Reshaping primary care: the Healthy Steps Initiative.

The Healthy Steps Initiative, funded by the Commonwealth Fund in New York and developed and implemented by Boston University School of Medicine, is an enhanced approach to pediatric care in the first 3 years of life. The goals of this effort in transforming pediatric care include (a) supporting the physical and emotional development of each infant and young child; (b) supporting a parental sense of confidence in their child-rearing knowledge and skills; and (c) supporting the clinical effectiveness of pediatric primary care practices to meet the needs of young children and families. The Healthy Steps Initiative enhances well-child care to achieve these goals by providing child development information and support as part of an expanded approach to pediatric primary care. Healthy Steps offers both pediatric practices and families a vehicle for meeting the needs of infants and young children within a preventative framework. This unique program, which is being quantitatively and qualitatively evaluated over 3 years, has been initiated in more than 24 pediatric sites nationwide.

Violence prevention: a community approach.

Violence among children and adolescents has been elevated to the status of a public health problem in the United States today. Pediatric nurse practitioners are in a unique position to play a major role in violence prevention. This article describes the impact of violence on the preschool child including developmental and behavioral issues. Violence prevention must be all-inclusive as a routine component of anticipatory guidance for preschool children and their families. Ways to integrate violence prevention into a primary care approach are addressed. Community-based outreach programs that further buffer the impact of violence on these children are discussed.

The Centre for Tropical Veterinary Medicine (CTVM) pulling its weight in the field of draught animal research.

Draught animal research carried out by scientists at the Centre for Topical Veterinary Medicine (CTVM) in Edinburgh and overseas is reviewed and the major findings are reported. The remit for the work has been to provide basic information on draught animals which can be applied by researchers and extension workers to their own geographic situations. Instrumentation is described which has been designed and manufactured to assist in the measurement of draught animal performance, particularly work output and energy consumption. Energy requirements of cattle, buffaloes and equids for work and ways in which these can be met from feed intake and body reserves reported. Studies on heat stress and diseases, 2 of the constraints to work performance, are also described.

Pharmacologic interventions for the neonate with compromised cardiac function.

The developmental aspects of myocardial performance must be considered when pharmacologic agents are used to support the neonate with compromised cardiac function. Neonatal cardiovascular function is characterized by a limited preload reserve, decreased ventricular compliance, limited contractile reserve, and CO that is primarily dependent on the HR. Nurses caring for these neonates need a baseline understanding of normal cardiovascular physiology to evaluate the effectiveness of pharmacologic interventions to augment CO. Neonatal nurses play a pivotal role in the therapeutic management of pharmacologic interventions to provide safe, high quality care for the sick neonate.

Accreditation of personnel administrators: an alternative interpretation.

As accreditation is a fairly new procedure to the field, it still continues to generate controversy. In this the first of two articles on accreditation, the author presents reasons for not taking the accreditation test.