Technical note: Digital quantification of eye pigmentation of cattle with white faces.

Cancer of the eye in cattle with white faces occurs less frequently in cattle with pigmented eyelids. Corneoscleral pigmentation is related to eyelid pigmentation and occurrence of lesions that may precede cancer. Objectives of this study were to assess 1) variation in the proportion of eyelid and corneoscleral pigmentation in Hereford, Bos taurus, and Bos indicus crossbreds and 2) the occurrence of lesions with the presence of pigmentation in those areas. Hereford and Bos indicus crosses (Brahman or Nellore with Angus and Hereford and straightbred Brafords) and Bos taurus crosses (Angus-Hereford) were included in the study (n = 1,083). Eyelid pigmentation proportions were estimated by pixel quantification and were evaluated as total proportions and for upper and lower eyelids distinctly for each eye. Fixed effects included breed type, age categories, and sex of the animal. Lesion presence (1) or absence (0) was obtained by visual appraisal of image and was assumed to be binomially distributed. Eyelid pigmentation proportions (overall, upper, and lower eyelids) for Hereford ranged from 0.65 ± 0.03 to 0.68 ± 0.03 and were significantly lower than Bos indicus (range from 0.93 ± 0.02 to 0.95 ± 0.02) or Bos taurus (ranged from 0.88 ± 0.02 to 0.92 ± 0.02) crosses. Corneoscleral pigmentation in Hereford cows (0.17 ± 0.06) did not differ (P = 0.91) from Hereford calves and yearlings (0.16 ± 0.07). Bos indicus and Bos taurus crossbred cows had larger corneoscleral pigmentation (0.38 ± 0.05 and 0.48 ± 0.04 for left eyes and 0.37 ± 0.05 and 0.53 ± 0.04 for right eyes, respectively) than all calves (P < 0.001), and their corneoscleral pigmentations were greater than that of Hereford cows (P < 0.003). Bos indicus and Bos taurus cows had greater proportions of left eye corneoscleral pigmentation (0.38 ± 0.05 and 0.48 ± 0.04, respectively) than Hereford cows (0.17 ± 0.06) and all young animal breed types (P < 0.05). Right eye proportions differed for all cow groups (P < 0.05; 0.53 ± 0.04, 0.37 ± 0.05, and 0.17 ± 0.06). Among calves and yearlings, Hereford had a lower right eye corneoscleral pigmentation proportion (0.16 ± 0.07) than Bos taurus (P = 0.02). The lesion proportion for Hereford (0.08 ± 0.03) was significantly greater than that of either Bos indicus (0.01 ± 0.005) or Bos taurus (0.01 ± 0.003). Crossbreeding with Bos taurus or Bos indicus animals appears to increase eye pigmentation, which may help reduce the occurrence of cancer in eyes of cattle with white faces.

Rubeosis of the iris in proliferative vitreoretinopathy.

PURPOSE: The authors report the findings and clinical course of rubeosis in patients with essentially reattached retinas after vitrectomy and silicone oil for proliferative vitreoretinopathy (PVR). METHODS: From 1989 on, the authors prospectively noted all patients with rubeosis and with attached retina posterior to the buckle after vitrectomy and silicone oil for PVR as a complication of rhegmatogenous retinal detachment. RESULTS: Thirty-eight patients (38 eyes) were studied. Mean follow-up after the appearance of rubeosis was 27 months (range, 6-66 months) in all patients, peripheral residual retinal detachment coexisted with rubeosis. Hypotony occurred in six patients. Cyclocryocoagulation for neovascular glaucoma had been performed in four patients. The peripheral detached retina was removed in 16 patients, resulting in total disappearance of rubeosis in 7 patients and regression in 4 more patients. In patients with visible, nonradially oriented iris vessels, the authors found vessels in the anterior chamber angle crossing the trabecular meshwork. The frequently present anterior synechiae in association with vessels never totalled more than three clock hours (except in the four patients who underwent cyclocryocoagulation). CONCLUSIONS: Detached retina peripheral to dense photocoagulation scars was present in all of these patients. Removal of this peripheral detached retina was statistically significantly associated with disappearance of rubeosis, which suggests that the peripheral detachment was a causative factor. Extensive anterior synechiae are not formed frequently in this condition. This may explain the infrequent (11%) occurrence of neovascular glaucoma. However, hypotony is more frequent.

Continuous quality improvement at work: the first team--Part II.

This second part of a two-part article follows Cape Canaveral Hospital's first continuous quality improvement team through the processes of goal setting, system analysis, data gathering, and problem resolution in the area of patients' assignment to observation status. The team's primary goal was data-driven improvement. As detailed here, the team's solution to improve the use of observation status is both time-efficient and offers opportunities for financial gain.

Continuous quality improvement at work: the first team--Part I.

This first part of a two-part article describes the process of making the theory of continuous quality improvement a reality. The successes, the failures, and the struggles of the first team effort are outlined. The evolution of the team approach is captured from the perspectives of the quality directors, the facilitator, and the team leader. The team project discussed in this article focused on inpatient admissions and the assignment of patients to observation status.

A mydriatic eye-drop combination without systemic effects for premature infants: a prospective double-blind study.

Eye drops used for diagnostic mydriasis may produce systemic side effects in preterm infants. Studies on the pupil dilating and systemic effect of various mydriatic agents yielded conflicting results. We conducted a prospective randomized double-blind study on the systemic effect of two mydriatic eye-drop combinations. Thirty-nine preterm infants were randomly assigned to two groups. An eye-drop combination of 2.5% phenylephrine and 0.5% tropicamide (group D) was compared with the combination of 0.5% cyclopentolate and 0.5% tropicamide (group F). Either eye-drop combination was followed by 0.5% tropicamide given 20 minutes later. Heart rate (HR) and the systolic, mean, and diastolic blood pressure (BP) were recorded before and after eye-drop instillation and after ophthalmoscopy. A control session with NaCl eye drops was added for each infant. A significant increase of BP and HR peak values was observed within 7 to 10 minutes after the cyclopentolate/tropicamide combination only. On the other hand, the mydriatic effect of the phenylephrine/tropicamide combination was significantly superior to that of the cyclopentolate/tropicamide combination. We recommend the combination of 2.5% phenylephrine and 0.5% tropicamide to achieve a sufficient diagnostic mydriasis without systemic side effects in preterm infants.

Balance of risks and benefits in preparation for earthquakes.

Widespread proposals to benefit from lessons of the 17 October 1989 (Loma Prieta) earthquake dramatize the difficulties associated with reducing seismic risk. There are three main problems. First, the understanding of earthquake generation is far from complete. For example, the unanticipated source style of this earthquake raises vital questions; claims of predicting its occurrence are weak, and, for practical reasons, the detailed pattern of damaging strong ground shaking was not predicted. Second, although their interactions are not well understood, competing social forces continue to prevent the optimum growth and application of knowledge for earthquake hazard mitigation. Third, the recent use of the probabilities of seismic risk has had mixed results. Because of indecision between minimizing loss of life and maximizing broader benefits, general agreement on acceptable earthquake risk remains confused.

Teaching program for patients with low-back pain.

Sometime during their lives, four out of five adults will suffer from back pain. A health problem with such a profound physical and emotional impact has wide-reaching implications for nursing. The nursing process was applied to address the needs of low-back pain patients on a 48-bed neurosurgery-general surgery ward at Walter Reed Army Medical Center. Patient needs were assessed by distributing 170 questionnaires over a nine-month period. Ninety-seven were returned, a 57% return rate. Using the results, we developed a nursing care plan, including nursing diagnoses, expected outcomes, and nursing interventions. Based on the care plan, 12 written teaching modules were developed, which took a multidisciplinary approach to this chronic problem.

Healthcare security quality and productivity program; a valid management tool.

The ever increasing demand for improved performance in healthcare facilities makes the development of a Quality Index a productivity approach worth considering. The author, who uses such a tool, spells out the thinking behind it as well as its implementation.