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[Goals in the discussion of old age insurance - a sketch].

In the Federal Republic of Germany often the discussion on social policy deals with instruments, yet seldom with goals to be realised. Scientific work on goals for old-age security policy is just starting. In this article the importance of distinctly defined goals is shown for rational economic and social policy, for an assessment of the existing situation, for a goal oriented selection and formation of measures and for success control. With reference to distributive goals in old-age security policy it is exemplified in which way scientific work can be helpful in defining goals in an operationalised form. For this it is important to deal with several distributive aspects, which are often mixed in discussions. As measures in one area of economic and social policy cannot be taken isolated, in order to avoid unwanted consequences, it is necessary for old-age security policies too, to take into consideration a general system of economic and social policy goals. As an example, it must be stated that e.g. aspects of business cycle and growth policy have to be considered while constructing a system of old-age security. Finally, some other criteria for old-age security policies, such as transparence, political feasibility and practicability are mentioned.

Aged↗

Engagement in Academic Work: The Role of Learning Goals, Future Consequences, Pleasing Others, and Perceived Ability

Engagement in academic work was viewed from a multiple goals perspective. Two studies were conducted in which high school math students completed an instrument measuring five goals students might have for doing academic work (learning goals, performance goals, obtaining future consequences, pleasing the teacher, and pleasing the family), perceived math ability, self-regulatory activities, strategies (deep or shallow) used when studying for math, and the amount of effort and persistence expended on the class. Factor analysis indicated that the five goals scales and the perceived ability scale represented unique factors. The correlations among the variables revealed theoretically consistent interrelationships. Multiple regression analyses indicated that various goals (e.g., learning goals, obtaining future consequences, and pleasing the teacher), perceived ability, and some interactions accounted for significant amounts of variance in the task engagement measures (self-regulation, strategy use, effort, and persistence) and achievement. Results are discussed in relation to current theory and their practical implications.

Journal Article↗

A Longitudinal Analysis of Elementary School Students' Achievement Goals in Literacy Activities.

The authors examined the temporal stability of elementary school students' (N = 432) motivation goals (task-mastery, performance, and work-avoidant) for literacy activities in the classroom. Task-specific assessments of students' goals were collected in the fall and spring of Grades 3, 4, and 5. Stability coefficients indicated a reasonable degree of consistency in students' goal responses over time, even though goals were initially assessed in relation to a specific learning assignment. However, there were also significant mean-level changes in students' goals within the school year and significant linear declines in task-mastery and performance goals over time. Changes were consistent across gender groups and across ability levels. Additionally, changes in task-mastery goal ratings explained variations in students' reported use of active learning strategies in reading and writing activities. The important implications of this study for future research are discussed. Copyright 2001 Academic Press.

Journal Article↗

Effects of switching statins on achievement of lipid goals: Measuring Effective Reductions in Cholesterol Using Rosuvastatin Therapy (MERCURY I) study.

BACKGROUND: In a multinational trial (4522IL/0081), we assessed the effects of switching to low doses of rosuvastatin from commonly used doses of atorvastatin, simvastatin, and pravastatin on low-density lipoprotein cholesterol (LDL-C) goal achievement in high-risk patients. METHODS: Hypercholesterolemic patients (n = 3140) with coronary heart disease, atherosclerosis, or type 2 diabetes were randomized to open-label rosuvastatin 10 mg, atorvastatin 10 or 20 mg, simvastatin 20 mg, or pravastatin 40 mg for 8 weeks. Patients either remained on these treatments for another 8 weeks or switched treatments from atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg to rosuvastatin 10 mg or from atorvastatin 20 mg to rosuvastatin 10 or 20 mg. The primary efficacy measure was the proportion of patients reaching the Joint European Societies' LDL-C goal (<116 mg/dL) at week 16. For measures of cholesterol goal achievement, treatment arms were compared using logistic-regression analysis. RESULTS: Significant improvement in LDL-C goal achievement was found for patients who switched to rosuvastatin 10 mg, compared with patients who remained on atorvastatin 10 mg (86% vs 80%, P <.05), simvastatin 20 mg (86% vs 72%, P <.0001), and pravastatin 40 mg (88% vs 66%, P <.0001), and between patients switched to rosuvastatin 20 mg and those who remained on atorvastatin 20 mg (90% vs 84%, P <.01). Similar results were found for achievement of the European combined LDL-C and total cholesterol goals and National Cholesterol Education Program Adult Treatment Panel III LDL-C goals. All statins were well tolerated over 16 weeks. CONCLUSIONS: We demonstrated that switching to a more efficacious statin is an effective strategy to improve lipid goal achievement in patients requiring lipid-lowering therapy.

Aged↗

Rosuvastatin is cost-effective compared with atorvastatin in reaching cholesterol goals.

BACKGROUND: Lowering low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of coronary heart disease. The introduction of a highly efficacious new statin, rosuvastatin, may enable more patients to be treated to LDL-C goal within a fixed budget. OBJECTIVES: To compare the cost-effectiveness of rosuvastatin 10 mg and atorvastatin 10 mg in lowering LDL-C and achieving guideline goals after 12 weeks of treatment. The LDL-C goals were those recommended by the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III and the Third Joint European Task Force. METHODS: The analysis was performed on pooled data from three clinical trials. Efficacy was measured as the percent reduction in LDL-C and the proportion of patients who reached guideline LDL-C goals following the first 12 weeks of treatment, prior to dose titration. Costs comprised drug acquisition costs only. The cost-effectiveness measures were cost per 1% reduction in LDL-C and cost per patient treated to their LDL-C goal. RESULTS: Treatment with rosuvastatin 10 mg costs 1.85 per 1% reduction in LDL-C, compared with 2.37 per 1% reduction with atorvastatin 10 mg. The average costs per patient treated to the European LDL-C goals were 130.18 for rosuvastatin 10 mg and 242.44 for atorvastatin 10 mg. Treating to NCEP ATP III goals costs 115 per patient treated with rosuvastatin 10 mg vs. 163 per patient treated with atorvastatin 10 mg. CONCLUSIONS: Rosuvastatin has the same acquisition costs as and is more efficacious than atorvastatin in lowering LDL-C and treating patients to target LDL-C levels.

Adolescent↗

[Therapeutic goals in psychological medicine--state of research and development of a standardized self-rating instrument].

From the patient's as well as from the therapist's point of view goals of therapy undoubtedly play an important role in all fields of psychological medicine (psychiatry, psychotherapy, psychosomatic medicine). On the other hand, there is a substantial lack of systematic i.e. empirical studies on this issue. Giving an overview on the available scientific literature we start by characterising therapeutic goals as a secondary psychological construction. Therapeutic goals and their multiple associations and different aspects of psychotherapy are discussed. However, a variety of definitions of therapeutic goals, often influenced by the therapeutic orientation of the authors, make it difficult to integrate concepts and to compare findings. Hence, we focus on those results which were found in relation to general concepts, i.e. beyond specific theoretical approaches. Furthermore, we discuss the pros and cons of individual measures of therapeutic goals compared with standardised self-rating instruments. Finally, we underline the lack of studies on therapeutic goals in the psychiatric sphere and report on some results of our own pilot study on the Personal Goals Questionnaire in psychiatric inpatients.

Humans↗

Purposes and mechanisms of goal planning in rehabilitation: the need for a critical distinction.

PURPOSE: To determine a preliminary typology of purposes and mechanisms ascribed to goal planning in rehabilitation. To demonstrate the importance of making a critical distinction between these different purposes and mechanisms when reviewing or designing research on goal planning in rehabilitation. METHOD: A search of Medline, Embase, PsychINFO and CINAHL for articles on goal planning in rehabilitation. Articles were only included if they were about patient populations and made explicit statements regarding the function or purpose of goal planning in rehabilitation. Thematic analysis was used to qualitatively synthesise the purposes and mechanisms of goal planning described in the literature. RESULTS: Four major purposes for undertaking goal planning in rehabilitation are identified: (1) to improve patient outcomes (as determined by standardised outcome measures), (2) to enhance patient autonomy, (3) to evaluate outcomes, and (4) to respond to contractual, legislative or professional requirements. The first of these purposes is associated with four distinct mechanisms with the remaining three purposes appearing to relate to one underlying mechanism. CONCLUSIONS: This typology offers one approach for critically engaging with the wide-ranging issues in goal planning. Debate stemming from this work could facilitate systematic reviews of this area as well as guide research and application to practice.

Persons with Disabilities↗

Relationships among adolescents' weight perceptions, exercise goals, exercise motivation, quality of life and leisure-time exercise behaviour: a self-determination theory approach.

Exercise has an important role to play in the prevention of child and adolescent obesity. Recent school-based interventions have struggled to achieve meaningful and lasting changes to exercise levels. Theorists have suggested that this may, in part, be due to the failure to incorporate psychosocial mediators as they relate to behaviour change. Using a sample of 580 British schoolchildren, a model grounded in self-determination theory was explored to examine the effects of exercise goals on exercise motivation, leisure-time exercise behaviour and quality of life (QoL). Results of structural equation modelling revealed that adolescents perceiving themselves to be overweight and pressurized to lose weight, endorsed extrinsic weight-related goals for exercise. Extrinsic goals negatively predicted, whereas intrinsic goals positively predicted, self-determined motivation, which in turn positively predicted QoL and exercise behaviour. Furthermore, self-determined motivation partially mediated the effects of exercise goals on reported exercise behaviour and QoL. Multi-sample invariance testing revealed the proposed model to be largely invariant across gender. Results suggest that holding extrinsic exercise goals could compromise exercise participation levels and QoL. A role for teachers and parents is proposed with the aim of orienting young people towards intrinsic goals in an attempt to enhance future exercise behaviour and QoL.

Adolescent↗

GOAL: a simplified mental test for emergency medical admissions.

BACKGROUND: Several scoring systems are used in screening for cognitive impairment, but none are suited to the busy medical assessment environment. AIM: To construct, validate and assess the reliability of a simple scale (Gwent Orientation and Awareness Listing, GOAL) for this purpose, and to examine its application in consecutive emergency admissions in two general hospitals. DESIGN: Prospective cohort studies. METHODS: The validity and reliability of GOAL was assessed in three studies of patients aged > or =65 years who had been pronounced medically fit for discharge. The evaluation studies were carried out over 4-week medical intake periods in each participating hospital. RESULTS: Correlation of GOAL with the standard 30-point Mini-Mental State Examination was 0.89, and the inter-observer reliability was 0.90. Based on Receiver Operating Characteristics Curves, patients scoring <8 on GOAL were deemed to be cognitively impaired. Assessment by GOAL took half the time required for the widely used Abbreviated Mental Test Score. Of 1037 consecutive patients admitted to two hospitals' acute medical intakes and remaining for >24 h, 952 were able and willing to be scored by GOAL, and of these 201 (21%) 'failed', with a score of <8. DISCUSSION: Loss of orientation and awareness is common among patients admitted via medical intakes. GOAL is a practical brief screen for identifying and following-up these patients.

Acute Disease↗

Goals for oral health in Germany 2020.

Constant themes in the worldwide debate on public health policy are, on the one hand, the medical aspects, including those of social medicine, together with healthcare provision, and, on the other, considerations of health economics. Although it is essential for healthcare resources to be allocated appropriately, medical criteria should take precedence. One branch of research in the field of healthcare provision, the definition of health goals, is assuming increasing importance in this connection, in dentistry as in other spheres. In 1981, the FDI and the WHO jointly established the first 'Global Goals for Oral Health for the year 2000' and in 2004, drew up new goals for the year 2020. The FDI is thus allowing for the fact that not all recommendations are applicable equally to all countries and populations. Appropriate differentiation is important. This paper explores the transfer of the FDI goal initiative into a national context. On the basis of the FDl's 'Global Goals for Oral Health 2020', German academic dentistry and the dental profession have jointly drawn up new national 'Goals for Oral Health in Germany 2020'. Whereas the definition of goals used to be first and foremost tooth-related, it is now widened to include both disease-related aspects and the promotion of health and prophylaxis.

Adolescent↗

The determination of relevant goals and criteria used to select an automated patient care information system: a Delphi approach.

OBJECTIVES: To determine the relevant weighted goals and criteria for use in the selection of an automated patient care information system (PCIS) using a modified Delphi technique to achieve consensus. DESIGN: A three-phase, six-round modified Delphi process was implemented by a ten-member PCIS selection task force. The first phase consisted of an exploratory round. It was followed by the second phase, of two rounds, to determine the selection goals and finally the third phase, of three rounds, to finalize the selection criteria. RESULTS: Consensus on the goals and criteria for selecting a PCIS was measured during the Delphi process by reviewing the mean and standard deviation of the previous round's responses. After the study was completed, the results were analyzed using a limits-of-agreement indicator that showed strong agreement of each individual's responses between each of the goal determination rounds. Further analysis for variability in the group's response showed a significant movement to consensus after the first goal-determination iteration, with consensus reached on all goals by the end of the second iteration. CONCLUSION: The results indicated that the relevant weighted goals and criteria used to make the final decision for an automated PCIS were developed as a result of strong agreement among members of the PCIS selection task force. It is therefore recognized that the use of the Delphi process was beneficial in achieving consensus among clinical and nonclinical members in a relatively short time while avoiding a decision based on political biases and the "groupthink" of traditional committee meetings. The results suggest that improvements could be made in lessening the number of rounds by having information available through side conversations, by having other statistical indicators besides the mean and standard deviation available between rounds, and by having a content expert address questions between rounds.

British Columbia↗

Analytical goals for quantities used to assess thyrometabolic status.

Analytical goals for imprecision derived from data on intra-individual variation for total T4, free T4, total T3, free T3 and thyrotropin (TSH) are coefficients of variation (CV) less than or equal to 2.5, 4.7, 5.2, 3.9 and 8.1%, respectively. If total T4 is used to monitor replacement therapy with thyroxine, a more stringent goal of CV less than or equal to 1.4% is appropriate. For those analytes for which biological variation data are not available, analytical goals may be derived either from reference intervals or from the 'state of the art' as judged from the performance of a stated proportion of laboratories participating in an interlaboratory quality assessment scheme. Analytical goals for imprecision for reverse T3 and thyroxine-binding globulin derived from reference values are CV less than or equal to 10.7 and 7.2%, respectively. The goal for inaccuracy is that there should be none. Statements regarding the detection limit of an assay should be replaced with information about the range of concentrations over which specified goals for imprecision are met. If goals are not achieved at concentrations which are used for clinical decision making the 95% confidence limits of the extreme values of the 'working range' should be calculated using the relevant imprecision. Improved analytical performance will result in better between-laboratory comparability and eventually allow the use of universally applicable reference values.

Humans↗

Improving knowledge of strategic goals and the impact on organizational commitment.

A large health maintenance organization (HMO) in San Diego, California developed a year-long communication plan to increase employee knowledge of the company's strategic goals and enhance organizational commitment. Survey results indicated: Respondents remembered significantly more strategic goals after program implementation. Respondents who had personal involvement in achieving goals remembered significantly more goals than those without involvement. Department meetings and the employee/physician newsletter were identified as primary sources for learning about goals. These findings suggest that organizations may be able to strengthen employee commitment by increasing awareness of the organization's strategic goals and encouraging employees to become personally involved in the achievement of those goals.

Attitude of Health Personnel↗

Cost-effectiveness of ezetimibe coadministration in statin-treated patients not at cholesterol goal: application to Germany, Spain and Norway.

BACKGROUND: Despite the growing use of statins, many hypercholesterolaemic patients fail to reach their lipid goal and remain at elevated risk of coronary heart disease (CHD). Alternative treatment strategies, such as ezetimibe coadministration and statin titration, can help patients achieve greater lipid control, and thereby lower their CHD risk. But is it cost effective to more aggressively lower cholesterol levels across a broad range of current statin users? METHODS: Using a decision-analytic model based on epidemiological and clinical trials data, we project the lifetime benefit and cost of alternative lipid-lowering treatment strategies for CHD and non-CHD diabetic patients in Germany, Spain and Norway. RESULTS: It is projected that from 40% to 76% of these patients who have failed to reach their lipid goal with their current statin treatment will be able to reach their goal with ezetimibe coadministration; this represents a gain of up to an additional absolute 14% who will be able to reach their goal compared with a 'titrate to goal' strategy where patients are titrated in order to reach their lipid goal (up to the maximum approved dose). For CHD patients, the estimated incremental cost-effectiveness ratio for ezetimibe coadministration is under Euro 18 000 per life-year gained (Euro/LYG) and 26 000 Euro/LYG compared with strategies based on the observed titration rates and the aggressive 'titrate to goal' strategy, respectively; for non-CHD diabetic patients, these ratios are under 26 000 Euro/LYG and 48 000 Euro/LYG for ezetimibe coadministration compared with the two titration strategies. CONCLUSION: Compared with statin titration, ezetimibe coadministration is projected to be cost effective in the populations and countries studied.

Anticholesteremic Agents↗

Selecting groups of sires by computer to maximize herd breeding goals.

A computerized linear program, MAXBULL, selects sires for dairymen to obtain maximum Predicted Difference milk while maintaining other goals. Goals are minimum average Predicted Differences fat percent and type, six individual type traits, and maximum average semen price. Individuals traits for bulls are coded +1, 0, -1 according to evaluations from breed associations. Dairymen restrict bulls offered to the program by specifying unacceptable repeatability, Predicted Differences, and price. They further control breed, stud organizations, minimum bull numbers, use of sires with low repeatability (less than 50%) and without type proofs, and maximum use of specific bulls and sons of sires. Goals for individual type are specified as the percentage of cows in the herd needing improvement in each trait. The solution contains at least that percentage of semen from sires coded +1 in each trait. The dairyman receives a count of bulls surviving each of his edits, a reiteration of his goals, a list of recommended units and all information for each sire, averages for all traits weighted by the units recommended, and the expected increase in Predicted Difference milk from relaxing each goal one unit. MAXBULL has led to individualized breeding programs characterized by reasonable goals, balance in emphasis among traits, and stability in goals over time.

Animals↗

Institutional goal analysis: an approach to program evaluation.

Although nursing literature discusses the importance of goals in nursing, little if any research has been conducted on the subject. Many of the studies focusing on nursing education deal with faculty turnover, effectiveness of various types of nursing programs, and the role and functions of the nurse. To better understand these problems, an understanding of the current goals of various nursing programs is needed. This can establish a basis on which to explore other problems in nursing education and the nursing profession. Conducting an analysis of goals on a nursing program not only contributes to the profession of nursing but also benefits the individual schools by revealing areas of goal incongruency within each program. The use of the Institutional Goals Inventory is recommended for evaluation of all nursing programs. It can be useful not only to baccalaureate educators, but also to those involved in associate degree and diploma education as well as graduate nursing education. After identifying areas of goal consensus and differences, a delphi approach can be utilized to solve problems and establish relevant and realistic goals.

Education, Nursing, Baccalaureate↗

Functional outcome after high tibial osteotomy: a study using individual goal achievement as the primary outcome variable.

Functional outcome after high tibial osteotomy (HTO) was evaluated with respect to both improvement and goal achievement. Fifty-seven subjects, 32 men and 25 women, with a mean age of 55 years were examined with the Functional Assessment System (FAS) 6 and 12 months after surgery. The FAS is an evaluation system, specifically designed to monitor lower extremity dysfunction. It shows a profile with preoperative status, individual goal, and postoperative status. Statistically significant improvement was seen in 6/20 variables after 6 months, and in 10/20 variables after 12 months. When goal achievement was examined, the results were not as impressive. The treatment goal was not reached on the group level for almost all variables. On the individual level, only 20\N40% of the patients achieved the goal as a result of surgery in most variables. Exceptions were pain and leisure time/hobbies, where there was a high degree of goal achievement. It is possible that postoperative training was inadequate. The authors recommend a new randomized study, where patients who receive specific individual training related to the individual goal and functional profile are compared with a control group.

Activities of Daily Living↗

Adherence to National Cholesterol Education Program Treatment goals in postmenopausal women with heart disease. The Heart and Estrogen/Progestin Replacement Study (HERS). The HERS Research Group.

OBJECTIVES: To determine the proportion of volunteer women with established heart disease who have low-density lipoprotein cholesterol (LDL-C) levels at or below the National Cholesterol Education Program Adult Treatment Panel goals and to determine what factors are associated with levels above goal or not receiving lipid-lowering medication when indicated. DESIGN: Cross-sectional measurement of lipids and lipoproteins, blood pressure, height, weight, and other demographic and cardiovascular risk factors in 2763 postmenopausal women with heart disease. SETTING: At 18 centers throughout the United States, participants were recruited by means of lists of women with coronary heart disease from coronary units and catheterization laboratories, direct mail to age-eligible women, and advertisements. PATIENTS: Mean age of the cohort was 66.7 years (range, 44-79 years) and the distribution by race/ethnicity was 88.7% white, 7.9% African American, 2.0% Hispanic/Latina, 0.8% Asian/Pacific Islander, and 0.7% other. INTERVENTION: We report cross-sectional analysis of the cohort at baseline. OUTCOME MEASURES: We measured the frequency of achieving 1988 and 1993 Adult Treatment Panel treatment goals, and of being on a regimen of lipid-lowering medication. RESULTS: Although 47% of participants were taking a lipid-lowering medication, 63% did not meet the 1988 treatment goal of LDL-C level less than 3.4 mmol/L (130 mg/dL) and 91% did not meet the 1993 goal of LDL-C level less than 2.6 mmol/L (100 mg/dL). Factors independently associated with achieving the earlier goal were use of lipid-lowering medication, marital status, education, body mass index, exercise, hypertension, diabetes, gallbladder disease, and first diagnosis of coronary heart disease after 1990. Failure to use lipid-lowering medication was associated with age, being African American, marital status, body mass index, lack of exercise, alcohol consumption, current smoking, and first diagnosis of coronary heart disease before 1985. CONCLUSION: The majority of women enrolled in the trial had LDL-C levels that significantly exceeded the treatment goals set by the 1988 and 1993 Adult Treatment Panel guidelines. Better implementation of these guidelines among women with coronary disease would be highly desirable.

Aged↗