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Van Niekerk Juani - One of the best experts on this subject based on the ideXlab platform.
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Mediese Sertifikate ingevolge die Traditional Health Practitioners Act: Die Kwessie van Geldigheid en Betroubaarheid /Medical Certificates in terms of the Traditional Health Practitioners Act: The Issue of Validity and Reliability
'Academy of Science of South Africa', 2019Co-Authors: Van Niekerk JuaniAbstract:Abstract On 1 May 2014, various provisions of the Traditional Health Practitioners Act 22 of 2007, came into effect. This resulted in the establishment of the Interim Council for Traditional Health Practitioners with the accompanying requirement that traditional healers must register with the council in order to practice lawfully in South Africa. Due to this development, a registered traditional healer is now included in the provisions of section 23 of the Basic Conditions of Employment Act 75 of 1997 for the purposes of issuing a valid Medical Certificate. Section 23(2) of the Basic Conditions of Employment Act states that a valid Medical Certificate for the purposes of sick leave must be issued and signed by a Medical practitioner or any other person registered with a professional council and qualified to diagnose and treat patients. This stipulation raises several issues in relation to traditional healers. The requirement is that the person concerned must be qualified to diagnose and treat a person, but whether traditional healers qualify in this context is a bone of contention. It seems that the statutory provisions on the standards of training and the qualifications required for purposes of registration in terms of the Traditional Health Practitioners Act are lacking. This creates doubt about whether only fully-fledged traditional healers are registered in terms of the Traditional Health Practitioners Act and whether a registered traditional healer is competent to make a reliable diagnosis for purposes of sick leave. This means that employers remain uncertain about the reliability of a traditional healer's diagnosis and the incapacity of the employee. Uittreksel Op 1 Mei 2014 het 'n aantal bepalings van die Traditional Health Practitioners Act 22 van 2007 in werking getree. Die gevolg hiervan was die vestiging van die interim Raad vir tradisionele geneeshere en die nuwe vereiste dat tradisionele geneeshere nou by die interim Raad geregistreer moet wees ten einde wettiglik in Suid-Afrika te kan praktiseer. Weens hierdie nuwe vereiste sal 'n geregistreerde tradisionele geneesheer nou by artikel 23 van die Wet op Basiese Diensvoorwaardes 75 van 1997 vir doeleindes van die uitreiking van 'n geldige mediese sertifikaat, ingesluit word. In hierdie opsig bepaal artikel 23(2) van die Wet op Basiese Diensvoorwaardes dat 'n geldige mediese sertifikaat vir doeleindes van siekteverlof uitgereik en onderteken moet word deur 'n mediese praktisyn of 'n ander persoon wat by 'n beroepsraad geregistreer is en wat gekwalifiseer is om pasiënte te diagnoseer en te behandel. Hier kom die kwessie van tradisionele geneeshere sterk na vore. Die vereiste is dat die betrokke persoon gekwalifiseerd moet wees om 'n persoon te kan diagnoseer en te behandel, maar die kwalifikasie van tradisionele geneeshere in hierdie konteks is juis problematies. Dit blyk dat die statutêre bepalings aangaande standaarde van opleiding en kwalifikasies wat vir doeleindes van registrasie ingevolge die Traditional Health Practitioners Act verlang sal word, leemtes toon. Dit word betwyfel of tradisionele geneeshere wat ingevolge die Traditional Health Practitioners Act geregistreer word, bekwaam genoeg is om 'n betroubare diagnose vir doeleindes van siekteverlof te maak. Dit kan derhalwe vir werkgewers moeilik wees om sekerheid oor die betroubaarheid van 'n tradisionele geneesheer se diagnose en die ongeskiktheid van die werknemer te hê.
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Mediese Sertifikate ingevolge die Traditional Health Practitioners Act: Die Kwessie van Geldigheid en Betroubaarheid
'Academy of Science of South Africa', 2019Co-Authors: Van Niekerk JuaniAbstract:On 1 May 2014, various provisions of the Traditional Health Practitioners Act22 of 2007, came into effect. This resulted in the establishment of the Interim Council for Traditional Health Practitioners with the accompanying requirement that traditional healers must register with the council in order to practice lawfully in South Africa. Due to this development, a registered traditional healer is now included in the provisions of section 23 of the Basic Conditions of Employment Act 75 of 1997 for the purposes of issuing a valid Medical Certificate. Section 23(2) of the Basic Conditions of Employment Act states that a valid Medical Certificate for the purposes of sick leave must be issued and signed by a Medical practitioner or any other person registered with a professional council and qualified to diagnose and treat patients. This stipulation raises several issues in relation to traditional healers. The requirement is that the person concerned must be qualified to diagnose and treat a person, but whether traditional healers qualify in this context is a bone of contention. It seems that the statutory provisions on the standards of training and the qualifications required for purposes of registration in terms of the Traditional Health Practitioners Actare lacking. This creates doubt about whether only fully-fledgedtraditional healers are registered in terms of the Traditional Health Practitioners Act and whether a registered traditional healer is competent to make a reliable diagnosis for purposes of sick leave. This means that employers remain uncertain about the reliability of a traditional healer's diagnosis and the incapacity of the employee
Alexander E. P. Heazell - One of the best experts on this subject based on the ideXlab platform.
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Persistent inaccuracies in completion of Medical Certificates of stillbirth: A cross-sectional study.
Paediatric and perinatal epidemiology, 2018Co-Authors: Lucy Higgins, Alexander E. P. Heazell, Melissa WhitworthAbstract:BACKGROUND The UK Medical Certificate of Stillbirth (MCS) records information relevant to the cause of stillbirth of infants ≥24 weeks' gestation. A cross-sectional audit demonstrated widespread inaccuracies in MCS completion in 2009 in North West England. A repeat study was conducted to assess whether practice had improved following introduction of a regional care pathway. METHODS 266 MCS issued in 14 North West England obstetric units during 2015 were studied retrospectively. Cause of death was assigned following review of information available at the time of MCS completion. This was compared to that documented on the MCS, and to data from 2009. RESULTS Twenty-three Certificates were excluded (20 inadequate data, 3 late miscarriages). 118/243 (49%) MCS contained major errors. Agreement between the MCS and adjudicated cause of stillbirth was fair (Kappa 0.31; 95% CI 0.24, 0.38) and unchanged from 2009 (0.29). In 2015, excluding 34 terminations of pregnancy, the proportion of MCSs documenting "unexplained" stillbirths (113/211; 54%) was reduced compared to 2009 (158/213; 74%); causality could be assigned after case note review in 78% cases. Recognition of fetal growth restriction (FGR) as a cause of stillbirth improved (2015: 30/211; 14% vs 2009: 1/213; 0.5%), although 71% cases were missed. 47% MCSs following termination of pregnancy documented an iatrogenic primary cause of death. CONCLUSIONS Completion of MCSs remains inaccurate, particularly in recognition of FGR as a cause of stillbirth. Detailed case note review before issuing the MCS could dramatically improve the usefulness of included information; evaluation of practitioner education programmes/internal feedback systems are recommended.
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Do Medical Certificates of stillbirth provide accurate and useful information regarding the cause of death
Paediatric and perinatal epidemiology, 2011Co-Authors: Ruth Cockerill, Melissa Whitworth, Alexander E. P. HeazellAbstract:Stillbirth affects one in 200 pregnancies in the UK. Understanding the causes of stillbirth is essential to reducing perinatal mortality. Stillbirth Certificates represent a potential source of data on perinatal mortality. We aimed to assess whether the information on stillbirth Certificates used in the UK is accurate. A retrospective cross-sectional audit of stillbirth Certificates issued in a geographical region of the UK in 2009 was undertaken. Data were recorded from the stillbirth Certificate and health records. The cause of death was classified using the ReCoDe system. Two hundred and thirteen stillbirth Certificates were issued for stillbirths (feticides for fetal anomaly were excluded). Agreement for the primary factor associated with the stillbirth was fair (Kappa = 0.286). This contrasts with the gestation of stillbirth, which was almost complete agreement (Kappa = 0.883). The majority of stillbirths (58.7%) were classified on the Certificate as 'unknown cause'. A proportion of 9.4% of stillbirths were classified as congenital anomaly and 8.0% as placental abruption. Only 0.5% of stillbirth Certificates cited fetal growth restriction as a relevant condition contributing to death. A total of 49.6% of 'unexplained' stillbirths were associated with fetal growth restriction on review. Errors were present in 77.9% of Certificates, including missing co-morbidities (55.9%) and the wrong cause of death (40.4%). The cause(s) of death is (are) not recorded accurately on the UK Medical Certificate of stillbirth, and the majority of Certificates contain one or more errors. Training is required to improve understanding of the causes of stillbirth and completion of Medical Certificates. Data recorded directly from Medical Certificate of stillbirths are not sufficiently reliable for descriptive studies of causation and epidemiology.
John Ryan - One of the best experts on this subject based on the ideXlab platform.
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it is important to record obesity on the Medical Certificate of cause of death mccd
Pathology, 2014Co-Authors: Claire Buckley, Donal O Shea, John RyanAbstract:Recent data shows that 37% of the Irish adult population are overweight (body mass index, BMI 25–29.9) and a further 24% are obese (BMI>30). From 2007-2012 an average of 28,339 people died per annum in Ireland, yet obesity featured in the MCCD an average of only 84 times per annum. We examined figures from our autopsy service: in 200 cases where the BMI was recorded 22.5% were >30, but this was recorded in the MCCD in a minority of cases as a contributing factor to the death. All postmortem rooms in Ireland were surveyed on the ability to assess BMI at autopsy. The MCCD is an important source of information for national health statistics. We conclude that the omission of obesity on the MCCD is due to a combination of factors including fear of offending the family of the deceased, lack of knowledge on conditions associated with an elevated BMI and lack of education on the importance of recording BMI across all levels of the healthcare system. We suggest modifications to the MCCD to allow appropriate recording of risk factors for disease.
Melissa Whitworth - One of the best experts on this subject based on the ideXlab platform.
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Persistent inaccuracies in completion of Medical Certificates of stillbirth: A cross-sectional study.
Paediatric and perinatal epidemiology, 2018Co-Authors: Lucy Higgins, Alexander E. P. Heazell, Melissa WhitworthAbstract:BACKGROUND The UK Medical Certificate of Stillbirth (MCS) records information relevant to the cause of stillbirth of infants ≥24 weeks' gestation. A cross-sectional audit demonstrated widespread inaccuracies in MCS completion in 2009 in North West England. A repeat study was conducted to assess whether practice had improved following introduction of a regional care pathway. METHODS 266 MCS issued in 14 North West England obstetric units during 2015 were studied retrospectively. Cause of death was assigned following review of information available at the time of MCS completion. This was compared to that documented on the MCS, and to data from 2009. RESULTS Twenty-three Certificates were excluded (20 inadequate data, 3 late miscarriages). 118/243 (49%) MCS contained major errors. Agreement between the MCS and adjudicated cause of stillbirth was fair (Kappa 0.31; 95% CI 0.24, 0.38) and unchanged from 2009 (0.29). In 2015, excluding 34 terminations of pregnancy, the proportion of MCSs documenting "unexplained" stillbirths (113/211; 54%) was reduced compared to 2009 (158/213; 74%); causality could be assigned after case note review in 78% cases. Recognition of fetal growth restriction (FGR) as a cause of stillbirth improved (2015: 30/211; 14% vs 2009: 1/213; 0.5%), although 71% cases were missed. 47% MCSs following termination of pregnancy documented an iatrogenic primary cause of death. CONCLUSIONS Completion of MCSs remains inaccurate, particularly in recognition of FGR as a cause of stillbirth. Detailed case note review before issuing the MCS could dramatically improve the usefulness of included information; evaluation of practitioner education programmes/internal feedback systems are recommended.
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Do Medical Certificates of stillbirth provide accurate and useful information regarding the cause of death
Paediatric and perinatal epidemiology, 2011Co-Authors: Ruth Cockerill, Melissa Whitworth, Alexander E. P. HeazellAbstract:Stillbirth affects one in 200 pregnancies in the UK. Understanding the causes of stillbirth is essential to reducing perinatal mortality. Stillbirth Certificates represent a potential source of data on perinatal mortality. We aimed to assess whether the information on stillbirth Certificates used in the UK is accurate. A retrospective cross-sectional audit of stillbirth Certificates issued in a geographical region of the UK in 2009 was undertaken. Data were recorded from the stillbirth Certificate and health records. The cause of death was classified using the ReCoDe system. Two hundred and thirteen stillbirth Certificates were issued for stillbirths (feticides for fetal anomaly were excluded). Agreement for the primary factor associated with the stillbirth was fair (Kappa = 0.286). This contrasts with the gestation of stillbirth, which was almost complete agreement (Kappa = 0.883). The majority of stillbirths (58.7%) were classified on the Certificate as 'unknown cause'. A proportion of 9.4% of stillbirths were classified as congenital anomaly and 8.0% as placental abruption. Only 0.5% of stillbirth Certificates cited fetal growth restriction as a relevant condition contributing to death. A total of 49.6% of 'unexplained' stillbirths were associated with fetal growth restriction on review. Errors were present in 77.9% of Certificates, including missing co-morbidities (55.9%) and the wrong cause of death (40.4%). The cause(s) of death is (are) not recorded accurately on the UK Medical Certificate of stillbirth, and the majority of Certificates contain one or more errors. Training is required to improve understanding of the causes of stillbirth and completion of Medical Certificates. Data recorded directly from Medical Certificate of stillbirths are not sufficiently reliable for descriptive studies of causation and epidemiology.
Deirdre Mclaughlin - One of the best experts on this subject based on the ideXlab platform.
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Improving Medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative
BMC medicine, 2020Co-Authors: John D. Hart, H. R. Chowdhury, Renee Sorchik, Saman Gamage, Rohina Joshi, Viola Kwa, Buddhika Mahesh, Deirdre MclaughlinAbstract:Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the Medical Certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification. The three training strategies evaluated were (1) training of trainers (TOT) in the Philippines, Myanmar, and Sri Lanka; (2) direct training of physicians by the UoM D4H in Papua New Guinea (PNG); and (3) the implementation of an online and basic training strategy in Peru. The evaluation involved an assessment of MCCODs before and after training using an assessment tool developed by the University of Melbourne. The TOT strategy led to reductions in incorrectly completed Certificates of between 28% in Sri Lanka and 40% in the Philippines. Following direct training of physicians in PNG, the reduction in incorrectly completed Certificates was 30%. In Peru, the reduction in incorrect Certificates was 30% after implementation and training on an online system only and 43% after training on both the online system and basic Medical certification principles. The results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.