Program Evaluation

In 2003, the John A. Hartford Foundation Institute for Geriatric Nursing (Hartford Institute), in collaboration with the American Association of Colleges of Nursing, conducted a survey of baccalaureate schools of nursing in the United States to compare gerontological content to baseline data collected by the Hartford Institute in 1997. Since last surveyed in 1997, baccalaureate nursing programs have been the recipients of substantial new resources and initiatives focused on gerontological curriculum enhancement. While these initiatives are ongoing, and some are in an early stage of development, resurveying baccalaureate programs was seen as a means of taking a midcourse "pulse" as to the effectiveness of these efforts. Data suggest that there has been a fundamental shift in baccalaureate curriculum toward incorporation of a greater amount of gerontological content, integration of gerontological content in a greater number of nursing courses, and more diversity of clinical ...

Compares conceptualizations of homelessness as a temporary state through which people pass or a permanent trait that emanates from individual characteristics. Evidence from a longitudinal study of 564 homeless families in New York City and additional secondary sources supports the view that for families, homelessness is a temporary state that is resolved by the provision of subsidized housing. Even for single individuals with severe mental disturbances, housing is a key factor in ending homelessness, although here there is more evidence that social services also contribute. Policy implications are that governments should take a more active role in reducing homelessness by providing access to subsidized housing.

The Government of Canada's approach to performance measurement and reporting, though founded on solid principles, is undermined by flawed implementation. A large performance reporting "machine" generates data that are too rarely of use to public sector managers, Parliamentarians and Canadians. This paper analyzes the flaws of the current system and makes proposals for fixing it.

The National Health Service Knowledge and Skills Framework has been introduced as part of the Agenda for Change Reforms in the United Kingdom to link pay and career progression to competency. The purpose of this paper is to consider the implications for nurses, their managers and the impact on university departments delivering continuing professional development for nurses. The new system has the potential to increase the human resources management aspect of the clinical nurse managers' role and could have legal implications, for example if practitioners perceive that their needs for continuing professional development have been overlooked to the detriment of their pay and career aspirations. The new system also has implications for providers of continuing professional development in the universities and is likely to demand closer liaison between education providers and trust staff who commission education and training. The Knowledge and Skills Framework is of interest to nurses and nurse educators internationally because the system, if effective, could be introduced elsewhere.

Across the United States, community colleges offer millions of students an open-access, low-cost postsecondary education. However, of the students who enroll in community college hoping to earn a credential or transfer to a four-year institution, only about half achieve their goal within six years. For students who enter college needing developmental (remedial) education in reading, writing, or math, this rate is even lower. Learning communities, in which cohorts of students enroll in two or more linked courses together, are often employed to improve these students' success. In addition to linking courses, learning communities often incorporate other components, such as faculty collaboration, shared assignments and curricula, and connections to student support services.

This paper describes a project designed to equip direct care workers with the knowledge and skills to address communication as a central factor in the lives of people with learning disabilities who challenge services. The elements of the approach taken -'Challenging Communication'are described, outcomes discussed and possible implications for the speech and language therapy profession briefly considered.

Background: There is increasing recognition of the need to identify risk factors for poor mental health in pregnancy and following birth. In New South Wales, Australia, health policy mandates psychosocial assessment and depression screening for all women at the antenatal booking visit and at six to eight weeks after birth. Few studies have explored in-depth women's experience of assessment and how disclosures of sensitive information are managed by midwives and nurses. This paper describes women's experience of psychosocial assessment and depression screening examining the meaning they attribute to assessment and how this influences their response.

Our country's rapidly growing older adult population represents the core business of health care; however, few nurses are adequately prepared to care for their unique needs. This is caused, in part, by the limited attention paid by nursing educators to incorporating basic gerontological nursing principles into undergraduate programs. During the last 7 years, the American Association of Colleges of Nursing, through the generous support of the John A. Hartford Foundation, has led several initiatives to improve gerontological nursing education in baccalaureate programs. This article describes innovative educational strategies successfully implemented by three nursing programs-New York University, Tuskegee University, and University of Rhode Island-to increase knowledge and improve attitudes of nursing students in caring for older adults. Successful strategies include a long-term care guide, a senior mentor experience, student assignments addressing diversity issues, student debates, critical reflective journalizing, and an evaluation tool for measuring student attitudes. These strategies are readily reproducible and assist faculty to easily integrate gerontological nursing content into the curriculum while simultaneously enhancing student attitudes and knowledge. (Index words: Student attitudes; Health care; Nursing education; Older adults) J Prof Nurs 22: 91-97, 2006.

Research has indicated the importance of evaluating the experiences related to developing e-portfolios (electronic portfolio) to contribute to the overall excellence in teaching and learning. Researchers (instructors) of the present study used an exit e-portfolios, a questionnaire and follow up interviews to describe development and evaluation of e-portfolios with teacher education graduates in their final capstone experience at a major UAE (United Arab Emirates) national university. There is not any such research study conducted in the UAE and there are few studies conducted, in the topic, internationally. This study described the process of developing an e-portfolio and examined its validity and participants' perceptions to assess teaching performance in the UAE. E-portfolios and surveys of 67 pre-service teachers were included in the analysis and findings. A questionnaire was developed by the authors to examine common perceptions. Analyses of quantitative and qualitative data were presented. A major result indicated that the use of e-portfolio is considered as a pragmatic vehicle to assess pre-service teachers' performance and evaluate teacher education programs.

Introduction Despite a realistic strategy and availability of resources, multiple challenges still overwhelm countries grappling with the challenges of communicable disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy is by far the most pragmatic strategy in resource-poor settings. The objective of this study was to systematically review and document the lessons learned and the challenges identified with the implementation of the IDSR in low-and middle-income countries and to identify the main barriers that contribute to its sub-optimal functioning. Methods A systematic review of literature published in English using Web of Knowledge, PubMed, and databases of the World Health Organization (WHO) and the Centers for Disease Control (CDC) between 1998 and 2012 was undertaken. Additionally, manual reference and grey literature searches were conducted. Citations describing core and support functions or the quality attributes of the IDSR as described by WHO and CDC were included in the review. Results Thirty-three assessment studies met the inclusion criteria. IDSR strategy has been best adopted and implemented in the WHO-AFRO region. Although significant progress is made in overcoming the challenges identified with vertical disease surveillance strategies, gaps still exist. Mixed challenges with core and support IDSR functions were observed across countries. Main issues identified include nonsustainable financial resources, lack of coordination , inadequate training and turnover of peripheral staff, erratic feedback, inadequate supervision from the next level, weak laboratory capacities coupled with unavailability of job aids (case definitions/reporting formats), and poor availability of communication and transport systems particularly at the periphery. Best outcomes in core functions and system attributes were reported when support surveillance functions performed optimally. Apart from technical and technological issues, human resources and the health care system structures that receive the IDSR determine its output. Conclusions The challenges identified with IDSR implementation are largely 'systemic'. IDSR will best benefit from skill-based training of personnel and strengthening of the support surveillance functions alongside health care infrastructures at the district level.

Previous methodological reviews and the controversy regarding the adequacy of standard-setting technology are summarized. The judgmental nature of all standard-setting methods is examined, and the debate about whether fallible standards are better than none is recast in the context of three different test uses: pupil diagnosis, pupil certification (for high school graduation or professional licensure), and program evaluation. Exemplary standard-setting methods are reviewed, representing the following major approaches: (1) judgments of test content ; (2) judgments about mastery-nonmastery groups; (3) norms and passing rates; (4) empirical methods for discovering standards; and (5) empirical methods for adjusting cutoff scores, given a standard on an external criterion measure. Standards based on the performance of judged mastery groups (the Contrasting Groups method) and certain uses of normative data are likened to Known Groups validation. Recommendations are made for selecting standard-setting techniques depending on test use, including pupil diagnosis, pupil certification, and program evaluation. Future research on standard setting is discussed in the context of improving practical aspects of judgmental methods. For some time after criterion-referenced testing was invented (Glaser, 1963), standards or passing scores on the test were considered to be the distinguishing characteristic of criterion-referenced tests. These were the criterion levels required to make absolute rather than relative interpretations of performance. Now that the original intent of criterion referencing is more clearly understood to mean detailed specification of the content or behavior domains to be assessed (Millman, 1974; Popham, 1975), it is acknowledged that standards are not always needed for applications of criterion-referenced tests. Hambleton, Swaminathan, Algina, and Coulson (1978) distinguished two uses for criterion-referenced tests: (1) to estimate examinee domain scores and (2) to assign examinees to mastery states. The first use requires a report of how much of a content domain an examinee knows; the second use involves comparing the examinee's score to a standard to determine if he or she knows enough to be considered a master. Obviously, only the second use requires a judgment about how much knowledge constitutes mastery. When mastery classifications are desired, there is no ready technical solution to the setting of standards because there are no universal standards, and whether reasonable standards can be set at

A control scheme on BVDV was launched in Sweden in 1993 with the aim to prevent spread of the infection between herds, to eliminate virus from infected herds and, ultimately, to eradicate BVDV from Sweden. At the start it was voluntary and fully financed by the affiliated farmers. The estimated prevalence of infected herds was 40%. After 11 years there were only 205 (0.9%) herds still under clearance. Measures perceived to be of importance in concluding the scheme are subsidies on costs for analyses, gradually making regulations for contacts between herds and prevention of indirect infection stricter and also to eventually make the scheme compulsory.

In 2002, California adopted a non-name system for HIV case reporting. This study focused on the acceptability of a non-name reporting system among key stakeholders implementing the system. We conducted qualitative research during the pre-and post-implementation period of the non-name HIV reporting regulations. During both study periods we conducted key informant in-depth interviews (n = 48 and 52, respectively) with health department surveillance staff, laboratory personnel, health care providers and clinic staff; and we conducted four focus group discussions (n = 28 and 30, respectively) with representatives of community-planning group members and advocacy groups. We found that overall, California's non-name HIV reporting regulations were acceptable to most key stakeholders. Acceptability of a non-name system was highest among advocates and healthcare providers. Views of health department staff varied across the four counties, with some expressing a strong preference of a names based system and others accepting the non-name system.

moderuting ejjierts of scliool orgoni~rrtioiicrl clitrructeristirs (d i o o l dimtrte. s c h o o l Iieciltl?, trnc1,joh .scitisjiiction) on outcomes ($(I readier hedth hehcn>ior chrriige progrmn. T/iirt!'-hi'o prihlic schools ere mtitcl~ed und rundomly ~ssigned either to treatmerit or control conditions. 0r~ptini:trIional. dietun. und physiologic data bvere coll~~cted,fr(irii third to .fijih g r d e teuclrers oi'er three yecir,s. Treatment schools received N tericher wellness progrum .for /MY) years. Psychometrics oj'mo.st or,Sclrli,trtioiiol scu1e.s uchieiwl ncceptuhle 1ei~~l.s (f reliubiliry. Mi-red model unu1y.se.s n'ere conducted to teJ t,fiir moderating effec.ts. Treatment schools M'itli high or;Scini~afional climute mid hecrltli scores reported 1iigher.fr-uit crmfjiiice mid vegeruhle consumption (I t Yeur 2 compured M'ith intenwtion schools with /OM, score.s. Treatment .schools with higli ,job .sutisfactio?i scores reported Iiigherfi-uit und juice und lower,fiit,food con.srimption at Y e w 3 compared with intervention schools with low scores. These meusures mcry he used as n tool to msess tlie rri\zironnient in which .school hrulth promotion programs cire presentecl. Future intenwitioris mny need to he tuilored to the or,qurii:ationul c~liortrctrristic..~ c~f.sd7ool.s.

The Baby Basket initiative was developed by Apunipima Cape York Health Council (ACYHC) to address poor maternal and child health (MCH) in Cape York, the northernmost region of Queensland. While positive outcomes for Indigenous MCH programs are reported in the literature, few studies have a strong evidence base or employ a sound methodological approach to evaluation. The aim of the cost study is to identify the resources required to deliver the Baby Basket program in the remote communities of Cape York. It represents an initial step in the economic evaluation of the Apunipima Baby Basket program. The aim of this study was to report whether the current program represents an effective use of scarce resources. The cost study was conducted from the perspective of the health providers and reflects the direct resources required to deliver the Baby Basket program to 170 women across 11 communities represented by ACYHC. A flow diagram informed by interviews with ACYHC staff, administrative d...

Soaring obesity rates in the United States demand comprehensive health intervention strategies that simultaneously address dietary patterns, physical activity, psychosocial factors and the food environment. Healthy Bodies, Healthy Souls (HBHS) is a church-based, communityparticipatory, cluster-randomized health intervention trial conducted in Baltimore City to reduce diabetes risk among urban African Americans by promoting healthy dietary intake, increased physical activity and improvement to the church food environment. HBHS was organized into five 3-8-week phases: Healthy Beverages, Healthy Desserts, Healthy Cooking, Healthy Snacking and Eating Out and Physical Activity. A three-part process evaluation was adopted to evaluate implementation success: an in-church instrument to assess the reach, dose delivered and fidelity of interactive sessions; a post-intervention exposure survey to assess individual-level dose received in a sample of congregants and an evaluation form to assess the church food environment. Print materials were implemented with moderate to high fidelity and high dose. Program reach was low, which may reflect inaccuracies in church attendance rather than study implementation issues. Intervention components with the greatest dose received were giveaways (42.0-61.7%), followed by taste tests (48.7-53.7%) and posters (34.3-65.0%). The dose received of general program information was moderate to high. The results indicate successful implementation of the HBHS program.

This study investigates the distance education and information technology literature in an attempt to develop a model to measure quality and learning in online courses. The resulting model is the first proposed to address issues of flexibility, responsiveness, interaction, student learning, technical support, technology, and student satisfaction simultaneously. The reliability and validity of the model are explored with suggestions for future research. As Internet-based education continues to grow worldwide, this model may assist policymakers, faculty, students, and others in making reasonable and informed judgments with regard to the quality of and learning in Internet-based distance education.

The teacher is the decisive factor in the quality of education, the crux of the reform and innovation in modern general education. In order to improve the quality of teaching and learning to adapt to the general education program conditions and objectives, it is necessary to "change" the view, the look and the method to achieve positive and appropriate results in teaching and learning of Fine Art Education. The harmonious combination of theory and practice is a necessary and sufficient condition to help students, lecturers, and art teachers stand firm with their career, so that they are proud and aware of their self-esteem and professional values.

Background: A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities. Methods: An explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012-13), during (2007-08) and pre-(2002-04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level. Results: The MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas. Conclusions: MCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas.

The purpose of this study was to examine the effects of a nurse's counseling intervention on high-risk sexual behaviors of HIV-positive patients and to explore the relationship of gender, race, age, and education to high-risk sexual behaviors. A convenience sample of 20 adults who were newly diagnosed with HIV and were being treated at an inner-city out-patient clinic was used. Subjects were administered a questionnaire to determine their precounseling AIDS knowledge and precounseling sexual behaviors. A registered nurse then counseled them about safesex practices. After 2-3 months the questionnaire was readministered to determine the effects of counseling on AIDS knowledge and high-risk sexual behaviors. Although statistical analysis indicated a significant main effect for change in high-risk sexual behaviors after counseling, there were no significant relationships among change and the individual demographic variables of age, gender, race, and education. Pretest knowledge was not found to influence pretest behavior, nor was posttest knowledge found to affect posttest behavior. Paired t tests indicated a significant change in high-risk sexual behavior scores after counseling but no significant change in knowledge scores.

Community public health interventions based on citizen and community participation are increasingly discussed as promising avenues for the reduction of health inequalities and the promotion of social justice. However, very few authors have provided explicit principles and guidelines for planning and implementing such interventions, especially when they are linked with research. Traditional approaches to public health programming emphasise expert knowledge, advanced detailed planning, and the separation of research from intervention. Despite the usefulness of these approaches for evaluating targeted narrow-focused interventions, they may not be appropriate in community health promotion, especially in Aboriginal communities. Using the experience of the Kahnawake Schools Diabetes Prevention Project, in Canada, this paper elaborates four principles as basic components for an implementation model of community programmes. The principles are: (1) the integration of community people and researchers as equal partners in every phase of the project, (2) the structural and functional integration of the intervention and evaluation research components, (3) having a flexible agenda responsive to demands from the broader environment, and (4) the creation of a project that represents learning opportunities for all those involved. The emerging implementation model for community interventions, as exemplified by this project, is one that conceives a programme as a dynamic social space, the contours and vision of which are defined through an ongoing negotiation process. r (L. Potvin). 0277-9536/03/$ -see front matter r 2002 Published by Elsevier Science Ltd. PII: S 0 2 7 7 -9 5 3 6 ( 0 2 ) 0 0 1 2 9 -6

This paper investigates potential gender and age differences in conviction and crash occurrence subsequent to being directed to attend Iowa&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Driver Improvement Program (DIP). Binary logit models were developed to investigate the factors that influence conviction occurrence after DIP by gender and age. Because of the low crash occurrence subsequent to DIP, association rules were applied to investigate the factors that influence crash occurrence subsequent to DIP, in lieu of econometric models. There were statistical significant differences by driver gender, age, and conviction history in the likelihood of subsequent convictions. However, this paper found no association between DIP outcome, crash history, and crash occurrence. Evaluating the differences in conviction and crash occurrence subsequent to DIP between female and male drivers, and among different age groups can lead to improvements of the effectiveness of DIPs and help to identify low-cost intervention measures, customized based on drivers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gender and age, for improving driving behaviors.

To identify the factors influencing participation and outline the benefits and challenges of providing transitional rehabilitation for people with spinal cord injury (SCI) from rural and regional locations. Design: Grounded Theory analysis of service records and policy documents. Setting: One transitional rehabilitation service for people with SCI.

Despite launching the polio eradication initiative in 1995, India is among the world&#39;s largest reservoir of wild poliovirus with 559 cases of poliomyelitis reported in 2008. This continued failure has been criticised for its negative impact on routine healthcare delivery. We assessed the impact of the pulse polio immunization programme at the primary health level in terms of services, time and cost. All activities during a single round of intensified pulse polio immunization were modelled on actual requirements at the primary health centre at Dayalpur in Haryana. Total person-hours and cost per child vaccinated at the primary health centre were computed. Almost all routine healthcare services at the primary health centre were suspended during the round. Total person-hours consumed were 4446 and the total direct cost was Rs 24.2 per child vaccinated during a single round of the intensified pulse polio immunization programme. A single round of intensified pulse polio immunization ...

♦ Background: There is little information regarding the financial burden of peritonitis and the economic impact of continuous quality improvement (CQI) programs in peritoneal dialysis (PD) patients. The objectives of this study were to measure the costs of peritonitis, and determine the net savings of a PD CQI program in Colombia. ♦ Methods: The Renal Therapy Services (RTS) network in Colombia, along with Coomeva EPS, provided healthcare resource utilization data for PD patients with and without peritonitis between January 2012 and December 2013. Propensity score matching and regression analysis were performed to estimate the incremental cost of peritonitis. Patient months at risk, episodes of peritonitis pre- and post-CQI, and costs of CQI were obtained. Annual net savings of the CQI program were estimated based on the number of peritonitis events prevented. ♦ Results: The incremental cost of a peritonitis episode was $250. In an 8-year period, peritonitis decreased from 1,837 epis...

Eighty-two patients aged >70 years with heart failure were randomized to a gentle, seated exercise program or to usual care. Six-minute walk distance and quality of life did not change between groups, but daily activity as measured by accelerometry increased in the exercise group relative to the control group. ᮊ2005

The impact of class size on student achievement remains an open question despite hundreds of empirical studies and the perception amongst parents, teachers, and policymakers that larger classes are a significant detriment to student development. This study sheds new light on this ambiguity by utilizing nonparametric tests for stochastic dominance to analyze unconditional and conditional test score distributions across students facing different class sizes. Analyzing the conditional distributions of test scores (purged of observables using class-size specific returns), we find that there is little causal effect of marginal reductions in class size on test scores within the range of 20 or more students. However, reductions in class size from above 20 students to below 20 students, as well as marginal reductions in classes with fewer than 20 students, increase test scores for students below the median, but decrease test scores above the median. This non-uniform impact of class size suggests that compensatory school policies, whereby lower-performing students are placed in smaller classes and higher-performing students are placed in larger classes, improves the academic achievement of not just the lower-performing students, but also the higher-performing students.

This case study examined formative assessment of a first-year core course initiated in response to an external requirement. The paper discusses the campus assessment climate; describes how course faculty became proponents for assessment; explains how the core survey became housed in a larger student satisfaction survey; and outlines key elements of successful assessment programs. A researcher teamed with faculty to conduct the evaluation. The study examined the traditional knowledge and role of faculty in institutional assessment. Faculty, who were initially ambivalent or against formal assessment, were the primary audience. Qualitative methods were used to overcome faculty resistance. A research instrument was developed to assess the core program and students&#39; satisfaction with their first-year experience. Nearly 600 freshmen completed the survey; student focus groups were also conducted. Assessment results were delivered during a faculty workshop. Faculty were given time to di...

Objective: To evaluate a 3-week program comprising cooking demonstrations with free food samples in motivating elderly adults to cook more and improve their nutritional status. Design: An experimental pre-post study. Setting: Three districts in Hong Kong. Participants: Sixty aged 59-95 home-living adults. Intervention: Group A (one 1-day food sample given free weekly) and Group B (three 1-day food samples given free weekly). Main Outcome Measure: Satisfaction questionnaires were conducted every week. Mini Nutritional Assessment (MNA) scores were assessed at baseline and 6 months after the program's completion. Analysis: Nutritional status was assessed before and after intervention. Repeated analysis of variance measures of compliance, appetite, easiness of program at 3-week time-points were calculated to differentiate a more frequent (Group B) and a less frequent (Group A) provision of food sample reinforced their cooking skills to a greater extent. Results: The compliance rate of Group B was higher than that of Group A. More than 60% of the participants intended to continue cooking and a third of the participants expressed satisfaction with the program. The MNA scores had improved 6 months later (combined data from both groups). Conclusions: Nutrition education through cooking demonstrations and the community-based distribution of food ingredients can improve the nutrition status of the elderly population.

The assessment of the response of a prehospital/hospital system to a disaster will prove a complex and challenging undertaking for those who attempt it. Data availability and quality will prove to be an immediate problem. Finding the time to devote to assessment is usually difficult. Identifying qualified and interested members of the required multidisciplinary team and, in particular, an individual with health services research background who can assist in all phases of the design and implementation of the project, is often difficult. Obviously, these problems will be less severe if they are addressed to some degree in the disaster plan. That is, a general protocol for assessment could be developed as part of the disaster planning effort and evaluation staff could tentatively be identified by position (e.g., emergency department medical director). The issue of data availability could be confronted and provisions made for the recording of at least minimal information on patient log ...

The use of simulation and team training has become an excellent tool to reduce errors in high-risk industry such as the commercial airlines and in the nuclear energy field. The health care industry has begun to use similar tools to improve the outcome of high-risk areas where events are relatively rare but where practice with a tactical team can significantly reduce the chance of bad outcome. There are two parts to this review: first, we review the rationale of why simulation is a key element in improving our error rate, and second, we describe specific tools that have great use at the clinical bedside for improving the care of patients. These cross different (i.e. medical and surgical) specialties and practices within specialties in the health care setting. Tools described will include the pinch, brief/debriefing, read-backs, call-outs, dynamic skepticism, assertive statements, two-challenge rules, checklists and step back (hold points). Examples will assist the clinician in practical daily use to improve their bedside care of children.

In schools, the learning and optimal development of children with adaptive or behavioral problems may be seriously affected. In many schools, such problems are so prevalent that demand time and energy of the educators may dilute the educational experience of all children. This study examines the impact of the Primary Mental Health Project-a research-based, selective program. This early detection and prevention program for preschool and primary grades was implemented by the Jefferson County Public Schools. The Teacher-Child Rating Scale was used as a pre-and posttest measure for the participating students in the treatment schools. This study indicated that the school district participants had statistically significant positive scores in four critical domains: task orientation; behavior control; assertiveness; and peer sociability. Implications for policy and future research are discussed. Appendixes include rating scales and data. (Contains 19 references and 7 tables.) (GCP) Reproductions supplied by EDRS are the best that can be made from the original document.

ABSTRACT Children with motor difficulties are a very varied group. In order to target interventions more effectively researchers have attempted to identify specific sub‐groups; however, attempts to identify sub‐groups and provide interventions accordingly have met with limited success. Currently interventions can be classified into two main types, namely, general abilities and normative functional approaches. The current study outlines the Manchester Motor Skills Programme (MMSP), which adopts a normative functional approach and has been developed jointly by educational psychologists (EPs), specialist teachers and schools. In order to evaluate the effectiveness of the MMSP a quasi‐experimental repeated measures study was undertaken involving 24 children. The quasi‐experimental study yielded a medium effect size, which is a promising result for a naturalistic intervention. Methodological limitations and areas of future research are considered and identified.

Ways to expand access to antiretroviral treatment (ART) in low income settings are being sought. We describe an HIV care programme including ART in an industrial setting in South Africa. The programme uses guidelines derived from local and international best practice. The training component aims to build capacity among health care staff. Nurses and doctors are supported by experienced HIV clinicians through telephone consultation and site visits. Patients undergo a three-stage counselling procedure prior to starting ART. Drug regimens and monitoring are standardised and prophylaxis against opportunistic infections (isoniazid and cotrimoxazole) is offered routinely. Laboratory and pharmacy services, using namedpatient dispensing, are centralized. The programme is designed to ensure that data on clinical and economic outcomes will be available for programme evaluation. Between November 2002 Á December 2004, ART delivery has been established at 70 ART workplace ART sites. The sites range from 200 to 12000 employees, and from small occupational health clinics and general practitioner rooms to larger hospital clinics. During this period, 2456 patients began ART. Of those on treatment for at least three months, 1728 (78%) have been retained on the programme and only 38 (1.7%) patients have failed the firstline ART regimen. This model for delivery of ART is feasible and successful in an industrial setting. The model may be generalizable to other employment health services in settings of high HIV prevalence, and as a model for implementing ART in other types of health-care settings.