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Re: [Gnumed-devel] where are we at?

From: Ian Haywood
Subject: Re: [Gnumed-devel] where are we at?
Date: Sat, 14 Dec 2002 18:35:18 -0500
User-agent: Mutt/1.3.28i

On Sat, Dec 14, 2002 at 04:55:08PM +0100, Hilmar Berger wrote:
> Hi,
> On Sat, 14 Dec 2002, Ian Haywood wrote:
> Table script_drug: 
>  1. IMHO every prescription should be stored completely as text, too. 
>    Reason: There are drugs, that are prepared by the pharmacist and
> therefore are not listed in any drug database. Other examples might be
> prescriptions that for some reason do not match the structure given in the
> table (this might be the case for additional entries, drug timings
> not covered etc.). 
Sounds reasonable. 
>  2. I would suggest storing the brand name (if known) instead of
> having a default entry "GENERIC". 
>  Reason: 
>   a) Brands containing the same generic drug often have different adjuvants
> that might cause adverse drug effects. We should store information as
> precise as possible about the drugs prescribed.
>   Since we don't check for the presence of a related entry in
> "constituents" we might end up having an entry in script_drug without any
> information on the type of drug we prescribed. Maybe there should be a
> rule on inserting an entry in table script_drug ?

The main point of this information is to allow drug information to
survive a change in drug database (this is probably less of an issue in
Germany were there is one official database, but in Australia there will
be at least two to choose from)

Also, one of the databases (MIMS) is unstable in its internal data, for
example omeprazole is "Losec" in one edition and "Losec Tablets" in the
next. Richard had problems with his program in this regard. 
Therefore we need to store the generic information (omeprazole), even
though this will not perfectly describe the drug.

(IMHO, if an "adjuvant" has serious implications for indications,
adverse effects, etc., then its not really an adjuvant for our purposes:
it should have its own entry in "constituents")

Nevertheless, some prescriptions many have an entry in script_drug with
no entries in constituents, because the database does not have that
information, essentially forcing us to rely on brand name.

> 3. Frequency/time of drug application seems to be a rather complex issue.
> I'm not quite sure if you can really cover all possible/meaningful cases
> within a simple structure. Think of different dosages at different
> timepoints, more than 3 timepoints a day or drugs applied only at 22.00
> (that is, once a day, but not at the usual 'nocte' timepoint about
> 18-19.00. I Germany we use a scheme like 1-0-1/2 or 1-0-0-1 to denote
> dosages and timepoints of an applied drug. I feel that it would rather be
> difficult to come up with an easy structure to store this. 

True, the number is more a daily total for 'compliance-checking' so if
you prescribe
20 tablets of temazapam, 1 nocte, and the patient comes for a repeat
script in two weeks, the computer can alert you to the discrepancy.
Similarly, it can highlight continuing scripts that are about to 'run


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