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PubMedDate not supplied

Building academic and practical knowledge in nursing through TB skin testing certification in a BSN curriculum.

Tuberculosis (TB) is a communicable disease with worldwide health care consequences. After decades of declining incidence there was a 14% increase in the United States from 1985 to 1992, although rates are now declining due to focused programs. The State of Indiana mandates continuous TB monitoring by health care workers who have completed an educational course. The Indiana State Department of Health (ISDH) and the American Lung Association designed an educational program called a Basic TB Skin Test Course, which is used by the Community Health Nursing faculty at Indiana University School of Nursing (IUSON) in the baccalaureate curriculum to assist students in meeting state requirements. All students receive the didactic TB content of the course in the epidemiological concepts unit. Students can elect to receive certification by attending an additional 2-hour clinical session. Over 500 community health nursing students have completed the Basic TB Skin Test course in the past 5 years. The outcomes are positive for students, community, and public health.

Certification↗
PubMedDate not supplied

Death certificate case-control study of cancers of the prostate and colon and employment in the textile industry.

A case-control study was conducted to investigate possible relationships between employment in the textile industry and cancers of the prostate and colon. Death certificate information on occupation and industry was obtained for 1037 male prostatic cancer cases, 820 male and female colon cases, and matched controls who died during 1970-1978 in South Carolina. Black males were the only race-sex group to show an excess risk of prostate or colon cancer among employees of the textile industry. Nonstatistically significant excesses of prostate cancer were seen in dyeing and finishing businesses and broad woven fabric mills. Overall, there was no strong evidence indicating a relationship between the textile industry and either prostate or colon cancer. It is unlikely that limitations of the data masked real risks since previously reported associations with nontextile industries were confirmed.

Aged↗
PubMed1985

Education, training, professional certification, and work patterns of directors in interstate laboratories.

Education, professional training, certification, and work patterns of 988 laboratory directors employed in 440 clinical laboratories licensed under the Clinical Laboratories Improvement Act of 1967 are examined. Directors of hospital laboratories as opposed to independent laboratories were more likely to be physicians (82.8% vs. 68.0%), to have completed a formal residency program (75.5% vs. 62.0%), and to be certified in both anatomic and clinical pathology (65.3% vs. 57.1%). Only 51.9% of pathologists confined their work to a single laboratory, while 64.8% of directors with Ph.D.s or other doctorates directed only one laboratory. Most laboratories (81.5%) have at least one associate director. Hospital directors are more often full time (30 or more hours per week) than their independent laboratory counterparts, 74.4% vs. 42.4%, respectively. When the education and experience of individuals entering the field between the 1950s and 1970s are examined, it is evident that fewer individuals with bachelor's or master's degrees now are able to qualify as laboratory directors.

Certification↗
PubMed1985

Certification of death from ischaemic heart disease in Belfast.

All death certificates over a one-year period (20 July 1981 to 19 July 1982) for residents of Belfast were examined in order to ascertain those due to ischaemic heart disease. Some 1654 were included for further investigation of which 1288 (78%) were coded by ICD Nos 410-414 (9th revision). Additional data were obtained from hospital records, ECGs, cardiac enzyme measurements, post mortems, general practitioners and from relatives of the deceased. Some 108 deaths coded by 410-414 and 223 deaths coded by other rubrics were eventually excluded. For people aged less than 70 years the net effect of excluding these deaths and including some coded under rubrics other than 410-414 was very small representing a change from 498 to 496 deaths (-0.4%). For people aged 70 years and above the net effect also was small, namely an increase from 790 to 827 (+4.4%). We conclude that the total number of deaths recorded as being due to IHD in Belfast was reasonably accurate. While 76% of deaths registered under ICD Nos 410-414 had been coded by ICD No 410 (acute myocardial infarction) only 19% of all deaths due to IHD could be classified as definite myocardial infarction using World Health Organization criteria.

Age Factors↗
PubMed1984

Use of job-exposure matrix in an occupational analysis of lung and bladder cancers on the basis of death certificates.

A job-exposure matrix has been applied in a case-control study of lung and bladder cancer on the basis of occupational information abstracted from British death certificates. The expected association between lung cancer and jobs entailing exposure to asbestos was clearly demonstrated (relative risk, 1.5; 95% confidence interval, 1.2-1.9). The effects of three other known industrial carcinogens were not apparent, and reasons for this were discussed. Also included in the matrix were five substances whose carcinogenicity in humans has not been established. Formaldehyde, diesel fumes, and cutting oils were all associated with carcinoma of the bronchus, but the absence of a risk in "high-exposure" occupations was against a causal relationship. Bladder cancer was more common in jobs involving high exposure to printing inks (relative risk, 5.0; 95% confidence interval, 1.0-25.8) and cutting oils (relative risk, 1.5; 95% confidence interval, 0.8-2.8). Use of the job-exposure matrix added considerably to the conventional analysis of cancer risk in individual occupational categories.

Adult↗
PubMed1997

Accuracy of birth certificate data regarding the amount, timing, and adequacy of prenatal care using prenatal clinic medical records as referents.

This study compared birth certificate data on the amount, timing, and adequacy of prenatal care with the same data abstracted from the prenatal clinic records of 2,032 women who attended a health department prenatal clinic in northeast Georgia from 1980 to 1988. Overall accuracy was poor. Only 14.3% (n = 291) of the records completely agreed on the total number of visits, while approximately 36% (n = 738) and 53% (n = 1,081) agreed within one visit and two visits, respectively. Complete agreement for month and trimester prenatal care began was 31.1% (n = 632) and 50.6% (n = 1,202), respectively. Because of the small geographic region included in the current study, the generalizability of these findings to other populations may be limited.

Adult↗
PubMed1994

Medical examiner data in injury surveillance: a comparison with death certificates.

Increasingly, researchers use medical examiner reports to study the epidemiology of fatal injuries, often assuming that reports of all fatal injuries are included in medical examiner databases. This study evaluated that assumption by comparing the medical examiner database with the death certificates of persons who died of fatal injuries in Iowa during 1990-1991. The authors also examined the association between demographic variables and the presence of a medical examiner report. Overall, medical examiners reported 68.7% of fatal injuries. Among broad categories of injury deaths, the percentages of medical examiner reports varied: 36.9% of fatalities from unintentional falls, 79.2% of transportation fatalities, 82.6% of intentional fatalities, and 57.3% of other external causes of death. Age and sex were also associated with the presence of a medical examiner report. Women's deaths were half as likely as men's to be reported by the medical examiner. Deaths among the elderly were underreported as well. Among the elderly, fatalities from unintentional falls and, to a lesser extent, transportation fatalities were less likely to be investigated by a medical examiner, but intentional fatalities were more likely to be. Although medical examiner reports may contain detailed information, they underreport the actual number of injury deaths. This underreporting is of special concern for injury research, since certain demographic groups were found to be underrepresented in medical examiner reports.

Accidental Falls↗
PubMedDate not supplied

Comparative accuracy of clinical estimate versus menstrual gestational age in computerized birth certificates.

OBJECTIVE: This study compares gestational age data obtained by clinical estimate with data calculated from the date of the last menstrual period (LMP) as recorded on birth certificates. METHODS: The authors analyzed 476,034 computerized birth records from three overlap years, that is, those that contained both menstrual and clinical estimates of gestational age, concentrating on cases within the biologically plausible range of 20-44 weeks. RESULTS: The overall exact concordance between the two measurements was 46%. For +1 week it was 78%, and for +2 weeks it was 87%. Incidence of prematurity was 16% with menstrual gestational age, while it was 12% with clinical estimate. About 47% of the LMP-based preterm births were classified as term by clinical estimate. Eighty-three percent of clinical estimate-based preterms were also preterms by LMP-based gestation. Birthweight frequency distribution curves for LMP-based gestational age are bimodal, indicating probable miscoding of term births. An apparent over-representation of births coded as exactly 40 weeks by clinical estimate suggests rounding off near term for this method. CONCLUSION: Agreement between menstrual and clinical estimates of gestational age occurs most often close to term, with significant disagreement in preterm and postterm births. Use of different methods of determining gestation in different years or geographic populations will result in artifactual differences in important indicators such as prematurity rate.

Bias↗
PubMed1988

The forensic pathology specialty certifications.

The subspecialty of pathology known as forensic pathology has been certified by the American Board of Pathology since 1959, when the first examinations were offered in New Orleans, Louisiana, U.S.A. This article provides information on those who have been certified since 1959 and also the requirements for this certification by the American Board of Pathology.

Certification↗
PubMed1991

Developing the gastroenterology certification examination.

This paper describes a typical procedure for the development of credentialing examinations. Specifically, the paper provides the developmental history of the Certification Examination for Gastroenterology Nurses and Associates. In the course of the paper, a four-step approach to examination development is outlined. The steps include role delineation, item writing, examination construction and passing score determination. All phases of the examination development process are viewed in the light of their contribution to the public protection responsibility of the Certifying Board of Gastroenterology Nurses and Associates.

Certification↗
PubMed2000

Induced abortion in relation to breast cancer among parous women: a birth certificate registry study.

We wished to assess the relation of induced abortion to the subsequent incidence of breast cancer among parous women, using a design that would prevent the possibility of differentially complete reporting of abortion history by women with breast cancer and controls. Our study was conducted within a cohort of women who gave birth to a child during 1984-1994 while residing in 13 counties of western Washington. Cases were women from the cohort diagnosed with breast cancer between 1984 and 1994. From the remaining cohort members, five controls were matched to each woman with breast cancer by year of index birth (ie, the last child born before breast cancer diagnosis) and by age at delivery. We categorized 463 cases and 2,201 controls according to history of induced abortion as recorded on the index birth certificate. The risk of breast cancer was not found to be associated with a prior induced abortion (estimated relative risk (RR) = 0.9, 95% confidence interval (CI) 0.7-1.2). These results suggest that an induced abortion, if followed at some later time by pregnancy and childbirth, does not increase a woman's risk of breast cancer.

Abortion, Induced↗
PubMed2001

Using census data and birth certificates to reconstruct the early-life socioeconomic environment and the relation to the development of Alzheimer's disease.

The early-life environment and its effect on growth and maturation of children and adolescents are associated with several adult chronic diseases, including Alzheimer's disease. Because it is not feasible to collect information prospectively over the average life span, methods to reconstruct the early-life environment of the aged are necessary to evaluate these associations. In a community-based case-control study conducted in the United States, we collected U.S. census records and birth certificates to reconstruct the early-life socioeconomic environment of each elderly subject. Information was found on 82% of the available Alzheimer's disease cases (239 of 292) and 87% of the available controls (245 of 282). We investigated risk of Alzheimer's disease associated with father's occupation, parental age, household size, sibship size, and birth order. Subjects whose fathers were unskilled manual workers or laborers were at higher risk for Alzheimer's disease (odds ratio = 1.80, 95% confidence interval = 1.19--2.73). The risk of Alzheimer's disease was increased with increasing number of people in the household. We also evaluated whether subjects with the apolipoprotein epsilon 4 allele (APOE epsilon 4), a strong genetic risk factor that is not a necessary cause or a sufficient cause by itself for the development of Alzheimer's disease, were at higher risk than subjects who did not carry this allele. Among subjects with the APOE epsilon 4 allele whose fathers held lower-socioeconomic level occupations, the odds of developing Alzheimer's disease were higher (odds ratio = 2.35, 95% confidence interval = 1.07--5.16) compared with subjects without the allele (odds ratio = 1.40, 95% confidence interval = 0.78--2.52). Subjects carrying the APOE epsilon 4 allele alone have a threefold increased risk of Alzheimer's disease (odds ratio = 3.17, 95% confidence interval = 1.99--5.04). Compared with subjects with neither risk factor, subjects with both the genetic and the environmental risk factors (household size of seven or more and father's occupation being manual) had a relatively high risk of Alzheimer's disease (odds ratio = 14.8, 95% confidence interval = 4.9--46). The data suggest that APOE epsilon 4 may modify the associations between father's occupation, other early-life environmental factors, and development of Alzheimer's disease in late life.

Adolescent↗
PubMedDate not supplied

BCLS certification of the nursing staff: an evidence-based approach.

This article describes the application of the Iowa Model of Evidence-Based Practice to Promote Quality Care to creating standards of practice for Basic Cardiac Life Support certification of the nursing staff at a merged health center in Montreal, Quebec, Canada. Selected outcomes and adopted practice guidelines are presented.

Academic Medical Centers↗
PubMed1987

Ratings of residents' clinical competence and performance on certification examination.

The American Board of Internal Medicine (ABIM) requires directors of internal medicine residency programs to rate their residents in overall clinical competence and its essential components. In the study reported here, the authors investigated the relationships among these ratings and compared them with the residents' performance on the ABIM's certification examination in the years 1980 through 1985. The ratings of the individual components of clinical competence were correlated moderately with examination performance and very highly with each other. The individual components that were less dependent on medical knowledge (for example, interpersonal skills or humanism) had slightly smaller correlations with examination performance. The ratings of overall clinical competence were also related moderately to examination performance. Changes in the pattern of the ratings over time indicated that fewer candidates were receiving lower ratings while more were receiving higher ratings. The pass rates for each rating level were the same or lower; for example, the pass rate for candidates rated 5 was 68 percent in 1980 and 56 percent in 1985. The similar ranking of examinees by the program directors and the examination provides evidence for the validity of the examination.

Certification↗
PubMed1992

Development of the knowledge-based standard for the written certification examination of the American Board of Anesthesiology.

In 1988 and 1989, the American Board of Anesthesiology (ABA) developed a knowledge-based standard for its written certification examination. In brief, 13 "judges" developed a construct of a "borderline candidate," i.e., a candidate who was neither ideal nor clearly failing but rather had sufficient knowledge to just pass. In 1989, this construct was applied to 90 questions from the 1989 ABA examination to estimate candidate's score on that subset. When extended to the entire examination, the use of the construct resulted in a knowledge-based standard of 57% correct. (The 1988 exercise, also using the construct of a borderline candidate but with a totally different subset of questions, produced an identical standard). This standard resulted in higher success rates among the actual examinees taking the ABA examination (84% in 1989 and 90% in 1990) than had the normative standard used previously (80%). The authors suggest that the process they describe permits development of a reproducible criterion for success that is based entirely on mastery of a relevant body of knowledge rather than on normative considerations.

Anesthesiology↗
PubMed2000

Certification and specialization: do they matter in the outcome of acute myocardial infarction?

PURPOSE: To learn whether there are differences among certified and self-designated cardiologists, internists, and family practitioners in terms of the mortality of their patients with acute myocardial infarction (AMI). METHOD: Data on all patients admitted with AMI were collected for calendar year 1993 by the Pennsylvania Health Care Cost Containment Council and analyzed. Certified and self-designated family practitioners, internists, and cardiologists (n = 4,546) were compared with respect to the characteristics of their patients' illnesses. In addition, a regression model was fitted in which mortality was the dependent measure and the independent variables were the probability of death, hospital characteristics (location and the availability of advanced cardiac care), and physician characteristics (patient volume, years since graduation from medical school, specialty, and certification status). RESULTS: On average, cardiologists treated more patients than did generalists, and their patients were less severely ill. In the regression analysis, all variables were statistically significant except the availability of advanced cardiac care. Holding all other variables constant, treatment by a certified physician was associated with a 15% reduction in mortality among patients with AMI. CONCLUSIONS: Less patient mortality was associated with treatment by physicians who were cardiologists, cared for larger numbers of AMI patients, were closer to their graduation from medical school, and were certified.

Cardiology↗
PubMed2005

U.S. citizens who graduated from medical schools outside the United States and Canada and received certification from the Educational Commission for Foreign Medical Graduates, 1983-2002.

PURPOSE: To provide a descriptive overview of international medical school graduates (IMGs), U.S. and non-U.S. citizens, who obtained their medical degrees outside of the United States and Canada, with a focus on where U.S. citizens received their medical education and how this choice has changed over time. METHOD: The study group included all IMGs (n = 143,926) certified by the Educational Commission for Foreign Medical Graduates (ECFMG) from 1983-2002. Descriptive statistics were calculated, including historical certification rates for non-U.S. citizen and U.S. citizen IMGs. For IMGs who were U.S. citizens (n = 18,762), the data were summarized by medical school and country of medical school. RESULTS: U.S. citizens who attended medical schools abroad were more likely to attend schools in Central America and the Caribbean than in any other geographic region. There was a steady decrease in the number of U.S. citizens graduating from European medical schools. Conversely, the number graduating from medical schools in India and Israel rose. Over the period studied, the regions of Africa, Oceania, and South America graduated relatively few U.S. citizens. CONCLUSIONS: From 1983-2002, U.S. citizens graduated from medical schools in Central America and the Caribbean more than any other geographic region. Studying the characteristics of medical schools in this region and their similarities to U.S. medical schools, such as a four-year curriculum, may explain why U.S. citizens are attracted to this region in large numbers. Additional studies focusing on the characteristics of medical schools that train IMGs, the performance of the graduates, and their posttraining practice patterns are warranted.

Canada↗
PubMed1998

Preparing for the home health nurse certification examination.

Becoming certified in an area of nursing practice is one way of demonstrating expertise and competency in that area. Proper preparation is the key to successfully become certified. Study hints and test-taking strategies are discussed in detail. Specific information is provided on preparation to take the American Nurses Credentialing Center (ANCC) Generalist Home Health Nurse certification examination.

Certification↗