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PubMed2004

[Medical certificates issued to help the patient].

BACKGROUND: Medical certificates form the basis for important decisions in society, e.g. the issuing of a driver's licence or the granting of a disability pension. We wanted to know how often doctors deliberately write favourable certificates as seen from the patient's point of view, and why doctors do so. MATERIAL AND METHODS: Questionnaire survey to a representative sample of 1605 Norwegian doctors. Doctors who answered yes to the question above gave information about the frequency of such writing of various types of certificates and their reasons for doing so. RESULTS: 1175 (73%) doctors responded. 39% confirmed deliberately writing in favour of their patients. For most types of certificates, a frequency of less than once a year was most common. 55% admitted writing favourably in disability pension certificates more than once a year, 69% so in referrals. The most common reasons given were securing just treatment and quick access to treatment. Many doctors emphasised that by answering yes, they meant that they were indeed writing expert judgments based on correct facts. INTERPRETATION: Medical certificates deliberately written in favour of the patient is not uncommon. This should lead to a critical discussion of the need for such certificates and medical diagnoses as a basis for resource allocation, rather than the tightening of control over the practice of doctors.

Attitude of Health Personnel↗

PubMed2004

Certification of polio eradication: process and lessons learned.

Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, considerable progress has been made towards interrupting the transmission of wild poliovirus globally. A formal process for the certification of polio eradication was established on the basis of experience gained during smallpox eradication. Independent groups of experts were designated at the global, regional, and country levels to conduct the process. The main requirements for the global certification of the eradication of wild poliovirus are the absence of wild poliovirus, isolated from suspect polio cases, healthy individuals, or environmental samples, in all WHO regions for a period of at least three years in the presence of high-quality, certification-standard surveillance and the containment of all wild poliovirus stocks in laboratories. Three WHO regions--the Region of the Americas (1994), Western Pacific Region (2000), and European Region (2002)--have already been certified free of indigenous wild poliovirus. Eradication and certification activities are progressing well in the three endemic regions (African, Eastern Mediterranean, and South-East Asia). Several challenges remain for the certification of polio eradication: the need for even closer coordination of certification activities between WHO regions, the verification of laboratory containment, the development of an appropriate mechanism to verify the absence of circulating vaccine-derived polioviruses in the future, and the maintenance of polio-free status in certified regions until global certification.

Africa↗

PubMed1991

[The value of daily allowance certificates for sociomedical treatment].

In the Tarup district of Odense, an investigation was carried out concerning certificates in connection with maintenance allowances during a period olf two months. A total of 148 maintenance allowance certificates were collected consecutively for one month. Correspondingly, 81 certificates concerning 44 cases which were the subjects of sociomedical analysis were collected during the subsequent month, Four fifths of the certificates were written by the general practitioners. About half of the certificates were only of limited value for analysis of the cases, while one fifth supplied constructive supplementary information. Women in the age group 40-49 years were overrepresented and conditions in the locomotor system predominated (30-50%). These were followed by mental problems and disturbances with 14% and 11%, respectively. Great differences were found between the durations of sick-leave as assessed in the certificates and the factual durations. As assessment of the duration of sick-leave is important for the course of the maintenance allowance, an alteration in the certificate forms is proposed so that maintenance allowance cases are easier to classify.

Adult↗

PubMed1990

[Validity of death certificates in the study of ischemic heart diseases].

Mortality rates for ischaemic heart disease, as estimated from death certificates, show highly significant differences between countries. In order to study the validity of mortality rates for ischaemic heart disease, the authors, involved in the MONICA project, have compared the results obtained from the conventional death certificate code with the data collected in a complementary enquiry conducted for all deaths possibly due to ischaemic heart disease. Three hundred and thirty patients, aged from 25 to 64 years, belonging to the urban community of Lille, and who died between October 1 and December 31, 1984, were included in this study. The sensitivity of the death certificate for the diagnosis of ischaemic heart disease was 77.9 percent and its specificity was 95.9 percent. The concordance rate between death certificate and complementary enquiry was not modified by age, sex, socio-professional category, family situation, place of death and doctor who signed the certificate. The complementary study proved impossible in 31.8 percent of the cases, usually because the doctor who signed the death certificate was not fully conversant with the patient's condition. Our results therefore confirm that death certificates are valid to study mortality from ischaemic heart disease.

Adult↗

PubMed1990

Certification of death.

In Singapore, every deceased person must have a death certificate stating the cause of death. The death certificates are prepared from certificates of cause of death signed by medical practitioners, pathologists, coroners or inspectors of death. The death certificate is a legal document and the person who certifies the cause of death is responsible for the accuracy of the facts. Singapore has a Coroner's system and all deaths due to unnatural, violent, accidental, sudden and unknown causes must be reported to the coroner. These cases are usually subjected to post-mortem examination after which pathologist will sign the certificate of cause of death. Thus only pathologists are allowed to certify unnatural causes of death. All other categories of personnel are allowed to certify natural causes only. Any deviation will result in the certificate be rejected by the Registrar of Death and the matter referred to the Coroner. The offending doctor would be reprimanded by the court. Examples of wrong certification will be given and it is hoped that medical practitioners will not make similar mistakes.

Cause of Death↗

PubMed1993

Medical certification of causes of death in an Australian metropolitan hospital. Comparison with autopsy findings and a critical review.

OBJECTIVES: To compare the causes of deaths recorded on death certificates with findings at autopsy and to identify other deficiencies in the completion of death certificates. DESIGN AND SETTING: The causes of death (Part I and II) recorded on the death certificates of all patients undergoing autopsy at St Vincent's Hospital, Melbourne, in 1992 were compared with the autopsy findings. Additional clinical information about previous medical and surgical history and antemortem investigations was obtained from the clinical summary in the autopsy reports, and from hospital charts in some cases. PATIENTS: In 1992, 132 hospital autopsies were performed (autopsy rate of 24.2%). Of these patients, 68% were aged 65 years or over, and 30% were aged 75 years or over. RESULTS: Major discrepancies between the cause of death listed on the certificates and autopsy findings were found in 16 cases (12%). Other deficiencies of death certification included listing the mode of death (e.g., cardiac failure) without an underlying cause in 14 cases (11%); failure to cite recent major surgery in 17 of 20 cases (85%); failure to specify site or organism in 33 of 40 cases (82.5%) of infection or sepsis. CONCLUSIONS: This study confirmed findings of previous studies with respect to missed major diagnoses, but identified other deficiencies in certification of causes of death, which could compromise accuracy of statistics obtained from death certificates. Mechanisms by which these deficiencies can be prevented or corrected are discussed.

Adult↗

PubMed1993

Death certification by house officers and general practitioners--practice and performance.

The objective of this study was to assess the knowledge, attitudes and behaviour of House Officers and General Practitioners (GPs) in relation to death certification, to determine the scope for future intervention. A postal questionnaire was used to survey all House Officers (174) and a 10 per cent random sample of GPs (131) in Mersey Region. The main outcome measures were: death certification experience; knowledge, attitudes and behaviour in relation to data uses and coding; and acceptability of Cause of Death statements. Response rates were comparable-119/174 House Officers (68.4 per cent) and 95/131 GPs (72.5 per cent). Most House Officers (78.8 per cent) and GPs (85.3 per cent) reported that they made the best possible Cause of Death statement but, respectively, 62.4 per cent and 59.3 per cent of these might modify a statement in some circumstances. Significantly more House Officers (70.3 per cent) than GPs (44.2 per cent) acknowledge room for improvement and were amenable to more training (86.6 per cent versus 52.5 per cent), but significantly fewer felt sufficiently instructed (23.7 per cent versus 52.6 per cent). Most respondents (> 90 per cent) considered accurate death certification important, but 46.2 per cent of House Officers had not read the death certificate book instructions. Knowledge was variable, especially concerning Underlying Cause of Death. Written Cause of Death statements were broadly similar in style and standard between groups. Experience did not appear to improve death certification practice. Better and co-ordinated undergraduate and early post-graduate education (which should be continuing and audited), and practical accessible guidance on death certificate completion, might improve standards of practice and performance within the existing framework. Alternative methods of presenting guidance on death certificate completion should be explored.

Abstracting and Indexing↗

PubMedDate not supplied

Tuberculosis surveillance using death certificate data, New York City, 1992.

OBJECTIVE: To determine the accuracy and frequency of reporting tuberculosis as either the contributing or underlying cause of death on death certificates in New York City during 1992. METHODS: Death certificates from 1992 that listed tuberculosis were matched with the New York City tuberculosis registry. For those persons who had tuberculosis listed as a cause of death, but who were not listed in the registry, medical records were reviewed. The frequency of reporting tuberculosis on death certificates in patients who died with active tuberculosis was evaluated in the second part of this study. Death certificates of patients with active tuberculosis (persons who died within six months of starting anti-tuberculosis medications) in 1992 were reviewed. RESULTS: Tuberculosis was listed on 635 death certificates; 377 (59%) were confirmed cases based on registry data. Reviews of medical records were possible for 230 (89%) of the remaining 258 patients and confirmed only two additional tuberculosis cases. Of 310 persons who died with active tuberculosis in 1992 (second part of the study), only 104 (34%) had tuberculosis listed on their death certificates. CONCLUSIONS: In New York City, a diagnosis of tuberculosis on death certificates is an inaccurate measure of tuberculosis burden.

Adolescent↗

PubMed1998

Death certification by doctors in non-metropolitan Victoria.

OBJECTIVE: To examine the completeness and accuracy of death certification by general practitioners, specialists and resident medical officers (RMOs) in non-metropolitan Victoria. DESIGN: An examination of the death certificates written by a representative sample of community and hospital doctors and comparison with the clinical history. SETTING: The Ballarat statistical district. RESULTS: Eighteen percent of the death certificates at initial assessment, were unsatisfactory (the percentage for those written by RMOs were significantly higher). After review of the clinical record, 27% of certificates were found to inaccurately represent the cause of death, (again the percentage for RMOs was higher) Eighteen percent of certificates required a change of code. CONCLUSION: Monitoring the health of the public relies in part on information gained from death certificates. It is thus of concern that such a high percentage of death certificates are inaccurate to the extent that they are incorrectly coded. Consideration should be given to new educational initiatives and to the promotion of the existing toll free telephone advice service to doctors.

Death Certificates↗

PubMed1998

Advanced practice nursing certification: where do we go from here?

Certification requirements for advanced practice nurses (APNs) vary between APN specialties and the certification agencies. This variability perpetuates confusion for APNs, the health care system, and the public. Recommendations are made for the certification of APNs: (1) standardization of the certification process for APNs, (2) consistency in the requirement for graduate level education for all APNs, (3) regulation requiring certification for practice in all states, and (4) nurse practitioner (NP) program accreditation or preaccreditation for eligibility to take the certification examination. To support these recommendations, two questions are considered: Where are we now in certification? Where do we need to go?

Certification↗

PubMed2004

The role of physician specialty board certification status in the quality movement.

The Institute of Medicine's reports and discussions on quality of medical care have focused on a systems-based approach to quality improvement. Our objective is to summarize evidence and theory about the role of a physician's current board certification status in quality improvement. The first body of evidence includes the validity of board certification demonstrated by the testing process, the relationship of examination scores with other measures of physician competence, and the relationship between certification status and clinical outcomes. The second body of evidence involves the adaptation of error prevention theory to medical care. Patient safety is enhanced when problem-solving uses readily accessed habits of behavior, the same behavior necessary to achieve board certification. The third body of evidence, obtained through a Gallup poll, demonstrates that certification and maintenance of certification are highly valued by the public. The majority of respondents thought it important for physicians to be reevaluated on their qualifications every few years and that physicians should do more to demonstrate ongoing competence than is currently required by the profession. We conclude that a physician's current certification status should be among the evidence-based measures used in the quality movement.

Physician's Role↗

PubMed2004

[Problems for ophthalmologists in the certification of blindness ].

BACKGROUND: We compared the medical test results of 117 persons examined by the superintendent for blindness assessment in 2002 with their certificates of blindness (5.5% of the applications, 42% of the testimonial examinations performed in Hessen in 2002). METHODS: If the ratings as "blind" or "severely visually handicapped" (corresponding to a visual acuity of not more than 0.02 or 0.05, resp.) differed between the medical test and the certificate, visual acuity, visual field, further findings, and the methods of assessment were analyzed on the basis of the medical records. RESULTS: The medical test confirmed 75 certificates. Fourteen persons with a certificate of blindness were graded as severely visually handicapped by the medical test. In 8 and 12 cases, respectively, the criteria of neither blindness nor severe visual handicap were fulfilled. Eight persons with a certificate of severe visual handicap were graded as blind by the medical test. DISCUSSION: In 29% of the cases, the visual handicap did not reach the certified grade. Striking differences occurred between the certificate and the functions shown in the medical test. In the certificates, the declared visual handicap was regularly judged to correspond to the objective findings, but apparently in these cases symptom validity had not been critically assessed. An improvement of diagnostic validity could be achieved using relatively uncomplicated subjective and objective tests.

Adolescent↗

PubMed1998

BD8 certification of visually impaired people.

BACKGROUND: There is debate as to the completeness of the blind and partial sight registers in England and Wales. The purpose of this study was to estimate the proportion of eligible visually impaired people attending the hospital eye service who have a BD8 certificate and to identify factors associated with not being certified. METHODS: Cross sectional survey of patients attending outpatients by medical record review analysed by multiple logistic regression. RESULTS: 51% (43%, 58%) of patients identified as eligible for registration did not have a BD8 certificate. The severity of visual impairment and the main diagnosis in terms of requirements for treatment, permanence of visual loss, and visual field loss were independently associated with non-certification. A partially sighted patient is estimated to be three times more likely to not have a BD8 certificate as a blind patient of similar diagnosis (adj OR: 3.4 (95% CI: 1.7, 6.8)). A patient whose impairment is due to abnormal visual fields is estimated to be greater than three times more likely to be non-certified than one with low visual acuity of similar severity and cause (adj OR: 3.6 (95% CI: 1.0, 12.7)). People whose impairment is potentially reversible are estimated to be eight times (8.3 (2.2, 31.4)) more likely not to have a certificate compared with people who had permanent non-treatable visual loss; and in those with permanent visual loss, a requirement for ongoing treatment was found to be associated with a lower odds of certification. CONCLUSIONS: These data strongly suggest that epidemiological data collected during registration are biased towards permanent, non-treatable causes of visual loss and those which affect central rather than peripheral vision. Certain subgroups of the visually impaired are likely to be at greater risk of non-certification. BD8 guidelines need to be simplified.

Aged↗

PubMed2002

State certification for school nurses.

State-specific credentialing of school nurses is generally equivalent to state teacher certification and is regulated by state departments of education. This certification establishes statewide employment standards for school nurses, as opposed to competency-based professional certification. Although more than half of all states currently have some type of credentialing for school nurses, it takes many different forms. The advantages of certification are pronounced but are surpassed by the barriers to its establishment. Considerations in establishing certification are presented along with analysis of the various forms of certification that exist in states that have school nurse certification.

Adult↗

PubMed2003

[Medico-legal certificates in dentistry-oral medicine].

Certificates are acts meant to note facts of medical order. They constitute the proof of the bodily damage in a file of repair request. Only a doctor in medicine can write such a paper. The disciplinary, penal and civilian responsibility is committed every time that the doctor agrees to write a medical certificate. The medical secret must be respected when writing such a medical certificate. The document must be handed the patient. The dentist can establish certificates of different nature when he is asked by his patients, since the noted facts are part of his expertise. The certificate must be written after exam of the patient. The description of the lesions must be precise and complete. Under pain of nothing, the medical certificate must include: the identity of the doctor, the patient's one, the date of writing and the signature of the editor. The ITT show on the medical certificate is of great importance because it determines jurisdictions related to voluntary and involuntary violence.

Confidentiality↗

PubMed1995

Teacher certification among athletic training students.

Researchers have reported that athletic training students who earn teacher certification enhance their job marketability. The purpose of this study was to determine the number of athletic training students who pursue teacher certification. A survey was mailed to the directors of the 78 NATA undergraduate programs in 1992. Data from the returned surveys showed that 177 of the 703 expected graduates in 1992 and 148 of the 640 graduates in 1991 pursued teacher certification. The most common teacher certification subject area was Physical Education, followed by Health, and Science or Biology. These students should expect to take an additional 1.6 semesters (range 0 to 4) to complete teacher certification requirements. Program directors cited increased job opportunities as the main advantage, and increased time in school and financial burden as the main disadvantages of pursuing teacher certification. Although the potential for high school jobs seems enormous, there is little indication that high schools are increasingly hiring athletic trainers. Formal counseling and advising for athletic training students regarding teacher certification and job opportunities should occur in the first year of study. Additional research should assess the job market.

Journal Article↗

PubMed1962

Live birth certificates; evaluation of medical and health data in California.

In a study of 1,609 single live births occurring in San Francisco County, the information on the birth certificate was compared with that on the hospital record to determine completeness and accuracy of the items reported on the certificate. Items such as color or race of mother, age of mother, birth weight and birth length of child were well recorded on the certificate and agreed with information found in the hospital record. Medical conditions were grossly underreported on the birth certificate. Conditions relating to the mother were more frequently recorded than those relating to the infant, but the birth certificates recorded less than one-fifth of all medical conditions of both mother and infant that were entered in the hospital records. Methods suggested for improving the quality of maternal and newborn morbidity information include revision of the medical section of the present certificates of live birth and fetal death and use of a precoded hospital record.

Birth Certificates↗

PubMed1991

The 1989 revision of the U.S. Standard Certificates and Reports.

This report examines the procedures followed in the 1989 revision of the U.S. Standard Certificates of Live Birth and Death; License and Certificate of Marriage; Certificate of Divorce, Dissolution of Marriage, or Annulment; and Reports of Fetal Death and Induced Termination of Pregnancy. It outlines the history and basic principles of the standard certificates and reports and describes the principal additions, modifications, and deletions of items. In addition, it discusses changes in the format of the standard certificates and reports as well as the implementation of the new certificates and reporting forms.

Abortion, Induced↗