Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Credentialing”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,639 records · Page 91Linked to original sources
PubMed1990

Candidates for the Certificate of Added Qualifications in Geriatric Medicine. Who, why, and when?

We surveyed physicians who took the examination for certification for Added Qualifications in Geriatric Medicine, physicians who only inquired about the examination, and physicians who expressed no interest in the examination to learn about practice characteristics of those who took the examination and their reasons for taking it. Based on a 72% response rate, we were able to demonstrate that those who took the examination took care of an older population of patients and disproportionately more of the oldest-old. These physicians were more likely to report the care of older people to be a professional focus and, in internal medicine, were more likely to have had formal training in geriatrics. Their reasons for taking the examination were primarily to obtain credentials but also frequently to improve their ability to care for older people. Nearly two-thirds of those who had inquired about the exam but did not take it in 1988 plan to do so at a later date.

Certification↗
PubMed1993

Characteristics and quality of prescribing by doctors practicing in nursing homes.

OBJECTIVES: To describe the professional characteristics of doctors practicing in nursing homes and to determine whether those characteristics correlate with quality of prescribing. DESIGN: A prospective, cohort study. PARTICIPANTS: 306 physicians practicing in 12 nursing homes in greater Los Angeles. MEASUREMENTS: We surveyed doctors about their age, sex, education, credentials, and NH practice. We also determined medication orders for a 1-month period and evaluated them using explicit criteria for appropriateness developed by an expert panel. RESULTS: We obtained data from 72% of MDs. Respondents had a mean age of 53 years (29-78) and were 94% male. Fifty-seven percent trained in internal medicine, 20% graduated outside the US or Canada, 67% were board certified in their declared specialty, and 5% had a certificate of added qualification in geriatrics (CAQ). Sixteen percent spent > 10% of their professional time in NHs, and 46% had NH practices that were > 20% Medicaid; most did not consult psychiatrists when prescribing psychoactive drugs. Forty percent of residents had at least one inappropriate prescription. The characteristics of doctors associated with the best prescribing quartile were female sex, CAQ, no board certification, and frequent consultation with psychiatrists. The characteristics of doctors in the most inappropriate quartile were older age, graduation from medical school before 1965, graduation from US medical school, small NH practice, and infrequent consultation with psychiatrists. CONCLUSIONS: Although the quality of prescribing in nursing homes is related to some physician characteristics, the relationships are not those most commonly stated.

Adult↗
PubMed2004

Physician recognition of cognitive impairment: evaluating the need for improvement.

OBJECTIVES: To assess physician recognition of dementia and cognitive impairment, compare recognition with documentation, and identify physician and patient factors associated with recognition. DESIGN: Survey of physicians and review of medical records. SETTING: Health maintenance organization in southern California. PARTICIPANTS: Seven hundred twenty-nine physicians who provided care for women participating in a cohort study of memory (Women's Memory Study). MEASUREMENTS: Percentage of patients with dementia or cognitive impairment (using the Telephone Interview of Cognitive Status supplemented by the Telephone Dementia Questionnaire) recognized by physicians. Relationship between physician recognition and patient characteristics and physician demographics, practice characteristics, training, knowledge, and attitudes about dementia. RESULTS: Physicians (n=365) correctly identified 81% of patients with dementia and 44% of patients with cognitive impairment without definite dementia. Medical records documented cognitive impairment in 83% of patients with dementia and 26% of patients with cognitive impairment without definite dementia. In a multivariable model, physicians with geriatric credentials (defined as geriatric fellowship experience and/or the certificate of added qualifications) recognized cognitive impairment more often than did those without (risk ratio (RR)=1.56, 95% confidence interval (CI)=1.04-1.66). Physicians were more likely to recognize cognitive impairment in patients with a history of depression treatment (RR=1.3, 95% CI=1.03-1.45) or stroke (RR=1.37, 95% CI=1.04-1.45) and less likely to recognize impairment in patients with cognitive impairment without definite dementia than in those with dementia (RR=0.46, 95% CI=0.23-0.72) and in patients with a prior hospitalization for myocardial infarction (RR=0.37, 95% CI=0.09-0.88) or cancer (RR=0.49, 95% CI=0.18-0.90). CONCLUSION: Medical record documentation reflects physician recognition of dementia, yet physicians are aware of, but have not documented, many patients with milder cognitive impairment. Physicians are unaware of cognitive impairment in more than 40% of their cognitively impaired patients. Additional geriatrics training may promote recognition, but systems solutions are needed to improve recognition critical to provision of emerging therapies for early dementia.

Aged↗
PubMed2006

Guidelines abstracted from the Department of Veterans Affairs/Department of Defense clinical practice guideline for the management of stroke rehabilitation.

OBJECTIVES: To assist facilities in identifying those evidence-based processes of poststroke care that enhance measurable patient outcomes. The guideline(s) should be used by facilities (hospitals, subacute-care units and providers of long-term care) to implement a structured approach to improve rehabilitative practices and by clinicians to determine best interventions to achieve improved patient outcomes. OPTIONS: The guideline considers five elements of poststroke rehabilitation care: interdisciplinary teams; use of standardized assessments; intensity, timing, and duration of therapy; involvement of patients' families and caregivers in decision-making; and educational interventions for patients, families, and caregivers. Evidence, benefits, harms, and recommendations for each of the five designated elements and specific annotated recommendations for poststroke managements are presented separately. OUTCOMES: The overall guideline considers improvement in functional status measures as the primary outcome. Achieving community-dwelling status and preventing complications, death, and rehospitalization are also important outcomes. Costs are not specifically addressed. PARTICIPANTS: The Department of Veterans Affairs/Department of Defense (VA/DoD) Stroke Rehabilitation Working Group consisted of 28, largely VA and military hospital, representatives of medical and allied professions concerned with stroke diagnosis, management, and rehabilitation. Nine additional members with similar credentials served as the editorial committee. Technical consultation was contracted from ACS Federal Health Care, Inc., and the Center for Evidence-Based Practice, State University of New York-Upstate Medical University, Department of Family Medicine conducted evidence appraisal. Consensus was achieved over several years of facilitated group discussion and iterative evaluation of draft documents and supporting evidence. SPONSOR: The guideline was prepared under the auspices of the VA/DoD. No other source of support was identified in the document, or supporting documents.

Early Diagnosis↗
PubMed1994

Report of the NASPE Policy Conference training requirements for permanent pacemaker selection, implantation, and follow-up. North American Society of Pacing and Electrophysiology.

NASPE proposes and supports the concept of a two-tracked training system in cardiac pacing. Track I training will properly train physicians for the prescription of pacemakers and the monitoring of pacemaker patients, and track II training will properly prepare physicians for the implantation of pacemakers. Regardless of specialty (cardiologist or surgeon) or training venue (cardiac pacing fellowship, cardiac electrophysiology and pacing fellowship, sabbatical or mentor sponsored training), it is recommended that these minimum standards be required for hospital credentialing. NASPE also supports the voluntary institution by training program directors of core pacing training in cardiovascular disease and cardiac electrophysiology fellowships. This core training does not in itself constitute proper track I or II training for physicians interested in adequately prescribing, monitoring, or implanting cardiac pacemakers.

Cardiac Pacing, Artificial↗
PubMed2006

Fast-track training of nonelectrophysiologists to implant defibrillators: is it needed?

Standard training pathways in cardiac electrophysiology are being short-circuited for a "fast-track" approach to train nonelectrophysiologists (not necessarily cardiologists) to implant defibrillators in patients. This approach has been undertaken by a professional society (The Heart Rhythm Society), a society that cannot police, or properly credential. They have support from the American College of Cardiology and, perhaps, even the Combined Medicare and Medicaid Services. This issue is particularly disturbing as there are no data to support the approach taken with regard to the safety and benefit for patients. This process disrupts the standard training pathways and will have long-term implications for the field of clinical cardiac electrophysiology and for the availability of highly trained individuals qualified to implant defibrillators. This issue has broad implications with regard to medical training pathways. We discuss these issues in detail and provide the results of two surveys, including a survey from members of the Heart Rhythm Society, most of whom disagree with the "fast-track" approach. A survey of cardiologist faculty members of the American College of Cardiology yielded similar results. We are particularly concerned about the disruption of training pathways in medicine and how this can affect patient care and can influence established training pathways in medicine.

Cardiology↗
PubMed2006

Technical aspects of diastology: why mitral inflow and tissue Doppler imaging are the preferred parameters?

Doppler methods for assessing left ventricular (LV) diastolic function have increased in number and complexity. However, time constraints may prevent measurement of all parameters during routine transthoracic echocardiography. Therefore, we designed a study to determine which Doppler parameters could be most successfully and quickly obtained. The recording success rate and time required to record different LV diastolic function parameters were evaluated in 80 patients. A specific recording protocol was followed by an experienced, credentialed sonographer and time intervals to record each parameter were measured. In comparison with color Doppler M-mode of LV inflow propagation velocities (Vp) and pulmonary venous (PV) flow measurements, transmitral valve (MV) flow and tissue Doppler imaging (TDI) of the mitral annulus had the highest recording success rate and required the shortest time to record. PV flow and Vp took longer to obtain (80.1+/-34.3 sec and 57.1+/-29.1 sec, respectively) than did mitral valve inflow (36.3+/-20.7 sec) and mitral valve annular TDI (29.3+/-18.4 sec for septal and 33.3+/-14.5 sec for lateral). MV flow velocities, Vp, and TDI were successfully recorded in virtually all patients (99-100%). In comparison, the PV flow velocities and durations were successfully recorded less often. The range of success rates for the six PV flow parameters was 49-84%. Since MV flow and TDI also have been shown by us to have the lowest interreader variability, measurement of these two parameters may be preferred for routine clinical evaluation of LV diastolic function in a busy echocardiography laboratory.

Aged↗
PubMed1999

Report of a state-of-the-knowledge conference on U. S. nursing certification. ONCC Research Committee and Executive Staff. U. S. Oncology Nursing Certification Corporation.

PURPOSE: To describe the problems discussed, consensus established, and recommendations made during a "state of the knowledge" conference on nursing certification hosted by the Oncology Nursing Certification Corporation (ONCC), April 1996. ONCC planned the conference after finding little empiric data in the literature to support the value of nursing certification and after recognizing that consensus was lacking regarding several critical questions related to certification. SOURCES: Representatives of 24 specialty nursing certification organizations participated in the 3-day conference. METHODS: Through formal presentations and small groups, participants identified unresolved issues and areas of consensus, then strategized ways to address questions and problems. RESULTS: This historic conference identified problems that require proactive responses and solutions by organizations involved in nursing certification. Unresolved issues included the lack of standardization of basic certification procedures, the means of evaluating continued competency, and questions regarding the relationship between certification and patient outcomes. Development of a nursing multispecialty research council was proposed and has since been established under the leadership of the American Nurses Credentialing Center. CONCLUSIONS: The conference was a successful way to unite specialties in nursing. Of high priority is the need to validate that certification positively affects patient outcomes. Until this can be shown, it will be difficult to persuade employers and payers that nursing certification should be a workplace requirement.

Certification↗
PubMed2006

U.S. genetics nurses in advanced practice.

PURPOSE: To describe characteristics and professional roles of genetics nurses in advanced practice. DESIGN: A cross-sectional descriptive survey administered in 2004 as one component of a comprehensive study of genetic services and the health workforce. The sample was 211 U.S. members of the International Society of Nurses in Genetics. METHODS: The survey included demographic characteristics, education, credentials, professional roles, and attitudes about genetic healthcare issues. FINDINGS: The majority of respondents had master's degrees and many had earned doctorates in nursing (20%) or other fields (12%). Thirty-one percent were certified as nurse practitioners; 57% provided direct patient care, with the largest percentage working in genetics (26%) or oncology (22%) settings. Over one-third were educators and 19% conducted genome-related research. CONCLUSIONS: Genetics nurses in advanced practice in the US focus on both genomic discoveries and clinical health care through the application of genomic knowledge into health care, research, and nursing education.

Adult↗
PubMedDate not supplied

We are out here, still rearing our families: some thoughts on education and certification.

Establishing credentials in nursing is the subject of intense controversy and research. Decisions regarding advanced education pose more complex problems for some nurses than for others. Social changes tempt many to take for granted today's freedom of choice in life style, but persons still in very responsible and productive periods of their lives grew up in a different time. Life styles were formed under the pressures of narrower opportunities for self-esteem and social approval. Many chose to devote themselves to a combination of direct patient care and the long-term commitment of traditional family rearing. They must speak out lest their viewpoint be ignored by others whose pursuits may have gained them more verbal, organizational, and political skills.

Certification↗
PubMedDate not supplied

An in-house program of continuing education for perinatal nurses.

The value of continuing education for nurses continues to be stressed by nursing educators and nursing administrators. An in-house program, similar to the one described above, could be useful for other acute-care health facilities. It seems highly probable that certification by a recognized credentials-granting agency, especially a specialty of nursing, such as obstetrics or neonatology, wil become an important evaluation tool for those who employ nurses. It seems logical and cost-effective for nurses to take advantage of this opportunity to learn from resources in their own institution.

Clinical Competence↗
PubMed1994

A comprehensive fetal monitoring program for nursing practice and education.

Fetal monitoring is a critical part of obstetric nursing. Health-care institutions must educate staff, validate their competency, and evaluate their practice to assure high-quality care in fetal monitoring. This article chronicles the development of a comprehensive program for nursing education and practice in fetal monitoring. Basic education and credentialing, recredentialing, in-service and continuing education, policies and procedures, standards of care, terminology, quality assurance, and linkage with a professional advancement system are reviewed.

Certification↗
PubMed1998

Supporting emergency medicine research: developing the infrastructure.

The long-term goals of developing research within the specialty of emergency medicine (EM) include the following: 1) to continue to improve the quality and quantity of EM research in order to ultimately improve emergency patient care; 2) to maximize the research potential of emergency health care professionals in order to develop new emergency research talent and enthusiasm; and 3) to establish the academic research credentials of the specialty of EM in order to become competitive for federal research funding, and further improve emergency patient care. This article addresses the process by which the infrastructure for EM research can be developed at academic medical centers and provides recommendations. The roles of the academic chair, research director, senior researcher, and departmental faculty are discussed.

Academic Medical Centers↗
PubMed1999

Emergency center categorization standards.

The SAEM EC Categorization Task Force was developed in response to the 1994 Macy Foundation's recommendation that emergency medicine (EM) organizations "should revise the classification of emergency departments ... to reflect the level of care available in emergency departments, and indicate whether or not facilities are adequate and whether appropriately qualified and credentialed emergency physicians are available 24 hours a day." By holding Level 1 emergency centers (ECs) to objective standards based on the quality of care delivered as well as administrative, research, and educational efforts, SAEM hopes to improve patient care. The SAEM EC Categorization Task Force is now beginning the process of reviewing ECs that provide comprehensive emergency care and serve as regional resources for education, research, and administration in EM. This standards document describes relative and critical criteria to be met in order to receive designation as a Level 1 emergency center. Such centers must meet all critical criteria, and be in sufficient compliance with most or all relative criteria, in order to achieve this designation. This process is entirely voluntary. Any EC is eligible for review. Any institution can initiate the review process by applying. Application materials and further information, including the policies and procedures of the SAEM EC Categorization Task Force, are available from SAEM.

Education, Continuing↗
PubMed2002

Careers of graduates of combined emergency medicine/internal medicine programs.

UNLABELLED: In 1991, the American Boards of Internal Medicine and Emergency Medicine changed their credentialing requirements to recognize training common to both disciplines. This allowed the formation of a five-year track for dual board eligibility. From 1995 to 1998, 28 physicians graduated from eight emergency medicine/internal medicine (EM/IM) programs. This study was an analysis of career outcomes of these graduates. OBJECTIVES: To document career outcomes of EM/IM program graduates, establish a baseline for future studies of EM/IM graduates, and elucidate the role of EM/IM graduates in medicine. METHODS: The 28 EM/IM graduates were mailed a written questionnaire. Endpoints assessed included practice fields, practice environments, ongoing research, publications, academic appointments, board examination scores, career satisfaction, and career goals. RESULTS: Surveys were obtained from 23 of 28 (82.1%) graduates. Seven (30.4%) practice EM and IM, 15 (65.2%) practice EM exclusively, and one (4.3%) practices IM exclusively. Twelve (52.2%) are involved in research. The graduates authored a total of 30 papers or chapters. Ten (43.5%) currently work in administrative positions, but many more aspire to. The most common reasons for having chosen an EM/IM program are to be a better physician (22/23, 95.7%), to practice in both fields (15/23, 65.2%), and to become better prepared for an academic career (15/23, 65.2%). The EM/IM graduates reported high career satisfaction. CONCLUSIONS: Although the majority of EM/IM graduates do not practice both IM and EM, many would prefer to. The graduates are highly satisfied with their choice of residency and career. Early in career development, the graduates appear to gravitate toward academic and leadership positions.

Career Choice↗
PubMed2003

Resident evaluation of clinical teachers based on teachers' certification.

OBJECTIVE: To examine the influence of emergency medicine (EM) certification of clinical teaching faculty on evaluations provided by residents. METHODS: A prospective cohort analysis was conducted of assessments between July 1994 and July 2000 on residents' evaluations of EM faculty at the University of Alberta, Edmonton, Canada. Resident- and faculty-related variables were entered anonymously using the validated evaluation tool (ER Scale). Credentialing and demographic information on EM faculty was supplemented by data obtained through a nine-question survey. Groups were compared using ANOVA. RESULTS: The 562 residents returned 705 (91%) valid evaluation sheets on 115 EM faculty members. The four domains of didactic teaching, clinical teaching, approachability, and helpfulness were assessed. The majority of ratings were in the very good or superb categories for each domain. Instructors with certification in EM had higher scores in didactic, clinical teaching compared with others, and teachers without national certification scored lower in the helpful and approachable categories (p < 0.05). The route of obtaining EM certifications either through training or practice eligibility did not affect scores. Instructors under the age of 40 years had higher scores than the older age groups in three of four categories (p < 0.05). Instructors working at the teaching sites on a half-time basis received higher scores than those working full-time, and scores varied based on site. Overall, teaching ratings improved over the study period (p < 0.05). CONCLUSIONS: Significant differences exist among instructors in the EM setting that affect their teaching rating scores. National certification in EM, academic track, rotation year, and site are all correlated with better teaching performance.

Adult↗
PubMed2003

Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography.

OBJECTIVES: Emergency department (ED) bedside echocardiography may offer useful information on cardiac function and volume status. The authors evaluated the accuracy of emergency physician (EP) performance of echocardiography in the assessment of left ventricular ejection fraction (LVEF) and central venous pressure (CVP). METHODS: The authors conducted a cross-sectional observational study at an urban teaching ED, involving a convenience sample of patients presenting to the ED between September 2000 and February 2001. Level III-credentialed EP sonographers who had undergone a three-hour training session in limited echocardiography, focusing on LVEF and CVP measurement, performed echocardiograms. Vital signs and indication for echocardiography were documented on a study data sheet. LVEF was rated as poor (<30%), moderate (30%-55%), or normal (>55%) and an absolute percentage. Central venous pressure categories included low (<5 cm), moderate (5-10 cm), and high (>10 cm). Formal echocardiograms were obtained within a four-hour window on all patients and interpreted by a staff cardiologist. Correlation analysis was performed using the kappa correlation coefficient for LVEF and CVP categories and a Pearson correlation coefficient for LVEF measurement. RESULTS: A total of 115 patients were assessed for LVEF, and 94 patients had complete information for CVP. Indications for echocardiography included chest pain (45.1%), congestive heart failure (38.1%), dyspnea (5.7%), and endocarditis (10.6%). Results showed a LVEF correlation of r(2) = 0.712 with 86.1% overall agreement. Subgroup analysis revealed the highest agreement (92.3%) between EP and formal echocardiograms within the normal LVEF category, followed by 70.4% agreement in the poor LVEF category and 47.8% in the moderate LVEF category. Central venous pressure measurements resulted in 70.2% overall raw agreement between EP and formal echocardiograms. Subgroup analysis revealed the highest agreement (83.3%) within the high CVP category followed by 66.6% in the moderate and 20% in the low categories. CONCLUSIONS: Experienced EP sonographers with a small amount of focused additional training in limited bedside echocardiography can assess LVEF accurately in the ED.

Adult↗
PubMed2004

A national survey of flexible sigmoidoscopy training in primary care graduate and postgraduate education programs.

OBJECTIVES: Expanding the pool of primary care endoscopists to perform flexible sigmoidoscopy (FS) has been advocated as a strategy for building colorectal cancer screening capacity. The principal aim of this study was to evaluate the availability and structure of FS training among internal medicine (IM), family practice (FP), physician assistant (PA), and nurse practitioner (NP) training programs. METHODS: A postal survey of all accredited IM (n = 445), FP (n = 471), PA (n = 118), and NP (n = 149) training programs nationwide was conducted. The primary outcome was the proportion of programs offering or mandating FS training; and secondary outcomes, if applicable, were the number of participating trainees, the number of required procedures, the availability of instruction in endoscopic biopsy technique, mentors, and barriers. RESULTS: The overall response rate was 63%. Most IM (89%) and FP (99%) programs offered FS training versus only 12% of PA and 0% of NP programs. Family practice programs were more likely to offer training (p < 0.0001), require training (p < 0.0001), and teach biopsy techniques (p < 0.0001); Internal medicine programs were more likely to have minimum requirements (p < 0.0001) and required >/= 25 procedures per trainee (p < 0.0001). Physician assistant programs were less structured and often lacked minimum requirements. CONCLUSIONS: Flexible sigmoidoscopy training is widely available among FP and IM programs but more restricted or nonexistent among PA and NP programs. The lack of minimum standards for ensuring competency highlights the need for a standardized credentialing process.

Clinical Competence↗