PHYSICAL FUNCTIONING IN OLDER BREAST CANCER SURVIVORS: A 12-MONTH RANDOMIZED-CONTROLLED TRIAL WITH 6-MONTH FOLLOW UP

M.E. Medysky1, S. Stoyles1, N.F.Dieckmann1, K.M. Winters-Stone FACSM1,2 1School of Nursing, Oregon Health and Science University, Portland, OR; 2Knight Cancer Institute, Oregon Health and Science University, Portland, OR The largest age group of breast cancer survivors (BCS) in the U.S. is comprised of women ages 65+, who are susceptible to age-related decrements in physical function accelerated by cancer treatment toxicities. Though exercise is known to reverse age-related functional limitations, older BCS may be heterogeneous in baseline functioning which may affect the efficacy of exercise to reverse functional declines. PURPOSE: Determine the efficacy of each aerobic and resistance training to improve physical function in older BCS, considering baseline physical functioning. METHODS: Older, early-stage, BCS (mean age=72), who underwent chemo- or radio-therapy in the previous 2 years were randomized to 12 months of supervised, group aerobic (AER) or resistance (RES) training or control (CON) flexibility exercise, followed by 6 months of home-based training. Physical function was assessed by the Physical Performance Battery (PPB), 5x chair stand time (sec), maximum bench and leg press (kg), and 4-meter usual walk speed (m/sec) tests and self-reported lower-body function with the Late-Life Function and Disability Instrument (LLFDI). A linear mixed effects model was used to assess function after 12 and 18 months on the full sample and only in BCS with PPB scores ≥9. RESULTS: 114 BCS were enrolled and randomized to AER (n=37), RES (n=39), or CON (n=38). Within the full sample there was a significant improvement in bench press strength at 12 months (p=0.03) and PPB at 18 months in RES vs CON. After removing participants with low baseline physical functioning (n=79), the following additional significant differences were found between: 1) RES (Dmean=2.72±1.7) and CON (Dmean=-3.06±2.0) for self-report physical function at both 12 (p=0.04) and 18 months (p=0.005), 2) AER (Dmean=0.4±0.0) and CON (Dmean=-0.03±0.0) at 12-months for average walk speed and, 3) AER (Dmean=0.32±0.3) and RES (Dmean=0.50±0.2) at 18 months, for chair time (p=0.05). CONCLUSIONS: Although AE and RT are efficacious in improving physical function in older BCS across a range of baseline physical functioning, broader improvements may only be possible among women with better functioning and thus capable of achieving a greater dose of exercise. Older BCS may need to be stratified into groups based on their initial functioning, then matched to appropriate training. This study was funded by NIH grant #R01CA120123. Clinicaltrials.gov #NCT00662103

Falls, Functioning, and Disability Among Women With Persistent Symptoms of Chemotherapy-Induced Peripheral Neuropathy

Purpose Chemotherapy-induced peripheral neuropathy (CIPN) may persist after treatment ends and may lead to functional decline and falls. This study compared objective and self-report measures of physical function, gait patterns, and falls between women cancer survivors with and without symptoms of CIPN to identify targets for functional rehabilitation. Methods A secondary data analysis of 512 women cancer survivors (age, 62 6 6 years; time since diagnosis, 5.8 6 4.1 years) categorized and compared women self-reporting symptoms of CIPN (CIPN+) with asymptomatic women (CIPN2) on the following: maximal leg strength, timed chair stand, physical function battery, gait characteristics (speed; step number, rate, and length; base of support), selfreport physical function and disability, and falls in the past year. Results After an average of 6 years after treatment, 47% of women still reported symptoms of CIPN. CIPN+ had significantly worse self-report and objectively measured function than did CIPN2, with the exception of maximal leg strength and base of support during a usual walk. Gait was slower among CIPN+, with those women taking significantly more, but slower and shorter, steps than did CIPN2 (all P,.05). CIPN+ reported significantly more disability and 1.8 times the risk of falls compared with CIPN2 (P , .0001). Increasing symptom severity was linearly associated with worsening function, increasing disability, and higher fall risk (all P , .05). Conclusion This work makes a significant contribution toward understanding the functional impact of CIPN symptoms on cancer survivors. Remarkably, 47% of women in our sample had CIPN symptoms many years after treatment, together with worse function, greater disability, and more falls. CIPN must be assessed earlier in the clinical pathway, and strategies to limit symptom progression and to improve function must be included in clinical and survivorship care plans

Falls, Functioning, and Disability Among Women With Persistent Symptoms of Chemotherapy-Induced Peripheral Neuropathy

Purpose Chemotherapy-induced peripheral neuropathy (CIPN) may persist after treatment ends and may lead to functional decline and falls. This study compared objective and self-report measures of physical function, gait patterns, and falls between women cancer survivors with and without symptoms of CIPN to identify targets for functional rehabilitation. Methods A secondary data analysis of 512 women cancer survivors (age, 62 6 6 years; time since diagnosis, 5.8 6 4.1 years) categorized and compared women self-reporting symptoms of CIPN (CIPN+) with asymptomatic women (CIPN2) on the following: maximal leg strength, timed chair stand, physical function battery, gait characteristics (speed; step number, rate, and length; base of support), selfreport physical function and disability, and falls in the past year. Results After an average of 6 years after treatment, 47% of women still reported symptoms of CIPN. CIPN+ had significantly worse self-report and objectively measured function than did CIPN2, with the exception of maximal leg strength and base of support during a usual walk. Gait was slower among CIPN+, with those women taking significantly more, but slower and shorter, steps than did CIPN2 (all P,.05). CIPN+ reported significantly more disability and 1.8 times the risk of falls compared with CIPN2 (P , .0001). Increasing symptom severity was linearly associated with worsening function, increasing disability, and higher fall risk (all P , .05). Conclusion This work makes a significant contribution toward understanding the functional impact of CIPN symptoms on cancer survivors. Remarkably, 47% of women in our sample had CIPN symptoms many years after treatment, together with worse function, greater disability, and more falls. CIPN must be assessed earlier in the clinical pathway, and strategies to limit symptom progression and to improve function must be included in clinical and survivorship care plans

Do prelicensure nursing students' backgrounds impact what they notice and interpret about patients?

© 2019 Elsevier Ltd Background: Academic educators are challenged to foster the development of clinical judgment in diverse learners. The impact of nursing students' backgrounds on clinical judgment has not previously been studied. Aims: 1. Determine what identifiable background variables influence what students notice and how they interpret what is noticed; 2. Identify some implications for pedagogical approaches that may foster clinical judgment development among diverse learners. Sample: Prelicensure/preregistration students, representing three international English-speaking programs in 3 countries, comprised the sample (N = 532). All were enrolled in the first course in which perioperative content was taught. Data collection: An online learning activity was designed to elicit responses to a simulated case study of an expert nurse role model caring for an older adult patient experiencing delirium several days post-operatively. Data analysis: Dyads of coders did three rounds of coding. Logistic and multinomial logistic regression models used background variables to look for patterns in student responses. Findings: The data strongly suggest that background variables impact clinical judgment, however, not in interpretable patterns. Conclusion: Nurse educators must acknowledge that prelicensure students' backgrounds impact their clinical judgment and assist them to learn to think like nurses

Public perceptions of expert disagreement: Bias and incompetence or a complex and random world?

30 page PDFExpert disputes can present laypeople with several challenges including trying to understand why such disputes occur. In an online survey of the U.S. public, we used a psychometric approach to elicit perceptions of expert disputes for 56 forecasts sampled from seven domains (climate change, crime, economics, environment, health, politics, terrorism). People with low education, or with low self-reported knowledge of the topic, were most likely to attribute expert disputes to expert incompetence. People with higher self-reported knowledge tended to attribute disputes to expert bias due to financial or ideological reasons. The more highly educated and cognitively able were most likely to attribute disputes to natural factors, such as the irreducible complexity and randomness of the phenomenon. We highlight several important implications of these results for scientists and risk managers and argue for further research on how people perceive and grapple with expert disputes.We would like to acknowledge the generous support of the National Science Foundation: This material is based upon work supported by NSF under Grant Nos. #1231231 (Robin Gregory, PI; Nathan Dieckmann co-PI) and #0925008 (Nathan Dieckmann, PI) to Decision Research. All views expressed in this paper are those of the authors alone