Maggie is first seen digging graves, along with Glenn, who views her from a distance as they can not come into contact with one another. She then walks in on Glenn, who is coughing, and tells her that he has it (the illness). Maggie talks to Beth and tell hers that Glenn is infected, with Beth telling her they both have their jobs and to stay strong. Later in the episode, Maggie runs into Hershel, who is wanting to go into the isolated cell block and to help the sick. Maggie, along with Rick, plead him not to go in, knowing that he could get sick. Hershel refuses and goes in, saying that he knows he can help the sick. She then talks to Beth again, with both of them saying they need to be strong.
In addition to reporting of exacerbations, we related patient characteristics for timely taken type-A and type-B action measures during exacerbations. Interestingly for both types of action, current smoking had an increased likelihood of been associated with less appropriate self-management actions. Similar defaults in self-management behaviour by current smokers were seen from previous studies in using appropriately meter dose inhaler technique , being adherent to long term nebulizer therapy  and attending outpatient pulmonary rehabilitation [27, 28]. Furthermore, correct type-A actions were more frequently taken in patients with longer exacerbations episodes. Finally, the type of symptoms showed to influence patients' self-management decisions during exacerbations. Patients perceiving increased dyspnea at exacerbation onset are more likely to take type-B actions that patients without increased dyspnea. Patients with increased sputum purulence are less likely than patients without increased sputum purulence to take action. We believe this study provides valuable new insights in how patient respond to symptom deterioriation. This knowledge can support the development of improved patient information and material to enhance appropriate self-management of exacerbations. However, a few words of caution are needed when interpreting the results. First, although this study was the first to examine self-management decisions prospectively, it comprised a relatively small group of 108 consecutive patients followed up for only 6 weeks resulting in 75 exacerbations. This is equal to an annual rate of 6.0 per patient-year This relatively high event-rate can be explained by the fact that all patients were simultaneously followed-up in the same 6-week winter period in which exacerbations have shown to be 50% more likely than in other seasons [6, 29]. Also the relative high proportion of patients included immediately after hospitalisation might have contributed to a higher exacerbation rate.
Thirdly, another limiting factor is that after dichotomizing episodes by actions carried out, the number of events per predictor variable did not reach the rule of thumb to allow for multivariate logistic regression analysis . Therefore, the present study solely evaluated the association between single characteristics and actions taken. Adequately powered observational studies allowing multivariate analysis including adjustment for potential confounders are needed to validate current indicators of self-management behaviour. 781b155fdc