Download Establishing national noncommunicable disease surveillance in a

REVISTA
PANAMERICANA
DE SALUD PÚBLICA
PAN AMERICAN
JOURNAL OF
PUBLIC HEALTH
Material suplementario / Supplementary material / Material supplementar
Supplementary material to:
Rose AM, Hambleton IR, Jeyaseelan SM, Howitt
C, Harewood R, Campbell J, et al. Establishing
national noncommunicable disease surveillance
in a developing country: a model for small island
nations. Rev Panam Salud Publica. 2016;39(2):
76-85.
This material formed part of the original submission and has been peer reviewed.
We post it as supplied by the authors.
SUPPLEMENTARY MATERIAL
Rose et al. • Implementing national NCD surveillance
1: Case definitions and variables collected
Contents
1. Case definitions used by the BNR (all components)
2. Core and enhanced data items and residence definition used by the BNR
3. The case-defining form used by the BNR (stroke and acute MI components)
4. Brief outline of case report forms used by the BNR – stroke component
5. Brief outline of case report forms used by the BNR – acute MI component
6. The case report forms used by the BNR – cancer component
7. References
1. Case definitions used by the BNR (all components)
(a) Stroke case definition for the BNR–Stroke
Sudden onset of global or focal neurological deficit not resulting from trauma or injury, presumed to
be vascular in origin and lasting at least 24h or leading to death (1).
(b) Acute MI case definition for the BNR–Heart
A definite acute MI is one which was identified in a clinical setting of myocardial ischaemia by either
(a) diagnostic cardiac biomarkers with either clinical characteristics of an acute MI (and/or cardiac
failure), imaging changes, or positive ECG; or (b) unexpected cardiac death; or (c) post coronary
artery bypass graft or percutaneous coronary intervention with cardiac biomarkers five and three times
threshold levels, respectively; or (d) pathological findings of an acute MI. (Adapted from Thygesen et
al., 2007 (2).)
(c) Cancer case definition for the BNR–Cancer
The BNR–Cancer registered all in-situ and malignant neoplasms and select benign tumours of the
brain, central nervous system, pituitary and pineal glands, and the craniopharyngeal duct for 2008
diagnoses only.
2. Core and enhanced data items and residence definition used by the BNR
(a) Core and enhanced data items collected by the BNR–Heart and BNR–Stroke
Core data include demographic information (age, sex, national registration number, address and
contact details), vascular risk factors, clinical symptoms and signs, and results of laboratory and/or
radiological diagnostic tests. Enhanced data items include information on additional risk factors
(family history, tobacco and alcohol use), education level attained and employment.
(b) Definition of “resident” used by the BNR (all components)
For all registry components residency is defined, following the Barbados census, as those who have
lived on the island for at least 6 of the previous 12 months (3).
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3. The case-defining form used by the BNR (stroke and acute MI components)
Case-Defining Questions for Acute Myocardial Infarction (AMI)
To be completed by medical staff for all suspected and confirmed AMI admissions and in-hospital AMIs.
Please complete the entire form. Place an X in the box that indicates your response where required
Hospital Reg. No._________________ ID No._______-______ Ward_______ Consultant _____________________
Patient’s Surname:
First name:
Initial(s):
1. Date and time of onset of first ischaemic symptom(s) for this event
Date (dd/mm/yyyy) ____/_____/_____
□ Unknown
Time (hr:min) ____: ____ (24 hr clock)
2. Cardiac biomarkers measured serially at ~6-9hr intervals
3. Number of cardiac biomarkers that showed a rise to or
fall from a level above threshold
(Threshold= upper lab reference limit for AST, CK-MB, CKMBm and > 0.1µg/L for troponins)
Note: T0= onset time 1st symptoms
(tick all that apply)
□ None
□ CK-MBm
□ Troponin I
□ Troponin T
□ AST
□ CK-MB
□ None
4. Ischaemic region on ECG
□ None
□ Undetermined
□ ≥2
(tick all that apply)
□ None
□ LBBB
□ ST elevation (≥1.0mm)
1
2
□ ST depression □ T wave changes □ Pathological Q waves3
(II, III, aVF)
(I, aVL, V6)
□1
5. New ECG findings in at least two contiguous leads
□ Posterior (Inferior)
□ Anterolateral
□ Unknown
□ Anterior (V1,V2,
1Horizontal/down-sloping
depression ≥1.0mm
inversion of ≥1.0mm with R wave prominence or R/S
3Ratio>1)(≥0.04s and > ¼ of R wave amplitude
V3,V4,V5)
2T
□ Other
Specify:_____________________
6a. Was cardiac imaging (ECHO/ MRI) performed while the
7a. Has a definite diagnosis of an acute MI** been made?
patient was in hospital? □ Yes □ No
If ‘Yes’:
6b. Were new wall-motion abnormalities present on imaging?
□ Yes □ No □ Unknown
8a. I have informed this patient or his/her relative(s)/carers
about the BNR
□ Yes
□ No
If ‘No’:
7b. What other diagnosis best explains the patient’s
presentation?_______________________________
If ‘Yes’: 8b. Consent to being contacted by BNR staff has
□ Yes □ No
been granted
□ Yes □ No
8c. Indicate whether consent granted/refused by □ Patient
else Give name of relative/carer:_______________________________________________________
Signature: ________________________________ Date (dd/mm/yyyy):_____/_____/_____
Name: ____________________________________ Grade: □ SHO
□ Reg. 2 □ Reg.1 □ Snr Reg. □Consultant
**A definite AMI may be defined as (a) or (b) or (c) or (d) below, in a clinical setting of myocardial ischaemia:
a) Diagnostic cardiac biomarkers1 with at least one of:
 Typical/atypical AMI symptoms and/or signs of
cardiac failure
 Imaging changes (new wall motion abnormalities)
 Positive ECG2
b) Sudden (unexpected) cardiac death
c) Post coronary artery bypass graft (CABG) or percutaneous
coronary intervention (PCI) with cardiac biomarkers 5x and 3x
threshold levels,** respectively
d) Pathological findings of AMI
1
Diagnostic Cardiac Biomarkers are those with serial measurements 6-9 hrs apart, with a level above threshold that shows a rise/fall in
levels over time. (**Threshold levels for biomarkers=upper lab reference limit for AST, CK-MB, CK-MBm and > 0.1µg/L for troponins).
2
Positive ECG=NEW findings in at least two contiguous leads of either evolving ST elevation (ST elevation ≥1.0mm), or evolving non-ST
elevation (horizontal/ down sloping ST depression ≥1.0mm and/or T inversion of ≥1.0mm with R wave prominence or R/S ratio>1) or
evolving pathological Q waves (≥0.04s and > ¼ of R wave amplitude) or LBBB.
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SUPPLEMENTARY MATERIAL
Rose et al. • Implementing national NCD surveillance
Case-Defining Questions for Acute Stroke
To be completed by medical staff for all suspected and confirmed stroke admissions and in-hospital strokes.
Please complete the entire form. Place an X in the box that indicates your response where required
Hospital Reg. No._________________ ID No._______-______ Ward_______ Consultant
_____________________________________
Patient’s Surname _____________________________ First name ____________________________Initial(s) __________
1. Date and time of onset of first stroke symptom(s) for this event
Date (dd/mm/yyyy) ______/_______/______
□ Unknown
2. Time (hr:min) __ __: __ __ (24 hr clock)
□Unknown
3. Did the patient have sudden-onset neurological impairment?
□ Yes
□ No
□ Unknown
4a. Did stroke symptoms/signs last for 24 hours or more?
□ Yes
□ No
□ Unknown
4b. OR Did symptoms/signs lead to death in less than 24 hrs?
□ Yes
□ No
□ Unknown
5a. Has a definite diagnosis of an acute stroke** been made?
□ Yes
□ No
If No: go to 5c
If ‘Yes’:
5b. What stroke subtype was diagnosed, based on CT/MRI or other investigations?
□ Ischaemic
□ Primary Intracerebral Haemorrhage □ Subarachnoid Haemorrhage
□ Unclassified (i.e. non-diagnostic CT/MRI, or no imaging/post mortem done)
If ‘No’:
5c. What other diagnosis best explains the patient’s presenting signs/symptoms?
_____________________________________________________________________________________________________
6a. I have informed this patient or his/her relative(s)/carers about the BNR
□ Yes □ No
If Yes:
6b. Consent to being contacted by BNR staff has been granted
6b. Indicate whether consent granted/refused by:
□ Patient
□ Yes □ No
else Give name of relative/carer:_______________________
Signature: ______________________________________
Date (dd/mm/yyyy):_______/______/_______
Name: __________________________________________
Grade : □ SHO
□ Reg. 2 □ Reg.1 □ Snr Reg. □
Consultant
**A definite diagnosis of acute stroke may be defined as the following:
A focal or global neurological impairment


of sudden onset
lasting ≥24 hrs (or leading to death within 24 h)
and

of presumed vascular origin
The WHO case definition for acute stroke excludes:

Transient ischaemic attack (TIA), defined as focal
neurological symptoms lasting ≤ 24h

Subdural haemorrhage

Epidural haemorrhage

Poisoning

Symptoms caused by trauma
Now please notify the BNR of this patient by entering information in one of the notification books
located on wards C5, C9, MICU, and A6, or A&E.
Alternatively, please call the BNR HOTLINE at 256-4BNR (256-4267)
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4. The case report forms used by the BNR – stroke component
Brief outline of data collected from stroke case report forms (CRFs) – full CRFs available on request
from [email protected]
CRF
Scope of CRF
A
Patient demographic information (all patients): name, address, date-of-birth, age, sex,
national registration number, marital status, residence status, contact details, next-of-kin
information
B1
Event information (all patients): symptoms, onset date and time, stroke subtype, imaging
information, whether patient hospitalised
B2
Hospital information (hospitalised patients only): ambulance details, hospital admission and
ward details, Glasgow Coma Scale score, admission diagnosis, stroke history/family history,
risk factors, diagnostic tests, hospital assessments, hospital complications
B2M
Medication information (hospitalised patients only): details of all medications received by
patient (within 24 hrs of onset or admission and chronic use)
B3
Death information (patients with fatal events in the community only): autopsy details,
imaging information, subtype, cause(s) of death
B4
Event information (patients with non-fatal events in the community only): subtype,
diagnosis, community assessments, diagnostic tests, risk factors, history/family history,
medication information (within 24 hrs of onset and chronic use)
B5
Hospital discharge information (hospitalised patients only): date and time of discharge or
death, cause(s) of death, intensive care dates and times (if applicable), hospital
complications, final diagnosis, discharge medications, stroke unit information (if applicable)
B6
Case-defining information (hospitalised patients only): rapidity of stroke onset, length of
onset (whether at least 24 hrs), whether resulted in patient’s death, subtype information,
consent to follow-up, physician information
C1
28-day follow-up information (all patients): verbal consent details, information about
interview process, vital status, cause(s) of death (deceased patients), domestic situation
(surviving patients), information on residence, ethnicity, education, occupation, prior living
situation, re-admission information (if applicable), modified Rankin assessment (pre-stroke
and current), family history, risk factors (alcohol and tobacco)
C2
1-year follow-up information (all patients): verbal consent details, information about
interview process, vital status, cause(s) of death (deceased patients), domestic situation
(surviving patients), re-admission information (if applicable), modified Rankin assessment
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Rose et al. • Implementing national NCD surveillance
5. The case report forms used by the BNR – acute MI component
Brief outline of data collected from acute MI case report forms (CRFs) – full CRFs available on
request from [email protected]
CRF
Scope of CRF
A
Patient demographic information (all patients): name, address, date-of-birth, age, sex,
national registration number, marital status, residence status, contact details, next-of-kin
information
B1
Event information (all patients): symptoms, onset date and time, patient location at onset,
cardiac arrest and resuscitation information (if applicable), diagnosis, whether patient
hospitalised
B2
Hospital information (hospitalised patients only): ambulance details, hospital admission and
ward details, vital signs, admission diagnosis, acute MI history/family history, risk factors,
diagnostic tests (up to 3 cardiac biomarkers with dates/times: Troponin and CK-MB/AST)
B2E
Hospital information (hospitalised patients only): Diagnostic tests (ECG details with
dates/times), reperfusion information (with date/time), diagnosis information from casedefining form
B2M
Hospital information (hospitalised patients only): Diagnostic and therapeutic interventions,
hospital complications, medication information (within 24 hrs of onset or admission and
chronic use)
B3
Death information (patients with fatal events in the community only): autopsy details, ECG
information, cause(s) of death
B4
Event information (patients with non-fatal events in the community only): diagnosis, ECG
information, diagnostic and therapeutic interventions, risk factors, history/family history,
diagnostic tests (up to 3 cardiac biomarkers with dates/times: Troponin and CK-MB/AST),
medication information (within 24 hrs of onset and chronic use)
B5
Hospital discharge information (hospitalised patients only): date and time of discharge or
death, cause(s) of death, intensive care dates and times (if applicable), hospital
complications, final diagnosis, discharge medications
B6
Case-defining information (hospitalised patients only): date and time of onset of ischaemic
symptoms, whether cardiac biomarkers measured serially, ischaemic region from ECG,
cardiac imaging, diagnosis, consent to follow-up, physician information
C1
28-day follow-up information (all patients): verbal consent details, information about
interview process, vital status, cause(s) of death (deceased patients), domestic situation
(surviving patients), information on residence, ethnicity, education, occupation, prior living
situation, re-admission information (if applicable), family history, risk factors (alcohol and
tobacco)
C2
1-year follow-up information (all patients): verbal consent details, information about
interview process, vital status, cause(s) of death (deceased patients), domestic situation
(surviving patients), re-admission information (if applicable)
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6. The case report forms used by the BNR – cancer component
Type of information
Detail of information collected on CRF
Patient demographics
Name, address, date-of-birth, sex, national registration number,
marital status, residence status, race, occupation
Tumour
Site of primary (with ICD-O code), histology(with ICD-O code),
laterality, behaviour, basis of diagnosis
Laboratory (where applicable)
Laboratory number
Histology (where applicable)
Histology confirmation date
NOT YET IN USE
Site of mets, summary staging
Treatment
Initial treatment with date(s), other treatment with date(s), vital
status, date of last contact/death; if deceased: date of autopsy
Source
Information source type, information source name,
hospital/clinic number, consultant name, date of admission
(hospital), date of first consultation (non-hospital: GP and
surgeon)
Incidence
Incidence date
Tests/procedures
Type of examination/test/procedure, date and results
Administrative
Reviewers’ names and dates
7. References
1. World Health Organization. WHO STEPS Stroke Manual: The WHO STEPwise
approach to stroke surveillance [Internet]. Geneva: WHO; 2006. Available from:
http://www.who.int/chp/steps/Manual.pdf
2. Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, et al.
Universal definition of myocardial infarction. Circulation. 2007 Nov
27;116(22):2634–53.
3. Barbados Statistical Service. 2000 Population and Housing Census Report, Vol. 1.
Government Printing Department, Barbados: Barbados Statistical Service; 2002.
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Rose et al. • Implementing national NCD surveillance
2: Methods
Data management process: detail – from data collection to reports (Figure 1)
Steps 1-3: Case ascertainment, data entry and verification. For all BNR components,
data abstractor staff travel to multiple data sources to obtain information on suspected
cases from hand-written patient records or notes, and for a few data sources (e.g. some
private specialists), from computerised patient records. This information is entered
directly into locally designed case ascertainment databases on laptop computers (one for
each registry component; Step 2). There are principal data sources routinely visited for
each registry component, but in addition to this active case ascertainment, passive
notification is encouraged. Death information, for example, is received electronically
from the national registration department; however, private physician notifications are
rarely received. As it would be impossible to regularly visit every potential physician
who may diagnose a patient with one of the NCDs on the registry, BNR administrative
staff routinely perform telephone ‘call-rounds’ to secondary data sources, in order to
obtain information on new cases, which is then entered onto the case ascertainment
database.
The data variables collected for each registry component’s ascertainment databases are
listed in Supplementary Table 1. This information serves as ‘notification’ and allows the
data abstractors to then obtain patient records for each notified (i.e. suspected) case.
Abstractors use the information recorded in the patient’s notes to verify (Step 3) whether
the patient has had a confirmed event (for whom complete data should be abstracted, see
Step 4 below) or not (the reason why the suspected event was not confirmed is then
recorded in the case ascertainment database). Case definitions used are provided in
Supplementary File 1.
Steps 4-5: Data abstraction and data entry. For the CVD component, data are
abstracted from patient records onto pre-printed forms (Step 4) created using optical
recognition software Cardiff TeleForm® v.10.4; HP Autonomy, San Francisco, CA,
USA). On returning to the BNR office from the data source, paper forms containing
abstracted data are then scanned into the system (‘data entry’; Step 5). For the cancer
component, data are abstracted directly onto laptops (Steps 4 and 5 together) into a
database using CanReg5 software provided by the International Agency for Research on
Cancer (IARC; Lyon, France). For an outline of the data collected for each registry
component, please see Supplementary File 1.
Step 6. Quality control: review and verification. For the CVD component of the
registry, first the BNR registrar reviews the paper forms, and any errors found are
referred to the data abstractor for correction. This may involve simple changes to the
form (e.g. transposition error for the year of abstraction) or require return to the data
source for fuller completion (e.g. missing a page of information). Complex clinical
queries are referred to each registry component’s Clinical Director for expert review.
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Once forms have been reviewed, they are then batched and scanned. The scanned data are
verified by on-screen comparison with the paper form for scanning or optical recognition
errors. For the cancer component, initial data verification takes place at the time of data
entry, as verification checks (based on the IARC/IACR check program (1)) are built into
the IARC software. Similarly to the CVD component, the registrar reviews each
abstraction, notifying the data abstractor of errors found; the difference here is that the
reviews and subsequent corrections are conducted on electronic data.
Steps 7-8: Data cleaning, analyses, interpretation and reporting. The CVD data are
regularly exported from TeleForm (which automatically holds scanned data in a
Microsoft Access database) into Stata v12 (Stata Corp., College Station, TX, USA) for
cleaning. Data are cleaned and analysed prior to creation and dissemination of reports.
Annual reports were prepared with a 2–3 year delay for the first 4 data years (2009–
2012). From 2012, quarterly reports comprising data from the case ascertainment
database (preliminary data) as well as technical and staffing issues have been submitted
to all members of the governing bodies. From 2013, quarterly ‘live’ data have also been
produced from fully abstracted data. As national death data cannot be included in
analyses until they are obtained from the National Death Register (after the end of the
first quarter of each year, for all deaths occurring in the previous year), from 2013
onwards, complete annual data reports were completed between 9 months and 1 year
from the end of the year in question. For example, the annual report for 2013 data was
produced by the end of December 2014. The cancer registry component data will be
exported to Stata from CanReg5, where, similarly to the CVD component, they will be
cleaned and analysed prior to reporting. It is expected that the annual report for the first
year of cancer data (2008) will be ready by the end of 2014.
Annual reports are disseminated electronically to all medical professionals on the island
registered with the Barbados Association of Medical Professionals, and paper copies
distributed to colleagues in the MoH, polyclinics and several private physicians’ offices
across the island. Information packaged in a more ‘general public-friendly’ way,
including e.g. reports from survivors, has been compiled into regular (at least twice
yearly) editions of the BNR newsletter, The Register. This is sent to all physicians and is
placed in the public hospital and polyclinics across the island, as well as being
disseminated to the general public during health fairs, public lectures and other similar
events. Periodically, key facts from each year’s annual report have been sent to the
Government Information Service (GIS) to be broadcast as part of the GIS regular health
and wellness reporting slot in the televised media. Every year, once the annual report has
been accepted by the MoH, a public lecture is held in which the data are presented to the
general public.
Data sources
The BNR operates in an environment with limited electronic health records.
Consequently, there is a focus on certain data sources to maximise cases retrieved, given
the resource limitations. A previous study showed that two-thirds of stroke patients were
retrieved from the single tertiary hospital on the island, and discussions with local
cardiologists and other medical professionals revealed that all suspected acute MI
patients would be referred to the public hospital. Hence the primary data sources for the
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Rose et al. • Implementing national NCD surveillance
CVD components (stroke and acute MI) are this hospital, along with accident and
emergency centres (public and private), as both CVDs are acute events requiring
emergency attention. In addition, to ensure complete coverage within this setting, the
public hospital Medical Records Department, and wards from both the public hospital
and the private (for those who may have been admitted for elective surgery) are main
data sources. Finally, the national death register is a major data source to obtain
information on all those patients who may have died before reaching the hospital.
Secondary data sources for the CVD components include other hospital departments and
private physicians (see Supplementary Table 1). The cancer registry component, in
contrast, has data collected retrospectively (non-acute events). In Barbados, as tumours
should be diagnosed histologically where possible, the hospital laboratory is therefore a
main data source, along with the national death register (for the same reasons as given
above for the CVD components). In addition, as there may be patients treated for some
tumours (particularly the usually non-fatal, non-melanoma skin cancers) entirely in the
private sector, the single private hospital and private physicians are also a major data
source for the cancer component (Supplementary Table 1). Private laboratories should be
a primary data source but currently in Barbados they are not required by law to notify
cancer (other than to the physician requesting the laboratory test); they are therefore
listed as a secondary source.
Data collection
For each registry component, data are collected in a hierarchy of importance: core and
enhanced. Core data are required for the calculation of basic registry indicators
(incidence, mortality, and for the CVD patients, the proportion surviving to 28 days and 1
year). Enhanced data items include information on additional risk factors, education and
employment (for further details, see Supplementary file 1). All cases (i.e. not just those
with first-ever events) of all ages nationwide are registered, as long as they are Barbados
residents. For all registry components residency is defined, following the Barbados
census, as those who have lived on the island for at least 6 of the previous 12 months
(13). The data collected for the cancer component include the minimum information
required for a cancer registry, as specified by IARC (9), with some additional information
(e.g. laterality and treatment information; see details from the data collection form for the
cancer component in Supplementary file 1).
Governance
The BNR is governed by two advisory groups whose members include the National
Chronic NCD Commission, insurance companies, private physicians, CVD special
interest groups, the main public hospital and the MoH, as well as legal, ethical and
pathology experts. From these groups the BNR receives regular advice on, and review of
planning and implementation of BNR services and activities, as well as monitoring of
BNR objectives and support with promotion and sustainability efforts.
Communication and publicity
In the early implementation stages, limited human resources meant that communication
(including publicity) was limited, although this was acknowledged as key throughout the
development of the BNR. Although inadequate, early publicity did include an official
launch (in March 2009), open days targeting both the general public and the medical
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community, development of a website (www.bnr.org.bb), and installation of a telephone
Hotline, kindly donated by a local telecommunications company. In addition the director
and registrar continue to provide television interviews, presentations and face-to-face
meetings with audiences encompassing healthcare professionals, decision-makers, and
the general public. The key message has focused on the uniqueness of our NCD
surveillance system both regionally and internationally, and its usefulness for monitoring
the health of all Barbadians.
Communication with the public and the medical community require a targeted and
professional strategy from personnel with training in health promotion activities. Staff
recruited for routine health surveillance would not necessarily have such specialised
training (and, even if they did, might not have the time to design publicity activities in
addition to their surveillance duties). Health promotion activities which target public
awareness of the future system, particularly responding to the ethical concerns of the
public, may not be considered, and hence not budgeted for, in the design of a public
health surveillance system.
Human resources
Human resource costs are shared between the regional university (The University of the
West Indies) and the Barbados Government (Figure 3 shows the BNR team structure).
The BNR has one director (now part-time for 0.6 FTE or “full-time equivalent”; i.e. 3
days per week) providing overall leadership for all three components. Each registry
component also has a 0.05 FTE clinical director (one-half of a day per fortnight),
providing clinical advice in his or her area of expertise.
Making use of a national surveillance system
One of the major registry achievements has been its usefulness in both the identification
and the addressing of training needs for medical professionals. With the guidance of the
National Chronic NCD Commission, and with input from the Barbados MoH and the Pan
American Health Organization, the BNR team has implemented a series of training
seminars for medical professionals, the first of which, in May 2010, targeted diagnosis of
an acute MI. Through these seminars, valuable feedback on current diagnostic practice
and documentation has been provided to medical personnel. Sessions of the BNR
Continuing Education Seminar Series are now held regularly, once training needs are
identified from the data. The first in the series was repeated in September 2010. Another
seminar, covering ECG diagnoses for acute MI, was held in January 2011. The third in
the series, focusing on death certificate documentation, was conducted in February and
repeated in May 2011. The first seminar on a cancer topic (covering male genitourinary
cancer management) was held in 2012, with the second (on breast cancer management) in
2013. The first stroke-themed seminar, on acute stroke management, was held in 2012
and the second in 2014. Continuing Professional Education (CPE) credits have been
awarded for these seminars since 2012.
Another major benefit is that the registry has played a key part in identifying the need for
a standardised protocol for death certification in Barbados. The development of this
protocol was spearheaded by the MoH after the death certification seminars highlighted
the need for clarity in the correct procedure to be followed after certain deaths, e.g.
someone who has died while visiting the island from overseas.
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References
1.
Ferlay J, Burkhard C, Whelan S, Parkin DM. Check and conversion programs for
cancer registries. Lyon, France: WHO, IARC, IACR; 2005 p. 46. Report No. 42.
Available from: http://www.iacr.com.fr/TechRep42-MPrules.pdf
Supplementary Table 1. Required variables for BNR case-finding databases
BNR–Stroke and BNR–Heart BNR–Cancer
Registry identification number
Record identification number
Notification source
Notification source
Retrieval source
Retrieval source
First, middle and last names
First, middle and last names
Age
Age
Sex
Sex
Date of birth
Notification type
National identification number
Case-finding date
Notification date
Site
Hospital admission date
Year diagnosed
Hospital number
Eligibility for registration
Ward
Initial diagnosis
Name of doctor
Case status
Hospital status
Event (stroke/acute MI)
Date of death/discharge
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