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PubMed2006

The mental health professions: workforce supply and demand, issues, and challenges.

The U.S. mental health (MH) workforce is comprised of core disciplines: psychology, psychiatry, social work, psychiatric nursing, and marriage and family therapy. A broader group of practitioners also deserves recognition. Diverse professions provide significant services in a variety of settings, extending the de facto mental health workforce. A tally of key disciplines estimates there are 537,857 MH professionals, or 182 per 100,000 U.S. population. This article provides an overview of the need and demand for mental health services and summarizes the MH professions (e.g., training, educational credentials, workforce estimates). It also discusses a range of challenges confronting MH professionals and the need for greater understanding of the workforce and integration of services. Methodological factors that confound estimates of the magnitude of the MH workforce are reviewed.

Career Choice↗
PubMed2026

A comparative systematic review of pharmacist education systems and pharmacy service quality in ASEAN-5: Indonesia, Malaysia, Thailand, the Philippines, and Singapore.

BACKGROUND: The global transition toward patient-centered pharmaceutical care has exposed structural disparities in ASEAN pharmacy workforce training and deployment. This review examines four research questions: how pharmacy education systems and accreditation standards differ across Indonesia, Malaysia, Thailand, the Philippines, and Singapore (collectively, the ASEAN-5); the extent to which pre-registration education influences clinical service scope and professional confidence; how education reform and regulatory change have shaped pharmacist clinical roles; and what barriers and enablers exist for regional qualification harmonization. METHODS: A systematic literature review following PRISMA 2020 was conducted. Searches of PubMed/MEDLINE and Scopus, supplemented by grey literature, were completed in May 2026. Of 78 unique records screened, 46 studies published between 2005 and 2026 met inclusion criteria. Quality appraisal used an adapted Mixed Methods Appraisal Tool; synthesis employed narrative thematic analysis. RESULTS: The five countries represent four structurally distinct pharmacy education architectures: Thailand's standardized six-year Doctor of Pharmacy with dual specialization tracks; four-year Bachelor of Pharmacy programmes in Malaysia and the Philippines with institutional variation; Indonesia's clinically underdeveloped system despite rapid expansion; and Singapore's four-year Bachelor of Pharmacy followed by a nationally mandated one-year pre-registration pathway. Evidence links deeper clinical training to broader practice scope, higher confidence, and improved patient outcomes. Reform produced uneven results: Thailand's PharmD transition improved clinical recognition but exposed deployment paradoxes; Singapore achieved the strongest training-to-practice alignment; Indonesia's health insurance reforms were not absorbed by an underprepared workforce; the Philippines lacks a national competency framework. No binding mutual recognition arrangement was identified; divergent qualification structures, incompatible accreditation systems, and an asymmetric evidence base remain the primary barriers. DISCUSSION: These findings indicate that clinical service scope is bounded less by national policy ambition than by the depth and clinical orientation of the pre-registration education that precedes it, and that credentialing reforms which outpace a health system's capacity to absorb new clinical roles, or the reverse, do not by themselves translate into expanded practice. CONCLUSIONS: Pharmacy education across the ASEAN-5 remains nationally distinct and clinically uneven. Clinical service scope is directly bounded by pre-registration education quality. No country has fully closed the education-practice gap. Regional harmonization requires national-level educational reform as a prerequisite.

Humans↗
PubMedDate not supplied

A program for successful integration of international medical graduates (IMGs) into U.S. surgical residency training.

OBJECTIVE: U.S. surgery residency programs have traditionally attracted international medical graduates (IMGs). However, the qualifications and performance of IMGs are variable and difficult to predict. Poor performance negatively affects patient care, the residency program, and the IMGs. We sought to identify causes of poor performance and to develop a program to identify those with chances to succeed. DESIGN: Longitudinal study. Retrospective analysis. Description of a new program. SETTING: University of Washington, a tertiary care teaching hospital. PARTICIPANTS: Performance of former IMG residents was reviewed to define the most common reasons for failure. In August 2002, we developed an IMG Certificate Program that enrolls IMGs into a formal 8-week clinical experience with duties, responsibilities, and evaluations similar to fourth-year medical students. A final global score is given for potential for success as a resident in our program. RESULTS: Poor performance in past IMG residents could be attributed to: credential problems and poor performance. Performance problems were further subdivided to include knowledge issues and personal/cultural issues. Since August 2002, our Certificate Program enrolled 15 IMGs. Fourteen graduated, and 10 were offered preliminary spots in our program: 4 are successful interns, 1 returned to Italy, and 5 will start in 2004. One entered the 2004 match in Anesthesiology, and 1 was counseled to not be a candidate for a U.S. program. Three had above average performance and were felt to be better suited to a smaller program (1-2 hospitals). The mean "potential for success" global score was 3.9 (all grads), 4.6 (current interns), 1.0 (nongraduate), and 3.0 for the above average performers better suited to a smaller U.S. program. CONCLUSIONS: We developed a program that provides IMGs an 8-week clinical experience in a busy U.S. training program; it provides them with enough experience to successfully integrate into a U.S. residency and identifies those with better chances to succeed. Wide application of this program and exchange of information among program directors may facilitate recruitment and the successful completion of training of IMGs and provide the number of residents needed to fill critical positions in the United States.

Certification↗
PubMed2006

Susceptibility testing practices for Streptococcus pneumoniae: results of a proficiency testing survey of clinical laboratories.

In June 2003, a test sample was sent to 355 laboratories enrolled in a proficiency testing program to assess their ability to detect low-level penicillin resistance in a strain of Streptococcus pneumoniae. One hundred fifty participants reported results for antimicrobial susceptibility testing. Of the 62 respondents using disk diffusion, 34 (55%) failed to report a result that was acceptable for detecting penicillin resistance and 30 (48%) reported a result for one or more drugs not approved for testing S. pneumoniae. Moreover, 12 (14%) of the 88 respondents using minimum inhibitory concentration methods reported results for at least one unapproved drug. These findings support the conclusions of other studies that antimicrobial susceptibility testing practices are suboptimal in many laboratories. Resolution of this problem will require continued educational initiatives, studies to discover the reasons why laboratories fail to follow published standards, and enforcement of the use of standards by regulatory and credentialing agencies.

Bacteriological Techniques↗
PubMedDate not supplied

Medical Reserve Corps: strengthening public health and improving preparedness.

Across the United States, millions of Americans volunteer their time and efforts to improve the social fabric of their communities. Inevitably, some of these volunteers will be medical and public health professionals. However, because of the complexities of the health field, including concerns about credentialing, training and legal protections, many of these persons have not been able to volunteer in their professional capacities. The terrorist events of 2001 showed that not only would individuals with medical and public health expertise want to volunteer, but that their help could be very much needed in future mass catastrophic events. The Medical Reserve Corps Program was created as a national system of community-based units to promote the local identification, recruitment, training, and activation of volunteers, especially those with medical and public health backgrounds. These Medical Reserve Corps units supplement the existing public health and emergency response entities in the community.

Community Health Services↗
PubMed2005

Novel cytotoxic and biological agents for prostate cancer: where will the money be in 2005?

In 2004, docetaxel-based chemotherapy became the first treatment capable of extending life in androgen-independent prostate cancer. The era of therapeutic nihilism in this disease has thus been put to rest and a broad range of agents is being tested with the goal of improving on the successes of 2004. Lessons learned from other tumour types will need to be applied to prostate cancer in order to harness the bounty of available ideas. Target amplification or activating mutations and not merely the presence of a target are likely to be important to the success of targeted agents. Thus, the promise of the current crop of targeted agents is most likely to be realised when pursued in the context of well-credentialed targets and tested in highly translational clinical trials that are capable not only of assessing tumour response, but also of evaluating the status of the targeted pathway. The most promising agents in clinical development are reviewed.

Angiogenesis Inhibitors↗
PubMedDate not supplied

Funding mechanisms for depression care management: opportunities and challenges.

OBJECTIVE: Inconsistent third-party reimbursement for depression care management is a significant economic barrier to the utilization and sustainability of the chronic illness care model in primary care practice settings. We review common mechanisms used to procure payment for depression care management services, discuss obstacles encountered and suggest future directions. METHOD: We describe several extant models for funding depression care management services in use at the demonstration sites of the Robert Wood Johnson Foundation funded "Depression in Primary Care" project and similar programs. We derived this information from ongoing discussions with the sites' project directors and through an extensive electronic literature search on "care management, funding mechanisms and depression." RESULTS: Funding mechanisms include (a) practice-based care management on a fee-for-service basis, (b) practice-based care management under contract to health plans, (c) global capitation, (d) flexible infrastructure support for chronic care management, (e) health-plan-based care management, (f) third-party-based care management under contract to health plans and (g) hybrid models. CONCLUSIONS: While substantial obstacles remain in the way of fully implementing these depression care management funding mechanisms (e.g., variations in care managers' credentials and work locations and third-party payer concerns about overutilization and transaction costs), several recent policy advances provide some optimism for the potential adoption of financial mechanisms to support and disseminate these evidence-based practices.

Capitation Fee↗
PubMed2006

Can U.S. GI fellowship programs meet American Society for Gastrointestinal Endoscopy recommendations for training in EUS? A survey of U.S. GI fellowship program directors.

BACKGROUND: American Society for Gastrointestinal Endoscopy (ASGE) EUS training and credentialing guidelines exist, but the capability of U.S. GI fellowships to meet these guidelines has not been assessed. OBJECTIVE: To ascertain the capability of U.S. GI fellowship programs to meet ASGE guidelines for EUS training in the context of 3-year and advanced GI fellowships. METHODS: U.S. GI fellowship programs were surveyed for the presence or the absence, type, and extent of EUS training. Demographics regarding the programs and the program directors were obtained. MAIN OUTCOME MEASUREMENTS: Data on the annual total EUS volume and data on EUS performed by 3-year and/or advanced-year fellows were collected and analyzed. RESULTS: Ninety-one of 142 contactable GI programs responded (64%); 72% of programs performed >200 EUS/y and thus could train >or=1 EUS trainee/y. For 3-year GI fellows, 55% received less than 3 months of training, with 43% not receiving actual "hands-on" EUS experience, and 61% not learning EUS-guided FNA. The median EUS performed by 3-year fellows was 50 (0-350). Programs that offer advanced endoscopy fellowship had a median advanced-trainee EUS volume of 200 procedures (range, 50-1100 procedures). Of advanced fellows, 20% failed to receive "hands-on" training and 52% performed <200 procedures. We observed a significant difference in the median EUS volume performed by 3-year versus advanced-year fellows (P<.001). Program director variables did not correlate with training EUS volumes. CONCLUSIONS: The majority of U.S. GI fellowship programs have established the EUS volume to train at least 1 EUS fellow, per ASGE guidelines; however, most 3-year and many advanced fellows are currently receiving insufficient EUS training.

Clinical Competence↗
PubMed2006

Currently available simulators: ex vivo models.

The introduction of the ex vivo tissue endoscopy simulators represents a major advance in endoscopic training, particularly in therapeutic endoscopy. The simulators have been popular teaching tools from the start, and the data supporting their benefit are accruing, especially in hemostasis training. Simulators like the compact EASIE may prove most beneficial as training tools for interventional skills that require repetitive practice and a larger volume of procedures than may occur naturally during the course of standard endoscopy practice. More data are needed to confirm that hands-on simulator training improves outcomes in clinical endoscopic performance and to characterize better the influence of such simulator work on subsequent endoscopic practice. As ex vivo simulators become more available, it is likely that these models will enhance initial training and also allow practicing gastroenterologists to acquire new techniques, maintain their skills, and demonstrate proficiency for credentialing purposes.

Animals↗
PubMed2006

Certification from the American Board of Pathology: getting it and keeping it.

In the last 5 years, there have been significant changes in the process of obtaining (and maintaining) certification in anatomic and/or clinical pathology and in pathology subspecialties. These changes include the elimination of the requirement for a "credentialing year" with its attendant "double class" of residents; the implementation of a mandatory maintenance-of-certification program for all persons certified by the American Board of Pathology, Tampa, Fla, on or after January 1, 2006; and the alterations in format and manner of grading for the certifying examinations. This article updates the pathology community regarding these changes and provides references where candidates and diplomates can find the most recent information regarding all aspects of certification and maintenance of certification.

Certification↗
PubMed2005

Guidelines for operative vaginal birth. Number 148, May 2004.

OBJECTIVE: To provide guidelines for operative vaginal birth in the management of the second state of labour. OPTIONS: Nonoperative techniques, episiotomy, and Caesarean section are compared to operative vaginal birth. OUTCOME: Reduced fetal and maternal morbidity and mortality. EVIDENCE: MEDLINE and Cochrane databases were searched using the key words "vacuum" and "birth" as well as "forceps" and "birth" for literature published in English from january 1970 to June 2004. The level of evidence and quality of recommendations made are described using the Evaluation of Evidence from the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS: (1) Nonoperative interventions such as one-to-one support, partogram use, oxytocin use, and delayed pushing in women using epidurals will decrease need for operative birth (I-A). (2) Manual rotation may be used alone or in conjunction with instrumental birth with little or no increased risk to the pregnant women or the fetus (III-B). (3) Routine episiotomy is not necessary for an assisted vaginal birth (II-1E). (4) When operative intervention in the second stage of labour is required, the options, risks, and benefits of vacuum, forceps, and Caesarean section much be considered. The choice of intervention needs to be individualized, as one is not clearly safer or more effective than the other (II-B). (5) Failure of the chosen method, vacuum and/or forceps, to achieve delivery of the fetus in a reasonable time should be considered an indication for abandonment of the method (III-C). (6) Adequate clinical experience and appropriate training of the operator are essential to the safe performance of operative deliveries. Hospital credentialing boards should grant privileges for performing these techniques only to an appropriately trained individual who demonstrates adequate skills (III-C). VALIDATION: The Clinical Practice Obstetrics Committee and Executive and Council of the Society of Obstetricians and Gynaecologists of Canada approved these guidelines.

Cesarean Section↗
PubMed2004

Computer science education for medical informaticians.

The core curriculum in the education of medical informaticians remains a topic of concern and discussion. This paper reports on a survey of medical informaticians with Master's level credentials that asked about computer science (CS) topics or skills that they need in their employment. All subjects were graduates or "near-graduates" of a single medical informatics Master's program that they entered with widely varying educational backgrounds. The survey instrument was validated for face and content validity prior to use. All survey items were rated as having some degree of importance in the work of these professionals, with retrieval and analysis of data from databases, database design and web technologies deemed most important. Least important were networking skills and object-oriented design and concepts. These results are consistent with other work done in the field and suggest that strong emphasis on technical skills, particularly databases, data analysis, web technologies, computer programming and general computer science are part of the core curriculum for medical informatics.

Curriculum↗
PubMed2004

A cross-platform model for secure Electronic Health Record communication.

During the past decade, there have been many regional, national and European projects focused on the development of platforms for secure access and sharing of distributed patient information. A platform is needed because present local or enterprise-wide information systems are typically not intended for cross-organisational secure access of patient data. Most of the present secure platforms are local or regional. Commonly used platform types in the health care environment vary from secure point-to-point communication systems to internet-based portals. This paper defines an enhanced cross-security platform which makes it possible for different kinds of local, regional, and national health information systems to communicate in a secure way. The proposed evolutionary way interconnects regional or national security domains with the help of a cross-platform zone. A more revolutionary model based on peer-to-peer Grid like networks and dynamic security credentials is also discussed. The proposed evolutionary model uses cross-domain security and interoperability services to ensure secure communication and interoperability between different security domains. The platform supports both communication defined beforehand and adhoc dynamic access to distributed electronic health records (EHRs). The internet is proposed as the "glue" between different regional or national security domains.

Access to Information↗
PubMed2006

Information governance in NHS's NPfIT: a case for policy specification.

PURPOSE: The National Health Service's (NHS's) National Programme for Information Technology (NPfIT) in the UK with its proposed nation-wide online health record service poses serious technical challenges, especially with regard to access control and patient confidentiality. The complexity of the confidentiality requirements and their constantly evolving nature (due to changes in law, guidelines and ethical consensus) make traditional technologies such as role-based access control (RBAC) unsuitable. Furthermore, a more formal approach is also needed for debating about and communicating on information governance, as natural-language descriptions of security policies are inherently ambiguous and incomplete. Our main goal is to convince the reader of the strong benefits of employing formal policy specification in nation-wide electronic health record (EHR) projects. APPROACH: Many difficulties could be alleviated by specifying the requirements in a formal authorisation policy language such as Cassandra. The language is unambiguous, declarative and machine-enforceable, and is based on distributed constrained Datalog. Cassandra is interpreted within a distributed Trust Management environment, where digital credentials are used for establishing mutual trust between strangers. RESULTS: To demonstrate how policy specification can be applied to NPfIT, we translate a fragment of natural-language NHS specification into formal Cassandra rules. In particular, we present policy rules pertaining to the management of Clinician Sealed Envelopes, the mechanism by which clinical patient data can be concealed in the nation-wide EHR service. Our case study exposes ambiguities and incompletenesses in the informal NHS documents. CONCLUSIONS: We strongly recommend the use of trust management and policy specification technology for the implementation of nation-wide EHR infrastructures. Formal policies can be used for automatically enforcing confidentiality requirements, but also for specification and communication purposes. Formalising the requirements also reveals ambiguities and missing details in the currently used informal specification documents.

Access to Information↗
PubMed2005

A phase I/II trial to evaluate three-dimensional conformal radiation therapy confined to the region of the lumpectomy cavity for Stage I/II breast carcinoma: initial report of feasibility and reproducibility of Radiation Therapy Oncology Group (RTOG) Study 0319.

BACKGROUND: This prospective study (Radiation Therapy Oncology Group Study 0319) examines the use of three-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Reproducibility, as measured by technical feasibility, was the primary end point with the goal of demonstrating whether the technique is widely applicable in a multicenter setting before a Phase III trial is undertaken. METHODS AND MATERIALS: This study was designed such that if fewer than 5 cases out of the first 42 patients evaluable were scored as unacceptable, the treatment would be considered reproducible. Patients received 38.5 Gy in 3.85 Gy/fraction delivered twice daily. The clinical target volume included the lumpectomy cavity plus a 10-15-mm margin bounded by 5 mm within the skin surface and the lung-chest wall interface. The planning target volume (PTV) included the clinical target volume plus a 10-mm margin. Treatment plans were judged as follows: (1) No variations (total coverage), 95% isodose surface covers 100% of the PTV and all specified critical normal tissue dose-volume histogram (DVH) limits met. (2) Minor variation (marginal coverage), 95% isodose surface covers between > or = 95% and <100% of the PTV. No portion of PTV receives <93% of prescription (isocenter) dose. All specified critical normal tissue DVH limits fall within 5% of the guidelines. (3) Major variation (miss), 95% isodose surface covers <95% of the PTV. Portion of PTV receives <93% of prescription isocenter dose. Any critical normal tissue DVH limit exceeds 5% of the specified value. RESULTS: A total of 58 patients were enrolled on this study between 8/15/03 and 4/30/04, 5 of whom were ineligible or did not receive protocol treatment. Two additional patients were excluded, one because the on-study form was not submitted, and the other because no treatment planning material was submitted. This primary end point analysis is based on the first 42 (out of 51) evaluable patients, which were accrued from 17 different institutions (31 centers were credentialed for case enrollment, but because of rapid accrual, not all centers were able to submit cases before trial closure). These 42 patients had the following characteristics: median age was 61 years; 48% had a maximum tumor dimension of <1 cm; 86% had invasive ductal carcinoma; 64% were postmenopausal; the location of tumor was upper outer for 40% and upper central for 21%; 79% had no chemotherapy, and 64% had no hormonal therapy. There were 4 cases with major variations (all 4 related to normal tissue DVHs exceeding 5% of the specified limit). A total of 32 cases with minor variations in treatment plans were detected (16 related to normal tissue DVHs exceeding the specified limits [by < or = 5%], 6 related to suboptimal coverage of the PTV, and 10 related to both). There were 6 cases with no variations. Of the 51 total evaluable patients, 1 additional major variation was noted (PTV receiving <93% of the prescription dose). An additional 5 cases with minor variations in treatment plans were detected (3 related to normal tissue DVHs exceeding the specified limits [by < or = 5%], 1 related to suboptimal coverage of the PTV, and 1 related to both). There were 3 more cases with no variations. CONCLUSION: Accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy was shown in this preliminary analysis of the first 42 evaluable patients to be technically feasible and reproducible in a multi-institutional trial using exceptionally strict dosimetric criteria.

Adult↗
PubMed2007

The accuracy of focused assessment with sonography in trauma (FAST) in blunt trauma patients: experience of an Australian major trauma service.

UNLABELLED: Focused assessment with sonography for trauma (FAST) is a method for detecting haemoperitoneum in trauma patients on initial assessment in the Emergency Department. The aim of this paper is to present an Australian trauma centre's experience with FAST as a tool to screen for intraabdominal free fluid in patient's sustaining blunt truncal trauma. METHOD: Over a 63-month period, FAST scans were prospectively studied and compared with findings from a gold-standard investigation, either computed tomography (CT) or laparotomy. RESULTS: 463 FAST results were collected prospectively from 463 patients. 53 scans were excluded due to lack of a corresponding confirmatory gold-standard test. Overall sensitivity, specificity, positive and negative predictive values for FAST in detecting free fluid were 78%, 97%, 91%, 93%, respectively. Analysis of the credentialed operators demonstrated an improvement in accuracy (sensitivity 80%, specificity 100%, positive predictive value 100%, negative predictive value 94%). These findings are comparable with documented international experience. CONCLUSION: The study demonstrates that the use of non-radiologist performed FAST in the detection of free fluid is safe and accurate within an Australian Trauma Centre.

Adolescent↗
PubMed2004

Patterns of continuing professional education in registered dietitians and dietetic technicians, registered.

This study compared the continuing professional education (CPE) activities of registered dietitians (RDs) with those of dietetic technicians, registered (DTRs). A descriptive research study was used with data from the baseline survey evaluating the Commission on Dietetic Registration's (CDR) Professional Development Portfolio. The survey was sent to 3,530 randomly selected RDs and DTRs; 1,429 surveys were returned (40.5% response rate), with 41% of RDs contacted responding and 32% of DTRs responding. Guidance used when selecting CPE activities and type of CPE activity selected were measured. DTRs sought more guidance than RDs when selecting CPE activities (P=.001). A significantly higher percentage of RDs than DTRs selected lectures, workshops, journal clubs, satellite courses, exhibits, professional leadership, professional reading, and poster sessions as CPE activities (P<.05). These findings will aid CPE providers in knowing which CPE activities are typically selected by both dietetics credential groups. DTRs may need guidance in selecting CPE activities.

Adult↗
PubMed2005

Functions performed by level of practice of registered dietitian members of the diabetes care and education dietetic practice group.

The purpose of this study was to examine current professional practices of registered dietitians (RDs) in the Diabetes Care and Education dietetic practice group (DPG), analyzed by levels of practice: entry-level, specialty-practice, or advanced-level. The results of the Diabetes Care and Education DPG 2002-2003 membership survey were used for this study. The study was limited to RD members of the Diabetes Care and Education DPG who completed the membership survey in its entirety. Frequency distributions, chi2, Fisher exact test, and cluster analysis were performed with a prior alpha set at .10. Sixty-one (5.0%) RDs were functioning as an entry-level practitioner, 851 (69.1%) were functioning as a specialty-practice practitioner, and 320 (25.1%) as an advanced-level practitioner. Significantly more advanced-level practitioners were performing more tasks compared with entry-level practitioners. Entry-level RDs performed a mean of 2.4 functions, specialty-practice practitioners performed 7.7, and advanced-level practitioners performed 11.6 functions. The results of this survey further delineated that RDs function at various levels of practice and that credentials for RDs increased as level of practice advanced.

Chi-Square Distribution↗