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At least 775 records · Page 43Linked to original sources
PubMed2004

Treatment of high-risk patients with ezetimibe plus simvastatin co-administration versus simvastatin alone to attain National Cholesterol Education Program Adult Treatment Panel III low-density lipoprotein cholesterol goals.

This study assessed whether the co-administration of ezetimibe and simvastatin would be more effective than simvastatin monotherapy in allowing high-risk patients to achieve a low-density lipoprotein (LDL) cholesterol goal of <100 mg/dl. Men and women with LDL cholesterol >/=130 mg/dl and meeting National Cholesterol Education Program Adult Treatment Panel III criteria for coronary heart disease (CHD) or CHD risk equivalent were randomized to 1 of 4 daily treatments for 23 weeks: simvastatin 20 mg (n = 253), ezetimibe 10 mg plus simvastatin 10 mg (n = 251), ezetimibe 10 mg plus simvastatin 20 mg (n = 109), and ezetimibe 10 mg plus simvastatin 40 mg (n = 97). In all groups, patients not at goal had their simvastatin doses doubled at weeks 6, 12, and/or 18, up to a maximum of 80 mg. The primary efficacy objective was LDL cholesterol goal attainment (<100 mg/dl) after 5 weeks of treatment. Ezetimibe plus any dose of simvastatin produced greater reductions in LDL cholesterol and allowed more patients to achieve goal after 5 weeks (p <0.001) and at the end of the study (p <0.001) than simvastatin 20 mg alone. At 5 weeks, 75%, 83%, and 87% of patients receiving ezetimibe plus simvastatin 10, 20, and 40 mg had LDL cholesterol <100 mg/dl compared with 46% of patients receiving simvastatin 20 mg. In patients who started on ezetimibe plus simvastatin 10, 20 and 40 mg, 33%, 22%, and 12%, respectively, required simvastatin titration during the study compared with 68% of patients who started on simvastatin 20 mg. The corresponding median simvastatin doses used were 10, 20, 40, and 40 mg, respectively. Ezetimibe plus simvastatin was well tolerated, with an overall safety profile similar to that of simvastatin monotherapy. Thus, through the dual inhibition of cholesterol absorption and synthesis, ezetimibe plus simvastatin allowed more patients to reach LDL cholesterol <100 mg/dl at a lower simvastatin dose and with fewer dose titrations than simvastatin monotherapy.

Adult↗
PubMed2006

Rosuvastatin 5 and 10 mg/d: a pilot study of the effects in hypercholesterolemic adults unable to tolerate other statins and reach LDL cholesterol goals with nonstatin lipid-lowering therapies.

BACKGROUND: Patients with high levels of low-density lipoprotein cholesterol (LDL-C) might not tolerate 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ("statins") because of adverse effects (AEs) and might not respond well enough to nonstatin lipid-lowering therapies (LLTs) to meet LDL-C goals. OBJECTIVE: The purpose of this study was to assess the acceptability, effectiveness, and safety profile of rosuvastatin 5 and 10 mg/d in consecutively referred patients with primary high LDL-C who were unable to tolerate other statins because of myalgia and, subsequently in some cases, unable to reach LDL-C goals with nonstatin LLT. METHODS: This prospective, open-label pilot study was conducted in consecutively referred male and female patients aged 38 to 80 years with primary high LDL-C (mean, 177 mg/dL) at The Cholesterol Center, Jewish Hospital, Cincinnati, Ohio. Patients were instructed in the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) therapeutic lifestyle changes diet. Rosuvastatin 5 mg/d was administered to patients categorized by NCEP ATP III risk stratification as moderately high risk, and rosuvastatin 10 mg/d was administered to patients categorized as high or very high risk. End points included acceptability (assessed using patient-initiated discontinuation of rosuvastatin), effectiveness (absolute and percentage reductions in LDL-C and triglycerides), and safety profile (aspartate and alanine aminotransferases [AST and ALT, respectively] >3 times the laboratory upper limit of normal [xULN] or elevations in creatine kinase [CK]>10xULN). RESULTS: A total of 61 patients were enrolled (41 women, 20 men; mean [SD] age, 60 [10] years; 5-mg/d dose, 25 patients; 10-mg/d dose, 36 patients). Myalgia, a predominant AE, had caused 50 patients to previously discontinue treatment with atorvastatin; 30, simvastatin; 19, pravastatin; 5, fluvastatin; 2, ezetimibe/simvastatin; and 1, lovastatin. Eighteen patients subsequently failed to reach LDL-C goals with nonstatin LLT(s) alone (colesevelam, 10 patients; ezetimibe, 8; niacin extended release, 2; and fenofibrate, 1). After a median treatment duration of 16 weeks, rosuvastatin 5 mg/d+diet was associated with a mean (SD) decrease from baseline in LDL-C of 75 (34) mg/dL (mean [SD] %Delta, -42% [18%]) (P<0.001 vs baseline). After a median treatment duration of 44 weeks, rosuvastatin 10 mg/d+diet was associated with a mean (SD) decrease from baseline in LDL-C of 79 (49) mg/dL (mean [SD] %Delta, -42% [24%]) (P<0.001 vs baseline). Of the 61 patients, 1 receiving the 10-mg/d dose discontinued rosuvastatin treatment because of unilateral muscular pain after 4 weeks; no AST or ALT levels were >3xULN, and no CK levels were >10xULN. CONCLUSION: In these 61 hypercholesterolemic patients unable to tolerate other statins and, subsequently in some cases, unable to meet LDL-C goals while receiving nonstatin LIT monotherapy, these preliminary observations suggest that rosuvastatin at doses of 5 and 10 mg/d+diet was well tolerated, effective, and had a good safety profile.

Adult↗
PubMed2006

The influence of communication goals and physical demands on different dimensions of pain behavior.

The purpose of the present research was to examine the influence of communication goals and physical demands on the expression of communicative (e.g., facial grimaces) and protective (e.g., guarding) pain behaviors. Participants with musculoskeletal conditions (N=50) were asked to lift a series of weights under two communication goal conditions. In one condition, participants were asked to estimate the weight of the object they lifted. In a second condition, participants were asked to rate their pain while lifting the same objects. The display of communicative pain behaviors varied as a function of the communication goal manipulation; participants displayed more communicative pain behavior when asked to rate their pain while lifting objects than when they estimated the weight of the object. Protective pain behaviors varied with the physical demands of the task, but not as a function of the communication goals manipulation. Pain ratings and self-reported disability were significantly correlated with protective pain behaviors but not with communicative pain behaviors. The results of this study support the functional distinctiveness of different forms of pain behavior. Findings are discussed in terms of evolutionary and learning theory models of pain behavior. Clinical implications of the findings are addressed.

Adult↗
PubMed2005

Patients' and healthcare providers' understandings of life-sustaining treatment: are perceptions of goals shared or divergent?

In this cross-sectional qualitative study, researchers performed in-depth, semistructured interviews with 30 pairs of patients and their primary care providers in an outpatient clinic of a large, urban Veterans Affairs (VA) medical center in the United States. During audiotaped interviews to assess their understanding of advance directive concepts, participants were asked what "life-sustaining treatment" means to them and why they think of it in the way they do. The findings indicate that patients and providers in the United States tend to view and discuss life-sustaining treatment in terms of four goals for end-of-life care: (1) extending the length of life, (2) improving the quality of life, (3) maintaining or improving specific biological functions, and (4) assisting the body for a temporary period of time. Patients thought providers were more concerned with extending the length of life than with quality-based outcomes, and patients often discussed life-sustaining treatment as acceptable means for short-term but not long-term use. Many providers indicated that they struggle with conflicting quality-based and physiologic care goals. The findings highlight the importance of eliciting patient preferences not only for specific types of treatment, such as cardiopulmonary resuscitation, but also for end-of-life care goals or desired health-related outcomes, such as maximizing the quantity of life. The findings also suggest that advance directives and patient-provider discussions that focus on acceptable health states and valued life activities may be better suited to patients' end-of-life care goals than those that focus on specific medical interventions.

Adult↗
PubMed1996

Meeting national cholesterol education goals in clinical practice--a comparison of lovastatin and fluvastatin in primary prevention.

The available clinical data for 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors demonstrate their efficacy and safety in treating hypercholesterolemia and improving long-term morbidity and mortality related to coronary artery disease. Comparative studies among agents in this class support the general perception that, at the most commonly prescribed doses, all these drugs reduce low-density lipoprotein (LDL) cholesterol levels by about 20-30%. The primary measure of efficacy in the current study was the percentage of patients achieving goal levels for LDL cholesterol of < 160 mg/dL, as proposed by the National Cholesterol Education Program (NCEP). This study compares the most widely prescribed agent in this class, lovastatin, with the newest agent, fluvastatin. Patients enrolled had previously been satisfactorily treated with lovastatin 20 mg every evening. Following a placebo washout period, patients were randomized to receive lovastatin 20 mg with the evening meal (69 patients) or fluvastatin 20 mg at bedtime (68 patients) for 4 weeks of open-label therapy. In a second 4-week period, patients on lovastatin continued on the initial dosage while patients receiving fluvastatin had their daily dosage increased to 40 mg at bedtime to evaluate the range of efficacy from 20-40 mg/day. In both treatment arms, the majority of patients achieved the goal lipid level. Approximately 85% of patients on fluvastatin 20 mg and 90% of patients on lovastatin 20 mg achieved the goal within 4 weeks. This small difference was not statistically significant. Increasing the dosage to 40 mg at bedtime in the fluvastatin arm produced goal LDL cholesterol levels in about 90% of patients. Both agents were well tolerated; no patients discontinued therapy because of adverse events.

Fatty Acids, Monounsaturated↗
PubMed1997

Treatment goals for low-density lipoprotein cholesterol in the secondary prevention of coronary heart disease: absolute levels or extent of lowering?

The results of the Scandinavian Simvastatin Survival Study (4S) and the Cholesterol and Recurrent Events (CARE) study make abundantly clear the benefits of lowering low-density lipoprotein (LDL) cholesterol in patients with a history of coronary artery disease. Current guidelines in the United States and Germany recommend a treatment goal for LDL cholesterol of 100 mg/dl. However, the evidence for setting such a goal is not consistent among trials. It has even been argued that setting an absolute LDL goal may be unhelpful, per se, because the higher the patient's pretreatment LDL cholesterol, the more difficult achieving this goal becomes. It has also been recognized that measures to lower LDL cholesterol, and medications in particular, produce a relative rather than an absolute degree of reduction in circulating levels. For example, most statins produce a similar proportional decrease in LDL cholesterol irrespective of baseline LDL. Thus, if the baseline LDL is 180 mg/dl, the decrease in LDL with a particular statin dose may be 60 to 120 mg/dl, whereas if the baseline LDL is 120 mg/dl, the expected decrease in LDL with the same statin dose would be only 40 to 80 mg/dl (i.e., a 30% reduction in each case). These points have led some investigators to suggest that it may be more practicable to recommend the amount by which LDL should be lowered rather than by specifying an absolute level of LDL cholesterol which should be achieved. This report summarizes the proceedings of an international symposium held on this topic on October 4, 1996, in Berlin by the International Task Force for Prevention of Coronary Heart Disease and the Institute of Arteriosclerosis Research at the University of Münster.

Adult↗
PubMed1997

The effect of goal-subgoal conflict on planning ability after frontal- and temporal-lobe lesions in humans.

Twenty-one patients with unilateral prefrontal cortical neurosurgical lesions (11 left and 10 right) and 38 patients with unilateral temporal lobectomy (19 left and 19 right) were compared to 44 matched control subjects on their performance on the 3-D Computerized Tower of Hanoi (3-D CTOH) test. The problems were split into those with or without a significant goal-subgoal conflict determined by whether the correct first move in each problem took the subject apparently away or towards the final goal state. The left frontal lesion and right temporal lobectomy groups were significantly impaired on problems with goal-subgoal conflicts. In the left frontal group, this deficit was confined to earlier four-move problems, whereas the right temporal group showed a more general deficit on later five-move problems. The left frontal lesion deficit is explained in terms of an inability to inhibit the response compatible with achieving a final goal, whereas the impairment in the right lesion group was related to a specific impairment in spatial memory.

Adult↗
PubMed2002

Effects of D(1) receptor agonist SKF 38393 on male rat sexual behavior and postcopulatory departure in the goal compartment-runway paradigm.

Male rats were tested in an apparatus in which the goal compartment of the runway was connected with the start compartment by a one-way door. In this apparatus, the male spontaneously left the goal compartment containing the estrous female after a mount bout (the cluster of one or more copulatory events) and a new run started. This effect (the postcopulatory departure) seems to be due to the competition between the incentive value of the stimulus female and the runway. The dopamine D(1) receptor agonist SKF 38393 at the doses of 1-5 mg/kg sc significantly prolonged the time spent by the male in the goal compartment, while both run latency and run duration remained unaffected. Further analysis showed that the prolongation of the time in goal compartment results from increased duration of copulatory behavior accompanied by increased number of copulatory events. Although SKF 38393 did not influence the latency of postcopulatory departures, incomplete departures occurred in five out of eight males. In the free access to female conditions, the SKF 38393 did not influence copulatory performance, except for a reduction in the number of intromissions at the dose of 1 mg/kg sc. On the other hand, a significant reduction of postejaculatory ultrasonic vocalization was observed.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed2002

Kinematics of a coordinated goal-directed bimanual task.

The experiments address the problem of bimanual coordination in a familiar task of everyday life. A goal-directed drawer-pulling task, with asymmetrical assignments among hands, was analyzed with the objective to detect discrete kinematic events ('anchors') that potentially could serve in proper goal synchronization. The left hand reached out for the drawer and opened it while the right hand performed a prehension movement to pick up a peg from the drawer. The task was smoothly performed, independently of vision. Typically, trajectories and velocity profiles of the leading pull-hand were more stereotypical than the more variable ones of the pick-hand. The pull-hand had a large velocity peak during reaching, followed by a small peak during pulling. Velocity profiles of the pick-hand were not bell-shaped and exhibited one or two broad waves, often with an irregular and probing evolution. Velocity profiles of both hands were aligned with the first or the second velocity peak of the leading pull-hand. In the majority of cases, temporal associations of events in the kinematics of the two limbs could thus be identified, which could serve to synchronize the hands at the goal. The nearly straight biphasic reach-and-pull trajectory of the leading hand contrasted with the more curved trajectory of the right pick-hand whereas, in the same unimanual action, the latter trajectories were quasi-rectilinear. Changing constraints (no vision, cutaneous anesthesia of pulling fingers) could change the coordination pattern. We argue that bimanual coordination relies on two interacting mechanisms: (1) feedforward control on the basis of sensorimotor memory; (2) temporal adjustments during the evolving bimanual synergy. Multiple strategies, imposed by the leading pull-hand, appeared to be responsible for feedback-induced corrections in the pick-hand and were found to contribute to the goal-invariance and to the principle of motor equivalence.

Adult↗
PubMed1999

Postural adjustments during spontaneous and goal-directed arm movements in the first half year of life.

We studied the development of postural control during goal-directed reaching and spontaneous arm movements in early infancy. Two groups of infants participated. The first group consisted of 10 healthy infants, who were assessed four times at the ages of 3, 4, 5 and 6 months. Each assessment consisted of simultaneous recording of video-data and surface EMGs of arm, neck, trunk, and leg muscles in various lying and sitting positions. Additionally, postural adjustments during spontaneous arm movements were studied in a second group of five infants aged 1-3 months. Already before the onset of successful reaching, which occurred at 4 5 months, both spontaneous and goal-directed arm movements were accompanied by a high amount of postural activity. During the goal-directed arm movements a preference for neck muscle activation and a direction specific organisation (dorsal postural muscles activated before the ventral antagonists) prevailed, whereas during spontaneous arm movements such a specific postural organisation was absent. With increasing age and concurrent with successful reaching, the amount of postural activity decreased. Still, the persisting postural activity continued to become more organised with increasing age. Position affected the postural adjustments accompanying goal-directed arm movements at all ages.

Arm↗
PubMed1997

Case-based learning of plans and goal states in medical diagnosis.

We introduce a case-based system, BOLERO, that learns both plans and goal states. The major aim is that of improving the performance of a rule-based diagnosis system by adapting its behavior using the most recent information available about a patient. On the one hand BOLERO gets knowledge from cases in the form of diagnostic plans that are represented as sequences of decision steps. The advantages of this representation include: (1) retrieval and adaptation of parts of plans (steps) appropriate to the current problem state; (2) generation of new plans not previously available in memory; and (3) learning from experience, both from successful or failed plans. On the other hand, since goal states are sets of final diagnosis likelihoods they are not known beforehand, i.e. goal states are not defined and the system has to learn to recognize them. For this reason BOLERO has a case-based method that uses solutions of past cases to recognize a diagnostic state as a goal state of a new planning problem. BOLERO and a rule-based system are integrated into a meta-level architecture in which we emphasize the collaboration of both systems in solving problems. The rule-based system executes the plans generated by BOLERO. As a consequence of the execution of plans, the rule-based system furnishes BOLERO with new information with which BOLERO can generate a new plan to adapt the reasoning process of the rule-based system into correspondence with the recent available data. All the methods have been designed to be useful for medical diagnosis and have been tested in the domain of diagnosing pneumonia.

Artificial Intelligence↗
PubMedDate not supplied

A society of goal-oriented agents for the analysis of living cells.

This paper presents a new model for the segmentation and analysis of living cells. A multi-agent model has been developed for this application. It is based on a generic agent model, which is composed of different behaviors: perception, interaction and reproduction. The agent is further specialized to accomplish a specific goal. Different goals are defined from the different components of the cell images. The specialization specifies the parameters of the behaviors for the achievement of the agent's goal. From these goal-oriented agents, a society is defined, and it evolves dynamically as the agents are created and deleted. An internal manager is integrated in the agent to control the behavior's execution. It makes use of an event-driven scheme to manage the behavior priorities. The present design is mainly oriented toward image segmentation, however, it includes some features on tracking and motion analysis.

Animals↗
PubMed2002

A new reality: achieving cholesterol-lowering goals in clinical practice.

Physicians often fail to achieve recommended low-density lipoprotein (LDL) cholesterol goals for their patients using lipid-lowering therapies in the primary care setting. A variety of factors may contribute to this failure, including inadequate effectiveness of lipid-lowering drugs in reducing LDL cholesterol at commonly used doses. In the Lipid Assessment Treatment Project (L-TAP), for example, the success rates for lipid-regulating therapies and treatments according to National Cholesterol Education Program (NCEP) Adult Treatment Panel II (ATP II) LDL cholesterol goals were 43% for bile acid sequestrants, 39% for niacin, 32% for gemfibrozil, 28% for psyllium fiber, 40% for statins, and 40% for combination therapy. Rosuvastatin is a new statin that has been shown to achieve significantly greater reductions in LDL cholesterol compared with pravastatin, simvastatin, and atorvastatin in primary hypercholesterolemia and enabled greater proportions of patients to achieve LDL cholesterol goals. Similarly, rosuvastatin proved superior to atorvastatin in lowering LDL cholesterol in patients with familial hypercholesterolemia, with more patients achieving LDL cholesterol goals. Data from these trials suggest that rosuvastatin is as safe and well tolerated as other statins. The availability of lipid-lowering drugs with greater LDL cholesterol-lowering effects could simplify the approach to coronary heart disease risk reduction in primary care.

Adult↗
PubMed2000

Therapeutic approaches to achieve desired blood pressure goals: focus on calcium channel blockers.

The new guidelines for blood pressure control recommended by the World Health Organisation, the International Society of Hypertension, and the JNC VI require that blood pressure be lowered to levels of < 130/85 mmHg in persons with either diabetes or renal insufficiency. A review of over 20 clinical trials performed over the last two decades indicates that an average of 62% of the participants required more than two medications to achieve a goal of < 140/90 mmHg. Thus, with the new guidelines it is clear that an even higher proportion of people will require at least two different medications to achieve this lower goal. Certain classes of antihypertensive medications are relatively more efficacious for lowering blood pressure in certain ethnic and racial groups, thus reducing the probability that two or more agents will be needed to achieve a stated blood pressure goal. This is exemplified by the effects of calcium channel blockers in African-Americans. However, even in these groups many require at least two different antihypertensive agents to achieve the blood pressure goal. The fixed-dose combinations of a calcium channel blocker and ACE inhibitor offer the advantages of complementary physiologic action, improved tolerability, lower side-effect profile, enhanced salutary effects on target organs, better compliance, and lower cost. Varieties of fixed-dose combination regimens for blood pressure lowering are available for clinical use. This article focuses on the subclasses of calcium channel blockers and their role in altering the natural history of both cardiovascular and renal disease. The article further discusses the role of fixed-dose agents with regard to their place in the antihypertensive armamentarium.

Antihypertensive Agents↗
PubMed2002

Wisdom, casuistry, and the goal of reproductive counseling.

Reproductive counseling includes counseling of prospective parents by obstetricians, clinical geneticists, and genetic counselors regarding, for example, the use of assisted reproductive technologies, prenatal testing, and preimplantation genetic diagnosis. Two different views on wisdom and the goal of reproductive counseling are analyzed. According to the first view, the goal of reproductive counseling is to help prospective parents reach a wise decision. A specific course of action is recommended by the counselor in contrast to other possible alternatives. According to the second view, the goal of reproductive counseling is not to help prospective parents reach a wise decision but to help them reach their own decision wisely. It is the prospective parents who should make the decision, and it is their value commitments that should be decisive. It is argued that the second approach is to be preferred to the first. It combines respect for autonomy with a recognition of the need for assistance in decision-making. Both the first and second views relate the goal of reproductive counseling to wisdom. A problem is, however, what wisdom more precisely means - there are many different views. A casuistic view of wisdom is investigated. This view roughly defines wisdom as practical prudence in dealing with particular cases. What characterizes a casuistic decision-making method is elaborated in more detail. Applied to the second view, a casuistic view of wisdom implies that the counselor should encourage prospective parents to take into consideration the nature of the particular problem at hand, the context of the problem, their own individual identities, their personal value commitments, and various alternative perspectives, values and arguments.

Counseling↗
PubMed1989

The goal of forming accurate impressions during social interactions: attenuating the impact of negative expectancies.

Investigated the idea that impression formation goals may regulate the impact that perceiver expectancies have on social interactions. In simulated interviews, interviewers Ss were given a negative expectancy about one applicant S and no expectancy about another. Half the interviewers were encouraged to form accurate impressions; the others were not. As predicted, no-goal interviewers exhibited a postinteraction impression bias against the negative-expectancy applicants, whereas the accuracy-goal interviewers did not. Moreover, the ability of the accuracy goal to reduce this bias was apparently mediated by more extensive and less biased interviewer information-gathering, which in turn elicited an improvement in negative-expectancy applicants' performances. These findings stress the theoretical and practical importance of considering the motivational context within which expectancy-tinged social interactions occur.

Humans↗
PubMed1997

Assigned versus participative goal setting and response generalization: managing injury control among professional pizza deliverers.

Safety belt use, turn signal use, and intersection stopping were observed at 3 pizza delivery locations per driver's license plate numbers. After baseline observations, employees at 1 store participated in goal setting targeting complete stops. Employees at the other store were assigned a goal. Over 4 weeks, the group's percentages of complete intersection stopping were posted. Both intervention groups significantly increased their complete intersection stops during the intervention phase. The participative goal-setting group also showed significant increases in turn signal and safety belt use (nontargeted behaviors) concurrent with their increases in intersection stopping (targeted behaviors). Drivers decreased their turn signal and safety belt use concurrent with the assigned goal condition targeting complete stops.

Accidents, Occupational↗
PubMed2005

Understanding the emergence of state goal orientation in organizational work groups: the role of leadership and multilevel climate perceptions.

This article attends to a broad range of practically significant employee motivations and provides insight into how to enhance individual-level performance by examining individual-level state goal orientation emergence in organizational work groups. Leadership and multilevel climate processes are theorized to parallel each dimension of state goal orientation to cue and ultimately induce the corresponding achievement focus among individual work group members. It is argued that the patterns of leader behavior, which elucidate the leader's achievement priority, shape group members' psychological and work group climate to embody this priority. Resulting multilevel climate perceptions signal and compel group members to adopt the ascribed form of state goal orientation. The quality of the leader-member exchange relationship is viewed as a means to clarify leader messages in the formation of group members' psychological climate and internalize these cues in the emergence of state goal orientation. Considerations for future research and practice are discussed.

Achievement↗