OBJECTIVE: To determine the completeness and acceptability of the cause of (COD) statements in death certificates before and after the conduct of an educational intervention aimed at improving COD certification in Province X.

METHODS: A random sample of 7939 death certificates from the year 1986-2006 was obtained. Part 1 of the COD section of the certificates was evaluated for completeness and for acceptability of the COD. Interrupted time series study was employed with semi-annual as the time point used in the analysis. The study covered 42 time points from 1986-2006. The proportions of complete and acceptable COD for each time point were calculated and segmented linear regression was applied to compare the time trend before and after the educational intervention.

RESULTS: Of the 7939 death certificates, only 35.3% were completely filled up, of which 16.5% had acceptable overall COD. The average proportions of all the death certificates with acceptable item entries in the immediate, antecedent, and underlying causes are 30.1%, 57.0% and 25.0%, respectively. The time series data on the acceptability of the COD statement revealed a significantly higher trend after the educational intervention.

CONCLUSION: A large proportion of the COD section of death certificates have incomplete and unacceptable entries. However, the acceptability of the COD statement improved after the educational intervention.

Human ; Death Certificates ; Interrupted Time Series Analysis ; Certification ; Employment

Background and Objective: Convalescent plasma therapy (CPT) may reduce the risk of disease progression among patients with COVID-19. This study was undertaken to evaluate the efficacy and safety of CPT in preventing ICU admission among hospitalized COVID-19 patients. Methods: In this open-label randomized controlled trial, we randomly assigned hospitalized adult patients with COVID-19 in a 1:1 ratio to receive convalescent plasma as an adjunct to standard of care or standard of care alone. The primary endpoint was ICU admission within first 28 days of enrolment. Primary safety endpoints include rapid deterioration of respiratory or clinical status within four hours of convalescent plasma transfusion and cumulative incidence of serious adverse events during the study period including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), severe allergic reactions, and transfusion-related infections. Results: A total of 22 patients were assigned to receive convalescent plasma as an adjunct to standard of care and 22 to receive standard of care alone. The median time from onset of COVID-19 symptoms to study enrolment was eight days (IQR, 4 to 10). Two patients (9.1%) in the CPT group and one patient (4.5%) in the control group were admitted to the ICU. The primary outcome measure, ICU admission, was not different between the two groups (q-value >0.9). No patient who received convalescent plasma had rapid deterioration of respiratory/clinical status within four hours of transfusion and none developed TRALI, TACO, anaphylaxis, severe allergic reactions, or transfusion-related infections. There was also no significant difference in the secondary outcomes of 28-day mortality (two patients in the CPT group and none in the control group, q-value >0.90), dialysis-free days, vasopressor-free days, and ICU-free days. Conclusions Among hospitalized COVID-19 patients, no significant differences were observed in the need for ICU admission between patients given CPT as adjunct to standard of care and those who received standard of care alone. Interpretation is limited by early termination of the trial which may have been underpowered to detect a clinically important difference.
COVID-19 ; COVID-19 Serotherapy