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1.
Methodist Debakey Cardiovasc J ; 16(3): 199-204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133355

RESUMO

Americans expect their doctors to have the competence to deliver high-quality care and expect safeguards to be in place that assure their doctors are competent. However, competence requires knowledge, and people have trouble assessing their own knowledge and level of competence. Because external assessment is required, several organizations have taken on the roles of defining and assuring medical competence. For example, professional organizations such as the American College of Cardiology (ACC) have developed consensus documents that define core competencies for cardiologists. External organizations such as the Accreditation Council for Graduate Medical Education and the American Board of Internal Medicine (ABIM) have defined training requirements for cardiologists, and the ABIM has developed a process to certify that physicians maintain their competence, although the process has generated considerable criticism from the profession. Recently, the ACC and ABIM have worked together to make the certification process less onerous and more meaningful. This paper provides a brief summary of the history and ongoing efforts to assure the competence of cardiologists.


Assuntos
Acreditação , Cardiologistas/educação , Cardiologia/educação , Certificação , Competência Clínica , Educação de Pós-Graduação em Medicina , Acreditação/normas , Cardiologistas/normas , Cardiologia/normas , Certificação/normas , Competência Clínica/normas , Currículo , Educação de Pós-Graduação em Medicina/normas , Humanos
3.
Anesth Analg ; 131(5): 1412-1418, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079864

RESUMO

In 2018, the American Board of Anesthesiology (ABA) became the first US medical specialty certifying board to incorporate an Objective Structured Clinical Examination (OSCE) into its initial certification examination system. Previously, the ABA's staged examination system consisted of 2 written examinations (the BASIC and ADVANCED examinations) and the Standardized Oral Examination (SOE). The OSCE and the existing SOE are now 2 separate components of the APPLIED Examination. This report presents the results of the first-year OSCE administration. A total of 1410 candidates took both the OSCE and the SOE in 2018. Candidate performance approximated a normal distribution for both the OSCE and the SOE, and was not associated with the timing of the examination, including day of the week, morning versus afternoon session, and order of the OSCE and the SOE. Practice-based Learning and Improvement was the most difficult station, while Application of Ultrasonography was the least difficult. The correlation coefficient between SOE and OSCE scores was 0.35 ([95% confidence interval {CI}, 0.30-0.39]; P < .001). Scores for the written ADVANCED Examination were modestly correlated with scores for the SOE (r = 0.29 [95% CI, 0.25-0.34]; P < .001) and the OSCE (r = 0.15 [95% CI, 0.10-0.20]; P < .001). Most of the candidates who failed the SOE passed the OSCE, and most of the candidates who failed the OSCE passed the SOE. Of the 1410 candidates, 77 (5.5%) failed the OSCE, 155 (11.0%) failed the SOE, and 25 (1.8%) failed both. Thus, 207 (14.7%) failed at least 1 component of the APPLIED Examination. Adding an OSCE to a board certification examination system is feasible. Preliminary evidence indicates that the OSCE measures aspects of candidate abilities distinct from those measured by other examinations used for initial board certification.


Assuntos
Anestesiologia/normas , Certificação/normas , Avaliação Educacional , Competência Clínica , Comunicação , Humanos , Internato e Residência , Aprendizagem , Papel Profissional , Melhoria de Qualidade , Conselhos de Especialidade Profissional , Ultrassonografia , Estados Unidos
5.
BMJ Open ; 10(8): e040448, 2020 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-32868370

RESUMO

OBJECTIVE: To assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and protective behaviours. DESIGN: 2×3 experimental design. SETTING: Online. PARTICIPANTS: 1204 adults from a UK research panel. INTERVENTION: Participants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms describing the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test). MAIN OUTCOME MEASURES: Primary outcome: proportion of participants perceiving no risk of infection with SARS-CoV-2 given an antibody-positive test result. Other outcomes include: intended changes to frequency of hand washing and physical distancing. RESULTS: When using the term Immunity (vs Antibody), 19.1% of participants (95% CI 16.1% to 22.5%) (vs 9.8% (95% CI 7.5% to 12.4%)) perceived no risk of catching coronavirus given an antibody-positive test result (adjusted OR (AOR): 2.91 (95% CI 1.52 to 5.55)). Using the terms Passport or Certificate-as opposed to Test-had no significant effect (AOR: 1.24 (95% CI 0.62 to 2.48) and AOR: 0.96 (95% CI 0.47 to 1.99) respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 (95% CI 1.25 to 4.28)); there was no significant association with intended avoidance of physical contact (AOR: 1.37 (95% CI 0.93 to 2.03)). CONCLUSIONS: Using the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent hand washing. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/tjwz8/files/.


Assuntos
Anticorpos Antivirais , Comunicação , Infecções por Coronavirus , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Imunidade , Pandemias , Pneumonia Viral , Adulto , Anticorpos Antivirais/sangue , Betacoronavirus , Certificação , Infecções por Coronavirus/sangue , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Revelação , Feminino , Humanos , Internet , Masculino , Razão de Chances , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Medição de Risco , Reino Unido
6.
Nervenarzt ; 91(10): 902-907, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32930814

RESUMO

BACKGROUND: In order to treat the complete spectrum of neurovascular diseases at a high level of quality, which goes beyond the purely acute treatment of stroke, the German Stroke Society (DSG) together with the German Societies for Neurosurgery and Neuroradiology developed a certification procedure for neurovascular networks (NVN). Structurally, a NVN consists of a coordinating center with at least three neurovascular network partners with a certified stroke unit. From 2018 to 2020 a total of 15 NVN have so far been audited and certified according to this new standard. OBJECTIVE: How efficient are the NVN? Are high standards maintained? MATERIAL AND METHODS: The reports of the audits were analyzed. The data were taken from the period 2017-2019. RESULTS: The 15 NVN treated a total of 86,510 stroke patients in the years examined and were networked with a total of 107 partner clinics, which were situated an average of 25 km from the coordinating center and transferred a total of 2726 patients. The coordinating centers performed 2463 thrombectomies and treated 2383 patients with nontraumatic intracerebral bleeding. In 712 patients with acute aneurysmatic subarachnoid hemorrhages endovascular treatment was carried out and clipping in 401. The audit was successful in the majority of the NVN. CONCLUSION: The certification process of NVN has been successfully established and the audits proved to be a useful instrument for quality control and improvement. The 15 NVN are highly efficient and treat more than one quarter of stroke patients in German stroke units.


Assuntos
Acidente Vascular Cerebral , Trombectomia , Certificação , Humanos , Acidente Vascular Cerebral/terapia
9.
J Am Board Fam Med ; 33(Supplement): S1-S9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32928942

RESUMO

Family Medicine was a child of the 1960s. Triggered by compelling social need for care outside of large hospitals, Family Medicine emphasized access to personal physicians based in the community. As a protest movement, the ABFP required ongoing recertification for all Diplomates, with both independent examination and chart audit. Fifty years later, society and health care have changed dramatically, and it is time again to consider how Board Certification must respond to those change. We propose three interlocking arguments. First, even before COVID-19, health and health care have been in a time of fundamental transformation. Second, given the role Board Certification plays in supporting improvement of healthcare, Board Certification itself must respond to these changes. Third, to move forward, ABFM and the wider Board community must address a series of wicked problems - i.e., problems which are both complex-with many root causes-and complicated- in which interventions create new problems. The wicked problems confronting board certification include: 1) combining summative and formative assessment, 2) improving quality improvement and 3) reaffirming the social contract and professionalism and its assessment.


Assuntos
Certificação/normas , Competência Clínica/normas , Medicina de Família e Comunidade/normas , Melhoria de Qualidade , Certificação/métodos , Certificação/tendências , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/tendências , Humanos , Estados Unidos
10.
Vasc Endovascular Surg ; 54(8): 692-696, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32787694

RESUMO

OBJECTIVES: Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. METHODS: We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. RESULTS: PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). CONCLUSION: Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.


Assuntos
Traumatismos Abdominais/cirurgia , Aorta Abdominal/cirurgia , Certificação/normas , Técnicas Hemostáticas/normas , Centros de Traumatologia/normas , Procedimentos Cirúrgicos Vasculares/normas , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Bases de Dados Factuais , Feminino , Técnicas Hemostáticas/efeitos adversos , Técnicas Hemostáticas/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Indicadores de Qualidade em Assistência à Saúde/normas , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/mortalidade , Adulto Jovem
11.
Chin J Traumatol ; 23(5): 280-283, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32762981

RESUMO

PURPOSE: To investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma. METHODS: The study was carried out from 2017 to 2019. Findings in operations or on computed tomography (CT) were used as references to evaluate the accuracy of bedside abdominal ultrasonography. The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application. RESULTS: Bedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma, of which 71 critical patients received surgery. The overall diagnostic accordance rate was 88.68%. The diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation, retroperitoneal hematoma and multiple abdominal organ injury were 100%, 94.73%, 94.12%, 20.00%, 100% and 81.48%, respectively. Among the 71 critical patients, the diagnostic accordance rate was 94.37%, in which the diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation and multiple abdominal organ injury were 100%, 100%, 100%, 20.00% and 100%. The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan (4.45 ± 1.63 vs. 2.38 ± 1.19) min; however, the mean waiting time before examination (7.37 ± 2.01 vs. 16.42 ± 6.37) min, the time to make a diagnostic report (6.42 ± 3.35 vs. 36.26 ± 13.33) min, and the overall time (17.24 ± 2.33 vs. 55.06 ± 6.96) min were shorter for bedside abdominal ultrasonography than for CT scan. CONCLUSION: Bedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma. Especially for patients with free peritoneal effusion and critical patients, bedside ultrasonography has been proved obvious advantageous. However, for negative bedside ultrasonography patients with blunt abdominal trauma, we recommend further abdominal CT scan or serial ultrasonography scans subsequently.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Certificação , Diagnóstico Precoce , Auxiliares de Emergência/normas , Testes Imediatos , Ultrassonografia/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/epidemiologia , Análise de Dados , Emergências , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Tecnologia Radiológica , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/epidemiologia
16.
J Med Ethics ; 46(10): 652-659, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32817362

RESUMO

The COVID-19 pandemic has led a number of countries to introduce restrictive 'lockdown' policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people's civil liberties. We make tentative recommendations for the ethical introduction of immunity passports.


Assuntos
Certificação/ética , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Saúde Pública/ética , Viagem/ética , Doenças Assintomáticas/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Política de Saúde , Humanos , Pneumonia Viral/epidemiologia , Reino Unido
17.
Cancer Radiother ; 24(6-7): 722-725, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32792296

RESUMO

The French Higher Health Authority's (Haute Autorité de santé [HAS]) certification process is an important issue for a health care facility and in particular for a radiotherapy department. It is based on a quality-risk management methodology driven by the commitment and involvement of professionals. The radiotherapy department of the university hospital in Brest (France) has been engaged for many years in a demanding quality-risk management policy implementation, subjected to regular inspections by the French Nuclear Safety Authority (Autorité de sûreté nucléaire [ASN]). This implementation is driven by a strong commitment from department managers, who are determined to maintaining an efficient level for care quality and safety.


Assuntos
Certificação , Departamentos Hospitalares/normas , Radioterapia (Especialidade) , França , Gestão de Riscos
18.
Artigo em Inglês | MEDLINE | ID: mdl-32630242

RESUMO

Food safety has long been a major public concern in China. One question of the food processing industry's emphasis on food safety social responsibility is whether a food processing company should pursue food safety certification for its products. As part of their corporate image, some food processing companies focus on food safety in their corporate mission statements. To enhance the legitimacy of a mission statement, as a guide for a firm, can provide food companies the legitimacy of perhaps pursuing food safety certification. However, we find that under different equity natures, the pressures on the normative legitimacy of the firm are different and the impact of mission statements on the acquisition of food safety certifications is also different. By analyzing the mission statement of companies in the Chinese food industry, we find that firms with a mission focusing on food safety concerns are more willing to pursue food safety certification. Moreover, compared to the firms with more distributed shareholder ownership, in firms where a majority shareholder has substantial control, the relationship between mission statements and the possession of food safety certification is stronger; compared to non-state-owned enterprises, in state-owned enterprise (SOEs), the relationship between firm mission statements of and the acquisition of food safety certification is stronger.


Assuntos
Indústria Alimentícia , Inocuidade dos Alimentos , Certificação , China , Indústrias
19.
J Extra Corpor Technol ; 52(2): 96-102, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32669735

RESUMO

The American Society of Extracorporeal Technology Board of Directors, consistent with the American Society of Extracorporeal Technology's safe patient care improvement mission, charged the International Board of Blood Management to write a knowledge and skill certification examination for healthcare personnel employed as adult extracorporeal membrane oxygenation (ECMO) specialists. Nineteen nationally recognized ECMO subject-matter experts were selected to complete the examination development. A job analysis was performed, yielding a job description and examination plan focused on 16 job categories. Multiple-choice test items were created and validated. Qualified ECMO specialists were identified to complete a pilot examination and both pre- and post-examination surveys. The examination item difficulty and candidate performance were ranked and matched using Rasch methodology. Candidates' examination scores were compared with their profession, training, and experience as ECMO specialists. The 120-item pilot examination form ranked 76 ECMO specialist candidates consistent with their licensure, ECMO training, and clinical experience. Forty-three registered nurses, 28 registered respiratory therapists, four certified clinical perfusionists, and one physician assistant completed the pilot examination process. Rasch statistics revealed examination reliability coefficients of .83 for candidates and .88 for test items. Candidates ranked the appropriateness for examination items consistent with the item content, difficulty, and their personal examination score. The pilot examination pass rate was 80%. The completed examination product scheduled for enrollment in March 2020 includes 100 verified test items with an expected pass rate of 84% at a cut score of 67%. The online certification examination based on a verified job analysis provides an extramural assessment that ranks minimally prepared ECMO specialists' knowledge, skills, and abilities (KSA) consistent with safe ECMO patient care and circuit management. It is anticipated that ECMO facilities and ECMO service providers will incorporate the certification examination as part of their process improvement, safety, and quality assurance plans.


Assuntos
Oxigenação por Membrana Extracorpórea , Adulto , Certificação , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários
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