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At least 199 records · Page 11Linked to original sources

PubMed2006

Blood pressure goal attainment according to JNC 7 guidelines and utilization of antihypertensive drug therapy in MCO patients with type 1 or type 2 diabetes.

OBJECTIVE: Controlling hypertension (HTN) in patients with diabetes mellitus (DM) can reduce complications such as nephropathy, cerebrovascular disease, and cardiovascular disease. As part of a quality improvement project with a managed care organization (MCO), we evaluated blood pressure (BP) control relative to the type of drug therapy for patients with type 1 or type 2 DM who were identified from pharmacy claims for antihyperglycemic drug therapy. METHODS: Pharmacy claims for antihyperglycemic drugs, including insulin, were used to identify a random sample of commercial members in an MCO comprising 30 health plans across the United States. Retrospective medical record review was conducted in October 2003 to collect data from 4,814 patient charts. BP goal attainment according to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines was determined for each patient from the most recent BP reading documented in the medical chart. RESULTS: The distribution by type of DM was 21.0% (n = 1,011) for type 1, 75.7% (n = 3,644) for type 2, and 3.3% (n = 159) for cases not documented in the medical chart. Excluding 590 charts (12.3%) without BP values, there were 1,328 of 4,224 DM patients (31.4%) at JNC 7 BP goal (< 130/80 mm Hg). Of the 1,328 patients at JNC 7 BP goal, 577 (43.4%) were at JNC 7 BP goal with no drug therapy. Excluding the 577 patients who did not require drug therapy to reach JNC 7 goal, 751 (20.6%) of the remaining 3,647 patients who required antihypertensive drug therapy were at JNC 7 BP goal, and 788 (21.6%) received no antihypertensive drug therapy. For the population of 4,224 DM patients with a BP value recorded in the chart, application of the lower BP goals in the JNC 7 guidelines reduced the proportion with controlled BP to 31.4% (1,328/4,224) from 42.6% (1,799/4,224) according to the former JNC 6 guidelines (P < 0.01). The proportion of DM patients with HTN was 59.6% (n = 2,870), and 28.4% (n = 814) of these patients were not taking either an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). There were 704 patients with albuminuria or nephropathy (14.6%), of which 35.4% (n = 249) were not taking either an ACEI or an ARB, preferred therapy in these patients. CONCLUSION: In this population of MCO members with DM for whom a BP value was recorded in the medical chart, 13.7% met JNC 7 BP goal with no antihypertensive drug therapy. For the patients with DM who received antihypertensive drug therapy and had a BP value recorded in the medical chart, only 26.3% were at JNC 7 BP goal. The application of JNC 7 guidelines significantly reduced the proportion of DM patients at target BP goal from 42.6%% to 31.4%

Aged↗

PubMed2006

Antihypertensive efficacy of olmesartan medoxomil and candesartan cilexetil in achieving 24-hour blood pressure reductions and ambulatory blood pressure goals.

BACKGROUND: For patients with hypertension, effective 24-hour blood pressure (BP) control is vital to ensure protection against the early morning surge in BP and the associated increased risk of cardiovascular events. The aim of this analysis was to assess the 24-hour antihypertensive efficacy of olmesartan medoxomil (20mg once daily) compared with candesartan cilexetil (8mg once daily), with particular emphasis on BP control during the early morning period. METHODS: This is an additional analysis of a previously reported randomised, double-blind study in which 635 patients with mainly mild to moderate hypertension were randomised to 8 weeks of treatment with either olmesartan medoxomil 20 mg/day or candesartan cilexetil 8 mg/day. Changes from baseline during the last 4 and 2 hours of ambulatory BP measurement (ABPM) after 1, 2 and 8 weeks of treatment were compared between the two groups. In addition, the proportions of patients who achieved various ABPM goals, including those suggested by the European Society of Hypertension/European Society of Cardiology (ESH/ESC) [<125/80mm Hg] and the Japanese Society of Hypertension (JSH) [<135/80mm Hg], over 24 hours, during the daytime and at the last 4 and 2 hours of ABPM measurement were also compared. RESULTS: After 8 weeks, significantly greater proportions of patients treated with olmesartan medoxomil 20mg achieved 24-hour and daytime ABPM goals recommended by the guidelines of the ESH/ESC (25.6% and 18.3%, respectively) and JSH (37.5% and 26.6%, respectively) compared with candesartan cilexetil 8mg (24-hour ESH/ESC goal = 14.9%, p < 0.001; 24-hour JSH goal = 26.6%, p = 0.003; daytime ESH/ESC goal = 9.6%, p = 0.002; daytime JSH goal = 16.4%, p = 0.002). During the last 4 hours of 24-hour ABPM, the proportions of patients who achieved the ESH/ESC and JSH ABPM goals were significantly greater with olmesartan medoxomil (33.3% and 39.1%, respectively) than with candesartan cilexetil (22.9%, p < 0.001 and 31.6%, p = 0.047, respectively). Similarly, during the last 2 hours of 24-hour ABPM, the proportions of patients who achieved these BP goals were either significantly greater (JSH) or approached statistical significance (ESH/ESC) with olmesartan medoxomil (26.9% and 19.9%, respectively) compared with candesartan cilexetil (19.6%, p = 0.028 and 14.3%, p = 0.061, respectively). CONCLUSION: Compared with candesartan cilexetil 8mg, greater proportions of olmesartan medoxomil-treated patients (20mg) achieved ESH/ESC and JSH ABPM goals over 24 hours. The superior BP control of olmesartan medoxomil was also reflected in the larger proportions of olmesartan medoxomil-treated patients who achieved the ESH/ESC and JSH ABPM goals during the early morning surge period. This not only demonstrates that olmesartan medoxomil 20mg provides superior 24-hour BP reduction, but also suggests that olmesartan medoxomil may provide greater protection against the increased risk of cardiovascular events associated with the early morning BP surge period.

Adult↗

PubMed2006

Lipid management and cholesterol goal attainment in Norway.

OBJECTIVE: To document prescribing patterns of lipid-modifying therapies in hypercholesterolemic patients, cholesterol goal attainment, and factors associated with cholesterol goal attainment in Norway. METHOD: This was a retrospective, observational study using existing computerized patient records at 11 primary healthcare centers in Norway and the Norwegian Patient Register of hospital data. The study population was 3111 patients identified in the primary care database who were prescribed a lipid-modifying therapy between the dates of July 1987 and May 2003 and who were > or = 18 years of age at the time of the first prescription. Of these patients, 1337 patients had uncontrolled lipid measures at baseline. In the analysis of goal attainment, data were available for 877 (28% of the total study population) and 1144 (37%) patients with baseline and follow-up total cholesterol (TC) and/or low-density lipoprotein-cholesterol (LDL-C) levels after 4 and 12 months' treatment, respectively. OUTCOME MEASURES: Initial lipid-modifying therapy (drug and dosage), changes in initial lipid-modifying therapy, cholesterol goal attainment, and factors related to cholesterol goal attainment. Cholesterol treatment goals were defined as LDL-C <3.0 mmol/L and/or TC <5.0 mmol/L (as per the Second Joint Task Force of European Societies on the Prevention of Cardiovascular Disease). RESULTS: The initial lipid-modifying therapy was a HMG-CoA reductase inhibitor (statin) in 98% of patients, most often simvastatin (42%; mean initial dosage = 18.4 mg/day) or atorvastatin (34%; 12.7 mg/day). The median year of treatment initiation was 1999 and the mean duration of follow-up was 39 months. The initial prescription remained unchanged at year 1 for most patients (69%), whereas 17% discontinued drug treatment. Mean TC levels decreased from 7.36 mmol/L at baseline (n = 1337) to 5.31 mmol/L at 12 months (n = 1144; p < 0.05), whereas mean LDL-C levels decreased from 4.98 (n = 847) to 3.08 mmol/L at 12 months (n = 713; p < 0.05). These mean reductions occurred within 3 months of the initial prescription and did not change subsequently. A total of 32.9% of patients who were not at goal at baseline achieved cholesterol goal 12 months after initiating treatment. The factors related to cholesterol goal attainment at 12 months were: baseline TC level (odds ratio [OR] 0.64; 95% CI 0.58, 0.71), treatment with a statin (OR 8.60; 95% CI 1.13, 65.4), diagnosis of diabetes mellitus (OR 2.91; 95% CI 2.01, 4.21), and age (OR 1.02; 95% CI 1.01, 1.03). CONCLUSIONS: Lipid-modifying therapy in Norway is dominated by statin monotherapy. In this analysis of primary-care patients, maximal reductions in cholesterol levels were seen within the first 3-4 months after therapy initiation. After 12 months of treatment, 67% of patients remained above recommended cholesterol levels. More effective and well tolerated treatment strategies are needed to improve the probability of patients achieving cholesterol treatment goals.

Aged↗

PubMed2006

Reaction times of manual responses to a visual stimulus at the goal of a planned memory-guided saccade in the monkey.

Monkeys demonstrate improved contrast sensitivity at the goal of a planned memory-guided saccade (Science 299:81-86, 2003). Such perceptual improvements have been ascribed to an endogenous attentional advantage induced by the saccade plan. Speeded reaction times have also been used as evidence for attention. We therefore asked whether the attentional advantage at the goal of a planned memory-guided saccade led to speeded manual reaction times following probes presented at the saccade goal in a simple detection task. We found that monkeys showed slower manual reaction times when the probe appeared at the memorized goal of the planned saccade when compared to manual reaction times following a probe that appeared opposite the saccade goal. Flashing a distractor at the saccade goal after target presentation appeared to slow reaction times further. Our data, combined with prior results, suggest that a spatially localized inhibition operates on the neural representation of the saccade goal. This inhibition may be closely related or identical to the processes underlying inhibition-of-return. We also found that if the same detection task was interleaved with a difficult perceptual discrimination task, manual reaction times became faster when the probe was at the saccade goal. We interpret these results as being an effect of task difficulty; the more difficult interleaved task may have engaged endogenous attentional resources more effectively, allowing it to override the inhibition at the saccade goal. We construct and discuss a simple working hypothesis for the relationship between the effects of prior attention on neural activity in salience maps and on performance in detection and discrimination tasks.

Animals↗

PubMed2005

Health goal cognition and adjustment in women with fibromyalgia.

The purpose of this study was to identify individual differences in symptom-specific goal for persons diagnosed with fibromyalgia syndrome (FMS) and to determine whether those differences are related to adjustment outcomes. Women with FMS (N=71) rank ordered 12 FMS-specific goals and completed a packet of psychosocial outcome measures. Cluster analysis suggested that there were three relatively homogeneous subgroups defined. Cluster 1 ranked goals related to seeking professional care higher than all other groups. Cluster 2 ranked self-sufficiency goals higher than the other two groups. Cluster 3 ranked social-validation goals higher than the other two clusters. Multivariate analyses of variance (MANOVAs) and post-hoc tests showed that goal profiles covaried with differences in pain, negative affect, goal-specific social support, general social support, goal-related interference, and negative life events. Differences between groups are discussed in the context of proposed relations between goals and environmental support.

Adaptation, Psychological↗

PubMed2003

Inactivation of the infralimbic prefrontal cortex reinstates goal-directed responding in overtrained rats.

Over the course of extended training, instrumental responding in rats shows a transition from goal-dependent performance to goal-independent performance, as assessed by sensitivity to reward-devaluation induced by taste aversions or specific satiety. It has been suggested that this reflects the gradual dominance of reflexive, habit-based responding over voluntary, goal-directed actions. Previous research suggests that lesions of the medial prefrontal cortex disrupt this interaction between goal-directed and habitual responding. More specifically, whereas lesions of the prelimbic prefrontal cortex appear to disrupt normal goal-directed responding, lesions of the infralimbic prefrontal cortex cause animals to remain goal-directed even after substantial overtraining. The current experiment explored further the nature of this interaction between actions and habits. Rats were given extended training of an instrumental lever press response before bilateral intracerebral cannulae giving access to the infralimbic cortex were implanted. Following further reminder training all animals were given a test of goal sensitivity by specific-satiety devaluation of the instrumental outcome, or a matched reward, prior to extinction tests. Before these tests, half of the animals received bilateral infusions of muscimol into the infralimbic cortex, and the remainder, control vehicle infusions. As expected after extended instrumental training, control-infused animals showed habitual performance that was not selectively influenced by devaluation of the instrumental outcome. In contrast, animals receiving temporary inactivation of the infralimbic cortex by muscimol showed selective sensitivity to devaluation of the instrumental outcome, indicating a reinstatement of goal-directed responding in these animals. This suggests that the development of habitual responding reflects the active inhibition of goal-directed responses that are mediated by action-outcome associations.

Analysis of Variance↗

PubMed2006

Goal-based action selection and utility-based action bias.

According to artificial intelligence studies, goal-based and utility-based agents can select an action to attain a desired outcome. The goal-based agent sets a specific goal regardless of its utility at first, and selects the action that leads to that goal (goal-based action selection). The utility-based agent compares the utilities of different possible outcomes, and selects the action that causes the outcome with the highest utility (utility-based action bias). The medial prefrontal cortex is involved in implementing the goal-based action selection and the striatum is involved in implementing the utility-based action bias. Goal-based action selection may be temporarily dominant over the utility-based action bias in a new environment, whereas the utility-based action bias becomes dominant after acquisition of action utilities in the environment. This transition of dominance between the two decision systems may be enhanced by a reference-point shift based on the goal-setting process during goal-based action selection.

Animals↗

PubMed1997

Emotional responses to goal attainment: strength of regulatory focus as moderator.

Goals with a promotion focus versus a prevention focus are distinguished. Chronic ideal goals (hopes and aspirations) have a promotion focus, whereas ought goals (duties and responsibilities) have a prevention focus. The hypothesis that emotional responses to goal attainment vary as a function of promotion versus prevention goal strength (conceptualized as goal accessibility) was tested in correlational studies relating chronic goal attainment (self-congruencies or self-discrepancies) to emotional frequency and intensity (Studies 1-3) and in an experimental study relating immediate goal attainment (i.e., success or failure) to emotional intensity (Study 4). All studies found that goal attainment yielded greater cheerfulness-dejection responses when promotion focus was stronger and greater quiescence-agitation responses when prevention focus was stronger.

Affect↗

PubMed2000

Habits as knowledge structures: automaticity in goal-directed behavior.

This study tested the idea of habits as a form of goal-directed automatic behavior. Expanding on the idea that habits are mentally represented as associations between goals and actions, it was proposed that goals are capable of activating the habitual action. More specific, when habits are established (e.g., frequent cycling to the university), the very activation of the goal to act (e.g., having to attend lectures at the university) automatically evokes the habitual response (e.g., bicycle). Indeed, it was tested and confirmed that, when behavior is habitual, behavioral responses are activated automatically. In addition, the results of 3 experiments indicated that (a) the automaticity in habits is conditional on the presence of an active goal (cf. goal-dependent automaticity; J. A. Bargh, 1989), supporting the idea that habits are mentally represented as goal-action links, and (b) the formation of implementation intentions (i.e., the creation of a strong mental link between a goal and action) may simulate goal-directed automaticity in habits.

Adult↗

PubMed1993

Accessibility of information about goals during the processing of narrative texts.

We used a probe procedure to show that a goal established earlier in a text is active in memory at the point of its achievement. An initial experiment demonstrated that a goal category (began an investigation to nab the THIEF) is accessible, relative to a control condition, following the processing of a goal-achievement sentence (had the PURSER brought to his office). The remaining experiments provided evidence against several explanations of this result: (a) that the goal category's accessibility is due to an advantage in the strength of its initial encoding; (b) that the goal category is maintained in memory from the point at which the goal is established; or (c) that the goal category is reinstated at the point of goal achievement as the result of a high-level inference. The results suggest that the goal category is reinstated as the result of a low-level inference similar to the type that links an anaphor and its antecedent.

Achievement↗

PubMed2005

Goal regulation across time: the effects of feedback and affect.

This research focused on the processes individuals use to regulate their goals across time. Two studies examined goal regulation following task performance with 6 samples of participants in a series of 8-trial task performance experiments. The experiments involved: (a) 3 task types, (b) 2 goal types, and (c) actual or manipulated performance feedback referring to the focal participant's own performance or to the participant's performance compared with others' performance. Applying multilevel methods, the authors examined (a) how performance feedback influences subsequent goals within individuals across both negative and positive performance feedback ranges, and (b) the mediating role of affect in explaining the relationship between feedback and subsequent goal setting. Results showed that participants adjusted their goals downwardly following negative feedback and created positive goal-performance discrepancies by raising their goals following positive feedback. In each sample, affect mediated substantial proportions of the feedback-goals relationship within individuals.

Achievement↗

PubMed2003

Clarifying achievement goals and their impact.

The study of achievement goals has illuminated basic motivational processes, though controversy surrounds their nature and impact. In 5 studies, including a longitudinal study in a difficult premed course, the authors show that the impact of learning and performance goals depends on how they are operationalized. Active learning goals predicted active coping, sustained motivation, and higher achievement in the face of challenge. Among performance goals, ability-linked goals predicted withdrawal and poorer performance in the face of challenge (but provided a "boost" to performance when students met with success); normative goals did not predict decrements in motivation or performance; and outcome goals (wanting a good grade) were in fact equally related to learning goals and ability goals. Ways in which the findings address discrepancies in the literature are discussed.

Achievement↗

PubMed2003

Task interest and actual performance: the moderating effects of assigned and adopted purpose goals.

This research examined whether and which purpose goals moderate the relationship between task interest and actual performance and whether assigned goals have different effects (Study 1) than adopted goals (Study 2). Two studies were conducted using a full 2 X 2 design of the performance-mastery and approach-avoidance distinctions, plus control conditions. In the control conditions, that is, in a neutral purpose goal context, the expected positive relationship between initial task interest and actual performance was found. In a purpose goal context, this link held only for a congruent mastery-approach goal (either assigned or adopted). The gain in task interest found in a neutral purpose context was observed in the purpose goal conditions only when participants attained their purpose goals. It was concluded that having an incongruent purpose goal may undermine the positive effect of prior task interest on actual performance as well as on subsequent task interest.

Adolescent↗

PubMed2004

The projection of implicit and explicit goals.

In 3 studies, the authors analyzed whether projection occurs for both conscious and nonconscious goals. In Experiment 1, participants who were predisposed to hold a learning goal over a performance goal rated others as possessing more of a learning goal. In Experiment 2, participants who were either implicitly primed with or explicitly assigned to have the goal to compete perceived others as striving for competitive goals more than control participants. In Experiment 3, the authors demonstrated that it was the actual goal to compete rather than the trait construct of competitiveness that was projected. The control of automatic goal projection effects is discussed, and interpersonal consequences of goal projection are delineated.

Adult↗

PubMed2005

Memory and goal setting: the response of older and younger adults to positive and objective feedback.

Earlier research suggested that goal setting for memory does not have the same advantages for older adults as for younger adults. Using ideal goal-setting conditions with individualized goals, the authors compared goals plus positive feedback, goals plus objective feedback, and control. Performance increased over trials and was higher for both goal conditions than for control. The positive feedback condition showed the highest goal commitment and motivation. Older adults showed strong performance gains and more motivation and goal commitment than the young. The results showed that older adults can benefit from goal setting under optimal learning and feedback conditions.

Adolescent↗

PubMed2005

Weight loss goals and treatment outcomes among overweight men and women enrolled in a weight loss trial.

Participants in weight loss programs typically set unrealistically high weight loss goals that some believe are detrimental to success. This study examined outcomes associated with goal and ideal body mass index (BMI). Participants (N=1801) were enrolled in a weight loss trial comprised of low-intensity mail or telephone interventions vs usual care. Goal and ideal weight losses were assessed by asking participants how many pounds they expect to lose in the program (goal) and how much they would like to weigh (ideal). Goal and ideal weight losses were unrealistically high (men: -16 and -19%, women: -21 and -27%). For women, less realistic goals were associated with greater weight loss at 24 months. Goals were not associated with participation or weight loss for men. Results are more supportive of the idea that higher goals motivate women to lose weight than of the hypothesis that high goals undermine effort.

Adult↗

PubMedDate not supplied

Goal-setting, self-efficacy, and memory performance in older and younger adults.

Research in field and laboratory settings has shown that goals lead to improved self-efficacy and performance, especially when individuals also receive positive feedback. The present study extended goal-setting theory to examine self-set goals and feedback in relation to younger and older adults' memory performance and self-efficacy. Following a baseline recall trial, participants completed three shopping list recall trials. Half of the participants were instructed to set goals for the three experimental trials, and half in each goal condition received performance feedback after each trial. Young adults' self-efficacy, clustering, and recall exceeded that of older adults. Goal setting increased self-efficacy for younger but not older adults, and it did not affect performance. Younger adults and participants in the feedback condition increased their goals across trials, as did participants for whom feedback indicated success. These data provide a first look at the motivational impact of feedback and self-set recall goals in memory aging. Additional study is needed to understand the interactive effects of type of feedback, memory task difficulty, and type of goal setting at different ages.

Adolescent↗

PubMed2006

Approach and avoidance coping during task performance in young men: the role of goal attainment expectancies.

The present study investigated approach and avoidance coping strategies as a function of goal attainment expectancies in young men. Twenty-four male students participated in an experiment consisting of two rowing tests. After the initial test, participants were divided into two experimental groups and were assigned to conditions of attainable and unattainable goals for the final test, depending on performance in the initial test and experimental condition. Participants of the two groups reported similar goal attainment expectancies before the start of the final test; however, during the task expectancies for the attainable goal group increased, whereas those for the unattainable goal group decreased. After the conclusion of the task, participants were asked to respond with regard to coping strategies they used during the latest part of the final test, when goal attainment expectancies had been differentiated. The analysis revealed significant effects for effort increase, and mental and behavioural disengagement, whereas a non-significant but considerable effect was identified for planning. The higher goal attainment expectancies group scored higher on effort increase and planning, and lower on behavioural and mental disengagement, than the lower goal attainment expectancies group. The results of the present study are in accordance with the general theoretical assumptions of the control process theory, and more particularly highlight the importance of goal attainment expectancies as a factor influencing the employment of approach and avoidance coping strategies in achievement situations.

Achievement↗