Immediate physical therapy in dogs with rupture of the cranial cruciate ligament submitted to extracapsular surgical stabilization / Fisioterapia imediata em cães com ruptura do ligamento cruzado cranial submetidos à estabilização extracapsular

The study evaluated the influence of immediate physical therapy on the functional recovery of hind limbs of dogs with experimental cranial cruciate ligament rupture which underwent surgical extracapsular stabilization as well as to verify its interference in joint stability. Eight dogs were randomly divided into two groups: GI (control) (n=4) and GII (physical therapy) (n=4). The dogs in GII underwent the following therapeutic treatments in the postoperative period: cryotherapy, passive joint movement, massage, passive straightening, neuromuscular electrical stimulation, hydrotherapy (bath and aquatic mat) and therapeutic exercises. We performed evaluations of the thigh circumference, goniometry, X-ray, and knee stability (drawer test). Results did not demonstrate a significant difference between the groups nor between different post-operative times. Regarding gait analysis, we found that the 4 dogs in GI remained in degree 3 of lameness 45 and 90 days postoperatively. However, in GII, one dog remained in degree 3 45 and 90 days after surgery; one dog changed from degree 3 to 4 90 days after surgery and the other 2 dogs changed from degree 3 to 5 90 days after surgery. It is possible to conclude that dogs with CCL rupture that undergo immediate physical therapy demonstrate better results in regards to functional gait recovery. The therapeutic modalities used in the immediate post-operative period did not cause instability of the operated knee. Further studies are needed with a larger number of dogs to indicate the immediate physical therapy in dogs with CCL ligament rupture which underwent extracapsular stabilization.

Avaliou-se a influência da fisioterapia imediata na recuperação funcional do membro pélvico de cães com ruptura experimental do ligamento cruzado cranial (LCC) submetidos à estabilização cirúrgica extracapsular e verificou-se sua interferência na estabilidade articular. Foram utilizados oito cães distribuídos, aleatoriamente, em GI ou controle (n=4) e GII ou fisioterapia (n=4). Nos cães do GII, as modalidades terapêuticas empregadas no pós-operatório foram crioterapia, movimentação passiva da articulação, massagem, alongamento passivo, estimulação elétrica neuromuscular, hidroterapia (ducha e esteira aquática) e exercícios terapêuticos. Foram realizadas avaliações da circunferência da coxa, goniometria, radiografias e estabilidade do joelho (teste de gaveta) e os resultados não demonstraram diferença significativa entre os grupos e nos diferentes tempos de pós-operatório. Na análise da marcha, aos 45 dias, todos os cães do GI e do GII apresentaram grau 3 de claudicação. Aos 90 dias, quatros cães do GI permaneceram em grau 3 e no GII, um cão em grau 3, um em grau 4 e dois em grau 5. Conclui-se que cães com ruptura de LCC submetidos à fisioterapia imediata demonstraram melhores resultados quanto à recuperação funcional da marcha e as modalidades terapêuticas empregadas no pós-operatório imediato não ocasionaram instabilidade do joelho operado. Novas pesquisas são necessárias com um maior número de cães para poder indicar a fisioterapia imediata em cães com ruptura do ligamento cruzado cranial submetidos à estabilização cirúrgica extracapsular.

Recuperação funcional em cães com doença do disco intervertebral toracolombar sem percepção à dor profunda: 37 casos (2002-2010) / Functional recovery in dogs with thoracolumbar intervertebral disk disease without deep pain perception: 37 cases (2002-2010)

O objetivo deste trabalho foi avaliar a recuperação funcional de 37 cães com diagnóstico de doença do disco intervertebral (DDIV) toracolombar, sem percepção da dor profunda superior a 48 horas e não submetidos ao tratamento cirúrgico. Os dados identificados foram: raça, idade, sexo, localização da lesão, perda da percepção da dor profunda, duração dos sinais clínicos, recuperação funcional, retorno da percepção da dor profunda, recidivas, eutanásias ou morte. Foi observada recuperação funcional em 11 cães (55 por cento), sendo seis deles entre 30 e 60 dias após o início dos sinais clínicos. Dos onze cães que tiveram recuperação funcional satisfatória, dois (18 por cento) não tiveram retorno da percepção à dor profunda. Pode-se concluir que cães com diagnóstico de DDIV sem percepção à dor profunda superior a 48 horas e não submetidos ao tratamento cirúrgico podem apresentar recuperação funcional satisfatória e são necessários, no mínimo, 30 dias do início dos sinais clínicos para estabelecer um prognóstico quanto ao retorno dos movimentos voluntários.

The aim of this study was to evaluate functional recovery in 37 cases with diagnostic of thoracolumbar intervertebral disk disease in dogs without deep pain perception (more than 48 hours) and did not underwent surgical treatment from 2002 to 2010. The following data were obtained: Breed, age, sex, neuroanatomic localization, loss of deep pain perception, duration of clinical signs, functional recovery, deep pain recovery, recurrence and euthanasia or death. A satisfactory functional recovery was observed in 11 dogs (55 percent), mostly between 30-60 days after the beginning of the clinics signal (six dogs). Two of 11 dogs with satisfactory functional recovery did not recovered deep pain perception. The results showed that dogs with presumptive diagnoses of thoracolumbar intervertebral disk disease with more than 48 hours and that did not underwent surgical treatment are capable of a functional satisfactory recovery and should be waited 30 days after clinical signs begin to establish a prognosis on the recovery of voluntaries movements.

Evaluating laboratory performance on quality indicators with the six sigma scale.

CONTEXT: Laboratory quality indicator data, most often presented and reported as a percentage of variance, may be misleading, inasmuch as variances, and therefore percentages, appear to be low. METHOD: Current data from laboratory quality indicators and national data derived from several years of College of American Pathologists Q-Probes studies were normalized to parts-per-million defects, as commonly practiced in the manufacturing and service industries for benchmarking performance. RESULTS: Laboratory data in parts-per-million defects demonstrated opportunities for significant improvements in laboratory performance across the total testing process. CONCLUSIONS: Historical quality assurance programs do not appear to be significantly improving the total testing process. Manufacturing and service industries are using quality systems strategies, such as ISO 9000 and the Baldridge Award Criteria, to effect improvements in both productivity and cost. Quality system solutions for performance improvement may provide a systematic approach to improving laboratory performance.

Integrating quality management into clinical systems: tools for achieving clinical integration.

This article describes the use of quality systems as a tool for managers of health-care clinical services to establish a common framework across the different disciplines in the continuum of care. Quality systems used internationally in the manufacturing and service sectors are applicable to multidisciplinary clinical systems management because the essential elements of quality are universal. These elements have been redefined into health-care terminology and can be used by clinical systems managers as a basis for implementing a quality system. The structure for documents in a quality system also has been adapted to health care and allows for a common set of quality policies and processes to unify the different clinical services. By using a consistent quality management approach and documentation, managers can transcend technical operational differences and ensure effective clinical integration.

Quality pays--in every business!

For the past few years, blood banks within and outside of hospitals have been required to develop a documented quality assurance/quality improvement program to comply with regulator guidelines and accreditation standards. Concerns have been raised that the cost of compliance could exceed any plausible return on this investment. Unfortunately, little data exist in blood bank literature or are currently being captured to support or refute this contention. This article describes an approach for capturing the cost of quality based on models from the manufacturing industry, suggests how blood banks could document the cost and benefit of their quality efforts and presents some unpublished data on the impact of tracking the cost of poor quality in one blood bank.

Tools for improving quality in the transfusion service.

The initiation of testing for antibody to HIV in the donor blood supply opened a new era of operational, safety, and legal complications for facilities in which transfusion medicine is practiced. Mounting dissatisfaction with increasing incidents of questionable release of blood forced regulators to take tougher actions. Blood banks were surprised and concerned that their practices could no longer effectively ensure blood safety. Concurrently, US businesses and manufacturers were looking for new answers regarding the question of improved quality in goods and services. The progression from quality control to quality systems is reviewed. In addition, where transfusion medicine is today, and where it has yet to go, as well as the tools available to make the transition, are discussed.

A quality system for transfusion medicine ... and beyond.

When more than 500 serious blood banking problems arose in a recent 12-month period, the FDA and AABB knew it was time for a change. The quality system they developed can help the staff of any lab section stand up to the toughest inspection.

Randomized comparison of intravenous versus intracoronary streptokinase for myocardial infarction.

The efficacy of intravenous (i.v.) thrombolytic therapy has not been firmly established in comparison with the intracoronary (i.c.) route of administration. In a randomized trial of 28 patients who underwent angiography before and during i.v. and i.c. administration of streptokinase (STK), recanalization was achieved in 73% of patients who received the drug by the i.c. route, compared with 62% of patients who received the drug by the i.v. route (difference not significant). Reopening took 28 minutes for i.c. STK and 39 minutes for i.v. STK. Patients in whom recanalization was successful using either route of administration had shorter euglobulin lysis times and lower fibrinogen levels than did patients in whom it was not successful (p less than 0.05). Bleeding complications were closely correlated with heparinization after thrombolysis rather than with STK itself. These results in a limited patient series suggest that early administration of i.v. STK in the emergency department may yield recanalization rates similar to those for the i.c. route and may benefit myocardial preservation by restoring flow much earlier.

Prolongation of the human cardiac monophasic action potential by sotalol.

Sotalol and propranolol are nonselective beta-adrenergic blocking agents. Sotalol at low concentration, unlike propranolol, prolongs the duration of the transmembrane action potential. In a double-blind study, the electrophysiologic effects of intravenous sotalol (0.30 or 0.60 mg/kg; n = 9) were compared with intravenous propranolol (0.15 or 0.20 mg/kg; n = 8) in 17 patients with use of bipolar suction electrodes in the right atrium and right ventricle to determine whether sotalol prolongs the monophasic action potential duration in man. After administration of sotalol, there were significant increases (paired t test) in the Q-T interval (p less than 0.001), right atrial effective refractory period (p less than 0.05), right ventricular effective refractory period (p less than 0.005), right atrial monophasic action potential duration at 90% repolarization (p less than 0.01), and right ventricular monophasic action potential duration at 90% repolarization (p less than 0.005). Prolongation of the monophasic action potential duration was dependent on plasma sotalol concentration. There were no significant changes in these variables after propranolol. The spontaneous cycle length and Wenckebach cycle length increased significantly in both groups, and the mean blood pressure decreased in both, although not significantly after propranolol. In summary, sotalol but not propranolol prolonged atrial and ventricular effective refractory periods and lengthened the monophasic action potential and the Q-T interval of human myocardium after intravenous infusion. The ability to acutely prolong repolarization at therapeutic plasma concentration is unique among known competitive beta-adrenergic receptor antagonists.