Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Goals”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,333 records · Page 74Linked to original sources
PubMed2005

Shifts in global immunisation goals (1984-2004): unfinished agendas and mixed results.

The turn of the millennium has been marked by a large-scale mobilisation of resources for immunisation programmes in developing countries. The resources have been generated by public and private sector parties collaborating in the Global Alliance for Vaccines and Immunization (GAVI). GAVI was formed in response to deteriorating immunisation coverage rates occurring in the late 1990s. GAVI is the latest in a line of vaccine initiatives, which have operated over the past 20 years. This article reviews the five most important global immunisation initiatives that have taken place over those past 20 years. It analyses their origins, shifts in global immunisation goals, identifies key actors, assesses the initiatives' capacity to mobilise resources and increase immunisation coverage, and points to possible unintended effects of the initiatives. The study argues that shifts in global immunisation goals lead to fragmentation in the implementation of vaccine programmes at the local level in developing countries. It also suggests that global actors involved in the formulation of these initiatives appear to miss opportunities to build on past experiences and fail to learn from previous mistakes. This raises questions about the initiatives' sustainability and relevance to the overall objective of preventing vaccine-preventable deaths.

Adolescent↗
PubMed2006

What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)?

OBJECTIVE: Recent studies have suggested that the definition of optimal cytoreduction for advanced EOC should be changed from the current Gynecologic Oncology Group threshold of < or =1 cm residual disease to no gross residual disease owing to improved survival of patients (pts) rendered macroscopically disease-free. The objective of this study was to analyze survival rates at very specific residual disease diameters to determine the optimal goal of primary cytoreduction for bulky stage IIIC EOC. METHODS: A prospectively kept database was used to identify and review the records of all pts with Stage IIIC EOC who underwent primary cytoreductive surgery at our institution between January 1989 and December 2003. To analyze a homogeneous cohort of cases, we excluded pts with stage IIIC disease based on nodal metastasis alone (without bulky abdominal tumor), fallopian tube or primary peritoneal carcinomas, and borderline tumors. Standard statistical analyses were utilized. RESULTS: The study cohort included 465 pts. The median age was 60 years (range, 25-87), and the median follow-up was 38 months (range, 1-199). Univariate and multivariate analyses, which included various prognostic factors, identified amount of residual disease as a significant prognostic factor (P < 0.001). Median overall survival in relation to the 5 residual disease categories was: no gross residual, 106 months; gross < or =0.5 cm, 66 months; 0.6-1.0 cm, 48 months; 1-2 cm, 33 months; >2 cm, 34 months. Statistical comparison between the 5 residual disease categories revealed 3 distinct groups with significantly different survival rates (P < 0.01). These 3 groups were: (1) no gross residual; (2) gross < or =1 cm residual; and (3) >1 cm residual. Although the difference in survival did not reach statistical significance, within the gross < or =1 cm residual group, there was a trend toward improved survival in pts left with smaller volume, < or =0.5 cm residual compared with those with 0.6-1.0 cm residual (P = 0.06). CONCLUSION: Our data suggest that removal of all evidence of macroscopic disease is associated with prolonged survival and should be the goal of primary cytoreductive surgery. If complete gross resection is not feasible, however, cytoreduction to as minimal residual tumor as possible should be the focus of cytoreductive efforts, as each incremental decrease in residual disease below 1 cm may be associated with an incremental improvement in overall survival.

Adult↗
PubMed2000

Food-safety educational goals for dietetics and hospitality students.

OBJECTIVE: To identify food-safety educational goals for dietetics and hospitality management students. DESIGN: Written questionnaires were used to identify educational goals and the most important food safety competencies for entry-level dietitians and foodservice managers. SUBJECTS: The sample included all directors of didactic programs in dietetics approved by the American Dietetic Association and baccalaureate-degree hospitality programs with membership in the Council on Hotel, Restaurant, and Institutional Education. Fifty-one percent of the directors responded. STATISTICAL ANALYSIS: Descriptive statistics were calculated. chi 2 analysis and independent t tests were used to compare educators' responses for discrete and continuous variables, respectively. Exploratory factor analysis grouped statements about food safety competence. Internal consistency of factors was measured using Cronbach alpha. RESULTS: Thirty-four percent of dietetics programs and 70% of hospitality programs required or offered food safety certification. Dietetics educators reported multiple courses with food safety information, whereas hospitality educators identified 1 or 2 courses. In general, the educators rated food-safety competencies as very important or essential. Concepts related to Hazard Analysis and Critical Control Points (HAACP), irradiation, and pasteurization were rated less highly, compared with other items. Competencies related to reasons for outbreaks of foodborne illness were rated as most important. APPLICATIONS/CONCLUSIONS: Food safety certification of dietitians and an increased emphasis on HAACP at the undergraduate level or during the practice component are suggested. Research is recommended to assess the level of food-safety competence expected by employers of entry-level dietitians and foodservice managers.

Certification↗
PubMed1999

Setting goals for reductions in Canadian cesarean delivery rates: benchmarking medical practice patterns.

OBJECTIVE: The objective of this study was to present a structured method for determining achievable cesarean rate goals and specifying which hospitals should receive focused attention. STUDY DESIGN: Hospital level data from the largest 239 Canadian maternity units were analyzed for 1988-1989, when the number of Canadian cesarean deliveries peaked. Cesarean rate statistical limits within the largest, intermediate-sized, and smallest maternity unit classifications were successively set at the 75th, 50th, and 25th percentiles. RESULTS: The national impact resulting from using the 75th percentile rate as the assigned statistical cesarean rate limit was 2707 (50th 5568; 25th 11,018) fewer cesarean deliveries. CONCLUSION: Benchmarking provides a structured perspective on defining goals and on estimating how much change is required and at which hospitals.

Benchmarking↗
PubMed1998

Infants selectively encode the goal object of an actor's reach.

Research with young children has shown that, like adults, they focus selectively on the aspects of an actor's behavior that are relevant to his or her underlying intentions. The current studies used the visual habituation paradigm to ask whether infants would similarly attend to those aspects of an action that are related to the actor's goals. Infants saw an actor reach for and grasp one of two toys sitting side by side on a curtained stage. After habituation, the positions of the toys were switched and babies saw test events in which there was a change in either the path of motion taken by the actor's arm or the object that was grasped by the actor. In the first study, 9-month-old infants looked longer when the actor grasped a new toy than when she moved through a new path. Nine-month-olds who saw an inanimate object of approximately the same dimensions as the actor's arm touch the toy did not show this pattern in test. In the second study, 5-month-old infants showed similar, though weaker, patterns. A third study provided evidence that the findings for the events involving a person were not due to perceptual changes in the objects caused by occlusion by the hand. A fourth study replicated the 9 month results for a human grasp at 6 months, and revealed that these effects did not emerge when infants saw an inanimate object with digits that moved to grasp the toy. Taken together, these findings indicate that young infants distinguish in their reasoning about human action and object motion, and that by 6 months infants encode the actions of other people in ways that are consistent with more mature understandings of goal-directed action.

Attention↗
PubMed2003

[Clinical use of statins and cholesterol goals in patients with several cardiovascular risk factors].

BACKGROUND AND OBJECTIVE: Our goal was to determine the number of patients who achieve low-density lipoprotein cholesterol (LDL-c) targets according to new guidelines. PATIENTS AND METHOD: Descriptive and transversal study of patients from a cardiovascular clinic. LDL-c was calculated and targets were established according the NCEP-ATP III. RESULTS: 1,811 patients (46% males, 54% females) were studied. 35% of these were high-risk patients (group 1: coronary risk > 20% at 10 years), 19% were intermediate-risk patients (group 2: coronary risk 10-20% at 10 years) and 46% were low-risk patients (group 3: coronary risk < 10% at 10 years). Overall, 58% of patients achieved target LDL-c levels, yet success rates were 26% among group 1 patients, 51% among group 2 patients, and 86% among group 3 patients (p = 0.001, for differences between groups). Statin treatment was significantly related to achieving target LDL-c levels in group 1 patients (OR = 1.7; 95% CI, 1.2-2.4; p = 0.007). In group 1.41% of patients had LDL-c levels > 130 mg/dl without receiving lipid-lowering drugs. CONCLUSIONS: Although an overall 58% patients achieve target LDL-C levels, only one of four high-risk patients have LDL-c levels < 100 mg/dl, and statin treatment is a determining factor to achieve this goal. These findings indicate that a more aggressive treatment with statins is needed in secondary prevention.

Aged↗
PubMed2004

Effects of simvastatin on the lipid profile and attainment of low-density lipoprotein cholesterol goals when added to thiazolidinedione therapy in patients with type 2 diabetes mellitus: A multicenter, randomized, double-blind, placebo-controlled trial.

BACKGROUND: Coronary heart disease is the major cause of mortality in individuals with diabetes mellitus (DM). Given the increasingly aggressive low-density lipoprotein cholesterol (LDL-C) goals for patients with DM set by the National Cholesterol Education Program Adult Treatment Panel III and the American Diabetes Association, many patients remain above target. Treatment with thiazolidinediones (TZDs) improves glycemic control but does not lower (and may raise) LDL-C concentrations. OBJECTIVE: This study assessed the lipid-modifying efficacy and tolerability of adding the hydroxymethylglutaryl coenzyme A-reductase inhibitor simvastatin to existing TZD therapy in patients with type 2 DM. METHODS: This was a multicenter, randomized, double-blind, placebo-controlled, parallel-group trial. Patients with type 2 DM who were taking a stable dose of pioglitazone or rosiglitazone and had a glycosylated hemoglobin (HbA1c) value < or =9.0% and an LDL-C concentration > 100 mg/dL were randomized to receive simvastatin 40 mg (the recommended initial dose for patients with DM) or placebo for 24 weeks. The primary end point was the effect of treatment on LDL-C concentrations. Other lipid, lipoprotein, and safety measures were also assessed. RESULTS: Two hundred fifty-three patients (127 [50.2%] men, 126 [49.8%] women; mean age, 56 years) were randomized to treatment (123 simvastatin, 130 placebo). At the end of the study, mean LDL-C concentrations were reduced 34.)% from baseline (from 134.3 to 89.5 mg/dL) in the simvastatin group and were unchanged in the placebo group (P<0.001). Simvastatin produced significant reductions in concentrations of total cholesterol, triglycerides (TG), non-high-density lipoprotein cholesterol, and apolipoprotein (apo) B compared with placebo (all, P<0.001 ) and significant increases in concentrations of high-density lipoprotein cholesterol (HDL-C) ( P=0.002 ) and apo A-I ( P=0.006 ). In patients who had not attained target concentrations of LDL-C (<100 mg/dL), TG (<150 mg/dL), or HDL-C (>45 mg/dL) at baseline, significantly more simvastatin recipients had achieved these goals at the end of the study compared with placebo recipients (LDL-C: 67.3% vs 5.2%, respectively, P<0.001; HDL-C: 95.3% vs 83.6%, P<0.05; TG: 40.8% vs 11.0%, P<0.001 ). Simvastatin was well tolerated, and no clinically meaningful differences in the incidence of serious adverse events, treatment-related adverse events, or discontinuations due to adverse events were observed between groups. There were no significant between-group differences in glycemic control (HbA1c) or concentrations of fasting insulin, creatine phosphokinase, or hepatic transaminases. CONCLUSION: Simvastatin was an effective and generally well tolerated treatment for hyperlipidemia when used in combination with TZD therapy in this population of patients with type 2 DM.

Adult↗
PubMedDate not supplied

Paget's disease of bone: indications for treatment and goals of therapy.

Paget's disease of bone is a common disorder of unknown etiology characterized by increased bone remodeling and abnormal bone architecture. The pathologic process is initiated by an increase in osteoclast-mediated bone resorption, accompanied by a compensatory increase in bone formation. The increased bone remodeling results in a disorganized mosaic of woven and lamellar bone. This bone is highly vascular and gradually becomes enlarged and structurally weakened. Paget's disease is generally diagnosed in patients older than 40 years of age, usually as an incidental finding. The disease may be monostotic or polyostotic. The pelvis, femur, spine, tibia, skull, and humerus are most commonly involved. Most patients with Paget's disease are asymptomatic. Pain is the most common presenting symptom. Complications of the disease include bowing deformity of the long bones, fracture, and a variety of nerve compression syndromes. Malignant degeneration of Paget's disease is a rare complication. As safer, more effective therapies have become available, the indications for treatment and goals of therapy have changed. The difficult issue that clinicians are currently facing is whether to treat patients with asymptomatic disease. The progressive nature of the disease, the severity of its complications, its potential negative impact on quality of life, and the availability of therapy capable of controlling its activity have led many experts in the field to recommend treatment of asymptomatic patients who have active disease at sites where complications are likely to develop. There are, however, no data to prove that complications can be prevented by decreasing the rate of bone remodeling in Paget's disease, nor any data to define who is at risk for complications. Until more information is available, the management of patients with Paget's disease will continue to be based on clinical observation and theoretical considerations. This review examines the present understanding of Paget's disease, the rationale for the proposed indications for treatment and the goals of therapy.

Animals↗
PubMed1989

Goal-tracking behavior in the pond snail, Lymnaea stagnalis.

The occurrence of goal-tracking, an unconditioned stimulus (US)-directed autoshaping behavior, was studied in open-field tests with control and classically conditioned pond snails, Lymnaea stagnalis. In an appetitive classical conditioning paradigm with a tactile stimulus as conditioned stimulus (CS) and a localized food stimulus as US a conditioned feeding response built up in the experimental but not in the control animals. In the post-training open-field tests the experimental group alone showed an enhanced attraction toward the source of water current in the environment which previously signalled the arrival of the US but did not act as CS in the classical conditioning procedure. We suggest that this stimulus-directed goal-tracking behavior in Lymnaea is the result of a classical-operant interaction, described so far only in vertebrate animals, and that neurophysiological analysis of this behavior is possible in this snail.

Animals↗
PubMed2001

Finding a goal on dry land and in the water: differential effects of disorientation on spatial learning.

Two previous studies, Martin et al. (J. Exp. Psychol. Anim. Behav. Process. 23 (1997) 183) and Dudchenko et al. (J. Exp. Psychol. Anim. Behav. Process. 23 (1997) 194), report that, compared to non-disoriented controls, rats disoriented before testing were disrupted in their ability to learn the location of a goal on a dry radial-arm maze task, but that both groups learned at the same rate in the Morris water maze. However, the radial-arm maze task was much more difficult than the water maze. In the current set of experiments, we examined the performance of control and disoriented rats on more comparable dry land and water maze tasks. Compared to non-disoriented rats, rats that were disoriented before testing were significantly impaired in locating a goal in a circular dry arena, but not a water tank. The results constrain theoretical explanations for the differential effects of disorientation on different spatial tasks.

Animals↗
PubMed2003

On-line trajectory modifications of planar, goal-directed arm movements.

Sometimes a goal-directed arm movement has to be modified en route due to an unforeseen perturbation such as a target displacement or a hand displacement by an external force. In this paper several aspects of that modification process are addressed. Subjects had to perform a point-to-point movement task on a computer screen using a mouse-coupled pointer as the representation of the hand position. Trajectory modifications were imposed by unexpectedly changing the position of the target or by changing the relation between mouse and screen pointer. In the first series of experiments, we examined how often a trajectory is updated. Here, trajectory modifications were imposed by unexpectedly changing the normal relation between mouse and pointer to a shear-like relation, where a percentage of the forward/backward position of the hand was added to the pointer position in the left/right direction. Withdrawal of visual feedback during the movement revealed that trajectories were updated at interval times shorter than 200 ms. From the similarity with experiments where the original relation between mouse and pointer was restored during the movements, we conclude that motor plans are updated on-line to move the hand from its current perceived position to the target. In a second series of experiments, we studied whether a continuous change in target position yields similar trajectory modifications as a continuous hand displacement. To mimic the latter perturbation, we used the above-mentioned distortion of the mouse-pointer relation. We found that the resulting hand paths did not differ for the two visual perturbations and conclude that the perturbed, goal-directed movements are modified in a consistent way, irrespective of whether the position of the target or hand was perturbed. Simulations of the experimental data with a kinematic reaching model support this conclusion.

Acceleration↗
PubMed2003

Can we bridge the gap between goals and practice through a common vision? A study of politicians and managers' understanding of the provisions of elderly care services.

The objective of this study was to identify and describe how local politicians and managers experience and understand problems and goals regarding the structures and processes involved in the care of the elderly. Qualitative methodology of a conceptual modelling workshop was used. Participants were health care politicians, local municipal politicians, and executive care managers. The main result was that all participants agreed on four key visions for the health care of the elderly: see the person, see the individual's resources, see the encounter, and see yourself. Other findings indicated that (a) care of older persons was governed by diverse interests, (b) the organisation lacked clear leadership and comprehensive goals, (c) the organisation was fragmented, and (d) there was a lack of skilled staff members to meet patient needs. Older persons were regarded as passive receivers of care or as objects that did not take an active part in health care decisions that affect them.

Aged↗
PubMed1998

Treating patients with documented atherosclerosis to National Cholesterol Education Program-recommended low-density-lipoprotein cholesterol goals with atorvastatin, fluvastatin, lovastatin and simvastatin.

OBJECTIVES: This study compared the efficacy and safety of atorvastatin, fluvastatin, lovastatin, and simvastatin in patients with documented atherosclerosis treated to U.S. National Cholesterol Education Program (NCEP) recommended low-density-lipoprotein (LDL) cholesterol concentration (< or = 100 mg/dl [2.59 mmol/liter]). BACKGROUND: For patients with advanced atherosclerosis, NCEP recommends lipid-lowering drug therapy if LDL cholesterol remains > or = 130 mg/dl (3.36 mmol/liter). METHODS: A total of 318 men or women with documented atherosclerosis and LDL cholesterol > or = 130 mg/dl (3.36 mmol/liter) and < or = 250 mg/dl (6.5 mmol/liter), and triglycerides < or = 400 mg/dl (4.5 mmol/liter) participated in this 54-week, multicenter, open-label, randomized, parallel-group, active-controlled, treat-to-target study. Patients were titrated at 12-week intervals until the LDL cholesterol goal was reached. Number of patients reaching target LDL cholesterol levels and dose to reach target were evaluated. RESULTS: At the starting doses, atorvastatin 10 mg produced significantly greater decreases (p < 0.05) in plasma LDL cholesterol than the other treatments. Subsequently, the percentage of patients reaching goal at the starting dose was 32% for atorvastatin, 1% for fluvastatin, 10% for lovastatin and 22% for simvastatin. Atorvastatin-treated patients required a lower median dose than other treatments. Median doses at week 54 with the last available visit carried forward were atorvastatin 20 mg/day, fluvastatin 40 mg/day + colestipol 20 g/day, lovastatin 80 mg/day, simvastatin 40 mg/day. CONCLUSIONS: A significantly greater number (p < 0.05) of patients with confirmed atherosclerosis treated with atorvastatin reached the target LDL cholesterol concentration at the starting dose than patients treated with fluvastatin or lovastatin, and significantly fewer (p < 0.05) patients treated with atorvastatin required combination therapy with colestipol to achieve target LDL cholesterol concentrations than all other statins tested.

Anticholesteremic Agents↗
PubMed1998

High-dose nitrates in the immediate management of unstable angina: optimal dosage, route of administration, and therapeutic goals.

Nitrates are commonly used for rapid relief of ischemia in the initial management of unstable angina. However, their optimal dosage, route of administration, and therapeutic goals have not been fully established. This study was conducted to determine the optimal dosage and mode of administration (intravenous bolus versus sublingual spray) of nitrates and the therapeutic goals of their use in the immediate management of unstable angina. In a single-center prospective trial, 72 consecutive patients with unstable angina accompanied by typical ST-segment depression on electrocardiogram were randomly assigned to receive isosorbide dinitrate either as repeated intravenous boluses or as sublingual sprays while being delivered to the hospital by a mobile intensive care unit. Optimal nitrate dosage was tailored to pain relief while monitoring mean blood pressure reduction to an optimal range (5% to 20%) without dosage restriction. The mean nitrate dosage needed for ischemia control during the first hour of treatment was 7.8 +/- 3.8 mg. Optimal blood pressure reduction was achieved by significantly more intravenously treated patients than sublingually treated patients (68% v 41%, P = .037). Intravenously treated patients also experienced a more pronounced therapeutic effect, as assessed by reduction in chest pain score (67% v 39%, P = .0004) and decrease in ST-segment depressions (57% v 27%, P = .004). These results show that higher doses of nitrates than previously recommended are required for ischemia control during the initial management of unstable angina. The use of repeated intravenous boluses is safe and more easily controlled and, therefore, more efficacious than sublingual sprays in inducing the maximal anti-ischemic effect while avoiding significant hypotension.

Administration, Sublingual↗
PubMed1998

Study to validate the outcome goal, competencies and educational objectives for use in intensive care orientation programs.

Intensive care orientation programs have become an accepted component of intensive care education. To date, however, there have been no Australian-based standards defining the appropriate level of competence to be attained upon completion of orientation. The aim of this study was to validate a set of aims, competencies and educational objectives that could form the basis of intensive care orientation and which would ensure an outcome standard of safe and effective practice. An initial document containing a statement of the desired outcome goal, six competency statements and 182 educational objectives was developed through a review of the orientation programs developed by the investigators. The Delphi technique was used to gain consensus among 13 nurses recognised for their expertise in intensive care education. The expert group rated the acceptability of each of the study items and provided suggestions for objectives to be included. An approval rating of 80 per cent was required to retain each of the study items, with the document refined through three Delphi rounds. The final document contains a validated statement of outcome goal, competencies and educational objectives for intensive care orientation programs.

Australia↗
PubMed2005

Plasma glucose goals and therapeutic management in elderly diabetic patients.

In the elderly diabetic patient, therapeutic decision making is not entirely based on evidence acquired from large-scale studies conducted in young adults. In this population autonomy, co-morbidity and prognosis are all objective parameters which must be taken into consideration. Frail patients run the risk of hypoglycaemia if the therapeutic goal is too strict. Frail patients can be distinguished from autonomous patients free of serious co-morbidity using evaluation scales validated for geriatric patients enabling the establishment of appropriate goals for the treatment of diabetes without compromising the patients' quality-of-life.

Aged↗
PubMedDate not supplied

Computer based nursing documentation means to achieve the goal.

New functions have been integrated in the Giessen Hospital Information System WING to support the classification of all intensive care patients into the Therapeutic Intervention Scoring System (TISS). The use of those functions has been pushed when health insurance bodies demanded evidence for the correct classification of ICU beds. This article presents an overview on this development from the start in just one intensive care unit to the complete coverage of six intensive care units and three intensive monitoring units with a total of 109 beds. For those units complete TISS data has been documented for more than a year now at a detailed level. On average 14 interventions have been recorded per patient and day, accumulating to a database with more than a million entries. We describe the experiences made during introduction and the different front-end applications we used to achieve the goal. Results gained from the huge database and their implications for our future work are discussed. TISS documentation is now an established routine on every intensive care unit of our University hospital. It has been implemented without major financial or manpower investments and no specific intensive care information system has been needed. Establishing this type of basic care documentation made nurses aware of their activities, so that now they consider electronic care documentation to be in their very own interest. The next goal has been set by nurses themselves, they want to establish intervention based care documentation on normal wards as well. We think that step by step we will thus be able to achieve a more complete electronic patient record.

Attitude of Health Personnel↗
PubMed2000

Allocation of surgeries to operating rooms by goal programing.

High usage rate in a surgical suite is extremely important in meeting the increasing demand for health care services and reducing costs to improve quality of care. In this paper a goal programming model which can produce schedules that best serve the needs of the hospital, i.e., by minimizing idle time and overtime, and increasing satisfaction of surgeons, patients, and staff, is described. The approach involves sorting the requests for a particular day on the basis of block restrictions, room utilization, surgeon preferences and intensive care capabilities. The model is tested using the data obtained during field studies at Dokuz Eylul University Hospital. The model is also tested for alternative achievement functions to examine the model's ability to satisfy abstract goals.

Appointments and Schedules↗