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PubMed1981

[The results obtained from the first certificate of health between 1972 and 1979 at Ille-et-Vilaine (author's transl)].

The authors describe and comment on some of the results that have been obtained in a French département (Ille-and-Vilaine) using the information obtained from the first health certificate which has been set up compulsorily for all children in the eight days following delivery. This analysis makes it possible to carry out an annual survey of the demographic course of affairs (birth rate, perinatal mortality rate) and compare these with France as a whole. The certificate gives interesting information about labour (multiple births, Caesarean births, the state of the infant at birth, weight, length, skull circumference, prematurity and small for dates), and the pathology of the first week of life (transfer to other hospitals and death). Malformations are as yet poorly registered and there is need to obtain more information from doctors. Correlations can be established, as for example between neonatal mortality and social class. Finally, using this first certificate will make it possible to open a file on high-risk women for a possible future pregnancy. the authors point out that the contents obtained in the first certificate had to be modified and will later give extra information about the pregnancies, the number of antenatal visits, the number of admissions to hospital, and the preparation for delivery, etc. The results that have up till now been given for various maternity departments allow each obstetrician to audit the work in his department.

Adult↗
PubMed1978

Certification of medical and public health laboratory personnel by professional organizations.

Since 1928, 22 professional agencies have established certification procedures for 52 categories or levels of health laboratory personnel. Surveys indicate that 55% of technical personnel are certified by at least one registry or board. After reviewing some of the pros and cons of certification and its expanding role, the author concludes that certification has become a positive factor in calling attention to the need for quality personnel in health laboratories and has helped meet the needs of individuals and the public. Current movements to work together in a National Commission for Health Certifying Agencies and toward national certification standards are encouraging.

Allied Health Personnel↗
PubMedDate not supplied

[Efficacy of an informative seminar on the certification of causes of death].

BACKGROUND: Mortality statistics are of crucial importance in decision making from the point of view of Public Health Studies conducted on the reliability of such statistics have disclosed errors or biases, some of which may be avoided and/or reduced with information and training. The aim of the present work was to evaluate the efficacy of an informative seminar, received by pregraduate students, about the certification of causes of death in improving the formal quality of such statistics, thus increasing their reliability. METHODS: A total of 175 students in the 6th year of their medical studies participated voluntarily in the Seminar. The students first made 6 certifications of death by different causes, then received a theoretical session, and finally made a further 6 certifications of death in a new test. RESULTS: The results obtained point to an improvement in the set of indicators employed in the evaluation of the quality of the certifications of death. CONCLUSION: The informative seminar mode is proposed as a method to be used in the training of health personnel in mortality statistics.

Abbreviations as Topic↗
PubMed1979

Specialty certification in North America: a comparative analysis of examination results.

The pass/fail results of 44 North American medical specialty certification examinations are compared and analyzed. A calculated annual failure rate was used to equate one- and two-part examinations. Failure rates on American boards generally varied between 8 and 61 percent. Foreign medical graduates (FMGs) had failure rates two to three times higher than those of North American graduates in almost all specialties. Failure rates for comparable North American and FMG candidates tended to be higher on Royal College of Physicians and Surgeons of Canada specialty certification examinations than on equivalent American specialty board examinations. The place of specialty certification in the continuum of American graduate medical education is delineated. Questions are raised concerning the standards required for specialty certification.

Canada↗
PubMed1995

The cause of death in inflammatory bowel disease: a comparison of death certificates and hospital charts in Rochester, New York.

OBJECTIVE: This study examines the causes of death from Crohn's disease and ulcerative colitis by comparing death certificates with hospital charts as part of an ongoing, community-based analysis in Rochester, NY. METHODS: A registry of 1358 inflammatory bowel disease patients followed from January 1973 to December 1989 was analyzed for the cause of death by a study of death certificates as well as by a study of hospital records, including surgical pathology and autopsy records. A panel of physicians defined specific criteria for diagnosis, cause of death, and relation of death to inflammatory bowel disease. RESULTS: One hundred and thirty patients (59 with ulcerative colitis and 71 with Crohn's disease) from the registry were found to have death certificates recorded by Monroe County during this period. There was an 80% concordance of the death certificate to the hospital record for the cause of death and its relationship to inflammatory bowel disease. Discordance was noted in cases of colon cancer and surgical complications. CONCLUSIONS: Sixty-eight percent of Crohn's disease and 78% of ulcerative colitis patients died from causes unrelated to their inflammatory bowel disease. Deaths caused by Crohn's disease decreased from 44% in the 1973-1980 period to 6% in the 1981-1989 period. Crohn's disease was a direct cause of death in 25% of the female patients, whereas only 6% of male patients died directly of Crohn's disease. Colorectal cancer caused 14% of the deaths in ulcerative colitis patients, three times more often than in Crohn's disease patients. Excluding cancer, there were only two deaths directly due to ulcerative colitis, both in the first 2 yr after diagnosis.

Adolescent↗
PubMed1995

Birth certificates as a source for fetal alcohol syndrome case ascertainment--Georgia, 1989-1992.

Fetal alcohol syndrome (FAS) is a major cause of preventable mental retardation (1). The development and evaluation of programs for preventing FAS may be enhanced by timely and reliable estimates of the occurrence of this complex birth defect. In 1989, birth certificates were standardized nationally to include check-boxes for reporting FAS and other congenital abnormalities (2). These changes were implemented to improve the potential usefulness of birth certificates for timely and systematic population-based ascertainment of FAS and other abnormal conditions of the newborn (3). To assess the usefulness of birth certificates for surveillance of FAS, the Division of Public Health, Georgia Department of Human Resources (DPH-GDHR), compared information about congenital anomalies from birth certificates to data collected by CDC's Metropolitan Atlanta Congenital Defects Program (MACDP) during 1989-1992. This report summarizes the results of the assessment of FAS.

Birth Certificates↗
PubMed1994

Pediatric subspecialty training, certification, and practice: who's doing what.

OBJECTIVE: To examine the extent of pediatric subspecialty training, certification, and practice among general and subspecialty pediatricians and to determine how the diversity of pediatric careers may affect physician workforce supply estimates. METHOD: A sample of 4,000 self-designated pediatricians and pediatric subspecialists from the American Medical Association's Physician Masterfile were surveyed in 1991 by the American Academy of Pediatrics. Seventy-six percent of the sample responded to the 6-page questionnaire on practice characteristics, training, and demographic information. RESULTS: Two-thirds of pediatricians are not subspecialty trained (66.3%), 15.1% are certified subspecialists, 11.3% are trained but not subboard certified, and 7.3% are subspecialty trained in an area with no certification exam. Subspecialty training did not always predict subspecialty practice; 19% of pediatricians without subspecialty training spend some time in a subspecialty, and 13% of those who are subspecialty trained practice general pediatrics exclusively. Certified subspecialists and those who cannot as yet become certified are most likely to practice their subspecialty. One-fourth of those trained in a certifiable subspecialty but who remain uncertified practice general pediatrics exclusively. The proportion of direct patient care time spent overall, and the proportion of direct patient care time spent in the subspecialty are also related to subspecialty certification and training/practice consistency. CONCLUSION: Pediatric workforce supply projections should incorporate more than certification and training information in calculating estimates, as the practice of general and subspecialty pediatrics is very diverse and accommodating of integrative styles.

Certification↗
PubMed1996

Accuracy of death certificate completion: the need for formalized physician training.

OBJECTIVE: To assess the extent to which accuracy of death certificate completion varies with level of physician training and experience. DESIGN AND SETTING: In a classroom setting, subjects were presented with six written cases of hospital deaths adapted from materials from the National Center for Health Statistics and were asked to complete the cause-of-death section of the New York City death certificate. PARTICIPANTS: A total of 12 practicing general internists, 21 internal medicine residents, and 35 senior medical students. OUTCOME MEASURES: The underlying cause of death recorded by each participant was compared with the correct cause determined by a nosologist. Agreement and disagreement were classified as major or minor depending on concordance within the 17 International Classification of Diseases categories. RESULTS: Only one internist and five residents had received formal training in death certificate completion. The overall level of agreement between underlying cause of death reported by the three groups of participants and the correct cause was 56.9% for internists, 56.0% for residents, and 55.7% for medical students, although agreement varied with the type of case, ranging from 15% to 99%. CONCLUSION: If the misclassification observed in this pilot study were widespread, it would imply a substantial underreporting of mortality from both circulatory diseases and diabetes. These data strongly support the need to include training in death certificate completion as part of physician education.

Cause of Death↗
PubMed1996

The transition of the national certification examination from paper and pencil to computer adaptive testing.

The Council on Certification of Nurse Anesthetists (CCNA) has been exploring computerized adaptive testing (CAT) for the national certification examination (NCE) over the past several years. CCNA representatives have consulted with experts in testing and with individuals from professional associations who use CAT for certification or licensure testing. This article will provide an overview of CAT and discuss how the CCNA plans to implement CAT for the NCE beginning April 8, 1996. A future article that explains the theoretical concepts of CAT will be published in the April 1996 AANA Journal. It is important to note that the NCE will not be a new test, the current content outline and item bank will remain the same. It is only the method of test administration that is changed--from paper and pencil to CAT. Each candidate will answer questions and take a test that is individualized to his or her ability or competence level and meets the specifications of the test outline. All candidates must achieve the same passing score. The implementation of CAT for the NCE will be advantageous for the candidates and provide a more efficient competency assessment. The last paper and pencil examination was administered on December 9, 1995. The transition is a significant event in nurse anesthesia history, just as nurse anesthesia was the first advanced practice nursing specialty to implement the certification credential, the CCNA will be the first to introduce CAT.

Certification↗
PubMed1997

[Medical certification of deaths by trauma in the Chilean health services].

BACKGROUND: Trauma in the third cause of death in Chile and the most important among youngsters. AIM: To analyze the certification of deaths by trauma, studying those deaths in which it is not known if they were accidental or self inflicted. MATERIAL AND METHODS: Deaths certified as caused by trauma, poisoning or violence during the period 1992-1994 are analyzed. Those in which their accidental or self inflicted nature was ignored were specially considered. RESULTS: During the study period, 26,886 f 225,796 deaths were certified as caused by trauma, poisoning or violence. In 41.7% of these deaths, no defined cause (accidental or self inflicted) was reported) was reported. In the Metropolitan region 65.3% of deaths by trauma were not defined. Ninety seven percent of certificates in this area were extended by pathologists or coroners. In all health services, there was a positive correlation between the percentage of ill defined deaths by trauma and the percentage of certifications by pathologists or coroners. CONCLUSIONS: The deficiency in certification of deaths by trauma is possibly due to administrative causes and precludes the study of deaths caused by accidents, violence or suicide in Chile and its comparison with other countries. An effort should be done to solve this problem.

Adolescent↗
PubMed1998

[Reliability of death certificates. The reproducibility of the recorded causes of death in patients admitted to departments of internal medicine].

The aim of the study was to assess the reproducibility when different doctors fill in diagnoses on death certificates. Records from 40 patients who had died in 1994 during admission to a medical hospital department in Denmark were selected at random. Ten doctors filled in a death certificate for each patient (without knowledge of autopsy findings and results of examinations received after the patient's death). The agreement between the diagnoses was assessed using a rating scale with seven categories. Afterwards the 400 death certificates were mixed and coded by the Medicostatistical Section of the Danish National Board of Health. The diagnoses made by the ten doctors showed insignificant discrepancies in ten cases, larger discrepancies were found in eight cases and large discrepancies in 19 cases. In three cases the patient had died suddenly and little information was available. The coding was standardized at the Danish National Board of Health, but their diagnoses reflected the discrepancies between the doctors' diagnoses. In conclusion, the reproducibility of diagnoses on death certificates is so poor that information from the Registry of Causes of Death is of little use of administrative or scientific purposes.

Autopsy↗
PubMed1998

Core competency-based education, certification, and practice: the nurse-midwifery model.

It has been more than 70 years since the first nurse-midwives came to practice in the United States, and over 20 years since the American College of Nurse-Midwives (ACNM) established nationally recognized standards and core competencies for nurse-midwifery education, certification, and practice. Certified nurse-midwives are licensed in all 50 states and in the District of Columbia (DC) and have prescribing privileges in 45 states plus DC. More recent standard-setting activities include the establishment of a national mechanism for continuing competency assessment; adoption of the bachelor's degree as the minimum academic requirement for certification; development of national standards for education and certification of direct entry midwives; and placement of an 8-year time limit on certificates.

Certification↗
PubMed1998

Accreditation and certification.

In Italy the debate has focused on three different assessment systems: accreditamento autorizzativo (regulatory accreditation), accreditamento di eccellenza (excellence accreditation), and certification. Regulatory accreditation verifies the conformance to a set of quality standards that entitle an organisation to the status of belonging to the NHS. Excellence accreditation attempts to maintain incremental improvement of the quality of services. Certification is a means by which an independent third party declares that a determined product or process conforms to the ISO 9000 set of standards; the main objective of certification is to increase the "credibility" of a company on the market in order to orient and at the same time assure customers. Certification loses meaning in a regulated market, as the Italian NHS, in which there is a distinction between the consumer and the paying body. Regulatory accreditation should be deeply rooted in regional planning; the recognition of accredited organisations should be the result of a demonstrated capacity to co-operate in achieving the goals of regional planning and not of conformance to organisational standards. Regional experiences of regulating accreditation show a high level of contamination between systems for quality assessment. The large number of standards proposed seemed to be redundant with respect to the aims that should be pursued by a regulating accreditation system. The furthering of quality in the NHS requires a complex system of quality assessment within which a plurality of subjects, each with different interests, work together to determine the final result by each one setting up procedures consistent with its own particular problems: the institutions set up regulatory accreditation and the professions develop excellence accreditation in their individual professional associations. What is important is to establish relationships across the various levels so as to give the whole system cohesion and consistency. (Int J Artif Organs

Accreditation↗
PubMed1998

[Quality of death certificates in cases of cancer death in France].

International mortality statistics are based on death certificates on which the causes of death are coded using the World Health Organization's International Classification of Diseases. Most of these statistics are based on the underlying cause of death and do not use the contributory causes of death. We studied the validity of death certificates in a sample of 1,194 French patients known to have died of cancer, comparing the cause of death reported on the death certificate with the cause of death found in the medical record. Death certificates correctly identify cancer as the cause of death in 95% of the cases and with the exact site in 86% of the cases.

Cause of Death↗
PubMed1996

Children with Fetal Alcohol Syndrome in North Dakota: a case control study utilizing birth certificate data.

A retrospective case control study utilizing birth certificate data in a population of children with Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effect (FAE) and controls in North Dakota was completed. Using the North Dakota FAS registry, 97 cases of FAS and FAE aged birth-18 years of age were identified. The North Dakota Department of Vital Records then searched for the child's birth certificates. For each case child, four controls were selected from the birth records. The controls were of the same race, sex, month and county of birth as the cases. Birth certificates for 68 children were identified, 44 with FAS and 24 with FAE. When compared with the FAE group, the FAS group had lower birth weights and mothers who began prenatal care later in pregnancy. The FAS/FAE group combined had mothers who were older, were more likely to be unmarried, had less weight gain during pregnancy, started prenatal care later in pregnancy and had fewer prenatal visits compared to controls. The FAS/FAE children had lower birth weights and higher rates of sibling deaths. The use of birth certificate data is a useful data source to compare maternal, paternal and prenatal characteristics for a population of children with FAS/FAE.

Journal Article↗
PubMed1995

The Certification Board of Infection Control, Inc.

The Certification Board of Infection Control, Inc. (CBIC), was created in 1981 by the Association for Professionals in Infection Control and Epidemiology, Inc, for the sole purpose of developing and administering an examination by which competent infection control professionals could become certified. This independent, voluntary board is multidisciplinary, representing all levels of professionals in the field of infection control, as well as a consumer member. CBIC certification is the only recognized certification for infection control professionals. Since the first examination was administered in 1983, over 3,000 persons have attained infection control certification (CIC) status and are permitted to use the CIC credential.

Educational Measurement↗
PubMed2005

Care-needs certification in the long-term care insurance system of Japan.

The introduction of Japan's long-term care insurance (LTCI) system in April 2000 has made long-term care an explicit and universal entitlement for every Japanese person aged 65 and older based strictly on physical and mental status. At the start of the program, more than two million seniors were expected to apply for services to approximately 3,000 municipal governments, which are the LTCI insurers. The LTCI implementation required a nationally standardized needs-certification system to determine service eligibility objectively, fairly, and efficiently. The current computer-aided initial needs-assessment instrument was developed based on data collected in a large-scale time study of professional caregivers in long-term care institutions. The instrument was subsequently tested and validated by assessing data of 175,129 seniors involved in the national model programs before the start of LTCI. The computer-aided initial assessment (an 85-item questionnaire) is used to assign each applicant to one of seven need levels. The Care Needs Certification Board, a committee of medical and other professionals, reviews the results. Three years after implementation, the LTCI system and its needs-assessment/certification system have been well accepted in Japan. Despite the overall successes, there remain challenges, including area variations, growing demands for services, and the difficulty of keeping the needs certification free of politics. The LTCI computer network that links municipalities and the central government is instrumental in continuously improving the needs-certification system. Future challenges include promoting evidence-based system improvements and building incentives into the system for various constituencies to promote seniors' functional independence.

Activities of Daily Living↗
PubMed2006

Place-of-residence errors on death certificates for two contiguous U. S. counties.

BACKGROUND: Based on death certificate data, the Texas Department of Health Bureau of Vital Statistics calculates age adjusted all-cause mortality rates for each Texas county yearly. In 1998 the calculated rates for two adjacent Texas counties was disparate. These counties contain one city (Amarillo) and are identical in size. This study examined the accuracy of recorded county of residence for deaths in the two counties in 1998. In our jurisdiction, the county of residence is assigned by funeral homes. METHODS: A random sample of 20% of death certificates was selected. The accuracy of the county of residence was verified by using a large area map, Tax Appraisal District records, and U.S. Census Bureau databases. Inaccuracies in recording the county or zip code of residence was recorded. RESULTS: Eighteen of 354 (5.4%) death certificates recorded the incorrect county and 21 of 354 (5.9%) of death certificates recorded the zip code improperly. There was a 14.4% county recording error rate for one county compared to a 0.82% for the other county. The zip code error rate was similar for the two counties (5.9% vs. 5.8%). Of the county errors, 83% occurred for addresses within a zip code that contained addresses in both counties. CONCLUSION: This study demonstrated a large error rate (14%) in recording county of residence for deaths in one county. A similar rate was not seen in an adjacent county. This led to significant miscalculation of mortality rates for two counties. We believe that errors may have arisen in part from use of internet programs by funeral homes to assign the county of residence. With some of these programs, the county is determined by zip code, and when a zip code straddles two counties, the program automatically assigns the county whose name appears first in the alphabet. This type of error could be avoided if funeral homes determined the county of residence from Tax Appraisal District or Census Bureau records, both of which are available on the internet. This type of error could also be avoided if vital statistics offices verified the county and zip code of residence using official sources.

Journal Article↗