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PubMed2002

Outcomes for the sociology of mental health: are we meeting our goals?

In this paper I argue that a fruitful discussion of the choice of outcomes in the sociological study of the social antecedents of mental health problems would benefit from a consideration of the goals that we are trying to achieve. The most clearly articulated goal is that of uncovering those aspects of society that produce harm. I examine the premises of the current conceptual framework--the stress paradigm--in light of its ability to fulfill this goal, and I discuss the implications for the types of outcome measures we use.

Decision Making↗
PubMed2003

Response, remission, and recovery in bipolar disorders: what are the realistic treatment goals?

Bipolar disorder presents particular challenges with regard to assessing response to therapy. Criteria for determining remission and recovery have been suggested for mood disorders, but the clinical usefulness of these terms in bipolar disorder is elusive. Formal psychological rating scales may be impractical in a routine medical practice setting. As an alternative, clinicians might probe for information about particular "signal events," such as sleep disturbances, that may herald mood fluctuations. The ultimate goal of bipolar management should be complete and sustained remission, whenever possible, although most patients will not achieve this status for any significant length of time. Furthermore, overaggressive management might entail pushing medication doses to intolerable levels. Individual treatment goals should always take into account patient acceptance of side effect burden, allowing for trade-offs between treatment effect and quality of life. Noncompliance with therapy, notoriously common among patients suffering from bipolar disorder, can stem from drug side effects, treatment ineffectiveness, or even treatment success if the patient misses the manic symptoms. Despite effective treatment, relapse is common. Realistic treatment goals should strive for sustained symptom abatement while maximizing patient quality of life from visit to visit.

Bipolar Disorder↗
PubMed2006

[Goals in risk factor reduction and therapeutic failures].

UNLABELLED: Risk factors' reduction decreases the number of vascular events. The therapy is successful, when target values of risk factors became realised. AIMS: 3 modifiable risk factors - hyperlipidemia, hyperglycemia, hypertension - were checked in 350 high risk patients, comparing the target and the realised values of risk factors. METHODS: 1. Medical history of risk factors' therapy. 2. serum lipids and fasting blood glucose parameters. 3. Physical and ultrasound examinations for cerebro-, cardio- and peripheral vascular diseases, measurement of abdominal circumference and blood pressure. 4. Risk stratification. 5. Statistical analysis. RESULTS: 1. Mean LDL-cholesterol was 3 +/- 0.94 and 3.3 +/- 0.87 in the group of patients with and without therapy, respectively (p < 0.01). Number of not treated patients is high (47.3%). 2. There were significantly (p = 0.053) more treated patients above blood sugar goals (6,7 mmol/l), than in the group of untreated patients. Mean fasting blood glucose were 8.11 +/- 3,036 and 7.25 +/- 1.925 mmol/l in treated and not treated group of patients, respectively (p = NS). 3. There were significantly (p < 0.00001) more hypertensive patients above therapeutic goal in the treated and less in the untreated group of patients. Mean tension (153,4 +/- 22.42 and 139.7 +/- 20.76) was significantly (p < 0,001) higher in the treated, and lower in the untreated group of patients. 4. Number of risk factors are more in high risk patients. Only 5.2% of patients became free of risk factors by recent clinical practice and in 72.3% remained 2 or 3 factors. CONCLUSIONS: Most part of patients do not reach the therapeutic goals, and there are many persons without any therapy for hyperlipidaemia. To cure and to treat are different.

Aged↗
PubMed1990

The relationship of career goal and self-esteem among adolescents.

The purpose of this study was to investigate the relationship of career goal and self-esteem among adolescents. A sample of 221 high school sophomores and juniors was administered the Rosenberg Self-Esteem Scale (RSE). Their teachers also were asked to rate the students' self-esteem using the Self-Esteem Rating Scale for Children (SERSC). It was found that, on both the RSE and SERSC, adolescents with some career goals had significantly higher self-esteem than did those without any career goal.

Adolescent↗
PubMed1990

Quality control of multichannel haematology analysers: critique of current methods and the need for performance goals.

Performance goals for internal quality control of multichannel haematology analysers have been developed by consensus in the Subcommittee on Quantitative Cellular Haematology of the National Committee of Clinical Laboratory Standards (NCCLS). Conventional methods of quality control (i.e. use of standards for machine calibration and control samples to detect drift) are not feasible for the automated complete blood-cell count because standards and generally accepted reference methods for cell enumeration are not currently available. In the absence of an ideal system, a host of different quality control strategies are utilized with fresh whole blood, stabilized blood preparations, commercial surrogate materials, and statistical functions of measurements on patient specimens. All have their theoretical strengths and weaknesses which, up to now, have been difficult to quantify and to compare experimentally between methods and between laboratories. Performance goals, or what have been judged by a consensus of experts to be achievable tolerance limits for the various sources of analytical variations, were determined for the following measurements: haemoglobin concentration, erythrocyte count, leukocyte count, platelet count, and mean cell volume. These performance goals can be used to compare the effectiveness of the various quality control strategies now used and to determine which strategy would perform best and be most cost-effective in a particular laboratory situation.

Automation↗
PubMedDate not supplied

ET nurses: shared goals, different backgrounds.

The doctorally prepared ET nurse may assume many roles. The goals of these roles are to enhance nursing knowledge, advance patient care, and promote enterostomal therapy in the nursing profession. These are no different than the goal of the ET nurse who is not doctorally prepared. Only the tools one uses to accomplish these goals and, therefore, the route taken may differ. While the doctorally prepared ET nurse has a common background with all ET nurses, he/she has unique skills to share in regards to curriculum and research. By understanding the role, and educational background of an ET nurse, the opportunities to work together to enhance ET nursing are endless.

Consultants↗
PubMed1986

Goals of therapy: aggressive or moderate acid suppression?

Healing with moderate acid suppression is increasingly becoming the goal of therapy in patients with peptic ulcer. Comparative trials between cimetidine and other more potent H2-receptor antagonists indicate no difference in efficacy or pain relief despite the higher degree of acid suppression induced by the newer agents. Recent clinical trials with cimetidine have demonstrated that the inhibition of nocturnal acid secretion alone is the most important factor in the healing of peptic ulcer. The results of clinical trials conducted in the United States and Europe demonstrated that 800 mg of cimetidine at bedtime is the optimal dosage regimen, providing rapid pain relief and ulcer healing in approximately 80% of the patients. Furthermore this regimen has the advantages of easy compliance, convenience, and fewer potential drug interactions, as well as providing 24-hour moderate acid suppression with normal daytime gastric acid levels. Thus in ambulatory patients with duodenal ulcer, a single nightly dose of 800 mg of cimetidine is the optimal regimen for moderate acid suppression. This reinforces a basic concept of medicine that the lowest possible dosage of a drug can be used to treat a condition effectively and safely. While moderate acid suppression with nocturnal dosing will accomplish the goal of healing in the ambulatory patient, different objectives of acid-suppression therapy may be needed when treating hospitalized patients in the intensive care unit. For these patients, well-controlled clinical trials indicate the necessity for a more aggressive approach to gastric acid control, with the goal being to maintain the intragastric pH above 4.0.

Cimetidine↗
PubMed1983

The monitoring process and its importance for achievement of the global goals for oral health by the year 2000.

The establishing of the global goals for oral health in the year 2000 automatically implies an increased need to collect epidemiological data on various oral health problems in the specified age groups of the world's population. Baseline data for 1980 on dental caries in the young age groups and on the prevalence of edentulousness among adults are available only in some countries. Where baseline data are available, continuous surveillance at suitable time intervals is required to monitor changes in oral health. Where baseline data are not available, the main emphasis should be put upon clarification of the present situation. In this review, data on recent changes in oral health in some European industrialized countries are used to evaluate future trends. The predictions seem promising for the young age groups which, without difficulty, should be able to surpass the specified global goal by the year 2000. The proposed 50 per cent reduction in edentulousness at age 35-44 also seems to be realistic. The goal which will be difficult to achieve, at least for both the United Kingdom and Finland, is the 25 per cent reduction in edentulousness in the age group of 65 years and over. This part of the population may prove to be the 'lost generation' with regard to oral health. In developing countries very little information is available on this age group. It is concluded that the need to monitor will in itself initiate world-wide activity in epidemiological research. Monitoring is important not only because it provides data on the current situation but also because it is the only known way to predict the probable extent of future improvements in oral health.

Adolescent↗
PubMed1982

Assessing whether a clinical pharmacy program is meeting its goals.

An assessment of whether the clinical pharmacy program at Memorial Hospital Medical Center (MHMC), Long Beach CA, was meeting its goals is presented. MHMC is a 858-bed, nonprofit teaching hospital that initiated a clinical pharmacy program in 1967. The program's three foremost goals were to: (1) establish cohesive and standardized clinical services, (2) promote the acceptance of the roles and functions of clinical pharmacists by physicians and nurses, and (3) assure the provision of good quality care. The evaluation data were collected over a six-week period using questionnaire surveys of approximately 28 pharmacists, 146 physicians, and 389 nurses; pharmacist service reports from 5991 drug monitorings; 228 medical record audits for six drugs; 68 guideline compliance records for three drugs; interviews with 131 users of the drug information services; abd logs of 3946 pharmacist encounters with other health-care providers. Generally, the clinical pharmacy program was found to be meeting its goals. Most of the monitorings (81.6%) were initiated by pharmacists, and 20% resulted in changes in drug therapy. The pharmacists adhered to the pharmacy department's monitoring and dosing guidelines. There was unanimous satisfaction among users of the drug information service with the response received from pharmacists, and 99% satisfaction with the promptness of response and accuracy of the information. Sixty-eight percent of the pharmacists reported discussing general issues with physicians, and 72% answered patient-specific questions from physicians. The physicians (96%) and nurses (97%) thought that there was an improvement in the quality of patient care as a result of pharmacist involvement. Pharmacists at MHMC are providing useful clinical services.

California↗
PubMed1982

Postural support of goal-directed movements: the preparation and guidance of voluntary action in man.

Goal-directed movements, such as punching and pointing, need preprogramming of postural support and visual control. These processes are recorded in man by EEG, EMG, oculogram, and a platform. The earliest cerebral correlate of voluntary action is the Bereitschaftspotential (readiness potential) or, after a trigger signal, the expectancy wave (CNV). These bilateral negative potential shifts increase to a Zielbewegungspotential (aiming potential) when a goal-directed movement is made, and end with a positive shift, when the goal is reached. During these cerebral potentials an attentive eye saccade is directed towards the target and an ordered sequence of bilateral muscle activations follows. This coordinated motor activity in trunk and leg muscles corresponds to a readiness innervation that prepares body posture and balance. It precedes the final aimed movement of the arm towards the target and postural adjustments such as the compensation of body and head rotation by the vestibular-ocular reflex. The temporal order of the cerebral, oculomotor and muscular events is schematized for punching and pointing movements in a figure. The limits of conscious control and the necessity of automatized learning for voluntary skilled movement under visual control are discussed. Some speculations are made about a possible origin of slow potential shifts by surface negative dipoles in columnar modules of the parasagittal cortex during the programming and monitoring of aimed motion.

Arm↗
PubMed1995

Analytic goals, concentration relationships, and the state of the art for clinical laboratory precision.

We analyzed the College of American Pathologists' Quality Assurance Service 1990 database of 1500 clinical laboratories to evaluate concentration relationships and the state of the art for the precision of 37 analytes. We compared these data to previously reported Quality Assurance Service precision performance data from 1974 through 1980. The general trend of decreasing average long-term, within-method, within-laboratory coefficients of variation continues. However, among 24 routine chemical and therapeutic drug monitoring tests observed for 11 to 16 years, 11 showed no evidence of continuous improvement in precision. The 1990 average coefficients of variation usually exceeded analytic goals modeled by clinical responses when these models assumed that variability in test results arises solely from the analytic performance of the method. In contrast, they usually did not meet goals that take into account the presence of biologic factors among the sources of test variation. Notable exceptions are the average coefficients of variation for cholesterol and triglycerides, which markedly decreased during the National Cholesterol Education Program initiatives of the 1980s. Continuous improvement of precision in disciplines dominated by relatively mature automated methods may not be the norm unless structure and direction are provided by appropriate and accepted analytic goals.

Humans↗
PubMed1994

The effect of self-esteem, family structure, locus of control, and career goals on adolescent leadership behavior.

Since leadership in formal and informal high school activities is one possible indicator of positive social adjustment among adolescents, it is worthwhile to better understand why certain adolescents become leaders and others do not. This study was designed to investigate the relationship between leadership behavior (dependent variable) and self-esteem, locus of control, family structure, and career goals. The participants were divided into a leadership group (n = 79) and a nonleadership (comparison) group (n = 124). Adolescents in the leadership group tended to be higher in internal locus of control, to live in a two-parent family structure, and to have more prestigious career goals. There was no significant difference between the two groups in level of self-esteem, although those in the leadership group with higher self-esteem also tended to have higher career goals.

Adolescent↗
PubMedDate not supplied

The hopes and hazards of health goals development.

As part of the Edmonton Board of Health's centennial celebrations, health goals and objectives were developed for the city. The intensely collaborative process used to develop the goals and objectives is reviewed and critical activities such as communication, media and community involvement, committee membership, and implementation are discussed. It is hoped that the information will be useful for others who are developing health goals and objectives at the municipal level.

Alberta↗
PubMed1993

Physician goals and laboratory test turnaround times. A College of American Pathologists Q-Probes study of 2763 clinicians and 722 institutions.

Laboratory test turnaround times (TATs) for emergency department patients were studied in 722 institutions using Q-Probes, a quality improvement program of the College of American Pathologists. The medians of the TATs required by 2763 clinicians were 10 minutes for PO2, 20 minutes for hemoglobin, and 30 minutes for potassium and glucose measurements. Surgeons had the shortest TAT requirements for hemoglobin, potassium, and glucose measurements, whereas emergency department physicians had the shortest requirements for PO2. The measured TATs of most hemoglobin and potassium determinations did not meet clinician goals. In contrast to laboratorians, the majority of clinicians defined a TAT start time as test ordering, and a TAT ending time as result reporting. We recommend laboratorians and clinicians mutually agree on the definition of TAT, jointly develop timeliness goals, and together improve TAT performance to fulfill these goals.

Diagnostic Tests, Routine↗
PubMed1996

Outcome analysis of goal directed therapy for impotence.

PURPOSE: We assessed patient preference, satisfaction and overall outcome of goal directed management of erectile dysfunction. MATERIALS AND METHODS: The results of goal directed therapy of impotence were assessed by an independent telephone survey of 377 consecutive men who had not received prior therapy and who were followed for a minimum of 2 years. RESULTS: Patients preferred medical to surgical therapies despite significantly higher satisfaction rates achieved with surgery. Average number of treatment modalities chosen by each patient was 2 (range 0 to 5). Ultimately, only 40% of the patients achieved a long-term satisfactory result with goal directed therapy. The remainder were not satisfied with the last treatment but chose no further therapy, were lost to followup or refused therapy from the outset. CONCLUSIONS: Our results clearly demonstrate a patient preference for the least invasive forms of therapy. Patients avoid significantly more effective but also more invasive treatment options despite unsatisfactory results with less invasive methods. Future research efforts should be concentrated on the development of new medical therapies to enhance overall patient satisfaction.

Adolescent↗
PubMed1997

Structuring training goals for psychodynamic psychotherapy.

A multiaxial model that structures educational goals for psychodynamic psychotherapy has been developed. It specifies core aspects of psychodynamic psychotherapy, clusters them in categories that further define and link related areas, and presents a sequence that enables educators and students to focus on training goals in a consistent progression. This model has been used by the Director of Education as a basis for developing the curriculum, by students as a way of focusing learning and giving perspective to current work, and by supervisors to link individual teaching to the goals of the training program. This method has enhanced consistency, clarity, and efficiency in the psychotherapy program.

Curriculum↗
PubMed1998

[Quality assurance in a psychiatric day clinic. A catamnestic study with goal attainment scaling].

PURPOSE: For the second time after 1990, a community mental health service questioned the outcome quality of its day hospital in rehabilitating primarily psychotic patients. METHODS: In addition to the assessment of 66 persons at the beginning and at the end of an average of six months' treatment in the years 1990-95, a psychologist who had not been involved in the treatment interviewed 49 persons one year after discharge with the use of goal attainment scaling in five relevant fields. RESULTS: Due to the economic recession the goal attainment decreased with regard to the job situation in the sense that it was difficult to find unsheltered jobs. By defining the goals in accordance with the needs of the patients, an improvement in the lodging situation was observed. As a result of the first study, quality monitoring led to an improvement of the structures that promote spare time interests. Social contacts and coping with everyday life showed sustainable achievements. CONCLUSIONS: These achievements can be interpreted as a result of the comparably long time of exposure to social learning within the therapeutic milieu of the day hospital. This hypothesis of a positive correlation between the sustainability of the outcome and the length of treatment must be validated by another study.

Adult↗