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Biomedical subjects

R L Kane

Publications and source records attributed to R L Kane.

At least 181 records · Page 10Linked to original sources
PubMed1984

The costs of urinary incontinence in nursing homes.

A simple model was used to calculate the contribution of urinary incontinence (UI) to the costs of nursing home care. First-order costs are defined as the costs of managing UI: supplies, laundry, and labor. Second-order costs are defined as the costs of managing the complications of UI. Data were gathered from nursing homes, medical supply companies, and a large laundry company. First-order costs of four common methods of managing UI range between $ 3.00 and $ 11.00 per incontinent patient per day. Based on these estimates, UI accounts for between $ 0.5 and $ 1.5 billion (3-8%) of the costs of nursing home care. Management of UI with indwelling catheters results in the lowest first-order costs, but the second-order costs (as well as the potential increased morbidity and mortality risks) probably outweigh any cost savings. More active evaluation and treatment of UI in nursing homes could result in considerable cost savings and improved well-being for both patients and caregivers.

Bedding and Linens↗
PubMed1984

Level of care and complications among geriatric patients discharged from the medical service of a teaching hospital.

To assess the effects of hospitalization on the subsequent placement and supportive care of elderly patients, the medical records of 233 consecutive patients aged 75 years or older, admitted to the medical service of a university hospital, were reviewed. The level of care on admission and at discharge, hospital-associated complications, and demographic data were abstracted for each patient. At discharge, 1 per cent returned to a nursing home, 6 per cent were newly placed in a nursing home, 65 per cent returned to the same level of care as on admission, 10 per cent returned home with an increased level of care, and 18 per cent died or were discharged to another acute care facility. Complications occurred in 30 per cent of patients but did not correlate with age, increased level of care at discharge, or increased rate of nursing home placement. Few elderly patients were discharged to nursing homes, and most returned home without arrangements for increased care.

Activities of Daily Living↗
PubMed1983

Differential drawing size associated with unilateral brain damage.

Size of Greek Cross reproductions was compared using 35 persons having unilateral right (RHD), 35 having unilateral left (LHD) hemisphere damage and 38 non-neurologic controls. With right hand tapping speed statistically controlled, RHD drawings were significantly larger than LHD reproductions. Spatial Relations scores were significantly associated with drawing size in the RHD group only, following adjustment for right hand tapping speed. Aphasia Screening scores were unrelated to drawing size. These data demonstrate that LHD/RHD drawing size differences are independent of any basic motor impairment and that for RHD subjects, drawing size is positively correlated with visuospatial impairment.

Adult↗
PubMed1983

Factor analysis of the WAIS and Wechsler Memory Scale: an analysis of the construct validity of the Wechsler Memory Scale.

The WAIS and Wechsler Memory Scale subtest scores of 256 neurologic and nonneurologic subjects were factor analyzed. The results supported the construct validity of the Wechsler Memory Scale as a measure of verbal learning and memory, attention and concentration, and orientation. Construct validity was not demonstrated for the Visual Reproduction subtest as a measure of visual memory. Suggestions are offered for future development and research on measures of visual memory.

Attention↗
PubMed1983

Assessing the outcomes of nursing-home patients.

This paper describes the development of multidimensional measures of nursing-home patients' functioning. The technique was designed to gather information directly from the patients, using demonstrated ability in place of self-report wherever possible. Six domains are tapped: physiologic, activities of daily living, affective, cognitive, social, and satisfaction. Test-retest reliability ranges from .59 for social interaction to .85 for affect. Validity was tested by replication on successive waves of data as well as discriminant and content validity.

Activities of Daily Living↗
PubMed1983

The risk of placement in a nursing home after acute hospitalization.

Using data from an urban Professional Standards Review Organization, the authors examined the pattern of discharges for persons aged 65 years and older from acute hospitals for 1979 and 1980. Of the 9% of elderly persons who were discharged to nursing homes, those older than 85 years were 10 times as likely to enter a nursing home as those aged 65; females were twice as likely as males; and those with a diagnosis of mental illness were more likely than those with a diagnosis of physical disease, but the effects were additive. Even after adjustments for patient source, patient characteristics, and therapeutic service, the university teaching hospital was less likely to discharge elderly patients to nursing homes than were the 10 community hospitals in the area.

Aged↗
PubMed1982

Urinary incontinence in elderly nursing home patients.

Among elderly nursing home patients, urinary incontinence is a prevalent and costly condition. In seven nursing homes studied, 419 (50%) of the elderly patients were incontinence of urine. Most had been incontinent at admission (64%), had more than one incontinent episode per day or a catheter (72%), and had concomitant fecal incontinence (64%). The majority of incontinent patients had substantial cognitive impairment and limitations in mobility. The severity of these impairments was related to the extent of incontinence. Complications such as urinary tract infection and skin breakdown occurred in almost 45% and were more common in patients with catheters. Physicians recorded incontinence as a problem, or any efforts to evaluate it, in the nursing home records of less than 15% of these patients.

Aged↗
PubMed1982

Predicting rural health care utilization with archival data.

This study explored the usefulness of archival data in predicting rural health care utilization. A regression model was used to see how well observed utilization for local populations could be predicted by calculating expected values in advance from age- and sex-specific national rates applied to local age and sex profiles. Although the correlation between observed and expected utilization was reasonably high (r = 0.92), an attempt was then made to improve prediction by considering other data that do not require independent collection. These archival data included indicators of historic utilization (local Medicaid payments, the percentage of births to county residents occurring in the mother's county of residence, percentage of children immunized, and infant mortality) and services already available. Observed utilization data were obtained by surveys in eight rural counties, and the predictor was tested on three additional rural communities. A predictor equation that added to the expected utilization only one variable (the percentage of births to county residents occurring in the mother's county of residence) was found to account for approximately 95% of the variance in observed utilization. This predictor is recommended for planners who need convenient, low-cost market feasibility estimates for proposed project sites and a way to establish intermediate goals or incentives during early project development.

Ambulatory Care↗
PubMed1982

Neuropsychological analysis of a case of crossed aphasia: implications for reversed laterality.

We present a case of crossed aphasia and reversed laterality in a 60-year-old right-handed man. Neuropsychological assessment was conducted both prior, and three months subsequent, to the removal of a right temporal lobe tumor. Results, using the Luria-Nebraska Neuropsychological Battery, Wechsler Memory Scale and WAIS Block Design, plus various drawings from copy and to command revealed: (1) presurgery Luria profile very close to the mean profile for dominant temporal lobe dysfunction, (2) preserved visuospatial and visuoperceptive skills, (3) preserved limb praxis, and, (4) good postsurgery functional recovery. These findings are discussed in relation to literature on crossed aphasia and reversed laterality.

Aphasia↗
PubMed1982

The role of geriatric assessment units in caring for the elderly: an analytic review.

Specialized geriatric assessment units (GAUs) have been established across North America in response to the growing recognition of the many unmet needs of the frail elderly and the conviction that GAUs can have major beneficial impacts. Although their structures and objectives vary considerably, GAUs are generally designed to comprehensively assess elderly patients' medical and psychosocial problems, to determine optimal placement, and often to provide therapy and rehabilitation. We offer a framework for examining structural and outcome studies indicates that GAUs can provide important positive impacts on health care for the elderly, including more thorough diagnoses, improved levels of physical and psychological functioning, and better placement decisions.

Aged↗
PubMed1982

Predicting the outcome of primary care.

Each physician's ability to treat disease is limited by his/her ability to discriminate among patients on the basis of risk. The relationship of physician expectation of outcome (prognosis) to actual outcome and to cost were determined for 1,757 patients seeking primary care. Outcome was measured by a seven-level functional-status scale; patients who returned to their usual level of function after an acute illness were defined as having good outcomes. Although 24 per cent of patients experienced bad outcomes, physicians had anticipated only 6 per cent. Physician's predictions of bad outcomes had a sensitivity of 13.6 per cent and a specificity of 96.9 per cent. Patients with bad outcomes had slightly higher laboratory costs than did patients with good outcomes, but a much larger increase was seen in laboratory, office and total costs for all patients for whom physicians expected bad outcomes, regardless of the actual results. A feedback loop is recommended to provide a better perspective on outcome and eventually to improve the efficiency and cost benefit of the medical decision-making process.

Clinical Competence↗
PubMed1982

Effect of patient age on duration of medical encounters with physicians.

The authors analyzed the USC/DRME Practice Study data to determine if the characteristics of physician patient encounters change with patient age. The only significant change observed was a decline in encounter time for patients 65 years of age and older compared with those 45 through 64 years of age. This decrease was significant for raw data and for data weighted for the number of physicians of various types and standardized for complexity of case mix in various age groups, also for both nonhospital and hospital encounters and for almost all classes of encounters. Three types of generalists and four types of medical subspecialists were studied; encounter times for all types were, for patients 65 and older, either the same as or less than those for patients 45 through 64. The observed phenomenon may reflect a conscious decision on the part of some physicians to allot less time to elderly patients.

Age Factors↗
PubMed1981

Utilization review in nursing homes: making implicit level-of-care judgments explicit.

Comprehensive data on 3,579 patients in Baltimore nursing homes were collected by trained teams of reliable observers. The data included an implicit judgment about the level of care (LOC) deemed most appropriate for each patient. Two different approaches were used to fit the patient data to the LOC judgments: Several versions of an algorithm adapted from a utilization review scheme based on simple clinical criteria and a series of mathematical equations based on logistic regression were each tested. In the case of the latter, each equation was derived from a random half of the data and tested on the remaining half. Both approaches yielded comparable results. The best variation of the algorithm correctly identified 71 per cent of patients needing skilled care and 69 per cent of those needing unskilled care. The equations based on the logistic regressions could correctly classify 86 per cent of those needing skilled care and 63 per cent of those not needing such care. Further improvements in accuracy of prediction on one group came at the cost of less accurate identification of the other. In general, the simplest models proved the most useful. These techniques are recommended as useful for preliminary screening of nursing home patients for appropriate LOC but should not be used as a basis for final judgments. The advantages offered by this approach are the reduction of workload demands for skilled professional judgment and the availability of a very reliable preliminary screening judgment in a highly politicized atmosphere.

Activities of Daily Living↗