Jim Case

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Jim Case

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Jim Case 

SNOMED currently has extensive editorial guidance on terming patterns for disease combinations that involve the distinction of causal and temporal relationships between conditions.  One scenario that has not been adequately addressed is the representation of variably present clinical manifestations of a syndrome.  Syndromes often have multiple associated clinical manifestations that are variably present during the disease process or progression.  It is important to be able to specifically call out these conditions as being extant at the time of recording, i.e. they are not definitional for the syndrome in general, but are definitional at the time of clinical presentation.  An example is Bechet's disease, for which the pathognomic clinical presentation is oral ulcers, but other inflammatory conditions can occur with the disease (e.g. skin rashes, uveitis, arthritis, etc.).   

Current editorial guidance (Disorder Combination Modeling) suggests the use of "X with Y" as the FSN terming pattern.  Prior discussions have suggested that the use of terms such as "X with Y" and "X in Y" are too vague to represent the association of the condition with the syndrome.  The use of "X due to Y" has also been considered inappropriate as the condition is not caused by the syndrome, but is a variably present component of the syndrome.

•  Jim Case to provide a list of affected concepts

Nicola Ingram 

An updated Briefing note for transplantation procedures of both solid organs and tissues is provided.  An updated status report is also included below.

Discussion: Please read the short update document for today's EAG  attached for details (including numbers involved and inactivations). Excluded transplant procedure areas are described.

Here is a summary of the model:

Solid organ transplant procedures:

260686004 |Method (attribute)| = 410820007 |Surgical transplantation - action (qualifier value)|

405813007 |Procedure site - Direct (attribute)| = << 24486003 |Structure of transplant (body structure)|

363701004 |Direct substance (attribute)| = << 422285003 |Transplant solid organ (substance)|

For glands and viscera if required a new subtype of 24486003 |Structure of transplant (body structure)| was created. If no specific graft substances existed 261571005 |Tissue graft - material (substance)| was utilised (or 15879007 |Autograft (substance)|, similarly for allograft etc). See 119911006 |Salivary gland transplantation (procedure)| illustration on EAG update document. Any feedback comments?

The majority of tissue transplant procedure concepts (eg. nerves, muscle, tendon ,skin),  were inactivated as duplicate to the grafting procedure where this existed, or a new grafting procedure created. The transplant procedure was aded as a synonym to the grafting procedure and a normal body structure used as the procedure site plus a direct substance relationship as described above for glands and viscera.

Questions to be sent to Nicola Ingram and Jim Case for discussion and clarification at a future EAG call.

23 Sep 2024 

Access has been granted to the SNOMED Terminology server and some comments have been received:

Jeff Pierson 

Specifically addressing your comments after review of the content changes in the TS Browser: Transplantation model noted. Use of the body structure of "transplanted <X>" makes sense to avoid issues you outlined.

1. I don't think the “Direct substance” is needed (it's redundant to the body structure), unless it provides additional information: like "Allograft", "Tissue graft - material", etc.
2. I think a simplified model using only "Allograft" is better than to a pre-coordinated substance, because it is sufficient and limits creation of new content.
3. The model and approach look reasonable.

Decision:

•  Jim Case to request view access to the TS browser for the EAG members to allow them to look at the remodeling impacts.

Victor Medina 

Jim Case 

At the March 2024 EAG call, the group asked for an impact analysis of the change from Surgical approach to a more general Procedure approach.  The results of that analysis were presented at the April 2024 meeting.  At the April face-to-face meeting a list of non-surgical procedures that might benefit from this change was requested and is attached (download to view as spreadsheet).  

Discussion:

Decision:

2024-04-16: Request to distribute list of non-surgical procedures affected by this change

2024-08-19: Postponed

2024-09-23:

•  Victor Medina to distribute a list of non-surgical procedures affected by the proposed change

Jim Case 

Current and prior editorial policy for modeling of Events (<<272379006 |Event (event)|) stated that while the allowed attributes for events closely aligned with the Clinical finding concept model, editorial policy for using these attributes to model events were still under development.  However, one restriction has been applied and that is: "The Event hierarchy should not precoordinate periods of life/occurrence within the event concept."  It has been brought to our attention that there are a number of event concepts that do reference periods of life in which the event occurred.  Examples:

• 418189009 |Child abuse (event)|
• 242571000 |Accident due to neglect of child (event)|
• 12399091000119108 |Adult abuse (event)|
• 70055007 |Unexpected sudden death of adult (event)|
• 160957000 |Sudden infant death (event)|

A few of these have been modeled using the OCCURRENCE attribute in spite of the editorial guidance.  A member request has asked that we look at this policy as modeling of other concepts is being affected due to this restriction on modeling of events.  

Q: As  the OCCURRENCE attribute is currently an allowed attribute for EVENTS, should there be any restrictions on the use of these attributes.  If they should not be used, should the MRCM be modified to remove them from the allowed attributes set?

Discussion:

Decision:

Victor Medina 

Jim Case 

As requested from the EAG, a list of definitions has been developed that will guide content authors in the correct modeling of concepts related to bypass, bypass graft, shunt, etc.:

Proposal for definition of concepts under 48537004 |Bypass graft (procedure)|.
Proposal for Definitions.

• CONSTRUCTION OF BYPASS. Surgical creation of a passage to carry contents
  around a part of a structure in its normal route and back to a structure in its
  normal route.
• CONSTRUCTION OF BYPASS USING GRAFT. Surgical creation of a passage, using a
  biological or synthetic material, to carry contents around a part of a structure in its
  normal route and back to a structure in its normal route.
• CONSTRUCTION OF SHUNT. Surgical creation of a passage allowing contents to
  move from one structure to another, not following its normal route.
• CONSTRUCTION OF SHUNT USING GRAFT (SYN: INTERPOSITION SHUNT). Surgical
  creation of a passage using a biological or synthetic material, allowing contents to
  move from one structure to another, not following its normal route.
• INTERPOSITION GRAFT. A surgical repair, using a biological or synthetic graft, of a
  structural defect that does not allow tension-free anastomosis.
• ANASTOMOSIS. Surgical procedure to create a cross-connection between
  channels, tubes, fibers, or other parts of a network.

Discussion:

Decision:

2024-03-11 Comments will be added to the document by the EAG members. 

2024-04-16: Proposed definitions will be revised based on input and resubmitted to the EAG for review.  

2024-08-19: Postponed

2024-09-23:

•  Victor Medina to revise definitions based on input from the EAG

Jim Case 

September 23, 2024