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PubMed2003

Excess mortality due to diabetes in Mississippi and the estimated extent of underreporting on death certificates.

OBJECTIVE: To develop alternative estimates of the excess mortality attributable to diabetes in Mississippi. METHODS: For each age/sex group, the total (all cause) mortality rate in the population was partitioned into the mortality rates for diabetics (M1) and non-diabetics (M0), using age- and sex-specific mortality rate ratios for diabetics from the Verona Diabetes Study. M1 and M0 were used, respectively, to calculate the predicted number of deaths and the 'usual' number of deaths (the number expected if diabetics had the same mortality rates as non-diabetics) in diabetics. The difference between predicted and 'usual' deaths is the number of excess deaths in diabetics--that is, deaths attributable specifically to diabetes. This was compared to the number of deaths in which diabetes was registered on death certificates as an underlying and/or contributory cause. RESULTS: In Mississippi in 1998-2000, 2,322 male and 3,436 female deaths in diabetics were calculated to be excess. These numbers are approximately three times the numbers of deaths in which diabetes was registered on the death certificate as the underlying cause of death. The excess numbers of deaths are much closer to the total numbers of deaths due to diabetes (that is, where diabetes is listed as either an underlying or a contributory cause of death). CONCLUSIONS: When reporting diabetes mortality numbers, public health agencies should consider reporting total registered diabetes deaths, not just registered underlying deaths. Better education of providers and others to increase the awareness of the importance of listing diabetes on the death certificate would help to increase concern and make diabetes a priority for public health action. Persons with diabetes have higher mortality rates and excess premature mortality, and diabetes ranks consistently among the leading causes of death in Mississippi and the U.S. Yet it has long been known that mortality attributable to diabetes is underestimated. Cause-of-death statistics are unreliable due to underreporting of diabetes on death certificates, and estimates based on attributable risk calculations do not take into account competing risks for mortality. In view of the public health importance of diabetes, it would be useful to develop alternative estimates of the burden of excess mortality attributable to it. In this paper I estimate the excess mortality attributable to diabetes for the diabetic population of Mississippi using epidemiologic data on the prevalence of diabetes and the relative risk of mortality among persons with diabetes.

Cause of Death↗
PubMed2003

Quality assurance and certification of health IT-systems communicating data in primary and secondary health sector.

Each year more than 70% (25 mill) of all electronic health documents between secondary and primary health sector in Denmark are exchanged electronically using European EDI standards. Despite this widely use there have been several problems in showing the transferred data in correct and full context. These problems are solved in the 3 years MedCom certification and consolidation project. The project financed by Ministry of Health, Danish County Association and others through MedCom, involved all relevant health professional groups, organisations, all SW suppliers and all local governments. A new detailed and exact documentation with recommendations and obligatory needs published in "The Good EDI letters" was made, followed by training courses for programmers, test and certification of IT systems by MedCom and finally implementation of certified systems by all users in the country. The certification and implementation process are followed on www.medcom.dk The results are now a high quality of information and the state of art: One and only way of exchanging documents which are accepted by health professionals and implemented by all SW companies at all users. To day only MedCom certified IT systems are used[2] and the certification is a must for SW companies to be in the market.

Certification↗
PubMed2004

Polio control after certification: major issues outstanding.

Now that the global eradication of wild poliovirus is almost within sight, planning for the post-certification era is becoming a priority issue. It is agreed that a stockpile of appropriate polio vaccines will need to be established, and a surveillance and response capacity will need to be maintained, in order to protect the world against any possible future outbreaks attributable either to the persistence of wild poliovirus or vaccine-derived polioviruses (VDPVs) or to the unintentional or intentional release of poliovirus from a laboratory or vaccine store. Although it has been suggested that the stockpile should consist of monovalent oral poliovirus vaccine (mOPV), many questions remain concerning its nature, financing, management, and use--in particular, because of uncertainties over future national vaccination policies, and over the availability of different vaccines, after the certification of wild poliovirus eradication. There are further uncertainties concerning the possible role and efficacy of inactivated poliovirus vaccine (IPV) used either routinely or in outbreak control in low-hygiene settings, the potential for rapid geographical spread of polioviruses should an outbreak occur after certification, and the risks inherent in introducing additional oral polio vaccine (OPV) viruses into populations in which the vaccine coverage and prevalence of immunity have declined, and which may thus favour the spread of VDPVs. Given these important gaps in knowledge, no country should discontinue polio vaccination until a coordinated policy for the post-certification era has been developed and the recommended measures have been put in place.

Carrier State↗
PubMed2001

Predictive value of a senior comprehensive examination as to performance on a national certification examination.

OBJECTIVE: To determine what value a senior departmental comprehensive examination holds in predicting the future success of a student on the MT(ASCP) certification examination. DESIGN: Part 1: To evaluate the efficacy of the comprehensive examination, scores were obtained in the examination categories of hematology, clinical chemistry, immunohematology, and microbiology for all dinical laboratory science students who have graduated from the University of Mississippi Medical Center since 1993. The data were analyzed to determine if a correlation exists between student performance on the senior comprehensive, and their future performance on the MT(ASCP) national certification examination. Part 2: To determine the extent to which a senior comprehensive examination was required for graduation at other university-based clinical laboratory science programs, a simple survey was e-mailed to members of the clinical laboratory science educators forum. SETTING: 2+2 university-based dinical laboratory science program PARTICIPANTS: Part 1: Previous graduates of the Clinical Laboratory Science Program at the University of Mississippi Medical Center since 1993. Part 2: Program directors who are members of the Clinical Laboratory Sciences Educator's Forum. RESULTS: Part 1: Results indicated a distinct division between participants who scored higher than 74.36% (Group A) on the senior comprehensive examination, and those scoring below 74.36% (Group B). In Group A, 100% of participants passed the MT(ASCP) national certification examination on the first attempt. Results were mixed for Group B. Part 2: The survey indicated that of the 40 respondents, most were similar to the University of Mississippi Medical Center Clinical Laboratory Science Program in that they require a comprehensive to be taken, that the grade received is part of another course grade, and that the examination is prepared using questions submitted by the faculty. CONCLUSIONS: Part 1: The senior departmental comprehensive examination is of value in predicting the future success of a student on the MT(ASCP) national certification examination. Part 2: Unlike the University of Mississippi Medical Center, 16 of the 40 respondents stated that passage of the comprehensive examination was a requirement for graduation. In those programs, the comprehensive was a major part of a course grade.

Allergy and Immunology↗
PubMed1992

Certification of cholesterol measurements by the National Reference Method Laboratory Network with routine clinical specimens: effects of network laboratory bias and imprecision.

The National Reference Method Laboratory Network has initiated a program to certify clinical laboratory cholesterol measurement performance by using routine clinical specimens. Clinical laboratory and reference laboratory measurements of split samples are used to assess whether the clinical laboratory is meeting the Laboratory Standardization Panel's goals for accuracy and precision. We used a computer-based Monte Carlo simulation model of split-sample proficiency testing to evaluate the certification program and, in particular, to analyze the effects of reference laboratory bias and imprecision. Results of our simulations indicate that the accuracy of the certification program is strongly influenced by reference laboratory bias and less influenced by reference laboratory imprecision. The certification program is potentially highly accurate, but unless reference laboratory bias is tightly controlled, the number of classification errors may limit its utility. Moreover, the decision limit of the certification program needs to be higher than the Laboratory Standardization Panel's goal (3.5% instead of 3.0%) to ensure that an acceptably high proportion of well-performing clinical laboratories can become certified.

Certification↗
PubMedDate not supplied

Board certification status and pediatric dentists' practice characteristics.

PURPOSE: Board certification is often used as a surrogate indicator of provider competence and quality of care, although few studies have demonstrated its validity. The aim of this study was to assess the relationship between board certification status and a set of quality characteristics of pediatric dental practice. METHODS: A 30-item questionnaire was developed that collected information regarding practice characteristics in the areas of: (1) professional growth/practice management; (2) emergency readiness; (3) treatment guidelines utilization; (4) patient pool selection; (5) safety; and (6) behavior management. The questionnaire was mailed to 250 board-certified and 250 noncertified pediatric dentists paired by year and program of graduation. RESULTS: Overall, respondents-irrespective of pairing by program and year of graduation-tended to answer affirmatively or largely positively to most questions. Maintaining hospital privileges and having routinely CPR-certified staff were significantly related to the board certification status. When year of graduation and residency program attended was considered, however, this significance disappeared. In categories of treatment guidelines utilization, patient pool selection, safety protocols and behavior management, there was no significant difference between board certified and nonboard certified pediatric dentists (P > .05). CONCLUSIONS: Generally, pediatric dentists independent of certification status, practice at a high level of quality, as measured in this study.

Certification↗
PubMedDate not supplied

ANCC certification: personal and professional affirmation.

Certification is sited as one way of demonstrating competency. There are currently many reasons for pursuing certification, including personal satisfaction, validation of one's ability to effectively fulfill leadership roles, and to augment organizational efforts to become an ANCC Magnet Hospital. Regardless of the reason, achieving certification requires preparation and completion of an examination. Cary (2001) notes there are 4 avenues through which certification status can be recognized: public acknowledgement, financial compensation, career advancement, and retention. Colleagues who complete this process desire and deserve to be acknowledged and affirmed. Do you recognize colleagues in the attached list of ANCC certified nurses? If yes, take a minute and congratulate them on their accomplishment.

American Nurses' Association↗
PubMed2005

Death certification and doctors' dilemmas: a qualitative study of GPs' perspectives.

BACKGROUND: Death certificate inaccuracies have implications for funding and planning public health services, health research and family settlements. Improved training has been identified as a way of reducing inaccuracies. Understanding the influences on certifying doctors should inform that training. AIM: To explore what factors influence GPs as they complete death certificates. DESIGN: Focus groups held by teleconference with 16 GPs. SETTING: New Zealand general practice. METHOD: Four teleconferenced focus groups were taped and transcribed. Transcripts were examined for emerging themes. Credibility, transferability and confirmability were underwritten by a clear audit trail. RESULTS: Participants identified two factors that influenced death certification: clinical uncertainty and the family. Other themes provided an understanding of the personal and professional concerns for GPs. CONCLUSION: Improving death certification accuracy is a complex issue and needs to take into consideration factors that influence certifiers.

Adult↗
PubMed2005

[Sexual child abuse: correlation between medical certificates' conclusions and judiciary sanctions].

Sexual child abuse, comprises of indecency attitudes and physical misbehaviours, directed towards children are dominated by rape. The objective of our study was to assess in sexual child abuse the relation between the conclusion of medical certificates and court decision. It is a retrospective study carried out from 1994 to 1998 on the clerk's office correctional repertories in Dakar regional court. An overall number of 79 cases of child abuse were collected in 5 years period. Children under 18 years old of of both sex, were concerned. Data found were correlated with a review of requisition cases received by the of gynaecology and obstetrics clinic of Aristide Dantec Hospital. This facilitates the establishement of the relationship between the offences and the pronounced sanctions, as well as the initial medical certificate and these sanctions. The sanctions were severe whenever rape had been retained. Some cases were disqualified in indecent assault and were judged as such. The judge decision, which follow the medical certificate conclusions in 11 cases out of 14 shows the importance and reliability of this medical document. All files reviewed at the medical and legal level were incomplete. The difficulty of the materiality of the rape and the psychological consequences in the long run and especially HIV infection should invite to a multidisciplinary, specialized and organized management of sexual child abuse. This study has shown the importance of a correct and complete drafting of the medical certificate, to enable the establishment by the judge the materiality of the facts.

Anal Canal↗
PubMed2005

[Reliability of education and occupational class: a comparison of health survey and death certificate data].

OBJECTIVES: This study was done to evaluate the reliability of education and occupational class between using the health survey and the death certificate data. METHODS: The 1998 National Health and Nutrition Examination Survey (NHANES) was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the Korean National Statistical Office. The data from 263 deaths were used to estimate the agreement rates and the Kappa indices of the education and occupational class between using the NHANES data and the death certificate data. RESULTS: The simple and weighted Kappa indices for education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively, if the educational level was grouped into five categories: no-formal-education, elementary-school, middle-school, high-school and college or over. The overall agreement rate was 71.9% for these educational groups. The magnitude of reliability, as measured by the overall agreement rates and Kappa indices, tended to increase with a decrease in the educational class. The number of non-educated people with using the death certificate data was smaller than that with using the NHANES data. For the occupational class (manual workers, non-manual workers and others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower than that for the educational class. Compared with the NHANES, the number of non-manual workers for the deceased who were aged 30-64 tended to be increased (8 to 12) when using the death certificate data, whereas the number of manual workers tended to be decreased (59 to 41). CONCLUSIONS: The socioeconomic inequalities in the mortality rates that were based on the previous unlinked studies in South Korea were not due to a numerator/denominator bias. The mortality rates for the manual workers and the no-education groups might have been underestimated.

Adult↗
PubMed2006

[Physical and psychological predictors for the onset of certification of long-term care insurance among older adults living independently in a community a 40-month follow-up study].

OBJECTIVE: To ascertain predictors for the onset of different levels of certification of long-term care insurance among older adults living independently in a community. METHODS: Out of all residents aged 65 years and over living in Yoita town, Niigata prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline interview survey in 2000 (response rate, 92.3%). Among these participants, 1,229 persons (79.6% of responders) were ranked as level 1, based on the hierarchical mobility level classification. They were followed up for the subsequent 3 years and 4 months to see whether they continued without certification of long-term care insurance or suffered onset of a "mild level", certified as levels "needing support" and 1 for long-term care insurance, or a "severe level" as 2-5. The Cox proportional hazards model with a stepwise method was used to identify the most parsimonious combination of predictors for each type of long-term care insurance certification. RESULTS: Of those who were followed up, 1,151 persons showed no disability in basic activities of daily living (ADL) at baseline nor died before application for long-term care during the follow-up and thus served for analysis. 1,055 persons (91.7%) remained as "no event", but 49 (4.3%) and 47 persons (4.1%) had onset of the "mild level" and the "severe level" during the follow-up, respectively. The final model for prediction of the "mild level" in both genders included advanced age and poor walking ability (hazard ratio (HR) for either unable or with difficulty: 7.22[95% CI, 1.56-33.52] in males and both unable and with difficulty: 3.28[95% CI, 1.28-8.42] in females). The final model for prediction of the "severe level" in both genders included advanced age and poor instrumental ADL (HR for < or = 4 marks: 3.74[95% CI, 1.59-8.76] in males and 3.90[95% CI, 1.32-11.54] in females). Severe cognitive decline was a predictor only for the "severe level" in males. A history of hospitalization during past 1 year and poor chewing ability were predictive only for the "mild level" in females. CONCLUSIONS: Among older adults living independently in a community, most predictors for subsequent onset of mild level-certification of long-term care insurance, except for advanced age, may be controlled by preventive strategies. Evaluating effectiveness of programs for this purpose warrants further study.

Activities of Daily Living↗
PubMed1991

Comparison between diagnoses on death certificates and autopsy reports in Trieste: gynaecological cancers.

We have compared autopsy results with the diagnosis reported on 759 death certificates for gynaecological cancers. High levels of discrepancies were noted for all sites. Surprisingly, complete agreement between death certificates and autopsy reports was found for only 30% of cervical and corpus tumours and for 50% of ovarian tumours. This low level of agreement was due partly to the poor quality of death certificates of older women. No difference in accuracy was found over the 15-year period considered. The most obvious causes of the discrepancies were of two types. The first was erroneous interpretation of codes; confusion between 180 (cervix) and 182 (corpus) was very frequent. The second type was associated with clinical factors, such as confusion of anatomical site, adjacent organs or metastases being diagnosed as primary tumours. A relatively frequent cause of inaccuracy on death certificates was consideration of patients who had been cured of a cancer as having died of the disease.

Adult↗
PubMed1991

Sensitivity of death certificate data for monitoring diabetes mortality--diabetic eye disease follow-up study, 1985-1990.

Although death certificates are a primary source of data for characterizing mortality patterns in the United States, the underreporting of diabetes as a cause of death limit the use of death certificates for monitoring diabetes mortality. To determine whether diabetes was underreported on the death certificates of patients with known diabetic eye disease, CDC analyzed data from death certificates for persons identified as deceased by the Diabetic Eye Disease Follow-Up Study (DEDFUS).

Adult↗
PubMedDate not supplied

Evaluation of the hospital discharge diagnoses index and the birth certificate as sources of information on birth defects.

The hospital discharge diagnoses index (DI) for newborns and the birth certificate were evaluated as sources of information about birth defects by comparing them with the same births in the case registry of the California Birth Defects Monitoring Program (CBDMP). The CBDMP is an active surveillance system; the staff visit hospitals to identify children with birth defects diagnosed in the first year of life. The study population comprised 66,481 live births to residents of five counties in the San Francisco Bay area in 1983. Of these infants, 2,543 had at least one birth defect noted on the DI, and 1,623 were in the CBDMP registry; 1,020 with defects noted on the DI were also in the CBDMP registry. For this same population, 399 infants had one or more defects noted on the birth certificate; 304 of these were also in the CBDMP registry. Reporting of birth defects on the birth certificate was poor for every condition. Reporting on the DI was most reliable for oral clefts and chromosomal defects; for these defects, the DI omitted one-third of the cases but had identified only about 10 percent false-positive (that is, unverified) cases. Major central nervous system malformations were less well reported, with about one-third of them false-positive. For all other birth defects, the DI either omitted more than half of the cases, or more than half of the cases reported were false-positive cases. These findings raise questions about the validity of analytic studies of birth defects if the data are obtained only from the DI or the birth certificate.

Birth Certificates↗
PubMed1990

Certification in nephrology nursing: an interview with NNCB president Janel Parker. Interview by Patricia S Jordan.

Certification in nephrology nursing became a reality in 1987 with the formation of the Nephrology Nursing Certification Board (NNCB), and the development and administration of the nephrology nursing certification examination. Three years later, NNCB President Janel Parker discusses the evolution of the NNCB examination, the significance and impact of the examination, and the future of certification in nephrology nursing.

Certification↗
PubMed1987

Cause of death. Proper completion of the death certificate.

Mortality statistics derived from death certificates are the only continuously collected, population-based, disease-related information available in most parts of the world, including the United States. For this reason, every effort must be made to ensure that the most specific, accurate, and complete information regarding cause of death is registered on death certificates. This article discusses identification of the underlying and immediate causes of death, the mechanism and manner of death, and completion of the medical certification section of the death certificate. Examples are given to illustrate the appropriate sequencing of causal information and the selection of the proper underlying cause of death.

Aged↗
PubMed1984

Evaluating the impact of certificate-of-need regulation using measures of ultimate outcome: some cautions from experience in Massachusetts.

Prior evaluations of certificate of need (CON) have concluded that such regulation did little to reduce the level of hospital capital investment. These studies, however, failed to examine the underlying patterns of hospital investment behavior onto which CON was imposed and further neglected to determine the lag period that separates the introduction of regulation and the appearance of outcomes actually attributable to the presence of CON. This article addresses these two issues by using rate-setting data to examine the details of hospital capital investment across the whole voluntary hospital industry in one state--Massachusetts--both before and after the introduction of certificate of need. Massachusetts voluntary hospitals were found to devote most of their capital expenditures to the construction of major new inpatient facilities built in cycles of 14 years average duration throughout the post-World War II period. The date of completion of such a facility proved to be the major determinant of a hospital's capital expenditure pattern over time, and hospitals of similar teaching status and geographic location showed considerable synchrony in the construction of such facilities. At least in Massachusetts, the introduction of certificate-of-need regulation coincided with but was not responsible for the conclusion of a major construction peak among nonteaching hospitals and the beginning of such a peak among teaching hospitals, greatly complicating the evaluation of actual CON effects. Further, capital expenditures actually approved by CON did not appear until the third year of program operation, and even five years post-CON, the majority of hospital capital expenditures reflected projects approved in the first year of regulation, a period during which the program had neither the expert staff nor extensive review capacity that characterized CON function in later years. These findings hold implications for the evaluation of CON effectiveness and, indeed, for the future existence of certificate of need.

Boston↗
PubMed1984

The accuracy of occupation and industry data on death certificates.

To assess the accuracy of occupation and industry data on death certificates, we compared the known occupation and industry of 3,789 individuals with information on their death certificates. All individuals were members of the National Institute for Occupational Safety and Health cohort studies and their occupation and industry were known from personnel or union records. We focused our analysis on 2,198 long-term workers who had 10 or more years of work experience (average, 18 years). Our principal finding was that for the long-term workers in our sample, the probability of the known occupation being listed on their death certificates was 64.7% (SE = 1.1) (for white workers this figure was 73.5% (SE = 1.2). Furthermore, for the long-term workers the probability of the plant or industry being named on their death certificates was 70.1% (SE = 1.2). Women and non-whites had lower matching rates. For women the probability of a matched listing was 45.1% for occupation and 60.4% for industry. For nonwhites, it was only 30.1% for occupation and 49.2% for industry. Our results for white long-term workers generally agree with the results of previous investigators who have used different methods.

Black or African American↗