A Beginning Look at the Effect of Age on Dyspnea, Physical Functioning and Self-Efficacy for Home Walking and Managing Shortness of Breath in Adults with Chronic Obstructive Pulmonary Disease (COPD)

Chronic illness is common in older adults and is associated with functional impairments. Older adults with chronic obstructive pulmonary disease (COPD) face both age-related and disease-related decline in pulmonary function. Dyspnea, also referred to as shortness of breath, is a major symptom in COPD and progressive dyspnea is associated with decline in physical function. Aging, chronic illness and a decline in physical function can compromise the individual's confidence, also known as self-efficacy, for performing physical activities. Chronic disease self-management programs for COPD that include an exercise program have been reported to improve functional status, decrease dyspnea and improve self-efficacy for specific tasks. It is not known if advancing age moderates the effect of a dyspnea self-management program (DSMP) on functional performance, dyspnea and self-efficacy outcomes. Purposes: 1) Determine if advancing age is a moderator of functional performance, dyspnea, or self-efficacy outcomes following three different DSMP interventions; 2) Determine if predictors of self-efficacy for home walking and self-efficacy for managing shortness of breath are similar; and 3) Determine if self-efficacy for home walking and self-efficacy for managing shortness of breath change following three different DSMP interventions. Methods: This is a secondary analysis of a longitudinal, randomized-controlled DSMP trial. One hundred and three (103) participants with COPD (57 women; mean age 66 ± 8; mean FEV-1% predicted: 44.8 ± 14%) were randomized to: 1) a dyspnea self-management program (DM group); 2) a DSMP and four supervised treadmill exercise session (DM-Exposure group) or 3) DM plus 24 supervised treadmill exercise sessions (DM-Training) group. Functional performance outcomes, including self-reported measures and exercise tests, dyspnea intensity measures and self-efficacy for home walking and self-efficacy for managing shortness of breath ratings were measured at specific intervals over the 12 month study period. Results: Age was found to be a significant moderator of self-reported physical function, exercise test performance, and dyspnea intensity both during and after exercise. Additionally, self-efficacy for home walking and self-efficacy for managing shortness of breath improved in all groups following the DSMP intervention. Age was not a significant moderator of self-efficacy outcomes. The predictors of baseline self-efficacy domains evaluated in this study were not similar. Conclusions: Advancing age moderates the effect of three different DSMP interventions on self-reported and exercise test functional performance measures, and dyspnea intensity ratings during and after exercise. Self-efficacy for home walking and self-efficacy for managing shortness of breath ratings improved after the DSMP interventions. While not a completely consistent pattern, it does appear that a more intense exercise intervention may be favorable for the older adult

Simple measures of function and symptoms in hospitalized heart failure patients predict short-term cardiac event-free survival.

Background. Heart failure (HF) is a prevalent chronic condition where patients experience numerous uncomfortable symptoms, low functional status, and high mortality rates. Objective. To determine whether function and/or symptoms predict cardiac event-free survival in hospitalized HF patients within 90 days of hospital discharge. Methods. Inpatients (N = 32) had HF symptoms assessed with 4 yes/no questions. Function was determined with NYHA Classification, Katz Index of Activities of Daily Living (ADLs), and directly with the short physical performance battery (SPPB). Survival was analyzed with time to the first postdischarge cardiac event with events defined as cardiac rehospitalization, heart transplantation, or death. Results. Mean age was 58.2 ± 13.6 years. Patient reported ADL function was nearly independent (5.6 ± 1.1) while direct measure (SPPB) showed moderate functional limitation (6.4 ± 3.1). Within 90 days, 40.6% patients had a cardiac event. At discharge, each increase in NYHA Classification was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4-8.5). Patients reporting symptoms of dyspnea, fatigue, and orthopnea before discharge had a 4.0-fold, 9.7-fold, and 12.8-fold, respectively, greater risk of cardiac events (95% CI 1.2-13.2; 1.2-75.1; 1.7-99.7). Conclusions. Simple assessments of function and symptoms easily performed at discharge may predict short-term cardiac outcomes in hospitalized HF patients

Pairing pedagogical and genomic advances to prepare advanced practice nurses for the era of precision health

Abstract Background Broadly accessible curriculum that equips Advanced Practice Nurses (APNs) with knowledge and skills to apply genomics in practice in the era of precision health is needed. Increased accessibility of genomics courses and updated curriculum will prepare APNs to be leaders in the precision health initiative. Methods Courses on genomics were redesigned using contemporary pedagogical approaches to online teaching. Content was based on the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees. Results The number of students enrolled (n = 10) was comparable to previous years with greater breadth of representation across nursing practice specialty areas (53% vs. 20%). Prior to the first course, students reported agreement with meeting 8% (3/38) of the competencies. By completion of the 3rd course, students reported 100% (38/38) agreement with meeting the competencies. Conclusions Content on genomics sufficient to obtain self-perceived attainment of genomics competencies can be successfully delivered using contemporary pedagogical teaching approaches

Stability of Symptom Clusters in Patients With Lung Cancer Receiving Chemotherapy

ContextPatients with lung cancer who undergo chemotherapy (CTX) experience multiple symptoms. Evaluation of how these symptoms cluster together and how these symptom clusters change over time are salient questions in symptom clusters research.ObjectivesThe purposes of this analysis, in a sample of patients with lung cancer (n = 145) who were receiving CTX, were to 1) evaluate for differences in the number and types of symptom clusters at three time points (i.e., before their next cycle of CTX, the week after CTX, and two weeks after CTX) using ratings of symptom occurrence and severity and 2) evaluate for changes in these symptom clusters over time.MethodsAt each assessment, a modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence and severity of 38 symptoms. Exploratory factor analyses were used to extract the symptom clusters.ResultsAcross the two symptom dimensions (i.e., occurrence and severity) and the three assessments, six distinct symptom clusters were identified; however, only three of these clusters (i.e., lung cancer specific, psychological, nutritional) were relatively stable across both dimensions and across time. Two additional clusters varied by time but not by symptom dimension (i.e., epithelial/gastrointestinal and epithelial). A sickness behavior cluster was identified at each assessment with the exception of the week before CTX using only the severity dimension.ConclusionFindings provide insights into the most common symptom clusters in patients with lung cancer undergoing CTX. Most common symptoms within each cluster appear to be relatively stable across the two dimensions, as well as across time