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PubMedDate not supplied

Multiple-level goals in clinical teaching.

The maturation process of family practice intensifies the need for our educators to unify their material into concepts specific to our specialty. A method of teaching clinical topics is described in which integrative goals are combined with knowledge, skill, and attitudinal goals. The attitudinal goals are designed to enhance resident perception of the family physician's role. Most clinical problems are amenable to this integrative method. Evaluation has provided very positive results over two years of experience.

Family Practice↗
PubMedDate not supplied

Establishing national health goals and standards.

Four statements of national health goals and standards were proclaimed from the U.S. Department of Health and Human Services during the 1970s. Two were based on statutory mandates--the National Guidelines for Health Planning and the Model Standards for Community Preventive Health Services. Two were the results of administrative initiatives--the Forward Plans for Health and the complementary publications "Healthy People" and "Promoting Health/Preventing Disease". These efforts present a variety of approaches and experiences and can provide direction and lessons for future endeavors along these lines. The four issuances include guidance on national priorities, resource standards, and accessibility to care. They also offer goals and objectives for local services and health status. They address a multiplicity of issues, ranging from hospital bed supply and recommended uses of specialized medical equipment to infant mortality and proposed reductions in death and disability. Almost all urge further actions to prevent illness and promote health. The development of statements of national health goals and standards has been advocated by some experts and questioned by others. Advocates believe that these materials can help clarify purposes and priorities for health programs, resulting in more effective and efficient uses of resources and greater accountability. Critics are particularly concerned about deleterious impacts on creativity and local initiatives. Among the major lessons identifiable from these undertakings is the importance of committed leadership, broad-based consultation, and reliable data. Implementation inevitably encounters the complexities of the health system and depends upon available resources. In influencing the agenda of deliberation and debate, the symbolic value of these statements may often be more significant than the specific details. The continuing interest in these approaches suggests that future efforts along these lines are likely.

Adolescent↗
PubMed1994

Home exercise in rheumatoid arthritis functional class II: goal setting versus pain attention.

OBJECTIVE: To evaluate the effects of a 12-week home exercise and cognitive treatment program in functionally independent patients with rheumatoid arthritis. METHODS: Forty-two patients were assessed with the Arthritis Self-efficacy Scale, the Stanford Health Assessment Questionnaire, the Ritchie articular index, measurement of joint mobility, and registration of capacity and pain in functional tasks. The patients were then randomized to either a "goal-setting" subgroup, in which individual goals for the exercise were set and exercise encouraged despite pain, or to a "pain attention" subgroup, where advice to decrease exercise load in case of pain was given. All patients used the same home exercise program aiming at improved range of motion, muscle function and aerobic capacity. RESULTS: After the intervention period, exercise had conferred better self-efficacy for "other symptoms," increased capacity in most functional tasks, decreased activity induced pain, lowered Ritchie index, and increased joint mobility. Some improvements regarding pain were larger in the goal-setting subgroup. CONCLUSION: Home exercise influences self-efficacy for mood and fatigue, physical capacity, and pain. Additional cognitive treatment seems to positively influence the perception of pain.

Adult↗
PubMed1993

Translating the genetic library: the goals, methods, and applications of the Human Genome Project.

The information produced by the Human Genome Project will have profound effects on the medical community, biotechnology companies, research scientists, and others. The ultimate goal of the project is to locate the approximately 100,000 genes that contain the instructions for creating a human being. Once these genes are found, they can be studied to increase understanding of their role in health and disease. Information about the location of a gene, its function, and its connection to disease will be stored in a variety of computer databases. Medical librarians can help assure that this information reaches the people who need it. To aid in this effort, this paper provides an introduction to the Human Genome Project: its goals, examples of methods used to achieve these goals, the types of information produced, and examples of how this information can be used in medicine and basic research. Because rapid research progress makes it difficult to predict the exact course of the project, this paper will focus on the first five years, 1990-1995.

Chromosome Mapping↗
PubMedDate not supplied

[Unmarried women of the war generation: an explorative study of their goals in life and personal satisfaction].

Older never-married women are often confronted with negative stereotypes which find expression in terms like "spinster" or "old maid". Their life-situation, however, has rarely been a subject of empirical studies. In a research project at the University of Münster, started in 1985, some psychological and social aspects of the life-situation of never-married employed women born between 1919 and 1933 (in comparison to married women of the same age not employed) were studied by means of detailed interviews. Parts of the results concerning "life goals" and "life satisfaction" are described. The results relativize the negative stereotypes mentioned above. They indicate that in the retrospective view of their lives the never-married women had many life goals which they could not achieve, but that they do not regret this at present. They rate their life satisfaction as very high and actively pursue present goals and interests. There are only few differences between never-married and married women. The results are discussed with regard to cognitive theories of aging and to the specific historical background of the interviewees.

Aged↗
PubMed1996

[Goal analysis of participants and moderators of general practice quality circles].

Quality circles (peer review) are a process of a continuous, systematic and critical reflection of care providers on their own and colleagues' performance by using structured procedures with the aim of achieving a continuous improvement. Main goal of the topic-oriented quality circle model in Sudbaden (Germany) is the development of guidelines for primary health care. The quality circle programme of the society of health insurances of Sudbaden is currently given a systematic evaluation. The results presented refer to 246 participants and moderators of 25 groups who have completed questionnaires. Attention is given to the general goals of the doctors participating in quality circle groups. When asked about the most important goals of peer review the participants scored the highest ranking on (1) exchanging practice experiences with colleagues (2) the personal reflection of one's way of working (3) agreeing on guidelines and targets for desirable performance and (4) developing guidelines for general practice. From the results, conclusions regarding the concept of quality circles and the methods for developing practice guidelines are drawn.

Curriculum↗
PubMedDate not supplied

A practical approach to achieving recommended blood pressure goals in diabetic patients.

Approximately 11 million Americans have both hypertension and diabetes mellitus. This double diagnosis places such patients at high risk for renal damage, especially end-stage renal disease. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends a blood pressure goal of less than 130/85 mm Hg to reduce or slow the onset of renal disease and cardiovascular events in patients with hypertension and diabetes mellitus. Recent data, however, now suggest that an even lower diastolic blood pressure goal (ie, <80 mm Hg) may be necessary. Studies have shown that use of angiotensin-converting enzyme inhibitors can prevent the progression of microalbuminuria to overt proteinuria, reduce proteinuria in patients with overt diabetic nephropathy, slow the deterioration of the glomerular filtration rate, delay progression to end-stage renal disease, and lower blood pressure. Thus, all diabetic patients with blood pressure greater than 130/80 mm Hg should begin angiotensin-converting enzyme inhibitor treatment and be titrated to moderate or high doses until the blood pressure goal is achieved. However, monotherapy still may not control blood pressure to the recommended target. Studies have shown that use of multiple antihypertensive agents is necessary and successful in helping patients reach their target blood pressure, and this may offer more renoprotection than one agent used singly. A case study that applies these concepts in outpatient practice is included.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

Understanding of prognosis among parents of children who died of cancer: impact on treatment goals and integration of palliative care.

CONTEXT: Parents' understanding of prognosis or decision making about palliative care for children who die of cancer is largely unknown. However, a more accurate understanding of prognosis could alter treatment goals and expectations and lead to more effective care. OBJECTIVES: To evaluate parental understanding of prognosis in children who die of cancer and to assess the association of this factor with treatment goals and the palliative care received by children. DESIGN, SETTING, AND PARTICIPANTS: Survey, conducted between September 1997 and August 1998, of 103 parents of children who received treatment at the Dana-Farber Cancer Institute and Children's Hospital, Boston, Mass, and who died of cancer between 1990 and 1997 (72% of those eligible and those located) and 42 pediatric oncologists. MAIN OUTCOME MEASURE: Timing of parental understanding that the child had no realistic chance for cure compared with the timing of physician understanding of this prognosis, as documented in the medical record. RESULTS: Parents first recognized that the child had no realistic chance for cure a mean (SD) of 106 (150) days before the child's death, while physician recognition occurred earlier at 206 (330) days before death. Among children who died of progressive disease, the group characterized by earlier recognition of this prognosis by both parents and physicians had earlier discussions of hospice care (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06; P =.01), better parental ratings of the quality of home care (OR, 3.31; 95% CI, 1.15-9.54; P =.03), earlier institution of a do-not-resuscitate order (OR, 1.03; 95% CI, 1.00-1.06; P =.02), less use of cancer-directed therapy during the last month of life (OR, 2.80; 95% CI, 1.05-7.50; P =.04), and higher likelihood that the goal of cancer-directed therapy identified by both physician and parent was to lessen suffering (OR, 5.17; 95% CI, 1.86-14.4; P =.002 for physician and OR, 6.56; 95% CI, 1.54-27.86; P =.01 for parents). CONCLUSION: Considerable delay exists in parental recognition that children have no realistic chance for cure, but earlier recognition of this prognosis by both physicians and parents is associated with a stronger emphasis on treatment directed at lessening suffering and greater integration of palliative care. JAMA. 2000;284:2469-2475.

Adult↗
PubMed2006

The relation of ANS and HPA activation to infant anger and sadness response to goal blockage.

This study examined the relation of anger and sadness to heart rate and cortisol in 4-month-old infants' (n = 56) response to a goal blockage. The blockage occurred during a contingency learning procedure where infants' response no longer produced a learned interesting event. Anger and sadness were the major emotional expressions to the blockage. The two emotional expressions were differentially related to heart rate and cortisol. Anger was related to increased heart rate, but not cortisol, whereas sadness was related to increased cortisol, but not heart rate. Along with other work, the present results support the view that infant anger in response to goal blockage involves autonomic as opposed to adrenocortical activation as a consequence of an expectation of control over the event. In contrast, sadness in response to goal blockage involves adrenocortical as opposed to autonomic activation stemming from the absence of an expectation of control.

Affect↗
PubMed1999

Goals of treatment for Paget's disease of bone.

The goals of treatment of Paget's disease must be readdressed in the context of the availability of potent bisphosphonate compounds, including pamidronate and, more recently, alendronate and risedronate. These agents differ from the traditional mainstays of therapy, salmon calcitonin and etidronate, in several respects. First, they achieve a reduction in the elevated indices of pagetic bone turnover of about 80%, in contrast with the 50% reduction seen with the older agents. Second, a majority of patients (in the range of 50-75%, depending on the series) achieve biochemical remission, and the duration of remission may exceed 1 year or more after a single course of therapy. Third, with the newer bisphosphonates the quality of newly forming bone after successful treatment is lamellar in appearance (as was the case with etidronate) but there is no clinically significant mineralization abnormality associated with these more recent agents. With prior therapies, the primary goal of treatment was to relieve symptoms. In the absence of complete suppression of abnormal turnover, disease progression was not completely halted in many patients, increasing the risk of long-term complications. The characteristics of the newer agents, however, suggest that in those patients who achieve remission there is a possibility, albeit not yet proven, of arresting progression and reducing the risk of later complications. Many patients have no symptoms at presentation but have active disease at locations where progression could cause bone enlargement and deformity over time. These patients may be considered to be at increased risk of future complications if untreated. Thus, it is recommended that such individuals receive therapy with a potent bisphosphonate with the goal of attaining normal (or near normal) biochemical indices after initial treatment and/or retreatment. Patients should be followed with measurement of serum alkaline phosphatase every 4-6 months after a course of therapy, and retreatment is suggested when indices rise above the upper limit of normal or by 25% above the previous nadir. The uncommon possibility of secondary resistance to a given agent after more than one treatment course should be assessed in all patients.

Humans↗
PubMed2000

An Achievement Goal Theory Perspective on Issues in Motivation Terminology, Theory, and Research.

There are a number of important issues raised by Murphy and Alexander in the lead article of this issue. In this response, four general issues are discussed in light of current research and achievement goal theory. The four issues include: (1) the general definition and theoretical clarity of motivational constructs, (2) the accessibility and consciousness of motivational beliefs, (3) the interdependent or independent nature of the relations between motivational constructs, and (4) the stability of motivation over time, domains, and contexts. These issues are considered in the context of current achievement goal theory research with the hope that the discussion will help to clarify the four issues for both motivational theory and research in general as well as for specific theoretical and empirical efforts within goal theory research. Copyright 2000 Academic Press.

Journal Article↗
PubMed2000

Analyzing Goal-Striving Processes and a Test of the Generalizability of Perceptual Control Theory.

Theories that articulate dynamic processes are relatively rare, but methods for testing the theories are even rarer. This study illustrates two methods for examining goal-striving processes and a tool for collecting dynamic data. The first method tests a hypothesis regarding what variable the participants are attempting to maintain. The second method involves creating multilevel models used to describe the dynamic data generated by study participants, which can be used to test between- and within-subject manipulations or differences. The tool is a research simulation of a manager's role in scheduling subordinates in a hospital wing. Together these methods and the tool are used to test the generalizability of perceptual control theory in explaining striving for cognitive goals. The results confirm the viability of a control theory accounting of goal striving and highlight the potential of the methods and the research tool in future research. Copyright 2000 Academic Press.

Journal Article↗
PubMed1991

Obstacles to and future goals of ten comprehensive community health promotion projects.

Over 100 project staff, community coalition members, and other representatives from 10 comprehensive community health promotion projects in the western United States were surveyed two years into a three year funding cycle about: (1) the problems or obstacles they judged as preventing successful completion of their current goals and objectives, and (2) future goals and objectives they envisioned for their projects. The key issues confronting respondents were diverse, although issues around the process of implementing community health promotion programs were cited more frequently than issues related to the content of health promotion. When respondents were asked to prioritize Future Goals in the second survey, consensus across communities was obtained despite broad differences in the type of community surveyed and the health problem targeted. This study identifies the common organizational and community development problems faced by newly emerging community health promotion programs and has implications for other communities involved in designing, implementing, and evaluating community-wide health promotion programs.

Community Health Services↗
PubMed1997

[Goals and practical implementation of lipid therapy in coronary heart disease].

In all patients with coronary heart disease a fasting lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides) should be obtained. Hyperlipidemias can then be classified as hypercholesterolemia (LDL cholesterol elevated), mixed hyperlipidemia (LDL cholesterol elevated, triglycerides elevated) and hypertriglyceridemia (triglycerides elevated). Primary goal of lipid intervention is a LDL cholesterol < 100 mg/dl, secondary goals are HDL cholesterol > 35 mg/dl and triglycerides < 200 mg/dl. These goals can be reached by dietary intervention alone (reduction in fat and modification of fat intake) or in combination with lipid lowering drugs. Monotherapy with HMG-CoA reductase inhibitors or combined therapy with bile acid sequestrants will allow a reduction in LDL cholesterol by more than 50%; in predominant hypertriglyceridemia fibrates or nicotinic acid will lower triglycerides and elevate HDL cholesterol.

Combined Modality Therapy↗
PubMed2002

Goals and activities of the WMDA. World Marrow Donor Association.

The World Marrow Donor Association (WMDA) has the goal to facilitate reliable transfer of bone marrow and other forms of hematopoietic stem cells from one country to another, to promote exchange of information internationally about how to identify suitable donors and to protect the welfare and safety of the donor. It establishes guidelines on standards, ethics and other issues related to the goal of the WMDA. Full voting organisational members are those who deal directly with the donors and the logistics of hematopoietic stem cell transfer internationally for transplantation. Other members are non-voting organisational members and individual corresponding members (general members). They are working on, or interested in hematopoietic stem cell transplantation or science in the field. In order to execute its task, WMDA has several working groups that make proposals to the Board that takes decisions related to WMDA goals.

Hematopoietic Stem Cells↗
PubMed2004

Goal-directed medical therapy and point-of-care testing improve outcomes after congenital heart surgery.

OBJECTIVE: A goal-directed therapy algorithm based on serial lactate values obtained from a point-of-care testing device was utilized in an attempt to reduce the mortality of patients after congenital heart surgery. DESIGN: Prospective study of patients undergoing surgery utilizing a goal-directed therapy algorithm in the postoperative period. The results of this group are compared with a historical cohort. Operative risk was determined using the RACHS-1 scoring system. SETTING: A 12-bed cardiac intensive care unit (ICU) in a pediatric hospital. PATIENTS: Patients undergoing surgery from July 2001 through September 2003 (group B, n=710) were compared to cohorts from June 1995 through June 2001 (group A, n=1,656). Group B patients were smaller and younger (median weight 6.2 vs 8 kg, p<0.001; median age 184 vs 327 days, p=0.004). INTERVENTIONS: Beginning in July 2001, blood lactate measurements were performed serially for 24 h after heart surgery. Based on lactate values and trends, therapy was amended. MEASUREMENTS AND RESULTS: Mortality was lower for group B (1.8 vs 3.7%, p=0.02). A reduction in mortality between group B and group A was noted in neonates (3.4 vs 12%, p=0.02), but not in older patients. Group B patients undergoing higher risk operations (Risk Adjustment for Congenital Heart Surgery-1 [RACHS-1] categories 3-6) had a significant reduction in mortality when compared to group A (3 vs 9%, p=0.006), no difference was noted in patients undergoing lower risk operations (RACHS-1 categories 1 and 2). CONCLUSIONS: The combination of goal-directed therapy and point-of-care testing was associated with a marked decrease in mortality for patients undergoing congenital heart surgery. Improvement was greatest in the highest risk patients.

Algorithms↗
PubMed2006

Restoration of marine coastal ecosystem health as a new goal for integrated catchment management in Tolo Harbor, Hong Kong, China.

This article demonstrates why it is necessary to have the restoration of marine coastal ecosystem health as a new goal for integrated catchment management in the coastal area of Tolo Harbor. The present goal of integrated catchment management (ICM) in the Tolo Harbor is based on water quality objectives. The performance of the ICM plan, the Tolo Harbor Action Plan (THAP), was evaluated using marine coastal ecosystem health indicators including both stress and response indicators. Since the implementation of THAP in 1988, some significant reductions in pollution loading have been observed: reduction of 83% of biological oxygen demand load and 82% of total nitrogen between 1988 and 1999. There has also been an improvement in the health of Tolo Harbor's marine coastal ecosystem as evidenced by trends in physical, chemical, and biological indicators, although reverse fluctuations in some periods exist. However, such improvement can only be considered as the first sign of complete ecosystem health restoration, because ecosystem health covers not only physical, chemical, and biological aspects of an ecosystem, but also ecosystem service functions. The findings support the need to take the restoration and protection of marine coastal ecosystem health as a new goal rather than using water quality objectives. Steps necessary to further improve Tolo Harbor's marine coastal ecosystem health are also discussed.

Animal Husbandry↗
PubMed2000

Multiple Species Habitat Conservation Planning: Goals and Strategies of Local Governments.

Drawing from experiences gained from the development and implementation of four approved habitat conservation plans (HCPs), I describe the goals and strategies used by the nine local government members of the Riverside County Habitat Conservation Agency (RCHCA) to reconcile conflicts among a rapidly growing population and the need to conserve the habitat of a number of declining wildlife species in western Riverside County, California. Several important goals have been pursued by RCHCA member governments in their sponsorship of multiple-species habitat conservation plans (MSHCPs), including (1) establishing certainty and control over future uses of land; (2) eliminating project-by-project negotiations with federal and state wildlife agencies; (3) coordinating mitigation obligations under the Endangered Species Act, Clean Water Act, California Environmental Quality Act, and other federal and state laws; (4) reducing conflict and litigation resulting from land development activities; and (5) ensuring that wildlife conservation activities are conducted in a manner that permits local governments to perform those functions necessary to maintain public health, safety, and welfare. I also describe the emergence of strategies by local governments to achieve MSHCP goals, including (1) use of an inclusive planning process that seeks to build consensus among affected interests; (2) extensive involvement of federal and state wildlife agencies in the preparation of MSHCP documents; (3) management of public lands to support MSHCP conservation objectives; (4) encouragement of voluntary conservation by private property owners through incentive programs; and (5) active solicitation of federal and state funding for MSHCP implementation activities.

Journal Article↗