The knowledge assessment and reducing the errors of medical certificate of cause of death with sensitization training of physicians: A quality improvement intervention study.

BACKGROUND: A Medical Certificate of Cause of Death (MCCD) is a vital document issued by a doctor and has a prescribed format published by the World Health Organization. It is an essential tool to obtain scientific and reliable information in terms of the cause of mortality. The aim of this study is to assess the knowledge about MCCD and to evaluate the impact of sensitization training on the MCCD among the physicians working in the trauma and emergency department in a Tertiary Care Centre. MATERIALS AND METHODS: A quasi-experimental quality improvement hospital-based study executed in Trauma and Emergency Department of Tertiary Care Hospital in Chhattisgarh State, India. The physicians posted in the Trauma and Emergency Department were participated in the study and attended the sensitization training session on MCCD. Statistical analysis used; the data were entered in Microsoft Excel and analyzed with SPSS version 20 statistical software. Mean scores and standard deviation (SD) were used for pre and posttest data while statistical significance was tested using the paired t-test. P < 0.05 was considered as significant. The technical and medical errors in MCCD forms were depicted in percentages. RESULTS: A total of 54 physicians completed the study, including 42 junior resident doctors, 6 senior resident doctors, and 6 faculties. There was a significant difference in the scores before (M = 4.39, SD = 1.571) and after (M = 7.5, SD = 0.885) the training (t = 17.6, P < 0.0001). The participants showed substantial improvement by reduction in technical errors from 28% to 14% while the medical error also slashed down from 42% to 16%. CONCLUSIONS: Sensitization and educational training should be carried out consistently on regular intervals to improve the knowledge of physicians regarding the appropriate filling of MCCD and minimize the errors in MCCD, ultimately this will enhance usability and comparability of mortality statistics generated from International Classification of Diseases data.

Forensic nursing - Global scenario and Indian perspective.

Sexual violence is a significant cause of physical and psychological harm and suffering for women and children. Although sexual violence mostly affects women and girls, boys are also subject to child sexual abuse. Nurse is the person who attends the victim first. In order to meet the rigid and ever-changing demands of providing care to the victim and complying with our confusing system of laws, the nursing should has been forced to expand into a Forensic nursing, specialty of its own. Nursing roles in the criminal justice service known by many names worldwide-Custody nursing, Prison/Correctional nursing, Immigration centre nursing, Sexual Assault Nurse Examiner (SANE) or Sexual Assault Forensic Examiner (SAFE), SARTs (Sexual assault response team), SARCs (Sexual assault referral centre) and FNDIs (Forensic nurse death investigator). In India the premier institutes like AIIMS New Delhi and The PGI Chandigarh, do not have forensic content in their nursing curriculum manuals. The WHO and IAFN have urged inclusion of forensic content in both undergraduate and postgraduate nursing programs. Forensic Nurse Specialist can provide direct services to individual clients, consultation services to nursing, medical and law-related agencies, as well as providing expert court testimony in areas dealing with trauma and/or questioned death investigative processes, adequacy of services delivered, and specialized diagnoses of specific medical conditions. Research Findings on the Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs suggests various improvements in each and every step in care of victim of sexual assault.

Paraphenylenediamine Containing Hair Dye: An Emerging Household Poisoning.

Paraphenylenediamine poisoning is among one of the emerging causes of poisoning in Asian countries, because it is a constituent of hair dye formulations and is easily available in market at low cost. Hair dyes are rampantly used in Asian households compared with the western world. Locally, hair dye constituents may have allergic adverse effects, and acute systemic poisoning presents with characteristic angioedema, upper airway obstruction, rhabdomyolysis, methemoglobinemia, myoglobinuria, and acute renal failure. This study reports about the death of a 24-year-old Indian housewife who committed suicide by taking hair dye emulsion. She had an argument with her husband, and because of fit of rage, took a bowlful (80 mL) of hair dye emulsion kept prepared for the use by husband. She developed angioedema, cervical swelling, and rhabdomyolysis and died of acute renal failure within 24 hours. Toxicological analysis of viscera and blood revealed varying levels of paraphenylenediamine. Histopathological samples of kidney showed features of acute tubular necrosis and myoglobin casts in renal tubules. The aim of the study is to create awareness about the adverse effects of the hair dye, its poisoning outcome, and possible preventive measures.

Accuracy in certification of cause of death in a tertiary care hospital--a retrospective analysis.

Every physician is duty bound to issue a "Cause of Death" certificate in the unfortunate event death of his/her patient. Incomplete and inaccurate entry in these certificates poses difficulty in obtaining reliable information pertaining to causes of mortality, leads to faulty public health surveillance, and causes hindrance in research. This study intends to evaluate the completeness and accuracy of Medical Certification of Cause of Death in our Institute and to formulate strategy to improve the quality of reporting of cause of death. During the period from January 2012 to December 2012, a total of 151 certificates of cause of death were issued by the faculty members of various departments. Maximum number of death certificates were issued for patients in the extremes of the age <10 years (n = 42, 27.82%) and in >60 years (n = 46, 30.46%). The various inadequacies observed by us are as follows: 40 (26.49%) cases had inaccurate cause of death, interval between onset and terminal event was missing in 94 (62.25%) cases, in 68 (45.03%)cases the seal with registration number of the physician was not available on the certificate, incomplete antecedent & underlying cause of death was found in 35 (23.18%) & 84 (55.63%) cases, in 66 (43.71%) cases there was use of abbreviations and the handwriting was illegible in 79(52.32%) cases.

Organophosphorus poisoning: victim specific analysis of mortality and morbidity.

The aim of this study was to evaluate the pattern of acute organophosphorous (OP) poisoning cases including death, duration of hospitalization and time lapse before arrival at hospital. All OP poisoning cases admitted to the Emergency Department of MKCG Medical College Hospital and other fatal cases received at the mortuary between September 1999 and August 2001 were prospectively studied. Males outnumbered females and most OP poisoning occurred in the 21-30 year age group. In 68 (97.1%) cases the motive was suicide and more than 80% were from rural areas. Nearly one-third of cases occurred during the summer and in the later part of the day. Married females and unmarried males were most frequently affected. Most of the married females were housewives and the males were students or farmers. Fifty-four per cent of cases were admitted for treatment within three hours with a mean time lapse of 6.2 hours. The mean hospital stay for all OP poisoning cases was 5.1 days. Twenty-nine out of 66 admitted OP poisoning cases were fatal. There is a high incidence of OP poisoning with mortality in the region. OP compounds are readily available at low cost in the market. A time of stress and frustration can lead to their use as a common poison with which to commit suicide.

Self-defense injuries in homicidal deaths.

In order to determine specific patterns and distribution of defense wounds, this study was done on 162 homicidal deaths which showed defense wounds in 54 (33.3%) cases. Of these 54 victims, 85.2% were males and 14.8% were females. Maximum numbers of victims were in the age group of 21-40 years. In 68.5% of cases more than one assailant were involved. It was found that in 57.4% cases, sharp weapons were used, whereas, in 11.1% and 31.5% of victims, blunt weapons and multiple weapons, respectively, were used. Fatal wounds were seen most commonly on the head and neck region. In 40.7% of cases defense wounds were seen on left side only whereas in 37% cases both sides were involved. Victim's left forearm and hand were more commonly involved because these are nearest to the perpetrator and consistent with the preponderance of right handed individuals in the population.