Documenting employee problems.
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Documentation↗
Biomedical subjects
R N White
Publications and source records attributed to R N White.
A practical curb-climbing aid for wheelchair-bound paraplegic persons (a progress report).
The article describes in detail an arrangement of trough-shaped wheel ramps and telescoping articulating control rods intended to allow a wheelchair-bound paraplegic to quickly ascend and descend single steps or curbs as high as 8 in. Data on testing of the system with trained and untrained able-bodied male and female subjects is reported; very limited testing with paraplegics suggests that their performance may almost equal that of the able-bodied. Advantages claimed include simplicity, light weight (8 lb), and low cost. Required modification of a standard wheelchair is limited to welding a simple bracket to the outer end of each extended main wheel axle. With ramps and control rods mounted ready for prompt use, chair width is increased by a total of 6 in. When the chair is used indoors or no curbs are expected, a paraplegic occupant, unaided, can dismount the ramps and rods and store them in a canvas bag hanging from the seat back. In this configuration the chair is only 1 in wider than its original unmodified width. Further testing with handicapped occupants is intended. Good arm, hand, and lower-back strength and movement, plus good coordination, are user requirements.
Architectural Accessibility↗
Surgical management of intrathoracic tracheal avulsion in cats: long-term results in 9 consecutive cases.
OBJECTIVE: To evaluate the outcomes and complications in a consecutive series of cats undergoing surgical repair of intrathoracic tracheal avulsion injuries. STUDY DESIGN: Retrospective clinical study. ANIMALS: Nine client-owned cats. METHODS: The medical records of all cats undergoing surgical repair of intrathoracic tracheal avulsion injuries from 1994 to 1997 were reviewed. The results of physical examination, laboratory evaluations, radiography, tracheoscopy, surgery, and patient follow-up were reviewed. Complications that arose and long-term outcome were noted. RESULTS: Long-term resolution of clinical signs was achieved in all cats after resection of the damaged trachea and its repair by end-to-end anastomosis. Follow-up periods ranged from 12 months to 2.9 years. One cat developed unilateral left-sided laryngeal paralysis 2 to 3 months after surgery; however, this was transient and resolved without intervention within 6 months of surgery. CONCLUSIONS: Surgical management of intrathoracic tracheal avulsion injuries in cats can be accomplished via a right lateral thoracotomy. Careful anesthetic technique is an integral part of the surgical procedure if a successful outcome is to be achieved. The incidence of both short-term and long-term complications was low. Care should be exercised to visualize and protect the left recurrent laryngeal nerve if postoperative iatrogenic unilateral left-sided laryngeal paralysis is to be prevented. CLINICAL RELEVANCE: This retrospective study documents the successful surgical correction of a series of clinical cases of intrathoracic tracheal avulsion in cats.
Animals↗
Sinography in the investigation of draining tracts in small animals: retrospective review of 25 cases.
The signalment, history, clinical signs, radiographic findings, and surgical findings of 25 consecutive animals that had sinography were reviewed to assess the contribution made by sinography to diagnosing and surgically managing draining tracts in small animals. There were 23 dogs and 2 cats; a variety of breeds and both sexes were represented (18 males, 7 females). Before referral the mean duration of clinical signs was 9.8 months (range, 0.5 to 33 months) and a mean of 2.0 surgical procedures (range, 1 to 5) had been performed. Sinuses occurred in a variety of locations, most commonly the neck (10), head (6), and paws (5). The most common cause was foreign body (15). Survey radiographs showed abnormalities in 21 of 26 (78%) instances, including soft-tissue swelling (11), chronic-appearing periosteal reaction on adjacent bones (5), possible foreign body (4), and gas in soft tissues (2). Sinography (or fistulography) enabled definite diagnosis of the cause of the sinus (or fistula) in 15 of 26 (58%) instances and demonstrated 13 of 15 foreign bodies (sensitivity 87%; specificity 100%). Tracts caused by an esophageal perforation and otitis media were also correctly shown by fistulography. In 11 animals, sinography indicated that the position or extent of the lesion was different to that expected on the basis of clinical signs and survey radiographs.
Animals↗
A method for controlling portal pressure after attenuation of intrahepatic portacaval shunts.
Two dogs had right divisional intrahepatic portacaval shunts within the right lateral lobe of the liver. In both dogs, an extrahepatic portacaval vascular anastomosis was created, using an autologous right external jugular vein graft. The intrahepatic shunts were completely attenuated using a prehepatic intravascular caval approach. The creation of the vascular graft allowed postattenuation rises in portal pressure to be controlled, preventing the development of life threatening portal hypertension. Both dogs recovered from the procedure. One dog is clinically normal and does not require medication (8 months postoperatively); the other dog was euthanatized 5 months after surgery because of renal failure. Scintigraphy studies, performed before surgery, showed significant shunting of portal blood away from the liver (shunt indices 65% and 59%), whereas, similar studies done 4 weeks afterwards showed almost normal portal blood flow (shunt indices 16% and 18%, respectively).
Animals↗
Vaginourethroplasty for treatment of urethral obstruction in the bitch.
Vaginourethroplasty was performed in six bitches with infiltrative, obstructive urethral disease. The initial clinical signs included dysuria, hematuria, pollakiuria, and stranguria. Diagnosis was based on the clinical signs, plain radiography and contrast vagino-urethrogram examination, and urethral biopsy. Five dogs were diagnosed as having urethral neoplasia; the sixth dog had granulomatous urethritis. In all six dogs, up to 50% of the urethra and the urethral tubercle were resected to ensure adequate surgical margins. One dog was euthanatized 4 months after surgery for recurrence of a transitional cell carcinoma at the surgical site. Long-term resolution of the problem (minimum of 12 months) was achieved in the other five dogs. The frequency of serious complications, including urinary incontinence and ascending lower urinary tract infections, was low.
Animals↗
Detection of portal blood flow using per-rectal 99mTc-pertechnetate scintigraphy in normal cats.
This study reports data obtained from per-rectal 99mTc-pertechnetate portal scintigraphy in normal cats. It examines the effects of chemical restraint and the methods employed in defining regions of interest (ROIs) on the shunt index derived from this data. Six normal cats were used for the study; all six were chemically restrained for imaging using propofol and later four of them were manually restrained for comparison. Portal blood flow was studied and the mean shunt index was found to be 5.9% +/- 3.9 when ROIs were operator defined and 9.2% +/- 4.4 when ROIs were defined using an isocontour program. In cats that were restrained using propofol and operator defined ROIs, the mean value for the time between detection of radioactivity in the liver and in the heart was 14 +/- 1 seconds.
Animals↗
Iron status and erythrocyte volume in dogs with congenital portosystemic vascular anomalies.
Microcytosis, hypochromasia, and low mean corpuscular hemoglobin are frequent hematologic abnormalities in dogs with portosystemic vascular anomalies (PSVA). The relationship of iron status to these abnormalities is unclear. We evaluated iron status and hematologic and biochemical parameters in dogs with congenital PSVA before (25 dogs) and after (11 dogs) partial ligation of the vascular anomaly. Serum iron concentration and total iron binding capacity were subnormal in 56% and 20% of dogs with PSVA, respectively. Transferrin saturation was normal in 68%, decreased in 20%, and increased in 12% of the dogs. Plasma ferritin concentration was either normal (56%) or high (44%), and was not associated with increases in ceruloplasmin concentration. Hepatic stainable iron was increased in 10 of 16 dogs. Mean corpuscular volume (MCV), mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were decreased in more than 60% of dogs with PSVA. Serum biochemical abnormalities included high bile acid concentration and alanine transaminase (ALT) and alkaline phosphatase (ALP) activities; and low urea, creatinine, cholesterol, and total protein concentrations. Serum iron concentration and clinical status (normal or PSVA) significantly influenced MCV (P = .003 and P < .001, respectively), whereas age, ceruloplasmin, ferritin, cholesterol, bile acids, and total iron binding capacity did not. Partial ligation of PSVA was associated with resolution of clinical signs and the return to normal of iron status and all clinicopathologic abnormalities, except total fasting bile acid concentrations. These findings indicate that iron status is frequently abnormal in dogs with PSVA and that low serum iron concentration appears to be related to the development of microcytosis. The normalization of iron status and clinicopathologic abnormalities after treatment suggests that they are direct consequences of PSVA.
Alanine Transaminase↗
Real-time flexible preventive maintenance scheduling.
There are still obstacles to overcome as we enter the programming phase of this project. We envision an automated system, similar to an expert system, that performs the interval/history analysis and makes the changes. Initially a field will need to be added to the inventory to denote whether a device belongs to one of the previously described groups that are exempt from interval changes. An intermediate step will be the formatting of a periodic report showing equipment that meets the change criteria as described in the two rules. For now, the actual changes would be reviewed and made by our management and technical staff. This report would be retained as documentation of the basis for each change, for our own benefit and to meet JCAHO requirements. We are still discussing whether the repair count should include all repairs (user error, abuse, unpredictable failure, etc.) or just those that are "significant and preventable" and could have been averted by PM. This is perhaps a question whose answer might vary from hospital to hospital, depending upon size and patient mix. With more emphasis being placed on process outcomes, on quality of work, and on getting the most benefit for our efforts, we believe our flexible, real-time PM scheduling program is a major step in the right direction. It is outcome-driven and it focuses resources where they are needed the most.
Appointments and Schedules↗