Operation documentation. A program for the detection and statistical documentary evaluation of surgery reports

A computer program specifically designed for surgical data retrieval was tested for longer than one year. By using the information contained in operation reports, with this program statistical analysis may be achieved. The reports are generated and printed using a personal computer running MS-DOS. Entering data does not cause any additional effort for the secretary. The selection of requested data is possible with any combination of criteria, and the resultant information is displayed on the computer terminal screen or printed on the computer printer. A combination of terms is used instead of a numeric code for data entry allowing far greater selectivity, with a reduced risk of data loss due to wrong numeric code entry.     

Databases

A database is a structured collection of records or data that is stored in a computer so that it can be consulted by a program to answer queries. Records retrieved through queries become information that can be used to make decisions. A database consists of one or more tables containing records of values for fields that pertain to the attributes of the object being represented by the table. Relational databases contain multiple tables that are linked by means of key fields. A database management system is the computer program that manages the database and queries the data to produce reports of information. Examples of simple databases and how they are produced are described in this article.     

Databases

A database is a structured collection of records or data that is stored in a computer so that it can be consulted by a program to answer queries. Records retrieved through queries become information that can be used to make decisions. A database consists of one or more tables containing records of values for fields that pertain to the attributes of the object being represented by the table. Relational databases contain multiple tables that are linked by means of key fields. A database management system is the computer program that manages the database and queries the data to produce reports of information. Examples of simple databases and how they are produced are described in this article.     

Databases

A database is a structured collection of records or data that is stored in a computer so that it can be consulted by a program to answer queries. Records retrieved through queries become information that can be used to make decisions. A database consists of one or more tables containing records of values for fields that pertain to the attributes of the object being represented by the table. Relational databases contain multiple tables that are linked by means of key fields. A database management system is the computer program that manages the database and queries the data to produce reports of information. Examples of simple databases and how they are produced are described in this article.     

A BASIC language computer program for intraocular lens power calculations

I present a BASIC language computer program that can be used on a variety of home computers to calculate intraocular lens powers and print this information on a report that can be included with hospital or office records and easily read in the operating room.     

Computed tomography in traumatology with special regard to the advances of three-dimensional display

Summary There is a variety of methods to aid in the diagnosis of fractures requiring operative treatment. A computer program that produces pseudo-three-dimensional (3D) images from sets of axial computed tomograms is used for examining fractures in areas of complex skeletal anatomy. The resulting reconstructions, representing the surface in a form similar to that of anatomic preparations, can facilitate the process of diagnosis. They are also valuable for planning operations. The 3D information can be used to define the size, shape, and location of the various fracture types. We have used the technique in more than 500 patients with injuries to the skull, spine, acetabulum, sternoclavicular joint, shoulder, knee, and calcaneus and are able to demonstrate the benefit of special investigation protocols.     

A simple and inexpensive method of preoperative computer imaging for rhinoplasty

GOALS/PURPOSE: Despite concerns of legal liability, preoperative computer imaging has become a popular tool for the plastic surgeon. The ability to project possible surgical outcomes can facilitate communication between the patient and surgeon. It can be an effective tool in the education and training of residents. Unfortunately, these imaging programs are expensive and have a steep learning curve. The purpose of this paper is to present a relatively inexpensive method of preoperative computer imaging with a reasonable learning curve. MATERIALS AND METHODS: The price of currently available imaging programs was acquired through an online search, and inquiries were made to the software distributors. Their prices were compared to Adobe PhotoShop, which has special filters called "liquify" and "photocopy." It was used in the preoperative computer planning of 2 patients who presented for rhinoplasty at our institution. Projected images were created based on harmonious discussions between the patient and physician. Importantly, these images were presented to the patient as potential results, with no guarantees as to actual outcomes. RESULTS: Adobe PhotoShop can be purchased for 900-5800 dollars less than the leading computer imaging software for cosmetic rhinoplasty. Effective projected images were created using the "liquify" and "photocopy" filters in PhotoShop. Both patients had surgical planning and operations based on these images. They were satisfied with the results. CONCLUSIONS: Preoperative computer imaging can be a very effective tool for the plastic surgeon by providing improved physician-patient communication, increased patient confidence, and enhanced surgical planning. Adobe PhotoShop is a relatively inexpensive program that can provide these benefits using only 1 or 2 features.     

Surgical simulation software for insertion of pedicle screws

OBJECTIVE: As the first step toward finding noninvasive alternatives to the traditional methods of surgical training, we have developed a small, stand-alone computer program that simulates insertion of pedicle screws in different spinal vertebrae (T10-L5). METHODS: We used Delphi 5.0 and DirectX 7.0 extension for Microsoft Windows. This is a stand-alone and portable program. RESULTS: The program can run on most personal computers. It provides the trainee with visual feedback during practice of the technique. At present, it uses predefined three-dimensional images of the vertebrae, but we are attempting to adapt the program to three-dimensional objects based on real computed tomographic scans of the patients. The program can be downloaded at no cost from the web site: www.tums.ac.ir/downloads CONCLUSION: As a preliminary work, it requires further development, particularly toward better visual, auditory, and even proprioceptive feedback and use of the individual patient's data.     

Computer-aided localisation of peripheral nerve lesions

The clinical localisation of peripheral nerve lesions can sometimes be difficult, particularly following injury to the brachial plexus when multiple lesions are often present. In this situation, computers may be of assistance in interpreting the complicated patterns of clinical findings. This paper describes the evaluation of a computer program that uses a simulation model of the consequences of nerve injury, based on a representation of the relevant anatomy. A retrospective study of 26 patients with upper limb nerve lesions was carried out. The computer program compared favourably with three clinicians in interpreting the findings correctly. It is suggested that this approach may be transferable to other applications.     

Development of an information system for operations

The report describes a computer system that provides statistical information on the anesthetic and surgical procedures performed by anesthetists and surgeons, reports on the operative activity of the anesthesia and surgical departments, and assists in daily scheduling of the program. Additional programs can be used for billing, displaying the use of (operating room OR) facilities by the various surgical divisions, and showing the actual stage of on-line operations with monitors. The software system MUMPS has been found to be a low-priced yet efficient and versatile multiuser system. The main features of the program are ease of use, prospective data entry (i.e. during the entire stay of the patient), and the possibility of modifying and expanding the system easily. Missing or inaccurate data are automatically brought to the attention of those who have performed the operation or the anesthesia by a program that is run periodically. The system has been found to be a useful tool for the daily scheduling of the OR program. It provides data for better scheduling of personnel and records can also be kept regarding the professional experience of physicians. The major deficiency of the program at this stage is its lack of a hierarchical structure. For example, it is unable to record multiple operations and/or anesthetic procedures for the same patient. This deficiency will be corrected in a newer version of the program.     

Development of a nursing workload measurement instrument in burn care

Existing workload measurement instruments fail to represent specific nursing activities in a setting where patients are characterized by a diversity of cause, location, extent and depth of burns, of age and of history. They also do not include educational levels and appropriate time standards. The aim of this study was to develop a reliable measurement instrument for nursing workload in burn care, in order to match quality of patient care with staffing needs. In the first phase, a time study by semi-structured interviews and observations was used to assess direct and indirect care activities. A total of 34 nursing activities were identified, defined, connected to educational levels and attached to time standards. Two independent raters completed a test computer program by assessing performed nursing activities in 36 patients. This yielded intra-class correlations of 0.82, indicating good reliability. In the second phase, a computer program was developed to process quantity and quality of available staff and the sum of time standards of nursing activities per patient per day and to calculate the balance. After 1 year of running this program, the database was used to distinguish patients’ care demand into five care categories. This instrument justifies the investment of time by nursing staff needed for daily activities in the burn unit. It provides quick insight into the balance between care demand and staffing needs and can be used to optimise resource planning.     

Life tables using Lotus 1-2-3 software on a personal computer

An automated program to calculate life tables of cumulative patency on a personal computer is described. This program can be set up quickly, and the tables can be displayed graphically and are automatically updated as new information is added.     

Concept and Realization of a Multimedia Program for Veterinary Physiology

A multimedia program, a non‐linear system which supplements the traditional, linear way of learning (e.g. with a text book), was developed. Non‐linear systems allow the direct use of information in a free sequence. A problem of these systems is the danger that the reader becomes lost in detail. Therefore, a program was constructed which tries to combine the properties of linear and non‐linear teaching systems. Student groups were continuously involved during all stages of the project. The program is organized in several levels. These are: (1) choice of chapters; (2) table of contents of one chapter; (3) summary; (4) text and (5) pictures, animations, simulations and video sequences. The program can be used in different ways. In the linear mode, the reader selects via action words different levels of the program. The user can read either only on the level of the summaries or on detailed information (text, pictures, simulations and videos). In the non‐linear mode the user jumps via menu items or buttons to selected pictures, simulations or a searched term. In this way, more than 3500 screen pages are integrated into a multimedia program for veterinary physiology. The program is written in toolbook ^®, and can be used on a personal computer with Windows 95^® or higher.     

A comprehensive computer system for anesthetic record retrieval

We have developed computer software to store data on all surgical and obstetrical anesthetics administered by our department. The computer system provides information for monitoring the residency training program, department and operating room management, professional fee billing, and research. It imposes little additional workload on our clinical personnel, who use simple codes to record the necessary data directly on the anesthetic record. Department secretarial staff transcribe data from the anesthesia and operating room records into the computer file, which is then available for producing scheduled reports and for answering inquiries from a video terminal. The system employs extensive manual and computer verification to minimize errors and omissions in the data. We report design details and more than 3.5 years experience with this system, which is now used at four affiliated teaching hospitals, has over 50,000 cases on file, and adds more than 1800 cases monthly.     

Short crank cycle ergometry

The change in knee angle during cycling was mathematically analyzed. It was determined that if the crank length of the cycle ergometer was shortened, the arc of knee motion necessary to cycle could be reduced. A computer program was written to represent the above mathematical model utilizing a patient's lower limb lengths to generate an individualized, range of motion profile. A custom cycle ergometer was built with interchangeable crank lengths of 80 mm, 110 mm, 140 mm, and 170 mm. This device can be adjusted to achieve a desired range of motion for a specific patient. The above custom cycle ergometer can be used on early postoperative knee patients who are unable to ride a conventional cycle ergometer because of a lack of knee motion or on patients who require a limited arc of motion in their postoperative therapy protocol. J Orthop Sports Phys Ther 1991;13(2):95-100.     

Two years experience of computerised medical records in a regional hospital

The introduction of computerised medical records in public hospitals is, without a doubt, one of the biggest changes made in patient health care in the last few years. It is a gradual process and is not exempt from difficulties, but it will surely set a challenge in the way information is handled in health care. Taking this path, in November 2008, the computer program SELENE, from the multinational company Siemens, was purchased in the centre were we carry out our surgical activities. The introduction of this program was preceded by an intensive training course for all the workers in the hospital. At the start, it was decided that the computer application would come into operation throughout the entire hospital, replacing the handwritten records. There were difficult days during its gradual introduction, but the computerised medical record has been well accepted by the great majority of the workers at the centre. After the initial stage of becoming accustomed, design problems started to be seen in the application, as well as their possible solutions. Currently, the use of the SELENE program has led to fluid health care within the hospital, although there are problems which can be resolved with adequate funding.     

Calculation of the allowable blood loss before transfusion with a programmable pocket calculator

Introduction. The amount of blood loss during surgery that requires transfusion is frequently estimated with a linear formula (1) using blood volume--calculated on a volume per weight basis--, preoperative hemoglobin concentration, and an established minimum hemoglobin concentration. This formula, however, underestimates allowable pretransfusion blood loss, because it implies that all blood lost contains the initial hemoglobin concentration. In addition, hemodilution by infusion therapy prior to surgery is usually not taken into consideration. Methods. In order to estimate allowable pretransfusion blood loss more accurately and conveniently, a program was developed for a programmable pocket computer. This program calculates (number of equation in parenthesis): blood volume (2a, 2b) expansion of blood volume prior to surgery (3) hemodilution prior to surgery (4) allowable blood loss during isovolemic hemodilution (5). The applicability of the program to the situation during orthopedic operations was tested in a study in which allowable pretransfusion blood loss was estimated for one group of patients and was calculated with the computer program for another group of patients. Eighty patients undergoing major orthopedic surgery were studied. After preoperative evaluation the attending anesthetist established a minimum hemoglobin concentration and the type of cardiocirculatory monitoring to be used. Patients were divided at random into two groups: for one group blood volume was estimated on a volume per weight basis and allowable blood loss was calculated using equation (1); for the second group allowable blood loss was calculated with the computer program. During the evaluation of the data the computer calculations were also carrier out for group 1.(ABSTRACT TRUNCATED AT 250 WORDS)     

Measurement of tumor resection volumes from computerized images. Technical note.

The authors describe a method for quantitation of the area and volume of the resection cavity in patients who have undergone surgery for brain tumors. Using a slide scanner and Image 1.27, a public domain program for the Apple Macintosh II computer, computerized tomography scans and magnetic resonance images can be digitized and analyzed for a particular region of interest, such as the area and volume of tumor on preoperative and postresection scans. Phantom scans were used to analyze the accuracy of the program and the program users. User error was estimated at 2%, program error was 4.5%. This methodology is proposed as a means of retrospectively calculating the extent of tumor resection.     

PC-gestützte Planung und Dokumentation des Operationsbetriebes

A computer program for personal computers was developed to support and control the schedule in the operation theatre. With this program a great amount of operational and medical data will be recorded (e.g. the duration of operation and anesthesia, the number of operating rooms occupied, the personal involved, the diagnosis and surgical therapy). The screen shows up-to-date information about the ongoing events. All data can be easily evaluated for different criteria. In a four years period the program presented has proved valuable for daily routine planning and documentation in a great operation unit.