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

[Karsten Hilbert]

On Sun, Oct 02, 2011 at 09:31:25PM -0700, Jim Busser wrote:

> 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.

I guess so.

> Even though it could be argued that an entry (among a patient's medications) 
> of a medical isotope has value,

I conceptually agree.

> for example because
> - it is possible that such treatments have to be administered more than once, 
> and

Single dose is akin to vaccinations.

It may be more prudent to document this as a procedure.

> - 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>

Yes, or else as

- a patient label
- a Cave entry

> 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'

That is where the confusion stems from (which is why you put
it in ''): We are not talking a prescription. We are talking
drug treatment. Prescription is a legal formalism while drug
treatment is a medical actitivity.

> 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.

Or patient label (tag image) or Cave entry.

> 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

It needn't necessarily be fully excluded. Include the
minimum/maximum activity to facilitate phrasewheel entry,
document actual delivered dosage with each patient (leading
to many dosed-substance entries - which IMO is fine).

I believe that with, say, i.v. use of nuklides we need
better information on "dose depends on how it is used" to
make an informed decision.

After all, when I administer 1 ml of Tositumab 1.1-2.5 I
expect that at most 2.5mg Tositumab act within in the
patient.

Same with Ibuprofen 600mg orally. I don't know how much
actually acts in the patient.

Karsten
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