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PubMed1999

Current practices in clinical flow cytometry. A practice survey by the American Society of Clinical Pathologists.

The American Society of Clinical Pathologists surveyed 136 laboratories actively engaged in performing clinical flow cytometric testing to determine the demographics of these laboratories, the credentials of the personnel involved with testing, the volume and types of tests performed, and how data are analyzed and interpreted. These results are reported with commentary based on previous surveys and recommended practice guidelines.

Data Collection↗

PubMed1996

Academic and training requirements in advertisements for pharmacy management and clinical positions.

The academic and training requirements mentioned in advertisements for various pharmacy management and clinical positions were studied. Position advertisements appearing in five national pharmacy publications between January 1990 and December 1994 were analyzed for requirements or preferences for a particular pharmacy or other degree, postgraduate training (residencies and fellowships), board certification, and experience. The positions were classified as clinical pharmacist, clinical faculty member, pharmacy services manager, clinical manager, or academic manager. A total of 1052 position advertisements were eligible for analysis. Overall, 718 (68%) of the positions either required or preferred postgraduate training; graduates of ASHP-accredited residency programs were sought 10% of the time. Advanced degrees were specified for 934 (89%) of the positions--required for 581 (55%) and preferred for 353 (34%). No degree was specified for 98 (9%) of the positions. Only 20 (2%) of the advertisements indicated that the B.S. degree was a sufficient credential. Board certification was mentioned for 29 (3%) of the positions, although it was never required. Postgraduate pharmacy experience was often acceptable in lieu of advanced degrees and training. Pharmacy management and clinical positions advertised in national pharmacy publications tended to require or prefer residency or fellowship training and advanced degrees.

Advertising↗

PubMed2003

How nurse practitioners obtained provider status: lessons for pharmacists.

The history of nurse practitioners, their efforts to achieve provider status, and lessons learned from their activism are discussed. The nurse practitioner profession arose out of a need to meet a rising demand for primary care services, especially in rural areas. Some nurses and physicians vehemently opposed the nurse practitioner model, but studies documented the value of nurse practitioner services, and the utilization of these practitioners continued to grow. Compensation was provided via salary or per-member-per-month agreements. Nurse practitioners recognized that direct federal reimbursement (provider status) was needed to recognize them as independent health care providers and assign specific monetary values to their services, so they undertook an aggressive lobbying campaign. Contacts on Capitol Hill were exploited, and nursing organizations encouraged nurse practitioners to get involved in grass-roots activism. Nurse practitioners discussed their patients during meetings with their representatives in Congress, and legislators were invited to make site visits. In 1993, the American College of Nurse Practitioners was formed to unite the profession and move the campaign forward. Ultimately, the Balanced Budget Act of 1997 granted nurse practitioners provider status and authorized them to bill Medicare directly for services furnished in any setting. The key strategies that contributed to this victory were (1) gaining recognition that nursing had the potential to expand its role, (2) documenting nurse practitioners' value, (3) establishing standards in education and credentialing, (4) using professional organizations to empower individuals, and (5) being willing to accept small, incremental gains over time. The experience of nurse practitioners in obtaining Medicare provider status offers valuable lessons for pharmacists as they pursue the same goal.

Economics, Pharmaceutical↗

PubMed2004

Collaborative drug therapy management services and reimbursement in a family medicine clinic.

PURPOSE: The legislative and regulatory issues surrounding the reimbursement of pharmacists for cognitive services are reviewed and billing practices for a pharmacist-physician collaborative drug therapy management service (DTMS) in a family medicine clinic are examined. A case study is offered to illustrate the real-world application of these practices. SUMMARY: As regimens of prescription medications have become more complex and the potential for adverse drug reactions and interactions has increased, the need for individualized optimal drug therapy and drug-therapy experts has grown. Pharmacists, who are professionally trained to be an integral part of the medical team, are well prepared to ensure optimal drug therapy and medication safety for patients. Consequently, collaboration between physicians and pharmacists can lead to improved patient care and reduced medication errors. The following 10 steps are recommended for establishing a successful collaborative DTMS: (1) establish a working relationship with physician colleagues, (2) assess the needs of your patients, (3) draft collaborative DTMS protocols and agreements, (4) apply for credentialing status within your health organization, (5) consult the billing office staff at the clinic, (6) design a clinic-encounter form, (7) identify and train support personnel, (8) allocate resources, (9) advertise the DTMS, and (10) evaluate and improve your service. CONCLUSION: Establishing a DTMS presents many challenges and obstacles, but they should not lead to discouragement. Rather, pharmacists should be diligent and continue to explore ways in which they could provide optimal medication therapy to patients through appropriate channels that also facilitate reimbursement.

Ambulatory Care Facilities↗

PubMed2004

Psychological testing of sign language interpreters.

Twenty-eight sign language interpreters participated in a battery of tests to determine if a profile of cognitive, motor, attention, and personality attributes might distinguish them as a group and at different credential levels. Eight interpreters held Level II and nine held Level III Virginia Quality Assurance Screenings (VQAS); the other 11 held Registry of Interpreters for the Deaf (RID) certification. Six formal tests, the Quick Neurological Screening Test-II, the Wonderlic Personnel Test, the Test of Visual-Motor Skills (TVMS), the d2 Test of Attention, the Integrated Visual and Auditory Continuous Performance Test, and the Sixteen Personality Factor Questionnaire (16PF), were administered to the interpreters. Average scores were high on most of the tests; differences across the three groups were not statistically significant. Results from only one test, the d2 Test of Attention, were significantly correlated with interpreter level. Comparisons between educational and community interpreters also revealed no differences. Personality traits were widely distributed, but one trait, abstract reasoning, tested extremely high in 18 interpreters. Discussion of the potential implications of these results, particularly for educational interpreters, is offered.

Adult↗

PubMed1984

Thrombotic and embolic complications with silastic ball prosthetic valves.

Eighteen years of continuous clinical use with the Starr-Edwards ball-valve prosthesis provides an extensive data base for comparison with more recently introduced cardiac prostheses, and establishes the credentials of this valve for current clinical use. Since 1965, 558 aortic (model 1260) and 285 mitral (model 6120) ball-valve prostheses have been inserted at the University of Oregon. Thromboembolic rates for the entire series (1965-1983) and our more recent experience (1973-1983) were 3.8% per year and 2.8% per year for the aortic valve; and 5.1% per year and 2.6% per year for the mitral valve. Patients who had experienced one embolic episode were substantially more likely to experience a subsequent event. Thrombotic stenosis was seen at rates of 0.1% per patient year and 0.4% per patient year for the aortic and mitral valves, respectively. These results are compared with other current series using a variety of mechanical and tissue prostheses. The Starr-Edwards valve remains a durable mechanical cardiac prosthesis with thromboembolic complications similar to most other current prostheses. Thrombotic stenosis tends to be rare, gradual, and electively managed as opposed to the sudden, unpredictable, and catastrophic thrombosis seen with tilting disc valves.

Actuarial Analysis↗

PubMed1988

Diagnostic ultrasound in general practice.

A three-year diagnostic ultrasound training project for generalists is described. Specific applications and a rationale for the use of ultrasound by general physicians are presented. The current status of training programmes, credentialing strategies, and desirable equipment characteristics are also discussed. Finally, benefits, liabilities and controversies in diagnostic ultrasound imaging are reviewed.

Abdomen↗

PubMed1991

Music therapy practices in gerontology.

A national survey was conducted using a representative sample of music therapists who work with older adults. The goals of the survey were: (a) to provide a profile of music therapists working with geriatric clients with respect to professional credentialing, regional membership, age, gender, educational background, salary, and reimbursement practices; (b) to provide a description of assessment practices used by music therapists with geriatric clients; (c) to provide clarification relative to how music therapy practices with elderly clients fit into various settings in which the therapist may be employed; and (d) to identify the types of goals and objectives that are most frequently specified for this population. An 87% response rate yielded 176 usable questionnaires (72% of original sample). Frequency analyses of dichotic and multiple choice responses were conducted and reported as percentages of respondents. Free response items, which were provided as opportunities for clarification and explanation, were presented as a simple frequency count. Comparative analyses between salaried and contractual respondents, and respondents in the eight NAMT regions were not conducted due to unequal sample sizes.

Aged↗

PubMed2002

Beyond therapy: music, spirituality, and health in human experience: a review of literature.

In the current healthcare environment, there is a growing interest in the relationship between spirituality and health. The connections between music and both medicine and religious experience are well-established, but little is known about how the musical and spiritual aspects of human experience work together to influence well-being. A review of the healthcare literature from 1973-2000 identified 52 published reports on the topic of music, spirituality, and health. The majority of the papers were narrative descriptions or case studies, and appear within a variety of clinical contexts. Fifty-two percent of the authors were credentialed music therapists. Examination of the literature indicated that many papers used terms and concepts associated with both spirituality and health interchangeably, which might lend support to the basic interconnectedness of these two aspects of being. The function of music across the literature was explored, and a transformational model of music experience derived from the literature is proposed. Based on the findings of the review, several conclusions about the future role of music in spirituality and health are drawn, and recommendations for further research are offered.

Health Status↗

PubMed2006

Development of quality indicators for patients undergoing colorectal cancer surgery.

BACKGROUND: Colorectal cancer is the second most common cancer type among new cancer diagnoses in the United States. Attention to the quality of surgical care for colorectal cancer is of particular importance given the increasing numbers of colorectal cancer resections performed in the aging population. A National Cancer Institute-sponsored consensus panel produced guidelines for colorectal cancer surgery in 2000. We have updated and extended that work by using a formal process to identify and rate quality indicators as valid for care during the preoperative, intraoperative, and postoperative periods. METHODS: Using a modification of the RAND/UCLA Appropriateness Methodology, we carried out structured interviews with leaders in the field of colorectal cancer surgery and systematic reviews of the literature to identify candidate quality indicators addressing perioperative care for patients undergoing surgery for colorectal cancer. A panel of 14 colorectal surgeons, general surgeons, and surgical oncologists then evaluated and formally rated the indicators using the modified Delphi method to identify valid indicators. RESULTS: A total of 142 candidate indicators were identified in six broad domains: privileging (which addresses surgical credentials), preoperative evaluation, patient-provider discussions, medication use, intraoperative care, and postoperative management. The expert panel rated 92 indicators as valid. These indicators address all domains of perioperative care for patients undergoing surgery for colorectal cancer. CONCLUSIONS: The RAND/UCLA Appropriateness Methodology can be used to identify and rate indicators of high-quality perioperative care for patients undergoing surgery for colorectal cancer. The indicators can be used as quality performance measures and for quality-improvement programs.

Colectomy↗

PubMed1988

Physical therapy care for low back pain. Monitored program of first-contact nonphysician care.

We studied the process and outcomes of physical therapist management of 107 patients with low back pain at a walk-in clinic. Sixty-seven patients with low back pain concurrently were assigned randomly to internists at the clinic. Physicians and physical therapists recorded baseline clinical data and management plans on standard check lists. Physical therapists used a validated algorithm that directed diagnostic evaluations and physician consultations, but all other physical therapist treatment decisions were unconstrained. Patients in the physical therapist and physician groups did not differ significantly. Physical therapists referred more patients to the physical therapy department than did physicians but recommended muscle relaxants, prescription analgesics, and bed rest less frequently. The occurrence of new symptoms, duration of symptoms, and duration of activity limitations were similar between the physician and physical therapy patient groups at a one-month follow-up examination. Physical therapist-managed patients expressed greater satisfaction than physician-managed patients with several aspects of their care. The percentage of functional improvement for highly dysfunctional patients was significantly greater for the physical therapist-managed patients than for the physician-managed patients. The implications of a physical therapist first-contact care program for health service organizations, health care policy, physical therapist training, and credentialing are discussed.

Adolescent↗

PubMed2003

Understanding adjudication: origins, targets, and outcomes of ethics complaints.

Various bodies and standards regulate social work practice. Social workers can be held accountable by licensure or credentialing boards, by civil and criminal laws, and by various professional organizations to which they belong. NASW considers complaints against its members for violations of the organization's Code of Ethics, yet the average member may know little about the nature and process of such actions. This article describes the professional review process and analyzes the results of a study of ethics cases filed with NASW from 1986 to 1997. This article also describes the parties involved in complaints and violations, the disposition of cases, and the corrective actions required of those who were found in violation of the Code. These research findings are compared with NASW membership data and the results of other studies on malpractice and ethics violations.

Codes of Ethics↗

PubMedDate not supplied

Lessons learned while extending physiological principles from growth chambers to satellite studies.

Over the last three decades, physiological principles established in laboratory studies have been applied to systems at progressively larger scales and are now firmly merged into the fields of ecology, ecosystem modeling, forest protection, and global change research. To expand the vision of any field requires that scientists from different disciplines build a bridge across the chasm that normally exists between the knowledge bases and perspectives of different fields. Bridges are built most quickly when representatives of different disciplines see the possibility of mutual advantage in collaboration and seek to quickly demonstrate that potential. Usually, however, the process is laborious because approaches and techniques must be modified to address problems at a different level of integration. Successful bridge builders have, almost without exception, established credibility in their own field and have then identified a kindred spirit with similar credentials in another. They usually establish a pilot study that involves apprentices as well as established scientists. If the approach is successful, the younger members of the team often take the lead in further advancements. Managers of large centralized programs should foster interdisciplinary exchange, particularly at times when advancement in one field languishes. To expand collaboration, it is often necessary for scientists to seek common properties that simplify relations across a wide range of biological and physical conditions. This integrative perspective is essential and is fostered by participating in cross-disciplinary workshops and conferences and by reading outside one's field.

Journal Article↗

PubMed2002

Integrated fellowship in vascular surgery and intervention radiology: a new paradigm in vascular training.

OBJECTIVE: To evaluate an integrated fellowship in vascular surgery and interventional radiology initiated to train vascular surgeons in endovascular techniques and to train radiology fellows in clinical aspects of vascular diseases. SUMMARY BACKGROUND DATA: The rapid evolution of endovascular techniques for the treatment of vascular diseases requires that vascular surgeons develop proficiency in these techniques and that interventional radiologists develop proficiency in the clinical evaluation and management of patients who are best treated with endovascular techniques. In response to this need the authors initiated an integrated fellowship in vascular surgery and interventional radiology and now report their interim results. METHODS: Since 1999 vascular fellows and radiology fellows performed an identical year-long fellowship in interventional radiology. During the fellowship, vascular surgery and radiology fellows perform both vascular and nonvascular interventional procedures. Both vascular surgery and radiology-based fellows spend one quarter of the year on the vascular service performing endovascular aortic aneurysm repairs and acquiring clinical experience in the vascular surgery inpatient and outpatient services. Vascular surgery fellows then complete an additional year-long fellowship in vascular surgery. To evaluate the type and number of interventional radiology procedures, the authors analyzed records of cases performed by all interventional radiology and vascular surgery fellows from a prospectively maintained database. The attitudes of vascular surgery and interventional radiology faculty and fellows toward the integrated fellowship were surveyed using a formal questionnaire. RESULTS: During the fellowship each fellow performed an average of 1,201 procedures, including 808 vascular procedures (236 diagnostic angiograms, 70 arterial interventions, 59 diagnostic venograms, 475 venous interventions, and 43 hemodialysis graft interventions) and 393 nonvascular procedures. On average fellows performed 20 endovascular aortic aneurysm repairs per year. There was no significant difference between the vascular surgery and radiology fellows in either the spectrum or number of cases performed. Eighty-eight percent (23/26) of the questionnaires were completed and returned. Both interventional radiologists and vascular surgeons strongly supported the integrated fellowship model and favored continuation of the integrated program. Vascular surgery and interventional radiology faculty members wanted additional training in clinical vascular surgery for the radiology-based fellows. With the exception of the radiology fellows there was uniform agreement that vascular surgery fellows benefit from training in nonvascular aspects of interventional radiology. CONCLUSIONS: Integration of vascular surgery and interventional radiology fellowships is feasible and is mutually beneficial to both disciplines. Furthermore, the integrated fellowship provides exceptional training for vascular surgery and interventional radiology fellows in all catheter-based techniques that far exceeds the minimum requirements for credentialing suggested by various professional societies. There is a clear need for cooperation and active involvement on the parts of the American Board of Radiology and the American Board of Surgery and its Vascular Board to create hybrid training programs that meet mutually agreed-on criteria that document sufficient acquisition of both the cognitive and technical skills required to manage patients undergoing endovascular procedures safely and effectively.

Attitude of Health Personnel↗

PubMed1991

Developing the gastroenterology certification examination.

This paper describes a typical procedure for the development of credentialing examinations. Specifically, the paper provides the developmental history of the Certification Examination for Gastroenterology Nurses and Associates. In the course of the paper, a four-step approach to examination development is outlined. The steps include role delineation, item writing, examination construction and passing score determination. All phases of the examination development process are viewed in the light of their contribution to the public protection responsibility of the Certifying Board of Gastroenterology Nurses and Associates.

Certification↗

PubMedDate not supplied

A survey of role diversity among advanced practice nurses in pediatric gastroenterology.

A survey of advanced practice nurses in the Association of Pediatric Gastroenterology and Nutrition Nurses (APGNN) was conducted to assess role diversity in anticipation of sharing these results with our international colleagues at the World Congress in 2004. A single-page, 14-item survey was sent via e-mail or fax to 79 APGNN advanced practice nurses identified by their credentials (MS, PNP, FNP) in the membership database. Forty surveys were returned via e-mail or fax for an overall response rate of 51%. Most reported working full time as nurse practitioners in an outpatient gastrointestinal clinic, yet almost one third were hospital based. Additional job titles included clinical nurse specialist, researcher, and case manager or clinical coordinator. Slightly more than one half reported seeing any patients in their outpatient practice, whereas 43% saw specific populations, with constipation, gastroesophageal reflux, and abdominal pain being the most common diagnoses. Seventy percent had prescriptive privileges. Billing practices were the most diverse, with 30% always billing under their own number, 23% sometimes billing under their own number, and 40% never billing under their own number (5% not applicable). Overall, most advanced practice nurses in APGNN are pediatric nurse practitioners with a primary focus on outpatient care but also are involved in patient and family teaching, nutrition support, home care, and research. Only a few were involved with procedures, which may be surprising to our adult counterparts.

Canada↗

PubMed1976

Prediction of screening decisions in a medical school admission process.

To study and predict a set of screening decisions in a medical school admission process, a stratified sample (n = 864) was drawn to represent the range of applicants to the Yale University School of Medicine during a single year. A smaller sample from the following year's applicants was drawn in a similar fashion for purposes of cross-validation. Prior to the prediction of screening decisions, a set of independent variables was selected by a factor analytic procedure from credentials in an applicant's admission folder. These folder variables ranged in nature from quantitative measures of academic performance to demographic information and types of extracurricular activity. Two multivariate statistical procedures, Sonquist's Automatic Interaction Detection (AID) and linear discriminant analysis (LDA), were used to predict screening decisions. Measures of academic performance and ability proved to be the most effective predictors of screening decision, as evidenced in the final AID tree and the discriminant function.

Connecticut↗

PubMed1977

Economic and racial disadvantage as reflected in traditional medical school selection factors.

Medical College Admission Test scores and undergraduate grade-point averages show that both lower income applicants in general and minority applicants in particular are at a competitive disadvantage in gaining admission to medical school. This study examines the extent to which income and race, viewed independently of one another, affect these selection factors. By analyzing data collected by the Association of American Medical Colleges on applicants to the 1976-77 entering class, factors associated with race were found to have a far more significant influence on applicants' credentials than factors associated with lower family income. An admissions policy based exclusively on GPAs and/or MCAT scores would proportionately exclude minority applicants from medical education but would have no similar effect on lower income white applicants.

Black or African American↗