Forward slash in FSN

A review has commenced of those concepts with a forward slash in their FSN.  Editorial guidance exists disallowing the use of forward slashes in FSNs, and we have commenced a systematic review of those existing terms containing them.

Many areas are excluded for example, medicinal products where strength /1 is the denominator, assessment scales, explicit "and/or", gene names, enzyme and other substance naming, organisms, ratios, per in units (or future consideration), intervertebral structures, content added with an Orphanet map and others. The review is ongoing.

If the meaning is clear i.e. single meaning there is no change but groupers, disjoint ('or)' terming and ambiguous terms will be reviewed and possibly inactivated or have a new replacement FSN without a forward slash. Subject matter experts are being consulted as part of this work.

Update for Existing AJCC (American Joint Committee on Cancer) Allowable Values and New UICC (Union for International Cancer Control) Staging System Content

For << 1222584008 |American Joint Committee on Cancer allowable value (qualifier value)| and its 584 subtypes the following changes will be made:

• Preferred Term (PT) will be inactivated and a new PT added that contains the existing AJCC code with a new parenthetical addition of AJCC: (AJCC).
• The existing text definition that contains the attribution to the AJCC Cancer Staging System, American College of Surgeons will be inactivated and re-created as an annotation.

New concepts for the UICC (Union for International Cancer Control) staging system will be added:

• As a separate hierarchy, approximately 580 new concepts for the Union for International Cancer Control (UICC) TNM staging system will be added. This work is being done under a collaboration agreement between SNOMED International and the UICC.

Review of 129376004 |Construction - action (qualifier value)|

129376004 |Construction - action (qualifier value)| is a subtype of 257903006 |Repair - action (qualifier value) and sibling of 129377008 |Reconstruction - action (qualifier value)|.

Because some concepts modeled with 129376004 |Construction - action (qualifier value)| as target value concept for 260686004 |Method (attribute)| may not be considered a reparative procedure, a review of the 129376004 |Construction - action (qualifier value) and 410614008 |Construction (procedure)| hierarchies is being undertaken.

Expected outcomes may be the classification of 129376004 |Construction - action (qualifier value)| directly under 129284003 |Surgical action (qualifier value)| and the creation of new actions that better define the differences between reparative and construction procedures.

SNOMED CT to Orphanet Map - Attribution of In Scope Content

Work has commenced to annotate new concepts added to SNOMED CT with attribution to 'Inserm Orphanet'. As part of this effort, textual definitions for concepts previously added for this project will be updated to align with the current published version of the Orphanet definition. This will result in published text definitions being inactivated and replaced.

Update for Gout, Hyperuricemia and Crystal-associated Arthropathies

A recent consensus document on terminology for gout, hyperuricemia and crystal-associated arthropathies (https://pubmed.ncbi.nlm.nih.gov/31501138/) has been used to inform  the remodeling of gout in SNOMED CT. 

The prime definitional characteristic of gout is the deposition of monosodium urate crystals in tissues, with or without the presence of elevated levels of blood urate.  As elevated blood urates are no longer considered definitional, gout and its subtypes will no longer be subtypes of 269859006 |Blood urate above reference range (finding)|.  Gouty arthritis concepts have been re-termed in accordance with the consensus document and will be classified as subtypes of Crystal arthropathy.

Update of "Sample" to "Specimen" in FSN and PT of Clinical Finding Concepts

64 findings concepts which include "sample" in their FSN and/or PT will be updated to include "specimen" in place of "sample" in the FSN and/or PT. Descriptions will be inactivated and replaced; no concepts will be inactivated.

This follows similar work previously performed in the specimen hierarchy and noted in the Editorial Guide

Update Hierarchy 363680008|Radiographic imaging Procedure (procedure)| - Review 28367004|Cholangiography (procedure)| and Descendants

As part of the work being undertaken for IHTSDO-161, 28367004|Cholangiography (procedure)| and descendants will be reviewed.

Where a procedure concept is modeled with method 278110001|Radiographic imaging - action (qualifier value)| but is performed using a subtype of that modality such as 312275004|Fluoroscopic imaging - action (qualifier value)|, the concept will be inactivated and replaced with a new concept that specifies the imaging modality and the use of contrast.

Resolving Name Divergence for Subtypes of 398428002 |Salmonella enterica subsp. diarizonae (organism)|

One of the synonyms for many descendants of this concept is incorrect, e.g. "398387008 | Salmonella IIIb 61:c:z35 (organism) |" belongs to Salmonella IIIb i.e. "Salmonella  enteric subs. diarizonae" but has "Salmonella III arizonae 61:c:z35" as a synonym. 

A batch update will be performed to:

• Remove any synonyms containing "Salmonella III arizonae" (if one exists), e.g “Salmonella III arizonae 61:c:z35” 
• Add a similar synonym containing “Salmonella enterica subs. diarizonae”, e.g. “Salmonella enterica subsp. diarizonae 61:c:z35”.

Update Descriptions 169826009|Single live birth (finding)|

After consultation with the Content Managers Advisory Group, the descriptions for

169826009|Single live birth (finding)|

will be updated to

169826009 |Single live birth from singleton pregnancy (finding)|

A new concept will also be added 1351929005 |Single live birth from multiple pregnancy (finding)|

Changes to 365921005 | Weight change finding (finding) Hierarchy

Following multiple requests from members regarding overlaps and ambiguities in this hierarchy, the Nutrition and Dietetics Clinical Reference Group (CRG) conducted a systematic review. The requests highlighted confusion over similar and overlapping concepts, such as:

• 89362005 | Weight loss (finding) |
• 262285001 | Weight decreased (finding) |
• 161832001 | Weight decreasing (finding) |
• 426977000 | Recent weight loss (finding) |

The following changes will be implemented:

1. Inactivation of 426977000 | Recent weight loss (finding) | and 427572007 | Recent weight gain (finding)
   These terms are considered ambiguous due to the subjective nature of the word "recent."
2. Inactivation of 161832001 | Weight decreasing (finding) | and 161831008 | Weight increasing (finding)
   These terms will be inactivated because they do not align with editorial policy. They represent patterns or trends better handled by information models or statistical tools for data interpretation and analysis.
3. Inactivation of 89362005 | Weight loss (finding)
   This term is a duplicate of 262285001 | Weight decreased (finding) |. The term "Weight loss" will, however, remain as a synonym for 262285001.

Update Concepts Relating to Missile

Missile as a generalized projectile and missile with the narrower meaning of a specific type of weapon have been conflated in the disorders, events and physical object hierarchy.

1. 262572000 |Missile injury (disorder)| will be inactivated with reason ambiguous and historical association to 242999003 |Injury due to projectile (disorder)| and a new concept Injury due to missile weapon (disorder). The existing 52 subtypes of Missile injury (disorder)| will be remodeled to become subtypes of the two concepts.
2. 44468009 |Missile, device (physical object)| will be inactivated with reason ambiguous and historical associations to new concept Projectile weapon device (physical object)| and new concept Missile weapon device (physical object). 29 previous subtypes of 44468009 |Missile, device (physical object)| will become subtypes of these two new concepts.
3. 45224000 |Struck by missile (event)| will be inactivated with reason ambiguous and historical associations to new concept Struck by missile weapon (event)| and 63409001 |Struck by firearm discharge (event)|. Previous subtypes of 45224000 |Struck by missile (event)| all termed "Struck by object falling from x location" will become descendants of 71893005 |Struck by falling object (event)|.

Review Model for Descendants of 118240005|Finding by method (finding)|

Descendants of 118240005 |Finding by method (finding)| are currently being reviewed to ensure 418775008 |Finding method (attribute)| is appropriately grouped with other attributes.

Genomic Community Content

Phenotype concepts that currently exist in the genomics community content area are being gradually promoted to the International edition release.  All content is being reviewed and revised based on the current international editorial guidelines and publication will occur incrementally over several releases.

Update for Description Concept Non-Current Indicators

Concept Non Current (CNC) indicators are a type of inactivation indicator that are applied to active descriptions, when the concept they are attached to is made inactive. They are intended to allow implementers to show some visual cue to alert users that a description they have searched for relates to an inactive concept.

A bulk update will be implemented to inactivate CNC indicators where they are no longer required either because:

• The concept has since been re-activated or,
• The description itself has now been inactivated

This will result in a change to approximately 30,000 descriptions for the international edition release for January 2025.