Investigation of dairy cow performance in different udder health groups defined based on a combination of somatic cell count and differential somatic cell count.

Mastitis is still the costliest disease in milk production. In particular, its subclinical form, which may spread unnoticeably within a herd, is a major challenge. Somatic cell count (SCC) is broadly used as an indicator for mastitis and thus the basis for udder health management programmes, e.g. through dairy herd improvement (DHI) testing. Since recently, differential somatic cell count (DSCC, representing the combined proportion of polymorphonuclear neutrophils and lymphocytes as a percentage of total SCC) is available in addition. Our study was aimed to investigate dairy cow performance in four newly defined udder health groups (UHG) based on SCC and DSCC results from DHI testing. In total, 961,835 test-day results generated in Austria, China, Estonia, Germany, and Spain between January 2019 and March 2020 were available for data analyses. Cows were categorised into four UHG depending on test day SCC and DSCC results (UHG A: healthy/normal, ≤200,000 cells/mL and ≤65 %; B: suspicious, ≤200,000 cells/mL and >65 %; C: mastitis, >200,000 cells/mL and >65 %; D: chronic/persistent mastitis, >200,000 cells/mL and ≤65 %). Linear mixed effect models were used to compare the performance of cows between the UHG based on the parameters milk weight, energy-corrected milk, fat, protein, lactose, and estimated milk value. Highest performance was found for cows in UHG A and ranged between 21.4 (Austria) and 38.3 kg per cow and day (Spain). Interestingly, cows in group B were significantly less productive (0.9-2.4% less daily milk production) compared to those in group A. Cows in groups C (6.0-9.8% less daily production compared to group A) and D were, as expected, even less productive with a particularly significant drop for cows in group D (17.5-38.5% less daily production). These trends could be observed in all countries involved in this study. Proportions of cows in the four different UHG differed between countries, changed slightly within countries depending on season, differed depending on parity and days in milk, and were seen to vary hugely between herds. In conclusion, this study demonstrates changes in performance of dairy cows depending on their udder health status as defined based on the combination of SCC and DSCC. In particular cows in UHG B and D are of interest as they cannot be identified working with SCC only. Nevertheless, the actual udder health management measures that could be taken based on the new UHG still require further investigation.

Evaluation of an automated sphygmomanometer for use in the office setting.

OBJECTIVE: To determine whether the WatchBP Office sphygmomanometer can be used to obtain automated office blood pressure (AOBP) readings that are similar to the awake ambulatory BP. METHODS: One hundred patients referred for 24 h ambulatory BP monitoring had BP recorded three times using the WatchBP Office fully automated sphygmomanometer in accordance with standard AOBP measurement guidelines. The mean AOBP was compared with the mean awake ambulatory BP. RESULTS: The mean (± SD) AOBP (138.6 ± 13.7/79.7 ± 9.0 mmHg) was similar to the mean awake ambulatory BP (136.8 ± 12.4/79.0 ± 10.8 mmHg). The small difference in systolic BP (1.8 mmHg) was statistically significant (P=0.03), but was within the accepted range (5 mmHg) recommended by guidelines for equivalence between BP readings. There was a strong correlation (P<0.001) between the systolic/diastolic AOBP and awake ambulatory BP readings (r=0.819/0.801). CONCLUSION: The WatchBP Office produces BP readings that closely approximate the awake ambulatory BP, confirming that this automated sphygmomanometer is suitable for recording AOBP in clinical practice.

Can sphygmomanometers designed for self-measurement of blood pressure in the home be used in office practice?

OBJECTIVE: To examine the possibility of measuring automated office (AO) blood pressure (BP) using home BP recorders in place of the more expensive, fully automated devices designed specifically for professional use. PARTICIPANTS AND METHODS: Three groups of 100 patients each had five AOBP readings recorded with one of three home BP devices while resting alone in a quiet examining room. These devices were also used to obtain 24 home BP readings during 6 days. Five AOBP readings were also recorded using the BpTRU device and all patients had 24-h ambulatory BP and manual BP readings taken. RESULTS: Mean systolic AOBP was within 3-4 mmHg of the mean awake ambulatory BP for each of the three home BP recorders whether used in the office setting or at home. Diastolic readings tended to be higher than the corresponding awake ambulatory BP. For the 139 patients with hypertension, mean (±standard deviation) AOBP taken with the home BP devices (146±14/86±12) was higher (P<0.001) than the awake ambulatory BP (142±11/81±12) and AOBP taken with the BpTRU device (141±15/82±12). Systolic BP at home (142±14/85±10) was also similar to the awake ambulatory BP but diastolic BP was higher (P<0.001). There were no significant differences in correlation coefficients between each set of AOBP readings and awake ambulatory BP. CONCLUSION: Home BP devices may be used to record AOBP in selected patients. However, a fully automated sphygmomanometer is still the device of choice for obtaining AOBP readings similar to the awake ambulatory BP in patients with suspected hypertension.

Consistent relationship between automated office blood pressure recorded in different settings.

OBJECTIVE: Conventional office blood pressure (BP) readings are affected by various factors including the presence of an observer and the setting. This study was undertaken to assess the consistency of automated self-measurement of BP in the office during repeat visits and in different settings. Automated office BP readings were also compared with the mean awake ambulatory BP. METHODS: BP readings were obtained using an automated BpTRU sphygmomanometer during routine visits to a hypertension specialist before and after 24-h ambulatory BP monitoring (ABPM) was performed. A third automated BP reading was obtained during the visit to the ABPM unit. RESULTS: There were no significant differences among the three automated office BP readings, which were all similar to the mean awake ambulatory BP. A manual BP reading taken by the ABPM technician was significantly higher (P<0.001) than the mean awake ambulatory BP. There was good agreement among the three automated office BP readings (intraclass correlation coefficient for systolic/diastolic BP r = 0.896/0.873). CONCLUSION: Mean automated office BP readings are consistent from visit-to-visit regardless of the setting in which they are taken and they are similar to the mean awake ambulatory BP.

Comparison of two automated sphygmomanometers for use in the office setting.

OBJECTIVE: To compare readings obtained using two automated blood pressure (BP) recording devices, BpTRU and Omron 907, in a clinical setting. METHODS: Two series of 50 patients attending a hypertension unit for 24-h ambulatory BP monitoring had BP recorded either every 1 or every 2 min using BpTRU and Omron 907 devices with the order of the measurements being randomized. RESULTS: No significant differences for systolic BP between the mean readings taken using the BpTRU or Omron 907 recorders at either 1 or 2 min were observed. Diastolic BP readings were similar using the 1-min interval setting but were 5.0 mmHg lower for the Omron 907 (P<0.001) when readings were taken at 2-min intervals. CONCLUSION: BP measurements can be made in the clinical setting using either the BpTRU or Omron 907 automated sphygmomanometers.

Use of automated office blood pressure measurement to reduce the white coat response.

OBJECTIVE: To examine the possibility of reducing the white coat response using an automated sphygmomanometer designed for office use, the BpTRU. Consecutive patients referred from physicians in the community to an ambulatory blood pressure (ABP) monitoring unit in an academic hospital were included in the study. PARTICIPANTS AND METHODS: A total of 309 patients referred for diagnosis or management of hypertension were studied. Differences between mean awake ABP and BP readings taken by the patient's own physician using a manual sphygmomanometer or the automated BpTRU device with the patient resting alone in the ABP monitoring unit were compared. RESULTS: BP recorded in the examining room using an automated device (132 +/- 19/75 +/- 12) was similar to the mean awake ABP (134 +/- 12/77 +/- 10) with both values being lower (P < 0.001) than the BP recorded on a routine visit to the patient's own family physician (152 +/- 18/87 +/- 11). The coefficient of correlation between the systolic/diastolic ABP and the automated office BP (r = 0.62/0.72) was higher (P < 0.001) than with the family physician's manual BP (r = 0.32/0.48). The prevalence of white coat hypertension in untreated patients (n = 146) was significantly (P < 0.001) lower with automated office BP (16%) compared with the routine family physician BP (55%). CONCLUSION: The white coat response associated with office BP measurements can be virtually eliminated by recording BP with the automated BpTRU device with patients resting alone in a quiet examining room.

Optimum frequency of office blood pressure measurement using an automated sphygmomanometer.

OBJECTIVE: To determine the optimum interval between serial blood pressure measurements using an automated BpTRU sphygmomanometer. METHODS: Two groups of 200 patients each had automated office measurements taken using the BpTRU device at either 1-min or 2-min intervals from the start of one reading to the start of the next reading with a 24-h ambulatory blood pressure (ABP) recording being performed. Another series of 50 patients had BpTRU readings taken at 1-min and 2-min intervals before and after 24-h ABP monitoring. The difference between the mean awake ABP and the mean automated office BP readings were compared for recordings taken at 1-min versus 2-min intervals. RESULTS: In the between-patient comparison (n=400), mean awake ABP was similar to automated BP recordings in the examining room at either 1-min or 2-min intervals except for a slightly lower (-4 mmHg) diastolic BP with the 1-min interval (P<0.01 vs. ABP). In the within-patient comparison (n=50), there was no consistent difference between automated BP readings taken in the examining room at 1-min versus 2-min intervals. Overall, the mean automated BP values tended to be slightly lower than the mean awake ABP. CONCLUSION: Automated measurement of BP in the office setting with devices such as the BpTRU can be taken as frequently as every 1 min without affecting the accuracy of the reading. Small differences in BP between the 1 and 2-min settings and between the automated BpTRU and ABP readings were within accepted clinical standards for validation criteria.

Use of an automated blood pressure recording device, the BpTRU, to reduce the "white coat effect" in routine practice.

BACKGROUND: Patients often exhibit higher blood pressure (BP) readings in the doctor's office, a phenomenon known as the white coat effect. This study examines the presence of a physician in the examining room as a possible factor in provoking a white coat effect. METHODS: Blood pressure measurements taken by an automated BP recording device, the BpTRU (VSM MedTech Ltd., Vancouver, BC, Canada) with the patient alone in the examining room, were compared with the following: (1) BP taken by the patient's family physician; (2) BP taken on the first visit to a hypertension specialist; (3) BP measured by a trained research technician and (4) the mean awake ambulatory BP (ABP). The BpTRU and trained research technician readings were taken outside of the office (treatment) setting in an ABP research unit. RESULTS: Blood pressure readings (mm Hg, mean +/- SEM) taken by the BpTRU (155 +/- 5/88 +/- 2) tended to be lower than for the family physician (166 +/- 4/89 +/- 3) and the hypertension specialist (174 +/- 5/92 +/- 2; P <.001). However, BP taken by the trained research technician (158 +/- 4/90 +/- 2) was similar to the value obtained by the BpTRU. The mean awake ABP was lower (P < 0.01) than the other four BP values. CONCLUSIONS: Use of an automated BP recording device outside of the office (treatment) setting can partly eliminate the white coat effect. A similar finding was observed with readings taken by a trained research technician under similar conditions. Referral of patients to nonoffice settings for automated BP recordings may provide a more accurate estimate of a patient's BP status, with partial elimination of the white coat effect associated with readings taken by a physician.