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Background: The optimal treatment of desmoid tumours is controversial. We evaluated desmoid management in Dutch familial adenomatous polyposis (FAP) patients.Methods: Seventy-eight FAP patients with desmoids were identified from the Dutch Polyposis Registry. Data on desmoid morphology, management, and outcome were analysed retrospectively. Progression-free survival (PFS) rates and final outcome were compared for surgical vs non-surgical treatment, for intra-abdominal and extra-abdominal desmoids separately. Also, pharmacological treatment was evaluated for all desmoids.Results: Median follow-up was 8 years. For intra-abdominal desmoids (n=62), PFS rates at 10 years of follow-up were comparable after surgical and non-surgical treatment (33% and 49%, respectively, P=0.163). None of these desmoids could be removed entirely. Eventually, one fifth died from desmoid disease. Most extra-abdominal and abdominal wall desmoids were treated surgically with a PFS rate of 63% and no deaths from desmoid disease. Comparison between NSAID and anti-estrogen treatment showed comparable outcomes. Four of the 10 patients who received chemotherapy had stabilisation of tumour growth, all after doxorubicin combination therapy.Conclusion: For intra-abdominal desmoids, a conservative approach and surgery showed comparable outcomes. For extra-abdominal and abdominal wall desmoids, surgery seemed appropriate. Different pharmacological therapies showed comparable outcomes. If chemotherapy was given for progressively growing intra-abdominal desmoids, most favourable outcomes occurred after combinations including doxorubicin. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 85–91 (2010) Objective To assess the preferences of patients with Type 2 diabetes regarding self-care activities and diabetes education. Research design and methods Questionnaire survey carried out in general practices and outpatient clinics across the Netherlands. Outcomes: preferred setting for education, preferred educator, and preferred and most burdensome self-care activity. Multinomial logistic regression analysis assessed associations between outcomes and patient characteristics, preferences and opinions. Results Data of 994 consecutive individuals were analysed (mean 65 years; 54% male; 97% Caucasian; 21% low education level; 80% primary care). Of these, 19% thought they had poor to average glycaemic control, 61% thought they were over-weight and 32% thought they took too little exercise. Eighty per cent of respondents preferred diabetes education during regular diabetes check-ups. Patients taking insulin preferred education to be given by nurses [odds ratio (OR) 2.45; 95% confidence interval (CI) 1.21–4.96]. Individuals who thought their health to be poor/average preferred education to be given by doctors (OR 1.65; 95% CI 1.08–2.53). Physical exercise was the preferred self-care activity of those who thought they took too little exercise (OR 1.97; 95% CI 1.32–2.93) but was preferred less by patients with mobility problems (OR 0.65; 95% CI 0.43–0.97). Patients with eating disinhibition reported keeping to a healthy diet (OR 4.63; 3.00–7.16) and taking medication (OR 1.66; 95% CI 1.09–2.52) as the most burdensome self-care activities. Age was not an independent determinant of any preference. Conclusions When providing education for patients with newly diagnosed Type 2 diabetes, healthcare providers should consider making a tailored education plan, irrespective of the patient’s age. [ABSTRACT FROM AUTHOR]

The study reported here assessed the psychometric properties of an instrument to measure diabetes management self-efficacy in Dutch children, ages 8 to 12. Content validity of the item list was tested by consulting an expert panel of diabetes nurse specialists and a child-oriented rating scale was developed. A pretest was conducted to assess whether the instrument was clear and comprehensible for children. Then the instrument was tested in children with diabetes at the outpatient diabetes clinics for children at three Dutch hospitals. Reliability and criterion-related validity of the instrument were assessed. The instrument was judged content valid by the expert panel of diabetes nurse specialists, and the language of the instructions, the items and the rating scale was found to be clear and understandable for children of this age group. The study yielded only a moderate internal consistency estimate (Cronbach's = 0.71) and limited support for criterion-related validity. Several useful theoretical and methodological issues were identified.

According to the social cognitive theory of Bandura, self-efficacy predicts behavorial change. Bandura notes that self-efficacy is based on four major sources of information: performance accomplishments, vicarious experience, verbal persuasion and self-evaluation. This exploratory study examined the use of these four sources of information by Dutch nurse diabetes educators to enhance self-efficacy among people with diabetes mellitus. A survey questionnaire was sent to all Dutch nurse members of the European Association of Diabetes Educators (EADE) asking about the use of self-efficacy-enhancing methods, and four different educational programs were observed. Survey respondents said that performance accomplishments and verbal persuasion were often used, vicarious experience was hardly ever used, and the use of self-evaluation varied. The observations gave a different picture: only verbal persuasion was observed often; the other three sources were hardly ever used. Clearly, self-efficacy-enhancing educational methods are not systematically used in the Netherlands and there is little variety in the methods used. More varied methods of enhancing self-efficacy need to be developed and implemented in diabetes education programs.

Adherence to treatment is a major issue for people with diabetes mellitus, and attention has been given to improving self-management in persons with this chronic disease. Most studies show that knowledge alone will not improve self-management behavior. Self-efficacy, a concept introduced by Bandura, has been shown to be an important variable in improving health behaviors. In order to determine whether self-efficacy can influence self-management of diabetes, however, instruments to measure self-efficacy are needed in native languages at an appropriate developmental level, and with good psychometric properties. The study reported here was part of a larger project in the Netherlands, Belgium and the United States in which several instruments, measuring diabetes management self-efficacy, have been developed, both in English and Dutch, for different types of diabetes and different age groups. This article reports on the development and psychometric testing of an instrument measuring self-efficacy in adolescents with type 1 diabetes mellitus. Initially 30 items for the instrument were generated through focus group interviews and their relevance was judged by a team of 10 experts on self-management behavior in adolescents. The final instrument contained 26 items. The sample for psychometric testing consisted of 90 patients with type 1 diabetes who were between 12 and 18 years old. Cronbach's alpha of the instrument was 0.86. An exploratory factor analysis produced two factors which reflect general and more difficult diabetes self-management situations.

This article summarizes the development and validation of a scale to measure the level of self-efficacy of patients with type 2 diabetes mellitus. Self-efficacy is described as people's belief in their capability to organize and execute the course of action required to deal with prospective situations. This self-efficacy scale was developed based on the self-care activities these patients have to carry out in order to manage their diabetes. The following psychometric properties of this scale were established: content validity, construct validity, internal consistency and stability. The original scale contained 42 items. A panel of five experts in diabetes and four self-efficacy experts evaluated the original scale two times for relevance and clarity. This content validity procedure resulted in a final scale which consisted of 20 items. Subsequently, patients with type 2 diabetes were asked to complete this 20-item scale and further tests were done with the 94 usable responses. Factor analysis identified four factors, all of which were related to clusters of self-care activities used to manage diabetes which comprised this scale. The internal consistency of the total scale was alpha=0.81 and the test-retest reliability with a 5-week time interval was r=0.79 (P < 0.001).

Diabetes mellitus is a leading chronic illness in the United States and in the Netherlands. Assisting persons with diabetes and their families to manage the illness so that they can have satisfying lives is a challenge for all involved. Persons with diabetes mellitus and their significant others (family members, friends, or other caregivers) must learn and perform management behaviors in order to achieve this goal. Self-efficacy has been shown to be an important predictive variable in initiating and continuing management behaviors. In order to test the impact of self-efficacy on the management of diabetes mellitus and to conduct comparative studies in the Netherlands and the United States, a battery of valid and reliable measurement instruments were needed. Six different instruments in two languages were developed to test children with diabetes and their significant other, adults with insulin dependent diabetes and their significant other, and adults with non-insulin dependent diabetes and their significant other. An overview of the instrument development and testing is described. The testing of different formats due to language terminology and the testing of the instruments for the adults with non-insulin dependent diabetes mellitus will be presented.