F R Vicary (Ed.) Computers in Gastroenterology With 37 Figures Springer-Verlag Berlin Heidelberg GmbH ER Vicary, FRCP Consultant Physician, Whittington Hospital, Highgate HilI, London N19, UK ISBN 978-1-4471-3261-5 DOI 10.1007/978-1-4471-3259-2 ISBN 978-1-4471-3259-2 (eBook) British Library Cataloguing in Publication Data Computers in Gastroenterology Gastroenterology Applications of Computer systems I Vicary, FR (Frederick Robin), 1946616.3'3'00285 ISBN 978-1-4471-3261-5 This work is subject to copyright All rights are reserved, whether the whole or part of the material is concemed, specifically the rights oftranslation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on mü;rofilms or in other ways, and storage in data banks Duplication of this publication or parts thereof is only permitted under the provisions ofthe German Copyright Law of September 9,1965, in its version of June 24, 1985, and a copyright fee must always be paid Violations fall under the prosecution act of the German Copyright Law © Springer-Verlag Berlin Heidelberg 1988 Originally published by Springer-Verlag Berlin Heidelberg New York in 1988 Softcover reprint of the hardcover 1st edition 1988 The use of registered names, trademarks etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book In every individual case the respective user must check its accuracy by consulting other pharmaceuticalliterature Filmset by Tradeset, Welwyn Garden City, Herts AL7IBH Printed by Henry Ling, The Dorset Press, Dorchester 2128/3916543210 Preface All over the United Kingdom gastroenterologists have been excited in the last few years by the microcomputer revolution All over the United Kingdom individuals have been beavering away, producing systems for use in their units Practising gastroenterologists have wanted endoscopy systems, surgeons wanted the ability to audit, academics wanted to teach, and everyone wanted expert diagnostic systems In a few centres, mathematicians saw the potential for applying mathematical techniques to clinical problems Hardware and software experts viewed the hospitals and individual units with eagle eyes, desperate to provide complete hospital systems and local networks It was clear that all of these people needed to be got together, to discuss the present and future This book is the result of this meeting of minds The meeting eventually occurred (after one or two hiccoughs!) at the Whittington Hospital on 12 and 13 May 1987 This book contains almost all of the papers given at the meeting The meeting was divided into five sessions entitled "Existing systems", "Endoscopy systems", "Audit", "Teaching systems", and "Diagnosis and therapy" Four of the sessions started with overviews of the areas under discussion, given by invitation by senior figures in the field, to present a background introduction for those unfamiliar with the field Each session concluded with a free-format discussion In between sessions, there were "nutrition" breaks, to allow delegates to visit the two demonstration areas There was a trade area for commercial companies-both software and hardware retailers and pharmaceutical companies with educational materials In a separate room, eight home-developed systems were demonstrated by individual delegates Those reading this book are unable to appreciate the excitement generated by some of these systems-mere black type and white page being a poor substitute for the communication of the imagination shown in the development of the systems Undoubtedly the most excitement was around the stand where Shukri Shami demonstrated his dynamic, interactive "expert tutorials in gastroenterology" It was the combination of the purity of the intelligence-written in Prolog-and his brilliant use of split-screens and colour which made his system so compulsive vi Preface Other systems enjoyed included Gladys, the grandmother of interactive systems, led along by Robin Knill-Jones Chris Venables showed "Ulcers", Kyran Bulger brought his colorectal database, and Peter Finch brought Gastrofile, his real endoscopy system, based on a commercial package but adapted and compiled by him for their unit's requirements North-east London was well represented; Chris William's polyp retrieval system was seen, as was the home team's Solubile Finally one of the "grand old men" of computing in medicine, John Dickinson from Barts, brought the MacMaster mainframe educational programme for gastrointestinal bleeding Also in this room were the five posters These are included in the book as abstracts The papers were presented in five-minute sessions each by their authors, with some discussion on day two This book was produced with the help of a number of people, Chris Venables of Newcastle provided support in the setting-up and design of the meeting His experience and knowledge of the area was invaluable to me Michael Jackson of Springer provided important technical help and his relaxed style made him a pleasure to work with Finally my session colleague, Eric Beck, gave me great encouragement and provided the Academic Centre in which to hold the meeting London, 1987 Robin Vicary Contents PART 1: Existing Systems Current Trends in Microcomputers A P McCann Computer Networks: A Technology Whose Time Has Come? D Bryce and N W Carter Experience in Implementing Microcomputer Clinical Databases in Gastroenterology E G Devas 13 Metabase: A Microcomputer System in Evolution in a Gastroenterology Hospital C B Williams and N Padmanabhan 21 PART II: Endoscopy Systems An Overview of Computerised Endoscopy Record Systems C W Venables 29 A Computerised System for Recording and Reporting on Upper Gastrointestinal Endoscopy Data Ph Van Hootegem, J De Troyer, P Rutgeerts, J Janssens, G Coremans and G Vantrappen 39 Practical Experience of Soluscope: A New Endoscopy Records System F R Vicary 43 A Multiuser Personal Computer Endoscopy Unit Filing System P J Finch and I T Gilmore 51 ULCERS: The BSG Developed Endoscopy Record System C W Venables,A.P.McCann,F T DeDombaland A P Manning .- 57 PART III: Audit 10 Audit of Gastrointestinal Surgery in a District General Hospital Using dBase II R G Wilson and J D Holdsworth 69 viii Contents 11 A Computerised Clinical Audit System in Practice J R Coughlan, W A Corbett, M J Taylor and R Shields 79 12 A Microcomputer for General Surgical Audit and Administration S G Pollard, P J Friend and D C Dunn 87 13 A Non-application-specific Approach to Medical Software Design M.A Walker, D Bryce and N W Carter 97 14 A Computerised Patient Record System Using a Fourth Generation Language A A Seifalian and K E Hobbs 105 PART IV: Teaching Systems 15 Choles: An Expert System for the Interactive Learning of Gallstone Disease Management G Palasciano, A Circella, P Portincasa, G Baldassarre and Albano 109 16 A Clinical Simulation Environment for Medical Education C E Johnson, M J Taylor and W A Corbett 119 17 Surgical Emergencies: A New Learning Experience P.R Edwards, W A Corbett, M J Taylor and J R Coughlan 129 18 Computer-aided Instruction S K Sharni and S Knight 139 19 A Computerised Personal Bibliographic System K N Bulger and T J McKenna 145 PART V: Diagnosis and Therapy 20 Computers in Gastroenterology: An Overview of Diagnostic Applications R P Knill-Jones 149 21 Can A Computer Help in the Management of Small Bowel Obstruction? J A Pain, D St J Collier and R Hanka 161 22 A Colorectal Cancer Database System K Bulger, N Afdhal and D O'Donoghue 167 23 Microcomputer-aided Diagnosis of Jaundice (Solubile) N Newman, E W F W Alton and F R Vicary 175 Contents ix 24 Computer-aided Analysis of Dietary Nutrient and Fibre Intakes in Gastroenterology A S Mcintyre, M Ibbotson, J Duthie, S P Burnham, J O'Brien, S Day and W R Burnham 185 25 Computing and the Histopathology of Intestinal Inflammation D Jenkins 193 26 Microcomputer Data Acquisition in a Developing Country with Transfer to a Mainframe Computer for Analysis T H C Williams, G F Sargent, I R John, S P Ashmore and M S Tanner 205 27 Gastroenterology, Computing and the Artificially Intelligent Pathologist D Jenkins 213 28 Experience with Computer Interviewing of Patients R P Knill-Janes, G P Crean, R J Holden and G Lindberg 215 29 Pharmaceutical Dosing ofTobramycin M Vissing, P Billesb(lllle, E Iversen, E Bruun and L K Hansen 217 Subject Index 219 Contributors N Afdhal Gastroenterology and Liver Unit, St Vincent's Hospital, University College, Dublin, Ireland Albano Institute of Clinical Medicine I, 70124 Policlinico, Bari, Italy E.W.F.W Alton Department of Gastroenterology, Whittington Hospital, Highgate Hill, LondonN19, UK S.P Ashmore Department of Child Health, University of Leicester, Leicester, UK and Department of Paediatrics, King Edward Memorial Hospital, Pune, India G Baldassarre Institute of Clinical Medicine I, 70124 Policlinico, Bari, Italy P Billesb0lle Department of Surgical Gastroenterology, Gentofte Hospital, University of Copenhagen, Denmark D Bryce Department of Medical Computing, Ninewells Hospital and Medical School, Dundee DDl 9SY, UK E Bruun Department of Surgical Gastroenterology, Gentofte Hospital, University of Copenhagen, Denmark K.N Bulger 763 VFW Parkway, West Roxbury, Boston, Mass 02132, USA S.P Burnham Department of Gastroenterology, Oldchurch Hospital, Romford, Essex RM70BE,UK and The London Hospital, Whitechapel, London EllBB, UK Microcomputer Data Acquisition in a Developing Country 207 Local facilities were provided to make the system of immediate value to colleagues in India: Recall of patient data, with data displayed alongside the reconstructed questionnaire, provided a convenient means of patient data storage A search facility allowed the search and display of up to ten variables for an infinite number of cases (Fig 26.2) By reformating the search output appropriately it could be read into a modest statistical package Data disks were mailed to Leicester from Pune in Inmac disk mailers, and amalgamated with the master database, with additional laboratory data from transported serum and biopsy samples Data Transfer to Mainframe Computer BBC datafiles have a format in which there are both non-printing characters and strings of data held in reverse character order Although it was convenient to use this standard format for data manipulation on the microcomputer itself, a fixed format "text" file was required for compatibility with SPSS-X* Data was translated using a short Basic program in which strings read in from the data file were then written "byte-wise" to a text file Both the "variable list" and "variable label" statements required for use in an SPSS-X command file were generated systematically by short Basic programs These used the data held in the question descriptor files Because the data files contained a large number of variables, a variable list typed by hand in the conventional manner is unlikely to be accurate, but a software-generated list was accurate The use of software-generated variable labels gave an added degree of confirmation on subsequent printouts Variable names were composed by the linkage of data block number, question number, and question replicate number; for example, B4Q99N3 represented the name of the variable held as the third reply to question 99 in data block Column numbers were deduced from stored question length data "Variable labels" were created by associating 40 characters from each question with its respective variable name Files containing data, the variable list, and variable labels were transferred to a VAX 8600 mainframe computer using Kermit file transfer programst Files containing the variable list and variable labels were edited into an SPSS-X command file using a text editor on the VAX (Fig 26.3), and a sample printout is shown in Fig 26.4 *Release 2.1, SPSS Inc 444 N Michigan Avenue, Chicago tBBC Kermit Ram vl.33 and VMS Kermit-32 v3.1.066 distributed by Lancaster University Computing Department in the United Kingdom, and worldwide by Columbia University Center for Computing Activities, New York 208 Computers in Gastroenterology ICC STUDY DATA SEARCH Demonstration 28/4/87 Study number Search variable TEMPO Escape C1-600l List variables ( 1) Date of entry - day (:;) Date of entry - year (5) Se>: Cmale=1 female=2 (7) Biopsy number (9) Portal tract fibrosis Case Number 10 11 12 13 14 15 16 17 18 19 20 21 22 :23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 39 39 4(1 41 Fig 26.2 ( 1) 10 14 18 16 16 22 14 20 20 26 27 28 30 s 12 14 21 22 26 26 27 28 10 16 16 21 23 23 28 28 30 t: (2) 2 2 2 2 2 2 3 3 3 3 3 3 4 4 4 4 4 4 4 5 (3) 80 80 80 80 80 80 90 90 90 90 80 80 80 80 80 80 81) 80 81) 80 80 80 80 80 80 80 so 80 80 80 80 eo 80 80 80 eo eo 80 80 80 80 (2) (4) (6) (8) ( 10) 30 13 60 24 36 18 84 60 30 36 18 24 30 15 60 13 15 84 21 24 18 60 18 18 39 18 72 54 11 36 11 60 36 36 12 Part of the search routine output (5) 1 1 1 1 1 1 1 2 2 1 1 1 1 2 1 (6) 57152 96551 75165 571!59 45300 57152 57310 571:52 :57152 27510 5702() 57152 96559 57152 57152 57152 57152 57143 57152 57152 75165 57143 57152 57143 57152 57159 57152 57152 57152 57152 96559 57159 75165 57152 57152 96556 96559 57152 57152 57152 - Date of entry month Age in month·s (I) to 100 Final hi stol •:Jgi cal diagnosis Cirrhosis gr.ading Parenchymal ·fibrosis (7) 1 1 1 1 1 l 1 1 1 1 1 1 1 1 1 1 (8) 2 2 2 2 2 2 2 2 2 2 2 2 2 I) (9) 3 B5Q'16NI 17 D5G97N1 18 B5!l98NI 19 B5Q99Nl 20 D5QIOOfll 21 B5Q102Nl 23 B51l103NI 24 05Q104Nl 25 D51l105NI 26 050106NI ;!7 D51li07NI 28 D50111N1 3'1-41 D50112Nl 42-44 D5GI13N1 45-47 051J114N1 48-50 B50115NI 51-53 D51l116Nl 54-56 IIARJI\l0=1:-'1 !120 THRU 130.,131 1130 THRU 140=141 1140 THRU 150=15) 1150 THUU J/;0,161