.8 m, P = 0.023). The learning curves of the experienced operators plateaued at the second session, although greater numbers of sessions were necessary for intermediate (seven) and novice (nine) surgeons to achieve similar levels of skill. CONCLUSIONS Gynaecological surgeons with minimal laparoscopic experience can improve their skills during short-phase training on a VR procedural module. In contrast, experienced operators showed nonsignificant improvements. Thus, VR simulation may be useful for the early part of the learning curve for surgeons who wish to learn to perform laparoscopic salpingectomy for ectopic pregnancy.
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Affiliation(s)
- R Aggarwal
- Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
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Abstract
The quality of cancer treatment is judged by both morbidity and mortality. Patients benefit if morbidity is reduced without compromising mortality. This applies particularly for women who develop gynaecological malignancy during their childbearing years where curative treatment also renders them infertile. This study reviews the increasing role of fertility-sparing surgery in such women. A literature search was undertaken using PubMed, entering the terms endometrial cancer, cervical cancer and ovarian cancer in conjunction with the terms fertility and fertility sparing. Each relevant identified paper was reviewed, references checked and results collated to provide an evidence-based summary of fertility-sparing treatments for gynaecological malignancy. Fertility-sparing surgery is appropriate in many circumstances, and all doctors who advise young women with gynaecological malignancy should be aware of these possibilities. However, data are relatively sparse in many situations, and careful counselling and balanced guidance are essential if patients are to understand the full implications of their choices.
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Affiliation(s)
- A Farthing
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, London, UK.
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25
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Affiliation(s)
- N J Sebire
- Department of Histopathology, St Mary's Hospital, Paddington, London, UK
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26
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Bevan R, Farthing A. Combined laparoscopic and hysteroscopic guided removal of an interstitial pregnancy. J OBSTET GYNAECOL 1999; 19:438-9. [PMID: 15512357 DOI: 10.1080/01443619964904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R Bevan
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
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Abstract
AIMS To determine the sensitivity of the hybrid capture method for human papillomavirus (HPV) detection and potential clinical uses as a screening method for the identification of cervical intraepithelial neoplasia. METHODS The presence of oncogenic types of HPV was tested for in samples taken from the cervix at colposcopy, and compared with detection by polymerase chain reaction (PCR) in 60 patients. Both sets of results were corrected with the pathology determined by biopsy and smear cytology. RESULTS Hybrid capture detection showed 86% agreement with PCR. Eighty three percent of CIN 3 lesions, 62% of CIN 2, 59% of CIN 1 and 21% of normal controls were positive for oncogenic HPV types. CONCLUSION The hybrid capture detection method is reliable, sensitive, and easy to use. The addition of HPV testing to cytological screening would detect a greater proportion of cervical dysplasia with a higher false positive rate.
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Affiliation(s)
- A Farthing
- Ludwig Institute for Cancer Research, St Mary's Hospital, London
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McGregor JM, Farthing A, Crook T, Yu CC, Dublin EA, Levison DA, MacDonald DM. Posttransplant skin cancer: a possible role for p53 gene mutation but not for oncogenic human papillomaviruses. J Am Acad Dermatol 1994; 30:701-6. [PMID: 8176007 DOI: 10.1016/s0190-9622(08)81498-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Loss of p53 tumor suppressor function is a critical step in the development of diverse malignancies, including skin cancers in nonimmunosuppressed patients where UV-specific p53 gene mutations have been identified. In tumors associated with human papillomavirus (HPV), such as cervical carcinoma, p53 may be inactivated instead by binding to a viral oncoprotein. OBJECTIVE Our purpose was to examine the hypothesis that HPV may play an analogous role in the development of posttransplant skin cancer. METHODS p53 Immunoreactivity, suggestive of p53 gene mutation, was examined by immunocytochemistry. Oncogenic HPV DNA was detected by polymerase chain reaction. RESULTS Comparable p53 immunoreactivity was seen in skin tumors from both transplant and nontransplant patients. HPV DNA was not demonstrated in any tumor specimen. CONCLUSION Our data do not implicate oncogenic HPV in posttransplant skin cancer. p53 Gene mutation, rather than HPV-induced p53 degradation, may be more significant in the development of these tumors.
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Affiliation(s)
- J M McGregor
- Department of Dermatology, Guy's Hospital, London, United Kingdom
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Crook T, Farthing A. Human papillomavirus and cervical cancer. Br J Hosp Med (Lond) 1993; 49:131-2. [PMID: 8382097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cervical cancer is the fifth most common cancer worldwide, and is second only to breast cancer as the leading cause of cancer deaths in women. Half a million cases are diagnosed annually with the highest rates in developing countries.
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Affiliation(s)
- T Crook
- Ludwig Institute for Cancer Research, St Mary's Hospital Medical School, London
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Farthing A. Obstetric short communications Ventouse extraction using piped wall suction. J OBSTET GYNAECOL 1992. [DOI: 10.3109/01443619209013608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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