Will we be getting good doctors and safer patients?

Last week, the Department of Health announced its plans for reforming regulation of doctors. The BMJ asked some of those affected for their opinions

Will we be getting good doctors and safer patients?

Last week, the Department of Health announced its plans for reforming regulation of doctors. The BMJ asked some of those affected for their opinions

Will we be getting good doctors and safer patients?

Last week, the Department of Health announced its plans for reforming regulation of doctors. The BMJ asked some of those affected for their opinions

Will we be getting good doctors and safer patients?

Last week, the Department of Health announced its plans for reforming regulation of doctors. The BMJ asked some of those affected for their opinions

Will we be getting good doctors and safer patients?

Last week, the Department of Health announced its plans for reforming regulation of doctors. The BMJ asked some of those affected for their opinions

[Repercussions at the level of required health insurance of the introduction of three distinct professional titles in dentistry]

From July 2007 on, Belgian dental graduates must complete one year of vocational training in general dentistry or a specialization in the field of either orthodontics or parodontology in order to obtain a licence for the Belgian Social Security System. This introduction of special professional titles required massive legislation in concert with State Health Insurance (RIZIV/INAMI), the Departments of Education of both Communities, manpower planning, comparable arrangements for physicians, and European Directives. Overall the process of subsequent changes in legislation and implementation took up to 15 years. The author includes some critical remarks and indicates what still needed to be done at the end of 2005 to conclude this far-reaching change in the organisation of dentistry in Belgium.

How many polysomnograms must sleep fellows score before becoming proficient at scoring sleep?

OBJECTIVES

In the field of sleep medicine, there is a paucity of evidence-based curriculum development strategies in the literature. We chose to determine the number of polysomnograms (PSG) necessary to be scored by sleep fellows in order to reasonably approximate sleep scoring by a Diplomate of the American Board of Sleep Medicine (DABSM).

DESIGN

The fifth PSG scored by two sleep fellows during the 12 consecutive months of training was chosen for analysis. A DABSM not involved in the training of fellows scored sleep on each of the selected PSG with replication of montage and filter settings. Epoch by epoch comparison of sleep stage scoring is described as the frequency of concordance between fellow and DABSM (f correct).

MEASUREMENTS AND RESULTS

The mean (SD) f correct for all PSG for each fellow was 0.83 (0.06) and 0.83 (0.08) (p = 0.93). Concordance between sleep fellow and DABSM approached 0.8 after scoring between 20-30 PSG. This milestone was reached after the fourth month of training. F correct was highest for stage 2 sleep and REM sleep and most variable for slow wave sleep and stage 1 sleep. The variability in f correct for these stages was in part related to the relative paucity of these sleep stages.

CONCLUSIONS

Scoring of sleep becomes reasonably proficient after scoring approximately 20-30 PSG and/or four months of dedicated sleep disorders training. A standard measure of concordance that corrects for epoch sample size may be helpful for use in future similar investigations.

A template for spiritual assessment: a review of the JCAHO requirements and guidelines for implementation

Growing consensus exists regarding the importance of spiritual assessment. For instance, the largest health care accrediting body in the United States, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), now requires the administration of a spiritual assessment. Although most practitioners endorse the concept of spiritual assessment, studies suggest that social workers have received little training in spiritual assessment. To address this gap, the current article reviews the JCAHO requirements for conducting a spiritual assessment and provides practitioners with guidelines for its proper implementation. In addition to helping equip practitioners in JCAHO-accredited settings who may be required to perform such an assessment, the spiritual assessment template profiled in this article may also be of use to practitioners in other settings.

Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2007; certain provisions concerning competitive acquisition for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); accreditation of DMEPOS suppliers. Final rule

This final rule will update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2007 (for discharges occurring on or after October 1, 2006 and on or before September 30, 2007) as required under section 1886(j)(3)(C) of the Social Security Act (the Act). We are revising existing policies regarding the prospective payment system within the authority granted under section 1886(j) of the Act. In addition, we are revising the current regulation text to reflect the changes enacted under section 5005 of the Deficit Reduction Act of 2005. This final rule will also establish certain requirements related to competitive acquisition for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and establish accreditation of DMEPOS suppliers as required under section 302 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Unlicensed residential programs: the next challenge in protecting youth

Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families and journalists describing mistreatment in a number of the unregulated programs. This article summarizes the information gathered by A START regarding unregulated facilities. It provides an overview of common program features, marketing strategies and transportation options. It describes the range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who pursue residential treatment.

Strategic opportunities in the oversight of the U.S. hospital accreditation system

Hospital accreditation and state certification are the means that the Centers for Medicare & Medicaid Services (CMS) employs to meet quality of care requirements for medical care reimbursement. Hospitals can choose to use either a national accrediting agency or a state certification inspection in order to receive Medicare payments. Approximately, 80% of hospitals choose the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The purpose of this paper is to analyze and discuss improvements on the structure of the accreditation process in a Principal-Agent-Supervisor framework with a special emphasis on the oversight by the principal (CMS) of the supervisor (JCAHO).

Establishing dental hygiene education in Germany: current facts and future perspectives

As there is a marked need to increase the number of dental hygienists (DHs) working in German dental practices, efforts are being made to establish dental hygiene education in accordance with international standards. However, as current German legislation does not envisage a perennial full-time training programme, dental hygiene education may currently be provided within a modular concept only. The basic qualification for enrollment in a modular hygienist training programme of this kind is accredited vocational training as a dental assistant (DA), followed by board-certified continuing education as an oral prophylaxis assistant. Thus, the current system of advanced training for qualification as a DH is subject to at least 6 years' work experience in the field of dentistry. A 950-h full-time advanced training course, meeting all the requirements of this concept, was established by the Westphalia-Lippe Dental Association in cooperation with the University of Münster. The curriculum underlying this programme was outlined considering the recommendations for dental hygiene education issued by the European Federation of Periodontology, although reduced in standards to comply with current German legislation. In addition, the recommendations for American Dental Hygiene education by the American Dental Association were used as a guide for programme development. The contents and implementation of the Münster Dental Hygienist Curriculum may allow the professional competence generated during practical work experience to be linked with international requirements of dental hygiene education.

Developing standards, criteria, and thresholds to assess fitness to practise

Do we need explicit, clear guidance on the professional behaviour of doctors or should guidance be largely implicit to account for the context and circumstances of clinical practice? In the aftermath of the Shipman case, doctors need to answer this question

TRICARE; changes included in the National Defense Authorization Act for fiscal year 2005; TRICARE Dental Program. Interim final rule

The Department is publishing this interim final rule to implement sections 711 and 715 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA-05), Public Law 108-375. Specifically, that legislation makes young dependents of deceased Service members eligible for enrollment in the TRICARE Dental Program when the child was not previously enrolled because of age, and authorizes post-graduate dental residents in a dental treatment facility of the uniformed services under a graduate dental education program accredited by the American Dental Association to provide dental treatment to dependents who are 12 years of age or younger and who are covered by a dental plan established under 10 U.S.C. 1076a. This rule also corrects certain references in 32 CFR 199.13. The rule is being published as an interim final rule with comment period in order to comply with statutory effective dates. Public comments are invited and will be considered for possible revisions to the final rule.

Medical practitioners and competition law in Australia and New Zealand

There is a lack of awareness among Australian and New Zealand medical practitioners about how competition law applies to them. In this article, basic legal issues relating to interaction between medical practitioners (which all medical practitioners should be aware of) are discussed. The New Zealand Ophthalmologists Case and some relevant Australian and United States cases are analysed. Three key areas of competition law (of relevance to medical practitioners) are identified as being important and relevant. In conclusion, medical practitioners must be able to distinguish between legal and illegal activities; and guidelines outlined in this paper provide some clarification.

Australian policy on overseas‐trained doctors

Since the late 1990s Australian employers have recruited an increasing number of overseas-trained doctors (OTDs) to hospital and "area of need" general practice positions. While assessment standards vary by state and field of medicine, most OTDs are appointed without a formal assessment of their medical knowledge and clinical skills, with registration to practice being conditional only on their working in hospitals and "areas of need". By comparison, formal assessment is required before an OTD can practise medicine in the United States, the United Kingdom and Canada. Most of these doctors hold temporary resident visas, but a minority are permanent residents who have not completed their Australian Medical Council accreditation examinations. In 1997-98, most OTDs arriving under temporary resident visas were from the United Kingdom and Ireland, and by 2002-03 this had dropped to under 50%; OTDs now come from a greater diversity of countries.