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 Discus is a server-based software written in Oracle specifically designed for clinical management, data collection and research in sickle cell disease.
Menu driven screens ensure complete data collection and on-line editing procedures make available all haematological and biochemical results for patient management, Finally, all clinical complications receive 2 digit codes for easy recall in clinical research. This is the second generation of the Patient Management System (PMS) evolved by the MRC Laboratories and invaluable in clinics managing 5,500 patients.
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Hematology
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| Hematological indices displayed sequentially are downloaded from hematology analyzers. Data from other methods (eg HbA2, HbF, reticulocytes, serum iron values) may be added manually. Computer derived indices include MCHC, MCH, age and other information including spleen size and clinical codes are relayed from clinical screens. Steady state hematological indices are derived according to programs selecting all steady state values over age 5 years. Serial values tabulated and readily available for management and research. A rapid graphing facility is available. |
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| Graphing option displays serial values visibly. This graph shows evolution of hemoglobin levels over 23 years. |
Clinical Examination
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| Prior Status review screen prompts question on presence of leg ulcers. Selection of ‘yes’ produces leg ulcer documentation screen below. Clinical Review screen enquires of events since last seen and also current status. Prior status enquires on enuresis, leg ulceration, priapism, pubertal development including menarche and last menstrual period. Programs detect intervals >30 days and alert to amenorrhoea. Basic clinical information includes temperature, liver & spleen size, chest, cardiovascular and ENT findings. |
Growth
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| Height & weight may be inserted in metric or Imperial units and are automatically converted. Z-scores are computed against internal standards for growth among Jamaican SS children but alternative standards may be loaded. Growth for height or weight may be plotted against median, 25th and 75 centiles for standards. |
Bone Pain
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| Bone pain screen allows recording of precipitating factors, duration and severity of pain and any previous treatments. Pain distribution options include ‘pain all over’ or localized pain when detailed pain distribution may be indicated on a sub-screen by selecting the appropriate cursor and placing on site of pain. Underlying digitization of the body image converts pain sites to text as shown below avoiding clerical errors such as confusion of right and left. Similar documentation is possible for sites of swelling. |
Leg Ulcers
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| Ulcer site can be indicated by cursor which will generate text indicating position. Selection of Code Ulcer Details prompts screen below which documents configuration, colour, size, status and provides a text box for additional details |
Images
| Cross referencing to stored image files allows display of clinical images within DISCUS |
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| Image screens allow storage of clinical images, Xrays, ultrasound examinations. Gall bladder ultrasound showing biliary sludge and 2 gallstones |
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| Cross referencing to stored image files allows display of clinical images within DISCUS |
Examples of Coding System
2 digits: one letter representing system involved; one number giving options. The number 0 represents a condition awaiting final diagnosis.
| A Anaemia |
B Bone pain/infection |
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A0 Unexplained hypoplasia
A1 Aplastic crisis (also V8 if B19 confirmed)
A2 Acute splenic sequestration
A3 Chronic hypersplenism
A4 Megaloblastic change
A5 Iron deficiency
A6 Haemorrhage
A7 Acute malaria
A8 Anaemia secondary to other infection
A9 unused
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B0 Bone pain pending diagnosis
B1 Bone pain crisis, severe
B2 Bone pain crisis, mild
B3 Bone pain of ribs or sternum
B4 Dactylitis
B5 Avascular necrosis of femoral head
B6 Avascular necrosis of other bones
B7 Osteomyelitis, suspected
B9 Osteomyelitis, other
B8 Osteomyelitis, Salmonella
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| G General anaesthesia for surgery |
S Skin problems |
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G1 Splenectomy
G2 Cholecystectomy
G3 Tonsillectomy/adenoidectomy
G4 Gastro-duodenal procedures
G5 Appendicectomy
G6 Other abdominal surgery
G7 D&C
G8 Caesarean section
G9 Other gynaecological procedure
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S0 Leg ulcer present (duration but < 3m)
S1 Leg ulcer healing within 3m
S2 Chronic leg ulceration >3m
S3 Skin trauma
S4 Ankle fixation (equinus deformity)
S5 Cellulitis
S6 Abscess
S7 Impetigo/skin sepsis
S8 Rash, undiagnosed
S9 Thrush
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