Janet Hornbuckle

King Edward VIII Hospital, Port Natal, KwaZulu-Natal, South Africa

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Publications (4)8.44 Total impact

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    ABSTRACT: Background Australian Aboriginal women attend antenatal care less frequently and experience poorer pregnancy outcomes than non-Aboriginal women. Improving access to antenatal care is recognised as a means to improve pregnancy outcomes for mother and baby.Objective To estimate the costs of inadequate antenatal care and provide baseline measurements and implications for policy that targets improving access to care in rural and remote Western Australian (WA) Aboriginal communities.Methods An individual sampling model of pregnancy was developed that simulated hypothetical women with pregnancy events and outcomes observed in the WA Aboriginal population. Weekly pregnancy events were modelled via logistic regression according to maternal characteristics, events during pregnancy and current gestation, with adequate and inadequate care (⩾4 and <4 antenatal visits) to reflect differences in outcomes reported in the literature. The pregnancy model simulated clinical management including antenatal visits, hospitalisations, and transfers to tertiary care.ResultsThe mean cost of pregnancy was AUD$8985, with a large difference depending on access to antenatal care (AUD$7635 and AUD$10,216 for adequate and inadequate care respectively). The main difference in costs resulted from neonatal care (AUD$1021 vs AUD$3205 for adequate and inadequate care respectively). In a rural community with 150 births per year, up to AUD$123,082 may be spent to improve access to care at no extra cost to the total current expenditure (AUD$1,347,733).Conclusions The large difference in pregnancy costs between those receiving adequate and inadequate care demonstrates that additional expenditure on improving access to antenatal care may be cost-effective and should be further investigated.
    European Journal of Operational Research 04/2013; 226(2):313–324. · 2.04 Impact Factor
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    ABSTRACT: The introduction of an audience response system (ARS) in the obstetrics and gynaecology course for medical students at The University of Western Australia provided an opportunity to measure knowledge gain by ARS lecture formats compared with didactic lectures. The study was conducted over four obstetrics and gynaecology terms, alternating the ARS and didactic format between two selected lectures each term. Students completed multiple-choice quizzes immediately post-lectures and 5 weeks later. Immediate post-lecture quiz mean scores for the ARS lectures were significantly higher compared with scores for the didactic lectures (7.5 vs. 6.7, p < 0.001). Pairwise comparisons between ARS and didactic lectures for each lecture topic showed significantly higher quiz scores for ARS lectures (preterm labour 8.3 vs. 7.4, p = 0.032; and prenatal diagnosis 6.9 vs. 6.0, p = 0.014). Quiz scores for the didactic preterm labour lecture were significantly higher than scores for the didactic prenatal diagnosis lecture (6.0 vs. 7.4, p < 0.001). Quiz results at 5 weeks showed no differences in scores between the ARS and the didactic lectures and no differences between lecture topics. Use of the ARS in lectures appeared to improve knowledge gain immediately post-lecture but no difference was found after retesting at 5 weeks.
    Medical Teacher 01/2012; 34(4):e269-74. · 1.82 Impact Factor
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    ABSTRACT: The Growth Restriction Intervention Trial found little difference in overall mortality or 2-year outcomes associated with immediate or deferred delivery following signs of impaired fetal health in the presence of growth restriction when the obstetrician was unsure whether to deliver. Because early childhood assessments have limited predictive value, we reevaluated them. Children were tested with standardized school-based evaluations of cognition, language, motor performance, and behavior. Analysis and interpretation were Bayesian. Of 376 babies, 302 (80%) had known outcome: either dead or evaluated at age 6-13 years. Numbers of children dead, or with severe disability: 21 (14%) immediate and 25 (17%) deferred groups. Among survivors, the mean (SD) cognition scores were 95 (15) and 96 (14); motor scores were 8·9 (7·0) and 8·7 (6·7); and parent-assessed behavior scores were 10·5 (7·1) and 10·5 (6·9), respectively, for the 2 groups. Clinically significant differences between immediate and deferred delivery were not found.
    American journal of obstetrics and gynecology 11/2010; 204(1):34.e1-9. · 3.28 Impact Factor
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    ABSTRACT: To determine the outcomes of preterm small for gestational age (SGA) infants with abnormal umbilical artery (UA) Doppler studies. A retrospective cohort study of SGA singleton infants delivered between 24 and 32 weeks gestation at King Edward Memorial Hospital, Perth, who had UA Doppler studies performed within seven days of birth. Main outcomes assessed were perinatal mortality and morbidity, and neurodevelopmental outcomes at >or= 1 year of age. Outcomes were compared by normality of UA blood flow. There were 119 infants in the study: 49 (41%) had normal UA Doppler studies, 31 (26%) had an increased systolic-diastolic ratio >or= 95th centile, 19 (16%) had absent end diastolic blood flow (AEDF) and 20 (17%) had reversed end-diastolic flow (REDF). Infants in the AEDF and REDF groups were delivered significantly more preterm (P = 0.006) and had lower birthweights (P < 0.001). Ninety four per cent (110 of 117) of live born infants survived. Neurodevelopmental follow-up at 12 months of age or more (median 24 months) was available on 87 of 108 (81%) of live children. Twenty-eight per cent (11 of 39) of fetuses who had had AEDF or REDF died or were classified with moderate or severe disability. There was no significant association between abnormality of UA blood flow, perinatal morbidity, perinatal mortality and neurodevelopmental disability after correction for gestational age. Fetuses that are SGA with abnormal UA Doppler studies remain at significant risk of perinatal death, perinatal morbidity and long-term neurodevelopmental disability, associated with their increased risk of preterm birth.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 02/2009; 49(1):52-8. · 1.30 Impact Factor

Publication Stats

21 Citations
8.44 Total Impact Points

Institutions

  • 2013
    • King Edward VIII Hospital
      Port Natal, KwaZulu-Natal, South Africa
  • 2010
    • University of Western Australia
      • School of Women's and Infants' Health
      Perth City, Western Australia, Australia
  • 2009
    • King Edward VII's Hospital
      Londinium, England, United Kingdom