David I. Ben-Tovim

Outcome in patients with eating disorders: a 5-year study

BACKGROUND Eating disorders are disabling, unpredictable, and difficult to treat. We did a prospective 5-year investigation of a representative sample of patients with eating disorders. Our aim was to identify predictors of outcome and to assess effects of available treatments. METHODS We prospectively investigated 95 patients with anorexia nervosa, 88 with bulimia nervosa, and 37 with eating disorders not otherwise specified (EDNOS), who sought treatment in Adelaide, South Australia. We divided patients into those who had, and had not, received treatment in specialist units and reached a safe body weight. Individuals were then further classified dependent on intensity of any treatment received. We assessed clinical symptoms, body-related attitudes, and psychosocial function. FINDINGS 216 (98%) patients were available for follow-up after 5 years. Three patients with anorexia nervosa and two with EDNOS died. 65 (74%) bulimic, 29 (78%) EDNOS, and 53 (56%) anorexic patients had no diagnosable eating disorder. A small proportion of patients in every group had poor Morgan-Russell-Hayward scores at outcome. Final outcome was predicted by extent and intensity, but not duration, of initial symptoms in patients with anorexia nervosa, and by initial body-related attitudes and impaired psychosocial functioning in bulimia patients. We were unable to predict EDNOS outcome. Treatment did not affect outcome for any group. INTERPRETATION Deaths in the study confirm the serious nature of eating disorders. However, our results suggest that the efficacy of existing interventions is questionable.

Redesigning emergency department patient flows: Application of Lean Thinking to health care

Objective:  To describe in some detail the methods used and outcome of an application of concepts from Lean Thinking in establishing streams for patient flows in a teaching general hospital ED.

The development of the Ben-Tovim Walker Body Attitudes Questionnaire (BAQ), a new measure of women's attitudes towards their own bodies

A measure has been developed which assesses a broad range of attitudes which women hold towards their bodies. The Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) is a 44-item self-report questionnaire whose subscales encompass six distinct aspects of body experience (feelings of overall fatness, self-disparagement, strength, salience of weight, feelings of attractiveness and consciousness of lower body fat). The development of the BAQ involved administering increasingly refined versions to a wide range of female respondents. The final version appears to have satisfactory psychometric properties. When the BAQ scores of 29 patients with anorexia nervosa were compared with those of a large community sample, a more complex pattern of deviant attitudes appeared than would previously have been suspected. The BAQ appears to have potential as a research instrument in this and other fields in which the measurement of attitudes towards the body is important.

Telepsychiatry: ‘tele’ yes, but what about the ‘psychiatry’?

To investigate what is lost or gained in a psychiatric evaluation when it takes place via telepsychiatry we compared the inter-rater reliability between two psychiatrists interviewing 63 subjects in an observer/interviewer split configuration in telepsychiatry and same-room settings. The measures used were the BPRS and interviewer ratings from a semi-structured interview. Patients also rated their experience. There were some clear differences between the telepsychiatry and same-room evaluations. Despite these variations, diagnoses were as reliably made by telepsychiatry. Patient acceptance of telepsychiatry was high.

Women's body attitudes: A review of measurement techniques

Techniques for measuring womens attitudes towards their own bodies have been reviewed. Four major, measuring strategies were identified: self-report questionnaires, projective tests, silhouette choices, or interview assessments

Body image, disfigurement and disability

The body-related attitudes of groups of women suffering from physical conditions that are commonly regarded as being disfiguring and/or disabling were studied by means of the Body Attitudes Questionnaire. Despite their conditions, the women did not necessarily disparage their bodies. They also seemed to worry less about small changes in weight and shape than did comparable women without physical difficulties, and to have an enhanced sense of their own robustness. There was an indication that development of negative body attitudes might be linked to emergence of a chronic physical condition during adolescence, rather than from birth or during adulthood. If our results are confirmed, they point to the need to pay special attention to the psychological needs of women whose bodies become dysfunctional at this sensitive time.

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

Abstract Objective To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility. Design Randomised controlled trial. Setting Three public hospitals in Southern Adelaide. Participants 320 elderly patients (mean age 83 years) in acute hospital beds (212 randomised to intervention, 108 to control). Interventions A transitional care facility where all patients received a single assessment from a specialist elder care team and appropriate ongoing therapy. Main outcome measures Length of stay in hospital, rates of readmission, deaths, and patients functional level (modified Barthel index), quality of life (assessment of quality of life), and care needs (residential care scale) at four months. Results From admission, those in the intervention group stayed a median of 32.5 days (95% confidence interval 29 to 36 days) in hospital. In the control group the median length of stay was 43.5 days (41 to 51 days) (95% confidence interval for difference 6 to 16 days). Patients in the intervention group took a median of 21 days (6 to 27 days) longer to be admitted to permanent care than those in the control group. In both groups few patients went home (14 (7%) in the intervention group v 9 (9%) in the control group). There were no significant differences in death rates (28% v 27%) or rates of transfer back to hospital (28% v 25%). Conclusions For frail elderly patients who are awaiting a residential care bed transfer out of hospital to an off-site transitional care unit with focus on aged care “unblocks beds” without adverse effects.

A study of factors affecting suicide in Aboriginal and ‘other’ populations in the Top End of the Northern Territory through an audit of coronial records

Objective: A recent increase in suicide among the Tiwi people of Bathurst and Melville Islands in the Northern Territory led to a review of recent suicides in the Top End of the Northern Territory using the coroners records. The aim of the review was to establish through the coronial files whether there were any significant differences in the factors that related to suicide in Aboriginal people and other people in the Top End. Method: Coronial determinations of suicide in the Top End for the years 1991–1998 were examined using a structured coding instrument. Results: Hanging was a prominent method of suicide among Aboriginal people. Aboriginals who committed suicide were more likely to have a history of self-harm behaviour. Suicide among Aboriginal people was irregular in distribution with a higher general risk for Aboriginal people resident in the east Arnhem region. A recent rise in suicide in the Tiwi community occurred against a background of social disruption similar to that which occurred against suicides in the Aboriginal population of the Kimberley region in Western Australia. Conclusions: There are some important differences in the factors attributed to suicide in the Aboriginal and other populations in the Top End. Furthermore, our study highlights regional differences in suicide risk among different Aboriginal populations in the Top End.

Mental health status of the South Australian population

Objective : To determine, by the use of a telephone survey, the mental health status of SA adults (18+ years) using the GHQ‐28, SF‐12 and self‐report as indicators of mental health, and to examine risk factors for mental health morbidity.

Electroconvulsive therapy: a study of attitudes and attitude change after seeing an educational video

Despite the proven efficacy of Electroconvulsive Therapy [ECT], negative attitudes occur in some patients towards its use. However, research into attitudes of patients and public towards ECT, and the influence of the media on these attitudes, is limited and often contradictory. The aims of this study were: to develop a self-administered questionnaire to assess attitudes; to assess the effect of an educational video on attitudes; and to assess the effect of the media on attitudes. The questionnaire was administered to psychiatric and non-psychiatric patients of a Veterans’ hospital and to a group of general hospital patients. A video was shown to a randomly assigned group of the Veteran hospital psychiatric patients. Their attitudes were assessed before and after the video. An overall positive attitude towards ECT was demonstrated in all three groups. Showing a video to the Veteran psychiatric patients produced an improvement in some attitudes, but no reduction in fear. For the psychiatric patients, the effect of the media was negative.