Empowering Self-Care in Chronic Illness.

This study describes a conceptual model about empowering self-care. Such a model is important because of its potential for influencing health outcomes in chronic conditions, a leading cause of illness and disability. A defining characteristic of chronic illness is the need for effective self-care management. Therefore, a self-care management plan that is collaboratively developed and considers the patient's goals, resources, culture, and lifestyle was proposed. The philosophical perspective of oppression and story theory provided the theoretical lenses used to define the concept empowering self-care. Identified are qualities of empowerment, which stress a non-hierarchical relationship that promote authentic dialoguing and valuing of each individual's contribution. Story theory structures ideas around the nurse-person intentional dialogue. It is especially useful when the nurse is attempting to understand what matters most to someone living with a health challenge. The story was gathered using the story path method to structure the dialogue. A synthesized definition of empowering self-care was created through the lens of Freire (2005) and the story of what matters to a person living with the health challenge of a chronic condition. Empowering self-care can promote increased patient accountability and responsibility for self-care management leading to improved patient outcomes. Health outcomes may improve when nurses actively support patients' efforts to achieve their own goals.

Finite Mixture Modeling for Program Evaluation: Resampling and Pre-processing Approaches.

BACKGROUND: Finite mixture models cluster individuals into latent subgroups based on observed traits. However, inaccurate enumeration of clusters can have lasting implications on policy decisions and allocations of resources. Applied and methodological researchers accept no obvious best model fit statistic, and different measures could suggest different numbers of latent clusters. OBJECTIVES: The purpose of this article is to evaluate and compare different cluster enumeration techniques. RESEARCH DESIGN: Study I demonstrates how recently proposed resampling methods result in no precise number of clusters on which all fit statistics agree. We recommend the pre-processing method in Study II as an alternative. Both studies used nationally representative data on working memory, cognitive flexibility, and inhibitory control. CONCLUSIONS: The data plus priors method shows promise to address inconsistencies among fit measures and help applied researchers using finite mixture models in the future.

Evaluation of Respiratory Therapist Extender Comfort With Mechanical Ventilation During COVID-19 Pandemic.

BACKGROUND: Staffing strategies used to meet the needs of respiratory care departments during the COVID-19 pandemic included the deployment of respiratory therapist extenders. The purpose of this study was to evaluate respiratory therapist extenders' comfort level with critical care ventilators while caring for patients with COVID-19. To our knowledge, this is the first study to evaluate the deployment of certified registered nurse anesthetists (CRNAs) in a critical care setting. METHODS: A qualitative survey method was used to assess CRNA experience with critical care ventilators. Prior to deployment in the ICU, CRNAs were trained by clinical lead respiratory therapists. Education included respiratory clinical practices and ventilator management. Sixty-minute sessions were held with demonstration stations set up in ICUs for hands-on experience. RESULTS: Fifty-six CRNAs responded to our survey (63%). A mean ± SD of 9.48 ± 12.27 h was spent training prior to deployment in the ICU. CRNAs were at the bedside a mean ± SD of 73.0 ± 40.6 h during the pandemic. While CRNA comfort level with critical care ventilators increased significantly (P < .001) from the beginning to the end of their work experience, no statistically significant differences were found between CRNA comfort based on years of experience. Differences in comfort level were not found after training (chi-squared test 23.82, P = .09) or after ICU experience was completed (chi-squared test = 15.99, P = .45). Similarly, mean comfort level did not increase based on the number of hours spent working in the ICU (chi-squared test = 13.67, P = .55). CONCLUSIONS: Comfort level with mechanical ventilation increased for CRNAs working alongside respiratory therapists during the COVID-19 pandemic.

Characterization of decision commitment rule alterations during an auditory change detection task.

A critical component of decision making is determining when to commit to a choice. This involves stopping rules that specify the requirements for decision commitment. Flexibility of decision stopping rules provides an important means of control over decision-making processes. In many situations, these stopping rules establish a balance between premature decisions and late decisions. In this study we use a novel change detection paradigm to examine how subjects control this balance when invoking different decision stopping rules. The task design allows us to estimate the temporal weighting of sensory information for the decisions, and we find that different stopping rules did not result in systematic differences in that weighting. We also find bidirectional post-error alterations of decision strategy that depend on the type of error and effectively reduce the probability of making consecutive mistakes of the same type. This is a generalization to change detection tasks of the widespread observation of unidirectional post-error slowing in forced-choice tasks. On the basis of these results, we suggest change detection tasks as a promising paradigm to study the neural mechanisms that support flexible control of decision rules.NEW & NOTEWORTHY Flexible decision stopping rules confer control over decision processes. Using an auditory change detection task, we found that alterations of decision stopping rules did not result in systematic changes in the temporal weighting of sensory information. We also found that post-error alterations of decision stopping rules depended on the type of mistake subjects make. These results provide guidance for understanding the neural mechanisms that control decision stopping rules, one of the critical components of decision making and behavioral flexibility.

Crying and suicidal, but not depressed. Pseudobulbar affect in multiple sclerosis successfully treated with valproic acid: Case report and literature review.

OBJECTIVE: Pseudobulbar affect/emotional incontinence is a potentially disabling condition characterized by expressions of affect or emotions out of context from the normal emotional basis for those expressions. This condition can result in diagnostic confusion and unrelieved suffering when clinicians interpret the emotional expressions at face value. In addition, the nomenclature, etiology, and treatment for this condition remain unclear in the medical literature. METHOD: We report the case of a 60-year-old woman with multiple sclerosis who was referred to an inpatient psychiatry unit with complaints of worsening depression along with hopelessness, characterized by unrelenting crying. Our investigation showed that her symptoms were caused by pseudobulbar affect/emotional incontinence stemming from multiple sclerosis. RESULTS: The patient's history of multiple sclerosis and the fact that she identified herself as depressed only because of her incessant crying suggested that her symptoms might be due to the multiple sclerosis rather than to a depressive disorder. Magnetic resonance imaging demonstrated a new plaque consistent with multiple sclerosis lateral to her corpus callosum. Her symptoms resolved completely within three days on valproic acid but returned after she was cross-tapered to dextromethorphan plus quinidine, which is the FDA-approved treatment for this condition. SIGNIFICANCE OF RESULTS: This case provides important additional information to the current literature on pseudobulbar affect/emotional incontinence. The existing literature suggests a selective serotonin reuptake inhibitor (SSRI) and dextromethorphan/quinidine (Nuedexta) as first-line treatments; however, our patient was taking an SSRI at the time of presentation without appreciable benefit, and her symptoms responded to valproic acid but not to the dextromethorphan/quinidine. In addition, the case and the literature review suggest that the current nomenclature for this constellation of symptoms can be misleading.

Race and health in Guyana: an empirical assessment from survey data.

This paper examines racial differences in physical health and mental well-being in Guyana, South America: a country with cultural ties to the Caribbean. It explores the complex relationship among race, socioeconomic status and health outcomes which in developed societies continues to be of significant research interest. Utilizing a random probability sample of over 900 adults, the analyses provide information on the general physical and mental health status of this population and examine the differences by racial groups when other factors are controlled. The results indicate significant age-specific racial differences in physical and mental health in Guyana. Higher rates of diabetes, arthritis or rheumatism, back and breathing problems among Indo-Guyanese when compared to other groups were noted. Racial differences in physical health were attenuated when gender and educational levels were controlled.