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PubMed1990

Certificates of added qualifications in orthopedic surgery.

The debate on the issue of certificates of added qualifications (CAQs) will continue since the arguments are strong in each direction. Unlike orthopedic surgery, the vast majority of medical specialties link certification with accreditation (CAQs with fellowship training). Differentiation in specialties and subspecialties is inevitable because of the advances in science and technology and the influence of social and economic factors. Accreditation and certification both have an important role in the definition of new and established subspecialties and the goal to genuinely improve patient care. Constant and repetitive reassessment of these issues is critical.

Accreditation↗
PubMed1989

Death certification. Purposes, procedures, and pitfalls.

Completing a death certificate properly and promptly is an important duty for physicians, who must understand how the death certificate is used and be able to recognize and employ the concepts of immediate, underlying, and contributing causes of death. Accurate, concise terminology should be used to give in a logical order a sequence of events leading to death. Avoiding mistakes in death certification helps reduce potential medicolegal problems and provides more meaningful statistics for health care personnel.

Death Certificates↗
PubMed1989

The effect of death certification practice on recorded national asthma mortality rates.

There is a wide variation in the mortality from asthma between the countries of the European Community. Studies using a standard case history of a typical asthmatic to assess death certification practice have suggested that this variation is not related to the ways that doctors fill out death certificates. Reanalysis of the data from one of these studies suggests, however, that the way doctors certify more ambivalent case histories may explain much more of the variation. Repetition of this study in a small group of French and English doctors with a special interest in asthma came to the same conclusion, suggesting that these differences are due to both a genuine difference in nosology between the countries as well as to the quality of death certification.

Adolescent↗
PubMed1989

Correlates of certification in family medicine in the billing patterns of Ontario general practitioners.

There is conflicting evidence as to whether physicians who are certified in family medicine practise differently from their noncertified colleagues and what those differences are. We examined the extent to which certification in family medicine is associated with differences in the practice patterns of primary care physicians as reflected in their billing patterns. Billing data for 1986 were obtained from the Ontario Health Insurance Plan for 269 certified physicians and 375 noncertified physicians who had graduated from Ontario medical schools between 1972 and 1983 and who practised as general practitioners or family physicians in Ontario. As a group, certificants provided fewer services per patient and billed less per patient seen per month. They were more likely than noncertificants to include counselling, psychotherapy, prenatal and obstetric care, nonemergency hospital visits, surgical services and visits to chronic care facilities in their service mix and to bill in more service categories. Certificants billed more for prenatal and obstetric care, intermediate assessments, chronic care and nonemergency hospital visits and less for psychotherapy and after-hours services than noncertificants. Many of the differences detected suggest a practice style consistent with the objectives for training and certification in family medicine. However, whether the differences observed in our study and in previous studies are related more to self-selection of physicians for certification or to the types of educational experiences cannot be directly assessed.

Canada↗
PubMedDate not supplied

Review of death certificates to assess completeness of AIDS case reporting.

To assess the level of reporting of acquired immunodeficiency syndrome (AIDS) cases, the authors reviewed death certificates for periods of 3 months during July through December 1985 in each of four cities: Washington, DC, New York City, Boston, and Chicago. Since reporting began in 1981, these cities have reported 38 percent of all AIDS cases in the United States. Death certificates were selected and matched to the AIDS surveillance registries in each city, and medical records of those not on the AIDS registry were reviewed to determine if AIDS had been diagnosed. The estimated completeness of AIDS case reporting to AIDS surveillance systems was high in all four cities (ranging from 83 percent to 100 percent). The unreported cases were similar to reported cases with respect to sex, race, risk factor, and specific diagnosis. Of the causes of death examined, AIDS, Pneumocystis carinii pneumonia, and Kaposi's sarcoma were predictive of AIDS as defined by the CDC case definition. However, 77 of 588 deaths (13 percent) attributed to 1 of these 3 causes occurred in cases that were presumptively AIDS but did not meet the diagnostic requirements to be classified as AIDS for reporting purposes. A review of death certificates provides an easy and rapid means of evaluating surveillance efforts and can be a useful adjunct to other methods of surveillance for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Development of milk powder reference materials certified for aflatoxin M1 content (Part II): Certification of milk powder RM 283.

The development of a full cream milk powder reference material, certified for its aflatoxin M1 content (target concentration: 0.1 microgram/kg), is described. The material (RM 283) was prepared and certified within the Reference Material Programme of the Community Bureau of Reference, along with other members of a series of milk powder reference materials. Homogeneity, evaluated by determining the aflatoxin M1 content of 30 units, was found to be acceptable (coefficient of variation of analysis results: 9.1%); stability has been demonstrated in a long-term study. The certification exercise involved 7 laboratories. Calibration, control of recoveries, blank values, and independence of the replicate measurements were emphasized. All sets of results of the certification exercise were accepted for statistical evaluation. A certified value for the aflatoxin M1 content: 0.09(+0.04)(-0.02) micrograms/kg was derived. The certification of RM 283 completes the series of 4 milk powder reference materials having certified aflatoxin M1 contents.

Aflatoxin M1↗
PubMed1988

Validation of coronary heart disease death certificate diagnoses.

Data from a coronary heart disease register in Auckland have been used to validate routine death certificate data produced by the National Health Statistics Centre. The register used current World Health Organisation criteria for definite or possible coronary heart disease and identified all suspected events in people aged less than 65 years for the years 1983 and 1984. During this period 768 coronary heart disease cases were included in the register and in the same population 772 death certificates were coded 410-414 (coronary heart disease), according to the ninth revision of the International Classification of Diseases, by the National Health Statistics Centre. Ninety one percent of deaths meeting the register's criteria for definite or possible coronary heart disease were coded 410-414 in the official data. Conversely of all death certificates coded 410-414, 93% were registered as due to coronary heart disease. The validity of subcategories was considerably lower; only 49% of deaths coded 410 (acute myocardial infarction) were categorised as definite myocardial infarction by the register. These findings suggest that the broad official statistics for the category coronary heart disease mortality (codes 410-414) are accurate to within approximately 10% in New Zealand; the validity of the subcategory myocardial infarction (code 410) is considerably lower.

Aged↗
PubMedDate not supplied

A study of underreporting of Down's syndrome on birth certificates in an Ohio County, 1970-78.

In a previous statewide assessment in Ohio of the percentage reporting of Down's syndrome (DS) on birth certificates, it was found that 33.9 percent of the cases chromosomally analyzed were so recorded. The objectives of this study were to gain a greater understanding of the basis of this low reporting percentage by concentrating on Hamilton County births only, to compare these percentages among hospitals in the county, and to determine the commonality of their causes. Since it was anticipated that both a thorough search of hospital records and access to chromosome analysis records would provide essentially complete ascertainment of DS births in the county during 1970-78, the data were also used to test the validity of chromosome analysis as a sampling procedure in estimating the total number of DS births by means of the Lincoln-Peterson capturerecapture method.The percentage of reporting of DS on the birth certificates by hospital ranged from 0.0 to 57.1, with a mean of 26.0 for the 6 hospitals within the county. Although variation among some hospitals was statistically significant, three of the six hospitals had zero percent reporting. The explanation for these low reporting percentages was fundamentally similar for all hospitals-a communications flow problem, produced by poor timing and use of the wrong sources of available information. The only data typically available to the birth certificate clerk were derived from the labor and delivery sheet, the form with the worst reporting percentage of DS of any in the medical record. On the other hand, by the time of discharge, 92.5 percent of the cases had either been definitely diagnosed as DS and were recorded on the face sheet or were entered as "chromosome analysis pending" in the file.The use of the chromosome analysis data gave an estimate of total DS births (N = 201 +/- 34) statistically consistent with the total observed, thereby providing support for this estimation procedure. Annual incidence rates for DS were also calculated for 1970-78, with a total incidence rate for the 9-year period of 1.14 per 1,000 live births.

Birth Certificates↗
PubMed1984

Clinical competence certification: a critical appraisal.

The American Board of Internal Medicine has requested that residency program directors certify the clinical competence of their candidates. The clinical evaluation exercise (CEX) is one component of the overall certification process. During 1980-1982, 120 residents at the University of Michigan Hospitals participated in a CEX. The results show recurrent inadequacies among the residents in eliciting the social and family histories and performing the mental status and neurologic examinations. The ability to elicit a complete medical history correlated (p less than .01) with communication skills. In three of four specific organ examinations, the ability to perform a technically correct and complete physical examination correlated with the accuracy of the residents' findings (p less than .05). Separate evaluations by senior faculty members generally did not correlate with the residents' performance on the CEX. Analysis of the program described here showed that it requires considerable faculty time, requires training of evaluators to develop interrater reliability, and raises questions as to the validity of the CEX. As national certification boards integrate a formal clinical component into the certification process, such problems need to be addressed and rectified.

Certification↗
PubMed1978

Federal preclusion of state certificate-of-need exemptions for research and education expenditures.

The National Health Planning and Resources Development Act of 1974 requires each state to enact a certificate-of-need program in compliance with federal standards in order to remain eligible for continued receipt of federal funds for health resource development after 1980. This Note contends that the Act and related HEW regulations preclude states from exempting health care facilities' research expenditures and education expenditures from the scope of the states' certificate-of-need programs. The Note recommends that, as an alternative to such state exemptions, each state develop a streamlined certificate-of-need procedure that fulfills federal requirements while efficiently meeting the special needs of research and education projects.

Certificate of Need↗
PubMed1983

[Documentation of clinical death in preliminary death certificates].

The emergency physician acting within the framework of organised first-aid service, is not obliged to perform a post-mortem examination or to hold a coroner's inquest and to issue a death certificate. It is easy to understand why the relevant authorities must insist on the immediate submission of a death certificate. Such a certificate can be issued only if unequivocal signs of death definitely confirm that the decrease is an indisputable fact. To cope with this situation, a printed form has been designed which is used to document the occurrence of clinical death.

Brain Death↗
PubMed1982

An adaptive private pilot certification exam.

Adapting aviation certification exams to each examinee's ability may reduce administration costs and increase the accuracy of certification decisions. Several means of adapting exams are based upon item response theory. Item response theory allows one to empirically describe a test item very precisely before it is administered. Use of each item's description and an examinee's response enables one to estimate the examinee's ability and select the next item to best refine this estimate. An exploratory application of this technique to one step of the certification of private pilots has raised several important questions.

Aerospace Medicine↗
PubMed1995

Educational inequality in adult mortality: an assessment with death certificate data from Michigan.

Education was added to the U.S. Standard Certificate of Death in 1989. The current study uses Michigan's 1989-1991 death certificates, together with the 1990 Census, to evaluate the quality of data on education from death certificates and to examine educational differences in mortality rates. With log-rates modeling, we systematically analyze the variability in educational differences in mortality by race and sex across the adult life cycle. The relative differences in mortality rates between educational levels decline with age at the same pace for all sex and race categories. Women gain a slightly greater reduction in mortality than men by reaching the secondary-education level, but a modestly smaller reduction by advancing beyond it. Blacks show a reduction in predicted mortality rates comparable to whites' by moving from the secondary to the postsecondary level of education but experience less reduction than whites by moving from the primary to the secondary level. Thus, the secular decline in mortality rates that generally accompanies historical improvements in education might actually be associated with an increase in the relative differences between blacks' and whites' mortality. We discuss limitations of the data and directions for future research.

Adult↗
PubMed1994

Comparison of autopsy, clinical and death certificate diagnosis with particular reference to lung cancer. A review of the published data.

Some clinicians and some epidemiologists appear to be under the illusion that techniques available for the diagnosis of internal diseases such as lung cancer have improved so much that autopsies are not necessary on the bodies of most people who die. Partly for this reason, partly for economic reasons and partly because clinicians fear litigation if autopsy shows that they treated patients for the wrong disease, autopsy rates have been falling in most developed countries. The object of the present review was to ascertain how much reliance can reasonably be put on clinical diagnoses made and death certificates completed in the absence of autopsy data. In the case of lung cancer, high rates of false positive and false negative diagnoses are universally prevalent, with biases influencing these rates, so that smokers are more likely to be appropriately investigated for lung cancer, and false negatives are commoner in non-smokers. All investigators who have compared clinical-based and autopsy-based death certificates have concluded that higher autopsy rates are necessary and the results of one study suggest that a high autopsy rate in a hospital leads to improvements in the accuracy of clinical diagnoses. The extent to which diagnoses on death certificates that are dependent solely on clinical data are seriously inaccurate for internal diseases such as lung cancer should engender caution in all who use mortality data to guide public health policies and to identify and quantify environmental risks to healths.

Autopsy↗
PubMedDate not supplied

Certification. Hospital versus national standards.

"Certification" and "credential" are frequently used terms in nursing. How these terms are used and what they mean to nursing practice is the focus of this article. Definitions, history, and application of these concepts are explored. Recommendations are made that a hospital not assume responsibility for the granting of certification or credentials to nursing staff members. Nurses and nursing administrators are urged to support nationally recognized certification programs.

Certification↗
PubMed1996

[Evaluation of seminars on international criteria for medical certification of cause of death].

OBJECTIVE: To evaluate the efficacy of seminars on the international criteria for medical certification of the causes of death. DESIGN: A pre-test/post-test evaluation, with no reference group. SETTING: A primary care health district in Andalusia, Spain. PARTICIPANTS: The 44 doctors in this district. INTERVENTION: Training seminars and evaluation of the filling-in of the Statistical Decease Forms (SDF) during the six months after the seminar. MEASUREMENTS AND MAIN RESULTS: Four quality indicators were used to assess doctors' filling-in of the SDFs, which contain the international criteria for certification of the causes of death, six months before and six months after the holding of the seminars. The results were then compared. In 11.4% the legibility of the hand-writing improved; and in 16.5% there was less confusion between the mechanism of death and the cause. The clinical sequence of causes reported and the indicator of more than one diagnosis per line did not vary significantly. CONCLUSIONS: Although the seminars on international norms of certification are necessary in order to improve the standard of mortality statistics, a change in the ways of certifying causes of death requires ongoing commitment to the training of certifying doctors.

Cause of Death↗
PubMed1996

Certification of competence: a national standard for dentistry in Canada.

After consulting a large community of interested parties, the National Dental Examining Board of Canada (NDEB) and the provincial licensing authorities recently made significant changes to the certification process for dentists in Canada. This paper provides a chronology of the evolution of national certification and a summary of the present certification processes for graduates of both accredited and non-accredited programs.

Canada↗
PubMed1997

Nosological Inaccuracies in death certification in Northern Ireland. A comparative study between hospital doctors and general practitioners.

We aimed to audit nosological inaccuracies in death certification in Northern Ireland and to compare performance of hospital doctors and general practitioners. Nosology is the branch of medicine which treats of the classification of disease. 1138 deaths were registered in Northern Ireland in a 4-week period commencing 3/10/94. 195 of these were either registered by HM Coroners (HMC) or required further investigation by their staff; these cases were excluded from the study. The remaining 943 were analysed for wording and formulation inaccuracies according to the revised notes (1974), Northern Ireland Medical Certificate of Cause of Death. These are issued in book form by the Registrar of Births and Deaths. The commonest inaccuracies in death certification occur in the areas of poor terminology, sequence errors and unqualified mode. One or more inaccuracies were found in 317 (33.6%) of cases. In 13 of these (4%) cases, the inaccuracies were serious enough to warrant referral by the Registrar of Deaths to HM Coroner. The numbers of general practitioners and hospital doctors were recorded, with general practitioners being responsible for 122 (38%) and hospital doctors being responsible for 195 (62%) of inaccuracies.

Cause of Death↗