Credentialing for breast lymphatic mapping: how many cases are enough?
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OBJECTIVE: To evaluate credentialing issues for sentinel lymphatic mapping for breast cancer. SUMMARY BACKGROUND DATA: The sentinel lymph node (SLN) is defined as the first lymph node receiving lymphatic drainage from a tumor. The SLN accurately reflects the status of the axillary nodes in patients with early-stage breast cancer, and SLN mapping is gaining widespread acceptance. Few of the many published feasibility studies of lymphatic mapping for breast cancer have adequate numbers to assess credentialing issues for this new procedure. METHODS: Five hundred consecutive SLN biopsies were performed at one institution, over a 20-month period, by eight surgeons, using isosulfan blue dye and technetium-labeled sulfur colloid. The authors reviewed each surgeon's success rate in finding the SLN, and false-negative rate, relative to level of experience with the technique. RESULTS: Lymphatic mapping performed by an experienced surgeon (surgeon A, B, or C) was associated with a higher success rate (94%) than when it was performed by one with less experience (86%). Ten failed mapping procedures occurred in the first 100 cases. For each of the ensuing 100 cases, there were eight, six, six, and four failed mapping procedures, suggesting that increasing experience does not eradicate failed mapping procedures completely. The false-negative rate among 104 patients in whom axillary dissection was planned in advance was 10.6% (5/47). Most false-negative results occurred early in the surgeon's experience: when the first six cases of every surgeon were excluded, the false-negative rate fell to 5.2% (2/38). CONCLUSIONS: With increasing experience, failed SLN localizations and false-negative SLN biopsies occur less often. Combined dye and isotope localization, enhanced histopathology, a backup axillary dissection, and judicious case selection are required to avoid the high false-negative rate of one's early experience. (+info)
A survey of postgraduate (specialist) orthodontic education in 23 European countries.
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This paper reports on a survey of the duration, funding, and assessment of postgraduate specialist orthodontic training, the requirement for postgraduate training prior to entering specialist orthodontic training and registration of specialist orthodontists in Europe. A questionnaire and explanatory letter were mailed to all members of the EURO-QUAL BIOMED II project. Answers were validated during a meeting of project participants and by fax, when necessary. Completed questionnaires which were subsequently validated, were returned by orthodontists from 23 countries. The results indicated that a period of postgraduate training, prior to entering specialist orthodontic training was required in 12 of the responding countries. Specialist orthodontic training was reported as lasting 2 years in three countries, 3 years in 17, and for 4 years in three. Part-time training was reported as a possibility in four countries. In 21 of the 23 countries specialist training was reported to take place in full or part within universities, with some training taking place in government clinics in four countries. In five countries some or all training was reported to take place in specialist practices. Training was said to be funded solely or partially by governments in 15 of the 23 countries, to be solely self-funded in five countries, and partly or solely funded by universities in six countries. A final examination at the end of specialist training was reported to be held in 21 of the 23 countries. The nature of this examination varied widely and there was no such examination in two countries. Twelve of the 23 countries reported that they had a specialist register for orthodontics; 11 that they had no register. In none of the countries surveyed was there a requirement for those on a register to undergo periodic reassessment of competence once they are on the register. It was concluded that there was wide diversity in all aspects of specialist orthodontic training and registration within the countries surveyed. (+info)
Orthodontics around the world: orthodontics in Brazil: excellence for a minority.
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Brazil is the largest country of South America, with an area of 8.511.965 km(2) and 150 million people. It has 113 dental schools and several orthodontic postgraduate courses variously at Certificate, Master, and Doctoral levels. The current article gives an overview of the speciality in Brazil. The discussion puts the delivery of orthodontic care within the context of social conditions in Brazil. Included is a description of two full-time orthodontic courses located in the city of Rio de Janeiro. (+info)
Unconventional dentistry: Part II. Practitioners and patients.
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This is the second in a series of five articles providing a contemporary overview and introduction to unconventional dentistry (UD) and its correlation with unconventional medicine (UM). Dentists may provide unconventional services and use or prescribe unconventional products because of personal beliefs, boredom with conventional practice, lack of understanding of the scientific process or financial motivation. To promote these UD practices, unrecognized credentials and self-proclaimed specialties are advertised. Characteristics of users of unconventional practices are varied; however, UD users are more often female and highly educated. UD practitioners and users generally appear to be analogous to UM practitioners and users. Some UD treatments are more invasive or more costly than conventional dentistry. (+info)
Chairpersons of pathology in the United States. Benchmarks for academic publications and professional credentials.
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Chairpersons of pathology often are viewed as departmental role models in academic medical centers. To objectify this view, we undertook a systematic survey of publication records and professional certification among 126 chairpersons in the United States. The median of the total number of scientific publications by the cohort was 105 since graduation from medical school, and the median yearly number of peer-reviewed papers was 3.34 per person (mean, 4.25). A random 10% of the study population was analyzed further with reference to the percentage of publications that reflected basic science research; 41% of the total literature contributions of this subgroup fit that description, and only 38% of the chairpersons in the subgroup had 80% or more non-service-related publications. Of all chairpersons, 85% had obtained primary board certification in anatomic pathology, clinical pathology, or both, and 25% of the group had earned at least 1 subspecialty board certificate in addition. These numbers reflect an evolution in the professional backgrounds of chairpersons of pathology such that demands for academic scholarship and proficiency in hospital practice and management seem to pertain to that group. (+info)
Trends in allied dental education: an analysis of the past and a look to the future.
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Allied dental healthcare providers have been an integral part of the dental team since the turn of the 19th century. Like dental education, allied dental education's history includes a transition from apprenticeships and proprietary school settings to dental schools and community and technical colleges. There are currently 258 dental assisting programs, 255 dental hygiene programs, and 28 dental laboratory technology programs according to the American Dental Association's Commission on Dental Accreditation. First-year enrollment increased 9.5 percent in dental hygiene education from 1994/95 to 1998/99, while enrollment in dental assisting programs declined 7 percent and declined 31 percent in dental laboratory technology programs during the same period. Program capacity exceeds enrollment in all three areas of allied dental education. Challenges facing allied dental education include addressing the dental practicing community's perception of a shortage of dental assistants and dental hygienists and increasing pressure for career tracks that do not require education in ADA Commission on Dental Accreditation accredited programs. The allied dental workforce may also be called upon for innovative approaches to improve access to oral health care and reduce oral health care disparities. In addition, allied dental education programs may face challenges in recruiting faculty with the desired academic credentials. ADEA is currently pursuing initiatives in these and other areas to address the current and emerging needs of allied dental education. (+info)
Continuing-education needs of the currently employed public health education workforce.
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OBJECTIVES: This study examined the continuing-education needs of the currently employed public health education workforce. METHODS: A national consensus panel of leading health educators from public health agencies, academic institutions, and professional organizations was convened to examine the forces creating the context for the work of public health educators and the competencies they need to practice effectively. RESULTS: Advocacy; business management and finance; communication; community health planning and development, coalition building, and leadership; computing and technology; cultural competency; evaluation; and strategic planning were identified as areas of critical competence. CONCLUSIONS: Continuing education must strengthen a broad range of critical competencies and skills if we are to ensure the further development and effectiveness of the public health education workforce. (+info)
Medicare, Medicaid, and CLIA programs; extension of certain effective dates for clinical laboratory requirements under CLIA. Centers for Disease Control and Prevention (CDC) and Health Care Financing Administration (HCFA), HHS. Final rule with comment period.
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This final rule extends certain effective dates for clinical laboratory requirements in regulations published on February 28, 1992, that implemented provisions of the Clinical Laboratory Improvement Amendments of 1988 (CLIA). This rule extends the phase-in date of the quality control requirements applicable to moderate and high complexity tests and extends the date by which an individual with a doctoral degree must possess board certification to qualify as a director of a laboratory that performs high complexity testing. These effective dates are extended to allow the Department to revise quality control requirements and establish the qualification requirements necessary for individuals with doctoral degrees to serve as directors of laboratories performing high complexity testing. These effective date extensions do not reduce the current requirements for quality test performance. (+info)