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This article provides some humorous examples of how agencies might approach their Medicare survey and ways to avoid pitfalls in keeping their Medicare certification.
In 1977, training directors of 55 child psychiatry training programs agreed to provide the Committee on Certification in Child Psychiatry of the American Board of Psychiatry and Neurology, Inc. with confidential data about the clinical performance of each of their graduates in 1978, 1979, and 1980. Information about 267 graduates from 37 programs was received. Almost all programs were university affiliated and located in medical centers. By 1986, 112 of these graduates had taken the child aboard examination. Training director ratings were found to be statistically correlated to a significant degree with actual pass or fail results on the written and on the overall examination.
The Veterans Administration has developed a program to evaluate the level of competency of its medical equipment repairmen and to recognize those who surpass an established level of competency. This evaluation is carried out by means of testing. A passing score of 70% on all sections of the exam results in certification while failure results in enrollment in correspondence or short courses. Periodic evaluations of the exam are carried out to determine questions to be added or deleted and those which should be reworded. Since time limits are set for completing the exam, those time limits are also evaluated.
This research addresses the efficacy of certification in nursing in terms of differences in job performance and self-esteem. Study results could help nurse managers determine hiring criteria, design professional development programs and restructure pay scales and reward systems.
Although voluntary, JCAHO's disease-specific care certification is a measure of achievement and distinction.
Screening of newborns with growth curves derived from populations dissimilar to their own can lead to sizable errors. I present a technique for constructing percentile curves for birth weight at different gestational ages, using North Carolina's computerized birth certificate file. This method eliminates from the analysis most erroneous data on gestational age. The resulting intrauterine growth curves show weights at term for North Carolina newborns. These curves differ from previously reported norms in that weights are higher than those reported for two low-income hospital subpopulations, and lower than birth weights in populations with better living standards and prenatal care. Plotting North Carolina births on the Colorado intrauterine growth curve resulted in considerable overdiagnosis of "large for gestational age," while most infants who were small for gestational age failed to be identified.
Data from death certificates in Kentucky in 1987 and 1988 for persons 65 years old and older were analyzed. There were 205 suicides in the 2-year study period. Suicide rates were higher for the elderly than for any other population group. White men, the group at highest risk, committed approximately 80% of the suicides in the elderly group. Suicide among minorities was rare. Self-inflicted gunshot wounds accounted for 88% of the suicides in the elderly group. Despite their high risk of suicide, elderly white men are underrepresented in terms of psychiatric admissions.
In conjunction with the decision of the Oncology Nursing Certification Corporation (ONCC) to computerize its examinations, the literature was reviewed to identify comparative studies of computerized versus paper-and-pencil testing methods and to determine the relative advantages of each. Data sources included journal articles and newsletter features identified via the ERIC, CINAHL, and PubMed databases or through frequent citation in the literature. The majority of studies found test scores to be independent of delivery mode. Several advantages of computerized testing were identified, including scheduling convenience, instant scoring capability, and enhanced security. One disadvantage may be an increase in testing anxiety for those without previous experience, although results in this area were mixed. Finally, studies and surveys often indicate an acceptance and preference for linear computer-based testing (CBT) by examinees.
There are currently a variety of pathways toward certification in occupational medicine. These options may be a source of confusion for potential candidates. As such, this report is offered as a guide for those attempting to complete the requirements for Board eligibility in occupational medicine.
We evaluated the risk of gastric cardia cancer by occupation and industry in a case-control study using information from death certificates for 24 US states in 1984-1992. One thousand fifty-six cases of gastric cardia cancer were identified among men aged 20 years or more, including 1,023 whites and 33 blacks. Controls were 5,280 subjects who died of nonmalignant diseases, 5:1 matched to cases by geographic region, race, gender, and 5-year age group. Among white men, occupations with elevated risk included financial managers (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.3-28.8), janitors and cleaners (OR = 1.7; 95% CI, 1.0-2.9), production inspectors (OR = 3.2; 95% CI, 1.5-6.9), and truck drivers (OR = 1.5; 95% CI, 1.0-2.2). Industries with elevated risk included pulp and paper mills (OR = 2.0; 95% CI, 1.0-37), newspaper publishing and printing (OR = 2.6; 95% CI, 1.0-6.3), industrial and miscellaneous chemicals (OR = 2.0; 95% CI, 1.0-3.9), water supply and irrigation (OR = 5.6; 95% CI, 1.6-19.9). Among black men, risks were nonsignificantly increased for subjects employed in railroads (3 cases, 2 controls) and for carpenters (3 cases, 0 controls). We created job-exposure matrices for asbestos, inorganic dust, metal dust, lead, polycyclic aromatic hydrocarbons, nitrogen oxides, nitrosamines, sulfuric acid, fertilizers, herbicides, other pesticides, and wood dust. Among white men, a consistent pattern of risk increase by level and probability of exposure was observed only for sulfuric acid mists, with a twofold excess (95% CI, 0.6-7.3) associated with high probability of high intensity exposure. A significant 30% increase in risk was observed for those subjects with a high probability of exposure (all levels combined) to lead, and a 60% increase was observed for subjects with high-level exposure to lead (all probabilities combined). However, crosstabulation of gastric cardia cancer risk by probability and level of exposure to lead did not show consistent trends. Asbestos exposure also showed an overall 50% increase but no consistent trends among white men. None of the 12 occupational hazards showed an association with risk for black men.
To examine trends in the proportions of deaths with various diseases among deaths with HIV infection, we analyzed multiple-cause death certificate data for all deaths in the United States from 1987 through 1999. Disease proportions were adjusted to control for demographic changes. Deaths reported with HIV infection increased from 15,331 in 1987 to 47,977 in 1995 and then decreased to 16,061 in 1999. Among these reported deaths, new trends during the period from 1995 through 1999 included decreases in the proportions with cytomegalovirus disease (from 6.8% to 2.8%), wasting/cachexia (9.8% to 6.8%), and dementia/encephalopathy (6.3% to 3.9%) and increases in the proportions with septicemia/septic shock (from 9.2% to 13.4%) and diseases of the liver (4.9% to 11.6%), kidney (6.3% to 9.1%), and heart (4.2% to 6.9%). Continuations of pre-1995 trends included decreases in the proportions with nontuberculous mycobacteriosis (7.1% to 3.1%) and Kaposi sarcoma (5.3% to 2.6%). Advances in antiretroviral therapy probably caused deaths due to HIV infection to decrease after 1995. Consequently, the proportions of deaths with HIV that were caused by other conditions increased. Improved prophylaxis or treatment of some opportunistic infections could also have reduced the proportions of deaths with those diseases, whereas antiviral drug toxicity could have contributed to increases in the proportions with noninfectious organ diseases.
This empirical study examines 387 union certification elections conducted by the National Labor Relations Board in nursing care facilities (North American Industry Classification System 623) from January 1999 to December 2001. Unions won 60% of the elections. Service Employees International Union was involved in 42% of the elections. Bargaining unit size significantly impacted union victory. Unions had a better probability of winning elections in the northeast and midwest than in the south. Unlike other industries, American Federation of Labor-Congress of Industrial Organizations affiliated unions did not suffer a big labor image in nursing care facilities. Implications for union organizers and administrators of nursing care facilities are discussed.
The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004. The purpose of this research was to validate the currency and relevancy of the certified case manager examination. The results of this study are shared in 2 parts of an article. Part I discusses the process the CCMC used for the development of the Case Manager's Role and Functions Survey Instrument (CMRFSI). The research leads to the identification of 6 new essential functions and 6 new knowledge areas, which describe case management practice. These findings were based on the survey of a large national sample of practicing case managers. Part II continues the analysis of the survey results and focuses on identifying the empirical activity and knowledge domains of case management practice, using factor analysis. It also discusses the similarities and differences found among various subgroups of case managers who were compared on the basis of certain demographic variables. In addition, it summarizes future changes in the field of case management as perceived by those who participated in the study.
OBJECTIVE: The objective of this study was to document cancer mortality among American butchers. METHODS: Death certificates collected in 24 American states were used to calculate mortality odds ratios (ORs) and their confidence intervals (CIs) for 18,639 butchers. RESULTS: Butchers experienced an increased mortality of cancer of the oral cavity (OR, 1.40; 95% CI = 1.09-1.81), esophagus (OR, 1.19; 95% CI = 1.01-1.40), pharynx (OR, 1.22; 95% CI = 0.91-1.64), and larynx (OR, 1.19; 95% CI = 0.92-1.54), as well as a reduced mortality from melanoma (OR, 0.70; 95% CI = 0.52-0.94), non-Hodgkin lymphoma (OR, 0.82; 95% CI = 0.69-0.97), and breast cancer (OR, 0.76; 95% CI = 0.58-0.99). CONCLUSIONS: It is likely that occupational exposures experienced by butchers have contributed to the increased risk of cancers of the oral cavity and esophagus.
The importance of wood for human societies can hardly be understated. If dry wood were amenable to molecular genetic investigations, this could lead to major applications in wood forensics, certification, archaeology and palaeobotany. To evaluate the potential of wood for molecular genetic investigations, we have attempted to isolate and amplify, by PCR, DNA fragments of increasing size corresponding to all three plant genomes from different regions of 10 oak logs. Stringent procedures to avoid contamination with external DNA were used in order to demonstrate the authenticity of the fragments amplified. This authenticity was further confirmed by demonstrating genetic uniformity within each log using both nuclear and chloroplast microsatellites. For most wood samples DNA was degraded, and the sequences that gave the best results were those of small size and present in high copy number (chloroplast, mitochondrial, or repeated nuclear sequences). Both storage conditions and storage duration play a role in DNA conservation. Overall, this work demonstrates that molecular markers from all three plant genomes can be used for genetic analysis on dry oak wood, but outlines some limitations and the need for further evaluation of the potential of wood for DNA analysis.
This paper reports the experience of a quality management project leading to an ISO 9001 certification in a Swiss regional hospital. It describes the motivations for the project, the process that was followed and the benefits of the approach. It also shows its limitations, problems encountered as well as costs and resources involved. The emphasis is on practical issues. Choices that were made are discussed and lessons are drawn.
Health care professionals (nurses, a midwife, a physiotherapist and an occupational therapist) working in a large NHS Trust hospital who had completed the Certificate in Health Education with the support of their employer, were interviewed. The study objectives were to seek their views on the quality of the course, to determine the extent to which participants were able to apply their new found knowledge and skills in the care they provided to patients and the level of support received to allow them to do this. Barriers that prevented staff from routinely applying health education in their work were identified. The findings indicated that the majority found the course content to be good and relevant to their clinical work but they identified lack of time due to the pressure of routine clinical work as the main barrier to the promotion of health education in their clinical area.
This paper describes the educational activity of a group of 149 nurse teachers and administrators following completion of the nursing education and nursing administration certificate courses of the University of Edinburgh (1958-1975). The data were obtained by a postal questionnaire and three particular types of courses reported by the respondents are discussed. Emphasis is given to the analysis involving degree courses as this was a prominent educational activity, especially among nurse teachers. The conclusion discusses the potential of an all graduate nurse teacher group and suggests some implications for the nursing profession.