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At least 1,063 records · Page 59Linked to original sources
PubMed2005

Achieving National Cholesterol Education Program goals in coronary artery disease.

National Cholesterol Education Program (NCEP) guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL for patients with coronary artery disease (CAD) and lipid-lowering therapy if LDL-C remains >100-130 mg/dL after dietary intervention. Studies consistently report that the majority of CAD patients do not achieve NCEP goals in clinical practice; we sought to determine if our practice fared better. We performed a retrospective chart review of 600 CAD patients followed by cardiologists. The mean age was 69, and 66% of patients were male. Of persons with a cardiology clinic lipid profile (60%), most (76%) achieved an LDL-C <100 mg/dL; however, only 61% were treated to the NCEP secondary goal of non-HDL-C <130 mg/dL. Of patients not at an LDL-C goal, 81% were on lipid-lowering therapy, but only 18% were on maximal statin doses and 6% on combination therapy. We concluded that the majority of CAD patients have had recent lipid measurements and are treated according to NCEP guidelines, but many patients remain on suboptimal therapy.

Age Distribution↗
PubMedDate not supplied

Improving patient compliance: a major goal in the management of hypertension.

The primary goal in the treatment of hypertension is to reduce the incidence of cardiovascular events in hypertensive patients. Studies performed to assess the impact of treating hypertension have revealed very disappointing reductions in the incidence of coronary heart disease. There are several reasons for these poor reductions in the incidence of cardiovascular disease; however, the most important is related to the fact that worldwide less than one quarter of hypertensive patients are adequately controlled for hypertension. Again, there are multiple reasons for these poor blood pressure (BP) control rates; however, most physicians would agree that patient compliance with their antihypertensive treatment is a major contributing factor. This is an area that we need to refocus on in our management of hypertensive patients. Issues such as safety, convenience, polypharmacy, cost, and education in the selection of antihypertensive agents are all critically important issues in the treatment of hypertensive patients. In addition, the level of patient involvement in their treatment seems to be essential in obtaining goal BP. Newer approaches to the management of hypertension such as earlier control of BP and the more aggressive use of low-dose combination therapy as first-line treatment of hypertension also need to be considered in our effort to improve BP control rates. Achieving goal BP in hypertensive patients is one of the most important clinical dilemmas facing physicians. There is little doubt that an improvement in control rates will result in substantial reductions in cardiovascular disease.

Antihypertensive Agents↗
PubMed2003

Focused training of emergency medicine residents in goal-directed echocardiography: a prospective study.

OBJECTIVES: To determine if a focused transthoracic echocardiography (TTE) training course would improve the accuracy of completion and interpretation of a goal-directed TTE by emergency medicine residents. METHODS: This was a prospective, observational, educational study of the impact of a focused training course on the change in physician performance on pre- and postcourse examinations testing competency in goal-directed TTE defined by five criteria: 1). image orientation, 2). anatomy identification, 3). chamber size grading, 4). ventricular function estimation, and 5). pericardial effusion identification. Subjects included were emergency medicine residents with between ten and 20 hours of noncardiac ultrasound didactics and between 20 and >150 proctored noncardiac ultrasound examinations. All underwent five hours of focused echocardiography didactics and one hour of proctored practical echocardiography training designed and implemented by an emergency physician ultrasound director and a cardiologist. Before the start of the training course, participants completed two examinations: 1) written 23-question test on the above concepts and 2) performance of a TTE on a healthy subject testing 16 elements that define a properly performed examination. After the training course, participants again completed both examinations. RESULTS: A total of 21 emergency medicine residents qualified for and underwent standardized testing and training. The percentage correct on the precourse written examination was 54% (95% CI = 50% to 59%), and the postcourse examination score was 76% (95% CI = 71% to 80%) (p < 0.005, paired t-test). The percentage correct on the precourse practical examination was 56% (95% CI = 51% to 60%), and the postcourse examination score was 94% (95% CI = 91% to 96%) (p < 0.005). CONCLUSIONS: A focused six-hour echocardiography training course significantly improved emergency medicine residents' percentage scores on both written and practical examinations testing essential components required for correct goal-directed TTE performance and interpretation.

Echocardiography↗
PubMed1990

Clinically based quality goals; a NORDKEM project.

The three main aspects of analytical quality are 'goals for analytical quality', 'creation of analytical quality', and 'control of analytical quality'. In the NORDKEM-project 'medical need for quality specifications within laboratory medicine' the aspects of analytical quality are combined. The aims is to make an appraisal of the different approaches to goal setting, and to develop a practical procedure for assessing analytical quality requirements. The goals are used to define which demands should be met by the process of establishing and maintaining the quality, and for design of internal as well as external quality assurance procedures. The project is an umbrella project with three main subprojects and several satellite projects. In this presentation a model for evaluation of influence of analytical bias and imprecision on the outcome from a diagnostic classification based on bimodal distribution is described.

Clinical Laboratory Techniques↗
PubMed2005

Reproductive health and the Millennium Development Goals: the missing link.

This report was commissioned by the Population Program of the William and Flora Hewlett Foundation in December 2004. The author was charged with analyzing the United Nations' deliberations that led to the adoption of the Millennium Development Goals (MDGs) to answer the question of why there is no specific reproductive health goal. Her report, of which this is a lightly edited version, is also available online at . This coverage of the MDG process will be complemented by a special section of Studies in the June 2005 issue on reproductive health and the MDGs. The section will include excerpts about reproductive health from the final report of the Millennium Development Project entitled "Investing in Development: A Practical Plan to Achieve the Millennium Development Goals," which was submitted to Secretary General Kofi Annan in January 2005, as well as commentaries by leading scholars and policymakers in the fields of population and reproductive health.

Family Planning Services↗
PubMed2005

Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal.

Despite increasingly stringent clinical practice guidelines for glycaemic control, the implementation of recommendations has been disappointing, with over 60% of patients not reaching recommended glycaemic goals. As a result, current management of glycaemia falls significantly short of accepted treatment goals. The Global Partnership for Effective Diabetes Management has identified a number of major barriers that can prevent individuals from achieving their glycaemic targets. This article proposes 10 key practical recommendations to aid healthcare providers in overcoming these barriers and to enable a greater proportion of patients to achieve glycaemic goals. These include advice on targeting the underlying pathophysiology of type 2 diabetes, treating early and effectively with combination therapies, adopting a holistic, multidisciplinary approach and improving patient understanding of type 2 diabetes. Implementation of these recommendations should reduce the risk of diabetes-related complications, improve patient quality of life and impact more effectively on the increasing healthcare cost related to diabetes.

Blood Glucose Self-Monitoring↗
PubMed2004

Changing dentate status of adults, use of dental health services, and achievement of national dental health goals in Denmark by the year 2000.

OBJECTIVES: This study analyzes the current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, assesses the impact on dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and highlights the changes over time in dental health conditions among adults. Finally, the intention of the study was to evaluate the Danish dental health care system's level of achievement of the official goals for the year 2000 as formulated by the World Health Organization and the National Board of Health. The subjects of this study included a national representative sample of 16,690 Danish citizens aged 16 years and older (response rate=74.2%). A subsample (n=3,818) took part in a survey of dental care habits in childhood and prevalence of removable dentures; 66 percent of persons selected responded. METHODS: Personal interviews were used to collect information on dentate status, use of dental health services and living conditions; data on dental care habits in childhood and prevalence of removable dentures were collected by self-administered questionnaires. RESULTS: In all, 8 percent of interviewed persons were edentulous, while 80 percent had 20 or more natural teeth. At age 65-74 years, 27 percent were edentulous and 40 percent had 20 teeth or more; 58 percent wore removable dentures. Dentate status and prevalence of dentures were highly related to educational background and income, particularly for older age groups. Among persons interviewed, 80 percent paid regular dental visits and visits were most frequent among persons of high education and income. At age 35-44 years 95 percent had participated in regular dental care in childhood compared to 49 percent of 65-74-year-olds. Multivariate analyses revealed that sociobehavioral factors had significant effects on dentate status. CONCLUSIONS: Compared to similar studies carried out in 1987 and 1994, the present survey indicates a positive trend of improved dentate status in adult Danes in general and regular use of dental health services increased considerably over time. The WHO goals for better dental health by the year 2000 were achieved for 35-44-year-olds, whereas the goal of more people with functional dentitions at age 65 years or older was not achieved. It remains a challenge to the Danish dental health system to help even out the social inequalities in dental health.

Adolescent↗
PubMed2000

Setting global goals for oral health for the year 2010.

OBJECTIVE: To discuss the determinants for the possible setting of global goals for oral health for the year 2010. RESULTS AND CONCLUSIONS: If the application of oral health goals is to measure the outcome of oral health strategies and plans, they need to be substantially redesigned to reflect disparities in oral health and access to oral health care. It is no longer acceptable to focus only upon one or two arbitrarily selected disease entities and say these reflect the oral well-being of communities and the success (or failure) of oral health programmes. The use of validated socio-dental indicators to assess prevalence of socio-dental impacts seems essential, as does the avoidance of goals for conditions that are strongly influenced by culture, class, ethnicity and other widely variable local influences.

Ethics, Dental↗
PubMed1999

Cardiovascular demands of competition on low-goal (non-elite) polo ponies.

Knowledge of the competitive demands of different sports or activities is important for designing appropriate training programmes to ensure that animals reach a sufficient level of fitness to reduce the risk of overexertion and injury or illness and to achieve the best possible performance in relation to an individual's genetic potential. Whilst the physiological demands of many equestrian sports have been described, to the best of our knowledge the cardiovascular demands of polo have not. The aims of the present study were therefore to record heart rate during and after competitive polo games in a group of low-goal (non-elite) polo ponies in order to describe the absolute heart rates during play, the relationship of these heart rates to maximal heart rate and the characteristics of a typical chukka in terms of effort. Six low-goal polo ponies were studied during a total of 59 chukkas. Heart rate was monitored continuously before, during and after competition using a commercial heart rate monitor. Maximal heart rate was determined with field and treadmill incremental exercise tests and used to express work intensity in terms of time during play that each ponies heart rate was less than 75% HRmax, between 75 and 90% HRmax and greater than 90% HRmax. Mean maximum heart rate was not different during play or during field and treadmill exercise tests; 215+/-7 (mean +/- s.d.), 211+/-7 and 213+/-2 beats/min, respectively (P>0.05). Mean heart rate for all ponies over all chukkas was 166+/-6 beats/min with a mean chukka duration of 611+/-18 s. Of this time, 44+/-7% of the time was spent below 75% HRmax, 39+/-8% between 75 and 90% HRmax and 17+/-8% of time above 90% HRmax. When only one chukka had been played, there was a good correlation between mean heart rate during play and 3 min recovery heart rate (r = 0.63, P<0.001). Based on these observations, it is proposed that low-goal polo places moderate to high stress on the cardiovascular system.

Animals↗
PubMed1987

The safety goals of the U.S. Nuclear Regulatory Commission.

In August 1986, after 6 years of effort, the U.S. Nuclear Regulatory Commission adopted a Policy Statement on safety goals for nuclear power reactors. The commission's qualitative goals state that individual members of the public should be provided a level of protection from the consequences of nuclear power plant operation such that they bear no significant additional risk to life and health, and societal risks to life and health from nuclear power should be comparable to or less than the risks of generating electricity by viable competing technologies and should not be a significant addition to other societal risks. The commission's safety goal Policy Statement also includes quantitative design objectives.

Accident Prevention↗
PubMed1979

A clinical view of analytical goals in clinical biochemistry.

The analytical goals inferred desirable by a group of clinicians for the imprecisions of a wide range of analytes have been studied by survey. The goals required have not in general become more stringent in the past decade and are not as demanding as those promulgated by laboratory professionals. Clinical biochemistry laboratories can now attain analytical imprecisions which satisfy the general demands of clinicians except for analyses of calcium and of low levels of glucose. The lack of published data on analytical goals does not allow wide comparison of criteria for performance standards with the results of this study.

Attitude of Health Personnel↗
PubMed1995

Tropospheric ozone: respiratory effects and Australian air quality goals.

OBJECTIVE: To review the health effects of tropospheric ozone and discuss the implications for public health policy. DESIGN: Literature review and consultation with scientists in Australia and overseas. Papers in English or with English language abstracts were identified by Medline search from the international peer reviewed published reports. Those from the period 1980-93 were read systematically but selected earlier papers were also considered. Reports on ozone exposures were obtained from environmental agencies in the region. RESULTS: Exposure to ozone at concentrations below the current Australian air quality goal (0.12 ppm averaged over one hour) may cause impaired respiratory function. Inflammatory changes in the small airways and respiratory symptoms result from moderate to heavy exercise in the presence of ozone at levels of 0.08-0.12 ppm. The changes in respiratory function due to ozone are short lived, vary with the duration of exposure, may be modified by levels of other pollutants (such as sulphur dioxide and particulates), and differ appreciably between individuals. Bronchial lavage studies indicate that inflammation and other pathological changes may occur in the airways before reductions in air flow are detectable, and persist after respiratory function has returned to normal. It is not known whether exposures to ozone at low levels (0.08-0.12 ppm) cause lasting damage to the lung or, if such damage does occur, whether it is functionally significant. At present, it is not possible to identify confidently population subgroups with heightened susceptibility to ozone. People with asthma may be more susceptible to the effects of ozone than the general population but the evidence is not consistent. Recent reports suggest that ozone increases airway reactivity on subsequent challenge with allergens and other irritants. Animal studies are consistent with the findings in human populations. CONCLUSION: A new one hour air quality ozone goal of 0.08 ppm for Australia, and the introduction of a four hour goal of 0.06 ppm are recommended on health grounds.

Adaptation, Physiological↗
PubMed2002

Canadian STI national goals and phase specific strategies.

National goals should be "SMART"-specific, measurable, achievable, resource sensitive, and timed. To be meaningful, these goals must be sustainable and realistic within the time frame and fiscal limitations. Multisector partnerships are essential for the goals to become operational.

Canada↗
PubMed2004

Contextual modulation of central thalamic delay-period activity: representation of visual and saccadic goals.

This study examines the influence of behavioral context on the activity of visuomotor neurons in primate central thalamus. Neurons that combine information about sensory stimuli and their behavioral relevance are thought to contribute to the decision mechanisms that link specific stimuli to specific responses. We reported in a previous study that neurons in central thalamus carry spatial information throughout the instructed delay period of a visually guided delayed saccade task. The goal of the current study was to determine whether the delay-period activity of thalamic neurons is modulated by behavioral context. Single neurons were evaluated during performance of visually guided and memory-guided variants of a saccadic choice task in which a cue designated the response field stimulus as the target of a rewarded saccade or as an irrelevant distracter. The relative influence of the physical stimulus and context on delay-period activity suggested a minimum of 3 neural groups. Some neurons signaled the locations of visible stimuli regardless of behavioral relevance. Other neurons preferentially signaled the locations of current saccadic goals and did so even in the absence of the physical stimulus. A third group signaled only the locations of currently visible saccadic goals. For the latter 2 groups, activity was the product of both stimulus and context, suggesting that central thalamic neurons play a role in the context-dependent linkage of sensory signals and saccadic commands. More generally, these data suggest that the anatomical substrate of sensorimotor decision making may include the cortico-subcortical loops for which central thalamus serves as the penultimate synapse.

Action Potentials↗
PubMed1997

Motor task difficulty and brain activity: investigation of goal-directed reciprocal aiming using positron emission tomography.

Differences in the kinematics and pattern of relative regional cerebral blood flow (rCBF) during goal-directed arm aiming were investigated with the use of a Fitts continuous aiming paradigm with three difficulty conditions (index of difficulty, ID) and two aiming types (transport vs. targeting) in six healthy right-handed young participants with the use of video-based movement trajectory analysis and positron emission tomography. Movement time and kinematic characteristics were analyzed together with the magnitude of cerebral blood flow to identify areas of brain activity proportionate to task and movement variables. Significant differences in rCBF between task conditions were determined by analysis of variance with planned comparisons of means with the use of group mean weighted linear contrasts. Data were first analyzed for the group. Then individual subject differences for the movement versus no movement and task difficulty comparisons were related to each individual subjects' anatomy by magnetic resonance imaging. Significant differences in rCBF during reciprocal aiming compared with no-movement conditions were found in a mosaic of well-known cortical and subcortical areas associated with the planning and execution of goal-directed movements. These included cortical areas in the left sensorimotor, dorsal premotor, and ventral premotor cortices, caudal supplementary motor area (SMA) proper, and parietal cortex, and subcortical areas in the left putamen, globus pallidus, red nucleus, thalamus, and anterior cerebellum. As aiming task difficulty (ID) increased, rCBF increased in areas associated with the planning of more complex movements requiring greater visuomotor processing. These included bilateral occipital, left inferior parietal, and left dorsal cingulate cortices--caudal SMA proper and right dorsal premotor area. These same areas showed significant increases or decreases, respectively, when contrast means were compared with the use of movement time or relative acceleration time, respectively, as the weighting factor. Analysis of individual subject differences revealed a correspondence between the spatial extent of rCBF changes as a function of task ID and the individuals' movement times. As task ID decreased, significant increases in rCBF were evident in the right anterior cerebellum, left middle occipital gyrus, and right ventral premotor area. Functionally, these areas are associated with aiming conditions in which the motor execution demands are high (i.e., coordination of rapid reversals) and precise trajectory planning is minimal. These same areas showed significant increases or decreases, respectively, when contrast means were compared with the use of movement time or relative acceleration time, respectively, as the weighting factor. A functional dissociation resulted from the weighted linear contrasts between larger (limb transport) or smaller (endpoint targeting) type amplitude/target width aiming conditions. Areas with significantly greater rCBF for targeting were the left motor cortex, left intraparietal sulcus, and left caudate. In contrast, those areas with greater rCBF associated with limb transport included bilateral occipital lingual gyri and the right anterior cerebellum. Various theoretical explanations for the speed/accuracy tradeoffs of rapid aiming movements have been proposed since the original information theory hypothesis of Fitts. This is the first report to relate the predictable variations in motor control under changing task constraints with the functional anatomy of these rapid goal-directed aiming movements. Differences in unimanual aiming task difficulty lead to dissociable activation of cortical-subcortical networks. Further, these data suggest that when more precise targeting is required, independent of task difficulty, a cortical-subcortical loop composed of the contralateral motor cortex, intraparietal sulcus, and caudate is activated. This is consistent with the role of motor cortex

Adult↗
PubMed1996

Use of Goal Attainment Scaling to measure treatment effects in an anti-dementia drug trial.

We report data on the validity and responsiveness (i.e. sensitivity to change) of assessment instruments including Goal Attainment Scaling (GAS), at a single site in a multicentre trial of the experimental therapeutic agent linopirdine. Fifteen people (11 women) were evaluated. GAS yielded a mean 3.7 goals per patient (range 2-6). The mean gain in the GAS scores, 2.7 +/- 16.4, was compared to changes in the Alzheimer's Disease Assessment Scale-Cognitive Section, the Global Deterioration Scale, Clinical Global Impression and the Mini-Mental State Exam. GAS had the largest relative efficiency (0.47) when compared to the standard. GAS also had the largest effect size (0.61). The data suggest that an individualized approach may have merit as an outcome measure and as a means to better understanding treatment effects. Qualitative analysis revealed consistent goal setting in self-care, behaviour, cognition and leisure, suggesting that these areas should routinely be evaluated.

Activities of Daily Living↗
PubMed1997

Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group.

The Modification of Diet in Renal Disease Study showed a beneficial effect of a lower-than-usual blood pressure (BP) goal on the progression of renal disease in patients with proteinuria. The purpose of the present analyses was to examine the achieved BP, baseline characteristics that helped or hindered achievement of the BP goals, and safety of the BP interventions. Five hundred eighty-five patients with baseline glomerular filtration rate between 13 and 55 mL/min per 1.73 m2 (0.22 to 0.92 mL/s per 1.73 m2) were randomly assigned to either a usual or low BP goal (mean arterial pressure < or = 107 or < or = 92 mm Hg, respectively). Few patients had a history of cardiovascular disease. All antihypertensive agents were permitted, but angiotensin-converting enzyme inhibitors (with or without diuretics) followed by calcium channel blockers were preferred. The mean (+/- SD) of the mean arterial pressures during follow-up in the low and usual BP groups was 93.0 +/- 7.3 and 97.7 +/- 7.7 mm Hg, respectively. Follow-up BP was significantly higher in subgroups of patients with preexisting hypertension, baseline mean arterial pressure > 92 mm Hg, a diagnosis of polycystic kidney disease or glomerular diseases, baseline urinary protein excretion > 1 g/d, age > or = 61 years, and black race. The frequency of medication changes and incidence of symptoms of low BP were greater in the low BP group, but there were no significant differences between BP groups in stop points, hospitalizations, or death. When data from both groups were combined, each 1-mm Hg increase in follow-up systolic BP was associated with a 1.35-times greater risk of hospitalization for cardiovascular or cerebrovascular disease. Lower BP than usually recommended for the prevention of cardiovascular disease is achievable by several medication regimens without serious adverse effects in patients with chronic renal disease without cardiovascular disease. For patients with urinary protein excretion > 1 g/d, target BP should be a mean arterial pressure of < or = 92 mm Hg, equivalent to 125/75 mm Hg.

Adolescent↗
PubMed1989

Going north on a north-bound trail: a model for achieving health management goals and objectives.

A basic managerial problem in decision making is to synthesise and priorise information relating to the achievement of organisational goals and objectives. This paper discusses the role of critical success factors in health services planning as a means for sorting out and specifying relevant information necessary for achieving organisational goals and managerial objectives. The proposed approach enhances existing planning procedures for health care organisations. Within a conceptual framework of the health care system, managerial insights are provided for the realisation of organisational goals via measurable managerial objectives using critical success factors as pointers to success. More importantly, this paper introduces a planning model which incorporates the CSF concept for developing new health care programmes and for evaluating or restructuring existing programmes.

Health Facility Planning↗