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Re: [Gnumed-devel] clin_medication

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] clin_medication
Date: Fri, 15 Oct 2004 09:40:31 +0200
User-agent: Mutt/

> > *Additionally* one must store sufficient data (name,
> > packaging) to be able to identify the drug regardless.i
> There's the rub.
To sleep! To sleep, perchance to dream. And in that sleep
to dream of horrors that we know not of.

> I see 2 options: formatted free string, such as
> "ticarcillin/clavulanic acid 3g/100mg",
This would end up as a form_data row attached to the
form_instance row for the script anyways as it is what is
going to be printed on paper.

> or a second table to
> store the (ID, drug, amount, unit) tuple, with multiple entries 
> for compounds. I'm not sure which is best.
Am I thinking correctly that when we prescribe generics we
would do this:

phenoxymethylpenicilline 1.5 Mio i.E.
clavulanic acid 3g

which being TWO SEPARATE ROWS in clin_medication ?
Whereas when I would prescribe a particular drug by brand name
containing both of the above it would be just one row. This is
how I designed the table anyways.

> dosage could be represented by two intervals: length of dose cycle, and
> length of treatment, as Jim has said.
I understand that "length of treatment" is handling by
dispensing amount in your sort of country. Over here we don't
decide on the amount dispensed by rather state "take a week,
take for 10 days" or something. We then select package sizes
N1/N2/N3 (containing 10/20/50 units most of the time). Any
excess goes unaccounted for (!).

> The problem is "asymmetric"
> dosing, such as 40mg frusemide in the morning, 20mg at midday, so
> we need an array of up to four floats to describe the dosing pattern
> throughout the interval (default 24 hours),
Well, your suggestion of float-array (== array of numeric) for
dosage and dose cycle being an interval seems to cover things
well, no ?

> so "2-1-0-0" for above, this is the "German" idiom (or is it the
> "Hilbert" idiom?? ;-)
German idiom. Regularly observed in discharge summaries, among
other places.

> Certainly we need a free string as a "backup", triphasic Pills are
> an example where trying to represent the constituents as they vary in
> the 28-day cycle in structured data is too much complexity for too 
> little gain IMHO,
Most any such medication is going to be dispensed by brand -
or at least by compound drug such that one prescribes "Valette
1 each daily until gone/pause/restart". I don't see the need
to capture the compounds that are in that drug.

To come back to the big picture, what do we want the list of
current medications to do ? We want it to tell us what the
patient is taking now/has been taking previously - and how. Do
we want it to tell us what each drug contains ? No (but we want
the widget to allow us to *jump to* that information in
Hilmar-space). Will there be cases where more detail is needed
from the current medication list ? Yes - athletes competing in
license-requiring competitions will want to be given different
back pain shots than other people. Eg. I'd need to record the
diclophenac and the flexase that I've been giving them such
that it is quite clear that we deliberately left out the
dexamethasone other people would have gotten with the diclo.
This is accounted for by the brandname vs generic rows.

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