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PubMed2004

Cost analysis of post-polio certification immunization policies.

OBJECTIVE: An analysis was conducted to estimate the costs of different potential post-polio certification immunization policies currently under consideration, with the objective of providing this information to policy-makers. METHODS: We analyzed three global policy options: continued use of oral poliovirus vaccine (OPV); OPV cessation with optional inactivated poliovirus vaccine (IPV); and OPV cessation with universal IPV. Assumptions were made on future immunization policy decisions taken by low-, middle-, and high-income countries. We estimated the financial costs of each immunization policy, the number of vaccine-associated paralytic poliomyelitis (VAPP) cases, and the global costs of maintaining an outbreak response capacity. The financial costs of each immunization policy were based on estimates of the cost of polio vaccine, its administration, and coverage projections. The costs of maintaining outbreak response capacity include those associated with developing and maintaining a vaccine stockpile in addition to laboratory and epidemiological surveillance. We used the period 2005-20 as the time frame for the analysis. FINDINGS: OPV cessation with optional IPV, at an estimated cost of US$ 20,412 million, was the least costly option. The global cost of outbreak response capacity was estimated to be US$ 1320 million during 2005-20. The policy option continued use of OPV resulted in the highest number of VAPP cases. OPV cessation with universal IPV had the highest financial costs, but it also had the least number of VAPP cases. Sensitivity analyses showed that global costs were sensitive to assumptions on the cost of the vaccine. Analysis also showed that if the price per dose of IPV was reduced to US$ 0.50 for low-income countries, the cost of OPV cessation with universal IPV would be the same as the costs of continued use of OPV. CONCLUSION: Projections on the vaccine price per dose and future coverage rates were major drivers of the global costs of post-certification polio immunization. The break-even price of switching to IPV compared with continuing with OPV immunizations is US$ 0.50 per dose of IPV. However, this doses not account for the cost of vaccine-derived poliovirus cases resulting from the continued use of OPV. In addition to financial costs, risk assessments related to the re-emergence of polio will be major determinants of policy decisions.

Certification↗
PubMed1992

The proposed death certificate for South Africa. Part II. Feasibility study.

The proposed new death certificate was tested in urban and rural hospitals and among general practitioners. Of the 471 death certificates returned, 70% were correctly completed. The underlying cause of death was identifiable in 86.6% of cases. The accuracy of cause of death statements was analysed in greater detail. Some items on the proposed form were not clear and needed improvement, i.e. instructions to mark an applicable answer and refer to instructions on the reverse page. The participants completed a questionnaire to assess and comment on the new form. A refined version thereof was prepared as a result of this study.

Cause of Death↗
PubMed1978

Certification of smallpox eradication.

The world's last known case of smallpox resulting from human-to-human transmission in an endemic focus occurred in Somalia in October 1977, and there remains the task of documenting the global eradication of the disease and establishing the safety of vaccination. Those countries as yet uncertified have been grouped into four categories according to the procedures recommended for their certification. An important criterion for deciding the type of procedure is how recently smallpox was endemic in a particular country. This paper is concerned with those countries in which the disease has been nonendemic for some years but which have not yet received certification of eradication. One such country is Burma, which was certified free of smallpox in 1977, some 8 years after its last reported case but 2 years after the last case in Bangladesh, with which it shares a long frontier. The procedures used in Burma and the lessons that were learnt therefrom are described.

Adolescent↗
PubMed2004

[Validity of the causes of death from tuberculosis as evidenced by medical death certificates].

Despite the violations made in filling in "Medical Death Certificates", the rate of tuberculosis mortality forms with a high degree of significance. To minimize the above pitfalls, it is necessary to keep a computer-aided record of deaths from tuberculosis, which involves the standardization of entries of a postmortem diagnosis, by decoding it in accordance with the lines of item 1 (a, b, c) of the "Certificate".

Aged↗
PubMed2005

Death certification: issues from a pilot of the Shipman Inquiry's interim proposals.

This article investigates the issue of death certification in England and Wales. The Shipman Inquiry published interim proposals designed to make the system of death certification safer and more accurate. The proposed forms were piloted by doctors and relatives on a sample of deaths in one locality. They were then interviewed to assess the forms' feasibility and acceptability.

Death Certificates↗
PubMed2005

Quality labelling and certification of electronic health record systems.

The Danish Health IT strategy 2003-2007 demands implementation of Electronic Health Records (EHR) in all Hospitals based on common standards. The aim is to achieve integration and semantic interoperability between different EHR systems in order to support a better communication and coherence between the health care parties. The National Board of Health has developed a common model, which is a prerequisite for the development and implementation of interoperable EHR systems. The adoption of the common EHR model has been promoted and validated through a number of pilot projects in different Hospitals. The Danish EHR Observatory, which has been monitoring the development of EHR in Denmark since 1998, have developed a methodology for Quality labelling and certification of EHR systems. The methodology for certification of EHR systems has been used to validate EHR systems from different vendors to document to which extent the systems are based on the national requirements for EHR.

Certification↗
PubMed2006

A certificate program in health informatics: Brazil/USA experience.

Considering the continued demand for a large number of trained professionals we decided to offer a certificate program in health informatics. The objective is to prepare professionals to conduct research and implement the curriculum content in their original institutions. We selected 14 candidates from several national institutes. The disciplines are taught by Brazilian and US faculty. Researches conducted by the certificate students were relevant to Brazil's health needs. The goal is to promote better health informatics education, regardless of geographic distribution of students.

Brazil↗
PubMedDate not supplied

[Rationalizing the evaluation of death certificates by using a personal computer].

For the coverage of specific epidemiological facts the Public Health offices have a considerable number of data available, i.e. the death certificates they have to check; until now, however, the problem-oriented evaluation of these data has been restricted because the conventional methods require a large staff and take up a lot of time. The "Märkische Kreis" Public Health office introduced a computer-based system to evaluate death certificates. The programme described here allows the use of descriptive statistical methods for the evaluation of individually selected mortality data. Compared to the official statistics on the causes of death the system described takes additional items into consideration, i.e. several diseases involved in the cause of death.

Cause of Death↗
PubMed1991

Certification: a teamwork approach.

The purpose of this article is to demonstrate how a teamwork approach in studying for the Certification Examination is beneficial. The paper also provides guidelines and encouragement to others who may be considering certification.

Certification↗
PubMed1990

Certification in nephrology: credentialing issues.

Credentialing with certification does not ensure pay raises or well-known initials, but it does verify personal knowledge and skills needed to practice in a specialty area. This documentation of special knowledge is a starting point for nursing to take control of its practice and for its members to become autonomous and collaborative practitioners. Unification and standardization of the present system will only bring more power and prestige to the credentials. Documenting quality patient care delivered by certified nephrology nurses is the next step in the nephrology field. Lastly, nurses need to unite and support each other during the certification process as it evolves into a well-respected institution.

Certification↗
PubMedDate not supplied

[Histopathologic evaluation of death certificates in Soria in 1985].

The aim of this paper is to evaluate the quality of the Death Certificates by means of the Death Statistics Bulletins, in their NEOPLASIC aspect in the year 1985 in the Province of Soria, determining the histopathologic confirmation of the deaths by means of the neoplasic patients' records in the two existing Pathology Services. An overall histologic verification of 80.76% is observed in the cases with an I.C. of +/- 4.79. In the case of BREAST, HEMATOLOGIC, OROPHARYNX, ENDOMETRIUM, ESOPHAGUS, OVARIAN, LARYNX and VULVA tumors, it is 100%. Whereas it is 14.3% in HEPATIC Tumors. Of the total of deaths registered in said year, the percentage of deaths caused by malignant neoplasias is over 26%, more than a fourth of which were Gastric. The preparation of the Death Certificates should be modified so that they can be objectively evaluated epidemiologically without bias or mistakes.

Death Certificates↗
PubMed1989

[Certification of main cause of death in Barcelona, 1985].

The aim of the present study was the validation of the underlying cause of death of the patients who died in Barcelona hospitals in 1985. A sample of deaths was stratified on the basis of the 17 categories of International Classification of Diseases (ninth revision), and the underlying cause as stated in the Statistical Death Certificate was compared with the cause that was considered to be "more likely" according to the available clinical documentation. The agreement index in the 17 ICD-9 categories was 71.8%. The groups with reliable rates were tumours, congenital defects and perinatal abnormalities. It is concluded that the fulfillment of the Statistical Death Certificate should be improved following the WHO recommendations; this could be achieved with training programs for clinicians.

Death Certificates↗
PubMed1989

Using death certificates to estimate the completeness of AIDS case reporting in Ontario in 1985-87.

The completeness of AIDS (acquired immune deficiency syndrome) case reporting in Ontario was assessed by reviewing all AIDS death certificates compiled by the Registrar General between Jan. 1, 1985, and Dec. 31, 1987. Several demographic variables were used to match death certificates with cases reported to the provincial AIDS registry. The completeness of case reporting was then estimated by examining the ratio of reported deaths of patients with AIDS to the total number of deaths reviewed. The estimated completeness of case reporting was 81.1% in 1985, 71.5% in 1986 and 75.4% in 1987; the overall rate for 1985-87 was 75.2%. The difference in the completeness of case reporting from year to year was not statistically significant. There was a significant increase from 1985 to 1986 in the proportion of unreported cases in people who had never been married (p less than 0.02). Reporting was not associated with the patient's age, sex, occupation or place of residence. The deficiency in AIDS case reporting could adversely affect the long-term planning of health care resources and the development of programs to prevent and control the spread of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Cause od death statistics and death certificate documentation. 1. Historical development of cause of death statistics of fetal death, infants and children and current regulations in the GDR].

After having described the beginnings of documentation and statistics of causes of death of newborns and children the development of this branch of medical statistics in the GDR and the introduction of a special death certificate in 1961 is dealt with. To help obstetricians, perinatologists and pediatrists to tackle the problem of documentation of the causes of death of stillborns and newborns the 9th revision of ICD, the nowadays valid death certificate and special rules of signing are explained to avoid mistakes, which are often met with in the daily practice.

Cause of Death↗
PubMed1989

[Documentation of the death certificate for stillborn infants/infants dying before 1 year of age].

The analysis of 311 death certificates of stillbirths and live born under one year of age covering the period from 1979 to 1984 and the analysis of the clinical dates referring to revealed: a high frequency of mistakes both in the nondiagnostic and in the diagnostic part, the handling of the documents was not in correspondence with the law, the number of mistakes in the nondiagnostic part has decreased, obstetricians made more mistakes than pediatrists, physicians with great experience in the field of death certificates made less mistakes, the number of secundinae to be morphologically investigated was to low and the possibility of corrections of the cause of death was not made use of. To improve the situation recommendations are given.

Cause of Death↗
PubMed1987

Validity of scoring 'dangerous answers' on a written certification examination.

The American Board of Anesthesiology (ABA) investigated the possibility that selection of a disproportionately high number of incorrect "dangerous answers" by candidates who would otherwise pass the board's written certification examination might relate to dangerous clinical practice by the candidates. In that case, scoring the examination for dangerous answers would provide an alternate scoring method. Twenty-nine multiple-choice questions in the 1983 written examination were identified by a panel of judges as containing incorrect answers with "truly, not potentially" dangerous consequences. The 1,036 candidates who passed the 1983 examination selected an average of 1.6 dangerous answers, and the 1,413 who failed the examination selected an average of 3.4 (p less than .001). Ninety-two candidates who passed and who selected four or more dangerous answers were tracked through the certification process to learn whether labeling them as "smart but dangerous" was justified. Reports of their clinical competence from their residency programs did not relate dangerous behavior for any of these candidates. The 86 of these 92 candidates who subsequently took the ABA oral examination had pass rates that were identical to those of all candidates in 1983 and that were completely independent of the candidates' absolute and relative frequency of choosing dangerous answers. It is concluded that selection of dangerous answers in a multiple-choice test is the result of lack of information rather than a purposeful action and implementation of the scoring system for dangerous answers would likely be unjustified and unfairly punitive.

Achievement↗