No description available.

The aim of the thesis was to reveal reserves for improving the piglets breeding and to reduce losses by death. The highest number of all (13.52 pcs) and live born (11.88 pcs) piglets were achieved in gilts embedded in more than 247 days of age. Gilts covered within 224 days of age showed the lowest average number of piglets born (13.13 pcs). Statistically, however, has not been demonstrated difference (p > 0.05) between age groups of gilts during the first recess in the number of piglets born. Effect of order of litter on litter size was found to be statistically highly significant (p < 0.01), especially between the first and third parturition. The highest number of born piglets was found on the third litter (14.95 pcs) and lowest in the first litter (13.3 pcs). Most live piglets born were at the second litter (14.03 pcs) and least live born piglets were found on the 5th and higher litter (11.57 pcs). Among the number of piglets born alive in the individual litters was also evaluated statistically highly significant difference (p < 0.01). In assessing the impact on the duration of labor litter size was found to be a higher number of piglets born at night on average by 0.33 piglet more, but the number of piglets born alive was found higher in childbirth during the day (childbirth with assist). During statistical evaluation was not demonstrabled difference between the number of all even in the case of piglets born alive in viewpoint of the time of birth. From the perspective of the impact of the length of the interval from weaning to sows on litter size was found to be a higher number of all (14.83 pcs) and live (12.79 pcs) piglets born of sows recessed for more than 6 days after weaning. From the viewpoint of the impact sequence of litter for childbirth was detected statistically detectable difference (p > 0.05). In each of the litters was observed an average of 75 % births through the day. When evaluating the number of live births, depending on the number of piglets, born piglets showed a statistically highly significant relationship (p < 0.01) with high tightness on dependence (R = 0.83). Between the number of all born piglets and born alive was found a direct correlation.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / O cálcio tem se mostrado útil na regulação do metabolismo energético, favorecendo a perda de peso. Visto que tanto o desmame precoce como a exposição materna à nicotina na lactação são fatores condicionantes para o desenvolvimento de obesidade, hiperleptinemia e resistência à insulina, além de outras alterações endócrinas na idade adulta, decidimos avaliar os possíveis efeitos da suplementação dietética com cálcio sobre as disfunções apresentadas pelos seguintes modelos experimentais: 1) Desmame precoce (DP): ratas lactantes foram envolvidas com atadura para interromper o acesso da prole ao leite nos 3 últimos dias da lactação. As proles das ratas controles tiveram livre acesso ao leite materno durante todo o período da lactação (21 dias). 2) Exposição materna à nicotina (N): Dois dias após o nascimento, ratas lactantes receberam implantes de minibombas osmóticas contendo solução de nicotina (6 mg/kg/dia, 14 dias) ou salina (C), nas mesmas condições. Aos 120 dias de idade, as proles de ambos os modelos de obesidade experimental receberam dieta padrão ou dieta suplementada com cálcio (10g de carbonato de cálcio/kg de ração). O sacrifício ocorreu aos 180 dias de idade. Os dados foram considerados significativos quando p<0,05. Corroborando dados anteriores do nosso grupo, as proles de ambos os modelos de programação (N e DP) apresentaram maior gordura corporal total e visceral, hiperleptinemia, resistência hipotalâmica a leptina e distúrbios na homeostase glicêmica. Além disto, verificamos que as proles N e DP também exibiram aumento dos níveis séricos de 25-hidroxivitamina D3. Todos essas alterações endócrino-metabólicas foram corrigidas pelo tratamento com suplementação com cálcio. Além disso, a prole DP aos 180 dias mostrou hiperfagia e hipertrigliceridemia, que também foram normalizados pela suplementação dietética com cálcio. A prole N apresentou hipotireoidismo, maior conteúdo de catecolaminas e maior expressão de tirosina hidroxilase (TH). A terapia com cálcio reverteu a disfunção adrenal, embora não tenha sido eficaz para normalizar a hipofunção tireoideana. Assim, a suplementação dietética com cálcio normalizou a maioria dos parâmetros da síndrome metabólica observadas nos dois modelos de plasticidade ontogenética. É possível que a redução da adiposidade central induzida pela terapia com cálcio, por si, tenha sido o principal mecanismo que resultou na melhora dos parâmetros estudados. Uma vez que a suplentação de cálcio reverteu as concentrações séricas de 25-hidroxivitamina D3 dos animais obesos, é possível que o efeito anti-obesidade do cálcio também ocorra via ação do calcitriol sobre o adipócito. / Calcium influences energy metabolism regulation and causes body weight loss. Since early weaning and maternal nicotine exposure during lactation programs for obesity, hyperleptinemia, insulin resistance and others endocrine dysfunctions, we studied the possible effect of dietary calcium supplementation on endocrine dysfunctions in these two experimental model of obesity: 1) Early Weaning (EW): lactating rats were involved with a bandage to interrupt the lactation during the last 3 days of standard lactation, and C (control) - dams whose pups had free access to milk during all lactation (21 days). 2) Maternal nicotine exposure (N): Two days after birth, it was implanted on the mothers, osmotic minipumps containing nicotine solution (6 mg/Kg/day, 14 days) or saline (C) in the same condition. At 120 days-old, all offspring received dietary calcium supplementation (10g of calcium carbonate/Kg of rat chow) or standard diet. Rats were killed at 180 days-old. Significant data were p<0.05. As expected, N and DP offspring showed higher visceral and total body fat mass, hyperleptinemia, hypothalamic leptin resistance and insulin resistance. In addition they presented higher serum 25-hydroxyvitamin D3. All these disturbances were corrected after calcium supplementation. Besides, adult EW offspring displayed hyperphagia and hypertriglyceridemia that was normalized with calcium therapy. Also, N offspring presented hypothyroidism, higher tyrosine hydroxylase expression and higher adrenal catecholamine content. Despite calcium treatment have normalized adrenal dysfunction, it did not reverse the hypothyroidism. So, dietary calcium supplementation seems to revert most of the metabolic syndrome parameters observed in our two developmental plasticity models. It is conceivable that the reduction in fat mass per se, induced by calcium therapy, is the main mechanism that improves all parameters. Because serum 25-hydroxyvitamin D3 levels were corrected by calcium supplementation in obese offspring, it is possible that the anti-obesity effect of calcium occurs through calcitriol action on the adipocyte.

Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-20Bitstream added on 2014-06-13T19:15:09Z : No. of bitstreams: 1 rocha_nb_me_araca.pdf: 753568 bytes, checksum: fe35e8823e28b5889b61841255bf3e22 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A prática de aleitamento materno é de fundamental para o crescimento, desenvolvimento, saúde e nutrição dos bebês, sendo uma intervenção simples e efetiva para reduzir mortalidade e morbidade infantil. Objetivou-se identificar a prevalência do aleitamento materno, os fatores que influenciam seu sucesso e as causas do desmame precoce, comparando entre cidades com ou sem Estratégia da Saúde da Família (ESF), bem como a associação do aleitamento com os hábitos de sucção não-nutritivos. Neste estudo longitudinal, prospectivo, foram entrevistadas 84 mães durante a gestação e acompanhados 87 bebês até o sexto mês de vida. O estudo foi dividido em duas etapas. A primeira foi constituída de entrevistas com gestantes nas Unidades Básicas de Saúde (UBS) e visitas domiciliares. Após o nascimento dos bebês, na segunda etapa do estudo, foram realizadas entrevistas domiciliares mensais do primeiro até o sexto mês de vida do bebê. Testes estatísticos foram realizados para verificar-se associações, bem como construídas curvas de sobrevivência, com auxílio dos programas EpiInfo v.3.5.1 e o Bioestat v.5.0. Todas as mães pretendiam amamentar seus filhos, por em média 11 meses, alegando como motivos principais a proteção do “leite materno” e “por amor”. Quase a totalidade (94,3%) das mães começou amamentar os bebês no primeiro mês, mas destas apenas 49,4% amamentavam exclusivamente. Ao final do sexto mês nenhuma mãe estava amamentando exclusivamente e 46% das crianças já tinham sido desmamadas. Os principais motivos alegados foram escassez ou falta de leite e o fato de os filhos não aceitarem mais o peito. As seguintes variáveis do estudo mostraram associação significante com aleitamento materno: idade da mãe (0,0033), situação conjugal (0,0004), orientações sobre amamentação pré (0,0118) e perinatal (0,0033), dificuldades... / The practice of mother’s suckling is essential for growing, development, health and nutrition of babies, being a simple and effective intervention to reduce child mortality and morbidity. It was objective to identify prevalence of mother’s suckling, factors that influence its successful and causes of premature wean, comparing it among cities with or without Family Health Care Strategy (ESF), and association of breastfeed with non nutritive suction habits. In this longitudinal and prospective study were interviewed 84 mothers during pregnancy period and 87 babies were accompanied until 6th month after birth. The study was divided on two parts. First, there were interviews with pregnancy women on Health Basic Unities (UBS) and domiciliate visits. After birth of babies, on the second part of study, domiciliate interviews were realized by month from first at sixth month of baby life. Statistics tests were realized to verify associations and built survival curves, with help of Epi Info version 3.5.1 and Bioestat version 5.0 programs. Every mothers intended breastfeed them suns during near 11 months, pointing like principal motives the protection of “mother’s milk” and “due love”. Near totality (94,3%) of mothers begun breastfeed the babies on first month, but just 49,4% of these women breastfed exclusively on breast. In the end of sixth month, any mother wasn’t breastfeeding exclusively and 46% of children had been weaned. Principal motives pointed were scarcity or absence of milk and that the sun didn’t want it anymore. The follow study variables showed significant association with mother’s suckling: mother’s age (0,0033), conjugal situation (0,0004), orientation about suckling pre (0,0118) and perinatal (0,0033), difficulties on suckling (<0,0001), use of alcohol (0,0044), familiar base (0,00036), habits (<0,0001), use of dummy (<0,0001) and feeding bottle... (Complete abstract click electronic access below)

INTRODUÇÃO: A literatura tem postulado que a ventilação por pressão positiva não invasiva (VNI) pode facilitar o desmame de um grupo específico de pacientes. O objetivo deste estudo foi comparar a utilização da VNI como método alternativo na supressão da ventilação mecânica no pós-operatório de cirurgia cardíaca. MÉTODOS: Neste estudo prospectivo controlado e randomizado, foram estudados 100 pacientes submetidos a cirurgia de revascularização do miocárdio ou cirurgia valvar. Os pacientes foram admitidos na Unidade de Terapia Intensiva (UTI), sob ventilação mecânica e randomizados posteriormente em grupo estudo (n= 50), que utilizou VNI com dois níveis pressóricos após extubação, e grupo controle (n= 50), que utilizou a técnica convencional de supressão da ventilação mecânica. Foram analisados os tempos correspondentes à anestesia, cirurgia, circulação extracorpórea e ventilação mecânica na UTI. As variáveis gasométricas, hemodinâmicas e radiológicas foram avaliadas antes e após a extubação. RESULTADOS: Os grupos controle e estudo apresentaram comportamento semelhante quanto ao tempo de desmame ventilatório e as outras variáveis estudadas não apresentaram diferença estatística. A utilização da VNI por 30\' após a extubação, nos pacientes com atelectasias, promoveu diferença significativa na PaCO2 no grupo coronariano e na PaO2 no grupo submetido à cirurgia valvar. CONCLUSÃO: O tempo para supressão da ventilação mecânica foi similar nos grupos. Fatores extrísecos interferiram na evolução do desmame. O uso da VNI por 30 minutos após extubação apresentou diferença estatisticamente significante nas variáveis gasométricas em pacientes com atelectasias / INTRODUCTION: It was postulated that noninvasive positive pressure ventilation (NPPV) could facilitate ventilatory weaning in specific patients. The aim was to compare NPPV as alternative ventilatory weaning method with a standard ventilatory weaning protocol in the immediate postoperative period of cardiac surgery. METHODS: One hundred consecutive patients submitted to coronary artery bypass grafting or valvar surgery were addmitted in the Intensive Care Unit (ICU) and mechanicanically ventilated. They were randomly assigned to a study group (n=50) wich use NPPV witn bilevel presssure in the airways and a control group (n=50) witch used the conventional weaning thecnique. The outcome measures were anestesie, surgery, cardiopulmonar bypass and mechanical ventilation time. Arterial blood gases, hemodynamics and chest X-rays were assessed pre and post extubation. RESULTS: Weaning times were similar in both groups, and no differences were found in the studied variables. There were statistic significance considering PaCO2 in coronary and PaO2 in valvar group using NPPV 30\' after extubation, when atelectasis was detected. CONCLUSION: The ventilatory weaning time was similar in both groups. Extrinsics factors had interfered in weaning evolution. NPPV use during 30\' after extubation had statistical significance in gasometric variables in patients with athelectasis

Orientador: Luiz Antonio Rossi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Agrícola / Made available in DSpace on 2018-08-25T02:28:06Z (GMT). No. of bitstreams: 1 Barros_JulianadeSouzaGranja_M.pdf: 1975791 bytes, checksum: 57f688903342bc7bc27950bf884ac3b3 (MD5) Previous issue date: 2014 / Resumo: O uso de sistemas de aquecimento em creches suínas é necessário para proporcionar conforto térmico e bem-estar aos animais dentro das instalações. A maioria dos equipamentos de fornecimento de calor utilizados na suinocultura demanda energia elétrica; cujo custo é sempre crescente. Portanto, há a necessidade de ajustes nos sistemas de aquecimento hoje empregados, com o intuito de viabilizar o uso racional de energia elétrica pelo setor. Deste modo, por meio da aplicação de um sistema eletrônico de controle da temperatura dentro das creches é possível manter o bem-estar e o desempenho produtivo do animal, com maior eficiência do uso de energia elétrica, em relação a dispositivos de controle tradicionais, como por exemplo, o termostato. O objetivo deste trabalho foi comparar duas tecnologias de controle de temperatura quanto ao uso racional de energia elétrica, manutenção das condições de conforto térmico e de desempenho produtivo dos animais em fase de creche. Os tratamentos estudados foram: resistências elétricas suspensas controladas por termostato digital simples, que representou a testemunha, e resistências elétricas suspensas controladas por controlador PID (Proporcional, integral e derivativo). Os tratamentos foram analisados quanto ao consumo de energia elétrica (kWh), consumo específico (kWh.kg? ¹), custo específico (R$.kg? ¹), demanda máxima de potência (kW), eficiência elétrica, ganho de peso (kg), conversão alimentar, taxa de mortalidade (%), temperatura de bulbo seco (°C), Índice de Temperatura e Umidade (ITU) e entalpia (kJ.kg? ¹ ar seco). O sistema de aquecimento resistivo com termostato manteve o ambiente mais tempo dentro da zona de conforto de temperatura em comparação ao sistema de aquecimento com controlador PID. No entanto, em relação aos índices de conforto térmico, o sistema de aquecimento com controlador PID proporcionou melhores condições de conforto em comparação ao sistema com termostato. Além disso, o sistema de aquecimento com controlador PID apresentou maiores valores de ganho de peso e menor consumo e custo específico de energia elétrica. Desta forma, concluiu-se que o sistema de aquecimento resistivo com controlador PID foi o que melhor atendeu as condições de conforto térmico dos leitões, foi o mais eficiente quanto ao uso de energia elétrica e o que proporcionou melhor desempenho produtivo aos animais / Abstract: The use of heating systems in nursery pigs is required to provide thermal comfort and welfare of animals within the facility. Most heat supply equipment used in swine electricity demand, whose cost is ever increasing. Thus, there is the need for adjustments to the heating systems used today, in order to facilitate the rational use of energy by industry. Thus, through the application of an electronic temperature control within the nurseries is possible to keep the welfare and the productive performance of the animal, more efficient use of electricity, compared to traditional control, such as example, the thermostat. The objective of this research had to compare two technologies for temperature control regarding the rational use of electricity, maintaining of thermal comfort and productive performance of the animals in the nursery phase. The treatments were: suspended electrical resistances controlled by a simple digital thermostat and suspended electrical resistances controlled by PID controller (proportional, integral and derivative). The treatments were analyzed regarding the electrical energy consumption (kWh), specific consumption (kWh.kg-¹), specific cost (R $.kg-1), maximum demand (kW), electrical efficiency, weight gain (kg), feed conversion, mortality rate (%), dry bulb temperature (° C), Temperature and Humidity Index (THI) and enthalpy (kJ.kg- ¹ dry air). The resistive heating system with thermostat kept more time environment within the comfort zone temperature compared to the heating system with the PID controller. However, regarding to thermal comfort indices, the heating system with PID controller provided better comfort conditions compared to the system with thermostat. Furthermore, the heating system with PID controller showed higher weight gain and lower specific consumption and cost of electricity. The resistive heating system with PID controller was that better provided the conditions for thermal comfort of pigs, was the most efficient regarding the use of electrical energy and which provided better performance for the animals / Mestrado / Construções Rurais e Ambiencia / Mestra em Engenharia Agrícola

Des asynchronies patient-ventilateur sont fréquemment observées en ventilation assistée. Objectif : Déterminer l'incidence et les facteurs favorisants des asynchronies, venant du patient, du ventilateur ou des réglages, et préciser le réglage optimal du ventilateur. Méthodes : Nous avons évalué l'incidence des asynchronies avec une méthode simple et non invasive basée sur l'analyse des courbes du ventilateur. Chez les patients qui présentaient des efforts inefficaces, nous avons mesuré l'effort inspiratoire avec une sonde œsophagienne afin d'optimiser le réglage du ventilateur. Nous avons évalué l'impact du mode ventilatoire sur la qualité du sommeil avec une polysomnographie complète. Enfin, tous les ventilateurs de réanimation ont été testés sur banc afin de comparer les performances en termes de trigger et pressurisation. Résultats : Près d'un quart des patients présentaient des asynchronies fréquentes. La durée de ventilation de ces patients était plus longue et le sevrage plus difficile. Les efforts inefficaces, qui représentaient les asynchronies les plus fréquentes, étaient favorisés par une assistance ventilatoire excessive. La réduction du niveau d'aide inspiratoire (AI) permettait d'éliminer quasi-complètement les efforts inefficaces, sans augmenter l'effort inspiratoire et sans modifier la vraie fréquence respiratoire du patient. Le mode ventilatoire n'avait pas d'influence sur la qualité du sommeil et les asynchronies. Les efforts inefficaces survenaient aussi bien en AI qu'en ventilation assistée contrôlée. Avec un niveau d'AI adéquat, les apnées centrales étaient peu nombreuses et n'avaient pas d'influence sur la qualité du sommeil. Les performances insuffisantes observées avec certains ventilateurs peuvent également altérer la synchronisation. Conclusion : Les asynchronies patient-ventilateur sont fréquentes et associées à une durée de ventilation prolongée. Une « dose de ventilation » excessive favorise les efforts inefficaces, mais un réglage optimal du ventilateur permet de minimiser ces asynchronies. Cette thèse est un support pour déterminer dans une étude plus large si une synchronisation adéquate peut réduire la durée de ventilation. / Major patient-ventilator asynchrony seems common on ventilator screen during assisted mechanical ventilation. Objectives: To evaluate the incidence of major asynchrony and to identify factors related to patient's characteristics and ventilator parameters associated with asynchrony, and to determine optimal ventilator adjustments. Methods: We evaluated the incidence of major patterns of asynchrony easily detected using a noninvasive method based on flow and airway pressure curves. In patients with frequent ineffective efforts we measured patient's effort using esophageal pressure measurements to optimize ventilatory settings. We evaluated the impact of ventilatory mode on sleep quality using a complete polysomnography. All intensive-care-unit ventilators were compared on a bench test in terms of trigger performance and pressurization capacity. Results: One-fourth of intubated patients exhibited major asynchrony. Duration of mechanical ventilation was longer and weaning more difficult in patients with asynchrony as compared to patients without asynchrony. Ineffective triggering was the main pattern of asynchrony and was promoted by excessive ventilatory assistance. Reducing the pressure-support completely eliminated ineffective efforts in most of patients, without inducing excessive respiratory muscle effort and without modifying the true patient's respiratory rate. Ventilatory mode did not influence sleep quality and asynchrony. Ineffective efforts were detected during both pressure-support ventilation and assist-control ventilation, and central apneas were not common using adequate level of pressure-support. Some ventilators exhibited poor performances which could promote patient-ventilator asynchrony. Conclusion: Patient-ventilator asynchrony is frequent during assisted ventilation and associated with prolonged duration of mechanical ventilation. Excessive ventilatory support could promote ineffective efforts although optimal ventilatory settings could minimize asynchrony. This work is a starting point to determine in a large study, whether optimization of ventilatory settings could shorten duration of mechanical ventilation.

Le contrôle de la ventilation procède d’une interaction complexe entre des efférences centrales à destination des groupes musculaires ventilatoires et des afférences ventilatoires provenant de mécano et de chémorécepteurs. Cette commande de la ventilation s’adapte en permanence aux besoins ventilatoires. L’activation électrique du diaphragme (EAdi) informe sur la commande ventilatoire, la charge des muscles respiratoires, la synchronie patient-ventilateur et l’efficacité de la ventilation des patients de réanimation. L’utilisation inadaptée d’un mode deventilation spontanée avec une sur ou sous-assistance peut entrainer des dysfonctions diaphragmatiques, des lésions alvéolaires et des asynchronies. La première étude a permis de cibler l’assistance du mode NAVA en fonction de l’EAdi enregistrée lors d’un échec de test de sevrage. Nous avons observé une augmentation quotidienne de cette EAdi au cours du sevrage jusqu’à l’extubation. La deuxième étude a montré que cette augmentation n’est pas associée à une modification de l’efficacité neuro-ventilatoire lors du test de sevrage, possiblement en rapport avec l’inhibition d’une sédation résiduelle. La troisième étude a montré l’importance de l’inhibition de cette sédation résiduelle par midazolam sur l’EAdi et le volume courant au début du sevrage ainsi que la corrélation qui existe entre les deux. Une dernière étude a montré l’absence d’augmentation du volume courant sous NAVA chez des patients transplantés pulmonaires aux poumons dénervés sans réflexe de Herring Breuer par rapport à un groupe contrôle. Par ailleurs le volume courant sous NAVA était corrélé à la capacité pulmonaire totale. Ces études ont montré l’intérêt du monitorage l’EAdi dans le sevrage. / The control of breathing results from a complex interaction involving differentrespiratory centers, which feed signals to a central control mechanism that, in turn, provides outputto the effector muscles. Afferent inputs arising from chemo- and mechanoreceptors, related to thephysical status of the respiratory system and to the activation of the respiratory muscles, modulatepermanently the respiratory command to adapt ventilation to the needs. Diaphragm electricalactivation provides information about respiratory drive, respiratory muscle loading, patientventilatorsynchrony and efficiency of breathing in critically ill patients. The use of inappropriatelevel of assist during spontaneous breathing with over or under assist might be harmful withdiaphragmatic dysfunction, alveolar injury and asynchrony. The first study settled NAVA modeaccording to the EAdi recorded during a failed spontaneous breathing trial (SBT). An unexpecteddaily increase of EAdi has been found during SBT until extubation. The second study did not findany increase of the neuroventilatory efficiency during weaning, possibly because of residualsedation. A third study described the inhibition of residual sedation on EAdi and tidal volume at thebeginning of the weaning, and the correlation between them. The last study did not find anyincrease of tidal volume under NAVA after lung transplantation, with denervated lung withoutHerring Breuer reflex, compared to a control group. Moreover tidal volume under NAVA wascorrelated to total lung capacity. These studies highlight the interest of EAdi monitoring duringweaning.

Bakgrund: Specialistsjuksköterskor med inriktning mot intensivvård har ansvar för omvårdnaden av de svårast sjuka patienterna samt kommunicerar med deras närstående. Coronaviruset (SARS-CoV-2) även kallad för Covid-19, leder till en atypisk form av akut andningsbesvär som i vissa fall kräver ventilatorbehandling. Dessa patienter kommer alla att behöva urträning ur respiratorn inför extubation. Urträning initieras oftast på intensivvårdsavdelningen och tillhör intensivvårdssjuksköterskans arbete. En förkortad ventilatorbehandling kan minska patientens lidande, mortaliteten och sänka samhällskostnader. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors framgångsfaktorer för ventilatorurträning av patienter med Covid-19. Metod: Vi har använt oss av kvalitativ metod och intervjuat åtta intensivvårdssjuksköterskor i Västra Sverige. Intervjuerna analyserades kvalitativ innehållsanalys med manifest ansats som resulterade i tre kategorier. Resultat: Denna kvalitativa intervjustudie visade att en längre och svårare urträningsprocess kräver tålamod och försiktighet. Samtliga intensivvårdssjuksköterskor beskrev urträningsprocessen för patienter med Covid-19 som både längre och svårare i jämförelse med patienter som ventilatorbehandlats av andra orsaker. Tidiga insatser kan lindra sjukdomsförlopp och underlätta urträningen. Intensivvårdssjuksköterskorna beskrev att de under pandemin lärt sig använda både medicinska och omvårdnadsmässiga insatser tidigt för att bromsa, lindra eller förhindra ett progrederande sjukdomsförlopp. Mobilisering, teamsamverkan och kontinuitet var viktigt vid urträning och framgångsfaktorer som påverkades av personalens kompetens, stressnivå och andraorganisatoriska faktorer. Slutsats: Denna kvalitativa intervjustudie visade att intensivvårdssjuksköterskor upplever att erfarenhet under pandemins gång har förbättrat förutsättningarna för patienter med Covid-19 i behovav urträning från ventilatorbehandling. Och dessa lärdomar ligger till grund för de faktorer som i dagsläget ofta ligger till grund för en framgångsrik ventilatorurträning. Deras erfarenhet och kunskaper skiljer sig åt och resultatet tyder på att mer utbildning och kontinuitet krävs för att kunna ge en säkrare vård.

In der vorliegenden Arbeit wurde die Bedeutung des Einflusses von Laktationsnummer, Laktationsstadium, Körperkondition und Absetzverfahren auf Merkmale der Milchleistung und Eutergesundheit einer Herde Ostfriesischer Milchschafe untersucht. Die Tiere wurden nach dem Ablammen zufällig einer Früh- bzw. Spätabsetzergruppe zugeordnet (Absetzen der Lämmer 3 bzw. 42 Tage post partum). An insgesamt 40 Terminen wurden über eine vollständige Laktation Vorgemelks-, Hälftenanfangsgemelks- und Einzeltiergemelksproben gewonnen. Das Spektrum der untersuchten Merkmale umfasste die Milchmenge, die Milchinhaltsstoffe (Fett, Eiweiß, Laktose), die klinische Untersuchung des Euters, die somatische Zellzahl, die elektrische Leitfähigkeit und bakteriologische Untersuchungen. Zusätzlich wurden das Körpergewicht und die Körperkondition der Mutterschafe erfasst. Das durchschnittliche Leistungsniveau der Herde betrug 301±101,3 kg Milch, bei mittleren Milchfett-, Milcheiweiß-, und Laktosegehalten von 5,00, 5,14 bzw. 5,00 % (150-Tageleistung). Die Laktationsnummer hatte keinen signifikanten Effekt auf die Milchleistung. Schafe der Spätabsetzer-Gruppe produzierten im Anschluss an die Säugephase eine um 300 g signifikant höhere Testtagsmilchmenge als Tiere der Frühabsetzer-Gruppe. Das Absetzverfahren hatte keinen nachweisbaren Effekt auf die Milchinhaltsstoffe. Die Herde wies eine gute Eutergesundheit auf. Der Anteil bakteriologisch positiver Schafmilchproben betrug 28,5 %. Als dominante Erreger wurden in 96,6 % der bakteriologisch positiven Schafmilchproben Koagulasenegative Staphylokokken nachgewiesen. Der Anteil bakteriologisch positiver Euterhälftenbefunde stieg signifikant mit dem Fortschreiten der Laktation und zunehmender Laktationsnummer. Eine Euterinfektion mit Koagulasenegativen Staphylokokken sowie das Verfahren des Spätabsetzens beeinflussten alle drei untersuchten Eutergesundheitsparameter (logarithmierte Zellzahl, elektrische Leitfähigkeit und Laktosegehalt) negativ (p < 0,001).