Medical Certification Research Articles

Corpse or not? Two peculiar cases of misidentification.

Irrespective of whether they are intended for collectors or for the fetish market, dolls are being produced to look more and more realistic with such a degree of life-like detail that they can be mistaken for a real person. This paper reports two cases of misidentification due to this increasing similarity: In the first case, a sex doll was mistaken for a corpse; in the second case, a corpse was mistaken for a doll. While in the latter case, only medical laypersons were at the discovery site, in the first case, an emergency doctor had issued a medical certificate of death for the purported corpse. The medicolegal examiner who was subsequently called to the scene could still rectify the misconception on-site. Mistakes of this nature are likely rare phenomena. It, however, remains to be seen if the increasingly life-like appearance of dolls on the one hand, and the increasingly doll-like appearance of some people, e.g., through cosmetic surgery, will lead to a rise in such cases. To avoid misidentification as in the first reported case, it is essential to prepare medical students well for the task of performing a primary external postmortem examination; it is equally important that fully-trained doctors regularly refresh their expertise in this respect.

REVIEW OF COMPLETENESS OF DEATH CERTIFICATE FILLING AT BANTEN

Background: Filling in the Death Certificate at RSU Banten is the part that gets attention in this study. The Death Certificate form was found to be incomplete in patient identification, completeness of important reports, author authentication and good records. The Medical Certificate of Cause of Death (SMPK) is the main source of mortality data. Death information is usually obtained from health practitioners or in cases of death due to accidents, violence and other diseases. Based on a preliminary study in March 2020 at Banten General Hospital, it was found that out of 20 death certificate forms there were 10 incomplete death certificate forms, including the incomplete identification component of 7.75 (39%) such as in the death serial number section, the main number population and population number. 9 (45%) important report components were incomplete, such as the type of examination, ICD code, method and location of burial. The incomplete authentication component of 10 (50%) is as in the reporting signature and reporting name. An incomplete record component of 6.6 (35%) is like a lot of blanks. The purpose of the study was to find out the Completeness of Filling in Death Certificates at RSU Banten and the results of this study were expected to be useful for hospitals as input and consideration in addressing the issue of completeness of medical certificates causing death. and the approach used in this research is to use a comparative approach, namely through a checklist and interviews at RSU Banten. The research method used is quantitative research. The population in January- February 2020 was 233 death certificate forms at RSU Banten, while the subject population was 12 officers who were responsible for completing death certificates. The sample object taken for this research is a Death Certificate form as many as 77 samples. While the sample of subjects in this study were 2 officers who filled out death certificates. Sampling Technique Subjects in this study used non-random (non-probability sampling) with purposive sampling. The results showed that the SOP (Standard Operating Procedure) already exists and is complete which regulates the Filling of Death Certificates at RSU Banten in the installation section of the funeral procession (IPJ), but it is still not fully implemented because there are still many incomplete forms, from the 5 SOP items it is known that those who are complete with SOP guidelines are (100%) while those that are incomplete with SOP guidelines are (0%). The results of completeness in patient identification with a complete percentage are found in the sub-components of medical record numbers and names, which are 77 (100%), while the incomplete percentages are found in the sub-components of death serial number, population identification number and population identification number, which is 77 (100% , Important reports on death certificates that are filled out completely are found in the time of death sub-component, which is 77 (100%), while the completeness of filling out important reports that are incomplete on the death serial number is 77 (100%).Authentication Author on death certificates which is filled in completely is contained in the sub-components of the doctor's TTD sign and the doctor's name, which is 77 (100%), while the incomplete completeness of author authentication on the reporting blood pressure, the name of the reporter, the identity card number of the reporting person, the address of the reporter is 77 (100%). Both the death certificate that is filled in completely, there are sub-components, there are no scribbles and there is no type - ex, which is 77 (100%). while the completeness of incomplete filling on a good record is found in the sub-components, there are no empty parts, namely 77 (100%). Data collection was carried out by survey, namely the researcher conducted direct interviews with respondents using a questionnaire. The research results obtained the following data; There were97 toddlers who had pneumonia or 26.5%, almost all of them 94.5% of mothers had good knowledge about pneumonia, 46.7% of mothers had sufficient behavior and 49.5% of mothers had sufficient attitudes and more than half of them 70.2% of mothers had not been exposed to information about pneumonia. The Bivariate results found that attitude and information exposure had a significant relationship with the incidence of pneumonia, while behavior and knowledge had no significant relationship with the incidence of pneumonia among toddlers in the city of Cilegon. From the results of this study, it is hoped that the Cilegon City Health Office can increase socialization and counseling about pneumonia through cooperation with related agencies so that it can improve the degree of public health.

Trends in mortality related to venous thromboembolism in the European Union, 2012-2020.

We sought to assess the sex- and age-specific trends in venous thromboembolism (VTE) mortality in the 27 European Union Member States (EU-27) between years 2012 and 2020. Data on cause-specific deaths and population numbers by sex for each country of the EU-27 were retrieved through the publicly available European Statistical Office (EUROSTAT) dataset for the years 2012-2020. VTE-related deaths were ascertained when ICD-10 codes I26, I80, and I82.9 were listed as the primary cause of death in the medical death certificate. To calculate annual trends, we assessed the average annual percent change (AAPC) with relative 95% confidence intervals (CIs) using Joinpoint regression. During the study period, 96,037 (55,278 males and 40,759 females) died for VTE. The age-adjusted mortality rate (AAMR) linearly declined from 2.86 (95% CI 2.84-2.90) deaths per 100,000 individuals in 2012 to 2.53 (95% CI 2.50-2.56) deaths per 100,000 population in 2020 [AAPC: - 2.1% (95% CI - 3.6 to - 0.6), p = 0.001] without differences between sexes (p = 0.60). The higher AAMR was observed in some eastern European countries such as Bulgaria, Czech Republic, and Lithuania. On the contrary, the lower AAMR was mainly clustered in the Mediterranean area (Italy, Spain, and Cyprus). Over the last decade, the age-adjusted VTE-related mortality has been continuously declining in most of the in EU-27 Member States. However, some disparities still exist between western and eastern European countries.

Utilizing Linear Logistic Test Models to Explore Item Characteristics of Medical Subspecialty Certification Examinations

ABSTRACT Linear logistic test models (LLTMs), leveraging item response theory and linear regression, offer an elegant method for learning about item characteristics in complex content areas. This study used LLTMs to model single-best-answer, multiple-choice-question response data from two medical subspecialty certification examinations in multiple years and found that word count, proportion of complex words, number of options (3- vs. 4-option), whether including an image, nature of the question task (identifying risks, diagnostic test, management), and whether including application context significantly predicted item difficulty in one or both of the Critical Care Medicine and Pediatric Anesthesiology exams. The differences in the item characteristics that were significant predictors of item difficulty and their associated coefficient estimates between the two exams suggest possible domain differences. This study highlights the possibilities and challenges of using LLTMs to identify item characteristics for complex assessments. The results may help inform or expedite item writing and reviewing processes.

Variability in Alzheimer's disease mortality from European vital statistics, 2012-2020.

Data regarding the trends in Alzheimer's disease (AD) mortality in the modern European Union (EU-27) member states are lacking. We assess the sex- and age-specific trends in AD mortality in the EU-27 member states between years 2012 and 2020. Data on cause-specific deaths and population numbers by sex for each country of the EU-27 were retrieved through publicly available European Statistical Office (EUROSTAT) dataset from 2012 to 2020. AD-related deaths were ascertained when the ICD-10 code G30 was listed as the primary cause of death in the medical death certificate. To calculate annual trends, we assessed the average annual percent change (AAPC) with relative 95% confidence intervals (CIs) using Joinpoint regression. During the study period, 751,493 deaths (1.7%, 233,271 males and 518,222 females) occurred in the EU-27 because of AD. Trends in the proportion of AD-related deaths per 1000 total deaths slightly increased from 16.8% to 17.5% (p for trend <0.001). The age-adjusted mortality rate was higher in women over the entire study period. Joinpoint regression analysis revealed a stagnation in age-adjusted AD-related mortality from 2012 to 2020 among EU-27 Member States (AAMR: -0.1% [95% CI: -1.8-1.79], p=0.94). Stratification by Country showed relevant regional disparities, especially in the Northern and Eastern EU-27 member states. Over the last decade, the age-adjusted AD-related mortality rate has plateaued in EU-27. Important disparities still exist between Western and Eastern European countries.

The Global Burden of Alcohol-associated Cirrhosis and Cancer in Young and Middle-aged Adults

Alcohol is a substance that impacts premature mortality and morbidity.1 The liver is invariably subjected to the impact of alcohol, which can result in cirrhosis and cancer. Alcohol also has detrimental effects that extend beyond the liver. While traditionally associated with advanced age, emerging data reported a rising burden of cancers and alcohol-associated liver disease in the young.1-3 Thus, the primary objective was to evaluate the trend of alcohol-associated cirrhosis and cancer in young and middle-aged adults (aged 15-49) utilizing the Global Burden of Disease Study (GBD) 2019.4 We chose the age group less than 50 years old based on the definition of early-onset cancer and the inherent selection of the age group in the GBD database.4-6 The detailed methods are provided in the Supplementary Appendix. Briefly, data were sourced from population-based cancer registries, vital registration systems, or verbal autopsy studies. Verbal autopsy is a well-established approach for monitoring health, providing valuable information on mortality patterns and the reasons behind deaths in areas lacking robust medical death certification processes. The researchers employed the Cause of Death Ensemble model to estimate the burden linked to cancer and cirrhosis associated with alcohol use.

Личные дела китайских подданных: из истории трудовой миграции на Северо-Западе России в годы Первой мировой войны

The article presents for the first time an overview of the personal files of one of the funds of the National Archive of the Republic of Karelia. For the first time, biographical documents were introduced into scientific circulation, which formed the basis for completing the personal files of employees of the Murmansk Railway (admission lists, medical certificates, form lists, applications for employment). The content of documents of personal files of labor migrants from China during the First World War is analyzed. The information potential of archival documents for the development of the historical and biographical method is revealed and shown.

Impact of an Educational Measure on the Quality of Medical Certificate of Cause of Death at a Tertiary Care Teaching Hospital: A Pre-post Interventional Study.

Background A death certificate is an important document that serves as a tool for gathering epidemiological data and as an essential legal document. Although it is a mandatory document to be given for all deaths, the quality of its filling is often an ignored aspect and errors are frequently encountered. This documentation process can be mastered with minimal educational efforts. This study aimed to determine the utility of an educational measurein improving the accuracy of death certificate documentation. Methods and materials This pre- and post-interventional study was conducted at Maharaja Agrasen Medical College, Agroha, a tertiary care teaching hospital in Hisar, Haryana, India, wherein an audit of death certificates was done before and after an educational intervention on doctors responsible for filling death certificates. Errors in the death certificates were classified into major and minor errors and compared in the pre- and post-intervention groups. Results A total of 184 pre-intervention and 136 post-intervention death certificates were audited. In the pre-intervention certificates, at least one major and one minor error were present in 88% and 92.93% of the certificates, respectively, which was reduced to 33% (p < 0.01; relative risk (RR) = 3.62; 95% confidence interval (CI) = 2.69-4.91) and 38% (p < 0.01; RR = 3.33; 95% CI = 2.53-4.37), respectively, post-intervention. Reduction in all types of major and minor errors was statistically significant (p < 0.05). Conclusions Errors in death certification are a common but frequently ignored problem that can have a negative impact on epidemiological data and can be drastically reduced with simple educational measures, which need to be carried out regularly.

Outcome of the Compensation Process Initiated by an Occupational and Environmental Diseases Center.

Regional Centers for Occupational and Environmental Pathologies (CRPPE) are responsible for identifying possible occupational etiologies of pathologies. When an occupational origin is determined, an Initial Medical Certificate (IMC) is given to the patient to allow him to initiate a procedure for recognition as an occupational disease (OD) by his health insurance organization. The main aim of this study was to investigate the outcome of occupational disease claims in patients who received an IMC delivered by the CRPPE of Lyon. A telephone interview was systematically conducted with patients who consulted the CRPPE for a claim for occupational disease recognition between 07/2020 and 06/2021, about six months after the consultation. It was conducted by a physician using a standardized questionnaire. Out of 128 patients eligible for this study, 98 were included. Diseases of the respiratory system (34.7%) and cancers (28.6%) were the most common pathologies in our population. A process of OD compensation was initiated by 86 patients (87.8%). At the time of the study, the outcome was favorable for 63 patients (73.3%). Moreover, 18 patients (18.4%) wished for additional help from the CRPPE to carry out the procedures. Nine patients requested a new consultation, including five who still needed to complete the process. This study shows the benefit of a consultation by occupational disease consultants. However, difficulties still need to be solved in these procedures. Thus, the systematic follow-up of patients shows its advantages. The provision of support to carry out the process seems necessary.

A Three-Year Investigation on Corpses Referred to Legal Medicine Organization from An Iranian General Hospital: A Cross-Sectional Study.

A Medical Certificate of Cause of Death (MCCD) is a legal and enforceable document issued by the attending physician. However, according to the instructions, in many cases such as sudden, unexplained, and extraordinary deaths, along with some uncommon causes, such as cases suspicious of murder, the deceased patient must be referred to the Iranian Legal Medicine Organization (ILMO). Moreover, the unnecessary referral of corpses to ILMO can increase the workload of the staff, finally confronting the family of the deceased with high emotional and financial costs. In this cross-sectional study, the medical records of all deceased patients referred from Hazrat Rasool Hospital to the ILMO (565 cases) in a three-year period from April 2016 to March 2019 were investigated and analyzed using SPSS22 software with chi-squared and T-test. Among all the patients who passed away during this time (4,239 patients), 565 were referred to ILMO, accounting for 13.3% of deaths. The most common causes of referral were car and motorcycle accidents, with a total prevalence of 27.1%, dead-on-arrival (DOA) prevalence of 21.3%, and death with an unknown cause prevalence of 15.3%. Significant correlation was also detected between causes of referral with gender, time of death, and age. For example, Car accidents and lawsuits against medical staff were more common in men and women, respectively. Car and motorcycle accidents, DOA, and unknown causes were the most prevalent causes of referral in this study. In general, few studies have been conducted regarding the causes of referral of the deceased to the Legal Medicine Organization. In this study, we collected relevant variables to investigate this issue thoroughly.

Soviet vacation is a getaway to communism (a medical certificate is necessary!): a review of Thanks to the party: vacation, travel and the soviet dream, by D. Koenker

Soviet vacation is a getaway to communism (a medical certificate is necessary!): a review of Thanks to the party: vacation, travel and the soviet dream, by D. Koenker

Trends in atrial fibrillation-related mortality in Europe, 2008-2019.

Update data regarding the atrial fibrillation (AF)-related mortality trend in Europe remain scant. We assess the age- and sex-specific trends in AF-related mortality in the European states between the years 2008 and 2019. Data on cause-specific deaths and population numbers by sex for European countries were retrieved through the publicly available World Health Organization mortality dataset for the years 2008-2019. Atrial fibrillation-related deaths were ascertained when the International Classification of Diseases, 10th Revision code I48 was listed as the underlying cause of death in the medical death certificate. To calculate annual trends, we assessed the average annual % change (AAPC) with relative 95% confidence intervals (CIs) using Joinpoint regression. During the study period, 773 750 AF-related deaths (202 552 males and 571 198 females) occurred in Europe. The age-adjusted mortality rate (AAMR) linearly increased from 12.3 (95% CI: 11.2-12.9) per 100 000 population in 2008 to 15.3 (95% CI: 14.7-15.7) per 100 000 population in 2019 [AAPC: +2.0% (95% CI: 1.6-3.5), P<0.001] with a more pronounced increase among men [AAPC: +2.7% (95% CI: 1.9-3.5), P<0.001] compared with women [AAPC: +1.7% (95% CI: 1.1-2.3), P<0.001] (P for parallelism 0.01). Higher AAMR increases were observed in some Eastern European countries such as Latvia, Lithuania, and Poland, while the lower increases were mainly clustered in Central Europe. Over the last decade, the age-adjusted AF-related mortality has increased in Europe, especially among males. Disparities still exist between Western and Eastern European countries.

Understanding the Orthopedic Conditions for Which Patients Are Seeking Medical Cannabis Certification.

Amidthe ongoing national crisis of opioid misuse in the United States, medical cannabis (MC) has emerged as a potential alternative for chronic pain conditions. This study was performed to understand which orthopedic conditions patients are seeking MC certification for. This prospective study was conducted at the Department of Medical Cannabis, Rothman Orthopaedic Institute, Philadelphia, PA, USA. It included consecutive patients with chronic musculoskeletal noncancer pain who were certified for MC, following the Pennsylvania state certification process. Data collected included demographic data, diagnoses, anatomic site of pain, and Patient-Reported Outcomes Measurement Information System (PROMIS) global health scale. The outcome measures from the PROMIS global health scale were used to generate Global Physical Health (GPH) quality of life (QoL) T scores and Global Mental Health (GMH) QoL T scores. A total of 78 patients were available for analysis following initial MC certification, with 50 (64%) being female and 28 (36%) male. The average age was 63 years with 60% of patients in the 65+ age group. Ethnically, 73 (92%) identified as White, and 70 (90%) were not of Hispanic or Latino origin. The most common reason for seeking MC certification was low back pain (56%), followed by neck pain (21%)and then extremity complaints. The mean GPH QoL T score was 43.71 with a standard deviation of ± 9.86 (p-value = 0.001), while the mean GMH QoL T score was 46.85 with a standard deviation of 8.28 (p-value = 0.0015). MC cannabis certification was more often sought by women than menand most commonfor spinal complaints, specifically lower back followed by cervical spine concerns.. This cohort of patients had lower GPH QoL and GMH QoL T scores compared the USgeneral population, representing a significant reduction in the overall physical and mental health.

2000 Cause of death amongst frail and non-frail older people post-hospital admission in northern Tanzania

Abstract Introduction Verbal autopsy (VA) is a tool used to determine cause of death (COD) in regions lacking routine medical certification. Automated algorithms are widely used to interpret VA data. This study aimed to investigate potential differences in COD between frail and non-frail older people in northern Tanzania. Method This work forms part of a longitudinal study investigating the clinical outcomes of 308 consecutive adults aged ≥60 years following admission to four hospitals in northern Tanzania. Frailty status was established on admission using the Clinical Frailty Scale (CFS) and dichotomised with CFS ≥5 indicating frailty. For participants who passed away in the 10-12 months following admission, VA data were collected through telephone interview using the 2022 World Health Organization (WHO) VA instrument. COD estimates were established using the SmartVA-Analyze program, implementing the Tariff 2.0 Method. Results After a mean follow-up period of 10.8 (±0.9) months, VA data were available for 69 participants. At admission screening, 51 (73.9%) were frail, while 18 (26.1%) were non-frail. SmartVA produced COD estimates for 42 (60.9%) participants, while 27 (39.1%) remained undetermined. Cause Specific Mortality Fractions (CSMFs) for non-communicable disease were higher for those with frailty than the non-frail group (70.6% vs. 54.0%, respectively). An undetermined COD was more likely in those with frailty. Of the 27 undetermined COD, 22 (81.5%) were attributed to frail individuals and 5 (18.5%) to non-frail. These undetermined COD represent 43.1% of frailty-related deaths and 27.8% of non-frailty-related deaths. Conclusions Older people with frailty living in Tanzania are more likely to die from non-communicable diseases compared to non-frail older people. Although employing SmartVA to analyse VA data from this population was feasible, it faced challenges ascribing COD to all participants. This limitation may be due to the multi-morbidity often present in older populations where multiple factors combine to cause mortality.

A Novel Evaluation Model for Assessing ChatGPT on Otolaryngology-Head and Neck Surgery Certification Examinations: Performance Study.

ChatGPT is among the most popular large language models (LLMs), exhibiting proficiency in various standardized tests, including multiple-choice medical board examinations. However, its performance on otolaryngology-head and neck surgery (OHNS) certification examinations and open-ended medical board certification examinations has not been reported. We aimed to evaluate the performance of ChatGPT on OHNS board examinations and propose a novel method to assess an AI model's performance on open-ended medical board examination questions. Twenty-one open-ended questions were adopted from the Royal College of Physicians and Surgeons of Canada's sample examination to query ChatGPT on April 11, 2023, with and without prompts. A new model, named Concordance, Validity, Safety, Competency (CVSC), was developed to evaluate its performance. In an open-ended question assessment, ChatGPT achieved a passing mark (an average of 75% across 3 trials) in the attempts and demonstrated higher accuracy with prompts. The model demonstrated high concordance (92.06%) and satisfactory validity. While demonstrating considerable consistency in regenerating answers, it often provided only partially correct responses. Notably, concerning features such as hallucinations and self-conflicting answers were observed. ChatGPT achieved a passing score in the sample examination and demonstrated the potential to pass the OHNS certification examination of the Royal College of Physicians and Surgeons of Canada. Some concerns remain due to its hallucinations, which could pose risks to patient safety. Further adjustments are necessary to yield safer and more accurate answers for clinical implementation.

Use of the ETV6/RUNX1 probe to verify the performance of the fluorescence in situ hybridization probe before clinical detection

Objective: To explore the standardized performance of a FISH probe before clinical detection. Methods: The probe sensitivity and specificity of ETV6/RUNX1 were analyzed via interphase and metaphase FISH in 20 discarded healthy bone marrow samples. The threshold system of the probe was established using an inverse beta distribution, and an interpretation standard was established. Finally, a parallel-controlled polymerase chain reaction detection study was conducted on 286 bone marrow samples from patients at our hospital. The clinical sensitivity, specificity, and diagnostic coincidence rate of ETV6/RUNX1 FISH detection were analyzed, and the diagnostic consistency of the two methods was analyzed by the kappa test. Results: The probe sensitivity and specificity of the ETV6/RUNX1 probe were 98.47% and 100%, respectively. When 50, 100, and 200 cells were counted, the typical positive signal pattern cutoffs were 5.81%, 2.95%, and 1.49%, respectively, and the atypical positive signal pattern cutoffs were 13.98%, 9.75%, and 6.26%, respectively. The clinical sensitivity of FISH was 96.1%, clinical specificity was 99.6%, diagnostic coincidence rate was 99.00%, diagnostic consistency test kappa value was 0.964, and P value was <0.001. Conclusion: For FISH probes without a national medical device registration certificate, standardized performance verification and methodology performance verification can be performed using laboratory developed test verification standards to ensure a reliable and accurate reference basis for clinical diagnosis and treatment.

What a medical certificate should contain

What a medical certificate should contain

Book by V.A. Klevno, V.V. Frolov and I.A. Frolova “Forensic medical assessment of traumatic brain injury” as an addition to the textbook on forensic medicine: Review

This review contains an overview of the textbook “Forensic medical assessment of traumatic brain injury” published in “Practical Medicine” by V.A. Klevno, V.V. Frolova, and I.A. Frolova. The review emphasized the importance of the peer-reviewed publication for modern medicine and content of the main sections devoted to the epidemiology of traumatic brain injury, revealed the main mechanisms of traumatic effects for causing traumatic brain injury and brain damage both with well-studied impression, compression, inertial trauma, and with impulse action, and emphasized the importance of defining the concept of traumatic brain injury, disclosure, and systematization of the concept of “damaging factors.” set out in the first five sections. The review also noted the importance of practical forensic experts’ knowledge of traumatic isolated subdural hematoma and chronic subdural hematoma, including the pathogenesis of its development and macroscopic signs in Sections 6 and 7 of the textbook. The review also evaluated the important role of practical recommendations on the rules for the collection and referral of biological materials for forensic histological examination, examples of the design of a forensic medical diagnosis, a medical death certificate, and conclusions for various types of traumatic brain injury. A detailed list of literary sources is provided, which presents the names of the most authoritative experts on the problem under consideration, as well as a glossary that is important for the unification and uniform understanding of the terms and concepts used. The review emphasizes the high quality of the book’s design, convenience for readers of the chosen publication format, and rich color schemes and illustrations. The analysis shows that the reviewed textbook contains the main information on traumatic brain injury and intracranial hemorrhages to date, which gives readers a full understanding of this problem, interests them with the need to understand complex and controversial issues and study the works referred to by the authors, which will undoubtedly improve the understanding of the complex mechanisms of various types of traumatic brain injury and the quality conducted forensic medical examinations. The textbook is extremely relevant, modern, and designed at a high level and contains comprehensive information for the training processes and use in the work of most medical specialists. The review concluded with a statement of hope that Vladimir Alexandrovic et al. will not stop there and will release a full-fledged manual on the forensic diagnosis of traumatic brain injury, with a more detailed classification and content that meets modern scientific and practical needs.

Available but inaccessible: patient experiences during the first 2years of a primary care-based medical cannabis program at an academic medical center.

Medical cannabis use and public acceptance in the United States have increased over the past 25years. However, access to medical cannabis remains limited, particularly for underserved populations. To understand how patients experience medical cannabis accessibility, we measured medical cannabis use and barriers to use after medical cannabis certification in an urban safety-net academic medical center. We conducted a retrospective cohort study among patients seen in Montefiore's Medical Cannabis Program (MMCP) from 2017 to 2019. Patient demographic and clinical characteristics, as well purchase history of medical cannabis, were extracted from electronic medical records. We also administered a phone questionnaire to a subset of patients to assess usage patterns, effectiveness, and barriers to medical cannabis use. Among 562 patients who were newly certified for medical cannabis between 2017 and 2019, 45% purchased medical cannabis, while 55% did not. Patients who purchased medical cannabis were more likely to be white and have private insurance or Medicare. Unregulated cannabis use and current tobacco use were less common among those who purchased medical cannabis. In multivariable logistic regression analysis, unregulated cannabis use remained negatively associated with purchasing medical cannabis. Patients reported that affordability and dispensary accessibility were their main barriers to purchasing medical cannabis. Among patients certified for medical cannabis use, fewer than half purchased medical cannabis after certification. Improving access to medical cannabis is crucial for ensuring equitable access to regulated cannabis, and to reducing unregulated cannabis use.

Diseases of the nervous system as the underlying cause of death

To identify the leading causes of death in the adult population from the class of diseases of the nervous system (DNS, class G) according to medical death certificates (MDC) and to discuss the problems of their assessment. The source of information was the electronic database of the Main Department of the Civil Registry Office of the Moscow Region. All cases of class G deaths were selected (total 10.739), an analysis was carried out according to underlying cause of death (UCD) codes and the immediate cause of death. In 2022, mortality from diseases included in the DNS amounted to 130.7 per 100 000 of the population over 18 years old (100.3 among men, 191.0 among women). The average age of men is 74.3±14.1, women - 83.5±9.9 years (p<0.0001) due to the younger age of death of men from «G31.2 Degeneration of the nervous system caused by alcohol» and a higher contribution of this cause to male mortality; 82.5% of deaths were for codes G90-G99 («Other disorders of the nervous system»); 15.5% were neurodegenerative diseases (G10-G32). Sixty-six percent of all UCD in both women and men accounted for «unspecified encephalopathy» (G93.4), in 2nd place (10.5%) was «cerebral cyst» (G93.0). In 45 cases, code G93.6 (cerebral edema) was mistakenly used as UCD. Differences in the structure of causes of death at home, in hospital and elsewhere are statistically significant (p<0.00001). In 58.3%, cerebral edema and herniation were indicated as the immediate cause of death (G93.6 and G93.5). Nosologically unfounded, insufficiently well-defined UCD were established in most cases of death from DNS, In 0.5% of the total number of deaths from DNS, an erroneous presentation as UCD of transient disorders of cerebral circulation or cerebral edema was noted. The results indicate the need for an analysis of the causes of death based on a comparison of medical records and MDC.