Telemedicine in remote Australia: The Royal Flying Doctor Service (RFDS) Medical Chest Program as a marker of remote health.

INTRODUCTION: Remote communities across Australia lack the ready access to medical care generally afforded to metropolitan populations. The Royal Flying Doctor Service (RFDS) medical chest program provides medical resources to these communities allowing medications to be dispensed in conjunction with a telehealth consulting service. More than 3000 medical chests are located throughout Australia and each year the Queensland RFDS conducts approximately 20 000 telehealth consultations. The aim of this study was to review the use of the medical chest model within the state of Queensland and to analyse changes in the medical chest program from 10 years earlier to evaluate the changing healthcare needs of remote Australian populations. METHODS: All telehealth consultations and items dispensed from the medical chests were reviewed over a 1-year period from 1 July 2013 and 30 June 2014. Items dispensed were categorised and compared to those in 2005-06 in absolute terms by one-way ANOVA and proportionately by χ2 with Fisher's exact test. Consultations using the medical chest were categorised and compared to those in 2005-06 by χ2 with Fisher's exact test. RESULTS: The number of telehealth consultations conducted in 2013-14 (N=20 707) was not different to the number conducted in 2005-06 (N=21 470). Fewer items were dispensed from the medical chests in 2013-14 (3936 total items) than in 2005-06 (8607 total items; p<0.0001). In the specific categories of 'burns and other dressings' and 'antihistamines', the number of individual items dispensed increased. Resources from the medical chest were used more for genitourinary system consultations and less for consultations involving specific infectious diseases; the circulation, respiratory and abdominal systems; skin diseases; injury; symptoms without a diagnosis; and following other contact with a health service. CONCLUSIONS: The medical chests remain a vital tool for medical care of remote populations and the need for telehealth medical advice remains unchanged, although fewer items are being dispensed. The use of the medical chest for each diagnostic category of consultation has shown some variation over the past 10 years, reflective of changing patterns of accident, injury and disease.

Genotypic analyses of Mycoplasma gallisepticum isolates from songbirds by random amplification of polymorphic DNA and amplified-fragment length polymorphism.

Mycoplasma gallisepticum (MG) conjunctivitis emerged in 1994 as a disease of free-ranging house finches (Carpodacus mexicanus) in North America and has also been isolated from other songbirds with conjunctivitis. Random amplification of polymorphic DNA (RAPD) of house finch and other songbird isolates has suggested that a single 'strain' initiated this outbreak. To explore the possibility of genomic variability among house finch isolates of MG and to evaluate the utility of a second technique for MG genotyping, we selected samples from our archive of reference strains and wild songbird isolates to analyze using both RAPD and amplified-fragment length polymorphism (AFLP); this is a newer technique that has been successfully used to explore the genomic variability of several Mycoplasma species. Both RAPD and AFLP results confirmed previous observations that during the initial stages of the MG epidemic in songbirds, isolates from different geographic locations and songbird species had genotypes that appeared to be highly similar, further supporting a single point source of origin. One 2001 isolate from New York was clearly different from the other songbird samples and clustered together with the vaccine and reference strains, indicating that substantial molecular evolution or a separate introduction has occurred.