bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Content Validation of the Health Care Transition Outcomes Inventory
Authors: PIERCE JESSICA , WYSOCKI TIM , GANNON ANTHONY 
Published: June 2018

Background: Much of the literature on the healthcare transition from pediatric to adult centered-care focuses on how to prepare adolescents and young adults with chronic illness for a successful healthcare transition, with much less emphasis on how to measure whether the healthcare transition was successful. Research on healthcare transition outcomes is fraught with methodological difficulties, making it difficult to generalize and compare findings across studies. To address these gaps, we began an integrative research agenda to develop a multidimensional, multi-informant (i.e., young adult, parent, and healthcare provider versions) measure of healthcare transition outcomes, the Healthcare Transition Outcomes Inventory (HCTOI). Our preliminary qualitative study defined six content domains for the measure. The current study describes the development and refinement of the HCTOI item pool.
Results: Using rigorous measurement development methods including mixed qualitative and quantitative methods, the researchers developed a pool of 88 items evaluating the extent to which a young adult with T1D is successful on each of the six domains of healthcare transition outcomes. Ten physician and psychologist experts provided content validity ratings and feedback and the item pool was reduced and refined to 69 items. Cognitive interviews were then conducted on every item with end users (young adults, parents, and healthcare providers) and the item pool was further reduced to 54-item young adult- and parent-versions and a 47-item healthcare provider version.
Conclusions: Each stage informed development and refinement of the item pool. The HCTOI represents the first multi-informant, rigorously developed item pool that comprehensively measures the multiple components of the transition from pediatric to adult specialty healthcare. Discussion includes clinical implications and next steps for validation, item reduction and refinement.

Disclosure
J. Pierce: None. T. Wysocki: None. A. Gannon: None.
The Influence of Outpatients’ Wait Times and Health Care Professionals’ Communication Behaviors on Treatment Satisfaction and the Intention to Drop Out
Authors: SATO SHIORI , TOSAKI TAKAHIRO , OSHIRO CHIE , KUDARA AYAE , INAGAKI AKEMI , KONDO MASAKI , TSUNEKAWA SHIN , KATO YOSHIRO , KAMIYA HIDEKI , NAKAMURA JIRO 
Published: June 2018

We studied influences of perceptions of patients’ wait times and communication behaviors of healthcare professionals on treatment satisfaction and the intention to drop out in diabetes outpatients. A questionnaire was sent to 888 outpatients with diabetes or impaired glucose tolerance who visited our clinic in April 2016. We also measured time spent in clinics. Totally, 759 patients responded to the questionnaire; 717 valid responses were obtained for statistical analyses. In the group with the intention to drop out,” many replied that they felt that “the wait time from physical examination to accounting” was long; this association was significant (P = 0.009, χ2 test). Time spent in clinics was also significantly associated with the “perception of wait time (total).” Communication behaviors of healthcare professionals were also significantly associated with the presence of the intention to drop out. Median scores of the first factor of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) were lower in those who intended to drop out than in those who did not (52 vs. 632 patients); the DTSQ first factor score was significantly associated with the presence of intention to drop out (P &lt; 0.001, Mann-Whitney U test). Receiver operating characteristic curve analysis revealed the DTSQ score as a significant predictor of the presence of intention to drop out (area under the curve = 0.746, P &lt; 0.001), with an optimal cut-off of 22.5 (sensitivity 70.6%, specificity 67.3%). The findings of this study suggest that improved treatment satisfaction may reduce incidences of drop out. Thus, improved wait times and better communication behavior from healthcare professions may improve patient satisfaction and reduce the intention to drop out and possibly the dropout rate.

Disclosure
S. Sato: None. T. Tosaki: Other Relationship; Self; Eli Lilly and Company, Takeda Development Center Asia, Pte. Ltd., MSD K.K., Mitsubishi Tanabe Pharma Corporation. C. Oshiro: None. A. Kudara: None. A. Inagaki: None. M. Kondo: None. S. Tsunekawa: None. Y. Kato: Speaker's Bureau; Self; Merck Sharp & Dohme Corp., Sanofi, Takeda Pharmaceutical Company, Eli Lilly Japan. H. Kamiya: Other Relationship; Self; MSD K.K., Ono Pharmaceutical Co., Ltd., Sanofi K.K., AstraZeneca, Astellas Pharma KK, Eli Lilly and Company, Novartis Pharma K.K., Dainippon Sumitomo Pharma Co., Ltd, Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Co., Ltd, Ono Pharmaceutical Co., Ltd. J. Nakamura: Other Relationship; Self; Astellas Pharma US, Inc., AstraZeneca, Ono Pharmaceutical Co., Ltd., MSD K.K., Kyowa Hakko Kirin Co., Ltd., Kowa Pharmaceuticals America, Inc., Sanofi K.K., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Mitsubishi Tanabe Pharma Corporation, Eli Lilly and Company, Novartis Pharma K.K., Pfizer Inc..
Diabetes Self-Management Education (DSME) and Diabetes Preventive Care Practices among People With and Without Vision Impairment
Authors: SEKAR SWATHI , GERZOFF ROBERT B. , SAADDINE JINAN B. , SAUNDERS MAGON M. 
Published: June 2018

Objective: To examine whether participating in Diabetes Self-Management Education (DSME) was associated with increased diabetes preventive care practices among those with and without self-reported vision impairment (VI).
Background: Over 30 million people in the United States have diagnosed diabetes. DSME is a vital component of care, facilitating the knowledge and skills needed to improve self-care for diabetes. Those with VI are more likely to have diabetes than those without, highlighting a need to examine DSME participation and preventive care practices among those with and without VI.
Methods: We used data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a large ongoing landline and cellular telephone based survey. The question “Have you ever taken a course or class in how to manage your diabetes yourself?” was asked in 37 states plus the District of Columbia and Guam. In a logistic regression, we examined if the association between DSME and 9 preventive care practices was significantly modified by VI status.
Results: Regardless of VI status, respondents with diabetes who participated in DSME had a greater predicted probability of engaging in each preventive care practice than those who did not. Compared to respondents with VI who did not participate in DSME, those with VI who participated in DSME had a significantly greater predicted probability of having administered a daily glucose check (83.7% vs. 59.3%) and having had an annual visit to a health care professional for their diabetes (95.3% vs. 82.1%).
Conclusions: Participants with VI who received DSME have increased predicted probability of engaging in certain self-care practices compared to those with VI who did not receive DSME. This highlights the importance of people with diabetes and VI acquiring the appropriate tools to positively affect their own health.

Disclosure
S. Sekar: None. R.B. Gerzoff: None. J.B. Saaddine: None. M.M. Saunders: None.
Effects on Insulin Sensitivity, but Not on Mitochondrial Function Are Dependent on Insulin Resistance Status after High Intensity Interval Training
Authors: APOSTOLOPOULOU MARIA , PESTA DOMINIK , KARUSHEVA YANISLAVA , GANCHEVA SOFIYA , JELENIK TOMAS , BIERWAGEN ALESSANDRA , MÜSSIG KARSTEN , SZENDROEDI JULIA , RODEN MICHAEL 
Published: June 2018

High intensity interval training (HIIT) is a time-efficient training approach to stimulate biogenesis in healthy populations. We hypothesized that HIIT would increase skeletal muscle insulin sensitivity due to improved muscle mitochondrial function in type 2 diabetes (T2D) patients and age- and BMI-matched controls (CON). We examined 18 sedentary male patients with T2D and 23 healthy male CON (age: 58±5 vs. 57±4 years, BMI: 31.4±2.4 vs. 30.4±2.3 kg.m-2) that were enrolled in a 12-week HIIT cycling protocol. CON were further grouped in insulin-sensitive (IS) and -resistant (IR) (baseline M in mg.kg-1.min-1; 7.4 ± 1.3 vs. 4.2 ± 1.1, p&lt;0.001). Two-step hyperinsulinemic-euglycemic clamps, skeletal muscle biopsies for high resolution respirometry and magnetic resonance spectroscopy for liver fat quantification were performed. After 12 weeks of HIIT, T2D and IR CON increased their insulin sensitivity (3.9±1.9 vs. baseline: 2.7±1.6, p=0.02 and 5.5±2.1 vs. 4.2 ± 1.1, p=0.03, respectively), which returned to baseline after detraining. T2D and IR CON increased suppression of endogenous glucose production (EGP) during the high-insulin clamp (T2D: 91 ± 14% vs. baseline: 76 ± 11%, p=0.003 and IR CON: 107 ± 13% vs. 94 ± 14%, p=0.04). IR CON also increased suppression of lipolysis during the low-insulin clamp (82 ± 9 vs. 84 ± 8%, p=0.04). In T2D liver fat was decreased by 17% and remained decreased after detraining. Liver fat content remained unchanged by HIIT training in both CON groups. Muscle maximal uncoupled respiration increased in T2D and CON by 44% and 48%, respectively, at 12 weeks and remained increased after detraining in all groups (p&lt;0.01). We conclude that at the same level of insulin resistance HIIT training improved hepatic and peripheral insulin sensitivity in patients with T2D and insulin resistant controls whereas changes in mitochondrial function occurred irrespective of insulin resistance status.

Disclosure
M. Apostolopoulou: None. D. Pesta: None. Y. Karusheva: None. S. Gancheva: None. T. Jelenik: None. A. Bierwagen: None. K. M ssig: None. J. Szendroedi: None. M. Roden: Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH. Consultant; Self; Poxel SA. Research Support; Self; Danone Nutricia Early Life Nutrition, GlaxoSmithKline plc., Nutricia Advanced Medical Nutrition, Sanofi.
Free Weight-Loss Apps and Diabetes Management for the Patient
Authors: WU GLORIA , BILLARD LAURA , NGO VY-VY , DOAN AMY , MURO ELENA , LE BRYAN 
Published: June 2018

Weight loss and obesity are concerns shared by diabetic patients and the lay public. These search terms, "weight loss," "obesity," generate 72M and 30M webpages, respectively. "Diabetes" as a search term generates 104M webpages. According to Google Trends, "weight loss," " diabetes" terms are searched 7x more than "obesity." In 2016, there were 59,000 medical health apps. It is expected that at the end of 2017, apps will reach $26 billion in revenue. Are these apps useful to our diabetic patients?
Purpose: To evaluate free weight loss droid apps in terms of the Diabetes Self-management Education and Support Guidelines.
Methods: Using Google Play to find the most droid downloads in free weight loss apps in 2017. Droid apps downloads are documented by Google Play whereas iPhone apps' downloads are not available to the public. We included only those apps that emphasized weight loss. We excluded those apps with malfunctioning web on a daily basis.
Results: The majority of the apps have calorie counting. However, 4/10 are lacking in basic information about BMI; only half of the apps have a med log/diary. None include psychological moods.
Conclusions: Weight loss mobile phone app are commonly used by the general public not only diabetic patients. Most do not track fasting blood glucose, lipids and blood pressure. There is room for improvement for this growing field of health apps and diabetes.

Disclosure
G. Wu: None. L. Billard: None. V. Ngo: None. A. Doan: None. E. Muro: None. B. Le: None.
Introduction of a Web-Based Computerized Personal Diabetes Educational System
Authors: CHEN KWANG-WEN , CHUANG YUH-JUE , LIU CHAO KUN , CHIU YU-YEN , LIN HAN-YI 
Published: June 2018

We establish a computerized diabetes educational system which may provide a personal educational advice come after a prior questionnaire. The questionnaire and educational advice were formed by a team of a physician, a dietitian, 3 nurses, and 3 information technology (IT) personnel. The questionnaire comprises the basic data of age, weight, height, and the level of blood pressure, lipid profile, and also the status of retinaopthy, nephropathy, and neuropathy. Our IT personnel design the programmatic link bewteen the result of questionnaire and educational advice on website, which using open source software, including Apache software, with Hypertext Preprocesssor (PHP) and MySQL database server. The precision and fluency of the advice was modified after repeated discussion on multiple clinical conditions. The final version was first applied on 14 patients (10 men, 4 women), the mean age is 51.6± 11.0 years (from 30 to 71 years). Furthermore, a satisfaction survey was performed and showed this system is helpful, feasible, and satisfied to them, also learning motivation was raised.
Conclusion: We developed a web-base computerized diabetic educational system which may provide individualized education, and the system is helpful and feasible to people with diabetes.

Disclosure
K. Chen: None. Y. Chuang: None. C. Liu: None. Y. Chiu: None. H. Lin: None.
The Efficacy of Registered Dietitian Interventions in Type 2 Diabetes Management in a Family Practice Clinic in North Alabama
Authors: CHESTER BRITTANNIE H. , STANLEY WAYNE G. , THANGIAH GEETHA 
Published: June 2018

Background: Diabetes self-management education and support (DSMES) and medical nutrition therapy (MNT) have been proven to improve patient outcomes. However, many patients rely on their physician solely for diabetes education despite referrals for diabetes education outside of the physician’s office.
Objective: Our aim was to optimize type 2 diabetes management in a family practice clinic by providing patients with individualized DSMES and MNT by a Registered Dietitian inside of the family practice clinic.
Methods: A random sample of 40 charts was chosen from the electronic medical records of patients with type 2 diabetes completing DSMES and individualized MNT with a Registered Dietitian. Data was extracted from a retrospective chart review on hemoglobin A1C levels before and after appointments with the Registered Dietitian in the family practice clinic from September 2015-November 2015. Analyses were used to assess frequency of patients decreasing their hemoglobin A1C levels, which reveals good glycemic control.
Results: A paired sample t test was performed (n=40). The results revealed that post DSMES and MNT Hemoglobin A1C values (M = 6.84%, SD ± 1.0) were significantly lower than the pre DSMES and MNT Hemoglobin A1C values (M = 7.17%, SD ± 1.3), t (40) = 2.89, p &lt; 006.
Conclusions: Many healthcare professionals can give dietary advice to patients, but Registered Dietitians are trained to provide individualized nutrition therapy to patients. Combining the knowledge of the physician and registered dietitian can help patients to reach optimal diabetes control in order to prevent or minimize complications. Research has demonstrated a 1% decrease in Hemoglobin A1C levels result in a 21% reduction in diabetes associated mortality, a 14% reduction in myocardial infarction, and a 37% reduction in microvascular complications.

Disclosure
B.H. Chester: Employee; Self; Huntsville Hospital Diabetes Control Center, Wayne G. Stanley, MD, PC, Boston Heart Diagnostics. W.G. Stanley: Other Relationship; Self; Wayne G. Stanley, MD, PC. G. Thangiah: None.
Implementation and Evaluation of Gestational Diabetes Management Using Mobile Health Care Service—A Pilot Study
Authors: LEE MINKYUNG , PARK CHEOL-YOUNG , PARK SUNG-WOO , LEE DA YOUNG , SUNG JI-HEE 
Published: June 2018

Background: Gestational diabetes mellitus (GDM) affects approximately 7% of all pregnancies and is associated with increased risk for the development of diabetes. It is important to recognize and treat GDM to minimize the risk of complications to mother and baby. Multifaceted professional interventions are more effective and mobile healthcare can be one of the good approaches. In this study, we aimed to develop and evaluate the model for prevention and management of GDM using mobile healthcare.
Methods: A total of 21 subjects with no previous history of diabetes, who were diagnosed with GDM during 24-28 weeks of gestation were randomly divided into conventional management group (CM group, n=10) and mobile management group (MM group, n=11). CM group received conventional GDM management and could use mobile application about healthcare freely. MM group received mobile healthcare service including tailored mobile coaching.
Results: Baseline characteristics including HbA1C were not significantly different between the two groups. There were no statistically significant differences in maternal laboratory findings, fetal status and cesarean section rate between the two groups at the time of delivery. Both groups were satisfied with the gestational diabetes management service. Four patients (CM group, n=2 and MM group, n=2) were diagnosed with diabetes by oral glucose tolerance test that followed 4 to 12 weeks after delivery and there was no significant difference in glycated hemoglobin between the two groups. However, postpartum weight and body fat were significantly lower in the MM group.
Conclusions: Mobile healthcare service in patients with GDM showed no significant difference in GDM self-management compared to the conventional management. In addition, it resulted in a significant reduction in maternal weight gain after delivery. Our study showed that mobile healthcare service could be an efficient GDM management tool.

Disclosure
M. Lee: None. C. Park: None. S. Park: None. D. Lee: None. J. Sung: None.
Medical Student Knowledge of Current Recommendations for Glucose Screening and Obesity-Related Risk Assessment in Children
Authors: GUSEMAN EMILY H. , WHIPPS JONATHON , JENSEN LAURA L. , BEVERLY ELIZABETH A. 
Published: June 2018

Surveillance data regarding diabetes rates among Appalachian youth are limited. Risk factors for type 2 diabetes among children include obesity, food insecurity, physical inactivity, and familial history. Child obesity runs especially high in Appalachian Ohio, where at least 22% of third graders are obese, compared to 14.3% in suburban counties. In addition to this, one in four children in Appalachian Ohio live below the federal poverty level and many can be expected to have parents with type 2 diabetes, given the high prevalence among adults in the region. Therefore, medical students must be knowledgeable about screening recommendations. We distributed a modified version of the National Cancer Institute’s Physician Survey of Practice on Diet, Physical Activity, and Weight Control: Questionnaires on Child/Adolescent Care to osteopathic medical students at one university. Descriptive and frequency analyses were used to analyze students’ knowledge and attitudes related to childhood obesity and diabetes. Participants in this study were 238 first- through fourth-year medical students (62% pre-clinical, 38% in clinical rotations) Time spent working directly with pediatric patients in a clinical setting differed between pre-clinical and clinical students (21.4 ± 62.0 h vs. 129.7 ± 195.8 h, p&lt;0.001 respectively). Most students (74%) indicated being unfamiliar with obesity screening recommendations. Few correctly identified BMI percentile cut-points for child overweight (21.2%), obesity (23.7%), and normal weight (29.4%). Students indicated they would initiate glucose screening approximately 4.5 years earlier in overweight/obese patients with risk factors than those with perceived lower risk (p&lt;0.001). Although students recognize the need for earlier diabetes screening in children with additional risk factors and/or family history, there is a need to emphasize systematic approaches to diabetes risk reduction in medical school.

Disclosure
E.H. Guseman: None. J. Whipps: None. L.L. Jensen: None. E.A. Beverly: None.
Narrative Medicine in Diabetes—A Randomized Trial
Authors: ROSÁRIO FRANCISCO , CORREIA ISABEL , OLIVEIRA JORGE , RAPOSO JOAO 
Published: June 2018

Background and Aims: Group dynamics in diabetes have positive outcomes. This study attempts to determine if a group dynamic using narrative and reading is non-inferior to a conventional group approach.
Material and Methods: We studied 49 patients (32 - intervention, 17 - control) with type 2 diabetes, were randomized to two different Group Care dynamics. “Control group” - Classical structured educational approach of six monthly sessions. “Intervention group” - Close reading and creative writing using literary narratives. They were evaluated before the first session and after the third and the sixth, including weight, A1c and satisfaction questionnaire (GSS). A1c in the six previous years were collected from clinical records. The statistical procedures were based on ANOVA and Pearson bivariate correlations.
Results: The entire sample had an initial BMI of 29,1 (SD- 4,67) and A1c of 7,51% (SD- 1,13). There were 7 drop-outs, (5 intervention; 2 control). 5 other patients didn’t finished the evaluations by medical reasons. Both groups showed a reduction of A1c between the first and the last session (intervention group initial A1c 7,55% (SD-1,13); last A1c 6,83% (SD - 0,94) p&lt;0,001; control group initial A1c 7,44% (SD- 1,11); last A1 7,21% (SD - 1,48) p&lt;0,001. Regarding patients previous records, a decrease of A1c levels was observed in the trial (p&lt;0,05). A significant increase (p&lt;0,05) in satisfaction with therapist and with group process was observed.
Conclusions: This is the first randomized trial evaluating a Group Care intervention to manage type 2 diabetes using narrative skills. A significant reduction of A1c in the intervention group showed non-inferiority in relation to the classical approach. A significant decrease in A1c was observed in relation with the A1c levels of the previous six years. A significant increase in satisfaction with therapist and with group process was observed. This may be a useful model for patients with several years of formal education, and may constitute an alternative for the long term educational process.

Disclosure
F. Rosário: None. I. Correia: None. J. Oliveira: None. J. Raposo: Advisory Panel; Self; Boehringer Ingelheim GmbH, Sanofi, Novo Nordisk A/S, Eli Lilly and Company, AstraZeneca.