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PubMed1999

Achievement goals and intrinsic motivation: a meta-analytic review.

This article presents a meta-analysis of the experimental literature that has examined the effect of performance and mastery achievement goals on intrinsic motivation. Summary analyses provided support for the hypothesis that the pursuit of performance goals has an undermining effect on intrinsic motivation relative to the pursuit of mastery goals. Moderator analyses were conducted in an attempt to explain significant variation in the magnitude and direction of this effect across studies. Results indicated that the undermining effect of performance goals relative to mastery goals was contingent on whether participants received confirming or nonconfirming competence feedback, and on whether the experimental procedures induced a performance-approach or performance-avoidance orientation. These findings provide conceptual clarity to the literature on achievement goals and intrinsic motivation and suggest numerous avenues for subsequent empirical work.

Journal Article↗
PubMed2004

More Western hypercholesterolemic patients achieve Japan Atherosclerosis Society LDL-C goals with rosuvastatin therapy than with atorvastatin, pravastatin, or simvastatin therapy.

BACKGROUND: Data from Western comparative trials suggest that rosuvastatin is more effective than atorvastatin, simvastatin, and pravastatin in helping hypercholesterolemic patients achieve US and European lipid-lowering guidelines. The purpose of this analysis was to assess the comparative efficacy of rosuvastatin in reducing low-density lipoprotein cholesterol (LDL-C) to levels recommended by the Japan Atherosclerosis Society (JAS). METHODS AND RESULTS: A post hoc analysis of data from 6 randomized, double-blind, active-controlled trials was conducted to evaluate the relative efficacy of rosuvastatin and comparator statins in helping patients achieve the LDL-C goals established by the JAS. The first 5 trials, prospectively designed for pooling, were originally conducted to compare the effects of rosuvastatin with either atorvastatin, simvastatin, or pravastatin in reducing lipid levels and helping patients achieve the LDL-C goals established by the National Cholesterol Education Program. The 6th trial was conducted with similar objectives, but in patients with heterozygous familial hypercholesterolemia (HeFH). Data from 2,139 hypercholesterolemic patients in the first 5 trials were pooled for analysis: rosuvastatin 5 mg (n=390) or 10 mg (n=389) vs atorvastatin 10 mg (n=393); rosuvastatin 5 mg (n=240) or 10 mg (n=226) vs simvastatin 20 mg (n=249) or pravastatin 20 mg (n=252). In the studies with atorvastatin as the comparator, JAS-defined LDL-C goals were reached by 67.2% of the rosuvastatin 5-mg group, 82.3% of the rosuvastatin 10-mg group, and 58.0% of the atorvastatin 10-mg group (p<0.001 for both rosuvastatin groups vs atorvastatin) at 12 weeks. Similarly, in the trials with pravastatin and simvastatin as comparators, the JAS LDL-C goals were reached by 77.5% of the rosuvastatin 5-mg group, 86.7% of the rosuvastatin 10-mg group, 45.2% of the pravastatin 20-mg group and 65.5% of the simvastatin 20-mg group (p<0.001 for both rosuvastatin groups vs pravastatin and simvastatin). In the trial of HeFH patients (n=433 for rosuvastatin, n=187 for atorvastatin), 31.9% of patients treated with rosuvastatin 20 mg achieved JAS LDL-C goals, compared with 17.6% of patients treated with atorvastatin 20 mg (p<0.001). CONCLUSIONS: Rosuvastatin has demonstrated clinical superiority over atorvastatin, pravastatin, and simvastatin in reducing LDL-C levels and in enabling patients to reach goals established by the JAS.

Aged↗
PubMed1992

Sign- versus goal-tracking: effects of conditioned-stimulus-to-unconditioned-stimulus distance.

Three pigeons were exposed sequentially across experimental phases to five different distances between the conditioned stimulus and the site of the unconditioned stimulus in a sign-/goal-tracking procedure. A computer-controlled tracking system provided a continuous record of the bird's position by continuously monitoring the location of the bird's head in three-dimensional space. It was found that birds sign-tracked (i.e., approached the conditioned stimulus) when the conditioned stimulus was closest to the site of the unconditioned stimulus, goal-tracked (i.e., approached the site of the unconditioned stimulus in the presence of the conditioned stimulus) when the conditioned stimulus was farthest from the site of the unconditioned stimulus, and engaged in both sign- and goal-tracking (or something intermediate) at intermediate conditioned-stimulus-to-unconditioned-stimulus distances. When both sign- and goal-tracking occurred, the former tended to occur in the first half and the latter in the second half of the interval in which the conditioned stimulus was present. The results suggest (a) whether sign- or goal-tracking (or both) occurs is a function of the distance of the conditioned stimulus from the site of the unconditioned stimulus, (b) the fact that pigeons but not rats have been found to sign-track consistently throughout the duration of the conditioned stimulus may be due to quantitatively rather than qualitatively different effects of conditioned-stimulus-to-unconditioned-stimulus distance across species (i.e., a "short" conditioned-stimulus-to-unconditioned-stimulus distance for a pigeon may be a "long" one for a rat), and (c) sign- and goal-tracking may be competing behavioral tendencies that can (e.g., at intermediate conditioned-stimulus-to-unconditioned-stimulus distances) cancel each other out. The findings lend support to theories that specify an interaction between phylogenetic and reinforcement variables in determining whether sign- or goal-tracking will occur in any given experimental preparation.

Animals↗
PubMed1992

Setting national health goals and targets in the context of a fiscal crisis: the politics of social choice in New Zealand.

The setting of national health goals and targets in New Zealand has taken place in the context of fiscal crisis. The mandate for State intervention for social goals has also been under a sustained ideological challenge. These circumstances, together with other developments within the New Zealand health service, prepared the way for the development of the first set of health goals and targets. Six criteria were used to identify health problems for which goals and targets could be set. Ten areas were included, and specific, timed and quantified targets were set in each area for the year 2000 with shorter term targets for 1995. The Minister of Health gave priority to three areas: tobacco control, secondary prevention of cervical cancer, and reduction of road accident injury and death. An important aspect of the program is that the goals and targets are to be the focus of the annual contract between the Minister of Health (the primary funder of health care) and the Area Health Boards (the primary providers of health care). A matrix of policy options is presented for resource allocation and public health. The case study described represents one solution to the set of policy choices presented by fiscal and ideological challenge; the "new managerialism" has been allied with the "new public health." The authors argue that a combination of ideological renewal and fiscal probity has preserved a vigorous role for the State in health and health care. This matrix of policy options also underlines the necessity to consider health outcomes, as well as organizational goals, in the evaluation of the performance of health systems.

Cost Control↗
PubMed2005

Adherence to statin therapy and LDL cholesterol goal attainment by patients with diabetes and dyslipidemia.

OBJECTIVE: The purpose of this study was to assess the relationship between adherence to statin therapy and LDL cholesterol goal achievement in patients with diabetes and dyslipidemia. RESEARCH DESIGN AND METHODS: The records of patients being medically treated for dyslipidemia in a managed care diabetes program from January 2001 to December 2002 were used to assess LDL cholesterol goal attainment (<100 mg/dl) and to compute a 9-month medication possession ratio (percentage of days when medication was available [MPR], beginning with the first prescription in the database). RESULTS: A total of 653 patient records was analyzed. The average MPR was significantly higher for men than for women (0.75 vs. 0.66, P < 0.05). Overall, 44% (n = 290) of the patients achieved an LDL cholesterol level <100 mg/dl (52% of men and 37% of women, P < 0.05). A significant correlation emerged between MPR and plasma LDL cholesterol (P < 0.001), and MPR was significantly higher in patients who achieved the LDL cholesterol target than in those who did not (0.82 vs. 0.61, P < 0.05). CONCLUSIONS: Although statins are highly effective for decreasing LDL cholesterol levels in patients with dyslipidemia, including those with diabetes, failure to reach LDL cholesterol targets remains common. Adherence to statin therapy, as reflected by MPR, is closely related to LDL cholesterol goal attainment in patients with diabetes and dyslipidemia. The probability of goal achievement appears to increase substantially when the MPR is >0.80. Pharmacy records can be used to identify patients who are poorly compliant with statin therapy and at high risk for failure to attain LDL cholesterol goals. Because outcomes are directly related to patients' medication-taking behavior, when clinical goals (such as serum cholesterol levels) are not being reached, adherence should be the first item assessed by the clinician.

Anticholesteremic Agents↗
PubMedDate not supplied

Occupational therapy goal achievement for persons with postacute cerebrovascular accident in an on-campus student clinic.

OBJECTIVES: A retrospective study was conducted to determine to what extent persons with postacute cerebrovascular accident (CVA) made progress toward rehabilitation goals during occupational therapy treatment and whether age and time since CVA onset affected the rate of goal achievement. METHOD: Data were collected from the admission and discharge records of persons with CVA who had received occupational therapy at a university clinic, who were at least 8 months post CVA, and who had not received therapy in the community for at least 6 months. The treatment was provided by occupational therapy students under supervision and had a mean length of 12 1-hr sessions over one semester. A sample size of 85 was obtained from 13 years of clinic records. RESULTS: All patients in the sample except one made progress toward at least one of their selected rehabilitation goals. The group mean score for goal progress indicated that as a whole, the patients made significant gains. In addition, independent t tests showed no significant differences in mean scores between younger and older patients, between longer and shorter times since onset, between men and women, or between right and left CVA. There was no significant linear association between mean score and the number of treatments received. CONCLUSION: Patients with CVA showed progress toward rehabilitation goals during postacute treatment. Patients with recent CVA onset or of younger age did not achieve goals at a significantly higher rate than those with less recent onset or of greater age.

Adult↗
PubMed2003

Related factors of meeting National Cholesterol Education Program-recommended goals with atorvastatin.

The aim of this study was to observe the efficacy of atorvastatin and the related factors of meeting the National Cholesterol Education Program (NCEP)-recommended low-density lipoprotein (LDL) cholesterol levels in patients with hypercholesterolemia. A total of 107 patients were treated with atorvastatin 10 mg/day for 12 weeks. Eighty % of the patients achieved the target goals. There was a significant difference in the initial body mass index (BMI) between patients achieving the target goals and those not achieving the target goals (p < 0.05). In multiple stepwise logistic regression analysis, initial BMI and complications correlated with reaching the NCEP-recommended target goals (p < 0.05). A great number of patients treated with atorvastatin, including those previously poorly controlled with other therapies, reached the target goals at the starting dose 10 mg/day. BMI may be a useful index of achieving the NCEP-recommended target goals with atorvastatin.

Aged↗
PubMed1999

[Individually arranged and continuously reevaluated treatment goals as an instrument for improving inpatient psychotherapy]

An agreement about individual therapy goals at the beginning of inpatient psychotherapy improves motivation and engagement of patients, and makes orientation about the planned therapy easier. Furthermore, therapy goals are an effective tool in the quality-assurance of the therapeutic process. On our ward, therapy goals are negotiated individually between patient and therapist some time before admission. The therapy goals of our inpatients are documented and concretized weekly. First empiric results showed, that individual therapy goals are an interesting instrument not only for the evaluation of the therapeutic process, but also for the evaluation of outcome. The introduction of individualized treatment goals in the treatment setting was well accepted by patients and team members.

Journal Article↗
PubMed2000

Creation of a client goal-setting framework.

During the past decade, there has been a noticeable shift in the philosophical approach to health care. This change in thinking, from problem-focused to goal-oriented and from discipline-specific to team driven, has been apparent in rehabilitation as well. The Spinal Cord Program at G. F. Strong Rehab Centre in Vancouver, Canada, has developed a goal-setting framework to define and meet clients' needs by promoting a partnership between the client and family and the clinical team. Donabedian's paradigm provides the model on which the interdisciplinary goal-setting framework is based. The purpose of the framework is to clearly outline clients' and staffs' expectations of the rehabilitation program, identify responsibilities, ensure accountability of clients and staff, and facilitate measurement of goal achievement. Evaluation of the framework indicates that most staff and clients believe the framework provides more structure and direction to the client's rehabilitation program than the previous approach; others believe the use of a goal checklist imposes too much structure and compromises the specificity of goals. This paper will discuss the design, implementation, and evaluation of the framework and recommendations for improvement.

British Columbia↗
PubMed2004

Modelling clinical goals: a corpus of examples and a tentative ontology.

Knowledge of clinical goals and the means to achieve them are either not represented in most current guideline representation systems or are encoded procedurally (e.g. as clinical algorithms, condition-action rules). There would be a number of major benefits if guideline enactment systems could reason explicitly about clinical objectives (e.g. whether a goal has been successfully achieved or not, whether it is consistent with prevailing conditions, or how the system should adapt to circumstances where a recommended action has failed to achieve the intended result). Our own guideline specification language, PROforma, includes a simple goal construct to address this need, but the interpretation is unsatisfactory in current enactment engines, and goals have yet to be included in the language semantics. This paper discusses some of the challenges involved in developing an explicit, declarative formalism for goals. As part of this, we report on a study we have undertaken which has identified over 200 goals in the routine management of breast cancer, and outline a tentative formal structure for this corpus.

Breast Neoplasms↗
PubMed2006

[Efficacy of goal-directed therapy in the treatment of septic shock].

OBJECTIVE: To investigate the efficacy and effect on outcome of goal-directed therapy in patients with septic shock compared with conventional therapy. METHODS: Sixteen patients with septic shock were randomly assigned to receive goal-directed therapy, with central venous pressure (CVP) 8-12 mm Hg (1 mm Hg=0.133 kPa), mean arterial pressure (MAP) >or=65 mm Hg, venous oxygen saturation (SvO(2))>0.70 (superior vena cava saturation), and urine output >or=0.5 ml/min as therapeutic goals. Another 17 patients received conventional therapy as controls. The arterial oxygen saturation (SaO(2)), SvO(2), MAP, CVP, heart stroke volume cardiac index (CI), serum lactate, volume of fluid, amount of vasopressors, the numbers of organ injured and patients who needed continuity blood purification (CBP) and/or ventilation were recorded serially for 6-48 hours, and they were compared between the two groups. The mortality of the patients in two groups on 7 days and 14 days were also recorded. RESULTS: There were no significant differences between the groups with respect to base-line characteristics. During the interval from 24 to 48 hours, the patients assigned to goal-directed therapy had a significantly higher in SaO(2), SvO(2), MAP, CVP, CI (P<0.05 or P<0.01), a lower lactate concentration (P<0.01), significantly more fluid during 6-24 hours and less vasopressors (both P<0.01). Seven and 14 days in-hospital mortality were lower in goal-directed therapy group as compared with the control group(P<0.05). CONCLUSION: The efficacy of goal-directed therapy in patients with septic shock is significantly better than conventional therapy in ameliorating outcome of shock and can be easily used in intensive care unit (ICU).

Adult↗
PubMed1990

Analytical goal setting prior to selection of a method for glycated haemoglobin.

Without a consensus on either a reference method or a single glycated haemoglobin standard, the individual laboratory has to establish and secure its own assay method. Prior to selection of a method for glycated haemoglobin we used an assessment model and defined our clinical goals. Based on clinical goals it was possible to set up goals of analytical quality and evaluate available literature concerning the performance characteristics of different assay methods. We wanted a method that measured HbAlc, without measuring the labile intermediate pre-HbAlc, and that provided separate detection of haemoglobin variants. Low imprecision was required to secure the measured, non-diabetic reference interval, and to minimize random analytical error. We found the isoelectric focusing method the only one able to meet our goals, and a method evaluation was carried out. Clinical goals of analytical quality should always be defined before method selection and implementation. Using this model, we were able to establish a precise isoelectric focusing method that fulfilled our clinical goals by measuring HbAlc with a total coefficient of variation of 2.1% and a non-diabetic reference interval from 5.2% to 6.8% HbAlc.

Blood Chemical Analysis↗
PubMed1993

Analytical goals developed from the inherent error of medical tests.

Biological variation is inherent in all medical tests and is a major source of error in clinical test interpretation. We use inherent test error due to biological variability as the touchstone by which to validate the clinical acceptability of analytical goals. Analytical goals should consist of sets of complementary limits for total error, bias, and imprecision and a medical usefulness criterion (MUC) to ensure that the total error goal is met with stated certainty. We propose analytical goals that are limits for the total error of a measurement system, the joint capability of the process control procedures and the measurement process. Thus, the goals are the allowable analytical error for proficiency evaluation, internal process control, and the total error budget for design of method performance characteristics. We define MUC as the allowable maximum proportion of test diagnostic efficiency lost due to analytical error near medical decision points. MUCs < 0.03 are not routinely clinically useful; MUCs > 0.08 allow method performance characteristics that are undesirable for general clinical use. Using MUC = 0.05 and recommendations that imprecision not exceed one-half of the biological CV, we propose that fixed bias should not exceed one-fourth to one-third of the intraindividual biological CV of the analyte and that total analytical error should not exceed 1.25 to 1.40 times the biological CV. Modification of these analytical goals may arise for reasons of documented clinical practice or process stability. Our model quantifies in medical utility terms the results of such modifications.

Bias↗
PubMed1996

Termination and the problem of analytic goals: patient and analyst, different perspectives.

The author of this paper explores the different perspectives through which patient and analyst view termination and the problem of analytic goals. These differences become clear through a case study, in which the patient offered resistance to many of the treatment goals, which did not fit her life goals and, at the same time, threatened her defences and her precarious well-being. In order to achieve the main treatment goal, that of maturity and growth (which in analysis was expressed through sub-goals like separation from her mother, understanding of her symptoms, acceptance of her feminine identity, acceptance of limitations of age and the terminability of life), the patient and the analyst had to confront an intense psychic pain connected to what they perceived as irretrievable losses. The fear of growth and growing old affected both partners of the analytic couple and had an impact on the extent to which analytic goals were met. The author explores the satisfactory aspects of termination, as well as what the analyst viewed as the incomplete results of analysis, when analysis was terminated and ten years later.

Adult↗
PubMed1979

Goal attainment and satisfaction scores for CMHC clients.

The purpose of this study was to explore the psychometric properties of goal attainment scales and client satisfaction measures. The findings revealed that goal attainment results, like other types of self-report psychotherapy outcome measures, are directly related to (a) indicators of a client's social class, and (b) the manner of treatment termination (unilateral dropout vs. mutual consent). The extent of client--therapist agreement on goal scores was relatively low thereby supporting the necessity of obtaining both perspectives in evaluating treatment outcome. Furthermore, because measures of client satisfaction were found to be sufficiently independent from goal outcome scores, it was concluded that they provide a unique source of program evaluation data. Finally, it was concluded that Goal Attainment Scaling is best considered to be a quality assurance tool for individual client/therapist dyads rather than a mechanism for the determination of the effectiveness of specific mental health programs and services.

Community Mental Health Services↗
PubMed1995

Treatment goal-planning: outcome findings of a British prospective multi-centre study of adolescent inpatient units.

A set of 16 treatment goals, related to 4 areas of adolescent functioning, were defined and employed in the initial and discharge assessments of 276 patients, admitted to 4 inpatient units, examined during a multi-centre prospective study of adolescent psychiatric hospitalizations. At discharge, subjects showed a substantial improvement across all treatment goals; least improvement was observed amongst those goals most frequently targeted. The clinical investigators consider the treatment goal definitions used in this study a meaningful way of measuring psychiatric disturbances in adolescence as well as a useful measure of change in an inpatient population. Further development of the treatment goal definitions would produce a robust clinical and audit tool.

Adolescent↗
PubMed2003

Neglect-like behavior in healthy subjects: dissociation of space exploration and goal-directed pointing after vestibular stimulation.

Evidence has been reported favoring the view of a dual mode of space representation for action and spatial cognition. While the dorsal system seems to be mainly involved in direct coding of space for action by means of several effector-specific representations, the ventral system appears to be responsible for more enduring and conscious representations underlying spatial cognition and awareness. In accordance with this view are recent studies documenting dissociations between exploratory and goal-directed movements in patients with brain damage. Patients with neglect exhibit a spatial bias of exploratory movements to the ipsilesional side, while goal-directed movements land precisely on target. The exploratory bias was found susceptible to asymmetric sensory stimulation such as caloric vestibular stimulation, inducing transient reduction of contralateral neglect. The present study compared exploratory and goal-directed hand movements in healthy subjects following cold caloric stimulation of the right vestibular organ. We observed a rightward shift of tactile exploration, while goal-directed pointing remained unaffected. Asymmetric vestibular stimulation in healthy subjects thus produced a neglect-like behavior with a similar dissociation between impaired exploratory and nonimpaired goal-directed hand movements. The stimulation provoked a further, very characteristic symptom of neglect patients: a deviation of spontaneous head orientation toward the right. The present observations strengthen substantially the assumption of different modes of space representation for action and spatial cognition in humans.

Adolescent↗
PubMed2005

Visual disability variables. I: the importance and difficulty of activity goals for a sample of low-vision patients.

OBJECTIVE: To test the validity and reliability of latent trait measures estimated from ratings by low-vision patients of the importance and difficulty of selected activity goals. DESIGN: Validation of a telephone-administered functional assessment instrument using Rasch analysis of self-assessment ratings. SETTING: Telephone interviews of respondents in their homes. Participants Consecutive series of 600 outpatients with low vision. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ratings of the importance and difficulty of achieving 41 activity goals. Person and item traits were measured with the Andrich rating scale model. Measurement validity and reliability were tested statistically by comparing response patterns and distributions with measurement model expectations. RESULTS: Patients could distinguish only 3 categories of importance and 4 categories of difficulty. The distributions of person and item measure fit statistics were consistent with 2 unidimensional constructs: value of independence estimated from importance ratings and visual ability estimated from difficulty ratings. However, 8 of 41 activity goals were poor estimators of value of independence and 7 of 41 activity goals were poor estimators of visual ability. Person measure distributions could be divided into 3 statistically distinct strata for estimates from both importance ratings and difficulty ratings. Item measure distributions could be divided into 21 strata for estimates from importance ratings and 7 strata for estimates from difficulty ratings. CONCLUSIONS: The 2 variables that define visual disability-value of independence and visual ability-are valid constructs that can be estimated accurately and reliably from patient ratings of the importance and difficulty of activity goals.

Activities of Daily Living↗