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Biomedical subjects

J Hyndman

Publications and source records attributed to J Hyndman.

13 recordsLinked to original sources
PubMed1999

Nutritional counselling in general practice: a cost effective analysis.

STUDY OBJECTIVE: To study the clinical and cost outcomes of providing nutritional counselling to patients with one or more of the following conditions: overweight, hypertension and type 2 diabetes. DESIGN: The study was designed as a random controlled trial. Consecutive patients were screened opportunistically for one or more of the above conditions and randomly allocated to one of two intervention groups (doctor/dietitian or dietitian) or a control group. Both intervention groups received six counselling sessions over 12 months from a dietitian. However, in the doctor/dietitian group it was the doctor and not the dietitian who invited the patient to join the study and the same doctor also reviewed progress at two of the six counselling sessions. SETTING: The study was conducted in a university group general practice set in a lower socioeconomic outer suburb of Perth, Western Australia. PATIENTS: Of the 273 patients randomly allocated to a study group, 198 were women. Age ranged from 25 to 65 years. Seventy eight per cent of patients resided in the lower two socioecnomic quartiles, 56 per cent described their occupation as home duties and 78 per cent were partnered. RESULTS: Both intervention groups reduced weight and blood pressure compared with the control group. Patients in the doctor/dietitian group were more likely to complete the 12 month programme than those in the dietitian group. Patients in the doctor/dietitian group lost an average of 6.7 kg at a cost of $A9.76 per kilogram, while the dietitian group lost 5.6 kg at a cost of $A7.30 per kilogram. CONCLUSION: General practitioners, in conjunction with a dietitian, can produce significant weight and blood pressure improvement by health promotion methods.

Adult↗
PubMed1997

The effect of spatial definition on the allocation of clients to screening clinics.

We compared four strategies for inviting 91,456 women aged 50-69 years to one of six clinics for mammography screening and 40,142 men aged 60-79 years to one of 10 clinics for abdominal aortic aneurysm (AAA) screening. The strategies were invitation to the clinic nearest to the client and invitation to the clinic nearest to the client's area of residence defined by census small area, postcode and local government area. For each strategy we calculated the expected demand at each clinic and the travel distances for clients. We found that when women were allocated to mammography clinics on the basis of the local government area instead of their individual address, expected demand at one clinic increased by 60%, and 19% of clients were invited to attend a more remote clinic, entailing 99,000 km of additional travel. Similar results were obtained for men allocated to AAA clinics by their postcode of residence instead of their individual address: 55% difference in expected demand, 13% to a more remote clinic and 60,000 km of extra travel. Allocation on the basis of small areas did not show such great differences, except for travel distance, which was about 5% higher for each clinic type. We recommend that allocation of clients to screening clinics be made according to residential address, that assessment of the location of clinics be based on distances between residences and nearest clinic, but that planning new locations for clinics be aided with spatial analysis tools using small area demographic and social data.

Aged↗
PubMed1997

Estimating the cost of an interview survey using geographic information system software.

Estimating the cost of interview surveys is difficult but important. A geographic information system (GIS) was used to determine the shortest time route to survey 533 medical facility locations in Perth. The results provided time and cost estimates for undertaking the survey and the interviewer agreed to a contract for the job on the basis of these estimates.

Costs and Cost Analysis↗
PubMed1995

Cervical screening in general practice.

This study examined the effect of three interventions for encouraging women to have a Pap smear in a general practice: tagging the medical record to remind the doctor to offer a Pap smear, sending an invitation to make an appointment for a Pap smear, and sending an invitation with an appointment to attend for a Pap smear at a special screening clinic staffed by women. The study took place in a university general practice at Lockridge, near Perth. A computerised practice age-sex register provided 2139 women in the age range 36 to 69 inclusive. Of these, 757 were eligible for inclusion in the study and were allocated randomly to one of three intervention groups or a control group. In total, 177 women had a Pap smear during the study. Significantly more Pap smears were taken for the appointment-letter and letter-only groups than the control group (odds ratio (OR) 2.13, 95% confidence interval (CI) 1.34 to 3.57, and OR 1.67, CI 1.01 to 2.77 respectively), but there was no significant difference between the tagged-notes and the control groups. Women who attended the screening clinic rated the experience positively. Attendance, however, was inadequate for the clinic's viability in a private practice.

Adult↗
PubMed1993

A study of the characteristics and needs of people transferred from acute hospitals to nursing homes.

OBJECTIVES: To describe the categories of people being approved for admission to nursing homes; to consider whether any alternatives would have been more appropriate; and to outline the care needed for each category. PARTICIPANTS AND SETTING: Patients in acute-care facilities in metropolitan Perth for whom a request had been made for nursing home admission. DESIGN: Patients were interviewed (by R B L and M D) and records in the acute hospital were examined. A second interview of those patients still available was conducted after their transfer to the nursing home. RESULTS: Nursing care was considered necessary for 123 of the 201 people seen in the acute hospitals; domestic care in a standard hostel for 24 people; care in a special dementia unit (SDU) hostel for 26 people; and care in a psychiatric institution for 16 people. Twelve others had various specific needs. Several different categories were identified in the group needing nursing care. CONCLUSIONS: Applicants for nursing home admission do not form a homogeneous group; there are several categories with different needs. SDU hostels should be added to the available facilities. In addition to undertaking the assessment of nursing home applicants, personnel from geriatric services should be encouraged to become involved in their continuing care.

Aged↗
PubMed1993

Retention and survival of hostel residents--a 12 year study.

BACKGROUND: The admission of a proportion of disabled people to hostels is inevitably followed by their transfer to nursing homes. Our hypothesis was that such admissions are justified in terms of quality of life and the cost to the community, notwithstanding the necessity of subsequent transfer. AIMS: To test this hypothesis by measuring the retention and survival times of residents in hostel and in nursing home; to consider the relevance of these factors to the future policy of the two institutions. METHODS: A retrospective study was made of 159 residents admitted over a period of 12 years to a hostel with 32 places. Times spent in the hostel and in the nursing home were recorded. Probabilities of survival in hostel and in nursing home were calculated according to the Kaplan-Meier method. Comparison with the expected survival of a matched cohort of the total population was determined. Estimation was made, using the SAS software package, of the likely number of places needed in nursing homes for residents following transfer. RESULTS: Although the majority of hostel residents eventually needed nursing home care, a worthwhile proportion of their total institutional time (approximately two-thirds) was spent in the hostel. Ongoing support from the personnel in a geriatric service is likely to increase retention time in the hostel. Because of the ultimate outcome for the majority of residents, planning for hostel care should include consideration of places needed in nursing homes.

Aged↗
PubMed1992

A five-year study of residents of a special hostel for people with dementia.

In order to consider whether admission to a special hostel was a desirable policy in view of the likelihood of subsequent transfer to a nursing home, this study compared the time spent by residents in a special hostel with the period in a nursing home after they were transferred out of the hostel. We also estimated the number of nursing home places necessary for residents who were transferred and studied the reasons for transfer. The setting was a special hostel in Perth, Western Australia, for 36 people with moderate or severe dementia. The periods spent in the hostel or a nursing home were calculated for all residents admitted between 1985 and 1990. Forty-two of the 84 residents admitted during the study period were transferred to nursing homes. About two thirds of the total time in the two institutions was spent in the hostel. The two principal reasons necessitating transfer to a nursing home were advancing dementia and the addition of a physical impairment. Because a major proportion of the care of selected people with dementia (who can no longer remain at home) can be undertaken in a special hostel, this facility should be included with standard hostel and nursing home in arrangements for institutional care. Between 20 and 25 nursing home places are necessary for residents transferred from a hostel of this size.

Aged↗
PubMed1980

Diagnosis of fetal hydrocephalus by ultrasound.

An ultrasound scan of a fetus at 26 weeks gestation suggested abnormal dilatation of a lateral cerebral ventricle. Serial scans confirmed progressive dilatation of both lateral ventricles. Clinical hydrocephalus causing obstructed labour occurred and required craniotomy. Post mortem upon the fresh still born infant confirmed internal hydrocephalus.

Adolescent↗
PubMedDate not supplied

Rotational osteotomies of the leg: tibia alone versus both tibia and fibula.

From a chart review of 45 consecutive cases (mean age 8.9 years) of patients who had rotational osteotomies of the tibia alone (group 1, 27 cases) or of both the tibia and fibula (group 2, 18 cases) for torsional deformities of the leg, we compared the length of surgery and postoperative complications. We also describe the surgical technique for tibial osteotomy alone. The most common complication, posterior and varus/valgus angulation at the osteotomy site, was significantly higher in group 2 than in group 1 (p < 0.05). The mean operative time was 21% faster for tibial osteotomy alone. One case of chronic lateral compartment syndrome occurred in group 2. When indicated, tibial osteotomy alone is a simple, safe, fast, and stable surgical procedure for correcting excessive tibial torsion.

Adolescent↗
PubMedDate not supplied

Recurrence after Achilles tendon lengthening in cerebral palsy.

We performed a retrospective review of all hemiplegic and diplegic cerebral palsy (CP) patients who had tendo-Achillis lengthening by open Z-plasty between 1974 and 1985. Fifty-seven patients with 77 heelcord lengthening were followed approximately 10 years. Our postoperative regimen did not routinely include bracing and physiotherapy, but our recurrence rates of 18 and 41% for diplegic and hemiplegic patients, respectively, are comparable to those reported in the literature. Children aged > or = 6 years at initial operation did not have recurrence. Diplegic patients who were operated on before age 4 years or patients who had longitudinal incisions had statistically significantly higher recurrence rates.

Achilles Tendon↗
PubMedDate not supplied

Cervical cancer: an inpatient screening service.

This paper describes the implementation and patient and staff acceptance of a pilot cervical cancer screening service for women aged 20 to 69 years who were inpatients in a 700 bed teaching hospital in Perth, Western Australia. Eligible women were identified daily by using the hospital admission lists, reviewing medical records and, where necessary, consulting with staff. Patients' and staff's acceptance of the service was evaluated by interviews and self-administered questionnaires. Thirty-five percent of the women whose records could be examined needed a Pap smear and 72% of these women had a smear. Fifty-five percent of women screened were aged from 50 to 69 years and 29% had not previously had a Pap smear. Patients and staff were very satisfied with the service and its continuation was strongly supported by the hospital's administrative, nursing and medical personnel. Based on 4000 admissions of women in the 20 to 69 age group and 684 smears per year, the projected annual cost of the service is $46,000. The service proved to be an effective strategy for reaching underscreened women and its success demonstrates the important role that nurses can play in reducing the morbidity and mortality caused by cervical cancer.

Adult↗