Prescribing guidelines based on a flexible scope of practice.

Nurse practitioners (NPs) are in demand nationwide as primary care providers both in the inpatient and outpatient settings. Lack of prescriptive privileges and/or a narrow scope of practice can be practice limiting. This article provides a written template for prescribing authority, generic scope of practice, and furnishing policy, including evaluative process, for nurse practitioners who wish to obtain prescriptive privileges. Developed at the Palo Alto Veterans Affairs Health Care System, these documents can be used by NPs nationwide. They can be adapted to each provider's unique practice, whether in the hospital, clinic, or private practice setting.

Expanding nurse practitioner scope of practice within the Veterans Affairs Palo Alto Health Care System.

Healthcare priorities and use have changed dramatically over the last several years. Expansion of the nurse practitioner (NP) role has been a hallmark of the restructuring efforts, which have emphasized primary care and the use of nonphysician specialists. NPs are practicing in a wider range of settings than ever before, including acute hospital settings, outpatient clinics, and specialty services. While the Veterans Health Administration (VHA) has employed NPs since the early 1970s, their practice has been limited at many VHA medical centers. Such was the case at the Veterans Affairs Palo Alto Health Care System (VAPAHCS), when physicians produced a scope of practice (SOP) for NPs that was practice limiting. This article highlights the historical progress of NPs in defining their practice, discusses barriers to NP practice at the VAPAHCS, outlines strategies to overcome barriers, and discusses future possibilities for advanced practice nursing within the VA.

Intrusions in Alzheimer's disease in immediate and delayed memory as a function of presentation modality.

Young and elderly participants, and participants with Alzheimer's disease (AD) were compared via the suffix paradigm, where a not-to-be-recalled item is appended onto sequences to be immediately recalled. This task was followed by delayed tasks. In immediate recall, AD subjects showed both extralist and suffix intrusions. Recall of auditorily as compared with visually presented stimuli was superior, with the difference increasing in older subjects. The auditory but not the visual suffix produced an end-of-sequence decrement, which was greater in AD than in other groups. After delay, the elderly and young showed virtually perfect performance. The AD participants showed relatively high performance; however, extralist intrusions were frequent, resulting in a relatively low hit rate. As in immediate recall, intrusions showed specificity for AD, and in this paradigm appeared to be a marker differentiating AD and normal subjects. However, the sample size limits the power and generalizability of these findings.

Suffix effects and intrusion errors in young and elderly subjects.

Potential age differences in selective attention and response inhibition in 16 young and 16 elderly college students were explored using the stimulus suffix paradigm. Subjects were presented with auditory and visual lists of seven-letter sequences. Half the lists were appended with a letter suffix that was not to be recalled. Recall was spoken and written and in strict serial order. Despite similar letter spans, serial recall was more difficult for the elderly than for the young. Final-item recall advantage in the control condition was reduced more for the elderly than for the young in the auditory modality, and the elderly were more susceptible to a small degree of visual suffix interference. Older subjects made more suffix and extralist intrusion errors than did young subjects. Oral recall, along with the method of recording written responses, may have allowed these errors to surface. The extralist intrusion errors were phonological or based on alphabetic order, suggesting that the elderly may experience task-competitive, internally generated noise, which enters the response set. The suffix intrusions, along with greater susceptibility to the suffix, suggest an attentional type of deficit related to ineffective response inhibition in the elderly.

The epidemiology of AIDS in Tarrant County from 1982 through 1992.

From 1982 through 1992, the Fort Worth-Tarrant County Health Departments monitored the AIDS epidemic in 1080 cases. Vital records and surveillance data were used to describe the epidemiological characteristics of AIDS in Tarrant County by age, risk, racial/ethnic, sex, and geographic factors. The study found that the male-to-female ratio of cases was 12:1, that incidence among blacks was nearly twice that in whites and Hispanics, that the incidence rate was highest in the group aged 30 through 39 years, and that transmission patterns differed dramatically among zip codes, particularly affecting the poorest and the affluent in Fort Worth. Distribution of AIDS was influenced by demographic characteristics, risk-associated behaviors, and viral seroprevalence. The epidemiological information gleaned by active and passive surveillance enables the county health department to enhance its community-wide efforts to provide programs for prevention and education and to support AIDS-related services.

Similarity ratings and confusability of lipread consonants compared with similarity ratings of auditory and orthographic stimuli.

Similarity ratings of pairs of lipread consonants were obtained using a 5-point scale. Matrices were constructed showing mean similarity ratings and confusions among stimuli. Both the similarity and the confusion data provide normative data useful for researchers in many areas. Lipread data collected here are compared with similarity ratings of orthographically and auditorily presented consonants collected by Manning (1977). These comparisons provide information about how stimulus similarity both within and between presentation formats may affect information processing of the three types of stimuli. These data are of special interest to researchers studying the visual processing of speech and the effect of format of presentation on recall.

The effects of recoding and presentation format on recency and suffix effects.

The primary linguistic theory of Shand and Klima (1981) hypothesizes that stimuli that cannot be directly processed without recoding are not in the primary linguistic mode of the subject and thus should lead to lesser recency and associated suffix effects. In three experiments, different normal hearing subjects learned to pair American Sign Language (ASL) stimuli, visual "quasivocables" (QVs), word-like letter strings, and auditory QVs with common English words. In the first experiment, the subjects were given sequences of ASL or QV stimuli and required to recall the associated words in strict serial order. In two other experiments involving auditory and visual presentation, respectively, subjects who had never been given paired associate training were required to recall the English words that had previously been associated with the ASL and QV stimuli, in a standard suffix paradigm. The results showed recency and suffix effects to be present only with auditorily presented QVs and words. Contrary to the predictions of the primary linguistic hypothesis, greater recency and larger suffix effects were present with the auditory QVs than with the auditory words, although the QVs were not primary linguistic and the task involved forced recoding. Previous results showing recency with ASL stimuli in normal subjects were not replicated. It is concluded that recency and suffix effects are not related either to the primary linguistic mode of the subject or to stimulus recoding, as we and Shand and Klima have defined them.

Visual and auditory modality and suffix effects in young and elderly adults.

Research has shown that elderly as compared with young adults show relative deficits both in processing visually as compared with auditorily presented stimuli and in tasks having attentional components. In this study, visual and auditory presentation was compared in young and elderly adults using the suffix paradigm in which the control condition involves immediate serial recall and the experimental condition, a suffix, a not-to-be-remembered final item. The standard finding in this paradigm is called the modality effect, superior auditory as compared with visual performance in the control condition which is localized at the end of the sequence. Generally, auditory suffixes following auditory sequences reduce the modality effect while visual suffixes following visual sequences do not. The results showed generally standard modality and suffix effects for both age groups. Relatively inferior performance was present in the elderly in the visual as compared with the auditory control conditions suggesting recoding deficits in this group. Auditory suffixes following auditory sequences had a relatively greater performance effect on the elderly than the young, while visual suffixes following visual sequences did not impair the performance of either group. This suggests a modality specific attentional deficit in the elderly. Rank order correlations suggest that individuals within both age groups showing large differences in performance between auditory and visual control conditions may have relative recoding difficulties for their age. Additionally, increased susceptibility to auditory interference for elderly as compared with young subjects may be a marker of aging, while relative within-group susceptibility to auditory interference may be a deficit on the part of young subjects.

Recency and suffix effects in pictures as a function of recall method.

Two studies compared recency and suffix effects in pictures. In Experiment 1, which used strict serial recall, the recall curve for the control condition fell sharply until the final position when it exhibited a small but significant amount of recency. No suffix effects were present. In Experiment 2, a modified free recall condition exhibited a U-shaped serial position curve and significant recency. Picture and graphic suffixes led to small, reliable end-of-sequence suffix effects, but spoken suffixes did not. Thus pictures appear to lead to recency and suffix effects similar to those produced by static visual alphanumeric stimuli when strict serial recall is used. With a modified free recall procedure, recency is enhanced and suffix effects appear. The implications of the results with pictures and of differences between the two recall procedures are discussed with respect to literature in the area on pictures (Cohen, 1972) and American Sign Language (Krakow & Hanson, 1985; Shand & Klima, 1981). Additionally, some new methods of defining and analyzing recency, which are also applicable to primacy, are proposed and used in the paper to bring out more clearly the effects present.

Effects of visual and tactual stimulus presentation on learning two-choice patterned and semirandom sequences.

Three experiments compared the effects of visual and tactual stimulus presentation in two-choice sequential learning situations requiring a predictive response. In Experiments 1 and 2, subjects received a five- or six-unit repeating pattern; in Experiment 3, they received a semirandom sequence. Tactual as compared to visual stimulus presentation resulted in less trials to criterion in predicting a repearing pattern and in earlier frequency matching in predicting a semirandom sequence. These results suggest an unusual tactual adeptness in binary serial learning. Additionally, a new method of analyzing conditional responding in th brobability learning paradigm is described and applied to the data in Experiment 3.