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At least 1,621 records · Page 90Linked to original sources
PubMed1995

Using an objective structured clinical examination to evaluate competency in sport medicine.

This article discusses the development, format, administration and scoring of the objective structured clinical examination (OSCE) to evaluate competency in sport medicine. The credentials committee of the Canadian Academy of Sport Medicine has developed an examination to evaluate the competency of practicing physicians in the field of sport medicine. The examination is based on a sport medicine matrix that includes five areas: (a) clinical patient care, (b) team and event coverage, (c) medical/legal issues, (d) teaching and administration, and (e) research. The emphasis is on clinical patient care followed by team and event coverage, with the other three areas having a lesser degree of importance. The OSCE format consists of a number of stations or scenarios based on this matrix. The candidates are evaluated on a check list that reflects the emphasis of each station. A typical clinical patient care problem includes check list items related to the history, physical examination, investigations, diagnosis, and treatment. The candidates are also evaluated for their attitudes and techniques on each station. The examination includes volunteer examiners and patients both simulated and real. The candidates are evaluated through the use of checklists that are filled in by the examiners on optical scoring sheets. These are collated and analyzed to generate comparisons between candidates and to determine the psychometric properties of the overall examination. The examination has consistently scored reliability coefficients of 0.8 or greater. The 1993 examination demonstrated reliability coefficients of 0.89-0.97. Interrater reliability was also calculated, and these values ranged from 0.85 to 0.99. The examination also reflects both face and content validity.(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗
PubMed2002

The effect of a health care management initiative on reducing workers' compensation costs.

The effect of both a cost control and health care management initiative (HCMI) on Workers' Compensation costs at a self-insured University Hospital was assessed. Seven cohorts of injured workers were studied. Cost control measures started in 1993 included early return to work and injury prevention programs, internal administration of legal cases, and utilization of modified duty assignments. The health care management initiative fully in place in 1997 included aggressive case management and preferred provider panel utilization. Workers' Compensation indemnity costs and lost workdays incurred by each cohort were compared. A 41 to 59% reduction in indemnity payments and 46 to 67% reduction in lost time cases were realized after the health care management initiative was fully in place. During this time, accepted claims were reduced by 10 to 15%. The quality of the provider panel, as measured by academic credentials, experience and board certification, did not change. Cost control measures, without comprehensive case management, did not decrease these parameters significantly. The health care management initiative realized reductions in lost time cases and Workers' Compensation indemnity costs.

Costs and Cost Analysis↗
PubMedDate not supplied

Making the magnet commitment.

With a nursing shortage upon us, hospitals are seeking American Nurses Credentialing Center's Magnet designation as a way to recruit and retain staff. This article outlines the steps involved in achieving this prestigious award. Emphasis is placed on the role nursing staff development plays in fulfilling Magnet standards and participating in the application process.

Benchmarking↗
PubMedDate not supplied

Public health workforce development: progress, challenges, and opportunities.

The public health workforce is key to strengthening public health infrastructure. National partners have articulated a vision of a sustainable and competent workforce prepared to deliver essential public health services. Six strategic elements provide a framework for action: monitoring workforce composition; identifying competencies and developing related curriculum; designing an integrated life-long learning delivery system; providing individual and organizational incentives to ensure competency development; conducting evaluation and research and assuring financial support. Partners convened in January 2003 to review progress and to re-evaluate strategies in light of the recently released Institute of Medicine reports on infrastructure and workforce issues. Although significant challenges remain, there is convergence on priorities for competency development, research questions to be addressed and next steps in the national dialogue on certification and credentialing in public health.

Disaster Planning↗
PubMedDate not supplied

Standards and guidelines for CFTR mutation testing.

One mission of the ACMG Laboratory Quality Assurance (QA) Committee is to develop standards and guidelines for clinical genetics laboratories, including cytogenetics, biochemical, and molecular genetics specialties. This document was developed under the auspices of the Molecular Subcommittee of the Laboratory QA Committee by the Cystic Fibrosis (CF) Working Group. It was placed on the "fast track" to address the preanalytical, analytical, and postanalytical quality assurance practices of laboratories currently providing testing for CF. Due to the anticipated impact of the ACMG recommendation statement endorsing carrier testing of reproductive couples, it was viewed that CF testing would increase in volume and that the number of laboratories offering CF testing would also likely increase. Therefore, this document was drafted with the premise of providing useful information gained by experienced laboratory directors who have provided such testing for many years. In many instances, "tips" are given. However, these guidelines are not to be interpreted as restrictive or the only approach but to provide a helpful guide. Certainly, appropriately trained and credentialed laboratory directors have flexibility to utilize various testing platforms and design testing strategies with considerable latitude. We felt that it was essential to include technique-specific guidelines of several current technologies commonly used in laboratories providing CF testing, since three of the four technologies discussed are available commercially and are widely utilized. We take the view that these technologies will change, and thus this document will change with future review.

Cystic Fibrosis↗
PubMed2006

Demographics and trends in nonoperating-room anesthesia.

PURPOSE OF REVIEW: Nonoperating-room anesthesia includes sedation or anesthesia for radiological imaging, cardiac catheterization, office-based surgery, and pediatric procedures or investigations, all of which have seen explosive growth over the last decade. This review discusses the factors that are driving this growth and the challenges we face as a profession to accommodate new practice paradigms. RECENT FINDINGS: Many departments have difficulty providing services for nonoperating-room anesthesia. A shortage of providers, insufficient reimbursement, and lack of institutional support have been identified as barriers limiting delivery of pediatric nonoperating-room sedation services. Practitioners from other specialties appear increasingly eager to provide sedation at an institutional level. The use of propofol by nonanesthesiologists is widespread, and the issue of provider credentialing has yet to be fully resolved. The shift to nonoperating-room locations will continue, driven by cost savings and convenience for patients and providers. SUMMARY: Nonoperating-room anesthesia will play a central role in anesthesia practice in the future. Provision of these services requires planning, personnel, and institutional resources. This should be a high priority for anesthesiology departments to ensure delivery of the highest quality of patient care in a cost-effective and organized manner.

Adult↗
PubMed2004

Organizing the orthopaedic trauma association mass casualty response team.

Physicians and surgeons in the United States have become increasingly aware of the requirement for an organized response to mass casualty and disaster situations. This has not always been the case. The terrorist acts in Oklahoma City in 1995 and at the World Trade Center in 1993 and 2001 showed the inefficiencies and confusion of the civilian managed disaster response. Trauma surgeons are uniquely suited to play a leadership role in the planning and coordination of disaster care because of their integration in prehospital emergency medical systems and trauma centers. The Orthopaedic Trauma Association has developed strategies to facilitate the orthopaedic response to mass casualties and to develop an educated approach to disaster management. The current initiatives include the establishment of a link with the American College of Surgeons Committee on Trauma in addition to the development of training programs for orthopaedic surgeons as responders to disaster and mass casualty situations. A team of volunteer orthopaedic traumatologists also has been credentialed to become part of the National Disaster Medical System's International Medical-Surgical Response Team.

Association↗
PubMed2004

Simulation in critical care and trauma education and training.

PURPOSE OF REVIEW: To review theory and practice of simulation technology in critical care and trauma training. RECENT FINDINGS: Simulators provide a safe and realistic environment in which active learning, enhanced by repetition and feedback, can take place. Simulation and computer-based education address the needs of knowledge and skill acquisition across a continuum of professional development. SUMMARY: Simulation appears poised to revolutionize education, training, and credentialing in critical care, surgery, and anesthesiology. However, advances in computing and technology have outpaced the evaluative and validation studies of simulation-based education.

Computer Simulation↗
PubMed2006

An analysis of 20 years of radiation-related health care complaints in Texas for the purposes of quality improvement.

In an effort to reveal the possible underlying causes of radiation-related health care complaints in the State of Texas, complaint data were evaluated using historical Texas Department of Health-Bureau of Radiation Control (TDH-BRC) reports. A major aim of the study was to generate a summary of the most commonly reported complaints that might be generalized to health care providers using sources of radiation across Texas. A generalizable list of common complaints would be a valuable tool for education and prevention programs, serving to possibly reduce the overall incidence of radiation-related medical complaints. Descriptive text summary reports of complaints were obtained from the TDH-BRC for the 20-y period inclusive of 1981 to 2001. The information was systematically coded into a computerized database. During the 20-y period of study, 481 health care-related complaints were identified, with approximately 74% consisting of claims of an "uncredentialed technician" (39%), "overexposure" (21%), or "regulatory violation" (14%). The most common categories of complaints imply some patient understanding or knowledge of the credentialing requirements of workers, the applicable dose limits, or the regulatory requirements associated with medical procedures. Since it is unlikely that an average patient would be aware of such issues, the findings suggest the complaints are not actually indications of the inappropriate uses of radiation, but are rather based on the patient's broader perception of services rendered. Most of the complaints levied during the period of study were done so anonymously (58%) and were levied against a generic facility (61%) rather than a specific technician (5%), doctor (4%), or student (1%). Approximately 61% of the complaints resulted in the issuance of a notice of violation upon investigation by the TDH-BRC, but the available data did not permit definitive linkage between the initial complaint and the violation issued. Taken in aggregate, the analysis suggests that improved communications between health care providers and the patients they serve could possibly serve to prevent future complaints. Although the analysis was limited to the data from a single state, the results may be of use to quality assurance programs on a broader scale because of the objective identification of likely common issues. Possible options for improving the means of systematically collecting initial compliant data in the future are also discussed.

Accidents, Occupational↗
PubMed2004

The educational experience of pediatric emergency medicine fellows in the use and application of procedural sedation/analgesia.

OBJECTIVES: The purpose of this study is to describe the clinical and educational experience provided to the pediatric emergency medicine (PEM) fellows in procedural sedation/analgesia during their course of training. METHODS: A nonanonymous survey was completed by the program director of each Accreditation Council for Graduate Medical Education (ACGME)-accredited PEM fellowship program listed in the 2001 to 2002 Graduate Medical Education Directory. Information relating to program demographics, agents available for use in the emergency department (ED), and the educational opportunities offered to trainees was sought. RESULTS: Each of the 32 ACGME-accredited programs completed the survey. Thirty programs report using procedural sedation and analgesia (PSA) to facilitate the completion of nonpainful and 32 programs to facilitate the completion of painful procedures in the ED. Twenty-nine programs (92%) permit their fellows to provide PSA independently after meeting credentialing criteria at their institution. Formal didactic sessions, direct supervision of procedures, and dedicated journal clubs were the 3 most frequently cited educational methods reported. The educational method chosen was not predicted by the ED type, the size of the training program, or by the volume of patients evaluated in the ED. Twelve program directors report their belief that a minimum number of procedures should be completed prior to completion of the training program. CONCLUSION: There is wide variation in the educational methods used by PEM fellowship training programs in procedural sedation/analgesia.

Analgesia↗
PubMed2006

A new tool for assessing standard of care in medical malpractice cases.

BACKGROUND: Physician experts hired and prepared by litigants provide most of the information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, the authors examined the feasibility and potential value of surveying peer physicians to assess standard of care. METHODS: The survey method for assessing standard of care was evaluated for a medical malpractice case involving an abdominoplasty that had a poor cosmetic result. An abstract of the case that included the patient's characteristics and physician's decisions that were most likely to influence patient outcome was created from the transcribed testimony of the plaintiff's expert witness. This abstract and a survey that included questions about four decisions made by the defendant were sent to 28 plastic surgeons in the Midwest who were identified by searches of public documents. RESULTS: Eleven plastic surgeons experienced in abdominoplasty completed the survey. Their responses in all four areas contrasted sharply with those of the highly credentialed medical expert for the plaintiff. CONCLUSIONS: These results suggest that physician surveys are feasible and may provide very different results than those from expert witnesses about standard of care in medical malpractice cases.

Abdomen↗
PubMed2005

Neurosurgical coverage: essential, desired, or irrelevant for good patient care and trauma center status.

SUMMARY AND BACKGROUND DATA: As a result of many factors, the availability of neurosurgeons (NS) to care for trauma patients (TP) is increasingly sparse. This has precipitated a crisis in access to neurosurgical support in many trauma systems, often placing undue burden on level I centers. This study examines the profile of head-injured (HI) trauma patients and their actual need for the specific expertise of a neurosurgeon. METHODS: The National Trauma Data Bank (NTDB) was queried for specific information relating to the volume, nature, timeliness, and outcome of HI TP. Study patients were identified by reported International Classification of Diseases, 9th Edition (ICD-9) codes denoting open (OHI) or closed head injury (CHI) in isolation or in combination with other injuries. RESULTS: Total number of NTDB patients studied was 731,823, of which 213,357 (29%) had a reported HI. CHI represented 22% of all TP and 74% of HI. OHI was reported in 8% of all TP and was 26% of HI. Craniotomy (crani) was performed in 3.6% of all HI (1% of all TP). This was in 2.8% of OHI and 2.6% of CHI. Mean Glasgow Coma Scale score (GCS) of crani patients was 9, and 13 for the noncrani group. Subdural hematoma occurred in 18% of HI (5% of TP), with 13% undergoing crani. Epidural hematoma occurred in 10% of HI (3% of all TP), with 17% undergoing crani. Median time to OR for all cranis was 195 minutes (195 for CHI; 183 for OHI). Of all cranis, 6.5% were performed within 1 hour of hospital admission. Intracranial pressure (ICP) monitoring was reportedly used in 0.7% of TP and 2.2% of HI. CONCLUSIONS: Care of TP with HI rarely requires the explicit expertise and immediate presence of a neurosurgeon due to volume and nature of care. HI was diagnosed in <30% of TP reported to the NTDB. Over 95% required nonoperative management alone, with only 1% of all TP and 2%-4% of HI TP requiring crani and/or ICP monitoring. Immediate availability of NS is not essential if a properly trained and credentialed trauma surgeon or other health care provider can appropriately monitor patients for neurologic demise and effect early transfer to a center capable of, and committed to, operative and postoperative neurosurgical care. A subgroup of patients known to have a high propensity for the specific expertise of a neurosurgeon may be able to be identified for direct transport to these committed centers.

Craniocerebral Trauma↗
PubMed2002

Animal conservation, carbon and sustainability.

International conventions to reduce carbon dioxide levels focus on ecosystems and do not specifically recognize the need to conserve species. However, species are the building blocks of ecosystems, they are more widely understood among the public, and they provide means of capturing market values from ecosystems. Achieving successful conservation globally will require ensuring that the systems under which species and ecosystems are conserved are more inclusive than statutory protected areas. Equal emphasis needs to be placed on including effective regimes that also encompass private and communal ownership through incentive-based approaches. Nevertheless, if globalized industries such as nature-based tourism or consumptive use are to provide meaningful incentives locally, a key requirement is to reduce leakage of revenue that is earned as a result of conserving species, such that local development concerns are addressed. However, current biodiversity conventions that address these needs are largely aspirational, while globalized industries such as tourism mainly promote their green credentials only through voluntary codes of conduct. Greatly improved linkages are needed between international conservation concerns and ensuring effective solutions to sustainability, which inevitably rest at national and sub-national levels, through systems of rights, tenure, benefits and incentives.

Agriculture↗
PubMed1986

Implementing faculty practice: a question of human and financial resources.

Two issues confronting nursing education are: improving the relationship between nursing service and nursing education, and achieving status as an academic discipline. The concept of faculty practice addresses both of these problems. By definition faculty practice requires demonstration of clinical competence through practice, and scholarly outcomes of practice which satisfy the research requirement of the nursing faculty role. While scholarly practice by nursing faculty members may benefit the nursing service-education relationship, it is a myth that nursing faculty members were more effective teachers prior to nursing education's move into institutions of higher education. While few argue against the need for clinical competence of nursing faculty members for effective teaching, the need to attain educational preparation for effective teaching must not be overlooked. The vast majority of nursing faculty members hold master's degree as their highest earned credential. To establish itself as an equal in academe and to increase teaching effectiveness, nursing education needs faculty prepared at the doctoral level. If nursing faculty members add faculty practice and doctoral study to the standard faculty role requirements of teaching, research and service, chronic overload will result. Nursing faculty members cannot solve all the problems confronting nursing education by continuously increasing their workload. Nursing programmes need to assess their resources and priorities. For all of its merits, faculty practice should not be implemented until a programme has adequate resources to support it.

Clinical Competence↗
PubMed2004

Assessment of patient management skills and clinical skills of practising doctors using computer-based case simulations and standardised patients.

CONTEXT: Standardised assessments of practising doctors are receiving growing support, but theoretical and logistical issues pose serious obstacles. OBJECTIVES: To obtain reference performance levels from experienced doctors on computer-based case simulation (CCS) and standardised patient-based (SP) methods, and to evaluate the utility of these methods in diagnostic assessment. SETTING AND PARTICIPANTS: The study was carried out at a military tertiary care facility and involved 54 residents and credentialed staff from the emergency medicine, general surgery and internal medicine departments. MAIN OUTCOME MEASURES: Doctors completed 8 CCS and 8 SP cases targeted at doctors entering the profession. Standardised patient performances were compared to archived Year 4 medical student data. RESULTS: While staff doctors and residents performed well on both CCS and SP cases, a wide range of scores was exhibited on all cases. There were no significant differences between the scores of participants from differing specialties or of varying experience. Among participants who completed both CCS and SP testing (n = 44), a moderate positive correlation between CCS and SP checklist scores was observed. There was a negative correlation between doctor experience and SP checklist scores. Whereas the time students spent with SPs varied little with clinical task, doctors appeared to spend more time on communication/counselling cases than on cases involving acute/chronic medical problems. CONCLUSION: Computer-based case simulations and standardised patient-based assessments may be useful as part of a multimodal programme to evaluate practising doctors. Additional study is needed on SP standard setting and scoring methods. Establishing empirical likelihoods for a range of performances on assessments of this character should receive priority.

Adult↗
PubMed2006

To blind or not to blind? What authors and reviewers prefer.

In order to inform discussions about possible changes to Medical Education's blinding policy, members of the journal's editorial board were interested in discovering reviewers' and authors' preferences with regard to the current double-blind policy and various alternatives. In September 2005, an 8-question, web-based survey was sent to all authors and reviewers who had submitted or reviewed a manuscript for Medical Education in 2003 and 2004 (n = 2632). The questions asked about authorship and reviewing experiences and preferences regarding 5 types of blinding procedure, from double-blinding to fully unblinded, open reviews. Following 2 electronic mailings, 838 surveys were completed. There was a range of experience among respondents, with a high proportion of experienced authors (49% with over 20 publications) and reviewers (41% with over 20 reviews). Overall, 68% of respondents preferred a review process that concealed author names and 72% preferred a process that allowed for concealment of reviewer names. Less experienced authors and reviewers were significantly more likely to prefer concealing author names, but even the most experienced respondents had a 54% preference for author concealment. Reasons for concealing identities included facilitating fairness and honesty in reviews and acknowledging the need to avoid personal conflicts or rivalries. Reasons for revealing identities included facilitating greater transparency and accountability, and a better understanding of the author's and reviewer's contexts and credentials. The Medical Education authors and reviewers who chose to respond to the survey voted strongly in favour of continuing the double-blinding procedure of concealing both author and reviewer identities during the review process.

Attitude↗
PubMed2006

Achieving Magnet accreditation in the UK: a case study at Rochdale NHS Trust.

AIMS: This study explored the Magnet accreditation process in the first health care organization outside the USA to attempt to gain the award, Rochdale NHS Trust United Kingdom. The development was supported by the American Nurses Credentialing Center as a pilot project and the research conducted as a case study in organizational response to the requirements of a new accreditation system. METHOD: Information was collected via 23 face-to-face and three telephone interviews carried out with 11 senior figures at Rochdale during the 2-year period of the Magnet project, from field notes of meetings attended by the researchers and from analysis of documents associated with the project. RESULTS: The work of applying for Magnet accreditation built upon a previous 2-3 year programme of shared governance and clinical leadership throughout the Trust which senior staff felt had been an essential foundation for the Magnet project. The process enabled staff to assemble evidence which held up a mirror to their practice and contributed to other quality-related initiatives. The experience at Rochdale suggests that Magnet enables care areas to identify and celebrate examples of good practice and for lessons to be learned and shared within the organization. Although the Magnet concept is primarily nursing oriented, medical and allied health professionals were able to contribute and benefit. The application was successful and Rochdale was awarded Magnet status in April 2002. CONCLUSIONS: The Magnet project at Rochdale was essentially a process of collecting evidence to formally recognize previous leadership initiatives and their effects within the organization. The emergent approach to implementing the Magnet project was one which attempted to integrate and utilize existing systems and resources. The project provides evidence that Magnet can be transferred to non-US health care systems. The principal issues associated with this transfer were the costs incurred, the interpretation of terminology and the engagement of medical and allied health professionals.

Accreditation↗
PubMed1997

Home away from home.

A discourse on the careers and events that relate to Everard Home's Lectures on Comparative Anatomy, published in six volumes, of which the final supplementary volume of 1828 is in the Gordon Craig Library. This volume contains 68 engravings, of subjects as diverse as the stomach of the alpaca and the female organs of the duckbilled platypus Ornithorhynchus, and Home's credentials occupy about half of the title page.

Anatomy, Comparative↗