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Biomedical subjects

Robert L Kane

Publications and source records attributed to Robert L Kane.

At least 19 recordsLinked to original sources
PubMed2007

Assessment of health-related quality of life of adolescent cancer patients using the Minneapolis-Manchester Quality of Life Adolescent Questionnaire.

BACKGROUND: Improved survival after childhood cancer has shifted the focus to health-related quality of life (HRQL)-an understudied problem, especially among adolescents. PROCEDURE: We assessed HRQL among adolescents utilizing a validated self-report tool, the Minneapolis-Manchester Quality of Life (MMQL) Adolescent Form, consisting of 46 items comprising seven domains: physical, cognitive, psychological and social functioning, body image, intimate relations, and outlook on life, and computed an overall QoL score. The MMQL Adolescent Form was administered to 226 adolescent survivors of childhood cancer a median of 7.8 years from diagnosis (off therapy-median age: 16.2 years), 136 adolescent cancer patients undergoing therapy (on therapy-median age: 16.4 years), and 134 healthy adolescents (controls-median age: 15.5 years). Primary diagnoses included leukemia (46%), lymphoma (26%), brain tumors (5%), and other solid tumors (23%). RESULTS: Compared to healthy controls, on-therapy patients were at increased risk for reporting poor overall QoL [Odds Ratio (OR) = 3.3, P = 0.002)] and poor physical functioning (OR = 11.8, P < 0.001). Off-therapy survivors did not differ significantly from healthy controls for overall QoL (OR = 1.6, P = 0.5) or any HRQL domains. Female patients, both on- and off-therapy, were more likely to report poorer overall QoL, physical, psychological and cognitive functioning as well as poorer body image when compared with male patients. CONCLUSIONS: While adolescent cancer patients undergoing active therapy report poor physical functioning, there is no evidence of long-term QoL sequelae.

Adolescent↗
PubMed2006

Neuropsychological assessment in extreme environments.

In this paper, we summarize studies that used ANAM tests to assess the effects of environmental stressors. The findings document performance changes resulting from conditions relevant to military operational medicine. These conditions included radiation exposure, toxins, high altitude, undersea conditions, Marine basic training, advanced military training, and fatigue. The results of these studies demonstrate that ANAM detects cognitive changes in extreme environments.

Diagnosis, Computer-Assisted↗
PubMed2006

Initial construct validation of frequently employed ANAM measures through structural equation modeling.

ANAM measures were based on procedures used in both clinical and performance assessment. This paper reviews data from studies designed to delineate specific neurocognitive functions assessed by more commonly used ANAM measures. Data are brought together from both exploratory and confirmatory analyses. Current findings support the use of these measures for assessing aspects of attention, processing efficiency, and working memory. Recommendations for further research include the need for larger samples and the inclusion of specific marker variables.

Cognition Disorders↗
PubMed2006

Army research needs for automated neuropsychological tests: monitoring soldier health and performance status.

Information on the mental status of soldiers operating at the limits of human tolerance will be vital to their management in future deployments; it may also allow earlier intervention for conditions such as undiagnosed Gulf War illnesses and Parkinson's Disease. The Army needs a parsimonious set of neuropsychological tests that reliably identify subtle changes for: (1) early detection of individual health and military performance impairments and (2) management of occupational and deployment health risks. Testing must characterize cognitive lapses in healthy individuals faced with relevant operational stressors (i.e., anxiety, information overload, thermal strain, hypoxia, fatigue, head impact, chemical or radiation exposures, metabolic challenges). This effort must also explore the neuropsychological methods in militarily relevant conditions to extend our understanding of relevant functional domains and how well they correspond to modes of testing. The ultimate objective is unobtrusive real-time mental status monitoring.

Cognition Disorders↗
PubMed2006

The use of ANAM to assess the side-effect profiles and efficacy of medication.

Cognition has become increasingly important as an outcome measure in studies of medication. Traditional neuropsychological assessment is limited in its ability to detect subtle, medication-related changes and it is not suitable for the rapid serial assessment required in most clinical trials. Thus, investigators have turned to computerized neuropsychological assessment for its repeatability, sensitivity to subtle cognitive changes, and ease of administration. The automated neuropsychological assessment metrics (ANAM) is one such computerized battery that has been used to measure the effects of numerous CNS-active drugs. This paper is an exhaustive review of studies that have used ANAM to measure cognitive changes associated with pharmacological treatments. The benefits and limitations of using ANAM in clinical trials are discussed.

Brain↗
PubMed2006

Identifying and monitoring cognitive deficits in clinical populations using Automated Neuropsychological Assessment Metrics (ANAM) tests.

In this article we review studies in which Automated Neuropsychological Assessment Metrics (ANAM) measures were used to screen for impairment in various clinical populations. These clinical groups include patients with multiple sclerosis, systemic lupus erythematosus, Parkinson's disease, Alzheimer's dementia, acquired brain injury, and migraine headache. Data are also presented from a group of outpatient referrals unselected with respect to clinical condition. Findings support the use of ANAM as a screening procedure for identifying the impaired patient.

Brain Injuries↗
PubMed2006

Poststroke rehabilitation: outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs.

BACKGROUND AND PURPOSE: To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs. METHODS: Clinical data were linked with Medicare claims for 58,724 Medicare beneficiaries with a recent stroke who completed treatment in 1996 or 1997 in IRFs and subacute rehabilitation SNFs that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome measures were discharge destination, discharge FIM ratings and Medicare Part A reimbursement during the institutional stay. RESULTS: IRF patients that were more likely to have a community-based discharge, compared with rehabilitation SNF patients, were patients with mild motor disabilities and FIM cognitive ratings of 23 or greater (adjusted odds ratio [AOR]=2.19; 95% CI: 1.52 to 3.14), patients with moderate motor disabilities (AOR=1.98; 95% CI: 1.49 to 2.61), patients with significant motor disabilities (AOR=1.26; 95% CI: 1.01 to 1.57) and patients younger than 82 with severe motor disabilities (AOR=1.43; 95% CI: 1.25 to 1.64). IRF patients with significant and severe motor disabilities achieved greater motor function of 2 or more FIM units compared with rehabilitation SNF patients. Medicare Part A payments for IRFs were higher than rehabilitation SNF payments across all subgroups. CONCLUSIONS: For most patients, poststroke rehabilitation in the more costly and intensive IRFs resulted in higher functional outcomes compared with care in a SNF-based rehabilitation program. IRF and SNF outcomes were similar for patients with minimal motor disabilities and patients with mild motor disabilities and significant cognitive disabilities. Cost-effectiveness analyses require considering the costs of the full episode of care.

Aged↗
PubMed2006

Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score>-2.5 for alendronate therapy: a modeling study.

Most fractures occur in postmenopausal women who do not have osteoporosis by bone density criteria (T-score>-2.5). Prevalent vertebral deformity is a strong risk factor for incident fractures independent of bone mineral density, yet the majority of these deformities are clinically unapparent. Spine imaging on a dual-energy densitometer, called vertebral fracture assessment (VFA), can accurately detect these deformities. The purpose of this modeling study was to estimate the lifetime societal costs and health benefits of VFA and confirmatory follow-up radiography to detect prevalent vertebral deformity in osteopenic (T-score -1.5, -2.0, or -2.4) postmenopausal women, followed by anti-resorptive drug therapy for those with one or more deformities. We compared three strategies; no initial drug therapy, 5 yr of initial alendronate therapy, or VFA followed by 5 yr of alendronate therapy in those with one or more vertebral deformities confirmed on radiography (VFA strategy). Results for the base-case analyses showed that the cost per quality adjusted life year (QALY) gained for the VFA strategy relative to no initial drug therapy ranged from 18,000 US dollars (for a 60-yr-old with a femoral neck T-score of -2.4) to 77,000 US dollars (for an 80-yr-old with a T-score of -1.5). VFA with selective confirmatory radiography is cost-effective, assuming a societal willingness to pay per QALY gained of 50,000 US dollars, for postmenopausal women aged 60 to 80 yr with femoral neck T-scores between -2.0 and -2.4, and for women age 60 or 70 yr with a T-score of -1.5. Assuming a societal willingness to pay of 100,000 US dollars per QALY gained, VFA is also cost-effective for women age 80 yr with a T-score of -1.5. These conclusions are robust to reasonable changes in fracture rates, assumed fracture disutility, discount rates, relative risk of fracture attributable to vertebral deformity, alendronate cost, and drug adherence.

Absorptiometry, Photon↗
PubMed2006

Variations on a theme called PACE.

BACKGROUND: The Program for All-inclusive Care of the Elderly (PACE) has been hailed as successful but of limited appeal. This study contrasts the effects on hospital utilization of PACE and a more liberal variant, the Wisconsin Partnership Program (WPP). METHODS: Hospital and emergency room (ER) utilization data from two sites that used both PACE and WPP to serve elderly clients were compared. The analysis of utilization was conducted using a cross-sectional longitudinal approach. The statistical significance of the difference between WPP and PACE groups was calculated by using regressions that adjusted for gender, race (white/nonwhite), age, original reason for entitlement in Medicare (elderly/disabled), dual eligibility, diagnoses during the previous 6 months, and county of residence. RESULTS: The PACE enrollees had fewer hospital admissions, preventable hospital admissions, hospital days, ER visits, and preventable ER visits than the WPP enrollees had. There was no difference in the length of hospital stays. CONCLUSIONS: PACE is more effective in controlling hospital and ER utilization than is the more flexible variant (WPP).

Aged↗
PubMed2006

Ptolemaic bathing.

Explore the source record for details and available documents.

Activities of Daily Living↗
PubMed2006

Who recommends long-term care matters.

PURPOSE: Making good consumer decisions requires having good information. This study compared long-term-care recommendations among various types of health professionals. DESIGN AND METHODS: We gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, we asked the professional to recommend the appropriate forms of long-term care. RESULTS: Although the professional respondents used the full spectrum of options offered to them, some professionals tended to favor the sector they worked in. Advanced practice nurses recommended day care and homemaking more and adult foster care less. Gerontologists used skilled nursing-facility placement more actively and rehabilitation, homemaking, and home health care less actively. Geriatricians and primary care physicians both favored rehabilitation and skilled nursing-facility care and were both less enthusiastic about assisted living, homemaking, and informal care, but the geriatricians favored day care more than did the primary care physicians. Registered nurses were highly supportive of assisted living, adult foster care, homemaking, and home health care, and they opposed skilled nursing-facility care. Social workers were less likely than other participants to endorse rehabilitation and adult foster care. IMPLICATIONS: Because consumer preference should be a major factor in making long-term-care decisions, many consumers need information about what options may best fit their situation. In the absence of empirical data on which types of long-term care work best for whom, consumers have to rely on expert judgment-but that judgment varies. Clients should be aware that an expert's background (as defined by discipline and work situation) may affect his or her recommendations. Each discipline appears to have its own set of experiences and beliefs that may influence recommendations.

Health Personnel↗
PubMed2006

Agreement about indications for total knee arthroplasty.

UNLABELLED: Total knee arthroplasty is an effective and cost efficient procedure that improves the quality of life for patients with end stage knee arthritis. With the prevalence of arthritis expected to increase with the aging of the population, the demand for total knee arthroplasty will increase substantially. We examined current indications for total knee arthroplasty by reviewing articles extracted from a comprehensive Med-line search. We studied the indications for proceeding with a total knee arthroplasty, the indications for referring a patient for a total knee arthroplasty, and the contraindications among orthopaedic surgeons, rheumatologists, and primary care providers. We evaluated 27-42 different patient factors. "Pain not responsive to drug therapy" was the only factor with consensus for total knee arthroplasty. "Major psychiatric disorder, including dementia" was the only contraindication to total knee arthroplasty that had a consensus. The lack of consensus within orthopaedics and across specialties likely represents a limitation in empirical data associated with total knee arthroplasty outcomes. Achieving better consensus will require conducting and disseminating better research on patient characteristics that predict the success of total knee arthroplasty. LEVEL OF EVIDENCE: Economic and decision analyses, level IV (analyses with no sensitivity analyses). See Guidelines for Authors for a complete description of levels of evidence.

Arthroplasty, Replacement, Knee↗
PubMed2006

Predicting nursing facility residents' quality of life using external indicators.

PURPOSE: A newly developed brief measure of nursing facility (NF) resident self-reported quality of life (QOL) has been proposed for inclusion in a modified version of the minimum data set (MDS). There is considerable interest in determining whether it is possible to develop indicators of QOL that are more convenient and less expensive than direct, in-person interviews with residents. DESIGN AND METHODS: QOL interview data from 2,829 residents living in 101 NFs using a 14-item version of a longer instrument were merged with data from the MDS and the Online Survey and Certification Automated Record (OSCAR). Bivariate and multivariate hierarchical linear modeling were used to assess the association of QOL with potential resident and facility level indicators. RESULTS: Resident and facility level indicators were associated with self-reported QOL in the expected direction. At the individual resident level, QOL is negatively associated with physical function, visual acuity, continence, being bedfast, depression, conflict in relationships, and positively associated with social engagement. At the facility level, QOL is negatively associated with citations for failing to accommodate resident needs or providing a clean, safe environment. The ratio of activities staff to residents is positively associated with QOL. This study did not find an association between QOL and either use of restraints or nurse staff levels. Approximately 9 percent of the total variance in self-reported QOL can be attributed to differences among facilities; 91 percent can be attributed to differences among residents. Resident level indicators explained about 4 percent of the variance attributable to differences among residents, and facility factors explained 49 percent of the variance attributable to differences among NFs. However, the different variables explained only 10 percent of the variance in self-reported QOL. IMPLICATIONS: A brief self-report measure of NF resident QOL is consistently associated with measures that can be constructed from extant data sources. However, the level of prediction possible from these data sources does not justify reliance on external indicators of resident QOL for policy purposes.

Aged↗
PubMed2006

Changes in the use of postacute care during the initial Medicare payment reforms.

OBJECTIVE: To examine changes in postacute care (PAC) use during the initial Medicare payment reforms enacted by the Balanced Budget Act of 1997. DATA SOURCES: We used claims data from the 5 percent Medicare beneficiary sample in 1996, 1998, and 2000. Linked data from the Denominator file, Provider of Service file, and Area Resource File provided additional patient, hospital, and market-area characteristics. STUDY DESIGN: Six disease groups with high PAC use were selected for analysis. We used multinomial logit regression to examine how PAC use differed by year of service, controlling for patient, hospital, and market-area characteristics. PRINCIPAL FINDINGS: There were major changes in PAC use, and a portion of services shifted to settings where reimbursement remained cost-based. During the first reform, the home health agency interim payment system, home health use decreased consistently across disease groups. This decrease was accompanied by increased use in skilled nursing facilities (SNFs). Following the implementation of the prospective payment system for SNFs, the use of inpatient rehabilitation facilities increased. CONCLUSIONS: The shift in usage among settings occurred in two stages that corresponded to the timing of payment reforms for home health agencies and SNFs. Evidence strongly suggests the substitutability between PAC settings. Financial incentives, in addition to clinical needs and individual preferences, play a major role in PAC use.

Acute Disease↗
PubMed2006

The effects of a variant of the program for all-inclusive care of the elderly on hospital utilization and outcomes.

OBJECTIVES: To compare the effects of the Wisconsin Partnership Program (WPP) on hospital, emergency department (ED), and nursing home utilization with those of traditional care. DESIGN: Quasi-experimental longitudinal cohort design. SETTING: Selected counties in Wisconsin. PARTICIPANTS: WPP elderly enrollees and two matched control groups consisting of frail older people enrolled in fee-for-service insurance plans, Medicare, and Medicaid and receiving home- and community-based waiver services, one from the same geographic area as the WPP and another from a location in the state where the WPP was not offered. MEASUREMENTS: Data came from administrative records. Regression and survival analyses were adjusted for case-mix variables. RESULTS: No significant differences in hospital utilization, ED visits, preventable hospitalizations, risk of entry into nursing homes, or mortality were found. WPP enrollees had more contact with care providers than did controls. CONCLUSION: WPP did not dramatically alter the pattern of care. Part of the weak effect may be attributable to the small numbers of WPP cases per participating physician.

Aged↗
PubMed2006

Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life.

OBJECTIVES: To identify factors associated with the use of selected medical services near the end of life in cognitively impaired residents of rural and urban nursing homes. DESIGN: Retrospective cohort study using Centers for Medicare and Medicaid Services administrative data for 1998 through 2002. SETTING: Minnesota and Texas nursing homes. PARTICIPANTS: Nursing home residents aged 65 and older with severe cognitive impairment who subsequently died during 2000/01. MEASUREMENTS: Minimum Data Set and Medicare Provider Analysis and Review, Hospice, and Denominator files were used to identify subjects and to assess medical service use. U.S. Department of Agriculture metro-nonmetro continuum county codes defined rural (codes 6-9) and urban (codes 0-2) nursing homes. Nursing home residents with hospice or health maintenance organization benefits were excluded. Use of hospital services at the end of life was adjusted for use of corresponding services before the last year of life. Outcome variables were feeding tube use, any hospitalization, more than 10 days of hospitalization, and intensive care unit (ICU) admission. RESULTS: The population included 3,710 subjects (1,886 rural, 1,824 urban). In multivariable logistic regression analyses (all P<.05), feeding tube use was more common in urban nursing home residents, whereas rural nursing home residents were at greater risk for hospitalization. CONCLUSION: Rural residence was also associated with lower risk of more than 10 days of hospitalization and ICU admission. Nonwhite race and stroke were associated with higher use of all services. Rural nursing home residence is associated with lower likelihood of use of the most-intensive medical services at the end of life.

Aged↗
PubMed2005

Measuring pain presence and intensity in nursing home residents.

OBJECTIVES: To examine the extent of agreement between nursing home residents' (or their proxies') reports of pain presence and intensity as derived from an interview questionnaire and the Minimum Data Set (MDS) nearest to the interview date. DESIGN: Cross-sectional comparison of the 2 data sources on pain measurements. SETTING: Nursing homes included in evaluation projects of EverCare program and Minnesota Senior Health Options. PARTICIPANTS: Nursing home residents (n = 3100) were grouped based on the type of respondent answering the interview questionnaire: resident, family proxy, or staff proxy. MEASUREMENTS: We used kappa statistics and multinomial logit regression to examine agreement between the interview questionnaire and the MDS on pain presence and intensity. RESULTS: Presence of pain was reported 1.3 to 1.8 times more often on the questionnaire, depending on the respondent group. Agreement on the presence of pain was slight to fair (kappa = 0.17 to 0.28) between the MDS and the questionnaire. There was slight agreement on pain intensity (kappa = 0.13 to 0.18). The family proxy respondent group showed the largest discrepancy between questionnaire and the MDS in reporting of pain presence and intensity. The staff proxy respondent group had better agreement on pain intensity than did the other respondent groups, but it achieved only slight agreement (kappa = 0.18). CONCLUSIONS: Detecting and quantifying pain in nursing home residents is complex. Pain information is best obtained directly from residents; observations should be standardized. The MDS should be revised accordingly.

Aged, 80 and over↗