Workplace violence: preventive and interventive strategies.

Violence is pervasive in the workplace. Homicides are a major cause of death among workers, but their impact and cost are considerably outweighed by the prevalence of near-misses, physical assaults, abusive behavior, and threats of violence, much of which remains unreported and unrecognized. Violence is not just a criminal justice problem nor just one involving aberrant behavior attributable to alcohol, drugs, or mental illness. It is often predictable and preventable. This article describes a plan for a coordinated effort by employers, workers, occupational health professionals, and other relevant specialists to develop and implement a coherent set of strategies for prevention and intervention.

Accuracy of death certificate completion: the need for formalized physician training.

OBJECTIVE: To assess the extent to which accuracy of death certificate completion varies with level of physician training and experience. DESIGN AND SETTING: In a classroom setting, subjects were presented with six written cases of hospital deaths adapted from materials from the National Center for Health Statistics and were asked to complete the cause-of-death section of the New York City death certificate. PARTICIPANTS: A total of 12 practicing general internists, 21 internal medicine residents, and 35 senior medical students. OUTCOME MEASURES: The underlying cause of death recorded by each participant was compared with the correct cause determined by a nosologist. Agreement and disagreement were classified as major or minor depending on concordance within the 17 International Classification of Diseases categories. RESULTS: Only one internist and five residents had received formal training in death certificate completion. The overall level of agreement between underlying cause of death reported by the three groups of participants and the correct cause was 56.9% for internists, 56.0% for residents, and 55.7% for medical students, although agreement varied with the type of case, ranging from 15% to 99%. CONCLUSION: If the misclassification observed in this pilot study were widespread, it would imply a substantial underreporting of mortality from both circulatory diseases and diabetes. These data strongly support the need to include training in death certificate completion as part of physician education.