Workplan

Concerning nutrient intake terms and tangential discussions about nutrient absorption and metabolism effecting intake. Because deficiency, absorbtion, and metabolism occur at the cellular level there are number of SNOMED-CT disease (disorder) terms in the Findings hierarchy that describe deficiency, malabsorption, and disordered metabolism for several macro and micro nutrients. This would seem appropriate and I am not sure why there is discussion to place them in the Nutrient intake (finding) hierarchy..

Inadequate and excessive intake diagnoses from the NCPT are by definition dependent upon a Comparative Standard such as an RDI or evidence- based or evidence-informed condition specific standard (critical care, renal disease...). For example, Inadequate (oral) intake of folate related to change in health status (pregnancy) as evidenced by < RDI consumption per diet history. Another example,

Inadequate intake of protein related to increased needs as evidenced by tube feeding infusion < recommended 1.2 gm/kg for ventilator dependency. Either term Inadequate enteral intake of protein or Inadequate intake of protein could be used correctly. I appreciate the distinctions among oral, enteral, and parenteral intakes and other routes (IM for B12). However,  Intake would seem to be intake no matter the route. How does one handle when a person is receiving nutrients via 2 or more routes? Do we need terms in NCPT for all the possible combinations of intake routes? Is specifying the route of intake too much precoordination?

Also need some explanation as to why Enteral route is a (qualifier value) as is Oral route and Parenteral route is a (navigational concept/special concept). (Special concept) is a hierarchy I am not familiar with. One would think these routes would be in the same hierarchy. I find it confusing that these routes are placed in different hierarchies.

I do not think discussion of deficient intake, malabsorption, or disorder metabolism has a place in the work plan proposing terms for Inadequate and Excessive intake since these are significantly covered terms in the Disease (disorder) hierarchy which is a part of the Finding hierarchy. Also since the route of intake is handled in various ways either as a qualifier value or a navigation concept, I do not think we should propose intake terms based on route until this situation can be clarified.

Thanks William, I concur on the navigational concepts.  These are a mixture of concepts with no useful purpose and concepts where the words are useful and used clinically, but the hierarchy makes it useless.  This hierarchy should probably be made inactive, with represenation as appropriate for clinically useful concepts in the correct semantic area

Hello, all. Bill's comments to a degree reflect the discussion we had on the last mtg on 4/16, and I completely agree w. all points summarized by Bill.