Preparing safe discharge in a complex practice: A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards

INTRODUCTION

It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge.

AIM

To explore the process of preparing discharge for patients with COPD in a hospital setting.

METHOD

Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical.

RESULTS

We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike.

CONCLUSION

This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.

Exploring needs, barriers to, and facilitators of rehabilitation exercise following revision hip replacement - A grounded theory study

PURPOSE

Evidence on rehabilitation after revision total hip replacement (THR) is inadequate and development of rehabilitation interventions is warranted. Even so, little is known about patients' experiences with revision THR rehabilitation. This study aimed to explore patients' rehabilitation exercise experiences after revision THR.

MATERIALS AND METHODS

Using constructivist grounded theory, we conducted semi-structured qualitative interviews with twelve patients with completed or almost completed rehabilitation exercise after revision THR. Data collection and analysis were a constant comparative process conducted in three phases; initial, focused, and theoretical.

FINDINGS

From the data, we generated a substantial theory of the participant's circumstances and ability to integrate rehabilitation exercise into their everyday life after revision THR. Four categories were constructed based on patients' experiences in different contexts: hesitance, fear avoidance, self-commitment, and fidelity.

CONCLUSIONS

This study highlighted that patients' expectations, past experiences, attitudes, trusts, and circumstances interact to influence engagement and adherence to rehabilitation exercise and described four categories relating to the integration of revision THR rehabilitation exercise into their everyday life. Clinicians should be aware of and account for these categories during rehabilitation exercise. Tailored individual rehabilitation exercise interventions and clinician approaches to optimize engagement and adherence are needed among patients with revision THR.

How does mHealth influence consulting practice between health professionals and individuals with low back pain? - A qualitative study from the perspective of health professionals

PURPOSE

This study explored how health professionals experience in what way a digital self-monitoring solution influences their consulting practice targeting individuals with low back pain.

MATERIAL AND METHODS

This was a qualitative study adopting a constructivist grounded theory approach. Nineteen health professionals participated in the pilot test of the digital self-monitoring solution BackTrace. Data were collected cross-sectionally and consisted of: (a) audio recordings from focus groups with health professionals, (b) field notes from participant observation of online meetings with health professionals, (c) field notes from participant observations of consultations between health professionals and individuals with low back pain and (d) audio recordings from workshops with health professionals.

RESULTS

Two main themes and one sub-theme were identified, describing how BackTrace enabled more focused consulting practices, supported patient-self management and improved the relationship between individuals with low back pain and health professionals. Barriers were identified describing how the implementation of digital health solutions required a change in workflow, resources and culture - as well as management support.

CONCLUSIONS

Findings indicated a need for a change at the system level, including a changed view of digitisation in healthcare systems containing a more supporting approach.

Filling the gap in service provision. Partners as family carers to people with Parkinson's disease: A Scandinavian perspective

OBJECTIVES

The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson`s disease (PD) in Denmark and Norway.

METHODS

A qualitative exploratory design was applied. The sample consisted of 14 people from Denmark (n = 9) and Norway (n = 5) living with a partner with PD. Semi-structured individual interviews were conducted between June and September 2020, digitally recorded, transcribed verbatim and analysed using a reflexive thematic analysis approach combining inductive and deductive approaches.

RESULTS

The main themes were 'negotiating systems of support' and 'balancing being both a partner and a family carer'. Partners take responsibility for the people with whom they live and attempt to fill gaps in the public healthcare system. The most frequently described needs were more information, service coordination as the illness progressed and acknowledgement of the complex role.

DISCUSSION

A recommendation for practice is recognition of the complex roles of partners to people with PD and reaching out to both regularly to determine needs. This may enhance the collaboration between partner carers, people with PD and healthcare providers, ensure sustainability of the system and optimise living with PD in the family.

Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study

BACKGROUND

Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease.

OBJECTIVE

This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships.

METHODS

A mixed-methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta-ethnography approach was used to analyse and synthesize cross-national findings.

RESULTS

A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services.

CONCLUSIONS

Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory.

PATIENT OR PUBLIC CONTRIBUTION

Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.

Perspectives of people with Parkinson's disease and family carers about disease management in community settings: A cross-country qualitative study

AIM

To explore perceptions of people with Parkinson's disease and family carers about the use and impact of health and social care services, community and voluntary sector resources for the management of Parkinson's disease.

BACKGROUND

Resources from outside the formal health care system and collaborations between different levels and sectors could address the unmet needs of people with Parkinson's disease and their family carers and improve the management of Parkinson's disease in the community setting.

DESIGN

A qualitative exploratory study was carried out in Denmark, Norway, Spain and the United Kingdom and was reported using the COREQ.

METHODS

Individual semi-structured interviews were conducted with people with Parkinson's disease and family carers between May and August 2020. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. A meta-ethnographic approach was used to analyse and synthesise cross-national findings.

RESULTS

Forty-seven people with Parkinson's disease and 39 family carers participated in the four countries. Four themes and eight sub-themes emerged: (1) Personalised care for needs throughout the Parkinson's disease journey; (2) Accessibility of different types of support systems (including initiatives to support emotional well-being, physical rehabilitation, information on the healthcare services, voluntary associations and community groups); (3) Multiagency collaborations, a more comprehensive approach; (4) Acknowledgment of people with Parkinson's and family carers own role in Parkinson's disease management.

CONCLUSIONS

An integrated and person-and-community-centred approach, which includes the participation of the health, social, voluntary and community sectors, is desired by people with Parkinson's disease and their family carers to improve the management of Parkinson's in the community setting. These findings could contribute to the creation of more sustainable care systems at the European level that would better respond to individual and changing needs in people with Parkinson's disease and their family carers, and in other long-term conditions.

PATIENT OR PUBLIC CONTRIBUTION

The Patient and Public Involvement groups contributed to the design of the study, the interview guides and validation of findings.

RELEVANCE TO CLINICAL PRACTICE

This study will inform the management of Parkinson's disease at the community level and the use of resources not only directly linked to the health system. Taking into account all the actors that provide care and support to people with Parkinson' disease and family carers facilitates the creation of strategies that better respond to individual needs. Nurses and other health and social care professionals in the community and specialist levels of care should collaborate to develop multisectoral strategies that promote personalised and integrated care throughout the Parkinson's journey.

An inconvenience to the nurse's practice: A Foucault-inspired study of ethnic minority patients

Ethnic minority patients have been discussed and problematised in Western health literature. Drawing on an interpretation of central parts of the French philosopher Michel Foucault's authorship, we analysed a broad selection of materials to identify mechanisms through which the truth about ethnic minority patients is constructed. We identified a single, yet consistent discursive strategy that we termed 'figure of inconvenience' in which ethnic minority patients were classified and assigned a specific subjection illustrating them as 'inconvenient' to the nurse's practice. Concurrently, their relatives were afforded the position of substitutes. The discourse exemplifies how the behaviour or appearances of ethnic minority patients cannot be reconciled with the traits of ethnic Danish patients. Finally, we discussed implications that such a strategy may have for the provision of healthcare services for ethnic minority patients in Denmark.

Feasibility and acceptability of a six-month exercise and patient education intervention for patients with hip dysplasia: A mixed methods study

BACKGROUND AND OBJECTIVES

To evaluate the feasibility and acceptability of exercise and patient education for patients with hip dysplasia not receiving surgery.

DESIGN

Feasibility study.

METHODS

The participants received exercise instruction and patient education over six months. Feasibility covered recruitment, retention, and mechanisms of change (MC). MC were measured with Hip and Groin Outcome Score (HAGOS), muscle strength tests, Y-balance test, and hop for distance test (HDT) over six months. Acceptability covered adherence, expectations, perceptions, benefits, and harms.

RESULTS

Thirty of 32 were recruited (median age: 30 years); six were lost to follow-up. Twenty-four participants improved by a mean of 11 (95%CI: 5-17) HAGOS pain points, improvements in all subscales were 1-11 points. Mean hip abduction strength improved 0.2 (95%CI: 0.04-0.4) Nm/kg, similar to flexion and extension. Median Y-balance test improvements: anterior: 70 (IQR: 64-74) to 75 (IQR: 72-80) centimetres; posteromedial: 104 (IQR: 94-112) to 119 (IQR: 112-122) centimetres and posterolateral: 98 (IQR: 89-109) to 116 (IQR: 108-121) centimetres (p < .001). Median improvement in HDT was: 37 (IQR: 30-44) to 52 (IQR: 45-58) centimetres (p < .001). Participants adhered to 84% of scheduled sessions (1,581:1,872), expectations were met, and perceptions were characterized by high self-efficacy for exercise. Benefits were reported with no serious harms.

CONCLUSION

Patients with hip dysplasia are willing to be recruited for exercise and patient education, with acceptable retention. MC were observed through improvements in pain, strength and function with high acceptance of the exercise and patient education intervention. Thus, it seems feasible to conduct a full-scale randomised controlled trial.

Comparing exercise and patient education with usual care in the treatment of hip dysplasia: a protocol for a randomised controlled trial with 6-month follow-up (MovetheHip trial)

INTRODUCTION

Surgery is not a viable treatment for all patients with hip dysplasia. Currently, usual care for these patients is limited to a consultation on self-management. We have shown that an exercise and patient education intervention is a feasible and acceptable intervention for patients not receiving surgery. Therefore, we aim to investigate whether patients with hip dysplasia randomised to exercise and patient education have a different mean change in self-reported pain compared with those randomised to usual care over 6 months. Furthermore, we aim to evaluate the cost-effectiveness and perform a process evaluation.

METHODS AND ANALYSIS

In a randomised controlled trial, 200 young and middle-aged patients will be randomised to either exercise and patient education or usual care at a 1:1 ratio through permuted block randomisation. The intervention group will receive exercise instruction and patient education over 6 months. The usual care group will receive one consultation on self-management of hip symptoms. The primary outcome is the self-reported mean change in the pain subscale of the Copenhagen Hip and Groin Outcome Score (HAGOS). Secondary outcomes include mean changes in the other HAGOS subscales, in the Short Version of the International Hip Outcome Tool, in performance, balance and maximal hip muscle strength. Between-group comparison from baseline to 6-month follow-up will be made with intention-to-treat analyses with a mixed-effects model. Cost-effectiveness will be evaluated by relating quality-adjusted life years and differences in HAGOS pain to differences in costs over 12 months. The functioning of the intervention will be evaluated as implementation, mechanisms of change and contextual factors.

ETHICS AND DISSEMINATION

The study protocol was approved by the Committee on Health Research Ethics in the Central Denmark Region and registered at ClinicalTrials. Positive, negative and inconclusive findings will be disseminated through international peer-reviewed scientific journals and international conferences.

TRIAL REGISTRATION NUMBER

NCT04795843.

Toward Nurses' Transformative Agency in Transitional Care for Older Adults: A Change-Laboratory Intervention

Mobilization of nurses' agency across healthcare sectors is needed to counter challenges associated with older adults' transitions between hospital and primary care. Based on Cultural Historical Activity theory and the Change Laboratory method, we developed a learning intervention with 16 nurses. The aim was to foster the nurses' transformative agency to improve care. Video-recording of nine learning sessions were transcribed and analyzed. Results demonstrated that shared transformative agency exhibited as an emergent phenomenon crossing sectoral boundaries as a prerequisite for change in transitional care. The nurses progressed from acting as individuals criticizing the current conditions to collectively forming a vision around a transitional care model. This was nurtured through the nurses' negotiations which included a recognition of sharing similar challenges deriving from the healthcare organization and related financial restrictions, and conflicting healthcare and nursing ideals across healthcare sectors. The evolution of transformative agency was grounded in a professional nursing identity.

Systemic contradictions as causes to challenges in nurses' transitional care: A change laboratory intervention

BACKGROUND

Transitional care involves coordination of care for patients transitioning between primary care and hospital care. This necessitates collaboration with patients, health professionals and organizations with different goals for patient care. This can result in fragmented patient care pathways. Education of health professionals is a means to improve transitional care. We therefore developed a learning intervention in order to enable nurses to develop transitional care.

OBJECTIVE

The objective was to understand how participants identified needs for development can improve transitional care.

DESIGN

The design was that of a formative intervention design based on Cultural Historical Activity Theory.

SETTING

A regional hospital and a primary care department in a municipality in Denmark.

PARTICIPANTS

Nine health professionals from primary care services and seven health professionals from hospital services.

METHOD

The change laboratory method and the principle of double stimulation guided the facilitation of the learning intervention, which consisted of nine learning sessions (from May to October 2019). A quantitative and qualitative analytical framework was used for data analysis.

RESULTS

The participants identified needs for development, including a wish to involve patients and their next of kin more and to emphasise relational care. Participants developed an appreciation of challenges concerning collaboration between nurses and the formation of nursing practice. Furthermore, participants began to view challenges as caused by a systemic contradiction between nurses' preoccupation with bureaucratic and managerial demands and patients' expectations of coherent care in transitional care.

CONCLUSION

The process of understanding challenges enabled the participants to change their perception from a need to solve problems as they appear on the surface to a need to address underlying systemic contradictions. This possibly has far-reaching consequences for long-term processes underpinning the development of practice and may serve as an alternative to expedient problem solving.

Living with the risk of being infected: COPD patients' experiences during the coronavirus pandemic

Aims

To explore the existential significance of living with the risk of being infected with coronavirus in patients with COPD.

Background

Distancing measures aim to break the coronavirus transmission chains. Physical separation from social networks and social isolation are correlated with anxiety and depression. People with a chronic obstructive lung disease are particularly vulnerable due to the increased risk of a serious course of illness, so therefore many of them choose self‐isolation to protect themselves from COVID‐19.

Design

A qualitative exploratory study using individual semi‐structured interviews.

Methods

From June–September 2020, 13 participants were recruited through advertisements on Facebook as a convenience sample for semi‐structured individual interviews. The interviews took place through virtual platforms or in physical meetings. Data were analysed using Ricoeur's phenomenological approach, involving naïve reading, a structural analysis and a critical interpretation strategy. The study has been reported in line with COREQ guidelines.

Findings

Living with the threat of being infected with coronavirus has greatly affected everyday life for patients with COPD. The nagging fear of coronavirus as a death threat was a dominant feeling, together with anxiety, loneliness and hope. With self‐isolation, followed concerns of being forgotten and thoughts of the future, balancing between fearing the worst, and hoping the best.

Conclusions

Patients with moderate to severe COPD feel compelled to self‐isolate, as they fear dying from COVID‐19. The study revealed a need for proactive contact with health professionals to calm the patients' feelings of deprivation, loneliness, hopelessness and anxiety.

Relevance to clinical practice

Information about the patient's perspective may be used to develop targeted interventions aimed at giving adequate information, supporting hope, implementing digital or virtual solutions to keep in contact and avoid the feeling of being alone and forgotten during a pandemic crisis.

'Striving for normality' when coping with Parkinson's disease in everyday life: A metasynthesis

BACKGROUND

Parkinson's disease is a chronic, progressive neurodegenerative disease which affects more than ten million people worldwide. Living with Parkinson's disease has a high impact on everyday life, and may affect quality of life negatively. Individualized coping strategies are needed to deal with the disease on a daily basis and still enjoy a social life.

OBJECTIVE

The aim of this study was to identify and describe strategies for coping adopted by individuals living with Parkinson's disease in their daily lives.

DESIGN

The study is designed as a meta-ethnographic metasynthesis and follows Sandelowski and Barroso's guidelines for synthesizing qualitative research.

DATASOURCES

Based on an exhaustive literature search in the following databases: CINAHL, MEDLINE, PsychINFO, Scopus and Swemed, as well as Mednar, parkinson.org, Google Scholar and OpenGrey, with no limit on the search date, 14 articles were included.

REVIEW METHODS

The data were analyzed through a taxonomic and inductive analysis focusing on coping with Parkinson's disease in daily life.

RESULTS

The findings revealed that the overarching motivation for patients to cope with Parkinson's disease was maintaining normality and preserving the self. The coping strategies used were: Staying independent, Focusing on the present and Avoiding challenging situations.

CONCLUSIONS

Coping with Parkinson's disease is an ongoing and complex process of balancing the strategies used, while holding on to the 'self' that pre-dated Parkinson's disease, and at the same time adjusting one's identity to embrace living with a chronic condition. In this process, optimism and positive thinking would seem to be very fruitful. Further, the synthesis revealed that relatives often act as informal caregivers and hence as an important support in daily life. Healthcare professionals must know about coping strategies in order better to support the patients.

Insulin resistance in vascular endothelial cells promotes intestinal tumour formation

The risk of several cancers, including colorectal cancer, is increased in patients with obesity and type 2 diabetes, conditions characterized by hyperinsulinemia and insulin resistance. Because hyperinsulinemia itself is an independent risk factor for cancer development, we examined tissue-specific insulin action in intestinal tumor formation. In vitro, insulin increased proliferation of primary cultures of intestinal tumor epithelial cells from Apc^Min/+ mice by over 2-fold. Surprisingly, targeted deletion of insulin receptors in intestinal epithelial cells in Apc^Min/+ mice did not change intestinal tumor number or size distribution on either a low or high-fat diet. We therefore asked whether cells in the tumor stroma might explain the association between tumor formation and insulin resistance. To this end, we generated Apc^Min/+ mice with loss of insulin receptors in vascular endothelial cells. Strikingly, these mice had 42% more intestinal tumors than controls, no change in tumor angiogenesis, but increased expression of vascular cell adhesion molecule-1 (VCAM-1) in primary culture of tumor endothelial cells. Insulin decreased VCAM-1 expression and leukocyte adhesion in quiescent tumor endothelial cells with intact insulin receptors and partly prevented increases in VCAM-1 and leukocyte adhesion after treatment with tumor necrosis factor-α. Knockout of insulin receptors in endothelial cells also increased leukocyte adhesion in mesenteric venules and increased the frequency of neutrophils in tumors. We conclude that although insulin is mitogenic for intestinal tumor cells in vitro, its action on tumor cells in vivo is via signals from the tumor microenvironment. Insulin resistance in tumor endothelial cells produces an activated, proinflammatory state that promotes tumorigenesis. Improvement of endothelial dysfunction may reduce colorectal cancer risk in patients with obesity and type 2 diabetes.

Nurses' experiences of working in organizations undergoing restructuring: A metasynthesis of qualitative research studies

BACKGROUND

Health care organizations worldwide undergo continual reconfiguration and structural changes in order to optimize the use of resources, reduce costs, and improve the quality of treatment.

OBJECTIVE

The objective of this study was to synthesize qualitative studies of how nurses experience working in organizations undergoing structural changes.

DESIGN

The review is designed as a metasynthesis and follows the guidelines put forth by Sandelowski and Barroso for synthesizing qualitative research.

DATA SOURCES

From January to April 2015, literature searches were conducted in the CINAHL, PubMed, ProQuest, and Web of Science databases for the period from 1994 to 2014.

REVIEW METHODS

A total of 762 articles were found and screened, 12 of which were included in the review after being appraised using a specially designed reading guide. The inclusion criteria were qualitative studies in English, German, Norwegian, Swedish, or Danish on nurses' experiences with being employed in organizations undergoing structural changes. The data were then analyzed in a metasummary and metasynthesis.

RESULTS

Four overall categories that illustrate how nurses experience working in organizations undergoing structural changes were identified: nursing management, emotional responses, nursing work, and colleagues. Generally, nurses seemed to describe their experiences working in organizations undergoing structural changes in a negative way, as all of the included articles reported that nurses experience an increased workload due to restructuring. However, some of the articles reported that nurses also experience a certain joy associated with the nursing work despite the negative consequences of the structural changes.

CONCLUSIONS

The findings can be seen as a paradox because former research has shown that an increased workload reduces the pleasure in working. Further research on this topic is needed to ensure a better working environment for nurses.

High environmental temperature around farrowing induced heat stress in crated sows

The aim of the experiment was to study the impact of high ambient temperature (25°C) around farrowing on crated sows unable to perform thermoregulatory behavior. Twenty sows were housed in 2 farrowing rooms in conventional farrowing crates. In 1 room (CONTROL) temperature was kept at 20°C. In the other room (HEAT) temperature was initially kept at 20°C and gradually raised until it reached 25°C from d 112 to 115 of gestation. Then the temperature was gradually lowered to 20°C. Sows were continuously video recorded for behavior recording. Sows' respiration rates were recorded from d 3 before farrowing to d 5 after farrowing. Sows' rectal temperatures were recorded from d 1 before farrowing to d 8 after farrowing, and sows' udder surface temperatures were recorded from the day of farrowing to d 3 after farrowing. All measures were recorded daily. Sows' BW were recorded at d 108 of gestation and at weaning. Sows' back fat was recorded on farrowing day, when room temperature was set again at 20°C, and at weaning. Piglets were weighed at d 1, 14, and 21. The HEAT sows spent a higher proportion of time lying in the lateral position than CONTROL sows, both during the 16 h before farrowing and the 24 h after the start of farrowing ( < 0.05), but with no difference in the amount of time spent lying down between groups ( > 0.10). The HEAT sows had higher rectal temperature on d 1 after farrowing ( < 0.05) and had udder surface temperature 0.9°C higher than that of CONTROL sows during the recording period ( < 0.05). The HEAT sows also tended to have longer farrowing duration ( < 0.10). Respiration rate was higher in HEAT sows on d 1 before farrowing and on the day of farrowing. On d 7, 8, and 9, CONTROL sows had higher feed intake ( < 0.05), and piglets from CONTROL sows were heavier at d 21 after farrowing ( < 0.05). High ambient temperature around farrowing altered sows' postural behavior. Sows reacted to the thermal challenge with higher respiration rate around farrowing, but both their rectal and udder temperatures were elevated, indicating that they were not able to compensate for the higher ambient temperature. High ambient temperature negatively influenced sows' feed intake, with negative impact on piglets' weaning weight. High temperatures around farrowing (25°C) compromise crated sows' welfare, with a potential negative impact on offspring performance.

Practical wisdom: a qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses

OBJECTIVES

To describe the reasoning and actions of experienced nurses caring for patients with non-invasive ventilation due to acute respiratory failure from chronic obstructive pulmonary disease.

INTRODUCTION

Treatment success for patients requiring non-invasive ventilation remains challenging. Understanding the reasoning and actions of experienced nurses that care for patients with non-invasive ventilation can identify how nurses contribute to treatment success, and this information can be used to train less experienced nurses to provide excellent care.

DESIGN

Qualitative descriptive study. A secondary analysis on data of qualitative participant observations during non-invasive ventilation treatment and additional six interviews with experienced ICU nurses was carried out in 2012.

RESULTS

The experienced nurses exhibited 'practical wisdom'. Each nurse could stay alert to the patient's condition and respond to NIV. Conceptualisation of the complexities in nurses' reasoning and actions illustrated their tendency to separate problematic situations into three interrelated components: (1) achieving non-invasive adaptation, (2) ensuring effective ventilation and (3) responding attentively to patients' perceptions of non-invasive ventilation. Each component comprises a set of nursing reasoning and actions that experienced nurses use to achieve treatment success.

CONCLUSIONS

Understanding how experienced nurses think and act during non-invasive ventilation care may help to optimise continuing professional development and help educate junior nurses.

Nurse-patient collaboration: a grounded theory study of patients with chronic obstructive pulmonary disease on non-invasive ventilation

OBJECTIVES

This paper provides a theoretical account of nurses' collaboration with patients with chronic obstructive pulmonary disease during non-invasive ventilation treatment in hospital.

BACKGROUND

Despite strong evidence for the effect of non-invasive ventilation treatment, success remains a huge challenge. Nurse-patient collaboration may be vital for treatment tolerance and success. A better understanding of how nurses and patients collaborate during non-invasive ventilation may therefore contribute to improvement in treatment success.

DESIGN

A constant comparative classical grounded theory.

METHOD

The data comprised sessions of qualitative participant observation during the treatment of 21 patients with non-invasive ventilation that included informal conversations with the nurses and semi-structured interviews with 11 patients after treatment completion. Data were collected at three intensive care units and one general respiratory ward in Denmark.

RESULTS

Succeeding emerged as the nurses' main concern in the nurse-patient collaboration during non-invasive ventilation treatment. Four collaborative typologies emerged as processing their main concern: (1) twofold oriented collaboration; (2) well-being oriented collaboration; (3) outcome oriented collaboration; and (4) absent collaboration.

CONCLUSIONS

This study offers a theoretical account of nurses' main concern and how they activate different ways of collaboration to achieve successful treatment. We offer a theoretical basis for developing complex interventions.

Antibiotic and biosurfactant properties of cyclic lipopeptides produced by fluorescent Pseudomonas spp. from the sugar beet rhizosphere

Cyclic lipopeptides (CLPs) with antibiotic and biosurfactant properties are produced by a number of soil bacteria, including fluorescent Pseudomonas spp. To provide new and efficient strains for the biological control of root-pathogenic fungi in agricultural crops, we isolated approximately 600 fluorescent Pseudomonas spp. from two different agricultural soils by using three different growth media. CLP production was observed in a large proportion of the strains (approximately 60%) inhabiting the sandy soil, compared to a low proportion (approximately 6%) in the loamy soil. Chemical structure analysis revealed that all CLPs could be clustered into two major groups, each consisting of four subgroups. The two major groups varied primarily in the number of amino acids in the cyclic peptide moiety, while each of the subgroups could be differentiated by substitutions of specific amino acids in the peptide moiety. Production of specific CLPs could be affiliated with Pseudomonas fluorescens strain groups belonging to biotype I, V, or VI. In vitro analysis using both purified CLPs and whole-cell P. fluorescens preparations demonstrated that all CLPs exhibited strong biosurfactant properties and that some also had antibiotic properties towards root-pathogenic microfungi. The CLP-producing P. fluorescens strains provide a useful resource for selection of biological control agents, whether a single strain or a consortium of strains was used to maximize the synergistic effect of multiple antagonistic traits in the inoculum.

Identification of indicator microorganisms using a standardized PNA FISH method

A standardized fluorescent in situ hybridization (FISH) method using Peptide Nucleic Acid (PNA) probes for analysis of gram-negative and gram-positive bacteria, as well as yeast, has been developed. Fluorescently labeled PNA probes targeting specific rRNA sequences of Escherichia coli, Pseudomonas aeruginosa, Staphyloccocus aureus, Salmonella were designed, as well as PNA probes targeting eubacteria and eucarya. These PNA probes were evaluated by PNA FISH using 27 bacterial and 1 yeast species, representing both phylogenetically closely related species, as well as species important to both clinical and industrial settings. The S. aureus and P. aeruginosa PNA probes did not cross react with any of the organisms tested, whereas the E. coli PNA probe, as expected from sequence data, also detected Shigella species. The Salmonella PNA probe reacted with all of the 13 Salmonella strains, representing the 7 subspecies of Salmonella, however, it is also complementary to a few other bacterial species. The eubacteria- and eucarya-specific PNA probes detected all bacterial species and one yeast species, respectively. The general applicability of the PNA FISH method made simultaneous identification of multiple species, both gram-negative and gram-positive, in a mixed population an attractive possibility never accomplished using DNA probes. Four color images using differently labeled PNA probes showed simultaneous identification of E. coli, P. aeruginosa, S. aureus and Salmonella, thereby demonstrating the potential of multiplex FISH for various diagnostic applications within both clinical and industrial microbiology.

Cyclic lipoundecapeptide amphisin from Pseudomonas sp. strain DSS73

The crystal structure of the lipoundecapeptide amphisin, presented here as the tetrahydrate, C(66)H(114)N(12)O(20).4H(2)O, originating from non-ribosomal biosynthesis by Pseudomonas sp. strain DSS73, has been solved to a resolution of 0.65 A. The primary structure of amphisin is beta-hydroxydecanoyl-D-Leu-D-Asp-D-allo-Thr-D-Leu-D-Leu-D-Ser-L-Leu-D-Gln-L-Leu-L-Ile-L-Asp (Leu is leucine, Asp is aspartic acid, Thr is threonine, Ser is serine, Gln is glutamine and Ile is isoleucine). The peptide is a lactone, linking Thr4 O(gamma) to the C-terminal. The stereochemistry of the beta-hydroxy acid is R. The peptide is a close analogue of the cyclic lipopeptides tensin and pholipeptin produced by Pseudomonas fluorescens. The structure of amphisin is mainly helical (3(10)-helix), with the cyclic peptide wrapping around a hydrogen-bonded water molecule. This lipopeptide is amphiphilic and has biosurfactant and antifungal properties.

Identification of Dekkera bruxellensis (Brettanomyces) from wine by fluorescence in situ hybridization using peptide nucleic acid probes

A new fluorescence in situ hybridization method using peptide nucleic acid (PNA) probes for identification of Brettanomyces is described. The test is based on fluorescein-labeled PNA probes targeting a species-specific sequence of the rRNA of Dekkera bruxellensis. The PNA probes were applied to smears of colonies, and results were interpreted by fluorescence microscopy. The results obtained from testing 127 different yeast strains, including 78 Brettanomyces isolates from wine, show that the spoilage organism Brettanomyces belongs to the species D. bruxellensis and that the new method is able to identify Brettanomyces (D. bruxellensis) with 100% sensitivity and 100% specificity.

Protein modification by fermentation: effect of fermentation on the potential allergenicity of pea

The effect of fermentation on components of potential significance for the allergenicity of pea was analyzed. Pea flour was fermented with three lactic acid bacteria, Pediococcus pentosaceus, Lactococcus raffinolactis, and Lactobacillus plantarum, and two fungi, Rhizopus microsporus, var. oligosporus and Geotrichum candidum. Residual antigenicity against antipea antibodies was reduced to 10% by the three lactic acid bacteria and R. microsporus. Reactions to anti-pea profilin and anti-Bet v 1 were still detectable after fermentation. The contents of lectin and pea protease inhibitor were not reduced by the microorganisms.

Effect of vincristine or bleomycin on radiation-induced cell killing of mice spermatogonial stem cells: the importance of sequence and time interval

The effect of single doses of vincristine (VCR) or bleomycin (BLM) on mice spermatogonia was investigated, and the influence of either of these drugs on the radiation response of murine spermatogonial stem cells was examined. When assessed by flow cytometry, VCR (1.0 mg/kg) or BLM (100 mg/kg) reduced the survival in the differentiated spermatogonia to 4% and 37% of controls, respectively (p less than 0.05). VCR reduced the stem cells to 79% of controls (p less than 0.05), whereas BLM had no apparent effect on the stem cells (p greater than 0.05). Drugs were administered intraperitoneally up to 28 days before or after local irradiation with 9 Gy. VCR produced significant enhancement of radiation-induced damage to spermatogonial stem cells, which was most prominent when administered 6 or 12 hr after irradiation. BLM administered before irradiation or 1 hr after radiotherapy produced significant enhancement.

Parapoxvirus papillomatosis in the muskoxen (Ovibos moschatus): genetical differences between the virus causing new outbreak in a vaccinated herd, the vaccine virus and a local orf virus

Since 1981 a domesticated muskoxen herd had been successfully vaccinated against papillomatosis with homogenated, glutaraldehyde inactivated papilloma tissue. In the fall of 1985 a new clinical outbreak of disease occurred, affecting previously infected as well as vaccinated animals. The purification of parapox virions directly from papilloma tissue and orf scabs collected in a local sheep farm was followed by restriction endonuclease analysis of viral DNA. The morphological identity of purified virus was controlled by electron microscopy. Comparison of restriction endonuclease digests (10 different enzymes) by gel electrophoresis demonstrated that the muskoxen parapoxvirus from the new outbreak 1985 differed considerably from the 2 other isolates (muskoxen 1981 and local orf). The latter viruses demonstrated a high degree of homology, but differences were evident after digestion with the enzyme EcoRI. During metrizamide gradient purification minor bands containing morphologically intact virions were isolated in addition to the major fractions. The restriction enzyme digests indicated that the virions of the minor bands differed from those in the major bands.

Simultaneous blank correction in a turbidimetric continuous flow system for immunochemical quantitation of plasma proteins

By shortening the reaction time by polymer enhancement, it was possible to introduce a line for automatic blank correction in a turbidimetric continuous flow system. The turbidity resulting from the reaction was measured by a simply constructed photometer, the serum turbidity being subtracted by the reference photoelectric cell and the resulting net signal amplified by means of the recorder's stepwise electronic amplifier. Serum transferrin values obtained by this method correlated well with values obtained by estimating blank in separate runs, and with values given be electroimmune assays.