PubMed Health⌕ Search

Biomedical subjects

R A Kane

Publications and source records attributed to R A Kane.

At least 109 records · Page 6Linked to original sources
PubMed1988

CT-guided aspirations for the body: comparison of hand guidance with stereotaxis.

Forty computed tomography (CT)-assisted aspirations performed with only hand guidance were prospectively compared with 40 performed with a CT body-stereotaxic system. Although there was no statistically significant difference in lesion size and path length between the two groups, use of stereotaxis compared with hand guidance decreased by 75% the number of needle manipulations required to place a needle within a lesion. With the stereotaxic method, only 43 needle manipulations were required to confirm a needle placement in 40 lesions, with no lesion requiring more than two attempts. Use of stereotaxis decreased the number of localization scans by 80% and biopsy time by 50%. It is concluded that CT-guided needle placements with hand guidance are often inaccurate and, unless the lesion is large, require multiple needle manipulations to place a needle within the lesion. Stereotaxis-guided biopsies, on the other hand, decrease radiation exposure, biopsy time, and trauma from multiple needle punctures.

Biopsy, Needle↗
PubMed1988

Long-term care: variations on a quality assurance theme.

Quality assurance in long-term care (LTC) diverges from approaches in acute care because of inherent features of LTC: the slower pace, the reliance on "low technology" services, the goals of LTC, and the multiple transitions across care sites typical of LTC users. LTC quality assurance activities should focus on outcomes, using process measures only when they are related to desirable outcomes or are intrinsic to respectful treatment of patients. Outcome measures should compare what is achieved with what can be reasonably expected. Because LTC services can be given interchangeably at various LTC sites (e.g., home care, day care, nursing homes), a data base must be developed that permits monitoring and comparing outcomes across diverse LTC programs.

Aged↗
PubMed1988

Assessing quality in nursing homes.

Quality assurance (QA) in nursing homes requires recognition of differences between acute and long-term care in goals, technology, and pace. This article outlines an approach to nursing home QA that would both generate an information system for a facility to review its performance compared to external regulations, and also allow a proactive stance on the part of nursing home staff. After reviewing existing nursing home regulations, this article discusses three necessary components of QA: defining quality and developing criteria; assessing quality; and correcting deficiencies. It argues that a prompt and clear feedback system to personnel is one key to a proactive QA system that becomes self-improving.

Aged↗
PubMed1987

Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC.

Algorithms↗
PubMed1987

Assessing social function in the elderly.

Physicians and health care providers need to assess aspects of their patients' social functioning. This article discusses assessment of social relationships, social activities, social environment and resources, social support, caregivers and caregiver burden, and quality of life in the context of what a health care provider might need to know. Incorporating appropriate questions is emphasized as much as using more formal measures. This article explores ways in which such assessment of social function may be incorporated into routine practice, and suggests when more specialized assessments might be ordered from community agencies.

Aged↗
PubMed1986

Normal uterine activity on a 99mTc-glucoheptonate renal scan.

Uterine radioactivity uptake has previously been reported for a variety of radionuclide agents in the presence of uterine pathological disorders, such as leiomyomata as well as uterine and cervical neoplasma and infections. Activity within the normal uterus has also been reported in Meckel's scans using 99mTc-pertechnetate, but this has not been reported for other radionuclide agents. We report a case exhibiting radioactivity uptake within a normal uterus on a 99mTc-glucoheptonate scan of a renal transplant. Awareness of the possibility of radioactivity uptake in a normal uterus is important in order to avoid potential confusion with abnormal pelvic masses or fluid accumulations.

Adult↗
PubMed1985

Health policy and social workers in health: past, present, and future.

From its beginnings, social work has concerned itself with the broad social problems and issues affecting all society's citizens, and health care in this country has been one arena for this concern. Practice in health settings has both shaped and been shaped by health policy. What will its direction be in the years to come?

Forecasting↗
PubMed1985

Focal splenic disease demonstrated by ultrasound and computed tomography.

Twenty-five patients with focal splenic disease were analyzed retrospectively to determine the relative strengths and weaknesses of ultrasound and computed tomography (CT) in the detection and analysis of focal splenic lesions. Lesions were detected in all 25 patients by ultrasonography and in 22 of 25 patients by CT. Ultrasonography appears to be more sensitive in the detection of focal lymphoma within the spleen and may be slightly more sensitive in the detection of microabscesses. CT may offer more specific information regarding the nature of certain lesions, including the detection of cyst wall calcification, gas within an abscess, and the specific site of origin of tumor invading the spleen. Ultrasonography may at times be more specific in the diagnosis of cystic lesions. We recommend ultrasonography as the first method for splenic imaging with CT used when necessary for further characterization of focal lesions.

Abscess↗