Keywords rhinoplasty - medical informatics - database
Introduction
Computerization is becoming increasingly necessary to professional practice in several
fields, including the health area, because it eases the recovery of stored data. Further,
it is being used to promote the production of research with a high degree of scientific
rigor. The development of data bases with systematically organized information permits
the use of computerization in scientific work and thereby results in more reliable
conclusions. Therefore, the improvement of data collection via computerization is
indisputably important.
The Integrated System of Electronic Protocol (SINPE©, intellectual property of Professor
Osvaldo Malafaia) was created in 1999 and has been registered with the National Institute
of Industrial Property (INPI) under the number 00051543[1 ]. The system enables the development of research in the otorhinolaryngology and facial
plastic surgery fields with greater readiness and versatility in data collection,
allowing the immediate sharing of information within the scientific community.
The present study integrates the line of research named “Computerized Protocols” from
the post-graduation program at the Surgical Clinic of the Division of Health Sciences
at Federal University of Parana.
Method
For developing a theoretical database, all necessary information in the field of otorhinolaryngology
and facial plastic surgery was gathered from text books and published periodicals[22 ]. Once the information was compiled, an electronic database was created using the
Microsoft Word and Microsoft Excel programs. Afterwards, the generated files were
converted to text format archives to enable their incorporation into SINPE© .
We created a master protocol containing 20,109 items. The structure incorporates practical
sorting and is constituted of anamnesis, general physical examinations, complementary
exams, and clinical treatment. For each area, as determined from the physical exam,
the information is specific and encompasses the diagnosis, surgical treatment, complications,
and follow-up. A specific protocol termed “Rhinoplasty” was created from 954 items.
Two different manager protocols were developed to organize data in the software: (1)
a master protocol that works as a receptacle for information related to otorhinolaryngologic
diseases but in a non-selective manner and (2) a specific protocol that selects, covers,
and groups exclusive information from determined fields of practice.
Results
After concluding the elaboration and review of the master protocol (20,209 items),
which encompassed the greater field of otorhinolaryngology, we hierarchized an idealization
of the specific protocol (954 items) containing the entire subject related to patients
with aesthetic and functional nasal complaints referred to surgical treatment (i.e.,
rhinoplasty) into 6 main categories related to research: anamnesis, physical examination,
complementary exams, diagnosis, treatments, and outcome.
For the present research, we used the categories of treatment and outcome (main roots)
and their sub-items, as listed below.
Finality
Accesses
Surgical maneuvers on the nasal dorsum
Surgical maneuvers on the nasal tip
Surgical maneuvers on the base of the nose
Clinical evolution—3 months
Clinical evolution—6 months
Clinical evolution—12 months
Revision surgeries
Qualitative evaluation (satisfaction)
Quantitative evaluation (measures of the nose)
1.1 The creation of the master protocol
Clicking on “Protocols” will display the protocol options (master or specific). Clicking
on “Data” will present the option to initiate or simulate data collection or initiate
a search. Using the option “Patients,” the user can identify or insert a patient in
the program, or even consult pre-existing data. By selecting “Doctors,” the user is
allowed to insert, modify, or exclude a particular professional. In the item “Parameters,”
one can verify users, access permissions, subscribe to new institutions, and view
a unit's fields and fees. Finally, help options are available under the item “Help:
protocols system help; how to make security copies; how to restore a security copy;
how to send a copy to the central database; and data regarding the program.”
By clicking on the icon “ + ” beside the word root, one can open it to show the content
of the master protocol. The icon “ + ” next to the root of a folder or an archive
indicates that the folder or archive is closed (i.e., the content is not exposed).
Clicking on the icon “ + ” will convert it into “X,” exposing the content to be used.
Along the horizontal column above this icon are shown 5 options in the master protocol:
clicking on the blank box beside “View in alphabetic order” will result in the folder
contents being shown in alphabetic order. By clicking on “Expand,” the folder content
is selected and entirely exposed. Conversely, clicking on the option “Reduce” will
close the folder. Clicking on the option “Father” will create a new father item. The
option “$” can be used to modify numerical value data, such as fees, procedures codes,
and medications. In addition, 3 options are available in the right vertical column:
the magnifying glass icon is utilized to perform a search within the entire master
protocol and is aimed at finding specific information; by clicking the up and down
arrows, the user can alter the position of an item inside the folder. At the bottom
of the screen, 5 options can be found in the master protocol: “Add sibling,” “Add
son,” “Remove,” “Refresh,” and “Visualize in HTML.” All options can only be used after
opening the root, when the master protocol content is exposed. To close the master
protocol and return to the computerized protocol operation, just click on the option
“Close” positioned at the right side of the bottom of the screen.
The screen in [Figure 1 ] shows the content corresponding to the master protocol with the opened root. The
folders contain clinical data from several otorhinolaryngological pathologies.
Figure 1. Screen editing master protocol in which the root “Otolaryngology” has been opened.
When the root is opened, it is possible to list the functions of the options shown
at the bottom horizontal line. Clicking on “Remove,” the user can exclude a folder
or archive selected by using the mouse. To alter the characteristics of a selected
folder or archive, such as the orthography, just use the option “Alter” by clicking
over it with the mouse. After concluding the desired alteration, the user confirms
the text and again includes the folder or archive selected by clicking on the option
“Refresh.” For creating and including a new folder or archive of features similar
to the ones for the selected item, the user must use the option “Add sibling.” When
the archive or folder is a branch of the selected item, the option to be used is “Add
son.” The “Visualize in HTML” option permits the transposition of data from the protocol
to a Word archive spreadsheet. As explained previously, the option “Close” at the
bottom right corner enables the user to close the master protocol.
Since 6 activity fields (ear; face; nose and paranasal sinus; oral cavity; pharynx;
and larynx) are present in all the specific protocols, only the folders corresponding
to “Clinical condition” and “Physical exam” were determined as general. The remaining
folders were applied exclusively in the specific protocol of the activity field.
1.2 Creation of the specific protocol
Using the option “Specific registered protocols,” the user can create a specific protocol
for new areas from the master protocol. Afterwards, a new screen will appear with
the options “Insert,” “Exclude,” “Alter,” “Cancel,” and “Save.”
Two boards are presented on this screen ([Figure 2 ]). The board on the left, with the previously opened root, shows all the folders
of the master protocol. The board on the right presents spaces for the specific protocol
items. Using both arrows between the boards, the user can transpose data from the
master protocol to the specific protocol, selecting them on the board on the left
and clicking on the arrow pointing to the right. In the reverse way, clicking on the
arrow pointing to the left, the selected item on the board on the right will be transposed
to the board on the left. To print or save the specific protocol in HTML format, just
click on the existing options at the bottom right line. To save the alterations and
close the screen, return to the figure 9 screen, just click on the option “Close.”
When the user follows these steps, all items necessary for data collection in the
research will be in the specific protocol ([Figure 3 ]).
Figure 2. Placing items in a specific protocol.
Figure 3. A specific protocol (rhinoplasty) concluded.
Discussion
Shortliffe[23 ] defines medical informatics as a field of study in which informatics resources can
be applied to the management and utilization of biomedical information. Shortliffe
and Blois[24 ] cite the first application of informatics as the gathering of epidemiological data
for the U.S. census. This method was applied in epidemiology from 1920 to 1930. The
first reports on the computerization of medical records are from 1970 by the Mayo
Clinic[25 ].
Watts defines 3 important aspects in the computerization in the medical field: requests
for increased productivity, diminished costs, and an improvement in the quality of
the service[26 ].
In the 1990s, a series of computerizing systems emerged in the health field for the
monitoring of the health care process and increased the quality of assistance to the
patient, since these systems assisted in the diagnosis process and therapy prescription.
This capacity can be implemented due to intelligent systems, which permit the inclusion
of clinical reminders for assistance follow-up, warnings about drugs interaction,
alerts in dubious treatments, and deviations from clinical protocols[27 ].
Electronic protocols, in which questionnaires are filled using the computer, can be
used as tools for prospective data collection. These protocols are effective because
they enable the inclusion of systematized data through software that permits posterior
manipulation by crossing data to generate quality scientific information.
Quality clinical studies are fundamental to continued scientific development. They
allow secure access to new information with a consequent improvement of knowledge,
goal planning, disclosure of procedure evaluations, and professional conduct.
SINPE© permits the user to create, modify, and add necessary information into master and
specific protocols. This type of collected data storage allows the research to inform
all parameters of the research[28 ]. Furthermore, the possibility of interconnecting computers and institutions expands
the collection and storage of data, which will be of fundamental importance in the
development of computerized and multicenter databases in improving reliability.
The creation of a protocol specific to rhinoplasty emerged from the requirement for
standardized and reliable information collection and led to the elaboration of descriptive
and analytical studies in the field of nasal aesthetics, in which the subjectivity
of the evaluations of surgical maneuvers and indications is preponderant.
At large medical centers in Europe and the United States, the computerization of patient
data has enabled these difficulties to be resolved and has led to a steady increase
in the inclusion of such studies in journals that avoid the subjective nature of data
collection[27 ].
This protocol contains the option of direct filling. This feature enables the researcher
to avoid the subjectivity that is characteristic of information collection and that
complicates the interpretation of the results in high quality journals. A collector
can fill in the initial information on the patient, such as name, age, gender, and
insurance. However, a doctor must perform the collection of information related to
the medical area, which was encompassed in this study in performed surgical maneuvers,
and data related to satisfaction and interpretation of nose measures.
Conclusion
Applied in a simple and systematic way, the developed electronic specific protocol
(SINPE) is a viable method for registering information on patients with an indication
for rhinoplasty.
