Fragility and Resilience: Stories of Recovering From Hip Fractures in the Oldest-Old Age

This study uses a narrative approach to explore the experiences of adults in the oldest stage of old age after they suffered a hip fracture. The focus was on participants' perceptions and descriptions of the traumatic event, the recovery process, and the impact of the fracture on their lives. The study had a longitudinal design and included interviews with 10 participants (mean age 89) who had suffered hip fractures. Up to three semi-structured interviews were conducted with each of the participants (a total of 27 interviews) over a 3-month period. The first interviews were at the hospital, the second at municipal rehabilitation facilities, and the third at the participants' homes. The material was analysed by means of narrative analysis. The results show how the incident affected the participants' active and meaningful lives and how they seemed to mobilise their resources and motivation to train and recover to be able to come back home and resume the life they had before the hip fracture. The study provides nuances in the understanding of how a hip fracture can impact lives in old age. The stories emphasise the resources and capacity for resilience elderly people can possess and the importance of listening to the individual life stories, situation, personal goals, and needs when planning services for elderly people recovering from a hip fracture.

Nurse mentors' experiences with suitability assessments in clinical placement: A qualitative study

AIM

This study aims to explore mentors' experiences with assessing the suitability of nursing students in clinical placements in a context where suitability assessment is required by law.

BACKGROUND

It is the schools' responsibility to assess students, but mentors play an important role when students are in clinical placements. Clinical placements are typical arenas for assessing suitability.

DESIGN

An explorative qualitative study METHODS: Participants were 17 registered nurses with experience as mentors for nursing students in clinical placement. The participants represented somatic and surgical wards from three different hospitals in Norway. Individual, semi-structured interviews were conducted.

RESULTS

The analysis revealed a total of four themes: 1) the understanding of suitability, 2) experiencing borderline performance, 3) the heavy responsibility of doing the assessment and 4) the importance of support.

CONCLUSIONS

The mentors found it difficult to assess suitability. They reported having little or no knowledge about leading rules and guidelines. The mentors experienced support from their colleagues, something which lightened the burden of assessing the students. This study indicates that mentors need more information about suitability and suitability assessments.

REGISTRATION NUMBER

To be included in abstract after acceptance.

Kickstart in nursing home-Nursing students experiences of a model for active and collaborative learning in clinical placement

AIMS AND OBJECTIVES

To explore students' experiences from a pilot project testing out a model for active, collaborative learning in first-year placement at a nursing home.

BACKGROUND

There is a need for innovative learning activities and projects to improve clinical education in nursing homes. Active, collaborative approaches in placement learning may enhance students learning outcome.

DESIGN

The study had a qualitative and explorative design, in which the experiences of students participating in the pilot were investigated through paired interviews at the end of their placement.

METHODS

Twenty-two students participated in the study, and data from paired interviews were analysed using qualitative content analysis. COREQ reporting guidelines were used.

RESULTS

Three themes emerged from the analysis: (1) The learning cell as facilitator for learning; (2) Discovering learning possibilities in nursing homes and (3) Applying tools and resources for learning.

CONCLUSIONS

The model could reduce tension and anxiety while helping the students focus on learning options and use their environment more actively for learning. Working with a learning partner seems to increase student learning through common planning, feedback and reflection. The study emphasises the importance of facilitating active learning through the scaffolding structures and configuration of the students' learning space.

RELEVANCE TO CLINICAL PRACTICE

This study indicates the potential for introducing active and collaborative pedagogical models in clinical placement. The model can promote nursing homes as a conducive learning arena for nursing students and help prepare students for a future work role in a rapidly changing health care field.

PATIENT OR PUBLIC CONTRIBUTION

The result of the research is shared and discussed with stakeholders prior to finalising the article.

Suitable, fit, competent and safe to practice nursing? Assessing nursing students' personal qualities in clinical placement-An integrative review

AIMS AND OBJECTIVES

This study aims to explore, describe, and synthesize the personal requirements student nurses are assessed in their clinical placement to be suitable, fit, competent, and safe for the nursing profession.

BACKGROUND

There are different terms and concepts used when describing what nursing students are assessed by regarding personal requirements needed to be eligible to enter the nursing profession. This is regulated and enforced mainly by different standards and guidelines.

DESIGN

An integrative review using Whittmore and Knafl's (2005) methodology.

METHODS

Searches were systematically conducted in CINAHL, Education Source, ERIC, Academic Source Elite, MEDLINE and EMBASE, NORART, SveMed+, and Bibliotek.dk. The PRISMA checklist for systematic reviews was used.

RESULTS

Eighteen studies were included in the review. The results present various factors student nurses are assessed by in clinical placements, which were categorized into three themes: attitude and personal characteristics, behavior, and basic knowledge. Assessing students is a complex and subjective endeavor, and decisions are based on a holistic assessment of several different aspects of the student's performance and behavior CONCLUSIONS: The personal requirements to be deemed suited for det nursing profession are complex and composed of several different components. Assessments are often based more on assessors' subjective standards and intuition than on the provided guidelines and standards. There is no universal understanding of which characteristics or qualities are considered necessary for a student to be deemed suited for the nursing profession.

RELEVANCE TO CLINICAL PRACTICE

This study points at challenges with the assessment of nursing students today as there are no clear standards or understanding of the requirements needed.

Professional caregivers' participation in the International Caregiver Development Programme: A qualitative study of psychosocial care in nursing homes

AIM

This paper aims to explore professional caregivers' experiences of psychosocial care for older persons living in nursing homes following the professional caregivers' participation in the International Caregiver Development Programme (ICDP).

DESIGN

A qualitative study.

METHODS

About 15 focus group interviews and 25 participatory observations of five ICDP group courses were conducted with 31 employees in nursing homes, including registered nurses, enrolled nurses and nursing aids. The findings emerged through hermeneutic analysis.

RESULTS

Main findings: (i) Adjusting the communication to the residents' psychosocial needs, (ii) Seeing the residents as individuals and (iii) Adjusting to individual interaction with the residents. The professional caregivers experienced that the residents participated more in communication, interaction and activities, in addition to be more satisfied, calm, happy and thankful in interaction with the caregivers. Furthermore, they described that the environment in the units became calmer and that they were considering psychosocial care before medication. Work-related stress seems to impact ICDP participation and may be a barrier to implementation.

Compassion, emotions and cognition: Implications for nursing education

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, their philosophical underpinnings and the consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion.

Simulation as a joint learning activity in clinical placement-interaction between first-year nursing students and qualified nurses

AIMS

The purpose of the study was to explore students' experiences from joint simulation training with qualified nurses that took place in students´ first-year placement at a nursing home.

BACKGROUND

Nursing students' clinical placement in nursing homes has been pictured as inadequate, boring and irrelevant. There is a need for innovative learning designs that include increased collaboration between the educational institution and clinical placement site to support student learning in practice. Simulation training is highlighted as a learning activity that enhances practical skills and reflection.

DESIGN

The study had a qualitative evaluation design to explore and capture students' experiences and provide an understanding of the impact of the joint simulation activity during placement.

METHODS

Three retrospective focus group interviews were conducted with a total of twenty nursing students. Written reflective notes from sixteen of the students were included in the study. The data were analysed by means of a thematic content analysis. COREQ reporting guidelines were used.

RESULTS

Four themes were identified as follows: (a) anxiety and arrangements, (b) realistic scenarios-real nurses, (c) debriefing and reflection and (d) the aftereffect of the simulation training for the clinical placement.

CONCLUSIONS

The joint simulation training gave the students an opportunity to actively participate in a complex clinical learning situation together with qualified nurses and within a safe environment. This learning activity provoked feelings and stress within the students. However, it also enriched the students' learning experience and strengthened the outcome of the clinical placement through an improved relationship between the students and qualified nurses.

RELEVANCE TO CLINICAL PRACTICE

Creating collaborative learning activities between nursing homes and universities, such as joint simulation, can increase relevance and enhance learning and student satisfaction in their clinical placement. It can also promote nursing homes as interesting learning arena and future workplace for nursing students.

Nobody Dies Alone in the Electronic Patient Record-A Qualitative Analysis of the Textual Practices of Documenting Dying and Death

In this study, we analyse the electronic patient record (EPR) as a genre and investigate how a death is documented as part of the EPR, that is, what kind of textual practices can be found, and how they can be understood based on extracts from 42 EPRs from medical wards in Norwegian hospitals. Following from our analysis, we see four distinct patterns in the documentation of patient death: a) registering the bare minimum of information, b) registering a body stopped working, c) documenting dying quietly and placing it in peaceful surroundings, and d) highlighting the accompanied death. The textual practices of documenting the transition to death in the EPR make death appear manageable and sanitised, depicting death as either uneventful or good. While the EPR genre is steeped in biomedical language, other discourses relating to death can be seen as ways to accommodate the ideal of a dignified death.

Planning and implementing quality improvement projects in clinical practice: Third-year nursing students' learning experiences

AIMS AND OBJECTIVES

To evaluate the impact of an educational design to develop nursing students' competence to work systematically with quality improvement in clinical practice.

BACKGROUND

Competence in how to improve the quality and safety of healthcare services based on new knowledge is crucial for healthcare quality. Nursing education should give students opportunities to engage in quality improvement projects to gain this competence.

DESIGN

This project qualitatively evaluated the impact of the course on students' ability to plan and implement a quality improvement project in their clinical placement.

METHODS

Data from retrospective focus group interviews and written project reports were analysed by means of qualitative content analysis. Fifty-five students participated in the study. COREQ reporting guidelines were used.

RESULTS

Three themes were derived from the analysis: (a) the importance of anchoring the quality improvement project in the clinic; (b) experiencing the steps of a quality improvement project; and (c) challenging student role.

CONCLUSIONS

Course design that facilitates student-run small-scale quality improvement projects under supervision can enhance nurse students' competence in quality improvement work, as well as raise the students' awareness of the responsibility they will undertake as future nurses.

RELEVANCE TO CLINICAL PRACTICE

Nursing students work on quality improvement project in clinical placement may enhance their awareness and competence in developing quality and safety of healthcare services as future nurses.

Nursing and midwifery students' experiences and perception of their clinical learning environment in Malawi: a mixed-method study

Background

The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives' experiences and perception of the clinical learning environment in Malawi.

Methods

A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed.

Results

A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment.

Conclusion

Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

Hospital nurses' professional accountability while using the National Early Warning Score: A qualitative study with a hermeneutic design

AIM

To explore general hospital ward nurses' experiences with the National Early Warning Score and to determine its impacts on their professionalism.

BACKGROUND

The National Early Warning Score has broad appeal; it is a patient safety initiative designed to ensure early identification of and response to deteriorating patients in hospitals. However, it is still unclear how the tool impacts nurses' professionalism.

METHODS

A qualitative study with a hermeneutic design was conducted in autumn 2017; the study consisted of semi-structured, in-depth interviews with 14 hospital nurses. The data were analysed thematically to understand and interpret the nurses' experiences. Methods are reported using COREQ guidelines (see Appendix S1).

RESULTS

The study examined nurses' experience with the National Early Warning Score and its perceived impact on their professionalism. Four themes were identified: (a) the National Early Warning Score and clinical judgement in patient assessment, (b) responding to the National Early Warning Score standard, (c) involving the professional community and (d) adjusting the tool.

CONCLUSION

The National Early Warning Score may impact nurses' professionalism in diverse ways. Nurses are aware of the importance of incorporating all of their professional competence, comprising clinical judgement, discretion and accountability, with the National Early Warning Score to accurately assess patients' conditions. Findings indicated that the National Early Warning Score was beneficial to nurses' professional practice; however, accountability to this standard alone does not ensure quality care and patient safety.

RELEVANCE TO CLINICAL PRACTICE

A greater understanding of the role of nurses' professional accountability when using the National Early Warning Score is needed to improve practice and ensure patient safety.

Introducing the National Early Warning Score - A qualitative study of hospital nurses' perceptions and reactions

AIM

The aim of this study was to explore hospital nurses' perceptions and reactions to the National Early Warning Score during an introduction programme.

DESIGN

A qualitative case study approach with participatory observations was used for this study.

METHODS

In total, nine seminars and 23 simulation sessions attended by nurses were observed. An activity theory system analysis was applied to interpret the material.

RESULTS

The findings revealed four tensions related to the working context: (a) tension between using a standardized tool and relying on clinical judgement (the tool could be either an aid or a barrier to patient assessment); (b) tension in the community of practice (the tool could be beneficial or increase stress and anxiety); (c) tension related to rules and compliance (the tool could be perceived as optional or compulsory); and (d) tension related to the division of labour (nurses feared more work).

Leadership in interprofessional collaboration in health care

Purpose

There is a need to develop more knowledge on how frontline managers in health care services facilitate the development of new roles and ways of working in interprofessional collaborative efforts and the challenges they face in daily practice. The article is based on a study that examines the modes of governance adopted by frontline managers in Norway, with a special focus on leadership in collaborations between the Norwegian profession of social educator and other professions.

Materials and methods

A qualitative research design was chosen with interviews of eleven frontline managers from district psychiatric centers, municipal health care services and nursing homes.

Results

The results show that frontline managers largely exercise leadership in terms of self-governance and co-governance and, to a lesser degree, hierarchical governance. Self-governance and co-governance can facilitate substantial maneuverability in terms of professional practice and strengthen both discipline-related and user-oriented approaches in the collaboration. However, one consequence of self-governance and co-governance may be that some occupational groups and professional interests subjugate others, as illustrated by social educators in this study. This may be in conflict with frontline managers' abilities to quality assure the services as well as their responsibility for role development in their staff.

Conclusion

The results show that frontline managers experience challenges when they try to integrate different professions in order to establish new professional roles and competence. Frontline managers need to support individual and collective efforts in order to reach the overall goals for the services. They must be able to facilitate change and support creativity in a working community that consists of different professions. Moreover, the social educator's role and competence need clarifications in services that traditionally have been dominated by other clinical and health care professions.

Young-onset Alzheimer dementia: a comparison of Brazilian and Norwegian carers' experiences and needs for assistance

OBJECTIVES

Although dementia typically occurs in older people, it can also emerge in people aged younger than 65 years in the form of young-onset dementia, the most common type of which is Alzheimer's disease (AD). However, few studies have examined the needs of persons with young-onset AD (YO-AD) and their families, and cross-cultural research on the topic is even scarcer. In response, we investigated the situations, experiences and needs for assistance of carers of persons with YO-AD in Brazil and Norway.

METHODS

As part of our qualitative study, we formed a convenience sample of Brazilian (n = 9; 7 women) and Norwegian carers (n = 11; 6 women) in 2014 and 2015, respectively, and analysed data in light of a modified version of grounded theory.

RESULTS

Carers' narratives from both countries revealed five common themes in terms of how YO-AD affected carers' psychological and emotional well-being, physical well-being, professional and financial well-being, social lives and need for support services.

CONCLUSIONS

The infrequent differences between carers of persons with YO-AD in Brazil and Norway indicate that carers' problems are highly similar regardless of cultural differences and public services provided. Copyright © 2017 John Wiley & Sons, Ltd.

Lack of compassion or poor discretion? Ways of addressing malpractice

In this article, our point of departure is the 'compassion crisis' in the National Health Service in the UK and the initiatives introduced in the aftermath of scandals that were intended to strengthen healthcare professionals' ability to show compassion. We look at the two main strategies, which we term the 'recruitment and staff development strategy' and the 'amelioration of the quality systems strategy' and the debate that has arisen related to them. Based on this analysis, we question whether compassion really is a helpful concept to understand the crisis and hence to underpin relevant strategies. We introduce the concept of discretion as an alternative and better concept to comprehend the situation. One of the benefits of the concept of discretion is that it clarifies how problems can be addressed, both as structural problems and as epistemic problems and how these aspects are intertwined. It also helps us to see how solving these problems is complicated and demands comprehensive, in-depth approaches, involving formative aspects related to healthcare education, as well as development of new healthcare policies.

Enhancing students’ moral competence in practice

Background:

Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education.

Objective:

To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students’ moral competence in clinical practice.

Research design:

A qualitative hermeneutic approach was employed to interpret the teachers’ experiences.

Participants and research context:

Individual interviews (N = 8) and a focus group interview with teachers (N = 9) from different nursing colleges were conducted.

Ethical considerations:

Ethical approval was granted and all participants signed their informed consent.

Findings:

Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources.

Discussion:

Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting.

Conclusion:

There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients’ rights and safety.

Experiences of Older Men Living Alone: A Qualitative Study

More and more old people live alone, and living alone is reported to be a key risk factor for experiencing loneliness and developing poor health. The purpose of this qualitative study was to explore the experiences of living alone for older men. Systematic text condensation and hermeneutic interpretation were used in analysis of the data. Four themes emerged: lonely at times, missing and longing for a shared life, keeping active, and some kind of freedom. The findings revealed that inner and outer resources come into play and have influence on the processes of managing and solving the situation of living alone. The findings are in accordance with theoretical perspectives on loneliness, aloneness, and solitude. The findings offer nurses in any clinical context valuable information to allow them to address the core emotional and potential mental health issues old men face in coping with the situation of living alone.

«Du må bare skrive ut, ønske lykke til, og stole på at det går bra!» En kvalitativ undersøkelse av sykepleieres muligheter og begrensninger for skjønnsutøvelse når pasienter skal utskrives fra sykehus til kommunale helse- og omsorgstjenester

<strong>“You can only discharge them, wish them luck, and hope for the best!”</strong><br />The aim was to investigate nurse’s experiences of the possibilities to act according to their professional discretion in the process where patients are transferred from hospital to primary health services. Six in-depth interviews and one focus group interview with hospital nurses were conducted. The theoretical framework was based on Dworkin’s concepts of discretion and Martinsen’s description of prerequisites for discretion. Nurses collected and assessed complex information about the patients to be able to define the necessary level of care after discharge. Prerequisites for a robust assessment were adequate time, and the relationship to patients. Focus on effectivity, medical treatment, and limited possibilities to hand over their assessments to the municipal health services, created challenges. Nurses were negotiating between professional ideals and requirements from regulations. This created a potential conflict within the nurses between a professional role and a performer role, which in turn can lead to problematic consequences, both for nurses and for patients.

Caries assessment and restorative treatment thresholds reported by Swedish dentists

The aim was to study any variability in approximal and occlusal caries diagnoses and restorative treatment decisions among Swedish dentists. The material consisted of a pre-coded questionnaire sent to a random sample of 923 dentists with 4 items concerning approximal and occlusal caries diagnosis and restorative treatment decisions. Responses were received from 651 (70.5%) dentists. In an adolescent with low caries activity and good oral hygiene, more than 90% of the dentists stated that they would not automatically restore a primary approximal caries lesion if its radiographic appearance did not show obvious progression in the outer 1/3 to 1/2 of the dentin. Moreover, 67% of the dentists would only consider immediate restorative treatment of an occlusal surface if obvious cavitation and/or radiographic signs of dentin caries could be observed. When diagnosing questionable occlusal caries, the dentists largely relied on the radiographic appearance. Concerning both approximal and occlusal caries, the threshold for restorative treatment differed between the metropolitan regions in Sweden, and younger more often than older dentists would postpone restorative treatment of approximal caries until the lesion had reached a relatively advanced stage of progression. The responses also showed that dentists in private practice would restore approximal caries at an earlier stage of progression than the dentists in the Public Dental Health Service.

Prefeeding plasma acetoacetate and glucose in healthy, lactating heifers. Variations related to milk yield, metabolic balances and stage of lactation

When measured before morning feeding plasma acetoacetate (ACAC) increased and glucose (GL) decreased significantly with increasing milk yield (fat corrected, FCM) within 2 groups of half-sister related heifers which did not suffer from clinical ketosis. The groups received respectively A: 7 kg and B: 4 kg/d of concentrates in addition to grass silage ad libitum (each group 88 animals). Correlation coefficients of the same magnitude between the 3 variables mentioned were obtained in the 1st and 3rd month of lactation in spite of a narrowing of the ACAC range from 0.024-0.66 to 0.019-0.16 mmol/l. Reproducibility of differences between animals in milk yield and in the plasma components was evidenced by significant correlations between measurements in the 1st and 3rd month. The B-animals produced 2.4 kg/d less FCM than the better fed A group (A, 1st month of lactation 19.8 +/- 3.1 kg/d) while the mean values for ACAC and GL remained practically unaffected by the difference in feeding. B cows gave consistently 5-6% lower GL means (p < 0.01) than A animals with identical yields. Animals which showed marked ACAC increment during the first 5-6 weeks of lactation produced 3-4 kg more FCM/d than equally fed animals with constantly low ACAC levels. The estimated energy deficit of this ketonaemic, high-producing category corresponded to the production of 4.5-6 kg FCM/d from body reserves. Low ACAC values (< 0.05 mmol/l) were reproduced with a standard deviation of +/- 4% with the automated nitroprusside method described.

Prefeeding plasma acetoacetate and glucose in healthy, lactating heifers. Variations related to milk yield, metabolic balances and stage of lactation

When measured before morning feeding plasma acetoacetate (ACAC) increased and glucose (GL) decreased significantly with increasing milk yield (fat corrected, FCM) within 2 groups of half-sister related heifers which did not suffer from clinical ketosis. The groups received respectively A: 7 kg and B: 4 kg/d of concentrates in addition to grass silage ad libitum (each group 88 animals). Correlation coefficients of the same magnitude between the 3 variables mentioned were obtained in the 1st and 3rd month of lactation in spite of a narrowing of the ACAC range from 0.024-0.66 to 0.019-0.16 mmol/l. Reproducibility of differences between animals in milk yield and in the plasma components was evidenced by significant correlations between measurements in the 1st and 3rd month. The B-animals produced 2.4 kg/d less FCM than the better fed A group (A, 1st month of lactation 19.8 +/- 3.1 kg/d) while the mean values for ACAC and GL remained practically unaffected by the difference in feeding. B cows gave consistently 5-6% lower GL means (p < 0.01) than A animals with identical yields. Animals which showed marked ACAC increment during the first 5-6 weeks of lactation produced 3-4 kg more FCM/d than equally fed animals with constantly low ACAC levels. The estimated energy deficit of this ketonaemic, high-producing category corresponded to the production of 4.5-6 kg FCM/d from body reserves. Low ACAC values (< 0.05 mmol/l) were reproduced with a standard deviation of +/- 4% with the automated nitroprusside method described.

Etiology of acetonemia in Norwegian cattle. 2. Effect of butyric acid, valeric acid, and putrescine

A feeding experiment was performed on 16 cows in order to test the effect of naturally occurring substances in silage on forage intake, ketonemia, and milk yield. The cows were divided into a control group and three experimental groups. The cows in the three experimental groups were fed 100 g/d of putrescine, 200 g/d of valeric acid, or 200 g/d of butyric acid through a ruminal tube for 3 d. Butyric acid increased plasma acetoacetate; the effect was largest in high yielding cows. Putrescine influenced both milk yield and forage intake and may possibly be a contributory factor, alone or combined with other amines, for the development of ketonemia. Valeric acid did not influence feed intake or plasma acetoacetate concentration. A rapid method for acetoacetate analysis also is described.

Etiology of acetonemia in Norwegian cattle. 1. Effect of ketogenic silage, season, energy level, and genetic factors

Plasma acetoacetate concentration in the 1st mo of lactation and its relation to BW change, milk yield, DMI, and BW postpartum were studied in 361 first lactation cows during 6 yr. The cows were fed concentrate at 6 and 3 kg/d. Calvings took place from August to December. Single observations for all cows were fitted by a multitrait animal model that accounted for all genetic relationships. Heritability for acetoacetate was .11 with a genetic correlation of .87 for milk yield, -.65 for weight change, and -.13 for BW postpartum. Acetoacetate was higher at 3 kg/d of concentrate than at 6 kg/d, and calving after 3 to 4 mo of indoor feeding was related to higher acetoacetate than was calving shortly after the pasture season. Acetoacetate was related to weight loss postpartum, but at a different degree in different years. In some years, compounds of the silage caused strongly elevated plasma concentrations of acetoacetate after feeding. Experiments were performed to compare hay with silages of different qualities. Rumen concentration of different amines 3 h postfeeding was taken as an index of the amine load of the cow. The concentration of several amines in rumen fluid were high after feeding ketogenic silage.

Heritability of hypocalcemia at first parturition in Norwegian cattle: genetic correlations with yield and weight

Minimum plasma calcium level around parturition and its relation to BW at parturition, milk yield, and weight change in mo 1 of lactation were studied in 334 first lactation Norwegian cows. Minimum plasma calcium level was reached 18 to 30 h postpartum. Single observations for all animals were fitted with a multitrait animal model including all genetic relationships. Heritabilities of the traits were calcium postpartum, .11; milk yield, .35; BW, .65; and weight change, .17 with standard errors about .10. Genetic correlations between calcium postpartum and the other traits were milk yield, -.49; BW, -.66; and weight change, .42 with standard errors about .25. Environmental factors with detectable effect on hypocalcemia were age at parturition and calving season. Regression of calcium postpartum on age was -2.66 x 10(-4) mmol/L per d. Calvings shortly after the pasture season were related to higher calcium postpartum than calvings after 3 to 4 mo with indoor feeding.

Plasma glucose, ketone bodies, insulin, glucagon and enteroglucagon in cows: diurnal variations related to ketone levels before feeding and to the ketogenic effects of feeds

Ingestions of a moderately ketogenic silage twice daily were followed by transient increments in plasma insulin and ketone bodies and decreases in plasma glucose. Ketone bodies and glucose were negatively correlated throughout the day, but the insulin elevations culminated before the maximal effects on ketone bodies and glucose were established. Cows with varying glucose levels before morning feeding reacted to a highly ketogenic silage by decreasing their glucose level uniformly to about 3 mmol/l, in spite of a widely varying feeding-induced insulin increment. Hay-feeding caused insulin increments of the same magnitude as silage-feeding, but the glucose decrease and the ketone increment was much smaller. The results indicate some direct action of ketone bodies on blood sugar regulation, in addition to effects mediated by insulin. The role of ketone bodies as the insulinotropic factor was not confirmed. The insulin level after feeding seems to be determined by the carbohydrate status of the animal before feeding. No significant changes in plasma glucagon were observed after feeding, and no consistent differences in plasma levels of this hormone were found when non-ketonemic, ketonemic, and clinically ketotic cows were compared. The plasma level of enteroglucagon (GLI) was positively correlated to the relative amount of concentrates consumed, but no relation to plasma glucose was found.

Traumatic rupture of the thoracic aorta. A clinicopathological study

In a county hospital serving a population of roughly 240,000, the hospital records from the period 1982 to 1987 included 27 patients who presented with traumatic rupture of the thoracic aorta. Eighteen patients died instantaneously, one was dead on admission, five died in hospital and three survived operation. Two patients had direct cross clamping of the aorta and Dacron interposition graft soon after admission; both survived. The third patient had a Gott shunt and Dacron interposition graft the day after the accident and survived with paraplegia. In all patients who died in hospital except one, the condition was not diagnosed before death. We conclude that traumatic rupture of the thoracic aorta occurs more frequently than is generally thought. Although most patients die at the scene of the accident, a liberal use of angiography is indicated in all trauma cases admitted to hospital with a history of a forceful deceleration or acceleration injury.

Plasma glucose, ketone bodies, insulin, glucagon and enteroglucagon in cows: diurnal variations related to ketone levels before feeding and to the ketogenic effects of feeds

Ingestions of a moderately ketogenic silage twice daily were followed by transient increments in plasma insulin and ketone bodies and decreases in plasma glucose. Ketone bodies and glucose were negatively correlated throughout the day, but the insulin elevations culminated before the maximal effects on ketone bodies and glucose were established. Cows with varying glucose levels before morning feeding reacted to a highly ketogenic silage by decreasing their glucose level uniformly to about 3 mmol/l, in spite of a widely varying feeding-induced insulin increment. Hay-feeding caused insulin increments of the same magnitude as silage-feeding, but the glucose decrease and the ketone increment was much smaller. The results indicate some direct action of ketone bodies on blood sugar regulation, in addition to effects mediated by insulin. The role of ketone bodies as the insulinotropic factor was not confirmed. The insulin level after feeding seems to be determined by the carbohydrate status of the animal before feeding. No significant changes in plasma glucagon were observed after feeding, and no consistent differences in plasma levels of this hormone were found when non-ketonemic, ketonemic, and clinically ketotic cows were compared. The plasma level of enteroglucagon (GLI) was positively correlated to the relative amount of concentrates consumed, but no relation to plasma glucose was found.

Thyroid activity in relation to feed intake, growth rate and feed conversion in growing heifers

Phenotypic and genetic parameters for thyroid activity (T4 serum level, T4 apparent distribution volume, T4 fractional turnover rate and T4 degradation), and for certain production traits (roughage dry matter intake, daily weight gain and roughage dry matter/kg weight gain), were investigated in cattle. In the experiment, 480 growing heifers were studied, daughters of 20 AI sires previously tested for thyroid activity. Repeatabilities for thyroid traits 2-3 months apart varied, with an average 0.3-0.6 for the different traits. Heritability estimates based on sire components were 0.1-0.4 for the thyroid traits, 0.16 +/- .10 for roughage intake and 0.18 +/- .11 for daily gain. The sire component for feed efficiency (roughage dry matter/kg weight gain) was 0, and genetic correlations between thyroid traits and the production traits in growing heifers were low with large standard errors.

Suppression and stimulation of TSH and thyroid hormones in bulls during starvation and refeeding

Sixteen bull calves were fasted during two periods, 31/2 and 7 months old. Blood samples were taken every 6 h during an experimental period of 9 days: 2 control days, 5 fasting days and 2 refeeding days. During the control days with ad libitum feeding, T3, T4 and TSH increased during the day. During the fasting period, T4 decreased with a half-life of 3.5 days and T3 with a half-life of 3 days. TSH decreased in a less regularly way to a mean of 60% of control mean. Six h after refeeding, TSH had increased to 300% of control mean. T3 and T4 had a maximum 12 h after refeeding. As the T4 decreased with a rate nearly similar to the T4 disappearance rate in starving bulls, the secretion of T4 from the thyroid gland must have been almost stopped during the starvation period. The morning values were below normal for all three hormones after 2 days of refeeding.

T4 degradation rate and plasma levels of TSH and thyroid hormones in ten young bulls during feeding conditions and 48 h of starvation

The effect of starvation on thyroid hormones was studied during a starvation period of 48 h in 10 young bulls. Mean thyroxine degradation rate decreased from K/day 0.32 during feeding to 0.23 during fasting. Mean plasma concentration of T4 decreased to 75% of normal, and it was calculated that the mean thyroxine secretion rate during the starvation period was 24% of normal. Plasma concentration of free thyroxine decreased to 54% of normal, indicating that the concentration of binding protein was not decreased. T3 and reverse T3 decreased to about 60% of normal. This indicated a parallel decrease in the secretion of all 3 hormones. We did not find evidence of an inactivating pathway for T4 as has been shown in humans during starvation. TSH decreased to 85% of normal.

Creatine kinase and lactate dehydrogenase in the cerebrospinal fluid in patients with head injuries

The concentration of CK and LDH in the cerebrospinal fluid was determined in 290 patients with head injuries. The highest concentration of these enzymes appeared in patients with the most severe brain injury. CK correlated somewhat better than LDH with the severity of the head injury. In the group with moderate head injuries there was no significant difference statistically between patients with increased CK level and patients with normal CK level in the cerebrospinal fluid with regard to the duration of posttraumatic headache, dizziness or working disability.