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PubMed1997

Assessment of gestational age using birth certificate data compared with medical record data.

We assessed the extent to which use of medical record data might improve gestational age estimates compared with reliance on the birth certificate alone. Using population-based data from four northern Californian counties, we constructed an algorithm to select the best gestational age estimate from antenatal assessments recorded in medical records. A total of 172 singletons with moderate or severe congenital cerebral palsy from the California Cerebral Palsy Project were compared with 472 randomly selected controls with regard to discrepancies between the algorithm-derived estimated gestational age (bestgest) and an estimate based solely on the last menstrual period as recorded on birth certificates. Agreement between bestgest and birth certificate estimated gestational age was exact or within one week for at least 60% of both cases and controls in each of the three birthweight strata. In general, the greater the birthweight of the babies, the better the agreement. The mean number of weeks of overestimation by the birth certificate was 0.7 weeks for cases and 1.1 weeks for controls in the lowest birthweight group (< 1500 g). When compared with bestgest, clinical examination of the infant also tended to overestimate gestational age. In the < 1500 g birthweight group, cases were twice as likely as controls to have a bestgest of 'low certainty,' but antenatal estimates of 'high certainty' were obtained for at least a third of very low birthweight babies born during the mid-1980s. More widespread use of early ultrasound in more recent birth cohorts may result in a greater proportion of accurate antenatal estimates. When a distinction between immaturity and intrauterine growth retardation is important to the understanding of the aetiology of the outcome under investigation, the use of antenatal estimates from medical records may substantially improve the certainty of the data.

Algorithms↗
PubMed2004

Trends in mortality rates for death-certificate-coded diabetes mellitus in an English population 1979-99.

AIMS: Mortality statistics have customarily been coded and analysed using only one underlying cause of death. Rules for selecting the underlying cause, when more than one cause is certified on a death certificate, have changed twice in England over the past 20 years. We used data from death certificates for 1979-99 to compare mortality rates for diabetes mellitus certified anywhere on death certificates with those certified as the underlying cause. METHODS: Analysis of data from 18,917 death certificates that included diabetes mellitus in the former Oxford health region. RESULTS: Based on the underlying cause of death, mortality rates for diabetes varied substantially between the periods defined by rule changes. Based on mentions of diabetes anywhere on the death record, mortality rates were almost unchanged over time: they showed a non-significant rise of 0.1% per year (95% confidence interval -0.3, 0.6). Circulatory diseases were certified causes of death in 71% of all deaths in people with diabetes. Although mortality rates from circulatory diseases in the general population fell by 2.5% per year, rates for circulatory diseases in combination with diabetes did not fall. CONCLUSIONS: Two explanations are possible for the lack of change in mortality rates for diabetes based on all certified mentions between 1979 and 1999. Increasing prevalence and improved survival may have resulted in no net change; and/or there may have been no improvement in survival for people whose diabetes is associated with life-threatening pathology and in particular with circulatory diseases.

Adult↗
PubMed2003

Cause of death in patients with end-stage renal disease: assessing concordance of death certificates with registry reports.

OBJECTIVES: To assess concordance in reporting, in two Australian national datasets, of cause of death of patients with end-stage renal disease (ESRD). METHODS: For deaths in 1997-99, we compared 'cause of death' and 'primary renal disease', as coded in the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), with 'underlying' and 'associated' causes of death (based on death certificates), as coded by the Australian Bureau of Statistics (ABS). Dates of birth and death and sex identified the same individuals in the two datasets. Deaths from the three States for which date of birth was not available from death certificates were excluded. Cause of death was compared at the ICD-10 chapter level. RESULTS: Of 1,728 ANZDATA patients from NSW, SA, WA, NT and ACT who died during 1997-99, 1,117 (65%) could be matched to a record in the ABS dataset for the corresponding jurisdictions. The death certificates of 219 (20%) of these 1,117 patients made no mention of chronic renal failure. Overall, agreement on cause of death was poor (kappa = 0.22). Using ANZDATA information on cause of death and ABS underlying cause of death, only 38% of patients had the same cause (at the ICD-10 chapter level) recorded in both datasets. Additional information on primary renal disease (ANZDATA) and up to 12 associated causes of death (ABS) was required to obtain substantial agreement. CONCLUSION AND IMPLICATIONS: Death certificates and ANZDATA records provide differing causes of death for ESRD patients. Information from these sources was not directly comparable. Neither dataset provided a complete picture of renal disease as a cause of death in Australia.

Australia↗
PubMed2006

Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction.

BACKGROUND: Patients and purchasers prefer board-certified physicians, but whether these physicians provide better quality of care and outcomes for hospitalized patients is unclear. OBJECTIVE: We evaluated whether care by board-certified physicians after acute myocardial infarction (AMI) was associated with higher use of clinical guideline recommended therapies and lower 30-day mortality. SUBJECTS AND METHODS: We examined 101,251 Medicare patients hospitalized for AMI in the United States and compared use of aspirin, beta-blockers, and 30-day mortality according to the attending physicians' board certification in family practice, internal medicine, or cardiology. RESULTS: Board-certified family practitioners had slightly higher use of aspirin (admission: 51.1% vs 46.0%; discharge: 72.2% vs 63.9%) and beta-blockers (admission: 44.1% vs 37.1%; discharge: 46.2% vs 38.7%) than nonboard-certified family practitioners. There was a similar pattern in board-certified Internists for aspirin (admission: 53.7% vs 49.6%; discharge: 78.2% vs 68.8%) and beta-blockers (admission: 48.9% vs 44.1%; discharge: 51.2% vs 47.1). Board-certified cardiologists had higher use of aspirin compared with cardiologists certified in internal medicine only or without any board certification (admission: 61.3% vs 53.1% vs 52.1%; discharge: 82.2% vs 71.8% vs 71.5%) and beta-blockers (admission: 52.9% vs 49.6% vs 41.5%; discharge: 54.7% vs 50.6% vs 42.5%). In multivariate regression analyses, board certification was not associated with differences in 30-day mortality. CONCLUSIONS: Treatment by a board-certified physician was associated with modestly higher quality of care for AMI, but not differences in mortality. Regardless of board certification, all physicians had opportunities to improve quality of care for AMI.

Aged↗
PubMed2000

Use of certificates of confidentiality in nursing research.

PURPOSE: To discuss the use of Certificates of Confidentiality in nursing research. ORGANIZING CONSTRUCT: In situations that are particularly complex, sensitive, and in which the participants are extremely vulnerable, a Certificate of Confidentiality issued by the U.S. Department of Health and Human Services (DHHS) may be useful to help ensure the privacy of research participants. SOURCES: Theoretical and research literature, DHHS documents, and research experience. FINDINGS AND CONCLUSIONS: Not all research with vulnerable populations requires the additional protection provided by Certificates of Confidentiality. However, certificates may be indicated in studies in which participants and researchers may be exposed to compelled legal disclosure of research data.

Certification↗
PubMedDate not supplied

Clinical and professional role development among experienced pediatric nurses: the pediatric medical nursing certificate program.

ISSUES AND PURPOSE: The development of a multiunit-based certificate program to promote retention by increasing experienced pediatric nurses' knowledge, skills, and professional role development through a blend of didactic, clinical, and mentoring components. CONCLUSIONS: The certificate group demonstrated an increase in knowledge and skill, advanced leadership role acquisition, promotion, certification, and graduate school matriculation, and achieved a 95% retention rate within the organization. PRACTICE IMPLICATIONS: With support from management and multidisciplinary team members, a certificate program like this can be implemented in a variety of settings and specialties.

Certification↗
PubMed1989

Regional differences in mortality from dementia in Australia: an analysis of death certificate data.

Australian death certificate data were analysed to determine whether they can provide useful information on regional differences in the prevalence of dementia. Strong differences between the Australian states were found in the prevalence of dementing disorders at death. However, evidence indicated that death certification practices influenced the prevalence rates found: a) the reported prevalence of various dementing disorders at death has changed greatly over quite a short period; b) the prevalence of dementing disorders at death was more strongly influenced by place of death than by place of birth; and c) the differences between states were a result of very high rates in particular regions which, in one case, could be traced to the death certification practices of a single medical practitioner. It is concluded that death certificate data are not useful for investigating regional differences in the prevalence of dementia.

Aged↗
PubMed2002

Comparing hospital discharge records with death certificates: can the differences be explained?

STUDY OBJECTIVE: The quality of mortality statistics is important for epidemiological research. Considerable discrepancies have been reported between death certificates and corresponding hospital discharge records. This study examines whether differences between the death certificate's underlying cause of death and the main condition from the final hospital discharge record can be explained by differences in ICD selection procedures. The authors also discuss the implications of unexplained differences for mortality data quality. DESIGN: Using ACME, a standard software for the selection of underlying cause of death, the compatibility between the underlying cause of death and the final main condition was examined. The study also investigates whether data available in the hospital discharge record, but not reported on the death certificate, influence the selection of the underlying cause of death. SETTING: Swedish death certificates for 1995 were linked to the national hospital discharge register. The resulting database comprised 69 818 people who had been hospitalised during their final year of life. MAIN RESULTS: The underlying cause of death and the main condition differed at Basic Tabulation List level in 54% of the deaths. One third of the differences could not be explained by ICD selection procedures. Adding hospital discharge data changed the underlying cause in 11% of deaths. For some causes of death, including medical misadventures and accidental falls, the effect was substantial. CONCLUSION: Most differences between underlying cause of death and final main condition can be explained by differences in ICD selection procedures. Further research is needed to investigate whether unexplained differences indicate lower data quality.

Adolescent↗
PubMed1994

Asthma mortality and death certification in Northern Ireland.

BACKGROUND: Asthma mortality has been rising in many western countries for largely unknown reasons. One cause could be change in certification practice. This study was designed to investigate the accuracy of death certification in Northern Ireland for the years 1981-4 and, in addition, to assess the reliability of trends observed in asthma death registration from 1957 to 1985. METHODS: The following death certificates were obtained for the years 1981-4: those mentioning asthma (all age groups), chronic obstructive airway disease, emphysema, or chronic bronchitis, but only where the decreased was 55 years or less. Information was collected from medical records, questionnaires to the general practitioner, and interviews with a close relative of the decreased. Death as a result of asthma was confirmed or otherwise by a panel and the confirmed deaths were compared with those registered. The numbers of deaths from asthma for the years 1957-85 were obtained from the offices of the Northern Ireland Registrar General. RESULTS: A total of 174 deaths from asthma was identified; 123 (70.7%) had been registered, while the remainder had been coded under another diagnosis. The annual number of confirmed deaths differed little from the figures of the Registrar General. A sharp increase in the annual number of deaths from asthma was observed, beginning in 1977, following a decline in the mid 1970s. CONCLUSIONS: During the years 1981-4 death certification for asthma was found to be inaccurate. The number of false positive registrations was balanced by the number of false negatives, suggesting that the registered totals reflect actual asthma mortality.

Adolescent↗
PubMed2006

Certification for regional and international trade in livestock commodities: the need to balance credibility and enterprise.

The current system for the certification of internationally traded animal commodities can act as a barrier to developing countries accessing high-value international markets. In this Viewpoint article, Gavin Thomson and colleagues discuss the situation as it stands and identify inconsistencies with respect to the certification process. They suggest ways to address the lack of capacity for credible certification in some developing countries that will encourage market access for livestock commodities. They emphasise the role of mechanisms other than demonstrating that an area of production is free from a range of animal diseases, arguing that this could be of significant benefit to developing regions and countries, but that a reliable and independent system of certification based on international standards is essential.

Animals↗
PubMedDate not supplied

[A pilot program to improve causes of death certification in primary care of Catalonia, Spain].

OBJECTIVE: The BEDTAR pilot program assessed changes in the quality of certification of death's causes after a training session for the primary care physicians in the Tarragona's Area of Catalonia, in the Northeast of the Iberian Peninsula. DESIGN: Before-after evaluative study with intervention and without control group. SETTING AND PARTICIPANTS: The study population was the physicians of the reformed primary health care network of the AT. MATERIAL AND METHODS: The training session began with a test consisting of certifying 3 deaths. This test was followed by a theoretical and practical seminar. The session concluded with a final test consisting on certifying the same 3 cases. The variables used to evaluate the quality the certification were: logical sequence the death causes, correct position on death certificate of the immediate, intermediate and basic causes, precise use of cardiac arrest and other ill-defined diseases, appropriate use of abbreviations, legibility, vocabulary and, finally, use of all the available information. RESULTS: The final participation of the study population was 71% and the global program efficacy was 59%. CONCLUSIONS: The BEDTAR program improved the quality of certification and emphasized the relevancy and the applicability of the results.

Adult↗
PubMed1992

Vascular dementia: a clinical and death certificate study.

We compared the extent of documentation of the diagnoses, vascular dementia and stroke, on inpatient (hospital) medical records and death certificates among 23 multi-infarct dementia index cases and 14 multi-infarct controls without cognitive dysfunction who were enrolled in a hospital-based case-control study and were followed longitudinally. Both the inpatient medical records and the death certificates markedly under-diagnosed vascular dementia when compared to the case-control study diagnosis. Furthermore, the diagnosis of stroke was grossly underdiagnosed on the death certificates. In lieu of the lack of medical record and death certificate documentation of vascular dementia, studies that utilize such information may be in considerable error. Clarification of the criteria for the diagnosis of vascular dementia and greater physician and public awareness of vascular dementia are needed.

Activities of Daily Living↗
PubMedDate not supplied

Accuracy of death certification of stroke: the Framingham Study.

The validity of death certification of stroke was studied in the general population cohort at Framingham, MA. During the last 30 years, 5106 people aged 30 to 62 and free of CHD and stroke at entry have been followed for the development of cardiovascular disease including stroke. Of the 280 decedents with certified stroke 113 (40% false negative rate) had no mention of stroke on the death certificate. THe false negative rate increased significantly with increasing age at death and increasing interval from last stroke to death. Among the 216 certificates listing stroke there were 46 false positives (21%). Analysis by type of stroke disclosed marked over-reporting of cerebral hemorrhage and under-reporting of cerebral embolus. This comparison of prospectively collected data to death certificates should raise questions about the accuracy of studies dependent on ths source of information.

Adult↗
PubMed2004

Subspecialty certification by the American Board of Psychiatry and Neurology.

OBJECTIVE: The authors describe the approval processes for subspecialties and the mechanisms for certification and recertification and review the status of training programs and numbers of diplomates with subspecialty certification. METHODS: Published information and relevant data bases were reviewed. To date, 5,327 child and adolescent psychiatry, 2,595 geriatric psychiatry, 1,854 addiction psychiatry, and 1,384 forensic psychiatry certificates have been awarded. In clinical neurophysiology and pain medicine, specialties that are primarily for neurologists and child neurologists, 21 and 28 psychiatrists, respectively, have been certified. There are 113 residency programs in child and adolescent psychiatry, 62 in geriatric psychiatry, 43 in addiction psychiatry, and 40 in forensic psychiatry. There are no psychiatry-based training programs in clinical neurophysiology and pain medicine. While this may not be of concern for clinical neurophysiology, it may lessen psychiatry's contribution to pain medicine. RESULTS: The ABPN took a conservative approach to establishing subspecialty certification in psychiatry. CONCLUSION: It is expected that subspecialists will enhance patient care through their clinical activities as well as through teaching and research.

Certification↗
PubMed1994

Validating interpretive arguments for licensure and certification examinations.

To validate the interpretation assigned to test scores is to support the rationale for this interpretation. The interpretations for licensure and certification tests involve a sequence of inferences, or an argument, leading from the test score to decisions about licensure or certification. This article examines several possible interpretive arguments for licensure and certification test scores and analyzes the evidence required to support each type of argument. Particular attention is given to a competency-based argument that involves a sequence of several inferences leading from test scores to statements about competence, and then to conclusions about expected performance in practice. Decisions about licensure or certification are based on expected performance in practice.

Certification↗
PubMed2001

National school nurse certification. Part II: Questions and answers.

The National Association of School Nurses proposed the concept of certification for school nurses in the 1970s. The development and evolution of the school nurse certification process, from concept to reality, were described in the October 2000 Journal of School Nursing (Gregory & Marcontel, 2000). Readers were asked to submit questions to be answered in the second article. This article describes issues and answers questions from school nurses about national certification, gives information from past and current presidents and certified school nurses regarding their experiences, and presents a forecast on the future of school nurse certification.

Certification↗
PubMed1998

Age-dependent inaccuracy of asthma death certification in Northern England, 1991-1992.

Asthma mortality appeared to increase two-fold in the UK from the mid- 1970s to the early 1990s, but there is evidence of inaccuracy in asthma death certification and so a region-wide investigation was undertaken to assess whether this recorded statistical trend might have been partly or wholly artefactual. A total of 35 respiratory physicians, distributed in panels of three, systemically reviewed the hospital and general practice records of 210 subjects with physician-diagnosed asthma who died in 1991 and 1992. The death certificates indicated that asthma was considered to be the primary cause of death in 103 (group 1), a contributory cause in 70 (group 2) and not relevant in 37 (group 3). There was agreement within the panels that 43% of the subjects had probably never suffered from asthma. Discordance between the panels and the certifying physicians over the correct death certification category was high for group 1 (45% for those aged <65 yrs, 75% for those aged > or =65 yrs and 64% overall) and group 2 (67%), but much less for group 3 (22%). This study concludes that asthma death certification provides a markedly inaccurate picture of asthma mortality, particularly in elderly subjects. Thus, it is speculated that if the magnitude of this source of inaccuracy has increased over the last two decades, the apparent recent increase in asthma mortality may be largely artefactual.

Aged↗
PubMed2006

Leading causes of certification for blindness and partial sight in England & Wales.

BACKGROUND: Prevention of visual impairment is an international priority agreed at the World Health Assembly of 2002--yet many countries lack contemporary data about incidence and causes from which priorities for prevention, treatment and management can be identified. METHODS: Registration as blind or partially-sighted in England and Wales is voluntary and is initiated by certification by a consultant ophthalmologist. From all certificates completed during the year April 1999 to March 2000, the main cause of visual loss was ascertained where possible and here we present information on the leading causes observed and comment on changes in the three leading causes since the last analysis conducted for 1990-1991 data. RESULTS: 13,788 people were certified as blind, 19107 were certified as partially sighted. The majority of certifications were in the older age groups. The most commonly recorded main cause of certifications for both blindness (57.2 %) and partial sight (56 %) was degeneration of the macula and posterior pole which largely comprises age-related macular degeneration. Glaucoma and diabetic retinopathy were the next most commonly recorded main causes. Overall, the age specific incidence of all three leading causes has increased since 1990-1991--with changes in diabetic retinopathy being the most marked--particularly in the over 65's where figures have more than doubled. CONCLUSION: The numbers of individuals per 100,000 population being certified blind or partially sighted due to the three leading causes--AMD, diabetic retinopathy and glaucoma have increased since 1990. This may to some extent be explained by improved ascertainment. The process of registration for severe visual impairment in England and Wales is currently undergoing review. Efforts must be made to ensure that routine collection of data on causes of severe visual impairment is continued, particularly in this age of improved technology, to allow such trends to be monitored and changes in policy to be informed.

Adolescent↗