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PubMed2000

Delay of reinforcement effects: timing of reinforcement or narrow goal-box confinement.

The present experiment investigated whether narrow goal-box confinement in studies of delay of reinforcement in the runway may have had aversive or punishing effects. Analysis showed no difference in performance between groups of rats who were either confined in a narrow goal-box or a large compartment while receiving their delay of reinforcement. The results suggest that narrow goal-box confinement does not have aversive characteristics.

Animals↗
PubMed2006

Ezetimibe added to ongoing statin therapy improves LDL-C goal attainment and lipid profile in patients with diabetes or metabolic syndrome.

This analysis of the Ezetimibe Add-on to Statin for Effectiveness (EASE) trial examined the effectiveness and safety of ezetimibe 10 mg added to ongoing statin therapy in patients with diabetes, metabolic syndrome without diabetes, or neither disorder who had low-density lipoprotein cholesterol (LDL-C) levels exceeding National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) goals. After six weeks of treatment, ezetimibe added to statin reduced LDL-C in patients with diabetes by 28%, metabolic syndrome by 24%, or neither by 26%, compared with a 3% reduction for placebo for each group. In each group, more patients receiving ezetimibe plus statin reached LDL-C goal (67-74%) compared with those receiving placebo plus statin (19-22%). Other parameters demonstrating greater improvement with ezetimibe included triglycerides, apolipoprotein (Apo)B/Apo A-I ratio, high-density lipoprotein cholesterol (HDL-C), and C-reactive protein. Ezetimibe plus statin was well tolerated in each group. Ezetimibe added to ongoing statin therapy offers a new treatment option that is consistently effective in improvement of lipid profiles and attainment of LDL-C goals in patients with without diabetes or metabolic syndrome.

Aged↗
PubMed2001

Application of admissions criteria to applicants with practice versus non-practice career goals in North American schools /colleges of veterinary medicine.

PURPOSE: The study was intended to determine whether North American veterinary schools/colleges apply admissions criteria differently to applicants with practice versus non-practice career goals. METHODOLOGY: A written questionnaire with seven queries on admissions criteria was sent to the associate deans for academic affairs at each of the 31 North American veterinary schools/colleges. RESULTS: Questionnaires were completed and returned by 25 of the 31 institutions. The responses were summarized and individual comments were compiled. For veterinary and animal experience, similar amounts but different types of experiences were acceptable to most institutions for applicants with practice versus non-practice career goals. The required pre-veterinary course work was not different for the two groups of applicants. The backgrounds of mentors providing written evaluations were often allowed to be different for the two groups of applicants. The responses expected in applicant interviews were different for the two groups for queries related to veterinary and career experiences and knowledge of specific career areas but were similar for various basic qualities and skills expected of all applicants. CONCLUSION: Although institutions vary, North American veterinary schools/colleges tend to apply admissions criteria differently to applicants with practice versus non-practice goals, except for pre-veterinary course requirements.

Career Choice↗
PubMed2005

Derivation of sustainable breeding goals for dairy cattle using selection index theory.

The objective was to present 2 methods for the derivation of nonmarket values for functional traits in dairy cattle using deterministic simulation and selection index theory. A nonmarket value can be a value representing animal welfare and societal influences for animal production, which can be added to market economic values in the breeding goal to define sustainable breeding goals. The first method was restricted indices. A consequence of adding a nonmarket value to a market economic value for a given functional trait is less selection emphasis on milk yield. In the second method, the loss in selection response in milk resulting from greater emphasis on functional traits was quantified. The 2 methods were demonstrated using a breeding goal for dairy cattle with 4 traits (milk yield, mastitis resistance, conception rate, and stillbirth). Nonmarket values derived separately using restricted indices were 0.4 and 2.6 times the value of market economic values for mastitis resistance and conception rate, respectively. Nonmarket values for mastitis resistance and conception rate were both lower when derived simultaneously than when derived separately. This was due to the positive genetic correlation between mastitis resistance and conception rate, and because both traits are negatively correlated with milk yield. Using the second method and accepting a 5% loss in selection response for milk yield, nonmarket values for mastitis, conception rate, and stillbirth were 0.3, 1.4, and 2.9 times the market economic values. It was concluded that the 2 methods could be used to derive nonmarket values for functional traits in dairy cattle.

Animals↗
PubMed1992

Goal-directed care: caring for aggressive nursing home residents with dementia.

1. Aggressive behavior in elders with dementia occurs most often during personal care. It is often a response to invasion of private space and may be prevented or reduced by interpersonal approaches that reflect a set of individualized goals for the resident. 2. Five resident goals for preventing or reducing aggressive behavior are to feel safe, to feel physically comfortable, to experience a sense of control, to experience optimal stress, and to experience pleasure. 3. These goals provide a framework for humane care that respects the personhood of the individual and minimizes the need for psychotropic medications and physical restraints.

Aged↗
PubMedDate not supplied

Goal-oriented evaluation as a program management tool.

Health promotion programs, like all human services activities, must be well managed in order to be effective. In an age of reduced financial resources to support new programs and sustain old ones, all program directors must be concerned with the efficiency with which available resources are used to meet program goals and objectives. In times such as these, competition is high for those resources that are available. Programs that can demonstrate both effectiveness in meeting their goals and operational efficiency in doing so are more likely to be successful in the competition for these scarce resources. In this article, practical suggestions for the use and presentation of evaluation data in the analysis of program effectiveness and efficiency are presented. The methodology is based on the contention that program evaluation should be useful to program directors as an integral part of their management of program resources in relation to program goals.

Efficiency↗
PubMed1986

Occupational therapy treatment goals for adults with developmental disabilities.

This study examined whether occupational therapists were using treatment time to prepare adults with developmental disabilities for independent living opportunities. Eighty-eight occupational therapy evaluations for 54 adults with developmental disabilities in 18 different community agencies in the Boston area were reviewed to ascertain the focus of treatment goals that reflect treatment approaches. Results indicate that remedial goals significantly outnumbered adaptive ones. Within the adaptive goals, self-care and community living skills were equally represented, but some important community skill areas like advocacy, money management, personal care attendant management, sexuality, and transportation received little or no attention. Implications of these findings for therapists, clients, and third-party payers are discussed.

Activities of Daily Living↗
PubMed2004

Inter-organisational integration for rehabilitation in Sweden - variation in views on long-term goals.

PURPOSE: The aim was to study variation in views on long-term goals expressed by members in a project concerning rehabilitation of individuals in an area in mid Sweden. The organisations participating were the municipal social services, the county council's health care organisation, the governmental social insurance office, the national employment service and the national labour market institute. THEORY: A number of different meanings of the concept of integration are accounted for and the background of inter-organisational rehabilitation in Sweden is described. METHODS: Qualitative interviews using a semi-structured interview guide with altogether 20 leading representatives of the various organisations, all members of the Steering Committee of the project. The analysis consisted of two parts: an in-depth analysis using a phenomenographically inspired approach and qualitative content analysis. RESULTS: Two main views regarding the goal of inter-organisational integration were identified in the in-depth analysis: Category A, which regards integration as a new approach to rehabilitation, and Category B, which regards integration as a way of rendering the existing organisations more efficient. The content analysis showed a wide variation in spontaneously mentioned topics e.g. on the task of the group. CONCLUSIONS AND DISCUSSION: There exists a risk that divergent views in the Steering Committee concerning the future direction of the collaboration may send mixed messages providing uneven support for the professionals within the different organisations. The study points to the importance of having a common vision and common, well-defined goals at the outset of a collaborative project in order to support micro-level cooperation.

Journal Article↗
PubMed2003

Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care.

BACKGROUND: Hypertension in patients with type 2 diabetes mellitus is a prevalent condition that leads to substantial morbidity and mortality. PURPOSE: To evaluate the goals and optimal agents for treatment of hypertension in type 2 diabetes. DATA SOURCES: Review of the medical literature STUDY SELECTION: Randomized trials that evaluated the pharmacologic treatment of hypertension in patients with diabetes and reported microvascular and macrovascular outcomes. DATA EXTRACTION: Studies were identified by using the Cochrane Library, MEDLINE, meta-analyses, review articles, and expert recommendation. The searches of the Cochrane Library and MEDLINE were performed in May 2000 and updated in April 2002. Data were abstracted to standardized forms by a single reviewer and were confirmed by a second reviewer. DATA SYNTHESIS: Treatment of hypertension in type 2 diabetes provides dramatic benefit. Target diastolic blood pressures of less than 80 mm Hg appear optimal; systolic targets have not been as rigorously evaluated, but targets of 135 mm Hg or less are reasonable. Studies that compare drug classes do not suggest obviously superior agents. However, it is reasonable to conclude that thiazide diuretics, angiotensin-II receptor blockers, and perhaps angiotensin-converting enzyme (ACE) inhibitors may be the preferred first-line agents for treatment of hypertension in diabetes. beta-Blockers and calcium-channel blockers are more effective than placebo, but they may not be as effective as diuretics, angiotensin-II receptor blockers, or ACE inhibitors; however, study results are inconsistent in this regard. CONCLUSIONS: Treatment of hypertension in type 2 diabetes, with blood pressure goals of 135/80 mm Hg, provides dramatic benefits. Thiazide diuretics, angiotensin II receptor blockers, and ACE inhibitors may be the best first-line treatments, although other agents are usually necessary and goals may not be achieved even with three or four agents. Aggressive blood pressure control may be the most important factor in preventing adverse outcomes in patients with type 2 diabetes.

Adrenergic beta-Antagonists↗
PubMed1991

Beyond management by objectives: the implementation of a goal-directed performance management system in an Australian teaching hospital.

This paper describes management by objectives (MBO) as an approach by which organisations can be managed, with particular reference to health care institutions. An evaluation of MBO is presented and the disadvantages of MBO are discussed. A more comprehensive performance management system than MBO is advocated. The experience of St Vincent's Hospital, Sydney, in designing and implementing a goal-directed performance management program which builds on MBO methodology, is described. This experience provides guidelines by which senior managers may successfully implement goal-directed performance management programs in health care institutions in order to enhance organisational effectiveness and the goal-oriented behaviour of managers.

Employee Performance Appraisal↗
PubMed1999

Goal attainment scaling in a geriatric day hospital. Team and program benefits.

PROBLEM BEING ADDRESSED: The Geriatric Day Program (GDP) of the Capital Health Region in Victoria, BC, is concerned with effective team processes, accountability for health service outcomes, and improving the quality of programs. The GDP identified a need to improve its interdisciplinary processes and generate useful patient outcome data. OBJECTIVE OF PROGRAM: To determine whether Goal Attainment Scaling (GAS) could be introduced to facilitate interdisciplinary processes and to generate useful health outcome data. MAIN COMPONENTS OF PROGRAM: The GAS procedures were incorporated into clinical routines based on published guidelines. The authors determined GAS outcome scores for patients who completed the program and developed outcome scores for specific geriatric problem areas requiring intervention. Outcome scores were made available to the clinical care team and to program managers for continuous quality improvement purposes. CONCLUSIONS: The GAS process was successfully implemented and was acceptable to clinicians and managers at the GDP. Team processes were thought to be improved by focusing on patient goals in a structured way. The GAS provided data on both patient outcomes and outcomes of interventions in specific problem areas. Accountability for patient care increased. Goal Attainment Scaling provided indicators of care for which clinicians could develop program quality improvements.

Aged↗
PubMed1999

Reaching the goals of "Healthy People 2000" regarding breastfeeding.

The Healthy People 2000 objectives for breastfeeding were to move the breastfeeding initiation rate to 75% from 54% and the breastfeeding continuation rate to 50% at age 6 months from the 1988 baseline of 21%. The 1996 data indicated that the goal will not be met either for initiation or duration in spite of governmental strategic planning and coalition building, the acknowledgement of the benefits of breastfeeding by professional associations, the implementation of the Baby-Friendly Hospital Initiative, or the efforts of individual health professionals. Clearly, there is still work to be done. The Baby-Friendly Hospital Initiative was organized within Baby-Friendly USA too late in the decade to have had any impact on the 1996 data. It may take an additional decade before sufficient hospitals and birthing centers are engaged in the process to make a measurable difference in duration. Work protection legislation was not introduced until 1998. A national breastfeeding committee was not formed until 1998. National breastfeeding promotion programs were still either in the planning stage or in early stages of implementation in 1996. There is no paid maternity leave guaranteed by legislation for women in the United States. The International Code on Marketing has not been addressed, except to propose ways of examining the issue. The blueprints developed by the Surgeon General's Workshop on Breastfeeding and the Call for Action workshop enumerated strategies that will be carried over to the 2010 objectives. New blueprints will be developed to meet the 2010 goals, but it is not enough to strategize and plan. The substantive advantages of breastfeeding make accomplishment of the goals imperative if we are to achieve "health for all."

Breast Feeding↗
PubMed2001

[Treatment goals for blood lipids in high risk patients of atherosclerotic disease].

BACKGROUND: The results from clinical studies with statins have directed attention to the benefits of risk factor intervention in atherosclerotic disease, and achievement of treatment goals for blood lipids. MATERIAL AND METHODS: In 1999, a total of 3,935 patients treated with a statin were screened in 412 general practices in Norway for their blood lipids, in order to evaluate the achievement of the new European treatment guidelines (total cholesterol < 5 mmol/l and LDL cholesterol < 3 mmol/l). Inclusion criterion was ongoing medication with a statin, independent of indication. Consecutive patients were interviewed and examined when they attended their regular check-ups. The mean age of the patients was 63 years; 42% of them were women. Two-thirds of the patients were in secondary prevention. RESULTS: Before treatment, the mean level of total cholesterol was in primary prevention 8.8 mmol/l, in secondary prevention and in diabetes 7.5 mmol/l. In the total material, 36% of the patients achieved the treatment goal of total cholesterol and LDL cholesterol. Significantly more patients in secondary prevention than in primary prevention achieved the treatment goal (44% versus 17%), more patients with than without diabetes achieved it (45% versus 34%), and more men than women (42% versus 27%). These differences were mainly due to differences in base levels of total cholesterol and LDL cholesterol. To assess the statin doses, the average dose of each type of statin was converted to a simvastatin dose. The average dose in this manner was found to be 23.8 mg, with small differences between the subgroups. INTERPRETATION: The doctors did not uptitrate the statin doses according to the lipid levels and in line with the evidence from the clinical trials. General practitioners in Norway should intensify their use of lipid lowering therapy.

Adult↗
PubMed1999

Maximizing Cardiorenal Benefit in the Management of Hypertension: Achieve Blood Pressure Goals.

Current recommendations by the Sixth Report of Joint National Committee (JNC) suggest that lower blood pressure levels than previously recommended should be obtained in order to preserve renal function and reduce cardiovascular risk. This holds true for people with diabetes as well as those with renal insufficiency. By all accounts, we as a nation are doing a poor job of even achieving the general guideline for blood pressure control (i.e., less than 140/90 mm Hg). This has contributed to a plateau in mortality reduction from cardiovascular events and a may have contributed to an increase in the incidence of end stage renal disease. This paper reviews the rationale for achieving lower blood pressure goals (i.e., less than 130/85 mm Hg) in people with diabetes and/or renal disease. It also provides an approach as to how to achieve these lower goal blood pressures with a minimum of side effects. Lastly, the use of fixed dose combinations is discussed as a method to improve compliance. In brief, patients with diabetes or renal disease will require an average of 2.6-4.3 different antihypertensive medications to achieve these lower blood pressure targets. The number of medications is a function of the degree of renal insufficiency. If done appropriately, patients can consume these medications in 2 to maybe 3 pills per day. By achieving these lower blood pressure goals there is a good possibility of reducing morbidity as well as mortality from cardiovascular and renal disease. More recent reports document that it is more cost effective in these high risk groups to achieve levels of diastolic blood pressure of less than 85 mm Hg. (c)1999 by Le Jacq Communications, Inc.

Journal Article↗
PubMed2001

Quantitative target values of predictors of mortality in rheumatoid arthritis as possible goals for therapeutic interventions: an alternative approach to remission or ACR20 responses?

Predictors of longterm mortality in rheumatoid arthritis (RA) include patient questionnaire measures, grip strength, walk time, physician and patient assessment of global status, joint examination abnormalities, erythrocyte sedimentation rate (ESR), and morning stiffness. In the rheumatology literature, these measures have been analyzed primarily according to mean values in groups or regression analyses, which are valuable to recognize that mortality in RA is predicted by more severe disease, but do not provide the clinician with specific goals of therapy. Goals for therapeutic intervention are often expressed either as complete remission or as statistically significant differences versus a placebo, as in a 20% or even 50% response of a measure such as the American College of Rheumatology Core Data Set. Remission may be too stringent, while statistically significant efficacy of a drug compared to placebo may not necessarily indicate effectiveness to control longterm damage. An alternative approach might be to identify possible target values for therapeutic efficacy that markers of a poor prognosis be "near normal" rather than necessarily at normal or remission levels, as has been explored in management of hypertension and diabetes. However, it remains uncertain whether the goal of therapy should be a "near normal" or entirely normal values for a clinical marker. Better control of quantitative markers that predict early mortality could provide a valuable approach to improving outcomes in RA.

Arthritis, Rheumatoid↗
PubMed2001

Lipid management: tools for getting to the goal.

The treatment of hypercholesterolemia in the United States begins with the recognition of elevated low-density lipoprotein cholesterol (LDL-C) as the primary target. An optimal LDL-C level has been defined as < 100 mg/dL. The first step in lowering LDL-C continues to be lifestyle modification, which includes a restriction of saturated fat and cholesterol, increased physical activity, and weight loss, if applicable. Approximately half of all patients with elevated LDL-C levels will ultimately need treatment with a lipid-lowering drug to achieve treatment goals. The preferred drug for first-line treatment in most patients is a statin; a bile acid resin or niacin can be used in patients who cannot tolerate statins or who are not candidates for stain therapy. Combination therapy is an option, with several combinations showing efficacy in lowering LDL-C (statin plus bile acid resin, niacin plus bile acid resin) and in lowering both LDL-C and triglycerides (statin plus fibrate, statin plus niacin, bile acid resin plus niacin). Successful lipid management includes treating to reach the LDL-C goal level, treating to reach the non-high-density lipoprotein cholesterol goal level if applicable, and managing other risk factors for coronary heart disease.

Anticholesteremic Agents↗
PubMed2002

[Treatment goals as an instrument of quality management in psychosomatic rehabilitation].

The present article outlines the development of a system of categories of treatment goals in psychosomatic rehabilitation. As a first step a content analysis of 242 letters of discharge was carried out. In order to give a systematic describe of the thus extracted goals a system of categories was developed. Which was then in a second step used as the basis for detailed discussions by psychosomatic rehabilitation experts aimed at revising and optimizing the system of categories. This developed classification of treatment goals--owning to the possibility in principle of operationalization--will provide the conditions for further strategies within the context of evaluation and measures of quality assurance.

Humans↗
PubMed2001

Efficient or family-centred? Practitioners' goals in decisions regarding parental presence during invasive procedures.

Little is currently documented about how health care professionals determine when parental presence is appropriate during an invasive procedure. The research profiled in this article was a qualitative study of the decision-making by 10 nurses and five physicians in PICU regarding when and how to include parents as witnesses to invasive procedures. This article includes one aspect of the research findings: practitioners' goals in such decisions. Specifically, the authors will detail how practitioners' perspectives about the primacy of particular goals of the child's care influenced their decisions to encourage or discourage parents from remaining with their children during invasive procedures. It was found that participants' decisions whether or not to permit parents to remain during invasive procedures were primarily determined by what the practitioner held as the priority goal of his/her practice (i.e., efficiency or family-centred care). The authors conclude by identifying some clinical and research directives that arise from the research findings.

Attitude of Health Personnel↗