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Biomedical subjects

M J Graney

Publications and source records attributed to M J Graney.

At least 55 records · Page 3Linked to original sources
PubMed1991

Comparison of subjective ratings of function with observed functional ability of frail older persons.

BACKGROUND: Important clinical decisions often hinge on patients' functional status. Previous studies have shown disagreement among sources of ratings of patients' functional status. This study compared patient self-ratings, family member ratings, and physician ratings of patient function to performance-based functional testing criteria. METHODS: Five activities of daily living of 73 older patients were studied at admission to a rehabilitation unit following discharge from an acute care community hospital. Data were collected from patients, family members, and physicians and were compared with performance-based function testing. RESULTS: Patient ratings were significantly more accurate than physician ratings for walking, transferring, and telephoning. Patients were significantly more accurate than family members for rating walking and telephoning, but patients were not significantly more accurate than family members or physicians for rating eating or dressing. CONCLUSIONS: We conclude that decisions about patients' functional level should be based on performance testing. If performance testing is unavailable, patients' own ratings are most accurate, followed by family ratings. Physicians' ratings are least accurate.

Activities of Daily Living↗
PubMed1990

A randomized, controlled trial of a geriatric assessment unit in a community rehabilitation hospital.

We conducted a randomized trial in a community rehabilitation hospital to determine the effect of treatment in a geriatric assessment unit on the physical function, institutionalization rate, and mortality of elderly patients. Functionally impaired elderly patients (mean age, 78.8 years) who were recovering from acute medical or surgical illnesses and were considered at risk for nursing home placement were randomly assigned either to the geriatric assessment unit (n = 78) or to a control group that received usual care (n = 77). The two groups were similar at entry and were stratified according to the perceived risk of an immediate nursing home placement. After six months, the patients treated in the geriatric assessment unit had significantly more functional improvement in three of eight basic self-care activities (P less than 0.05). Those in the lower-risk stratum had significantly more improvement in seven of eight self-care activities. Both six weeks and six months after randomization, significantly more patients treated in the geriatric assessment unit than controls (79 vs. 61 percent after six months) were residing in the community. During the year of follow-up, the control patients had more nursing home stays of six months or longer (10 vs. 3; P less than 0.05). However, there was no difference between the groups in the mean number of days spent in health care facilities (acute care hospital, nursing home, or rehabilitation hospital). Survival analysis showed a trend toward fewer deaths among the patients treated in the geriatric assessment unit, and mortality was significantly reduced in the patients considered to be at lower risk of immediate nursing home placement (P less than 0.05). We conclude that the treatment of selected elderly patients in a specialized geriatric rehabilitation unit improves function, decreases the risk of nursing home placement, and may reduce mortality. The beneficial effects on mortality and function appear greatest for patients at a moderate rather than high risk of nursing home placement.

Follow-Up Studies↗
PubMed1990

An index for estimating probabilities of surgical success for cataract patients with retinal disease.

Patients with cataracts and coincident retinal disease are at increased risk for unsuccessful cataract surgery. We developed a method for estimating probabilities of surgical success for older cataract patients with retinal disease. Using data from a prospective study of cataract surgery outcomes, 36 patients with both cataracts and retinal disease were identified, 13 of whom attained surgical success with 20/40 or better vision 4 months after surgery. Age, presurgical Snellen letter acuity, location of retinal lesions, and presurgical visual function in everyday life (newspaper reading or television viewing) were all reliable correlates of surgical outcome. These data were analyzed using multiple logistic regression to develop a clinical index combining presurgical Snellen letter acuity, location of retinal lesions, and age to predict surgical success. The resulting index demonstrated 83% sensitivity and 85% specificity in sample data, correctly predicting 83% of patients (predictive value positive: 73%; predictive value negative: 90%).

Activities of Daily Living↗
PubMed1990

Meta-analysis for the refinement of gerontological nursing research and theory.

A meta-analysis review of literature addresses concerns such as inclusion and exclusion criteria for articles in the meta-analysis and seeks potentially biasing effects of sample size and characteristics, measurement of variables, type of design, and analytic techniques. Whereas the narrative review of literature provides direction by identifying potential variables and relationships of concern, meta-analysis quantifies those relationships by integrating findings and providing explicit direction for research, practice, and theory development. Despite its strengths for quantitatively integrating study results, meta-analysis is time consuming, labor intensive, and may omit other sources such as case studies, historical and qualitative research, and clinical decision making.

Geriatric Nursing↗
PubMed1990

Meta-analysis techniques.

The three elements of meta-analysis include exact specification of sources from which primary studies are identified; transformation of primary study findings to a common metric; and statistical analysis of primary study findings. Meta-analysis has several drawbacks, such as dependence on the quality of the reporting of primary analysis findings; dependence on sufficient numbers of eligible studies to justify statistical analysis; a lack of a universal common metric; and a lack of expert agreement about the best form of statistical analysis. As researchers become more familiar with meta-analysis, two effects will be seen: an increased use of meta-analysis elements in all review of literature, and increased attention to reporting important details of research in scientific journals.

Humans↗
PubMed1989

Prediction of in-hospital cardiopulmonary arrest outcome.

Clinical and demographic characteristics of 122 patients undergoing cardiopulmonary resuscitation were retrospectively collected to develop a predictive model for immediate success of resuscitation (restoration of pulse and blood pressure). The project focused on objective measurement of parameters available before resuscitation was performed. Variables included age, diagnoses, objective severity of illness, laboratory data, and clinical course variables. A four-variable model was developed using logistic regression to predict resuscitation success immediately after resuscitation. The four predictive before arrest factors were age between 40 and 70 years, scheduled for surgery, location of arrest in an intensive care unit, and before arrest PO2 greater than 8 mm Hg. The model had an accuracy of 69%, sensitivity of 76%, and specificity of 61%.

Adult↗
PubMed1988

A clinical index for predicting visual acuity after cataract surgery.

We developed a clinical index for predicting postoperative visual acuity of cataract patients and cross-validated it using data from 182 patients aged 70 years and older. The index consisted of four statistically combined indicators: age, preoperative visual acuity, frequency of reading, and comorbidity. Validation of the index included comparisons to two standard technical instruments for measurement of retinal visual acuity. For the clinical index, 72% of predictions were accurate within one Snellen line of postoperative visual acuity compared to 37% using a laser interferometer and 33% using a potential acuity meter. Testing of the clinical index's external validity using data from 111 patients in a different ophthalmology clinic disclosed 61% of predictions accurate within one Snellen line.

Aged↗
PubMed1988

Predictions of outcomes from cataract surgery in elderly persons.

To determine how well visual outcomes of cataract surgery can be predicted from acuity estimations by visual instruments and an ophthalmologist, the authors compared predictions of postsurgical visual acuity with the measured acuity at 4 months in 82 elderly persons. Comparisons were made between the potential acuity meter (PAM), laser interferometer (LI), and an ophthalmologist, who predicted the final vision before surgery using screening visual information, including PAM, LI data, and results of the patient's examination. Neither instrument alone was successful in predicting postsurgical acuity +/- 1 contiguous Snellen chart line (bivariate correlation [r] = 0.03 for PAM and 0.07 for LI). The ophthalmologist was the most accurate predictor of acuity within 1 line (r = 0.41, p less than or equal to 0.001). These results indicate that the PAM and LI did not independently predict postsurgical vision in elderly cataract patients, but results of a clinical examination markedly improved the accuracy of predictions.

Aged↗
PubMed1988

Functional outcome one year following cataract surgery in elderly persons.

We conducted a prospective study of 164 patients aged 70 and over who had undergone cataract removal and intraocular lens implantation to determine variables which predicted change in physical function experienced by the patients one year after cataract surgery. Path analysis was used to estimate direct and indirect effects of ADL change. Direct effects were estimated for mental status (-.35), mental status change (.51), binocular visual disability (-.39), binocular visual disability change over one year (.51), and baseline ADL (.36), with 45% of variance explained. Age and baseline mental status had important indirect effects through mental status change, and presurgical visual disability had important indirect effects through both visual disability change and mental status change. In summary, change in level of function one year after cataract surgery was not explained solely by change in vision, but was conditional on baseline function and baseline mental status and mediated in part by change in mental status.

Activities of Daily Living↗
PubMed1985

Preoperative radiation therapy with sensitizers in the management of carcinoma of the rectum.

There is enough evidence to show that adjuvant radiation therapy contributes to the management of patients with carcinoma of the rectum. In an effort to improve resectability and possibly survival rates, the use of chemosensitizers, combined with moderate doses of radiation used presurgically, was introduced for carcinomas larger than 5 cm in diameter requiring abdominoperineal resection. Based on our experience and that of others, it is believed that the method of administration of 5FU and mitomycin-C is an important factor in obtaining an increased therapeutic ratio. Because of the locoregional pattern of spread of rectal cancer, this adjuvant approach would appear suitable. A series of approximately 60 patients is discussed and the surgical findings and five-year survival is reported.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1981

Causes and consequences of health self-report variations among older people.

Older people's health self-reports are highly correlated with their utilization of health care services and are frequently cited in explanations for changes in social status, social participation-activity, and personal attitudes. The purposes of research reported here were threefold: 1. to review previous health self-report findings using comparable statistics and systematic categories of correlates; 2. to specify indicators of established correlates in national random sample data; and 3. to develop a path analysis model utilizing these variables as causes and consequences of health self-report variations among older people. Findings emphasize the importance of health self-concept to social participation-activity.

Aged↗
PubMed1975

Happiness and social participation in aging.

This paper reports on a 4-year longitudinal study of 60 elderly women. Data about their happiness and social activities were collected using the Affect Balance Scale and nine measures of socially relevant activities, including three measures of media use, three of interpersonal interaction, and three of activities in voluntary associations. Direct relationships between happiness and social activity among elderly people were found in analysis of these data. This finding was not spurious according to longitudinal data: activity increments were associated with happiness and decrements with unhappiness. Although these findings describe the over-all picture, changes in activities may be more important to happiness among the most elderly persons interviewed than others.

Adaptation, Psychological↗