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At least 1,081 records · Page 60Linked to original sources
PubMed2006

Dermatology Internet Yellow Page advertising.

BACKGROUND: Patients may use Internet Yellow Pages to help select a physician. OBJECTIVE: We sought to describe dermatology Internet Yellow Page advertising. METHODS: Dermatology advertisements in Colorado, California, New York, and Texas at 3 Yellow Page World Wide Web sites were systematically examined. RESULTS: Most advertisements (76%; 223/292) listed only one provider, 56 listed more than one provider, and 13 listed no practitioner names. Five advertisements listed provider names without any credentialing letters, 265 listed at least one doctor of medicine or osteopathy, and 9 listed only providers with other credentials (6 doctors of podiatric medicine and 3 registered nurses). Most advertisements (61%; 179/292) listed a doctor of medicine or osteopathy claiming board certification, 78% (139/179) in dermatology and 22% (40/179) in other medical specialties. Four (1%; 4/292) claims of board certification could not be verified (one each in dermatology, family practice, dermatologic/cosmetologic surgery, and laser surgery). Board certification could be verified for most doctors of medicine and osteopathy not advertising claims of board certification (68%; 41/60; 32 dermatology, 9 other specialties). A total of 50 advertisements (17%) contained unverifiable or no board certification information, and 47 (16%) listed a physician with verifiable board certification in a field other than dermatology. LIMITATIONS: All Internet Yellow Page World Wide Web sites and all US states were not examined. CONCLUSION: Nonphysicians, physicians board certified in medical specialties other than dermatology, and individuals without verifiable board certification in any medical specialty are advertising in dermatology Internet Yellow Pages. Many board-certified dermatologists are not advertising this certification.

Advertising↗
PubMed2003

Registered dietitians' use of physical assessment parameters in professional practice.

OBJECTIVE: To examine how registered dietitians who have completed one of two physical assessment programs use the knowledge and skills learned in practice and whether method of instruction had an affect on use of skills in practice. SUBJECTS/SETTING: Surveys were mailed to 891 persons, all of whom completed a Dietitians in Nutrition Support dietetic practice group or University of Medicine and Dentistry of New Jersey continuing education program. Four hundred seventeen surveys were returned and 407 were usable. STATISTICAL ANALYSIS: chi(2) analysis and stepwise logistic regression was used to analyze the data. Statistical significance was P=.05. RESULTS: Sixty percent of respondents worked in a clinic setting. Four of the five most-used competencies were similar between the two programs. More registered dietitians are using physical assessment competency information in clinical assessment, but not performing the competencies independently. Respondents with the Certified Diabetic Educator credential (P=.007) and Certified Nutrition Support Dietitians credential (P=.215) were more likely to use select physical assessment competencies. Confidence was reported as enhancing use of physical assessment competencies (n=153, 45%) and time was a barrier to using physical assessment competencies (n=159, 52%). APPLICATIONS/CONCLUSIONS: There were no significant differences in use of physical assessment competencies between the University of Medicine and Dentistry of New Jersey program and the Dietitians in Nutrition Support program. Although not statistically significant, there appeared to be more use of physical assessment competencies by those who received additional training and those who completed the University of Medicine and Dentistry of New Jersey program. This study reveals that registered dietitians are using the values in clinical assessment, however they must move to actually performing physical assessment competencies in practice.

Adult↗
PubMed1999

Legal, ethical, and professional issues to consider when communicating via the Internet: a suggested response model and policy.

Providing nutrition information via the Internet enables dietetics professionals to expand their practices, markets, and networks, but also presents new legal, ethical, and professional issues. Based on her experiences responding to unsolicited questions through a Spanish-language nutrition Web site, this author presents issues related to electronic communication, a process for formulating responses, and makes suggestions for a policy. The issues include the global nature of cyberspace; cultural variations in Spanish-language food terms and models, credentialing, licensure, and scope of practice; presentation of credentials; the inquirer's knowledge and information sources; the nature of the cyberspace relationship; and protection of the client and the professional. These issues have created a need for an electronic communication policy and some components of such a policy are identified, including the nature of electronic nutrition, distinguishing between public and client-specific communication, question-and-answer formats, opening and closing caveats, and recording processes.

Computer Simulation↗
PubMed1993

Complications after laparoscopic cholecystectomy.

After becoming alarmed about seven unusual and severe complications reported by New York State hospitals after laparoscopic cholecystectomy, the Department of Health of New York State tabulated all reported adverse incidents. After observing unusual injuries to the great vessels of the abdomen and an increase in major bile duct injury during laparoscopic cholecystectomy, the Department of Health prepared a memorandum to New York State hospitals advising closer attention to education, credentialing, proctoring, and outcome after these operations. The frequency of cholecystectomy has increased sharply, by 21%, since the advent of laparoscopic cholecystectomy. The serious injury rate may be approximately 15 times that observed after an open cholecystectomy. Recognizing the theoretic advantages of the procedure, the Department of Health reminded hospital Boards of Trustees of their obligation to establish mechanisms for credentialing and privileging surgeons and surgical teams so that the risks do not exceed those expected of the open procedure and to detect and correct deviations from this standard.

Aged↗
PubMed2000

Still photography versus videotaping for documentation of cecal intubation: a prospective study.

BACKGROUND: Documentation of cecal intubation is important for credentialing and continuous quality improvement. However, convincing cecal photographs can be difficult to obtain. The aims of the study were to determine (1) the anatomic variations and photographic factors associated with convincing cecal photographs; (2) whether a prospective attempt to capture specific features resulted in more convincing photographs; and (3) how a prospective attempt at capturing convincing cecal features during still photography compares with videotaping as a method of documenting cecal intubation. METHODS: A single examiner evaluating 165 consecutive patients photographed the entire cecum from just distal to the ileocecal valve, the appendiceal orifice, the ileocecal valve orifice, and in the last 110 consecutive cases, the terminal ileum, if it could be intubated. The photographs were then scored by 8 experts according to how convinced they were that cecal intubation had occurred. Features associated with high and low scores were determined, and 50 additional consecutive patients were photographed with a specific effort to capture these features, along with videotaping of the cecum. These photographs and videotapes were then scored by 7 of the 8 experts on a scale of 1 to 5, with 5 representing "definitely the cecum." RESULTS: There was marked variation in scores of still photographs among reviewers. A combination of photographs produced the highest mean score and the highest percentage of scores that were either "probably" or "definitely" of the cecum. The photograph of the cecum from just distal to the ileocecal valve was most convincing and the terminal ileum photograph was least convincing. In the 50 cases in which an attempt was made to capture specific features, mean scores improved for the overall cecal photograph by 0.10, the appendiceal orifice by 0.23, the ileocecal valve lips by 0.20, and the terminal ileum by 0. 19. The cecum, appendiceal orifice, valve lips, and terminal ileum photographs for the last 50 patients were scored higher than those from the first 165 patients by 4, 4, 4, and 5 reviewers, respectively. Videotapes were consistently convincing (overall mean score 4.78 out of 5) and were scored more convincing than the combination of still photos from the final 50 cases by 6 of 7 reviewers. CONCLUSIONS: Still photography of the cecum can be improved somewhat by attempting to capture specific cecal features. However, because of anatomic variation among normal individuals, still photography remains inconsistently convincing. A combination of photographs is most convincing. Videotaping of the cecum is consistently convincing and would appear to serve effectively as a means of documenting cecal intubation rates for the purposes of continuous quality improvement and credentialing.

Cecum↗
PubMed2001

Telesurgery. Remote monitoring and assistance during laparoscopy.

In comparison to open surgery, laparoscopy results in less postoperative pain, shorter hospitalization, more rapid return to the work force, a better cosmetic result, and a lower incidence of postoperative intra-abdominal adhesions. These advantages are indisputable when comparing large series for cholecystectomy and smaller series for pelvic lymph node dissection, nephrectomy, and bladder neck suspension in experienced hands. Urologists have an obligation to explore the application of these methods to urologic disease and to adjust the standard of care accordingly. Several barriers to the expansion of urologic laparoscopic surgery exist. The experience in extirpative and reconstructive urologic procedures is limited when compared with the data on cholecystectomy. These procedures are technically complex and demand advanced laparoscopic skills and familiarity with laparoscopic anatomy. The steep learning curve translates into long operative times and an unacceptably high rate of complications for inexperienced laparoscopic surgeons. Most practicing urologists have no formal training in advanced laparoscopy, and no formal credentialing guidelines exist. Telesurgical technology may provide one solution to this problem. Through telesurgical mentoring, less experienced surgeons with basic laparoscopic skills could receive training in advanced techniques from a world expert without the need for travel. These systems could also be used to proctor laparoscopic cases for credentialing purposes and to provide a more uniform standard of care. This review has outlined some of the exciting progress made in the field of telesurgery over the past 10 years and described some of the technical and legal obstacles that remain to be surmounted. During the 1990s, urologists were at the forefront of innovation in remote telepresence surgery. As the scope of minimally invasive urologic surgery expands during the first few decades of the twenty-first century, telesurgical mentoring should have an increasingly important role.

Education, Medical, Continuing↗
PubMed1998

Emergency medicine resident choice of practice location.

STUDY OBJECTIVE: To describe the geographic distribution of practice locations for 1995 emergency medicine residency graduates and factors that are important to residents in their choice of practice location. METHODS: Self-administered questionnaires were distributed to Emergency medicine residents who graduated in 1995. The survey ascertained practice city and state, resident employment characteristics, and the importance of factors that influenced the residents' selection of employment. RESULTS: Eighty-six of 87 programs and 441 (69.4%) of 635 eligible residents participated. Forty-three percent of graduates chose to practice in the city or metropolitan area in which they trained; 46% of these had no personal tie to the area before their residency training. Liking the city was cited as being more important (P<.001) than other factors in picking practice location. Group personality and coworkers' credentials were more important (P< or =.01) than contract and salary arrangement. Twenty percent of respondents were not practicing in the city or area of their first choice. CONCLUSION: Residency training location, regardless of prior ties to the geographical area, appears to be a major factor in the choice of practice location of emergency medicine residency graduates. Coworkers' personalities and credentials are more important factors in job selection than salary and employment arrangements.

Adult↗
PubMed1992

Scoring and setting pass/fail standards for an essay certification examination in nurse-midwifery.

Examination for certification or licensure of health professionals (credentialing) in the United States is almost exclusively of the multiple choice format. The certification examination for entry into the practice of the profession of nurse-midwifery has, however, used a modified essay format throughout its twenty-year history. The examination has recently undergone a revision in the method for score interpretation and for pass/fail decision-making. The revised method, described in this paper, has important implications for all health professional credentialing agencies which use modified essay, oral or practical methods of competency assessment. This paper describes criterion-referenced scoring, the process of constructing the essay items, the methods for assuring validity and reliability for the examination, and the manner of standard setting. In addition, two alternative methods for increasing the validity of the pass/fail decision are evaluated, and the rationale for decision-making about marginal candidates is described.

Certification↗
PubMed2000

The development of a post-baccalaureate certificate program in molecular diagnostics.

A post-baccalaureate certificate program in diagnostic molecular sciences was created in 1995 by the Diagnostic Genetic Sciences Program in the School of Allied Health at the University of Connecticut. The required on-campus lecture and laboratory courses include basic laboratory techniques, health care issues, cell biology, immunology, human genetics, research, management, and molecular diagnostic techniques and laboratory in molecular diagnostics. These courses precede a 6-month, full-time practicum at an affiliated full-service molecular laboratory. The practicum includes amplification and blotting methods, a research project, and a choice of specialized electives including DNA sequencing, mutagenesis, in situ hybridization methods, or molecular diagnostic applications in microbiology. Graduates of the program are immediately eligible to sit for the National Credentialing Agency examination in molecular biology to obtain the credential Clinical Laboratory Specialist in Molecular Biology (CLSp(MB). This description of the University of Connecticut program may assist other laboratory science programs in creating similar curricula.

Connecticut↗
PubMed1999

Designing and Evaluating Standard-Setting Procedures for Licensure and Certification Tests.

Passing scores for licensure and certification tests are justified by showing that decisions based on the passing score achieve the purposes of the credentialing program while avoiding any serious negative consequences. The standard should be high enough to provide adequate protection for the public, and not so high as to unnecessarily restrict the supply of qualified practitioners or to exclude competent candidates from practicing. This paper begins by examining the intended outcomes of licensure and certification programs and by outlining the interpretive argument that is typically used for written credentialing examinations. Criteria are then developed for evaluating standard-setting methods in terms of how well they serve the goals of protecting the public, maintaining an adequate supply of practitioners, and protecting the rights of candidates. Finally, the criteria are used to evaluate the Angoff method. This analysis identifies two potential sources of bias in the Angoff method, and suggests ways to control these weaknesses.

Journal Article↗
PubMed2000

Medical malpractice among physicians: who will be sued and who will pay?

This paper examines whether a physician's future claims of medical malpractice are predictable from information on the physician's recent claims history, training credentials, practice characteristics, and demographics. Data on the medical malpractice experience of 8,733 Michigan physicians between 1980 and 1989 is analyzed. We find strong evidence of repetition over time regarding who was sued and who paid claims. The worse a physician's malpractice litigation record during 1980-1984, the worse was his record during 1985-1989. Training credentials were also highly predictive of future malpractice experience. Physicians trained at lower ranked medical schools or who went through lower-ranked residency programs faced higher odds of developing adverse malpractice records, even after controlling for their previous litigation record. Growing internet access to information on these characteristics will help inform prospective patients if they wish to avoid physicians likely to be sued and likely to make payments in the future for malpractice.

Adult↗
PubMed1998

A performance indicator of psychosocial services in enhanced prenatal care of Medicaid-eligible women.

OBJECTIVE: Psychosocial services for low-income pregnant women vary widely in practice, and validated indicators of effective performance are lacking. The study presented here aims to determine whether a measure of provider compliance with a psychosocial service delivery guideline is associated with improved birth outcomes and therefore meets an important validity criterion of a performance indicator. METHODS: Data on psychosocial services delivered to 3467 pregnant women came from 27 sites certified by the California Department of Health Services to provide enhanced perinatal services to Medicaid-eligible women. Multivariate regression analyses were used to test the association of adequate service delivery according to a performance guideline with birth outcomes and the dependence of the association on the credentials of the provider and the type of practice setting. RESULTS: Women who received at least one psychosocial assessment each trimester of care according to the guideline were half as likely as women with inadequate services to have a low birthweight (OR = 0.49; CI 0.34, 0.71) or preterm birth (OR = 0.53; CI 0.40, 0.72) outcome. The effect did not depend on the credentials of the provider or the practice setting type. CONCLUSIONS: The indicator of the adequacy of psychosocial services according to a performance guideline appears to meet a fundamental criterion for a performance indicator, an association with improved outcomes. This indicator may be useful in monitoring performance of enhanced perinatal services for continuous quality improvement of services to low-income pregnant women.

Birth Weight↗
PubMed2003

What consumers want to know about commercial weight-loss programs: a pilot investigation.

OBJECTIVE: In 1999, the Partnership for Healthy Weight Management recommended that providers of commercial weight-loss programs (and products) voluntarily disclose information concerning the safety, costs, and central components of their programs, as well as the credentials of program staff. These guidelines were drafted without the benefit of data from consumers concerning the specific information they desired. The present study provides such data. RESEARCH METHODS AND PROCEDURES: Participants were 90 women with a mean age of 44.02 +/- 9.17 years and body mass index of 36.11 +/- 4.82 kg/m(2) who were participants in one of two randomized weight-control trials. Before treatment, respondents were asked to imagine that they were "looking for a weight-loss plan" and to rate how important each of 16 factors would be in helping them select a plan. Ratings were made using 5-point scales, anchored by "not at all important" and "extremely important," (scored 1 and 5, respectively). Participants also identified the five factors that they thought were the most important, as well as the single most important. RESULTS: The mean rating for the importance of safety (4.57 +/- 0.60) was significantly greater than that for each of the 15 other variables (all p values < 0.05). In addition, significantly more respondents (27.8%) selected safety as the single most important factor than any other variable (all p values < 0.05). Other factors that were consistently judged as very important included information about diet (4.38 +/- 0.68), behavior modification (4.32 +/- 0.76), cost (4.19 +/- 0.92), and maintenance of weight loss (4.15 +/- 0.91). Staff credentials (3.88 +/- 0.83) were among the lowest rated items. DISCUSSION: The results generally support the disclosure guidelines proposed by the Partnership for Health Weight Management. Consumers, however, seem to desire information about weight loss, in addition to that concerning safety, cost, and central program components.

Adult↗
PubMed2003

History and evolution of a successful certification program in nutrition support: the CNSD experience.

As early as the 1970s, articles were published on the role of dietitians in nutrition support. Both the American Society for Parenteral and Enteral Nutrition and The American Dietetic Association addressed the issues of specialization and certification. Development of a specialty area credential requires a strong demand by practicing clinicians, a unique area of clinical practice with a distinct body of knowledge and the commitment to evolve with clinical practice. Numerous dietitians were involved in the inception, development, and leadership that brought forth certification in nutrition support. This article documents the efforts and participation of a dedicated group of professionals whose common goals resulted in the establishment of a successful, sustaining certification in a specialty area of clinical dietetics: certified nutrition support dietitian. The certified nutrition support dietitian program is now in its 15th year with 2,000 dietitians currently certified both nationally and internationally. A primary focus of the credential is to recognize minimum competency for dietitians practicing in the field of enteral and parenteral nutrition and to provide safe and effective nutrition support therapy. This article provides a framework for persons in other specialty areas attempting to develop certification programs.

Certification↗
PubMed2000

The role of the advanced practice nurse in the care of organ transplant recipients.

The role of the advanced practice nurse (APN) in transplantation has evolved from the role of the clinical transplant coordinator. This report attempts to define the credentials, practice domains, barriers to practice, and reimbursement issues related to APN practice while contrasting the role with that of clinical transplant coordinator. The nephrology APN working in a collaborative transplant practice can be an integral part of a multidisciplinary health care team. The APN's education and credentials empower them to provide a wider scope of services than transplant coordinators who are "experts by experience." These services can include providing primary care and performing procedures such as percutaneous transplant biopsies, insertion of peripheral and central venous catheters, and wound debridement as well as management of patients along their continuum of transplant care. Patient education and advocacy also are key components of APN practice. In addition, the services the APN provides generally are reimbursable and therefore can provide revenue for the practice.

Humans↗
PubMed2001

Molecular targets for nutrients involved with cancer prevention.

Dietary nutrients can influence cancer risk by inhibiting or enhancing carcinogenesis through diverse mechanisms of action. The identification and elucidation of their sites of action have been a focus of nutrition and cancer research for more than four decades. Transforming nutrition and cancer research from a predominantly observational to a molecular approach offers exciting opportunities for truly identifying those who will and will not benefit from dietary intervention strategies. The emerging field of nutritional genomics, defined here as the study of any genetic or epigenetic interaction with a nutrient, will be key to this evolution. Unraveling which genetic upregulation or downregulation leads to subsequent phenotype changes will not be easy. There is evidence that genetic polymorphisms can influence the dynamics between nutrients and molecular targets and, thus, contribute to variation in response among individuals. Because many molecular targets will likely be identified, it may be necessary to credential nutrients, that is, to determine which specific nutrient-related genetic and epigenetic changes bring about phenotypic changes, to establish which interactions are the most important and under what circumstances. Vitamin D, calcium, folate, selenium, genistein, and resveratrol are highlighted, because they represent specific classes of nutrients and illustrate the need to credential various nutrients to understand their physiological significance in cancer prevention. As the science of nutrition unfolds, a clearer understanding will emerge about how nutrients can modulate cancer risk through molecular interactions and how foods might be changed by agronomic approaches and/or biotechnology. Undeniably, embracing new genomic technologies offers exciting opportunities for advances in the broad area of nutrition, especially those related to cancer prevention.

Anticarcinogenic Agents↗
PubMed1995

The role of Army physical therapists as nonphysician health care providers who prescribe certain medications: observations and experiences.

For two decades, Army physical therapists have been granted limited privileges to prescribe certain medications when serving as nonphysician health care providers for the primary evaluation and treatment of patients with neuromusculoskeletal dysfunctions. A brief summary of the events that led to this physician-extender role is presented. This article describes the Army regulations, credentialing process, and expanded clinical privileges developed to prepare and support physical therapists working as primary neuromusculoskeletal screeners who are credentialed to order certain pharmacologic medications. A historical synopsis of Army physical therapists ordering pharmacologic medications. A historical synopsis of Army physical therapists ordering pharmacologic medications in their expanded role as nonphysician health care providers is also presented. Results of a 1994 Army-wide survey of physical therapy clinics are provided in terms of medications prescribed and observations by those involved. The educational opportunities designed to ensure safe and appropriate uses of these privileges are described.

Drug Prescriptions↗
PubMed1995

Who uses transesophageal echocardiography in the operating room?

A survey was made of 155 anesthesiology residency programs in the United States to determine the patterns of use, responsibility for interpretation, and training of those responsible for intraoperative transesophageal echocardiography (TEE). Survey questions included numbers and types of cases for which TEE is used, who interprets TEE data and how they are trained, the extent of resident training in TEE, and beliefs about the utility of TEE. One hundred eight completed surveys were returned (70% response). Of those responding, 98 (91%) use intraoperative TEE. In 53 of those 98 institutions (54%), an anesthesiologist was primarily responsible for the interpretation of TEE data, whereas a cardiologist was responsible in the remainder. Approximately 35% of anesthesiologists using TEE had training in its use during residency or fellowship; the remainder were trained after finishing residency or fellowship. Forty-two percent of anesthesiologists who use TEE leave a formal interpretation on the chart apart from the anesthesia record, and 43% bill specifically for performing TEE. Although 69% of those responding thought that formal credentials should be required for anesthesiologists to use intraoperative TEE, only 32% reported that their institutions actually mandated this. 38% of those responding stated that they offer a dedicated TEE rotation to their residents, and 13% thought that their graduating residents were trained well enough to use TEE on their own. Among academic institutions responding, the use of intraoperative TEE is nearly universal, responsibility for its interpretation is split almost evenly between cardiologists and anesthesiologists, and there is a disparity between opinions and reality with regard to TEE credentialing for anesthesiologists.

Anesthesiology↗