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PubMed1993

Analytical performance goals for measuring prostate-specific antigen.

We have assessed the feasibility of using fixed-limit criteria based on medical relevance and biological variation for evaluating the analytical performance of the prostate-specific antigen (PSA) test. The estimated within-subject variation of serum PSA is on the order of 10-20% at clinical decision points. The calculated performance goals of 5-10% CV are attainable with current immunoassay technology and agree with precision goals based on clinical experience and the current clinical use of the test. However, new clinical applications of PSA may require a degree of analytical performance that current methods may not be able to provide. The PSA model demonstrates the need for biologically based fixed-limit criteria for all tumor-marker tests.

Biomarkers, Tumor↗
PubMed1993

[Concrete goals of the licensing regulation in social medicine education based on legal educational requirements].

The compilations of educational objectives known as "Gegenstandskataloge" link the global educational goals of the German licensing regulations and the more specific demands of the multiple-choice examinations. Favouring formerly the concept of operationalised educational objectives, the procedure is now restricted to the definition of medical subjects on which the examinations are based. The procedure of defining sociomedical objectives as part of the revised "Gegenstandskatalog" is described. More or less desired "side effects" and the representation and integration of sociomedical goals in the medical curriculum are discussed.

Clinical Competence↗
PubMed1993

The elusive generalist physician. Can we reach a 50% goal?

National attention has focused on the goal of attaining 50% primary care practitioners to facilitate patient access and cost-effectiveness. To determine how long it might take to achieve this goal, we used the Bureau of Health Professions' aggregate physician supply model to forecast the generalist-specialist balance. Assuming that 30% of graduates will enter generalist practice after 1993 (the percentage in the mid-1980s), the number of generalists would increase from 174,940 in 1990 to 232,000 in 2040 (77 per 100,000 population), but the percentage would remain at about 30%; specialists would continue to make up about 70% of all active physicians, but their total number would grow from 345,600 to 537,000 (178 per 100,000 population). If 50% of graduates were to enter generalist practices, by the year 2040 the number of generalists would grow to 373,000, or 124 per 100,000 (48.4% of all physicians). If entry into generalist practice falls to 20%, as suggested by recent medical student preferences, the number of generalists would peak at 192,000 (26.4%) in 2010 and would fall to 160,000 (21%) by 2040, resulting in 53 generalists and 201 specialists per 100,000 population. We discuss the implications of these findings on aggregate physician supply and on policy initiative affecting the ratio of generalists to specialists. Reform proposals affecting the specialty mix should clearly identify the desired future ratio of generalists and specialists per capita.

Family Practice↗
PubMed1993

[Normalization of HBA1--a realistic therapeutic goal?].

Optimal regimen for therapy should lead to near-normal glycaemia in children with diabetes mellitus. Therefore normal or near-normal values of glycated haemoglobin (HbA1) during long periods seem to be very important for the assessment of the quality of metabolic control. However, reports published so far indicate that this goal for paediatric diabetology is currently not achieved in a considerable number of patients. We report on the results of HbA1-estimations in 76 children with diabetes mellitus during a one-year period. We found in 14 (18.4%) children HbA1-values within the normal range (mean + 2 SD) and in 25 (32.9%) children HbA1-values in the range below mean + 3.5 SD. The therapeutic goal near-normal glycaemia with HbA1-values below mean + 3.5 SD and probably no or only a small risk for diabetics to develop late vascular complications could be achieved in 39 (50.1%) diabetic children. Our results are compared with those published in literature and with current therapeutic regimens.

Adolescent↗
PubMed1977

Social goals, health policy and the dynamics of development as bases for health education.

Among the most powerful social forces in this century is self determination of nations and of people. The relatively recent phenomenon of community participation in health decisions in some countries is but one aspect of the larger societal value. We can assume that self care, mutual care and collaborative involvement between providers and citizens flow from the concept of self determination. Although the pace is uneven and varies greatly among different communities and in different countries, there is a global movement towards health by the people. This is reflected in the decline of professional dominance of the health field as people in communities assume greater responsiblity for tasks previously monopolized by the health professionals. At the macro level, communities are making decisions in the allocation of resources for health and setting health priorities. At the macro level, health education is increasingly concerned in assisting consumers to develop skills in self diagnosis, self help and self care. However, if health is a human right, it must also be appropriated responsibly by those who claim it. Many healthy problems have their roots in community life. Today, major reductions in death and disability cannot be expected from curative services; instead, future progress will have to result from changes in the environment and lifestyle. Environmental changes will require in turn the cooperation of non-health sectors. Traditionally, professionals and others in these sectors have been reluctant to touch health planning and health policy due to medical dominance and a general attitude that health care belongs to the health professions. A primary task in health education is therefore to build stable linkages with other workers and the public in order that health status may be improved by finding areas of common concern and by institutionalizing joint efforts in seeking solutions through multipurpose planning. In-service training and continuing education for professionals and decision-makers are important strategies in this connection. The fostering of community capabilities for health planning and citizen responsibility in health matters is a priority in health education. This represents an investment in health resource development since the basic resources for collaboration in health improvement are people themselves, both professional and lay. Through community participation, all of us become both shapers of societal goals and governmental policies concerning health and health care, and recipients of the fruits of those goals and policies.

Community Participation↗
PubMed1995

Balancing learner control and realism with specific instructional goals: case studies in fluid balance for nursing students.

In designing instruction, there is an inherent tension between permitting learner control and focusing on specific instructional goals. This tension is particularly problematic in computer-based clinical case studies. In addition, the question of the appropriate level of realistic detail is central to case study design. More learner control and greater detail require greater complexity and interactivity, and consequently longer development time per case. They may also lead to difficulty in focusing on specific content. This program is designed to present computer-based case studies as an adjunct to classroom instruction in a specific content area, with significant compromises in realism compensated by the potential to focus on a specific set of problems and expose students to a fairly large number of "patients." The degree of learner control is necessarily limited by the program's structure, but the design attempts to allow a considerable amount of self-direction within those limits. The program's main path goes through a series of case studies illustrating a variety of fluid and electrolyte problems. These case studies are fairly simple and tightly structured: history, physical assessment, and laboratory data are presented near the beginning of each study, and learners are given predefined choices with immediate feedback at specified decision points. The case studies are designed to be completed fairly rapidly, typically no more than about thirty minutes per case. The distortion of the case study format by the obvious focus on fluid and electrolyte problems is compensated somewhat by inclusion of a number of cases with no relevant problems. Within this structured format, the program gives the learner control over a number of aspects of the learning experience. Hypertext is used hierarchically, with two levels of explanation for some central concepts and one level for material not directly relevant to the main instructional goals. Consequently, the learner controls content density to a considerable degree. Since nursing students are under pressure to absorb large amounts of clinically relevant information within a relatively short time, the availability of additional information on diagnoses, charting abbreviations, normal ranges for lab values, etc., may provide an added incentive to use the program. Though the case studies are linear with no branching, learners have several options in using them. The basic user mode involves simply going through the case studies and "solving" them: evaluating the data, identifying problems, and making basic treatment decisions. Alternatively, the learner may choose a particular problem and use the program as a "semi-tutorial." Backward movement is allowed, either to review the development of a case or to try again after an incorrect response. Accumulated information is available in an on-screen "chart" for ready reference. A "reference library" is accessible for browsing from any point in the program. Learner evaluation of the program is in progress.

Computer Simulation↗
PubMed1996

Healthy People 2000 Goal 1.12: primary care physicians and exercise counseling.

The Healthy People 2000 Goal 1.12 was designed to increase to 50% the number of primary care physicians who regularly counsel their patients concerning the appropriate frequency, duration, type and intensity of exercise. To assess the overall progress in relation to this goal, a survey of 212 physicians was conducted in an eight county region of northern Mississippi. Fifty-nine physicians completed and returned the survey. The findings indicate that 90% of the physicians perceive exercise to be important and that they are discussing exercise with approximately 50% of their patients aged 40 and older. However, the average length of the counseling segment is two minutes or less. It is therefore probable that the appropriate frequency, duration, type and intensity of exercise may not be adequately discussed during physician-based exercise counseling.

Adult↗
PubMed1996

Exceeding the Healthy People 2000 goal for influenza vaccination through a collaborative effort at eight primary care clinics.

The use of trivalent influenza vaccination has been shown to reduce hospitalizations and mortality in high risk persons receiving the vaccine prior to endemic periods. Despite the generally accepted benefit of this vaccine, its use remains relatively low, with less than 40% of high risk persons actually receiving the vaccination. Increasing the vaccination rate is particularly difficult for physicians in small groups, practicing without sophisticated information systems, and for those practices in which small percentages of the patients are in HMO's or capitated plans. The setting for our study was eight primary care clinics, in a predominantly fee for service environment. We used several interventions to achieve the Healthy People 2000 goal of vaccinating 60% of the high risk of population. Those interventions included: mailings to patients recommending they get vaccinated, empowering non physician clinic personnel to administer vaccines without specific physician orders, and distributing comparative data of the vaccination rates at all participating clinic sites. We found that by using these interventions at eight different primary care clinic sites, we were able to achieve an influenza vaccination rate of 66.4% for our high risk population. We concluded that through collaboration eight primary care clinics can exceed the Healthy people 2000 goal of 60% compliance with influenza vaccination.

Data Collection↗
PubMed1997

Study questions whether equalization of health care services a logical goal.

Ontario is in the midst of major health care reform, and one of the goals is to equalize the care available across the province. The authors of a study on the health status of people living in Southwestern Ontario question whether equalization is a wise goal, given that some areas face more serious health problems than others. Dr. Evelyn Vingilis, one of the authors, said government calls for standardization of health care delivery run "completely contrary" to the requirements of a needs-based system.

Health Care Rationing↗
PubMed1977

[Some considerations on the goals of rehabilitation - as seen from the viewpoint of social insurance agencies (author's transl)].

1. The final goal of rehabilitation is - according to & 39 cap. 3 BSHG (Federal Law on Social Assistance) - the integration of the disabled person into society. This goal is reached as soon as the disabled person has been resettled into employment and professional life through adequate measures and when it is possible for him/her to participate in community life. Through his resettlement into employment and professional life the disabled person's integration into society is thus achieved in part. 2. The responsibility for the various phases of the rehabilitation process is divided among different social security agencies. Comprehensive rehabilitation is guaranteed through the close cooperation between these agencies.

Adult↗
PubMed1996

[3.3-style nurses' training goal made by the ABC analytical method].

Statistics of the structure of educational level and worked years of 140 occupied nurses, analysed by ABC curvegram, showed that the key training objects are class A (1 to 10 years at work) and class B nurses. Then the goal of nurses' training at work during 3 years for class A and B was made according to the difference of their classes and need of knowledge. In order to improve the effect of 3.3 style nurse training goal a method of two-direction teaching and assessing were applied, actual effect was achieved during a three-year conduction.

China↗
PubMed1997

What are the goals of treating pediatric asthma?

For many years improvement in symptoms and normalization of lung function have been the main goals in treatment of pediatric asthma. Recently, other parameters, such as reductions in frequency and severity of exacerbations, reduced mortality, normalization of airway hyperresponsiveness, reduction in chronic inflammation of the airways and airway remodeling, normal development of lung function, and normal psychosocial development, are thought to be of similar, or possibly greater, importance. The present understanding of the effects of various drugs used for asthma control is at an early stage. For example, excellent control of one outcome measure may be achieved by a particular drug without any effect on other outcome measures, and the dose of drug needed to control one outcome measure may be quite different from the dose required to control others. Furthermore, the time course of the effect of a drug on the various parameters can differ for each parameter. Improvements in lung function and symptoms often precede, and even reach a plateau, before the maximum reduction in responsiveness is observed. This makes it difficult to determine whether all the goals have been achieved. Therefore, treatments and doses that have been shown in controlled trials to improve most outcome measures are preferred, but their side-effect profiles must also be considered. The majority of parameters seem to be related to the degree of airway inflammation. Unfortunately, at present, the tools of measure all aspects of airway inflammation in the day-to-day management of asthma are not available. Also, the degree to which the inflammatory process must be suppressed, or which aspects of inflammation need to be controlled, to influence the various parameters is not known.

Adolescent↗
PubMed1994

Reaching toward and beyond the year 2000 goals for cigarette smoking. Research and public health priorities.

The 1980s witnessed decreases in adult smoking prevalence in the face of increasing morbidity and mortality from past and current tobacco use. To facilitate even greater cessation activity, innovative research continues to be conducted on methods of improving intensive, individual approaches to smoking cessation, particularly through pharmacologic intervention. However, the major thrust in this country today is toward broad, systemic, public health campaigns, targeting selected high risk groups and the general public. Vulnerable populations continue to include various ethnic groups, especially those with unusually low or high prevalence, women, persons with smoking-related diseases, and heavy smokers. Self-help methods, physician advice, work site and community based interventions, and antismoking coalitions have been in the forefront. Methodologic and intervention studies are needed, concurrent with ongoing large scale public health efforts. What efforts in research and in the public arena are requisite to reach the year 2000 goals for tobacco use? Prevention remains the number one priority. Bringing about a substantial decline in teenage smoking will require the combination of school based programs, environmental and advertising restrictions, and societal revision of norms toward the relative dangers of smoking and drug use in adolescence. Research is needed to define the optimal combinations of such interventions with booster components to sustain effects. Public health efforts, symbolized by the Community Intervention Trial for Smoking Cessation (COMMIT) and the American Stop Smoking Intervention Study (ASSIST) programs, must be combined with stronger advocacy, taxation, antismoking policy formation and implementation to realize a smoke free society.

Adolescent↗
PubMed1976

Locus of control as predictive of goal-directed behavior.

EEO Upward Mobility Program participants were compared with three different control groups along I-E locus of control dimensions. With this instrument and these Ss, no significant differences were found when participation in the program was used as an indicator of goal-directed behavior.

Behavior↗
PubMed1978

Goal choice of alcoholics: a comparison of those who choose total abstinence vs. those who choose responsible, controlled drinking.

Examined possible pre-treatment differences between alcoholic veterans who choose total abstinence and those who choose responsible drinking as their drinking goal. The two groups were compared on a variety of behavioral, cognitive, affective, and demographic characteristics. It was found that those who choose responsible drinking had a significantly shorter history of abusive drinking (6.5 years vs. 11.5 years) and more education (12.5 years vs. 10.8 years). In addition, the responsible drinking group showed a stronger belief that their chance for success was 100%.

Alcohol Drinking↗
PubMed2001

Psychometric properties of goal-attainment scaling in the assessment of mann's time-limited psychotherapy.

This study tested the reliability and validity of Goal-Attainment Scaling (GAS) in assessing outcome in Mann's Time-Limited Psychotherapy (TLP). Judges constructed GAS scales for 33 patients on five dimensions: severity of symptoms, self-esteem, same-sex friendships, romantic relationships, and work performance. Patients in the treatment group received 12 sessions of TLP, whereas controls were in a waiting list for the same period of time (12 weeks) before starting time-limited psychotherapy. Judges rated all patients on GAS before beginning therapy, at termination, and follow-up. Mean interrater reliability of scores between pairs of judges was r = .88. Convergent validity of the GAS was confirmed by moderate to high correlations with the Health-Sickness Rating Scale (r = .70, p < .001), the Target Complaints Scale (r = .50, p <.01), and the Brief Symptom Inventory (r = .38, p < .05). The findings are discussed and recommendations are made for the reliable and valid use of the GAS in psychotherapy outcome research.

Adult↗
PubMed2005

Prefrontal cortical cell firing during maintenance, extinction, and reinstatement of goal-directed behavior for natural reward.

The prefrontal cortex (PFC) is important for higher cognitive functioning and the processing of reward-related information. Here, electrophysiological recording procedures were used to examine cell firing in the PFC in rats (n = 12) during water reinforcement sessions consisting of three phases. In phase one (maintenance), animals pressed a lever (fixed ratio 1) for water reinforcement (0.05 ml/press) paired with an auditory stimulus. Of 62 neurons recorded during maintenance, 39 (63%) exhibited one of three types of patterned discharges relative to the reinforced response for water. Specifically, PFC neurons exhibited increases in firing rate within seconds preceding the response (type PR; n = 9 cells) or increases (type RFe; n = 16 cells) or decreases (type RFi; n = 14 cells) in firing rate immediately following response completion. The remaining neurons did not alter their firing profiles relative to the reinforced response (type nonphasic cells; n = 23 cells). In phase two (extinction), lever press responses had no programmed consequences (i.e., water reinforcement and the auditory stimulus were not presented). After 30 min of no responding, phase three (reinstatement) began, during which each lever press response was again associated with water reinforcement paired with the stimulus. Results indicate differential effects of extinction/reinstatement on cell firing rates and patterns dependent on cell type. These findings are discussed with respect to the adaptive nature of PFC activity during goal-directed behaviors for "natural" rewards, and are considered relative to prior studies that examined nucleus accumbens cell firing during a similar behavioral task.

Action Potentials↗
PubMed2001

Resilient students' goals and motivation.

This paper presents the results of an exploratory analysis, description, and comparison of the self-concept and motivational patterns of academically resilient, non-resilient students, advantaged achievers, and advantaged low-achievers. Resilient students are defined as coming from an impoverished and stressful environment, yet achieving a 2.75 or greater grade point average (GPA). Non-resilient students come from the same background, yet do not have the requisite GPA. There are 17 resilient students and there are 19 non-resilient students. The advantaged achievers come from a low-stress, high-SES background and have a 2.75 or greater GPA. The advantaged low-achievers come from a low-stress, high-SES background, but their GPA falls below 2.75. There are 19 advantaged achievers and nine advantaged low-achievers. Goals, self-concept, and environmental support beliefs are measured by the Assessment of Personal Agency Beliefs and the High School Assessment of Academic Self-Concept. The results show significant results in the cognitive beliefs subscale, social beliefs subscale, general extra-curricular beliefs subscale, and the personal trust subscale.

Achievement↗