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PubMed1995

Australian dietary targets in 1995: their feasibility and pertinence to dietary goals for 2000.

To ascertain whether the diet of young students in health-related courses conformed to Australian dietary targets for 1995 and to identify nutritional needs in view of dietary targets for 2000, 246 undergraduate students analysed their weighed diet for three or five days. Eight of ten male participants were meeting the dietary goals for 1995 for fibre and fat intake and six of ten were meeting the goals for 2000. More female participants were meeting the goals for fat, but less than half of the female were meeting the 1995 goals for fibre. Some 84 per cent of females, but only 29 percent of males, were meeting the 1995 dietary goals for sodium. Few participants derived 10 per cent or less of their energy from saturated fat or 10 per cent of their energy from polyunsaturated fatty acids. Substantial numbers of participants failed to meet the recommended daily intakes of zinc. calcium, magnesium and iron (females). Education of specific subgroups and modifications to food production and processing are proposed.

Adult↗
PubMed2002

Goal-equivalent joint coordination in pointing: affect of vision and arm dominance.

This study used the uncontrolled manifold (UCM) approach to study joint coordination underlying the control of task-related variables important for success at reaching and pointing to targets. More combinations of joint motions are available to the control system to achieve task success than are strictly necessary. How this abundance of motor solutions is managed by the nervous system and whether and how the availability of visual information affects the solution to joint coordination was investigated in this study. The variability of joint angle combinations was partitioned into 2 components with respect to control of either the hand's path or the path of the arm's center of mass (CM). The goal-equivalent variability (GEV) component represents trial-to-trial fluctuations of the joint configuration consistent with a stable value of the hand or CM path. The other component, non-goal-equivalent variability (NGEV), led to deviations away from the desired hand or CM path. We hypothesized a style of control in which the NGEV component is selectively restricted while allowing a range of goal-equivalent joint combinations to be used to achieve stability of the hand and CM paths. Twelve healthy right-handed subjects reached across their body to the center of a circular target with both the right and left arms and with their eyes open or closed on different trials. When repeating the task with the same arm under identical task conditions, subjects used a range of goal-equivalent joint configurations to control the entire trajectory of both the hand's and the arm's CM motion, as well as the terminal position of the pointer-tip. Overall joint configuration variability was consistently larger in the middle of the movement, near the time of peak velocity. The style of joint coordination was qualitatively similar regardless of the arm used to point or the visual condition. Quantitative differences in the structure of joint coordination were present for the non-dominant arm, however, when pointing in the absence of vision of the hand and target. The results of this study suggest that the nervous system uses a control strategy that provides for a range of goal-equivalent, rather than unique, joint combinations to stabilize the values of important task-related variables, while selectively restricting joint configurations that change these values. The possible advantage of this style of control is discussed. Absence of vision during reaching affected joint coordination only quantitatively and only for the less skilled left arm, suggesting that the role of visual information may be greater when organizing the motor components of this arm.

Adult↗
PubMed1975

Automated evaluation of goal-attainment ratings.

At the Fort Logan Mental Center in Denver, an automated system for evaluating treatment effectiveness is based on a goal-attainment approach. Patients, staff, and patients' relatives or friends specify treatment goals from a standardized list of 703 goal statements. They rate the importance of each goal at the time it is set, and later rate the degree of goal attainment. The authors describe uses of the system and emphasize its value in obtaining information during treatment that can help improve the treatment process.

Community Mental Health Services↗
PubMed1989

Coaches' goals for young children in a recreational sports program.

Almost all children participate in sports at some time, and programs are being established for even younger children. Adults who coach the children largely determine what the children's sports experience will be. Coaches' perceptions of what is important for the young children they instruct have not yet been carefully investigated. This study was designed, therefore, to determine coaches' goals for young children. Data were gathered by use of an attitude questionnaire administered to 29 coaches of a recreational basketball program of children ranging in age from 6 to 10 years old. Of the 12 goals, feeling part of a team, learning to do my best, and having fun and excitement were most highly rated as extremely important, while becoming popular was lowest rated as not important. Results revealed that coaches in general are able to clearly define their goals and priorities, and these goals seem developmentally appropriate for the children. However, coaches make little differentiation in goals based on age.

Attitude↗
PubMed1993

[Quality assurance by developing strategical and professional nursing care goals].

Quality assurance by developing strategical and professional nursing care goals. The purpose of this study was to develop strategical and professional nursing care goals. The theoretical base for the study was the 'VIPS-model' This model includes four concepts: well-being, integrity, prevention and safety, from which a taxonomy is generated. In order to measure the quality of nursing care the DySSSy-model was used. Four standards, based on the previously mentioned concepts were developed and evaluated at two surgical wards. The ward nurses were asked through a questionnaire how they valued the strategical and professional nursing care goals. The conclusion from the study is (1) that the taxonomy can be useful for structuring strategical and professional nursing care goals (2) that three of the developed standards are useful at surgical wards, and (3) that the questionnaire can be used as an instrument for defining how nurses value the chosen nursing care goals.

Humans↗
PubMedDate not supplied

Goal post injuries in soccer. A laboratory and field testing analysis of a preventive intervention.

Soccer is the most popular team sport worldwide, with approximately 40 million amateur participants. Most fatalities in soccer are related to player impact with the goal post. This study focuses on two case reports, a laboratory testing phase, and a pilot field testing phase of preventive equipment that can be used around the goal to prevent injury. Horizontal and vertical impact testing in the laboratory revealed impact force was diminished when the goal post was covered with protective padding (reduction of 31% and 63%) (P < 0.05). These data showed a statistically significant decrease in force at all temperatures. In the pilot field testing phase of the study, 471 games were monitored. Soccer teams participating in youth, teen, and adult soccer leagues were included in this phase of the study. During the 3-year study, there were seven player collisions with padded goal posts, and no injuries were recorded. The use of padded goal posts within the game of soccer has been documented to reduce the possibility of injury, both in the laboratory phase and in the pilot field testing phase.

Athletic Injuries↗
PubMed2006

Achieving 2003 European lipid goals with rosuvastatin and comparator statins in 6743 patients in real-life clinical practice: DISCOVERY meta-analysis.

BACKGROUND: There is an increasing body of evidence to support the benefits of reducing low-density lipoprotein cholesterol (LDL-C) levels and this has been reflected in a lowering of LDL-C goals recommended by international guidelines. Therefore, there is a growing need for effective lipid-modifying therapies to optimise the achievement of these more stringent LDL-C goals. OBJECTIVE: A meta-analysis of data pooled from five studies participating in the DISCOVERY (DIrect Statin COmparison of LDL-C Values: an Evaluation of Rosuvastatin therapY) Programme was performed to compare the effect of rosuvastatin treatment with other statins in real-life clinical practice. RESULTS: These studies included 6743 patients with hypercholesterolaemia from different ethnicities, countries and cultural environments. The meta-analysis showed that significantly more patients receiving rosuvastatin 10 mg achieved the 2003 European LDL-C goals compared with those who received atorvastatin 10 mg or simvastatin 20 mg (p < 0.001 for both comparisons). A significantly greater proportion of patients receiving rosuvastatin 10 mg also achieved the 2003 European total cholesterol goal compared with those on atorvastatin 10 mg (p < 0.001). CONCLUSIONS: The meta-analysis showed that rosuvastatin was more effective than comparator statins at lowering LDL-C levels and enabling patients to achieve lipid goals at recommended start doses. In addition, all statins studied were well tolerated and confirmed that rosuvastatin had a similar safety profile to other statins.

Aged↗
PubMed2006

Reaching goal in hypercholesterolaemia: dual inhibition of cholesterol synthesis and absorption with simvastatin plus ezetimibe.

Lowering serum cholesterol levels reduces the risk of coronary heart disease (CHD)-related events. Statins are commonly prescribed as first-line treatment but many patients at high-risk for CHD still fail to reach their cholesterol or low-density lipoprotein cholesterol (LDL-C) goals with statin monotherapy. National and international guidelines for the prevention of CHD recommend the modification of lipid profiles and particularly LDL-C [e.g. the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III; 2001) and Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (2003) Guidelines]. Several recent clinical trials indicated an added benefit from aggressive lowering of LDL-C levels. Based on these findings, the NCEP ATP III revised the LDL-C target from < 100 mg/dL (2.6 mmol/L) to < 70 mg/dL (1.8 mmol/L) (optional target) for very high-risk patients and < 130 mg/dL (3.4 mmol/L) to < 100 mg/dL (2.6 mmol/L) for moderately high-risk patients. For patients who fail to achieve their LDL-C target, inhibiting the two main sources of cholesterol - synthesis and uptake - can produce more effective lipid lowering, allowing more patients to reach their LDL-C goal. Ezetimibe is a highly-selective inhibitor of cholesterol absorption and simvastatin is an evidence-based inhibitor of cholesterol synthesis. The LDL-C-lowering efficacy of targeting both major sources of cholesterol with ezetimibe plus simvastatin was demonstrated in several multicentre, double-blind, placebo-controlled trials in patients with hypercholesterolaemia. For patients who do not reach their cholesterol goal with a statin, adding ezetimibe 10 mg significantly reduces LDL-C compared with statin monotherapy. Thus, this treatment option may help patients reach the new 'stricter' cholesterol goals. This review, based on a Medline database search from January 2000 to August 2005, considers the LDL-C-lowering efficacy of ezetimibe and discusses the role of this agent for patients who fail to achieve guideline cholesterol goals with statin monotherapy.

Anticholesteremic Agents↗
PubMed2001

Self-efficacy and goal importance in the prediction of physical disability in people following hospitalization: a prospective study.

OBJECTIVES: This prospective study evaluates the role of self-efficacy and goal importance in predicting decreases in disability in activities of everyday living. METHOD: Disability, self-efficacy and goal importance were each assessed before and at 3 and 9 months after participants underwent joint replacement surgery. RESULTS: Disability had decreased at 3 and 9 months post-surgery assessments. Self-efficacy beliefs were higher at 3 and 9 months following surgery while goal importance was increased at 9 months but not at 3 months. Medical variables and prior disability predicted disability at 3 months. Social-cognitive variables did not contribute to the prediction of 3 months disability. Pre-surgery goal importance and self-efficacy at 3 months were independent predictors of disability at 9 months after controlling for pre-surgery and 3 months disability. Evidence also suggested that goal importance and self-efficacy interacted to predict levels of disability at 9 months following surgery. CONCLUSIONS: The findings demonstrate that recovery is governed not solely by medical phenomena but also by psychological variables and suggest that modification of these variables may have an impact on recovery outcomes. Moreover, attention should be paid to the timing of such intervention and to the length of follow-up.

Journal Article↗
PubMed2006

Attainment of treatment goals by people with Alzheimer's disease receiving galantamine: a randomized controlled trial.

BACKGROUND: Although cholinesterase inhibitors have produced statistically significant treatment effects, their clinical meaningfulness in Alzheimer's disease is disputed. An important aspect of clinical meaningfulness is the extent to which an intervention meets the goals of treatment. METHODS: In this randomized controlled trial, patients with mild to moderate Alzheimer's disease were treated with either galantamine or placebo for 4 months, followed by a 4-month open-label extension during which all patients received galantamine. The primary outcome measures were Goal Attainment Scaling (GAS) scores from assessments by clinicians and by patients or caregivers of treatment goals set before treatment and evaluated every 2 months. Secondary outcome measures included the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Clinician's Interview-based Impression of Change plus Caregiver Input (CIBIC-plus), the Disability Assessment for Dementia (DAD) and the Caregiving Burden Scale (CBS). To evaluate treatment effect, we calculated effect sizes (as standardized response means [SRMs]) and p values. RESULTS: Of 159 patients screened, 130 (mean age 77 [standard deviation (SD) 7.7]; 63% women) were enrolled in the study (64 in the galantamine group and 66 in the placebo group); 128 were included in the analysis because they had at least one post-baseline evaluation. In the intention-to-treat analysis, the clinician-rated GAS scores showed a significantly greater improvement in goal attainment among patients in the galantamine group than among those in the placebo group (change from baseline score 4.8 [SD 9.6]) v. 0.9 [SD 9.5] respectively; SRM = 0.41, p = 0.02). The patient- caregiver-rated GAS scores showed a similar improvement in the galantamine group (change from baseline score 4.2 [SD 10.6]); however, because of the improvement also seen in the placebo group (2.3 [SD 9.0]), the difference between groups was not statistically significant (SRM = 0.20, p = 0.27). Of the secondary outcome measures, the ADAS-cog scores differed significantly between groups (SRM = -0.36, p = 0.04), as did the CIBIC-plus scores (SRM = -0.40, p = 0.03); no significant differences were in either the DAD scores (SRM = 0.28, p = 0.13) or the CBS scores (SRM = -0.17, p = 0.38). INTERPRETATION: Clinicians, but not patients and caregivers, observed a significantly greater improvement in goal attainment among patients with mild to moderate Alzheimer's disease who were taking galantamine than among those who were taking placebo.

Aged↗
PubMed1986

Acceptability of nonabstinence treatment goals among alcoholism treatment programs.

The main objective of this study was to identify the number and type of alcoholism programs in the province of Ontario, Canada, which endorse treatment goals other than complete abstinence. A survey of all alcoholism programs in the province revealed that 36.7% of the programs found nonabstinence goals appropriate for at least some clients. Endorsement of nonabstinence goals was lowest for detoxication centers and residential treatment services, and highest for nonresidential programs and assessment-referral services. Endorsement of nonabstinence goals was higher among programs aimed at young people and those associated with the criminal justice system. Within a treatment program, the use of various kinds of assessment methods and treatment modalities did not appear to be closely associated with the endorsement of abstinence vs nonabstinence treatment goals.

Alcohol Drinking↗
PubMed2002

Maintenance of low-density lipoprotein goal with step-down pravastatin therapy.

STUDY OBJECTIVE: To determine whether patients who had achieved their National Cholesterol Education Program (NCEP)-derived goals for low-density lipoprotein (LDL) cholesterol with pravastatin would benefit from step-down therapy. DESIGN: Prospective, randomized, open-label study SETTING: Kansas City Veterans Affairs Medical Center. PATIENTS: One hundred four men who were taking pravastatin once/day and had maintained their NCEP-defined LDL goal for at least 3 months. INTERVENTION: Fifty-three patients were randomized to group 1, for which the dosing frequency was changed from daily to every other day, and 51 patients were randomized to group 2, for which the daily dose was halved. MEASUREMENTS AND MAIN RESULTS: Fasting lipid profiles and hepatic transaminase levels were analyzed at baseline, 2 months, and 4 months. Lifestyle, concomitant drug therapy, adverse events, weight, and compliance were noted at baseline and month 4. Thirty-one patients (58%) from group 1 and 22 patients (43%) from group 2 did not remain at their LDL goal after step-down pravastatin therapy Mean LDL at study end was 113 mg/dl for group 1 and 104 mg/dl for group 2 (p=0.04). CONCLUSION: More than half (51%) of the patients enrolled did not remain at their LDL goal with step-down pravastatin therapy Therefore, we do not recommend a step-down approach for patients who have achieved their LDL goals. If a clinician decides, however, to attempt dosage reduction, the preferred regimen appears to be to halve the current dose once/day (vs administering the current dose every other day). A fasting lipid profile should be evaluated at 2 months and 4 months after step-down therapy begins to ensure that desired outcomes are achieved.

Aged↗
PubMed2006

Effect of rosuvastatin compared with other statins on lipid levels and National Cholesterol Education Program goal attainment for low-density lipoprotein cholesterol in a usual care setting.

STUDY OBJECTIVE: To compare, in a usual care setting, the effects of rosuvastatin and other 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) on lipid levels and on goal attainment of low-density lipoprotein cholesterol (LDL) levels from the National Cholesterol Education Program (NCEP) third report of the Adult Treatment Panel (ATP III). DESIGN: Retrospective, longitudinal, cohort study. DATA SOURCE: Managed care medical and pharmacy claims and laboratory database. PATIENTS: A total of 8251 patients starting treatment with rosuvastatin, atorvastatin, simvastatin, pravastatin, lovastatin, or fluvastatin from August 1, 2003-September 30, 2004, excluding those who received dyslipidemic therapy in the previous 12 months. MEASUREMENTS AND MAIN RESULTS: Patients with at least one pretreatment and posttreatment lipid level were followed until their initial statin was changed or they reached the end of benefit eligibility or the study period. Percent changes in lipid levels were calculated, and adjusted changes in LDL and goal attainment were evaluated by regression techniques. Absolute and percent reductions in LDL, triglyceride, and total cholesterol levels were significantly greater with rosuvastatin than with other statins (all p<0.05 except for triglyceride reduction vs atorvastatin). After adjustment for age, sex, and baseline LDL, percent LDL reductions still were significantly greater with rosuvastatin than with other statins (p<0.05). Changes in high-density lipoprotein cholesterol were not significant. Goal attainment was higher with rosuvastatin than with other statins after adjustment for age, sex, baseline LDL, risk status, dose, and duration of therapy (p<0.05). Dose-stratified analysis showed that LDL goal attainment was significantly higher with rosuvastatin 10 mg than with atorvastatin 10 or 20 mg. CONCLUSION: Rosuvastatin was more effective than other statins in reducing LDL, triglyceride (except vs atorvastatin), and total cholesterol levels. Significantly more patients taking rosuvastatin than patients taking other statins attained their LDL goals.

Adult↗
PubMed2004

Practical management of type 1 diabetes mellitus in adolescent patients: challenges and goals.

Type 1 diabetes mellitus in adolescents presents diagnostic and management challenges. Diagnostically, the challenge is to distinguish type 1 from type 2 diabetes. A thin adolescent in diabetic ketoacidosis is easily recognized as having type 1 diabetes. However, since obesity does not negate the presence of type 1 diabetes, it is appropriate to measure diabetes-related antibody, C-peptide, and insulin levels in individuals who are thought to have type 2 diabetes to ensure that they do not have type 1 or a mixed type of diabetes. The goals for the management of type 1 diabetes in adolescents are to (i) prevent diabetic ketoacidosis; (ii) prevent severe hypoglycemia; (iii) maintain normal growth and development; and (iv) prevent long-term diabetic complications. To prevent diabetic ketoacidosis, patients must take their insulin appropriately. To ensure that this happens, increased parental supervision, psychological counseling, or placement in a different home environment may be necessary. All patients must be taught to appropriately manage sick days and test their urine for ketones when hyperglycemia is present. Prevention of severe hypoglycemia involves ensuring that the patient understands the symptoms of hypoglycemia and knows to test and treat it when the signs are present. Patients and families also need to know how to adjust insulin doses to prevent hypoglycemia and how to manage exercise appropriately. Patients with hypoglycemic unawareness need to meticulously avoid hypoglycemia. To maintain normal growth and development, adolescents with type 1 diabetes must have the appropriate tools to effectively match their meals to their lifestyle and to avoid the increased weight gain associated with improved glycemic control without intentionally manipulating their insulin dose to lose weight. The Diabetes Control and Complications Trial demonstrated that improved glycemic control decreased the risk of long-term diabetic complications. The goals of treatment in this study should be the goals for all adolescents with type 1 diabetes. To reach these goals, home glucose monitoring is critical. Patients need to know how to adjust insulin to maintain glucose levels in the range of 70-120 mg/dL (3.9-6.7 mmol/L) before meals. Insulin regimens need to be individually tailored to meet each patient's needs. Patients should be followed in a clinic using a multidisciplinary team approach at least every 3 months. Glycosylated hemoglobin should be measured at each visit. Regular eye exams, blood pressure monitoring, and urinary microalbumin measurements are critical. In this manner, the goals of management of type 1 diabetes in adolescents can be met.

Adolescent↗
PubMed1995

Means, goals, and outcomes of a comprehensive occupational health program for telephone operators.

A means-goals analysis requires a plan with some degree of distinctness, which is worked out beforehand and specifies reasonably clear goals and intended means. This article draws its material from a broadly designed strategy for organizational change that meets these criteria. A service division of Swedish Telecom underwent a program of comprehensive organizational change; major efforts were made to improve the occupational health of 300 telephone operators in manual service operations. Over a full three-year period, a number of specific problems were to be resolved. An independent research team evaluated the implementation of the program prospectively. The team followed an evaluation model in which stringent distinction was made between: (1) action areas, (2) intended specific means, (3) intended immediate goals, and (4) the longer-term favorable effects of achieving these immediate goals. In addition, an attempt was made to interpret and understand the findings of the means-goals evaluation by paying systematic attention to the implementation process and factors that might permit an understanding of the final outcomes of the program. Compared with other efforts to improve telephone operators' work conditions as reported in the research literature, this strategy for the promotion of change is broad and ambitious.

Comprehensive Health Care↗
PubMed2006

Health inequities, environmental insecurity and the attainment of the millennium development goals in sub-Saharan Africa: the case study of Zambia.

The United Nations Millennium Development Goals (MDGs) are a series of 8 goals and 18 targets aimed at ending extreme poverty by 2015, and there are 48 quantifiable indicators for monitoring the process. Most of the MDGs are health or health-related goals. Though the MDGs might sound ambitious, it is imperative that the world, and sub-Saharan Africa in particular, wake up to the persistent and unacceptably high rates of extreme poverty that populations live in, and find lasting solutions to age-old problems. Extreme poverty is a cause and consequence of low income, food insecurity and hunger, education and gender inequities, high disease burden, environmental degradation, insecure shelter, and lack of access to safe drinking water and basic sanitation. It is also directly linked to unsound governance and inequitable distribution of public wealth. While many regions in the world will strive to attain the MDGs by 2015, most of the countries in sub-Saharan Africa, with major human development challenges associated with socio-economic disparities, will not. Zambia's MDG progress reports of 2003 and 2005 show that despite laudable political commitment and some advances made towards achieving universal primary education, gender equality, improvement of child health and management of the HIV/AIDS epidemic, it is not likely that Zambia will achieve even half of the goals. Zambia's systems have been weakened by high disease burden and excess mortality, natural and man-made environmental threats and some negative effects of globalization such as huge external debt, low world prices for commodities and the human resource "brain drain", among others. Urgent action must follow political will, and some tried and tested strategies or "quick wins" that have been proven to produce high positive impact in the short term, need to be rapidly embarked upon by Zambia and other countries in sub-Saharan Africa if they are to achieve the Millennium Development Goals.

Child↗
PubMed2005

Effectiveness of outpatient geriatric assessment programs: exploring caregiver needs, goals, and outcomes.

In this study, the authors examined the goals and outcomes of 141 caregivers of older adults with cognitive impairment who attended a comprehensive geriatric assessment program (CGA). The vast majority of caregivers expressed at least one assessment goal, suggesting that the concept was relevant to them. Most caregiver goals focused on patient needs, with only 10% expressing goals specifically related to their own coping needs. At follow up, more than two-thirds of caregiver goals were attained. The findings confirm the great potential of CGA programs in promoting positive outcomes and point to the opportunities for nurses to improve the process of care.

Aged↗
PubMed1998

Goals for Alzheimer's care in nursing homes: what kind of differences do special care units expect to make?

Special Care Units (SCUs) for people with dementia have been enthusiastically promoted although many residents with dementia live elsewhere in their nursing home. In response to open-ended questions during personal interviews, coordinators of all 64 SCUs in Minnesota nursing homes described their goals and criteria for success. They then rated the importance of a list of possible goals and their unit's success in achieving them. Unit coordinators of 173 nursing home units in facilities with SCUs and 135 units in facilities without SCUs answered the same questions about people with dementia in their own units. When unprompted, respondents both in and outside SCUs were varied, sparse (averaging 3.1 goals per person), vague, process-oriented rather than outcome-oriented, and sometimes unrealistic. Yet, respondents later strongly endorsed most of the 24 goals the researchers suggested. ANOVA and regression analyses revealed few statistically significant differences according to unit type, although SCU coordinators were more likely to aspire to fewer medications, reduced disruptive behavior, and reduced agitation and anxiety, and were less likely to want residents to sleep through the night. Some differences were only between SCUs and non-SCUs in facilities without SCUs. Characteristics of facilities, coordinators, and case mix (e.g., proportion of dementia on the unit) were as predictive of goals and perceptions of success as SCU units. Findings reinforce the lack of conceptual clarity about expectations for direct and indirect effects of SCUs.

Aged↗