[Medical Professionalism as a Pivotal Goal in the Postgraduate Clinical Training].

Postgraduate clinical training for physicians in Japan has been mandatory since 2004, with the provision that the system itself is to be revised every 5 years if necessary. Major revisions were implemented in 2020, involving the objectives, strategies, and evaluations of the clinical training program. Among the revisions was a section on professionalism in the first part of objectives. As one of the committee members involved in the process of this revision, I provide an explanation of the historical background, learning strategies, and assessment of professionalism in physician training.

Evaluation of the long-term effect of selective tibial neurotomy for the treatment of spastic foot using a personal goal-centered approach.

OBJECTIVE: The objective of this study was to evaluate the long-term effectiveness of selective tibial neurotomy (STN) for the treatment of the spastic foot using a goal-centered approach. METHODS: Between 2011 and 2018, adult patients with a spastic foot (regardless of etiology) who received STN followed by a rehabilitation program were included. The primary outcome was the achievement of individual goals defined preoperatively (T0) and compared at 1-year (T1) and 5-year (T5) follow-up by using the Goal Attainment Scaling methodology (T-score). The secondary outcomes were the presence of spastic deformities (equinus, varus, and claw toes), modified Ashworth scale (MAS) score for the targeted muscles, and modified Rankin Scale (mRS) score at T0, T1, and T5. RESULTS: Eighty-eight patients were included. At T5, 88.7% of patients had achieved their goals at least "as expected." The mean T-score was significantly higher at T1 (62.5 ± 9.5) and T5 (60.6 ± 11.3) than at T0 (37.9 ± 2.8) (p < 0.0001), and the difference between T1 and T5 was not significant (p = 0.2). Compared to T0, deformities (equinus, varus, and claw toes; all p < 0.0001), MAS score (p < 0.0001), and mRS score (p < 0.0001) were significantly improved at T1 and T5. Compared to T1, MAS score increased slightly only at T5 (p = 0.05) but remained largely below the preoperative value. There was no difference between T1 and T5 regarding other clinical parameters (e.g., deformities, walking abilities, mRS score). CONCLUSIONS: This study found that STN associated with a postoperative rehabilitation program can enable patients to successfully achieve personal goals that are sustained within a 5-year follow-up period.

Treatment Objectives, Memory, and Desire.

This article explores the problems of the frequent loss, in the course of treatment, of the initial goals and motivation for treatment by both patient and therapist, and the connected lack of clarity of the real initial motivation for treatment on the part of both participants. It is strongly proposed that a true coincidence of at least one important initial motivational goal of patient and therapist is essential to assure the success of psychotherapy and that particular care is required to establish such agreement. On this basis, the goals of therapy may be expanded in the course of the therapist's experience, countertransference, and the patient's changing reality during treatment, and the existential and philosophical value systems of the therapist may play an important role in such widening of the therapist's expectations for the patient.

Motivational Interviewing improves postoperative nutrition goals within the Enhanced Recovery after Surgery (ERAS®) pathway in elective bowel surgery - A randomized clinical pilot trial.

BACKGROUND & AIMS: Exploration whether Motivational Interviewing (MI) could be learned and implemented with ease within a surgical in-hospital setting and whether participation in the intervention led to significantly higher compliance with ERAS®-recommended protein intake goals. The individual healing process of many patients is delayed because they fail to cover their calorie requirement, which could be counteracted by a patient-centered conversational intervention that is new in perioperative practice. METHODS: This patient-blinded pilot-RCT included 60 patients (≥18 years) following the certified ERAS® bowel protocol for colorectal surgery between March and August 2022. Five perioperative MI interventions were conducted by two health employees certified to perform MI. Key endpoints were the number of protein shakes drunk, calories of proteins ingested and overall calorie intake. RESULTS: A total of 60 patients (34 men [56.7%]; mean [SD] age, 60.7 [13.3] years) were randomized. MI patient-group had significantly higher protein shake intake on all postoperative days except day 3. For days 0-3 MI group drank significantly more shakes overall (median 5.5 vs. 2.0; P = 0.004) and consumed more calories (median 1650.0 vs. 600.0 kcal; P = 0.004) and proteins (median 110.0 vs. 40.0 g; P = 0.005). Total calorie intake for each day by shakes and dietary intake was significantly higher in the MI-intervention group on day 2 (mean 1772.3 vs. 1358.9 kcal; P = 0.03). CONCLUSIONS: MI may contribute to improve compliance with nutritional goals in the certified ERAS® protocol by increasing protein and calorie intake. The findings suggest further investigation of MI to help patients achieve their perioperative nutrition goals in different clinical settings. TRIAL REGISTRATION: DRKS - Deutsches Register Klinischer Studien; DRKS-ID: DRKS00027863; https://drks.de/search/de/trial/DRKS00027863.

Lifelong development in medicine: a thematic analysis of coaching goals throughout medical careers.

OBJECTIVES: Healthcare grapples with staff shortages and rising burnout rates for medical students, residents and specialists. To prioritise both their well-being and the delivery of high-quality patient care, it becomes imperative to deepen our understanding of physicians' developmental aims and needs. Our first aim is, therefore, to gain comprehensive insights into the specific developmental aims physicians prioritise by examining the coaching goals they set at the beginning of coaching. Since physicians face distinct roles as they advance in their careers, our second aim is to highlight similarities and differences in developmental aims and needs among individuals at various medical career stages. DESIGN: We conducted a qualitative analysis of 2571 coaching goals. We performed an inductive thematic analysis to code one-half of coaching goals and a codebook thematic analysis for the other half. Our interpretation of the findings was grounded in a critical realist approach. SETTING: Sixteen hospitals in the Netherlands. PARTICIPANTS: A total of 341 medical clerkship students, 336 medical residents, 122 early-career specialists, 82 mid-career specialists and 57 late-career specialists provided their coaching goals at the start of coaching. RESULTS: The findings revealed that coachees commonly set goals about their career and future, current job and tasks, interpersonal work relations, self-insight and development, health and well-being, nonwork aspects and the coaching process. Furthermore, the findings illustrate how the diversity of coaching goals increases as physicians advance in their careers. CONCLUSIONS: Our findings underscore the significance of recognising distinct challenges at various career stages and the necessity for tailoring holistic support for physicians. This insight holds great relevance for healthcare organisations, enabling them to better align system interventions with physicians' needs and enhance support. Moreover, our classification of coaching goals serves as a valuable foundation for future research, facilitating a deeper exploration of how these goals influence coaching outcomes.

Goal-Directed Treatment of Patients With Anxiety and Mood Disorders in a Regular Curative Mental Health Care Setting.

This study examined whether goal-directed treatment leads to improved treatment outcomes for patients with a primary mood or anxiety disorder and whether beneficial outcomes are achieved sooner compared to treatment as usual. In a quasi-experimental controlled study with a nested design, 17 therapists received training in goal-directed treatment and treated 105 patients with anxiety or mood disorders using principles of goal-directed treatment. Treatment results on a generic self-report instrument were compared with two control groups: a historical control group consisting of 16 of the 17 participating therapists, who provided treatment as usual to 97 patients before having received training in goal-directed treatment, and a parallel control group consisting of various therapists, who provided treatment as usual to 105 patients. Symptom reduction on a self-report measure was compared using multilevel analysis. A survival analysis was performed to assess whether a satisfactory end state had been reached sooner after goal-directed treatment. The results of this study show that goal-directed treatment only led to a significantly better overall treatment outcome compared to the parallel treatment as usual group. Furthermore, goal-directed treatment was significantly shorter than both treatment as usual groups. In conclusion, this research suggest that goal-directed treatment led to a similar or better treatment outcome in a shorter amount of time.

Progress on the health-related Sustainable Development Goals and targets in the Eastern Mediterranean Region, 2023: 2nd progress report

The 2030 Agenda for Sustainable Development includes a vision of healthy lives and well-being for all at all ages. This major report provides an update on progress towards the health-related Sustainable Development Goals (SDGs) in the WHO Eastern Mediterranean Region. It presents regional trends between 2010 and 2022 for 50 health-related SDG indicators using available data from WHO and estimates from other United Nations agencies. The report reveals some successes at the country level amid a marked slowdown regionally with setbacks across indicators on health health risks and determinants and access to services. We are at the halfway point for the 2030 Agenda for Sustainable Development: to reverse current trends and ensure the health and well-being of our population we must take bold steps now.

Relevance of the Sustainable Development Goals (SDGs) to Adolescent Health Measurement: A Systematic Mapping of the SDG Framework and Global Adolescent Health Indicators.

PURPOSE: To assess the relevance of the Sustainable Development Goals (SDGs) framework for adolescent health measurement, both in terms of age disaggregation and different health domains captured, and how the adolescent health indicators recommended by the Global Action for Measurement of Adolescent Health (GAMA) can complement the SDG framework. METHODS: We conducted a desk review to systematically map all 248 SDG indicators using the UN metadata repository in three steps: 1) age-related mandates for SDG reporting; 2) linkages between the SDG indicators and priority areas for adolescent health measurement; 3) comparison between the GAMA indicators and the SDG framework. RESULTS: Of the 248 SDG indicators, 35 (14%) targeted an age range overlapping with adolescence (10-19 years) and 33 (13%) called for age disaggregation. Only one indicator (3.7.2 "adolescent birth rate") covered the entire 10-19 age range. Almost half (41%) of the SDG indicators were directly related to adolescent health, but only 33 of those (13% of all SDG indicators) overlapped with the ages 10-19, and 15 (6% of all SDG indicators) explicitly mandated age disaggregation. Among the 47 GAMA indicators, five corresponded to existing SDG indicators, and eight were adolescent-specific age adaptations. Several GAMA indicators shed light on aspects not tracked in the SDG framework, such as obesity, mental health, physical activity, and bullying among 10-19-year-olds. DISCUSSION: Adolescent health cannot be monitored comprehensively with the SDG framework alone. The GAMA indicators complement this framework via age-disaggregated adaptations and by tracking aspects of adolescent health currently absent from the SDGs.

Synergizing habits and goals with variational Bayes.

Behaving efficiently and flexibly is crucial for biological and artificial embodied agents. Behavior is generally classified into two types: habitual (fast but inflexible), and goal-directed (flexible but slow). While these two types of behaviors are typically considered to be managed by two distinct systems in the brain, recent studies have revealed a more sophisticated interplay between them. We introduce a theoretical framework using variational Bayesian theory, incorporating a Bayesian intention variable. Habitual behavior depends on the prior distribution of intention, computed from sensory context without goal-specification. In contrast, goal-directed behavior relies on the goal-conditioned posterior distribution of intention, inferred through variational free energy minimization. Assuming that an agent behaves using a synergized intention, our simulations in vision-based sensorimotor tasks explain the key properties of their interaction as observed in experiments. Our work suggests a fresh perspective on the neural mechanisms of habits and goals, shedding light on future research in decision making.

What matters to you? A mixed-method evaluation of goal setting and attainment within reablement from a client perspective.

BACKGROUND: Goal setting is an essential component of reablement programmes. At the same time it is also an important aspect in the evaluation of reablement from the perspective of clients. OBJECTIVES: As part of the TRANS-SENIOR project, this research aims to get an in-depth insight of goal setting and goal attainment within reablement services from the perspective of the older person. MATERIAL AND METHODS: A convergent mixed methods design was used, combining data from electronic care files, and completed Canadian Occupational Performance Measure (COPM) forms with individual interviews. RESULTS: In total, 17 clients participated. Participants' meaningful goals mainly focused on self-care, rather than leisure or productivity. This mattered most to them, since being independent in performing self-care tasks increased clients' confidence and perseverance. Regarding goal attainment, a statistically significant and clinically relevant increase in self-perceived performance and satisfaction scores were observed. CONCLUSION: Although most goals focused on self-care, it became apparent that these tasks matter to participants, especially because these often precede fundamental life goals. SIGNIFICANCE: Reablement can positively contribute to goal setting and attainment of clients and may contribute to increased independence. However, effectiveness, and subsequently long-term effects, are not yet accomplished and should be evaluated in future research.

Long-Term Impact of an Occupational Therapy Intervention for Children With Challenges in Sensory Processing and Integration.

IMPORTANCE: Research is limited regarding parent-caregiver perspectives of occupational therapy (OT) intervention for children with challenges in sensory processing and integration and whether changes immediately following OT intervention are sustained over time. OBJECTIVE: To evaluate whether changes in identified goals are maintained following OT intervention and to determine what aspects of OT intervention parents-caregivers perceive to be most valuable. DESIGN: A mixed-methods research design. SETTING: A large midwestern pediatric hospital, with follow-up telephone interviews with parents-caregivers. PARTICIPANTS: Sixteen children with sensory challenges and their parents-caregivers. INTERVENTION: Children participated in 1-hr OT intervention sessions, 3 days per wk, for 6 to 7 wk. Parents-caregivers of children who completed OT intervention were interviewed via the telephone 6 to 12 mo after the intervention. OUTCOMES AND MEASURES: The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were used to determine whether changes were made and sustained over time. Qualitative data on caregiver perceptions of OT intervention were collected via open-ended questions during phone interviews. COPM and GAS scores before intervention were statistically significant compared with scores immediately following intervention and at 6- to 12-mo follow-up. Five themes emerged from the qualitative data. CONCLUSIONS AND RELEVANCE: Children with sensory challenges made significant changes related to occupational performance following OT intervention, and goal achievement was sustained over time. Parents-caregivers valued many aspects of the OT program, including the increased frequency of therapy services, the occupational therapist's advanced knowledge and skills, and the education and information provided during the program. Plain-Language Summary: This study supports the results of previous studies on OT intervention for children with challenges in sensory processing and integration. The study also adds to the body of knowledge that shows that changes and progress toward goals that result from skilled OT intervention can be sustained over time. The study showed that children participating in OT intervention made statistically significant changes while receiving OT services and maintained progress after intervention ended; however, the children did not continue to make significant progress toward goals once skilled OT services ended. Parents and caregivers of children with sensory challenges reported that they found OT intervention to be beneficial. Other important factors influencing the effectiveness of OT intervention that were identified by parents-caregivers included the education provided by the occupational therapist, the increased frequency of therapy services, and the increased knowledge and skills of the occupational therapists who provided the intervention.

Mediating effects of achievement goal orientation on the relationship between growth mindset and learning engagement in medical students: A cross-sectional descriptive study.

Learning engagement is an important factor to improve the quality of medical education. Exploring the level of medical students' learning engagement and its internal mechanism is of practical significance to improve their academic achievement. The aims of this study were to investigate the relationship between achievement goal orientation, growth mindset and learning engagement of medical students, and explore the mediating effect of achievement goal orientation on growth mindset and learning engagement. A correlational cross-sectional study was performed using an online questionnaire. The study was conducted from February to March 2024 among 279 medical college students. General information questionnaire, the Mindsets Scale, Achievement Goal Orientation Scale and Learning Engagement Scale were used for investigation. Calculations were performed using Statistical Packages for Social Sciences 27.0 and Mplus 7.0. Descriptive statistics, correlation, and mediation effect analyses were used to analyze the data. A total of 279 valid questionnaires were finally recovered. The learning engagement score of medical students was (56.17 ±â€…13.01), growth mindset score was (11.26 ±â€…3.37). The approach goal orientation played a partial mediating role between growth mindset and learning engagement in medical college students. Growth mindset can influence learning engagement through achievement goal orientation. Medical college educators should pay attention to the cultivation of students' growth mindset and enhance their learning engagement. The verification of the mediating effect of approach goal provides data support for formulating relevant intervention measures.

Addressing the elephant in the room: economic growth and the nation's poor health - changing the economy's goal for a healthier future.

This opinion piece focuses on how in order to improve the nation's poor health, the government needs to place more value on social justice and wellbeing as well as the use of regulation to positively change culture and health behaviour.

Behavioral proxies compete by the time courses of their rewards, including endogenous rewards.

Natural selection is slow, so behavioral goals must be based on patterns of reward. Addictions are rewarded in the same way as adaptive choice, so they can be distinguished only by their time course. In addition, the reward process is more plastic than is generally recognized, so abstract goals are shaped by the "legibility" of their proxies.

On abstract goals' perverse effects on proxies: The dynamics of unattainability.

Proxies should not be classified as failures or successes because, in most cases, they are impossible translations of abstract, polysemous goals to supposedly univocal concrete measures. The "success" or "failure" of a proxy does not depend on its actual accuracy as a valid indicator of goal attainment, but on a social system's willingness to maintain an illusion of its accomplishment.

Proxies, heuristics, and goal alignment.

Decision-making heuristics rely on proxies so the elements of heuristics appear to map well to the elements of proxies identified by John et al. However, unlike proxy failure, heuristics do not fail because of feedback. This may be because for successful heuristics the goals of regulators and agents are aligned, but this is not the case for proxy failure.

Navigating challenges and opportunities: AI's contribution to Pakistan's sustainable development goals agenda - a narrative review.

Sustainable Developmental Goals (SDGs) were introduced by the United Nations to ensure the sustainable progress of mankind through various domains. Pakistan, a low-middle-income country, faces many challenges in achieving SDGs. Artificial Intelligence is a rapidly evolving technology presenting significant importance in achieving SDGs. Therefore, this narrative review aimed to evaluate the artificial intelligence technologies that have been utilized globally and nationally which can be implemented in Pakistan focusing on Goal 3 (Good Health and Well-being) of SDGs. AI has been utilized primarily in high-income countries aiming to improve healthcare, thereby progressing towards achieving different targets of Goal 3 of SDGs. Pakistan lacks such initiatives with modest to no improvement across different SDGs. Therefore, Pakistan can adapt initiatives undertaken by resourceful countries to achieve its own SDGs.