A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients

Objective:  To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients.
Design:  Quality improvement project utilising a prospective, observational design.
Setting:  Sixteen Australian organisations caring for HACC eligible clients.
Subjects:  One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 ± 7.2 years) were screened for nutritional risk during 2003–2005.
Interventions:  Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Generated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment.
Results:  According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 ± 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating.
Conclusion:  The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.     

BLINDNESS IN NEW SOUTH WALES An estimate of the prevalence and some of the contributing causes

The information available on the prevalence of blindness in Australia is examined in an attempt to estimate the number of blind people in New South Wales. Records of the causes of blindness made by the authors at the Royal Blind Society's Low Vision Clinic arethen examined to estimate their relative significance.
If blindness is to be prevented, a more detailed analysis of causes will be needed. This could be obtained by examination and coding of the records for Disability (Blind) Pensions at the Department of Social Security.
There are at least seven thousand people blind, out of a total population of 5,145,900. Macula pathology contributes 37.2% and 81.5% of those affected are over 60 years old. Diabetes is responsible for approximately 10%. Genetically determined disease causes 25% between ages 16 and 60 years.
Blindness in Aboriginals is not discussed.     

The Acromegaly Syndrome: RELATION BETWEEN CLINICAL FEATURES, GROWTH HORMONE VALUES AND RADIOLOGICAL CHARACTERISTICS OF THE PITUITARY TUMOURS

One hundred and fifty-five acromegalics, 76 males (mean age44 ± 1.3 years) and 79 females (45 ± 1.4 years)were studied. The frequency of clinical features were: acralenlargement 100 per cent, hyperhidrosis 65 per cent, headache55 per cent, paraesthesiae 49 per cent, cardiac problems 34per cent, hypertension 32 per cent, diabetes mellitus (clinicaland chemical) 27 per cent, and visual field defects 6 per centSigns and symptoms, and particularly headache, did not showany relation with the size or shape of pituitary tumours, norwith growth hormone (GH) values, age, sex or weight Mean ofGH values at 60, 90 and 120 minutes during a GTT averaged 135mIU/I, range 8–1833. Diabetes mellitus was more frequentand severe in patients with higher GH values, occurring in 32per cent of patients with mean GH values 50 mIU/1 and only in16 per cent of the rest (p < 0.05). GH values correlated positively with size of tumours. Forty-nineper cent of patients presented with entirely intrasellar tumours,27 per cent with suprasellar extensions and 23 per cent withpartially empty sellae. The mean GH (238 mIU/I) of patientswith suprasellar extensions was significantly higher (p <0.004) than those of the others. Younger acromegalics showeda tendency to larger tumours. Early treatment of acromegaly, particularly in young patientsand those presenting with high GH values, is recommended.     

Treatment of Prolactin-Secreting Pituitary Tumours in Young Women by Needle Implantation of Radioactive Yttrium

Twentyone young female patients are described who presentedwith amenorrhoea, galactorrhoea or infertility, and were treatedby ⁹⁰Y pituitary implantation of 20 000 rads. There was no morbidity.In all patients serum prolactin values were elevated and radiographsof the pituitary fossa were abnormal. Observations are available for 1–76 months (mean 27) afterimplantation. The median fall in prolactin values was 60 percent while there was no deterioration in pituitary functionif normal pre-operatively. Luteinizing hormone values, bothbasally and following gonadotrophin-releasing hormone, roseto normal after operation; several instances of sellar remodellingwere observed radiologically, and no instance of relapse wasfound radiologically, biochemically or clinically. Thirteen patients desiring fertility have been observed sinceimplantation; so far nine have become pregnant, in three instanceswithout any additional therapy; since four patients became pregnanttwice, a total of 13 pregnancies have occurred. No case of tumourexpansion was observed during pregnancy. ⁹⁰Y implantation can be considered as a therapeutic procedurein young female patients requiring fertility which is competitivewith surgical methods, and together with a short course of bromocriptineif needed, could prove to be the treatment of choice.