I wanted to discuss the changes to the Laparoscopic content that were published November 2023 (and continue to trickle through since). Since I suspect EAG members not maintaining an extension may not have noticed.
While I appreciate some change may have been required my concerns fall into two parts:
The actual “implemented solution”
The execution of the change
The actual “implemented solution”.
For context Endoscopy and endoscopic procedures - SNOMED CT Editorial Guide - SNOMED Conflue
In reviewing some recent requests for amputation procedures, I have run up against a conundrum that I would like input on. There are currently several procedures representing amputations of lateralized body structures, but without specifying the precise laterality. Back in 2015-16 we inactivated concepts that specified "unilateral" procedures as being both ambiguous and a threat to patient safety if added to an EHR. While the existing procedures that do not specify laterality act as org
Presumably the "threat to patient safety" posed by non-lateralised procedures relates to their potential contribution to instances of "wrong site surgery" (as an example of a "never event").
As such my suggestion would be that SI considers how SNOMED CT can play its part in a more complete risk management approach rather than simply looking to suppress/remove particular content from the reference data.
It is also not clear what the scope of the concern is. The suggestion seems to be that disorders are of lesser concern than procedures (but no evidence is given to support this - and what about, for example, specimens) and the nature of the in-scope procedures is left open. Is it only amputations, or does it include any 'destructive' or 'excising' surgical action, or is it, in fact, any action at all?
Likewise, is the concern limited to bilateral symmetrical structures or could it include any class of body structure which can be specifically described or can be referred to in a more abstract way (teeth, vertebrae, ribs etc.)?
I imagine that retaining non-lateralised content is also of considerable value for text-entity matching in NLP use cases where explicit mention of sidedness may not be available or required.
It is also worth noting that, even if we limited scope to amputations and considered only the set of concepts specified by...
<< 81723002 | Amputation |:
{405813007 | Procedure site - Direct | = ^ 723264001 | Lateralisable body structure reference set |}
...of the 120-or-so international concepts returned nearly half are found at least once in the UK primary care usage data for 2022/3 (the most frequently used being the 'doubly abstract' 371186005 |Amputation of toe|).
We have noticed an inconsistency in our review of nontraumatic vs. spontaneous injury. In some cases we make a distinction between them:
1296953008 |Nontraumatic rupture of extensor tendon of left hand (disorder)|
321371000119100 |Spontaneous rupture of extensor tendon of left hand (disorder)|
whereas in other cases we treat them as synonymous:
image.png
In determining the meaning of nontraumatic vs. spontaneous, we have found that nontraumatic means injury not caused by an exter
Thanks Jim.
In response to your 'remaining questions', for (a) I would repeat my suggestion above that "...'non-traumatic' could be seen as better for FSN-naming...in that it at least commits to some explicit exclusion...", and for (b) I would say no - deal with it where it already occurs or is requested but don't propagate it over all the 'non-traumatic' data; there are dozens of other situations where word and phrase equivalence is incompletely manifested in the English language reference data, and if people need it for improving search sensitivity then this should be done by search-specific means.
In other areas where 'spontaneous' appears as a synonym, I'd suggest that (given the troublesome polysemy of 'spontaneous') you look at an approach where, if there is an equally acceptable alternative word then that word should appear in the FSN. Where 'spontaneous' is the only clinically adopted word you probably have no choice but to use it.
In the handful of cases where distinct concepts currently exist (presumably as fall-out from a recent wave of concept additions) the 'spontaneous'/'nontraumatic' pairs can be treated as duplicates and justifiably same_as merged (preserving the older conceptId as active).
Regarding the 'spontaneous event' definition and the due_to=spontaneous event modelling stuff: to my mind this just doesn't hold up to scrutiny. You seem to be saying that the distinguishing characteristics of 'spontaneous events' are that they are (a) 'unexpected' and (b) that the 'cause may be known' but is definitely not an 'external force'. OK (leaving aside the likely fact that 'no external force' is a judgement of scale - I'm sure health and weakened vessels and membranes are bursting all the time due to external forces, it's just most of the time those forces are really small). The 'unexpected' aspect introduces notions of 'risk' and 'chance' of occurrence, and might arguably be invoked for any illness for which there is not a demonstrable macroscopic ('human scale') external cause (or chain of causes back to some arbitrary point). I appreciate that this thread is motivated by 'non-traumatic' notions, but current due_to=spontaneous event modelling already goes well beyond this. Plenty of illnesses present 'out of the blue' ('unexpectedly') - and either immediately or over time their 'cause may be known'; why would they not also be modelled with due_to=spontaneous event? I will continue to argue the due_to=spontaneous event modelling should be removed - it adds nothing to the knowledge contained in SNOMED CT, and the fact that it allows a number of concepts to be sufficiently defined may, in fact, be more of a risk than a benefit.
A number of diseases exist in which the literature describes the potential for there to exist a recognised set of associated "systemic manifestations". In an attempt to model these systemic manifestations there has been a requirement to identify a modelling pattern which lies somewhere between the concepts of "Co-occurrent" and "Due to".
The issue arose from a discussion on how we should model the systemic manifestation of Sjögren's syndrome and the thread relating to this has been inclu
To summarize the issues as I see it, we want to distinguish between two types of disorder associations, one in which a finding or disorder is a manifestation of a multi system disorder for which the manifestation and the underlying disorder may share a common pathological process and morphology and the other in which there are 2 discrete disorders that are found together more than would be expected by chance alone and may be related by a common predisposition. I think you are suggesting to use associated with for the former and simple co-occurrence for the latter. Jim seems to be suggesting to use simple co-occurrence for the former and temporally related to for the latter. In a separate e-mail, I expressed my concern about using temporally related to which is essentially a symmetric property to relate two conditions where neither one is secondary to the other. I would like to propose the following solution:
For the situation where a disorder or finding is a manifestation of a multisystem disorder, create a new attribute, is manifestation of (note there is currently a link assertion “417318003 |Is manifestation of (link assertion)|”.
Another option would be to use as Jim suggested temporally related to where the manifestation is temporally related to the underlying systemic disorder. A manifestation may precede and/or occur during the underlying disorder but would never as far I know occur after the underlying disorder has resolved.
For two distinct disorders that may share a common predisposition, represent as simple co-occurrence with a due to relationship to the predisposing factor which may be one or more findings or disorders such as a mutation, substance, organism, physical force or event or some combination of the above. If the predisposing factor is unknown, then a due to relationship would not be included.
The semantics of historical associations, quality of the corpus of already authored associations, and future editorial guidance in their authoring and end-user processing.
Hi jrogers, many thanks. I will copy this across into the subproject page.
PS - Anne is away on annual leave for 3 weeks so she has suggested we progress without her. I will send round a further doodle poll for the next couple of weeks.
This discussion will determine the appropriate editorial guidance for acceptance of and content development of responses to questions in surveys and questionnaires. Initial topics include:
Content acceptance criteria:
Only assessment instruments that are in the public domain or with expressed permission will have their response values added.
IP-restricted assessment values may only be added upon permission of the publisher. It is the responsibility of the requester to secure that permiss
Ad item 7 from the Jan 2018 EAG meeting: Data on the range of 'procedure without procedure' type codes and their actual utilisation rates within UK primary care settings
The majority of X absent concepts are in the findings hierarchy rather than the situation hierarchy. If we think it is appropriate to keep these as findings then Jeff's suggestion might work.
Discussion surrounding the proposal to retire from use the WAS-A historical attribute and the inactivation of the existing relationships. The issue originated when a concept slated for inactivation served as a destination concept for a WAS-A relationship to a limited status concept. The tooling required reconciliation of the WAS-A relationship to an active concept. It was reported that historically there was some push back inactivation of a WAS A from a limited inactive concept pointing
A summary of a discussion with JTC/GRE/JRO can be found at:
https://docs.google.com/document/d/17dOZwNITk0cZIqalSbXvG_702lsWlLOhS-FPNSGOv8o/edit https://docs.google.com/document/d/17dOZwNITk0cZIqalSbXvG_702lsWlLOhS-FPNSGOv8o/edit
Until the batch fix to the issue is applied, the following steps should be taken when the target of a WAS A relationship is inactivated:
Assign the next proximal parent as the target of the WAS A relationship
Do not make changes to the inactivation status or add additional historical relationships.
At the Wellington meeting it was determined that the current definition of "Product" was both too broad and included terms that were not universally useful. It was determined that to address the needs of the new Drug Concept Model and to make sure that the definition of products in the International release is consistent with the content.
Current definition Editorial Guide July 2016: "This hierarchy was introduced as a top-level hierarchy in order to clearly distinguish drug products (products) from their chemical constituents (substances). It contains concepts that represent the multiple levels of granularity required to support a variety of uses cases such as computerized provider order entry (CPOE), e-prescribing, decision support and formulary management. The levels of drug products represented in the International Release include Virtual Medicinal Product (VMP), Virtual Therapeutic Moiety (VTM), and Product Category.”
Ed Cheetham