Sugi-94-42 DAlmada K..
Contents
1. CHART ABSTRACTION WAIN MERU ate forns 1 Medical chart abstraction single record data entry 2 Medical chart abstract ion nultiple record browsing 3 Growth chart single recard data entry d Growth chart single muitigle recort browsing Other information 5 Orientation 6 Other activities print select lists counts etc Quit Press F10 Figure 1 FASAF main menu submenu DISPLAY window branching from the main menu allows the user access to a two screen DISPLAY listing key notes or instructions Also accessible through the submenu is a credit or acknowledgement screen DISPLAY identifying the participants associated with the interagency collaborative effort for South Dakota FAS Surveillance For this application these screen DISPLAY types were stored as HELP entries in a single FASAF catalog Figure 2 All menu and submenu VILO ATTA ASSFRM MENU El Comaand gt Option dame Type tibref Catalog Menu Link 1 ASSFANDE PROGRAM z 2 ABSFRWG PROGAAW i 3 ECHRTIE PROGAAW 7 4 GCHATE PROGRAM gt 5 ORIENT MENU Figure 2 ATTR window for main menu DISPLAY windows were stored as MENU entries in the same FASAF catalog To assist the user in understanding any extended features of the current menu selection or in order to ensure that data entry personnel are certain about their selected main menu option confirmation DISPLAY windows open following one of four menu selections whereby t2. to front FASAF with a security window In this window FASAF is clearly identified as U S Government property and without proper clearance the user cannot access the database Various warnings are issued upon repeated attempts to by pass this window This security feature comprises a DISPLAY window and a SOURCE window and is stored in the FASAF catalog as a PROGRAM entry SAS FSP software SAS FSP software is implemented for data entry or browsing of data sets The user selects an option from the main menu and respands affirmatively in the confirmation window Transparent to the user SCL code executes and the user gains access to the database To facilitate data entry a series of customized screens are displayed in order to effect uninterrupted keying of an abstraction form Specifically data entry proceeds one record at a time into a relational database consisting of two SAS data sets The medical chart data set comprises 359 labeiled and formatted variables accessed through 17 data entry screens The accessory growth chart data set includes 17 labelled and formatted variables displayed on one data entry screen and contains multiple records per individual corresponding to a single record per abstraction form keyed into the medical chart data set Opening the data entry facility for the growth chart can occur either directly from the main menu or from the appropriate screen during data entry of the medical chart abstracted data
3. SURVEILLANCE OF FOETAL ALCOHOL SYNDROME FAS USING SAS FSP AND SAS AF SOFTWARE WITH SCL Philip J d Almada Battelle Memorial Institute Atlanta Georgia Valborg Kvigne Battelle Memorial Institute Rapid City South Dakota Michele D Strachan Indian Health Service Rapid City South Dakota ABSTRACT About 8 000 babies are born each year with the characteristic birth defects or developmental disabilities associated with jn utero exposure to maternal consumption of alcohol These characteristics are collectively know as Foetal Alcohol Syndrome FAS The CDC uses an epidemiological approach to assist states to address public health problems The first step to help South Dakota address the FAS problem was to develop and establish a surveillance system SAS software on the PC featuring SAS AF and SAS FSP software was used to construct a PC based menu driven database management facility Foetal Aicohot Syndrome Applications Facility FASAF FASAF is characterised by the capability for precise and accurate data entry using SAS Screen Control Language SCL FASAF therefore can be easily implemented in the field by nonSAS users for automated medica chart abstraction INTRODUCTION According to the Centers for Disease Control and Prevention CDC about 4 000 babies are born each year with a defined set of abnormal physical characteristics or birth defects to mothers who have consumed inordinate quantities of alcohol while
4. browsing of data and the first routine allows data to be enterred and data sets to be editted Figure 7 This SCL code is also used to issue warning informational messages for example how to quickly terminate the current session main if gcbs Y amp gcbm Y then do alarm cursor gcbs _msg_ Make one selection only end if gcbs Y amp gcbm ne Y gebs ne Y amp gcbm Y then do call putlegend 1 p call putlegend 2 ent N call putlegend 3 c r call putlegend 4 c r cali legend Growth Chart browsing if gcbs Y then do cail fsedit Ir ge Ir fascat gescr browse end if gcbm Y then do call fsprint Ir gc end call endlegend end return Figure 7 SCL browsing growth chart data Quality control of data entry was designed to allow for nonscientific staff to key data The three types of data checking include i 93 validation checks which ensure that the correct values are keyed ii 12 consistency checks which ensure that logical entries are made among associated fields and iii 20 range checks which ensure that outliers are not accidentally created by incorrect keying SCL was developed to perform the first two of these data entry quality control checks Validation and consistency checks used the ARRAY and IF statements SCL was used to sound an alarm w
5. he database may be added to editted or simply browsed Figure 3 In these windows 4 Growth chart browse r Command gt Td exit quickly press F10 SOUTH DAKOTA FAS SURVEILLANCE FASAF VERSION G GAQWTH CHART BROWSE CORFIRWATION Tais option apens the Growth Chart data set in browse eode You may browse the data set i one record at a time using the data entry screen or ii in tabular fora headed with the SAS variable names Hote Ro records nay be added No records aay be editted Press TAB or SKF TAB ta select brosse aotion Make one selection Bo you wish to browse individual records per screen _ Y Yes Do you wish to browse aultiple records per screen _ Yes Tf not press F10 to return to the sain eenu Figure 3 Data browsing confirmation growth chart the specific features of the selected main menu option are 224 displayed and describes more fully the particular selection and restrictions which could possibly be encountered The user then has to choose between proceeding with this main menu selection or returning to the main menu Transparent to the user if the user chooses to proceed is the SCL code written in the SOURCE window which invokes SAS FSP software using the CALL statement Each DISPLAY window and its associated SOURCE window were stored in the FASAF catalog as a PROGRAM entry Preserving security for this database was a concern of the FAS Surveillance Project staff SAS AF was used
6. hen a check failed tocate the cursor at the source of the error and display a warning message using the ALARM CURSOR and _MSG_ statements Figure 8 Range checks including maxima and minima constraints did not require SCL syntax but were set up in the MAXIMUM and MINIMUM frames of the FSEDIT Attribute window Another aspect of data entry quality control was the allowance of error override in certain cases By design this was contingent on supervisory approval since an error or warning message was always issued upon accessing a record which failed at least one SCL syntax check Error override was implemented via the FSEDIT Parms or parameter definitions window main link compute return compute Validate previous mentions of FAS FAE array pmdxnum 10 pmdx1 pmdx10 doi 1 to 10 if pmdxnum i ne amp pmdxnum i It 1 pmdxnum i gt 9 then do alarm _msg_ Improper entry Use codes on screen end end Produce on screen distribution of previous mentions of FAS FAE array cntarr 9 cntt cnt9 diffdx 0 doj 1 to 9 entarr j do k 1 to 10 if pmdxnum k j then entarr j 1 end Produce 1 response on Screen 17 from Screen 13 if cntarr j gt O then diffdx 1 end if diffdx gt 1 then multdx Y else multdx N i Produce 1 response on Screen 17 from Screen 5 if etohO Y then alcdx Y else alcdx N Compute IUGR gi
7. ieval functions in the respective PROGRAM catalog entries This is done in order to reduce the chance of the user incorrectly keying the entry number when growth chart data are to be enterred The user can interrupt data entry and safely return to the point of interruption and therefore to the correct abstraction form being keyed in addition there are computed fields in the data entry facility which exempt the user from performing certain calculations or from keying summary information derived from examining the data already keyed or collected on the abstraction form These features are hinted to the user by an on screen expression ENTER gt Figures 5 and 6 Command Obs 0 WAANING No observations on data set Please press END or ADD Screen 3 ICO 9 search code Entry Pi SECTION 1 PATIENT INFORWATION 2nd of 2 screens Gestational age Weeks Sirth weight gn oor 1b _ oz _ ENTER gt TUGR Length cn oor fin Head circunference ca L or in _ Address at tine of birth Uate address recorded Street city County State _ lip code __ Other birth defects Ted code aana irre Screens 1 2 SHF F7 Screens 4 17 SHF Figure 5 Medical chart data entry Screen 3 Although the user may browse any of the data sets using the data entry selections from the main menu during browsing as specifically selected from the main menu the user is barred from any editting of the data The main feature of the
8. or sequential data fields mentioned above Finally an informative and fully illustrated documentation coding manual was prepared to be primarily a technical reference guide and also a user s manual insofar as onscreen information and instruction was incomplete This manual therefore documented procedural requirements and anomalies and discussed the unique features of each screen Prefacing the documentation was a one page quick reference user s guide on how to implement FASAF Appended to the documentation were the specifics on data entry quality control illustrations of the pop up help windows lists of variables and attributes of the database produced by PROC CONTENTS and the SCL associated with confirmation windows and data entry RESULTS The advantages of applying SAS AF and SAS FSP software to database management fies in the ability to custom design the facility to suit the end user in this case considering the environment under which FAS surveillance is to take place and the data storage facilities an application facility FASAF was able to be constructed with a security front end immediately upon invoking SAS on the user s PC The current disadvantage of this artful feature is that authorized data managers cannot readily access the database Considering the expertise of the data entry personnel SAS AF and SCL were combined to produce a user friendly instrument with Contact tead author at data entry controls f
9. or the nonSAS nonscientific data entry personnel However for scientific staff the obverse of c o CDC smooth may prove to be sticky Also FASAF was developed 4770 Buford Hwy Mail Stop F 75 on a Compaq 486 PC in Atlanta Georgia and implemented on Atlanta GA 30341 3724 a Compaq 386 PC in Rapid City South Dakota whereby the contrasting demands between these two PCs reflecting the 404 488 7283 limitation of resources have become evident CONCLUSION In an effort to assist the state of South Dakota with addressing FAS the CDC offered software support to develop and establish a surveillance system Contracting through Battelle SAS software was selected because of the attributes of SAS AF and SAS FSP software The product presented to the South Dakota FAS Surveillance Project was a PC based menu driven multiscreen data entry facility known as FASAF which was designed to allaw nonSAS users to easily implernent FASAF Implementation of FASAF results in the construction of a relational database Using SAS SCL quality control checks were built into FASAF allowing for the capability of implementing the facility in the field for a fully automated precise and accurate data entry system The features of SAS AF and SCL contributed to the application opening with a security window thus disallowing unauthorized access to the system REFERENCES CDC Preventing Fetal Alcohol Syndrome and Other Alcohol Related Developmental Disabilitie
10. pregnant Another 4 000 babies are born each year with a predisposition for cognitive and behavioural deficiency or developmental disabilites to similarly behaved mothers These types of birth defects and developmental disabilities caused by jn utero exposure of the baby to maternal consumption of alcohol are termed Foetal Alcohol Syndrome Other not easily detectable effects of in utero exposure to alcohot are termed Foetal Alcohol Effects FAE or Alcohol Related Birth Defects ARBD and Alcohot Related Developmental Disabilities ARDD In its epidemiologic approach to prevention of public health problems the CDC assists states in setting up surveillance for these problems Surveillance for FAS and FAE will allow the state to have a database on hand by which to be able to identify mothers at high risk to be delivered of an FAS FAE baby to be able to assist such mothers in reducing their risk and to be able to provide assistance to those babies or children who are already characterized by FAS or FAE That is the state will have the ability to conduct case prediction early intervention and case management The task to provide surveillance assistance to the state of South Dakota has been borne out of an interagency collaborative effort between the CDC the indian Health Service and the states of Alaska and South Dakota The data entry facility described herein was to be used by clerical staff to enter data from hard copy medical record abst
11. raction 223 forms and is a component of the Foetal Alcohoi Syndrome Applications Facility FASAF FASAF is the outgrowth of two sources of data collection and an automation tool Specifically the South Dakota FAS Surveillance Project draws upon medical chart abstraction administered by the FAS Surveillance Coordinator and the developmental clinic visits conducted by the FAS Surveillance Director a physician The automation tooi selected was SAS software version 6 04 for the PC and the applications developer blends the capabilities of the software with the preferences of the Project Director and Coordinator This is reflected in the third objective to reaching the goal of devcloping and establishing an FAS surveillance system that is to control for accurate and precise data entry since clerical staff with tittle to no scientific experience would perform data entry Since the developmental clinic component is still under development the acronym FASAF will be used without loss of interpretation to represent the medical chart abstraction database management facility METHOD SAS AF software SAS AF software was used to construct a menuing system in order to preserve user transparency in creating and accessing SAS data sets FASAF is characterised by a main menu DISPLAY window for database management Figure 1 A hart Abstraction Wain enu Select Option gt SOUTH DAKOTA FAS SURVEILLANCE FASAF VERSION G
12. s FAS Prevention Section Centers for Disease Control and Prevention Atlanta Georgia August 1993 Hall Judith G Ursula G Froster iskenius and Judith E Allanson Handbook of normal physical measurements Oxford University Press New York 1989 504 pp Lubchenco Lula O M D Charlotte Hansman M D Marion Dresster M D and Edith Boyd M D ntrauterine growth as estimated from liveborn birth weight data at 24 to 42 weeks gestation Pediatrics November 1963 Pp 793 800 SAS institute Inc Developing SAS FSP Software Applications Course Notes Cary NC SAS Institute inc 1991 449 pp SAS Institute Inc SAS AF Software Applications Using Screen Control Language Release 6 06 Course Notes Cary NC SAS institute Inc 1992 497 pp SAS SAS AF and SAS FSP are registered trademarks or tradernarks of SAS Institute Inc in the USA and other countries indicates USA registration Other brand and product names are registered trademarks or trademarks of their respective companies 227
13. se browse selections are to be able to display the data either one record at a time in data entry layout as invoked by the FSEDIT routine in BROWSE mode or to display the data in tabular form for a multirecord comparative display as invoked by the FSPRINT routine SAS Screen Control Language SAS Screen Control Language SCL was developed is transparent to the user and executes for confirmation of main menu selection options and for quality control during data entry Once the user confirms his her main menu selection via the confirmation window the SCL SOURCE program executes and a CALL statement invokes the FSEDIT routine the FSEDIT routine in BROWSE mode or the FSPRINT routine 225 SEDIT SD ABSTFORY Command 22 gt ts 0 HARMING Xo observations on data set Please gress EKD or ADD Screen 3 1C0 9 search code Entry a SECTION 5 PREVIOUS WENTIONS OF FAS FAE ARBD AADO treweene nen emanwnmnnn nd Sate Diagnostician Diagnosis f FAS 2 Fak 3 FAS FAE 4 Susoact S Probabie F Possible P Rule aut R Fas S P P R FAE S i 5 Ro FAS FAE T Alcohol exposure i in utero i 182 ARBD 9 AROD eee ew ener rewenewece ENTER gt FAS S P P R S P P A No Alc exp FAS FAE FAE FAS FAE FAS sm utero ARBD ARDD Frequency of mention Screens 1 12 SKF 7 Screens 14 17 SHF F8 Figure 6 Medical chart data entry Screen 13 where the latter two routines allow nonedittable
14. using a CALL FSEDIT statement in the SCL Figures 1 and 4 Prior to keying data FSEDIT SD ASSTFORM Command gt Obs 0 WAAHING No observations on data set Please press END or ADD Screen 10 ICD 9 search code Entry FAS OIAGNOSTICS GROWTH DEFICIENCY SECTION 3 Is growth deficiency mentioned in the chart _ Y Yes N Ko Was failure to thrive FIT diagnosed _ Ys es Ho Was growth deficiency calculated _ s es R ko Do you wish to enter growth chart data non _ Y Yes then press ENTER If No then leave blank Otherwise To access the growth chart data independent of the char abstraction fora return to the main nenu press F10 then select option 3 Press Fi fron any screen All gata entries or changes will be saved Tais current nenu selection will be tergisated You will return to the gain genu Screens 1 9 SHF FT Screens 11 17 SHF FA Figure 4 Medical chart data entry Screen 10 from an abstraction form and in order to facilitate data entry an identification or entry number is assigned to that form and keyed into the first data entry screen of that record SCL is used to pass and display that number onto all following screens where this repeated field is protected from editting This feature was set up in the PROTECT frame of the FSEDIT Attribute window The entry number is also passed to the growth chart data set using the CALL SYMPUT and SYMGET macro variable assignment and retr
15. ven sex and gestational age and birthweight it Intrauterine growth es estimated from fiveborn birth weight data at 24 to 42 weeks of gestation Lula O Lubchenco M D Charlotte Hansman M D Marion Dressler M D and Edith Boyd M D Pediatrics November 1963 Pp 793 800 226 if sex M amp ga ne amp bwtgm ne then do if ga 24 amp bwtgm It 610 ga 42 amp bwtgm It 2780 then iugr SGA else if ga 24 amp bwtgm gt 1230 ga 42 amp bwtgm gt 3995 then iugr LGA else iugr AGA end if sex F amp ga ne amp bwtgm ne then do if ga 24 amp bwigm it 490 ga 42 amp bwtgm It 2690 then iugr SGA else if ga 24 amp bwtgm gt 1250 ga 42 amp bwtgm gt 3840 then iugr LGA else iugr AGA end return Figure 8 SCL medical chart data entry Other applications of SCL syntax during data entry were to open DISPLAY windows of HELP catalog entries at various points in the data entry facility SCL was used to evaluate the entry of certain fields and if incorrect or illogical entries had been keyed a CALL DISPLAY statement would execute and these pop up help windows would open so as not to obscure the field in question For other invalid entries SCL was used to issue warnings and to draw the user s attention to an onscreen window displaying valid data entry values SCL was also used for the computation and display of summary
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