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Abstract
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Audit of any surgical
treatment or intervention is likely to become mandatory in the United
Kingdom and is the hall mark of good clinical practice.
Audit of results in surgical
management of endometriosis is the only acceptable way of assessing the
effectiveness and morbidity of such intervention. Redwine (1996) has
demonstrated the power of audit using a conventional relational database
on a PC.
Such analysis usually
involves recording data from the case records some time distant from the
event. Whilst an alternative strategy is to record patient and operative
data onto pre-prepared forms for subsequent entry into a computer
database for analysis, this method involves tedious and repetitive input
by secretarial staff and is highly susceptible to translation and coding
errors (Benson 1991).
To reduce error, data should
be recorded directly into the base data set at the time of the event. An
effective and unobtrusive method of collecting patient data is with palm
top computers which are relatively inexpensive and extremely powerful
data collection tools.
The recorded data can be
exported as a simple numeric string for analysis by all common PC
database and statistical software. Current data on groups of patients is
readily available so that trends in treatment efficacy and morbidity
become quickly apparent.
The system can be linked to
a hospital network or departmental PC and equipped with letter
generating and surgical summary software so allowing the automation of
tedious secretarial tasks. This tool is a simple method of recording
clinical data in a form which reduces error and allows rapid analysis of
paired and group data sets.
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Method
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Using
a Psion 3 Series palm top computer, a custom program was written using
the in-built high level 'Organiser Programming Language' (OPL).
OPL is a 'source language' translated
into 'object code' by the internal ROM compiler of the Psion 3 series.
OPL has command syntax broadly similar to Visual Basic and is extremely
powerful. The compiled program of 4 files occupies less than 60kb. The
database size is limited solely by the available storage, currently 8mb
in the Series 3.
The program accesses the internal
database contained in the standard Psion ROM using a sequence of dialog
boxes. The dialogs list questions which have a variable number of
mutually exclusive answers, the user selects one per question. Each
question has a default answer which is the most likely or neutral
response. Each answer is returned to the database as a single integer
representing it's position in the pre-defined list.
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Data Export
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The
program allows the data to be translated to the simplest data export
type: comma delimited text file. This format can be imported directly
into all commonly available spreadsheets, databases, presentation and
statistics software. Each export file contains the data and time of
export and a date code is included into the export file name for ease of
identification.
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Security
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Entry
to the program is via unique password. The exported data text file
contains only basic patient demographic data and a string of apparently
meaningless numbers.
No clinical data can be determined from
the file without access to the decode formulae. The software and export
files comply with requirements of Sections 8.2, 9 of the Data Protection
Act 1984.
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Results
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Reviews
of data from >60 patients using this data collection and audit tool
are presented in this site.
The system represents a simple,
prospective audit tool by which means data can be readily collected and
transferred for analysis to allow assessment of patient response to
surgical treatment for endometriosis.
The system has the ability for
customisation to allow it's application in a wide range of modalities
requiring medical audit.
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References
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Benson, T.
(1991) "Health care information and communication - Some
Problems" in Medical Infomatics. Longman Health Services
Management.
Data Protection Registrar. "Guidelines to The Data
Protection Act" 1984. HMSO. ISBN 1 870466 19 5
Redwine D.B, Olive, DL (1996) "Database management on a
personal computer" Journal of the American Association of
Gynaecological Laparoscopists. Nov 1996, Vol 4 No1 95-110
All trade marks are acknowledged as the
property of their respective owners.
Psion images Copyright © Psion PLC.
EndoStat™ screen images Copyright © N.J.Tyrrell
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EndoStat™ Endometriosis
Audit Database for Psion Series 3
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| Opening screen with password protection |
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| Patient details |
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| Master Edit Menus |
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| Patient demographic data entry. |
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| Initial consultation |
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| Initial examination & outcome advice |
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| Operative findings, treatment and histology. |
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| Operative complications. |
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| Post Operative Review and Follow up Review |
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| Free Text Field and Save Data dialog |
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| Data Export dialogs |
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Data Export format
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Authors Note
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Since
this paper was published in 1997 the EndoStat™ Endometriosis Audit
Database has undergone continuous development and is now available for
Windows 98, ME, 2000 and XP systems.
Click here for details
It still available as freeware for the
Psion 3c and MX series of handheld computers. Email psion@psiesys.com
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