Patients’ Perspectives on Engaging in Their Healthcare while Hospitalized

Aims and objectives To examine patients’ experiences and preferences for engaging in their healthcare while hospitalised. Background Promoting patient engagement or involvement in healthcare has become an important component of contemporary, consumer‐oriented approaches to quality care. Previous research on patient engagement highlights that preferences for engagement are not assessed while hospitalised, leading to patient role confusion and frustration. Methods Semistructured interviews were conducted with patients from January–March 2017 to examine their experiences and preferences for engaging in their care while hospitalised on medical‐surgical units in the United States. Inductive thematic analysis was used to uncover the themes from the interview transcriptions. The reporting of research findings followed the COREQ checklist. Results Seventeen patients, eight male and nine female, aged between 19–83 years old were interviewed. Patients had a difficult time articulating how they participated in their care while hospitalised, with the majority stating there were few decisions to be made. Many patients felt that decisions were made prior to or during hospitalisation for them. Patients described their engagement through the following themes: sharing the subjective, involvement of family, information‐gathering, constraints, “I let them take care of me,” and variability. Conclusions Engagement is a dual responsibility of both nurses and patients. Patients’ experiences highlight that engagement preferences and experiences are not universal between patients, speaking to the importance of assessing patient preferences for engagement in health care upon hospital admission. Relevance to clinical practice The articulation of what patients actually experience in the hospital setting contributes to improve nursing practice by offering insight into what is important to the patient and how best to engage with them in their care. The constraints that patients reported facing related to their healthcare engagement should be used to inform the delivery of future engagement interventions in the acute care setting

The House Doesn\u27t Always Win

In June 2015, fourteen South Korean casino executives were arrested on charges of soliciting Chinese players to gamble in their casinos. This single event foreshadowed a seismic change in the Australian casino market that few would have anticipated. The events which unfolded led to the two largest casino operators in Australia being found unsuitable to operate their casinos, and unable to hold their licenses. Collectively, these two casino groups reported revenues of $5.0bn in 2019, accounting for 92% of the total Australian casino market. Both are now operating under various forms of special supervision until it can be demonstrated that the serious failures of compliance with Anti-Money Laundering/Count Terrorism Financing legislation, failures of Host Responsibility obligations, as well as incidence of gaming duty under-payments, fraudulent reporting, and misleading and deceptive conduct are addressed. Despite their rhetoric, regulators were also found wanting, and changes to regulations and legislation have also been recommended to provide stronger governance over the industry. The paper will examine the background to the events, summarise the key findings of the statutory reviews commissioned, and postulate the set of circumstances that led to such a significant industry-wide failure. Implications: The geopolitical landscape is evolving, leading to profound change in the Asian and Australasian casino market. The remediation underway in the Australian casino gaming market will be outlined, the recommendations to address key risks will be evaluated, and the potential implications for the global land-based casinos will be discussed

The Cost of Compassion: Assessing the Impact of Organizational Culture & Self-Care on Compassion Fatigue & Compassion Satisfaction in Counselors

It is the responsibility of mental health counselors to provide compassion for broken and hurting populations. For counselors, the continuous strain of empathizing with distressed clientele can often result in physical and emotional exhaustion known as compassion fatigue (Figley, 1995a). Although providing continuous compassion for others may contribute to negative experiences such as compassion fatigue, counselors can also experience positive outcomes from showing compassion towards clients, known as compassion satisfaction (Figley, 2002b). While risk factors to compassion fatigue have been widely explored among various occupations within the literature, less has been researched regarding moderating effects between compassion fatigue and compassion satisfaction, specifically among counselors. The purpose of this quantitative study is to assess the moderating effects of organizational culture and self-care practices between counselor compassion fatigue and compassion satisfaction, using regression analysis. Participants include licensed and pre-licensed counselors. As expected, compassion fatigue and compassion satisfaction were negatively correlated (r = -.367, p \u3c .001). Data analysis results indicated that organizational culture and self-care practices did not have a significant moderating effect between compassion fatigue and compassion satisfaction. However, peer support, supervisory support, personal self-care, and professional self-care transmitted a significant positive effect on compassion satisfaction. Limitations for this study and implications for future research are presented

Communication and Posttraumatic Growth: The Power of Positive Declarations

Research has explored the relationship between posttraumatic growth (PTG) and communication trends. Yet, there is a gap in research regarding how positive declarations of desired outcomes can influence PTG and be applied in a therapeutic context. The purpose of this quantitative study was to examine if positive declarations of psychological growth facilitate PTG after trauma and impact levels of hope, anxiety, or depression. A small pilot study was conducted through six counseling sessions with participants (N = 16) divided into either the control (n = 8) or experimental group (n = 8). A novel Positive Communication Approach (PCA), distinguished by linguistic psychoeducation and use of positive declarations, was only implemented with the experimental group. Pretest-posttest data was collected using the SRGS-R, AHS, GAD-7, and PHQ-9 and analyzed by an analysis of covariance (ANCOVA). ANCOVA results indicated no significant difference between group level for each research question. However, cumulative scores on all four questionnaires were higher for the experimental group than the control group, with a more substantial change noted for PTG and hope. The differences between clinical and statistical findings may be attributed to the study’s small sample size. Findings support existing literature regarding communication and PTG while providing an empirical source of support for scripture. Furthermore, PCA may be an effective therapeutic intervention for facilitating PTG by cultivating hope and expectation

Building Innovation Capacity in a Learning Health System: The Innovation Cohort Experience

Introduction: People with ideas about how to improve products and services often benefit from a structured process to test their ideas. The Innovation Cohort was developed to empower staff at MaineHealth to create solutions to unmet needs. This article describes the progress and perspectives gained over 3 years of the program. Methods: The Innovation Cohort was loosely modeled on the National Science Foundation’s iCorp that emphasizes customer discovery and hypothesis testing early during development. Innovation Cohort applicants proposed a specific problem and answered 5 basic questions related to solving that problem. Selected participants shared readings and attended 5 in-person meetings focused on customer discovery, developing prototypes, and testing hypotheses at each step of development. In 5 cycles over 30 months, 62 people applied, and 24 projects were incubated. Results: The projects independently attracted $130,000 in investments to advance the work. Projects were developed into commercial products for sale, published, and continue to iterate in a local accelerator. Connections formed among people and institutions that have not routinely collaborated on projects of this type. Discussion: The Innovation Cohort model is useful for cultivating people and ideas that may impact care, education, and research across a health care system. The most significant challenge to scaling this type of work is not funding, but rather to retain the high intellectual friction and low social friction required to cultivate ideas. Conclusions: With a structured but approachable process, a small team that values ideas and progress over hierarchy, and a little capital that can be deployed quickly, ideas can interact and progress in a learning health system

Exploring single trial appetitive conditioning and the modulation of attention

Pavlovian conditioning processes may be central to hedonic overeating. The following experiments were conducted to explore how learning shapes motivational and attentional processes that might enhance reactivity to food-related cues. A primary aim was to explore the efficacy of a novel, naturalistic appetitive conditioning procedure, first described by Blechert et al. (2016), for producing rapid conditioned responses in as little as a single conditioning trial. This novel paradigm was designed to mimic a real-life experience with a new food, from the initial sight, smell and touch, to consumption. Subjective measures of craving, expectancies and liking tapped in to explicit motivational processes, and an Emotional Blink of Attention (EBA) task, originally reported by Piech, Pastorino & Zald (2010), was used to explore implicit attentional processes. The degree of incentive salience acquired by newly learned cues was measured as the extent to which they captured attention in a rapid serial visual presentation task (RSVP), preventing accurate target detection in a phenomenon known as an attentional blink. Experiments 1 and 2 (Chapter 3) failed to show evidence for appetitive conditioning on explicit measures, which I suggest can be attributed to the relatively low reward value of the food item chosen for conditioning (marzipan). Findings presented in Chapters 4 – 7 found more convincing evidence that appetitive conditioning shapes motivational processing of newly learned food cues; after a single pairing, an edible object made from a highly rewarding foodstuff (chocolate) elicited cravings, expectancies for chocolate and was perceived as more highly pleasant than a visually similar plastic object. Experiment 4 (Chapter 5) demonstrated that additional trials did not enhance conditioning, supporting the view that single trial learning with hedonic food rewards is a powerful phenomenon. Furthermore, Chapter 6 demonstrated how this learning spreads to cues varying in their similarity to the original conditioned stimulus via generalisation. A consistent finding throughout Chapters 3-6 was that attentional processing was modulated by this naturalistic conditioning procedure, although not as originally predicted. After just one conditioning trial, both reinforced and non-reinforced cues captured attention more readily than neutral cues, suggesting salience acquisition independent of reward. Whilst Chapter 4 confirmed that reward-paired cues acquire greater salience than novel or familiar cues after a single exposure, it seems that the novelty has a synergistic influence over this process. I suggest that contextual novelty, in the form of the unusual conditioning procedure, promotes further learning and exploration of newly encountered stimuli, thus maximizing the possibility of acquiring reward. Chapter 7 presents a final experiment, which explored the neural correlates of appetitive conditioning in a single trial. Again, conditioning was evident based on subjective evaluations. Tentative evidence suggested a potential role for the right superior frontal gyrus in enhancing inhibitory control in response to passive viewing of cues signalling no reward. Brain activity in areas related to salience attribution was greater for a reward-paired cue presented briefly in an EBA paradigm. Although, evidence for reward-driven attentional capture was absent at a behavioural level. Overall, this thesis supports the utility of a novel naturalistic conditioning paradigm for studying appetitive conditioning processes in a single trial. Just one experience with a novel edible object transformed it into a highly desirable, craved cue. Potential applications of these findings for informing treatment and interventions for obesity and eating disorders, as well as methodological considerations and limitations are discussed in chapter 8

Taking care of Tootsie: Making a place for nurses.

Theresa “Tootsie” Smoder, better known as my grandma, always seemed larger than life. She bore eight children in nine years (The “Crazy Eights”), raised them almost single-handedly when her husband died and managed a 160 acre farm. Doing whatever it took to create security and stability for her family, Tootsie worked multiple jobs to feed her brood. She was a social butterfly who always tended to others and modeled the value of caring throughout her life

MiR-142-3p is downregulated in aggressive p53 mutant mouse models of pancreatic ductal adenocarcinoma by hypermethylation of its locus

Pancreatic ductal adenocarcinoma (PDAC) is an extremely aggressive disease with poor prognostic implications. This is partly due to a large proportion of PDACs carrying mutations in TP53, which impart gain-of-function characteristics that promote metastasis. There is evidence that microRNAs (miRNAs) may play a role in both gain-of-function TP53 mutations and metastasis, but this has not been fully explored in PDAC. Here we set out to identify miRNAs which are specifically dysregulated in metastatic PDAC. To achieve this, we utilised established mouse models of PDAC to profile miRNA expression in primary tumours expressing the metastasis-inducing mutant p53R172H and compared these to two control models carrying mutations, which promote tumour progression but do not induce metastasis. We show that a subset of miRNAs are dysregulated in mouse PDAC tumour tissues expressing mutant p53R172H, primary cell lines derived from mice with the same mutations and in TP53 null cells with ectopic expression of the orthologous human mutation, p53R175H. Specifically, miR-142-3p is downregulated in all of these experimental models. We found that DNA methyltransferase 1 (Dnmt1) is upregulated in tumour tissue and cell lines, which express p53R172H. Inhibition or depletion of Dnmt1 restores miR-142-3p expression. Overexpression of miR-142-3p attenuates the invasive capacity of p53R172H-expressing tumour cells. MiR-142-3p dysregulation is known to be associated with cancer progression, metastasis and the miRNA is downregulated in patients with PDAC. Here we link TP53 gain-of-function mutations to Dnmt1 expression and in turn miR-142-3p expression. Additionally, we show a correlation between expression of these genes and patient survival, suggesting that they may have potential to be therapeutic targets