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Computerised database for pre-prosthetic surgery
Computerised database for preprosthetic surgery
N. A. Barnard R. Bainton Regional Oral and Maxillofacial Unit, Broadgreen Hospital, Liverpool, England
N. A. Barnard: Computerised database for pre-prosthetic surgery. J. Oral Maxillofac. Surg. 1990; 19." 272-274. Abstract. A system has been implemented using a commercial database management program and a microcomputer for computerising pre-prosthetic surgery. Using selection criteria, clinical records can be added, edited/deleted, searched for, displayed on screen, generate consultation summaries and operative discharge letters to the referring consultant, general medical and general dental practitioners together with a synopsis of the clinical assessment and surgical admission. Surgical audit may be conducted on the records. This progam will hold 30 000 clinical records. Such a system is beneficial for personal and departmental audit, epidemiological studies and research into the prevalence of surgical treatment and postoperative morbidity.
The number of clinical records generated by pre-prosthetic surgery and the need for surgical audit make a filing and retrieval system obligatory. Manual methods which have been developed for this purpose are inadequate when the number of records exceeds about 200 entries. Systems have been described for computerising general surgical audit which are based on mainframe computers but have limited application because at present few clinicians and research workers have access to such computers. Microcomputers are widely available and used because of their relatively low cost and large number of programs that can be run on them. We have developed a personal system which enables the clinical record of the initial consultation and subsequent surgical admissions to be stored and recalled, so that the data may be manipulated.
Method
The computer used was the Amstrad 1640 and the MSDOS (Microsoft disc operating system). It had an integral hard disc with a storage capacity of 40 megabytes, a built in visual display unit, and a detachable keyboard. The application program used was dBase III plus (by Ashton-Tate, United States of America), a relational database managment system that is widely available. The software package was specially adapted for handling clinical data using
the incorporated structural program and editor. The final application program is menu driven, thus enabling the user with no computer training or experience to run it by simply selecting options displayed on the screen. After the computer is switched on the user invokes the program by typing the loading command, which consists of two English words chosen so that they can be remembered easily. The computer requests a password which, if entered correctly, will display the opening submenu. This defines the parameters of the pre-prosthetic database and at a keystroke the main menu is displayed (Fig. 1). The appropriate function may be selected by typing the numerals against it. The use of passwords is helpful because it prevents inadvertent erasure or alteration of the data and limits unauthorised use of the database. Each new patient is added to the database (i.e. appended - Selection 01, Fig. 1) and the record is automatically indexed and placed in the correct position in the database. The following data fields are used: Hospital number Patient details Consultant, under whose care the patient is admitted. General medical and dental practitioner details. Patient complaint. Relevant dental history Relevant medical history, especially that pertaining to implant surgery, Clinical examination, including facial
Key words: computer database; pro-prosthetic surgery. Accepted for publication 3 May 1990
changes and ridge classification. Relevant radiological findings pertaining to implant feasibility. Summary of clinical assessment. Treatment plan. Surgeon/opcode/operation date. Type of anaesthesia. Specific surgical treatment with availability to record three separate operative procedures. Post-operative surgical complications. Post-operative complications specific to pre-prosthetic surgery. Discharge date and destination. The computer is programmed to accept only the relevant code or codes in the designated fields and only numerals in the date fields. This provides a limited but useful validation and helps to reduce errors. If data items are unknown or unavailable the field is left blank. Scrolling (moving) up and down the record is possible. A record may be located for editing (Sel~tion 02 - Fig. 1) by searching on
(01) Append records. (02) Edit/Delete records. (03) Display records. (04) Print records. (05) Research and report/Listing. (06) ~How many records in file. (07) Do statistics. (08) Back up data file. (00) Finish. Please type in a number (code)
Fig. 1. Pre-prosthetic surgery: file for audit records.
A pre-prosthetie surgery database
the patient's first name, last name and hospital number, or first and last name only. The validation facilities provided during the append mode also apply to editing. Scrolling through the record enables alterations to be effected quickly and easily. After editing the record is completed, control is returned to the main menu, or password controlled deletion of designated clinical records may be selected. If the deletion mode is selected the records are deleted and the database with the related indices are rebuilt. The details of the initial consultation and surgical admission may be displayed on screen (Selection 03 - Fig. 1) after it has been located from the patient's first name, last name and hospital number or first and last name only. The clinical details are displayed on screen in consecutive order by scrolling through the record. A synopsis of the consultation or surgical procedure may be printed together with the appropriate letter for distribution to the referring consultant, general medical practitioner and general dental practitioner (Selection 04 - Fig. 1). The current data and left margin are selected initially. The main print menu enables the selection of any desired combination of the above choices. The patient's record is located by searching on the first name, last name and hospital number or on first and last names only. The program prompts the correct setting of the printer and commencement of printing. On completion of printing, the main print menu will be displayed for any further selection to be made. A search of the whole database or a specified selected subset may be conducted and the output displayed on screen or sent to the printer (Selection 05 - Fig. 1). The search facility in dBase has been simplified in successive editions of the program and in dBase III plus it is straightforward to select the designated subsets. Database fields are represented by mneumonics for simplicity. A search is initiated by choosing the appropriate fields together with the various codes, which represent the items sought, and this defines a subset of the database. The search facility is probably the most powerful function of this program. The total number of records in the database can be displayed (Selection 06 - Fig. 1). The statistics facility (Selection 07 - Fig. 1) is entered by input of the correct password. The whole data-
base or a selected subset can be displayed on the V D U screen as previously defined formats, or may be sent automatically to the printer. The database may be backed up (Selection 08 - Fig. 1) to a floppy disc, tape streamer, Bernoulli box or an optical R O M disc. The system prompts the insertion of a formatted floppy disc and the selection of an available destination disc drive for the backup copy of the database. The utility then automatically completes the backing up of the database.
Some operational data
A loose leaf proforma is used by the admitting officer to record the patient's details and subsequent treatment. The proforma is colour coded so only the particular sheets required are used. On completion the relevant portion of the proforma is given to the departmental secretary, so that the necessary Consultation or discharge letters and/or synopsis may be promptly generated. The layout of the proforma is identical to the append and edit screens, which facilitates the input of clinical information by the secretary.
Discussion
dBase III plus, now well established and documented 9, is an example of a database management system. It is widely used for applications in which records on a particular subject are computerised and has facilities for analysing and retrieving data. One advantage of this program over some other database management systems is that it incorporates a structural program which makes it possible for the user to create menus and to write additional codes that will instruct the computer to execute specified functions. The dBase family of programs has been used successfully in data management in libraries for the storage of supplies 1, trade literature6, for producing a book index 8, and in clinical medicine for the storage and analysis of information on surgical workload 5. For the management of clinical records this program has all the advantages of the mainframe system and more utilities, but at much reduced cost as it can be used on any Bm PC/XT or AT compatible microcomputer with the MSDOS operating system. The dBase program is able to support
273
two or more users in the same, or another institution, entering clinical records. This facility is invaluable for the efficient use of the database, but if multiple entry facility is required it is important that the computer can support networks, multitasking and file serving. The main disadvantage is the cost of the dBase program; however, the generated software could be adapted to utilise specific parameters that the user would require. The entry of data is facilitated by copious on screen prompting and hence a minimum of staff training is required to use this system. The generation of discharge letters and clinical record synopsis from the database has been shown to save approximately 4 to 6 h per week of secretarial time, whereas surgical audit should be seen as a secondary benefit from this system 4. It is impossible to conduct a useful clinical audit without using a computer 7. There is no other modern software available at this time for the recording of pre-prosthetic surgery. The recent classification of the edentulous jaw 2, and its relationship to the attached mucosa, has led to the development of criteria for selecting the appropriate pre-prosthetic treatment in individual cases 3. Epidemiological research into the efficacy of such criteria and the centralised collation of the results of multicentre treatment trials would be facilitated by a computerised database. Other modules available are head and neck tumour, cranio-maxillofacial trauma, temporomandibular joint dysfunction/surgery, orthognathic surgery and dento-alveolar surgery. In development are craniofacial, aesthetics and cleft lip and palate surgery.
References
1. BORDWELLS. dBase II - library use of a microcomputer database management system. Program 1984: 18:157 65. 2. CAWOOD J I, HOWELLR A. A classification of the edentulous jaws. Int J Oral Maxillofac Surg 1988: 17: 232-6. 3. CAWOODJ I, HOWELLR A. Anatomical considerations in the selection of patients for preprosthetic surgery of the edentulous jaws. In: Current perspectives on implantable devices, Volume 1. JAI Press Inc., 1989: 139-80. 4. DUNN D C. Incorporating a microcomputer in the surgical office. In: Coleridge Smith P D, Scurr J H, eds. Micro-computers in medicine. London: SpringerVerlag, 1988: 27.
274
Barnar d
5. HOLDSWORTH J D. Surgical audit in dBase II. In: Coleridge Smith P D, Scurr J H. eds. Micro-computer in medicine. London: Springer-Verlag, 1988: 31-41. 6. MILLAR P, COCHRANEJ. Administration of a reserve collection at Paisley College using dBase II. Progam 1985: 19: 262-70.
7. POLLACK A, EVANS M. Surgical audit. London: Butterworths, 1989: 63. 8. SELLUD P, MCGLADDERYS D. Accident and emergency content of general surgical workload. Injury 1985: 16: 457-60. 9. SIMPSON A. Advanced techniques in dBase III plus. London: Sybex, 1988.
Address: AT. A. Barnard Aberdeen Royal Infirmary Forresterhill Aberdeen Scotland
N. A. Barnard R. Bainton Regional Oral and Maxillofacial Unit, Broadgreen Hospital, Liverpool, England
N. A. Barnard: Computerised database for pre-prosthetic surgery. J. Oral Maxillofac. Surg. 1990; 19." 272-274. Abstract. A system has been implemented using a commercial database management program and a microcomputer for computerising pre-prosthetic surgery. Using selection criteria, clinical records can be added, edited/deleted, searched for, displayed on screen, generate consultation summaries and operative discharge letters to the referring consultant, general medical and general dental practitioners together with a synopsis of the clinical assessment and surgical admission. Surgical audit may be conducted on the records. This progam will hold 30 000 clinical records. Such a system is beneficial for personal and departmental audit, epidemiological studies and research into the prevalence of surgical treatment and postoperative morbidity.
The number of clinical records generated by pre-prosthetic surgery and the need for surgical audit make a filing and retrieval system obligatory. Manual methods which have been developed for this purpose are inadequate when the number of records exceeds about 200 entries. Systems have been described for computerising general surgical audit which are based on mainframe computers but have limited application because at present few clinicians and research workers have access to such computers. Microcomputers are widely available and used because of their relatively low cost and large number of programs that can be run on them. We have developed a personal system which enables the clinical record of the initial consultation and subsequent surgical admissions to be stored and recalled, so that the data may be manipulated.
Method
The computer used was the Amstrad 1640 and the MSDOS (Microsoft disc operating system). It had an integral hard disc with a storage capacity of 40 megabytes, a built in visual display unit, and a detachable keyboard. The application program used was dBase III plus (by Ashton-Tate, United States of America), a relational database managment system that is widely available. The software package was specially adapted for handling clinical data using
the incorporated structural program and editor. The final application program is menu driven, thus enabling the user with no computer training or experience to run it by simply selecting options displayed on the screen. After the computer is switched on the user invokes the program by typing the loading command, which consists of two English words chosen so that they can be remembered easily. The computer requests a password which, if entered correctly, will display the opening submenu. This defines the parameters of the pre-prosthetic database and at a keystroke the main menu is displayed (Fig. 1). The appropriate function may be selected by typing the numerals against it. The use of passwords is helpful because it prevents inadvertent erasure or alteration of the data and limits unauthorised use of the database. Each new patient is added to the database (i.e. appended - Selection 01, Fig. 1) and the record is automatically indexed and placed in the correct position in the database. The following data fields are used: Hospital number Patient details Consultant, under whose care the patient is admitted. General medical and dental practitioner details. Patient complaint. Relevant dental history Relevant medical history, especially that pertaining to implant surgery, Clinical examination, including facial
Key words: computer database; pro-prosthetic surgery. Accepted for publication 3 May 1990
changes and ridge classification. Relevant radiological findings pertaining to implant feasibility. Summary of clinical assessment. Treatment plan. Surgeon/opcode/operation date. Type of anaesthesia. Specific surgical treatment with availability to record three separate operative procedures. Post-operative surgical complications. Post-operative complications specific to pre-prosthetic surgery. Discharge date and destination. The computer is programmed to accept only the relevant code or codes in the designated fields and only numerals in the date fields. This provides a limited but useful validation and helps to reduce errors. If data items are unknown or unavailable the field is left blank. Scrolling (moving) up and down the record is possible. A record may be located for editing (Sel~tion 02 - Fig. 1) by searching on
(01) Append records. (02) Edit/Delete records. (03) Display records. (04) Print records. (05) Research and report/Listing. (06) ~How many records in file. (07) Do statistics. (08) Back up data file. (00) Finish. Please type in a number (code)
Fig. 1. Pre-prosthetic surgery: file for audit records.
A pre-prosthetie surgery database
the patient's first name, last name and hospital number, or first and last name only. The validation facilities provided during the append mode also apply to editing. Scrolling through the record enables alterations to be effected quickly and easily. After editing the record is completed, control is returned to the main menu, or password controlled deletion of designated clinical records may be selected. If the deletion mode is selected the records are deleted and the database with the related indices are rebuilt. The details of the initial consultation and surgical admission may be displayed on screen (Selection 03 - Fig. 1) after it has been located from the patient's first name, last name and hospital number or first and last name only. The clinical details are displayed on screen in consecutive order by scrolling through the record. A synopsis of the consultation or surgical procedure may be printed together with the appropriate letter for distribution to the referring consultant, general medical practitioner and general dental practitioner (Selection 04 - Fig. 1). The current data and left margin are selected initially. The main print menu enables the selection of any desired combination of the above choices. The patient's record is located by searching on the first name, last name and hospital number or on first and last names only. The program prompts the correct setting of the printer and commencement of printing. On completion of printing, the main print menu will be displayed for any further selection to be made. A search of the whole database or a specified selected subset may be conducted and the output displayed on screen or sent to the printer (Selection 05 - Fig. 1). The search facility in dBase has been simplified in successive editions of the program and in dBase III plus it is straightforward to select the designated subsets. Database fields are represented by mneumonics for simplicity. A search is initiated by choosing the appropriate fields together with the various codes, which represent the items sought, and this defines a subset of the database. The search facility is probably the most powerful function of this program. The total number of records in the database can be displayed (Selection 06 - Fig. 1). The statistics facility (Selection 07 - Fig. 1) is entered by input of the correct password. The whole data-
base or a selected subset can be displayed on the V D U screen as previously defined formats, or may be sent automatically to the printer. The database may be backed up (Selection 08 - Fig. 1) to a floppy disc, tape streamer, Bernoulli box or an optical R O M disc. The system prompts the insertion of a formatted floppy disc and the selection of an available destination disc drive for the backup copy of the database. The utility then automatically completes the backing up of the database.
Some operational data
A loose leaf proforma is used by the admitting officer to record the patient's details and subsequent treatment. The proforma is colour coded so only the particular sheets required are used. On completion the relevant portion of the proforma is given to the departmental secretary, so that the necessary Consultation or discharge letters and/or synopsis may be promptly generated. The layout of the proforma is identical to the append and edit screens, which facilitates the input of clinical information by the secretary.
Discussion
dBase III plus, now well established and documented 9, is an example of a database management system. It is widely used for applications in which records on a particular subject are computerised and has facilities for analysing and retrieving data. One advantage of this program over some other database management systems is that it incorporates a structural program which makes it possible for the user to create menus and to write additional codes that will instruct the computer to execute specified functions. The dBase family of programs has been used successfully in data management in libraries for the storage of supplies 1, trade literature6, for producing a book index 8, and in clinical medicine for the storage and analysis of information on surgical workload 5. For the management of clinical records this program has all the advantages of the mainframe system and more utilities, but at much reduced cost as it can be used on any Bm PC/XT or AT compatible microcomputer with the MSDOS operating system. The dBase program is able to support
273
two or more users in the same, or another institution, entering clinical records. This facility is invaluable for the efficient use of the database, but if multiple entry facility is required it is important that the computer can support networks, multitasking and file serving. The main disadvantage is the cost of the dBase program; however, the generated software could be adapted to utilise specific parameters that the user would require. The entry of data is facilitated by copious on screen prompting and hence a minimum of staff training is required to use this system. The generation of discharge letters and clinical record synopsis from the database has been shown to save approximately 4 to 6 h per week of secretarial time, whereas surgical audit should be seen as a secondary benefit from this system 4. It is impossible to conduct a useful clinical audit without using a computer 7. There is no other modern software available at this time for the recording of pre-prosthetic surgery. The recent classification of the edentulous jaw 2, and its relationship to the attached mucosa, has led to the development of criteria for selecting the appropriate pre-prosthetic treatment in individual cases 3. Epidemiological research into the efficacy of such criteria and the centralised collation of the results of multicentre treatment trials would be facilitated by a computerised database. Other modules available are head and neck tumour, cranio-maxillofacial trauma, temporomandibular joint dysfunction/surgery, orthognathic surgery and dento-alveolar surgery. In development are craniofacial, aesthetics and cleft lip and palate surgery.
References
1. BORDWELLS. dBase II - library use of a microcomputer database management system. Program 1984: 18:157 65. 2. CAWOOD J I, HOWELLR A. A classification of the edentulous jaws. Int J Oral Maxillofac Surg 1988: 17: 232-6. 3. CAWOODJ I, HOWELLR A. Anatomical considerations in the selection of patients for preprosthetic surgery of the edentulous jaws. In: Current perspectives on implantable devices, Volume 1. JAI Press Inc., 1989: 139-80. 4. DUNN D C. Incorporating a microcomputer in the surgical office. In: Coleridge Smith P D, Scurr J H, eds. Micro-computers in medicine. London: SpringerVerlag, 1988: 27.
274
Barnar d
5. HOLDSWORTH J D. Surgical audit in dBase II. In: Coleridge Smith P D, Scurr J H. eds. Micro-computer in medicine. London: Springer-Verlag, 1988: 31-41. 6. MILLAR P, COCHRANEJ. Administration of a reserve collection at Paisley College using dBase II. Progam 1985: 19: 262-70.
7. POLLACK A, EVANS M. Surgical audit. London: Butterworths, 1989: 63. 8. SELLUD P, MCGLADDERYS D. Accident and emergency content of general surgical workload. Injury 1985: 16: 457-60. 9. SIMPSON A. Advanced techniques in dBase III plus. London: Sybex, 1988.
Address: AT. A. Barnard Aberdeen Royal Infirmary Forresterhill Aberdeen Scotland