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[Gnumed-devel] gmdrugs structure


From: Hilmar Berger
Subject: [Gnumed-devel] gmdrugs structure
Date: Wed, 20 Nov 2002 01:53:03 +0100 (CET)

Hi,

just had another go on the drug tables. Maybe I should have complained
before Ian set up the PHP interface, but I was too busy coding the drug
browser. 

1. table adverse effects: 
 severity should be a foreign key pointing to a table
"severity_description". Reason: many sources of drug data use different
(ordinal) scales. It will be difficult to translate one scale to another.

2. tables conditions, subsidized_products:
 those are certainly country specific and should IMHO be marked as such
(i.e. conditions_au or similiar). I'm not quite sure if those tables
should be part of the standard gnumed drug database, on the other hand
these tables can be just ignored by a client running in a different
country.  

3. table drug_element: 
 - what is the difference between therapeutic vs. pharmaceutic class ?
 - I'm somewhat confused what the entities 'drug_element' and 'product'
mean. I would suggest a three-level hierarchy here:
 a) the substance itself (i.e. active substance, adjuvant or whatever,
e.g. paracetamol, fentanyl etc.). This entity  has a name and belongs
to one class (e.g. NSAID). I might be linked to further information
(interactions, indications, adverse effects) that are supposed as an
default value if no preparation-specific information is supplied. 

 b) the specific form of appearance of substances defined by formulation,
(i.e. tablet, solution etc.), amount of drug, adjuvants etc. This is IMHO
absolutely needed, since often important characteristics of a drug depend
not only on the active substance. Think of low- and high-dose heparine
(different indication, different halftime etc.), low- and high dose
aspirin (different primary indication of tablet containing 100mg and those
with > 500mg), normal and retarded (by use of zinc as an adjuvant) insulin
and so on. This level should be able to add and/or modify information
supplied by the substance-level. I'm not quite sure how to name that
level without being ambiguous ('preparation' ?).

 c) the package-level (containing x units of level b), having a brand
name, manufacturer and so on. 

 There may be two types of compounds then: compound packages (containing
two or more types of level b) and compound 'preparations' (level b)
containing two or more active substances (level a).

 Certain links and tables would have to be reordered in order to keep the
 database consistent with this design.

4. table interactions :
 severity: see table adverse_effects
 
5. table link_drug_adverse_effects:
 frequency : should be a foreign key, too.
 important : this should differentiate "severe" (that is, life threatening
or damaging) from "normal, not severe" adverse events irrespective of the
frequency (one would not expect to have frequent severe events in
available drugs, though). This is how adverse events are usually handled
in pharmaceutical studies.

6. table link_drug_component:
 id_component:   references drug_element, as does table
product.id_generic_drug. What is the difference ?


Please comment on those suggestions.

Regards, Hilmar





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