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Biomedical subjects

R S Kane

Publications and source records attributed to R S Kane.

13 recordsLinked to original sources
PubMed1997

Cardiopulmonary resuscitation policies in long-term care facilities.

OBJECTIVES: To describe CPR policies and the procedures for discussing CPR policies of Wisconsin long-term care facilities. DESIGN: Mail survey and telephone interview. MEASUREMENTS: Information about CPR policy, how policy is disclosed to residents and by whom, emergency medical technician team (EMT) response time, and number of CPR attempts during 1993. RESULTS: The 1994 survey response rate was 85% (346/ 404 facilities). Four percent of responding facilities maintain a policy of never initiating CPR. Another 23% never initiate CPR but would call an EMT. Lack of efficacy was the usual basis for policies never initiating CPR. About 15% of facilities would initiate CPR only on residents who had previously indicated a preference. On individuals who had not made an advanced directive decision, 57% of facilities would initiate CPR in the event of an arrest. Almost 30% of facilities offering CPR would initiate CPR on unwitnessed arrests. Approximately 51% of all facilities assigned a social worker alone to discuss CPR policy and preference, whereas 12.5% assigned a physician alone or as part of a team. During 1993, an estimated 118 attempts at CPR were reported for 172 facilities with a total of 19,596 licensed beds, for a frequency of one CPR attempt per 166 beds per year. CONCLUSIONS: Poor efficacy in this population was the main reason given for policies of never initiating CPR. Specific factors relating to CPR efficacy, such as EMT response time and ease of maintaining trained staff, were not major influences. Almost 30% of facilities offering CPR would perform it in unwitnessed situations, despite unlikely success. Many decisions about CPR may not be fully informed as nurses and physicians are not often assigned to discuss advance directives with residents or surrogates. Utilization of CPR in nursing homes offering resuscitation is low.

Aged↗
PubMed1995

Minimal trauma fractures in older nursing home residents: the interaction of functional status, trauma, and site of fracture.

OBJECTIVE: This study was conducted to determine the incidence of long bone fractures in institutionalized older persons and to describe preceding traumatic events and the functional status of individuals sustaining fractures. DESIGN: A 1-year, prospective, cumulative incidence survey. SETTING: Eleven skilled nursing care facilities in the state of Wisconsin. PATIENTS: All residents of the 11 facilities. MEASUREMENTS: All incident reports of long bone fractures, description of events preceding the fractures, and functional status of the fracture cases. In addition, demographic and medical information was collected on fracture cases and the general nursing home population. MAIN RESULTS: Overall long bone fracture incidence was 3.52 per 100 subjects per year. Minimal trauma fracture incidence was 0.84 per 100 subjects per year. Fracture location was significantly related to type of trauma. Functional status was significantly related to fracture location and to the type of trauma preceding the fracture. Minimal trauma fractures occurred in individuals who were less mobile and more likely to be bed-bound, and the location was more likely to be the lower extremity below the hip. CONCLUSION: This is the first prospective survey of long bone and spontaneous fracture incidence rates in multiple nursing home facilities. Minimal trauma fractures are common in the nursing home, and most have no clear precipitating factors other than severely impaired mobility.

Accidental Falls↗
PubMed1993

Factors affecting physician participation in nursing home care.

Physicians generally consider nursing home practice a low priority compared with other aspects of their practices. In order to encourage more enthusiastic physician involvement, negative influences needed to be identified so that corrective ideas can be formulated. Negative factors include low reimbursement, frequent office interruptions, excessive paperwork, and a sense of loss of authority. The problem of quality physician involvement must be viewed from new perspectives. An increase in reimbursement is only part of the solution. Other measures that enhance the professional image and responsibility will increase physician participation more than laws and regulations, which increase physician time commitment without increasing reimbursement. Laws and regulations, through misperception, misinterpretation, and misapplication, can have unintended adverse results. Only creative solutions addressing identified negative factors will cut through the Gordian knot, which prevents enthusiastic and quality medical care for all NH residents.

Attitude of Health Personnel↗
PubMed1991

Spontaneous fractures of the long bones in nursing home patients.

Six long-term nursing home residents who experienced fractures of the long bones in the absence of obvious trauma are described. All patients had been essentially non-weight-bearing for at least 2 years before the episode. Four patients experienced fractures on more than one occasion. There was no evidence of physical abuse in any of these of patients; indeed, evidence against abuse was fairly good. Nonetheless, physical abuse was alleged by the patients' families in four of the cases. Long bone fracture in the absence of trauma in patients after prolonged bed rest has been well described in the radiologic and orthopedic literature, but not previously in geriatrics. It is important that this phenomenon be recognized, lest all unexplained fractures in nursing home patients automatically be taken as evidence of abuse or neglect.

Aged↗
PubMedDate not supplied

Unilateral decisions.

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Beneficence↗