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[Gnumed-devel] Vaccination as a starting point

From: richard terry
Subject: [Gnumed-devel] Vaccination as a starting point
Date: Sun, 21 Jul 2002 22:15:06 +1000
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> For each immun. a timestamp, the immun.type (reason:
> prevention, travel, exposure, ...), the exact name of the
> vaccine, the charge/lot/batch ID, the injection site/type
> should be recorded.

+should we have a line for 'reacton' in case patient has a problem with a 
particular vaccine.
> Certain vaccination types should be able to trigger GNUmed
> "request" events (check HepB titer 10 years post vacc., prompt
> for boosters/repeat vacc. on multiple base immunisations, alert
> for overdue vacc.s)

Agree. In my program I linked age to the schedules and did a check when the 
patient was first loaded. The flashed up a sign if immunizations were 
missing. Got a little messy because of
a)Doctors putting vaccines in incorrect schedules
b)vaccine equivalency problems
And I never quite got it right but it sort of worked (see the png dumps)

> Those mechanisms should be based on pluggable guidelines.

This raises many issues. In australia we have immunization schedules (as I 
presume all countries do). The schedules however are constantly being 
modified e.g we had a situation not long back where kids born prior to 
01/05/2000 were on one schedule, and those after 01/05/2000 on another. This 
is not a problem if you present vaccines as either a schedule or a disease 
eg in my edit area:
Date given
Serial no
(reaction)  - not there but perhaps we should

The Target can be a disease, combinations of diseases or schedules eg:
see the attatched png for examples.
One a schedule is chosen, all the vaccines in this schedule are automatically 
presented, or or a disease is chosen, here meningococcal, ditto.
Hitting enter on a vaccine them puts in a default date(today) which you can 
change if entering past vaccine information, and the last vaccine_serial 
number used for this brand of vaccine (which again you can edit).
To put in the site, I just enter by hand, but one should have quick 
abbreviations built into this line eg ld  would autoexpand to left deltoid 

See the display or previous vaccinations by the schedule/target disease list 
below the editing area.

> It may be beneficial to be able to "link" vaccinations to
> particular lab results.

Agreed, but looking into the future here
> Vacccine type <-> patient age should be checked if possible.

I did this in my program (see the png which for this 5year old lists vaccines 
the system says she should have had but are not recorded (plus see my note 
> Recording a vaccination should create an event in the patient
> state tracking time line (where major things like hospital
> admissions, major diagnoses, off-work, pregnancies, etc. are
> linked together to form a coherent picture).

Yes, but again we need to walk before we run.

See some table definitions to start the ball rolling:

Table: Data_Immunisations
        Name    Type    Size
        consult_ID      Number (Long)   4
        Date_given      Text    10
        Vaccine_ID      Number (Integer)        2
        Schedule_ID     Number (Integer)        2
        Serial_No       Text    20
        Site    Text    25
        Deleted Yes/No  1

Table: lu_Vaccine_Equivalents
        Name    Type    Size
        Vaccine_ID      Number (Long)   4
        Equivalent_ID   Number (Long)   4

 Table: lu_Vaccine_Schedules
        Name    Type    Size
        Schedule_ID     Number (Integer)        2
        Age_Due_Months  Number (Integer)        2
        Age_Due_From    Number (Integer)        2
        Age_Due_To      Number (Integer)        2
        Age_Due_Units   Number (Integer)        2
        Schedule_Text   Text    55
        Archived        Yes/No  1
        Female_Only     Yes/No  1
        Display_Schedule_only   Yes/No  1
        Aboriginal_TSI_only     Yes/No  1
        Seasonal_ID     Number (Long)   4

Table: lu_vaccines      
        Name    Type    Size
        Vaccine_ID      Number (Long)   4
        Description     Text    75
        Trade_Name      Text    75
        Abbreviation    Text    50
        Disease_target  Text    50
        Live_vaccine    Yes/No  1
        formulation     Text    50
        Last_Batch_No   Text    15
        Archived        Yes/No  1
        Updated Date/Time       8

Table: lu_vaccines_in_schedule
        Name    Type    Size
        Vaccine_ID      Number (Integer)        2
        Schedule_ID     Number (Integer)        2
        Booster_Interval_from   Number (Integer)        2
        Booster_interval_to     Number (Integer)        2
        Booster_inteval_units   Number (Integer)        2
        Sequence        Number (Byte)   1
        Seasonal_month_Due      Number (Integer)        2

> Vaccinations should be linkable to Episodes (PneumoVax well
> after hospital admission in order to prevent recurrence).
> Anything else comes to mind ? Comments ? Additions ? We will
> get tables going for this but we need input. _This_ is your
> time to make yourself heard.
> Karsten

Attachment: target_as_disease.png
Description: PNG image

Attachment: targetasschedule.png
Description: PNG image

Attachment: vaccineselection_inshedule.png
Description: PNG image

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