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Biomedical subjects

J R Kelly

Publications and source records attributed to J R Kelly.

At least 37 records · Page 2Linked to original sources
PubMed1993

The Adult Day Health Care Evaluation Study--impact on VA programs.

The research study in Adult Day Health Care (ADHC) has had a fourfold impact on the Veterans Administration: 1) It defined the health care focus of ADHC and shaped consequent program design; 2) It forged a partnership between research and clinical staff in ADHC programmatic development; 3) It enhanced the perception of research in program development in long-term care; and 4) It provided VA with direction for program redesign to render ADHC more cost-effective. With careful planning, the program is expected to grow in the future as a part of VA's continuum of long-term care programs.

Adult↗
PubMed1993

Overview and patient recruitment in the Adult Day Health Care Evaluation Study.

Although Adult Day Health Care (ADHC) is increasingly prominent in the continuum of long-term care services, the results from previous studies of the effects of ADHC are mixed. The objectives of the ADHC Evaluation Study were to determine the effect of ADHC on health status, utilization, and cost of care. The first phase was a randomized controlled trial evaluating ADHC provided directly by the VA. Patients at four medical centers (n = 826) were randomly assigned to receive either ADHC or customary care, and outcomes were compared for the two groups. The second phase was a prospective cohort study evaluating ADHC provided under contract to community agencies in which patients at four additional medical centers (n = 163) were assigned to contract ADHC programs. Outcomes were compared with those of similar patients in the randomized trial. Patients and care givers were assessed at intake and 6 and 12 months after intake. To be admitted to the study, patients must have met one of the following criteria: residence in a nursing home; dependence in ambulation, dressing, or toileting; bowel incontinence; or significant cognitive impairment. Patients at intake demonstrated major impairment in function and high levels of prior use of health care services.

Adult↗
PubMed1993

Summary and discussion of methods and results of the Adult Day Health Care Evaluation Study.

This article summarizes the study results and presents an evaluative summary of the implementation of study methods designed to provide guidance in the degree of confidence with which the results may be accepted and generalized to other situations. Patients who were offered VA-ADHC services in the first phase of this study had significantly higher VA health care costs on average than patients assigned to customary care, with no apparent incremental health benefit to themselves or their care givers. One can have a high level of confidence in these results. The ADHC clinical services were implemented as planned, the randomized controlled trial was implemented successfully, and such threats to validity as insufficient numbers of patients and differential attrition were not present. Certain subgroups of patients assigned to VA-ADHC had VA costs of care that were not significantly higher than those assigned to customary care, although these results must be interpreted with caution. The findings of the second phase of the study evaluating contract ADHC provide no support for choosing to provide either contract ADHC or VA-ADHC over the other. The nonrandomized design and smaller sample size suggest that inferences from the contract ADHC evaluation should be drawn with more caution than those from the VA-ADHC evaluation.

Activities of Daily Living↗
PubMed1991

Ordinary retirement: commonalities and continuity.

Case studies of twenty-five recent retirees from a Midwest plant are the basis for a profile of ordinary retirement. The commonalities of preparation, satisfaction, activity patterns, and relationships are found to far outweigh differences. Exceptions are the widowed, divorced, and those with health disabilities.

Aged↗
PubMed1991

Adult day health care evaluation study: methodology and implementation. Adult Day Health Care Evaluation Development Group.

The Adult Day Health Care Evaluation Study was developed in response to a congressional mandate to study the medical efficacy and cost effectiveness of the Adult Day Health Care (ADHC) effort in the Department of Veterans Affairs (VA). Four sites providing ADHC in VA facilities are participating in an ongoing randomized controlled trial. Three years of developmental work prior to the study addressed methodological issues that were problematic in previous studies. This developmental work resulted in the methodological approaches described here: (1) a patient recruitment process that actively recruits and screens all potential candidates using empirically developed admission criteria based on predictors of nursing home placement in VA; (2) the selection and development of measures of medical efficacy that assess a wide range of patient and caregiver outcomes with sufficient sensitivity to detect small but clinically important changes; and (3) methods for detailed, accurate, and efficient measurement of utilization and costs of health care within and outside VA. These approaches may be helpful to other researchers and may advance the methodological sophistication of long-term care program evaluation.

Aged↗
PubMed1990

A model for reducing the cost of care in VA medical centers that offer adult day health care.

One approach to providing cost-effective adult day health care (ADHC) services is to guide both the inputs to ADHC services and the provision of other services so that substitution for institutional services can realistically take place. This approach has been used in a randomized clinical trial to evaluate the medical efficacy and cost of ADHC in the Department of Veterans Affairs (DVA). This article describes the strategies that were used to improve the cost effectiveness of ADHC during the evaluation. Cost and use estimates were developed based on the best data available from the DVA and previous research on the cost for patients' use of ADHC, nursing home, hospital, and ambulatory care. A cost workshop was attended by the ADHC managers to develop plans for controlling costs. Plans were identified that increase the likelihood that ADHC can be shown to be less costly than customary care.

Adult↗
PubMed1989

Fracture-surface analysis of dental ceramics.

This study demonstrated that quantitative fractography can be used to study failed aluminous and glass-ceramic central porcelains. Fracture surfaces of DICOR and Vitadur-N core porcelain modulous-of-rupture bars were studied to identify fracture mirror features useful in (1) locating the source of fracture and (2) calculating the stress at fracture in clinically failed restorations. The morphology of fracture surfaces results from events related to the initiation and propagation of the crack front during failure. Modulus-of-rupture testing was performed in four-point bending. Fracture surfaces were studied by scanning electron microscopy. The mean fracture stress for the Vitadur-N porcelain was 94.7 +/- 12.4 MPa (13,730 psi); for DICOR the fracture stress was 55.4 +/- 10.6 MPa (8,030 psi). The standard quantitative fractography relationship between in mirror radius and ln fracture stress was followed for both materials. This quantitative fractography relationship was used to calculate the in vivo stress at failure in a clinically fractured DICOR molar crown. Five clinically failed DICOR crowns were seen to fail from the internal surface.

Aluminum↗
PubMed1989

Nondestructive, three-dimensional internal fit mapping of fixed prostheses.

Crown fit may be three-dimensionally mapped by using a nondestructive optical technique. Reflected light transmission through thicknesses of a colored impression material was shown to follow the Beer-Lambert relationship over a range of approximately 10 to 300 microns, a useful range of interest for study of cement layer thickness. Control thicknesses of impression material were first formed between the measuring platens of a micrometer, and light transmission values (relative reflections) were measured through these control thicknesses of impression material held against air-abraded, noncast gold alloy. Relative reflection values were similarly measured from impression material formed inside cast gold crowns seated on their respective dies and these values were plotted against direct thickness measurements by using the Beer-Lambert relationship. It was established that the micrometer-produced control specimens yielded a valid standard curve for use with the cast gold crowns. Precementation space measurements determined photometrically were found to correlate significantly (r = 0.72, p less than 0.001) with zinc phosphate cement thickness measured on subsequently cemented and cross-sectioned crowns. A three-dimensional representation of the precementation space inside one crown was developed after mapping of 45 points in less than 5 minutes.

Cementation↗
PubMed1989

Use of an elastomeric material to improve the occlusal seat and marginal seal of cast restorations.

A method to improve the fit of castings by the use of a light-bodied condensation silicone impression material was tested. Eighteen-full coverage castings were made on individual resin dies and divided into two groups. The experimental group was adjusted internally to a uniform precementation space by using the silicone impression material as a disclosing agent for binding of the castings on the axial or occlusal walls. Measurements of marginal fit were made with a light microscope using a filar eyepiece both externally and internally by sectioning after cementation with a zinc phosphate cement. Results demonstrated a significant improvement in marginal seal and occlusal seating in the experimental group compared with the control group. The condensation silicone material proved to be an appropriate research tool for nondestructive, three-dimensional evaluation of the postcementation space and offers a new method of evaluation of cement thickness because seating was found to be not significantly different from that with zinc phosphate cement.

Cementation↗
PubMed1987

Evaluation of biangular reflection photometry for quantitative study of etched alloy surface roughness.

Biangular reflection photometry was correlated with quantitative stereology and direct pit-depth measurements for an electrolytically etched nickel-chromium-beryllium alloy. Effects of viewing angle, viewing aperture, and plane polarization of incident and viewing light were also studied. The results showed that architectural changes in the etched metal surface could be quantitatively described with the use of reflection photometry. An off-specular peak, located at an angle of reflection considerably different from the angle of incidence, was observed to have an intensity comparable with that of the specular reflection peak. Viewing aperture was found to affect one's ability to distinguish among degrees of surface roughness.

Acid Etching, Dental↗
PubMed1987

Social integration, leisure activity, and life satisfaction in older adults: activity theory revisited.

The relative contributions of objective integration, subjective integration, and total leisure activity to the life satisfaction of older adults are examined. A random sample of 400 persons ages forty through eighty-nine residing in a demographically typical midwestern city were interviewed by phone. Results show that Objective Integration does not contribute incrementally to Life Satisfaction except among males under age sixty-five. Subjective Integration, on the other hand, contributes significantly to Life Satisfaction of males and females under and over age sixty-five. Even when demographic variables, Objective Integration, and Subjective Integration are taken into account statistically, Total Leisure Activity contributes significantly to Life Satisfaction in all groups examined.

Adult↗
PubMed1987

Effect of the Today contraceptive sponge on growth and toxic shock syndrome toxin-1 production by Staphylococcus aureus.

Toxic-shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus MN8 was grown in dialyzed beef heart infusion broth, or dialyzed beef heart infusion broth supplemented with 5% human blood or with 5% human semen, in the presence and absence of Today contraceptive sponges. Early growth of the organism was inhibited by the presence of the sponges in aerobic, static aerobic, and anaerobic cultures. In aerobic cultures that contained the sponge, minimal TSST-1 was detected by immunodiffusion assay, whereas in control cultures that did not contain the sponge, extensive toxin production was seen. In static and anaerobic cultures, the presence of the contraceptive sponge resulted in toxin levels less than or equal to the low levels seen in control cultures. These results suggest that Today contraceptive sponges may inhibit TSST-1 production by S aureus.

Aerobiosis↗
PubMed1986

Resin-bonded prostheses: microleakage and luting agent thickness of etched and cast-meshwork retainers.

The purpose of this study was to compare in vitro marginal leakage, metal surface features, and luting resin film thickness between electrolytically etched and cast mesh resin-bonded retainer designs. The rate of microleakage along an etched metal-composite interface appears to be considerably slower than along a cast mesh-composite interface. Significant differences in surface area between these two retention systems, especially at the margin, is thought to be primarily responsible. Whether such a microleakage difference will be meaningful in terms of clinical longevity remains a matter for further study. Luting resin thickness was found to be significantly less for etched retainers. This may be due to characteristics of framework adaptation to the teeth under the conditions of this investigation.

Acid Etching, Dental↗
PubMed1985

Relationships among motivational orientation, level of leisure activity, and life satisfaction in older men and women.

With telephone and mailed questionnaire data from 217 persons between the ages of 40 and 89 years and residing in a midwestern city, the effects of selected aspects of motivation on levels of leisure activity and life satisfaction were investigated. Differences between employed and retired persons and between men and women were examined. Analysis of covariance, with a measure of problem perception serving as a covariate, was used to analyze the data. Results indicated that three motivational orientations--challenge seeking, concern with recognition and reward, and family focus--were systematically related to life satisfaction in the sample. The study provides an explanation for some of the inconsistencies in the literature on activity theory and strongly suggests that blanket prescriptions for increases in leisure activity are not necessarily desirable for all retired persons.

Adult↗