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--- documentation:next_cdm:denominator_units [2015/12/29 16:57] – klaus_bonadt
+++ documentation:next_cdm:denominator_units [2017/07/07 15:20] (current) – clairblacketer
@@ Line 1: / Line 1: @@
 ===== Denominator Units for liquid drugs and quantity field in DRUG_EXPOSURE =====
+=== Proposals are now tracked as github issues ===
+[[https://github.com/OHDSI/CommonDataModel/issues/72|link to github issue]]
   * Requester: Klaus Bonadt
@@ Line 36: / Line 38: @@
 === Options: ===
-  - We could agree on using mg instead of g for the quantity in case 1c. However, this would require additional conventions and steps for the ETL process: We would use mL for liquids and products with different denominator units (for example 42799258 "Benzyl Alcohol 0.1 ML/ML / Pramoxine hydrochloride 0.01 MG/MG Topical Gel"). However, we would use mg for products which exclusively use a mass unit. Thus, we would need to check all corresponding entries in the DRUG_STRENGTH table beforehand in order to know whether we can apply mg or mL.
+  - We could agree on using mg instead of g for the quantity in case 1c. However, this would require additional conventions and steps for the ETL process: We would use mL for liquids and products with different denominator units (for example 42799258 "Benzyl Alcohol 0.1 ML/ML / Pramoxine hydrochloride 0.01 MG/MG Topical Gel"). However, we would use mg for products which exclusively use a mass unit. Thus, we would need to check all corresponding entries in the DRUG_STRENGTH table beforehand in order to know whether we can apply mg or mL. __I don't recommend this.__
-  - We could use an additional field quantity_unit_concept_id to denote the unit. However, this would also require additional sets of conventions to avoid incompatible entries between quantity_unit_concept_id and denominator_unit_concept_id.
+  - We could use an additional field quantity_unit_concept_id to denote the unit. However, this would also require additional sets of conventions to avoid incompatible entries between quantity_unit_concept_id and denominator_unit_concept_id. __I don't recommend this.__
-  - In the DRUG_STRENGTH table we could allow additional units for masses (besides mg), or volumes (besides mL) or time (besides h). However, this would add not only additional complexity for the conversions but also for the checks to decide whether a DRUG_STRENGTH entry belongs to a dose release over time, to a mass or a volume unit.
+  - In the DRUG_STRENGTH table we could allow additional units for masses (besides mg), or volumes (besides mL) or time (besides h). However, this would add not only additional complexity for the conversions but also for the checks to decide whether a DRUG_STRENGTH entry belongs to a dose release over time, to a mass or a volume unit. __I don't recommend this.__
-  - In the DRUG_EXPOSURE table we could add a flag to indicate that this record is part of a compounding.
+  - We might want to distinguish between drugs used in compounding and normal drugs dispensed on the same day. In the DRUG_EXPOSURE table we could use a compounding_sequence (holding a sequence number for each compounding on the same day for the same patient) or a compound_sequence (holding a sequence number for each compound. The sequence will restart from 1 for all subsequent compounding). __I do recommend this, preferably the latter one.__
 === Use Cases ===
-^  1     ^ Tablets^
+^  1     ^ Solid preparations, preparations where dose cannot be split^
-^ :::|//Example: In Europe packs with a fixed pack size are dispensed, for example Paracetamol 500 mg, 20 tablets.//|
+^ :::|Example: 20 tablets of 19020053 "Acetaminophen 500 MG Oral Tablet"|
-^ DRUG_STRENGTH  | The denominator_unit is empty |
+^ DRUG_STRENGTH  | The denominator_unit is empty. Amount_value and amount_unit_concept_id contain the effective dose. //Note that in non-US databases the quantity could be retrieved from the box_size field, however, the ETL should copy that to the DRUG_EXPOSURE.quantity field.//|
-^ DRUG_EXPOSURE  | Quantity refers to number of pieces, e.g. tablets    |
+^ DRUG_EXPOSURE  | Quantity refers to number of pieces, e.g. 20 tablets    |
-^ :::|//In the example: 20//|
+^ :::||
-^ ''Ingredient dose=''|''quantity x amount_value [amount_unit_concept_id]''|
+^ ''Total dose=''|''quantity x amount_value [amount_unit_concept_id]''|
-^ :::|''//Paracetamol dose = 20 x 500mg = 10,000mg//''|
+^ :::|''Acetaminophen dose = 20 x 500 mg = 10,000 mg''|
 | | |
 ^  2     ^ Puffs of an inhaler ^
-^ :::|Note: There is no difference to use case 1 besides that the DRUG_STRENGTH table may put {actuat} in the denominator. In this case the strength is provided in the numerator.|
+^ :::|Example: 150 puffs of 21174430 "Nicotine 0.5 MG/ACTUAT [Nicorette]". Note: There is no difference to use case 1 besides that the DRUG_STRENGTH table has {actuat} in the denominator_unit. In this case the strength is provided in the numerator.|
-^ DRUG_STRENGTH  | The denominator_unit is {actuat}|
+^ DRUG_STRENGTH  | The denominator_unit is {actuat}. The numerator value and numerator unit contain the dose per actuation (puff) |
-^ DRUG_EXPOSURE  | Quantity refers to the number of pieces, e.g. puffs |
+^ DRUG_EXPOSURE  | Quantity refers to the number puffs, e.g. 150 |
-^ ''Ingredient dose=''|''quantity x numerator_value [numerator_unit_concept_id]''|
+^ ''Total dose=''|''quantity x numerator_value [numerator_unit_concept_id]''|
+^ :::|''Nicotin dose = 150 x 0.5 mg = 75 mg''|
 | | |
 ^  3     ^ Quantified Drugs^
-^ :::|//Example: The Clinical Drug is Paracetamol 250 mg/mL in a 5mL oral suspension. The Quantified Clinical Drug would have 1250 mg / 5 ml in the DRUG_STRENGTH table. Two suspensions are dispensed.//|
+^ :::|Example: 43275770 "60 ML Acetaminophen 50 MG/ML Oral Solution", meaning, there are 60 mL of Acetaminophe (Paracetamol) of a concentration of 50 mg/mL. Two such bottles are prescribed. |
-^ DRUG_STRENGTH  | The denominator_unit is either mg or mL. The denominator_value might be different from 1. |
+^ DRUG_STRENGTH  | The concentration is given in the numerator/denominator fields, with the denominator unit either mg or mL, and the denominator value typically not 1. E.g. 3000 mg in 60 mL. |
-^ DRUG_EXPOSURE  | Quantity refers to a fraction or multiple of the pack. |
+^ DRUG_EXPOSURE  | Quantity refers to a fraction or multiple of the container. E.g. 2|
-^ :::|// Example: 2// |
+^ ''Total dose=''|''quantity x numerator_value [numerator_unit_concept_id]''|
-^ ''Ingredient dose=''|''quantity x numerator_value [numerator_unit_concept_id]''|
+^ :::|''// Acetaminophen dose = 2 x 3000 mg = 6000 mg//''|
-^ :::|''// Paracetamol dose = 2 x 1250mg = 2500mg//''|
 | | |
-^  4     ^Drugs with the total amount in quantity^
+^  4     ^Liquid drugs, or drugs where the amount can be split randomly. The total amount in given in quantity^
-^ :::|//Example: 42799258 "Benzyl Alcohol 0.1 ML/ML / Pramoxine hydrochloride 0.01 MG/MG Topical Gel" dispensed in a 1.25oz pack.//|
+^ :::|Example: 42799258 "Benzyl Alcohol 0.1 ML/ML / Pramoxine hydrochloride 0.01 MG/MG Topical Gel" dispensed in a 1.25 oz pack.|
-^ DRUG_STRENGTH  | The denominator_unit is either mg or mL.|
+^ DRUG_STRENGTH  | The concentration is given in the numerator/denominator fields, with the denominator unit either mg or mL, and the denominator value as null. E.g. Benzyl Alcohol in mL and Pramoxine hydrochloride in mg |
-^ :::|// Example: Benzyl Alcohol in mL and Pramoxine hydrochloride in mg// |
+^ DRUG_EXPOSURE  | Quantity refers to the unit provided in DRUG_STRENGTH. Since both mL and mg are found mg is preferred. E.g. 1.25 x 30 (conversion factor oz -> mL) x 1000 (conversion mL -> mg) = 37,000 |
-^ DRUG_EXPOSURE  | Quantity refers to mL or g.|
+^ ''Total dose=''|''quantity x numerator_value [numerator_unit_concept_id]''|
-^ :::|// Example: 1.25 x 30 (conversion factor oz -> mL) = 37// |
+^ :::|''Benzyl Alcohol dose = 37,000 x 0.1 mL x 0.001 = 3.7 mL''|
-^ ''Ingredient dose=''|''quantity x numerator_value [numerator_unit_concept_id]''|
+^ :::|''Pramoxine hydrochloride dose = 37,000 x 0.01 mg = 370 mg''|
-^ :::|''// Benzyl Alcohol dose = 37 x 0.1mL = 3.7mL//''|
+^ :::|//Note: At analysis time, the denominator should be checked in the DRUG_STRENGTH table. As mg is used for the second ingredient the factor 1000 should be applied to convert between g and mg.//|
-^ :::|//''Pramoxine hydrochloride dose = 37 x 0.01mg x 1000 = 370mg''//|
-^ :::|//Note: The analytical side checks the denominator in the DRUG_STRENGTH table. As mg is used for the second ingredient the factor 1000 will be applied to convert between g and mg.//|
 | | |
-^  5     ^Compounding^
+^  5     ^Compounded drugs^
-^ :::|//Example: Ibuprofen 20%/Piroxicam 1% Cream, 30ml in 5ml tubes.//|
+^ :::|Example: 30 mL Ibuprofen 20% / Piroxicam 1% Cream.|
-^ DRUG_STRENGTH  | We need entries for the ingredients of Ibuprofen and  Piroxicam, probably with an amount_value of 1 and a unit of mg.|
+^ DRUG_STRENGTH  | Two separate entries for the ingredients of Ibuprofen and  Piroxicam are required, with an amount value of null and a amount unit of mg. |
-^ DRUG_EXPOSURE  | Quantity refers to the total amount of the compound. Use one record in the DRUG_EXPOSURE table for each compound.|
+^ DRUG_EXPOSURE  | Quantity refers to the total weight amount of the compounded ingredient. Use one record in the DRUG_EXPOSURE table for each compound. Eg.g 20% Ibuprofen in 30 mL = 6 mL, 1% Piroxicam in 30 mL = 0.3 mL |
-^ :::|// Example: 20% Ibuprofen of 30ml = 6mL, 1% Piroxicam of 30ml = 0.3mL// |
+^ ''Total dose=''|Depends on the drugs involved: One of the use cases above.|
-^ ''Ingredient dose=''|Depends on the drugs involved: One of the use cases above.|
+^ :::|''Ibuprofen dose = 6 x 1000 = 6000 mg''|
-^ :::|''// Ibuprofen dose = 6 x 1mg x 1000 = 6000mg//''|
+^ :::|''Piroxicam dose = 0.3 x 1000 = 300 mg''|
-^ :::|//''Piroxicam dose = 0.3 x 1mg x 1000 = 300mg''//|
+^ :::|//Note: At analysis time, the denominator should be checked for both ingredients in the DRUG_STRENGTH table. If it is not mg a conversion factor of 1000 should be applied to convert between mL/g and mg.//|
-^ :::|//Note: The analytical side determines that the denominator for both ingredients in the DRUG_STRENGTH table is mg and applies the factor 1000 to convert between mL/g and mg.//|
+| | |
+^  6     ^Drugs with delayed release over time, e.g. Patches^
+^ :::|Example: 1518199 "Ethinyl Estradiol 0.000833 MG/HR / norelgestromin 0.00625 MG/HR Weekly Transdermal Patch|
+^ DRUG_STRENGTH  | The release is provided as numerator/denominator pair, with the denominator value as null and the denominator unit hour. E.g. Ethinyl Estradiol 0.000833 mg/h / norelgestromin 0.00625 mg/h|
+^ DRUG_EXPOSURE  | Quantity refers to the number of pieces. E.g. 1 patch. |
+^ ''Release rate=''|''numerator_value [numerator_unit_concept_id]''|
+^ :::|''Ethinyl Estradiol rate = 0.000833 mg/h''|
+^ :::|''norelgestromin rate 0.00625 mg/h''|
+^ :::|//Note: This can be converted to a daily dosage by multiplying it with 24. (Assuming 1 patch at a time for at least 24 hours)//|