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PubMed2002

Trend of cervical cancer mortality in Belgium (1954-1994): tentative solution for the certification problem of unspecified uterine cancer.

We investigated the evolution of mortality from cervical cancer in Belgium between 1954 and 1994 in terms of absolute number of deaths, and standardised and age-specific mortality rates. Changes over generations were summarised using the standardised cohort mortality ratio. Trend studies of cervical cancer mortality were hampered by certification problems. The number of deaths due to cancer of the uterine cervix is not known exactly since a substantial proportion of death causes are coded as cancer of the uterus without specifying the anatomic site: cervix or corpus uteri. This inaccuracy in codification has been corrected using distribution tables derived from countries where this certification problem is minimal. Trends in mortality from certified and corrected cervical cancers were compared. The corrected age-standardised mortality rate decreased continuously over the last 4 decades, from over 14 to 5 per 100,000 woman-years (slope -0.26/100,000 woman-years, 95% CI -0.28 to -0.24). Its slope is 3.1 times (95% CI 2.9-3.5) more important than for the rate of mortality from certified cervical cancer. In addition to the almost linear decrease, substantial nonlinear cohort influences were observed in certified and corrected mortality rates. The tendency of increasing mortality in women born after 1935 required particular attention. Nevertheless, the slope of the corrected recent cohort effect remained limited in Belgium, probably as a consequence of screening.

Adult↗
PubMed2002

The influence of motivations for seeking ISO 14001 certification: an empirical study of ISO 14001 certified facilities in Hong Kong.

This study proposes a model linking firm motivations for seeking ISO 14001 certification to the effectiveness of three major components of an environmental management system (EMS)--environmental policy, the assessment of environmental aspect and impacts, and management review. The relationship of these EMS components with a self-reported measure of environmental performance is also examined. From a sample of 29 ISO 14001 certified facilities in Hong Kong (of 71 total certifications at the time the data was collected), it was found that motivations to enhance firm reputation are positively related to perceptions of the effectiveness of the policy statement. Motivations for reputation enhancement and cost reduction were positively related to perceptions of EMS effectiveness in assessing environmental aspects and impacts. The effectiveness of the methodology for identifying environmental aspects and impacts was also found to be positively related to improved environmental performance.

Certification↗
PubMed1996

Accuracy of death certification of pleural mesothelioma in Italy.

In order to provide estimates of the accuracy of death certification of malignant pleural mesothelioma in Italy, the causes of death of a series of ascertained cases were investigated. The study included 523 cases of pleural mesothelioma diagnosed in 1984-1988 by 88 hospital departments and clinics. Vital status at 7 May 1990 was ascertained for 92.7% of subjects. The overall concordance between pathological diagnosis and death certification was about 75%.

Adult↗
PubMedDate not supplied

Perceptions of the certification standards of the American Board of Internal Medicine.

Perceptions of the certification standards of the American Board of Internal Medicine (ABIM) and the qualities of care provided by certified and non-certified practicing internists are reported from surveys of ABIM Board members, internal medicine program directors, and samples of third-year residents, practicing internists, nurses, and hospital administrators. ABIM pass rates were estimated accurately and viewed as appropriate. Physicians perceived the deficiencies of non-certifiable residents to be in clinical judgment and factual knowledge; non-physicians indicated deficiencies in humanistic qualities. The groups estimated that approximately 70% of all practicing internists and 37% of the non-certified internists they know provide excellent care while 15% of the certified internists give inappropriate care. Perceived deficiencies of internists giving low-quality care were nearly identical to those of non-certifiable residents. The results support ABIM's initial certification process and suggest that a written examination with well chosen standards would be useful for experienced internists.

Attitude of Health Personnel↗
PubMed1994

Certification in internal medicine: 1989-1992.

OBJECTIVE: To determine whether changes in the demographic/educational mix of those entering internal medicine from 1986 to 1989 were associated with differences among them at the time of certification. PARTICIPANTS: Included in the study were all candidates for the 1989 to 1992 American Board of Internal Medicine certifying examinations in internal medicine. MEASUREMENTS: Demographic information and medical school, residency training, and examination experience were available for each candidate. Data defining quality, size, and number of subspecialties were available for internal medicine training programs. RESULTS: From 1990 to 1992, the total number of men and women candidates increased as did the numbers of foreign-citizen non-U.S. medical school graduates and osteopathic medical school graduates; the number of U.S. medical school graduates remained nearly constant and the number of U.S.-citizen graduates of non-U.S. medical schools declined. The pass rates for all groups of first-time examination takers decreased, while the ratings of program directors remained relatively constant. Program quality, size, and number of subspecialty programs had modest positive relationships with examination performance. CONCLUSIONS: Changes in the characteristics of those entering internal medicine from 1986 to 1989 were associated with declines in performance at the time of certification. These declines occurred in all content areas of the test and were apparent regardless of program quality. These data identify some of the challenges internal medicine faces in the years ahead.

Certification↗
PubMed2004

[Assessment and certification of hospital care in Germany].

The increasing call for evaluating and certifying the quality of hospital care is to be seen in connection with the need for more transparency in the German health care system. Hospitals can have themselves evaluated or compared on four levels of quality: the level of medical, nursing, and organizational core services, the level of the quality system of the hospital, the level of the internal quality management, and the level of business excellence. The external comparisons of hospitals legally established in Germany deal with the evaluation of core services of hospitals. All the other levels are covered by holistic evaluation and certification procedures following the models of the EFQM and the ISO, the genuine medical certification systems (KTQ and JCI), or peer reviewing. Each of them has different objectives and all are applied in German acute care hospitals. However, their methods are not yet fully developed and certainly will have to be further optimized in view of the forthcoming changes in the German health care system.

Certification↗
PubMed2006

Psychiatric disorders certified on death certificates in an English population.

BACKGROUND: Psychiatric disorders are sometimes certified on death certificates, but seldom selected as the underlying cause of death. The majority of deaths with a certified psychiatric cause are usually omitted from official mortality statistics, which are typically based on the underlying cause alone. AIM: To report on death rates for psychiatric disorders, as certified on death certificates, including all mentioned causes as well as the underlying cause of death. METHOD: Analysis of database including all certified causes of death in 1979-1999, in three time periods defined by coding rule changes. RESULTS: Statistics on the underlying cause of death grossly under-estimated certified psychiatric disorders. For example, in the first period of our study they missed 88% of deaths in which schizophrenia was a certified cause, 98% of affective psychosis, and 96% of depression. Over time, considering all certified causes, age-standardised death rates for schizophrenia declined, those for affective psychosis showed no change, and those for depression and dementia increased. CONCLUSION: The decline in mortality rates for schizophrenia, and the increase for depression and dementia, may reflect real changes over time in disease prevalence at death, although other explanations are possible and are discussed.

Age Distribution↗
PubMed1976

The epidemiology of amyotrophic lateral sclerosis in Finland. A study based on the death certificates of 421 patients.

The mortality and prevalence of ALS in the various countries of Finland was studied. The work was based on death certificates derived from a 10-year period from 1963 to 1972, and altogether 421 cases were found. The mean duration of the disease was 2.7 years, and the mean age at death was 61.2 years. The average annual mortality rate was 0.91 per 100,000. The male to female ratio was 0.87 to 1, males outnumbered females only in age groups under 65. Some clustering of the cases seems to be taking place in the south-eastern part of the country. The rural to urban distribution of the patients' places of birth and domiciles did not differ markedly from that of thw whole population. After ALS itself pneumonia was the most common direct cause of death. Of other significant conditions coded in the death certificates schizophrenia and cancer did not occur more often than could be expected by chance. No evidence of inheritance of the disease was found.

Adult↗
PubMedDate not supplied

Criterion-referenced competency assessment and the national certification examination in nurse-midwifery.

The paper presents an overview of the recent change from norm-referenced to criterion-referenced score interpretation for the ACNM certification examination for entry level practice in nurse-midwifery. The advantages of criterion-referenced interpretation are presented. A successful adaptation of the Nedelsky method for the calculation of the minimum pass index, based on the identification of acceptable error, is discussed. Implications for the nurse-midwifery profession and for the national certification examination in nurse-midwifery are considered.

Certification↗
PubMedDate not supplied

Home birth in the United States, 1989-1992. A longitudinal descriptive report of national birth certificate data.

This study was conducted to profile home birth in the United States from 1989 to 1992 using two birth certificate data sources from the Natality Branch of the National Center for Health Statistics (NCHS). Analysis included published and unpublished descriptive tables about all U.S. home births from 1989 to 1992, and a subset of the 82,210 U.S. home births from 1989 to 1991 that were drawn from NCHS national birth certificate data tapes. Results indicated that less than one-third of reported home births were attended by nurse-midwives or physicians. Distinct regional patterns in the frequency of home births were observed, with higher concentrations in the southwestern and western states. When compared with the average childbearing woman in the United States, mothers who gave birth at home were more likely to be older, have fewer years of education, be married, and be white; they were also more likely to be of higher parity and to receive less prenatal care. Home birth mothers were less likely than average to smoke or drink alcohol prenatally, to have a prenatal medical risk condition or an obstetric complication, or to receive certain prenatal tests. The outcomes of newborns born at home compared favorably to the national average during the same period. Several findings varied considerably by race or ethnicity of the mother.

Birth Certificates↗
PubMed1983

Economic advantages of board certification.

While several recent studies have examined selected characteristics of board certified physicians, none have directly and completely examined the economic advantages it conveys. Using data from a nationwide survey of physicians, estimates of the empirical relationship between income and board certification are shown. Being board eligible increases annual practice income by about $8000 and being board certified increases income by almost $13,000, holding other factors constant. The economic advantages of board certification thus appear to be substantial.

Adult↗
PubMed1994

Changes in causes of death in diabetic patients based on death certificates during a 30-year period in Osaka District, Japan, with special reference to cancer mortality.

As reported previously, we have conducted studies on causes of death among diabetic patients during the 25-year period, from 1960 to 1984, in Osaka District, Japan. We have now added the most recent 5-year data, for 1985-1989, and analyzed changes in causes of death during the entire 30-year period as a whole. The subjects studied were those for whom a total of 32,222 death certificates had been filed in Osaka Prefecture, from 1960 to 1989, with diabetes mentioned either as the underlying cause or as a contributory condition. The relative number of death certificates mentioning diabetes as the underlying cause, which had been decreasing during the 25-year study period, showed a further decrease, reaching the lowest value, 33.4%, for the period 1985-1989. The mean age at death exceeded 70 years for all causes of death, showing a continuous increasing trend. An increase in disease of the heart and a decrease in cerebrovascular disease were observed, making the difference between the two causes greater since 1980-1984. Malignant neoplasms, ischemic heart disease, and pneumonia and bronchitis also showed steady increases. The O/E ratios (ratio of observed/expected number of deaths) for cirrhosis of the liver and tuberculosis were markedly increased, while that for malignant neoplasms was only about 0.5, suggesting extreme underestimation of the number of diabetic cases with cancer. Among malignant neoplasms, an increasing trend in liver cancer was remarkable and was associated with a relatively high O/E ratio.

Age Factors↗
PubMed1990

Self-certification in lay midwives' organizations: a vehicle for professional autonomy.

The recent resurgence of lay midwifery in the United States has been intimately connected with the establishment of grassroots organizations which address women's health issues and make the reappearance of the lay midwife a different kind of phenomenon than was the case earlier in this century. This paper describes the organizational structure of 32 lay midwives' organizations and compares them to a model of alternative women's health groups as well as more traditional health professional organizations. Are lay midwives' groups the beginnings of new professional organizations which eventually will become part of the dominant system or do they model themselves more closely after alternative women's health groups? Voluntary self-certification in five lay midwives' groups is described in detail as a means of determining how a group handles the question of integration with or separation from the existing medical care system. Certification plays a critical role in promoting acceptance and credibility of midwifery practice and is seen increasingly as a mechanism to preempt regulation by another body.

Age Factors↗
PubMed1989

Accuracy of diagnosis on death certificates for underlying causes of death in a long-term autopsy-based population study in Hisayama, Japan; with special reference to cardiovascular diseases.

Major categorical diagnosis by International Classification of Diseases and type-specific diagnosis for cardiovascular diseases in death certificates were compared to the diagnosis made at autopsy in 864 consecutive autopsy cases aged 20 or over, among the Japanese residents in Hisayama town. Cerebral stroke was correctly diagnosed in 84%, malignant neoplasms in 78% and cardiac disease in 66%. Cerebral stroke and cardiac disease tended to be overdiagnosed, while malignant neoplasms were underdiagnosed. The validation of certified diagnosis was less reliable in the aged population, and in type-specific diagnosis of cardiovascular diseases. Cerebral hemorrhage with false negative or false positive diagnoses was usually classified into type unspecified stroke or different categories of cerebral stroke, while those misdiagnosed as cases of cerebral infarction frequently had no significant lesions in the autopsied brain. Finally, the relationship between the validation of diagnosis on the death certificates and the secular trend in cardiovascular disease in the Japanese vital statistics was discussed.

Adult↗
PubMed1992

Linkage of death certification of AIDS and cancer registration in Vaud, Switzerland.

58 death certifications (40 males and 18 females) of residents of the Canton of Vaud (Switzerland) which reported AIDS as the cause of death in 1986-1989 were matched with the list of incident cancers available since 1974 from the Vaud Cancer Registry. Such linkage was successful for 20 individuals (age range 25-63, median 37), mostly males (18/20), homosexual or bisexual (11/18) and affected by Kaposi's sarcoma (14 males and 1 female). Other identified neoplasms included one Burkitt's lymphoma, one prostate adenocarcinoma and one multiple myeloma (whose histological picture included, however, lymphocytosis in addition to plasmocytosis). Three additional malignancies (one undifferentiated skin cancer, one carcinoma of the salivary glands and one in situ cervical carcinoma), and one myelodysplastic syndrome had also been diagnosed from 1 to 2 years before AIDS death. Cancer was mentioned on the death certificate, in addition to AIDS, in only 2 cases. Albeit of limited size, the present report confirms that a systematic integration of AIDS and cancer registration statistics provides additional information, of particular interest for histological classification, on the AIDS-cancer relationship.

Acquired Immunodeficiency Syndrome↗
PubMed2006

ABO certification in the age of evidence and enhancement.

The American Board of Orthodontics (ABO) phase III certification examination was originally constructed and recently modified to "help the Board determine the candidate's knowledge of clinical orthodontics and provide a basis to assess the quality of the candidate's clinical treatment results." For the most part, the ABO phase III examination measures the orthodontic treatment-induced changes in occlusion in a limited and biased patient sample. The process and outcome measures used in the current model-the discrepancy index and the objective grading system-are so narrowly focused that an orthodontist might lack up-to-date clinical knowledge, psychomotor and critical thinking skills, diagnostic acumen, patient management ability, and patient-centered ethics, and still pass the examination largely because of mechanically morphing the patient's teeth into the board's construct of ideal occlusion. The goal of this article is to provide provocative insight into the core concepts that drive the ABO phase III certification process and to recommend an alternative paradigm predicated on a patient-centered, evidence-based clinical practice model.

Certification↗
PubMed2004

Unnecessary cesarean delivery in Louisiana: an analysis of birth certificate data.

OBJECTIVE: The purpose of this study was to explore the temporal trends and factors that are associated with cesarean deliveries and potentially unnecessary cesarean deliveries. STUDY DESIGN: The Louisiana birth certificate database was evaluated to identify a total of 57 potential indications/risk factors and maternal demographic factors that are associated with methods of delivery over the period from January 1993 to December 2000. A cesarean delivery without any potential indications/risk factors in the birth certificate was classified as unnecessary. RESULTS: The primary cesarean delivery rate decreased and the repeat cesarean delivery rate increased significantly during the study period. But neither the absence nor the presence of potential indications/risk factors accounted for these changes. The average potentially unnecessary primary and repeat cesarean deliveries in Louisiana were 17 and 43, respectively, per 100 cesarean deliveries over the years 1993 through 2000. CONCLUSION: The proportions of potentially unnecessary cesarean deliveries are relatively high in Louisiana. It is important to explore the influence of nonclinical factors on unnecessary cesarean delivery to reduce the cesarean rates.

Birth Certificates↗
PubMed2005

A comparison of death certificate out-of-hospital coronary heart disease death with physician-adjudicated sudden cardiac death.

The number of deaths due to out-of-hospital coronary heart disease as determined by death certificates was compared with the number physician-adjudicated sudden cardiac deaths in the Framingham Heart Study from 1950 to 1999. Out-of-hospital coronary heart disease deaths overestimated sudden cardiac death by 47%, suggesting that out-of-hospital coronary heart disease death rates derived from death certificates should be interpreted with caution.

Aged↗