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Laura M. Hays

Bio: Laura M. Hays is an academic researcher from Regenstrief Institute. The author has contributed to research in topics: Health care & Randomized controlled trial. The author has an hindex of 3, co-authored 3 publications receiving 690 citations.

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Journal ArticleDOI
TL;DR: In this article, the authors evaluated the effect of a patient, health care provider, and systems intervention on the prevalence of risk factors for lower extremity amputation in patients with non-insulin-dependent diabetes.
Abstract: OBJECTIVE To evaluate the effect of a patient, health care provider, and systems intervention on the prevalence of risk factors for lower extremity amputation in patients with non-insulin-dependent diabetes. DESIGN Blinded, randomized, controlled trial. SETTING Academic general medicine practice. PARTICIPANTS Of the 395 patients with non-insulin-dependent diabetes who underwent the initial patient assessment, 352 completed the study. INTERVENTION The 12-month intervention was multifaceted. Patients received foot-care education and entered into a behavioral contract for desired self-foot care, which was reinforced through telephone and postcard reminders. Health care providers were given practice guidelines and informational flow sheets on foot-related risk factors for amputation in diabetic patients. In addition, the folders for intervention patients had special identifiers that prompted health care providers to: 1) ask that patients remove their footwear, 2) perform foot examinations, and 3) provide foot-care education. RESULTS Patients receiving the intervention were less likely than control patients to have serious foot lesions (baseline prevalence, 2.9%; odds ratio, 0.41 [95% CI, 0.16 to 1.00]; P = 0.05) and other dermatologic abnormalities. Also, they were more likely to report appropriate self-foot-care behaviors, to have foot examinations during office visits (68% compared with 28%; P < 0.001), and to receive foot-care education from health care providers (42% compared with 18%; P < 0.001). Physicians assigned to intervention patients were more likely than physicians assigned to control patients to examine patients' feet for ulcers, pulses, and abnormal dermatologic conditions and to refer patients to the podiatry clinic (10.6% compared with 5.0%; P = 0.04). CONCLUSIONS An intervention designed to reduce risk factors for lower extremity amputations positively affected patient self-foot-care behavior as well as the foot care given by health care providers and reduced the prevalence of lower extremity clinical disease in patients with diabetes.

428 citations

Journal ArticleDOI
TL;DR: Assessing physical activity behavior and its correlates in older adults with type 2 diabetes found the low prevalence of physical activity found in this and other studies should raise concerns among clinicians.
Abstract: OBJECTIVE: Physical activity is integral to the management of type 2 diabetes. Unfortunately, the majority of adults with type 2 diabetes do not regularly engage in physical activity. The purpose of this study was to assess physical activity behavior and its correlates (i.e., physical activity knowledge, barriers, and performance and outcome expectations) in older adults with type 2 diabetes. RESEARCH DESIGN AND METHODS: A subgroup of 260 adults with type 2 diabetes was identified from a larger stratified random sample of adults aged > or = 55 years. Participants completed an interviewer-administered survey designed from focus group findings and social learning theory. RESULTS: The majority of the respondents (54.6%) reported 0 min of weekly physical activity. This was especially true of older female respondents. Performance expectation scores were lower among respondents who were in the oldest age-group, namely, white women. Physical activity knowledge varied by age-group, and barriers to physical activity were prevalent in all groups. The following are significant correlates of reported weekly physical activity: younger age, more education, fewer motivational barriers, and greater perceived health and performance expectations. CONCLUSIONS: Given the importance of physical activity to diabetes management, the low prevalence of physical activity found in this and other studies should raise concerns among clinicians. Future research to identify predictors of physical activity is needed to guide clinicians in the promotion of physical activity.

168 citations

Journal Article
TL;DR: The intervention in this study was designed to reduce the prevalence of risk factors for lower extremity amputations in patients with noninsulin-dependent diabetes and involved the three major elements of a prevention program: the patient, health care providers, and the health care system.
Abstract: Objective: To evaluate the effect of a patient, healthcare provider, and systems intervention on the prevalence of risk factors for lower extremity amputation in patients with non–insulin-dependent...

104 citations


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Journal ArticleDOI
12 Jan 2005-JAMA
TL;DR: Substantial evidence supports screening all patients with diabetes to identify those at risk for foot ulceration and recommending certain prophylactic interventions, including patient education, prescription footwear, intensive podiatric care, and evaluation for surgical interventions.
Abstract: ContextAmong persons diagnosed as having diabetes mellitus, the prevalence of foot ulcers is 4% to 10%, the annual population-based incidence is 1.0% to 4.1%, and the lifetime incidence may be as high as 25%. These ulcers frequently become infected, cause great morbidity, engender considerable financial costs, and are the usual first step to lower extremity amputation.ObjectiveTo systematically review the evidence on the efficacy of methods advocated for preventing diabetic foot ulcers in the primary care setting.Data Sources, Study Selection, and Data ExtractionThe EBSCO, MEDLINE, and the National Guideline Clearinghouse databases were searched for articles published between January 1980 and April 2004 using database-specific keywords. Bibliographies of retrieved articles were also searched, along with the Cochrane Library and relevant Web sites. We reviewed the retrieved literature for pertinent information, paying particular attention to prospective cohort studies and randomized clinical trials.Data SynthesisPrevention of diabetic foot ulcers begins with screening for loss of protective sensation, which is best accomplished in the primary care setting with a brief history and the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy with biothesiometry, measure plantar foot pressure, and assess lower extremity vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, enable clinicians to stratify patients based on risk and to determine the type of intervention. Educating patients about proper foot care and periodic foot examinations are effective interventions to prevent ulceration. Other possibly effective clinical interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, debridement of calluses, and certain types of prophylactic foot surgery. The value of various types of prescription footwear for ulcer prevention is not clear.ConclusionsSubstantial evidence supports screening all patients with diabetes to identify those at risk for foot ulceration. These patients might benefit from certain prophylactic interventions, including patient education, prescription footwear, intensive podiatric care, and evaluation for surgical interventions.

2,469 citations

Journal ArticleDOI
TL;DR: An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status.
Abstract: Objectives.This study evaluated the effectiveness (changes in health behaviors, health status, and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of

2,249 citations

Journal ArticleDOI
TL;DR: The revised version of the Summary of Diabetes Self-Care Activities (SDSCA) measure is presented, and the inclusion of this measure in studies of diabetes self-management is recommended when appropriate.
Abstract: OBJECTIVE: To review reliability, validity, and normative data from 7 different studies, involving a total of 1,988 people with diabetes, and provide a revised version of the Summary of Diabetes Self-Care Activities (SDSCA) measure. RESEARCH DESIGN AND METHODS: The SDSCA measure is a brief self-report questionnaire of diabetes self-management that includes items assessing the following aspects of the diabetes regimen: general diet, specific diet, exercise, blood-glucose testing, foot care, and smoking. Normative data (means and SD), inter-item and test-retest reliability, correlations between the SDSCA subscales and a range of criterion measures, and sensitivity to change scores are presented for the 7 different studies (5 randomized interventions and 2 observational studies). RESULTS: Participants were typically older patients, having type 2 diabetes for a number of years, with a slight preponderance of women. The average inter-item correlations within scales were high (mean = 0.47), with the exception of specific diet; test-retest correlations were moderate (mean = 0.40). Correlations with other measures of diet and exercise generally supported the validity of the SDSCA subscales (mean = 0.23). CONCLUSIONS: There are numerous benefits from standardization of measures across studies. The SDSCA questionnaire is a brief yet reliable and valid self-report measure of diabetes self-management that is useful both for research and practice. The revised version and its scoring are presented, and the inclusion of this measure in studies of diabetes self-management is recommended when appropriate.

2,105 citations

Journal ArticleDOI
TL;DR: Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term, and further research is needed to assess the effectiveness on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.
Abstract: OBJECTIVE —To systematically review the effectiveness of self-management training in type 2 diabetes. RESEARCH DESIGN AND METHODS —MEDLINE, Educational Resources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization. RESULTS —A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up ( CONCLUSIONS —Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.

1,886 citations

Journal Article
TL;DR: Cardiovascular Disease in Dialysis Patients Tables: An Overview of Epidemiology of Cardiovascular disease in Children and Work Group Members and Foreword.

1,258 citations