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Certification
Kinds of Certification Terms modified by Certification Selected AbstractsDETERMINANTS OF A FIRM'S ISO 14001 CERTIFICATION: AN EMPIRICAL STUDY OF TAIWANPACIFIC ECONOMIC REVIEW, Issue 4 2007Shih-Ying Wu Only rarely have empirical studies analysed the responses of Taiwanese manufacturing firms to ISO 14001, despite firm responses to environmental issues being an important aspect of environmental management. This study empirically examines the determinants of firms' environmental self-governance. Export oriented Taiwanese firms, which face environmental concerns from foreign consumers, are found to be more likely than domestic focused firms to adopt ISO 14001. This study also finds that several firm attributes are decisive for firm adoption of ISO 14001. However, this study does not find any significant impact of local governors' political party affiliation on firms' ISO 14001 certifications. [source] Timber Certification: Where Is the Voice of the Biologist?CONSERVATION BIOLOGY, Issue 4 2000Elizabeth L. Bennett No abstract is available for this article. [source] International Board Certification in Dermatopathology http://www.icdermpath.orgEXPERIMENTAL DERMATOLOGY, Issue 4 2008Article first published online: 24 FEB 200 No abstract is available for this article. [source] Board Certification in DermatopathologyEXPERIMENTAL DERMATOLOGY, Issue 6 2005Article first published online: 10 MAY 200 No abstract is available for this article. [source] Teacher Certification Praised in Recent StudyFOREIGN LANGUAGE ANNALS, Issue 2 2005Article first published online: 31 DEC 200 No abstract is available for this article. [source] Preparation and Certification of High-Grade Gold Ore Reference Materials (GAu 19-22)GEOSTANDARDS & GEOANALYTICAL RESEARCH, Issue 1 2001Tiexin Gu materiau de référence certifié; gisement d 'or,GAu 19-22,IGGE,valeurs certifiées Two types of gold deposit with both good homogeneity and a high-grade of gold were selected to prepare four gold ore reference materials (GAu-19,GAu-20,GAu-21 and GAu-22) by the Institute of Geophysical and Geochemical Exploration (IGGE),China. Seven laboratories participated in the certification programme. Volumetric methods for GAu19-21 and atomic absorption spectrometry for GAu-22 were used for the homogeneity testing,the coefficient of variation being found to be less than 3%. After sample digestion and preconcentration,the samples were analysed by flame atomic absorption spectrometry (AAS),colorimetry,neutron activation analysis (NAA)and volumetric analysis. The certified values for the gold concentration in GAu19-22 are 18.3 ,g g -1, 32.3 ,g g -1, 53.0 ,g g -1 and 5.72 ,g g -1,respectively. Deux types de gisements d'or, présentant à la foisune bonne homogénéité et une teneur élevée en or, ont été sélectionnés par l'Institut d 'Exploration Géophysique et Géochimique de Chine (IGGE)afin de préparer quatre matériaux de référence pour l'or (GAu-19,GAu-20,GAu-21 et Gau-22). Sept laboratoires ont participé au programme de certification. Des méthodes volumétriques (GAu-19-21)et de spectrométrie par absorption atomique (GAu 22)ont été utilisées pour tester l'homogénéité de ces échantillons;les coefficients de variation se sont révélés inférieurs à 3%.Après la mise en solution et la préconcentration des échantillons,ceux-ci ont eté analysés par spectrométrie d 'absorption atomique (AAS), colorimétrie,activation neutronique (NAA)et analyse volumétrique.Les valeurs certifiées pour la concentration en or de GAu19-22 sont respectivement de 18.3 ,g.g -1,32.3 ,g g -1, 53.0 ,g g -1 et 5.72 ,g g -1. [source] Do Medicaid Wage Pass-through Payments Increase Nursing Home Staffing?HEALTH SERVICES RESEARCH, Issue 3 2010Zhanlian Feng Objective. To assess the impact of state Medicaid wage pass-through policy on direct-care staffing levels in U.S. nursing homes. Data Sources. Online Survey Certification and Reporting (OSCAR) data, and state Medicaid nursing home reimbursement policies over the period 1996,2004. Study Design. A fixed-effects panel model with two-step feasible-generalized least squares estimates is used to examine the effect of pass-through adoption on direct-care staff hours per resident day (HPRD) in nursing homes. Data Collection/Extraction Methods. A panel data file tracking annual OSCAR surveys per facility over the study period is linked with annual information on state Medicaid wage pass-through and related policies. Principal Findings. Among the states introducing wage pass-through over the study period, the policy is associated with between 3.0 and 4.0 percent net increases in certified nurse aide (CNA) HPRD in the years following adoption. No discernable pass-through effect is observed on either registered nurse or licensed practical nurse HPRD. Conclusions. State Medicaid wage pass-through programs offer a potentially effective policy tool to boost direct-care CNA staffing in nursing homes, at least in the short term. [source] Doing Better to Do Good: The Impact of Strategic Adaptation on Nursing Home PerformanceHEALTH SERVICES RESEARCH, Issue 3p1 2007Jacqueline S. Zinn Objective. To test the hypothesis that a greater commitment to strategic adaptation, as exhibited by more extensive implementation of a subacute/rehabilitation care strategy in nursing homes, will be associated with superior performance. Data Sources. Online Survey, Certification, and Reporting (OSCAR) data from 1997 to 2004, and the area resource file (ARF). Study Design. The extent of strategic adaptation was measured by an aggregate weighted implementation score. Nursing home performance was measured by occupancy rate and two measures of payer mix. We conducted multivariate regression analyses using a cross-sectional time series generalized estimating equation (GEE) model to examine the effect of nursing home strategic implementation on each of the three performance measures, controlling for market and organizational characteristics that could influence nursing home performance. Data Collection/Abstraction Methods. OSCAR data was merged with relevant ARF data. Principal Findings. The results of our analysis provide strong support for the hypothesis. Conclusions. From a theoretical perspective, our findings confirm that organizations that adjust strategies and structures to better fit environmental demands achieve superior performance. From a managerial perspective, these results support the importance of proactive strategic leadership in the nursing home industry. [source] The Effect of State Medicaid Case-Mix Payment on Nursing Home Resident AcuityHEALTH SERVICES RESEARCH, Issue 4p1 2006Zhanlian Feng Objective. To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Data Sources. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. Study Design. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. Data Collection/Extraction Methods. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Principal Findings. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. Conclusions. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents. [source] Does Prospective Payment Really Contain Nursing Home Costs?HEALTH SERVICES RESEARCH, Issue 2 2002Li-Wu Chen Objective. To examine whether nursing homes would behave more efficiently, without compromising their quality of care, under prospective payment. Data Sources. Four data sets for 1994: the Skilled Nursing Facility Minimum Data Set, the Online Survey Certification and Reporting System file, the Area Resource File, and the Hospital Wage Indices File. A national sample of 4,635 nursing homes is included in the analysis. Study Design. Using a modified hybrid functional form to estimate nursing home costs, we distinguish our study from previous research by controlling for quality differences (related to both care and life) and addressing the issues of output and quality endogeneity, as well as using more recent national data. Factor analysis was used to operationalize quality variables. To address the endogeneity problems, instrumental measures were created for nursing home output and quality variables. Principal Findings. Nursing homes in states using prospective payment systems do not have lower costs than their counterpart facilities under retrospective cost-based payment systems, after quality differences among facilities are controlled for and the endogeneity problem of quality variables is addressed. Conclusions. The effects of prospective payment on nursing home cost reduction may be through quality cuts, rather than cost efficiency. If nursing home payments under prospective payment systems are not adjusted for quality, nursing homes may respond by cutting their quality levels, rather than controlling costs. Future outcomes research may provide useful insights into the adjustment of quality in the design of prospective payment for nursing home care. [source] Combining Stated and Revealed Preferences on Typical Food Products: The Case of Dry-Cured Ham in SpainJOURNAL OF AGRICULTURAL ECONOMICS, Issue 3 2010Helena Resano-Ezcaray C25; D12; Q13; Q18 Abstract An extensive body of research concerns the valuation of EU certification schemes of quality based on the origin of food products. This literature focuses mainly on stated preferences (SPs) and reported behaviours by the consumers. We combine consumers' SPs, obtained through a conjoint ranking experiment, with revealed preferences (RP), obtained through a retail scanner database. We evaluate SPs as predictors of RP, and investigate whether SPs and RPs are consistent. Dry-cured ham in Spain is chosen as the anchor product, mainly because of its broad customer base and long history of origin certification. A ,trick' nested logit model with non-identical and identical samples of consumers is estimated to answer each of the objectives. Results show that, irrespective of the analysed samples, SP can predict general market trends and choices but not accurately predict market shares, and that consumers' actual behaviour is partly consistent with their SPs. We find that consumers prefer ham produced in Teruel, compared with unspecified Spanish origin. Quality Certification and a Distributor's Brand are preferred over the alternatives of no quality label or identified with a brand owned by the producer. Interestingly, SPs for the Quality Certification and the distributor's brand lead to an over- and under-estimation, respectively, of the market share. [source] ICDP-UEMS International Board Certification in Dermatopathology 2010JOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2010Article first published online: 11 FEB 2010 No abstract is available for this article. [source] National Board Certification (NBC) as a catalyst for teachers' learning about teaching: The effects of the NBC process on candidate teachers' PCK developmentJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 7 2008Soonhye Park Abstract This study examined how the National Board Certification (NBC) process, especially the portfolio creation, influenced candidate teachers' pedagogical content knowledge (PCK). In a larger sense, this study aimed to construct a better understanding of how teachers develop PCK and to establish ecological validity of the National Board assessments. Qualitative research methods, most notably case study, were utilized. Participants were three high school science teachers who were going thorough the NBC process. Data sources included classroom observations, interviews, teachers' reflections, and researcher's field notes. Data were analyzed using the constant comparative method and enumerative approach. Findings indicated that the NBC process affected five aspects of the candidate teachers' instructional practices that were closely related to PCK development: (a) reflection on teaching practices, (b) implementation of new and/or innovative teaching strategies, (c) inquiry-oriented instruction, (d) assessments of students' learning, and (e) understanding of students. © 2008 Wiley Periodicals, Inc. J Res Sci Teach 45: 812,834, 2008 [source] The State Perspective on Teacher Shortage, Certification, and RecruitmentMODERN LANGUAGE JOURNAL, Issue 2 2009JAQUELINE BOTT VAN HOUTEN First page of article [source] Certification in neuromuscular medicine: A new neurologic subspecialty,,MUSCLE AND NERVE, Issue 4 2007Michael J. Aminoff MD Information is provided concerning the new subspecialty certificate in neuromuscular medicine of the American Board of Psychiatry and Neurology and the eligibility requirements for such certification of practicing neurologists and child neurologists. The Accreditation Council for Graduate Medical Education has approved fellowship training in the subspecialty, and it is likely that residents who wish to pursue a career in neuromuscular medicine will select this training option. Muscle Nerve 35: 409,410, 2007 [source] The MERC at CORD Scholars Program in Medical Education Research: A Novel Faculty Development Opportunity for Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 2009Jeffrey N. Love MD Abstract Medical educators are increasingly charged with the development of outcomes-based "best practices" in medical student and resident education and patient care. To fulfill this mission, a cadre of well-trained, experienced medical education researchers is required. The experienced medical educator is in a prime position to fill this need but often lacks the training needed to successfully contribute to such a goal. Towards this end, the Association of American Medical Colleges (AAMC) Group on Educational Affairs developed a series of content-based workshops that have resulted in Medical Education Research Certification (MERC), promoting skills development and a better understanding of research by educators. Subsequently, the Council of Emergency Medicine Residency Directors (CORD) partnered with the AAMC to take MERC a step further, in the MERC at CORD Scholars Program (MCSP). This venture integrates a novel, mentored, specialty-specific research project with the traditional MERC workshops. Collaborative groups, based on a common area of interest, each develop a multi-institutional project by exploring and applying the concepts learned through the MERC workshops. Participants in the inaugural MCSP have completed three MERC workshops and initiated a project. Upon program completion, each will have completed MERC certification (six workshops) and gained experience as a contributing author on a mentored education research project. Not only does this program serve as a multi-dimensional faculty development opportunity, it is also intended to act as a catalyst in developing a network of education scholars and infrastructure for educational research within the specialty of emergency medicine. [source] Teaching and evaluating point of care learning with an Internet-based clinical-question portfolioTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2009MSc Associate Professor of Medicine, Michael L. Green MD Abstract Introduction: Diplomates in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program satisfy the self-evaluation of medical knowledge requirement by completing open-book multiple-choice exams. However, this method remains unlikely to affect practice change and often covers content areas not relevant to diplomates' practices. We developed and evaluated an Internet-based point of care (POC) learning portfolio to serve as an alternative. Methods: Participants enter information about their clinical questions, including characteristics, information pursuit, application, and practice change. After documenting 20 questions, they reflect upon a summary report and write commitment-to-change statements about their learning strategies. They can link to help screens and medical information resources. We report on the beta test evaluation of the module, completed by 23 internists and 4 internal medicine residents. Results: Participants found the instructions clear and navigated the module without difficulty. The majority preferred the POC portfolio to multiple-choice examinations, citing greater relevance to their practice, guidance in expanding their palette of information resources, opportunity to reflect on their learning needs, and "credit" for self-directed learning related to their patients. Participants entered a total of 543 clinical questions, of which 250 (46%) resulted in a planned practice change. After completing the module, 14 of 27 (52%) participants committed to at least 1 change in their POC learning strategies. Discussion: Internists found the portfolio valuable, preferred it to multiple-choice examinations, often changed their practice after pursuing clinical questions, and productively reflected on their learning strategies. The ABIM will offer this portfolio as an elective option in MOC. [source] American board of medical specialties and repositioning for excellence in lifelong learning: Maintenance of certificationTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2005FACS President, Stephen H. Miller MD Abstract The board certification movement was founded out of a concern for the quality of care, and today, more than 85% of all physicians licensed to practice medicine in the United States have been certified by an American Board of Medical Specialties (ABMS) member board. There is increasing evidence of a need for continuous monitoring and promotion of quality as well as for assessment and documentation that certified medical specialists are keeping up-to-date so that their continuing competence can be documented. To help, the ABMS established a program called Maintenance of Certification, a system that includes periodic examination of knowledge and the comprehensive evaluation of practice. Maintenance of Certification includes 4 major components: professional standing, including an unrestricted license to practice medicine; lifelong learning and self-assessment; demonstrated cognitive expertise; and practice performance assessment. The efforts of the Conjoint Committee on Continuing Medical Education press continuing medical education providers to facilitate self-directed learning and directed self-learning while driving lifelong learning and assessment into the clinical practices of all physicians who seek to continuously upgrade their knowledge, skills, and behaviors to provide quality medical care. [source] Maintenance of Certification: An UpdateTHE LARYNGOSCOPE, Issue 4 2007Jesus E. Medina MD No abstract is available for this article. [source] The Association Between Emergency Medical Technician-Basic (EMT-B) Exam Score, Length of EMT-B Certification, and Success on the National Paramedic Certification ExamACADEMIC EMERGENCY MEDICINE, Issue 9 2009Antonio R. Fernandez MS, NREMT-P Abstract Objectives:, Factors that affect success on the national paramedic certification examination have been identified. However, there are no known studies that have examined success on the paramedic exam with respect to either Emergency Medical Technician-Basic (EMT-B) examination score or length of EMT-B certification (which may reflect field experience gained prior to enrolling in paramedic training). The objectives of this study included assessing the relationship of EMT-B examination score and length of EMT-B certification to success on the national paramedic certification examination. Methods:, Study data were obtained from the National Registry of EMTs (NREMT). First attempts of the NREMT paramedic certification exam from 2002 to 2006 were included. To assure that EMT-B certification exam scores were recorded, analysis was limited to individuals in the 14 states that have utilized NREMT for initial certification of both EMT-Bs and paramedics since January 1, 1997. This also facilitated accurate calculations of the length of EMT-B certification. Results:, There were 11,163 individuals meeting inclusion criteria, and a complete case analysis was performed on 9,148, of whom 5,826 (63.7%) passed the national paramedic exam. The mean (±SD) score on the EMT-B cognitive exam was 75.5 (±6.4%), and the mean (±SD) length of EMT-B certification prior to paramedic testing was 3.2 (±2.3) years. When placed in a logistic regression model, the EMT-B exam score variable was categorized in quartiles (,71%, 72%,75%, 76%,79%, and ,80%), and the length of EMT-B certification variable was dichotomized (,1.6 years vs. >1.6 years). With respect to paramedic exam success, after controlling for known confounders, there was an increase in the odds ratio (OR) across each of the quartiles of EMT-B exam score. The largest difference was seen when comparing the lowest and highest quartiles (paramedic exam pass rates of 45.6 and 80.8%, respectively; OR = 5.4, 95% confidence interval [CI] = 4.7 to 6.2). Individuals whose length of EMT-B certification was >1.6 years had increased odds of passing the paramedic examination (OR = 1.2, 95% CI = 1.1 to 1.3). The multivariable logistic regression model demonstrated good fit (p = 0.62). Conclusions:, Both EMT-B examination score and ength of EMT-B certification are associated with success on first attempt at the cognitive portion of the national paramedic certification exam. Educators may wish to consider these two factors when determining paramedic program admission standards and/or consider these variables when determining how to allocate program resources. [source] Can a Plantation be Fair?ANTHROPOLOGY OF WORK REVIEW, Issue 1 2008Paradoxes, Possibilities in Fair Trade Darjeeling Tea Certification Abstract This paper explores interactions between the Indian government's colonially inspired Plantations Labour Act and TransFair USA's fair trade standards. Although fair trade makes claims to universalistic notions of social justice and workers' empowerment, what "fairness" means and how it is experienced varies by locale. In this paper, I discuss how state laws and fair trade certification agencies complement and contradict each other on Darjeeling tea plantations. I argue that by reinforcing neoliberal logic, fair trade undermines the state, which has maintained the responsibility of regulating the treatment of workers on plantations. Certification often leads to the dissolution of unions, which are regarded as a barrier to trade. [source] Methods: Retrospective hospital-based searches for cases of acute flaccid paralysisAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2002R.M. D'Souza Objective: Australia had to demonstrate adequate acute flaccid paralysis (AFP) surveillance by achieving a rate of one per 100,000 in children under the age of 15 to fulfil one of the requirements of the Regional Commission for the Certification of Poliomyelitis Eradication to be declared polio free. To increase the ascertainment rate of AFP cases, a hospital search was conducted to identify cases not reported to the active AFP surveillance. Methods: A computerised search of hospital admissions in New South Wales (NSW) and Western Australia (WA) on ICD-9 codes of Guillain Barré Syndrome (GBS), unspecified encephalitis, poliomyelitis, vaccine-associated paralytic polio (VAPP) and flaccid paralysis was conducted for the period 1995,98. Medical records of cases that were not reported to the active surveillance were reviewed in three hospitals of NSW and two hospitals in WA. Results: Twenty additional cases recorded as GBS and five as transverse myelitis (TM) were identified through the searches, which increased the average four-year AFP rate from 1.0 to 1.4 per 100,000 in children under the age of 15 years in these two states and the overall AFP rate in Australia increased from 0.78 to 1.14. There were no cases of polio or VAPP found. Nine cases of GBS and five of TM reported to the active AFP surveillance were not found in the hospital searches. Conclusion: A combination of active surveillance and hospital-based searches increased the investigated AFP rate, which fulfilled one of the certification requirements for Australia to be certified polio free. Implications: Until global certification is achieved, AFP surveillance needs to be improved to identify cases of importation of wild poliovirus. [source] Certification in Colorectal Surgery , What Next?COLORECTAL DISEASE, Issue 7 2008Graham Williams No abstract is available for this article. [source] Inter-organizational use of EMSs in supply chain management: some experiences from Poland and SwedenCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 5 2008Dagmara Nawrocka Abstract The paper investigates the possibility of using environmental management systems (EMSs) as a tool for the environmental management of supply chains. Based on interviews with environmental managers of selected companies, the paper highlights the importance of taking a long-term perspective in terms of both the cooperation with suppliers and developing the supply chain perspective for EMSs. The role of cultural influence from foreign partner companies in building the proactive environmental focus and stimulating the spread of EMSs is underlined here. In addition, the paper looks at the development, use and control of supply chain environmental requirements and their possible integration into the buyer's and supplier's EMSs. Finally, important shortcomings of EMSs, such as the lack of enforcement forbearance and the credibility of ISO 14001 certification, are discussed. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [source] The ,pros' and ,cons' of joint EMS and group certification: a Swedish case studyCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 3 2007Thomas Zobel Abstract Small and medium-sized enterprises (SMEs) are collectively responsible for a significant portion of the total environmental burden worldwide. A common tool used by SMEs to improve their environmental performance is the environmental management system (EMS), which has the disadvantage that it has been developed with larger organizations in mind. A common approach used by Swedish SMEs to facilitate the implementation of an EMS is joint EMS and group certification. This paper evaluates this approach by means of a case study. It is found that the approach is effective for small and micro-sized companies in achieving ISO 14001 certification as fast and cost effectively as possible. A few short cuts including joint environmental policy and objectives and insufficient environmental organization are however threatening to undermine the trustworthiness of the approach. Notwithstanding these flaws, however, it must be concluded that the joint EMS approach is a good alternative for small and micro-sized companies. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source] Trends in Pediatric Melanoma Mortality in the United States, 1968 through 2004DERMATOLOGIC SURGERY, Issue 2 2008KEVAN G. LEWIS MD BACKGROUND AND OBJECTIVE Mortality from melanoma in children is a poorly understood and controversial problem in dermatology. There is paucity of research into this important public health dilemma. The purpose of this study was to characterize pediatric melanoma mortality in the United States and to evaluate trends over time. METHODS AND MATERIALS Deaths were derived from a database of more than 75 million records of the U.S. Center for National Health Statistics based on routine death certification. Information on age, race, gender, and geographic location was available for years 1968 through 2004. RESULTS During the 37-year period, there were 643 deaths attributed to melanoma in children under 20 years of age in the United States, an average of 18 per year. The overall age-adjusted mortality rate for melanoma in children was 2.25 deaths per year (per 10 million at-risk individuals). Mortality rates were strongly associated with age. In the oldest age group (age 15,19 years) the mortality rate was approximately an order of magnitude 8,18 times higher compared to younger age groups. Mortality among males was 25% higher than females. Mortality rates for white children were more than twice as high as black children. Overall mortality from melanoma in children declined steadily from 1968 to 2004. The highest mortality rates were observed in Idaho, Nevada, Arizona, and New Mexico. CONCLUSIONS Although mortality from melanoma among children in the United State is low, the magnitude of the public health burden from this preventable cause of death is substantial. In contrast to results of studies suggesting that the incidence of melanoma may be rising in children and adolescents, the data suggest that mortality in these groups may be falling. Additional study is warranted to further characterize and ultimately reduce mortality from childhood melanoma. [source] Adverse Event Reporting: Lessons Learned from 4 Years of Florida Office DataDERMATOLOGIC SURGERY, Issue 9 2005Brett Coldiron MD, FACP Background Patient safety regulations and medical error reporting systems have been at the forefront of current health care legislature. In 2000, Florida mandated that all physicians report, to a central collecting agency, all adverse events occurring in an office setting. Purpose To analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2004. Methods We reviewed all reported adverse incidents (the death of a patient, serious injury, and subsequent hospital transfer) occurring in an office setting from March 1, 2000, through March 1, 2004, from the Florida Agency for Health Care Administration. We determined physician board certification status, hospital privileges, and office accreditation via telephone follow-up and Internet searches. Results Of 286 reported office adverse events, 77 occurred in association with an office surgical procedure (19 deaths and 58 hospital transfers). There were seven complications and five deaths associated with the use of intravenous sedation or general anesthesia. There were no adverse events associated with the use of dilute local (tumescent) anesthesia. Liposuction and/or abdominoplasty under general anesthesia or intravenous sedation were the most common surgical procedures associated with a death or complication. Fifty-three percent of offices reporting an adverse incident were accredited by the Joint Commission on Accreditation of Healthcare Organizations, American Association for Accreditation of Ambulatory Surgical Facilities, or American Association for Ambulatory Health Care. Ninety-four percent of the involved physicians were board certified, and 97% had hospital privileges. Forty-two percent of the reported deaths were delayed by several hours to weeks after uneventful discharge or after hospital transfer. Conclusions Requiring physician board certification, physician hospital privileges, or office accreditation is not likely to reduce office adverse events. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase adverse events if patients are shifted to riskier approaches. State and/or national legislation establishing adverse event reporting systems should be supported and should require the reporting of delayed deaths. [source] Patient Injuries from Surgical Procedures Performed in Medical Offices: Three Years of Florida DataDERMATOLOGIC SURGERY, Issue 12p1 2004Brett Coldiron MD, FACP Background. Many state medical boards and legislatures are in the process of developing regulations that restrict procedures in the office setting with the intention of enhancing patient safety. The highest quality data in existence on office procedure adverse incidents have been collected by the state of Florida. Objective. The objective was to determine and analyze the nature of surgical incidents in office-based settings using 3 years of Florida data from March 2000 to March 2003. Methods. An incidence study with prospective data collection was performed. Individual reports that resulted in death or a hospital transfer were further investigated by determining the reporting physician's board certification status, hospital privilege status (excluding procedure specific operating room privileges), and office accreditation status. Results. In 3 years there were 13 procedure-related deaths and 43 procedure-related complications that resulted in a hospital transfer. Seven of the 13 deaths involved elective cosmetic procedures, 5 of which were performed under general anesthesia and 2 of which were performed with intravenous sedation anesthesia. Forty-two percent of the offices reporting deaths and 50% of the offices reporting procedural incidents that resulted in a hospital transfer were accredited by an independent accreditation agency. Ninety-six percent of physicians reporting surgical incidents were board-certified, and all had hospital privileges. Conclusions. Restrictions on office procedures for medically necessary procedures, such as requiring office accreditation, board certification, and hospital privileges, would have little effect on overall safety of surgical procedures. These data also show that the greatest danger to patients lies not with surgical procedures in office-based settings per se, but with cosmetic procedures that are performed in office-based settings, particularly when under general anesthesia. Our conclusions are dramatically different from those of a recent study, which claimed a 12-fold increased risk of death for procedures in the office setting. [source] No Smoking Gun: Findings From a National Survey of Office-Based Cosmetic Surgery Adverse Event ReportingDERMATOLOGIC SURGERY, Issue 11 2003Rajesh Balkrishnan PhD Background. Because of recent press reports of adverse outcomes, office-based cosmetic surgery has come under intense scrutiny and associated legislative regulatory action. Objective. To assess the safety of office-based cosmetic surgery through a national survey of state agencies that collect information on adverse patient outcomes. Methods. Medical boards or other responsible authorities were contacted in 48 states to obtain records on adverse outcomes from cosmetic surgery procedures performed in an office-based setting. Results. Five states were able to provide complete information regarding 13 cases of adverse outcomes that resulted from office-based cosmetic surgery procedures. Thirteen states had incomplete information or were unable to provide information. The remaining states reported no adverse outcomes. Information collected by state agencies varies greatly and is inadequate to define the safety of office-based cosmetic surgery practice. Conclusions. The need to regulate physician office surgery on the basis of hospital privileges and office certification is not supported by current data. Mandatory reporting of adverse outcomes from office-based surgery is warranted to identify modifiable risk factors and to reduce the risk of adverse outcomes. [source] Smallholder Preferences for Agri-environmental Change at the Bhoj Wetland, IndiaDEVELOPMENT POLICY REVIEW, Issue 5 2008Rob Hope Incentive-based approaches have gained policy interest in linking change in agricultural land management with environmental conservation. This article investigates how scheme design influences smallholder farmers' decisions to switch to organic farming to reduce water pollution, drawing on a study at a Ramsar wetland site providing water for the city of Bhopal. Results from a choice experiment suggest that transitional payments are necessary to overcome farmer constraints to adopt organic farming, and that effective land certification has the potential to act as a self-enforcing mechanism linking farmer incomes with wetland conservation benefits. [source] | ||||||||||||||||||||||||||||||||||||||||||||||