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Medical Article Critique and Analysis: Death Certificates

I am looking for help with interpretation of the following questions as related to the medial literature article "Death Certificates are Not Reliable: Revivification of the Autopsy," by Ravakhah, Keyvan.

http://journals.lww.com/smajournalonline/Fulltext/2006/07000/Death_Certificates_Are_Not_Reliable_.10.aspx

After review of this research study, please answer the following questions:
1. What is the main purpose of the study?
2. What statistical test(s) or epidemiological concepts do the author(s) use?
3. Based on the knowledge of epidemiology and statistics, what questions about these tests do you have? Did the article use everything correctly?
4. Would you do anything differently from a presentation of results, testing or measurement of variables point of view?
6. What real-life conclusions can be drawn from the study? What does the study mean for patients or nursing practice?

Solution Preview

This is a very interesting article, especially from my viewpoint as a pathologist.

When reviewing articles, I begin by reading the abstract and look for the answers to the following questions (not very different from your assignment). What are they trying to find out with this study? Did they use the appropriate study methods to answer the question? How would these findings apply to my situation/my patients/my practice? If I think it is worth reading further (or if the assignment requires I read further), I highlight key points that answer my questions above, make notes/questions in the margins, and look for problems in reasoning/calculations/use of data. It is important to remember that just because something is published in a journal, does not mean you should completely trust the results.

After reviewing the article, there are some problems from a medical point of view. Some of this may just need more explanation in the article, or perhaps they weren't considered. But let's go through the article, step-by-step to better understand this research study.

Introduction. First, they point out the importance of cardiovascular disease as it relates to deaths in the US. Then they note that cause of death data is taken from death certificates (not autopsy reports or clinical notes). The next paragraph explains how death certificates are completed. All of this introductory material is important to know in order to interpret their results. The next paragraph (starting with Medical information page 729) could have a better explanation of the autopsy/death certificate process. When a patient dies and an autopsy is requested, the death certificate needs to be filled out before the body can leave the hospital. Some doctors fill it out right away while some wait for the preliminary autopsy report. The preliminary report is done after the body has been dissected, but prior to any additional studies such as microscopic examination. So they are correct in saying that complete autopsy results are not available at the time of completion of the death certificate. As for the reasons that autopsy numbers have declined, many of the reasons listed are matter of opinion that is a topic for a different discussion, and I'm not sure why it was included in this paper. Finally, they discuss the value of autopsy and how physicians should work together to provide an accurate cause of death. Great, let's get to the meat of the paper.

Materials ...

Solution Summary

This solution examines, step-by-step, an article from the medical literature that analyzes the reliability of death certificate cause of death. The techniques used can be applied to many other journal articles in the medical literature. It is important to not only look at the statements of the paper, but also form your own judgments about the quality of the research study and understand how this would apply to real life. The original article analyzed in this solution is easy to read, and understanding the analysis will make future critiques of any research study more efficient. The solution contains over 1,600 words of text with two references that guide interpretation of medical literature.

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