¹⁸FDG-PET/CT Is a Useful Tool in Staging Procedure before Chemo-Radiotherapy in Patients with Limited Disease Small-Cell Lung Cancer. Pattern of Failure and Survival Is Analyzed

Background: The purpose of this study was to evaluate the use of 18FDG-PET/CT in staging procedure, the pattern of failure and survival in patients with small-cell lung cancer limited disease (LD-SCLC) undergoing chemo-radiotherapy. Methods: A total of 79 LD-SCLC patients were treated with a combination of chemotherapy and chest radiotherapy. Radiotherapy of the tumour and the pathological lymph nodes was performed either as 45 Gy twice-daily or 46 - 50 Gy once-daily. 18Fluro-2-deoxy-D-glucose (18FDG)-PET/CT was performed in 35 patients as part of the staging procedure. Results: With a median follow-up time of 17 months 6% developed isolated loco-regional failures while 57% developed distant metastases. No isolated regional failures were seen. Median overall survival was 22 months. Patients staged with a 18FDG-PET/CT had a significantly lower incidence of distant failures and a significantly improved overall survival compared with patients only staged with a CT scan (p = 0.03) (median overall survival of 34 versus 17 months, respectively). Conclusion: The pattern of failure showed a high risk of distant metastases but a low incidence of isolated loco-regional failures. Patients staged with an 18FDG-PET/CT had a significantly lower incidence of distant failures and better overall survival, indicating that 18FDG-PET could be beneficial in patients with LD-SCLC before deciding on treatment regimen.

A Recursive Algorithm for Offspring's Genotype Frequency of Selfing Population on Multiple Alleles with Limited Loci

This paper studies the offspring＇s genotype frequency of the selfing population on multiple alleles with limited loci.A recursive algorithm is given for it.It is discovered that the genotype frequency of homozygous gene of limited loci increases by generations.Relative increment reduces by generations and the genotype frequency tends to a definite value finally.The genotype frequency of limited loci with hybrid gene tends to 0 finally.But it is possibility that the genotype frequency increases in previous generations then reduces later.It is found that the number of the hybrid gene are more,the speeds tending to 0 are quicker.

Soluble ST2:A Novel Biomarker for Diagnosis and Prognosis of Cardiovascular Disease

The increasing incidence of cardiovascular disease(CVD)is a significant global health concern,affecting millions of individuals each year.Accurate diagnosis of acute CVD poses a formidable challenge,as misdiagnosis can significantly decrease patient survival rates.Traditional biomarkers have played a vital role in the diagnosis and prognosis of CVDs,but they can be influenced by various factors,such as age,sex,and renal function.Soluble ST2(sST2)is a novel biomarker that is closely associated with different CVDs.Its low reference change value makes it suitable for continuous measurement,unaffected by age,kidney function,and other confounding factors,facilitating risk stratification of CVDs.Furthermore,the combination of sST2 with other biomarkers can enhance diagnostic accuracy and prognostic value.This review aims to provide a comprehensive overview of sST2,focusing on its diagnostic and prognostic value as a myocardial marker for different types of CVDs and discussing the current limitations of sST2.

Metabolic dysfunction-associated steatotic liver disease:The question of long-term high-normal alanine aminotransferase as a screening test

The growing prevalence of metabolic dysfunction-associated steatotic liver disease(MASLD)is being driven by the obesity epidemic.The quest for solutions continues particularly with regard to early detection.This editorial comments on the utility of long-term high-normal alanine aminotransferase(ALT)in screening for MASLD.Chen et al found that new onset MASLD can be detected by repetitively high normal ALT.Implicit in this concept is the question of what should be the accepted upper limit of normal(ULN)for ALT.It was previously set at 40 IU/L based on studies that included people with subclinical liver disease but the new consensus is 30/19 U/L in healthy males/females.Thus,when Chen et al defines the ULN as 40 U/L,others may view it as excessively high.It is important to recognize the variables affecting ULN e.g.instrumentation,diurnal variations,exercise and ageing.These variables matter when the distinctions are subtle e.g.normal vs high-normal.In this regard,the utility of long-term high normal ALT as a disease marker could be enhanced by combining it with other biomarkers,imaging and MASLD genetics to create machine learning classifiers.All in all,Chen et al’s work on long-term high normal ALT as a marker of new-onset MASLD deserves merit.

Impact of chronic disease self-management programs on type 2 diabetes management in primary care

AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.

Dynamic analysis of lymphocyte subsets of peripheral blood in patients with acute self-limited hepatitis B

Purpose: To investigate dynamic changes and significance of lymphocyte subsets (T lymphocytes, B lymphocytes, NK cells and T cell subsets) of peripheral blood in patients with acute self-limited hepatitis B (AHB). Methods: Immune cells of peripheral blood were compared among 17 cases of self-limited acute hepatitis B patients, 36 patients with chronic hepatitis B (CHB) and 32 healthy controls by flow cytometry (FCM). CD4+/CD8+ was monitored dynamically, meanwhile relations between T lymphocyte subsets and ALT and clearance of HBV DNA were explored. Results: Dynamic changes of lymphocyte subsets were found in AHB, the level of CD3+T cells was significantly higher compared to CHB group and healthy control group. Frequencies of CD3+CD4+ T cells in the third and fourth week and CD4+/CD8+ in the second week were higher compared to other groups. Frequ- ency of NK cells was low and was significantly lower compared to other groups in the third week specially. It was showed that CD4+/CD8+ was low followed by high abnormal ALT during early stage by dynamic monitoring of CD4+/CD8+, and CD4+/CD8+ was increasing accompanied by normal ALT set by set, but CD4+/CD8+ had no significant relation to ALT and HBV DNA. Conclusion: Immune status of AHB, compared to CHB and healthy controls, was significantly different and dynamic changes of lymphocyte sub- sets may be related to progress of disease.

Efficacy of Phacovitrectomy Combined with Internal Limiting Membrane Peeling for Macular Diseases

Purpose:To observe the efficacy of vitrectomy with internal limiting membrane.(ILM) peeling combined with phacoemulsification with intraocular lens.(IOL) implantation in the treatment of cataract with co-existing macular diseases.Methods:A total of 28 cataract patients (28 eyes) with coexisting macular diseases were admitted to Aier Eye Hospital between May 2008 and May 2011.The clinical characteristics were analyzed in this study.Subjects included 6 men and 22 women,aged from 56 to 77 years (mean 64 years),with duration of disease ranging from 2 to 36 months (mean 9.3 months).All patients underwent phacoemulsification with implantation of a hydrophobic acrylic IOL into the capsular bag and pars plana vitrectomy with ILM peeling.Results:Postoperatively,patients underwent 3-to 18-months of follow-up.(mean 7.2 months).Only one eye had macular hole failing to close.Normal macular structure was restored in the other 27 eyes.The presenting visual acuity and best corrected visual acuity.(BCVA) did not differ significantly (t =-1.724,P =0.096),with the BCVA in 27 eyes.(96.4%).improving by 2 lines or more.The improvement in minimum angle of resolution.(MAR).was > 0.3 in 21 eyes,≥0.1 in 6 eyes and<0.1 in 1 eye.The mean spherical equivalent.(SE) was-4.67±5.98D preoperatively and-0.38±0.69D postoperatively (t=4.157,P<0.005).Conclusion:Combined phacovitrectomy surgery is a reliable and safe procedure in the treatment of cataract complicated by macular disease.

Self Evaluation in Department of Communicable Diseases, Faculty of Medicine, Tehran University of Medical Sciences

Introduction: Self evaluation is a process that defines and collects required data to judge about decision making issues at educational system on whether the educational department is fit to educate students? The objective of this study was determining the quality of the structural elements of the department of Communicable Diseases & determining the strengths, weaknesses, opportunities and threats to improve the quality of activities in the department under research. Materials and Methods: The employed method was Mixed methods (qualitative & quantitative research), on the basis of 10 procedural steps and within 8 sections dealing with evaluated factors;such as 1) organizational and management structure 2) scientific board members 3) students 4) Manpower 5) Space of educational research and health care 6) Equipment 7) curriculum 8) satisfaction of graduates, which were studied using 61 criteria and 172 indicators. Five-point Likert Scale was used for the responses in the questionnaire (1 - 1.75 = undesirable, to 4.2 - 5 completely desirable). Finally the data were analyzed using descriptive statistics indices and the assessment software of the Educational Development Center of TUMS. The instruments used in this method included assessment software, interview, observation and self-prepared questionnaire which consisted of 7 questionnaires and 2 check lists. Finding: The results of the research showed that general average of 8 investigating sections was 56.9% as a rather desirable research work. Conclusions: Therefore, it was concluded that function of the educational management in that group was directly in line with evaluation process, but continuing the process of evaluation seems necessary.

Management of occluded self-expanding biliary metal stents in malignant biliary disease

Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of patients.Methods: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS,management strategies, stent patency, subsequent interventions, survival time and case charges.Results: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency(88 vs. 143 days, P = 0.069), median survival time(95 vs. 192 days, P = 0.116), median subsequent intervention rate(53.4% vs. 40.0%, P = 0.501)and median case charge(€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months,significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS(93.3% vs. 57.1%, P = 0.037).Conclusions: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management strategy.

The relationship between intermittent limit cycles and postural instability associated with Parkinson’s disease

Background:Many disease-specific factors such as muscular weakness,increased muscle stiffness,varying postural strategies,and changes in postural reflexes have been shown to lead to postural instability and fall risk in people with Parkinson's disease(PD).Recently,analytical techniques,inspired by the dynamical systems perspective on movement control and coordination,have been used to examine the mechanisms underlying the dynamics of postural declines and the emergence of postural instabilities in people with PD.Methods:A wavelet-based technique was used to identify limit cycle oscillations(LCOs) in the anterior–posterior(AP) postural sway of people with mild PD(n = 10) compared to age-matched controls(n = 10).Participants stood on a foam and on a rigid surface while completing a dual task(speaking).Results:There was no significant difference in the root mean square of center of pressure between groups.Three out of 10 participants with PD demonstrated LCOs on the foam surface,while none in the control group demonstrated LCOs.An inverted pendulum model of bipedal stance was used to demonstrate that LCOs occur due to disease-specific changes associated with PD:time-delay and neuromuscular feedback gain.Conclusion:Overall,the LCO analysis and mathematical model appear to capture the subtle postural instabilities associated with mild PD.In addition,these findings provide insights into the mechanisms that lead to the emergence of unstable posture in patients with PD.

Evaluation of Self Management Behavior of Chronic Kidney Disease Patients

CKD （chronic kidney disease） is a progressive disease. If it is left untreated, it can eventually result in end stage renal failure and necessitate dialysis or kidney transplantation. There is no cure for CKD; instead a great deal of self management over time is essential. The purpose is to evaluate self management behaviour of patients at different stages of CKD. A total of 300 CKD patients were recruited in this cross sectional study from March to July 2015 at nephrology clinic of a tertiary care setting using convenience sampling. Self management behaviour score was determined using in Partners in Health scale and was then compared at different stages of CKD. Demographic and clinical factors contributing to self management behaviour were determined. Results： There was a significant difference in age （p 〈 0.001）, gender （p 〈 0.001）, education level （p 〈 0.001）, marital status （p 〈 0.001）, duration of illness （p 〈 0.001） and number of co-morbidities （p 〈 0.001） among CKD stages. A significant difference in self management behaviour mean score was found among CKD stages （p 〈 0.001）. Post hoc analysis showed self management behaviour mean score for Stage Ⅰ （mean ± SD： 77.81 ± 9.41） was significantly higher than Stage Ⅳ （mean ± SD： 70.53 ± 13.91） and Stage Ⅴ （mean ± SD： 69.54 ± 12.31）. Self management behaviour mean score for Stage Ⅱ （mean ± SD： 78.46 ± 10.01） was significantly higher than Stage Ⅳ and Stage Ⅴ. Multiple linear regression revealed education level （p 〈 0.001） and number of co-morbidities （p = 0.01） as significant predictors of self management behaviour. It can be concluded that special attention should be focused on patients at late stage of CKD, especially those with diabetic nephropathy; low education level and multiple co-morbidities to improve self management behaviour.

Expiratory Flow Limitation and Its Relation to Dyspnea and Lung Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease: Analysis Using the Forced Expiratory Flow-Volume Curve and Critique

Background: Tidal expiratory flow limitation (tEFL) is defined as absence of increase in air flow during forced expiration compared to tidal breathing and is related to dyspnea at rest and minimal exertion in patients with chronic airflow limitation (CAL). Tidal EFL has not been expressed as a continuous variable (0% - 100%) in previous analyses. Objective: To relate the magnitude of tEFL to spirometric values and Modified Medical Research Council (MMRC) score and Asthma Control Test (ACT). Methods: Tidal EFL was computed as percent of the tidal volume (0% - 100%) spanned (intersected) by the forced expiratory-volume curve. Results: Of 353 patients screened, 192 (114 M, 78 F) patients (136 with COPD, 56 with asthma) had CAL. Overall characteristics: (mean ± SD) age 59 ± 11 years, BMI 28 ± 7, FVC (% pred) 85 ± 20, FEV1 (% pred) 66 ± 21, FEV1/FVC 55% ± 10%, RV (% pred) 147 ± 42. Tidal EFL in patients with tEFL was 53% ± 39%. Using univariate analysis, strongest correlations were between tEFL and FVC and between tEFL and RV in patients with BMI < 30 kg/m2. In patients with nonreversible CAL, tEFL was positively associated with increasing MMRC, negatively with spirometric measurements, and positively with RV/TLC. In asthmatics, ACT scores were higher in patients with mean BMI ≥ 28 kg/m2 (p < 0.00014) and RV/TLC values > 40% (p < 0.03). Conclusions: Dyspnea is strongly associated with tEFL and lung function, particularly in patients with nonreversible CAL. Air trapping and BMI contribute to tEFL.

Assessment of a portfolio as an effective tool to promote self-management among patients with ischemic heart diseases: A preliminary trial

Portfolio has been used as an approach to promoting self-learning in the field of education and its effectiveness was reported in school education. The purpose of this study was to assess effectiveness of portfolio as a tool for educating patients with ischemic heart diseases as self-management behavior in terms of applicability and efficacy. Subjects of this study were seventeen patients who had myocardial infarction or angina. They were assigned to collect information about their themes chosen from diet, exercise, alcohol intake, smoking cessation, and stress management and gathered in files. Thirty minutes face-to-face educational interviews were conducted by a nurse for once per month over three months. Self-management, self-efficacy, and physiological data were evaluated for baseline and 3 months. Two participants dropped within two months (completion rate is 88.2%). The results showed that portfolio was effective as a self-management education tool on patients who were willing to participate, but did not improve physiological data if they did not continuously implement lifestyle change. Moreover it was dangerous when the patients acquired incorrect information on diseases. For these patients, health education by health professionals is required prior to conducting portfolio. Attributes fit for portfolio were assessed. Effectiveness of portfolio related to high self-efficacy and high self-management, but did not relate to living status, having job, educational background, and health locus of control.

Effect of Continuous Nursing on Self-Efficacy and Quality of Life of Patients with Inflammatory Bowel Disease

Objective:To implement continuous nursing for patients with inflammatory bowel disease,and to explore and analyze the self-efficacy of patients and its impact on the quality of life.Methods:From May 2019 to April 2020,50 patients with inflammatory bowel disease in our hospital were selected as research subjects.The patients were divided into control group and observation group by drawing lots.The treatment effects and impact on quality of life of the two groups were compared and analyzed.The control group adopted routine nursing mode and the observation group adopted continuous nursing mode.Results:Compared with before admission,there was no significant difference in self-efficacy and quality of life between the two groups.After continuous nursing intervention,the scores of self-efficacy and quality of life in the observation group were better than those in the control group 6 and 12 months after discharge,and the negative emotions such as anxiety and depression were improved.There were significant differences between the two groups(P<0.05).Conclusion:Continuous nursing for patients with inflammatory bowel disease can improve their bad mood,improve their sense of self-efficacy and quality of life,which is worthy of clinical application and promotion.

“I Am Getting Healthier”. Perceptions of Urban Aboriginal and Torres Strait Islander People in a Chronic Disease Self-Management and Rehabilitation Program

Chronic disease is a main contributor to the disproportionately high burden of illness experienced by Aboriginal and Torres Strait Islander Australians. However, there are very few programs addressing chronic disease self-management and rehabilitation which are designed specifically for urban Aboriginal and Torres Strait Islander people. This paper aims to explore client and staff perceptions of the Work It out Program, a chronic disease rehabilitation and self-management program designed for urban Aboriginal and Torres Strait Islander people. The study used a mixed methods approach to explore the success, barriers and self-reported outcomes of the program. Quantitative data were collected through a structured survey, comprising social and demographic data. Qualitative data were collected through interviews using Most Significant Change theory. Twenty-eight participants were recruited, 6 staff and 22 clients (M = 7, F = 21) with an age range between 21 and 79 years of age (Mean = 59.00, SD = 17.63). Interviews were completed in 2013 across four Work It out locations in Southeast Queensland. Semi-structured interviews were conducted either individually or in groups of two or three, depending on the participants’ preference. Thematic analysis of the data revealed six main themes;physical changes, lifestyle improvements, social and emotional well-being, perceptions about the successful features of the program, perceived barriers to the program and changes for the future. This exploratory study found that clients and staff involved in the Work It out Program perceived it as an effective self-management and rehabilitation program for urban Aboriginal and Torres Strait Islander Australians. Further evaluation with a larger sample size is warranted in order to establish further outcomes of the program.

Cardiac-self efficacy predicts adverse outcomes in coronary artery disease (CAD) patients

Background: Little is known about the predictive role of Cardiac Self Efficacy (CSE) in the ensuing months following a coronary event. We sought to determine whether CSE predicts adverse events in the months following discharge in patients with Coronary Artery Disease (CAD). Design: Data from a prospective study of 193 patients recently hospitalized for CAD. Methods: Data were collected via participant self-report and medical records at 3-month post-discharge (baseline;T1), 6-month post-discharge (T2) and 9-month post-discharge (T3). CSE was measured using the Cardiac Self Efficacy Scale. Multi-variate regression modeling was applied to explore the association between baseline CSE scores and cardiac-related hospital admissions and functional cardiac status at T2 and T3. Other outcomes included any hospital admissions, self-reported mental and physical health at follow up. Results: Higher CSE scores at baseline significantly predicted better cardiac functioning and self-rated mental and physical health at both T2 and T3 (with one exception);this was consistent across all five models. While baseline CSE did not predict cardiac or other hospital admission at T2, CSE was a significant predictor of both outcomes at T3;higher CSE scores resulted in reductions in likelihood of hospital admissions. After adjustment for psychosocial variables however, neither association remained. Baseline depression explained the association between baseline CSE and any cardiac admissions, as well as baseline CSE and any hospital admissions at T3 follow up. Conclusions: While CSE can predict key outcomes following a CAD event, much of the association can be explained by the presence of depression.

Complications of airway self-expandable metallic stent in benign airway diseases

Objectives: To present the complications of Ultraflex Self-Expandable Metallic Stents (SEMSs) applied in patients with benign tracheobronchial diseases. Methods: Eighty patients received 124 SEMSs were retrospectively reviewed in a tertiary hospital. Results: The baseline characteristics of patients received SEMS implantation including age (mean + standard deviation: 62.5 + 14.8 years), gender (male, 60.5%), smoking (46.8%), forced expiratory volume in first one second (FEV1) (mean + standard deviation, 0.92 +0.41 L/s), follow-up days after SEMS implantation (median (interquartile range);457 (131 - 897)) and covered SEMS (33.9%) were listed. Symptoms improved after SEMS implantation among 95 patients (76.6%). Time to complications developed was 236 (median;interquartile range, 59 - 672) days. The overall complication rate was 41.9% after SEMS implantation. The complications included SEMS migration (6.5%), granuloma (19.3%) and SEMS fracture (16.1%). Successful management rates of SEMS migration, granuloma and SEMS fracture were up to 100%, 83.3%, and 85% respectively. Conclusions: Patients received SEMS implantation due to benign conditions had poor lung function and were old. The complication rate in patients with benign conditions was high after longer follow-up period, however, successful management achieved in most patients with complications.

Factors Affecting Disease Risk Perception and Self-Management Behaviors among Japanese Long-Term Overseas Volunteers

Introduction: Many overseas volunteers have worked in low and middle-income countries. However traveling abroad and staying in an unfamiliar environment with inadequate medical infrastructure exposes volunteers to a wide range of health risks. The aim of this study was to clarify the relationships among disease knowledge and symptoms, disease risk perception, and self-management skills. Methods: This was a questionnaire survey of 189 Japanese who were preparing to volunteer abroad. A factor analysis was conducted on 13 items (six general risk events and seven major diseases) of risk perception. Correlation analysis was performed between the identified risk perception factors and disease knowledge and symptoms. Risk perception scores by factors from the seven disease items were compared between the Self-management Score (SMS) group and disease knowledge and risk of symptoms group, using T-tests. St. Luke’s International University Ethics Committee (19-A092) approved this study. Results: Many participants expected to suffer from digestive diseases (69.3%) and dermatitis (55%) in the field. On the other hand, few expected high risk of malaria (26.5%) or dengue fever (36%). Factor analysis yielded robust factor loadings creating a “Dread” and an “Unknown” factor accounting for 62.2% of total variance. Strong correlation was not found between SMS and disease risk perception. A weak negative correlation was observed in dengue fever, digestive disorders, and dermatitis (r = −0.20 to −0.25, p < 0.001) on the “Unknown” factor. A high SMS score was associated with a lower “Unknown” factor score for malaria, diarrhea, dermatitis, and dental disorders. In addition, higher disease knowledge was significantly associated with higher “Dread” factor score for dental disorders. Conclusions: Self-management skills and disease knowledge will enable higher risk awareness of common diseases and high lethality diseases.

Effectiveness of a Self-Foot-Care Educational Program for Prevention of Diabetic Foot Disease

Objective: To verify the effectiveness of a “self-foot-care educational program (SFCEP)” for prevention of type 2 diabetes foot disease. Methods: A single-center, randomized and controlled trial was conducted. Fifty-five patients with type 2 DM, 40 - 75 years of age who were asked to return for a follow-up hospital visit, were allocated to either an SFCEP group (n = 29) or a conventional education program (CEP) group (n = 26). Both of the groups were given foot-care education, monthly for four times in the SFCEP group and in the CEP group one time only by a printed leaflet. The two groups had no statistically significant differences in patient background of the type 2 diabetes history. We evaluated removal rate of skin debris, and the symptoms and conditions of the feet. Results: Between the SFCEP and CEP there were significant differences in removal rate of skin debris (p Conclusion: This study strongly suggests the effectiveness of SFCEP in preventing the occurrence or worsening of diabetic foot diseases.

Use of Social Cognitive Theory to Assess Salient Clinical Research in Chronic Disease Self-Management for Older Adults: An Integrative Review

The purpose of this integrative review is to evaluate research pertaining to self-management programs for older adults with chronic diseases using Albert Bandura’s Social Cognitive Theory (SCT) for behavior change. The focus is application of the SCT domains to self-management programs. The exploration of the current chronic disease self-management research provides an understanding of the Social Cognitive Theory concepts studied in interventional self-management research. The integrative review explicated two areas related to the theory in need of further research. First, social support has not been thoroughly explored as a mechanism for enhancing self-management interventions. Second, moral disengagement was not identified as a focus within chronic disease research raising the question about the impact of moral disengagement on long-term adherence and behavior change.