Janet Hornbuckle

University of Western Australia, Perth City, Western Australia, Australia

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Publications (6)56.74 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. DOI:10.1016/j.ejor.2012.10.041 · 1.84 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 04/2012; 34(4):e269-74. DOI:10.3109/0142159X.2012.660218 · 2.05 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. DOI:10.1016/j.ajog.2010.09.019 · 3.97 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. DOI:10.1111/j.1479-828X.2008.00941.x · 1.62 Impact Factor
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    ABSTRACT: Although delivery is widely used for preterm babies failing to thrive in utero, the effect of altering delivery timing has never been assessed in a randomised controlled trial. We aimed to compare the effect of delivering early with delaying birth for as long as possible. 548 pregnant women were recruited by 69 hospitals in 13 European countries. Participants had fetal compromise between 24 and 36 weeks, an umbilical-artery doppler waveform recorded, and clinical uncertainty about whether immediate delivery was indicated. Before birth, 588 babies were randomly assigned to immediate delivery (n=296) or delayed delivery until the obstetrician was no longer uncertain (n=292). The main outcome was death or disability at or beyond 2 years of age. Disability was defined as a Griffiths developmental quotient of 70 or less or the presence of motor or perceptual severe disability. Analysis was by intention-to-treat. This trial has been assigned the International Standard Randomised Controlled Trial Number ISRCTN41358726. Primary outcomes were available on 290 (98%) immediate and 283 (97%) deferred deliveries. Overall rate of death or severe disability at 2 years was 55 (19%) of 290 immediate births, and 44 (16%) of 283 delayed births. With adjustment for gestational age and umbilical-artery doppler category, the odds ratio (95% CrI) was 1.1 (0.7-1.8). Most of the observed difference was in disability in babies younger than 31 weeks of gestation at randomisation: 14 (13%) immediate versus five (5%) delayed deliveries. No important differences in the median Griffiths developmental quotient in survivors was seen. The lack of difference in mortality suggests that obstetricians are delivering sick preterm babies at about the correct moment to minimise mortality. However, they could be delivering too early to minimise brain damage. These results do not lend support to the idea that obstetricians can deliver before terminal hypoxaemia to improve brain development.
    The Lancet 01/2004; 364(9433):513-20. DOI:10.1016/S0140-6736(04)16809-8 · 45.22 Impact Factor
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    ABSTRACT: We describe the prospective application of Bayesian monitoring and analysis in an ongoing large multi-centre, randomized trial in which interim results are released to investigators. Substantial variability in prior opinion led us to reject the use of elicited clinical priors for monitoring, in favour of archetypal prior distributions representing reasonable scepticism and enthusiasm. Likelihoods for odds ratios for different covariate values are derived from a logistic regression model, which allows us to incorporate information from prognostic factors without resorting to specialized software. Priors, likelihoods and posterior distributions are regularly reported to both an independent Data Monitoring Committee and the trial investigators.
    Statistics in Medicine 12/2001; 20(24):3777-87. DOI:10.1002/sim.1171 · 2.04 Impact Factor

Publication Stats

162 Citations
56.74 Total Impact Points

Institutions

  • 2010–2013
    • 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
  • 2001
    • University of Leeds
      • Section of Obstetrics and Gynaecology
      Leeds, England, United Kingdom