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Biomedical subjects

R A Kane

Publications and source records attributed to R A Kane.

At least 73 records · Page 4Linked to original sources
PubMed1994

Implications of the Clinton health reform plan for older persons and long-term care.

The Clinton plan for older persons and those in need of long-term care offers short-term problems and long-term promises. Final judgment depends in part on the level of commitment assumed for various aspects of the plan. In the near term, even under the best scenario, there will be problems of discoordination as certain groups (like the dually eligible and those needing long-term care) are caught in the gaps between the new and the old. In the longer term, there are potential gains from a more integrated system of care that can accommodate both acute and chronic care and eliminate the administrative incentives to shift fiscal responsibility. Medicare was passed in an effort to correct a disparity. It would be ironic if its existence created a new one. At the same time, older persons are currently better served than many uninsured younger persons. Before they open their mouths to grab for the bone in the water, they had best hang on to the one they have.

Aged↗
PubMed1994

The impact of intraoperative ultrasonography on surgery for liver neoplasms.

To analyze the effect of IOUS on surgical decision making, we performed a retrospective study of 45 patients who had exploratory laparotomy and IOUS for liver neoplasms. Preoperative lesion detection was compared with intraoperative findings. The effect of IOUS on the choice of surgical procedure was analyzed. Preoperative imaging detected 67% of lesions, 78% when combined with surgical inspection and palpation, and 97% were recognized by IOUS. Surgery was modified in 23 of 45 cases (51%); 19 of those 23 cases (83%) were based on IOUS findings alone. IOUS demonstrated superior lesion detection over noninvasive preoperative liver imaging, and IOUS significantly affected surgical decision making.

Adult↗
PubMed1994

Perspectives on home care quality.

Home care quality assurance (QA) must consider features inherent in home care, including: multiple goals, limited provider control, and unique family roles. Successive panels of stakeholders were asked to rate the importance of selected home care outcomes. Most highly rated outcomes were freedom from exploitation, satisfaction with care, physical safety, affordability, and physical functioning. Panelists preferred outcome indicators to process and structure, and all groups emphasized "enabling" criteria. Themes highlighted included: interpersonal components of care; normalizing life for clientele; balancing quality of life with safety; developing flexible, negotiated care plans; mechanisms for accountability and case management. These themes were formulated differently according to the stakeholders' role. Providers preferred intermediate outcomes, akin to process.

Data Collection↗
PubMed1994

Ethics and long-term care. Everyday considerations.

This article deals with ethical issues intrinsic to long-term care, emphasizing those that relate to the daily practice of the physician. First, some general issues are considered, followed by a brief discussion of nursing home care and home care, the two most common service systems that apply to patients receiving long-term care. For the most part, this article focuses on the ethical issues involved for patients who live with such care rather than those concerning the death of long-term care clients. The author argues that the balance needs to shift to more attention to these everyday matters.

Aged↗
PubMed1994

Case managers discuss ethics: dilemmas of an emerging occupation in long-term care in the United States.

As case management programs mature, ethical questions undoubtedly arise. Yet there are few, if any, standards by which case managers can guide their actions and decisions. In this article, the authors present the results of a survey of 251 frontline case managers in 10 states who were asked to describe the ethical challenges they face. The respondents were conscious of struggling with difficult, even life-and-death decisions involving important choices in their clients' lives. Generally, the case managers were committed to the ideology of respect for client autonomy but found themselves making uneasy compromises with the concept at every turn. Ethical issues arose not only with the client but also with the client's family, colleagues, and providers. Case managers, long-term care providers, and governmental policymakers could all benefit from both theoretical and practical explorations of desirable approaches to individual and societal long-term care decisions.

Adult↗
PubMed1993

Characteristics of prostate cancers detected in a multimodality early detection program. The Investigators of the American Cancer Society-National Prostate Cancer Detection Project.

BACKGROUND: Few data are available to describe the clinical and pathologic characteristics of prostate cancers detected through early detection programs. The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) is a multimodality, multicenter study of the feasibility of early prostate cancer detection using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). One hundred fifty-six prostate cancers are available from this project for analysis. METHODS: The ACS-NPCDP is a prospective, comparative study of a cohort of 2,999 men between 55 and 70 years of age not suspected of having prostate cancer. DRE, TRUS, and PSA are performed for each subject on an annual basis for as long as 5 years. Biopsies are performed on the basis of recommendations from DRE or TRUS results. Although elevated PSA alone was not typically a basis for biopsy, in some instances biopsies were recommended because of the degree of elevation in PSA. Diagnoses are confirmed by participating pathologists and by pathologic analysis. RESULTS: A small proportion of cancers detected were advanced in terms of the clinical stage at time of diagnosis. A total of only six cancers were stage C1 to D1, and five of these were preexisting cancers detected at the first examination. Cancers detected by DRE tended to be more advanced than those found on the basis of only TRUS or PSA. A large proportion of patients received curative therapy, involving radical prostatectomy for 67.9% and radiation therapy for 17.9%. Of 100 men presumed to have organ confined disease and treated by prostatectomy, 64 actually proved to have localized cancer, a rate of upstaging of 36.0%. PSA level and PSA density were associated with the detection of organ confined cancer, but several advanced cancers had PSA levels in the normal range, limiting the usefulness of these measures for staging. CONCLUSIONS: The cancers resulting from this multimodality detection effort represented a spectrum of pathologic findings. These data, however, suggest that early detection interventions in men not suspected to have prostate cancer will yield tumors with a favorable stage distribution that are likely to benefit from treatment. Further follow-up evaluation is needed to determine whether these benefits are reflected in long-term mortality and survival experience.

Aged↗
PubMed1993

American Cancer Society--National Prostate Cancer Detection Project. Results from multiple examinations using transrectal ultrasound, digital rectal examination, and prostate specific antigen.

BACKGROUND: The American Cancer Society-National Prostate Cancer Detection Project is a prospective study of the feasibility of early prostate cancer detection by digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). Two thousand nine hundred ninety-nine men not previously suspected of having prostate cancer have been entered on study in ten participating clinical centers. METHODS: The study protocol requires these men to undergo testing with the three detection methods under investigation on an annual basis for up to 5 years. Data currently are available on 1972 men who have completed protocol requirements for two sequential series of examinations. RESULTS: At the first visit, it was recommended that 16.5% of subjects undergo biopsy based on the TRUS and/or DRE findings. Seventy-three (3.7%) men were found to have cancer after the first series of examinations. When the 1899 men who did not have cancer were reexamined, in 11.4%, a biopsy was recommended, and an additional 33 (1.7%) cancers were detected. Cancer detection rates were higher in older men, and the sensitivity of TRUS was higher than that of DRE at both examinations. The positive predictive values (PPV) of TRUS and DRE varied significantly depending on the PSA level; PPV decreased at the second examination. Positive findings during the second examination were associated with elevated PSA levels during the earlier visit and rising PSA levels between examinations. Analyses of the 106 cancers detected currently showed a preponderance of early-stage cancer and low Gleason scores. CONCLUSIONS: It may be possible to increase the early detection of prostate cancer by periodic examination by a combination of detection modalities.

Aged↗
PubMed1993

Small subunit (18S) ribosomal RNA gene divergence in the genus Schistosoma.

An entire 18S rRNA gene sequence from Schistosoma spindale (1990 bases) and partial 18S rRNA gene sequences from S. haematobium (1950 bases) and S. japonicum (1648 bases) have been determined. Together with the previously published sequence of the S. mansoni 18S rRNA gene, these data encompass the 4 recognized Schistosoma species groups. Although Schistosoma 18S rRNA genes are highly conserved, the sequences permit a preliminary molecular phylogeny to be established for the genus. This identifies S. haematobium and S. spindale as sister taxa in a clade with S. mansoni. S. japonicum does not appear to be closely related to this clade. Much of the observed variation occurs within a 'hypervariable' stretch of the gene corresponding to part of the V4 region of 18S rRNA. Despite this variation, the 3 new sequences fit models of 18S rRNA secondary structure predicted from the S. mansoni sequence.

Animals↗
PubMed1993

Home care quality and the home care worker: beyond quality assurance as usual.

Using data from diverse sources, we conclude that the jobs of paraprofessional home care workers who provide ongoing care for older clients would be more intrinsically rewarding and offer better conditions for high-quality care if workers had more contact with supervisors and peers, more information about clients and care plans, clearer accountability, and more authority. The home care worker's relationship with clients, which also affects quality of care, can be improved by addressing such issues as adequate compatibility, communication, boundary maintenance, balance of power, commitment, and flexibility.

Caregivers↗
PubMed1993

Imaging of the portal venous system in patients with cirrhosis: MR angiography vs duplex Doppler sonography.

OBJECTIVE: To determine the relative performances of MR angiography and duplex Doppler sonography in the evaluation of the portal venous system in patients with portal hypertension, we compared two-dimensional time-of-flight MR angiography and duplex Doppler sonography in 60 sequential patients with cirrhosis. All 60 subsequently underwent liver transplantation. SUBJECTS AND METHODS: MR imaging and duplex Doppler sonography were performed on the same day, and in all patients the imaging findings were validated at surgical exploration. Five transplantation candidates had surgical portosystemic shunts in situ at the time of imaging. MR images were acquired during breath-holding, and flow in the portal vein was evaluated with presaturation bolus-tracking MR imaging. Sonography included color Doppler and pulsed gated Doppler images of the portal vein. MR angiograms and sonograms were analyzed independently and prospectively for patency of the portal vein, patency of surgical shunts, and grade and distribution of portosystemic collateral vessels. Scores on both imaging techniques were compared by using regression analysis. RESULTS: MR angiograms showed all five cases of portal vein occlusion and all 55 cases of patent portal veins. Sonograms showed three of five cases of portal vein occlusion and 52 of 55 cases of patent portal veins. The techniques concurred in assessing flow direction in 54 (90%) of 60 patients, and both procedures enabled detection of occlusive portal vein thrombus in one patient. We found a significant correlation (p < .001) between the grades of gastric varices detected with MR angiography and surgery but no significant correlation between the grades seen on sonography and found at surgery. Shunt patency in four of five patients and shunt occlusion in one were correctly assessed on MR angiograms, whereas three of these shunts were not visible on sonograms. CONCLUSION: Our results show that MR angiography is more reliable than duplex Doppler sonography for evaluating the portal venous system in patients with portal hypertension caused by cirrhosis.

Esophageal and Gastric Varices↗
PubMed1992

Prostate-specific antigen levels in 1695 men without evidence of prostate cancer. Findings of the American Cancer Society National Prostate Cancer Detection Project.

The American Cancer Society National Prostate Cancer Detection Project is a prospective, multidisciplinary, and multicenter trial to assess the potential for early detection of prostate cancer by transrectal ultrasonography (TRUS), digital rectal examination (DRE), and serum prostate-specific antigen assay (PSA). By November 1990, 2805 men between the ages of 55 and 70 years with no known signs or symptoms of prostate cancer were enrolled in the study, which is planned to run for 5 years. Annual TRUS, DRE, and PSA tests were done on these subjects, and biopsies were recommended for suspicious lesions when detected. To study the performance of PSA testing in presumed normal subjects, all men were eliminated who had (1) prostate cancer detected on their initial examinations and proven by biopsy or (2) cancer detected during the year or subsequent examinations. Additionally, all men with TRUS or DRE findings that were interpreted as suspicious for cancer but who are being followed and have not yet had biopsies done were removed from this series. This left a unique, extensively screened group of 1695 men who were free of prostate cancer, as far as could be determined. Analyses of the PSA levels in this large population in the appropriate age range for increasing risk of prostate cancer revealed several important findings. First, there was a direct relationship between serum PSA levels and estimated prostate volume for both the currently available monoclonal and polyclonal PSA assays. Individuals with benign prostatic hyperplasia and larger gland volume have a higher normal limit of PSA than men with normal gland volume. Second, analyses showed no relationship between age and PSA levels or between symptoms of prostatism and PSA levels independent of gland enlargement. It was concluded that volume-adjusted upper limits of normal PSA can be determined for different levels of specificity desired. This information may be applicable to the use of PSA in men not already suspected of having prostate cancer and may increase its effectiveness as a tool for early detection.

Age Factors↗
PubMed1992

Correlative imaging of malignant liver tumors.

Radiologists play a vital role in the management of malignant liver disease, both by providing accurate data regarding extent and segmental localization of lesions as well as demonstrating their relationship to major vascular structures. The interrelationship between the major cross-sectional imaging modalities (ultrasound, CT, and MRI) must be understood in order to use each modality effectively and efficiently. Characteristic behavior of certain tumors (such as venous invasion by hepatomas) can help in recognition of tumor type and may have a major impact on decisions regarding resectability. Pitfalls in liver imaging (such as the presence of benign conditions that may mimic malignant lesions) must be well understood in order to avoid errors in diagnosis. Difficulties may arise in underdetection of tumors arising in chronically diseased livers and overstatement of the extent of tumors in livers with coexistent benign and malignant lesions. The appearances and behavior of primary and metastatic liver cancer is reviewed, emphasizing the features listed previously.

Humans↗