Some Clarity, Some Fog: AG Opines on Physician-Optometrist Relationship.

An opinion by the Texas attorney general will keep the Texas Optometry Board (TOB) from exerting influence over the practice of medicine - to a certain point.

Small is beautiful, but large is certified: A comparison between fisheries the Marine Stewardship Council (MSC) features in its promotional materials and MSC-certified fisheries.

The Marine Stewardship Council (MSC) sets a standard by which sustainable fisheries can be assessed and eco-certified. It is one of the oldest and most well-known fisheries certifications, and an estimated 15% of global fish catch is MSC-certified. While the MSC is increasingly recognized by decision-makers as an indicator for fishery success, it is also criticized for weak standards and overly-lenient third-party certifiers. This gap between the standard's reputation and its actual implementation could be a result of how the MSC markets and promotes its brand. Here we classify MSC-certified fisheries by gear type (i.e. active vs. passive) as well as by length of the vessels involved (i.e. large scale vs. small scale; with the division between the two occurring at 12 m in overall length). We compared the MSC-certified fisheries (until 31 December 2017) to 399 photographs the MSC used in promotional materials since 2009. Results show that fisheries involving small-scale vessels and passive gears were disproportionately represented in promotional materials: 64% of promotional photographs were of passive gears, although only 40% of MSC-certified fisheries and 17% of the overall catch were caught by passive gears from 2009-2017. Similarly, 49% of the photographs featured small-scale vessels, although just 20% of MSC-certified fisheries and 7% of the overall MSC-certified catch used small-scale vessels from 2009 to 2017. The MSC disproportionately features photographs of small-scale fisheries although the catch it certifies is overwhelmingly from industrial fisheries.

The evolving maintenance of certification process: update on the financial status of the medical boards.

Medical board organizations have accumulated large asset balances, in part due to the monetization of physician board recertification, as well as capital gains in positive investment conditions. Physicians across the country have raised concerns regarding the effectiveness and efficiency of existing recertification processes, to which the American Board of Medical Specialties and independent accreditation boards have responded with newly instituted changes. The present article analyzes the publicly available F990 tax forms of the medical boards in an effort to provide data to the ongoing debate. Although some boards have begun to mobilize assets in recent years, many continue to accumulate wealth. It remains to be seen whether the new recertification programs will bring about change or perpetuate organizational wealth.

Las redes sociales en el cuidado de la salud: implicaciones éticas y profesionalismo enfermero / Social networks in health care: Ethical implications and nursing professionalism

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Data Accuracy and Predictors of High Ratings of Colon and Rectal Surgeons on an Online Physician Rating Website.

BACKGROUND: Online physician rating Web sites are used by over half of consumers to select doctors. No studies have examined physician rating Web sites for colon and rectal surgeons. OBJECTIVE: The purpose of this study was to evaluate the accuracy and rating patterns of colon and rectal surgeons on the largest physician rating Web site. DESIGN: Physician characteristics and ratings were collected from a randomly selected sample of 500 from 3043 Healthgrades "colon and rectal surgery specialists." Board certifications were verified with the American Board of Surgery and American Board of Colon and Rectal Surgery Web sites. SETTINGS: Data acquisition was completed on July 18, 2018. PATIENTS: Patients were not directly studied. MAIN OUTCOME MEASURES: The primary outcome was to assess the accuracy of Healthgrades in reporting American Board of Surgery and American Board of Colon and Rectal Surgery certification. The secondary outcome was to identify factors associated with high star ratings. RESULTS: A total of 48 (9.6%) of the 500 sampled were incorrectly identified as practicing US surgeons and excluded from subsequent analysis. Healthgrades showed 80.1% agreement with verified board certifications for American Board of Surgery and 85.4% for American Board of Colon and Rectal Surgery. The mean star rating was 4.2 of 5.0 (SD = 0.9), and 77 (21.6%) had 5-star ratings. In a multivariable logistic model (p < 0.001), 5-star rating was associated with 1 to 9 years (OR = 2.76; p = 0.04) or >40 years in practice (OR = 3.35; p = 0.04) and fewer reviews (OR = 0.88; p < 0.001). There were no significant associations with surgeon sex, age, geographic region, or board certification. LIMITATIONS: Data were limited to a single physician rating Web site. CONCLUSIONS: In the modern age of healthcare consumerism, physician rating Web sites should be used with caution given inaccuracies. More accurate online resources are needed to inform patient decisions in the selection of specialized colon and rectal surgical care. See Video Abstract at http://links.lww.com/DCR/B91. PRECISIÓN DE DATOS Y PREDICTORES DE ALTAS CALIFICACIONES DE CIRUJANOS DE COLON Y RECTO EN UN SITIO WEB DE CALIFICACIÓN MÉDICA EN LÍNEA: Más de la mitad de los consumidores utilizan los sitios web de calificación de médicos en línea para seleccionar médicos. Ningún estudio ha examinado los sitios web de calificación de médicos para cirujanos de colon y recto.Evaluar la precisión y los patrones de calificación de los cirujanos de colon y recto en el sitio web más grande de calificación de médicos.Las características y calificaciones de los médicos se obtuvieron de una muestra seleccionada al azar de 500 de 3,043 "especialistas en cirugía de colon y recto" de Healthgrades. Las certificaciones del Consejo se verificaron en los sitios web del Consejo Americano de Cirugía y del Consejo Americano de Cirugía de Colon y Recto.La adquisición de datos se completó el 18 de julio de 2018.Los pacientes no fueron estudiados directamente.El resultado primario fue evaluar la precisión de Healthgrades al informar la certificación por el Consejo Americano de Cirugía y por el Consejo Americano de Cirugía de Colon y Recto. El resultado secundario fue identificar factores asociados con altas calificaciones en estrellas.Un total de 48 (9.6%) de la muestra de 500 fueron identificados incorrectamente como cirujanos practicantes de EE. UU. y excluidos del análisis subsecuente. Healthgrades mostró un 80.1% de concordancia con las certificaciones verificadas del Consejo Americano de Cirugía y el 85.4% con el Consejo Americano de Cirugía de Colon y Recto. La calificación promedio de estrellas fue 4.2 / 5 (SD 0.9), y 77 (21.6%) tuvieron calificaciones de 5 estrellas. En un modelo logístico multivariable (p <0.001), la calificación de 5 estrellas se asoció con 1-9 años (OR 2.76, p = 0.04) o más de 40 años en la práctica (OR 3.35, p = 0.04) y menos evaluaciones (OR 0.88, p <0.001). No hubo asociaciones significativas con el género, edad, región geográfica o certificación por los Consejos del cirujano.Los datos se limitaron a un solo sitio web de calificación de médicos.En la era moderna del consumismo en atención médica, los sitios web de calificación de los médicos deben usarse con precaución debido a imprecisiones. Se necesitan recursos en línea más precisos para que las decisiones de los pacientes sean informadas en la selección de atención quirúrgica especializada de colon y recto. Consulte Video Resumen en http://links.lww.com/DCR/B91. (Traducción-Dr. Jorge Silva-Velazco).

Capitalizing on specialists' services in rural family health unit: Interventional study.

For achieving universal health coverage in Egypt, Ministry of Health aims to improve the accessibility to quality specialized health care. OBJECTIVES: The objectives of the study were to explore legal and regulatory environment for the policy of specialists' visits to unit and assess the impact of gynecology specialist's visits on utilization pattern of gynecological services and clients' satisfaction. METHODS: Settings The study settings were Ministry of Health/Headquarters, Giza Health Directorate, El-Badrashin Health District and Hospital, and Met-Rahinah Unit. Study design The study includes qualitative research (in-depth interviews with policymakers at all Ministry of Health levels and focus group discussions with service providers) and quantitative research (interventional operation research using separate sample pretest (n = 210) and posttest (n = 209) and family-planning service statistics). RESULTS: Analysis of specialist outreach services indicated integration absence between preventive and curative sectors. Capitalizing on the policy of specialists' outreach visits to the unit could support clients' access quality services and reduce referral to get specialist services in hospitals. There is a 6-month intervention of scheduled visits of a female gynecologist to a rural health unit. The intervention led to 12% increase in efficiency and utilization of services compared with the previous 6 months. Clients' satisfaction increased from 27% to 73% after the intervention (.001, OR = 7.5, CI = 4.9-11.6). CONCLUSION: Scheduled specialists' visits increase services' efficiency and clients' satisfaction.

Nursing Now y los Colegios Profesionales de Enfermeras en España / Nursing Now and Professional Nurses Associations in Spain

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Is the General Medical Council in need of revalidation?

The General Medical Council was originally set up to 'protect, promote and maintain the health and safety of the public'. In 2012, the Privy Council instructed the General Medical Council to set up and run a licensing and revalidation system for all practicing doctors in the UK, to protect patients from actions of medical staff. Despite this mandate, the General Medical Council has been a bystander in a series of regulatory failures. Without these episodes having been highlighted by family members, public investigations would not have been carried out. The maintenance of medical performance is delegated to NHS employers, which could cause conflicts of interests when employers have to investigate doctors as part of a team. The other responsibility of the General Medical Council is to monitor teaching standards and curricula of medical schools in the UK, which it does by eliciting feedback from students and trainees. The General Medical Council has not responded to 'new ways of working' (especially in England) involving non-medical staff undertaking tasks previously carried out by doctors. Furthermore, the General Medical Council has not updated its description of the role of the future doctor in light of increasing use of technology, use or non-use of which could both be considered to be evidence of poor practice.

Surgical training and research in the Netherlands.

In contrast to many other countries, training of medical specialists is funded by the Department of Health. The curriculum of medical specialist training including general surgery is well structured and lasts 6 years. Specialist (trainers) and hospitals involved in surgical training have been accredited by the Dutch Association of Surgeons. Surgical training includes 4 years of general surgery followed by two years of differentiation in one of the sub-specialities. These are gastrointestinal, oncological, vascular, pediatric and trauma surgery. The training program is competency based: there are key procedures and so called EPA (entrusted professional activities) that are defined to monitor the progress of an individual. Unique in the Dutch system is the quality control and governance of surgical training that will be discussed in my lecture.The number of positions available for surgical trainees is limited and determined by the government each year. Hence, to enter surgical training has always been very competitive and not easy for young doctors. This is one of the reasons why many students start a PhD program after medical school and to gain experience in basic or clinical research. These young and talented students usually work for 3-4 years full time and are well capable of coordinating trials. This is just one of the reasons that many clinical (randomised) studies come from the Netherlands. Besides this strong academic environment, lack of private practice, strong multidisciplinary working parties and the geographical situation in our small country facilitates multicenter studies. Some more crucial factors for success will be discussed in the lecture.(Presented at the 1983th Meeting, July 10, 2019).

Sexta evaluación de test editados en España: Resultados e impacto del modelo en docentes y editoriales / Sixth review of tests published in Spain: Results and impact of the model on lecturers and publishers

El cuestionario para la Evaluación de los Tests (CET; Prieto y Muñiz, 2000) y su revisión (CET-R; Hernández et al., 2016) se han venido aplicando sistemáticamente desde 2010, impulsado por la Comisión de tests del Consejo General de la Psicología del Colegio Oficial de Psicólogos. El objetivo es proporcionar información contrastada sobre la calidad de las pruebas a los profesionales, con el fin de mejorar el uso de los tests. El presente trabajo tiene un doble objetivo. El primero, presentar los resultados de la sexta evaluación de tests psicológicos y educativos, en la que se han revisado un total de 10 tests. El segundo, evaluar el impacto que la aplicación del CET/CET-R ha tenido durante estos años en dos agentes cruciales: las editoriales de tests, y los profesores universitarios encargados de formar a los futuros profesionales usuarios de tests. Los resultados de la sexta evaluación, así como los resultados de la encuesta para evaluar el impacto del CET/CET-R, se pueden considerar en general satisfactorios. Sin embargo, se identifican varios aspectos que son susceptibles de mejora

The Questionnaire for the Assessment of Tests (CET; Prieto & Muñiz, 2000) and the revised version of this questionnaire (CET-R; Hernández et al., 2016) have been applied systematically since 2010 by the Test Commission of the Spanish Psychological Association. The main goal is to provide practitioners with reliable information on the quality of the tests in order to improve test use. The aim of this paper is twofold. First, to present the results of the sixth review of psychological and educational tests, in which a total of 10 tests have been evaluated. Second, to assess the impact that the application of CET/CET-R has had over these years on two key agents: test publishers and university lecturers who are responsible for training future test users. Both the results of the sixth review and the results of the survey to assess the impact of CET/CET-R are satisfactory in general terms. However, some issues where there is room for improvement have been identified

Las habilidades de comunicación de los aspirantes a la certificación en Reumatología se asocian con su desempeño en el examen clínico objetivo estructurado / Communication skills in candidates for accreditation in rheumatology are correlated with candidate's performance in the objective structured clinical examination

Introducción: El Consejo Mexicano de Reumatología certifica anualmente reumatólogos mediante una prueba teórica y un examen clínico objetivo estructurado (ECOE). Desde el año 2015, se evalúan las habilidades de comunicación (HC) de los candidatos. Los objetivos fueron comparar las HC evaluadas por el paciente (HCP) y por el médico (HCM) y correlacionarlas con el desempeño de los candidatos en el ECOE. Material y métodos: Durante los años 2015, 2016 y 2017, se evaluaron las HC en las estaciones dinámicas, mediante una escala de Likert aplicada a 8 áreas. Pacientes y evaluadores fueron entrenados cada año para calificar a los aspirantes, lo cual se realizó el día del ECOE, de manera ciega, por ambos. Se calcularon coeficientes de correlación de Pearson. Resultados: En general, a lo largo de los 3años, los candidatos obtuvieron puntajes altos en las HC. Los pacientes puntuaron mejor a los candidatos que los evaluadores médicos. Las HCP y las HCM correlacionaron entre sí (de leve a moderado) en la mayoría de las estaciones. El puntaje de las HC de cada candidato correlacionó con su desempeño en la estación correspondiente; se encontraron mejores correlaciones con las HCP. El promedio de las HC de cada candidato correlacionó con el desempeño global en el ECOE, pero no así con la prueba teórica (salvo en el año 2017, cuando hubo una correlación baja). Conclusiones: Las HC evaluadas durante un examen de certificación en Reumatología correlacionan con el desempeño de cada candidato en cada estación y en el ECOE global

Background: The Mexican Accreditation Council for Rheumatology annually certifies trainees in Rheumatology using a multiple-choice test and an objective structured clinical examination (OSCE). Since 2015, candidate's communication skills (CS) have been rated by both patients and by physician examiners and correlated with results on the OSCE. This study compared the CS from candidates to annual accreditation in Rheumatology as rated by patients and by physician examiners, and assessed whether these correlated with candidate's performance in the OSCE. Material and methods: From 2015 to 2017, 8areas of CS were evaluated using a Likert scale, in each OSCE station that involved a patient. Both patient and physician evaluators were trained annually and their evaluations were performed blindly. The associations were calculated using the Pearson correlation coefficient. Results: In general, candidates were given high CS scores; the scores from patients of the candidate's CS were better than those of physician examiners; within the majority of the stations, both scores were found to correlate moderately. In addition, the scoring of CS correlated with trainee performance at the corresponding OSCE station. Interestingly, better correlations were found when the skills were rated by the patients compared to physician scores. The average CS score was correlated with the overall OSCE performance for each trainee, but not with the multiple-choice test, except in the 2017 accreditation process, when a weak correlation was found. Conclusions: CS assessed during a national accreditation process correlated with the candidate's performance at the station level and with the overall OSCE

The Relationship Between Board Certification and Disciplinary Actions Against Board-Eligible Family Physicians.

PURPOSE: Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM). METHOD: Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action. RESULTS: Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001). CONCLUSIONS: Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.