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The Canadian certification examination in psychiatry. I: Historical notes.

There has been much criticism of the format and process of the certification examination in psychiatry, and some of this is based on lack of information regarding the history of the specialty certification procedures, the Royal College of Physicians and Surgeons and the Board of Examiners. In this first of three reports the history of the Royal College as the certifying organization is traced, and the relevant College structures are briefly described, including the Specialty Committee on Psychiatry which is instrumental in appointing the clinical examiners. The clinical examiners since 1965 are identified.

Canada↗

The Canadian certification examination in psychiatry. II: Who passes and who fails.

No analysis of Canadian certification examinations in psychiatry has previously been published although analyses of the American Board of Psychiatry and Neurology and the British Membership examinations are available. Because candidates, directors of residency training, mental health planners and consumers are all interested in who passes and who fails the certification examinations, available examination data for English speaking candidates are analyzed. Successful candidates are more likely to be younger; to have attended medical schools in English speaking countries (in North America, the British Isles, or the "old Dominions"); to have placed in the upper two-thirds of their medical school class; to have entered psychiatric training soon after graduating from medical school and then to have completed their training without interruption. Some limitations of the examinations and the problem of candidates who fail are briefly discussed.

Canada↗

Certification in child neurology: new directions for the twenty-first century.

The American Board of Psychiatry and Neurology was formed in 1934, and the first certifying examination was administered in 1935. It was not until 1969 that the American Board of Psychiatry and Neurology began conducting certifying examinations in child neurology. Since then, 10 child neurologists have served as American Board of Psychiatry and Neurology directors and nearly 1500 child neurologists have been certified, more than 200 of whom have also attained certification in the subspecialties of clinical neurophysiology, neurodevelopmental disabilities, and pain medicine. This article describes the evolution of the certification process as the Board has endeavored to use the best testing methodologies to fulfill its commitment to the public and to its constituents in psychiatry and neurology. Training pathways in child neurology are also reviewed as they have evolved in response to evident staff shortages and to promote entry into academic careers.

Certification↗

Hospital response variation to the demands of preadmission certification.

This paper reports findings from a study of the impact of preadmission certification programs from the perspective of the hospital--a deeply affected party. A series of field studies was undertaken to explore and delineate the range of hospital responses to the challenges posed by this third-party payer mandate and to identify factors associated with variation in responses. The evidence presented suggests wide variation in how hospitals chose to share responsibility for pre-certification with physicians and patients. The findings are broadly consistent with a proposed model that hospital response is determined by both external and internal considerations, but a larger scale hospital survey is necessary to test the hypotheses that can be derived from this study.

Admitting Department, Hospital↗

CHWs get credit: a 10-year history of the first college-credit certificate for community health workers in the United States.

Community health workers have become increasingly important in the U.S. health care system, playing a significant role in basic health promotion and care coordination; however, their status and visibility have not kept pace with their wider use. A major impediment has been the absence of systematic preparation-the field needs standardized education in programs that emphasize the actual skills and knowledge used by community health workers, programs that attract and retain nontraditional students from underserved communities and that foster professional advancement. This article chronicles the 10-year history of the first college credit-bearing community health worker certificate program in the country to address this need. Systematic research resulted in a program centered on the core competencies universally practiced by community health workers regardless of their topical focus. The certificate program combines performance-based methods with popular education into an innovative pedagogical approach that teaches skills, while solidifying, contextualizing, and enhancing crucial experiential knowledge. Program outcomes validate the approach.

California↗

Mortality from pleural mesothelioma in Rio de Janeiro, Brazil, 1979-2000: estimation from death certificates, hospital records, and histopathologic assessments.

To obtain information about the occurrence of pleural mesothelioma on a population basis in Brazil, mortality related to pleural tumors in the State of Rio de Janeiro during 1979-2000 was examined. Death certificates with pleural tumors as the main cause of death and hospital records were analyzed, together with histopathologic material, which was reevaluated. Of 217 death certificates coded as pleural tumors, 34.1% were considered wrongly coded. Results after reclassification were: definite mesothelioma = 45 cases; probable = 7; possible = 31; inconclusive = 65; other tumors = 11. Thus, the number of mesotheliomas in Rio de Janeiro in 1979-2000 is estimated to have been 83. The analysis also suggests a problem with mortality codification in the State.

Asbestos↗

Long-term survival, place of death, and death certification in clinically diagnosed pre-senile dementia in northern England. Follow-up after 8-12 years.

BACKGROUND: Information on survival and cause of death in pre-senile dementia is scarce and the organisation of services controversial. AIMS: To study survival, place of death and death certification in pre-senile dementia. METHOD: Patients aged 45-64 were identified from hospital and community sources in the Northern health region (1985-89) and classified as having pre-senile dementia of Alzheimer type (PDAT) or pre-senile vascular dementia (PVD) by applying an algorithm to case notes. Deaths were ascertained from the National Health Service Central Registry (NHSCR) to 31 December 1998. Survival analysis was performed using the SPSS/PC program, and expected survival calculated from life tables. RESULTS: Median survival time from diagnosis was 6.08 years and did not differ significantly in PDAT and PVD, or by age or gender; 19.3% of deaths occurred at home, 24.5% in nursing or residential homes and 56.3% in hospital; 72.4% of the death certificates mentioned dementia or Alzheimer's disease; 15.4% were still alive. CONCLUSIONS: Pre-senile dementia has a variable but usually chronic course, requiring appropriate planning and services.

Age Distribution↗

Evaluation and certification of computerized provider order entry systems.

Computerized physician order entry (CPOE) is an application that is used to electronically write physician orders either in the hospital or in the outpatient setting. It is used in about 15% of U.S. Hospitals and a smaller percentage of ambulatory clinics. It is linked with clinical decision support, which provides much of the value of implementing it. A number of studies have assessed the impact of CPOE with respect to a variety of parameters, including costs of care, medication safety, use of guidelines or protocols, and other measures of the effectiveness or quality of care. Most of these studies have been undertaken at CPOE exemplar sites with homegrown clinical information systems. With the increasing implementation of commercial CPOE systems in various settings of care has come evidence that some implementation approaches may not achieve previously published results or may actually cause new errors or even harm. This has lead to new initiatives to evaluate CPOE systems, which have been undertaken by both vendors and other groups who evaluate vendors, focused on CPOE vendor capabilities and effective approaches to implementation that can achieve benefits seen in published studies. In addition, an electronic health record (EHR) vendor certification process is ongoing under the province of the Certification Commission for Health Information Technology (CCHIT) (which includes CPOE) that will affect the purchase and use of these applications by hospitals and clinics and their participation in public and private health insurance programs. Large employers have also joined this focus by developing flight simulation tools to evaluate the capabilities of these CPOE systems once implemented, potentially linking the results of such programs to reimbursement through pay for performance programs. The increasing role of CPOE systems in health care has invited much more scrutiny about the effectiveness of these systems in actual practice which has the potential to improve their ultimate performance.

Certification↗

Procedure skill competence and certification in internal medicine residency training.

BACKGROUND: Procedure skill training and competency certification are an important part of internal medicine residency training. Expert guidelines exist on the minimum number of procedures recommended to attain competence, but these have not been validated. PURPOSE: To study the validity of the American Board of Internal Medicine (ABIM) recommended procedure guidelines. METHODS: We performed a retrospective review of all monthly procedure log sheets collected during residency training for the graduates of our internal medicine residency program. The number of procedure attempts and the length of time needed to be certified as competent in 13 different procedures were recorded and compared with ABIM guidelines. RESULTS: There were 69 graduates with an average of 32.7 monthly procedure log sheets per resident. There was a wide variation in the number of attempts and time needed to attain competence in the measured procedures. Overall, our residents received their competency certification for each required procedure within 1 SD of the corresponding ABIM recommendation. CONCLUSIONS: Our study suggests that the ABIM recommended guidelines on procedure skill competence may be valid on the program level

Certification↗

[Reliability of birth certificate data in Rio de Janeiro, Brazil, 1999-2001].

The objective of this article is to assess coverage and reliability of data from the Information System on Live Births in the City of Rio de Janeiro, based on an analysis of live birth certificates issued by the various hospitals and compared to information from the "Study on Neonatal and Perinatal Morbidity and Mortality and Care in the City of Rio de Janeiro". A total of 9,608 interviews with post-partum women were paired case-by-case with the respective birth certificates. The statistical analysis consisted of calculating the Kappa index adjusted to the prevalence of categorical variables and the intra-class correlation coefficient for continuous variables, with a 95% significance level. The study showed excellent coverage (96.5%) for hospital births in the City of Rio de Janeiro during the period studied. The variables presenting the highest concordance levels (over 0.90) were the infant's sex, birth weight, mother's age, type of delivery, and type of pregnancy. The variables marital status, mother's schooling, and number of prenatal visits showed lower reliability indices (Kappa < 0.70). The article discusses the importance of data quality in the Information System on Live Births (SINASC) and the system's use as a tool to help define maternal and child health policies.

Birth Certificates↗

Reforming managed care certification of mental health services.

This article examines the issues associated with the current managed care delivery system for certification of mental health services, including pain management. Inconsistencies in dispositions having impacts upon patient care appear to be inherent in the current peer review certification system. Issues related to public assistance clients will be given particular attention. After introducing the issues, this article reviews the literature to survey what facets have been the subjects of academic research and reflection. It then presents case examples of inconsistencies, followed by recommendations for a model with checks and balances. In conclusion, creation of an independent monitor group is recommended.

Certification↗

Reporting of Down's syndrome from birth certificate data in the State of Minnesota.

Following a study of 421 suspected cases of Down's syndrome which were referred during a 10-year period to the Human Genetics Unit of the Minnesota Department of Health for chromosomal analysis, the following conclusions were reached: 1. There was an overall underreporting on the matched birth certificate of 52% of the cytogenetically confirmed cases. 2. This underreporting on birth certificates was greater (79%) for those born in the years 1946-1964 when less specific information was requested than in more recent years (36%), 1967-1974, when identification of the abnormality was requested.

Adolescent↗

Down's syndrome: percentage reporting on birth certificates and single year maternal age risk rates for Ohio 1970-79: comparison with upstate New York data.

Estimates of single year maternal age risk rates for Down's Syndrome births to White residents of Ohio over the period 1970-79 are reported. The rates were estimated from birth certificate data, which first necessitated estimating the percentage of reporting of Down's Syndrome on Ohio birth certificates. Using data from cytogenetic laboratories within the state, percentages of Down's Syndrome cases reported were found to be 36.5 (319/875) for White and 33.9 (342/1,010) overall. Final single year maternal age risk rates reported here are corrected for underreporting using these figures. They should be useful for genetic counselors and obstetricians. Comparisons of observed, uncorrected single year maternal incidence rates were made within Ohio 1970-74 vs 1975-79, and between Ohio and upstate New York for various time periods using both a hierarchial log-linear model for multiway cross-tabulations and a weighted least squares solution. All comparisons showed excellent agreement, indicating no evidence for temporal or geographic differences and implying that environmental factors are unimportant in determining single year maternal age incidence rates in Down's Syndrome for the time periods and populations studied.

Adolescent↗

Comparison of occupation and industry information from death certificates and interviews.

Information on occupation and industry obtained via an interview prior to death was compared to occupation and industry on the death certificate of 184 colon cancer patients in Utah. The data were coded blindly using a five-digit code. Overall, agreement in the five-digit codes was found for 63 per cent. The industry codes agreed for 67 per cent of the individuals, and the occupation was identical for 68 per cent. Agreement by subjective evaluation of the two data sources, disregarding the five-digit codes, was 73 per cent. There were no differences in agreement of the five-digit codes by age, sex, and county of residence. The number of years worked at the job given by interview was related to agreement. Misclassification occurred in a random manner. It is concluded that the use of death certificates to study the association of occupation and disease is most appropriate for pilot studies.

Adult↗

Inaccuracies in certification of nonmelanoma skin cancer deaths.

Nonmelanoma skin cancer is the most common cancer site in the United States, yet mortality from this cause is poorly understood. We sought medical records of the 16 reported deaths during 1979 through 1987 from this cause (International Classification of Diseases, 9th version [ICD-9], code 173) among Rhode Island residents to evaluate the accuracy of the reported cause of death. Of the 110 cases for which the cause of death could be classified as correct or incorrect, 59 (54%) were misclassified, 49 (83%) of which were mucous-membrane, squamous-cell carcinomas of the head and neck. For most of these, the written death certificate diagnosis was squamous-cell carcinoma of the head and neck, which was coded 173.4. Other problematic diagnoses were cancer of the head and neck and malignant fibrous histiocytoma. In response to a mailed survey, most health departments replied that squamous-cell carcinoma of the head and neck was coded under rubric 173 and malignant fibrous histiocytoma was coded under rubric 171, but there was no unanimity. The misclassification of other causes of death to ICD-9 rubric 173 is substantial. The vast majority were coded to rubric 173.4 and were due to a small number of diagnoses that are recognizable on examination of the death certificate.

Abstracting and Indexing↗

The quality of the new birth certificate data: a validation study in North Carolina.

A random sample of 395 December 1989 North Carolina birth certificates and the corresponding maternal hospital medical records were examined to validate selected items. Reporting was very accurate for birth-weight, Apgar score, and method of delivery; fair to good for tobacco use, prenatal care, weight gain during pregnancy, obstetrical procedures, and events of labor and delivery; and poor for medical history and alcohol use. This study suggests that many of the new birth certificate items will support valid aggregate analyses for maternal and child health research and evaluation.

Birth Certificates↗

Method of linking Medicaid records to birth certificates may affect infant outcome statistics.

OBJECTIVES: This study assessed how different methods of matching Medicaid records to birth certificates affect Medicaid infant outcome statistics. METHODS: Claims paid by Medicaid for hospitalization of the newborn and for the mother's delivery were matched separately to 1995 North Carolina live birth certificates. RESULTS: Infant mortality and low-birthweight rates were consistently lower when Medicaid was defined by a matching newborn hospitalization record than when results were based on a matching Medicaid delivery record. CONCLUSIONS: Studies of birth outcomes in the Medicaid population may have variable results depending on the method of matching that is used to identify Medicaid births.

Bias↗

Population-based estimates of mortality associated with diabetes: use of a death certificate check box in North Dakota.

OBJECTIVES: Overall and cause-specific mortality among persons with diabetes in North Dakota was estimated and compared with estimates from previous population-based studies. METHODS: Data were derived from North Dakota death certificate data, which included unique information on decedents' diabetes status and Behavioral Risk Factor Surveillance System estimates of the diabetic and nondiabetic adult populations of North Dakota. RESULTS: The risk of death among adults with diabetes was 2.6 (2.2, 2.9) times that of adults without diabetes. Relative risks of death among adults with diabetes were at least twice as high for heart disease, cerebrovascular disease, accidents and adverse events, and kidney disease and 70% to 80% higher for pneumonia and influenza, malignant neoplasms, arterial disease, and other causes. Risks remained substantial in the oldest age group. These findings are comparable to results of other population-based studies. CONCLUSIONS: Diabetes status information enhanced the usefulness of death certificate data in examining mortality associated with diabetes and confirms that the effect of diabetes on death is substantial.

Adult↗