PowerPoint Presentation

Steps to design and build an injury surveillance system= for use in policy Introd= uction to injury surveillance II

Lesso= n 4 = Secti= on II. Injury information systems (surv= eillance and surveys)

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Main objective of this lesson

To teach students the different steps that are necess= ary to build an injury surveillance system. =

Core competencies that students should attain by the end of the session

1. Ide= ntify the attributes of an injury surveillance system.

2. Describe the process for identifying stakeholders = of an injury surveillance system.

3. Define the objectives of a surveillance system.= 3;

4. Describe case definitions and potential sources of data in the process of creating or

enhancing an injury surveillance system.

5. Identify existing available resources for injury surveillance.

6. Describe the data needs of an injury surveillance system and formulate strategies and

procedures for data collection.

7. Describe the conceptual basis for establishing a system for data processing.

8. Identify the basic elements for designing and disseminating reports.

9. Formulate the principles for injury surveillance system training.

10. Formulate strategies for data quality control.= 3;

11. Evaluate critically the importance of the compatibility of data with standard

&n= bsp; (international) and existing data systems.

12. Evaluate critically an existing injury surveillan= ce system or plan the creation of a system

<= /span>

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Introduction to

injury surveillance II

TEACH-VIP

Definition:

Injury surveillance is the continuing scrutiny of all aspects of occurrence and patterns of injury that are pertinent to effective prevention and control.

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Attributes of a surveillance system

<= span style=3D'font-family:Arial;font-size:117%'>• Simplicity

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span>

<= span style=3D'font-family:Arial;font-size:117%'>• Flexibility

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span>

<= span style=3D'font-family:Arial;font-size:117%'>• Acceptability

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span>

<= span style=3D'font-family:Arial;font-size:117%'>• Reliability

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span>

<= span style=3D'font-family:Arial;font-size:117%'>• Utility

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span>

<= span style=3D'font-family:Arial;font-size:117%'>• Sustainability <= /div>

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span>

<= span style=3D'font-family:Arial;font-size:117%'>• Timeliness

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Simplicity of the system should be strived for =

Example:

•= comparison of sources of information

- hospital, police, forensic sciences, etc.

Attributes of a surveillance system

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Attributes of a surveillance system

Flexi= bility – how well can the system adapt?

<= /div>

Examples:

<= /div>

• change in definition of sexual violence

<= span style=3D'font-family:Arial'>• sudden increased repo= rting due to changes in injuries

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Attributes of a surveillance system

Acceptability

Examples:

<= /div>

<= span style=3D'font-family:Arial'>• data collection over time=3Droutine

<= span style=3D'font-family:Arial'>• feedback from stakeholders

<= span style=3D'font-family:Arial'>• participation in decision-making processes

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Attributes of a surveillance system

Reliability – does the system classify = events correctly?&= #13;

Examples:

• discrepancies in definitions betw= een sources

• changes over time, de= lays in reporting

• detection of all events

• exclusion of non-inju= ry events

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Attributes of a surveillance system

Utility

<= /div>

Example:

<= span style=3D'font-family:Arial'>• selection of key variables or sou= rces of information

= can help the system survive or can lead to its collapse =

• too many variables or burden to get information will

= hamper the system

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Attributes of a surveillance system

Sustainability = ;

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span>

Examples:

<= span style=3D'font-family:Arial'>• information flow from outlying to= central

= offices should be clear and easy to conduct.

<= span style=3D'font-family:Arial'>•periodic updates and use of information

•established user guides and case definitions t= o allow new users to easily underst= and system •<= /span>established protocols for data an= alysis and = interpretation.

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Timeliness

<= /div>

Example:

• sexual violence or an outbreak of suicides requires

= fast evaluation for rapid response. Less time between

= event and information means less time for response.

Attributes of a surveillance system

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Improving or building a surveillance system

<= span style=3D'font-family:Arial;font-size:83%'>• Process needs careful planning and organizatio= n

•

• Can involve several agents

•

• It is a cyclic proces= s

•

<= span style=3D'font-family:Arial'>• Design should take in= to account basic attributes of the

= system

•

<= span style=3D'font-family:Arial;font-size:117%'>• Follows 12 steps !

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Designing and building a surveillance system

Define/redefine

objectives

Identify
data sources

and systems

Assess available resources

Sensitise/orient

stakeholders

State data needs

Draft form and formulate

data collection system

Process data

Design output fo= r dissemination

Implement and train=

Monitor and evaluate

Starting

point

The di= agram depicts the process of building an injury surveillance system and the flow of information needed to create an effective system (2). The 12 steps to cre= ate such a system are shown on slides which follow.

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Designing and building a surveillance system

Step 1: identifying stakeholders

<= span style=3D'font-family:Arial'>• identifying who wants= to do injury surveillance

•

• involving all potenti= al stakeholders

Step 2: defining s= ystem objectives

• addressing why an inj= ury surveillance system is =

= necessary

•

• defining the type of surveillance required

Step 1= refers to the identification of stakeholders. For example, agencies that need informati= on on injuries to set prevention priorities and to evaluate their work can be optimal for this purpose (e.g. Ministry of Health). Agencies that routine= ly collect information can also participate. Many times, while not in their primary mandate, some agencies can provide useful information about an in= jury problem. This information is not necessarily used for public health purpo= ses but it can very well complement public health activities.

Agenci= es should not be only within the health sector as much injury information is actually collected in other sectors such as transportation or police.

Step 2= involves the definition of the objectives of the system. These objectives should addre= ss why studying a particular injury problem or group of injury problems is necessary. In this process the type of surveillance to be used should be defined.

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Step 3: defining &= #8220;a case”

=

• case definition is always linked to surveillan= ce objectives

Designing and building a surveillance system

Step 4: identifyin= g data sources

=

• consider multiple definitions of a problem = ;

<= span style=3D'font-family:Arial;visibility:hidden'>•

<= span style=3D'font-family:Arial'>• data can already exis= t but have different purposes

<= span style=3D'font-family:Arial;visibility:hidden'>•

<= span style=3D'font-family:Arial'>• determine whether or = not data is collected consistently

<= span style=3D'font-family:Arial;visibility:hidden'>•

<= span style=3D'font-family:Arial'>• consider data accessi= bility

Step 3= refers to the definition of a case. This is very important because that definition will determine whether or not events will be counted or classified in one way = or another. It is also important given the participation of multiple stakeholders from different sectors and disciplines that frequently define issues differently. Arriving at a common definition of a case is thus essential.

Step 4= refers to the identification of data sources. In part this is also achieved when the stakeholders are identified. This step also refers to the quality and reliability of such sources. Agencies might collect data in different ways and with different methods that sometimes might not be compatible. In oth= er cases, data entry can be difficult and time consuming. If access to electronic resources is limited then information flow will be slowed down= . In other cases the sources might not be representative of the population that the surveillance system intends to cover. Surveillance data systems that = only collect frequency data (numerator) and cannot define the population represented (denominator) data can nevertheless be very useful for injury prevention. In such a system, the relative frequencies and severities of injuries can be determined and monitored over time.

If spe= cific injury types are very frequent and severe and preventative measures are availabl= e, then intervention is warranted even though there may be some bias in the injury data collected.

Anothe= r common problem that addresses reliability and data quality refers to how consistently data are gathered.

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Potential = data sources

This t= able shows an example of potential data sources where injury information can be obtained and used. The nature and severity of an injury will also determine where information about the event is picked up by existing sources of informati= on.

Usuall= y the most easily identifiable consequence of an injury is a fatal one as the table shows (3).

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Disability, self/home treatment and all other severity <= /b>= levels: =

= household survey

= Other medical treatment:

= sentinel practitioner networks

= Hospital treatment and discharge:

ED register

= Deaths:

vital statistics, medico-legal examinations

Hospital admissions: discharge certificates, injury <= /span>admissions registry

Va= lidity/Reliability

Data sources and the injury pyramid

This d= iagram shows in a different way what types of information can be tied to potential sou= rces of data on injuries. Since death is the most easily assessed condition, d= ata on fatal events are usually more reliable than less severe events (3).

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Designing and building a surveillance system

Step 5: assessing available resources

<= /span>

<= span style=3D'font-family:Arial'>• expertise of personne= l

<= span style=3D'font-family:Arial;font-size:83%;visibility:hidden'>•<= /span> <= /span>

<= span style=3D'font-family:Arial'>• existence of supplies, equipment

<= span style=3D'font-family:Arial;font-size:83%;visibility:hidden'>•<= /span> <= /span>

<= span style=3D'font-family:Arial'>• consider institutional environment

Step 6: informing = and involving stakeholders

<= /span>

<= span style=3D'font-family:Arial'>• invite stakeholders &= #8211; clarify data ownership

<= span style=3D'font-family:Arial;font-size:83%;visibility:hidden'>•<= /span> <= /span>

<= span style=3D'font-family:Arial'>• consider multiple nee= ds and uses of information

<= span style=3D'font-family:Arial;font-size:83%;visibility:hidden'>•<= /span> <= /span>
• state potential benef= its of participating and using the system

Step 5= involves an assessment or evaluation of the existing resources to be used by the syst= em. It implies evaluating the expertise of the personnel, the existence of adequate technological and logistic resources as well as the actual functioning of the agencies involved. The environment where data is gathe= red is also important for assuring completeness and reliability but also for providing injured people or their relatives the best possible environment= to address their needs.

Step 6= refers to the inclusion and participation of stakeholders all along the process. It mea= ns that the multiple needs and uses from different agencies have to be prioritized. The system must respond to the most important needs of the stakeholders in order to ensure acceptability. At the same time, agency involvement in decision-making processes can improve the functioning of t= he system by addressing and responding to agency-specific concerns.

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Step 7: defining data needs

•<= /span> =

• = the core minimum data set

•<= /span> <= /div>
• = the core optional data set

•<= /span> <= /div>
• supplementary data sets

<= span style=3D'font-family:Arial;font-size:92%'>– the supplementary minimum data set=

<= span style=3D'font-family:Arial;font-size:92%'>– the supplementary optional data se= t

Designing and building a surveillance system

Step 7= refers to the definition of data needs. This specifically means to define what types of variables will or will not be collected. Overall, there are some basic or core minimum data needs for an injury surveillance system to be effective= . If resources allow it, other core optional data can also be collected.

Additi= onally some minimal and optional supplementary data is identified and explained ahead= .

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Core minim= um data set (MDS)

• Identifier&#= 13;

• Age

• Sex

• Intent <= /span>

• Place of occurrence

• Nature of activity

• Mechanism of injury

• Nature of in= jury

The mi= nimum core data includes variables that should allow the person to be identified by a number, age, sex, injury intent, place where event occurred, activity conducted when event occurred, the mechanism or cause involved in the occurrence of the injury and the nature or description of the injury.

These = eight variables should be the minimum recommended for inclusion in an injury surveillance system.

This i= nformation enables the counting of injuries but it is limited in terms of case categorization.

For ex= ample if a two-year-old boy were scalded by water heated by a paraffin burning stove= on the floor of his dwelling while playing, this would be recorded in the minimum data set as: two-year-old male, unintentional burn injury while playing at home.

That i= s, key information needed for prevention would be missing.

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Core optio= nal data set (ODS)

• = Race/ethnicity =

•<= /span> Date of injury <= /div>
•<= /span> Time of injury <= /div>
•<= /span> External cause <= /div>
•<= /span> Residence

•<= /span> Alcohol use

<= span style=3D'font-family:Arial'>• Other psychoactive

substance

•<= /span> Abuse

•<= /span> Severity

•<= /span> Disposition
•<= /span> Incident summary

The op= tional core data can provide additional information on time and place, as well as some risk factors for occurrence and the severity of the injury. Specifically, information on ethnicity could be included, date and time of event, exter= nal causes that lead to the injury, residence of the injured person, if use or abuse of substances was involved, severity of the injury and what happene= d to the person after the injury occurred. An incident summary could also be included. These additional variables can enhance the information about an injury event (3).

For ou= r example of the two-year-old’s scald, this optional core data set would add lit= tle useful information. However, this data set would potentially add substant= ial information for a case involving violence.

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Supplement= ary data sets

Land-mines:

• displacement status

•<= /span> cause of injury (anti-personnel mi= ne, cluster bomb)

• was area known to be mined?

• was the area marked?

• had person received mine awareness training

• were there other victims in the sa= me blast?

Supple= mentary data sets refers to information collected for specific types of injuries for example those only related to traffic crashes or violent assaults (3, 4).= The example above shows some supplementary data for a surveillance system that gathers data from land-mine victims. The questions and variables added wi= ll depend naturally on the type of injury. The optional information for these supplementary data sets might include type of weapon used or information = on perpetrators and circumstances of the event.

In the= case of burns and scalds, the detailed circumstances of injury would be identified by a similar specific supplementary data set.

Data l= inkage between relevant data sets is a further potential means of supplementing injury d= ata. For example, police-reported traffic crash data has been linked with heal= th sector data in several countries to provide detailed data on road traffic crashes and resulting injuries.

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Designing and building a surveillance system

Step 8: collecting the data

=

• = choosing locations for surveillance

• <= /div>
• = data collection forms

–<= /span> who collects them within each institution

– design of data collection forms= 3;

– coding or classification of the da= ta

Step 8= refers to the actual collection of data. Once the data set requirements are defined, the process for collection needs to be put in place and tested. A good time a= nd resource saving strategy is to build surveillance systems on already exis= ting sources of information. In some occasions entire systems might be in place and with only minor modifications the required data could be obtained. If= the use of multiple independent systems is involved, then interagency agreeme= nts will be necessary and adequate conceptual and technical knowledge on link= age of information will be needed.

There = are many existing examples of injury surveillance data collection forms and these could be adapted to meet the needs of many new systems. In some cases ent= ire new forms might need to be created. The whole process of the evaluation of the system will include the piloting of these forms to determine whether = or not they are acquiring the information that is needed. Form design and selection will also involve the use of appropriate coding or classificati= on systems. Obtaining approval for the data collection form to be included in the patient medical record as an official document tends to improve the quality of the data collected and to inform the patient’s medical management. In this case duplicate forms may be required.

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Designing and building a surveillance system

Step 9: establishing a data processing system

=

= • establishing protocols for data collection and transmission

• <= /div>
• = define data processing mechanisms

- electronic

- manual

Step 9= refers to the establishment of a data processing system. This includes the creation of written protocols for data collection and transmission, and defines wheth= er these will be manually or electronically created and transmitted. For this step, adequate technical preparation must exist among the users for input, transmission, collation and maintenance of the data and the system as a whole. Data processing is best done electronically and can use software t= hat is readily and freely available. The analysis of the data will imply that technical expertise for this purpose already exists among the surveillance system personnel.

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Designing and building a surveillance system

Step 10: designing= and distributing reports

• consider timeliness&#= 13;

•

• consider audience = ;

•

• consider data to be reported

Step 11: training = staff and activating the system

• knowledge of procedur= es among staff involved

•

• attempt activation as exercise

•

<= span style=3D'font-family:Arial'>• documents stating procedures should be available

Step 1= 0 involves the design and distribution of reports based on the analysed data. Frequent reporting can maintain stakeholders up to date on injury issues relevant = to them. These reports are the means by which results are conveyed to stakeholders. In general, they should be produced and distributed at least quarterly. If such reports are electronic, reporting can be more frequent= and the delivery prompt. The information contained in the reports should at t= he least reflect all the characteristics of the minimum core data sets. Repo= rts can also be tailored with more detail for users with greater technical expertise. Standardized data output improves the efficiency of disseminat= ion of information.

Step 1= 1 refers to the training of staff and activation of the system. Training should occur= at three levels with everyone taking the first level and selected individuals taking the other two. The first level of training should include basic concepts of epidemiology and surveillance and an overview of the system. = The second level should include detailed review of forms with emphasis on the categories of data and coding and knowledge on required procedures to obt= ain the data including confidentiality guarantees. The third level should inc= lude hands-on practice in extracting information, coding it and transmitting i= t. It should also include testing the operation of the data entry and analys= is programs. The activation of the system can actually be conducted as part = of an exercise thus allowing people to get acquainted with all the procedures and work routines. Manuals for training and procedures should also be rea= dily available for all personnel.

Ideall= y inter-rater and intra-rater reliability testing should be conducted on data coding and entry.

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Designing and building a surveillance system

Step 12: monitoring and evaluating the system

• = consider other system attributes

•<= /span> <= /div>
• evaluation aimed at

–<= /span> quality of data =

–<= /span> flow of information

–<= /span> established processes of reporting=

Types of evaluation:

– retrospective
– process

– = system environment

Step 12 refers to t= he monitoring and evaluation of the system. This process should be continuous and should address any gathering, reporting or analysis problems. After t= he system has been in operation for about six months, a detailed evaluation should be carried out to determine whether or not the system's objectives= are being achieved. This evaluation should include the ability of the system = to identify actual injury cases and correctly categorize them. It should also focus on the accuracy of reporting and the determination of percentages of missing data, the ease of use of the forms for gathering and processing d= ata, and the usefulness of the information provided after the analysis and thr= ough the dissemination process. A feedback process is required to inform those responsible for data collection of the strengths of the data collected and any deficiencies that require attention.

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Designing and building a surveillance system

=

Summary

This lesson has expanded on the previous= lesson to provide a step-by-step process= to establishing and evaluating an injury surveillance system. <= /div>

Summary

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‹header›

‹date/time›= =

Click to edit Master text styles

Second level

Third level

Fourth level

Fifth level

‹footer›

‹#› =

General topic description
This lecture devel= ops in detail each of the 12 steps required to build an injury surveillance system. These steps are ba= sed on WHO recommendations and follow a sequential and logical process aimed at ensuring data qual= ity and viability of= a surveillance system. The steps are illustrated with actual examples from different geographic areas.=

The definition of injury surveillance continues to underpin this lesson.

An effective surveillance system should typically have the following attributes:

simplicity

flexibility <= /span>

acceptability (to many)

reliability

utility

sustainability = ;

timeliness. <= /span>

The following sect= ion will briefly expand on these attributes (1).

This attribute refers to the capacity of a system to gather the information it needs in the most straightforward and simple way thus saving time, quanti= ty of information = and resources. A simple surveillance system includes adequate identification of the quantity, quality and reliability of sources of information. A smaller number of sources gives greater guarantees for simplicity. (Instructors should refer to local examples where available.) While paper-based data collection, foll= owed by computer data entry is simple in some respects, direct electronic data entry (e.g. in hospital emerg= ency departments) is mo= re efficient and can provide data in real time. Whether data is collected on a form or electronically, the collection system should be pre-coded so that data is collected in a standardized format.

Flexibility refers to how well the system can adapt itself to chang= es in information, introduction of new items to the system or sudden changes in occurrence of injuries. The inclusion o= f a new injury, population or data providing institution will require a good level of flexibility. The inclusion of one line of text narrative is collected in many injury surveillance systems in response to the question, “what went wrong?” The narrative is a rich source of information on circumstances of injury, products and persons involved, and emerging injury problems. The one line narrative data is usually entered into the database and searched using key words.

Acceptability refers to the commitment of working groups and stakeholders in the participation and operation of the system. The more acceptable the system = is to participants and users, the more likely it is to function well and have a long-term effect. Users need to get answers = from the system and if they do, it is highly likely they will accept it and use it. Routine efforts can affect acceptability. This is why feedback to stakeholders and participation in decision-making processes is also important.

This refers to the capacity of the system to count or classify even= ts correctly. It means the sy= stem should record all events (cases), exclude the non-cases and cover the population it intends to cove= r. It should also address potential discrepancies of definitions between sources with the aim of identifying true cases. <= /span>In order to achieve the required inclus= ion and exclusion of "cases", it is necessary to provide data collectors wi= th written instructions and training.

This refers to how practical and affordable the system should be. T= he practicality of the system should include obtained information, information used and the process for gathering and analysing it. This is especially important when confronted with limited resources. It also addresses the issue of defining priorities f= or gathering relevant information.

A surveillance system must work with minimum effort and be easy to maintain and update. = This also means that those who work within the system and those who use it find that it provides adequa= te information. If the users of the system accept it, they can contribute to supporting and sustaining it. Naturally, sustainability is also linked to the rational use of resources.

This attribute ref= ers to the capacity of the system to maintain an acceptable temporal difference between the moment of an injury and the actual reporting of it. The most timely system would be one that actually provides information about an eve= nt almost as soon as it happens. Since this is rarely possible, nevertheless,= the system should identify problems or changes in injury patterns promptly so = as to provide rapid information to decision-makers.

The whole process needed to plan and organize a system needs to be careful and follow s= ome well-tested steps. It usually involves several agents, people or institutions and it follows a cyclic process. For the design of a good injury surveillance system, the attributes sho= uld be taken into account in every step. The following 12 steps can guide injury specialists in the creation of such a system (2).

The diagram depicts the process of building an injury surveillance system and the flow of information needed to create an effective system (2). The 12 steps = to create such a system are shown on sl= ides which follow.

Step 1 refers to the identification of stakeholders. For example, agencies that need informa= tion on injuries to set prevention priorities and to evaluate their work can be optimal for this purpose (e.g. Ministry of Health). Agencies that routinely collect information can also participat= e. Many times, while not in their primary mandate, some agencies can provide usef= ul information about an injury problem. This information is not necessarily used for public health purposes but it can very = well complement public health activities. Agencies should not be only within the health sector as much injury information is actually collected in other sectors = such as transportation or police. Step 2 involves the definition of the objectives of the system. The= se objectives should addre= ss why studying a particular injury problem or group of injury problems is necessary. In this process = the type of surveillance to be used should be defined.

Step 3 refers to the definition of a case. This is very important because that definition w= ill determine whether or not events will be counted or classified in one way or another. It is also important gi= ven the participation of multiple stakeholders from different sectors and disciplines that frequently define issues differently. Arriving at a common definition of a case is thus essential. Step 4 refers to the identification of = data sources. In part this is also achieved when the stakeholders are identified. T= his step also refers to the quality and reliability of such sources. Agencies might collect data in differe= nt ways and with different methods that sometimes might not be compatible. In other cases, data entry can be difficult and time consumi= ng. If access to electronic resources is limited then information flow will be slowed down. In other cases t= he sources might not be representative of the population that the surveillance system intends to cover. Surveillance data sys= tems that only collect frequency data (numerator) and cannot define the population represented (denominat= or) data can neverthe= less be very useful for injury prevention. In such a system, the relative frequencies and severities of injuries can be determined and monitored over time. If specific injury types are very frequ= ent and severe and preventative measures are available, then intervention is warranted even though there may= be some bias in the injury data collected. Another common problem that addresses reliability and data quality refers to how consiste= ntly data are gathered.

This table shows an example of potential data sources where injury information can be obtai= ned and used. The nature and severity of an injury will also determine where information about the e= vent is picked up by existing sources of information. Usually the most easily identifiable consequence of an injury is a fatal one as the table shows = (3).

This diagram shows in a different way what types of information can= be tied to potential sources of data on injuries. Since death is the most easily assessed condition, data on fatal events are usu= ally more reliable than less severe events (3).

Step 5 involves an assessment or evaluation of the existing resourc= es to be used by the system. It implies evaluating the expertise of the personnel, the <= span lang=3DEN-GB style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bi= di-font-family: Arial;mso-hansi-font-family:Arial'>existence of adequate technological and logistic resources as well as the actual functioning of the agencies involved. T= he environment where data is gathered is also important for assuring completeness and reliability but also for providing injured people or their relatives the b= est possible environment to address their needs. Step 6 refers to the inclusion and participation of stakeholders all along the process. It means that the multiple nee= ds and uses from different agencies have to be prioritized. The system must resp= ond to the most important needs of the stakeholders in order to ensure acceptability. At the same time, ag= ency involvement in decision-making processes can improve the functioning of the system by addressing and responding to agency-specific concerns.

Step 7 refers to the definition of data needs. This specifically me= ans to define what types of variables will or will not be collected. Overall, there are some basic or core minimum data needs for an injury surveillance system to be effective. If resources allow it, other core optional data can also be collected. Additionally some minimal and optional supplementary data is identi= fied and explained ah= ead.

The minimum core data includes variables that should allow the pers= on to be identified b= y a number, age, sex, injury intent, place where event occurred, activity conducted when event occurred,= the mechanism or cause involved in the occurrence of the injury and the nature or description of the injury. These eight variables should be the minimum recommended for inclusion in an injury surveillance system. = This information enables the counting of injuries but it is limited in terms of case categorization. For example if a two-year-old boy were scalded by water heated by a paraffin burning stove on the floor of his dwell= ing while playing, this would be recorded in the minimum data set as: two-year-old m= ale, unintentional burn injury while playing at home.
That is, key information needed for prevention would be missing.

The optional core data can provide additional information on time a= nd place, as well as some risk factors for occurrence and the severity of the injury. Specifically, information on ethnicity could be included, date and time of event, external causes that lead to the injury, residence of the injured person, if use or abuse of substances was involved, sever= ity of the injury and what happened to the person after the injury occurred. An incident summary could als= o be included. These additional variables can enhance the information about an injury event (3). For our example of the two-year-oldR= 17;s scald, this optional core data set would add little useful information. However, this data set would potentially add substantial information for a case involving violence.

Supplementary data sets refers to information collected for specific types of injuries for example those only related to traffic crashes or violent assaults (3, 4). = The example above shows some supplement= ary data for a surveillance system that gathers data from land-mine victims. The questions and variabl= es added will depend natur= ally on the type of injury. The optional information for these supplementary data sets might include t= ype of weapon used or information on perpetrators and circumstances of the event. In the case of burns and scalds, the detailed circumstances of injury would be identified by a similar specific supplementary data set. Data linkage between relevant data sets is a further potential mean= s of supplementing inju= ry data. For example, police-reported traffic crash data has been linked with health sector data in several countries to provide detailed data on road traffic crashes and resulting injuries.

Step 8 refers to the actual collection of data. Once the data set requirements are defined, the process for collection needs to be put in place and tested. A good = time and resource saving strategy is to build surveillance systems on already existing sources of information. In some occasions entire systems might be in place and with only minor modifications the required data could be obtained. If the use of multiple independent systems is involved, then interagency agreements will be necessary and adequa= te conceptual and technical knowledge on linkage of information will be needed. There are many existing examples of inj= ury surveillance data collection forms and these could be adapted to meet the needs of many new systems. In some cases entire= new forms might need to be created. The whole process of the evaluation of the system will include t= he piloting of these forms to determine whether or not they are acquiring the information that is needed. F= orm design and selection will also involve the use of appropriate coding or classification <= span lang=3DEN-GB style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bi= di-font-family: Arial;mso-hansi-font-family:Arial'>systems. Obtaining approval for the data collection form to be included in the patient medical record as an official document tends to improve the quality of the data collected and to inform the patient’s medical management. In this case duplicate forms may be required.

Step 9 refers to the establishment of a data processing system. This includes the creation= of written protocols for data collection and transmission, and defines whether these will be manually or electronically created and transmitted. For this step, adequate technical preparation mu= st exist among the users for input, transmission, collation and maintenance of the data and the system = as a whole. Data process= ing is best done electronically and can use software that is readily and freely available. The analysis of t= he data will imply that technical expertise for this purpose already exists among t= he surveillance system personnel.

Step 10 involves the design and distribution of reports based on the analysed data. Freque= nt reporting can maintain stakeholders up to date on injury issues relevant to them. These reports are the means by which results are conveyed to stakeholders. In general, they should be produced and distributed at least quarterly. If such reports are electronic, reporting can be more frequent and the delivery pro= mpt. The information contained in the reports should at the least reflect all the characteristics of the minimum core data sets. Reports can also be tailored with more detail for users with greater technical expertise. Standardized data output improves the efficiency of dissemination of information. Step 11 refers to the training of staff and activation of the syste= m. Training should occur at thr= ee levels with everyone taking the first level and selected individuals taking the other two. The first level of training should include basic concepts of epidemiology and surveillance and an overview of the system. The second level should include detailed review of forms with emphasis on the categories of data and coding and knowledge on required procedures to obtain the data including confidentiality guarantees. The third l= evel should include hands-on practice in extracting information, coding it and transmitting it. It should al= so include testing the operatio= n of the data entry and analysis programs. The activation of the system can actually be conducted as par= t of an exercise thus allowing people to get acquainted with all the procedures and work routines. Manuals f= or training and procedur= es should also be readily available for all personnel. Ideally inter-rater and intra-rater reliability testing should be conducted on data coding and entry.

Step 12 refers to = the monitoring and evaluation of the system. This process should be continuous= and should address any gathering, reporting or analysis problems. After the sy= stem has been in operation for about six months, a detailed evaluation should be carried out to determine whether or not the system's objectives are being achieved. This evaluation should include the ability of the system to iden= tify actual injury cases and correctly categorize them. It should also focus on= the accuracy of reporting and the determination of percentages of missing data, the ease of use of the forms for gathering and processing data, and the usefulness of the information provided after the analysis and through the dissemination process. A feedback process is required to inform those responsible for data collection of the strengths of the data collected and= any deficiencies that require attention.

Summary
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slide0034.htm",1,-1,1),new hrefList("slide0035.htm",1,-1,1),new hrefList("s= lide0036.htm",1,-1,1),new hrefList("slide0037.htm",1,-1,1),new hrefList("sl= ide0038.htm",1,-1,1),new hrefList("slide0039.htm",1,-1,1),new hrefList("sli= de0040.htm",1,-1,1),new hrefList("slide0041.htm",1,-1,1),new hrefList("slid= e0042.htm",1,-1,1),new hrefList("slide0002.htm",1,-1,1),new hrefList("slide= 0026.htm",1,-1,1),new hrefList("slide0006.htm",1,-1,1),new hrefList("slide0= 031.htm",1,-1,1),new hrefList("slide0014.htm",1,-1,1),new hrefList("slide00= 15.htm",1,-1,1),new hrefList("slide0029.htm",1,-1,1),new hrefList("slide001= 6.htm",1,-1,1),new hrefList("slide0018.htm",1,-1,1),new hrefList("slide0019= .htm",1,-1,1),new hrefList("slide0020.htm",1,-1,1),new hrefList("slide0030.= htm",1,-1,1),new hrefList("slide0032.htm",1,-1,1),new hrefList("slide0027.h= tm",1,-1,1),new hrefList("slide0033.htm",1,-1,1),new hrefList("slide0043.ht= m",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function RemoveFilePrefixFromHref(href) { var regExp =3D /^file:\/\/\//i; return href.replace(regExp, "") } function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if (MHTMLPrefix !=3D "") href =3D RemoveFilePrefixFromHref(href) if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; =09 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(obj.mSldHref= )) else PPTSld.location.replace(obj.mSldHref) =09 if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(href)) else PPTSld.location.replace(href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('

' + ENDSHOW_MESG + '
') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr= row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; 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	An eff= ective surveillance system should typically have the following attributes:
	simpli= city
	flexib= ility
	accept= ability (to many)
	reliab= ility
	utilit= y
	sustai= nability
	timeli= ness.
	The fo= llowing section will briefly expand on these attributes (1).


	This a= ttribute refers to the capacity of a system to gather the information it needs in = the most straightforward and simple way thus saving time, quantity of informa= tion and resources.
	A simp= le surveillance system includes adequate identification of the quantity, qua= lity and reliability of sources of information. A smaller number of sources gi= ves greater guarantees for simplicity. (Instructors should refer to local examples where available.)
	While = paper-based data collection, followed by computer data entry is simple in some respec= ts, direct electronic data entry (e.g. in hospital emergency departments) is = more efficient and can provide data in real time.
	Whethe= r data is collected on a form or electronically, the collection system should be pre-coded so that data is collected in a standardized format.


	Gen= eral topic description
	This l= ecture develops in detail each of the 12 steps required to build an injury surveillance system. These steps are based on WHO recommendations and fol= low a sequential and logical process aimed at ensuring data quality and viabi= lity of a surveillance system. The steps are illustrated with actual examples = from different geographic areas.


	The de= finition of injury surveillance continues to underpin this lesson.


	Accept= ability refers to the commitment of working groups and stakeholders in the participation= and operation of the system. The more acceptable the system is to participants and users, the more likely it is to function well and have a long-term effect. Users need to get answers from the system and if they do, it is highly likely they will accept it and use it. Routine efforts can affect acceptability. This is why feedback to stakeholders and participation in decision-making processes is also important.


	This r= efers to the capacity of the system to count or classify events correctly. It means the system should record all events (cases), exclude the non-cases and cover = the population it intends to cover. It should also address potential discrepancies of definitions between sources with the aim of identifying = true cases.
	In ord= er to achieve the required inclusion and exclusion of "cases", it is necessar= y to provide data collectors with written instructions and training.


	This r= efers to how practical and affordable the system should be. The practicality of the sy= stem should include obtained information, information used and the process for gathering and analysing it. This is especially important when confronted = with limited resources. It also addresses the issue of defining priorities for gathering relevant information.


	A surv= eillance system must work with minimum effort and be easy to maintain and update. = This also means that those who work within the system and those who use it find that it provides adequate information. If the users of the system accept = it, they can contribute to supporting and sustaining it. Naturally, sustainability is also linked to the rational use of resources.


	The wh= ole process needed to plan and organize a system needs to be careful and follow some well-tested steps. It usually involves several agents, people or institut= ions and it follows a cyclic process. For the design of a good injury surveill= ance system, the attributes should be taken into account in every step.=
	The fo= llowing 12 steps can guide injury specialists in the creation of such a system (2).<= /font>


	Step 1= refers to the identification of stakeholders. For example, agencies that need informati= on on injuries to set prevention priorities and to evaluate their work can be optimal for this purpose (e.g. Ministry of Health). Agencies that routine= ly collect information can also participate. Many times, while not in their primary mandate, some agencies can provide useful information about an in= jury problem. This information is not necessarily used for public health purpo= ses but it can very well complement public health activities.
	Agenci= es should not be only within the health sector as much injury information is actually collected in other sectors such as transportation or police.
	Step 2= involves the definition of the objectives of the system. These objectives should addre= ss why studying a particular injury problem or group of injury problems is necessary. In this process the type of surveillance to be used should be defined.


	Step 3= refers to the definition of a case. This is very important because that definition will determine whether or not events will be counted or classified in one way = or another. It is also important given the participation of multiple stakeholders from different sectors and disciplines that frequently define issues differently. Arriving at a common definition of a case is thus essential.
	Step 4= refers to the identification of data sources. In part this is also achieved when the stakeholders are identified. This step also refers to the quality and reliability of such sources. Agencies might collect data in different ways and with different methods that sometimes might not be compatible. In oth= er cases, data entry can be difficult and time consuming. If access to electronic resources is limited then information flow will be slowed down= . In other cases the sources might not be representative of the population that the surveillance system intends to cover. Surveillance data systems that = only collect frequency data (numerator) and cannot define the population represented (denominator) data can nevertheless be very useful for injury prevention. In such a system, the relative frequencies and severities of injuries can be determined and monitored over time.
	If spe= cific injury types are very frequent and severe and preventative measures are availabl= e, then intervention is warranted even though there may be some bias in the injury data collected.
	Anothe= r common problem that addresses reliability and data quality refers to how consistently data are gathered.


	This t= able shows an example of potential data sources where injury information can be obtained and used. The nature and severity of an injury will also determine where information about the event is picked up by existing sources of informati= on.
	Usuall= y the most easily identifiable consequence of an injury is a fatal one as the table shows (3).


	This d= iagram shows in a different way what types of information can be tied to potential sou= rces of data on injuries. Since death is the most easily assessed condition, d= ata on fatal events are usually more reliable than less severe events (3).


	Step 5= involves an assessment or evaluation of the existing resources to be used by the syst= em. It implies evaluating the expertise of the personnel, the existence of adequate technological and logistic resources as well as the actual functioning of the agencies involved. The environment where data is gathe= red is also important for assuring completeness and reliability but also for providing injured people or their relatives the best possible environment= to address their needs.
	Step 6= refers to the inclusion and participation of stakeholders all along the process. It mea= ns that the multiple needs and uses from different agencies have to be prioritized. The system must respond to the most important needs of the stakeholders in order to ensure acceptability. At the same time, agency involvement in decision-making processes can improve the functioning of t= he system by addressing and responding to agency-specific concerns.


	Step 7= refers to the definition of data needs. This specifically means to define what types of variables will or will not be collected. Overall, there are some basic or core minimum data needs for an injury surveillance system to be effective= . If resources allow it, other core optional data can also be collected.
	Additi= onally some minimal and optional supplementary data is identified and explained ahead= .


	The mi= nimum core data includes variables that should allow the person to be identified by a number, age, sex, injury intent, place where event occurred, activity conducted when event occurred, the mechanism or cause involved in the occurrence of the injury and the nature or description of the injury.
	These = eight variables should be the minimum recommended for inclusion in an injury surveillance system.
	This i= nformation enables the counting of injuries but it is limited in terms of case categorization.
	For ex= ample if a two-year-old boy were scalded by water heated by a paraffin burning stove= on the floor of his dwelling while playing, this would be recorded in the minimum data set as: two-year-old male, unintentional burn injury while playing at home.
	That i= s, key information needed for prevention would be missing.


	The op= tional core data can provide additional information on time and place, as well as some risk factors for occurrence and the severity of the injury. Specifically, information on ethnicity could be included, date and time of event, exter= nal causes that lead to the injury, residence of the injured person, if use or abuse of substances was involved, severity of the injury and what happene= d to the person after the injury occurred. An incident summary could also be included. These additional variables can enhance the information about an injury event (3).
	For ou= r example of the two-year-old’s scald, this optional core data set would add lit= tle useful information. However, this data set would potentially add substant= ial information for a case involving violence.


	Supple= mentary data sets refers to information collected for specific types of injuries for example those only related to traffic crashes or violent assaults (3, 4).= The example above shows some supplementary data for a surveillance system that gathers data from land-mine victims. The questions and variables added wi= ll depend naturally on the type of injury. The optional information for these supplementary data sets might include type of weapon used or information = on perpetrators and circumstances of the event.
	In the= case of burns and scalds, the detailed circumstances of injury would be identified by a similar specific supplementary data set.
	Data l= inkage between relevant data sets is a further potential means of supplementing injury d= ata. For example, police-reported traffic crash data has been linked with heal= th sector data in several countries to provide detailed data on road traffic crashes and resulting injuries.


	Step 8= refers to the actual collection of data. Once the data set requirements are defined, the process for collection needs to be put in place and tested. A good time a= nd resource saving strategy is to build surveillance systems on already exis= ting sources of information. In some occasions entire systems might be in place and with only minor modifications the required data could be obtained. If= the use of multiple independent systems is involved, then interagency agreeme= nts will be necessary and adequate conceptual and technical knowledge on link= age of information will be needed.
	There = are many existing examples of injury surveillance data collection forms and these could be adapted to meet the needs of many new systems. In some cases ent= ire new forms might need to be created. The whole process of the evaluation of the system will include the piloting of these forms to determine whether = or not they are acquiring the information that is needed. Form design and selection will also involve the use of appropriate coding or classificati= on systems. Obtaining approval for the data collection form to be included in the patient medical record as an official document tends to improve the quality of the data collected and to inform the patient’s medical management. In this case duplicate forms may be required.


	Step 1= 0 involves the design and distribution of reports based on the analysed data. Frequent reporting can maintain stakeholders up to date on injury issues relevant = to them. These reports are the means by which results are conveyed to stakeholders. In general, they should be produced and distributed at least quarterly. If such reports are electronic, reporting can be more frequent= and the delivery prompt. The information contained in the reports should at t= he least reflect all the characteristics of the minimum core data sets. Repo= rts can also be tailored with more detail for users with greater technical expertise. Standardized data output improves the efficiency of disseminat= ion of information.
	Step 1= 1 refers to the training of staff and activation of the system. Training should occur= at three levels with everyone taking the first level and selected individuals taking the other two. The first level of training should include basic concepts of epidemiology and surveillance and an overview of the system. = The second level should include detailed review of forms with emphasis on the categories of data and coding and knowledge on required procedures to obt= ain the data including confidentiality guarantees. The third level should inc= lude hands-on practice in extracting information, coding it and transmitting i= t. It should also include testing the operation of the data entry and analys= is programs. The activation of the system can actually be conducted as part = of an exercise thus allowing people to get acquainted with all the procedures and work routines. Manuals for training and procedures should also be rea= dily available for all personnel.
	Ideall= y inter-rater and intra-rater reliability testing should be conducted on data coding and entry.