Impact Of Mccd Workshop On Knowledge And Awareness In Post Graduate Residents At A Tertiary Care Teaching Hospital

Background: Medical Certificate of Cause of Death is a vital document, important scientific tool issued by the doc-tors. It is the physician’s primary responsibility to complete the medical certificate of cause of death correctly. Incor-rect filling up of the certificate will result in gross errors in legal scrutiny in medico-legal deaths. Method:At the beginning the self-designed, pretested questionnaire open ended was distributed to participants, immediately after dis-tribution pre-test was conducted. After the pre-test an interactive workshop was conducted on theMCCD. After the workshop post test was conducted. Result:There was an increase in the knowledge about who issues death certifi-cates, long form of MCCD, who issues death certificate, maximum period within which you have to inform the regis-trar office about death in your clinic/hospital, detent dead body until your bills paid, what matter you are going to write on 1a. column and version present available in medical students from 0% to 61%, 30% to 100 %, 0% to 91 %, 0% to 91 %, 70 % to 96 %, 26 % to 87 % and 39 % to 100 % respectively. Conclusion:In the present study there is an improvement in knowledge and awareness in post graduates students after an interactive workshop on theMCCD.

Bioethical debate regarding gyms need for medical certificates for amateur sportsmen / Debate bioético respecto de la necesidad de los gimnasios de contar con certificados médicos para deportistas amateur / Debate bioético sobre a necessidade de atestados médicos para os desportistas amadores em ginásios

Sports Medicine comprises two branches: one, related to professional athletes and the other, related to the general population vis a vis sports and physical activity. The bioethical conflicts involving professional athletes are different from those of amateur practitioners. There is a constant deliberation related to the requirement of medical evaluation before admission to a gym. There are regional laws that make the medical certificate an obligatory document. It is observed that in the creation of these laws, the arguments are guided by a way to transfer responsibility from the gym to the physician who has attended the client. In a sense, the laws that indiscriminately require medical certificates subvert the ethics of the medical practice because the medical officer is not capable to assure that a given patient has no medical issue; instead the medical work is to try to identify the cause to a complaint. The gyms provide clients with orientation and supervision by providing them with qualified professionals. Although the need for medical certificates for everybody is unethical, a detailed medical evaluation is needed for gym clients who may present clinical manifestations during exercise or have some specific clinical conditions.

La medicina deportiva abarca dos ramas: una relacionada con atletas profesionales y la otra con la población general, vis a vis deportes y actividad física. Los conflictos en bioética con atletas profesionales son diferentes de los que tienen los practicantes amateur. Existe un debate relacionado con el requisito de evaluación médica antes de ser admitido a un gimnasio. Hay leyes regionales que exigen presentar un certificado médico. Se observa que, en la creación de estas leyes, los argumentos se guían por una forma de transferir responsabilidad desde al gimnasio al médico que atiende al cliente. En cierto modo, las leyes que indiscriminadamente exigen certificados médicos socavan la ética de la práctica médica, porque el médico oficial no es capaz de garantizar que un paciente dado no tiene un problema médico; en vez de ello el trabajo médico consiste en tratar de identificar la causa de una demanda. Los gimnasios proporcionan a los clientes orientación y supervisión mediante profesionales cualificados. Aunque la necesidad de certificados médicos para todos no es ética, se necesita una evaluación médica detallada para clientes de gimnasio que puedan presentar manifestaciones clínicas durante el ejercicio o que tengan alguna condición clínica específica.

Medicina Desportiva compreende dois ramos: um, relacionado com os atletas profissionais e outro, relacionado com a população em geral, vis a vis esportes e atividade física. Os conflitos bioéticos envolvendo atletas profissionais são diferentes daqueles de praticantes amadores. Há uma deliberação constante relacionada com a exigência de avaliação médica antes da admissão para um ginásio. Existem leis regionais que fazem do atestado médico um documento obrigatório. Observa-se que na criação dessas leis, os argumentos são guiados pela intenção de transferir a responsabilidade do ginásio para o médico que atendeu o cliente. Em certo sentido, as leis que exigem indiscriminadamente atestados médicos subvertem a ética da prática médica porque o médico não é capaz de assegurar que um determinado paciente não tem nenhum problema médico; ao contrário, o trabalho médico é tentar identificar a causa de uma denúncia. Os ginásios fornecem aos clientes orientação e supervisão, proporcionando-lhes profissionais qualificados. Embora a necessidade de atestados médicos para todos não é ética, é necessária uma avaliação médica detalhada para os clientes do "gym" que podem apresentar manifestações clínicas durante o exercício ou têm algumas condições clínicas específicas.

The Best-Matched Pure Tone Average and Speech Recognition Threshold for Different Audiometric Configurations / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The agreement between pure-tone average (PTA) and speech recognition threshold (SRT) has become more important with the increasing demands for medical certification. The purpose of this study was to explore the relationships between the SRT and several variations of PTA, and to determine which PTA formula would provide the best agreement with SRT for different audiometric configurations. SUBJECTS AND METHOD: Audiological data on 783 ears were retrospectively collected. The air-conduction PTAs were calculated using five different formulas: three-frequency average (3FA), weighted three-frequency average (W3FA), four-frequency average (4FA), weighted four-frequency average (W4FA), and six-frequency average (6FA). The audiometric configuration was classified into five categories. The PTA-SRT relationships were analyzed using correlation and simple linear regression for each audiometric configuration. RESULTS: Highest correlation was observed between the SRT and W3FA for all audiometric configurations with the correlation coefficient of 0.964 as a whole. The SRT and 3FA were best-matched in the linear regression models for overall/flat/high frequency gently sloping/low frequency ascending; the SRT and W3FA were best-matched for high frequency steeply sloping (HFSS); the SRT and 4FA were best-matched for miscellaneous audiograms. CONCLUSION: The most stable PTA variations that make the best-matched pairs with SRT for any audiogram are the conventional 3FA and W3FA doubling 1 kHz threshold. The addition of frequencies higher than 2 kHz to a PTA formula seems to have impeded the PTA-SRT agreement, especially for HFSS audiograms. W3FA should be the method of choice in predicting SRT from PTA for HFSS audiograms.

A study on legal problems concerning issuance of false medical certificates

Today, medical certificates are widely used in society; for example, for school enrollment and employment, as well as for insurance purposes, and military service. In addition, they serve an important judicial function. Criminal and violent acts such as murder frequently occur, and traffic and industrial accidents that cause injury and intrude upon a person's life are increasing; therefore, the courts and the organizations required to deal with such cases are heavily dependent on medical certificates. Recently, a television program called 'Madam's Outgo', that describes the stay of execution of the wife of a company CEO, became a subject of public debate. The trial of the professor at a famous medical school, who received criticism for his major role in making a stay of execution possible for the wife of the CEO, evokes the importance and social function of such medical certificates. Criminal laws and medical laws institutionalize the important social function of medical certificates and establish regulations designed to prevent the writing of false medical certificates. This paper minimizes the use of legal terminology, concentrating on Supreme Court precedents, so that the main translation problems associated with such legal regulations can be utilized as data of doctors and non-jurists, and focuses its discussion on issues that can be practically discussed. On the basis of a theory of analysis of criminal guilt associated with false medical certificates, this paper suggests that to be guilty of issuing of false medical certificates, the following elements are required to be proved: who (subject), what document (object), how it should be written to be classified as a false medical certificate (behavior), and what subjective facts should be perceived to be guilty of issuing of false medical certificates (intent), besides examining the medical requirements associated with writing medical certificates. It therefore appears necessary for the Korean Medical Association to henceforth systematically review its "Guidelines for Writing Medical Certificates," written in February 2003, from a legal perspective.

Medical certificate and confinement

A press release recently reported a case in which legal decisions, regarding the stay of execution of a criminal sentence, and the extension of this stay, were made based on medical certificates, containing a definitive medical history, prepared and issued by a family doctor. Thereafter, the family doctor who prepared these medical certificates was accused of being guilty of a crime related to the preparation of a number of false medical certificates and has been subject to adjudication for this crime. Under the circumstances, having recognized that a medical certificate would be considered the significant basis for making a decision regarding the determination of damages of a civil nature and the determination of confinement in cases of a criminal nature, as well as of the stay of execution of sentences related to the restriction of physical freedom, a doctor is required to accurately describe a patient's medical status and other general facts when preparing a medical certificate, and if a doctor has cooperated with other specialists during the treatment of a specific disease, the medical certificate is required to honor and reflect such specialists' judgment. Furthermore, information regarding either a patient's previous treatment history or any complications developed in the future is to be included in a medical certificate only when these matters are directly related to the patient's current health status from a clinical perspective.

Declaração de óbito, compromisso no preenchimento: avaliação em Belém - Pará, em 2010 / Commitment in the completion of the medical death certification: evaluation in Belém, Pará, Brazil in 2010

OBJETIVO: Avaliar o preenchimento das declarações de óbito em Belém-PA, registradas no ano de 2010. MÉTODOS: Foram analisadas 800 declarações de óbito de morte não violenta, sorteadas aleatoriamente, referentes ao ano de 2010. Quanto ao correto preenchimento, foram avaliados todos os campos do documento, com exceção dos campos V (Morte fetal ou menor que um ano), I (Destinado aos cartórios) e VIII (Causas externas/Mortes violentas). Cada campo foi analisado seguindo os seguintes parâmetros: preenchidos de maneira incompleta, campos em branco, ilegíveis e preenchimento incorreto. RESULTADOS: A partir dos dados coletados, foram encontrados altíssimos índices de equívocos no preenchimento das certidões; 98,7% delas apresentavam, pelo menos, um erro em seu preenchimento. Entretanto, os mais notáveis e de maior repercussão foram encontrados no campo VI, destinado ao registro da causa de morte, onde, tal erro foi encontrado em 71,5%, principalmente pela utilização de termos vagos no registro. CONCLUSÃO: Os altíssimos índices de declarações de óbito mal preenchidas demonstram uma grande falha por parte dos currículos das escolas médicas, bem como uma carência de projetos de educação médica continuada que abordem tal temática de inestimável importância. Os resultados demonstraram negligência ou desconhecimento da própria fisiopatogenia das doenças por parte dos médicos.

OBJECTIVE: To evaluate the completion of medical certificates of death in Belém, state of Pará, Brazil in 2010. METHODS: In the present study, 800 medical certificates of non-violent death, randomly chosen, and produced in 2010 were analyzed. Regarding correct completion, all fields of the Trabalho document were evaluated, except for fields I (reserved for civil registries), V (stillbirth or death under age of one year), and VIII (external causes/violent death). Each field was analyzed regarding the following parameters: incomplete fields, fields left blank, illegibility, and incorrect completions. RESULTS: Based on the data collected, very high rates of errors in completion were observed; 98.7% of the certificates had at least one mistake. The most remarkable and important mistakes were found in field VI, intended for the cause of death, with a frequency of error of 71.5%, especially due to vagueness. CONCLUSION: The very high rates of poorly completed medical certificates of death highlights a significant failure in the medical schools' curriculum, as well as a lack of continuing medical education programs addressing such topic of paramount importance. The results demonstrated neglect or lack of knowledge on the pathophysiology of diseases by physicians.

Useful Points for Physiatrist When Writing Medical Certificates for Physically Disabled / The Japanese Journal of Rehabilitation Medicine

According to statistics from the Japanese Ministry of Health, Labour and Welfare for the last ten years, the number of people with physically disabled persons' certificates increased from about 4,370,000 in 2001 to more than 5 million in 2008 and reached about 5,110,000 in 2010. The incidence of stroke and various internal diseases are increasing following an increase in lifestyle-related diseases and the development of Japan's rapidly aging society. In this social background, the physiatrist has many chances to write a physically disabled persons' medical certificate during the patients' care-planning. The most important point to consider is to understand the reason why the patient wants to get a physically disabled persons' certificate. Patients have several needs in their care-plan requiring a physically disabled persons' certificate such as financial aid for medical bills and travel expenses, and also for the cost or supply for orthosis, prosthesis and other technical aids for the disabled. The degree of invalidity must correlate with the medical findings and impairment in the medical certificate. For example the medical findings are the grade of paralysis, joint range of motion and muscle weakness, etc. Activities of daily living (ADL) provide the evidence of those findings and the degree of invalidity. The best practice when writing a medical certificate for physically disabled is that there must be no discrepancy between the medical opinion for the degree of invalidity and the medical findings, impairment and ADL of the patients.

Physician Liability and Social Responsibility Related with Medical Certificates / 이화의대지

Medical certificate, post-mortem examination or certificate guarantee their authenticity of the content through the article 233 of the criminal act. The article 233 of the criminal act states that if a medical or oriental medical doctor, dentist or midwife prepare false medical certificate, postmortem examination or certificate life or death, one shall be punished. To constitute the crime of issuance of falsified medical certificates, it is necessary for the contents of the certificate to be substantially contrary to the truth, as well as it is needed the subjective perception that the contents of the certificate are false. On the article 17 of the medical service act, no one may prepare a medical certificate, a report or certificate of postmortem examination to a patient or public prosecutor in a district public prosecutors' office, who conducts a medical service and has given the medical treatment or conducted the postmortem examination by him/herself: Provided that, such certificate or report may be issued for a patient without giving any medical treatment, if the patient has died within 48 hours after his/her last medical treatment, while if the medical doctor, dentist or oriental medical doctors who examined a patient or conducted a postmortem examination of the dead patient is unable to issue such certificate or report due to an inevitable cause or event, any other medical doctor, dentist or oriental medical doctor who works for the same medical institution, may issue such certificate or report based on the medical records of the patient.

Operational Status of Airman Medical Examinations in Korea / 항공우주의학회지

OBJECTIVES: International Civil Aviation Organization (ICAO) strongly supports that AME (Aviation Medical Examiner) system. AMEs are private physicians, trained and authorized by the government to perform airman medical examinations and to issue or deny medical certificates. In Korea, AME system was introduced in 2000. As of December 31, 2006, there were 48 AMEs in Korea. Applications for airman medical certificate which contain the results of the medical examination conducted by an AME, are typically forwarded to the advisory committee of Aerospace Medical Association of Korea. With a increasing demand for air travel, the number of civil airman population has increased, as a result, airman medical examinations have also increased. Although the number of airman medical examinations are increasing, research related to this field is nil. The purpose of this study was to examine the operational status of airman medical examinations in the calendar year 2006. METHODS: The data were based on the total reported applications of airmen medical certificate collected in the Aerospace Medical Association of Korea in the calendar year 2006. And all data were examined according to the three categories, which are fit, waiver, and deny. RESULTS: The total data were 5,713 airman medical examinations which were collected in the calendar year of 2006. This total included 5,292 applications for first class, 162 for second class, and 216 for third class medical certificates. The number of medical certificate issued were 5,010 as fit, 680 as waivers, and 23 as denials. The majority for waivers was consisted of cardiovascular diseases, otorhinolaryngologic and ophthalmologic diseases. Denials were due to phoria, refractive eye surgery, diabetes, and/or coronary artery disease. CONCLUSION: Some of the denials were made because of the failure to submit required subsequent evaluation reports to the advisory committee of Aerospace Medical Association of Korea. The consequence of negligent or wrongful certification which would permit an unqualified person to take the controls of an aircraft. may result in mishap. For proper issuance of airman medical certificate, the establishment of a guidebook for AME is necessary and database of previous medical records is required. Aeromedical standard is an important factor in flight safety. Therefore, in order to update on aeromedical standards in accordance with evidence-based medicine, more aeromedical research is required and its research findings should be reflected in the revision of standards of airman medical examination in the future.

Accuraey of Cancer Death Certificates in KOREA: A comparison between diagnoses in the central cancer registry and certified underlying causes of death / 대한암학회지

PURPOSE: We evaluated the accuracy of death certificates for persons who registered in the Central Cancer Registry in 1993 and died from 1993 to 1995. MATERIALS AND METHODS: The study consisted of 27,058 cases which were classified into five groups. according to the possibility of accuracy of the underlying causes of death. We compared the distribution of five groups according to several demographic factors. Also we calculated the detection rate and the confirmation rate for a selected 23,858 persons reported to die of a cancer. RESULTS: Among the 27,058 deaths, only 64.4% was included in the group which had reported the same cancer site with registry as underlying cause of death. The accuracy decreased with increasing age and was worse for women and rural residence. And physicians certification was an important factor to improve the accuracy. Cancers of stomach, lung, esophagus and breast were included into the high accuracy group, cancers of the colon, rectum and gallbladder and extrahepatic biliary tract into the low accuracy group. Cancers of the colon, pancreas, liver and lung were overreported, varied from 1.2 to 1.4 times, and cervical cancer was severely underreported, about 0.5 times. CONCLUSION: These results suggest that the caution in the use and interpretation of cancer certificate data would be required.

Hospital Stay in 1000 Consecutive Head Injuries

We present a study on hospital stay in 1000 consecutive head injuries. The mean hospital stay and standard deviation were calculated in a given condition according to some variables, such as sex, age, Glasgow Coma Score on admission, skull fracture, CT findings, and treatment. Usually, standard deviation was greater than the mean value in a given condition and hospital stay varied in a wide range, representing that the duration of treatment is related not only to the severity but also various individual properties. Since the associated injuries were variable in location, type and severity, they altered hospital stay greatly. Thus hospital stay was analyzed in patients without associated injuries. Hospital stay was largely dependant on three variables. Low Glasgow Coma Score on admission, presence of intracranial mass lesion or diffuse axonal injury, and operative treatment prolonged hospital stay. Skull fracture also lengthened hospital stay but only in patients without associated injuries. Duration of treatment should be recorded in all medical certificates related to the injury. For the proper estimation of duration of treatment, more reports are needed in this field.

Investigation with a Questionnaire for Diagnosis and Duration of Treatment of Head Injury

Recent advances in diagnosis and therapy for head injury have brought some changes in concepts, definition of the terms, therapeutic methods and the duration of treatment. In medical certificates, the diagnosis and duration of treatment also need to be changed according to the new concepts. Mixed use of the terms according to the classic and the new concepts may cause confusion. We investigated with a questionnaire to assess the acceptability of the new concepts of head injury, and seeked for a plan to avoid possible confusion in medical certificates. We sent questionnaires for diagnosis and duration of treatment of 10 given examples of head injury to 367 neurosurgeons whose addresses could be identified. Questionnaires were answered by 52 neurosurgeons. The diagnosis described in the questionnaires showed wide variability with a range of 10 to 32 different descriptions, on average 16.8 different descriptions for each case. Duration of treatment also revealed great discrepancy. Coefficients of variation for duration of treatment varied from 33.44% to 54.37%. Cerebral contusion was the most commonly used term. It was described in every 10 given examples, and to take an average, 32.3 neurosurgeons used cerebral contusion or each case. To avoid possible confusion in medical certificates, it is necessary to make a guide for medical certificates for head injuries according to the new concepts, and a chance of training of this guide should be provided.