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PubMedDate not supplied

The revised standard certificate of live birth: analysis of medical risk factor data from birth certificates in Alabama, 1988-92.

The latest revision of the birth certificate features a new checkbox format designed to collect more effectively information for public health research. One of the new checkbox items, medical risk factors for this pregnancy, is designed to collect information on risk factors which result in adverse pregnancy outcomes. Data from 308,573 birth certificates filed in Alabama between 1988 and 1992 were analyzed. Although problems exist with the data collected for this item, useful information can be obtained to investigate important public health issues. First, the data can be used to determine the prevalence of medical risk factors in the population. Second, differences between subpopulations with these conditions can be examined. For example, some differences between racial groups in adverse pregnancy outcomes may be explained by the fact that black mothers are more likely to have a medical risk factor than whites. Third, some medical factors are associated with elevated risks for low birth weight, while others are associated with reduced probability of low birth weight. Although useful data can be obtained from the medical risk factor item, it and other checkbox items would be more useful if efforts were made to improve reporting. Improvements in training persons who complete the birth certificate are especially needed. Reporting of checkbox items also needs to be validated by comparing results with other sources. In future revisions of the birth certificate, new items need to be examined carefully to determine if that instrument is the appropriate medium for collecting the information.

Alabama↗
PubMed1997

[Specialty certification for physicians with pre or postgraduate degree who studied abroad. Experience of the National Autonomous Commission for the Certification of Medical Specialties (CONACEM)].

BACKGROUND: The number of foreign or Chilean physicians with pre or postgraduate studies abroad, seems to be increasing. AIM: To report the experience of CONACEM in the certification of specialties for Chilean or foreign physicians that studied abroad. MATERIALS AND METHODS: The certification process for 90 physicians (38 Chilean and 52 foreign) with studies abroad is reported. Criteria for certification of specialties were the same used for physicians with studies in Chile and results were compared with those obtained by the latter. RESULTS: Physicians with studies abroad required additional evaluations with a greater frequency than local physicians, due to the fact that foreign training programs are not well known by CONACEM members. Eighty five percent of foreign physicians required those further evaluations, compared with 66.6% of all physicians certified by the commission. Fifty five percent of Chilean physicians with studies abroad did not accept this additional assessment. Applications for specialties of physicians with studies abroad, were rejected with a greater frequency than those of Chilean physicians (31% and 13%, respectively). CONCLUSIONS: Physicians with studies abroad applying for certification of medical specialties required more evaluations and were rejected with a greater frequency than Chilean physicians.

Certification↗
PubMed1995

Completeness of AIDS reporting and quality of AIDS death certification in Tuscany (Italy): a linkage study between surveillance system of cases and death certificates.

In Italy, the AIDS cases defined according to the CDC criteria are reported to the National AIDS Registry (RAIDS, compulsory surveillance system). The aim of the present study is to evaluate the completeness of AIDS cases reported and the quality of AIDS death certification in an Italian Region (Tuscany, about 3,500,000 inhabitants). The 737 AIDS cases reported to RAIDS as residents in Tuscany (1987-91) were cross-linked (key link: name and date of birth) with the data of the Mortality Registration system of the Region (RMR). For the residents in Tuscany decreased with a 279.1 death diagnosis (the code for AIDS deaths stated by the Italian Census Bureau) and not reported to RAIDS as AIDS cases, the clinical records were reviewed to check whether the diagnosis fitted the 1987-CDC diagnostic criteria. This study shows that there is a high completeness (97-98%) of the AIDS cases resident in Tuscany, reported to the RAIDS. The quality of RAIDS data is not as good with regard to life status assessment (23% of under-reporting of death). In Tuscany, the death certification for AIDS (code 279.1 of ICD IX) has a sensitivity of 88% and a specificity around 100% in comparison to RAIDS. About 50% of 'false negatives' in death certification are due to causes of death presumably unrelated to HIV infection. The evaluation of the quality of AIDS surveillance and mortality data is important in the assessment of the impact for AIDS epidemic in a target population.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Why are a quarter of all cancer deaths in south-east England registered by death certificate only? Factors related to death certificate only registrations in the Thames Cancer Registry between 1987 and 1989.

This paper describes the results of a study set up to investigate factors associated with the high proportions of 'death certificate only' registrations (DCOs) for all cancers registered in south-east England between 1987 and 1989 and to identify those which might be subject to registry intervention. DCOs as a proportion of all registrations (n = 162,131) were analysed by age, sex, district of residence, place of death and survival. DCO registration ratios (standardised for age and sex) were then derived for each of the 56 districts in the Thames Regions. A multiple logistic regression model was generated to estimate the effect of age at diagnosis, tumour survival and patient sex on final source of registration. To minimise the number of dummy variables needed, each of the 56 districts was ranked into quartiles: quartile 1 contained the 14 districts with the lowest age- and sex-standardised ratios for DCO registrations and quartile 4 comprised the 14 districts with the highest DCO ratios. Final source of registration was treated as a binomial trial (case notes or death certificates). The significance of associations was measured using the deviance difference as an approximate chi-square statistic. The effect of each variable on source of registration was estimated as an odds ratio. Interaction terms were also fitted. To estimate the effect of place of death on DCO registrations, a second model was generated for deceased patients only (n = 98,455, adding 'place of death' to the list of explanatory variables already used. A further interaction term was fitted to account for interaction between place of death and district quartile of residence. Around 24% of all patient deaths were registered as DCOs by the Thames Cancer Registry between 1987 and 1989. Of these, 40.9% died in an acute NHS hospital setting, 37.1% died at home, 10.4% died in hospices and 3.4% died in non-NHS hospitals. Increasing age, decreasing survival, district of residence and place of death were positively associated with death certificate registrations. The district effect was sustained in the regression model with significant positive associations shown for DHA quartile of residence. In the deceased group of patients, both district of residence and place of death were independent predictors of DCOs. Death occurring outside the acute NHS hospital setting increased the odds of being a DCO within and across district quartiles. DCOs could be reduced by better case ascertainment in some districts.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

Update on the Medical Transcriptionist Certification Program and core certification examination.

The Medical Transcriptionist Certification Program is well under way toward development of the new core exam. The following report was given to the 1992 house of delegates (HOD) by Carrie Boatman, CMT, chair of the Medical Transcriptionist Certification Program. It contains preliminary information regarding the core exam and the steps that have already been taken. The certification board approved the blueprint for the written portion of the core exam, which is also printed here.

Certification↗
PubMed1980

Public Health Service--health systems agencies and state health planning and development agencies; certificate of need reviews. Notice regarding certificate of need programs.

This Notice sets forth advance information regarding amendments to the regulations governing certificate of need reviews by health systems agencies and State health planning and development agencies. This Notice is intended to provide early guidance to States prior to publication of interim final regulations implementing the amendments to certificate of need provisions of the Public Health Service Act made by the Health Planning and Resources Development Amendments of 1979 (Pub. L 96-79). This early guidance will assist the States in beginning to revise their certificate of need laws. Under the amended provisions of the Public Health Service Act, the planning agencies are required to review and determine the need for proposed capital expenditures, institutional health services and major medical equipment. The Secretary intends to publish these interim final regulations within a few weeks. Following consideration of comments which will be solicited with regard to the interim regulations, the Secretary will publish an analysis of the comments and will revise those regulations as appropriate.

Certificate of Need↗
PubMed1989

Continuing Education Program Handbook on Maintenance of Certification. Council on Certification, American Medical Record Association.

The Continuing Education Program Handbook on Maintenance of Certification delineates the rules and regulations established by the Council on Certification to implement the AMRA Standards for Maintenance of Certification. It is the responsibility of all credentialed individuals to read this Handbook and become familiar with its contents. It is used by the CE Division in administering the CE program.

Certification↗
PubMed1992

The proposed death certificate for South Africa. Part I. Death certificate description.

An altered 'Cause of Death' certificate is proposed. The major changes involve the use of the international format for certification of death and provision for collection of extra data, i.e. estimated age at death, sex, population group and, where relevant, the mass of an infant at birth. The new format will facilitate improved data collection and the certificate will stand international comparison.

Data Collection↗
PubMed2004

Certification of herds as free of Mycobacterium paratuberculosis infection: actual pooled faecal results versus certification model predictions.

Dutch dairy herds closed for at least 3 years with no history of paratuberculosis were recruited for a study on herd-certification. One hundred dairy herds were tested for Mycobacterium paratuberculosis at 6-month intervals by pooled faecal culture (five individual animal samples per pool) with solid media. Ninety of the herds completed 9 herd tests and 10 herds dropped out of the study for reasons other than a paratuberculosis diagnosis. Of the 90 herds completing the full study, 61% eventually were found to be M. paratuberculosis-infected. The number of infected herds detected decreased with each round of testing. Assuming that all infected herds had been detected by the ninth herd test, the observed percentage of herds that were truly noninfected (P-free) after each round of testing was calculated. The observed P-free was compared to the predicted P-free based on a previously reported herd-certification model. The P-free predicted by the model was significantly different from the observed P-free. When a single assumption in the model was changed and a diagnostic sensitivity of 40-50% was selected, the predicted P-free closely approximated the observed P-free for the 90 Dutch dairy herds studied. The critical assumption that was changed for Version 2.0 of the model was within-herd infection prevalence for infected but test-negative herds after each round of serial testing. Model Version 1.0 had assumed a 50% decrease in within-herd prevalence but Version 2.0 assumed a stable within-herd prevalence. Culture of pooled faecal samples provides a high-sensitive, high-specific, low-cost test for herd-certification programs.

Animals↗
PubMed1979

The Canadian certification examination in psychiatry. III. Towards better certification techniques.

Although there has been much criticism of specialty certification examinations there is general agreement that they are an important safeguard of competence in medical specialties where the consumer cannot judge this. The Canadian Royal College has made strenuous attempts to improve certification techniques but these have not been heretofore widely reported. This paper reports on the rationale for the replacement of the essay examination by multiple choice questionnaires, the problems associated with MCQ, and the efforts made to improve the fairness, validity and reliability of the clinical (oral) examination. These efforts have been in the areas of selection of examiners, training for examiners, standardization of marking and the conduct of the examination. A description is given of the conduct of the examination and what the examiners look for in the candidate's performance. The development and increasing importance of the In-Training Evaluation are discussed. The publication of A Resident's Guide to Psychiatric Education with multinational participation advances the possibility of future reciprocity in psychiatric examinations conducted in several English speaking countries.

Canada↗
PubMedDate not supplied

Certificate-trained staff nurses' perceptions of the changes in nursing education in Ireland from certificate to diploma level.

Over the past decade, nursing education in Ireland has experienced revolutionary changes, during which the hospital-based apprenticeship certificate model of nurse training was replaced with a college (diploma level) education model. This article reports on a qualitative study that explored traditionally trained staff nurses' perceptions of their role in the facilitation of learning for diploma students in clinical contexts and their attitudes toward such students. A central issue that emerged was participants' perceptions of the diploma program vis-à-vis the traditional apprenticeship training to which they themselves had been exposed. Guided by the strategy of grounded theory, in-depth interviews were conducted with 16 participants, and interview transcripts were analyzed. Three subthemes emerged: feeling the old way was best, confusion and uncertainty, and acceptance of change. These subthemes reflect the finding that although certificate-trained staff nurses thought the traditional apprenticeship model of educating nurses was superior and expressed confusion and uncertainty about the concept of supernumerary status, a sense of acceptance of change also mediated their accounts.

Certification↗
PubMed1989

[Cause of death statistics and death certificate documentation of stillborn infants and infants. II: Preventable errors in filling out death certificates for stillborn infants and for infants dying before 1 year of age].

The analysis of 311 death certificates of stillbirths and dead persons under one year revealed a lot of mistakes both in the diagnostic and nondiagnostic part of the form. All mistakes are mentioned and discussed. 90% of the death certificates had been written out by obstetricians and pediatrists, but also pathologists made many mistakes. It is recommended to perform a training referring hereto for obstetricians, pediatrists, neonatologists, pathologists and specialists in forensic medicine on the one hand and to combine the various rules printed in the pocket- and handbook of ICD and in the interpretations of LEOPOLD and HUNGER on the other.

Cause of Death↗
PubMed1967

MLA certification: the certification program and education for medical librarianship.

The certification program was formally adopted by the Medical Library Association in 1948 in an attempt to establish standards for medical librarians. The program is reviewed, and some of its effects on education for medical librarians are discussed. At the time of its adoption the program defined the kind of education librarians in the field thought necessary for work in medical libraries. New techniques and a shortage of personnel demand consideration of new educational programs, and the Medical Library Assistance Act will provide the means for their establishment. The Association should assume leadership in determining what and where these programs should be and should evaluate its certification and standards programs as often as current needs require.

Libraries, Medical↗
PubMed1999

Anticoagulation services: quality improvement direction pursuing a certification process. Anticoagulation Provider Certification Working Group.

There is still in a certification process for anticoagulant therapy providers. The primary, and certainly most important, goal is to improve patient care. Defining measurable competencies to which the anticoagulation provider is made accountable is but one mechanism to help improve quality in patient care. Great improvements have been achieved in the field of anticoagulation. For example, determining optimum intensity levels, for the traditional as well as the newer indications for treatment, have yielded greater efficacy and safety. Additionally, the acceptance of the INR reporting system has greatly reduced hemorrhagic and thromboembolic complications. However, the process of care, that is, how patients are managed and by whom, remains a variable that is difficult to quantify and measure. Anticoagulation providers are comprised of professionals from three major disciplines, namely, medicine, nursing, and pharmacy. This multidisciplinary approach enriches the quality of care for patients. However, this very fact presents a dilemma when seeking an appropriate certifying body. Nevertheless, keeping quality patient care as the primary focus, a multidisciplinary group has developed a body of knowledge that is unique to anticoagulant and antithrombotic therapies. The foundation of this project stems from the Fourth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy and the recently published paper by Ansell et al. on consensus guidelines for coordinated outpatient oral anticoagulation therapy management. This work in progress includes a mission statement and outlines five major knowledge domains along with measurable competencies for each section. This effort will help standardized the process of care across the country.

Anticoagulants↗
PubMed2000

[Thoughts on certification on ambulatory care--exemplified by DIN EN ISO certification].

In the worldwide discussion about the quality and possibility to finance institutions in public health, certified quality management programs are often stressed as suitable means. It is, however, an essential requirement for a successful quality management in out-patient care to consider quality aspects in the system of reimbursement, to solve the interface problem, and to invest considerably in personnel and financing. Additionally, the fact that medical institutions increasingly take it for granted to dedicate themselves to services and customer satisfaction can pose a problem. Growing pressure due to competition within health care does encourage spreading of certified quality management systems. However, certification in industry implemented for this very same reason did not as a rule lead to a continuing improvement of quality. Against this background, it is necessary to reckon with a considerable discrepancy between certified quality management systems and actual continuing quality improvement.

Ambulatory Care↗
PubMed2003

Pros and cons of certificates. American Health Planning Association directory suggests that certificate-of-need process is regulatory in theory, not in practice.

As state lawmakers diluted the impact of certificate-of-need laws last year, more and more CON boards are approving a vast array of projects. Almost one-third of the 27 states that regulate acute-care hospitals gave the OK to every project they reviewed. Condell Medical Center, Libertyville, Ill., shown at left and on the cover, spent $99,300 three years ago to win state approval for its expansion project.

Certificate of Need↗
PubMed2004

[Certification of pathology institutions --a new direction? The view of a certification institute].

A variety of standards for quality-management systems is presently applied in German healthcare institutions, ranging from the international standard ISO 9001:2000 to specific national models like KTQ for hospitals. Pathology institutes currently apply the ISO 9001 in the context of a certification, or alternatively the ISO 17020 as a basis for accreditation. The present article illustrates the different quality-management systems in view of their application in pathology. The focus is placed on the ISO 9001, since this broader system serves the needs of smaller private institutions as well as those of university institutes. For the latter, in addition, ISO 9001 provides the opportunity to include research and teaching activities. Examples of how to conform with the ISO 9001 standard are discussed.

Academies and Institutes↗