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John Paul Cook

Many-to-many relationships in pharmacology

When I was in my pharmacology class this morning, I realized that the instructor was presenting a classic relational database management system problem: the many-to-many relationship. He said that all of us in nursing school must know our drugs backwards and forwards. I know how to model that! There are so many things in both healthcare and higher education that could benefit from an appropriate application of technology.

As a student, I'd like to be able to start with a drug, a disease, a name of a bacteria, a side effect, or any other datum and see everything related to it, either graphically or in tabular format. I'd like technology to allow me to spend less time with data and more time with information. If my Excel skills were better, I'd start by making a pivot table of drugs and diseases. Ideally I'd have a data visualization tool, but that's way beyond what I have time for now. I wish I could take my PowerPoint slides from lecture and load them into a searchable database, but I'd settle for a parser that would extract all of the unique keywords from them.

As a future healthcare professional, I see plenty of opportunities for data mining. Such much data and so little information.

Healthcare IT has the added dimension of life and death. Medical mistakes and errors are a significant cause of death in the United States. I've learned a few interesting things about how to prevent mistakes. In science courses, students are taught to use trailing zeros to indicate precision. In pharmacology, trailing zeros are NEVER used. Writing 5.0 gm is considered dangerous. Using 5 gm is safer, research has found. The problem with 5.0 instead of 5 is that sometimes the decimal point isn't noticed or even worse, isn't written. If a drug has what is known as a narrow therapeutic index, if 5.0 gm is written and 50 gm is administered, the patient dies. For similar reasons, a leading zero is ALWAYS used it the quantity is less than one. Writing .5 gm is potentially unsafe, but writing 0.5 gm is safer. The leading zero helps call attention to the decimal point and prevent a fatal error. Computerized systems can provide an extra level of safety by checking dosages against safety limits. Both procedural and technical measures are necessary to keep the public safe.

Published Thursday, June 16, 2011 1:56 PM by John Paul Cook

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jonmcrawford said:

One of the things our Pharm D is always asking for is medical history by drug category. (e.g. patients on NSAIDs or psychotropics, what medical claims have they had?) This has been a challenge on the reporting side of things, for various reasons, but could have major impact. I've always wondered if it were possible to develop profiles in this way, say someone has behavioral health claims, then you could expect a challenge in drug compliance over some regimen, and plan accordingly.

Definitely an interesting field to be in, and like you said, many, many opportunities for data mining :)

June 16, 2011 4:04 PM

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About John Paul Cook

John Paul Cook is a Technology Solutions Professional for Microsoft's data platform and works out of Microsoft's Houston office. Prior to joining Microsoft, he was a Microsoft SQL Server MVP. He is experienced in Microsoft SQL Server and Oracle database application design, development, and implementation. He has spoken at many conferences including Microsoft TechEd and the SQL PASS Summit. He has worked in oil and gas, financial, manufacturing, and healthcare industries. John is also a Registered Nurse who graduated from Vanderbilt University with a Master of Science in Nursing Informatics and is an active member of the Sigma Theta Tau nursing honor society. He volunteers as a nurse at safety net clinics. Contributing author to SQL Server MVP Deep Dives and SQL Server MVP Deep Dives Volume 2. Opinions expressed in John's blog are strictly his own and do not represent Microsoft in any way.

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