Saving Ourselves From Infection: A Theraputic Model of Peer Led Education

The purpose of this action research is to explore non-hierarchical peer led education as a means to end the Hepatitis C epidemic, promote empowerment and self-esteem in current injection drug users, and create a more global understanding of power structures that perpetuate opioid use so that those living with addiction are better able to educate, organize and fight for structural change. The current healthcare system is not able to test, treat or educate those most at risk for Hepatitis C infection or reinfection - people who inject drugs. The United States is currently in a losing battle with opioid addiction, with an ever-growing number of people dying from opioid overdose each year. Dovetailing on this trend is a rise in Hepatitis C infections. Hepatitis C is a viral disease that causes fibrosis and cirrhosis of the liver and can lead to liver transplants and death if not treated in a timely fashion. Peer education has been used successfully around the world to promote other life-saving behaviors among those who inject drugs and many other populations. However, most peer education programs in harm reduction demand that people stop using drugs completely before they are able to work with peers. In addition, there are very few providers who actively teach patients how to safely inject IV drugs in order to prevent not just Hepatitis C, but also HIV, endocarditis, cellulitis and xylazine-related wounds. This thesis aims to promote action research on a peer educator program for people who actively inject drugs or are maintained on Medication Assisted Therapies such as methadone and suboxone to educate their peers. Educators will be taught to teach peers about a number of issues related to Hepatitis C and its treatment, with the hope that like other programs, this program will empower educators to take more control over other aspects of their health and self-care

Implications of Individuals with Music Learning Experience Using a Segmented Multimedia Lesson in a Non-Music Discipline

The purpose of this study was to investigate how prior music learning experience relates to learning with multimedia resources in non-music disciplines. Specifically, whether years of music learning experience, type of music learning experience, or type of multimedia were associated with task scores and task duration in a non-music discipline. The study revealed the transferable benefits of music learning experience to learning outcomes in other disciplines. Encouraging music studies as part of the base curriculum is thus strongly encouraged. However, as years of music learning and the presence or absence of segmenting in multimedia learning resources were not found to associate with learning outcomes, it may be worthwhile to examine other potential factors that are developed as a byproduct of music learning

The Influence of Heart Failure Self-Care on Health Outcomes: Hypothetical Cardioprotective Mechanisms

Lapses in self-care are commonly cited as a major cause of poor outcomes in persons with heart failure (HF). Not surprisingly, self-care is assumed to be central to improving health outcomes in this patient population. Empirically, however, this assumption is not well supported, and mechanistically, relationships between self-care and outcomes in HF have not yet been described. In this review, it is proposed that effective self-care maintenance (adherence) and self-care management (symptom evaluation and management) practices are complementary to optimal medical management in delaying HF progression and improving health outcomes in this population. Potential mechanisms through which effective HF self-care practices are complementary to pharmacological therapy in improving outcomes include (a) facilitating partial blockade and partial deactivation of deleterious neurohormones, (b) limiting inflammatory processes, (c) decreasing the need for administration of detrimental pharmacological agents, and (d) minimizing myocardial hibernation. Because these mechanisms are hypothetical, research findings are required to establish their validity. Several strategic research questions are proposed

Caregiving Immediately After Stroke: A Study of Uncertainty in Caregivers of Older Adults

BACKGROUND: Caregivers of stroke survivors experience high rates of mental and physical morbidity. Stroke has sudden onset, and the outcome is not immediately known. Uncertainties surrounding the new caregiving role may not only necessitate major changes in the lives of family caregivers but also contribute to negative health outcomes for the caregiver. PURPOSE: The purposes of this study were to describe caregiver uncertainty across the early weeks after a family member\u27s stroke and to explore characteristics of caregivers and stroke survivors associated with that uncertainty. METHODS: A prospective, longitudinal exploratory observational study was conducted with a convenience sample of 40 caregivers and older adult (≥65 years) stroke survivors recruited from urban acute care settings in the mid-Atlantic region. Caregivers were enrolled by 2 weeks poststroke (T1) and revisited 4 weeks later (T2). Uncertainty was measured usingthe Mishel Uncertainty in Illness Scale for Family Members. An unadjusted linear mixed model was computed to examine significant associations between each caregiver or stroke survivor characteristic and repeated measures of uncertainty. RESULTS: Uncertainty at T1 (83.73 ± 23.47) was higher than reported in other caregiver populations and remained high 6 weeks poststroke (T2: 85.23 ± 23.94). Each of the following characteristics was independently associated with greater caregiver uncertainty: caregivers\u27 older age (p = .019), being a spouse (p = .01), higher stress (p \u3c .001), more depressive symptoms (p = .001), more comorbidities (p = .035), and poorer coping capacity (p = .002) and stroke survivors\u27 recurrent stroke (p = .034), poorer functional status (p = .009), and insurance type (p = .008). CONCLUSIONS: Caregivers experienced persistently high uncertainty during the first 6 weeks poststroke. Better understanding of uncertainty, its associated characteristics, and its outcomes may help clinicians identify caregivers at highest risk who may benefit from targeted interventions

Biomarkers of Myocardial Stress and Systemic Inflammation in Patients Who Engage in Heart Failure Self-Care Management

Background: Self-care is believed to improve heart failure (HF) outcomes, but the mechanisms by which such improvement occurs remain unclear. Methods: We completed a secondary analysis of cross-sectional data collected on adults with symptomatic HF to test our hypothesis that effective self-care is associated with less myocardial stress and systemic inflammation. Multivariate logistic regression modeling was used to determine if better HF self-care reduced the odds of having serum levels of amino-terminal pro-B-type natriuretic peptide and soluble tumor necrosis factor α receptor type 1 at or greater than the sample median. Heart failure self-care was measured using the Self-care of Heart Failure Index. Results: The sample (n = 168) was predominantly male (65.5%), and most (50.6%) had New York Heart Association III HF (mean left ventricular ejection fraction, 34.9% [SD, 14.0%]); mean age was 58.8 (SD, 11.5) years. Self-care management was an independent factor in the model (block χ2 = 14.74; P = .005) after controlling for pertinent confounders (model χ2 = 52.15; P \u3c .001). Each 1-point increase in self-care management score (range, 15-100) was associated with a 12.7% reduction in the odds of having levels of both biomarkers at or greater than the sample median (adjusted odds ratio, 0.873; 95% confidence interval, 0.77-0.99; P = .03). Conclusion: Better self-care management was associated with reduced odds of myocardial stress and systemic inflammation over and above pharmacological therapy and other common confounding factors. Teaching HF patients early symptom recognition and self-care of symptoms may decrease myocardial stress and systemic inflammation

Experimental Models of Impaired Hypoglycaemia-Associated Counter-Regulation

Impaired awareness of hypoglycaemia (IAH) affects around a quarter of patients with diabetes who receive insulin treatment. This condition is characterised by a progressive reduction in symptomatic and behavioural responses to hypoglycaemia, increasing risk of deeper drops in blood glucose, unconsciousness, and collapse. Thus, patients with IAH experience severe hypoglycaemic episodes more frequently, resulting in significant morbidity and mortality. IAH is thought to develop as a consequence of whole-body adaptations to repeated insulin-induced hypoglycaemia (RH), with widespread deficits in the hypoglycaemia counter-regulatory response (CRR). Despite this important insight, the precise pathophysiology by which RH leads to an attenuated CRR is unknown. Studies into the underlying mechanisms of IAH have employed a variety of protocols in humans and experimental species. The use of animal models has many investigational benefits, including the unprecedented increase in the availability of transgenic strains. However, modelling impaired hypoglycaemia-associated counter-regulation remains challenging and appropriate interpretation of findings across species and protocols even more so. Here, we review the experimental modelling of IAH and impaired hypoglycaemia-associated counter-regulation, with a focus on understanding species-specific variation in glucose homeostasis. This review will aid investigators in interpreting outputs from different studies in IAH and aid progress in the field.</p

Developing First-Line Management in Nursing

An historical approach demonstrates the parallel development and practice of management in nursing and the industrial business sector. The role of the first-line nurse manager today is discussed as shaped by the impact of prospective payments, decentralized administration, and partictpative forms of management. A review of the literature is used to ascertain important topics to be included in a management development program. Factors affecting the role of the nurse manager are sorted into four groups; fit of the role within the organization, selection process for advancement, role conflict and ambiguity, and the skills required. A framework based upon Katz\u27s technical, human, and conceptual skills of an administrator is then offered upon which the nurse executive can develop the talents of his/her junior managers