Outcome Goals Research Articles

Goals of Care Conversations and Subsequent Advance Care Planning Outcomes for People with Dementia.

Advance care planning has been shown to improve end of life decision-making for people with dementia. However, the impact of goals of care conversations between people with dementia and their caregivers has not been characterized. In this study, we evaluate the association between goals of care conversations and advance care planning outcomes. Retrospective advance care planning measures were collected via a questionnaire administered to 166 caregivers after the death of the person with dementia for whom they provided care. At time of death, the majority of decedents with dementia had advance directives, health care agents, and previous goals of care conversations with their caregiver. Goals of care conversations were significantly associated with the perceived usefulness of advance directives, the perceived adherence to advance directives, and decedent dying at their desired place of death, but not with disagreements around end-of-life care. Our findings suggest that goals of care conversations are an important component of advance care planning. These findings support the development of interventions that facilitate such conversations between people with dementia and their caregivers.

Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus

IntroductionConsiderable confusions on treatment target have resulted from recent changes in guidelines. Evidence in medical guidelines came from clinical trials with highly selected patients, whereas treatment goals may differ in...

Ethics Reviews in Socially Engaged Arts Research

This article explores researchers’ perceptions of discrepancies between the creative goals of research projects in which artists are recruited and requirements established by ethical review boards in higher education. It describes issues that researchers typically face when applying for the ethical clearance of research projects that engage various communities in participatory activities involving creative professionals. While the observation of ethical codes of practice is very important in all academic research, it is equally important to understand how the goals of research and artistic outcomes may be affected by regulatory procedures as well as variable institutional practices related to ethical reviews of research. Ethical requirements may impact research in any discipline and are certainly not unique to the arts, but it is important to understand the specific effects of ethics review boards on research projects that venture into new creative areas that might involve vulnerable participants or include unforeseeable artistic outcomes. The article analyses studies undertaken by a research team made of academics, artists and other entities at the University of Malta and shows how the ethics review process affects timeframes, levels of participants’ involvement and the organic development of creative processes. Finally, it makes some recommendations for ethical review boards in the evaluation of socially engaged arts research projects.

Prevalence of Diseases in Elderly Patients with Medication Related Problems

Introduction: The elderly population commonly known as geriatrics constitute nearly 21% of the world population. With the increasing age, the human body undergoes physiologic changes, leading to pharmacokinetic and pharmacodynamic alterations, hence making this sector of the patients more prone to medication related problems. Medication related problems are any unwanted events or circumstances that occur during the drug therapy which has the potential to interfere with the desired goals of health outcomes. Methods: A community based observational study was conducted in different places of Dakshina Kannada district for a duration of 6 months by enrolment of 150 patients aged above 60 years of either sex diagnosed with any disease except for cancer and bed ridden patients. The data was collected with the help of patient interview forms and was analysed. Results: Out of the 150 patients, 107 patients were identified with medication related problems. The total number of identified medication related problems were 196. From this study it was found that the medication related problems were more prevalent in cardiovascular disorders and endocrine disorders. As hypertension and diabetes mellitus are the most common diseases found among the elderly, the risk factors for developing medication related problems in such patients include the need of additional drug therapy or adequate monitoring of the clinical outcomes. Conclusion: It was found that the geriatrics suffering from multiple co-morbidities, undergoes multiple drug therapies thereby leading to medication related problems. Hence in order to ensure optimum care, a targeted approach is essential. Keywords: Medication related problems, Geriatrics, Hepler-Strand classification.

Systematic Review of Motor Function Scales and Patient-Reported Outcomes in Spinal Muscular Atrophy.

Spinal muscular atrophy is a heterogeneous disease that results in loss of motor function. In an evolving treatment landscape, establishing the suitability and limitations of existing motor function scales and patient-reported outcomes used to monitor patients with this disease is important. A systematic review was conducted to examine utility of motor function scales and patient-reported outcomes in evaluating patients with spinal muscular atrophy. Published literature was reviewed up to June 2021 with no start date restriction. Of the reports screened, 122 were deemed appropriate for inclusion and are discussed in this review (including 24 validation studies for motor function scales or patient-reported outcomes). Fifteen motor function scales and patient-reported outcomes were identified to be commonly used (≥5 studies), of which 11 had available validation assessments. Each instrument has its strengths and limitations. It is imperative that the patient population (e.g., age, mobility), goals of treatment, and outcomes or endpoints of interest be considered when selecting the appropriate motor function scales and patient-reported outcomes for clinical studies.

Motivators, goal setting, and helpful feedback for weight management among individuals with spinal cord injury.

Objective: To gain a fuller understanding, in the context of biopsychoecological factors, of drivers/motivators, goal setting, and feedback, individuals with spinal cord injury (SCI) find helpful to gauge their weight management progress. Research Method/Design: We conducted in-depth interviews around weight management in SCI. Participants included veterans and civilians with SCI. Thematic analysis methodology was used to categorize data into relevant recurrent and/or conceptually significant themes. Results: Twenty-five individuals identified three primary reasons they wanted to participate in weight management, including overall health and wellness, appearance, and functional mobility. Their self-identified weight management goals included reaching/maintaining a specific body weight and/or trimming a focused body part; engaging in any or more physical activity/exercise; gaining strength and endurance; participating in life and activities; and alleviating weight-related health symptoms (e.g., pain). Individuals identified progress assessments, recognition, regular check-ins, and encouragement as helpful feedback toward weight management achievement. Conclusions/Implications: Our work identified what drives weight management in individuals with SCI, what is important to them in terms of goal setting, and what feedback they would find helpful. These findings may be used in intervention planning and program development to facilitate participation and behavior modification. Weight management efforts and interventions are needed that 1) incorporate motivators for weight management that are important to individuals with SCI; 2) help them identify actionable process and performance goals to facilitate achievement of self-identified meaningful outcome goals; and 3) provide person-centered weight management progress feedback such as those identified in this study (progress assessments, recognition, regular check-ins, and encouragement). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prevalence and Impact of Neuropathic and Nonneuropathic Pain in Chronic Spinal Cord Injury

ObjectiveTo compare prevalence, intensity ratings, and interference ratings of neuropathic pain (NeuP) and nociceptive pain in people with chronic spinal cord injury (SCI) DesignCross-sectional survey. SettingSix SCI Model System centers in the United States. ParticipantsConvenience sample of 391 individuals (N=391) with traumatic SCI, 18 years or older, 81% male, 57% White. InterventionsNot applicable. Main Outcome MeasuresSurvey based on the International Spinal Cord Injury Pain Basic Data Set and the Spinal Cord Injury Pain Instrument, including 0-10 numeric ratings of pain intensity and pain interference with daily activities, mood, and sleep ResultsA total of 80% of those surveyed reported having at least 1 pain problem; 58% reported 2 or more pain problems; 56% had probable NeuP; and 49% had non-NeuP. When comparing ratings for all pains (n=354 for NeuP, n=290 for non-NeuP) across participants, probable NeuPs were significantly more intense (6.9 vs 5.7) and interfered more with activities (5.2 vs 3.7), mood (4.9 vs 3.2), and sleep (5.4 vs 3.6) than non-NeuPs (all P<.001). However, when comparing ratings for probable NeuPs and non-NeuPs within participants, for the subgroup of 94 participants with both pain types, only ratings for sleep interference were found to be significantly different between the pain types. Additionally, we found significantly greater prevalence of NeuP and non-NeuP for women compared with men and of NeuP for those with paraplegia compared with those with tetraplegia. ConclusionsIndependent assessment of the pain conditions experienced by an individual with SCI is useful in understanding the differential effect that pain type has on quality of life. This is particularly important regarding sleep interference and should be kept in mind when determining treatment strategies for meeting patient-centered outcome goals.

Acceptance and Commitment Training for Ice Hockey Players: A Randomized Controlled Trial.

Recent systematic reviews on the topic of mindfulness- and acceptance-based approaches in sport psychology conclude that there is a need for further trials using a more robust research methodology with direct performance as outcome. Acceptance and Commitment Training (ACT) is a contextual behavioral change method that focuses on facilitating psychological processes such as values, committed action, acceptance and mindfulness. In the present study designed as a randomized controlled trial, 34 junior elite ice hockey players were allocated into either an ACT group intervention or a wait list control group. Results showed significant effects on both objective performance outcomes (goals, assists, and taken shots) and blinded coach ratings of players’ performance, focus and commitment to their development in favor of the ACT group. Effects lasted at 3-month follow-up for the coach ratings, but not for the objective performance measures. All ACT trained players recommended ACT to other players and considered the training as important for their development as ice hockey players. The results add to the growing body of evidence on ACT interventions for athletes and its effect on performance. Future studies should investigate the maintenance of effects from the psychological training over time, using robust research methodology and investigate theoretical coherent potential mediating variables.

Advancing Physician Assistant Faculty Development: A New Model.

The purpose of this article is to describe the development, implementation, and evaluation of an innovative physician assistant (PA) faculty development model. The Maryland Physician Assistant Leadership and Learning Academy's (PALLA's) executive team developed a 10-month fellowship designed to build a skilled faculty pipeline. The fellowship framework was grounded in the PA educator competencies, the 3 pillars of academia, and the 5th edition Accreditation Standards for Physician Assistant Education. The self-perceived impact of the fellowship was evaluated through multiple surveys. Survey results show that all of the learning activities met fellows' expectations, and fellows indicated strong agreement in self-perceived achievement in meeting the fellowship outcome goals. Study results provide evidence that formal training increases self-perceived competence in clinicians transitioning to academia. PALLA can serve as a model for other states to ensure faculty capacity within PA education.

Fibromyalgia in Older Individuals.

Fibromyalgia (FM) is a condition of chronic widespread pain (CWP) that can occur throughout the life cycle and is likely underrecognized in older patients. FM is associated with considerable suffering and reduction in quality of life and may occur as a unique condition, but in older patients is most likely to be associated with another medical illness. Understood mechanistically to be a sensitization of the nervous system, recently identified as nociplastic pain, FM is accepted as a valid medical illness that requires a positive diagnosis and directed treatments. The cornerstone of treatments for FM are nonpharmacologic interventions, with the understanding that medications provide only modest benefit for most patients, and with particular concern about adverse effects in older patients. If FM is not recognized, treatments may be misdirected to the other medical condition, with failure to address FM symptoms, leading to overall poor outcome. In contrast, new complaints in older patients should not immediately be attributed to FM, and physicians should be vigilant to ensure that onset of a new illness is not ignored. As FM is most often a lifelong condition, patients should be encouraged to identify their own personal strategies that can attenuate symptoms, especially when symptoms flare. Continued life participation should be the outcome goal.

Does quality help the financial viability of hospitals? A data envelopment analysis approach

In this work, we analyze the financial viability of U.S. hospitals by investigating the impact of clinical and experiential quality as its determinants. We adopt Simar and Wilson's two-stage bootstrapped truncated regression approach. Specifically, we use data envelopment analysis (DEA) in the first stage to estimate efficiency scores. Then, we use truncated regression estimation with the double-bootstrap method to test the significance of the quality variables. Given the financial problems recently experienced by U.S. hospitals, we use readmission rates and costs as our outputs to investigate how well hospitals can lower readmission rates while minimizing their costs, since recent policy changes have tied a portion of hospital reimbursements to their readmission rates, making both variables crucial outcome goals. We find that both clinical and experiential quality are significantly associated with the higher financial viability of hospitals. Further, focusing on these two quality dimensions together has additional benefits.

Cross-Sectional and Longitudinal Tests of Social Cognitive Model of Well-Being in Korean College Students

This study examined the cross-cultural utility of a modified social cognitive model of academic and life satisfaction (Lent &amp; Brown, 2008) by adding independent and interdependent self-construals with Korean college students in a cross-sectional (Study 1) and a longitudinal design (Study 2). In Study 1, 604 participants completed measures of academic self-efficacy, outcome expectations, goal progress, environmental support, positive affect, academic satisfaction, life satisfaction, and self-construals. In Study 2, 171 participants completed the same measures at two time points with a 15-week interval. Results of Study 1 indicated that the modified model provided a good fit to the data and that 21 out of 25 of the hypothesized paths were significant. In Study 2, the bidirectional model, which included three theorized sets of reciprocal relations (i.e., academic satisfaction to life satisfaction, positive affect to both environmental support and self-efficacy, and self-efficacy to both outcome expectations and goal progress) demonstrated an optimal fit to the data. Overall, the findings of the present study provide evidence for the validity of the modified social cognitive well-being model in Korean populations.

Student Surveys: Measuring the Relationship between Satisfaction and Engagement

This study explores the relationship between satisfaction and engagement survey items through an institutionally based survey, drawing on the two largest higher education student experience surveys in the world. The UK-based National Student Survey (NSS) was designed to inform student choice and drive competition and the US-based National Survey of Student Engagement (NSSE) was developed to provide actionable data for institutional enhancement. Comparing these surveys leads to a critical review of how such data can be used for policy decisions and institutional enhancement. The Institutional Experience Survey thus draws on findings from a survey of 1480 non-final year undergraduate students in a research-intensive UK university. Those who reported higher levels of engagement, measured across 17 engagement benchmarks, also reported significantly higher levels of satisfaction. Results are used to discuss the application of engagement-based surveys in the UK, compared to satisfaction-based surveys, and the benefits and challenges of both approaches. Conclusions are made about the usefulness of nationally standardised experience surveys, the different outcome goals of engagement and satisfaction, such as responsibility for learning and change, audience and results and lessons for other countries looking to measure the student experience. The paper highlights the need for a shift in perspective in relation to the role of student surveys in determining national and institutional policy from a student-as-customer approach to one that sees students and institutions as co-responsible for learning and engagement.

Exploring Factors Related to Goal Scoring Opportunities in Professional Football

ABSTRACT Purpose Outscoring opponents is the primary goal in football. To optimise goal scoring opportunities (GSOs), it is important to understand the preceding physical and tactical performance. This observational study explored whether running behaviour prior to GSOs related to the subsequent outcome (goal or no goal) or contextual factors. Methods Tracking data was collected from one professional team during its 2016/2017 season. Physical output was differentiated for attacking styles and analysed for attackers (taking shots) and defenders (trying to prevent shots). Results Counter attacks were found most effective, as outcomes improved with fewer defenders behind the ball (r=-0.27; p=0.03). Offensively, running behaviour in the minute prior to GSOs explained most variance and increased activities correlated with success (r=0.26; p=0.04). Moreover, decreased high-intensity distances covered during matches significantly correlated with favourable outcomes (r=-0.21; p=0.02). Finally, increased attacking effectiveness was found to relate to greater defensive covered distances (r=0.51; p<0.01). Discussion Running behaviour prior to GSOs was found to relate to the subsequent outcome. Specifically, space ahead of attackers, forcing defenders to cover more ground, was found to relate to GSO effectiveness. The running behaviour of attackers was found unrelated to previous activity, highlighting the significance of physical capacity and well-timed substitutions.

A framework for stakeholder management ecosystem

PurposeThe purpose of this study is to develop a stakeholder management ecosystem, which is an improved concept of stakeholder management practices implemented in organizations. The approach is to strategically manage, monitor and assess stakeholders' involvement efficiently during the various stages of the project. The paper aims to structure and organize the stakeholder management ecosystem concept, which would enhance working standards by gaining support and healthy interest of stakeholders in the ever-changing and increasing complex business environment.Design/methodology/approachA theoretical framework study is incorporated on the secondary data of stakeholder management, engagement and assessment. The conceptual insights are drawn for the comprehensive framework of 4Ps (project, people, process and promoting participation) to establish a stakeholder management ecosystem.FindingsThe findings expand the understanding and importance of efficient stakeholder management practices through a stakeholder management ecosystem concept. The implementation of efficient practices can exert a significant effect on the project outcome and organizational goals. Thus, these practices should be assessed and altered according to changing situations and dynamics at the various stages of the project.Practical implicationsThe paper contributes to the literature on stakeholder management. First, it holds organizational and managerial implications to efficiently channelize stakeholder resources to maximize the output of the project and the performance of an organization. Second, managing people associated with an organization formally or informally can not only draw their interest, trust and involvement but also can develop further scope and vision of growth and development.Social implicationsThe philosophy behind the concept is social cooperation and value creation. The more the people are engaged with the organization, the more will be the organizational support and well-being in the community as it broadens the pool of people involved, both inside and outside the organization.Originality/valueThe paper advances the practices of stakeholder management and organization management by introducing the ecosystem concept, 4Ps framework and assessment matrix. The ecosystem concept can be used to develop value and explore the potential of each person associated with an organization and further develop a functional relationship. The 4Ps framework is a structured and flexible approach to ease the process of understanding, analyzing, evaluating and involving stakeholders. The assessment matrix supports the evaluation of the incorporated strategy and further decision-making for the project by gauging project performance and stakeholder involvement.

Setting robust biodiversity goals

AbstractThe new global biodiversity framework (GBF) being developed under the Convention on Biological Diversity must drive action to reverse the ongoing decline of the Earth's biodiversity. Explicit, measurable goals that specify the outcomes we want to achieve are needed to set the course for this action. However, the current draft goals and targets fail to set out these clear outcomes. We argue that distinct outcome goals for species, ecosystems, and genetic diversity are essential and should specify net outcomes required for each. Net outcome goals such as “no net loss” do, however, have a controversial history, and loose specification can lead to perverse outcomes. We outline seven general principles to underpin net outcome goal setting that minimize risk of such perverse outcomes. Finally, we recommend inclusion of statements of impact in action targets that support biodiversity goals, and we illustrate the importance of this with an example from the draft GBF action targets. These modifications would help reveal the specific contribution each action would make to achieving the outcome goals and provide clarity on whether the successful achievement of action targets would be adequate to achieve the outcome goals and, in turn, the 2050 vision: living in harmony with nature.

Patient Motivations and Goals for Bariatric Surgery: A Mixed Methods Study.

Existing research has primarily focused on weight as the outcome of interest for bariatric surgery; however, patients frequently report other lifestyle and interpersonal surgery motivations and goals. Understanding the spectrum of bariatric surgery goals and motivations has important implications for enhancing patient-centered care and surgery outcomes. The current study characterized the nature of bariatric patient motivations and goals for surgery, described the extent to which motivations matched goals, and examined whether men and women differed in the specific motivations/goals described. Teaching hospital, United States METHODS: Data were obtained via retrospective chart review of bariatric patient responses to the clinic's standard open-ended questions about motivations and goals for bariatric surgery. A mixed method approach was used, including content analysis, to identify themes and χ2/t test analyses to test gender differences. Surgery motivations and outcome goals were reflected by 8 overarching and overlapping themes. The most common motivations were related to general health and quality of life. The most common goals were to improve health/longevity and mobility. Over a quarter of patients showed no overlap between motivations and goals. Few gender differences were observed. Findings underscore the importance of goals beyond weight loss, as well as the utility of helping patients shape their goals in accordance with goal-setting theories.

Service Providers’ Influence in Collaborative Governance Networks: Effectiveness in Reducing Chronic Homelessness

Abstract In fragmented policy areas, collaboration between government entities and nonprofit providers is thought to promote knowledge sharing and reinforce mutual accountability, hopefully improving performance. The popularity of this trend is matched only by the difficulties in actually meeting these multiplex goals. This is partly because there are both process (e.g., engagement and mutual learning) and outcome (e.g., effectiveness) goals that can work at cross-purposes. In this article, we use longitudinal data from a specific collaborative governance model—Housing and Urban Development (HUD) Homeless Continuums of Care (CoCs)—to investigate the relationship between meaningful inclusion of nonprofit service providers in the network and a valued outcome: reducing regional chronic homelessness. Specifically, we use structural equation modeling to assess the degree to which provider influence and local government support play mediating roles between network governance structure, growth in federal resource munificence, and reductions in chronic homeless. Combining HUD administrative data and data from a national survey of the population of CoCs (N = 313, 75% response rate), we find that while both (1) provider influence in decision-making and (2) federal funding growth are directly associated with reductions in chronic homelessness, provider influence also serves as an important mediator in the relationships between network governance structure, federal funding growth, and reductions in chronic homelessness. Qualitative case examples are then used to demonstrate how these trends are experienced in practice. Overall, we argue that collaborative governance can best improve client outcomes when it is truly collaborative and providers are given meaningful ways to engage with and influence the process.

State capacity in response to COVID-19: A case study of China

Countries across the world responded very differently in their prevention and control of coronavirus disease 2019 (COVID-19), and state capacity is likely driving these differences. In this study, we define state capacity in preventing and controlling COVID-19 as the extent to which a state takes rapid intervention measures based on scientific evidence to prevent and control infectious diseases. This case study explores China’s experience in terms of pandemic prevention and control, showing that the goal of pandemic prevention and control in the country is a concrete combination of outcome goals and multidimensional process objectives. This research also demonstrates the important role of state capacity in pandemic prevention and control in China by analyzing different ways to quickly achieve accessibility and full coverage of intervention measures for the target population. Finally, we argue that a country’s political system is not a decisive factor in pandemic prevention and control. Rather, the historical experience of a country in dealing with similar outbreaks and current state capacity play important roles.

Clinical Pathway Implementation with the Quality of Service and Satisfaction Patient of DM Gangrene in the General Surgery Poly at RSUD Ra Basoeni Gedeg Mojokerto

DM management requires collaborative and integrated team involvement in working with patients to set goals and implement treatment for patients. The need for treatment to individuals with DM helps provide psychological support, psychomotor skills, promote self-management, and set goals for better and optimal outcomes. Therefore, in the care of DM patients, it is necessary to apply services that can help patients in undergoing treatment better, one of which is by applying clinical pathways. The design of this research is crossectional analytics. The variables of this study are the application of clinical pathways as independent variables as well as quality of service and patient satisfaction as dependent variables. The population of all dm gangrene patients in the General Surgery Department of RSUD RA Basoeni Gedeg Mojokerto was 137 patients in February - March 2020. Samples were taken with simple random sampling techniques as many as 105 respondents. The data was collected by questionnaire and processed using editing, coding, scoring and tabulating and tested with chi square test. The results of this study showed that partially and simultaneously independent variables influence the occurrence of dependent variables due to the value of &lt; of 0.05. The application of clinical pathways can help patients know all forms of services that will be received from the beginning of the action until the patient returns home. Mechanism of application of clinical pathway will be a basis of communication that is built with good quality between hospital staff and patients so that patients will receive the maximum service and patients are satisfied with the service