Browsing by Subject "Outcomes"

Now showing 1 - 3 of 3
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    Analysis Of The Relationship Between Psychosocial Factors And Self-Efficacy On Self-Management Behaviors In Adult Patients With Type 2 Diabetes
    (2013-11) McClernon, Susan
    Objectives Only 20% of patients with type 2 diabetes implement recommended self-management behaviors (DAWN study) (Funnell, 2006). In this research, psychosocial factors significantly influenced self-management behaviors and A1c, having more influence than SES factors. The integrated conceptual model illuminated complex relationships between psychosocial factors, self-management(SM) and A1c levels. It posited self-efficacy (SE) as mediator between self-management and other psychosocial factors. Method This study explored direct and indirect relationships between diabetes social support (DSS), knowledge, affect, self-efficacy and dependent variables including diet, exercise, competency in adult patients with type 2 diabetes with suboptimal glycemic control (A1c <&ge> 7%) using cross sectional data from the IDEA study using structural equation modeling. Results The conceptual model fit test statistics are <&chi>;a1c2= 379 (df = 112; n=564, <&rho>-value = 000). The RSMEA estimate was .043 (.037 - .051 CI), SRMR was .045, and GFI was .94. The direct effects for knowledge (<&beta> = .647, <&rho> value ≤ .001) influenced SE and SE indirectly influenced A1c (<&beta> = .253, <&rho> value ≤ .001). DSS directly influenced knowledge (<&beta> = .579, <&rho> value ≤ .001) and SE (<&beta> range = .482, <&rho> value ≤ .001). Affect directly influenced knowledge (<&beta> range = .296, <&rho> value ≤ .05) and indirectly influenced SE (<&beta> = .192, <&rho> value ≤ .05). A second hypothesis found SE mediated SM and A1c only for knowledge, not for DSS or affect. DSS, knowledge, and affect indirectly influenced SM behaviors and A1c significantly (affect only for exercise and A1c). Knowledge was a mediator for DSS to SE. Conclusions The theoretically integrated conceptual model has merit. Affect and DSS (mediates) are directly influencing knowledge, with is significantly linked with SE. SE mediates SM and A1c. This new knowledge of relationships between psychosocial factors may assist caregivers in better engaging their patients with diabetes in improving SM behaviors and outcomes.
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    Does patient rurality predict quality colon cancer care? a population based study
    (2013-06) Chow, Christopher J.
    Introduction: Over fifty million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized. We hypothesize that patient rurality impacts colon cancer care quality measures. Methods:Using the 1996-2008 California Cancer Registry, we identified 123,129 patients with stage 0-IV colon cancer. Baseline characteristics were compared by rurality status. Controlling for covariates, multivariate regression models were used to examine the impact of rurality on stage, adequate lymphadenectomy and receipt of chemotherapy. Cox proportional hazards was used to examine cancer specific survival. Results: Of our cohort, 18,735 (15%) resided in rural areas. Rural residence was associated with white or American Indian race. Controlling for covariates, our multivariate models demonstrate that rurality was associated with later stage of diagnosis, inadequate lymphadenectomy and inadequate receipt of chemotherapy. In addition, rurality was associated with worse cancer specific survival. Conclusions: A significant proportion of patients treated for colon cancer live in rural areas. Yet, rural residence is associated with later stage, poor adherence to quality measures and poorer survival. Future quality improvement measures should target rural patients to ensure both that structure of care is optimal and that appropriate processes of care are followed.
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    Pregnancy Outcomes After Myomectomy In Infertile Women With Fibroids: A Systematic Review Of The Literature
    (2017-08) Okeke, Esther
    ABSTRACT Objectives: To analyze the impact of abdominal myomectomy on pregnancy outcomes of infertile women with fibroids, and to conduct a comparative effectiveness study of abdominal and laparoscopic myomectomy. Study design: A systematic review of all relevant literature in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 2015 respectively. English language restriction was applied to searches. Results: Out of 352 articles identified by literature search, and subsequently reviewed, six articles met the study inclusion criteria, three case series on effectiveness studies and three studies (one RCT, one cohort, one case series) on comparativeness effectiveness studies. There was a very low quality of strength of evidence for effectiveness studies though they support the hypothesis that pregnancy outcomes are improved after abdominal myomectomy. Furthermore, the comparative effectiveness studies showed no statistical significant difference in pregnancy outcomes. Conclusion: There is need for further research to be conducted.