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Biomedical subjects

H L Kayne

Publications and source records attributed to H L Kayne.

At least 19 recordsLinked to original sources
PubMed1998

Determinants of home health visit length: results of a multisite prospective study.

OBJECTIVES: The authors (1) compare visit length across four categories of skilled nursing home health visits which reflect recent changes in home health casemix-AIDS-related, hospice/terminal (HT), intravenous (IV) therapy, and maternal and child health (MCH)-with general adult medical/surgical (MS) visits and (2) identify factors influencing visit length. METHODS: The study sites were 12 nonproprietary Massachusetts home health agencies (HHAs). Staff nurses collected data concurrently on a sample of visits they provided between December 1, 1992 and November 30, 1993. The visits were stratified by agency, time of year, and visit category. The authors used analysis of variance to test for significant differences across visit categories in Home Length of Visit (the number of minutes between when the nurse entered and left the home) (HLOV). The authors used multivariate regression analysis to develop models identifying determinants of HLOV and adjusted R2 to measure the explanatory power of partial models. RESULTS: In univariate analysis, the categories differed significantly from each other in length (P < 0.0001). HT visits were the longest (median visit length = 60, 80, and 59 minutes for HT Only visits, visits in both the HT and AIDS categories (HT/AIDS), and HT/IV visits, respectively). MS visits were the shortest (median = 30 minutes). The remaining categories were intermediate in length (medians = 37 to 50 minutes). Almost half the variability in HLOV was explained by the full multivariate regression model, which includes all independent variables (adjusted R2 = .4486; P < 0.0001). Visit characteristics alone in a partial model explained 18% of the variability in HLOV. Three other variable sub-groups-agency, client characteristics, and nursing workload-each explained about 15% of the variability in HLOV. Nursing activities performed during the visit explained 11%; several of these related to teaching, education, or assessment. CONCLUSIONS: Accurate reimbursement reflecting casemix differences is important to protect the teaching, education, and assessment functions of nurses; measure nurse productivity and allocate caseloads; maintain access to services for clients with greater needs; and avoid creating economic disincentives to the agencies that serve them. Payers formulating prospective payment systems can adjust per visit reimbursement rates to reflect differences in visit length by category and incorporate functional limitations, clinical instability, and case coordination as classification variables. Developers of home health casemix systems can use factor analysis to improve the robustness of multivariate models and include nursing workload in predicting visit length. Home health agencies measuring productivity and caseload across complex client populations can classify visits into three groups-MS; HT; and AIDS, IV, and MCH-or use the regression results to develop more refined predictors of visit length and nursing caseload.

Adult↗
PubMed1996

The relationship of behavioral cues to assaultive behavior.

The purpose of this 2-year, case control study was to determine whether differentiation between assaultive and nonassaultive patients can be made based on behavioral assessments and/or sociodemographic variables. For each assault incident, the chart of the patient who assaulted and a randomly chosen patient who did not assault on that day were reviewed (N = 72 subjects or 26 pairs). Various scales were used to evaluate the subjects retrospectively (the day prior to the assault), and patients who assaulted staff were interviewed when possible. An analysis found no differences between patients who assaulted and controls on sociodemographic variables. Those who assaulted had significantly more prior assaults (p = .04) and more difficulty verbalizing angry feelings appropriately on their units (p < .01). Prior to the assault, assaultive patients were more verbally hostile (p = .037) and showed more increased motor activity (p = .001) than controls.

Cues↗
PubMed1995

A metaanalysis of home uterine activity monitoring.

OBJECTIVE: Our purpose was to assess by metaanalysis the evidence from randomized clinical trials regarding home uterine activity monitoring. STUDY DESIGN: Six randomized controlled trials of home uterine activity monitoring, the same six trials reviewed by the U.S. Preventive Services Task Force on home uterine activity monitoring, were studied. Data were extracted from published reports of the six trials. In addition, unpublished data were obtained by personal communication from the trials' principal investigators. Insofar as possible, the principle of intention-to-treat was maintained. Data regarding twins were handled by use of numbers of pregnancies rather than numbers of infants as sample sizes. Stratified metaanalyses were conducted according to whether the trial did or did not control in study design for the nursing contact factor that accompanies home uterine activity monitoring. In addition, stratified metaanalyses were conducted for singleton and twin pregnancies. The four outcomes investigated were incidence of preterm birth, incidence of preterm labor combined with cervical dilatation > 2 cm, infant referral to the intensive care unit, and mean birth weight. RESULTS: Overall, for all pregnancies home uterine activity monitoring was associated with a statistically significant reduction of 52% in risk of preterm labor combined with cervical dilatation > 2 cm (relative risk = 0.48, p = 0.001) and a statistically significant increase of 86 gm in mean birth weight (p = 0.038). When stratified by singleton or twin pregnancy, the pooled results generally differed by strata. Among singleton pregnancies, home uterine activity monitoring was associated with a statistically significant reduction of 24% in risk of preterm birth (relative risk 0.76, p = 0.037) and a statistically significant increase of 126 gm in mean birth weight (p = 0.009). Among twin pregnancies, there was a statistically significant effect of home uterine activity monitoring with a reduction of 56% in risk of preterm labor combined with cervical dilatation > 2 cm (relative risk 0.44, p = 0.005). There were no statistically significant effects found overall and in any stratum with regard to infant referral to the intensive care unit. Metaanalyses of studies that controlled in design for the nursing contact factor that accompanies home uterine activity monitoring showed either no difference or stronger pooled effects compared with metaanalyses of those studies that did not control for nursing contact. This suggests that the potential bias attributed to the nursing contact feature that accompanies home uterine activity monitoring is not as appreciable as home uterine activity monitoring critics have suggested. CONCLUSIONS: Metaanalysis of existing clinical trial evidence regarding home uterine activity monitoring reveals statistically significant benefits of home uterine activity monitoring. Of the outcomes investigated, home uterine activity monitoring is associated with reductions in risks of preterm birth (in singleton pregnancies only) and preterm labor combined with cervical dilatation > 2 cm, as well as with increased mean birth weight (in singleton pregnancies only).

Female↗
PubMed1995

Improved mortality and rehabilitation of transplant candidates treated with a long-term implantable left ventricular assist system.

OBJECTIVE: This nonrandomized study using concurrent controls was performed to determine whether the HeartMate implantable pneumatic (IP) left ventricular assist system (LVAS) could provide sufficient hemodynamic support to allow rehabilitation of severely debilitated transplant candidates and to evaluate whether such support reduced mortality before and after transplantation. METHODS: Outcomes of 75 LVAS patients were compared with outcomes of 33 control patients (not treated with an LVAS) at 17 centers in the United States. All patients were transplant candidates who met the following hemodynamic criteria: pulmonary capillary wedge pressure > or = 20 mm Hg with a systolic blood pressure < or = 80 mm Hg or a cardiac index < or = 2.0 L/minute/m2. In addition, none of the patients met predetermined exclusion criteria. RESULTS: More LVAS patients than control patients survived to transplantation: 53 (71%) versus 12 (36%) (p = 0.001); and more LVAS patients were alive at 1 year: 48 (91%) versus 8 (67%) (p = 0.0001). The time to transplantation was longer in the group supported with the LVAS (average, 76 days; range, < 1-344 days) than in the control group (average, 12 days; range, 1-72 days). In the LVAS group, the average pump index (2.77 L/minute/m2) throughout support was 50% greater than the corresponding cardiac index (1.86 L/minute/m2) at implantation (p = 0.0001). In addition, 58% of LVAS patients with renal dysfunction survived, compared with 16% of the control patients (p < 0.001). CONCLUSIONS: The LVAS provided adequate hemodynamic support and was effective in rehabilitating patients based on improved renal, hepatic, and physical capacity assessments over time. In the LVAS group, pretransplant mortality decreased by 55%, and the probability of surviving 1 year after transplant was significantly greater than in the control group (90% vs. 67%, p = 0.03). Thus, the HeartMate IP LVAS proved safe and effective as a bridge to transplant and decreased the risk of death for patients waiting for transplantation.

Adolescent↗
PubMed1992

Plasma homocysteine in vascular disease and in nonvascular dementia of depressed elderly people.

Depression among elderly people with reversible cognitive loss often manifests with concomitant vascular disease and can also precede the development of nonvascular degenerative dementia. Little is known about etiological factors for reversible or irreversible dementias in older depressed people. The amino acid homocysteine (HC), which is both a vascular disease risk factor and a precursor of the excitotoxic amino acids cysteine and homocysteic acid, could play a role in the pathophysiology of such individuals. Twenty-seven depressed elderly acute inpatients by DSM-III-R criteria had significantly higher plasma homocysteine levels and lower cognitive screening test scores than did 15 depressed young adult inpatients. HC was highest in the older patients who had concomitant vascular diseases (n = 14). HC was lowest in the older depressives who had neither vascular illnesses nor dementia (n = 8), comparable to the young adult depressives. Higher HC correlated significantly with poorer cognition only in the nonvascular geriatric patients (rs = -0.53). The findings extend earlier work showing higher HC in vascular patients from general medical populations, and also suggest a possible metabolic factor in certain dementias associated with late-life depression.

Adult↗
PubMed1992

Brief communication. Vitamin B1, B2, and B6 augmentation of tricyclic antidepressant treatment in geriatric depression with cognitive dysfunction.

This was a 4-week randomized placebo-controlled double-blind study to assess augmentation of open tricyclic antidepressant treatment with 10 mg each of vitamins B1, B2, and B6 in 14 geriatric inpatients with depression. The active vitamin group demonstrated significantly better B2 and B6 status on enzyme activity coefficients and trends toward greater improvement in scores on ratings of depression and congnitive function, as well as in serum nortriptyline levels compared with placebo-treated subjects (Ss). Without specific supplementation, B12 levels increased in Ss receiving B1/B2/B6 and decreased in placebo Ss. These findings offer preliminary support for further investigation of B complex vitamin augmentation in the treatment of geriatric depression.

Aged↗
PubMed1991

Multicenter randomized clinical trial of home uterine activity monitoring for detection of preterm labor.

Home uterine activity monitoring has been described as an effective means of detecting uterine contractions, but controversy exists whether it is home uterine activity monitoring or increased nursing support in conjunction with it that contributes to earlier detection of preterm labor. In this study 377 women at risk for preterm labor from three centers were prospectively, randomly assigned to high-risk prenatal care alone (not monitored) or to the same care with twice-daily home uterine activity monitoring without increased nursing support (monitored). The two groups were medically and demographically similar at entry into the study. Routine visits, nonroutine visits, and gestational age at diagnosis of preterm labor were similar in both groups. Preterm labor occurred in 41 of 198 monitored and 39 of 179 not monitored patients. Mean cervical dilatation was 1.4 cm in 41 monitored compared with 2.5 cm for 37 not monitored (p = 0.0006); 73.1% of monitored and 27.5% of not monitored had preterm labor detected before 2 cm dilatation (p = 0.00009). Neonatal outcome of singleton pregnancies showed greater birth weight, fewer days in the neonatal intensive care unit, and fewer babies requiring oxygen therapy and mechanical ventilation in the monitored group. The better outcomes are probably due to the increased likelihood of diagnosis of preterm labor before advanced cervical dilatation with home uterine activity monitoring, thus providing the clinician with a better chance to initiate tocolytic therapy directed at improving pregnancy outcome.

Birth Weight↗
PubMed1991

B complex vitamin patterns in geriatric and young adult inpatients with major depression.

This study compared the B complex vitamin status at time of admission of 20 geriatric and 16 young adult non-alcoholic inpatients with major depression. Twenty-eight percent of all subjects were deficient in B2 (riboflavin), B6 (pyridoxine), and/or B12 (cobalamin), but none in B1 (thiamine) or folate. The geriatric sample had significantly higher serum folate levels. Psychotic depressives had lower B12 than did non-psychotic depressives. Poorer blood vitamin status was not associated with higher scores on the Hamilton Depression Rating Scale or lower scores on the Mini-Mental State Examination in either age group. The data support the hypothesis that poorer status in certain B vitamins is present in major depression, but blood measures may not reflect central nervous system vitamin function or severity of affective syndromes as measured by the assays and scales in the present study.

Adult↗
PubMed1986

Impact of maternal work outside the home during pregnancy on neonatal outcome.

The impact of mothers' work during pregnancy upon neonatal outcome has not been fully elucidated. A study of maternal health habits and neonatal outcome conducted from 1977 to 1979 at Boston City Hospital assessed the effects of paid work outside the home during pregnancy, particularly third trimester work in a standing position, upon duration of gestation and intrauterine growth, while controlling for potentially confounding variables. Postpartum, 1,690 low-income women were interviewed to provide detailed information on their sociodemographic and health characteristics. Of the 1,507 women whose work status during pregnancy could be classified, 55% did not perform paid work outside the home or attend school, 7% worked into the third trimester in a standing position, and 38% had other work histories or attended school. Infants were examined according to a standard protocol by pediatricians blind to mothers' work history. There was no significant relationship between the mothers' work history during pregnancy and the infants' length of gestation, weight, or head circumference at birth, when confounding variables were controlled statistically by multiple regression analyses. However, women who worked in a standing position into the third trimester delivered infants who were longer than infants born either to mothers with other work histories or to mothers who did not work or attend school. Healthy women with uncomplicated low-risk pregnancies who feel well enough to attend school or work during pregnancy, even in a job requiring some standing, may do so without fear that their infant will suffer shortened gestation or impaired intrauterine growth.

Adolescent↗
PubMed1985

Statistical methods in rehabilitation research.

Of 128 articles in Volume 63 (1982) of the Archives of Physical Medicine and Rehabilitation 48 (37.5%) utilized some form of statistical methodology. The most commonly encountered methods were: mean (with or without standard deviation or standard error); analysis of variance (ANOVA); t-tests; simple correlation/linear regression; and chi-square analysis. A critical review of the analytic statistics used in 40 of these articles revealed that only 23 (57.5%) were considered satisfactory in descriptive and methodologic terms. The most frequently encountered deficiencies were: inadequate description of methods; misuse of t-tests; absence of appropriately complex statistical analysis. A greater understanding of and familiarity with biostatistics is essential for all readers of the Archives to allow critical evaluation of the rehabilitation literature.

Humans↗
PubMed1984

Evidence for mitosis in the adult corneal endothelium.

Intracellular structures probably representative of mitotic figures were seen by specular microscopy in the endothelium of a corneal graft following a rejection reaction. Serial measurements over an eight month period initially showed grossly enlarged cells and apparent mitotic figures. Subsequently, clusters of cells smaller than any cells previously seen were observed. Measurements of endothelial cell area over this period demonstrated a highly significant (P less than 0.0001) decrease in cell area, or increase in cell density, with time. These observations indicate that at least under some circumstances mitosis occurs in the endothelium of the adult human cornea.

Cataract Extraction↗
PubMed1983

Computed tomographic, neurologic, and neuropsychological correlates of Huntington's disease.

Twenty-six patients with Huntington's disease (HD) and three subjects at risk for HD were evaluated by computed tomographic, neurologic and neuropsychological examinations. These data were used to delineate the sequence of structural changes in early and intermediate HD, and the relationship of these changes to impairment of neurologic and cognitive function. CT scans documented an early neostriatal-frontal focus of atrophy in HD which spreads caudally over the cerebral cortex during the course of the disease. Chorea was positively correlated with caudate atrophy. Functional and cognitive (especially memory and visuospatial) impairments were strongly related to the degree of atrophy. Multiple regression analyses of CT and neuropsychological data further demonstrated that neostriatal changes make a significant contribution to the cognitive as well as to the motor impairments of HD patients.

Adult↗
PubMed1982

Survival of infants born at 24 to 28 weeks' gestation.

Factors affecting the survival of 136 consecutive live-born infants delivered at 24 to 28 weeks' gestation during a 4-year period were analyzed. After careful assessment of gestational age, perinatal care for the fetus of at least 26 weeks' gestation was aggressive. Survival at 26 weeks was 45% and at 28 weeks, 92%. Multivariate analysis showed that the set of variables that best predicts neonatal outcome is gestational age, antepartum glucocorticoid administration, and resuscitation at birth.

Birth Weight↗
PubMed1978

A randomized trial of preoperative radiotherapy in cancer of the oropharynx and hypopharynx.

One hundred patients with stage II and stage III cancer of the oropharynx and hypopharynx were treated under a protocol in which they were randomly selected for treatment by surgery alone or by combined preoperative radiotherapy and surgery. The schedule of preoperative radiation therapy chosen was 2,000 rads from a cobalt 60 machine delivered in five days. Eighty-six of the patients were evaluable at three years; there was no difference in the outcome of the treatment of the two groups. A similar study is urgently needed to determine the value of postoperative radiotherapy in the management of similar cancers.

Adult↗
PubMed1976

The Accelerated Medical Program and the Liberal Arts at Boston University.

Since September 1961, fifteen classes have matriculated in Boston University's Six- Year College of Liberal Arts--Medical Education Combined Degree Program. The applicant pool is approximately three to four times larger now than in the earlier years, with classes averaging 50 students. Academic qualifications (high-school class rank and Scholastic Aptitude Test and College Board Achievement Test results) of the entering classes have been at a consistently high level. Fifty percent or more of the graduates receive the BA degree with honors; 10% or more receive the MD degree with honors. The degree of flexibility in the liberal arts component of the program has increased and currently exceeds that of the traditional four-year premedical curriculum. These data, together with additional information concerning postgraduate professional activities, indicate that the combined accelerated program has been successful.

Boston↗
PubMed1976

A report on graduates of the Boston University six-year combined liberal-arts--medical program.

Graduates of a six-year combined Liberal-Arts-Medicine Program and their medical school classmates (traditional "eight-year" students) are compared as to their medical school performance and their professional postgraduate activities. On standardized examinations (Medical College Admission Test and examinations of the National Board of Medical Examiners) the six-year group was somewhat better than the eight-year group. In other aspects, such as class ranking, honors at graduation, and medicine clerkship grades, the six- and eight-year groups were similar. The two groups were remarkably similar in their postgraduate professional career choices and in achieving board certification. The data for the first three classes indicate that qualified high school students can succeed academically in an accelerated collegiate-degree program, do well in medical school, achieve postgraduate certification, and begin the practice of medicine at a younger age.

Achievement↗