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Biomedical subjects

R L Kane

Publications and source records attributed to R L Kane.

At least 163 records · Page 9Linked to original sources
PubMed1986

Reversed digit repetition involves visual and verbal processes.

Performance on Reversed Digit Repetition (RDR) was investigated using 102 subjects with documented disease of the central nervous system. Factor analysis yielded a factor on which WAIS Block Design, Wechsler Memory Visual Reproduction and RDR loaded. RDR, Forward Digit Repetition (FDR) and WAIS Similarities loaded on a second factor. In a multiple regression analysis, RDR was significantly predicted by FDR and WAIS Block Design. FDR was significantly predicted by Similarities. These results demonstrate that RDR involves both verbal and visual cognitive, memory and attentional processes.

Adult↗
PubMed1986

Outcome-based payment: a new beginning?

Although the trend toward case-mix reimbursement is a step in the right direction, it is an inadequate means of enhancing the quality of long-term care and optimizing cost-effectiveness. What is needed is a payment system that creates positive incentives for a facility to help patients improve or at least to slow their deterioration as much as possible. In calculating reimbursement, such a system must focus on outcomes actually achieved rather than on services rendered. Recent studies indicate that the status of long-term care patients (as measured by such indexes as activities of daily living and cognitive functioning) can usually be reliably predicted over intervals of approximately three months' duration. Using such predictions as standards, long-term care facilities can be financially rewarded or penalized according to whether their patients fare better or worse than expected. This emphasis on outcomes would encourage greater flexibility and creativity in approaches to care, while focusing attention where it belongs--on residents' quality of life.

Long-Term Care↗
PubMed1986

Differential prognosis and utilization patterns among clinical subgroups of hospitalized geriatric patients.

While screening elderly inpatients on acute Veterans Administration (VA) hospital wards for a special geriatric program, we prospectively classified all patients age 65 and over, who had been hospitalized at least a week, into five clinical subgroups using specific diagnostic, prognostic, and functional criteria. These five subgroups were "geriatric evaluation unit (GEU) candidate", "severely demented", "medical", "terminal", and "independent". Medical record data from the initial admission and a full year of follow-up were collected from random samples of each subgroup and of nonscreened patients who had been hospitalized for less than a week. Analysis revealed that each subgroup had a distinctive pattern of survival, living location, and use of institutional services during the follow-up period. For one major subgroup ("GEU candidate"), a specific intervention (the GEU) has proved very effective in reducing mortality, increasing patient functioning, improving placement, and decreasing use of institutional services. Moreover, there are specific treatment and intervention strategies appropriate for each of the other subgroups (e.g., hospital-based home care, hospice, respite, and day treatment programs), although these services are not universally available nor clearly proved effective. The process of identifying patient subgroups illustrated in this study may be useful in needs assessment, in planning new intervention programs for frail elderly patients, and for identifying appropriate patients for these programs.

Aged↗
PubMed1985

Hospice effectiveness in controlling pain.

Terminal cancer patients were randomly assigned to receive comprehensive hospice care or traditional medical care. Patients were followed up for two years or until death. Pain was measured by the McGill Pain Scale. Frequency and intensity of cancer-related symptoms were also noted. Over the course of the study, 34% of hospice patients and 21% of control patients never reported pain. No significant differences between the two groups could be detected in either the proportion of patients with pain at any time or the intensity of pain. Neither were there differences in the intensity or frequency of cancer-related symptoms. The presence of pain was associated with the presence of other symptoms; a significant correlation was found between the levels of depression and anxiety and pain scores.

Analgesics↗
PubMed1985

Statistical relationships and discriminative accuracy of the Halstead-Reitan, Luria-Nebraska, and Wechsler IQ scores in the identification of brain damage.

Ninety-two patients (46 brain-damaged and 46 control) were administered both the Halstead-Reitan and Luria-Nebraska Neuropsychological Batteries and the WAIS. The relationship between the Luria and the Halstead Battery was assessed using a common metric, T scores, and also by comparing impairment ratings for both batteries. Diagnostic screening accuracy was compared using discriminative functions and by computing the percentage of brain-damaged and control cases falling above and below the combined group medians. Results of the discriminative analyses were also compared with those obtained using only IQ scores from the WAIS. Findings support the comparability of the two neuropsychological test batteries with respect to diagnostic screening accuracy and the extent to which they measure level of impairment. Interestingly, equivalent discrimination between organic and control subjects was obtained using WAIS IQ scores. However, differences in the instruments did emerge on an individual case basis.

Adult↗
PubMed1985

Construct validity of various memory testing procedures.

The construct validity of Wechsler Memory Scale Logical Memory, Paired Associate Learning and Visual Reproduction subtests was evaluated, as well as the validity of the Benton Visual Retention Test, and the two memory factor scales of the Luria-Nebraska Neuropsychological Battery (LNNB). The results of a series of factor analyses based on test performances of 102 subjects indicated that delayed reproduction measures of visual memory were more valid than the traditional immediate reproduction administrations, which were more closely associated with visual-perceptual-motor abilities. Construct validity was also demonstrated for Logical Memory and Paired Associate Learning. Although both LNNB measures loaded on a memory factor, item heterogeneity and brief sampling of items raised serious questions about the clinical utility of these scales.

Adult↗
PubMed1985

Hospice role in alleviating the emotional stress of terminal patients and their families.

Terminally ill cancer patients in a Veterans Administration hospital were randomly assigned to receive hospice care. Follow-up evaluation through the time of death revealed no significant differences in anxiety or depression between hospice or control patients, but hospice patients exhibited significantly greater improvement in two of three measures of satisfaction (interpersonal care and involvement in care decisions). Hospice patients' significant others (SOs) showed some decrease in anxiety and greater satisfaction with involvement in care than did control SOs. The differences were attributable in part to hospice staff better meeting SOs' perceived needs.

Anxiety↗
PubMed1985

Acute hospitalization in a home for the aged.

All acute hospitalizations from a 229-bed home for the aged for a four-year period were analyzed. Of 373 residents eligible for the study, 239 individuals were hospitalized a total of 503 times. Five patients were admitted seven times. Median length of stay was 9.4 days. Of 235 primary diagnoses, only nine occurred at least 1% of the time. Sixty-six different complications, representing 131 occurrences, were noted during hospitalization. Hospital mortality was 11.7%. Of first admissions 9.2% died and 19% of survivors required a higher level of care. One year later 40% had died and 17% were at a higher level of care. Logistic regression identified four variables significantly associated with death within six months of first hospitalization: age, hospital complication, surgical procedure, and diagnosis of acute myocardial infarction. Compared with nonhospitalized residents, hospitalized residents were more likely to be male, but no age effect was noted. Survival differences did not emerge until the third year of the study.

Acute Disease↗
PubMed1985

The immediate and subsequent outcomes of nursing home care.

To determine the relationship between admission status and subsequent outcomes, 563 patients discharged during 1980 from 24 nursing homes were followed through 1982. Only 28 per cent of patients were discharged to their homes. Reconstructed life histories of 529 discharges for the two-year follow-up revealed only 38 persons (7.2 per cent) were alive and at home; of these, 36 had been initially discharged to their homes. Four hundred and one persons (75.8 per cent) were dead. Mental orientation, urinary continence, functional status, hip fracture, and diagnoses associated with dementia were found to be significant predictors of outcome status after discharge and at follow-up. Social support had only a modest effect on the former outcomes.

Activities of Daily Living↗
PubMed1984

Effectiveness of a geriatric evaluation unit. A randomized clinical trial.

We randomly assigned frail elderly inpatients with a high probability of nursing-home placement to an innovative geriatric evaluation unit intended to provide improved diagnostic assessment, therapy, rehabilitation, and placement. Patients randomly assigned to the experimental (n = 63) and control (n = 60) groups were equivalent at entry. At one year, patients who had been assigned to the geriatric unit had much lower mortality than controls (23.8 vs. 48.3 per cent, P less than 0.005) and were less likely to have initially been discharged to a nursing home (12.7 vs. 30.0 per cent, P less than 0.05) or to have spent any time in nursing home during the follow-up period (26.9 vs. 46.7 per cent, P less than 0.05). The control-group patients had substantially more acute-care hospital days, nursing-home days, and acute-care hospital readmissions. Patients in the geriatric unit were significantly more likely to have improvement in functional status and morale than controls (P less than 0.05). Direct costs for institutional care were lower for the experimental group, especially after adjustment for survival. We conclude that geriatric evaluation units can provide substantial benefits at minimal cost for appropriate groups of elderly patients, over and above the benefits of traditional hospital approaches.

Aged↗
PubMed1984

A randomised controlled trial of hospice care.

Terminally ill cancer patients at a Veterans Administration hospital were randomly assigned to receive hospice or conventional care. The hospice care was provided both in a special inpatient unit and at home. 137 hospice patients and 110 control patients and their familial care givers (FCGs) were followed until the patient's death. No significant differences were noted between the patient groups in measures of pain, symptoms, activities of daily living, or affect. Hospice patients expressed more satisfaction with the care they received; and hospice patients' FCGs showed somewhat more satisfaction and less anxiety than did those of controls. Hospice care was not associated with a reduced use of hospital inpatient days or therapeutic procedures and was at least as expensive as conventional care.

Activities of Daily Living↗