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Exercise after breast cancer diagnosis and treatment improves cancer-related outcomes, although the mechanisms involved are not clear. This study evaluated the impact of exercise on body composition, strength, endurance, quality of life (QOL), fatigue, and endocrine and inflammatory biomarkers in breast cancer survivors participating in a highly monitored, clinically supervised, moderate-intensity exercise program. The association of hormonal and inflammatory biomarkers with the observed physiological changes was assessed. Female breast cancer survivors (BCS; n = 46) who engaged in a goal-oriented 14-week triathlon exercise training program were compared to an untrained control group of female BCS (n = 16). Psychosocial metrics, QOL, cancer-related fatigue, and exercise self-efficacy were evaluated via pre- and post-exercise intervention questionnaires. Serum estradiol and inflammatory biomarkers (C-reactive protein (CRP), sTNFR1a, estradiol, leptin, and adiponectin) were measured prior to the exercise training program start and after the completion of the goal triathlon. After exercise training, the exercise group had lower BMI and arm circumferences. Greater positive change was noted in the trained group for QOL, fatigue, and self-efficacy questionnaires. Functional endurance improved in the trained but not the control group. Knee and elbow strength were not different between the groups, except that knee flexion at 180 degrees∙sec−1 was higher in trained. The only significantly different biomarker was adiponectin, which decreased in the trained group. Group triathlon exercise training may be beneficial to BCS by significantly improving their psychosocial measures, functional endurance, and BMI.

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants ( n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors.

Purpose The purpose of this study was to determine perceived cognitive functioning, fatigue, depression and general well-being among women before and after the initiation of chemotherapy for breast cancer compared to a sample of healthy women. Method This descriptive, repeated measures study compared women receiving chemotherapy and healthy women. Women completed measures of quality of life, fatigue, cognitive changes and depression. Results Before chemotherapy, women with cancer reported more fatigue and depression than healthy women. After chemotherapy, women with cancer reported decreased cognitive functioning accompanied by more fatigue and depressive symptoms than healthy women. Conclusion This study is one of the first to use multiple symptom measures before and after starting chemotherapy. Understanding cognitive changes and related symptoms that occur before and during chemotherapy for breast cancer is the first step toward helping women cope with changes that occur with breast cancer treatment.

11558 Background: Exercise after breast cancer treatment improves cancer-related outcomes, although the mechanism of action is unclear. Engagement in healthy active lifestyles after cancer treatment may also impact overall survival. We aimed to determine effectiveness of a highly structured, clinically overseen, goal oriented, group triathlon training program on improving physiological and psychosocial outcomes in female breast cancer survivors (BCS). Methods: After stage appropriate local and systemic breast cancer treatment, 53 female BCS were recruited to participate in this study. The 14-week group triathlon training program was individually adjusted for treatment side effects. 28 similar BCS who did not participate in the training served as controls. Pre- and post-exercise training measures included: Functional endurance (Timed 6MWT), quality of life (QOL, FACT-B), cancer-related fatigue (CRF, FACIT-F), exercise self-efficacy (ESE) via questionnaires, estradiol, and inflammatory biomarkers (C-reactive protein, TNFr1, leptin and adiponectin). Results: Complete data were obtained from 41 [mean age 51 (7) yr, mean BMI 29.5 (6.2)] triathlon finishers and 16 [mean age 56 (10) yr, mean BMI 31.5 (8.0)] controls. 6MWT improved (26 m) more in the triathlon group (p < 0.05). FACT-B, FACIT-F, and ESE all improved compared to controls (all p < 0.05). Body mass and BMI decreased in the training group compared to controls (p = 0.01, p = 0.04 respectively). Arm circumference decreased in the trained group but increased in controls (p < 0.05). Estradiol and leptin positively correlated with initial body weight in both groups but did not change after training. Adiponectin significantly decreased in the triathlon group (p = 0.01), perhaps due to selection bias of controls. No significant changes were seen in other serological markers. Conclusions: A highly structured, clinically overseen, moderate intensity exercise program can improve endurance, QOL, CRF, body mass, and possibly improve survival after breast cancer treatment. Furthermore, improvements in ESE may provide tools for patients to continue adherence to regular exercise guidelines that may lower obesity and its related comorbidities, including arm lymphedema.

Nurses in every setting provide patient teaching on a routine basis, often several times a day. Patient teaching skills are essential competencies to be developed during pre-licensure nursing education. While students learn what to teach for specific conditions, they often lack competence in how to teach in ways that individualize and optimize patient learning. The ultimate goal of patient teaching is to arm patients with the knowledge and skills, and the desire and confidence in their ability to reach their targeted health outcomes. We describe the creation of a theoretical framework to guide development of patient teaching skills. The framework, rooted in the contemporary health care values of patient-centered care, is a synthesis of four evidence-based approaches to patient teaching: patient engagement, motivational interviewing, adult learning theory, and teach-back method. Specific patient teaching skills, derived from each of the approaches, are applied within the context of discharge teaching, an important nursing practice linked to patient outcomes. This exemplar emphasizes the use of critical teaching process skills and targeted informational content. An online student learning module based on the theoretical framework and combined with simulation experiences provides the nurse educator with one strategy for use with nursing students. The theoretical framework has applicability for skill development during pre-licensure education and skill refinement for nurses in clinical practice.

Aims and objectives To examine motivational factors influencing breast cancer survivors to participate in triathlon training, complete a triathlon and maintain an exercise thereafter. Background Routine exercise has been shown to improve quality of life and reduce recurrence for breast cancer survivors. Yet physical and psychological factors present barriers for initiating and maintaining an exercise routine. Research is limited in exploring factors of exercise motivation from the survivor's perspective. Design Qualitative design using focus groups and individual follow-up phone interviews to explore motivation for exercise initiation and maintenance. Methods One to two weeks after completing a triathlon, 11 breast cancer survivors who trained together participated in one of three focus groups to discuss their experience. Five months post triathlon 6 of the 11 participants were successfully contacted and phone interviews were conducted to explore exercise maintenance. Focus groups and interviews were analysed using content and thematic analysis. Results Five themes emerged (1) Champion for Exercise, (2) Part of a Team, (3) Everyone Had a Story, (4) Not Really Exercise and (5) What Do We Do Now? Overall, survivors recognised their need for lifestyle change (e.g. moving from a sedentary lifestyle to a more active one). More importantly, they identified the team approach to exercise initiation was crucial in their success in sustaining a behavioural change. Conclusions Emphasis needed on developing team exercise training programmes for survivors. Nurses can play a critical role in discussing with survivors, the benefits of exercise initiation and maintenance. Relevance to clinical practice Breast cancer survivors are hesitant to initiate routine exercise. Training with women who share a common lived experience increases the likelihood of success. Nurses are in a position to encourage breast cancer survivors to participate in group exercise programmes as a way to improve quality of life.

In extending the use of functional MRI to neuropharmacology, a primary area of concern is that peripheral blood pressure changes induced by pharmacological agents could independently produce a change in the blood oxygenation level-dependent (BOLD) signal, resulting in difficulties distinguishing or interpreting drug-induced neural activations. In the present study, we utilized intravenous dobutamine, a beta-adrenergic receptor agonist, to increase the mean arterial blood pressure (MABP), while examining the effects of MABP changes on the BOLD signal in cocaine-dependent participants. Dobutamine infusion significantly increased the MABP from 93 +/- 8 mm Hg to 106 +/- 12 mm Hg (P0.0005), but did not produce a significant global BOLD signal. Yet, a few voxels in the anterior cingulate showed BOLD signal changes that paralleled the changes in blood pressure (BP). Our observations support the conclusion that following the infusion of psychoactive agents, brain BOLD signals accurately reflect neuronal activity, even in the face of relatively large peripheral cardiovascular effects that transiently increase systemic BP.

Purpose: This study was completed to determine the current knowledge and documentation patterns of nursing staff in the prevention of pressure ulcers and to identify the prevalence of pressure ulcers. Methods: This pre-post intervention study was carried out in three phases. In phase I, 67 nursing staff members completed a modified version of Bostrom's Patient Skin integrity Survey. A Braden Scale score, the presence of actual skin breakdown, and the presence of nursing documentation were collected for each patient ( n = 43). Phase II consisted of a 20-minute educational session to all staff. In phase III, 51 nursing staff completed a second questionnaire similar to that completed in phase I. Patient data ( n = 49) were again collected using the same procedure as phase I. Results: Twenty-seven staff members completed questionnaires in both phase I and phase III of the study. No statistically significant differences were found in the knowledge of the staff before or after the educational session. The number of patients with a documented plan of care showed a statistically significant difference from phase I to phase III. The number of patients with pressure ulcers or at risk for pressure ulcer development (determined by a Braden Scale score of 16 or less) did not differ statistically from phase I to phase III. Conclusion: Knowledge about pressure ulcers in this sample of staff nurses was for the most part current and consistent with the recommendations in the Agency for Health Care Policy and Research guideline. Documentation of pressure ulcer prevention and treatment improved after the educational session. Although a significant change was noted in documentation, it is unclear whether it reflected an actual change in practice.

Coping difficulties of 113 adults 3 weeks after hospital discharge were identified using the Post-Discharge Coping Difficulty Scale and a brief focused telephone interview (11-item guide). Overall, low difficulty scores were reported ( M = 23.9, SD = 18.2, range = 0 to 100). Qualitative data reveal specific coping difficulties in the categories of stressors, specific difficulties, caring for self, managing the condition, family, advice needed, contact with the health care system, and what they wished they knew before discharge. A core theme of biographical reconstruction emerged.

e288 Background: Advancements in early detection and new treatment options have improved outcomes for breast cancer survivors (BCS). With increased survivorship, improving quality of life (QOL) may be a challenge for some women. Exercise improves QOL for BCS and decreases recurrence, but, despite this many women do not routinely exercise. Underserved areas are at particular risk. Few studies have examined factors influencing exercise initiation and maintenance in underserved areas among minority overweight women. The purpose of this mixed methods study was to examine physiological outcomes and motivational factors in a community-based goal oriented walking program for BCS. Methods: A convenience sample of female BCS was recruited from an inner-city community center 12-week walking program. Women participated in physiological testing and focus groups before and after the program. Data was collected regarding strength, fitness, quality of life, and motivation of the women. Quantitative data was analyzed with paired t-tests. Two researchers independently analyzed focus groups’ transcriptions and like statements and phrases were coded. Themes emerged after discussions between the researchers. Results: The 13 participants [overweight BMI (n = 2), and obese BMI (n = 11)] had a mean survivorship of 5.4 years (range .25-14.5) years. Only 7 participants completed both pre and post physiological testing. Functional endurance significantly improved as indicated by the 6 Minute Walk Test (pre = 503(56), post = 570 (63) meters, mean(sd)), p = 0.02). While overall QOL did not improve, functional well-being showed significant improvement. Two focus group sessions were held at the beginning (n = 13) and end (n = 11) of the program. Themes emerged identifying 1) Treatment Weight Gain, 2) Familial Support, 3) Not Wanting to Go it Alone, 4) The Team Made the Difference Conclusions: Female BCS spoke of interpersonal and environmental factors involved in the decision to engage and maintain exercise with the walking program. Further research is needed to examine exercise motivation in underserved, overweight and obese breast cancer survivors.

The purpose of the study was to assess the psychometrics properties of the Readiness for Hospital Discharge Scale (RHDS), a 23-item instrument that measures patients’ perception of readiness for discharge. Data were obtained from 356 respondents from two urban tertiary medical centers (adult and children’s) in the midwestern United States who were participants in a larger study of predictors and outcomes of readiness for hospital discharge. Confirmatory factor analysis, contrasted group comparisons, and predictive validity testing supported the 4-factor structure and construct validity of the instrument. Following deletion of two poorly performing items, Cronbach’s alpha for the revised 21item scale was 0.90. The RHDS can be a useful tool for measurement of readiness for discharge for clinical and research purposes.

Purpose : The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients’ perceptions of their readiness for hospital discharge. Design : A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. Setting : Midwestern tertiary medical center. Sample : 147 adult medical-surgical patients. Methods : Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services. Findings : Living alone, discharge teaching (amount of content received and nurses’ skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions. Conclusions : Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis’ transitions theory as a useful model for conceptualizing and investigating the discharge transition. Implications for Practice : The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes. With the contemporary focus on minimizing length of hospital stay, patients are discharged in an intermediate rather than complete stage of recovery.

There is an accumulating body of literature reporting that cognitive deficits, possibly long lasting, including lack of concentration, short-term memory loss and difficulties in multitasking are observed in patients receiving chemotherapy (CT) (“chemobrain”). We have used functional magnetic resonance imaging (fMRI) to determine the nature of the changes in brain function that underlie the cognitive deficits that can result from CT. This research was carried out prospectively in women being treated with adjuvant CT for early-stage breast cancer (BC). Methods: Seven healthy aged-matched control subjects (No CT) and six subjects with BC took part in this study undergoing functional fMRI scanning on a 3.0T scanner prior to initiating CT and after receiving their fourth cycle of anthracycline-based CT. Task activation (n-back) and resting-state functional connectivity (fC) scans were carried out. The N-back letter task is a continuous performance task having 3 levels of increasing cognitive load designed to probe regions of the brain activated by attention and working memory. Resting-state fC measures spontaneous low frequency oscillations in MR signal in brain and is used to create maps of fC among brain regions. Results: There were no significant differences in n-back task performance between the CT group and controls. However, significant differences (p≤0.05) in task activation and fC between the two subjects groups were observed. N-back task activation was significantly greater in the BC group compared with controls in right inferior frontal gyrus and right cerebellum. There were significant interactions between subject group and cognitive load within right inferior parietal and left inferior occipital cortex. The default mode network consists of interconnected regions of the brain that are active while the subjects are at rest and reduce activity when subjects perform specific tasks. Within this network, the BC group has significantly less deactivation during task compared to controls. There were also differences between the groups in resting-state fC. Using the left amygdala as a seed region, changes in fC were seen in the pre-chemo scans of the BC group compared to the controls. The BC subjects showed a 185% increase in intraregional fC and increased fC with the superior temporal gyrus, an area along with the amygdala that is activated by emotional stimuli. These changes in fC may be due to increased stress response in BC subjects. After four sessions of CT the BC group showed significant decreases in fC between the amygdala and the parahippocampal gyrus, an area involved in encoding and retrieving memories. This decrease in functional connectivity along with alterations in brain activation by cognitive tasks may play a part in the memory and other cognitive complaints associated with cancer and CT and may inform the search for strategies to reduce CT associated cognitive dysfunction. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2654. doi:1538-7445.AM2012-2654

The purpose of this article is to describe a study that implemented concept maps as a methodology to teach and evaluate critical thinking. Students in six senior clinical groups were taught to use concept maps. Students created three concept maps over the course of the semester. Date analysis demonstrated a group mean score of 40.38 on the first concept map and 135.55 on the final concept map, for a difference of 98.16. The paired t value comparing the first concept map to the final concept map was -5.69. The date indicated a statistically significant difference between the first and final maps. This difference is indicative of the students' increase in conceptual and critical thinking.