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Biomedical subjects

R A Kane

Publications and source records attributed to R A Kane.

At least 37 records · Page 2Linked to original sources
PubMed1998

Comparison of the intergenic spacers and 3' end regions of the large subunit (28S) ribosomal RNA gene from three species of Schistosoma.

The sequences for the entire intergenic spacer (IGS) and 3' end region of the large subunit (28S) ribosomal RNA gene are presented for Schistosoma intercalatum, S. haematobium and S. mansoni. The IGS was found to have at least 2 size formats for S. intercalatum and S. haematobium and the region for all 3 species contains numerous repeats and evidence of recombination. An A + T rich sequence found in S. intercalatum and S. haematobium is described and its possible function and origins are discussed. The amplification of this region by means of the polymerase chain reaction can be used to discriminate clearly between the 3 species involved in this study. The putative end of the 28S gene is identified.

Animals↗
PubMed1998

Variation in state spending for long-term care: factors associated with more balanced systems.

Pressures to turn over responsibility for long-term care to the states will exacerbate the already sizable difference in such efforts. This article describes the nature of the interstate variation in the types and amounts of long-term care provided under Medicaid. The average Medicaid long-term care expenditure on persons sixty-five years and older varies from $2,720 in New York to $380 in Arizona. Likewise, payments for home and community-based services (HCBS) vary from $1,180 in New York to $29 in Mississippi. Only a modest portion (28 percent) of the variance in total long-term care expenditures appears to be related to differences in population characteristics, and even less (7 percent) appears to be related to differences in HCBS expenditures. When supply factors (e.g., nursing home beds) are added, the explained variance increases to 52 percent and 17 percent, respectively. Medicare replaces some--but not most--of the difference in Medicaid home and community-based services payments.

Aged↗
PubMed1998

Goals for Alzheimer's care in nursing homes: what kind of differences do special care units expect to make?

Special Care Units (SCUs) for people with dementia have been enthusiastically promoted although many residents with dementia live elsewhere in their nursing home. In response to open-ended questions during personal interviews, coordinators of all 64 SCUs in Minnesota nursing homes described their goals and criteria for success. They then rated the importance of a list of possible goals and their unit's success in achieving them. Unit coordinators of 173 nursing home units in facilities with SCUs and 135 units in facilities without SCUs answered the same questions about people with dementia in their own units. When unprompted, respondents both in and outside SCUs were varied, sparse (averaging 3.1 goals per person), vague, process-oriented rather than outcome-oriented, and sometimes unrealistic. Yet, respondents later strongly endorsed most of the 24 goals the researchers suggested. ANOVA and regression analyses revealed few statistically significant differences according to unit type, although SCU coordinators were more likely to aspire to fewer medications, reduced disruptive behavior, and reduced agitation and anxiety, and were less likely to want residents to sleep through the night. Some differences were only between SCUs and non-SCUs in facilities without SCUs. Characteristics of facilities, coordinators, and case mix (e.g., proportion of dementia on the unit) were as predictive of goals and perceptions of success as SCU units. Findings reinforce the lack of conceptual clarity about expectations for direct and indirect effects of SCUs.

Aged↗
PubMed1998

Effects of post-hospital Medicare home health and informal care on patient functional status.

OBJECTIVE: To examine the effect of post-hospital Medicare home health and informal care on the functional status of 755 Medicare beneficiaries six weeks after hospital discharge for treatment of stroke, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hip procedures, and hip fractures. STUDY SETTING/DATA SOURCES: Consecutive patients enrolled in the study between March 1988 and February 1989 prior to discharge from one of 52 hospitals in three cities. Data sources included patient interviews, medical records, and the Medicare Automated Data Retrieval System (MADRS). ANALYSIS: The effect of the two types of care on patients' subsequent functional status was estimated using a selectivity corrected least squares regression of functional status six weeks post-discharge on hours of informal care, Medicare home health expenditures, and patient prior functional and cognitive status. DATA COLLECTION/EXTRACTION METHODS: Patients were interviewed before hospital discharge and six weeks later. The patient's primary caregiver was interviewed by telephone six weeks post-discharge. Patient data included demographic characteristics, illness severity, cognitive status, functional status at discharge and six weeks later, post-discharge expenditures for Medicare home health, and hours of informal care. PRINCIPAL FINDINGS: More informal care after discharge was associated with greater patient functional impairment six weeks later. The amount of Medicare home health that patients used had a nonsignificant effect on subsequent functional status. CONCLUSIONS: Post-acute home care may maintain the patient at home and compensate for functional limitations, rather than promote restoration of function. Future studies are needed to examine the effects of specific types of care, services, and providers as well as factors that mediate their effects on patient functional outcomes.

Activities of Daily Living↗
PubMed1997

Observations on the early detection of prostate cancer from the American Cancer Society National Prostate Cancer Detection Project.

BACKGROUND: The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) was established in 1987. The experience of the ACS-NPCDP demonstrates the yield and impact of periodic examinations for the early detection of prostate cancer. METHODS: A cohort of 2999 well men ages 55-70 years was tested annually at 10 clinical centers by prostate specific antigen (PSA), transrectal ultrasound (TRUS), and digital rectal examination (DRE). Biopsies were performed on men with suspicious findings. Pathologic findings were reviewed. The initial study outcomes were the detection yield of multimodality testing and the comparative sensitivity and specificity of the different tests employed. Longer term outcomes included patient quality of life and survival. RESULTS: The cancer detection rate declined significantly across the years of intervention. DRE had lower sensitivity than TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that of DRE. Fewer than 9% of the cancers detected in this study were clinically advanced at the time of diagnosis. Ninety-four percent of patients in whom cancer was detected are alive after an average follow-up of 54 months. In one case, death occurred after surgery. Two deaths were attributed to prostate cancer, and eleven other deaths were unrelated to prostate cancer or its treatment. CONCLUSIONS: Results of the ACS-NPCDP indicate that a combined-modality approach to prostate cancer detection yields high levels of early detection with infrequent adverse outcomes. Continued follow-up is required to evaluate long term morbidity and mortality.

Aged↗
PubMed1997

Care-related preferences and values of elderly community-based LTC consumers: can case managers learn what's important to clients?

This article describes the development and implementation of a brief values assessment protocol to be used by case managers working in community-based long-term care (LTC) for the elderly and presents data on the values and preferences of 790 LTC clients at two locations. The importance that clients placed on selected issues related to their care (e.g., privacy, daily routines, activities, involvement of family in care, the trade-off between freedom and safety) varied as did the specific content of those issues. Associations were found between the content and strength of preferences. The work has implications for research and practice.

Activities of Daily Living↗
PubMed1997

The substitutability of adult foster care for nursing home care in Oregon.

OBJECTIVES: This study investigates the degree of substitutability of adult foster care for nursing home care in Oregon. METHODS: Using three tests, the authors determined (1) the extent to which an additional adult foster care resident in a county reduces the number of nursing home residents in that county, (2) which characteristics of residents and facilities are important in sorting residents into either nursing homes or adult foster care facilities, and (3) the price elasticity of demand for adult foster care, using the county as the unit of observation. RESULTS: It was found that for every additional foster care resident in a county, a nursing home loses 0.85 residents-almost a one-to-one substitution ratio. CONCLUSIONS: Despite the high degree of substitutability, residents perceive important differences in the characteristics of the two forms of care. Indeed, private residents are, on average, willing to pay twice as much for nursing home care as for adult foster care, suggesting that these differences are important. Finally, private consumers are sensitive to price differences among adult foster care facilities. The implications for policy are discussed.

Adult↗
PubMed1997

Everyday matters in the lives of nursing home residents: wish for and perception of choice and control.

OBJECTIVES: This study examined the importance that nursing home residents and nursing assistants ascribed to control and choice over everyday issues, the satisfaction of residents with their control and choice over these issues, and the nursing assistants' impressions of the extent to which control and choice exist for nursing home residents on everyday matters. DESIGN: Cross-sectional in-person interviews with a stratified representative sample of nursing home residents and nursing assistants using semi-structured interview protocols with both fixed-choice and open-ended questions. SETTING: A random sample of 25 nursing homes in the Twin Cities, MN area; a random sample of five nursing homes in North Little Rock, AR; all five nursing homes in Sante Fe, NM; and five purposively selected nursing homes in each of New York City and Los Angeles, CA. PARTICIPANTS: One hundred thirty-five cognitively intact residents, three from each facility, were selected and included the resident council chair, one randomly selected short-stay resident, and one randomly selected long-stay resident from each facility. Also participating were 134 nursing assistants (1 selected randomly from each shift from those employed at least two-thirds time and who had worked in the facility for at least 3 months). MEASUREMENTS: The most important measurements were ordinal-level ratings of the importance of choice and control for nursing home residents over 10 selected areas of everyday life; ordinal measures of residents' satisfaction with their choice and control over these areas; and nursing assistants' ratings of the extent to which they thought it possible for residents to achieve choice and control. Open-ended comments were also elicited. Also measured were demographic data, ADL status, frequency of trips away from the nursing home, frequency of receiving visitors, and (for nursing assistants) length of employment, wages, job satisfaction, and extent to which they knew the residents under their care. MAJOR RESULTS: Cognitively intact nursing home residents attach importance to choice and control over matters such as bedtime, rising time, food, roommates, care routines, use of money, use of the telephone, trips out of the nursing home, and initiating contact with a physician. Nursing assistants view such control as important to residents. Residents and staff differ significantly in the importance attached to particular items, with staff placing lower importance than residents on use of the telephone and personal expenditures and higher importance on control and choice over visitors and formal nursing home activities. Residents were not very satisfied with their control and choice, and nursing assistants viewed them as unlikely to experience control and choice. Nursing home, resident, and staff characteristics were not associated with the patterns of results. CONCLUSIONS: A self-defeating cycle has been identified where neither resident nor staff are optimistic about achieving more resident control and choice, which both groups perceive as desirable. To end this cycle, suggestions are offered for structuring the role of the nursing assistant, physician and nurse leadership, changes in nursing home routines and practices, and public policy changes.

Activities of Daily Living↗
PubMed1997

Agency approaches to common quality problems in home care: a scenario study.

In a study of best practices in home care quality assurance (QA), a sample of 128 respondents from exemplary home care agencies were presented with 7 brief scenarios depicting common problems in home care quality. Agency respondents were asked to describe their likelihood of identifying the problem in each scenario, how they would identify the problem, and how they would correct it. We found that agencies expressed considerable confidence they would identify the problems, but were unlikely to view their QA efforts as contributing to detecting the problems. Identification was more often perceived to come from ordinary care, with considerable burden placed on paraprofessional staff or clients to bring the problem to the attention of the agency. Medically-oriented agencies were significantly more likely than socially-oriented to rely on formal QA to identify deteriorating patient conditions and depression. Across all agencies, a relationship existed between the type of problem in the scenario and the most frequent responses about detection and correction nodes. Once the problem was identified, agencies presented an appropriate and fairly wide range of corrective strategies. The implications for making QA more organically related to clinical care are discussed.

Health Care Surveys↗
PubMed1997

Case management as a force for quality assurance and quality improvement in home care.

To examine the extent to which case managers engage consciously in quality assurance activities for the services they purchase or arrange, semi-structured interviews were conducted with representatives of 75 case management agencies responsible for allocating home and community-based services with public funds, and 17 private, fee-for-service case management agencies. Relatively few agencies had developed formal criteria for defining quality, or systematic ways to assess it. Several types of quality oversight provided by case managers were identified: on-site review by case managers themselves, administrative review, and independent review by quality assurance staff. This article contains examples of best practices and discusses the policy implications of having case managers adopt a more explicit and rigorous role in assuring the quality of the services their clients receive.

Aged↗
PubMed1997

Intraoperative ultrasonography of the pancreas: techniques and clinical applications.

Intraoperative ultrasound of the pancreas is a dynamic clinical diagnostic field providing crucial information to the surgeon at the time of exploration, and impacting on clinical management decisions and choices of surgical techniques. It is a rapid and effective technique for imaging the entire pancreas, differentiating normal from pathological processes, imaging the pancreatic and common bile ducts, and demonstrating the exact relationship between pathological processes of the pancreas and the adjacent arterial and venous structures, the common bile duct, and the duodenal wall. The demand for intraoperative ultrasound (IOUS) of the pancreas is expected to increase, particularly as management algorithms become accepted clinical practice, due to advances in intraoperative tumor ablation and radiotherapeutic techniques, as well as technical improvements in laparoscopic ultrasound methods and instrumentation. Not only is IOUS of the pancreas becoming a recognized modality for visualizing and characterizing solid and cystic lesions of the pancreas, but it also has superior lesion detection rates over other non-invasive preoperative imaging modalities. Provisional studies from our department suggest that data from IOUS significantly affects surgical decision making.

Journal Article↗
PubMed1997

Strategies for imaging biliary neoplasms.

Biliary tract neoplasms are rare, develop in either intra- or extrahepatic locations, and are represented by a spectrum of imaging characteristics. These tumors may be imaged using a variety of traditional methods, such as ERCP, PTC, ultrasound, or CT, and some newer innovative cross-sectional techniques, such as MR- or CT-cholangiography. The choice of imaging technique depends on whether the study is for diagnostic, staging, or therapeutic purposes. Because these tumors are frequently small, secondary features such as intrahepatic ductal dilatation or even hepatic metastases, may be the initial finding on screening studies. Benign tumors, postsurgical strictures, or even biliary sludge may mimic features of malignant tumors, and the radiologist must be aware of these potential sources of interpretative error.

Biliary Tract↗
PubMed1996

The results of a five-year early prostate cancer detection intervention. Investigators of the American Cancer Society National Prostate Cancer Detection Project.

BACKGROUND: The American Cancer Society-National Prostate Cancer Detection Project (ACS-NPCDP) is a multidisciplinary evaluation of early prostate cancer detection interventions. This report summarizes the experience of the investigators to date and describes the overall and relative performance of the different detection modalities studied in this project. METHODS: Two thousand nine hundred ninety-nine men aged 55 to 70 years at entry who were not already under evaluation for prostate cancer were recruited to participate in up to 5 annual examinations by prostate specific antigen (PSA), digital rectal examination (DRE), and transrectal ultrasound (TRUS). In the course of 5 years of intervention, ACS-NPCDP investigators have completed 9937 examinations, recommended 1215 biopsies, and detected 203 cancers. RESULTS: Loss to cohort follow-up was greatest in the first year. Overall, TRUS led to twice the number of recommendations for biopsy compared with DRE (8.9% versus 4.4%). Elevated PSA was observed in 13.0% of 9535 measurements performed. The overall cancer detection rate declined significantly during the five years of intervention. Detection was significantly associated with age and symptom status at entry. DRE had lower sensitivity compared with TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that for DRE. PSA was elevated in 69.2% of examinations that led to cancer detection, compared with only 10.9% when cancer was not found. PSA level, PSA density, and PSA change were all related to the presence of cancer. Less than 6% of the cancers detected in this study were clinically advanced at the time of diagnosis. CONCLUSIONS: These data quantify the yield of early cancer detection that may be expected when PSA, DRE, and TRUS are used in populations comparable to the men participating in the ACS-NPCDP. Continued follow-up and further research is needed to assess whether men receiving early prostate cancer interventions benefit as a result.

Aged↗
PubMed1996

Multimodality treatment of hepatocellular carcinoma in a hepatobiliary specialty center.

OBJECTIVES: To review the experience of the treatment of hepatocellular carcinoma by a single multimodality team during a 6-year period, including all patients who were referred for possible surgical intervention, to evaluate prognostic factors at presentation, and to determine the results of the different modalities of treatment that were used. DESIGN: Retrospective study of 154 patients who were referred to our Hepatobiliary Surgical Unit with the diagnosis of hepatocellular carcinoma from January 1988 through August 1995. SETTING: Tertiary care center. RESULTS: Methods of treatment included surgical resection (n=49), transplantation (n=22), hepatic artery chemoembolization (n=30), systemic chemotherapy (n=25), and no treatment (n=22). Predictive prognostic factors included coexisting cirrhosis, symptoms at presentation, and abnormal liver function test results. Unfavorable tumor characteristics were size (diameter, >5 cm) and multicentricity. For patients who underwent surgical exploration, advanced staging according to the manual of the American Joint Committee on Cancer, vascular invasion, and a margin of less than 1 cm in the group for patients who underwent resection impacted negatively on the prognosis. The median survival (42.4 months) for the group of patients who underwent resection was significantly higher than that for the groups of patients who did not undergo resection. Chemoembolization was associated with significantly better survival results than was systemic chemotherapy. CONCLUSIONS: Hepatic resection offers the best chance at cure for patients with hepatocellular carcinoma. The high association between hepatocellular carcinoma and cirrhotic liver disease makes surgical resection, even in favorable tumor types, a difficult task based on low hepatic reserve whose tumors are considered unresectable can be considered for chemoembolization. Liver transplantation should be reserved for selected patients with cirrhotic liver disease who have tumors (diameter, <5 cm) in the contest of neoadjuvant protocols.

Adolescent↗