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PubMed1993

Improving mortality data in South Africa: review of next of kin statements to determine cause of death in police certification.

STUDY OBJECTIVE: The study aimed to improve mortality data by finding ways of reducing the large number of deaths certified as being from "ill-defined" causes (ICD 780-798) in South Africa. This problem is attributable to the absence of cause of death information in many cases where the police issue the death certificate. DESIGN AND SETTING: A total of 600 consecutive death certification records at the Salt River State Mortuary, Cape Town were reviewed. MEASUREMENTS AND MAIN RESULTS: Altogether 347 (58%) deaths were from unnatural causes, 111 (18%) were certified by a doctor, 83 (14%) were certified as being the result of natural causes after a necropsy, and 59 (10%) were certified by the police as being from natural causes. Analysis of sworn statements obtained from the next of kin of all those certified dead by the police rather than a doctor provided a clear cause of death in 72.9%, and a history of recent contact with health services (less than one week previously) in 47.5%. All infants certified dead by the police had a history consistent with diarrhoeal disease. CONCLUSIONS: The method of death certification may be an indicator of access to health care and reviewing sworn statements to determine the cause of death should improve the quality of mortality data in the developing world.

Adolescent↗
PubMed2005

Population based mortality and quality of death certification in progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome).

OBJECTIVE: To estimate the mortality of progressive supranuclear palsy (PSP) and to assess the quality of death certification in patients with PSP who died in England and Wales. METHODS: An analysis was conducted of ICD-9 (International Classification of Diseases, version 9) coded deaths obtained through the Office of National Statistics over an eight year period. RESULTS: The crude annual mortality rate was 1.77 (95% confidence interval, 1.64 to 1.90) cases per million, using the mid-1996 population estimate for England and Wales. Annual mortality increased over time, possibly as a result of increased incidence or increased awareness of the disorder. Forty nine death certificates from deceased patients previously diagnosed clinically showed that the commonest proximate cause of death was pneumonia, occurring in 45% of cases (22/49). The underlying cause of death was cited as pneumonia in 14% of cases (7/49). PSP was mentioned in only 65% of death certificates (32/49). Eight of the 49 cases (16%) underwent necropsy and results were available for five of these cases. PSP was confirmed pathologically in four; the remaining case was diagnosed as Parkinson's disease. CONCLUSIONS: Further research is needed to establish the reasons for the observed increase in mortality. Determining the population mortality rate for PSP using the ICD-9 coding system is problematic but is likely to improve following the introduction of ICD-10 updated codes and coding rules.

Autopsy↗
PubMedDate not supplied

Multifetal pregnancies: evolution of methods of initiation and impact of REI certification for patients seeking reduction.

OBJECTIVE: Multifetal pregnancy as a result of ovulation induction (OI) and assisted reproductive technologies (ART) correlate with Board certification in reproductive endocrinology and infertility (REI). DESIGN: Retrospective chart analysis of 304 patients referred to Wayne State University (WSU) and Thomas Jefferson University (TJU) for multifetal pregnancy reduction (MFPR) from March 1986 to January 1995 compared to 275 patients referred from January 1 to December 31, 2000 at MCP Hahnemann University. MATERIAL AND METHODS: Chart review for fetal number, pregnancy generation (OI or ART) and physician REI Board certification from the American Board of Specialties Obstetrics and Gynecology. Information was available on 296 of 304 patients studied in the 1986-1995 WSU cohort and 275 patients studied from the MCP Hahnemann 2000 cohort. RESULTS: Analysis of 296 multifetal pregnancies at WSU and TJU for REI Board status showed non-REI Board-certified (NREI) physicians generated 174 pregnancies with quadruplets or more compared to 122 quadruplets or more by REI Board-certified physicians. Board certification did not impact quadruplet or more rates for OI or ART (p < 0.368). Of 275 patients with triplets or more at MCP Hahnemann, 156 (56.7%) were from ARTs versus 41.2% from 1986-1995 (chi(2) = 13.1, p < 0.001). Quintuplets or more decreased from 18.5 to 9.7% (chi(2) = 8.3, p = 0.004), and for REIs from 22.1 to 9.6% (chi(2) = 4.7, p < 0.01), while 14.4% of cases coming from non-REIs had quintuplets versus 9.6% from REIs (p = NS). CONCLUSIONS: Cases of MFPR from ARTs have risen, while percentage of cases with quintuplets have fallen in half. We found no difference in quintuplets between REIs and non-REIs overall, but REI quintuplets fell significantly, and NREI has not.

Adult↗
PubMed1983

Foreign medical graduates and board certification: myths and realities.

The participation of foreign medical graduates (FMGs) in American medicine is a longstanding phenomenon, yet the documentation of their role has been mainly impressionistic and anecdotal, particularly in psychiatry. Using the results of a survey on Board certification, the authors compared FMGs with U.S. medical graduates (USMGs) on several variables: demographic characteristics, attitudes toward certification, performance, and personal experience with the examination process. They found that FMGs are more similar than dissimilar to USMGs in attitudes, values, and opinions about certification. The authors conclude that the differences are not sufficiently remarkable to warrant some of the prevalent misconceptions about FMGs.

Attitude of Health Personnel↗
PubMed1988

Accreditation, certification, and the quality of care in state hospitals.

Data on 216 state psychiatric hospitals were analyzed to determine whether accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or certification by the Health Care Financing Administration (HCFA) were related to seven hospital characteristics generally accepted as reflecting quality of care. The characteristics were average cost per patient, per diem bed cost, total staff hours per patient, clinical staff hours per patient, percent of staff hours provided by medical staff, bed turnover, and percent of beds occupied. While a majority of the hospitals had either JCAHO accreditation, HCFA certification, or both, analysis revealed a weak relationship between accreditation or certification status and the indicators of quality of care. Accredited or certified hospitals were, however, more likely to have higher values on specific indicators than hospitals without accreditation.

Accreditation↗
PubMed1982

Pharmacists as drug prescribers: validation of certification exams and evaluation instruments.

The purpose of this article is to discuss the validity and reliability of certification tests and evaluation instruments for pharmacists as drug prescribers. Under California Law AB 717, the University of Southern California is operating one of two pilot programs to train and evaluate prescribing pharmacists. Various instruments have been created and administered, and validity results are presented. The presentation is organized into two areas dealing with the development of the examination instrument and then the assessment of the prescriptions written by pharmacists. The reliability of the three sections of the certification examination as measured by internal consistency was as follows: clinical therapeutics (KR 20=.84), physical assessment (KR 20=.88), and law (KR 20=.84). The exam was given to a group of physicians (N=14) to establish a cutting score. Thirty pharmacists who took the exam did slightly better than the physicians on clinical therapeutics, but the physicians performed better than pharmacists on physical assessment (p less than .01). A prescription evaluation form was constructed to evaluate the performance of the pharmacists as prescribers. The reliability of the form as measured by coefficient alpha was .84. Concurrent validity was explored by assessing the relationship between performance on the certification exam and judges' appropriateness scored on prescriptions for ambulatory hypertensive patients. These results indicate that the pharmacists, who passed the exam, can prescribe as appropriately as physicians.

California↗
PubMed1987

Three components in the establishment of a certification testing program.

Certification in the health professions is growing both in number of programs and in quality. Three important components in the development of any sound and defensible certification testing program are presented and discussed. The three are interrelated and sequential, and each has a growing technology. Guidelines are presented and discussed that should assist those involved in establishing new certification program testing that is more adequately prepared for the difficult challenges typically faced.

Certification↗
PubMed1986

The accuracy of local death certificates in cancer of the lung and stomach.

The study analysed the accuracy of local death certificates (LDC) for patients with lung cancer (424 males, 36 females) and stomach cancer (99 males, 62 females) who died between 1979 and 1984. All the diagnoses were confirmed histologically. For a subgroup of lung cancer (males), we also evaluated the national death certificate (NDC) and the correspondence of LDC vs. NDC. The reliability of LDC was quite poor. This paper examines the different reasons for the underevaluation of cancer in LDC and the variables which modify the accuracy of cause of death on the death certificate.

Death Certificates↗
PubMed1990

Rationale and development of an institutional pediatric chemotherapy certification course.

In a large pediatric teaching hospital located in the southwestern part of the United States, few nurses had participated in a formal program that taught the knowledge and skills required for the nurse to care for the patient receiving chemotherapy. In order to enhance the necessary clinical competency of the nursing staff, a Chemotherapy Certification Course was developed for this institution. In reviewing the literature there was minimal information on how to develop such a program. The purpose of this article is to describe the development of this course with the intent that it can serve as a guide in facilitating and implementing such a course in other institutions. As more hospitals adopt institutional certification as a form of continuing education in cancer nursing, perhaps the gap between knowledge and practice will decrease. The institutional certification course will be a significant step toward improving the level of practice of nurses caring for patients receiving chemotherapy. The goal of promoting professional competence will benefit the nurse, the institution, and patients and their families.

Antineoplastic Agents↗
PubMed1997

[An appraisal on the judgements of the Kumamoto Minamata Disease Certification Commission].

Medical records of 3,870 applicants living near the Shiranui sea coast who had been examined from August 1975 to April 1981 by the Committee on Certification of Minamata Disease were analyzed from the statistical point of view. The author analyzed the pattern of signs and reevaluated the applicants' records. Three hundred forty applicants (8.8%) were certified to have Minamata disease by the Committee on Certification of Minamata Disease. By application of the present criteria presented by the Japanese Environmental Agency in 1977 to the records, 947 inhabitants (27.9%) were judged likely to have Minamata disease. The author concluded that the certification of the patients of Minamata disease by the Committee was inconsistent with the results of applying the present criteria to the data and that the number of patients certified by the Committee to have Minamata disease was too low.

Adult↗
PubMed1999

[An appraisal of the judgements of the Kumamoto Minamata Disease Certification Commission from May 1981 to July 1992 for applicants from December 1975 to April 1981].

The differences of the diagnosis from December 1975 to April 1981 and from May 1981 to July 1992 of the Committee on Certification of Minamata Disease based on the medical records of 3,870 applicants who had been examined from December 1975 to April 1981 by the Committee were compared and analyzed from a statistical point of view. Three hundred forty inhabitants from December 1975 to April 1981 and two hundred ninety eight inhabitants from May 1981 to July 1992, in total six hundred and thirty eight inhabitants, were certified to have Minamata disease by the Committee on Certification of Minamata Disease. One hundred and eleven inhabitants who were judged likely to have Minamata disease by application of the present criteria presented by the Japanese Environmental Agency in 1977 were certified by the committee from May 1981 to July 1992, and one hundred and thirty three inhabitants who were judged not likely to have Minamata disease by application of the present criteria were certified from May 1981 to July 1992. The author concluded that certification of the patients of Minamata disease by the Committee was inconsistent with the results of applying the present criteria to the data and that the prevalence of the symptoms of the inhabitants certified from December 1975 to April 1981 was inconsistent with that from May 1981 to July 1992.

Certification↗
PubMed2005

The value of a gerontology certificate: a survey of Frank J Manning alumni, 1980-2001.

The Frank J. Manning Certificate Program in Gerontology at the University of Massachusetts Boston was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. The program was designed to implement concepts associated with productive aging theory and traditionally has targeted learners age 60 and older. Alumni representing classes from 1980 to 2001 were surveyed by phone to learn if the original program objectives still have relevance today and to document how alumni have utilized knowledge and skills attained in the program. Almost 80% (364) of surviving alumni completed interviews. Specifically, alumni were asked about their volunteer experiences, employment, and advocacy efforts within the aging network of programs and services, as well as the impact of their training on their own aging. About 3/4 of the alumni had volunteered with elders since completing the program, while 1/4 worked in the aging network. Additional outcomes support the notion of life-long learning with many alumni continuing their education beyond the certificate program. In addition, many alumni reported utilizing knowledge and skills in caregiving for family members and friends. This study will help document the value of certificate-level training in Gerontology for its students and for the communities they serve.

Adult↗
PubMed2002

Underascertainment of child maltreatment fatalities by death certificates, 1990-1998.

OBJECTIVE: Child fatality review teams have emerged across the United States in the past decade to address the concern that systems of child protection, law enforcement, criminal justice, and medicine do not adequately assess the circumstances surrounding child fatality as a result of maltreatment. METHODS: We compared data collected by a multidisciplinary child fatality review team with vital records for all children who were aged birth to 16 years and died in Colorado between January 1, 1990, and December 1, 1998. Odds ratios and 95% confidence intervals for ascertainment by the death certificate were estimated using logistic regression. RESULTS: Only half of the children who died as a result of maltreatment had death certificates that were coded consistently with maltreatment. Black race and female gender were associated with higher ascertainment, whereas death in a rural county was associated with lower ascertainment. Deaths resulting from violent causes (eg, shaking, blunt force trauma, striking) were more likely to be ascertained than those that involved acts of omission (eg, neglect and abandonment, drowning, fire). The most common perpetrators of maltreatment were parents. However, maltreatment by an unrelated perpetrator was 8.71 times (95% confidence interval: 3.52-21.55) more likely to be ascertained than maltreatment by a parent. CONCLUSIONS: The degree of underascertainment found in this study is of concern because most national estimates of child maltreatment fatality in the United States are derived from coding on death certificates. In addition, the patterns recognized in this study raise concern about systematic underascertainment that may affect children of specific sociodemographic groups.

Adolescent↗
PubMed1989

[Analysis of the completion of death certificates in a locality of the State of Rio Grande do Sul (Brazil), 1987].

It was analyzed the quality of death certificate information for deaths registered in Viamão county (Rio Grande do Sul, Brazil) during 1987, considering unfilled blanks, and unknown and incorrect responses. Small omissions were found in data identifying the person who had died; larger omissions in data concerning social and obstetric history, medical assistance, and violent deaths. To improve the quality of death certificate information it was suggested that physicians be continually reminded of the importance of giving the correct information on death certificates to allow for their later adequate administrative and research use.

Adult↗
PubMed1990

[The quality of the filling-in of death certificates of children below one year of age in the metropolitan area of Rio de Janeiro].

Within the scope of an investigation into infant mortality determinants in the metropolitan region of Rio de Janeiro during one-year period, the original death certificates of a sample of children were studied and compared with information provided on them by hospital case-histories and records. This was done with a view to assessing the quality of the filling in of certificates for the purpose of calling the attention of health officers to their use as documents furnishing data for the preparation and evaluation of health programmes and note simply as a legal requirement for burying. Only 52.3% of the basic causes given on the certificates were maintained after the examination of the case histories. Necropsy was carried out on only 42.8% of those neonatal deaths and 21.5% of post-neonatal deaths which took place outside the hospital. Other items that were evaluated included mother's age and education, time interval and complementary examination, birth weight and necropsy, all of which presented a degree of accuracy in their filling-in far below that required, thus evidencing the limitations of the official death statistics based on this information.

Brazil↗
PubMed1995

[Reliability of the certification of the basic causes of neonatal deaths: implications for the study of preventable mortality].

The main causes of neonatal mortality, the reliability of the underlying cause of death registered in the death certificate, and the impact of problems of reliability on the analysis of preventable death were studied. The information on death certificates from a 15% sample of neonatal deaths between May 1986 and April 1987 in the Greater Metropolitan Region of Rio de Janeiro was compared to the information in the hospital records of the 452 deceased infants. A "modified underlying cause" considered most correct according to disease classification rules was identified from the records. The great majority of deaths (87%) were due to perinatal causes. Agreement between the originally declared and modified underlying causes of death was poor: 38% for 3 digits of the International Classification of Diseases Codes (CID-9) and 33% for 4 digits. The modified underlying causes are more weighted towards maternal conditions and complications, which increased by a factor of 12.8, and towards complications of the placenta, umbilical cord, labour and delivery, which rose by a factor of 6.2 in relation to the original causes. The utilization of the "modified" underlying cause elevated considerably (58%) the proportion of deaths considered reducible by the classification of neonatal death proposed by the SEADE Foundation. Seventy-five percent (75%) of deaths were considered reducible or partially reducible. One hundred and seven (24%) of the deaths of them being in infants of normal birthweight, of which 60% considered preventable. Four (4) deaths from congenital syphilis, 3 from perinatal hemolytic diseases, and 21 unattended home deaths of infants were also identified. In summary, important problems were identified in the reliability of the declaration of the underlying causes of neonatal death, whose correction tends to elevate the proportion considered reducible or preventable. The potential for the use of death certificate data for the monitoring of quality is evident, nonetheless improvements are needed in the quality of these data.

Birth Weight↗
PubMed1999

[Female mortality in the Municipality of São Paulo: quality of medical death certificates].

OBJECTIVE: To evaluate the quality of the medical certification of deaths of 10-49 year-old women, resident in the Southern region of the city of S. Paulo METHODS: The Puffer methodology was utilized to investigate the causes of death of all 10-49 year-old women, resident in the region, and deceased in the year 1989 (664 deaths in the total). The main causes of death in the original death certificates and the "new" causes of death arisen from the research were compared. The sensitivity and the kappa index were calculated. RESULTS: In some chapters of the International Classification of Diseases and Causes of Death, 9th Revision (CID-9), a high sensitivity was found: "Diseases of the Circulatory System" (91.9%), "Neoplasms" (89.7%) and "External Causes" (84.1 %). In some others, a very low sensitivity was found. The chapter "Mental Illnesses", with a 34.3 percent sensitivity only, must be mentioned. From 11 deaths originally classified in this chapter, 32 cases were found. In most of these "new" cases, the main cause of death was found to be alcoholism. The chapter "Complications of Pregnancy, Delivery and the Puerperium", also showed a low sensitivity (44.9%). The kappa index was found to be 0.63, which indicated a regular concordance. DISCUSSION: The quality of the medical certification of causes of death is still unsatisfactory in the studied area. This poor quality may affect negatively the interventions in the area of women's health, masking the severity of important problems

Adolescent↗