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Are BSN students changing? Merritt says they are. Further, she says educators need to change their ways. They need to design programs for the average student, not for some ideal student who doesn't exist.
The financing and delivery of long-term care (LTC) need substantial reform. Many cannot afford essential services; age restrictions often arbitrarily limit access for the nonelderly, although more than a third of those needing care are under 65 years old; Medicaid, the principal third-party payer for LTC, is biased toward nursing home care and discourages independent living; informal care provided by relatives and friends, the only assistance used by 70% of those needing LTC, is neither supported nor encouraged; and insurance coverage often excludes critically important services that fall outside narrow definitions of medically necessary care. We describe an LTC program designed as an integral component of the national health program advanced by Physicians for a National Health Program. Everyone would be covered for all medically and socially necessary services under a single public plan, federally mandated and funded but administered locally. An LTC payment board in each state would contract directly with providers through a network of local public agencies responsible for eligibility determination and care coordination. Nursing homes, home care agencies, and other institutional providers would be paid a global budget to cover all operating costs and would not bill on a per-patient basis. Alternatively, integrated provider organizations could receive a capitation fee to cover a broad range of LTC and acute care services. Individual practitioners could continue to be paid on a fee-for-service basis or could receive salaries from institutional providers. Support for innovation, training of LTC personnel, and monitoring of the quality of care would be greatly augmented. For-profit providers would be compensated for past investments and phased out. Our program would add between $18 billion and $23.5 billion annually to current spending on LTC. Polls indicate that a majority of Americans want such a program and are willing to pay earmarked taxes to support it.
Current changes in the role of the federal government in human service programs are forcing states and local communities to deal with issues of administrative and program design. This involves making explicit choices among a number of alternatives in each element of program design. The author examines the alternatives in program model, program rationale, program mode, administrative auspice and form of consumer participation.
HMOs can use clinical data culled from computerized medical records and provider and patient interviews to examine the impact of premature infant births on the family. The results can help guide health plans in developing a clinical intervention program to address the physical and emotional consequences of low birthweight babies. The Harvard Pilgrim Health Care experience describes the data collection process administrators are taking to design such a clinical intervention.
The voice of adult learners is often overlooked in the design of programs that are specifically constructed to meet their learning needs. This article portrays the design of a midwifery re-registration program that commenced with a survey of non-practising midwives. The organisation of the course, together with the processes involved in curriculum building are explained. The adult learner, particularly in a situation where previous knowledge, skills and experience are vital inputs to the design of programs, have been highlighted.
Three commercial optical design programs are used to model familiar geometries in ultrafast optics. A set of macros has been created to calculate the pulse delay, group velocity dispersion, and third-order dispersion caused by the components in an ultrafast optical system. The results correspond to published values. This opens the possibility of using the well-developed optimization routines to improve the performance of ultrafast systems.
We have implemented an interactive digital filter design program in the HP 1000 computer at the Department of Electrical Engineering of the University of Washington. This program allows users to design different types of filters interactively with both amplitude and phase responses displayed on graphic devices. The performance of each designed filter can be evaluated conveniently before the best one is chosen and implemented for any particular application. This program can design recursive filters, e.g. Butterworth, Chebyshev and elliptic, or nonrecursive filters with one out of six different windows, i.e. rectangular, triangular, Hann, Hamming, Blackman and Kaiser. The main outputs from this program are coefficients of a transfer function of an analog filter, a digital filter, or both. Therefore, the design of both analog and digital filters is facilitated by using this program. The program is very simple to use and does not require background in analog or digital filter principles in order to run it. The program is written in standard FORTRAN and is about 30 kbytes in size excluding the graphics display routines. Since it uses standard FORTRAN, it can be easily transported to minicomputer and microcomputer systems that have a FORTRAN compiler and minimal graphics capabilities. This program is available for distribution to interested institutions and laboratories.
Patient education is an important part of safe, effective warfarin therapy. A review of warfarin patient education programs described in the periodical literature over the past 20 years was undertaken. Fifteen relevant articles published between 1972 and 1988 were identified. Most of the articles describe content to be taught. Elements of program design receive limited attention. Patient input into program design is not considered. The literature review clearly demonstrates that principles of program design and outcome evaluation should be applied further by health professionals involved in warfarin patient education.
PRIMO is a computer program that designs walking primers for large-scale DNA sequencing projects. Oligonucleotide primers are predicted automatically, using quality information associated with each base call, eliminating the need for manually viewing the sequence traces or inspecting contig assemblies to determine appropriate locations for primer design. This allows PRIMO to run in batch mode on an arbitrarily large number of templates. For shotgun sequencing, PRIMO reads assembled sequence contigs with corresponding base quality statistics and automatically designs walking primers as needed to extend and join contigs, or improve their overall quality. In the opposite extreme of single-pass or completely directed sequencing, PRIMO reads the unassembled sequence for each template and designs walking primers for extending each read. If the base-calling software does not provide base quality statistics, PRIMO assigns its own measure of base quality determined by the shapes of individual peaks in the trace data for each template. In this way, PRIMO can be used in the finishing stages of a shotgun sequencing project, in sequencing by directed primer walking, or in some intermediate strategy. The code is written in ANSI C and maintained in two versions: one for the Macintosh and the other for UNIX.
This article describes a unique continuing education program designed to enhance critical thinking, clinical judgment, and communication skills of practicing nurses in an acute care setting. The program design and implementation strategies are described in detail. The authors include specific examples for those who want to develop a similar program to improve the practice of registered nurses in the acute care setting.
Directors of postgraduate internal medicine programs face many problems in program design, particularly when numbers of house staff continue to decrease. This paper examines the training requirements of a resident in internal medicine and proposes a curriculum based on set rotations in the three key areas of training--subspecialty services, critical care and the clinical teaching unit. The distribution of time in these three areas and the balance of exposure to inpatients and outpatients are discussed in detail. This program design ensures exposure to all the key elements of internal medicine in 3 years and should prevent significant gaps in knowledge at the time of certification. The implications for "service" in major teaching hospitals is discussed. Hospital departments and administrators must confront the prospect of hospital units without house staff. Most important, program directors must resist sacrificing the pedagogic essentials of a training program for service requirements.
A program designed for DNA sequence analysis by people with no computer background or experience is described. The criteria used in the program design were (i) user friendliness, (ii) ability to handle large DNA files (greater than 10 kilobases), (iii) low storage requirements so that it could be put on a personal computer (IBM), (iv) written in a widely used language (FORTRAN 77) and (v) ability to handle all of the needed tasks for DNA analysis. The program consists of an executive that controls a set of modular subprograms. A file management system using 'SEQ' and 'SITE' files is also in place. SEQ files contain long DNA nucleotide sequences (e.g. restriction enzyme sites). Related SEQ and SITE files are grouped into categories. A SITE category can include related sequences a user wishes to search for in a longer SEQ sequence from a designated category. For example, all of the restriction enzyme recognition sites can group into a single category called 'Enzymes' and can be searched for in a SEQ sequence which has been placed in the SEQ file category 'Plasmids'. Colour graphics is also used as a visual aid.
OBJECTIVE: To review adherence to selected procedures outlined in the System to Manage Accutane-Related Teratogenicity (SMART) program during the first year of implementation vs the procedures in effect in the year prior to initiation of the SMART program. DESIGN: Observational. SETTING: A novel pharmacy compliance survey and an ongoing, voluntary survey. PATIENTS: Female recipients of isotretinoin. INTERVENTION: In April 2002, Hoffmann-La Roche Inc, Nutley, NJ, manufacturer of Accutane brand isotretinoin and at that time the sole source of isotretinoin, revised earlier guidelines and instituted the SMART risk management program, which included the use of qualification stickers to affix to all prescriptions for Accutane to indicate, among other things, a negative pregnancy test just before the prescription was written. The goal of the SMART program was to decrease or eliminate isotretinoin-exposed pregnancies. MAIN OUTCOME MEASURES: Use and completion of prescription qualification stickers; changes in pretherapy pregnancy testing and birth control use. RESULTS: The results of the pharmacy compliance survey indicated high (>90%) use of prescription qualification stickers. Results of the patient survey suggested that 9% of prescription qualification stickers within the observed user cohort were issued without a pregnancy test. Furthermore, the pregnancy rate for patients participating in the survey was similar to that reported for cohorts recruited before the SMART program. CONCLUSIONS: The usefulness of the results derived from 2 surveys designed to evaluate the SMART program is limited by the lack of reliability and validity of the survey instruments and by questionable generalizability to all female recipients of isotretinoin. The presence of a qualification sticker may not have an impact on pregnancy testing or compliance with effective birth control behavior as outlined in the SMART program.
The relationship between organizational control and normalization in treatment program design was examined in 30 community-based settings for juvenile offenders. Although these two dimensions were hypothesized to be converging indicators of the institutionality of a setting, the findings indicated that they are only marginally related. More hierarchical models of decision making were not associated with more depersonalized, isolating programming, and involvement of residents and line staff in decision making did not covary with autonomy and personalization in programming. The results are discussed as evidence that institutionality is a multidimensional construct, and that future investigations must distinguish between organizational decision making and characteristics of treatment program design when assessing the institutional quality of residential service settings.
In the present study, 36 specialized substance abuse treatment programs for women and their children were identified and chosen for review. These programs provide a wide range of services including substance abuse, mental health and medical treatment, life skills training (i.e. vocational and parenting training), and social services (i.e. child care and transportation). A cluster analysis was conducted, and three distinct patterns of program design were identified. Results suggest that programs vary considerably regarding the extent to which comprehensive services are provided and to whom they are offered. Many programs that appear to be comprehensive fail to provide the full range of services to all those who need them. In particular, many programs for pregnant women seem to focus almost exclusively on pregnancy-related issues. As such, specialized substance abuse treatment for women may be at risk for becoming too specialized. Recommendations are made for future substance-related program planning for women and their children.
A warm-up program designed for downhill skiers and conducted in alpine conditions was tested for its effectiveness in "warming up" the body prior to participation in 90 minutes of downhill skiing. Eight subjects were randomly allocated and participated in both the warm-up and control conditions. Measurements were taken of rectal temperature, skin temperature, heart rate and flexibility prior to warm-up, immediately post-warm-up/immediately pre-skiing, and at 15min intervals during 90 minutes of skiing. The main analyses used were planned contrasts on repeated measures analysis of variance. Participation in the warm-up program resulted in significant increases in: rectal temperature (F(1,6) = 8.196; p = 0.008); heart rate (F(1,7) = 32.97, p < 0.001); and flexibility (F(1,6) = 10.14, p = 0.003) when compared with the control condition. These findings demonstrate that the program was effective in warming up the body.
Concepts of quality management related to program design and implementation are relatively new to the health care field. The process used to satisfy the requirements of program evaluation, business planning, and clinical care quality assurance within the framework of quality management is discussed. Using an interdisciplinary approach, the authors trace the development of a specific rehabilitation program. Such programs can allow the health care provider to be more fruitfully involved in a health care service design beneficial to the patients served.
Two-generation programs are relatively new attempts to deal with the nation's social ills. In two-generation programs, services such as early childhood educational programs are offered to children to help them get the best possible start in life, while, at the same time, parents are offered training to help enhance their parenting skills, and education, literacy, or job training to help them become economically self-sufficient. These multistrategy programs are relatively new additions to the broad array of programs designed to serve children and families, but many have already been the subjects of fairly sophisticated evaluations. This article describes two-generation programs and how they differ from earlier single-focus approaches to serve children and families. In-depth descriptions of six premier two-generation programs are used to illustrate the variability in content and costs of these programs. The short-term results of these six programs are reviewed and indicate mixed and modest results in promoting the development of children and improving the parenting skills and economic self-sufficiency of parents. The results suggest several lessons, and the article concludes with recommendations for program improvement and future research.