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PubMedDate not supplied

Indicators of accuracy of consumer health information on the Internet: a study of indicators relating to information for managing fever in children in the home.

OBJECTIVES: To identify indicators of accuracy for consumer health information on the Internet. The results will help lay people distinguish accurate from inaccurate health information on the Internet. DESIGN: Several popular search engines (Yahoo, AltaVista, and Google) were used to find Web pages on the treatment of fever in children. The accuracy and completeness of these Web pages was determined by comparing their content with that of an instrument developed from authoritative sources on treating fever in children. The presence on these Web pages of a number of proposed indicators of accuracy, taken from published guidelines for evaluating the quality of health information on the Internet, was noted. MAIN OUTCOME MEASURES: Correlation between the accuracy of Web pages on treating fever in children and the presence of proposed indicators of accuracy on these pages. Likelihood ratios for the presence (and absence) of these proposed indicators. RESULTS: One hundred Web pages were identified and characterized as "more accurate" or "less accurate." Three indicators correlated with accuracy: displaying the HONcode logo, having an organization domain, and displaying a copyright. Many proposed indicators taken from published guidelines did not correlate with accuracy (e.g., the author being identified and the author having medical credentials) or inaccuracy (e.g., lack of currency and advertising). CONCLUSIONS: This method provides a systematic way of identifying indicators that are correlated with the accuracy (or inaccuracy) of health information on the Internet. Three such indicators have been identified in this study. Identifying such indicators and informing the providers and consumers of health information about them would be valuable for public health care.

Child↗
PubMed1995

Minimally invasive surgery.

With the widespread introduction of laparoscopic cholecystectomy in late 1989, the practice and expectations of general surgery were changed forever. The techniques of laparoscopy were not new--they had been adopted by gynecologists and orthopedic surgeons at least a decade before--but it was laparoscopic cholecystectomy that captured the attention of the surgical profession and the public and spawned the tremendous growth in what has come to be called minimally invasive surgery. Although this surgery has tremendous appeal, offering quicker recovery, less pain, and possibly greater safety, it presents new challenges in the areas of training, credentialing, and quality assessment and raises serious questions about the real benefits of new technology at a time when the political and economic sensitivity of these issues is greater than ever. In this chapter I limit myself to a discussion of laparoscopy in general surgery, with a focus on what we have learned from laparoscopic cholecystectomy and on what this knowledge suggests for the future of other laparoscopic general surgical procedures.

Cholecystectomy, Laparoscopic↗
PubMed1996

The social structure of schooling.

The term social structure refers to a relatively enduring pattern of social arrangements or interrelations within a particular society, organization, or group. This chapter reviews how the social structure of the larger society and the organizational structure of schools affect the educational process within American schools. The institutional context of schooling is first discussed. The ideology of mass education, social stratification, status attainment, credentialism, and the emphasis on ability differences are considered. The focus then shifts to the organizational structure of schools, beginning with a discussion of the external social context for school organization. Attention is given to professionalism and bureaucracy, institutional forms of organization, decentralized control, and community influences. Finally, the internal structure of school organization is considered: teachers' working conditions, status differences among students, and curriculum tracking. Throughout, the emphasis is on ways in which social structure influences what is taught in school, how it is taught, and what is learned.

Journal Article↗
PubMed2004

The public health workforce.

The development of a fully-competent public health workforce as a key component of the nation's public health infrastructure has become the focus of increasing attention. The subject is included in one, and is the major topic of a second, report from the Institute of Medicine published late in 2002. Workforce issues have stimulated the convening of the majority of public health-related associations in a range of collaborations on the subjects of defining, enumerating, credentialing, educating, and studying the workforce. The authors review the major questions confronting the field and introduce key components of current thinking about approaches to improvement.

Disaster Planning↗
PubMed2003

Linking radiation oncology and imaging through molecular biology (or now that therapy and diagnosis have separated, it's time to get together again!).

Among the areas defined by the National Cancer Institute as "Extraordinary Opportunities for Research Investment" that are highly relevant to the technology-oriented disciplines within the broad field of radiology are cancer imaging, defining the signatures (ie, underlying molecular features) of cancer cells, and molecular targets of prevention and treatment. In molecular target credentialing, a specific molecular target is imaged, the molecular signature is defined, a treatment is given, and the effect of the intervention on the image findings and the signature is then evaluated. Such an approach is used to validate the proposed target as a legitimate one for cancer therapy or prevention and to provide the opportunity to ultimately individualize therapy on the basis of both the initial characteristics of the tumor and the tumor's response to an intervention. Therapeutic radiation is focused biology (ie, radiation produces molecular events in the irradiated tissue). Radiation can (a) kill cancer cells by itself, (b) be combined with cytotoxic or cytostatic drugs, and (c) serve to initiate radiation-inducible molecular targets that are amenable to treatment with drugs and/or biologic therapies. Focused biology can be anatomically confined with various types of external beams and with brachytherapy, and it can be used systemically with targeted radioisotopes. These new paradigms link diagnostic imaging, radiation therapy, and nuclear medicine in unique ways by way of basic biology. It is timely to develop new collaborative research, training, and education agendas by building on one another's expertise and adopting new fields of microtechnology, nanotechnology, and mathematical analysis and optimization.

Combined Modality Therapy↗
PubMed1994

National survey of mammographic facilities in 1985, 1988, and 1992.

PURPOSE: To determine trends in mammography in the United States. MATERIALS AND METHODS: A sample of mammographic facilities was selected for each year of the Nationwide Evaluation of X-ray Trends. The same protocol was followed for the 1985, 1988, and 1992 surveys. Data were collected with use of the same imaging phantom for all three surveys and also with a different phantom in the 1988 and 1992 surveys. RESULTS: Of the 356 facilities surveyed in 1992, 59% claimed to be in compliance with the Health Care Financing Administration (HCFA) mammography requirements, 42% were accredited by the American College of Radiology (ACR), and 23% did not hold credentials from either the HCFA or the ACR. Since 1985, there has been a 34% improvement in acceptable phantom image quality score and a 20% decrease in the mean glandular dose. CONCLUSION: Mammography as practiced today is essentially a screen-film technique. Mammographic phantom image quality has improved considerably. The overall mean glandular dose has decreased primarily because of the elimination of xeroradiography.

Accreditation↗
PubMed2003

Improving vascular access outcomes: a systems approach to eliminating structural barriers.

Maximizing AV fistula creation, regular access monitoring, prompt outpatient interventions and minimizing catheter use are well-accepted approaches for vascular access management. Systemic barriers impede the application of these strategies. A misaligned reimbursement system coupled with educational deficits and a lack of accountability has contributed to the institutionalization of substandard vascular access care. The hallmark of performance management is to create systems in which incentives are aligned to produce desired behaviors. Realigning reimbursement through a combination of pre-ESRD funding, enhancements to the composite rate to reward outcomes and cover vascular access monitoring and updated reimbursement for outpatient vascular access procedures would improve care and decrease unnecessary hospitalizations. This should be coupled with clearly defined outcome standards and accountability incorporated into hospital accreditation and credentialing. Capitation may provide alternative solutions. A two-phased approach including reimbursement reform while exploring capitation represents a prudent course with the best likelihood of success.

Arteriovenous Shunt, Surgical↗
PubMed2006

Preparation of speech-language pathologists in the United States: The Master's degree.

In order to become credentialed as a speech-language pathologist in the United States, a masters's degree is required. This degree integrates course work with clinical practica. Course work covers normal anatomy and physiology involved in human communication and swallowing, disorders affecting these functions and methods of evaluation and treatment across the life span. Generally this master's degree education requires 1(1/2) to 2 years for students with some background course work on the undergraduate level.

Clinical Competence↗
PubMed2006

Carotid artery stenting: first consensus document of the ICCS-SPREAD Joint Committee.

BACKGROUND AND PURPOSE: The prevention of stroke and the correct treatment of carotid artery stenosis represent today a major debate in cardiovascular medicine. Beside carotid endarterectomy, carotid angioplasty and stenting is becoming more widely performed for the treatment of severe carotid obstructive disease, and is now accepted as a less invasive technique that may provide an alternative for selected patients, particularly those with significant comorbidities. An Italian multidisciplinary task force, in which converged the most representative scientific societies involved in carotid treatment, was created to provide neurologists, radiologist, cardiologists, vascular surgeons, and all those involved in prevention and treatment of carotid disease with a simple, clear and updated evidence-based consensus document. SUMMARY OF REVIEW: This First Consensus Document of the ICCS (Italian Consensus Carotid Stenting)/SPREAD group addressed the main issues related to methodology, definition of symptomatic and asymptomatic carotid stenosis, indication and procedures for carotid artery stenting, including the use of devices for preventing procedural embolic complications. Special attention was paid to credentials and competency for physicians qualifications to perform vascular angioplasty and stent placement, including training, acceptable complication rates and certification. CONCLUSIONS: As any guideline or consensus statement, also this document is valid as long as the evidence on which it is based remains up-to-date. In such a fast-evolving field of medicine as the management of carotid stenosis, it is mandatory to stimulate a continuous and fruitful discussion among all the professionals involved in this very evolutionary field.

Carotid Artery Diseases↗
PubMed1999

"Telestroke" : the application of telemedicine for stroke.

BACKGROUND: Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are "on call" around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. SUMMARY OF COMMENT: Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics (<1.5% nationally), and few benefit from the expertise and experience of the stroke teams. It is essential to develop new paradigms to improve acute stroke care in all settings, rural and urban. Rapid linkages to expert stroke care can help the underserved areas. Telemedicine for stroke, "Telestroke, " uses state-of-the-art video telecommunications that may be a potential solution and may maximize the number of patients given effective acute stroke treatment across the country and across the world. Telestroke could facilitate remote cerebrovascular specialty consults from virtually any location within minutes of attempted contact, adding greater expertise to the care of any individual patient. This model also has the potential to enhance patient entry into clinical trials. Telestroke would enhance stroke education through the use of Internet-based interactives for health-care professionals and patients. Education would be facilitated through the creation of telecommunication-linked classes providing interactive information on stroke care and prevention to places where they are otherwise not available. Health-care professionals will gain experience and expertise through the interaction with a remote expert--telementoring. Telestroke provides an excellent medium for data collection and an unprecedented opportunity for quality assurance. Monitoring of an entire tele-interaction can offer real-time assessments, which can then be analyzed in-depth at a later date for unique insights into health-care delivery. Prehospital use of telemedicine for stroke is already being piloted, linking patients in the ambulance to the emergency department. Legal and economic parameters must be established for telemedicine in the areas of reimbursement, liability, malpractice insurance, licensing, and credentialing. Issues of protection of privacy and confidentiality, informed consent, product liability, and industry standards must be addressed to facilitate the use of this new and potentially useful technology. CONCLUSIONS: Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.

Acute Disease↗
PubMed1980

Medicaid records and the psychiatric private sector.

The authors report a study or records maintained by private practitioners for their Medicaid patients. The quality of record keeping in general fell far short of Medicaid requirements. Board-certified or hospital-affiliated psychiatrists kept better charts than those who did not have these credentials. Educational background did not correlate with extent of record keeping.

Certification↗
PubMed2002

Readiness of psychiatry residency training programs to meet the ACGME requirements in cognitive-behavioral therapy.

The authors assessed the readiness of adult psychiatry residency programs to train residents in cognitive-behavioral therapy (CBT) prior to the January 2001 revision of program requirements by the Accreditation Council for Graduate Medical Education (ACGME). Adult residency training program directors were surveyed. Data analysis evaluated relationships between directors' confidence in CBT training and the program and faculty characteristics. Responses were received from 54.2% of programs. Half had no requirement for resident-performed CBT. Directors' confidence in CBT training was significantly related to didactic hours (P=0.041), psychotherapy hours (P=0.007), and ACT-certified faculty (P=0.035). A substantial lack of required training in CBT exists in least 25% of accredited programs. Assessing faculty credentials and working with specialty organizations recommended in this article could assist in developing better programs in CBT.

Journal Article↗
PubMed2003

Closing the loop: assessing the effectiveness of psychiatric competency measures.

BACKGROUND: During the past several years there has been a growing emphasis on competency assessment in graduate education in all specialties, including psychiatry. Methods of assessment are continuously being devised and refined. OBJECTIVE: To outline principles and methods of assessing the validity of competency measures and their relevance to trainees. METHODS: The authors reviewed the literature relevant to competency assessment and quality improvement in the fields of elementary and secondary education, adult learning, undergraduate medical education, and postgraduate medical training. Three means were used to evaluate the assessment program: 1) The authors surveyed graduates and credentialing agencies for feedback on the relevance of the measures they previously developed for current and envisioned future practice of psychiatry; 2) They measured the completion rates of competency measures by residents in the first 3 years of a program, measuring general psychiatric competencies; and 3) They surveyed residents and faculty regarding satisfaction with the existing process. RESULTS: Despite small numbers, the results indicated that measures devised in 1998 were relevant to the practice of psychiatry in 2001 and envisioned by practitioners for the subsequent 5 to 10 years. Resident completion rates of competency requirements indicated that the structure of the measures was appropriately paced to parallel the learning expectations of the training program. Participant satisfaction with the process of developing and implementing the measures was high. CONCLUSIONS: While devising and implementing competency assessments is critical, the process should not stop with the application of the measures. Ongoing evaluation of these measures for their continued suitability is essential. Training programs can readily determine the effectiveness of competency programs and improve them as necessary.

Education, Medical, Graduate↗
PubMed2005

The knight as patient of the squire.

Many types of non-professional, non-credentialed relationships are seen by laypersons as analogous to those occuring in psychotherapy. This paper takes a leap backwards several centuries and describes two examples of one such type of interaction as portrayed in artistic masterpieces. In Miguel de Cervantes' novel, "Don Quixote," an elderly, depressed man pursues a restitutive and grandiose delusion of being a heroic knight errant. In Ingmar Bergman's film, "The Seventh Seal," a disillusioned knight returns from the Crusades to face the lethal bubonic plague, and he uses obsessional means in an attempt to outwit death. Both men are accompanied by squires who try, with varying degrees of success, to help their masters relinquish their infantile needs for omniscience and omnipotence, accept their human limitations, and deal more appropriately with their surrounding realities. The powerful and inspiring insights of both works have much to teach contemporary therapists whose patients wear more metaphorical suits of armor.

Aspirations, Psychological↗
PubMed1976

An educational model for teaching living skills to long-term patients.

Establishing rehabilitation programs for long-term mental patients outside mental health settings can save mental health funds and further the patients' integration into the community, the author declares. He describes an approach that uses an educational model to teach patients the basic skills of everyday living. As "students," they enroll in a course taught by a credentialed teacher and sponsored by the adult education department of the local high school. Mental health professionals are used only for consultation, and the cost to the local mental health program is minimal. A key element in the course is having the students participate in planning the curriculum.

Activities of Daily Living↗
PubMed1988

Quality assurance in mental health care.

Quality assurance activities, in place at all institutions accredited by the Joint Commission on Accreditation of Healthcare Organizations and many other agencies, are sure to play an increasing role in the mental health care field. This paper familiarizes mental health professionals with the terminology and activities of quality assurance and how they relate to other health care monitoring programs, such as utilization review, peer review, risk management, and credentialing and privileging. The historical development of quality assurance and special problems encountered in trying to quantify the quality of psychiatric care are also discussed.

Humans↗
PubMed1994

Four decades of mental health trends: an empirical analysis of Hospital and Community Psychiatry.

OBJECTIVE: The authors examined important trends and developments within the mental health field since the 1960s as reflected in articles published in Hospital and Community Psychiatry. METHODS: A total of 798 articles were reviewed, representing all contributions to the journal in 1962, 1967, 1972, 1977, 1982, 1987, and 1992. Articles were classified into one of six categories, and empirical research articles were further classified by primary topic. In addition, all articles were indexed by primary setting (hospital, community, or both); academic credentials and gender of first author, and economic or public policy focus. RESULTS: The number and percentage of empirical research articles increased over time, while articles describing programs and professional roles declined. Some changes were observed in the primary topics of empirical research. Other findings reflect a shift in the setting of articles from hospitals to the community and a growth in the percentage of women who were first authors and of authors with a Ph.D. degree. CONCLUSIONS: The documented growth of empirical research in psychiatry suggests a greater emphasis on methodological rigor in the design and implementation of mental health services. Moreover, increases noted in scholarly contributions by women and nonmedical professionals indicate a broadening of disciplinary perspective over time that is likely to strengthen psychiatric research and services.

Community Psychiatry↗
PubMed1998

Guidelines for prescribing psychiatrists in consultative, collaborative, and supervisory relationships.

Most psychiatrists enter into a variety of professional relationships with other clinicians in which they prescribe medications or make recommendations about pharmacotherapy. This paper describes a set of guidelines for prescribing psychiatrists involved in consultation, collaboration, and supervision with other clinicians. The guidelines were developed by psychiatrists for the Harvard Risk Management Foundation. The terms consultation, collaboration, and supervision are defined, and the psychiatrist's roles and responsibilities in each type of arrangement are described. The guidelines limit consultation and collaboration to relationships with professionals who are licensed or credentialed. Based on the definitions, the paper describes a structure for working with other clinicians, which begins with a thorough assessment of the context and circumstances of the clinical situation. The guidelines strongly encourage structured communication among clinicians and with the patient and significant others, as well as clarification by clinicians of their respective responsibilities for treatment and follow-up.

Clinical Competence↗