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PubMed2002

Why health educators need epidemiology.

The aim of health education is to encourage health behaviors that promote a better quality of life and longer life expectancy. In the late 1960s, universities in the US began offering degree programs in health education. Most programs today require that at least one class be taken in epidemiology, where epidemiology involves the study of the distribution and determinants of disease frequency in human populations. In recent years, several competency areas have been set forth for health educators by the US National Commission for Health Education Credentialing. This paper specifically describes how training in epidemiology provides health educators with the ability to satisfy, in large part, these competency areas. The intent of this paper is to clarify to students and advisors of health education the rationale for requiring course work in epidemiology, as well as to emphasize that epidemiology is the cornerstone to all health education, whether conducted by physicians, nurses, or formally trained health educators.

Journal Article↗
PubMed2003

Motion analysis in the training and assessment of minimally invasive surgery.

Dexterity is a crucial aspect of surgical competence and is considered to be of high priority in the selection of trainees to specialities such as laparoscopic surgery. A motion analysis system, Imperial College Surgical Assessment Device (ICSAD) has undergone validation studies and is sensitive in discriminating surgeons according to their experience. It consists of a signal generator that creates an electromagnetic field in which sensors placed on the surgeon's hands can be detected using a special software. These positional data can be converted to data reflecting the surgeon's dexterity. It is a useful adjunct to training as trainees can be expected to achieve a certain level of proficiency prior to progress. They can also be provided with an objective feedback of their performance. As an assessment method it can be used for credentialing in laparoscopic surgery.

Journal Article↗
PubMed2002

Rationale and cost-efficiency compared for urine or saliva testing and behavioural inquiry among UK offender populations: injectors, arrestees and prisoners.

BACKGROUND: Costs, methodology and efficiency at obtaining behavioural information and biological sample to be tested for blood-borne viruses or illegal drugs are compared for UK surveys of offender populations: injectors in the community or attending drug agencies, arrestees and prisoners. METHODS: Arrestee surveys use extensive behavioural interview + urine sample and measure a key performance indicator in UK's Drugs Strategy. They have low efficiency (urine sample for drugs testing available from under 60% of eligible arrestees) at high cost (pound sterling 110-190 or 350 per urine sample and at least pound sterling 500-800 per injector). Random mandatory drugs testing of prisoners has the highest efficiency (because refusals are punishable), but the cost is high (pound sterling 110-120 per urine sample and pound sterling 300-500 per injector) and behavioural data are lacking. Prisoner surveys use self-completion questionnaire + saliva sample. They guarantee demonstrable anonymity in estimating the prevalence of blood-borne viruses and prisoners' associated risk behaviours, have high efficiency (saliva sample from over 80% of inmates) at low cost (pound sterling 30 per saliva and pound sterling 70-110 per injector), but behavioural data are limited to risk factors for blood-borne viruses. Low cost also characterises comprehensive interview + saliva sample from injectors in the community (pound sterling 90 per saliva sample, all from injectors) but efficiency cannot be assessed because the sampling frame of eligible injectors is not known. Voluntary unlinked anonymous surveys of injectors at drug agencies use self-completion questionnaire + saliva sample to be tested for blood-borne viruses. They are the least costly at pound sterling 43 per injector and moderately efficient with two-thirds volunteer rate by eligible injectors. DISCUSSION: For scientific added-value, we recommend co-location of survey types geographically and temporally; a common core set of behavioural questions; saliva sample as well as (and, eventually, instead of) the less acceptable urine sample. Survey methodologies for measuring key performance indicators should stand up to scrutiny in terms of openness, design credentials, statistical power, and costs. We examine how participation bias or inadequate survey size can compromise the effective monitoring of a key performance indicator.

Cost-Benefit Analysis↗
PubMed2004

Characteristics of opinion leaders in substance abuse treatment agencies.

OBJECTIVE: This study was part of a larger effort to test the effectiveness of technology transfer approaches related to evidence-based treatment of co-occurring substance abuse and mental health disorders. Specifically, this study examined characteristics of "opinion leaders" as technology transfer agents. METHOD: A network analysis was conducted within four large substance abuse treatment agencies to identify individuals that other counselors sought out for consultation on co-occurring issues. The identified opinion leaders were then compared with other counselors on demographic variables, education and experience, and attitudes and knowledge about working with individuals with co-occurring disorders. RESULTS: The analyses demonstrate that opinion leaders differed from other counselors in competency-related characteristics including more postgraduate education, relevant professional credentials, and years of experience in mental health treatment. They also had greater knowledge of the dynamics and treatment of co-occurring disorders as well as a greater willingness and confidence in working with such clients. CONCLUSION: These results suggest that opinion leaders are used within agencies for information and consultation regarding treatment issues. Therefore, opinion leaders may provide an important vehicle for dissemination and adoption of evidence-based treatment practices in community treatment settings.

Adult↗
PubMed2002

MRI of congenital heart disease: a paradigm of collaboration. new suggestions for a team approach from Madigan Army Medical Center.

Over the past decade, there has been increasing use of cardiac MRI in the evaluation of children with congenital heart disease. There has also been an increased number of radiologists and pediatric cardiologists desiring to perform cardiac MRI in the evaluation of these patients. At the present time, the number of pediatric cardiologists and radiologists fully trained in the use of MRI studies for CHD is inadequate to provide this modality at all institutions with MRI capabilities. This article describes the collaborative approach between pediatric cardiology and radiology at Madigan Army Medical Center and its implications for patient care and credentialing.

Cooperative Behavior↗
PubMed1995

The Certification Board of Infection Control, Inc.

The Certification Board of Infection Control, Inc. (CBIC), was created in 1981 by the Association for Professionals in Infection Control and Epidemiology, Inc, for the sole purpose of developing and administering an examination by which competent infection control professionals could become certified. This independent, voluntary board is multidisciplinary, representing all levels of professionals in the field of infection control, as well as a consumer member. CBIC certification is the only recognized certification for infection control professionals. Since the first examination was administered in 1983, over 3,000 persons have attained infection control certification (CIC) status and are permitted to use the CIC credential.

Educational Measurement↗
PubMed1997

Handwashing and glove use in a long-term-care facility.

OBJECTIVES: To determine glove use and handwashing practices, the factors associated with infection control practices, and the frequency of potential microbial transmission in a long-term-care facility (LTCF). DESIGN: Observational study of 230 staff-resident interactions in an LTCF. We recorded resident characteristics, type of activity, staff credentials, and movements of the staff member's hands, then used the LTCF's guidelines to judge appropriateness of glove use and handwashing. SETTING: 255-bed, university-based LTCF in Baltimore, Maryland. PARTICIPANTS: A systematic sample of staff-resident interactions. RESULTS: Gloves were worn in 139 (82%) of 170 interactions when indicated, but changed appropriately in only 1 (16%) of 132. Hands were washed when needed before an interaction in 27%, during an interaction in 0%, and after an interaction in 63%. Gloves were less likely to be used when caring for residents with gastrostomy tubes compared with other residents (relative risk, 0.85; 95% confidence interval, 0.73-0.98). Guidelines were followed more frequently during wound care than during other activities. Microbial transmission potentially could have occurred in 158 (82%) of 193 evaluable interactions. CONCLUSIONS: We documented marked deficiencies in glove and handwashing, demonstrated the possible impact of these deficiencies, and identified factors associated with inadequate handwashing and glove use. This information can be used in future educational and research efforts to improve infection control practices.

Baltimore↗
PubMed2002

Dosimetric considerations for validation of a sequential IMRT process with a commercial treatment planning system.

Commercial multileaf collimator (MLC) systems can employ leaves with rounded ends. Treatment planning beam modelling should consider the effects of transmission through rounded leaf ends to provide accurate dosimetry for IMRT treatments delivered with segmented MLC. We determined that an MLC leaf gap reduction of 1.4 mm is required to obtain an agreement between calculated and measured profile 50% dose points. A head and neck dosimetry phantom, supplied by the Radiological Physics Center (RPC), was planned and irradiated as a necessary credentialing requirement for the RTOG H-0022 protocol. The agreement between the RPC TLD measurements and treatment planning calculations was within experimental error for the primary and secondary planning target volumes (PTVs); however, the calculated mean dose for the critical structure was approximately 9% lower than the RPC TLD measurements. RPC radiochromic film profile measurements also indicated significant discrepancies (>5%) with calculated values especially in the high dose gradient region in the vicinity of the critical structure. These results substantiate our own in-house phantom measurements, performed with the same IMRT fields as for the RPC phantom experiment, using Kodak EDR2 film to measure absolute dose. Our results indicate a maximum underestimate of calculated dose of 12% with no leaf gap reduction. The discrepancy between measured and calculated phantom values is reduced to +/- 5% when a leaf gap reduction of 1.4 mm is used. A further improvement in the accuracy of dose calculation is not possible without a more accurate modelling of the leaf end transmission by the planning system. In the absence of published dosimetric criteria for IMRT our results stress the need for stringent in-house dosimetric QA and validation for IMRT treatments. We found the dosimetric validation service provided by the RPC to be a valuable component of our IMRT validation efforts.

Computer Simulation↗
PubMed2001

Breaking away from grounded identity? Women academics on the Web.

The World Wide Web has provided a new way for academics to find out about others' work and to present versions of their identity. In previous discussions we analyzed how people present themselves in this new medium, in terms of Goffman's ideas of the presentation of self, and commented on gender differences and how issues of credibility and authority are handled by women academics in their homepages. This paper reports discussions with women academics about how they have responded to this opportunity, both in how they present themselves in their own pages, and how they deal with the problems involved in presenting an individual identity within an institutional Web page framework. In presenting themselves in personal homepages, many women academics feel a need to establish their credentials and entitlement to an academic identity. However, the vulnerability of themselves as women remains part of their persona as academics. For example, they were ambivalent about the use of a self-photo on their homepages (most wanted to avoid it, but found it friendly and validating on other women's pages). The discussion considers how far new technology provides opportunities for new forms of identity, or how far the identity presented on the Web is still grounded in people's physical and institutional existence. Women academics feel that the Web has given them new freedom and reduces some traditional gender and status differences (as has been found with other aspects of electronic communication), but they are still wary of it being "yet another way of carrying on the same old gender plot."

Communication↗
PubMed1998

Treatment of human immunodeficiency virus-positive patients with complementary and alternative medicine: a survey of practitioners.

OBJECTIVE: To investigate complementary and alternative medicine (CAM) practices provided to human immunodeficiency virus (HIV)-infected individuals, provider experience in HIV disease, patients' characteristics, provider perceptions of treatment effectiveness, and feasibility and interest in future studies. DESIGN: Mailed survey. PARTICIPANTS: 117 providers, recruited from professional associations and conferences, who offer CAM therapies to HIV-infected individuals. OUTCOME MEASURES: Provider credentials, patient descriptors, treatments prescribed and their perceived effectiveness, health service information, medical information charted, and research participation capability and interest. RESULTS: Providers are treating patients at all stages of HIV disease with a variety of CAM practices, claiming a mean of 6.5 years of HIV disease treatment experience and 105 HIV-positive patients in treatment per provider (solo practice or clinic). Eighty percent of respondents report holding state licenses to practice. A total of 115 different CAM therapies with an average of 12 treatments per provider were used. Ninety percent of providers claimed their therapies were "somewhat" to "very effective" on all disease stages, indicating effectiveness for symptom management (96%), quality of life (98%), raising or maintaining CD4+ lymphocyte levels (66%), slowing progression to acquired immunodeficiency syndrome (AIDS) (69%), and extending survival (73%). Research readiness and willingness was reported by a majority of respondents. CONCLUSIONS: Providers with substantial experience treating HIV disease with a range of CAM practices claim effectiveness for their methods. Providers are generally willing to participate in studies that would examine such claims and appear to have the capacity meaningfully to contribute. These claims should be investigated.

Complementary Therapies↗
PubMed2005

Volunteer health professionals and emergencies: assessing and transforming the legal environment.

Volunteer health professionals (VHPs) are essential in emergencies to fill surge capacity and provide needed medical expertise. While some VHPs are well-organized and trained, others arrive spontaneously at the site of a disaster. Lacking organization, training, and identification, they may actually impede emergency efforts. Complications involving medical volunteers in New York City after September 11, 2001, led Congress to authorize federal authorities to assist states and territories in developing emergency systems for the advance registration of volunteer health professionals (ESARVHP). Through advance registration, volunteers can be vetted, trained, and mobilized more effectively during emergencies. The use of VHPs, however, raises multiple legal questions: What constitutes an emergency, how is it declared, and what are the consequences? When are volunteers liable for their actions? When may volunteers who are licensed or certified in one state legally practice their profession in another state? Are volunteers entitled to compensation for harms they incur? This article examines the legal framework underlying the registration and use of volunteers during emergencies and offers recommendations for legal reform, including: (1) establish minimum standards to facilitate interjurisdictional emergency response, improve coordination, and enhance reciprocity of licensing and credentialing; (2) develop liability provisions for VHPs that balance their need to respond without significant fear of civil liability with patients' rights to legal recourse for egregious harms; and (3) provide basic levels of protections for VHPs harmed, injured, or killed while responding to emergencies.

Compensation and Redress↗
PubMed2005

An empirical examination of client attitudes towards online counseling.

Trends over the past decade have shown that online counseling has grown in terms of popularity among consumers and clinicians alike; however, little, if any empirical evidence exists that examines client attitudes towards online counseling as alternative to traditional face-to-face therapy. Therefore, this study investigated client attitudes towards online counseling. Data was collected from 48 e-clients who received online counseling at the Center for Online Addiction. Variables such as client perceptions and concerns about using online counseling, clients' reasons for seeking online counseling over in-office treatment, and demographic profiles of e-clients were assessed. Results suggested that Caucasian, middle-aged males, with at least a four-year bachelors degree were most likely to use online counseling and anonymity, convenience, and counselor credentials were the most cited reasons they sought online counseling over in-office treatment. The lack of perceived privacy and security during online chat sessions and the fear of being caught while conducting online sessions were the main concerns reported by e-clients. A better understanding of client motives and perceptions towards online counseling helps to guide treatment in using the Internet as a clinical tool, especially as the Internet becomes increasingly more available in previously remote markets and the field of online counseling continues to grow.

Adult↗
PubMed2006

Importance of perioperative processes of care for length of hospital stay after laparoscopic surgery.

BACKGROUND AND PURPOSE: The technologic imperative has prompted the adoption of complex laparoscopic techniques by physicians with various degrees of skill. We sought to measure the impact of both case mix and physician practice (perioperative process/risk factors) on length of stay (LOS)-a common benchmark- after laparoscopic surgery. PATIENTS AND METHODS: We identified 911 patients undergoing laparoscopic retroperitoneal surgery between 1996 and 2004, who comprise our study population. Patients remaining in the hospital >5 days-the 90th percentile for the sample-were classified as having a prolonged LOS. Adjusted models were developed to determine the independent association of case mix and process measures with a prolonged LOS. The likelihood ratio test was used to discern the improvement of fit of the process model compared with the case-mix model. RESULTS: Among factors related to case mix and structure of care, increasing age (odds ratio [OR] 1.1; 95% CI 1.0, 1.2), less surgeon experience (OR 6.1; 95% CI 2.1, 17.2), male gender (OR 2.1; 95% CI 1.2, 4.0), and American Society of Anesthesiologists score of 3 or 4 (OR 7.2; 95% CI 2.2, 23.3) were independently associated with a prolonged LOS. The need for a transfusion (OR 9.4; 95% CI 33.9, 23.2), the development of a postoperative complication (OR 4.6; 95% CI 2.2, 9.5), and longer operative time (OR 1.5; 95% CI 1.3, 1.8) explained additional variation in prolonged LOS outcomes when considering perioperative process/risk factors in the model. Perioperative factors significantly improved the fit of the model (chi (2) statistic 101.8; p < 0.0001). CONCLUSIONS: Significant variation in outcomes is explained by factors describing aspects of surgical expertise. Variability in the surgical skill set is likely greatest during the laparoscopic learning curve, which raises a quality-of-care concern during the initial implementation of the technique. Policies attempting to smooth the laparoscopic learning curve, such as mentoring and skill measurement prior to credentialing, could improve the quality of care.

Aged↗
PubMed1992

Initial experience with laparoscopic surgery: establishing a new surgical procedure.

Laparoscopic surgery impacted the surgical world in the United States in 1990. This report reviews the initial experience of 34 surgeons in 8 teaching hospitals of the Northeastern Ohio Universities College of Medicine. There were 538 cases reported from May 1, 1990 to January 31, 1991. There was no mortality and the morbidity rate was 4.8%, including three bile duct injuries. The conversion rate to an open procedure was 6.1%. The criteria for credentialing, training, and resident and faculty education are included. The data reported by the Surgery Department of Northeastern Ohio Universities College of Medicine are very similar to reported series from the current literature.

Adult↗
PubMed1998

A proposed framework for economic evaluation of telemedicine.

Economic evaluation of telemedicine compares the costs and other consequences of delivering specific services through telemedicine vs. alternative means. Cost-effectiveness analysis, the most common method used for health issues, helps to assess whether the expected health benefits are worth the investment. Telemedicine raises particular challenges for evaluators: a telemedicine system may have multiple uses and joint costs that are difficult to apportion to one service, the existence of a system may lead to expanded indications for use, and technological change may rapidly make an evaluation outdated. Public and private regulation and payment may affect the diffusion of telemedicine. Uncertainty surrounds the policy of the U.S. Food and Drug Administration, which is still formulating its position. Changes are underway in policies on licensure and credentialing of clinicians, which have traditionally been done by state and by site, to reflect the fact that telemedicine services may cross these regional boundaries. Lack of insurance coverage for telemedicine services has been considered an impediment to adoption with fee-for-service payment. Under capitation payment and fixed budgets, however, providers have financial incentives to use the most efficient method to deliver services, and these arrangements would favor telemedicine if it is the less costly alternative. If telemedicine were most costly and the health benefits worth the cost, monitoring might be needed to ensure the quality of care.

Capitation Fee↗
PubMed2006

Training and certifying Physician Nutrition Specialists: the American Board of Physician Nutrition Specialists (ABPNS).

A significant obstacle to nutrition literacy among physicians is a paucity of Physician Nutrition Specialists (PNSs) on medical school faculties who can effectively advocate for change in medical school and residency curricula and who can serve as role models for incorporating nutrition into patient care. To address these issues, the Intersociety Professional Nutrition Education Consortium developed a paradigm for PNSs that is designed attract more physicians into the field; promulgated educational standards for fellowship training of PNSs; and established a unified mechanism for certifying PNSs, the American Board of Physician Nutrition Specialists (ABPNS). This article details the consensus paradigm and specific training standards and outlines the features and history of the ABPNS. The ABPNS certificate is intended to be the premier comprehensive credential for physicians who wish to identify nutrition as an area of expertise. Certification is equally accessible to physicians with backgrounds in any of the specialties relevant to clinical nutrition. It is hoped that more physicians will identify nutrition as a specialty interest if training opportunities are available in a variety of settings and are merged with their other professional interests. ABPNS invites input and feedback from colleagues around the world.

Certification↗
PubMed1996

Prevention of transfusion-associated cytomegalovirus infection. Practice parameter. American Society of Clinical Pathologists.

This practice guideline represents the opinions and recommendations of the author(s), the American Society of Clinical Pathologists (ASCP) Practice Parameters Committee and the ASCP Board of Directors regarding the appropriate strategies for each clinical condition or laboratory test discussed in this guideline. This guideline is designed primarily as an educational resource for physicians in the provision of quality medical services. Adherence to this guideline is completely voluntary and does not necessarily assure a successful medical treatment or result. This practice guideline should not be considered inclusive of all proper procedures and tests or exclusive of other procedures or tests that are reasonably directed to obtaining the same results. The physician should apply his or her own professional judgment to the unique clinical circumstances presented by the particular procedure or test. Physicians are encouraged to document the reasons for whatever procedure or test they use (whether or not in conformance with this guideline). Physicians should also take care to consider other medical and scientific advances that are available after the date of adoption of this guideline. This practice guideline was developed exclusively for the purposes set forth above and not for use in connection with matters involving reimbursement, credentialing, or utilization review.

Adult↗
PubMed1997

The ASCP Resident Physician Section: results of surveys pertaining to "graduated responsibility for residents in anatomic pathology". American Society of Cytopathology.

Graduated responsibility for residents in anatomic pathology has been the subject of discussion among supervising staff and residents during the past few years. Presently a wide variation exists within pathology residency programs in the United States both in the degree of autonomy given to residents and in the areas of anatomic pathology (ie, surgical pathology, cytopathology, and autopsy pathology) within which the autonomy is granted. Recent surveys of supervising staff and residents have indicated a willingness to increase the level of independence for residents, especially at senior levels. Impediments include reimbursement, credentialing, and medicolegal issues. The results of the ASCP-Resident Physician Section (RPS) surveys pertaining to graduated responsibility for residents in anatomic pathology are discussed.

Data Collection↗