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PubMed1992

A comparison of death certificates and autopsies in the Australian Capital Territory.

OBJECTIVE: To determine the accuracy of death certificates in the Australian Capital Territory (ACT) by comparison with autopsy reports. DESIGN: A retrospective study of 495 deaths occurring from 1979 to 1987, excluding coronial deaths and deaths of infants under one year of age. The main cause of death on the death certificate was compared with the main cause of death recorded on an autopsy-supported death certificate created for the study. SETTING: The deaths occurred in both major institutional hospitals in the ACT. These hospitals are government-funded and administered, catering for both private and public patients. PATIENTS: There were 495 autopsies recorded in the ACT over the study period. The age data were lost in two cases. MAIN OUTCOME MEASURES: To find a simple measure of death certificate accuracy and compare the results with previous work. RESULTS: The accuracy of death certificates was 77%. Age, sex and length of hospital stay made little difference to the accuracy. Neoplastic diseases were accurately reported in 90% of cases, digestive and cardiovascular diseases in 81%. CONCLUSIONS: There is a need for practical methods and standard criteria to evaluate accuracy of death certificates.

Adolescent↗
PubMed1992

Accuracy of asthma statistics from death certificates in South Australia.

OBJECTIVE: To assess the accuracy of asthma statistics from death certificates in South Australia. DESIGN: Comparison of death certificate coding with expert panel assessments of causes of death after interviews with certifying doctors, regular medical practitioners and close acquaintances of the deceased. SUBJECTS: 261 subjects for whom the term "asthma", "asthmatic" or "asthmaticus" was recorded in Part I or Part II of death certificates lodged in the 24-month period from May 1988. MAIN OUTCOME MEASURES: Sensitivity, specificity and predictive value of death certificate coding, with expert panel assessments as the reference standard. RESULTS: About 95% of deaths assessed as definitely due to asthma were so coded from death certificates, but only 69% of deaths assessed by the panel as not due to asthma were coded to a "non-asthmatic" cause. Of the 129 deaths coded to asthma, the percentage assessed as definitely or likely to be due to asthma was 56%. For ages under 65 years, this figure was 84% compared with only 38% for older subjects. CONCLUSION: The accuracy of death certificate data on asthma for the age group 65 years and over would be too low at present for most epidemiological purposes.

Abstracting and Indexing↗
PubMed1999

Accuracy of death certification in two tertiary care military hospitals.

To determine the number and type of errors in death certifications, death certificates and corresponding postmortem examination results for 98 patients were analyzed at two tertiary care military hospitals. Of the 98 death certificates, errors were found in 36 (37%). The most prevalent type of error was the use of a nonspecific diagnosis as the underlying cause of death (22 of 36 errors, 61%). No errors were found in the listed manner of death. Given the high prevalence of errors found in death certification, recommendations are made to ensure the proper completion of death certificates. In addition, it is suggested that for patients who are to undergo postmortem examination, the immediate, any intermediate, and the underlying cause of death may be listed as "pending" so that the clinician can use the autopsy results in the completion of the death certificate.

Autopsy↗
PubMed2000

The validity of information on "race" and "Hispanic ethnicity" in California birth certificate data.

OBJECTIVE: To evaluate the validity of racial/ethnic information in California birth certificate data. DATA SOURCES: Computerized birth certificate data and postpartum interviews with California mothers. STUDY DESIGN AND DATA COLLECTION: Birth certificates were matched with face-to-face structured postpartum interviews with 7,428 mothers to compare racial/ethnic information between the two data sources. Interviews were conducted in Spanish or English during delivery stays at 16 California hospitals, 1994-1995. PRINCIPAL FINDINGS: The sensitivity of racial/ethnic classification in birth certificate data was very high (94 percent to 99 percent) for African Americans, Asians/Pacific Islanders, Europeans/Middle Easterners, and Latinas (Hispanics). For Native Americans, however, the sensitivity was only 54 percent. The positive predictive value of birth certificate classification of race/ethnicity was high for all racial/ethnic groups (96 percent to 97 percent). CONCLUSIONS: Despite limited training of birth clerks, the maternal racial/ethnic information in California birth certificate data appears to be a valid measure of self-identified race and Hispanic ethnicity for groups other than Native Americans.

Adolescent↗
PubMedDate not supplied

Relationships between certification and job perceptions of oncology nurses.

PURPOSE/OBJECTIVES: To explore relationships between oncology nursing certification and oncology nurses' job perceptions. DESIGN: Descriptive, correlational. SETTING: Questionnaire mailed to homes of Oncology Nursing Society (ONS) members. SAMPLE: 703 certified and 514 noncertified ONS members (N = 1,217; 50% response rate). METHODS: Data were collected using survey methods and grouped by respondents' certification status for statistical analysis. MAIN RESEARCH VARIABLES: Certification, group cohesion, organizational commitment, and job satisfaction. FINDINGS: Certification was weakly correlated with cohesion, commitment, and satisfaction. Work setting, rather than certification, accounted for differences in job perceptions. Job perceptions were most positive in settings characterized by a high percentage of patients with cancer (> 75%), a high percentage of RNs (> or = 80%), and monetary support for continuing education. CONCLUSIONS: The hypothesis that oncology nurses' certification status is associated with job perceptions that are valued by employers was not supported. IMPLICATIONS FOR NURSING PRACTICE: Nurses' job perceptions have been linked to control over nursing practice and participation in organizational and clinical decision making. Managerial strategies that empower certified nurses to practice with more autonomy and participate in decisions that affect patient care should be emphasized.

Adult↗
PubMed2001

[Validity study on the certification and coding of underlying causes of death for the mortality statistic].

The study was designed to assess the differences in the quality of certification and coding practices of underlying causes of death, which the mortality statistics is based upon. The mains focus of the study was the problem of proper selection of the underlying cause of death in various diseases. In the analysis the potential impact of medical experience of the physicians and the hospitalization of patients before the death have been taken in consideration. There were 479 death certificates chosen randomly out of all certificates filled in by 240 medical doctors in 1999 in Krakow. For each death certificate the available clinical case histories for deceased persons have been collected in order that a team of medical experts could formulate their independent opinion about the underlying cause of death. From comparisons of the underlying causes of death from the death certificates with those of experts, the indices of agreement have been calculated. The best overall agreement has been found for the neoplasmatic diseases (83.1%) and the lowest for the chest diseases (30.7%). For cardiovascular diseases the overall agreement was 65.5%, however in coronary heart disease it reached 74.0% and in cerebrovascular diseases 78.7%. Generally, the better agreement has been demonstrated if the additional information about the coexistent diseases or direct causes of the death has been mentioned in the death certificates as well. The longer period of hospitalization of subjects before death was related significantly with the higher agreement indices.

Aged↗
PubMed2004

Under-reporting of diabetes on death certificates among a population with diabetes in Otago Province, New Zealand.

AIMS: To estimate the degree of under-reporting of diabetes on death certificates, and to describe the population of patients enrolled on the Otago Diabetes Register known to have died during the 6-year period to 31 December 2003. METHODS: The Otago Diabetes Register was established in 1998, as part of the Otago Diabetes Project, to monitor and evaluate diabetes care in the Otago region, New Zealand. Demographic and clinical data, including vital status, type of diabetes and year of diagnosis, diabetes complications, diabetes medication and clinical examination, and biochemistry test results were collected annually from general practice medical records. Copies of death certificate information were obtained from the national Births, Deaths and Marriages office, Department of Internal Affairs for 508 enrolled diabetic patients known to have died before 31 December 2003. Causes of death were coded using ICD-10. Date, place, and causes of death were added to the Otago Diabetes Register. RESULTS: The mean age at death was 78 years (SD=9.7) and the average duration of diagnosed diabetes was 12.1 (SD=8.6) years. Diabetes was mentioned on the death certificates of just over half (55.1%) of the 508 diabetic patients. More of those using insulin only, or oral hypoglycaemic and insulin therapies combined, before death had diabetes mentioned on their death certificate, 67.8% and 81.0%, respectively, compared with those taking oral hypoglycaemics only (55.7%) or diet only treatment (38.0%). Almost 50% of deaths were due to a circulatory system disorder, either cardiovascular or cerebrovascular disease. Five men with type 1 diabetes, all aged less than 50 years, died from diabetic ketoacidosis or hypoglycaemia. CONCLUSION: Diabetes is under-reported on death certificates in New Zealand. Improvements in the completion of death certificates are necessary, if the impact of the diabetes epidemic on mortality is to be monitored appropriately.

Aged↗
PubMed1992

The prevalence and aeromedical certification considerations of contact lens use by civilian pilots.

Federal Aviation Regulations permit the routine use of contact lenses by civilian pilots to satisfy the distant visual acuity requirements for obtaining medical certificates. Specific information identifying the prevalence of contact lenses in the civil airman population is required to guide future medical certification decisions, policy changes, and education safety programs to aviation personnel. A descriptive, retrospective epidemiologic study was performed of active airmen by 5-year intervals for a 20-year period (1967-1987) using FAA data-bases and publications. The percentage of airmen who use contact lenses quadrupled during the study period. When stratified by class of medical certificate and age, the prevalence rates for airmen with first-class medical certificates and older airmen showed the largest increases. A summary is provided of aeromedical certification factors that an optometrist and/or ophthalmologist should consider while fitting an airman with contact lenses. The increasing use of contact lenses indicates a need for ongoing review of adverse changes and safety consequences for pilots. Key words: vision; contact lens; epidemiology; medical certification.

Adult↗
PubMedDate not supplied

[Health certification requested for admission to degree courses in Italian university medical schools].

Prior to enrollment in degree courses in Italian university medical schools students are required to undergo health tests and preventive measures. The aim of this study was to census and assess the health certification required by Italian universities. Information was collected from course admission notices published on the university websites. Most universities requested health certificates for the academic year 2005-2006. Requirements usually focused on the risk of tuberculosis and hepatitis B for students enrolled in degree courses in medicine and surgery and in dentistry and dental prosthetics. Additional certification concerning physical and mental well being suited to specific tasks was also required for courses for the health professions of nurses, midwives, rehabilitation, technical and health prevention staff The request of several universities for antituberculosis vaccination clashed with legislation currently in force. Most universities did not notify the subsequent requirement for certification concerning physical and mental wellbeing on the website admissions list. The survey showed that Italian universities adopt different criteria in requesting certifications and different terms and conditions. In addition, requirements were often not updated. Competent university medical staff should be consulted to define what health certification is required from students for admission to different courses in university medical schools.

Certification↗
PubMed1991

[The usefulness of death certificates in epidemiological studies].

An analysis of a total of 189 deaths recorded between 1953 and 1990 from two companies in Hamburg was performed to examine the question whether and if so to what extent differences existed between the causes of death (primary disease) stated in the death certificates on the one hand, and the diagnoses based on subsequent medical (clinical and pathologico-anatomical) reports, on the other. Postmortems were conducted in 94 cases; the diagnoses resulting therefrom had also been taken into consideration in 58 of the pertaining death certificates. Considerable differences were seen for the remaining 36 postmortems where only clinical diagnoses were recorded in the death certificates. In 10 cases (= 27.8%) the statements made in the death certificates did not agree with the PM diagnoses. The overall rate of deviations was 12.7% the figures for the individual fatal diseases varied, the greatest difference occurring with diseases of the heart and with chronic bronchitis and the least difference with acute apoplexy, accidents, suicides and malignant tumours. It is noted that death certificates and hence also the official statistics derived therefrom are but an inaccurate reflection of the actual distribution of causes of death in case of unicausal evaluations. The quota of diagnoses based on PM and actually taken into consideration, is an important factor in this regard. However, the data supplied by the death certificates are reasonably useful for epidemiological studies to estimate the risks involved in certain diseases.

Autopsy↗
PubMed1991

Certification: past, present and future implications. Report of the National Commission on Nurse Anesthesia Education.

In 1942, the National Association of Nurse Anesthetists established a voluntary certification program to safeguard the interests of surgeons, hospitals and the public. Prerequisites for certification included minimum training standards, a valid nursing license and successful completion of a national certification examination. In 1975, the Council on Certification of Nurse Anesthetists was established as an autonomous decision-making body. Certification for nurse anesthetists is now recognized in two-thirds of the states and required by most employers--a factor that makes it vital to establish the job-relatedness of the examination. An innovative and responsible certification process will continue to be needed to address health care issues and advances in testing.

Certification↗
PubMed1990

Medical certification of cause of death in the General Hospital, Colombo.

To determine the accuracy of death certification by hospital doctors, all certificates of deaths issued for one month in the General Hospital, Colombo were studied. Only 97 (38%) of the 253 certificates were correctly recorded according to the internationally accepted criteria. The immediate, antecedent and contributory causes of death were not written in the correct place in 75 (30%) certificates, while unacceptable causes of death were found in 49 (19%). Abbreviations had been written in 13 (5%) instances. Death certificates had been issued without informing the coroner in 14 (6%) cases, which was irregular. The need for accurate certification of death for disease surveillance, research and planning is stressed.

Cause of Death↗
PubMed1977

Death certification in Dunedin hospitals.

An analysis is presented of death certification in Dunedin Hospitals. The study involved a comparison of death certificates with post-mortem findings in 643 deaths which occurred in Dunedin hospitals between 1 October 1971 and 30 September 1973. The cases were categorised according to diseases in the various body systems. The study also involved consideration of the format of the current death certificate and of attitudes towards death certification. Serious defects have been revealed in all areas of the study which are considered to be representative of the national scene. Errors of epidemiological significance were found in 64.7 percent of the certificates, and in 57.5 percent of individual diagnoses. Responsibility for the defects lies with the certification itself and not with the statisticians who diligently compile mortality data from the information supplied to them.

Autopsy↗
PubMed1987

Underreporting of alcohol-related mortality on death certificates of young US Army veterans.

We assessed the validity of death certificate data for alcohol-related mortality in a population-based follow-up study of young, male US Army veterans. In a random sample of more than 18,000 men who entered the service between 1965 and 1971, there were 446 postservice deaths through Dec 31, 1983. For 426 of these deaths, we obtained both the death certificate and all other available medical and legal records pertaining to cause of death. A nosologist recorded each death certificate in accordance with the ninth revision of the International Classification of Diseases. A medical panel, without having access to the death certificates, assigned underlying and contributory causes of death on the basis of a review of only the medical and legal records. The panel recorded 133 alcohol-related deaths, or more than six times the number (21 deaths) determined by the original death certifiers. Omission of elevated blood alcohol levels in deaths due to injury accounts for most of the underreporting of alcohol-related mortality on the death certificates. Our findings suggest that death certificate data grossly underestimate the contribution of alcohol to mortality, especially in the area of injury, and the validity of official vital statistics for alcohol-related deaths would be enhanced if death certifiers incorporated all available antemortem and postmortem diagnostic information.

Adult↗
PubMed1987

Occupation and industry data obtained from death certificates: the effect and influence of case selection.

This study first examined the accuracy of death certificate diagnoses of 4,954 cases of cancer of the lung, liver, nasopharynx, and pleura/peritoneum, then compared usual occupation and industry based on case selection from the Metropolitan Detroit Cancer Surveillance System (MDCSS), a population-based cancer registry, with cases selected from death certificates for the above types of tumors to examine the effect of misclassification. Accuracy of death certificate cancer diagnoses ranged from 93.4% for lung cancer to 28.6% for malignancies of the pleura/peritoneum. The mix of usual occupation/industry titles obtained from death certificate cases and MDCSS cases was similar for lung cancer but not for malignancies of the pleura/peritoneum (35.7% of cases from the registry v 11.1% from death certificates for the automobile industry, P = .05). The effect of misclassification and utility of usual occupation/industry statements on death certificates is discussed.

Death Certificates↗
PubMed1985

Determination of passing scores on certification examinations: an unresolved issue.

In the field of clinical laboratory science, certification may be obtained by passing the National Certification Agency for Medical Laboratory Personnel (NCA) examination. This multiple-choice test is competence-based and criterion-referenced, and uses a modified Angoff procedure to establish the passing score. For this study, the NCA examination scores of 1,868 certification applicants (mostly new graduates) and 111 selected laboratory practitioners were compared. Although the NCA examination is designed to define the level of minimum competence, the failure rate of practitioners identified by their supervisors as minimally competent was almost four times greater that that of the certification applicants. Even the most competent group of practitioners scored well below the applicants for certification. These findings suggest that the examination cut-off point may not really define minimal competence and that the method used to determine the passing score might not be appropriate for certification examinations.

Certification↗
PubMedDate not supplied

Agreement of occupation and industry data on Rhode Island death certificates with two alternative sources of information.

There is increasing interest in documenting the putative health effects of occupational hazards, prompting Federal and State efforts that rely primarily on occupational information obtained from the death certificate. Previous studies have assessed the agreement of occupational data on death certificates with actual lifetime employment by using current employment data from census records for comparisons. Such analyses have largely been confined to males. We compared lifetime occupational information obtained from a panel survey for both sexes with death certificate data for 446 deceased panel members. After adjusting for inadequate information, the occupation recorded on the death certificates of the men agreed with the occupation recorded in the survey 66 percent of the time. The comparable percentage for the industry where the deceased had been employed was 78 percent. Among the women's records, agreement on occupation was 65 percent, and on industry, 69 percent. Using another sample of death certificates, comparisons of the information for 322 decedents with city directory data produced similar results. The higher level of agreement for women was due in part to the large number who were reported as "housewives." In a separate analysis, the agreement rate for nonhousewives declined. Suggestions for improvements in the recording of occupational data and the constraints imposed by the use of death certificate data in occupational epidemiology are presented.

Data Collection↗
PubMed1979

Certification of medical librarians, 1949--1977 statistical analysis.

The Medical Library Association's Code for Training and Certification of Medical Librarians was in effect from 1949 to August 1977, a period during which 3,216 individuals were certified. Statistics on each type of certificate granted each year are provided. Because 54.5% of those granted certification were awarded it in the last three-year, two-month period of the code's existence, these applications are reviewed in greater detail. Statistics on each type of certificate granted each year are provided. Because 54.5% of those granted certification were awarded it in the last three-year, two-month period of the code's existence, these applications are reviewed in greater detail. Statistics on MLA membership, sex, residence, library school, and method of meeting requirements are detailed. Questions relating to certification under the code now in existence are raised.

Canada↗