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PubMed1999

Use of discriminant and regression analyses to modify a clinical certification board examination.

The National Dental Examining Board of Canada (NDEB) conducts mandatory, high stakes, pass/fail, certification examinations for dental licensure. One of these examinations was a seven-part, simulated clinical examination in which candidates were required to perform procedures on typodonts. These requirements were two intracoronal and two extracoronal preparations, an amalgam restoration, a provisional crown, and a diagnostic wax-up. Feedback from candidates and examiners indicated that one or more of the requirements may not have been contributing effectively to the overall evaluation of candidates. The NDEB's Clinical Examination Committee therefore requested that an in-depth statistical analysis be performed to identify potential areas of concern and to provide a basis for modifying the examinations. The results of two examination sessions with a total of 168 candidates were subjected to both a discriminant and a logistic regression analysis. Every candidate had results for each of the seven requirements, and no candidate participated in both sessions of the examination. The discriminant analysis revealed that six of the seven requirements could be used to reliably assign examinees according to their true pass/fail classifications. Stepwise discriminant analysis resulted in a 98.81 percent classification success rate with a corresponding 2.50 percent false-positive classification error rate. The logistic regression analysis showed that five components correctly predicted 99.40 percent with a 1.25 percent false-positive rate. The Clinical Examination Committee concluded that one requirement (diagnostic wax-up) should be eliminated and that a second requirement (PFM preparation) be significantly modified and reevaluated. This study demonstrates the usefulness of statistical methods in the analysis and modification of a clinical certification board examination.

Canada↗
PubMed1999

Evolving trends in critical care nursing practice: results of a certification role delineation study.

BACKGROUND: In 1997, the AACN Certification Corporation, in conjunction with Professional Examination Service, undertook a role delineation study as 1 component of a large-scale, comprehensive, and systematic study of practice to update previous data. Focus groups made up of practicing critical care nurses were used to determine trends and changes in adult, pediatric, and neonatal critical care nursing practice. METHODS: Sixteen focus groups (6 adult, 5 pediatric, and 5 neonatal) used specially prepared protocols to guide discussions. Questions were designed to elicit descriptions of changes in critical care nursing practice in the preceding 5 years. Qualitative comments of the participants were analyzed across all the focus groups, rather than separately for the adult, pediatric, and neonatal focus groups. Then data for the focus groups for each patient-age range were aggregated and reviewed to abstract themes. RESULTS: Trends and changes in practice for adult, pediatric, and neonatal critical care nurses were determined. Common themes include ethical and legal issues, changes in the population of patients, psychosocial factors, and the impact of managed care. CONCLUSIONS: The results of these focus groups can be used to update the test blueprints that underlie the CCRN certification examination programs for adult, pediatric, and neonatal critical care nurses. Critical care nursing practice is changing. Specific knowledge of the changes is important for educators, managers, and clinicians. The results of this role delineation study can be used to teach, adapt systems, and validate practice.

Adult↗
PubMed1999

[A model project on certification of continuous education by the Bavarian Chamber of Physicians].

Beginning with April 1st 1998 Bavarian physicians are invited to join a project on certification of continuing medical education on a voluntary basis. After a one year period, 1238 of practicing medical doctors (2.8%) received an official certificate on continuing medical education by the Bavarian Chamber of Physicians. In order to get the idea to certify postgraduate continuing medical education spread over the state of Bavaria, the Bavarian Chamber of Physicians takes every effort to support congress organizers to issue credit points. Customer oriented processes are applied as well as modern technologies such as bar-codes. The systematic approach to take part in continuing medical education as an important aspect of quality assurance in physician's profession reveals the chance to keep autonomy within the medical chambers.

Certification↗
PubMed1999

Development of dermatology nursing certification.

In February 1998 the first Dermatology Nursing Certification exam was administered to registered nurses. This added credential beyond licensure serves as a demonstration that Dermatology Nurse Certified (DNC) nurses have acquired a core body of specialized knowledge and adhere to specialized nursing standards. In addition to providing a sense of professional achievement, certification can serve other purposes: peer and collegial respect, documentation of advanced knowledge and skills, increased earning power, increased job satisfaction, and in the future, third-party reimbursement.

Certification↗
PubMed1999

Determining the relevance of a certification exam to home health care nursing practice.

Home health care is enjoying increased use and popularity. Unfortunately, in today's cost-cutting environment, home healthcare is also subject to increased scrutiny and inevitable reimbursement limitations. This is borne out by the impact on home healthcare as a result of the Balanced Budget Act of 1997. Berke (1998) reports that those at greatest risk for cutbacks in care are those that can least afford it--the oldest, sickest, poorest, and most frail. Compounding the financial dilemma that home health care clients face are multiple providers of care, an unrealistic media presentation of health care, and less time for anyone to provide psychosocial-focused care (Simmons, 1990). Home health care clients have a desperate need for an advocate to provide expert navigation through the health care system. Home health care providers are aware of and often responsible for bridging gaps in health, medical benefits, and social services. This article describes a process for determining the relevance of a certification to community nursing clinical practice--using the Advanced Certification in Continuity of Care (A-CCC) exam as the example.

Certification↗
PubMed2000

[Classification of myocardial dystrophies in aviation medical certification].

Myocardial dystrophy is one of the most common noncoronary lesions of the myocardium in pilots. However, the abundance of proposed classifications of myocardial dystrophies poses certain problems to medical experts. The authors attempt to consider the existing classifications from the standpoint of aviation medical certification and advocate the most acceptable, to their thinking, systematics by N.P. Paleev and L.I.Levitina (1991). Examples of establishing diagnoses of myocardial dystrophy are included. The best suited program for the aviation medical certification board to work out the final statement regarding the occupational fitness of pilots with myocardial dystrophy is proposed.

Aerospace Medicine↗
PubMed2000

Health care professionals' attitudes toward licensure, national certification, and continuing education requirements: results of a Texas survey.

Health care professionals are challenged to not only maintain their skills but take them to new levels. Continuing education (CE), mandated by licensure and national certification, is one means of working toward this goal. This study examined the opinions and attitudes of professionals in regard to these issues. The majority of the survey respondents supported the need for licensure and certification and perceived that they benefited personally. A significant percentage indicated that existing CE systems might not meet their intended purposes and goals and might not be the best criteria for renewal. Many had difficulty finding appropriate and convenient programs, and some programs did not deliver as advertised. The results suggest an opportunity to improve both CE systems and CE programs offered to health care professionals.

Attitude of Health Personnel↗
PubMedDate not supplied

[Proposal for a death certificate to improve recording and reporting of perinatal mortality].

OBJECTIVE: To analyze perinatal births and deaths recording at the Mexican Institute of Social Security (MISS), and to evaluate the correct classification of perinatal deaths. MATERIAL AND METHODS: From January to March 2000, data were collected from the 37 MISS districts on the total number of births and deaths occurring during 1999, deaths occurring before the seventh day of life, and gestational age and weight at birth. Early neonatal and infant mortality rates were analyzed including or separating newborns with < 1,000 g and < 28 weeks of gestational age. RESULTS: During 1999 there were 634,892 live births--whose gestational age and birth weight are unknown- and 3,984 stillbirths > or = 28 gestation weeks. There were 4,556 newborns who died before the seventh day of extrauterine life; 1,385 of them (30.4%) weighted less than 1,000 g and had a gestational age < 28 weeks. The analysis of mortality with and without these newborns shows a decrease of two points in early neonatal and infant mortality rates. CONCLUSIONS: This study shows that classification and reporting of perinatal mortality are inappropriate. A proposal is made to develop information systems that include weight and gestational age of all births. A new perinatal death certificate replacing current fetal and general death certificates would allow proper mortality classification and comparisons between countries.

Death Certificates↗
PubMed2001

[Annual report of perioperative mortality and morbidity for the year 1999 with a special reference to anesthetic methods at Certificated Training Hospitals of Japanese Society of Anesthesiologists].

The Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sends annually confidential questionnaires of perioperative mortality and morbidity to Certificated Training Hospitals of JSA. This report is on perioperative mortality and morbidity in 1999 with a special reference to anesthetic methods. Four hundred and sixty-seven hospitals reported the number of cases referred to anesthetic methods and total numbers of cases were 727,723. The incidences of cardiac arrest per 10,000 cases due to all etiology are estimated to be 6.77 cases in average, 5.33 cases in inhalation anesthesia, 34.26 cases in total intravenous anesthesia (TIVA), 5.26 cases in inhalation anesthesia plus epidural or spinal or conduction block, 5.29 cases in TIVA plus epidural or spinal or conduction block, 0.73 cases in spinal with continuous epidural block (CSEA), 2.85 cases in epidural anesthesia, 1.63 cases in spinal anesthesia, 2.53 cases in conduction block and 46.51 cases in other methods. However, the incidences of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 0.78 case in average, 0.51 case in inhalation anesthesia, 1.35 cases in TIVA, 0.97 case in inhalation anesthesia plus epidural or spinal or conduction block, 1.51 cases in TIVA plus epidural or spinal or conduction block, 0.73 case in CSEA, 1.71 cases in epidural anesthesia, 0.54 case in spinal anesthesia, 2.52 cases in conduction block and 1.08 cases in other methods. The incidences of severe hypotension per 10,000 cases due to all etiology are estimated to be 16.64 cases in average, 13.61 cases in inhalation anesthesia, 100.36 cases in TIVA, 13.32 cases in inhalation anesthesia plus epidural or spinal or conduction block, 9.07 cases in TIVA plus epidural or spinal or conduction block, 3.65 cases in CSEA, 6.26 cases in epidural anesthesia, 7.31 cases in spinal anesthesia, 2.52 cases in conduction block and 28.12 cases in other methods. On the other hand, the incidences of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 2.40 cases in average, 1.65 cases in inhalation anesthesia, 0.81 cases in TIVA, 3.92 cases in inhalation anesthesia plus epidural or spinal or conduction block, 2.77 cases in TIVA plus epidural or spinal or conduction block, 2.56 cases in CSEA, 3.42 cases in epidural anesthesia, 2.71 cases in spinal anesthesia, zero case in conduction block and zero case in other methods. The incidences of severe hypoxia per 10,000 cases due to all etiology are estimated to be 5.32 cases in average, 6.7 cases in inhalation anesthesia, 9.17 cases in TIVA, 5.16 cases in inhalation anesthesia plus epidural or spinal or conduction block, 4.53 cases in TIVA plus epidural or spinal or conduction block, 2.56 cases in CSEA, zero case in epidural anesthesia, 1.08 cases in spinal anesthesia, zero case in conduction block and 1.08 cases in other methods. On the other hand, the incidences of severe hypoxia per 10,000 cases totally attributable to anesthesia are estimated to be 2.39 cases in average, 3.22 cases in inhalation anesthesia, 2.43 cases in TIVA, 2.26 cases in inhalation anesthesia plus epidural or spinal or conduction block, 2.77 cases in TIVA plus epidural or spinal or conduction block, zero case in CSEA, zero case in epidural anesthesia, 0.54 cases in spinal anesthesia, zero case in conduction block and 1.08 cases in other methods. The mortality rates of cardiac arrest per 10,000 cases due to all etiology are estimated to be 3.56 cases in average, 2.82 cases in inhalation anesthesia, 24.55 cases in TIVA, 1.4 cases in inhalation anesthesia plus epidural or spinal or conduction block, 1.51 cases in TIVA plus epidural or spinal or conduction block, zero cases in CSEA, 0.57 cases in epidural anesthesia, 0.27 cases in spinal anesthesia, zero case in conduction block and 42.18 cases in other methods. On the other hand, the mortality rates of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 0.08 case in average, 0.09 case in inhalation anesthesia, 0.27 case in TIVA, 0.05 case in inhalation anesthesia plus epidural or spinal or conduction block, zero case in TIVA plus epidural or spinal or conduction block, zero case in CSEA, 0.57 case in epidural anesthesia, zero case in spinal anesthesia, conduction block and other methods. The outcomes of cardiac arrest totally attributable to anesthesia are 70.2% of full recovery without any sequelae, 10.5% of death within 7 days, 1.8% of vegetative state and 17.5% of unknown results while the outcome of critical events including severe hypotension and severe hypoxia totally attributable to anesthesia is 94.9% of full recovery without any sequelae, 0.4% of death within 7 days, 0.2% of vegetative state and 4.5% of unknown results. These results indicate that there are no differences in mortality and morbidity totally attributable to anesthesia among anesthetic methods in 1999 at Certificated Training Hospitals of Japan Society of Anesthesiologists.

Anesthesia↗
PubMed2001

Multiple-race mothers on the California birth certificate, 2000.

OBJECTIVES: Several data systems are beginning to allow respondents to report more than one race. Implications of multiple race reporting for the tabulation of race-specific birth characteristics are largely unknown. This analysis reports selected demographic characteristics and birth outcomes for multiple-race mothers, using California birth certificate data for 2000. DESIGN: Descriptive study of birth records. METHODS: Data were drawn from 530,305 electronically registered births. Demographics and birth outcomes were analyzed by race of mother for six multiple-race/ethnic groups with >300 births. RESULTS: 1.7% of mothers reported more than one race on the birth certificate. The most common multiple-race group reported was non-Hispanic Asian/White, followed by Hispanic/American Indian or Alaska Native/White. Characteristics varied widely among multiple-race subgroups, as well as between multiple-race groups and their single-race counterparts. For example, among multiple-race mothers, the proportion of births to teenage mothers was lowest among non-Hispanic Asian/White mothers (9%); this was significantly higher than percentages for non-Hispanic Asian or non-Hispanic White mothers (4% and 6%, respectively). CONCLUSIONS: Understanding the influence of multiple-race reporting on trends and comparisons in birth outcomes will be a challenge for public health researchers.

Adolescent↗
PubMed2002

[Certification of an RIA laboratory according to DIN EN ISO 9001-2000].

The university hospital Freiburg intends to establish step by step a total quality management system (TQMS) in all facilities with an external certification as its final aim. This has been reached already in the central laboratory. Therefore, it is effective for the department of nuclear medicine to do the same for its own lab specialized in thyroid hormones. The TQMS has been built up within six months on the basis of DIN EN ISO 9001:2000. This internationally accepted standard is of uttermost economical importance for an institution situated near the French and Swiss border. This review describes the procedure in detail. Responsible for the effort were the engagement of the coworkers in the lab as well as an adequate choice of the external adviser and the authority for certification. The procedure is formalized to a high degree and much understanding for analytic thinking and systematization is needed. Now it remains to be seen, if the desired effect (increased understanding for quality within the department, more efficient performance of the lab, better acceptance by the clients) will arise.

Certification↗
PubMed2002

Querying the ill-defined stroke diagnoses on death certificates and their effects on type-specific mortality in Taiwan.

In Taiwan, the high proportion of stroke deaths of which the underlying causes of death (UCD) has been classified to ill-defined categories, has impeded valid type-specific mortality studies. The aim of this study was to assess the extent of changes in the distributions of stroke subtypes and mortality after querying the certifying physicians. There were 2632 death certificates issued from January through June 1998 in Taiwan of which the UCD was classified to ill-defined cerebrovascular disease categories (International Classification of Diseases, 9th Revision ICD-9 code 436 or 437.9). Staff of the Office of Statistics, Department of Health copied 2035 death certificates issued by hospitals and mailed them back to the certifying physicians to request more specific information on the stroke subtype. Responses were obtained for 1505 (74%) of the 2035 queries sent. Four fifths of these (1191/1505) resulted in a change to a more specific code. In most cases, the ICD-9 code was changed to 431 (cerebral hemorrhage, CH, 239/1505) or 433-4 (cerebral infarction, CI, 819/1505). After the querying, the percentage changes in the age-adjusted death rate (per 100,000 population) for CH were +16% for men and +20% for women; and for CI the percent changed were +100% for men and +130% for women. The changes increased as the age of the deceased increased. The changes in the CH/CI death ratios resulting from querying were greater in younger (less than 65 years old) age groups than in older age groups. Given the large gains of more specific information on stroke subtypes, querying is a useful method to improve the quality of cause of death statistics. However, the large changes in distributions and death rates of different stoke subtypes as a result of querying, show the non-querying mortality data are not suitable for type-specific analysis.

Adult↗
PubMed2003

Safeguarding the patient and the profession: the value of critical care nurse certification.

Today's critically ill patients require heightened vigilance and extraordinarily intricate care. As skilled and responsible health professionals, the 403,000 critical care nurses in the United States must acquire the specialized knowledge and skills needed to provide this care and demonstrate their competence to the public, their employers, and their profession. Recognizing that nurses can validate specialty competence through certification, this white paper from the American Association of Critical-Care Nurses and the AACN Certification Corporation puts forth a call to action for all who can influence and will benefit from certified nurses' contribution to patient care.

Certification↗
PubMed1992

[Certification of specialists and their training outside the university].

A better appraisal of the training of medical specialists has been possible since the establishment of the National Certification Board in 1984. Participation of training centers outside the university environment has been considerable. Thus, after certification of the first 4500 medical specialists, it was noted that 7.5 of all applicants and 25% of those applying for official programs have received training in one or more of 137 extra-university programs. The quality and contents of these programs is variable. Their emergence is an inevitable fact derived from shortage of training centers in university teaching hospitals. Some control of these training programs is required to ascertain minimal standards of quality.

Certification↗
PubMedDate not supplied

Identification and certification of extracorporeal membrane oxygenation specialists in the United States.

Extracorporeal membrane oxygenation (ECMO) is a highly specialized technique widely practiced in many hospitals. Despite the proliferation of ECMO, little information has been generated relating to ECMO specialists, a new professional group responsible for managing the extracorporeal life support (ELS) system. A telephone survey of ECMO centers in the United States was conducted to determine the number of ECMO specialists, team composition by profession, and clinical components of ECMO specialist certification. Data were obtained in May 1991 from all 63 (100%) active ELS centers. The survey found that the average ECMO program performs 3,770 +/- 1,019 clinical hours of ELS per year with a team of 23 +/- 11 specialists. There are 1,431 practicing ECMO specialists in the United States: 73% registered nurses, 22% respiratory therapists, and 5% others. Most ECMO specialist teams (56%) are comprised of a single profession, with 44% of programs using a mixture of professions. The average ECMO specialist manages the ELS system 171 +/- 91 hr/yr. Thirty-six (57%) programs have a mean yearly clinical requirement of 77 +/- 23 ELS hours per specialist. These results represent the first complete report identifying the number of ECMO specialists in the United States. In addition, program demographics demonstrate variability in ECMO experience and certification requirements.

Adult↗
PubMedDate not supplied

Update on national certification for dialysis technologists.

Certification is an important step in the dialysis technologist's professional practice. We hope that candidates who are eligible will consider writing the national dialysis technology certification exam in order to validate the extensive and specialized body of knowledge required to practise.

Allied Health Personnel↗
PubMed1992

Ethical aspects of medical certification by general practitioners.

As well as acting as personal physicians, general practitioners are often asked to provide medical certificates, enabling patients to obtain benefits. In these cases doctors may act for the state, for other institutions or individuals, or as an advocate on the patient's behalf in a dispute. The ethical basis of this activity differs from the therapeutic doctor-patient relationship. Difficulties are particularly likely to arise when doctors are called on to combine the roles of therapist and certifier. Although this is often convenient and saves money, the damage to confidentiality and to the primary therapeutic relationship which may result must be weighted against this. The limitations of such certificates should also be borne in mind. Fairness and the preservation of the therapeutic doctor-patient relationship are best served by restricting the role of the personal doctor to the provision of clearly defined factual information on which others, who may be medical or non-medical, can make the final judgement.

Certification↗
PubMed2004

Outpatient osteopathic single organ system musculoskeletal exam form: training and certification.

The Outpatient Osteopathic Single Organ System Musculoskeletal Exam Form (SOS form) is a standardized examination data form. A standardized form is necessary to ensure that essential quality data are collected during osteopathic studies and that each submitted form is completed adequately and uniformly. Use of the standardized form permits reliable statistical computations from the collected data. The training process for the SOS form incorporated the following elements: (1) training investigators to use the form; (2) having trainees transcribe three clinical case examples onto SOS forms; (3) comparing each transcribed clinical case to a prepared key; (4) evaluating the trainees' work for accuracy; and (5) statistically evaluating the trainees' records for intraexaminer and interexaminer reliability. The success or failure of trainees to receive certification in their training process involved evaluating their ability to accurately and appropriately record data collected from three case examples. These cases were designed to evaluate recording accuracy and intraexaminer and interexaminer reliability. All trainees scored 80% or better for accuracy, and their work had good intraexaminer and interexaminer reliability. As a result, all trainees were awarded a numbered certificate for successful completion of the training process. Having a pool of well-trained, certified investigators available and ready to participate in the gathering of data through the use of the SOS form ensures that necessary data are collected and that the resulting databases are unified. It will also facilitate comparisons and statistical analysis of osteopathic research projects. Standardized forms and certified investigators will improve the quality of osteopathic research throughout the profession.

Ambulatory Care↗