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PubMed1992

Islet cell antigens in insulin-dependent diabetes: Pandora's box revisited.

A major goal of research into IDDM has been the identification of the 'causative antigen'. As described in this article by Len Harrison, this reductionist aim is confounded by the fact that numerous candidate islet cell antigens have been described. He scrutinizes the credentials of these candidates and discusses the problem of using autoantibodies to identify causative antigens in a T-cell-mediated disease.

Autoantibodies↗
PubMed1986

Certification: philosophy, goals, and methods, with application to the discipline of infection control practice.

The philosophy, goals, and methods of certification are complex and need to be understood in general before they can be applied to a specific practice discipline. This article is intended to provide background information about certification, summarize the history of credentialing for health occupations, and briefly describe methods for test design and construction. Philosophy, goals, methods, and preparation for certification are then applied to the discipline of infection control practice, with specific reference to the Infection Control Certification Examination, offered for the first time in November 1983 and in each subsequent year.

Certification↗
PubMed1986

Review of infection control literature 1973 through 1981.

A total of 446 manuscripts published between 1973 and 1981 were selected for analysis in this review of the literature. More than half of these articles used research designs, with presentations of epidemic outbreaks the single greatest category. The overall category of surveillance was addressed in some way in almost three fourths of all manuscripts reviewed. Some aspect of ICP role components was the topic of about 10% (n = 55) of the total sample. Physicians were credited as first authors in 56.7% of the articles. It was not possible to determine the exact extent of ICP authorship because credentials varied widely. Finally, a cursory effort was undertaken to quantify numbers of articles that might have met study criteria for inclusion in years after 1981. That effort confirmed the investigators' suspicion that the yearly total of published manuscripts continued to escalate, as did the number of specialty journals in infection control.

Authorship↗
PubMed1994

Social status and the health of families: a model.

The aim of this study is to examine the association of family health and social status, taking the family as the unit of analysis. One particular dimension of social status, lifestyle incongruity, is examined as a predictor of family health, relative to other stressors and sociodemographic variables. Lifestyle incongruity refers to the degree to which style of life (measured by the accumulation of consumer goods and the adoption of specific leisure activities) exceeds economic status (as assessed by occupational class and educational credentials). Using the 1980 General Household Survey of the United Kingdom, it was found that lifestyle incongruity discriminated between households with and without chronically ill members, and was associated with a global rating of family health, controlling for a variety of factors. The logic of studying the health of families, and the implications of these results for future research are discussed.

Adolescent↗
PubMed1991

ACC policy statement. Recommended guidelines for training in adult clinical cardiac electrophysiology. Electrophysiology/ Electrocardiography Subcommittee, American College of Cardiology.

Training in clinical cardiac electrophysiology should take place in an Accreditation Council for Graduate Medical Education accredited cardiology program, and the electrophysiology training program itself should be accredited by the Council. Each trainee must be eligible for board certification in Internal Medicine and either eligible for certification in Cardiovascular Diseases or in a program leading to eligibility. Training faculty should be certified in clinical cardiac electrophysiology or demonstrate equivalent credentials. At least two training faculty members are preferred. The faculty must be dedicated to teaching, active in performing or promoting research and must spend a substantial portion of their time in research, teaching and practice of clinical electrophysiology. A curriculum of training should be established. Faculty experts in the related basic sciences should be available and involved in teaching. The institution should have a fully equipped clinical electrophysiology laboratory and complete noninvasive capabilities. A close working relation with a cardiac surgery faculty member skilled in surgical treatment of arrhythmias is required. Training in application of pharmacologic and all current nonpharmacologic therapies, in the outpatient and inpatient setting, is necessary. The clinical exposure must include all facets of arrhythmia diagnosis and treatment and must be quantitatively sufficient to allow the trainee to develop proficiency. The period of training should not be less than one year in addition to the period of cardiology fellowship required by the ABIM for board eligibility. A continuous period of training is preferred.

Anti-Arrhythmia Agents↗
PubMedDate not supplied

Clinical procedures performed by emergency medicine resident physicians: a computer-based model for documentation.

To facilitate documentation and assess the number and types of clinical procedures actually performed by resident physicians, we developed a microcomputer-based recording process. After completing a procedure, including resuscitations, residents recorded in a precoded book issued for each monthly rotation. At the end of each rotation, the books were collected and the information was transferred to a database program by the clerical staff. During 1989, 17 emergency medicine resident physicians at PGY levels 1 through 3 utilized this system. Completed procedure record books were submitted for 124 of 148 clinically active months for a compliance rate of 84%. Of 1,857 procedures recorded, the most frequent were resuscitation (20%), orotrachael intubation (12%), and percutaneous central vein cannulation (12%). Commonly recorded were lumbar puncture (7%), diagnostic peritoneal lavage (5%), nasotrachael intubation (4%), and newborn delivery (4%). The high compliance rate suggests resident physicians acceptance. This system enables residency directors to closely monitor individual and group procedure experiences and to make curriculum changes based on objective findings. It also provides a means of storing and retrieving data for review organizations and credentials committees.

Documentation↗
PubMed1993

The Residency Review Committee for Surgery and the training of vascular surgeons.

PURPOSE: This article reviews the activities and actions of the Residency Review Committee (RRC) for Surgery in the accreditation process of of vascular surgery training programs since 1983. METHODS: The substantial changes of the Special Requirements for Graduate Education in General Vascular Surgery are discussed for 1983, 1987, 1989, and 1992. The rank-ordered list of RRC citations is reviewed. The national resident operative statistics for the past 4 years are reported for both general and vascular surgery residents. RESULTS: Changes in the Special Requirements have included deletion of two of the four types of programs, elimination of the need for institutional programs in specialties other than core general or thoracic surgery, and relaxation of the restriction against concurrent resident assignment. The most common citation continues to be the negative impact on general surgery residents. Nevertheless national operative statistics show a favorable increase in case load for both general and vascular surgery residents. CONCLUSIONS: Future challenges to surgical education and practice are summarized; the solutions to these challenges will require cooperative efforts of the RRC, the American Board of Surgery, and a number of specialty societies and credentialing or regulatory bodies.

Accreditation↗
PubMed2005

Advances in malaria genomics since MIM Arusha, 2002.

The promise of new interventions against malaria and other infectious diseases of global health importance derived from pathogen genomic sequence data may only be realized through the coordinated effort of genomic and post-genomics scientists, vaccine and drug developers along with lab- and field-based investigators. With the availability of the Plasmodium falciparum genome and the genomes of related species, post-genomics research can now be applied to the development of new interventions against malaria and may provide a more complete understanding of complex parasite biology. The vast amount of data that are generated through these new approaches must be organized, assembled and made accessible in a useful manner. By establishing a set of "credentials" for each gene in the genome, which captures information about gene expression, diversity, function and other information, the time and resources needed to test and evaluate candidate drugs and vaccines can be substantially reduced and a more complete picture of parasite biology can be created.

Animals↗
PubMedDate not supplied

EMS certification requirements for flight nurses.

INTRODUCTION: Emergency medical technician (EMT) or paramedic (EMTP) certification requirements for flight nurses (FNs) providing on-scene patient care vary. We surveyed those requirements and evaluated the relationships between flight team composition or program location and FN EMS certification. METHODS: Telephone survey of all 184 rotor-wing programs responding with a nurse to scenes RESULTS: The overall EMS training requirement for FNs was: none-57.6%, EMT-21.7%, EMTP-14.7%, local credential (not EMT or EMTP)-6.0%. Second team members were EMTP, RN, physician, or respiratory therapist (RRT). Overall, team configuration related significantly to FN EMS certification (P =.01). FN/EMTP and FN/RRT teams were individually significant (P <.01), with FN/EMTP teams tending not to require certification and all FN/RRT teams tending toward a certification requirement. Neither FN/FN nor FN/physician pairings related significantly with FN EMS certification requirements. Regional patterns emerged to both crew configuration and FN EMS certification requirements. CONCLUSION: Most flight programs do not require FN EMT/EMTP certification. Team configuration and geography are related to those requirements.

Air Ambulances↗
PubMed2005

Consumer health information on the Internet about carpal tunnel syndrome: indicators of accuracy.

PURPOSE: To identify indicators of accuracy for consumer health information on the Internet. METHODS: Several popular search engines were used to find websites on carpal tunnel syndrome. The accuracy and completeness of these sites were determined by orthopedic surgeons. It also was noted whether proposed indicators of accuracy were present. The correlation between proposed indicators of accuracy and the actual accuracy of the sites was calculated. RESULTS: A total of 116 websites and 29 candidate indicators were examined. A high Google toolbar rating of the main page of a site, many inlinks to the main page of a site, and an unbiased presentation of information on carpal tunnel syndrome were considered genuine indicators of accuracy. Many proposed indicators taken from published guidelines did not indicate accuracy (e.g., the author or sponsor having medical credentials). CONCLUSION: There are genuine indicators of the accuracy of health information on the Internet. Determining these indicators, and informing providers and consumers of health information about them, would be useful for public health care. Published guidelines have proposed many indicators that are obvious to unaided observation by the consumer. However, indicators that make use of the invisible link structure of the Internet are more reliable guides to accurate information on carpal tunnel syndrome.

Carpal Tunnel Syndrome↗
PubMed2006

Self-assessment during a 2-day laparoscopic colectomy course: can surgeons judge how well they are learning new skills?

BACKGROUND: The objectives of this study were to (1) establish the utility of an assessment tool for participants in a laparoscopic colectomy course and (2) to determine the accuracy of technical skill self-assessment in this group. METHODS: Twenty-two surgeons enrolled in a 2-day course participated. During the animal laboratory, each participant's operative performance was videotaped. Participants completed a global rating scale (GRS) instrument to self-assess their performances. By using the same GRS, 2 trained raters independently assessed each performance by videotape review. RESULTS: For the trained raters, the GRS showed excellent interrater reliability (r = .76, P < .001). There was no correlation between trained rater scores and self-assessment scores. Furthermore, the trained rater scores (mean, 2.62 and 2.99) were significantly lower than the self-assessment scores (4.05, P < .001). CONCLUSIONS: Surgeons consistently overestimated their performance during a laparoscopic colectomy course as measured by reliable GRS. This finding highlights the issue of credentialing and the importance of preceptorship for surgeons completing such courses.

Animals↗
PubMed2005

Emergency medicine clerkship directors: defining the characteristics of the workforce.

STUDY OBJECTIVE: Clerkship directors design and implement educational programs for students. Scholarly productivity is necessary for academic advancement. We define characteristics of emergency medicine clerkship directors and evaluate determinants of scholarly productivity and job satisfaction. METHODS: This is a cross-sectional survey. Clerkship directors for emergency medicine senior rotations completed a confidential online questionnaire. Demographic data were analyzed with descriptive statistics. Scholarly productivity and job satisfaction indices were created for multivariate analysis. RESULTS: One hundred eleven (82%) of 136 directors responded (age 38.9+/-7.0 years; men 72.1%; junior academic rank 72.1%; served as clerkship directors for < or =5 years 77.4%; formal training in education: medical education fellowship 36%, teaching credential 12.7%, emergency medicine subspecialty fellowship 6.3%; support for clerkship director's activities: clinical hours reduction 2.7+/-2.3 weekly; minimal training for clerkship director's role 85.6%; ongoing professional development 40.5%; scholarly productivity: < or =5 peer-reviewed publications 78.4%, grant 28%, textbook chapter 65%; plan to be clerkship director in 5 years 63%; perceived support from supervisor 88%; perceived value from colleagues 81%; perception that clerkship directors is as important as residency director 47.8%). Multivariate regression shows a significant effect of medical education fellowship (P =.013) and subspecialty training (P =.044). Departmental support enhances the effect of medical education (P =.008) or subspecialty (P =.026) fellowships and improves productivity for senior faculty (P =.047). Multivariate regression explaining job satisfaction shows a positive effect of reduced clinical hours (P =.038) and increased faculty development (P =.033). CONCLUSION: Most emergency medicine clerkship directors are junior faculty with minimal release time or training for their positions.

Adult↗
PubMed2005

The psychiatric nurse practitioner 1993-2003: a decade that unsettled a specialty.

Between 1993 and 2003, a debate raged in psychiatric mental health (PMH) nursing. It was a decade of discourse about the role and titling of PMH advanced practice nurses. The PMH role evolution that occurred throughout this decade was driven by several forces, not all of which were in the control of PMH nursing. This article traces the multiple dynamics that prompted the evolution of the PMH nurse practitioner role, foremost the ascendancy of primary care and the influence of managed care. It also analyzes the conflict created by the American Nurses Credentialing Center PMH Nurse Practitioner examination that became a lightning rod for the disruption occurring in the traditional PMH role. Although the controversy surrounding PMH advanced practice nurse titling is beginning to clear, with the clarity comes a new set of problems for the development of the PMH workforce.

Certification↗
PubMedDate not supplied

Quality assurance methods for the first Radiation Therapy Oncology Group permanent prostate implant protocol.

PURPOSE: To report the quality assurance methodology used by the Radiation Therapy Oncology Group in the first cooperative group, multi-institution Phase II trial of transrectal ultrasound guided permanent radioactive implantation of the prostate for definitive treatment of localized adenocarcinoma of the prostate. METHODS AND MATERIALS: Participating institutions were credentialed to participate in this protocol, Radiation Therapy Oncology Group 98-05. International Commission on Radiation Units and Measurements (ICRU) Report 58 was used as the basis for definition of terms. The AAPM's dosimetric prerequisites for low energy interstitial brachytherapy sources were adopted. A nondigital approach to central review was used. The implant dosimetry was recalculated based upon centrally reviewed target volumes by both a radiation oncologist and a diagnostic radiologist. RESULTS: There are differences in the definition of the postimplant prostate between the participating institution, the central review radiation oncologist, and the central review diagnostic radiologist. Thus, there are differences in dose/volume parameters. Six of the 95 patients reviewed did not meet the per protocol criteria based upon information supplied by the participating institution. This increased to 18 cases when using the postimplant target volume defined by the central oncologist and to 23 cases when defined by the radiologist. CONCLUSIONS: This work indicated that there is a need for a central review process of dose-volume analysis within the cooperative group setting. It is indicated that a digital approach to centralized review, which has now been developed, would result in a higher quality and easier review.

Adenocarcinoma↗
PubMedDate not supplied

Essential activities and knowledge domains of case management: new insights from the CCMC role and functions study.

The Commission for Case Manager Certification (CCMC) defines case management (CM) as "a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs. [Case management] uses communication and available resources to promote quality, cost-effective outcomes." The practice of CM spans the entire health-care spectrum, including pre-acute, acute, and post-acute settings, and the involvement of varied care providers, such as nurses, social workers, rehabilitation counselors, physicians, and other allied health professionals. So what does it mean to practice as a case manager? What roles and job functions are performed and what knowledge is required of a professional in the field for effective practice? These highly relevant questions reflect the thinking of the CCMC commissioners when the latest Case Manager Role and Functions study was undertaken. The primary purpose of this research, which is conducted every 5 years by the CCMC, is to capture the current state of CM practice. This type of in-depth research is required to support an evidence-based certification examination such as the one offered by CCMC-the certified case manager (CCM) credential. Moreover, as the first and largest nationally accredited organization to certify US case managers, the CCMC recognizes its responsibility to undertake and promote scientifically conducted research in the field of CM.

Case Management↗
PubMed2004

Using humans to study the physiological evolution of energy metabolism: a tribute to Peter Hochachka.

Comparative physiology traditionally relies on unusual animals to explore the mechanistic basis or evolution of physiological processes. Despite his credentials as a comparative physiologist, much of the recent work by Peter Hochachka relied upon humans as "comparative" models. Technological advances in clinical analyses and expanding databases of genomic diversity have made humans a very "convenient" model to study the evolution of metabolism. For example, a growing number of metabolic diseases have been shown to have a genetic basis. Obesity, type II diabetes, metabolic syndrome X may each have linkages to polymorphisms in genes encoding transcriptional regulators of bioenergetic genes. Genetic polymorphisms and gene families for these important transcription factors inspire questions about the evolution of energy metabolism in other animals. Thus, these biomedical studies provide important direction for researchers interested in exploring the regulatory basis of interspecies variations in bioenergetics.

Biological Evolution↗
PubMed2006

Nursing lessons from the MHA keystone ICU project: developing and implementing an innovative approach to patient safety.

Given the pivotal role of nurses in providing and supervising patient care, it is essential that nursing professionals are engaged fully in making care safer. Nursing involvement was instrumental in the Michigan Health and Hospital Association Keystone ICU Project, which resulted in rapid reduction in catheter-related blood stream infection rates and ventilator-associated pneumonia rates. Nurses of every credential and every nursing position participated in this broad scale improvement effort. This article describes the MHA Keystone ICU Project, including challenges implicit in changing nursing practice and team behavior in the ICU. The improvement strategies implemented by Keystone ICU teams, and lessons learned by nurses engaged in the work, are likely to have application in other clinical settings.

Catheterization, Central Venous↗
PubMed2005

Possible mechanisms for why desensitization and exposure therapy work.

Rosen and Davison [Rosen, G.M. and Davison, G.C. (2003). Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages. Behavior Modification, 27, 300-312] recommended that empirically supported principles be listed instead of empirically supported treatments because the latter approach enables the creation of putatively new therapies by adding functionally inert components to already listed effective treatments. This article attempts to facilitate inquiry into empirically supported principles by reviewing possible mechanisms responsible for the effectiveness of systematic desensitization and exposure therapy. These interventions were selected because they were among the first empirically supported treatments for which some attempt was made at explanation. Reciprocal inhibition, counterconditioning, habituation, extinction, two-factor model, cognitive changes including expectation, self-efficacy, cognitive restructuring, and informal network-based emotional processing explanations are considered. Logical problems and/or available empirical evidence attenuate or undercut these explanations. A connectionist learning-memory mechanism supported by findings from behavioral and neuroscience research is provided. It demonstrates the utility of preferring empirically supported principles over treatments. Problems and limitations of connectionist explanations are presented. This explanation warrants further consideration and should stimulate discussion concerning empirically supported principles.

Cognition↗