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Biomedical subjects

John Gommans

Publications and source records attributed to John Gommans.

8 recordsLinked to original sources
PubMed2006

Management of hypertension in the oldest old: a study in primary care in New Zealand.

BACKGROUND: The benefits of blood pressure (BP) lowering are well established except in the oldest old, and suboptimal control of hypertension has been found in many different populations. OBJECTIVE: To assess the frequency of hypertension and its adequacy of management in the oldest old in primary care. DESIGN: a cross-sectional study. SETTING: Sixty-seven general practitioners (GPs) in three urban centres in New Zealand. METHODS: We conducted structured reviews of medical records for all ambulatory people aged > or = 80 years who were registered with a participating GP. Hypertensive status and BP control were classified according to standard criteria. Logistic regression analyses were used to identify independent factors for BP control. RESULTS: Medical records of 3,068 people (mean age 85 years, 64% female) revealed 56% to be hypertensive, of whom 94% were on treatment and 58% had controlled BP levels. Major co-morbid conditions were common among hypertensive people, and half of them had associated target organ damage. Histories of stroke, heart disease and hypercholesterolaemia were independent factors for good BP control. CONCLUSION: A large proportion of the oldest old were currently receiving anti-hypertensive therapy, and most had adequately controlled BP. Previous vascular disease was the most important factor for both BP treatment and control. These findings indicate a high level of uptake of cardiovascular guidelines for older people.

Aged, 80 and over↗
PubMed2005

Guideline recommendations for the management of patients admitted with acute stroke: implications of a local audit.

AIM: To assess the feasibility of implementing the New Zealand guideline for management of stroke by auditing the gap between recommended care and that provided in Hawke's Bay Hospital (HBH). METHODS: Fifty randomly selected records of patients discharged with acute stroke between 1 June and 30 November 2003 were retrospectively reviewed using an audit tool developed from the guideline. RESULTS: Eight patients (16%) with non stroke syndromes were incorrectly diagnosed or coded as stroke on the basis of computed tomography (CT) scan reports. Brain imaging compliance was 100%; 86% within first 48 hours. Aspirin use or documented contraindications occurred in 62% patients within 48 hours, although the delay after imaging averaged 12.55 hours. At discharge, aspirin compliance was 100% in the surviving 42 patients. Twenty-nine (69%) patients were discharged on antihypertensive therapy, but two patients were readmitted with hypotension. Compliance with recommended multidisciplinary assessments within 48 hours included swallowing (88%), mobility (88%), communication (78%), and self care ability (60%). Patients not admitted directly to the stroke unit (19, 38%) were less likely to receive recommended interventions. Compliance with recommended predischarge assessments included suitability of accommodation (100%) and home supports (92%), but only 19% received documented advice about driving. CONCLUSIONS: Management of inpatients with acute stroke in HBH is close to most of the guideline recommendations. The identified deficiencies in patient care are potentially easily rectifiable and full implementation of the guidelines is feasible.

Acute Disease↗
PubMed2005

Management problems of spontaneous ICH.

The management of spontaneous intracerebral haemorrhage (ICH) can be challenging for hospital doctors. Although the management of ICH is covered in stroke guidelines, many difficult clinical questions remain. In this article the authors suggest approaches to ten common and difficult questions.

Anticoagulants↗
PubMed2003

Stroke rehabilitation services in New Zealand.

AIMS: To obtain an overall picture of the organisation of stroke rehabilitation services throughout New Zealand and to see if this is consistent with recommendations in evidence-based guidelines. METHODS: A questionnaire was sent to all hospitals in New Zealand. This included questions about access to organised stroke rehabilitation, guidelines for the management of common problems after stroke, and the use of audit. RESULTS: All 48 hospitals surveyed responded, with 37 providing inpatient stroke rehabilitation services. Only one hospital (serving 9% of the population) provided a dedicated, inpatient stroke rehabilitation facility. In the other 36 hospitals, stroke rehabilitation was performed in assessment, treatment and rehabilitation units (25 hospitals, 84%) or general medical wards (8 hospitals, 7%). Only 57% of the population had access to hospitals with a nominated lead clinician for stroke rehabilitation services. Thirty per cent were served by hospitals without a multidisciplinary therapy team expert in stroke care. Guidelines for the management of common problems following stroke were used in most hospitals. Only 8 hospitals (28%) had audited their stroke rehabilitation services. CONCLUSIONS: The organisation and type of rehabilitation services available for people with stroke are not consistent with best practice or accepted guidelines. The development of an organised approach to stroke rehabilitation services in New Zealand must be seen as a priority.

Age Factors↗
PubMed2002

Acute stroke services in New Zealand.

AIMS: To obtain an overall picture of the organisation of acute stroke management in hospitals throughout New Zealand. METHODS: A questionnaire was sent to all New Zealand hospitals. The survey included questions about access to organised stroke care, the presence of designated areas for stroke patient management, guidelines for stroke management and audit. RESULTS: Responses were received from all hospitals surveyed, with 41 admitting stroke patients acutely. Five hospitals (four regional and one large urban) had organised inpatient care. Five hospitals (three regional and two large urban) had stroke physicians. Only 40-60% of the New Zealand population had access to hospitals with guidelines for the management of complications following stroke or secondary prevention. Only fifteen of 41 hospitals had audited local stroke care. There were few differences in the management of stroke patients between urban and regional centres, but care in some regional hospitals was 'better' than that in most large urban hospitals. CONCLUSIONS: The development of an organised approach to inpatient stroke care in New Zealand and the training of general physcians, geriatricans and neurologists in stroke medicine must be seen as a priority.

Critical Pathways↗