Page History

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Access

Access (attribute) describes the route used to access the site of a procedure. It distinguishes open, closed, and percutaneous procedures.

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• • Concept
    t 174572001 |Open removal of bile duct stent (procedure)|

     has Access of Open approach - access (qualifier value) 

Direct device

Direct device (attribute) represents the device on which the method directly acts.

For example, 

• • Concept
    t 431698006 |Adjustment of gastric banding using fluoroscopic guidance (procedure)|

     has Direct device of Surgical band (physical object)

Direct morphology

Direct morphology (attribute) describes the morphologically abnormal structure that is the direct object of the Method action.

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• • Concept
    t 31512000 |Shaving of benign lesion with chemical cauterization (procedure)|

     has the Direct morphology of Lesion (morphologic abnormality)

Direct substance

Direct substance (attribute) describes the Substance or Pharmaceutical/biologic product on which the procedure's method directly acts.

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Has focus

Has focus (attribute) specifies the Clinical finding or Procedure which is the focus of a procedure.  This attribute is self-grouped.  

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• • Concept
    t 385941006 |Wound care assessment (procedure)|

     Has focus of Wound care (regime/therapy)

Has intent

The Has intent attribute is used when a procedure may be performed for various reasons, described with subtypes of 363675004 |Intents (nature of procedure values) (qualifier value)|, such as diagnostic, palliative, preventive, therapeutic, etc. These intents are not used to define procedures with intents that are inherent to the procedure; such as biopsies that are by definition diagnostic, or fracture fixations which are always therapeutic. 

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• • Concept
    t 108249004 |Audiologic AND/OR audiometric test including vestibular function (procedure)|

     is inherently diagnostic, so it would not be modeled with a Has intent (attribute) of Diagnostic intent (qualifier value).

  • Concept
    t 274432006 |Therapeutic aspiration of ovary (procedure)|

     and 

    Concept
    t 274389009 |Diagnostic aspiration of ovary (procedure)|

     are both modeled with the Has intent (attribute), as the aspiration of ovary procedure can be either therapeutic or diagnostic. 

Indirect device

Indirect device (attribute) represents action on something that is located in or on a device, but is not directly on the device itself. This attribute is infrequently needed. When modeling, carefully consider its use.

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In this example, the vegetation is being excised. The mitral valve prosthesis device is where the vegetation is located, but the mitral valve prosthesis, itself, is not excised. Thus, the mitral valve prosthesis device is the Indirect device.

Indirect morphology

Indirect morphology (attribute) describes the morphology that is acted upon, but is not the direct object of the Method action. This means the procedure acts directly on something else, e.g. a device, substance, or anatomical structure.

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• • Concept
    t 404205006 |Removal of mesh from wound (procedure)|

     has Indirect morphology of Wound (morphologic abnormality)

Method

Method (attribute) represents the action being performed to accomplish the procedure.

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• surgical approach, e.g. translumbar
• equipment, e.g. sutures
• physical force, e.g. laser energy

Method attribute grouping

Attributes should be grouped with the Method (attribute) to which they apply. In the absence of a Method (attribute), related attributes should be grouped together.

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No relationship group can contain more than one Method (attribute).  If a procedure has more than one method, each Method (attribute) serves as the anchor of a separate relationship group that will contain any defining relationships that represent a direct object (and, where relevant, indirect object) of the Method's action.  This is true even if the different Methods each act on the same direct object.  Each relationship group can be thought of as representing a component of the procedure that involves a particular action.   

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Occurrence

Priority Occurrence (attribute) is applied to procedures during a period of life.  For example, procedures related to the gravid uterus should be modeled by the combination of the occurrence of the maternal pregnancy period and the uterus.

Priority

Priority (attribute) is used when a procedure concept specifies a priority.  This attribute  is used when a procedure concept specifies a priority.  This attribute is self-grouped.  

For example, 

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Procedure device

Procedure device (attribute) is used to model devices associated with a procedure. This attribute is used to define high-level, general concepts that aggregate procedures according to the device involved.

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Procedure morphology

Procedure morphology (attribute) is used to specify the morphology, or abnormal structure, involved in a procedure. It is used when defining general concepts that subsume direct and indirect morphology. It subsumes the more specific attributes, Direct and Indirect Morphology. These should be used, if possible.

Procedure site

Procedure site (attribute) describes the body site acted on or affected by a procedure.  The Procedure site (attribute) is

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Use of Structure of <anatomical structure> vs. Entire <anatomical structure> as value of the Procedure site attributes

Structure of <anatomical structure> rather than Entire <anatomical structure> should be used as the value for procedure site attributes, except where the procedure FSN explicitly specified that the entire structure is the object of the procedure.

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• Concept
  t 23968004 |Excision of colon (procedure)|

  has

  Concept
  t 405813007 |Procedure site - Direct (attribute)|

  of

  Concept
  t 71854001 |Colon structure (body structure)|

• Concept
  t 26390003 |Total colectomy (procedure)|

  has

  Concept
  t 405813007 |Procedure site - Direct (attribute)|

   of

  Concept
  t 302508007 |Entire colon (body structure)|

Procedure site - direct

Procedure site - Direct (attribute) is used when the action of the procedure is directly aimed at anatomical or acquired body structure or site, rather than something else located there (e.g. a device), i.e. when the

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• Repair of rectocele (procedure) has a Procedure site - Direct (attribute) of Rectum structure and a Direct morphology (attribute) of Herniated structure
• Closure of skin wound (procedure) has a Procedure site - Direct (attribute) of Skin structure and a Direct morphology (attribute) of Wound
• Fixation of fracture (procedure) has a Procedure site - Direct (attribute) of Bone structure and a Direct morphology (attribute) of Fracture

Procedure site - indirect

Procedure site - Indirect (attribute) specifies the anatomical location but is not the direct focus of the procedure.  The direct object of the action may be a device, a substance, or a morphologic abnormality that is not a part of the tissue structure of the anatomical site in which it is located, such as a calculus, thrombus, or foreign body. Thus,

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Stated view of 371005009 |Removal of calculus of urinary bladder (procedure)|

Recipient category

Recipient category (attribute) specifies the type of individual or group upon which the action of the procedure is performed.

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Revision status

Revision status (attribute) refers to another procedure performed on the same site for the same condition. A procedure without a revision status is considered to be performed for the first time. A revision procedure can be modeled with a Revision status (attribute) of Revision - value (qualifier value).

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• • Concept
    t 128323000 |Revision of implant (procedure)|

     has has a Revision status (attribute) of Revision - value (qualifier value)

Using access device

Using access device (attribute) specifies the instrument or equipment used to access the site of a procedure.

For example, 

• • Concept
    t 274323008 |Endoscopic biopsy of colon (procedure)|

    has Using access device of Colonoscope, device (physical object)

Using device

Using device (attribute) refers to the instrument or equipment utilized to execute an action. It is used when the device is actually used to carry out the action, that is the focus of the procedure. If the device is simply the means to access the site of the procedure, then Using access device is the appropriate attribute.

For example, 

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Route of administration

Route of administration represents the route by which a procedure introduces a substance into the body.  The range involves subtypes of 284009009 |Route of administration value (qualifier value)|.  When using this attribute, an additional attribute of |Procedure site - indirect| should be modeled and grouped with the |Route of administration (attribute)|.   

For example, 

• • 410572008 | Injection of steroid via intravitreal route (procedure)|  has the | Route of administration (attribute)|  of Intravitreal route (qualifier value)

Image Added

Stated view of 410572008 |Injection of steroid via intravitreal route (procedure)|

While the values for |Procedure site - Indirect| and |Route of administration| attributes may be similar and seem redundant, their presence is necessary for consistent subsumption.  

For example,

Examples of complementary values of Route of administration and Procedure site - Indirect

Using access device

Using access device (attribute) specifies the instrument or equipment used to access the site of a procedure.

For example, 

• • Concept
    t 274323008 |Endoscopic biopsy of colon (procedure)|

    has a Using access device (attribute) of Colonoscope, device (physical object)

Endoscopes

Many procedures can be carried out using tools attached to or operated via channels within the endoscope. In some cases the device IS used for access (such as endoscopy of the GI tract), e.g. ERCP in particular allows you to both visualize and operate upon the sphincter of Oddi/ampulla of Vater using cutting devices (knives or wires etc.) and then passing a basket up into the CBD to remove stones. The correct attribute for the device is USING ACCESS DEVICE.

Using device

Using device (attribute) refers to the instrument or equipment utilized to execute an action. It is used when the device is actually used to carry out the action, that is the focus of the procedure. If the device is simply the means to access the site of the procedure, then Using access device is the appropriate attribute.

For example, 

• • Concept
    t 51064005 |Core needle biopsy of larynx (procedure)|

    has a Using device (attribute) of Core biopsy needle, device (physical object)

Endoscopes

When an Incision role group is included in the concept model, then |Using device| attribute is appended to the Inspection role group. For example, access to either the abdominal cavity or a joint capsule is achieved by an ordinary incision using a scalpel blade. The laparoscope or arthroscope is then introduced into the cavity through the incision, i.e. the endoscope is not the access device.

Using energy

Using energy (attribute) refers to the energy used to execute an action. 

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• • Concept
    t 65952009 |Gamma ray therapy (procedure)|

     has Using energy of Gamma radiation (physical force)

Using substance

Using substance (attribute) describes the Substance used to execute the action of a procedure. It is not the substance on which the procedure's method directly acts, the Direct substance.

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