Re: [Gnumed-devel] Consumable substance 'strength' unaccepting of radionucleides

[Jim Busser]

The following are incompatible with the GNUmed schema.

On reflection, am I correct to expect that no country permits prescribing, on a 
prescription, a radioisotope which therapy can;t be dispensed from your 
neighbourhood pharmacy but can only be filled by a facility with nuclear 
medicine support.

Even though it could be argued that an entry (among a patient's medications) of 
a medical isotope has value, for example because
- it is possible that such treatments have to be administered more than once, 
and
- these treatments can require post-administration precautions for up to 90 days

it may be possible to track such states in the problem list as

        status <post treatment>

whether the patient received their 'treatment' orally or intravenously or via 
radioactive implant (brachytherapy) which is analogous to vaccinations which 
can be recorded in GNUmed separately from any 'prescription' and the 
possibility of exposure concerns relative to other individuals is not unique to 
medications… the same applies for example following acute hepatitis or 
tuberculosis… these things could be handled from the problem list.

Here is what would be excluded from the US FDA-based components if GNUmed would 
continue to require non-null *single-value* strengths:

select description, dosage, strength_unit FROM staging.ingred
WHERE position('-' in dosage) > 0 ;
                   description                    |   dosage    | strength_unit 
--------------------------------------------------+-------------+---------------
 SODIUM IODIDE I-131                              | 1-250       | mCi/0.25ML
 SODIUM IODIDE I-131                              | 1-500       | mCi/0.5ML
 SODIUM IODIDE I-131                              | 2-200       | mCi
 SODIUM IODIDE I-131                              | 1-1000      | mCi/ML
 SODIUM IODIDE I-131                              | 9-100       | mCi
 SODIUM IODIDE I-131                              | 3.5-150     | mCi/VIAL
 SODIUM IODIDE I-131                              | 0.8-100     | mCi
 TECHNETIUM TC-99M SODIUM PERTECHNETATE GENERATOR | 0.25-3      | CI/GENERATOR
 TECHNETIUM TC-99M SODIUM PERTECHNETATE GENERATOR | 0.0083-2.7  | CI/GENERATOR
 FLUDEOXYGLUCOSE F-18                             | 10-100      | mCi/ML
 FLUDEOXYGLUCOSE F-18                             | 20-200      | mCi/ML
 FLUDEOXYGLUCOSE F-18                             | 20-300      | mCi/ML
 FLUDEOXYGLUCOSE F-18                             | 20-200      | mCi/ML
 TECHNETIUM TC-99M SESTAMIBI KIT                  | 10-30       | mCi
 TOSITUMOMAB                                      | 0.1-0.25    | MG/ML
 TOSITUMOMAB                                      | 1.1-2.5     | MG/ML
(16 rows)

-- Jim