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PubMed1984

Nursing careers: findings of a follow-up survey of graduates of the nursing education and administration certificate courses of the Department of Nursing Studies, University of Edinburgh, 1958-1975.

The paper discusses the findings of a survey of the career progress of graduates of certificate courses in nursing administration and education, between 1958 and 1975, at the Department of Nursing Studies, University of Edinburgh. Five sections are presented: age, sex, career patterns, educational attainments and scholarly work. Issues arising within these sections are discussed.

Administrative Personnel↗
PubMed1996

Content specificity and oral certification exams.

This study reports on the generalizability of different skills assessed in the oral certification examinations in Internal Medicine of the Royal College of Physicians and Surgeons of Canada. Assessments from the 1992 examination were examined prospectively to determine (i) inter-rater reliability, (ii) correlation from morning to afternoon sessions, and (iii) overall test reliability. While inter-rater reliability was acceptable and in the range reported from previous studies, the generalizability across sessions was very low, ranging from 0.30 to 0.47, presumably reflecting content specificity. As a consequence, the overall test reliability was low, ranging from 0.57 to 0.69. Collapsing the overall scores into three decision categories (pass, borderline, fail) lowered the test reliability still further. Strategies to resolve this problem are suggested.

Adult↗
PubMed1989

Revised U.S. certificate of birth--new opportunities for research on birth outcome.

The 1989 revision of the U.S. Standard Certificate of Live Birth includes a number of new items on medical and life-style risk factors of pregnancy and birth, obstetric procedures performed, method of delivery, abnormal conditions and congenital anomalies of the infant, expanded information on birth attendant and place of birth, and questions on the Hispanic origin of the parents. This major enhancement of medical and health data available on mothers and infants can greatly expand the scope of research on pregnancy outcome in the United States.

Birth Certificates↗
PubMed1990

Candidates for the Certificate of Added Qualifications in Geriatric Medicine. Who, why, and when?

We surveyed physicians who took the examination for certification for Added Qualifications in Geriatric Medicine, physicians who only inquired about the examination, and physicians who expressed no interest in the examination to learn about practice characteristics of those who took the examination and their reasons for taking it. Based on a 72% response rate, we were able to demonstrate that those who took the examination took care of an older population of patients and disproportionately more of the oldest-old. These physicians were more likely to report the care of older people to be a professional focus and, in internal medicine, were more likely to have had formal training in geriatrics. Their reasons for taking the examination were primarily to obtain credentials but also frequently to improve their ability to care for older people. Nearly two-thirds of those who had inquired about the exam but did not take it in 1988 plan to do so at a later date.

Certification↗
PubMed1996

Level I trauma certification and emergency medicine resident major trauma experience.

OBJECTIVE: American College of Surgeons (ACS) and Residency Review Committee for Emergency Medicine (RRC-EM) guidelines conflict regarding the role of emergency physicians in directing major trauma resuscitations. This article describes the impact of ACS level I trauma certification on emergency medicine (EM) resident trauma experience. METHODS: A written survey and a follow-up letter were sent to all 101 EM program directors as of August 16, 1994. The survey addressed demographics and trauma experience at hospitals designated by the RRC-EM as primary training sites. RESULTS: There were 95 (94%) survey respondents. Estimates of the percentage of trauma resuscitations directed by EM residents were significantly lower at level I centers (52% +/- 27%, 95% CI 45-59%) than they were at non-level I centers (70% +/- 30%, 95% CI 58-82%) (p < 0.01). There was no significant difference in trauma census between level I and non-level I centers. Of 14 respondents who said they were cited by the RRC-EM for inadequate trauma experience, ten (71%) were in ACS level I trauma centers (p = 1.0). Twelve of the 14 respondents cited for inadequate trauma experience were in either the Northeast or the Midwest. CONCLUSIONS: EM residents direct a smaller percentage of major trauma resuscitations at ACS level I hospitals than they do at non-level I facilities. This finding is not offset by an increased trauma census at level I facilities and may be more pronounced in the Northeast and the Midwest.

Certification↗
PubMed2006

Amended cause and manner of death certification: a six-year review of the New Mexico experience.

Little is known about the amendment of death certificates (DCs) issued by medical examiners and coroners. This retrospective study examined why, how, and with what frequency cause and manner of death were amended on DCs issued by forensic pathologists over a 6-year period at the New Mexico Office of the Medical Investigator. Approximately 1% of DCs had either cause or manner of death amendments, with arteriosclerotic cardiovascular disease and intoxicants the most commonly amended and resulting causes of death, respectively. There was a significant association between manner of death and number of DCs amended (p<0.001). By percent, natural and suicide DCs were the most frequently amended. The way in which manner of death changed was significantly associated with the amount of time elapsed between DCs (p=0.04). Toxicology was the most common reason for DC amendment.

Accidents↗
PubMed1987

Improving the validity and reliability of medical-legal certifications of suicide.

On a very basic level, those who study suicide are either explicitly or implicitly concerned with the certification of suicide deaths by coroners and medical examiners. Although many authors have questioned the reliability and validity of officially reported rates, these statistics continue to be quoted as fact--a potentially problematic practice for researchers who seek accurate and true causative factors for suicidal behavior. In relation to this topic, this article provides an overview of the existing vital statistics registry system and describes and proposes innovations that could ultimately improve the quality of officially reported suicide statistics.

Accidents↗
PubMed1988

Australian mortality statistics for rheumatoid arthritis 1950-81: analysis of death certificate data.

An analysis of mortality related to rheumatoid arthritis (RA) in Australia for the period 1950 to 1981 was undertaken based on information recorded in death certificates. These data include every death over a 32 year period where RA was considered to be the underlying cause. Death from RA was commonly reported (0.17% of all deaths). The mean age at death from RA in both sexes exceeded that of the general population for most of the period. There was little difference between patients dying of RA and the general population for age at death in the over 50 years' age group. There was a significant decrease in mortality for women dying of RA over the age of 75. RA accounted for more deaths in women than in men (in a ratio of 2.2:1). Men tended to die at a younger age from RA than did women. The impact of RA remained relatively constant in relation both to the total causes of death and to deaths due to other musculoskeletal diseases. There was a significant decline, however, in female RA deaths as a percentage of deaths due to all musculoskeletal diseases. Cohort analysis does not indicate any marked effect from extrinsic factors on mortality due to RA.

Age Factors↗
PubMed1985

Changes in incidence and prognosis of ischaemic heart disease in Finland: a record linkage study of data on death certificates and hospital records for 1972 and 1981.

The components of the decline in mortality from ischaemic heart disease in Finland were studied by analysing the changes in incidence and prognosis between 1972 and 1981. Using personal identification numbers, hospital discharge records and death certificates were linked for all men and women aged 40-64. During this period mortality decreased 15.9% in men and 23.5% in women, incidence 14.2% in men and 19.3% in women, being greatest among 40-49 year olds living in urban areas, and case fatality 7.3% in men and 10.3% in women, owing primarily to a decrease in patients dying of ischaemic heart disease without being admitted to hospital; survival was also better among patients admitted to hospital. Factors explaining these changes remain unknown because data on risk factors and factors influencing prognosis are limited and largely ecological.

Adult↗
PubMed2005

Mortality from heart failure in an English population, 1979-2003: study of death certification.

OBJECTIVE: It is widely held that there will be an epidemic of heart failure in Europe and North America as a result of increased survival from myocardial infarction and other coronary heart disease. The study objective was to discover if the decline in mortality from coronary heart disease has been accompanied by a rise in mortality from heart failure in the study population. DESIGN: Analysis of database of mortality records including all certified causes of death, not just the underlying cause, from 1979-2003. SETTING: Former Oxford NHS Region, England. PATIENTS: Data from death certificates of all who died in the population covered. MAIN RESULTS: Mortality rates for heart failure fell at very similar rates as those from coronary heart disease. In men, the average annual fall in mortality from coronary heart disease was -2.7% (95% confidence intervals -2.8 to -2.5) and that from heart failure was -2.9% (-3.2 to -2.5). In women, the average annual fall in mortality from coronary heart disease was -2.3% (-2.6 to -2.1) and that from heart failure was -2.6% (-3.0 to -2.3). CONCLUSIONS: The decline in mortality from coronary heart disease has not been accompanied by a rise in mortality from heart failure. A future epidemic of heart failure, as a consequence of the decline in mortality from coronary heart disease, seems unlikely.

Age Distribution↗
PubMed1985

Identification of cases of sudden infant death syndrome from death certificates.

A method is proposed for identification of cases of sudden infant death syndrome (SIDS) from information available on death certificates. Deaths at ages between 7 days and 2 years, referred to a coroner, having certain specified causes of death codes, identified 160 of 169 cases of SIDS confirmed as such by a pathologist. The sensitivity of the method was 94% and the specificity was 97%.

Death Certificates↗
PubMed1993

On the influence of data source in aggregated data studies: a comparative study of suicide information based on death certificates and judicial files.

STUDY OBJECTIVE: The aim was to assess the differences in suicide data obtained from different database sources. DESIGN: Death certificate based data on suicidal deaths were compared with the information obtained from the non-natural death investigation files at the Public Prosecutor's Office. SETTING: The study was confined to the time period of 1981-1984 and to the residents of the district of Leuven (Belgium) who died in the district. MAIN RESULTS: Differences were found in the number of suicidal deaths reported as well as in the demographic variables, the distribution of suicide methods, and the place of death. Sixty percent of the records in both databases could be matched for all variables studied (age, gender, civil state, place of death, and suicide method), and another 10% if only place of death was allowed to differ. For 4.5% of the cases in the judicial files and for 8% of the records in the official statistics database no corresponding record from the other data source could be found. Based on simple probability statistics [P(missing record)+P(different information[present)] the possible minimum global information bias could be estimated to range from 7 to 42%. CONCLUSIONS: Different epidemiological pictures of suicide mortality may result from studying different data sources.

Belgium↗
PubMed2002

Certification of deaths attributable to epilepsy.

OBJECTIVE: To estimate the number of sudden unexpected epilepsy deaths occurring annually in England and Wales in those 16-50 years of age. METHODS: All 1997 death entries mentioning epilepsy as a cause of death in those 16-50 years were examined and classified as sudden unexpected death in epilepsy (SUDEP), other epilepsy related deaths, or non-epilepsy deaths. RESULTS: 612 death entries were obtained with postmortem examination having been performed in 498 cases. Forty four deaths were certified as being attributable to SUDEP and a further 292 deaths were considered to be probable SUDEP cases. CONCLUSION: It is estimated that between 350 and 400 cases of SUDEP occurred in England and Wales in 1997 in those 16-50 years. SUDEP is the commonest category of epilepsy related death and accurate certification of such deaths is vital for the monitoring of trends in mortality.

Adolescent↗
PubMed1987

Occupation and five cancers: a case-control study using death certificates.

A case-control approach has been used to examine mortality from five cancers--oesophagus, pancreas, cutaneous melanoma, kidney, and brain--among young and middle aged men resident in three English counties. The areas studied were chosen because they include major centres of chemical manufacture. By combining data from 20 years it was possible to look at local industries with greater statistical power than is possible using routine national statistics. Each case was matched with up to four controls of similar age who died in the same year from other causes. The occupations and industries recorded on death certificates were coded to standard classifications and risk estimates derived for each job category. Where positive associations were found the records of the cases concerned were examined in greater detail to see whether the risk was limited to specific combinations of occupation and industry. The most interesting findings to emerge were risks of brain cancer associated with the production of meat and fish products (relative risk (RR) = 9.7, 95% confidence interval (CI) 2.6-36.8) and with mineral oil refining (RR = 2.9, CI 1.2-7.0), and a cluster of four deaths from melanoma among refinery workers (RR = 16.0, CI CI 1.8-143.2). A job-exposure matrix was applied to the data but gave no strong indications of further disease associations. Local analyses of occupational mortality such as this can usefully supplement national statistics.

Adolescent↗
PubMed2000

Mortality from multiple sclerosis and exposure to residential and occupational solar radiation: a case-control study based on death certificates.

OBJECTIVES: To explore whether mortality from multiple sclerosis is negatively associated with exposure to sunlight. METHODS: Two case-control studies based on death certificates were conducted for mortality from multiple sclerosis and non-melanoma skin cancer (as a positive control) to examine associations with residential and occupational exposure to sunlight. Cases were all deaths from multiple sclerosis between 1984 and 1995 in 24 states of the United States. Controls, which were age frequency matched to a series of cases, excluded cancer and certain neurological deaths. The effects of occupational exposure to sunlight were assessed among subjects with usual occupations requiring substantial activity, so as to exclude those whose indoor jobs resulted from disabilities subsequent to the onset of the disease. Multiple logistic regression analyses were applied, with adjustment for age, sex, race, and socioeconomic status. RESULTS: Unlike mortality from skin cancer, mortality from multiple sclerosis was negatively associated with residential exposure to sunlight (odds ratio (OR)=0.53 (multiple sclerosis) and OR=1.24 (skin cancer)). Odds ratios for the highest occupational exposure to sunlight were 0.74 (95% confidence interval (95% CI) 0.61 to 0.89) for mortality from multiple sclerosis, compared with 1.21 (1.09 to 1.34) for mortality from non-melanoma skin cancer. The OR was 0.24 for the combined effect of the highest levels of residential and occupational exposure to sunlight on multiple sclerosis, compared with an OR of 1.38 for skin cancer. CONCLUSIONS: In this exploratory study, mortality from multiple sclerosis, unlike mortality from skin cancer, was negatively associated with both residential and occupational exposure to sunlight.

Adult↗
PubMed2002

Sunlight and mortality from breast, ovarian, colon, prostate, and non-melanoma skin cancer: a composite death certificate based case-control study.

OBJECTIVES: To explore whether mortality from female breast, ovarian, colon, and prostate cancer were negatively associated with exposure to sunlight. METHODS: A death certificate based case-control study of mortality was conducted into five cancers: female breast, ovarian, colon, prostate, and non-melanoma skin cancer (as a positive control) to examine associations with residential and occupational exposure to sunlight. Cases were all deaths from these cancers between 1984 and 1995 in 24 states of the United States. Controls, which were age frequency matched to a series of cases, excluded deaths from cancer and certain neurological diseases. Multiple logistic regression was used in a model that included age, sex, race, residential exposure to sunlight (based on region), and socioeconomic status, occupational exposure to sunlight, and physical activity (the last three based on usual occupation). RESULTS: Residential exposure to sunlight was negatively and significantly associated with mortality from female breast, ovarian, prostate, and colon cancer. Only female breast and colon cancer, however, also showed significant negative associations with jobs with the highest occupational exposure to sunlight (odds ratio (OR) 0.82 (95% confidence interval (95% CI) 0.70 to 0.97) for female breast cancer; OR 0.90 (95% CI 0.86 to 0.94) for colon cancer). For both cancers, the negative association with occupational sunlight was greatest in the geographical region of highest exposure to sunlight and was independent of physical activity on the job. Non-melanoma skin cancer, as expected, was positively associated with both residential and occupational sunlight. CONCLUSIONS: In this exploratory study, unlike mortality from non-melanoma skin cancer, mortality from female breast cancer and colon cancer were negatively associated with both residential and occupational sunlight.

Adult↗
PubMed2000

A telepathology based Virtual Reference and Certification Centre for DNA image cytometry.

An increasing need for flexible consultation between pathologists, including the application of fast evolving supplementary technologies, has been identified during the last years. Although pathology is already one of the most advanced application of telemedicine there is more to come from the fast evolution towards computerized microscope image analysis: A reproducible quantification of measurable descriptors of the lesions in cells and tissues (so-called biological markers) is an indispensable adjunct to routine diagnostic application. Among such quantitative methods DNA image cytometry is increasingly applied by pathologists for assistance in diagnostics. As for other pathological issues, too, a reference center for the clinical application of DNA image cytometry might be therefore of utmost value for pathologists using that method. Based on advanced telematic technologies, a Virtual Reference and Certification Center (VRCC) could be installed for certifying the cytometry hardware and software, the analytical procedures, and the basic interpretation of the results. It will be designed to be operated as a non-attended service, based on quantification servers accessible via Internet round the clock. The VRCC will supply appropriate standardization and normalization materials and run a GroupWare platform for consensus making by experts.

Certification↗