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Nelson, Michael Barry, Janet L. Accurate assessment of cause of death COD is important for determining cause-specific survival in cancer research.

What's in a Vital Record?

It is possible to reliably ascertain COD by meticulous review of inpatient and outpatient medical records with the use of predetermined clinical algorithms 1. Unfortunately, this method, although useful for small retrospective studies, is impractical for large datasets and national tumor registries that are commonly used for cancer research.

When these large databases are used, COD is assigned with a standardized decision algorithm that uses International Classification of Diseases, ninth revision 2 , codes to assign both immediate and underlying COD 3. However, this methodology is unreliable 4 , 5 , particularly when patients are older or have considerable comorbidity, as is the case in prostate cancer 6 , 7.

In a study of mortality trends, Grulich et al. By contrast, in men with prostate cancer identified through the Connecticut Tumor Registry, Albertsen et al. It is important that prostate cancer-related mortality ascertained by death certificate be reliable because studies that use large datasets, such as the Surveillance, Epidemiology, and End Results SEER 1 Program, may be used to determine whether interventions e. This study assessed whether the underlying COD on death certificates for men with prostate cancer agreed with an independent review of inpatient medical records in a sample of prostate cancer patients who died in King County, WA, in Our goal was to assess the validity of the coding system currently used by each state for determining underlying COD from death certificate data that are submitted to the National Center for Health Statistics, Hyattsville, MD.

With the use of the Seattle—Puget Sound SEER Cancer Registry, we identified all men aged 58—98 years at time of death in King County who were diagnosed with prostate cancer from through and who died during Any subject who died at one of 11 selected hospitals in King County was eligible for the study. A trained abstractor used a standardized data form developed for a previous study 9 to review medical records and evaluate clinical course before death and comorbidity.

Following abstraction of the medical records, three clinicians a medical oncologist and two urologists , all of whom were blinded to the COD assigned by the death certificate, independently reviewed the abstraction forms and assigned an underlying COD to one of three prospectively defined categories: 1 related to prostate cancer, 2 unrelated to prostate cancer, or 3 uncertain.

Disagreements in assignments were resolved by consensus among the clinicians. The assignment by the clinicians of underlying COD was then compared with that of the death certificate, using the National Center for Health Statistics algorithm for International Classification of Diseases coding of underlying COD 3. After consensus was reached for the remaining 15 case subjects, all underlying CODs were compared with those from the death certificates Table 1. Of the two case subjects in which the clinicians were uncertain of COD, one had metastases detected by a bone scan 1 year before death.

This case subject also had clinically significant cardiovascular disease and increasing respiratory difficulty on final hospital admission. Because the clinicians were unable to determine the etiology of these respiratory problems, they coded the COD as uncertain, whereas the death certificate-assigned COD was prostate cancer. The second case subject was diabetic and had metastatic disease detected by a bone scan 1 year before death. He also had increasing renal failure, poor mental status, and general debilitation. The death certificate-assigned COD was not prostate cancer.

In the single case where the clinicians thought that the COD was unrelated to prostate cancer and the death certificate-assigned COD was prostate cancer, the subject had respiratory failure as a result of staphylococcal pneumonia. The only reference to prostate cancer was a brief mention in the admitting history. For the three case subjects where the clinicians believed that the COD was related to prostate cancer and the death certificate-assigned COD was not prostate cancer, the medical records clearly stated that the treating providers thought that the deaths were directly related to prostate cancer.


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For one case subject, the immediate COD was respiratory failure as a result of pulmonary embolus; for the second, it was respiratory failure as a result of myocardial infarction, chronic obstructive pulmonary disease, and metastatic prostate cancer; and for the third, the immediate COD was ventricular tachycardia and respiratory failure. This result leads to the conclusion that, at least for prostate cancer patients who die in the hospital, underlying COD stated on death certificates appears to reflect adequately what is occurring clinically and, therefore, can be used when calculating cause-specific survival.

This conclusion is important both to the researchers, who use large administrative databases, and to the clinical community, which applies the findings of these studies to regular practice. Our findings support the results of Albertsen et al. However, the lack of agreement between clinical assessment of COD and death certificate report noted by Steenland et al.

Although several studies 6 , 7 , 12 have questioned the validity of death certificate-assigned COD in other cancers, this methodology appears fairly accurate for prostate cancer.


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It is worth noting that, in our study, in the cases in which there was disagreement between clinician assessment and death certificate assignment of COD, there was always clinically significant respiratory and cardiac comorbidity, which may have affected the coding algorithm for assigning COD using death certificates. This observation is consistent with the findings of Satariano et al. This observation underscores the need for health care providers to carefully document all relevant details when completing death certificates, particularly in men with multiple comorbidities RCW Note that this definition specifically excludes three common devices that you'd assume would be included as nonprobate assets: life insurance policies, annuities, and employee benefit plans.

Despite this exclusion from the definition, these assets still act in all respects like other nonprobate assets.

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The only difference is that these three instruments are protected from the claims of creditors and the expenses of the estate. This is discussed further below. If you are considering whether to begin a probate, it is critical that you understand the difference between probate and nonprobate assets.

As the term implies, nonprobate assets can be obtained without the need for a probate. Rather, nonprobate assets pass according to a document or other instrument in which the owner directed how the asset would pass upon his or her death. Among the most widely understood nonprobate assets is a life insurance policy or a retirement plan. When you have one of these policies or plans, you normally complete paperwork telling the company holding the asset that when you die you want this item to pass to a particular person or persons i.

If however a beneficiary is not designated, these assets will usually become probate assets and pass to the estate and be distributed according to the will or the laws of intestate succession if there is no will. Nonprobate assets come in many shapes and sizes, and different rules often apply to the different types of nonprobate assets. Below is a description of many different types of nonprobate assets, as well as a discussion regarding special issues to consider when dealing with nonprobate assets.

If you need even more detailed information, you can go to a presentation I gave to lawyers at a recent probate seminar by clicking here.

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Joint tenancy is a form of ownership of real property whereby the ownership of the property immediately vests in the co-tenant s upon the death of one of the other owners. When this type of tenancy is created, the joint owners own an equal interest in the property during their lives. After the death of one of the joint owners, the surviving owner s does not create a new deed.

There should be no need to file a real estate excise tax affidavit. Washington recently adopted a new form of transferring real property i. With this newly recognized beneficiary deed, a property owner can convert an otherwise-probate asset into an asset that will pass outside of probate. As with joint tenancy, the administrator should carefully review the deed to ensure that it is a proper beneficiary deed.

After the death of the owner, the beneficiary does not prepare a new deed to show his or her new ownership to the property. It's simpler than that. The new owner will also need to file a real estate excise tax affidavit, although no excise is due unless the owner prepared the deed to satisfy a contractual obligation to the beneficiary, which is rare. A popular, but sometimes misunderstood, form of nonprobate asset is the joint bank account.

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RCW 30A. This means that prior to the death of one of the joint account holders, each depositor only owns the amount that he or she deposited into the account, absent some other evidence. Savings Bonds can be transferred outside of the probate process in a couple ways. First, if two people are named on the bond, the survivor becomes the owner of the bond. The owner may also register the bond payable on death to another person.

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However, before civil authorities began recording this information, earlier examples of birth, marriage, and death certificates, were often recorded by local churches and religious institutions. All of these US vital records are valuable sources to important extract family history details like life span, surnames, and place of origin, to list just a few. While the specific information may vary from state to state, and year to year, all vital records include specific details about your ancestor.