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At least 1,027 records · Page 57Linked to original sources
PubMed1997

Use of breast core biopsy in the United States: results of a national survey.

OBJECTIVE: We analyzed the results of a national survey to determine the current use and practice of breast core biopsy. MATERIALS AND METHODS: A survey was mailed to 1700 members of the Society of Breast Imaging who reside in the United States. The questions included frequency of biopsy, specialty of responsible physician, type of guidance used, physician credentialing, method and duration of follow-up, referral patterns, scheduling practices, and types of lesions biopsied. Opinions about the future usefulness of breast core biopsy were solicited. RESULTS: We received 458 responses (27% response rate) from 48 states and the District of Columbia. Eighty-one percent of the respondents indicated that breast core biopsy is performed at their practice or institution: among these, 85% are performed solely by radiologists. Of those performing the procedure, 61% do not have special credentials. Seventy-one percent use both stereotaxic and sonographic guidance. For follow-up after the procedure, patients are tracked manually and by computer in near-equal proportions. The median period of patient follow-up is 12 months: 11% of the respondents track indefinitely. Surgeons and primary care physicians most commonly refer patients for core biopsy. The procedure is most often performed after notification of the referring physician (76%), and 80% of the respondents schedule core biopsy without prior surgical consultation. Masses and calcifications categorized as probably benign to highly suspicious are included as indications for core biopsy. Forty percent of the respondents offer core biopsy on the same visit as when an abnormality is found. Eighty percent of the respondents believe the procedure will increase in use 48% believe that core biopsy will replace most surgical biopsies for nonpalpable lesions. CONCLUSIONS: Breast core biopsy is widely used in the United States for sampling a broad spectrum of imaging abnormalities. Both sonographic and stereotaxic guidance are commonly used. Credentialing requirements, practice patterns, and follow-up after the core biopsy procedure vary considerably among different sites.

Biopsy, Needle↗
PubMedDate not supplied

Initiation of a voluntary certification program for health education specialists.

As health education has become a major strategy for addressing current health problems, the need for expertise in health education has increased. Today health education specialists work not only in health agencies and educational institutions but also in hospitals and other health and medical facilities, in businesses and industries, and in consulting firms. To promote quality assurance in the delivery of health education services to the public, the profession has launched a voluntary credentialing system for health education specialists. Seven areas of responsibilities and the competencies that they require have been delineated as generic to the practice of entry level health education specialists, regardless of the setting (for example, school, health agency, work site) where they work. The purposes and rationale for new National Commission for Health Education Credentialing, Inc., are described as well as the benefits of certification for the profession. The events and accomplishments of the past decade that have provided the foundation for the newly established credentialing program for the health education profession are chronicled.

Allied Health Personnel↗
PubMedDate not supplied

State regulation of managed care: the impact on children.

As more and more children enroll in managed care, states have responded to concerns expressed by their constituents by passing legislation and developing credentialing requirements to assist families with children in receiving appropriate care from managed care plans. Although most of the legislation and credentialing requirements apply to the population generally, a few provisions apply specifically to children. The legislation and credentialing requirements attempt to improve both access to medical care and the quality of care by enacting access-to-care and quality-of-care provisions, reducing the financial incentives for providers to offer inappropriate care, and providing families with more information about their choices and opportunities to redress their grievances. Although there is no empirical evidence, analysis of similar types of legislation suggests that certain approaches will be more successful than others; one obvious indicator of success is the ability of the regulatory agency to develop clear, unambiguous, enforceable rules. Existing legislation varies widely across states in terms of the issues addressed and the specificity of the laws. For the most part, this legislation has been piecemeal, addressing specific issues as they arise. In the long run, state legislatures may not have the time or the expertise to regulate the managed care industry, and other regulatory bodies may be better equipped to address concerns about managed care. If utilized, however, existing regulatory bodies, which historically monitored fee-for-service medicine, will need to be redesigned to monitor managed care.

Child↗
PubMed1998

The National Practitioner Data Bank: implications for nurse anesthetists.

The National Practitioner Data Bank (NPDB), created by the 1986 Health Care Quality Improvement Act, has been in operation since 1990. Hospitals and other credentialing bodies must query the NPDB when granting and renewing privileges. The NPDB receives about 25,000 reports of adverse actions against health practitioners each year. The NPDB was designed to be a flagging system providing information to licensing or credentialing authorities who would further examine practitioner records. Its purpose is to ensure that decision makers have information that might not otherwise be readily available, especially in the case of incompetent practitioners who move from hospital to hospital or state to state. Access to NPDB information is a concern for consumers and providers alike. Only 2% of matched reports to the NPDB made a difference in hospital privileging decisions. A limitation of NPDB information is that malpractice payments recorded in the NPDB do not necessarily constitute a comprehensive and definitive reflection of actual health care incompetence. All health care providers need to be aware of the NPDB, its mission, potential impact on their ability to be credentialed, and proposed additional uses of its information.

Clinical Competence↗
PubMed2004

Accuracy of emergency medical information on the web.

A large amount of EM information can be found on the Internet, but the accuracy of this information has not been determined. This study compares the "gold standards" of EM information on four common emergencies with top healthcare web sites. The study also examines the relationship of web sites' credentials and certification on content. Checklists were developed for four emergency medical topics: influenza, febrile child, chest pain, and stroke from the "gold standards" promoted by the American Stroke Association, the American Heart Association, the National Heart, Lung and Blood Institute, and the American College of Emergency Physicians. Information found at the 20 most visited health information web sites were compared with the "gold standards." Completeness of the information, certification, and credentials were used to judge the accuracy of the web sites. Inaccurate or incorrect information from these web sites were noted. Correlations between the site's credentials and its content were also measured. This study, conducted from January 18, 2002, to January 31, 2002, excluded eight of the top 20 health web sites because they did not cater to the lay public. MEDLINEplus was the most complete web site with 74.8% of the items noted contained in the web site; MayoClinic.com had 54.5% and Medscape had 50.9%. Half of the web sites fell between 35% and 50%, including WebMD at 46.9%, InteliHealth at 45.5%, HealthWorld Online at 44.8%, Yahoo! Health at 41.3%, AllHealth.com at 40.6%, and Health.excite.com at 36.4%. Healthcentral.com at 35%, Drkoop.com at 35%, and AskDrWeil at 26.8% were the bottom three sites. Information on stroke was the most complete overall in 11 of 12 web sites. Four web sites contained questionable or concerning information. No correlation was found between possession of certification and the completeness of content (Pearson correlation -0.264 with a two-tailed significance of .406). Despite recent efforts to improve web site content through certification, few web sites contained a significant amount of EM information on all four topics investigated. In fact, some of the information provided on these health information web sites has the potential to be dangerous. Thus, most web sites are not good sources of reference for the public to find out what to do in the case of a medical emergency.

Adult↗
PubMed2005

The cutaneous surgery experience of multiple specialties in the Medicare population.

BACKGROUND: There has been tremendous growth in the performance of ambulatory surgical procedures. Traditional forms of peer review, commonplace for hospital-based procedures, are not typically performed in the office-based setting. Hospital credentialing of physicians has been suggested to be a means of assuring patient safety. Credentialing committees may be unaware of the level of experience of typical office-based physicians who perform cutaneous surgery. PURPOSE: To compare the levels of cutaneous surgery experience of dermatologists and other surgical specialists. METHODS: Medicare claims data on number of cutaneous surgery procedures performed by various medical disciplines, including dermatologists, plastic surgeons, general surgeons, and others, were obtained from the 1998-1999 Medicare Current Beneficiary Survey (MCBS) and analyzed. The number of physicians in each specialty was used to normalize the data to a per physician basis. RESULTS: Dermatologists performed half (50%) of the complex repairs and most of the excisions (58%) and intermediate repairs (62%). Dermatologists performed more flaps (40% of all flaps) than any other specialty, while plastic surgeons performed more total grafts (38%) than any other specialty. Dermatologists and plastic surgeons performed similar numbers of full-thickness skin grafts, while plastic surgeons performed more split-thickness skin grafts. CONCLUSION: As dermatologists seek hospital credentials for performing cutaneous surgery procedures, these data should help surgical colleagues understand the typical level of experience of their dermatologist colleagues.

Clinical Competence↗
PubMed2002

Position of the American Dietetic Association: food and nutrition misinformation.

It is the position of the American Dietetic Association that food and nutrition misinformation can have harmful effects on the health and economic status of consumers. It is the role of nationally credentialed dietetics professionals to advocate for and promote sound, science-based nutrition information to the public, function as primary nutrition educators to health professionals, and actively counter and correct food and nutrition misinformation. The federal government has recognized the strong link between nutrition and health in recent years. Consumers are taking greater responsibility for self-care and are hungry for food and nutrition information, creating opportunities for nutrition misinformation, health fraud, and quackery to flourish. The media are consumers' leading source of nutrition information, but news reports rarely provide enough context for consumers to interpret the advice given. Promoters turn preliminary findings into sales pitches with baseless claims, often for the sole purpose of economic gain. Effective nutrition communication is consumer focused and presented with sufficient context to allow consumers to weigh the information and determine whether it applies to his or her unique needs. Nationally credentialed dietetics professionals are best prepared to communicate sound advice and scientific advances about nutrition. These dietetics professionals have a responsibility to take an active role in providing accurate, easily understood food and nutrition information, interpreting emerging research for media and consumers and encouraging consumers to look for credentialed dietetics professionals as nutrition experts.

Consumer Advocacy↗
PubMed2003

Laser therapy on darker ethnic skin.

Like all medical procedures laser therapy comes with inherent risks and complications. Because of the increased risk in epidermal side effects when performing laser therapy on patients with darker skin, a higher level of laser expertise and clinical experience in treating darker ethnic skin is recommended to ensure that patients are treated safely. Test spots should always be done as an aid to selecting safe and efficacious treatment parameters. Because of the limited experience in treating patients with darker skin a conservative approach should always be used. Unfortunately, there are no national policies establishing credentialing requirements for those planning to practice laser surgery. The US Food and Drug Administration are responsible for granting individual laser manufacturers' permission to market their lasers for specific indications. The Food and Drug Administration also recommends operator training to use these lasers, but credentialing is a state function and consequently standards for laser therapy vary greatly from state to state. Until the bar is raised and national credentialing polices on laser therapy are established clinicians must police themselves and fully be aware of their capabilities and limitations to ensure that all patients regardless of skin color or ethnicity receive safe and effective treatments.

Adult↗
PubMed2005

Global mobility for psychologists: the role of psychology organizations in the United States, Canada, Europe, and other regions.

Global mobility for psychologists is rapidly improving because of an emerging consensus on recognition standards, the demand for cross-border mobility both internal and external to the profession, and the efforts of membership, credentialing, and regional organizations to promote mobility. In the United States, multiple credentialing organizations promote mobility, primarily through individual endorsement of credentials. The Canadian regulatory boards signed a mutual recognition agreement implementing fast-track mechanisms for licensed psychologists seeking mobility and a competency-based assessment for initial registration. Europe plans to reduce barriers to mobility through mutual recognition of qualifications via a EuroPsy diploma that provides a benchmark for professional psychology education and training. Other regions have not made as much progress with regard to promoting mobility, as many do not yet even regulate the practice of psychology. The authors examine who seeks mobility, which geographic regions promote mobility, and by which mechanisms.

Canada↗
PubMed1997

Ultrasound evaluation of blunt abdominal trauma: program implementation, initial experience, and learning curve.

OBJECTIVE: Although sonographic screening for blunt abdominal trauma is gaining acceptance, standards for implementation, training, credentialing, and quality control remain to be established. DESIGN: This prospective study examines a Level I trauma service experience with the de novo establishment of a trauma ultrasound (US) program credentialed through the Department of Surgery under the auspices of Continuous Quality Improvement. MATERIALS AND METHODS: All trauma surgeons attended a combined didactic and "hands on" 8-hour trauma US course. Abdominal sonography was subsequently performed on patients with potential blunt abdominal trauma followed by a standard diagnostic evaluation, which included computed tomographic scan, diagnostic peritoneal lavage, or observation. MEASUREMENTS AND MAIN RESULTS: Three hundred patients were studied over a 4-month period. They averaged 35 years of age with an average injury severity score of 12. The time required to perform the US examination averaged less than 3 minutes. Standard diagnostic evaluation included computed tomographic scan (21%), diagnostic peritoneal lavage (45%), and observation (34%). US examinations resulted in 277 true negatives, 17 true positives, two false positives, and four false negatives for a sensitivity of 81.0%, a specificity of 99.3%, and an accuracy of 98.0%. Annualized cost savings with the use of US evaluation versus standard diagnostic evaluation would amount to over $100,000.00. CONCLUSIONS: This experience with the de novo implementation of a trauma US program suggests that the training and credentialing requirements in this study are sufficient to provide surgeon ultrasonographers with acceptable competence in US diagnosis of blunt abdominal trauma.

Abdominal Injuries↗
PubMed2006

Respiratory care manpower issues.

OBJECTIVE: Although respiratory care is a relatively new profession, its practitioners are deeply involved in providing patient care in the critical care. In preparation for writing this article, we sought to explore the respiratory therapy manpower needs and activities designed to fulfill those needs in critical care practice. MATERIALS AND METHODS: We began by delineating the historical development of respiratory care as a profession, the development of its education, and the professional credentialing system. We then conducted several literature reviews with few articles generated. We requested and received data from the American Association for Respiratory Care (AARC), The National Board for Respiratory Care (NBRC), and the Committee on Accreditation of Respiratory Care education (CoARC) relative to their membership, number of credentialed individuals, and educational program student and graduate data for 2000 through 2004. We then conducted two electronic surveys. Survey 1 was a six-item survey that examined the use of mandatory overtime in respiratory care departments. We used a convenience sample of 30 hospitals stratified by size ( or=500 beds). Survey 2 was a five-item instrument distributed by blast E-mail to the Society of Critical Care Medicine's Respiratory Care Section members and members of the RC_World list serve. This survey elicited 51 usable and non-duplicative responses from geographically and size-varied institutions. We analyzed these data in several ways from distribution analysis to one-way analysis of variance procedure and appropriate post hoc analysis techniques. Where appropriate, a matched-pairs analysis was performed and these were compared across the variables intensive care unit (ICU) beds per actual number of respiratory care practitioners (RCPs) and ICU beds per preferred number of RCPs. RESULTS: The data gathered from the professional organizations indicated a relatively stable attrition rate (35.2%+/-1.7-3.1%), even in the face of varying enrollments (6,231 in 2004 vs. 4,589 in 2002). In survey 1, we looked at the institution of mandatory overtime policies and their use in 30 size-stratified hospitals. Mandatory overtime was selected as a survey topic under the supposition that manpower shortages might lead to the development of such procedures and also to their utilization. Fourteen of the 30 hospitals responding indicated that they had a policy addressing mandatory over time. Of the 14 hospitals with policies, only ten had disciplinary actions specific to refusing the overtime. Seven of the 30 hospitals indicated that they used mandatory overtime monthly of more frequently. Survey 2 data revealed that there was a wide variation in bed size, number of ICUs, and number of RCP staff assigned to the ICU. Serendipitously, our 51 responding centers were distributed among small (16), medium (19), and large (16) hospitals in a manner that appeared to reflect the national distribution pattern. We were able to use these data to develop a closeness of fit diagram ICU beds to preferred numbers of RCPs (DF=48; p<.0001; RSq=0.77; RMSE=4.114). The number of beds per preferred number of RCPs was 9.445 to 1.0 while the actual bed to RCP ratio was 10.75 to 1. CONCLUSION: This article provides a short history of the development of respiratory care and its historical relationship with critical care. We have, perhaps for the first time, provided a unified data set of key demographic information from the three professional bodies guiding the development of the respiratory therapy profession. This data set provides time-linked data on admissions and graduations from the CoARC, membership numbers for the AARC, and the numbers of active credentialed RCP from the NBRC. By two focused surveys, we were able to show that while mandatory overtime is a common practice in respiratory care departments, it was not overwhelming utilized. We also learned that in most hospitals, regardless of bed size, there is a perceived need for 1.3 RCPs more than the actual staff and that it appears that the critical staffing level between actual to preferred RCP to beds is between 9 and 11 beds.

Attitude of Health Personnel↗
PubMed2006

Hepatitis C knowledge among staff in U.S. drug treatment programs.

Staff in drug treatment programs are in an optimal position to support the hepatitis C related needs of their patients. To do so effectively, however, staff need to have accurate information about the hepatitis C virus (HCV). This article examines the HCV knowledge of staff (N= 104) in two drug-free and two methadone maintenance treatment programs (MMTPs) in the New York metropolitan area. Five of 20 items on an HCV Knowledge Assessment were not answered correctly by the majority of the participating staff, and total scores on the Assessment averaged 70%, 71%, and 45% among the medically credentialed staff, non-medically credentialed staff in the MMTPs, and non-medically credentialed staff in the drug-free programs, respectively. The majority of those in the latter group had never participated in a training specifically devoted to HCV. Results suggest the need for effective HCV-related training for all staff in drug treatment programs.

Adult↗
PubMed1998

Healing the mind-body and nursing specialty splits. Conference regarding the "Blended" role in psychiatric/mental health nursing. June 5, 1998--University of Massachusetts, Lowell.

When the idea for this conference was born last year, our primary concern was for the graduates of our "blended" clinical specialist/nurse practitioner (CS/NP) program and the availability of a national examination credentialing them for this new advanced practice role. As we launched our new program and answered students' questions about credentialing, we were keenly aware of the American Nurses Credentialing Center (ANCC) position of waiting for at least 100 graduates nationally from programs like ours before developing an examination for "blended" role graduates. The purpose of this article is to share the outcomes of this conference and to inspire national collegial conversation about the serious issues we face as a specialty group in advanced practice nursing.

Certification↗
PubMed1991

Assessing the continuing education needs of long-term care administrators in Ontario: results of a survey.

This article reports the results of a 1989 survey of the professional characteristics and educational needs of 429 managers and supervisors in long-term care institutions and community-based service agencies in greater metropolitan Toronto. The data identify important gaps in the professional training of these administrators: while two-thirds report attainment of postsecondary education credentials, the remaining third, including a quarter of senior managers, have no formal college or university training. Moreover, of those with postsecondary credentials, only a minority are trained in health or human services and administration--skills and knowledge areas key to establishing and managing a client-centered continuum of long-term care. The data also demonstrate that there is widespread support in principle and practice among current administrators in the Toronto region for programs of education which address the particular challenges of long-term care administration, and that specific credentials in the field are seen as a future requirement for promotion to management positions. Preferred modes of education program delivery are short, intensive seminars and night classes.

Attitude of Health Personnel↗
PubMed1994

A matter of degree: the trend toward physician executives' pursuing master's degrees.

As the health care delivery system continues to change, there is certain to be an increasing demand for the services of physician executives. For the moment, potential employers seem to be seeking managers with solid physician credentials and proven management experience. But will the criteria remain at this level, or will employers demand more formal management credentials? And if the latter is likely, what credentials will best serve the physician executive in the employment marketplace? Those and other questions are explored in the following article through interviews with physician executives and recruiters.

Education, Graduate↗
PubMed1984

New JCAH standards affect medical staff, quality assurance.

Medical staff composition, credentialing procedures, governance, and quality assurance are the major areas affected by recent revisions in the Joint Commission on Accreditation of Hospitals' Accreditation Manual for Hospitals. The most controversial revision expands the definition of the medical staff to include not only physicians and dentists but also other nonphysician practitioners. Much of this controversy is unwarranted, however, because the standard is purely permissive; no hospital is required to change its medical staff composition if it chooses not to. Institutions are now permitted, if not encouraged, to examine specific classes or categories of providers and to determine the appropriateness of their practice within the hospital setting. Criteria for granting staff membership or clinical privileges must be developed for each category. Mechanisms for appointing medical staff members and for granting clinical privileges must be "hospital-specific"; each hospital; even those within the same system, chain, or geographic area, must have separate and distinct policies and guidelines for decision making in the credentialing process. The credentialing mechanism also must be "described to each applicant." The phrases "ethical criteria," "ethical pledge," and "ethical standards" have been completely dropped from the accreditation requirements. The previous standards subjected both the JCAH and the hospital to liability hazards. The newer standards not only eliminate the potential liability associated with the adoption of a particular code of ethics but also give the hospital greater latitude in enforcement, since the institution is not limited to a particular codification of principles or religious ethics. The medical executive committee's (MEC's) role and composition have also been redefined.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗
PubMed1988

Antitrust implications of allied health practitioner privilege decisions and hospital-physician exclusive contracts.

The Health Care Quality Improvement Act, which often protects hospitals and medical staffs from damages resulting from physician credentialing decisions, offers no protection for (1) credentialing decisions affecting allied health practitioners or (2) challenges to exclusive contract between physicians and hospitals. Since many antitrust-health care actions have involved those two situations, antitrust litigation in those areas is not likely to decline. This article outlines steps that hospitals and their medical staffs can take to minimize the antitrust risks in awarding exclusive contracts and in decisions regarding the credentialing of allied practitioners.

Allied Health Personnel↗
PubMed1992

[Latent structure model of physicians' opinions on National Health Insurance].

The purpose of this study is to construct the latent structure models of physicians' opinions on National Health Insurance (NHI). The data for the analysis came from a mail survey of 1619 physicians in January of 1990. Five latent structure models were established as follows: Structure 1. Physicians' viewpoint on NHI. Hospital physicians: Steady, 69%; Turn-Over, 26%; Career-change, 5%. Clinic physicians: Steady-with Insurance Contract, 55%; Steady-without Insurance Contract, 41%; Career-Change, 4%. Structure 2. Physicians' expected impact of NHI. Hospital physicians: Pessimistic, 45%; Disadvantaged, 38%; Constant, 17%. Clinic physicians: Pessimistic, 72%; Constant, 12%; Ambitious, 16%. Structure 3. Physicians' expected workload change due to the implement of NHI. Hospital physicians: Decreasing, 30%; No-Change, 18%; Increasing, 52%. Clinic physicians: Decreasing, 30%; Non-Change, 23%; Increasing, 48%. Structure 4. Ideal practice pattern. Hospital physicians: Traditional, 47%; Transitional, 42%; Practice Abandoned, 12%. Clinic physicians: Traditional, 20%; Transitional, 21%; Rural-Orientated 59%. Structure 5. Expected payment methods for physicians. Hospital physicians: Credentiality-Specialty-based, 44%; Specialty-Equal Pay-based, 11%; Equal Pay-Specialty-based, 42%; Equal Pay-Credentiality-based, 4%. Clinic physicians: Credentiality-based, 24%; Mixed, 11%; Equal Service-Equal Pay-based, 60%; Urbanization Level-based, 5%.

Attitude of Health Personnel↗