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Biomedical subjects

D C Kennie

Publications and source records attributed to D C Kennie.

14 recordsLinked to original sources
PubMed1999

Costing for long-term care: the development of Scottish health service resource utilization groups as a casemix instrument.

OBJECTIVE: to create a casemix measure with a limited number of categories which discriminate in terms of resource use and will assist in the development of a currency for contracting for the provision of health care. DESIGN: nursing staff completed a questionnaire providing clinical data and also gave estimates of relative patient resource use; ward-based costs were collected from appropriate unit managers. SETTING: National Health Service continuing-care wards in 50 Scottish hospitals. SUBJECTS: 2783 long-stay patients aged 65 years and over. RESULTS: inter-rater reliability was assessed using 1402 patients; percentage agreement between raters for individual variables varied from 68% for feeding to 97% for clinically complex treatments. Nursing costs gave 62% agreement given categories of high, medium and low. The Scottish health service resource utilization groups (SHRUG) measure was developed using 606 cases, and 67% consistency was achieved for the five categories. The relative weights for the SHRUG categories ranged from 0.56 to 1.41. The five categories explain 35% of variance in costs. CONCLUSIONS: the five SHRUG casemix categories show good discrimination in terms of costs. The SHRUG measure compares favourably with diagnosis-related groups in the acute sector and with other casemix instruments for long-term care previously piloted in the UK. SHRUG is a useful measurement instrument in assessing the resource needs of elderly people in long-term care.

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PubMed1990

Postsurgical care of elderly women with fractures of the proximal femur.

The outcome for elderly women suffering a fracture of the proximal femur remains poor. Attempts to improve care in the past have mainly focused on surgical and perioperative techniques. More recently evidence has become available showing the impact of postoperative and rehabilitative care in these frail elderly patients. This article highlights this evidence and provides practical guidelines for good clinical practice.

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PubMed1988

Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial.

OBJECTIVE: To compare postoperative collaborative care between orthopaedic surgeons and physicians in geriatric medicine with routine orthopaedic care in elderly women with proximal femoral fracture. DESIGN: Exclusion of patients dying before fit enough to enter trial, those with pathological fractures, those likely to be discharged within seven days of entering the trial, and those remaining unfit for transfer to a peripheral hospital. Remainder allocated to two groups: treatment group and control group. SETTING: District hospital acute admission ward and rehabilitation ward. PATIENTS: 144 sequentially admitted elderly women with proximal fracture of the femur; 36 excluded on above criteria and remainder entered into trial. INTERVENTION: Both treatment and control groups (n = 54 in each) received physiotherapy and other services. The treatment group also received thrice weekly supervision by a geriatrician. END POINTS: Physical independence, residence after discharge, and length of hospital stay. MEASUREMENTS AND MAIN RESULTS: At discharge significantly more patients in treatment group were independent in terms of activities of daily living than controls (41 v 25) and their median stay was 24 days (range 8-197) compared with 41 (9-365) (95% confidence intervals for difference 2 to 25). Significantly fewer treatment patients were discharged to institutional care (10% v 32%; 95% confidence interval for difference 6% to 37%) and more to their own homes (63% v 38%; 95% confidence interval for difference 6% to 44%). These beneficial effects were consistent across a range of ages and mental state. CONCLUSIONS: Both hospital and patient benefited when postoperative rehabilitation was provided in a setting specialising in such care for elderly patients with trauma.

Activities of Daily Living↗
PubMed1986

Health maintenance of the elderly.

Health maintenance of the elderly is an attractive concept in both humanitarian and economic terms. However, knowledge of this subject is in its infancy. Available information suggests that effective maintenance for this age group may be difficult, will require a broader range of strategies than with younger adults, and may not be without risk of significant iatrogenic insult from the measures employed. Therefore, this article discusses the principles by which health maintenance measures should be applied to the elderly population, evaluates the role of screening, outlines two health maintenance packages that appear simple safe and effective to apply, and examines briefly the cost implications of the measures described.

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PubMed1983

Good health care for the aged.

Despite the recent upsurge of interest in geriatrics, relatively little guidance has been given on what constitutes good health care for the aged. Ten basic principles for good health care are outlined. They include emphasis on the restoration of functional ability; the building and maintenance of a support system; a broadened approach to health assessment; the application of specific medical knowledge and skills; cautious medical intervention; true advocacy for the patient; the acceptance of the legitimacy of death; increased community orientation; the allowance of sufficient time for recovery; and continuity of care. These principles should serve as the basis for educational, research, and service programs for the aged.

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PubMed1982

Functional disability in the hospitalized elderly.

Little documentation exists concerning the extent of functional disability in the hospitalized elderly and the impact of this disability on the care of these patients. A physician-led survey was conducted in a 400-bed community hospital of 279 patients aged 70 or more years. Considerable age-correlated disability was documented. Fifty-four percent of the patients aged 85 years or older were moderately or severely disoriented. Thirty-four percent had impaired hearing, 40% had impaired vision, and 25% had speech impairments. More than half of the patients 75 years or older needed assistance with activities of daily living. Modern hospital design and services may interfere with functional recovery. Evaluation of special care units to minimize the hazards of hospitalizing the elderly is recommended.

Activities of Daily Living↗
PubMed1980

Management of senile dementia.

An accurate and complete history, including accounts from the family and friends, is invaluable in assessing the patient with senile dementia. While the underlying condition is at present irremediable, active efforts to maximize the remaining mental and physical function, together with family counseling and guidance, can do much to reduce risk to the patient and stress on the supporters. This may enable the demented patient to be active and remain in the community for a longer period.

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