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PubMed2003

Health financing reform in sub-Saharan Africa: major constraints, goals, and strategies.

Health financing reform became a critical element of public sector reform in sub-Saharan Africa during the past decade. Within the framework of health sector reform, this article reviews the major constraints, goals, and strategies for health financing reform in sub-Saharan Africa. It identifies shrinking budgetary resources, increasing demand for health services, and rising health care costs as the primary factors driving the sub-region's health financing reform agenda. In light of these constraints, the article defines the major goals and the strategies for health care financing reform employed by many sub-Saharan African countries.

Africa South of the Sahara↗
PubMed2002

[Psychosocial and nutritional risk factors for cardiovascular disease--longitudinal cohort study. Assumptions, goals and methods of the screening survey].

In Poland after two decades of increase in mortality due to Coronary Heart Disease (CHD), the trend reversed and CHD mortality has decreased since 1992. Dynamic change in CHD mortality reflects changes in the incidence and can not be explained by improvement in the acute medical care. Neither could it be explained by changes in the exposure to known cardiovascular disease risk factors i.e. smoking, hypercholesterolemia and hypertension. There was a coincidence of decreasing trend in CHD mortality with rapid political and socioeconomic reforms in the country, which influenced lifestyle and the psychosocial environment of the individuals. Results of the studies indicate that health inequalities could be partially explained by psychosocial factors. Other studies suggested that favorable changes in diet and in alcohol consumption could contribute to favorable changes in health of the Polish population. The long term goal of the present project is to assess the relationship between the risk of coronary heart disease and 1) psychosocial factors, 2) type of diet (consumption of fresh fruits and vegetables, and, 3) alcohol consumption. Assumptions and goals of the project as well as methods of the initial screening, in which a representative sample of men and women at age 45-64 years, residents of Cracow was examined, are described.

Aged↗
PubMed1995

A patient's goal-directed approach to erectile dysfunction and Peyronie's disease.

Because both erectile dysfunction and Peyronie's disease are functional diseases and not life-threatening, I believe their diagnosis and treatment can be tailored according to the patient's general health, treatment goals and expectations. Therefore, I have proposed and used this patient's goal-directed approach in my practice for several years with generally satisfactory results.

Journal Article↗
PubMed1992

Analytical goal-setting for monitoring patients when two analytical methods are used.

Serial results from an individual are often obtained using more than one method. Results should be transferable over time and locale. Every method has inherent analytical error, and goals are required to delineate the maximum allowable random (imprecision) and systematic (inaccuracy, bias) errors to facilitate optimal patient care. Based on Harris's proposal [Am J Clin Pathol 1979;72:374-82] that desirable imprecision should be less than or equal to one-half the within-subject biological variation, if the methods have negligible imprecision, then the maximum allowable bias between two methods used for monitoring is one-third of the within-subject biological variation. A more general model has been developed that relates the analytical imprecisions of two methods, and the bias between them, to biological variation. Applying the general formula derived in specific clinical monitoring situations in which a known change in serial results (occurring at a stated probability) stimulates clinical action allows goals for the imprecisions of the two methods and allows the difference in bias between them to be determined quantitatively.

Bias↗
PubMed2003

Unmet medical needs and therapeutic goals in the treatment of type 2 diabetes.

One of the main goals in the treatment of type 2 diabetes mellitus is to produce near-normal glucose levels to prevent the development of diabetic complications. Available treatments do not succeed in restoring normoglycemia in the long term. The recently improved knowledge of key pathogenic mechanisms of type 2 diabetes has led to a multitude of new molecular targets. The main goal is the maintenance of beta-cell function, as its decline is the major reason for impairment in glucose tolerance over time. Other tissues or systems may also be interesting targets. No single drug is likely to reverse all aspects of the disease, but the main aim is to provide more effective, better tolerated and better patient-tailored combinations.

Diabetes Mellitus, Type 2↗
PubMed2003

From risky behaviors to chronic outcomes: current status and Healthy People 2010 goals for American Indians in Oklahoma.

OBJECTIVES: The objective was to estimate the rates of behavior-related risk factors among American Indians in Oklahoma, and compare those to the Oklahoma general population rates and Healthy People 2010 goals where available. METHODS: The REACH 2010 Native American Behavioral Risk Factor Survey, a random telephone survey, was conducted in 2000 as a part of the larger national REACH initiative. It had 3,732 respondents and it included measures related to health status, health care access, overweight, exercise, tobacco use, alcohol use, hypertension, cholesterol screening and diabetes. RESULTS: Self-reported health status was excellent or very good among 52% of respondents and fair or poor among 21%. Sixty-one percent of adults were overweight or obese. Prevalence of current cigarette smoking was at 33%. Binge drinking in the last month was present among 18% of American Indian adults. Thirty percent of adults did not engage in any leisure time physical activity during the last month. Diagnosed high blood pressure was reported by 26% of respondents, and prevalence of diabetes exceeded 8%. CONCLUSIONS: Majority of the recorded behaviors are above Healthy People 2010 goals, and exceed Oklahoma general population rates. There are also some significant gender differences, demonstrating the need for targeted intervention activities.

Adult↗
PubMedDate not supplied

Where are you going? The science of setting goals.

Picture this. You are at a workshop. Like most workshops, this one has interrupted your day and has taken you from more important tasks. Still, you are there. The presenter begins like this, "Good morning ladies and gentlemen Today, we will talk about setting goals!" You smirk and roll your eyes. "Been there, done that," you want to say. "I'm out of here!" You want to say. But you don't say; and you don't leave. So the presenter continues. "Here is a bow and arrow," he says. "Who wants to make a million dollars with it?" You are glad you stayed. You can use a bow and arrow and you can use a million dollars. You stand up, take the bow and arrow from the presenter's hand and say "I'm in! What do I have to do?" "It's easy," says the presenter. "Just draw the bow and hit the bull's eye with your arrow. If you do, I'll give you one million dollars!" Your heart pounds and your eyes scan the room. This should be easy, but it's not because you can't find the bull's eye. "Hurry up," says the presenter "You've only got 10 seconds. Hit the bull's eye." You look again. Everywhere. Still no luck. Still no bull's eye. Still no million dollars. "Three seconds!" says the presenter. You are tense. You scream, "There is no bull's eye! How can I hit what isn't there?" "You can't!" says the presenter triumphantly. You can't hit what isn't there. That is what setting goals is all about!" You don't want to leave anymore.

Decision Making, Organizational↗
PubMedDate not supplied

Results from a practice-based lipid clinic model in achieving low density lipoprotein cholesterol goals.

OBJECTIVE: Lipid clinic models that combine diet and drug therapy have shown significantly better hyperlipidemia management than usual care. The objective is to demonstrate that such a model can be established and utilized in a primary care practice, replicating the results obtained in specialty clinic settings. DESIGN: This study evaluated a "lipid clinic" model for cholesterol management in a primary care setting. SETTING/PARTICIPANTS: Men and women for both the study and control groups were selected from those with abnormal lipid profiles determined during the course of routine healthcare in community internal medicine group practices. INTERVENTION: Control subjects are those selected by chart review from the practices of four general internists. These physicians treated their patients according to "usual practice". Study subjects are those from another general internal medicine practice who volunteered to enroll in that practice-based "lipid clinic". MEASUREMENT & RESULTS: This program demonstrated significant reductions in total and low density lipoprotein cholesterol in patients with coronary heart disease, diabetes mellitus, and patients without coronary heart disease defined as high and low risk. It used a specialty clinic-based intervention that included diet, medication, and follow-up by nurses and physicians. Almost 90% of all patients were on appropriate drug therapy and achieved therapeutic goals. CONCLUSION: We believe that a primary care practice-based, lipid clinic model employing physician involvement, diet, maximal drug therapy and patient tracking can result in superior achievement of treatment goals.

Aged↗
PubMed2004

Reappraising prosthodontic treatment goals for older, partially dentate people: Part II. Case for a sustainable dentition?

The second of this two-part series, on the theme of estimating prosthodontic treatment needs and goals for older, partially dentate people, examines the roles of patient-perceived functional impairment, treatment outcome and changing demographic profiles in influencing these goals. In contradistinction with the lack of compelling evidence for the basis of the traditional, morphologically-driven prosthodontic treatment strategy, the evidence that the assessment of treatment need should take greater account of individuals' felt oral functional concerns, and thereby assuming a more problem-oriented, outcomes-based approach to prosthodontic decision-making, is gaining strength. Furthermore, the current blueprint guiding prosthodontic planning and procedures cannot be exempt from the far-reaching changes in society brought about by new economic and social realities, and will need to transform itself in the light of new evidence. How these realities translate in a developing country context is not certain, but it is known that inequalities in access to, and the provision of healthcare are related to socio-economic factors, be they prevailing or of residual nature from past structural conditions. Such conditions adversely affect peoples' health status and add urgency to the pursuit of viable and appropriate management strategies. In the context of a reappraisal of current prosthodontic paradigms, the shortened dental arch concept is presented as a potentially compelling strategy for the appropriate management of the ageing, partially dentate patients in South Africa, whose access to healthcare is inequitable. Since dental and oral health status is variable, the management strategy highlighted here should be seen as one, albeit an important one, within a range of available options.

Adaptation, Physiological↗
PubMed2003

Electromyographic activity in the Rhesus monkey forelimb muscles during a goal directed movement and locomotion before, during and after spaceflight.

The aim of the present study was to analyse the effects of microgravity on i) the achievement of goal-directed arm movements and ii) the quadrupedal non-human primate locomotion. A reaching movement in weightlessness would require less muscle contraction since there is no need to oppose gravity. Consequently the electromyographic (EMG) activity of the monkey forelimb muscles should be changed during or after spaceflight. EMG activity of the biceps and triceps muscles during goal-directed arm movements were studied in Rhesus monkeys before, during and after 14 days of spaceflight and flight simulation at normal gravity. The EMG activity was also recorded during treadmill locomotion before and after spaceflight. When performing arm motor tasks, the delay values of the EMG bursts were unchanged during the flight. On the contrary, mean EMG was significantly decreased during the flight comparatively to the pre- and post-flight values, which were very similar. Compared with flight animals, the control ground monkey showed no change in the burst durations and mean EMG. After spaceflight, quadrupedal locomotion was modified. The animals had some difficulty in moving, and abnormal steps were numerous. The integrated area of triceps bursts was increased for the stance phase during locomotion. Taken together these data showed that spaceflight induces a dual adaptative process: first, the discharge of the motor pools of the forelimb musculature was modified during exposure to microgravity, and then upon return to Earth, monkeys changed their new motor strategy and re-adapt to normal gravity.

Adaptation, Physiological↗
PubMed2005

JCAHO's safety goals--the clock is ticking, will your ED be compliant?

To comply with new safety goals from the Joint Commission on Accreditation of Healthcare Organizations, use specific processes and policies designed to minimize likelihood of errors. Nurse-to-nurse communication is the preferred method to use when handing off patients. Meet with staff on a regular basis to assess how well you are meeting Joint Commission requirements. Prepackaged medications can help you and your staff meet the new medication labeling goal.

Accreditation↗
PubMed2005

Definitions and goals of "self-directed learning" in contemporary medical education literature.

INTRODUCTION: Self-directed learning (SDL) has been an essential issue in medical education due to the expansion of knowledge, accessibility to information and greater emphasis on reflection. If SDL in educational research lacks a clear definition, terminological confusion may hinder the application of the results to practice. The aim of this study was to review and categorise the various forms of SDL described in the contemporary literature. METHODS: A search of Medline was conducted using the key word "self-directed learning". Articles published between 2000 and 2004 were extracted. Review articles, letters and articles from health profession education other than medical education, were excluded. Sixty-three articles were analysed in 2 stages: first, whether the definition of SDL is explicitly described was investigated and next, contents in the articles on SDL were qualitatively analysed using a framework approach. The concept of a compassionate-empathic physician, as developed by Carmel and Glick (1996), was used as the framework. RESULTS: Only 5 articles (8.0%) had an explicit and concrete definition of SDL. Content analysis showed that 26 (50.0%) of the 52 articles dealt with SDL only in the scientific-technical dimension, 3 (5.8%) dealt with that only in the socio-emotional dimension and 23 (44.2%) did so in both dimensions. CONCLUSION: Although many researchers use the term "self-directed learning", only a few clearly defined it to avoid semantic confusion. Scientific-technical goals tended to be discussed more frequently in SDL. From a patient-centred viewpoint, socio-emotional goals should be stressed more.

Education, Medical↗
PubMed2005

Succession planning: aligning strategic goals and leadership behaviors.

In the intense health care environment of today, human capital is an organizations most important asset. Leadership and human capital can often differentiate a successful organization from one that is not. In an ongoing effort to develop a strong and capable workforce, many organizations focus exclusively on hiring and training without regard for succession planning; this is a mistake. Succession planning is essential to develop and maintain organizational success. Succession planning supports the development of strong leadership because it leads to increased skills and competencies of staff who can best manage the organization toward achievement of organizational strategic goals. Dealing with the fears and issues surrounding the topic enables leaders to align an organizations strategic goals with its human capital needs to maintain and support leadership transitions and effective organizations.

Humans↗
PubMed2006

[HIV/AIDS spread and influence on other health-related Millennium Development Goals].

HIV/AIDS is threatening the development of countries with high HIV prevalence. This article analyses the impact of HIV/AIDS on the Millennium Development Goals for Health. The analysis is based on a literature survey on the impact of HIV on child health, maternal mortality, tuberculosis and malaria. We find a strong correlation between HIV and child mortality and HIV and TB. We conclude that, in order to reach the Millennium Development Goals, health strategies must include a comprehensive and coordinated approach to fight major health problems including improved resource allocation.

AIDS-Related Opportunistic Infections↗
PubMed1990

Achievable goals and relevant endpoints in cancer treatment.

The goals of cancer treatment range from eliminating cancer to prolonging the time to recurrence, controlling local disease, and palliating symptoms. For many cancer patients, disease elimination is an unrealistic treatment goal at the time of diagnosis due to the presence of metastatic disease and the lack of effective systemic treatment. For other patients, treatment options with similar survival expectation but differing side effects may complicate treatment selection. There is a clear need for new cancer treatment endpoints to be developed so that the effects of cancer treatment may be appropriately monitored. Some recently developed cancer treatment endpoints are described, and their use in clinical trials is advocated.

Combined Modality Therapy↗
PubMed1991

Analytical goals for determinations of theophylline concentration in serum.

Statistical principles for analytical goal-setting were applied to two medical applications of drug-monitoring data: (a) individualizing dosage requirements by reference to a population-based therapeutic range or to a patient-specific decision value determined by Bayesian decision analysis, and (b) prospective dosing by using pharmaco-kinetic principles. For application a, the analytical goal for total allowable analytical error (TE) was defined as the amount of error that does not decrease by more than 5% either the sensitivity (probability) for detecting dosage regimens that may require modification or the specificity for detecting appropriately dosed patients. The limiting factor in achievable sensitivity and specificity was the intra-individual variation of peak steady-state concentration (Css), with the TE determined to be a CV of 4%. For application b, error-propagation rules were applied to a proposed prospective dosing scheme (J Pharmacokinet Biopharm 1978;6:135-51). The TE was determined to depend on the rate of theophylline clearance. For clearance rates less than or equal to 0.6 mL/(kg.min), the TE (CV) must not exceed 3% if the predicted infusion rate is to produce, with 95% confidence, a concentration within the therapeutic range.

Humans↗
PubMed1990

Management of hyperlipidemia: goals for the prevention of atherosclerosis.

The goals of treatment for patients with hyperlipoproteinemia are to reduce plasma concentrations of known atherogenic lipoproteins, thereby exerting a favorable effect upon lipid deposition in the arterial wall and, less commonly, to prevent the adverse sequelae of hyperchylomicronemia in patients with severe hypertriglyceridemia. Diet is the cornerstone of the therapy after the exclusion of secondary factors; the decision to begin drug therapy should be made only after an adequate trial of diet has failed to achieve satisfactory concentrations of plasma lipids and lipoproteins. For patients without evidence of atherosclerosis the goals is to reduce the plasma concentrations of low density lipoproteins to below 160 mg/dl (4.2 mM/L); for those individuals with atherosclerosis or the concurrent presence of two risk factors, a lower level of LDL is desirable (less than 130 mg/dl; 3.4 mM/L). For regression to occur the LDL level may need to be below 100 mg/dl (2.6 mM/L). The bile acid sequestrants (cholestyramine and colestipol), nicotinic acid, fenofibrate, and inhibitors of HMG CoA reductase (e.g., lovastatin or simvastatin) are the most effective drugs for use in patients with primary hypercholesterolemia and these agents reduce plasma concentrations of total and LDL cholesterol by 15-45%. For those patients with concurrent hypertriglyceridemia, nicotinic acid, lovastatin or simvastatin, or fenofibrate are the preferred drugs for initial use. Fibric acid derivatives (e.g., clofibrate, gemfibrozil, bezafibrate, or fenofibrate) are all effective in the therapy of patients with type III hyperlipoproteinemia, as is nicotinic acid or lovastatin.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗