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Goal setting

Marleen Kunneman, Victor M Montori, Ana Castaneda-Guarderas, Erik P Hess
Both the practice of medicine and the expectations of patients regarding their care are changing. A point of confluence is in the need for medicine to be more patient centered, and in the need for patients to be more involved in their care.(1,2) This confluence is particularly pertinent when more than one reasonable approach is available to manage the patient's situation, and when those approaches differ in ways that matter to patients.(3) In shared decision-making (SDM), clinicians and patients work together to understand the patient's situation and to determine how best to address it...
October 21, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Karen R Sepucha, Maggie Breslin, Charles Graffeo, Christopher R Carpenter, Erik P Hess
Shared decision making (SDM) has been advocated as an approach to selecting medical tests and treatments for many situations. The goal of SDM is to ensure that patients are well informed, meaningfully involved in decisions, and receive treatments that meet their goals and preferences. There is considerable evidence about the tools used to promote SDM, called patient decision aids, and many different measures have been developed to assess the impact of SDM. However, fairly little is known about the applicability of the tools and measures in the emergency department setting...
October 21, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Mark R Gilbert, Stephanie L Pugh, Ken Aldape, A Gregory Sorensen, Tom Mikkelsen, Marta Penas-Prado, Felix Bokstein, Young Kwok, R Jeffrey Lee, Minesh Mehta
Angiogenesis, a hallmark of glioblastoma, can potentially be targeted by inhibiting the VEGF pathway using bevacizumab, a humanized monoclonal antibody against VEGF-A. This study was designed to determine the efficacy and safety of these regimens in the cooperative group setting. Eligibility included age ≥18, recurrent or progressive GBM after standard chemoradiation. Treatment was intravenous bevacizumab 10 mg/kg and either irinotecan (CPT) 125 mg/m(2) every 2 weeks or temozolomide (TMZ) 75-100 mg/m(2) day 1-21 of 28 day cycle...
October 21, 2016: Journal of Neuro-oncology
Matilde M Vaghi, Petra E Vértes, Manfred G Kitzbichler, Annemieke M Apergis-Schoute, Febe E van der Flier, Naomi A Fineberg, Akeem Sule, Rashid Zaman, Valerie Voon, Prantik Kundu, Edward T Bullmore, Trevor W Robbins
BACKGROUND: A recent hypothesis has suggested that core deficits in goal-directed behavior in obsessive-compulsive disorder (OCD) are caused by impaired frontostriatal function. We tested this hypothesis in OCD patients and control subjects by relating measures of goal-directed planning and cognitive flexibility to underlying resting-state functional connectivity. METHODS: Multiecho resting-state acquisition, combined with micromovement correction by blood oxygen level-dependent sensitive independent component analysis, was used to obtain in vivo measures of functional connectivity in 44 OCD patients and 43 healthy comparison subjects...
August 11, 2016: Biological Psychiatry
Sarah A Moore, Ruth Da Silva, Madelaine Balaam, Lianne Brkic, Dan Jackson, Dan Jamieson, Thomas Ploetz, Helen Rodgers, Lisa Shaw, Frederike van Wijck, Christopher Price
BACKGROUND: Loss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities...
October 21, 2016: Trials
Signe Mezinska, Péter Kakuk, Goran Mijaljica, Marcin Waligóra, Dónal P O'Mathúna
BACKGROUND: Conducting research during or in the aftermath of disasters poses many specific practical and ethical challenges. This is particularly the case with research involving human subjects. The extraordinary circumstances of research conducted in disaster settings require appropriate regulations to ensure the protection of human participants. The goal of this study is to systematically and qualitatively review the existing ethical guidelines for disaster research by using the constant comparative method (CCM)...
October 21, 2016: BMC Medical Ethics
Gem Mohan, Julius X Scott, Rizwana Nasrin, Latha Sneha, Rakesh Manohar, Lalitha Subramanian, Sowmiya Narayani, Aruna Rajendran
BACKGROUND: The first counseling or the exchange between the physician and the parent(s) of children with cancer is of vital importance as it sets the tone for the rest of the treatment. The goal of our study was to find out the preferences among parents of Indian children with cancer regarding communication and breaking of bad news when fully informed about the diagnosis. MATERIALS AND METHODS: A sample of 60 parents who had been counseled within 3 months from diagnosis were interviewed with a prepared questionnaire directed at eliciting their experiences with the physicians who broke the bad news to them and also suggestions to improve the exchange...
November 2016: Journal of Pediatric Hematology/oncology
Nils Krietenstein, Megha Wal, Shinya Watanabe, Bongsoo Park, Craig L Peterson, B Franklin Pugh, Philipp Korber
Chromatin remodelers regulate genes by organizing nucleosomes around promoters, but their individual contributions are obfuscated by the complex in vivo milieu of factor redundancy and indirect effects. Genome-wide reconstitution of promoter nucleosome organization with purified proteins resolves this problem and is therefore a critical goal. Here, we reconstitute four stages of nucleosome architecture using purified components: yeast genomic DNA, histones, sequence-specific Abf1/Reb1, and remodelers RSC, ISW2, INO80, and ISW1a...
October 20, 2016: Cell
Matej Voglar, Jeffrey Wamerdam, Idsart Kingma, Nejc Sarabon, Jaap H van Dieën
The goal of the present study was to determine the effects of prolonged, intermittent flexion on trunk neuromuscular control. Furthermore, the potential beneficial effects of passive upper body support during flexion were investigated. Twenty one healthy young volunteers participated during two separate visits in which they performed 1 hour of intermittent 60 seconds flexion and 30 seconds rest cycles. Flexion was set at 80% lumbar flexion and was performed with or without upper body support. Before and after intermittent flexion exposure, lumbar range of motion was measured using inertial measurement units and trunk stability was assessed during perturbations applied in the forward direction with a force controlled actuator...
2016: PloS One
Riccardo Toninato, Silvia Scuri, Vincenzo Tarzia, Gino Gerosa, Francesca M Susin
PURPOSE: The gold standard therapy for patients with advanced heart failure is heart transplant. The gap between donors and patients in waiting lists promoted the development of circulatory support devices, such as the total artificial heart (TAH). Focusing on in vitro tests performed with CardioWest™ TAH (CW) driven by the SynCardia Freedom® portable driver (FD) the present study goals are: i) prove the reliability of a hydraulic circuit used as patient simulator to replicate a quasi-physiological scenario for various hydrodynamic conditions, ii) investigate the hydrodynamic performance of the CW FD, iii) help clinicians in possible interpretation of clinical cases outcomes...
October 15, 2016: International Journal of Artificial Organs
Paolo Gabrieli, Francesca Scolari
The Mediterranean fruit fly (medfly) Ceratitis capitata (Wiedemann) (Diptera: Tephritidae) is a pest species with extremely high agricultural relevance. This is due to its reproductive behavior: females damage the external surface of fruits and vegetables when they lay eggs and the hatched larvae feed on their pulp. Wild C. capitata populations are traditionally controlled through insecticide spraying and/or eco-friendly approaches, the most successful being the Sterile Insect Technique (SIT). The SIT relies on mass-rearing, radiation-based sterilization and field release of males that retain their capacity to mate but are not able to generate fertile progeny...
October 1, 2016: Journal of Visualized Experiments: JoVE
Yu Jiang, Changying Li, Fumiomi Takeda
Currently, blueberry bruising is evaluated by either human visual/tactile inspection or firmness measurement instruments. These methods are destructive, time-consuming, and subjective. The goal of this paper was to develop a non-destructive approach for blueberry bruising detection and quantification. Experiments were conducted on 300 samples of southern highbush blueberry (Camellia, Rebel, and Star) and on 1500 samples of northern highbush blueberry (Bluecrop, Jersey, and Liberty) for hyperspectral imaging analysis, firmness measurement, and human evaluation...
October 21, 2016: Scientific Reports
Silvana Granado Nogueira da Gama, Elaine Fernandes Viellas, Jacqueline Alves Torres, Maria Helena Bastos, Odaléa Maria Brüggemann, Mariza Miranda Theme Filha, Arthur Orlando Correa Schilithz, Maria do Carmo Leal
BACKGROUND: The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections...
October 17, 2016: Reproductive Health
Eric J Lammers, Catherine G McLaughlin, Michael Barna
OBJECTIVE: To test for correlation between the growth in adoption of ambulatory electronic health records (EHRs) in the United States during 2010-2013 and hospital admissions and readmissions for elderly Medicare beneficiaries with at least one of four common ambulatory care-sensitive conditions (ACSCs). DATA SOURCES: SK&A Information Services Survey of Physicians, American Hospital Association General Survey and Information Technology Supplement; and the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013...
October 21, 2016: Health Services Research
Samir Malkani, Sheri A Keitz, David M Harlan
The current diabetes epidemic threatens to overwhelm the healthcare system unless we redesign how diabetes care is delivered. The number of endocrinologists is grossly inadequate to provide care for all individuals with diabetes, but with the appropriate utilization of the primary care workforce and alternative healthcare providers working together in teams, effective diabetes care can be provided to all. We propose a patient-centered, goal-based approach with resources devoted to care coordination, measurement of outcomes, appropriate use of technology, and measurement of patient satisfaction...
December 2016: Current Diabetes Reports
Aimee K Gardner, Matthew Kosemund, Deborah Hogg, Abraham Heymann, Joseph Martinez
INTRODUCTION: The role of goal setting within post-simulation debriefing is not well known. This study sought to examine how inclusion of group-level goals, individual-level goals, or no goals in the debriefing process impacts teamwork. METHODS: Students participated in two high-fidelity team training scenarios. Between scenarios, teams were assigned to one of three debriefing groups: jointly creating five teamwork goals for the group to achieve (group-level goals); independently creating five teamwork goals for each individual to attain (individual-level goals); or no goals...
October 8, 2016: American Journal of Surgery
Shaniece Criss, Emily Oken, Lauren Guthrie, Marie-France Hivert
BACKGROUND: Gestational weight gain (GWG) is an important predictor of short and long-term pregnancy outcomes for both mother and child, and women who set a GWG goal are more likely to gain within recommended ranges. Little information is available regarding potentially modifiable factors that underlie a woman's GWG goals. Our aims were to explore women's perceptions regarding factors that affect GWG, their understanding of appropriate GWG, their goal-setting experiences including patient-health care provider (HCP) conversations, and supportive interventions they would most like to help them achieve the recommended GWG...
October 20, 2016: BMC Pregnancy and Childbirth
J A Bohn, B M Kassaye, D Record, B C Chou, I L Kraft, J C Purdy, K A Hilton, D A Miller, S Getachew, A Addissie, J A Robison
BACKGROUND: Global childhood mortality rates remain high. Millennium Development Goal 4 focused efforts on reducing rates by two-thirds between 1990 and 2015. In Ethiopia, child mortality rates dropped 71 % from 1990 to 2015, however it is estimated that 184,000 Ethiopian children die each year. There is limited information about pediatric hospital admissions in Ethiopia. Our aims were to examine the temporal relationship of mortality to admission, describe the demographics, and identify cause mortality of children admitted to the Zewditu Memorial Hospital (ZMH)...
October 21, 2016: BMC Pediatrics
Eric Smart, Adeeta Aulakh, Carolyn McDougall, Patty Rigby, Gillian King
PURPOSE: Identify strategies youth perceive will optimize their engagement in goal pursuit in life skills and transition programs using an engagement framework involving affective, cognitive, and behavioral components. METHODS: A qualitative descriptive design was used. Two semi-structured interviews were conducted with seven youth. The first was informed by a prior observation session, and the second occurred after the program ended and explored youths' perceptions of whether and how their engagement changed...
October 21, 2016: Disability and Rehabilitation
Ida Leah Gitajn, Marilyn Heng, Michael J Weaver, Natalie Casemyr, Collin May, Mark S Vrahas, Mitchel B Harris
OBJECTIVES: The goals of this study are to evaluate mortality after Vancouver B periprosthetic fractures and determine predictors of mortality; compare mortality among patients with loose femoral stems treated with revision arthroplasty versus fixation alone; compare mortality among patients with radiographically "indeterminate" fractures treated with revision or fixation; evaluate the rate of return to surgery for patients who underwent revision compared to fixation. DESIGN: Retrospective study SETTING:: Three academic level 1 trauma centersPatients/Participants: 203 patients treated for Vancouver B periprosthetic fractures INTERVENTION:: N/A MAIN OUTCOME MEASUREMENTS:: The primary outcome measure was mortality...
October 1, 2016: Journal of Orthopaedic Trauma
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