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.

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.

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.

Association Relationships File

In the Modeling Advisory Group (MAG) the requirement for the new Association Relationships records (previously called "Additional Relationships") was identified. Although they will take the same form as the Inferred Relationships, and therefore be stored in the same format as the Inferred Relationships in the RF2 package, there has been discussion on whether they should be held in the Inferred Relationship file or a completely separate file. After consultation there is a preference for additional relationships to be held in new files. The naming and packaging conventions for new files will be discussed further.

MRCM Update <<540091010000105 |Calculation (calculation)|

The range for Component Attribute will be extended to Include <<540091010000105 |Calculation (calculation)|

Hierarchy Improvement 272185007 |Meters (physical object)| and Descendants

To support the addition of Gravity provision of device finding content, an improvement will be made to << 272185007 |Meters (physical object)|. 

New Semantic Tag - Calculation

A new semantic tag of (calculation) will be added as a descendant of (qualifier value). This will enable representation of concepts that are derived from calculations on other observations (e.g., “Anion gap in blood,”  “Anion gap in urine”) with a relationship of Component (attribute) and value from the (calculation) sub-hierarchy.

Restructure of 384760004 |Feeding and dietary regime (regime/therapy)| 

Following a review by the Nutrition and Dietetics Clinical Reference Group (CRG), in consultation with the Nursing CRG, a restructuring of this hierarchy is underway. The content will be reorganized more logically, identifying and addressing duplicate concepts (e.g. 414096000 |Enteral hyperalimentation (regime/therapy)| and 229912004 |Enteral feeding (regime/therapy)|) and removing outdated content (e.g. 37041007 |Forced feeding of patient (regime/therapy)|). Where possible, content will be sufficiently defined. 

Additionally, the top-level grouper concept 384760004 |Feeding and dietary regime (regime/therapy)| will be inactivated due to its ambiguity as it is unclear what a combined regime would represent or what the logical subtypes would be.  

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