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Certification from the American Board of Pathology: getting it and keeping it.

In the last 5 years, there have been significant changes in the process of obtaining (and maintaining) certification in anatomic and/or clinical pathology and in pathology subspecialties. These changes include the elimination of the requirement for a "credentialing year" with its attendant "double class" of residents; the implementation of a mandatory maintenance-of-certification program for all persons certified by the American Board of Pathology, Tampa, Fla, on or after January 1, 2006; and the alterations in format and manner of grading for the certifying examinations. This article updates the pathology community regarding these changes and provides references where candidates and diplomates can find the most recent information regarding all aspects of certification and maintenance of certification.

Certification↗

Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community.

OBJECTIVES: We sought to determine the annual incidence of sudden cardiac death (SCD) in the general population using a prospective approach. To assess the validity of retrospective surveillance, a simultaneous comparison was made with a death certificate-based method of determining SCD incidence. BACKGROUND: Accurate surveillance and characterization of SCD in the general population is likely to significantly facilitate current and future community-based preventive and therapeutic interventions. METHODS: We performed a prospective evaluation of SCD among all residents of Multnomah County, Oregon (population 660,486) using multiple sources of surveillance. A comprehensive analysis of circumstances of death, medical records, and available autopsy data was performed. Comparisons were made with a retrospective, death certificate-based determination of SCD incidence using International Classification of Diseases-Version 10 codes and location of death. RESULTS: Between February 1, 2002, and January 31, 2003, 353 residents suffered SCD (incidence 53 of 100,000; median age 69 years, 57% male) accounting for 5.6% of overall mortality. Of these, 75 cases (21%) were identified using sources other than first responders. Resuscitation was attempted in 237 cases (67%) and successful (survival to hospital discharge) in 28 (8%). The retrospective death certificate-based review yielded 1,007 cases (incidence 153 of 100,000; median age 81 years, 51% male), and the positive predictive value of this methodology was 19%. CONCLUSIONS: Sudden cardiac death accounts for 5.6% of annual mortality, and prospective evaluation in the general population appears to be feasible. The use of multiple sources of ascertainment and information significantly enhances phenotyping of SCD cases. Retrospective death certificate-based surveillance results in significant overestimation of SCD incidence.

Adolescent↗

Do birth certificate data accurately reflect the number of CNM-attended births? An exploratory study.

The number of midwife-attended births is increasing as reported on birth certificates in the United States. However, there is some evidence that births attended by certified nurse-midwives (CNMs) may not be accurately recorded. In this exploratory study, data on birth attendants for those clients giving birth during the study period were compared by using four sources: the client's hospital chart, the CNM birth log, hospital birth certificate records, and state vital statistics records. Researchers sought to determine the accuracy of birth attendant data as reflected in these four sources and whether other providers were listed as the birth attendant for actual CNM-attended births. During the study period, the CNM birth log showed that CNMs attended 97 vaginal births, whereas the client hospital charts for these same births noted 92 births as attended by CNMs (the other five were operative vaginal births). Hospital birth certificate and state vital statistics data during the study time period credited 88 and 82 of the client's births, respectively, to the CNMs. Exploration of the inaccurately reported birth attendant data, implications for practice, and recommendations for accurately recording birth certificate data are discussed.

Adult↗

The perceived value of certification by certified perioperative nurses.

We conducted this study to determine the perceived value of certification in perioperative nursing. Following development and pilot-testing, we mailed the 18-item Likert-type instrument, the Perceived Value of Certification Tool (PVCT), to a sample of 2750 perioperative nurses who had earned the CNOR or CRNFA credential or both. A total of 1398 surveys were returned (50.8% response rate). Factor analysis extracted three factors, accounting for 61% of the variance: personal value, recognition by others, and professional practice. Internal consistency reliability testing (Cronbach's alpha) identified a standardized alpha of.924. Over 90% of respondents agreed or strongly agreed with statements about the value of certification related to feelings of personal accomplishment and satisfaction, validating specialized knowledge, indicating professional growth, attainment of a practice standard, personal challenge, and professional commitment, challenge, and credibility. These results are consistent with previously published literature on specialty certification in nursing.

Attitude of Health Personnel↗

Psychometric analysis of the Perceived Value of Certification Tool.

The 18-item Perceived Value of Certification Tool (PVCT) was developed to support a multiphased research initiative related to assessing certification value among perioperative nurses. This article addresses the reliability and validity evaluation of the PVCT in a study of three samples of perioperative nurses: certificants (n = 954), noncertificants (n = 675), and administrators (n = 694). Factor analysis identified two-factor solutions for noncertificants and certificants. A three-factor solution for administrators was not clear; a two-factor solution was more interpretable. Explained variance ranged between 56.1% and 60.8% for the two factors of intrinsic and extrinsic value of certification. Confirmatory factor analysis model fit statistics for the two-factor model showed an acceptable fit of the data to the model. Internal consistency reliability (coefficient alpha) for the total PVCT ranged between .93 and .95 for the three samples. The coefficient alpha's ranged between .94 and .92 for the intrinsic value and from .86 to .84 for the extrinsic value among samples. Responses to the PVCT were also shown to adequately and correctly classify 76.9% of certificants and 48.2% of noncertificants. Overall, the PVCT is a valid and reliable tool to measure perceived value of certification.

Attitude of Health Personnel↗

The value of certification--a research journey.

ONE MEASURE OF NURSING EXCELLENCE is achieving specialty certification, which denotes a more advanced level of knowledge and practice. THE CERTIFICATION BOARD Perioperative Nursing (CBPN) provides specialty certification for perioperative nurses. The organization's mission is to be the leader in competency credentialing and education that promotes safe, quality patient care in the perioperative arena. THIS ARTICLE PRESENTS study findings regarding the perceived value of a barriers to obtaining certification.

Certification↗

[Validity of death certificates for cancer in Mallorca].

We assessed the quality and completeness of the information of death certificates (CMD) for cancer in Mallorca during 1989. Likewise we studied the possible bias introduced by the excluded cases for lack of clinical information (DCO cases). We compared the information of the death certificates with the clinical records and data of the Population-based Cancer Registry. A global concordance of 77.2% was obtained out of 1,173 certificates. This concordance varied according to sex (males: 79.8%, women: 73.1%; p < 0.01), place of death (hospital: 83.1%, home: 69.6%; p < 0.001) and age ( < 50 years: 77.8%; > 70 years: 74.2%; p < 0.05). The best notified sites were: breast, lung, and leukemias and the worst, unknown and poorly defined sites, bones and soft tissue tumours. We detected that the death certificates carry a subnotification of at least 5% in cancer deaths. Even so, they result a valid source of information for the Population-based Cancer Registry. The cases excluded for lack of clinical documentation present a more advanced age and a greater proportion of hepatic cancers and unknown and poorly defined sites.

Aged↗

[Cornea bank of Lyon: from quality diagnosis to ISO 9001 certification].

The tissue and cell bank of the HCL (Hospices Civils de Lyon) has, since 10 June 1999, consisted of two sections with related activities: cell culture for the Skin Substitutes Laboratory (Laboratoire des Substituts Cutanés, LSC) and preservation of corneas at 31 degrees C for the Cornea Bank. As the LSC had been ISO 9001 certified since March 1997 our aim, since merger, was to raise the Cornea Bank to the same level of quality as the LSC, so as to coincide with the renewal of the LSC certificate in February 2000. The methods we used (project, quality control, analysis and process optimization) led us to receive official certification only nine months after the merger. The procedure started with a program of quality control at the Cornea Bank from February 1999 onwards, in order to list the work and equipment required, evaluate its documentation system and what was needed to incorporate this new activity into the existing system of quality assurance at the LSC. On the 7th March 2000, the Tissue and Cell Bank of the HCL obtained an ISO 9001 certificate for its combined functions. As well as achieving our objectives and the strong points highlighted by the auditor during the renewal process, this quality assessment revealed many advantages: improvements in the conservation of corneas, economies in staff replacement and reductions in both the cost of maintaining quality, the cost of the corneas themselves, etc. The decree 'Banque' no. 99-741 of 30th August 1999, which put in place the system of authorization of tissue banks in France, demands quality control. Our application for certification which started in early 1999 had anticipated this regulation. This helped us enormously when compiling the dossier accompanying the official request and was an essential element in obtaining the favourable response of the ASSAPS on 21 June 2000.

Certification↗

Recording of diabetes on death certificates. Has it improved?

OBJECTIVE: To determine whether the recording of diabetes on death certificates improved from 1986 to 1993. METHOD: Comparison of two National Mortality Follow-back Surveys that selected independent samples of death certificates with the purpose of obtaining information from informants about the decedents. RESULTS: The recording of diabetes on death certificates did not improve from 1986 to 1993. CONCLUSION: Periodic monitoring of the accuracy of death certificates is essential for proper interpretation of mortality statistics which are routinely used to describe the burden of diabetes in our society.

Adult↗

The certification process in adolescent medicine.

The first and second certifying examinations in adolescent medicine were administered jointly by the American Board of Pediatrics (ABP) and the American Board of Internal Medicine (ABIM) on November 15, 1994, to 295 candidates, and on November 18, 1997, to 197 candidates including 170 who were taking the examination for the first time. This report describes the certification process and the characteristics of those taking the first and second examinations in adolescent medicine. The purposes of certification in adolescent medicine, consistent with the purposes of specialty boards, are to improve the quality of patient care during the second decade of life, expand and improve training to include a comprehensive and scientifically based approach to the care of young people as they enter adulthood, and stimulate faculty development and research for the problems of the adolescent population (1). Certification addresses these goals by establishing rigorous standards for training, verifying the knowledge base of candidates through a written examination, and requiring periodic recertification. This certification program recognizes a growing number of physicians with expertise in the medical problems of adolescents and the emergence in the past 30 years of a body of knowledge about the health problems, the effects of rapid biologic and psychologic change, and the interaction of biologic, psychologic, social, and environmental forces that characterize this unique developmental period (2).

Adolescent↗

Reliability of birth certificate data: a multi-hospital comparison to medical records information.

OBJECTIVE: To examine the reliability of birth certificate data and determine if reliability differs between teaching and nonteaching hospitals. METHODS: We compared information from birth certificates and medical records in 33,616 women admitted for labor and delivery in 1993-95 to 20 hospitals in Northeast Ohio. Analyses determined the agreement for 36 common data elements, and the sensitivity, specificity, and positive and negative predictive values of birth certificate data, using medical record data as a "gold standard." RESULTS: Sensitivity and positive predictive value varied widely (9-100% and 2-100%, respectively), as did agreement, which was "almost perfect" for measures of prior obstetrical history, delivery type, and infant Apgar score (K = 0.854-0.969) and "substantial" for several other variables (e.g., tobacco use (K = 0.766), gestational age (K = 0.726), prenatal care (K = 0.671)). However, agreement was only "slight" to "moderate" for most maternal risk factors and comorbidities (K = 0.085-0.545) and for several complications of pregnancy and/or labor and delivery (K = 0.285-0.734). Overall agreement was similar in teaching (mean K = 0.51) and nonteaching (K = 0.52) hospitals. Although agreement in teaching and nonteaching hospitals varied for some variables, no systematic differences were seen across types of variables. CONCLUSIONS: Our findings indicate that the reliability of birth certificate data vary for specific elements. Researchers and health policymakers need to be cognizant of the potential limitations of specific data elements.

Birth Certificates↗

The value of program certification for performance contracting.

A survey of clubhouses listed in the 1996 ICCD Clubhouse Directory provided a research sample of 80 ICCD-certified clubhouses and 88 non-certified clubhouses with which to test the discriminant validity of ICCD certification. A statistically significant logistic regression model revealed that ICCD certification status could be clearly predicted for 78% of the clubhouses in the survey sample on the basis of director-reported compliance with representative measures of the Standards for Clubhouse Programs. The predictive power of compliance with the Standards was obtained even while controlling for other organizational variables, including clubhouse age, total staff salaries, and receipt of Medicaid funding. These findings provide support for the practical utility of adopting program certification as a performance indicator in an era of managed care, as well as the specific value of relying on ICCD certification as a quality assurance indicator.

Certification↗

Dying of old age: an examination of death certificates of Minnesota centenarians.

OBJECTIVES: To compare how causes of death are recorded on the death certificates of centenarians with those who die in their 70s, 80s, and 90s. We also examined direct and indirect acknowledgment of age as a cause of death. DESIGN: Retrospective review of death certificates. SETTING: State of Minnesota. PARTICIPANTS: The death certificates of 26,415 individuals aged 70 and over who died in Minnesota in 1998 were examined for underlying causes of death. Of these, 449 were for individuals who were aged 100 and older at the time of their death. MEASUREMENTS: Causes of death. RESULTS: Diabetes mellitus, chronic obstructive pulmonary disease, cirrhosis, myocardial infarction, and most cancers decreased in frequency as reported causes of death with advancing age. Conversely, congestive heart failure, atherosclerosis, and neurological/mental and poorly defined conditions increased in frequency with age. CONCLUSIONS: Centenarians appear to "outlive" the risks for many of the conditions that are common causes of death for those who die in their 70s, 80s, and 90s, such as cancer and myocardial infarction. Conditions associated with aging, such as congestive heart failure and degenerative neurological conditions become more prominent as reported causes of death in the oldest individuals. The guidelines for the completion of death certificates should be modified to facilitate direct acknowledgment of age-related frailty as a contributing cause of death.

Aged↗

A modeling study on the sustainability of a certification-and-monitoring program for paratuberculosis in cattle.

Certification-and-monitoring programs for paratuberculosis are based on repetitive herd testing to establish a herd's health status. The available tests have poor sensitivity. Infected but undetected herds may remain among certified "paratuberculosis-free" herds. The objective was to determine if truly free herds acquire a certified status and keep it over time when infected but undetected herds remain. The Dutch program was used as a basis to construct a mechanistic deterministic model of the evolution over 25 years of the number of herds per health status. Three health states for herds were defined: not detected as infected in the certification process to obtain a free status; not detected as infected by any of the repetitive tests for monitoring the certified free status; detected as infected. Among undetected herds, two types were defined: truly free versus undetected but infected. Transitions between states were due to the purchase of an infected animal, infection via the environment, clearance via culling or sales, detection of an infected animal, and certification. A sensitivity analysis was carried out. We showed that--for a 100% specific test only--most of the truly free herds at the beginning of the program got a certified free status and kept it over time. Most infected herds were either detected as infected or cleared. The number of certified truly free herds increased with a decrease in the animal-level prevalence or in the risk of purchasing an infected cattle, for example by restricting purchases to cattle from herds at the highest level of certification.

Animal Husbandry↗

History and evolution of a successful certification program in nutrition support: the CNSD experience.

As early as the 1970s, articles were published on the role of dietitians in nutrition support. Both the American Society for Parenteral and Enteral Nutrition and The American Dietetic Association addressed the issues of specialization and certification. Development of a specialty area credential requires a strong demand by practicing clinicians, a unique area of clinical practice with a distinct body of knowledge and the commitment to evolve with clinical practice. Numerous dietitians were involved in the inception, development, and leadership that brought forth certification in nutrition support. This article documents the efforts and participation of a dedicated group of professionals whose common goals resulted in the establishment of a successful, sustaining certification in a specialty area of clinical dietetics: certified nutrition support dietitian. The certified nutrition support dietitian program is now in its 15th year with 2,000 dietitians currently certified both nationally and internationally. A primary focus of the credential is to recognize minimum competency for dietitians practicing in the field of enteral and parenteral nutrition and to provide safe and effective nutrition support therapy. This article provides a framework for persons in other specialty areas attempting to develop certification programs.

Certification↗

Reliability of birth certificate reporting of congenital anomalies.

Birth certificates comprise an important source of data on the prevalence of genetic conditions and for monitoring possible teratogens in the population. Investigators have found wide variability (12 to 100%) in the accuracy of reporting. In a large public hospital, of those congenital anomalies detected at birth, only 5.4% were recorded on the birth certificate. This is one of the lowest rates ever reported. An underreporting correction factor may be applied if congenital anomalies are distributed randomly with respect to reporting status, and the rate of reporting is sufficient to comprise a valid sample for estimating a correction factor (that is, 20% or more reported). In this study, factors such as numbers or types of anomalies, race, infant birthweight, or estimated gestational age did not significantly influence the rate of birth certificate reporting. Thus, our data satisfied the first but not the second criterion for derivation of a correction factor. In conducting epidemiologic studies, birth certificate data should be used with: (1) great caution; (2) a system of validation with the medical record to estimate the degree of underreporting and to derive a correction factor; and (3) a priori knowledge that underreporting of congenital anomalies on this document is highly prevalent.

Bias↗

The autopsy as a measure of accuracy of the death certificate.

To determine the extent of agreement on underlying cause of death between death certificates and autopsy reports, we analyzed 272 randomly selected autopsy reports and corresponding death certificates from among all such data on autopsies performed in Connecticut in 1980. In 29 per cent of the deaths, a major disagreement on the underlying cause of death led to reclassification of the death in a different International Classification of Diseases major disease category. In an additional 26 per cent, the death certificate and autopsy report agreed on the major disease category but attributed the death to a different specific disease. Deaths due to neoplasms were most accurately diagnosed, with a sensitivity of 87 per cent and a positive predictive value of 85 per cent. Deaths resulting from diseases of the respiratory or digestive system were associated with the highest rates of disagreement. Diseases most commonly overdiagnosed were circulatory disorders, ill-defined conditions, and respiratory diseases. Diseases most commonly underdiagnosed as the cause of death on the death certificate were specific traumatic conditions and gastrointestinal disorders. The autopsy remains an important method for ensuring the quality of mortality statistics.

Autopsy↗

Impact of physician-related factors on sickness certification in primary health care.

OBJECTIVE: To investigate what factors are associated with physicians' decisions on whether or not to sickness certify the patient at a consultation. DESIGN: Questionnaire survey sent to physicians in general practice and their patients. SETTING: General practitioners in Orebro county, central Sweden. SUBJECTS: Sixty-five physicians with up to 10 patients each. MAIN OUTCOME MEASURE: Whether a sickness certificate was issued. RESULTS: Physicians with long experience in family medicine and those working part time issued more sickness certificates when all encounters with patients were considered. When only musculoskeletal problems were studied physicians with long experience or who were trained in social insurance medicine as undergraduates issued more sickness certificates. When only appointments for infections were studied, part-time physicians issued more sickness certificates. No impact of the physicians' sex on sickness certifying was found. CONCLUSIONS: Length of professional experience and physicians' working time appear to influence practices in sickness certifying.

Adolescent↗