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Re: [Health-dev] Health-dev Digest, Vol 37, Issue 25


From: Roberto Novaes
Subject: Re: [Health-dev] Health-dev Digest, Vol 37, Issue 25
Date: Sun, 31 Aug 2014 22:55:43 -0300

Dear Luis Falcon,

First of all, thank you very much for your thorough answer.

> Thanks a lot for the library ! That would be a lot of work, but
> definitely a great asset !

Yes, it is a lot of work. Although the implementation is not that hard, the amount of data is very big, and we have to be very careful to correctly copy AJCC data.

> Let me try to answer, from a general practitioner perspective, how to
> integrate it in GNU Health.
> I would definitely take advantage and use the "Pathology Groups"
> functionality of GNU Health ( Health -> Configuration -> Diseases ->
> Pathology Groups ). You can link it to diseases from the current WHO
> ICD10 module. There is already a "neoplasic" group on it.

I was tinkering a little after your answer and I think it is a good way to go. I intend to add the T, N and M fields inheriting from disease, as well as the staging field. While our library is not ready, the doctor could fill the staging field by hand (that is what they already do nowadays)

> So, for example, you could call your TNM / Staging library if the
> patient disease list contains one of the Neoplasic . There are
> non-solid / diffuse oncological conditions where TNM does not work
> well or just would not apply.

We are aware of the limitations of TNM staging, but we expect to cover a large spectrum of tumors using this functionalities, specially if you consider (at least in Brazil) that the majority of cancers are breast, prostate, lung and colon. All of them could benefit from TNM staging. For prostate cancer, we would also have to add PCA and Gleason fields also, but we expect to cover an initial demand for those most common cancer types.

> You have all that information starting from the gnuhealth patient model.
> Appointments, evaluation dates, procedures, tests, etcetera are
> available from the main "patient control panel", which should be your
> friend :) .

Ok. Very nice!

> Finally, a personal side-note. We, as individuals, and our health
> conditions require an integrative approach. This concept stands up more
> when dealing with oncological conditions. We need to look at the
> bio/psycho/social/spiritual factors as a whole, both to promote health
> and for healing. I always have it present when designing and
> implementing GNU Health.

We are hoping to solve (or try to solve) a specific problem of automatically generating survival analysis curves. Of course, for this holistic approach we would like to count on the help of the community.

Sincerely,

Roberto Novaes
Silex Sistemas
www.silexsistemas.com.br


2014-08-30 8:47 GMT-03:00 <address@hidden>:
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Today's Topics:

   1. Re: Best way to add data to a patiente - Oncology Module
      (Luis Falcon)
   2. Re: Creating a local formulary / medicines product list for
      Tryton / GNU Health (address@hidden)


----------------------------------------------------------------------

Message: 1
Date: Sat, 30 Aug 2014 11:30:03 +0100
From: Luis Falcon <address@hidden>
To: Roberto Novaes <address@hidden>
Cc: address@hidden
Subject: Re: [Health-dev] Best way to add data to a patiente -
        Oncology Module
Message-ID: <address@hidden>
Content-Type: text/plain; charset=UTF-8

Dear Roberto
On Fri, 29 Aug 2014 12:14:51 -0300
Roberto Novaes <address@hidden> wrote:

> Hello to all!
>
> We are discussing the development of a module concerning specific
> needs for the oncological sector.
>
> The two main necessities are:
>
> 1) Register the ICD code of the disease, its TNM data (both clinical
> and pathological) and its correct staging classification. We are
> already developing a python library that exposes a function that
> receives the ICD, T, N and M values and returns the cancer staging
> (it is almost a wrapper around AJCC tables -->
> https://cancerstaging.org/references-tools/Pages/What-is-Cancer-Staging.aspx)
> soon to be released to public under GPL 3 license :). Where is the
> best place to store this TNM and staging data? Should I add fields
> through inheritance from the Pathology class or from the PatientData
> class? Another option would be to create another model (lets say,
> NeoplasicDisease) that would have a FK to a patient.
>
Thanks a lot for the library ! That would be a lot of work, but
definitely a great asset !

Let me try to answer, from a general practitioner perspective, how to
integrate it in GNU Health.

I would definitely take advantage and use the "Pathology Groups"
functionality of GNU Health ( Health -> Configuration -> Diseases ->
Pathology Groups ). You can link it to diseases from the current WHO
ICD10 module. There is already a "neoplasic" group on it.

So, for example, you could call your TNM / Staging library if the
patient disease list contains one of the Neoplasic . There are
non-solid / diffuse oncological conditions where TNM does not work
well or just would not apply.

> 2) It would also have to register some key dates, such as the date of
> the first appointment or the date of the diagnosis, the date when a
> relapse has been detected, the date when a progression has been
> detected, the date when a metastasis has been found,  and the date of
> death, in order to create the survival analysis curve for the clinic.
> I know some of those dates are already registered by the system, such
> as date of first appointment or date of death. Should the remaining
> dates be registered on the same ways discussed above (on separate
> model or on the existing models through inheritance?)

You have all that information starting from the gnuhealth patient model.
Appointments, evaluation dates, procedures, tests, etcetera are
available from the main "patient control panel", which should be your
friend :) .

Finally, a personal side-note. We, as individuals, and our health
conditions require an integrative approach. This concept stands up more
when dealing with oncological conditions. We need to look at the
bio/psycho/social/spiritual factors as a whole, both to promote health
and for healing. I always have it present when designing and
implementing GNU Health.

Best,

>
> Sincerely,
>
> Roberto Novaes
> S?lex Sistemas Ltda.
> www.silexsistemas.com.br




------------------------------

Message: 2
Date: Sat, 30 Aug 2014 12:46:44 +0100 (BST)
From: "address@hidden" <address@hidden>
To: <address@hidden>,  <address@hidden>
Subject: Re: [Health-dev] Creating a local formulary / medicines
        product list for Tryton / GNU Health
Message-ID:
        <address@hidden>
Content-Type: text/plain; charset="utf-8"

Thanks Alvin

I am sure that RxNorm is an excellent medicines database/dataset
but it is designed purely for the N. American market.

I am still convinced
that each new GNU Health clinic/hospital should build their own medicines
dataset based on the GNU Health "default" database structure. This will also
help with assigning a pregnancy warning category to each medicine product,
which is a very useful decision support (= patient safety) feature of GNU
Health.

Regards

Andrew
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