Medical Certification Research Articles

Oral 'Board Style' Examination for Surgery Clerkship.

Evaluating medical students during surgical clerkships relies on multifactorial methods of evaluation. Clinical evaluations, combined with standardized multiple-choice exams, are often the foundation of evaluation highlighting the challenge of combining subjective and objective measurements. Oral board exams are standard amongst medical certification and employ an additional element to evaluate students more holistically. Course evaluations from years that incorporated an oral board exam were compared to a year that omitted the exam. We found course satisfaction was higher in the years that included the oral exam (3.25 /5) than years without the oral board exam (3/ 5). The oral exam adds a novel element to the evaluation of a medical student that allows for a comprehensive understanding of a student's fund of knowledge and helps prepare them for future board certifications. Because students have an opportunity to demonstrate knowledge in a standard, more comprehensive format, they have higher satisfaction with the course.

Absenteeism at Two Occupational Health Services in Belgium from 2014 to 2021.

Medical certification is often needed for absences of longer than one workday. The literature remains unclear as to whether this changes absenteeism. Earlier research found that the merging of two firms can augment or diminish short-term absenteeism. This study was conducted to examine whether prolonging self-certification or merging increases short-term absenteeism. Data from January 2014 to December 2021 were retrospectively collected from HR absenteeism files at two occupational health services in Belgium. Sickness periods of longer than 4 weeks were excluded. Company 1 started a merger in 2014, and company 2 prolonged of the self-certification period in 2018. The total full-time equivalents (FTEs) of company 1 increased by 6%, while company 2 had an increase of 28%. At company 1, there was a decline in absenteeism, while company 2 had an increase. The ARIMA (1, 0, 1) model provided a statistically significant local moving average (company 1: 0.123; company 2: 0.086) but no statistically significant parameters for the intervention (company 1: 0.007, p = 0.672; company 2: 0.000, p = 0.970). Prolonging the self-certification period by up to 5 days without medical certification or merging was not found to increase short-term absenteeism.

Patient Reported Outcomes Using Medical Cannabis for Managing Pain in Charcot-Marie-Tooth Disease.

Objective: Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. This exploratory study examined patient reported efficacy of medical cannabis for pain management in this population. Methods: Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundation. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results: Nearly all (90.9%) of respondents reported experiencing pain, including all (100%) females and 72.7% of males (chi-square P < .05) with 91.7% of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80.0% of respondents reported using less opiates, 69% noted using less sleep medication, and 50.0% reported using less anxiety/antidepressant medications. Negative side effects were noted by 23.5% of respondents. However, almost all (91.7%) of that subgroup did not have plans to stop consuming cannabis. One-third (33.9%) possessed a medical cannabis certificate. Patient perceptions of their physicians' attitudes regarding patient medical cannabis use greatly impacted whether respondents informed their providers of their usage. Conclusion: The vast majority of patients with CMT reported that cannabis was effective to manage pain symptoms. These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT.

Using machine learning methods and EEG to discriminate aircraft pilot cognitive workload during flight

Pilots of aircraft face varying degrees of cognitive workload even during normal flight operations. Periods of low cognitive workload may be followed by periods of high cognitive workload and vice versa. During such changing demands, there exists potential for increased error on behalf of the pilots due to periods of boredom or excessive cognitive task demand. To further understand cognitive workload in aviation, the present study involved collection of electroencephalogram (EEG) data from ten (10) collegiate aviation students in a live-flight environment in a single-engine aircraft. Each pilot possessed a Federal Aviation Administration (FAA) commercial pilot certificate and either FAA class I or class II medical certificate. Each pilot flew a standardized flight profile representing an average instrument flight training sequence. For data analysis, we used four main sub-bands of the recorded EEG signals: delta, theta, alpha, and beta. Power spectral density (PSD) and log energy entropy of each sub-band across 20 electrodes were computed and subjected to two feature selection algorithms (recursive feature elimination (RFE) and lasso cross-validation (LassoCV), and a stacking ensemble machine learning algorithm composed of support vector machine, random forest, and logistic regression. Also, hyperparameter optimization and tenfold cross-validation were used to improve the model performance, reliability, and generalization. The feature selection step resulted in 15 features that can be considered an indicator of pilots' cognitive workload states. Then these features were applied to the stacking ensemble algorithm, and the highest results were achieved using the selected features by the RFE algorithm with an accuracy of 91.67% (± 0.11), a precision of 93.89% (± 0.09), recall of 91.67% (± 0.11), F-score of 91.22% (± 0.12), and the mean ROC-AUC of 0.93 (± 0.06). The achieved results indicated that the combination of PSD and log energy entropy, along with well-designed machine learning algorithms, suggest the potential for the use of EEG to discriminate periods of the low, medium, and high workload to augment aircraft system design, including flight automation features to improve aviation safety.

EHDHE: Enhancing security of healthcare documents in IoT-enabled digital healthcare ecosystems using blockchain

Nowadays, blockchain technology is one of the advanced technologies to ensure the security of users’ sensitive or confidential data. Blockchain technology plays a vital role in various applications like artificial intelligence, supply chain, cloud computing, the healthcare sector, and many more. It helps the healthcare domain to get benefitted from its many advanced features, such as confidentiality, decentralization, security, and privacy. Also, the Internet of Things (IoT) devices connect with the healthcare systems, and the healthcare sector application software further communicates with the IT industry. The blockchain-based IoT systems have significantly impacted the healthcare sector by enhancing security, privacy, transparency, and efficiency, providing better business opportunities. Moreover, traditional healthcare systems face severe security and privacy problems, such as phishing, masquerades, identity theft, and many others. Thus, a secure blockchain-based Proposed Application (PA) is designed to generate, maintain, and validate healthcare certificates. The PA acts as a communication medium between the backend blockchain network and application entities like hospitals, patients, doctors, and IoT devices to create and verify medical certificates. It also ensures various security features, namely confidentiality, authentication, and access control, using the concept of smart contracts. The comparative and performance analysis of the proposed work shows that it provides a more effective solution than the existing schemes.

Evaluation of Medical Certification of Cause of Death in Tertiary Cancer Hospitals in Northern India.

Medical certification of cause of death (MCCD) provides valuable data regarding disease burden in a community and for formulating health policy. Inaccurate MCCDs can significantly impair the precision of national health information. To evaluate the accuracy of cause of death certificates prepared at two tertiary cancer care hospitals in Northern India during the study period (May 2018 to December 2020). A retrospective observational study at two tertiary cancer care hospitals in Varanasi, India, over a period of two and a half years. Medical records and cause of death certificates of all decedents were examined. Demographic characteristics, administrative details and cause of death data were collected using the WHO recommended death certificates. Accuracy of death certification was validated by electronic medical records and errors were graded. A total of 778 deaths occurred in the two centres during the study period. Of these, only 30 (3.9%) certificates were error-free; 591 (75.9%) certificates had an inappropriate immediate cause of death; 231 (29.7%) certificates had incorrectly labelled modes of death as the immediate cause of death; and 585 (75.2%) certificates had an incorrect underlying cause of death. The majority of certificates were prepared by junior doctors and were significantly associated with higher certification errors. A high rate of errors was identified in death certification at the cancer care hospitals during the study period. Inaccurate MCCDs related to cancers can potentially influence cancer statistics and thereby affect policy making for cancer control. This study has identified the pressing need for appropriate interventions to improve quality of certification through training of doctors.

The mortality of patients with Parkinson's disease with deep brain stimulation.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in improving motor function in patients with Parkinson's disease (PD). This study aimed to investigate mortality associated with bilateral STN DBS in patients with PD and to assess the factors associated with mortality and causes of death after DBS. We reviewed the medical records of 257 patients with PD who underwent bilateral STN DBS at the Movement Disorder Center at Seoul National University Hospital between March 2005 and November 2018. Patients were evaluated preoperatively, at 3, 6, and 12 months after surgery and annually thereafter. The cause and date of death were obtained from interviews with caregivers or from medical certificates at the last follow-up. Of the 257 patients with PD, 48 patients (18.7%) died, with a median time of death of 11.2 years after surgery. Pneumonia was the most common cause of death. Older age of disease onset, preoperative falling score while on medication, and higher preoperative total levodopa equivalent daily dose were associated with a higher risk of mortality in time-dependent Cox regression analysis. These results confirm the mortality outcome of STN DBS in patients with advanced PD.

Risk of fatal and non-fatal cardiovascular events in men aged 25-44 in the city of Novosibirsk. Cohort study

Aim. To study the incidence and risk factors of cardiovascular events (CVEs) during an 8-year follow-up of a cohort of men aged 25-44 years (Novosibirsk).Material and methods. The cohort study included 1415 people aged 37,33 [31,83; 41,92] years (Median, Me [interquartile range, Q25; Q75], of which 670 (47,3%) were men. Median follow-up period was 6,9 [5,8; 7,8] years. CVEs were identified using the "Registry of Acute Myocardial Infarction", fatal cases — from the "Medical Certificates of Cause of Death". The examination program included a questionnaire, anthropometry, biochemical studies. Statistical processing was carried out using SPSS (version 13.0).Results. Thirteen CVEs were identified, of which 6 were fatal. Survival prognosis was more favorable in men without hypertension, with a heart rate (HR) &lt;80 bpm. The risk of CVEs increased by 14% with an increase in fasting plasma glucose by 0,5 mmol/l, by 1,8 times with creatinine increase by 10 pmol/l (decreased by 29% with an increase in glomerular filtration rate by 5 ml/min /1,73 m2); 2 times with a heart rate increase by 10 bpm, regardless of other cardiometabolic risk factors.Conclusion. Significant risk factors for fatal and non-fatal CVEs in men aged 25-44 years are hypertension, heart rate &gt;80 bpm, increased fasting plasma glucose, creatinine levels (or decreased glomerular filtration rate).

PRESBYOND Laser Blended Vision LASIK in Commercial and Military Pilots Requiring Class 1 Medical Certification.

To report the outcomes of PRESBYOND Laser Blended Vision LASIK (Carl Zeiss Meditec AG) in presbyopic commercial and military pilots requiring Class 1 aeromedical certification. This was a retrospective study of 23 consecutive pilots who underwent PRESBYOND Laser Blended Vision LASIK. Postoperative visits were conducted at 1 day and 1, 3, and 12 months. Standard outcomes analysis was performed using the data at 12 months. Objective quality of vision measures including mesopic contrast sensitivity (CSV-1000; VectorVision), Ocular Scatter Index (HD Analyzer; Keeler), and straylight (C-Quant; Oculus Optikgeräte GmbH) were determined before and 3 months after surgery. A questionnaire to assess the functional vision of pilots before and after surgery was derived to record subjective outcomes. Of the 23 pilots treated, data were available at 12 months for 22 pilots (95.7%) and at 3 months for 1 pilot (4.3%). Median age was 55 years (range: 42 to 65 years). At 12 months, binocular uncorrected distance visual acuity was 20/20 or better in 100% and 20/16 or better in 52% of pilots. Binocular uncorrected intermediate visual acuity was J3 in 73%, J5 in 95%, and J10 in 100% of pilots. Binocular uncorrected near visual acuity was J1 or better in 78% and J2 or better in 100% of pilots. Mean postoperative spherical equivalent refraction relative to the target was -0.04 ± 0.34 diopters (D) (range: -0.63 to +0.63 D), with 93% within ±0.50 D. There was a statistically significant increase in contrast sensitivity at 3, 6, 12, and 18 cpd. C-Quant straylight was 1.07 ± 0.16 before surgery and 1.06 ± 0.16 at 1 to 3 months after surgery (P = .705). All pilots achieved Class 1 medical certification from the United Kingdom Civil Aviation Authority and resumed flying. All pilots reported improved functionality compared to the previous vision correction method. PRESBYOND Laser Blended Vision LASIK enabled presbyopic commercial pilots to continue to fly without the need for glasses. With consideration of the visually challenging cockpit environment, PRESBYOND Laser Blended Vision LASIK provides clear continuous vision for tasks at near, intermediate, and far distance. Class 1 pilots reported a subjective improvement in visual tasks and comfort following surgery. [J Refract Surg. 2023;39(1):6-14.].

Causes of death in the Moscow region according to medical death certificates

Determination of the leading causes of death based on data from primary medical death certificates (MDCs) depending on the place of death. From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the USR registry office system) for 2021, all cases were selected in which diseases were indicated as the primary cause of death (PCD); all codes of external causes, injuries and poisonings were excluded. A total of 109.126 cases, 50.6% died in the hospital, 34% died at home, and 16.4% died elsewhere. Bureau of Forensic Medical Examination (BFME) issued 45.2% of MSS. Taking into account the frequency of use of ICD codes, the clinical similarity of individual codes, 20 groups were formed, which accounted for 90.1% of deaths from diseases. The frequency of registration of individual groups of causes of death largely depends on the place of death. 5 leading groups of causes of death were established: 1) in general from COVID-19 23.55%, chronic ischemic heart disease (CIHD-1) without postinfarction cardiosclerosis, aneurysm and ischemic cardiomyopathy (CMP) 14.5%, from encephalopathy indefinite (EI) 11.4%, malignant neoplasms (MN) 11.3%, stroke 6.2%; 2) in a hospital from COVID-19 45%, stroke 10%, MN 8.3%; CIHD-1 7.1%, CIHD with a history of MI/ischemic CMP 2.7%; 3) at home from CIHD-1 21.8%, EI 21.5%, MN 15.5%, from diseases associated with alcohol 3.3% and brain cyst 3.3%; 4) elsewhere from CIHD-1 22.7%, EI 21.6%, MN 12%, from other forms of acute coronary artery disease 5.4%, alcohol-associated diseases 4.8%. Acute MI ranked 6th among deaths in general - 2.7%. PCD is also associated with the place of issue of the MDCs - 90% of the MDC with the indication of EI and «other degenerative diseases of the nervous system» as the cause of death were issued by the BFME. Not a single MDC issued by the BFME contained such PCDs as "old age" or "brain cyst". The nosological structure of the causes of death and the issuance of individual ICD codes in the MDC as a PCD varies significantly depending on the place of death and the issuance of the MDC. The reasons need to be further clarified. The use of codes that are not permitted for use has been registered.

КЛИНИКО-ЭКСПЕРТНЫЕ ПОДХОДЫ ПРИ ОЦЕНКЕ НАРУШЕНИЙ СЕРДЕЧНОГО РИТМА У ЛЕТНОГО СОСТАВА ГОСУДАРСТВЕННОЙ АВИАЦИИ

The paper is devoted to validation of approaches to evaluation of cardiac rhythm disorders in flying personnel adequate to the present clinical medicine standards and criteria used in medical certification of state aviation pilots. We compared a number of classification criteria in context of their adequacy to the needs of the pilot medical certification community. Clinical classification criteria do not meet in full the requirements of aviation medicine certification. We suggest that cardiac rhythms disorders should be graded with consideration of pilot's functionality.

Leading past COVID-19: An analysis of remote work now and beyond.

In response to the coronavirus disease 2019 (COVID-19) pandemic, many cancer centers and clinics deployed remote work options for their employees. Due to the rapid response needed during this crisis, little to no feedback was obtained from dosimetrists. This study aimed to assess the productivity level and job satisfaction of medical dosimetrists in response to changes in working conditions due to the COVID-19 pandemic. With the assistance from the medical dosimetrists certification board (MDCB), critical data was gathered via an original instrument conducted and distributed by The University of Texas MD Anderson Cancer Center-School of Health Professions to all current practicing certified medical dosimetrists registered with the MDCB. Data were collected using Qualtrics and analyzed with IBM's SPSS. Most (326, 77.7%) participants indicated they transitioned to a version of remote work due to COVID-19. Almost half of the participants (208, 49.5%) reported increased job satisfaction due to the option to work remotely. The participants reported being extremely satisfied with the individual (247, 58.8%) and department (201, 47.9%) productivity levels even after implementing remote work options. Most participants (225, 53.6%), independent of age and years of experience, would prefer to stay in a hybrid role even after COVID-19 abates. These findings suggest that most dosimetrists prefer to perform their job remotely or asynchronously. A one size fits all job model design may make it difficult for organizations to attract, retain, and grow top dosimetrists. Industry leaders and employers may benefit by embracing this change as dosimetrists may value work-set-up flexibility over other employer-based benefits. Further research is needed to assess the unintended consequences of remote work environments in this profession.

Driver's License and Welfare Systems for Epilepsy Patients

Along with treatment, social life, including driving and welfare systems, are of great concern to patients with epilepsy. During treatment of epilepsy, guidance on these issues and actual treatment are two sides of the same coin, and both epileptologists and general neurosurgeons are required to have thorough knowledge of these issues. With regard to driving, Article 66 of the Road Traffic Law prohibits driving by persons who are likely to be incapable of normal driving. However, in epilepsy, legal criteria for driver's license eligibility has been established, and there are no legal problems if decisions are made in accordance with these criteria. Even if a patient has epilepsy, a driver's license will not be denied if the patient has not had a seizure that impairs consciousness or movement while awake for at least two years. Regarding social welfare, there are programs for patients with epilepsy related to medical expenses, disability certificates, and pension subsidies. It is necessary to present appropriate systems based on an understanding of a patient's disease and disability. These issues are described using actual examples.

Social Determinants of Health Associated with How Cannabis is Obtained and Used in Patients with Cancer Receiving Care at a Cancer Treatment Center in Pennsylvania.

Despite increased rates of cannabis use among patients with cancer, there are gaps in our understanding of barriers to accessing cannabis. Social determinants of health (SDoH) are associated with access to healthcare, but few studies have evaluated how SDoH relate to cannabis access and use among cancer patients. We examined whether access to and modes of cannabis use differed across indicators of SDoH among patients receiving treatment from a large National Cancer Institute (NCI) designated cancer center. This anonymous cross-sectional survey was developed in collaboration with the NCI Cannabis Supplement consortium, which funded 12 supplements to NCI Center Core Grants across the United States. We evaluated the association of race, gender, income, and age with mode of cannabis use, source of obtaining cannabis, what influences their purchase, and medical cannabis certification status. Overall, 1,053 patients receiving treatment for cancer in Pennsylvania completed the survey and 352 (33.4%) reported using cannabis since their cancer diagnosis. Patients who identified as Black/African-American were less likely to have medical cannabis certifications (p=0.04). Males and Black/African-Americans were more likely to report smoking cannabis (vs other forms, ps<0.01) and to purchase cannabis from an unlicensed dealer/seller (p<0.01). Lower-income patients were more likely to be influenced by price and ease of access (ps<0.05). Although cannabis users were younger than non-users, age was not associated with any outcomes. The current data shed light on how critical drivers of health disparities (such as race, gender, and income) are associated with where patients with cancer obtain cannabis, what forms they use, and what may influence their purchase decisions.

Place of obesity in medical death certificates

Place of obesity in medical death certificates

The leading causes of death at home according to medical death certificates in the Moscow region

The leading causes of death at home according to medical death certificates in the Moscow region

Deletion and Recovery Scheme of Electronic Health Records Based on Medical Certificate Blockchain

Deletion and Recovery Scheme of Electronic Health Records Based on Medical Certificate Blockchain

Quality of life in patients with neurofibromatosis type 1: a nationwide database study in Japan from 2015 to 2019.

This study examined the association between dermatological, neurological, and bone manifestations of neurofibromatosis type 1 (NF1) and quality of life (QoL) in patients with NF1 using a nationwide database of all patients who newly claimed for medical expense subsidies in Japan from 2015 to 2019. The Japanese Ministry of Health, Labour and Welfare provided the "National Database of Designated Intractable Diseases of Japan" containing clinical and personal records ("Medical Certificates of Designated Intractable Diseases") of all patients with NF1 following approval of the study protocol. To examine the association between the severity of symptoms and QoL, multinominal logistic regression analyses were performed, adjusted for potential confounders. The final study population consisted of 1,487 patients (775 females and 712 males; mean (standard deviation) age, 45.4 (17.9) years). More than 50% and nearly 45% of participants were recorded as having moderate or severe "pain/discomfort" and "anxiety/depression," respectively. The severity of neurological symptoms was significantly associated with all components of QoL, whereas the severity of dermatological symptoms was significantly associated with only moderate or severe subjective and mental health-related components of QoL, and the severity of bone lesions was associated with only moderate or severe physical health-related components of QoL. Subjective and mental health-related components of QoL tended to be deteriorated more than physical health-related components of QoL in younger and female patients. Severities of neurological and dermatological symptoms were significantly associated with subjective and mental health-related components of QoL, while the severity of bone symptoms was associated with only moderate and severe deterioration of physical health-related components of QoL.

Electronic Sick Leave Certificate on Telemedicine Service Implementation in Indonesia: A Legal Consideration

Telemedicine service has been developed in Indonesia and its use has increased during the Coronavirus Disease 2019 (Covid-19) pandemic. This service makes it easier for people to get health services without meeting face-to-face. One of them is getting electronic medical certificates i.e. sick leave. However, problems arose regarding the legitimacy of electronic sick leave certificate (e-sick leave) through telemedicine services. This study aims to analyse the legal aspects of electronic sick leave in Indonesia. This research was normative research with statue and conceptual approach. Regulations in Indonesia have not discussed in detail the provision of electronic sick leave through telemedicine services. During the Covid-19 pandemic, Indonesian Medical Council Regulation Number 74 of 2020 was issued which permitted the issuance of sick certificates in telemedicine services with due observance of the principles of caution and high accountability. However it does not regulate in detail the provision of electronic sick leave through telemedicine services. Further regulations comprising of specific requirements and procedures are needed in Indonesia regarding telemedicine services, specifically in order to have valid electronic sick leave certificate issuance that can guarantee patient safety and accountability. Technological support is also needed to support the examination of patients in telemedicine services. Issuance of electronic sick leave requires collaboration between health care facilities and companies.

Safe operation of buildings during the winter period

The article presents legal regulations and principles for the safe operation of buildings in winter and proposes a procedure for clearing snow from flat roofs.The Construction Law regulates the activities involving building design, construction, maintenance, and demolition and defines the operation principles of public administration bodies in these areas.The safety of buildings in the winter requires specialist knowledge and special care on the part of managers, employers, persons managing employees, and employees performing work related to their safe operation.The safe removal of snow from flat roofs requires adequate legal knowledge, skills, training, and experience on the part of employers, managers, and workers.The employer's most important obligations to employees in the case of snow clearance work on flat roofs (tantamount to work at height) include providing them with protective equipment appropriate to their position and tasks, with collective protective equipment. The employer is obliged to ensure that persons who carry out work at height are assisted by other employees who do not carry out such work directly. The employer should also ensure that workers receive instruction, taking into account, in particular, the personal division of work, the sequence of tasks to be performed, and the health and safety rules necessary for the various activities. It is also necessary to establish supervision of work at height.Employees carrying out snow clearing should have a current height examination and hold a valid (current) medical certificate of no contraindication to work at height. The employee must also receive health and safety training prior to working at height, as well as an introduction to the specifics of the job, know the potential hazards and risks, and learn to use the personal protective equipment required for the job properly.