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An ideal teaching file database should be searchable
and quick and easy to create and use, and it should be possible to print
out forms suited to the commonly used 4 in. x 6 in. vinyl slide holders
(Rochester 100 Inc., 40 Jefferson Road, Rochester, NY 14623, SL-3-264
Slide Holder, 585-475-0200).
Such a form can be created using the Microsoft Access
(2003, Office Products, Microsoft Corp., One Microsoft Way, Redmond, WA
98052-6399) database commonly available on many office computers. Though
different editions of Access may vary in their details, with this information
it should be possible to create a simple form suitable for general use.
These suggestions may also be helpful even if another database program
is used. What follows are instructions for creating both the searchable
database and the form that can be used as an insert for the vinyl slide
holders.
Create database, table, and form
The steps needed to create the database and design
the table and form may be summarized as follows:
- Create the table in Design view and set up the
various fields.
- Enter two or three sets of patient data into the
table.
- Create the form using Form Wizard and Forms Design.
- Fine-tune the appearance of the form using Page
Setup.
The first task is to create the table. Enter the database
program and select "New" and "Blank Database." Make a name such as "Teaching
File" and click "Create." This will bring up the screen seen in Fig.
1. Click on the "Create table in Design view" selection. Now create
the various fields in the screen seen in Fig. 2. The field names
and data types will be entered in the top of the screen and the size of
each field will be entered under the "Field Properties" section. Specify
their sizes and the type of data (text or autonumber) as indicated in
Fig. 2. Note that the maximum size for a text data box is 255 spaces.
At our institution, we use the following fields for
the database:
Autonumber: This is a way to keep count automatically
of the number of cases in the database.
Cyto number: This is the unique accession
number for each case.
History: This field contains a brief history
of the patient, for example, "62 y.o. female with abdominal mass."
Cyto diagnosis: This field contains the cytologic
diagnosis for each case and any additional comments as needed. "Negative.
Note the clusters of endocervical cells in honeycomb and picket fence
arrangements."
Histo number: This field is used for the unique
surgical pathology number of any confirmatory tissue samples.
Histo diagnosis: This field contains the surgical
pathology diagnosis for the case.
Comments: This field can be used to give additional
information, such as HPV results, flow cytometry results, additional followup
history, the results of immunohistochemistry staining, and special morphologic
features of note, such as "Note the cracked colloid present in the circle."
Topic: This is the educational topic for each
case. It may be a brief summary of the diagnosis—"Endocervical Adenocarcinoma,"
for example—or a specific feature that is the focus of the case—for
example, "Picket Fence Arrangement-Endocervical Cells" in a negative case.
These fields are created by the Design Table feature
of the program, and we have found the following field lengths and types
work well for our purposes:
| Autonumber |
default |
autonumber |
| Cytonumber |
50 |
text |
| History |
50 |
text |
| Cyto diagnosis |
255 |
text |
| Histo number |
50 |
text |
| Histo diagnosis |
255 |
text |
| Comments |
255 |
text |
| Topic |
50 |
text |
After creating the table in Design view, go to the
table and enter two or three patients. The table view will look something
like Fig. 3.
After entering two or three patients, then go to the
Forms Design page to create a new form. Click on the Forms icon and select
Form Wizard (Fig. 4). The program will ask which fields should
be on the form. Under Tables/Queries, select the name of the table (Table
3) from the pull-down menu. From available fields, select all except "autonumber,"
since that field is not needed on the form (Fig. 5).
On the next screen, the program will ask what layout
should be used. Select the "Columnar" layout (Fig. 6). Then select
which style to use for the form. We chose "Standard" (Fig. 7).
The next screen asks for the name of the form. After naming the form,
select "Modify the form's design" and then "Finish" (Fig. 8). The
program will then display the form in the Design Form view. The preliminary
version of the form will be displayed (Fig. 9).
The "label" for each field is displayed in a small
rectangular box to the left of the white field that will contain the contents
of each field. Make sure each label does not overlap past the 1-in. mark
on the ruler above the form. If it does, adjust it by mousing over the
right edge of the label box until a double-sided arrow is seen. Use this
to move the edge of the label box to the left. Then align the content
boxes (fields) as shown in the example (Fig. 10) so that each field
begins at the 1-in. mark. The right-hand edge of each field box should
be adjusted so that there is about a 3?8-in. margin for design purposes.
The displayed size of each content box can be adjusted as well. Remember
that the boxes do not adjust the ultimate size of the field;
this can be adjusted (up to a maximum of 255 spaces) only when the fields
are created in the Table template. Make sure, however, that the box is
big enough to accommodate the entire field, or the contents won't all
be displayed on the form. Two hundred fifty-five spaces will make a box
that contains about four lines of text on the 4 in. x 53?4 in. form.
The Topic field will need to be moved so that it is
in the upper righthand side of the form. This is a useful location so
that the cases can be filed or found quickly. Simply click and hold down
on the field and move it to the desired location. This field is the only
one that does not begin at the 1-in. mark. On our form, it begins at about
21?2 in. Again, make sure that all of the field boxes end about 1?4 in.
to 3?8 in. from the righthand edge of the form and are lined up on both
sides.
Toggle back to the Forms view, select the form, and
check to make sure that the form looks correct with the actual data within
it. In this view, select the font and the font size (Fig. 11).
For font style and size, the MS Sans Serif is a readable
font that is the default choice, but a size 10 rather than eight-point
font is recommended for legibility. Change this in the box above the form.
Switch back to the actual form by clicking on the name
given to the form in the Forms menu (Fig. 12). Note that the information
entered into the table is now displayed in the form. Also note that the
autonumber of each case is displayed at the bottom of the form page. There
is a line of text that begins with the word "Record" and then contains
a left-facing arrow with a line, a left arrow, a data box with the number
of the current record in it, a right-facing arrow, a right arrow with
a line, and a right arrow with an asterisk. These correlate with the first
record in the table, the previous record, the number of the current record,
the next record, the last record in the database, and the final "empty"
form into which new data can be entered. The number of the record is important
when printing out the forms, so make a note of it when beginning data
entry into the forms.
Enter data
Data can be entered for each case either in the table
view or in the form view. We most often use the form view for data entry.
Remember to make a note of the record number of the first case being entered
so that the cases can be printed out easily. Common abbreviations may
need to be used to save space on the forms (SCCA for squamous cell carcinoma,
for example).
Be sure to develop a convention for entering the data,
especially for frequently searched fields such as Cyto Number or Topic,
for example. This will make searching easier.
Print the forms Before printing the first time,
go to the File menu and select Page Setup. You will need to make several
adjustments to the margins and columns tabs in this area (Fig. 13).
Under the "Margins" tab, make the top margin 0.25 inches and the left
margin 0.25 inches. Then select the "Columns" tab (Fig. 14). On
the Columns tab, set the number of columns at one, the row spacing at
seven inches (so each form will print on a separate page), the width of
the form at 5.45 inches, and the height of the form at 3.7 inches. This
should make the form an appropriate size for the vinyl slide holder.
Finally, go to the File menu on the toolbar and select
"Print." Enter in the range of records that need to print, for example
From: 6 To: 10. Do not simply click on the printer icon or select
"ALL" because every record in the database will then print. The print
job would then have to be deleted. After several forms have been printed,
they can easily be trimmed to size all at once so that they fit into the
vinyl slide holders. Only one form per page should print.
Search the database
The table can be searched by any word or phrase. One
easy way to find a particular case is to search by accession number. Click
on the Table view and then go to the Find menu item under Edit. Enter
the case's accession number, select the Table, and select "Any Part of
Field" (Fig. 15). This will bring up the selected case number in
that field, even if other words were combined with it, such as N07-123
FNA Liver.
Additionally, a Query can be constructed to create
a report with many entries, such as all of the cases of adenocarcinoma
of the breast, for example. Further information on using Query can be
obtained from Microsoft Help. Again, note how important it will be to
enter the data in a uniform manner.
Additional considerations
In our hospital, all departmental databases were removed
from our computers and not reinstalled until all those with access to
the database had undergone training. This training consisted of ways to
ensure that Health Insurance Portability and Accountability Act regulations
relating to such databases could be followed. This ensured also that the
database was more secure and available only to those who had undergone
training.
Thus, this is a relatively simple use of a database
to create teaching file forms and to keep track of the slides used for
teaching. It creates a form that can be used in the 4 in. x 6 in. vinyl
slide holders and allows searching to find a specific case or set of cases.
Obviously, additional adjustments can be made to the form depending on
your institution's needs. Some institutions prefer to have the "answer"
on the back of the cases rather than on the front. Other databases may
also be used to create these forms. These comments may provide useful
suggestions for other databases as well.
Dr. Means, a consultant
to the CAP Cytopathology Committee, is a clinical associate professor, Cytotechnology
Program, School of Allied Health, University of Kansas Medical Center, Kansas
City, Kan.
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