Bristol Breastfeeding Assessment Tool-Thai Version: Translation, Validity, and Reliability.

BACKGROUND: In 2019, 14.0% of infants in Thailand were exclusively breastfed up to 6 months of age. To increase exclusive breastfeeding, an objective assessment measure would be useful to maternity care providers for appraising the problems encountered by new mothers' experiences with breastfeeding. RESEARCH AIMS: To translate the Bristol Breastfeeding Assessment Tool from English into Thai; to assess the reliability and validity of the Thai Bristol Breastfeeding Assessment Tool; and to explore the relationship of a mother's self-efficacy to successful breastfeeding. METHODS: Using a methodological design, we purposively sampled 302 new mothers from two tertiary hospitals in Thailand who had given birth to a single baby with an uncomplicated vaginal birth. The Thai Bristol Breastfeeding Assessment Tool's structure was examined using confirmatory factor analysis. Concurrent and convergent validity were assessed using the Thai LATCH instrument and Thai Breastfeeding Self-Efficacy Scale, respectively. RESULTS: The inter-item Thai Bristol Breastfeeding Assessment Tool correlation coefficients were positive and strong. The correlation between scores of the Thai Bristol Breastfeeding Assessment Tool and Thai LATCH instrument were positive and strong and had acceptable concurrent validity. The confirmatory factor analysis model fit the Thai Bristol Breastfeeding Assessment Tool data perfectly and the Cronbach's alpha coefficient had acceptable internal reliability. CONCLUSIONS: The Thai Bristol Breastfeeding Assessment Tool is a cross-culturally translated instrument equivalent to its English version and demonstrated acceptable validity and reliability. The instrument provides a mechanism for an objective assessment and monitoring system of optimal breastfeeding practices in Thai mothers with newborns.

The meaning of acceptance (Thum-jai) in Thai people: Letting it go so life goes on.

The purpose of this qualitative study was to explore the meaning of acceptance (Thum-jai) as a culturally embedded coping strategy in the lives of Thai people who have experienced adversity that caused suffering. Thematic analysis was used to examine the responses of 47 participants to written, open-ended questions or face-to-face interviews. The EQUATOR's COREQ checklist for qualitative research was followed. Participants came from diverse religious' traditions and geographic regions throughout Thailand. Findings revealed seven themes: circumstance and emotion; thought and action; time, experience, and effort; social and moral support; religious and spiritual ethos; acceptance and hope; and survive and thrive. The adverse circumstance is central to the concept of acceptance. Before acceptance, there is often hope; yet Thai people reach an existential point whether to accept the reality of the situation or continue in distress. Purposeful approaches to deal with the event flow from the cultural contexts of spirituality and social support. Drawing upon psychological strength, Thai people undertake purposive thought and action to facilitate redirecting their lives for better mental health. Thum-jai brings release and peace of mind. Clinicians may find that people experiencing adverse life events are best served by nondirective approaches. Acceptance and change in thoughts and behaviours may come from meditation and therapeutic mindfulness practices that allow those in Western and non-Western cultures to use their own values, expressions, and societal expectations to cope with suffering and formulate effective decisions.

Motivational Interviewing-Based Compliance/Adherence Therapy Interventions to Improve Psychiatric Symptoms of People With Severe Mental Illness: Meta-Analysis.

BACKGROUND: Nonadherence is the leading cause of relapse in mental illness. No quantitative synthesis of multiple studies has been conducted to determine the effect of motivational interviewing (MI)-based compliance/adherence therapy (CAT) interventions on people with severe mental illness. OBJECTIVE: To synthesize the studies that examined the effectiveness of MI-based CAT interventions to improve psychiatric symptoms. DESIGN: Quantitative meta-analysis. RESULTS: Sixteen primary studies were retrieved ( N =1267 participants). MI-based CAT interventions significantly improved psychiatric symptoms with a moderate effect size (ES) of .45. Longer sessions and higher intervention doses showed significantly greater ESs than shorter sessions and lower doses. ESs were significantly lower when participants were older and when there was a longer period between the intervention and outcome measurement. CONCLUSIONS: These findings support the effectiveness of MI-based CAT interventions. Session length and dose effect should be considered when tailoring MI to clients.

Living with schizophrenia in rural communities in north-east Thailand.

In the rural villages of Thailand, rich social support networks exist that bond the community members to help each other. This study explored the barriers and facilitators of living with schizophrenia in Thai villages. A descriptive qualitative study was conducted using semi-structured interviews with individuals with schizophrenia, family members, and significant others. Content analysis of transcripts involved examining the data, recording observations, data reduction, and coding themes. Four main themes emerged from the narratives: (i) keep doing day-to-day activities as a way of life; (ii) support sustains day-to-day living; (iii) controlling medication side effects maintains daily living; and (iv) managing self maintains daily living. Self-regulation and social support are keys to moving from dependence to a normative life goal in rural communities. The patterns of living in the rural communities provide a strong social network as people with schizophrenia learn to lead successful lives. Using supportive families and community members as resources is an alternative and effective way of providing supportive care.

Internalized Stigma of Mental Illness Scale - Thai Version: Translation and Assessment of Psychometric Properties Among Psychiatric Outpatients in Central Thailand.

This paper reports the translation of the English Internalized Stigma of Mental Illness scale into Thai and assessment of its psychometric properties. After forward- and backward-translation, Thai experts completed the content validity index with item agreements of .86 to 1.00. Data were collected from 390 psychiatric clinic patients in central Thailand using systematic random sampling. Unweighted least squares factor analysis with Promax rotation identified five subscales. Cronbach's alpha for scale reliability was .88, and correlations for construct validity ranged from r=.55 to .69. These findings support the validity and reliability of the Thai version of the scale.

A comparison of two nursing program exit exams that predict first-time NCLEX-RN outcome.

This retrospective descriptive correlational study compared the predictive accuracy of the Health Education Systems, Inc, Exit Exam (Elsevier) and Assessment Technologies Institute's RN Comprehensive Predictor, both of which were administered to nursing students in an upper-division baccalaureate nursing program during their final semester of study. Using logistic regression analyses, it was determined that the two examinations were statistically significant but weak predictors of success on the RN licensure examination. The RN Comprehensive Predictor had a slightly better odds ratio; however, both examinations had similar sensitivity, specificity, and overall accuracy. Because the RN Comprehensive Predictor was included in the Assessment Technologies Institute's Comprehensive Assessment and Review Program already being used by the BSN program, based on the results of this study, the nursing faculty decided to use only the RN Comprehensive Predictor during its NCLEX-RN preparation course.

Effect of Magnet hospital recognition on 2 patient outcomes.

The purpose of this study was to explore whether Magnet hospitals had better nursing-sensitive outcomes than non-Magnet hospitals. Eighty Magnet hospitals were identified in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project databases and matched with 80 non-Magnet hospitals on 12 hospital characteristics. Comparative analysis demonstrated no significant differences for risk-adjusted rates for pressure ulcers and failure to rescue. Future investigation should examine what clinical benefits might exist that distinguish Magnet from non-Magnet hospitals.

Blind insertion of feeding tubes in intensive care units: a national survey.

BACKGROUND: Although most critically ill patients experience at least 1 blind insertion of a feeding tube during their stay in an intensive care unit, little is known about the types of health care personnel who perform these insertions or about methods used to determine proper positioning of the tubes. OBJECTIVES: To describe results from a national survey of critical care nurses about feeding tube practices in their adult intensive care units. The questions asked included who performs blind insertions of feeding tubes and what methods are used to determine if the tubes are properly positioned. METHODS: Data were collected from members of the American Association of Critical-Care Nurses via pencil-and-paper and online surveys. Results from both forms were combined for data analysis and were compared with practice recommendations of national-level organizations. RESULTS: A total of 2298 responses were obtained. Physicians perform more blind insertions of styleted feeding tubes than do nurses; in contrast, nurses place more nonstyleted tubes. Radiographic confirmation of correct position is mandated more often for blindly inserted styleted tubes (92.3%) than for nonstyleted tubes (57.5%). The 3 most commonly used bedside methods to determine tube location are auscultation for air injected via the tube, appearance of feeding tube aspirate, and observation for indications of respiratory distress. CONCLUSIONS: Recommendations from multiple national-level organizations to obtain radiographic confirmation that each blindly inserted feeding tube is correctly positioned before the first use of the tube are not adequately implemented. Auscultation is widely used despite recommendations to the contrary.

Monitoring for intolerance to gastric tube feedings: a national survey.

BACKGROUND: Confusion about how to assess for intolerance to feedings often results in unnecessary feeding interruptions. OBJECTIVES: To report findings from a national survey of methods used by critical care nurses to assess tolerance to gastric tube feedings and to discuss the findings in light of current enteral nutrition guidelines. METHODS: A paper-and-pencil survey was mailed to 1909 members of the American Association of Critical-Care Nurses. In addition, the same survey was posted online in a newsletter circulated to association members. Results from both surveys were pooled for data analysis. RESULTS: A total of 2298 responses were obtained; most respondents reported using a combination of methods to assess tolerance to gastric tube feedings (listening for bowel sounds, measuring gastric residual volumes, observing for abdominal distention/discomfort and for nausea and vomiting). More than 97% of the nurses reported measuring gastric residual volumes; the most frequently cited threshold levels for interrupting feedings were 200 mL and 250 mL. About 25% of the nurses reported interrupting feedings for gastric residual volumes of 150 mL or less; only 12.6% of the respondents reported allowing gastric residual volumes of up to 500 mL before interrupting feedings. CONCLUSIONS: Practice among the 2298 critical care nurses varied widely. Many of the survey respondents are practicing in ways that can unnecessarily diminish the delivery of calories to patients. Protocols based on current enteral nutrition guidelines must be developed and implemented in practice settings.

Applying parameter-estimation methods to recovery-test and slug-test analyses.

Parameter-estimation methods, including an exhaustive-search method and PEST (Parameter ESTimation) software, were applied to recovery-test data and slug-test data to obtain best estimates of transmissivity (T) by minimizing the sums of residuals. Each residual represents the difference between the field-measured water-level value and the value calculated by the appropriate non-linear equation. The exhaustive-search method in both cases involves computing the sums of residuals for an array of transmissivity and storativity values selected by the user for testing. Two new Fortran programs are presented that employ the exhaustive-search method. They utilize Picking's method for analyzing recovery-test data and the analytical equation for analyzing slug-test data derived by Cooper, Bredehoeft, and Papadopulos. Picking's method involves application of the Papadopulos and Cooper's equation for drawdown in finite-diameter wells. Utilizing field data reported in the literature, the estimated transmissivity values from the exhaustive-search methods were compared to the literature values obtained by type-curve matching techniques. The exhaustive-search values corresponded closely to the curve-matching values. Estimates for T were also obtained from recovery-test and slug-test data from two sites in southeastern Pennsylvania. For these sites, the PEST program was also applied to the data to evaluate the accuracy of the exhaustive-search methods. The results from the two methods were generally in good agreement. The two new Fortran programs are practical tools for the hydrogeologist, as they require less time compared to type-curve matching and the PEST method, and they yield accurate estimates of transmissivity.

Synthesis and biological evaluation of bupropion analogues as potential pharmacotherapies for cocaine addiction.

A series of bupropion (1a) analogues (1b-1ff) were synthesized, and their in vitro and in vivo pharmacological properties evaluated with the goal of developing a 1a analogue that had better properties for treating addictions. Their in vitro pharmacological properties were examined by [(3)H]dopamine ([(3)H]DA), [(3)H]serotonin ([(3)H]5HT), and [(3)H]norepinephrine ([(3)H]NE) uptake inhibition studies, and by binding studies at the dopamine, serotonin, and norepinephrine transporters using [(125)I]RTI-55 in cloned transporters. Several analogues showed increased [(3)H]DA uptake inhibition with reduced or little change in [(3)H]5HT and [(3)H]NE uptake inhibition relative to bupropion. Thirty-five analogues were evaluated in a 1 h locomotor activity observation test and 32 in an 8 h locomotor activity observation test and compared to the locomotor activity of cocaine. Twenty-four analogues were evaluated for generalization to cocaine drug discrimination after i.p. administration, and twelve analogues were tested in a time course cocaine discrimination study using oral administration. 2-(N-Cyclopropylamino)-3-chloropropiophenone (1x) had the most favorable in vitro efficacy and in vivo pharmacological profile for an indirect dopamine agonist pharmacotherapy for treating cocaine, methamphetamine, nicotine, and other drugs of abuse addiction.

Evaluation of online and on-site options for master's degree and post-master's certificate programs.

Measures related to program evaluation were selected to compare on-site and online options of a master's and post-master's nursing program. Although some differences were found in student-related outcomes, the decision to continue the online options was based on program and organizational effectiveness. The decline in the number of on-site students has been offset by the expanding enrollments of online students and their national distribution. Increased costs were associated with offering online courses.

Primary reasons for ED visits and procedures performed for patients who saw nurse practitioners.

INTRODUCTION: Little is known, from a national perspective, about what types of patients are seen by nurse practitioners in the emergency department. METHODS: Data from 1545 participating emergency departments across the United States during 1997, 1998, 1999, and 2000 were collected from nationally representative samples of urban and rural hospitals using the National Hospital Ambulatory Medical Care Surveys. Results Nurse practitioners saw 5.76 million ED patients during the 4-year period. Using the Reason for Visit Classification developed by the National Center for Health Statistics, the primary category for patients seen by nurse practitioners was classified as "Injury by type and/or location." The types of injuries in this category were lacerations and cuts to an upper extremity and facial area; injuries to the head, neck, and face; and foreign bodies in the eye. The next most common category was classified under "General symptoms." Nurse practitioners saw patients in this category with symptoms of chest pain, side or flank pain, fever, and edema. DISCUSSION: The findings from this study provide insight into the types of patient visits seen by nurse practitioners in emergency departments in the United States and the services and procedures that were received by patients.

Nurse practitioners and physician assistants revisited: do their practice patterns differ in ambulatory care?

The education and regulation of nurse practitioners and physician assistants would suggest unique role differentiations and practice functions between the professions. This study explored to what extent their practice patterns in primary care actually differ. It was hypothesized that the primary care services provided by nurse practitioners would tend to be women and family health services, health prevention and promotion oriented, provided to minority and socioeconomic disadvantaged patients, and less dependent on physician supervision. In contrast, the services provided by physician assistants would more likely be medical/surgical oriented; diagnostic, procedural, and technical in nature; likely to be in rural areas; and more dependent on physician supervision. The study used patient data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Although some differences emerged, the argument is not compelling to suggest strong, unique, practice differences across all ambulatory care settings between the two types of nonphysician providers. It is the specific type of ambulatory setting that influences the practice pattern for both provider groups. If practice patterns are less distinctive than previously believed, more opportunities for interdisciplinary education need to be explored, and health policies that promote a discipline-specific primary care workforce may need to be reexamined.