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PubMed1996

Evaluation of client and staff satisfaction with a Goal Planning project implemented with people with spinal cord injuries.

This study assesses client satisfaction and canvasses staff opinions concerning the first year of a Goal Planning rehabilitation programme implemented with in-patients who had sustained a severe spinal cord injury. Questionnaires were completed by 33 patients. As a keyworker system is an integral part of Goal Planning, separate questionnaires were completed by 13 staff/keyworkers. The results indicated that patients believed Goal Planning to be informative about their injury and helpful in promoting a sense of control over their rehabilitation. In addition, a positive, and statistically significant association was found between perceived informativeness and control and the implications for successful rehabilitation are considered. Staff also gave favourable feedback regarding the perceived benefits of Goal Planning for patients, relatives and staff, although they acknowledged the resulting increase in their workload.

Adolescent↗
PubMed2002

Challenges to treatment goals and outcomes in pediatric asthma.

To achieve long-term control in pediatric asthma, it is essential to establish treatment goals acceptable to both the patient and care giver and to choose appropriate outcome measures that will show the benefits of the treatment. Differences between the perceptions of patients and care givers of what constitutes a desirable treatment goal, and poor perception of asthma control by both patient and physician, hinder optimal treatment of asthma. The use of objective outcome measures in pediatric asthma generally can provide a good evaluation of asthma severity as well as a basis for setting treatment goals that are acceptable to patients and care givers alike. Objective measurements that assess airway inflammation, which is the fundamental pathophysiology in asthma and the underlying mechanism for chronic airway remodeling, may be the most useful means for gauging pediatric asthma control and evaluating response to treatment. Techniques such as exhaled nitric oxide analysis, bronchoalveolar lavage, and sputum analysis, although used primarily in research, have successfully identified the level of airway inflammation in children. Furthermore, the association of meaningful outcome measures with education about the long-term effects of uncontrolled asthma and the need for anti-inflammatory treatment should help in developing treatment goals and strategies that will be acceptable to both patient and care giver.

Adolescent↗
PubMed1999

Determination and application of desirable analytical performance goals: the ISO/TC 212 approach.

Desirable analytical performance goals are needed to place clinical laboratories' quality management plan on a rational basis. While the most important basis of desirable analytical performance goals is medical needs, a well-established quality management plan must take into account economic and regulatory needs. There are many approaches that have been proposed for determining desirable analytical performance goals. The ISO/TC 212 approach for rationalizing the various approaches for determining desirable analytical performance goals, which is based on the ability to meet medical needs, is presented.

Clinical Laboratory Techniques↗
PubMed1993

Defining the year 2000 fruit and vegetable goal.

Various nutrition guidelines recommend increased consumption of fruits and vegetables (F+V); a Year 2000 goal targets five or more daily servings of F+V. Decisions are needed regarding how to define F+V to facilitate measurement of goal achievement. Four alternative definitions (narrow and broad, each with and without legumes) were developed and applied to food frequencies from 133 children and 211 parents. Results varied by definition. Mean intake met the goal of five or more daily servings regardless of definition and exceeded it for both broad definitions by children and both broad definitions and the narrow definition with legumes for adults. Median intakes met the goal for all definitions except for children with the narrow definition without legumes, and exceeded it for children with both broad definitions and for adults with the broad definition with legumes. These differences by definition indicate that a clear definition of F+V is needed.

Adult↗
PubMed2000

An industry, clinical, and academic telehealth partnership venture: progress, goals achieved, and lessons learned.

The goal of this project was to develop and test a multi-application telehealth workstation with an interface seamless to the end-users. This project required collaboration among the private sector, a clinical regional referral setting, a clinical tertiary receiving center, and a university academic unit. The project applied the usability testing methodology to design and test the workstation: (1) the developmental phase focused on planning, prototype workstation development, and end-user trials in the private sector research and development environment, and (2) the operational testing phase moved the workstation into the clinical setting. The latter included training of end-users and addressing policy and ethical issues. In addition, the partners documented the goals achieved and lessons learned. The project resulted in the refinement of the workstation for clinical applications. The unique, diverse, and at times complementary goals and lessons learned by each partner are noted. Collaboration around a shared goal was a key element in achieving the refined workstation. Collaborators reported that the lessons learned will aid them as they pursue telehealth activities.

Alberta↗
PubMed2000

Goals and strategies for teaching death and dying in medical schools.

Teaching medical students to respond to needs of the dying represents an important challenge for medical educators. This article describes the goals and objectives that should be identified before medical schools can meet this challenge, as well as strategies that, when implemented, will provide students with the necessary knowledge, skills, and attitudes to meet the needs of the dying patients. The goals and objectives were identified through a modified group consensus process developed during Choice In Dying's 5-year project "Integrating Education on Care of the Dying into Medical Schools." The authors have diverse experiences and backgrounds and are actively involved in death and dying teaching at 11 medical schools. They conclude that after accepting the goals and objectives, key medical school faculty can work cooperatively to develop strategies to integrate them into the school's curriculum. Without first establishing a set of goals and objectives and developing evaluation methods, medical schools could miss their mark in fostering the student's ability to care for the dying.

Journal Article↗
PubMed1995

The contribution of epidemiology to the definition of health goals and targets for Australia.

Health goals and targets may be used to improve the efficiency of investment of resources for health care and the promotion of health the better to fulfil the values and expectations of society. Australia has been developing health goals and targets since 1985. The first step was the establishment of the Better Health Commission that year. Its proposals led to the states and territories undertaking concerted health promotion activities through the National Better Health Program. Subsequently the health-care system as a whole, through the 1993 Medicare agreement, endorsed the goals and targets approach. Epidemiology has played a major role in every step in this process. Initially it was used to establish health status baselines or to point to serious data deficits which stopped a baseline being set. It provided data about the burden and distribution of illness in the community. It was used critically to appraise evidence about aetiology and the fraction of illness attributable to modifiable risk factors and the effectiveness of interventions, and to provide estimates of potential years of life lost through illness and injury. This has contributed, along with economic analysis which is a critically important corollary, to the definition of health care priorities. Epidemiology, while being necessary for these developments, however, has not been sufficient. This 'insufficiency' has three elements. First, existing epidemiological knowledge and methods have been inadequately applied or the data have been missing, or distorted by inappropriate interpretation. Second, there are now goals and targets in health literacy, the health care system, and the environment where epidemiological methods (and hence data) are poorly developed or non-existent.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed2004

Measuring progress in meeting healthy people goals for low birth weight and infant mortality among the 100 largest cities and their suburbs.

We examined the progress of the nation's 100 largest cities and their surrounding suburban areas toward achieving Healthy People 2000/2010 goals for two measures of infant health: low birth weight (LBW) and infant mortality (IM). Using data from the National Center for Health Statistics, we compared 1990 and 2000 urban and suburban LBW and IM rates to target rates for Healthy People 2000 and 2010 objectives. Although the 2000 LBW weight rate for the 100 largest cities was higher than the average for the suburbs (8.9% vs. 7.1%), the increase in LBW rates for the suburbs was nearly four times that of the cities (15.7% vs. 4.1%). Suburban and urban white infants led the increases in LBW rates; urban and suburban black infants showed a slight decrease or no change in LBW rates. Neither cities nor suburbs, on average, met the 2000 target rate of 5%. It appears unlikely that most of the 100 largest cities and suburbs will meet the Healthy People 2010 goal, which remains at 5%, without reductions in preterm births, nationally on the rise. The IM rate declined across most cities and suburbs between 1990 and 2000. However, the 100 largest cities on average did not meet the 2000 IM rate target of 7 infant deaths per 1000 live births; their suburbs did (8.5 vs. 6.4, respectively). The cities and suburbs that did not meet the 2000 target may be especially challenged to meet the 2010 goal for IM unless rates of preterm births are reduced. With the continuing black-white disparities in LBW and IM rates and the overall differences in the racial composition of the largest cities and suburbs, strategies for meeting Healthy People goals will likely need to be targeted to the specific populations they serve.

Black or African American↗
PubMed2004

GOAL: automated Gene Ontology analysis of expression profiles.

One of the most common problems encountered while deciphering results from expression profiling experiments is in relating differential expression of genes to molecular functions and cellular processes. A second important problem is that of comparing experiments performed by different labs using different microarray platforms, or even unrelated techniques. Gene Ontology (GO) is now used to describe biological features, since GO terms are associated with genes, to overcome the apparent distance between expression profiles and biological comprehension. Here we describe the development, implementation and use of GOAL (Gene Ontology Automated Lexicon), a web-based application for the identification of functions and processes regulated in microarray and SAGE (serial analysis of gene expression) experiments. We applied GOAL to a range of experimental datasets related to different biological problems, including cancer and the cell cycle. By using GOAL, reported and novel relevant processes were identified in a number of experiments by our collaborators and by us. Different datasets could also be compared with each other to define conserved functional modules. GOAL allows a seamless and high-level analysis of expression profiles and is implemented as a free WWW resource (http://microarrays.unife.it).

Data Interpretation, Statistical↗
PubMed1988

Prevention of coronary heart disease: how far is the Belgian population from the recommended nutritional goals and ideal serum cholesterol levels?

For 15 years, recommendations concerning the primary prevention of coronary heart disease (CHD) have been made by international bodies or national agencies. In a national Belgian nutritional study (the B.I.R.N.H. Study), the authors review how far the Belgian population is from the recommended nutritional goals and ideal serum cholesterol. They also make comparisons between genders and look at differences according to the linguistic background (French- or Dutch-speaking subjects). Only a small percentage of the Belgian population reach the nutritional goals for total fat intake in males (8.4%) and females (7%), saturated fat intake (7.0% and 6.2%, respectively), and P/S ratio (13.5% and 12.4%, respectively). The percentages reaching nutritional goals are somewhat higher for polyunsaturated fat intake (27.9% and 28.6%, respectively) and dietary cholesterol (39.4% and 54.6%, respectively). A total of 29.9% of the male population, and 32.7% of the female population are at 'high risk' of CHD according to their serum cholesterol levels. In general the results are better for the Dutch-speaking population than for their French-speaking counterparts. In conclusion, despite modifications in eating patterns and a decrease in CHD mortality in Belgium during the 1970s, a very high percentage of males and females are still far from the recommended nutritional goals and ideal serum cholesterol levels.

Adult↗
PubMed1982

Clinical trial of survivors' cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients.

The hypothesis was tested that the median values of survivors of life-threatening postoperative conditions, rather than the norms of unstressed healthy volunteers, are the appropriate therapeutic goals for critically ill postoperative patients. The authors studied prospectively a series of 100 consecutive critically ill postoperative patients; normal values were used as the therapeutic goals of the control patients, while the median values of survivors were used as the goals of therapy for the protocol group. The age, sex, primary illness, surgical operation, lowest mean arterial pressure (MAP), time in hypotension incidence of severe hypotension (MAP greater than 50 mm Hg), and presence of associated severe medical illnesses (defined by predetermined criteria) were comparable in the control and protocol groups; i.e., clinical conditions of the protocol group were at least as severe as those of the control group. The mortality was significantly less in the protocol group (13%) than in the control group (48%); the number of life-threatening complications were also greater in the control group. These data suggest that the cardiorespiratory pattern of survivors are the appropriate goals of therapy for critically ill patients.

Adult↗
PubMed1993

Goals for the resuscitation of shock.

OBJECTIVE: To remind practitioners of the conventional goals of resuscitation of overt hypotensive or uncompensated shock ("ABC," for airway, breathing, and circulation) and to introduce additional goals, represented by successive letters of the alphabet, to aid clinicians in recognizing the persistence of compensated shock in the splanchnic organs and in achieving more complete resuscitation by eliminating inadequate tissue perfusion in these organs. DATA SOURCES: Review and analysis of current medical literature on shock and organ failure, combined with the author's prior research and expertise in the areas of tissue oxygenation and tonometric monitoring in the critically ill. CONCLUSIONS: In traumatic and septic shock, multiple system organ failure is associated with a persistent state of compensated shock in which hypotension and oliguria are corrected, but in which inadequate perfusion persists in the splanchnic organs and especially in the mucosal lining of the gut. The additional goals recommended include "D" for increasing the delivery of oxygen to levels that meet the metabolic demand by all tissues in the body, especially those tissues within the splanchnic circulation, and "E" for ensuring extraction and utilization of oxygen by the tissues. Future needs for goals that address reperfusion injury, translocation of bacterial toxins, and the release of toxic mediators are also considered.

Animals↗
PubMed1982

Achieving the goals of day treatment.

The problem of defining relevant goals in the rehabilitation of severely ill psychiatric patients was addressed in a day treatment program. A method was evolved from a detailed assessment of each patient's specific community functioning. Behavioral treatment strategies were individually tailored to meet the needs of a wide variety of patients in an intensive time-limited day treatment program. The provision of long term supportive outpatient services as well as overnight hospital care was considered essential for the program. Evaluation of the effectiveness of the day treatment program suggested that it did meet the needs of severely ill psychiatric patients; that good outcome was associated with high levels of participation of patients in defining their goals; and that goals concerning social and vocational functioning were achieved more frequently than intrapersonal goals.

Adult↗
PubMedDate not supplied

A proposed format for tracking the Centers for Disease Control and Prevention's national HIV prevention goal.

In January 2001, the Centers for Disease Control and Prevention published a national HIV prevention strategic plan with the overarching goal of reducing new HIV infections in the United States from 40,000 to 20,000 per year by 2005, with a particular emphasis on eliminating the racial/ethnic disparities in new infections. In this article, a framework is proposed for tracking progress toward achievement of the goal. Information available to date suggests there apparently has been little progress in achieving the national goal and sparse expansion of resources needed to achieve the goal.

Centers for Disease Control and Prevention, U.S.↗
PubMed2004

Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients.

OBJECTIVE: We examined a physician-performed, goal-directed ultrasound protocol for the emergency department management of nontraumatic, symptomatic, undifferentiated hypotension. DESIGN: Randomized, controlled trial of immediate vs. delayed ultrasound. SETTING: Urban, tertiary emergency department, census >100,000. PATIENTS: Nontrauma emergency department patients, aged >17 yrs, and initial emergency department vital signs consistent with shock (systolic blood pressure <100 mm Hg or shock index >1.0), and agreement of two independent observers for at least one sign and symptom of inadequate tissue perfusion. INTERVENTIONS: Group 1 (immediate ultrasound) received standard care plus goal-directed ultrasound at time 0. Group 2 (delayed ultrasound) received standard care for 15 mins and goal-directed ultrasound with standard care between 15 and 30 mins after time 0. MEASUREMENTS AND MAIN RESULTS: Outcomes included the number of viable physician diagnoses at 15 mins and the rank of their likelihood of occurrence at both 15 and 30 mins. One hundred eighty-four patients were included. Group 1 (n = 88) had a smaller median number of viable diagnoses at 15 mins (median = 4) than did group 2 (n = 96, median = 9, Mann-Whitney U test, p <.0001). Physicians indicated the correct final diagnosis as most likely among their viable diagnosis list at 15 mins in 80% (95% confidence interval, 70-87%) of group 1 subjects vs. 50% (95% confidence interval, 40-60%) in group 2, difference of 30% (95% confidence interval, 16-42%). CONCLUSIONS: Incorporation of a goal-directed ultrasound protocol in the evaluation of nontraumatic, symptomatic, undifferentiated hypotension in adult patients results in fewer viable diagnostic etiologies and a more accurate physician impression of final diagnosis.

Adult↗
PubMed2005

Use of a treatment algorithm to achieve NCEP ATP III goals with atorvastatin.

This multicenter, 8-week, single-step titration, open-label study sought to assess the percentage of subjects who achieved their National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III low-density lipoprotein (LDL)-cholesterol target when assigned a starting dose of atorvastatin (10 mg, 20 mg, 40 mg, or 80 mg) selected using an algorithm based on their 10-year CHD risk and the magnitude of LDL-cholesterol lowering necessary to reach goal. Following an 8-week washout period, 1298 subjects, categorized as low, medium, or high risk, were assigned to 4 weeks of treatment with a starting dose of atorvastatin selected by the algorithm. At week 4, subjects who did not achieve goal (15.8%) were titrated to the next-higher dose. The primary endpoint was the percentage of subjects in each risk group who achieved LDL-cholesterol goal at week 8. At 8 weeks, 84.8% of subjects (low risk 92.9%; moderate risk 84.0%; high risk 81.1%) achieved LDL-cholesterol target. The majority of patients (84.2%) achieved their lipid target through the use of the algorithm-based starting dose (10-80 mg) without the need for titration. No patient had elevations in creatine phosphokinase >10 times the upper limit of normal. Elevations in alanine aminotransaminase or aspartate aminotransaminase were observed in <1% of study subjects and were unrelated to dose. Selecting the starting dose of atorvastatin using a treatment algorithm achieves NCEP ATP III LDL-cholesterol goals in the majority of patients and minimizes the need for dose titration.

Adolescent↗
PubMed2001

Practical methods for meeting remediation goals at hazardous waste sites.

Risk-based cleanup goals or preliminary remediation goals (PRGs) are established at hazardous waste sites when contaminant concentrations in air, soil, surface water, or groundwater exceed specified acceptable risk levels. When derived in accordance with the Environmental Protection Agency's risk assessment guidance, the PRG is intended to represent the average contaminant concentration within an exposure unit area that is left on the site following remediation. The PRG, however, frequently has been used inconsistently at Superfund sites with a number of remediation decisions using the PRG as a not-to-exceed concentration (NTEC). Such misapplications could result in overly conservative and unnecessarily costly remedial actions. The PRG should be applied in remedial actions in the same manner in which it was generated. Statistical methods, such as Bower's Confidence Response Goal, and mathematical methods such as "iterative removal of hot spots," are available to assist in the development of NTECs that ensure the average postremediation contaminant concentration is at or below the PRG. These NTECs can provide the risk manager with a more practical cleanup goal. In addition, an acute PRG can be developed to ensure that contaminant concentrations left on-site following remediation are not so high as to pose an acute or short-term health risk if excessive exposure to small areas of the site should occur. A case study demonstrates cost savings of five to ten times associated with the more scientifically sound use of the PRG as a postremediation site average, and development of a separate NTEC and acute PRG based on the methods referenced in this article.

Journal Article↗
PubMedDate not supplied

Prevalence of comorbidities and their influence on blood pressure goal attainment in geriatric patients.

Hypertension in elderly patients is common and is associated with unique challenges. This study examines the prevalence of comorbidities in elderly hypertensive patients and evaluates the association between comorbidities and other covariates with blood pressure goal attainment. Data were collected through retrospective review of medical records and included patient characteristics, comorbidities, treatment-related variables, and blood pressure goal attainment. At least 1 comorbidity was present in 88% of patients, and 61% had multiple comorbidities. The most common comorbidity was isolated systolic hypertension. The presence of diabetes or isolated systolic hypertension at initial visit and treatment with a thiazide diuretic at the final clinic visit were associated with significantly higher odds of patients not achieving blood pressure goal. A diagnosis of heart failure was associated with lower odds of not achieving blood pressure goal. These issues should be given special consideration during the evaluation, treatment selection, and long-term monitoring of this population.

Aged↗