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Biomedical subjects

R A Kane

Publications and source records attributed to R A Kane.

At least 55 records · Page 3Linked to original sources
PubMed1996

Imaging of primary and metastatic liver tumors.

Innovative liver surgical techniques are allowing improved survival for patients with liver tumors. To effectively plan this surgery, both the number and precise location of all lesions must be accurately documented. Numerous technical advances have occurred in cross-sectional imaging techniques for evaluating liver tumors. These improvements have increased the sensitivity of US, CT and MR for detecting primary and metastatic liver neoplasms. Depending on the specific clinical information required, such as extrahepatic spread of diseases or hepatic vascular invasion, each modality has its strengths and drawbacks. The specific choice of technique should be decided in consultation with the radiologist who interprets the studies. Both benign and malignant lesions may coexist in the same liver and, because this affects patient management and prognosis, care should be taken to evaluate each lesion that is identified. Tumors also may be simulated by pseudolesions such as focal fatty sparing or infiltration, regenerative nodules, or hepatic arterial perfusion defects. To best evaluate liver malignancies, a sensible combination of imaging modalities, depending on the patient population, radiologic strengths, and imaging equipment available, is recommended to provide the best overall assessment of the number and location of liver neoplasms.

Diagnosis, Differential↗
PubMed1995

Long-term care.

Long-term care has come to include both an acute component and the more traditional chronic component. The growth in subacute care has occurred under private prepaid auspices but has also been stimulated by changes in Medicare funding for hospitals. Quality improvement techniques, such as critical pathways, have been applied to long-term care.

Health Care Reform↗
PubMed1995

Who cares? The size, scope, and composition of the caregiver support system.

The informal care networks of 242 impaired older people were examined in terms of the primary caregiver and secondary helpers. Most primary caregivers had at least one secondary helper; 88% identified helpers who provided hands-on help, 19% reported that helpers contributed financially, and 44% had helpers involved in care decisions. The size of the network was larger for direct care compared to financial or decision-making assistance. Almost half of primary caregivers reported that their spouse helped. It was expected that after controlling for characteristics of the primary caregiver and of the older person, that characteristics of the secondary caregiver network would influence the amount and type of primary caregiver assistance and formal care used by the older person. However, both hours and type of care by the primary caregiver were independent of size, scope, and composition of the secondary helper network. This independence suggests that efforts to alter the secondary caregiver network may have limited effects on the primary caregiver.

Aged↗
PubMed1995

Effect on physical functioning of care in adult foster homes and nursing homes.

This study tested the effects on physical functioning of substituting adult foster care (AFC) for nursing home care. Secondary data from Oregon's Medicaid agency were used to compare change in ADL functioning of 1,032 nursing home and 279 AFC residents. Maximum likelihood estimation was used to analyze selection of long-term care setting and change in functioning. One-third of surviving AFC residents would have been better off in a nursing home, whereas almost all nursing home residents were placed appropriately. Further research on outcomes that clients value most along with efforts to support functioning are needed.

Activities of Daily Living↗
PubMed1995

Beyond labels: nursing home care for Alzheimer's disease in and out of special care units.

OBJECTIVE: To compare dementia special care units (SCUs) with their non-SCU counterparts in terms of unit and facility characteristics. DESIGN: Cross-sectional telephone survey and secondary database. SETTING: 1247 units in 436 Minnesota nursing homes. MEASUREMENTS: Specialized dementia care practices (e.g., staffing, environmental design and programming features) and organizational characteristics (e.g., size, geographic location, type of ownership, proportion dementia, case-mix and percentage Medicaid). RESULTS: Comparing unit level data for all units in 436 facilities, we found that 75 SCUs offered more dementia-specific features than did the 1122 units not designated as SCUs, but most units offered some dementia-specific features similar to those of SCUs. The designation of SCU did not automatically translate into richer or more tailored services for dementia compared with units without the designation. Facilities with designated SCUs are more likely to be rural, larger and divided into more units, have a higher proportion of residents with dementia, and have fewer residents at higher levels of acuity. CONCLUSION: Presence of a SCU in a facility may be related to care of dementia in the rest of the nursing home in complex ways; some dementia-specific features were less likely to be found in regular units of nursing homes with designated SCUs.

Alzheimer Disease↗
PubMed1995

Portal vein: US-guided localization prior to transjugular intrahepatic portosystemic shunt placement.

To mark the portal vein prior to transjugular intrahepatic portosystemic shunt (TIPS) placement, metallic coils adjacent to (n = 18) and a wire within (n = 18) the portal vein were placed with ultrasonographic (US) guidance. The mean number of punctures for successful portal vein entry was 3.0 with coils and 2.9 with a wire, and the mean total procedure time was 127.5 and 110.0 minutes, respectively (differences, not significant), and mean time at US was 20 and 10 minutes, respectively.

Adult↗
PubMed1995

Intraoperative ultrasonography of the liver.

Intraoperative ultrasound of the liver is a versatile and valuable adjunct to surgical inspection and palpation. The technique allows visualization of lesions that cannot be detected by routine cross-sectional imaging studies, allowing for more efficient and effective patient management. Demonstration of the proximity and the interrelationship of lesions to surrounding important vascular structures can be invaluable to the surgeon in choosing the most appropriate therapeutic option and in planning segmental resections. Specially developed intraoperative ultrasound probes can be used on standard diagnostic ultrasound B-mode machines. Electronic linear and curved-array scanners are most commonly used, with a 5-MHz frequency being optimal for liver imaging. Additional intraoperative uses for liver ultrasound include ultrasound-guided tumor cryoablation, ethanol injection, biopsy guidance, and laparoscopic ultrasound.

Humans↗
PubMed1995

Expanding the home care concept: blurring distinctions among home care, institutional care, and other long-term-care services.

Distinctions between home care and residentially based care are blurring because of two trends: home care providers are offering services, including personal assistance, outside of the private, self-contained family home or apartment; and a market-driven movement is underway to develop group residential settings where long-term-care (LTC) consumers with substantial disability receive personal care and nursing in their own, fully equipped, apartments where they largely control the schedule. For the customers, such boundary blurring can lead to experiences of greater power and normality in their everyday lives. State regulations will help determine the extent to which new, "residentially" oriented models of LTC are feasible. Home care providers are challenged to develop flexible and creative paradigms for service that are built on a recognition that older adults with disabilities have the right to choose risks.

Aged↗
PubMed1994

Cost-effective prostate cancer detection. Reduction of low-yield biopsies. Investigators of the American Cancer Society National Prostate Cancer Detection Project.

BACKGROUND: In hopes of limiting low-yield prostate biopsies, results of digital rectal examination (DRE), transrectal ultrasound (TRUS), prostate specific antigen (PSA) and age-related PSA values, gland-volume-adjusted PSA levels, and longitudinal PSA changes were analyzed to identify their cost-effectiveness as prognostic indicators in screening, biopsy, and follow-up of patients with prostate cancer. METHODS: Twenty-nine hundred men with complete data sets from an initial cohort of 2999 men with an annual follow-up for up to 5 years were examined. Intrapatient PSA and gland-volume variability, optimal PSA operating points (o.p.), and test performance scores were determined for each parameter. Decision analysis was then applied retrospectively to each parameter to determine the cancer detection yield, biopsy requirements, and costs for commonly used detection strategies. RESULTS: For the initial screening decision, the optimal PSA o.p. was 3.0 ng/ml but increased to 5.0 ng/ml in combination with DRE, whereas age-related PSA performed no better than did PSA. The mean intrapatient variability in TRUS gland volume (+5.5 cc) relative to mean volume (34 cc) was 16%, which was less than the 28% (0.64/2.3 ng/ml) relative variability for PSA. For biopsy decisions, using PSA density (PSAD) with a level of 0.12 ng/ml/cc there was no significant difference in accuracy compared with the systematic biopsy of all patients with elevated PSA or age-related PSA levels. Rather than perform systematic biopsy on all patients with PSA levels greater than 4 ng/ml, decision analysis showed that a 16-55% reduction in biopsies could be achieved with a respective cancer loss of 4-25% by limiting biopsy to patients with an increased PSAD level and/or abnormal results of DRE. Using age-related PSA criteria in combination with DRE reduced biopsies by 12% but resulted in minimal cost reductions. The greatest biopsy reduction relative to cancer yield and lowest cost per cancer detected occurred with PSAD-driven biopsy strategies. During follow-up, longitudinal changes in absolute PSA and PSAD levels were significantly better (P < 0.05) than the percentage change in PSA levels per year. CONCLUSIONS: Cost-effective prostate cancer detection with PSA as a parameter is better achieved if screening and biopsy decisions are not linked intimately. A tailored-biopsy approach for patients with disproportionately elevated PSA levels of suspicious DRE results in the greatest biopsy reduction by selecting lower risk groups for more conservative follow-up.

Age Factors↗
PubMed1994

Relative sensitivity and specificity of serum prostate specific antigen (PSA) level compared with age-referenced PSA, PSA density, and PSA change. Data from the American Cancer Society National Prostate Cancer Detection Project.

BACKGROUND: Different indexes that may enhance the early detection capability of prostate specific antigen (PSA) have been proposed. In addition to the indexes relating to the normal PSA level, there are data suggesting the usefulness of the PSA level relative to prostate gland volume (PSA density), age-referenced PSA level, and PSA change. Little research comparing the sensitivity and specificity of these measures in the same population has been reported. METHODS: All subjects were participants in the American Cancer Society National Prostate Cancer Detection Project. Specificity was studied in 2011 men without prostate cancer, and sensitivity was determined for 171 men with prostate cancer. RESULTS: Prostate specific antigen change showed the highest specificity (96.4%), and PSA density the lowest (85.3%). The most sensitive index was PSA density, which was positive for 74.7% of the 171 cases of known cancer. A PSA change of more than 0.75 ng/ml per year was the least sensitive index (54.8%). Sensitivity and specificity varied in a narrow range. Improved performance in specificity was achieved only with the loss of sensitivity. CONCLUSIONS: None of the alternative indexes commonly used in general early detection practice demonstrated particular advantage when compared with the normal PSA concentration, defined as no more than 4.0 ng/ml.

Adult↗
PubMed1994

Characteristics of prostate cancer detected in the American Cancer Society-National Prostate Cancer Detection Project.

The American Cancer Society-National Prostate Cancer Detection Project is a prospective, comparative study of a cohort of 2,999 men 55 to 70 years old not suspected on entry of having prostate cancer. A total of 164 prostate cancers is available from this project for analysis. A small proportion of tumors detected were advanced in terms of the clinical stage at diagnosis. Cancer detected by digital rectal examination tended to be more advanced than that found on the basis of only transrectal ultrasound or prostate specific antigen (PSA). A large proportion of patients received curative therapy involving radical prostatectomy in 67.1% and radiotherapy in 18.3%. Of 103 men presumed to have organ confined disease and treated by prostatectomy 64 (37.9%) actually had locally extensive cancer pathologically. PSA level and PSA density were associated with the detection of organ confined cancer but several advanced tumors had PSA levels in the normal range. Age referenced PSA, compared to conventional standards, demonstrated lower sensitivity to cancer with little improvement in specificity. The disease resulting from this multimodality detection effort represented a spectrum of pathological conditions. Further followup and evaluation are needed to determine whether these benefits are reflected in long-term mortality and survival experience.

Aged↗