Re: [Gnumed-devel] Re: Vaccinations tables/questions

[Karsten Hilbert]

On Wed, Feb 08, 2006 at 10:43:14PM +1100, Ian Haywood wrote:

> > I will take your word for it here and draw from your
> > experience. Let's perhaps not think of
> > vacc_indication.description as "disease to be vaccinated
> > against" but rather "agreed-upon human-comprehensible
> > indication identifier".
> This is complex, as all vaccine epitopes do target a single disease entity,
> the point is that not usually the way we use them (at least here)
The way we use them doesn't really have to do with how we
represent them in the database. In the backend we should
represent things "medically correct". As long as we do that
we can compute any aggregation thereof we wish to display.

Also, we are not talking about vaccine_indication here, but
rather about vaccination_indication, IOW the indications for
vaccination in general no matter whether there be any
single-epitope vaccine available for that or not.

> Oh, and Q-fever for meatworkers (do you have Q-fever in germany?)
Nope, not of any known significance, to my knowledge.

> The rest of the time we are giving according to a schedule,
> either because the patient has reached a certain age, or
> they wish to travel to a certain country.
Absolutely, and thus the "main" (as in most-used) initial
entry line in a vacc edit area should accept both schedule
and vaccine but not necessarily indication. Accepting
indications is bound to create consistency problems:

- user selects "hepatitis A" in "main" line
- user then selects TwinRix in the vaccine line

Now what ?

> Personally I think we should aim for a "fully automatic" system:
> the vaccine dialogue computes the outstanding vaccinations based on the 
> patient's
> age
We already have that in a view inside the database. It's not
perfect, though.

> Oh, asthmatics and a few others get pneumo+flu as well, so there is a good 
> case for linking
> vaccine indications to disease codes.
Ah, well, but that's decision support which is another can
of worms entirely. So, when you enter a diagnosis of asthma
et al simply ask the user whether to put the patient on the
pneumo/flu schedule(s) and be done with it.

> The means we *do* need schedule_max_age,
Yawn, we've been having that for ages.

clin.vacc_def.max_age_due

The *values* of which, however, are subject to much debate
and speculation, I suppose.

> so we don't try
> to vaccinate the 75-year-old Sudanese refugee grandmother
> against whooping cough.
For exactly this reason.

Karsten
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