Biomedical subjects
L L Wilson
Publications and source records attributed to L L Wilson.
Risk management: how doctors, hospitals and MDOs can limit the costs of malpractice litigation.
The concerns of doctors regarding their risk of malpractice litigation and the costs of indemnity premiums are resulting in calls for legal reforms to limit their liability. We do not believe these returns will be successful either practically or politically. Medical defence organisations often attempt to vindicate the doctor rather than settle the dispute--a strategy that might be morally satisfying to doctors but which is also more expensive than the approach taken by commercial insurers. Risk management--the activities required to minimise financial loss for hospitals and the doctors who work in them--is disorganised or absent in most hospitals. Hospital managers lack incentives for risk management because the costs of litigation do not come out of their budgets. The five mainstays of effective risk management are credentialling of medical staff, incident monitoring and tracking, complaints monitoring and tracking, infection control, and documentation in the medical record. The implementation of risk management activities in hospitals is the immediate responsibility of hospital management, not doctors.
The quality manager.
In the entire quality management jigsaw, no one piece is more important than an adequately trained and qualified quality manager. The terms quality co-ordinator and quality improvement officer do nothing to assist the understanding of this vital member of a hospital's staff. This paper describes the qualifications and role of a quality manager and emphasises that few such qualified quality managers exist in Australian hospitals.
Characteristics of veal calves upon arrival, at 28 and 84 days, and at end of the production cycle.
Holstein bull calves arriving at five special-fed veal farms (eight production groups) were scored for various physical condition traits and blood-sampled within 2 h after arrival and at 28 d, 84 d, and 1 wk prior to slaughter at 116 to 143 d. Of 1179 total calves in the production groups, 758 calves were scored and evaluated. Blood cell analyses (red and white blood cell counts, hemoglobin, and packed cell volume) were conducted at all four sampling times; total serum protein concentration was obtained at 0 and 28 d. The study was initiated in autumn and ended the following autumn. Mean initial and final body weights were 46.3+/-0.17 and 209.7+/-0.77 kg; mean mortality was 2.5%. Average daily gain of the eight groups ranged from 1.23 to 1.70 kg/d. Subjective scores of 5 = excellent to 1 = very poor condition were used to evaluate 16 different physical condition characteristics. With the exception of leg joint, hoof, and foot scores, most of the physical condition scores exhibited improvement during the first 28 d. Foot and leg impairments did not appear to hinder the ambulatory ability of the calves during the production period. Physical condition scores at d 0 and 28 were generally not related to numbers or types of medical treatments (enteric, respiratory, other, or total) or to average daily gain during the production period. Means for most erythrocytic and leukocytic traits upon arrival (d 0) were within normal ranges, although 27.4% of the calves were clinically or marginally anemic. Final mean hemoglobin and packed cell volume were 8.53 g/dl and 26.1%. Forty-three percent of the calves at d 0 were colostral deficient, assuming that total serum protein concentrations of <5.5 g/dl indicate colostral deficiency. No blood trait was consistently correlated with body weight gain when gain during the production period was divided into quartiles and the blood traits were averaged by gain quartile. Calves in the lowest serum total protein quartile (mean 4.58 g/dl) had more respiratory and total medical treatments than quartiles with higher total protein means. Dairy bull calves arriving at veal production units after transporting from the dairy farm to the auction market (or other collection facility) have several physical impairments. However, most of these physical impairments are improved early in the veal feeding period and are not generally related to subsequent growth rate or medical treatment.
Implant sequence effects in intact male Holstein veal calves: live and slaughter traits.
Seven sequences of growth promotant implants were used in special-fed intact male Holstein veal calves (n = 443). Calves received implants 4 d after arrival at the veal barn, 42, and 84. The following implants were used: placebo (0), Z (36 mg zeranol), ET (20 mg estradiol, 200 mg testosterone), EP/2 (10 mg estradiol, 100 mg progesterone), EP (20 mg estradiol, 200 mg progesterone), and EBA (24 mg estradiol, 120 mg trenbolone acetate). The following sequences were compared: 0-0-0 (negative control), 0-ET-ET, Z-ET-ET, 0-EP-EP, Z-EP-EP, 0-EP/2-EBA, and Z-0-EBA. From 0 to 42 d, Z implants increased (P<.05) ADG by 3.4% compared to placebo. However, implant schemes without an initial Z implant (0-ET-ET and 0-EP-EP) had higher (P<.05) mean ADG for the period from d 42 to 84. From 84 d to the end of the experiment, only the 0-EP/2-EBA treatment increased (P<.05) ADG compared to 0-0-0. Over the entire trial 0-ET-ET, 0-EP-EP, Z-EP-EP, and 0-EP/2-EBA implant sequences increased (P<.05) ADG by 3.2, 3.2, 2.4, and 4.7%, respectively, compared to the 0-0-0 sequence. Blood traits measured within 2 wk before slaughter were not affected by implant sequence, except that sequences with EP had higher (P<.05) leukocyte counts than were observed for the other sequences. Testicular weight was less (P<.01) for all of the implant sequences than for the negative control and less (P<.05) for Z-ET-ET than for 0-ET-ET, 0-EP-EP, 0-EP/2-EBA, and Z-0-EBA. The type and frequency of medical treatments did not differ among implant sequences for any of the 42-d phases, or over the entire trial. Generally, the growth promotant implants currently approved for beef cattle resulted in approximately 50% of the increase in growth rate in Holstein intact bull calves, as has been observed in beef-type steers or heifers.
Implant sequence effects in intact male Holstein veal calves: carcass characteristics.
Seven sequences of growth promotant implants were used in intact male Holstein veal calves (n = 443). Implants were administered on d 0 (within 4 d after arrival at the veal barn), 42, and 84. The implants used were placebo (0), Z (36 mg zeranol), ET (20 mg estradiol, 200 mg testosterone), EP/2 (10 mg estradiol, 100 mg progesterone), EP (20 mg estradiol, 200 mg progesterone), and EBA (24 mg estradiol, 120 mg trenbolone acetate). The following sequences were compared: 0-0-0 (negative control), 0-ET-ET, Z-ET-ET, 0-EP-EP, Z-EP-EP, 0-EP/2-EBA, and Z-0-EBA. Sequences 0-EP-EP, Z-EP-EP, and 0-EP/2-EBA increased (P<.05) carcass weight from 3.3 to 3.9% compared to nonimplanted controls. There were no differences (P>.05) in percentage of carcass weight accounted for by the fore vs. rear halves of carcasses, suggesting there was no difference in the distribution of weight. Although there were differences in longissimus area, the results were not consistent, except that there was a trend for longissimus area to be increased by the use of estrogenic-androgenic implants (ET and EBA). There were no differences among implant sequences for carcass conformation, fat cover, muscle texture, marbling/ feathering, muscle color, or muscle chemical composition. Of four implant sequences (0-0-0, 0-ET-ET, 0-EP-EP, and 0-EP/2-EBA) tested for differences in Warner-Bratzler shear force tenderness, the latter two sequences averaged higher (P<.05) for shear force than did the negative control. These results suggest that aggressive implant strategies in young, intact Holstein bull calves (raised as veal) have minimal effects on carcass characteristics.
Effects of individual housing design and size on behavior and stress indicators of special-fed Holstein veal calves.
The objectives of this study were to determine effects of housing design (calves tethered in open stalls vs untethered in individual pens) and widths of 56, 66, and 76 cm (2 x 3 factorial arrangement of treatments) on indicators of stress and behavior in special-fed veal calves. Three production cycles (groups) were used, each with 36 Holstein bull calves. Calves (n = 108) were randomly allotted to treatments upon arrival at the facility. Blood samples were collected four times (wk 4, 9, 13, and 18) during the 18-wk production cycle. Blood serum values for cortisol and alpha1-acid glycoprotein (AGP) exhibited few treatment differences. Blood leukocyte differential counts at 4 and 18 wk (segmented neutrophils [N], banded neutrophils, lymphocytes [L], basophils, and the N:L ratio) were not different (P > .05) among housing designs or widths. However, there were differences (P < .05) in monocytes and eosinophils during the 28-d period after arrival; calves in stalls 76 cm wide had the greatest percentage of both leukocytes, and calves in the 66-cm stalls had the lowest monocyte percentage. Calves were recorded on videotape during wk 4, 13.5, and 18 to determine frequencies and durations of postures and behaviors (e.g., lying, standing, chewing, tongue playing, grooming, and investigative activities). There were no consistent differences (P > .05) in postures or behaviors among calves in different housing designs or widths. Calves spent approximately 71 and 31% in lying and standing positions, with no preference for the right or left side while recumbent. There was a tendency for calves in wider stalls or pens at wk 9 and 18 to exhibit more self-grooming activities. Tongue playing and investigative and chewing activities were exhibited in all treatments, but no differences (P > .05) were observed. However, calves housed in the 56-cm pens displayed difficulty in changing from lying to a standing position and were unable to extend one or more legs while recumbent. Even though there were few differences in behavioral, physiological, growth, or anatomical traits in this study, further increases in age and(or) weight of finished calves will require a reassessment of the appropriateness of individual veal calf housing design and dimensions.
Quality and its measurement.
The concept of assessing or measuring the quality of clinical care has to date not been an integral part of Australian hospital culture. Assessing and measuring quality of clinical care in a way that enables it to be quantified is an essential ingredient for quality improvement. While indirect measures, familiar enough in hospitals, are available they are rarely seen as techniques for assessing the quality of care. Technology that has now been available for the past 10-15 years involves making judgements by using medical record data compared with a matrix of outcome and process criteria. This approach makes quantification of quality possible. The methodology employed, Structured Quality Review (a term devised by Wilson and Goldschmidt), is described. Quality Standards in Medicine, a commercial product embracing Structured Quality Review, is described as a tool for assessing the quality of clinical care and measuring quality improvement.
Effects of individual housing design and size on special-fed Holstein veal calf growth performance, hematology, and carcass characteristics.
The objective was to evaluate the effects of individual housing design (stalls vs pens) with widths of 56, 66, and 76 cm (2 x 3 factorial treatment arrangement) on growth, hematology, cleanliness, ambulation, abomasal hairball, and carcass measurements. Three groups of 36 Holstein bull calves (n = 108) were randomly allotted within group to treatments. There were no effects (P > .05) of housing design, width, or two-way interactions for BW, ADG, carcass weight, or dressing percentage. Blood samples were collected at approximately 33-d intervals. Mean values for hemoglobin, hematocrit, white blood cell count (WBC), and red blood cell count (RBC) were not different among treatments (P > .05), with the exception of d 28 hemoglobin, which was greater in the calves housed in 66-cm vs 76-cm stall. There were differences (P < .05) due to design and design x width effects for hind-quarter cleanliness; manure accumulation tended to be greater in pens vs stalls as width increased. There were increases (P < .05) in left front knee swelling scores as stall or pen size decreased; no important differences were observed in ambulatory ability among treatment groups. There were design effects (P < .05) for excitability scores, with calves in stalls being more excitable. There were no important treatment effects (P > .05) for liver, spleen, and lung condition, number of abomasal hairballs, or 0- and 24-h after slaughter flank or brisket color. These results indicate that housing designs and widths did not affect veal calf growth performance, WBC, RBC, hemoglobin, hematocrit, ambulation, or muscle color.
A comparison of milk protein sources in diets of calves up to eight weeks of age.
Four dietary ratios of dried skim milk and whey protein concentrate as the primary protein sources in milk replacers were evaluated using digestibility, growth performance, health characteristics, and blood measurements of calves that were 12 to 36 h of age to 8 wk of age. Sixteen Holstein bull calves, housed individually within an environmentally controlled facility, were randomly allotted to diets. Protein sources in the milk replacer were expressed as ratios (percentages) of dried skim milk to whey protein concentrate in diet 1, 100:0; diet 2, 67:33; diet 3, 33:67; and diet 4, 0:100. There were no significant differences in the mean number of days that calves scoured. Apparent biological value and N retention differed among diets over all weeks. Apparent digestibilities and biological values (percentages) over all weeks were diet 1, 82.50 and 67.71; diet 2, 82.85 and 70.15; diet 3, 83.82 and 67.46; and diet 4, 84.03 and 72.25, respectively. Diets varying in the ratio of dried skim milk to whey protein concentrates had no effect on health, growth, or apparent digestibilities in Holstein calves up to 8 wk of age.
Body measurements and body weights of special-fed Holstein veal calves.
Changes in various body dimensions of special fed veal calves were measured and correlated with body weight (BW) at three specific times during the growth period as contemporaries and over the entire feeding period as noncontemporaries. The calves (n = 826) were weighed and measured for body length, heart girth, wither height, and hip width at 2, 8, and 16 wk after arrival at the veal farms. Each of the four measurements, expressed as ratios to BW, decreased over the feeding period; decline in the ratio of hip width to BW was less than the decreases in the other ratios. Linear models to predict contemporary BW within each age group based on all body measurements were developed; R2 values for models for 2, 8, and 16 wk were 0.72, 0.77, and 0.76, respectively. Within each of the three age classes, a model including linear, quadratic, and cubic terms of heart girth yielded the highest R2 values of any single measurement (0.46, 0.63, and 0.67 for data for 2, 8, and 16 wk, respectively). The addition of heart girth as a second linear measurement to three-term models containing only one other measurement increased the R2 more than did the addition of any other single linear expression, except for the equation based on body length. When all records on all calves were combined and the observations were treated as noncontemporaries, the R2 was 0.97 for a linear model that included all four measurements. However, this R2 was essentially the same as the R2 from a three-term model using only heart girth. The cubic models in descending order of R2 values were heart girth, body length, hip width, and wither height. These results suggest that BW can be predicted accurately in a group of noncontemporary male veal calves ranging from 2 to 16 wk after the start of the feeding period. However, the BW of calves within contemporary groups (2, 8, and 16 wk) cannot be predicted accurately according to R2 values.
Credentialling of hospital medical staff.
This article is a brief account of what is meant by credentialling and what hospitals have to do to make credentialling an effective, rather than a token, exercise. Credentialling is a key element in reducing the risk of litigation for hospitals and the doctors who work in them. This article provides a history of this initiative in Australia and describes the context in which many hospitals find themselves from time to time. The relationship between appointing doctors and credentialling them is discussed and emphasis is placed on the structured process that is essential if difficulties, including legal ones, are to be avoided. A brief account of the various methods used is given.
Communication in hospitals: a quality management issue.
Explore the source record for details and available documents.
Blood, growth, and other characteristics of special-fed veal calves in private cooperator herds.
The objectives of this study were to determine the mean values for mortality, blood, and growth traits and the correlations among blood and growth traits on privately owned farms producing special-fed veal. Mortality percentages were available on 13 groups of special-fed veal calves (n = 1403) from four farms; growth and some blood traits were available on 9 groups from four farms (n = 975). Mean mortality percentages for periods 0 to 2, 2 to 7, and 7 to 16 wk, and over 16 wk were 1.0, 1.0, 1.0, and 3.1%, respectively. Means for average daily gain for 2 to 7 wk were 1.37 +/- .008 kg and for 7 to 16 wk were 1.52 +/- .001 kg. When calves arrived at the veal farm, total plasma protein averaged 6.2 +/- .05 g/dl. Examination of total plasma protein upon arrival of calves indicated that 81% of the calves had received colostrum. The base level indicating colostral deficiency was < 5.5 g/dl of total plasma protein; 51% of the calves had total plasma protein > 6.0 g/dl at arrival. Mean hemoglobin concentrations at arrival and at 2, 7, and 16 wk were 11.1 +/- .15, 10.6 +/- .18, 9.2 +/- .14, and 7.8 +/- .13 g/dl, respectively. Means for hemoglobin were generally higher than previously reported for special-fed veal calves reared in individual stalls. Hemoglobin and red blood cell counts were correlated positively with 16-wk average daily gain and body weight, and midtrial white blood cell counts were correlated negatively with average daily gain and body weight from 2 to 7 wk; there were no other significant relationships between blood traits and growth performance measures.
Clinical experiences for BSN students in a satellite telecommunication project.
Explore the source record for details and available documents.
Concerns about bovine somatotropin.
Explore the source record for details and available documents.
Assuring a residue-free food supply: special-fed veal.
The importance of extra-label drug use is discussed as this provision relates to special-fed veal production. Presently, there are 3 drugs approved and labeled for use in veal calves. Other medications and pharmaceuticals required to maintain and enhance calf health and well-being must be provided by consulting veterinarians under extra-label drug use provisions. Although special-fed veal has recently been reclassified as a minor use species (within Inter-Regional-4 designation), a sufficiently broad spectrum of safe and effective drugs will probably not be approved for use in veal calves within an acceptable and reasonable period. The use and practice of extra-label drug use provisions have apparently not represented a food safety hazard if the FSIS National Residue Program results are considered a measure of relative food safety. In 1988, the percentage of violative residues (based on all contaminants including antibiotics) was 3.3%; in 1991, this percentage was 0.24%. If existing extra-label drug use provisions were antagonistic with continuing efforts to enhance food safety, the percentage of violative residues would not have decreased. Perhaps not coincidentally, a comprehensive Veal Quality Assurance Educational Program (VQAEP) also was initiated in 1988. This industry-funded, industry-directed program is comparable to QAEP or total quality management programs conducted in other species and production systems. Over 80% of all US special-fed veal producers and others involved in the veal industry have participated in VQAEP seminars since 1988, with repeated attendance by many producers. Although the VQAEP has been effective, the goal of this and other programs must be zero violative residues.
Effects of different doses of zeranol on growth, hemoglobin, and carcass traits in veal calves.
Effects of different doses of zeranol on ADG, hemoglobin (Hb), feed efficiency (FE), and carcass traits were evaluated in special-fed veal calves in two trials. On d 0, calves were implanted subcutaneously in the middle third of the ear with either 0 (control, placebo pellet), 12, 24, 36, or 48 mg of zeranol. Trial 1 was conducted from February through May 1990 with 120 Holstein bull calves (17 to 21 d of age on d 0) and Trial 2 was conducted from May through August 1991 with 100 Holstein bull calves (24 to 28 d of age d 0). Calves were fed on an individual calf basis. Calves in Trial 1 that were implanted with 48 mg of zeranol had improved FE (P < .05) and ADG (P < .05) during Period 1 (0 to 43 d). No significant differences in ADG or FE were observed among treatments in Trial 2. Hemoglobin levels at slaughter averaged 7.88 +/- .096 and 8.19 +/- .149 g/dL over all treatments for Trials 1 and 2, respectively. The only postslaughter trait affected by zeranol dose was testicular weight. In both trials, testicular weight at slaughter decreased (P < .05) with increasing doses of zeranol. Dressing percentage tended to be higher for 48-mg implants than for controls but the difference was not significant. There were no significant zeranol dose effects on longissimus muscle area, flank color, carcass conformation, or percentage of fore- vs hind-quarter weight. These results indicated that higher doses of zeranol improved ADG and FE during the first 6 wk after the trial period (to 8 wk of age), decreased testicular weight, and increased hide-on carcass dressing percentage for calves implanted with 48 mg of zeranol compared with those that received 0 mg of zeranol.