Gastrointestinal ulcer with hemorrhage/perforation/obstruction (disorder) - new template - for review

Peter, needs updated template language please.

Looks OK to me...

Jim Case and Bruce Goldberg  This template appears to be an exception to our 'due to' approach given the naming convention and the lack of a due to attribute. Is this intended to be just noted as an exception?  Thanks, Cathy.

Hi Bruce Goldberg, the associated morphologies used on this template state specific concepts e.g. 50960005 |Hemorrhage (morphologic abnormality)| as the required values for the Associated morphology attribute yet SNOMED has concepts such as 55075001 |Bleeding ulcer (morphologic abnormality)| and 91182001 |Perforated ulcer (morphologic abnormality)|.  Was there a decision not to use the more specific subtypes where they exist? Thanks, Cathy

Bruce Goldberg just following up on my question above. Cheers, Cathy. 

Cathy Richardson , my thinking was that each of the 4 role groups containing these morphologies is optional so that more than one morphology such as hemorrhage and obstruction can be used. Does this make sense?

Bruce

Sorry, I just re-read your question. I thought there was some pushback on conflations such as this but perhaps Jim Case want to comment.

Bruce

Bruce Goldberg We have the guidance: Specific Clinical finding and Disorder Modeling#CombiningMorphologicAbnormalities, though the second example here will need to change. Will hold to see what Jim says. Thanks.

Yes, the examples in the ed. guide are not optimal as we have already decided that traumatic and non-traumatic morpholgies would go away and be replaced by traumatic event or spontaneous event with the base morphology. For the case in the ed. guide, just Complete rupture (morphologic abnormality) could be used.

Bruce Goldberg and Cathy Richardson , 

As I read through the comments, I am wondering about the benefits of creating individual RGs for 1) the ulcer and 2) the characteristic of the ulcer (e.g., bleeding or perforation).  Since 55075001 |Bleeding ulcer (morphologic abnormality)| has parents of both Ulcer and Hemorrhage, and 91182001 |Perforated ulcer (morphologic abnormality)| has parents of Perforation and Ulcer, I am not sure there is any benefit of having RGs specific to perforation and hemorrhage.  As for the notion of "conflated" morphologies, my opposition was the conflation of two characteristics (such as process and structure, e.g., traumatic abnomality), not the combination of two structures.

Jim Case . Thanks for the clarification. I made the changes but the template still needs 3 RGs. One for the obstruction and 1 each for the bleeding ulcer and the perforated ulcer. As any combination of obstruction, hemorrhage and perforation can occur it is difficult to state this in a template. Making all of these optional means that none would have to be present. Alternatively, I can merge the bleeding ulcer and perforated ulcer into a single required RG with a morphology of <56208002 |Ulcer (morphologic abnormality)| with the FSN enabling the appropriate choice or I can state the morphology as 91182001 |Perforated ulcer (morphologic abnormality)| AND/OR << 55075001 |Bleeding ulcer (morphologic abnormality)|  if AND/OR is allowed in the template

Bruce Goldberg ,

In an attempt to try and generalize this template further, one approach might be to generalize the "ulcer" RG to <<56208002 |Ulcer (morphologic abnormality)| (to support an ulcer without bleeding or perforation, but with obstruction) and make the cardinality of the RG 1..* (or 1..2).  This would allow the representation of any one or all three of the possible morphologies, while requiring that one ulcer morphology be present, as that is the primary notion in the FSN.

Jim Case. I will evaluate this further.

Thank you.

Hi Bruce Goldberg , It was raised in the education work that there are differences between this template and Hemorrhage of [body structure] (disorder)- Ready for implementation in relation to the finding site for the hemorrhage. The hemorrhage template uses <<  59820001 |Blood vessel structure (body structure)| for the finding site. The broader finding site here (and it's needed given the ulcer+ bleeding morphology) would mean these concepts would not subsume under the relevant hemorrhage concepts. So, this template will need a group for the hemorrhage to support the subsumption. Note, with the hemorrhage concepts, not all work has been completed as there was/ is a need for more blood vessel of site concepts to be created at this point. Cheers, Cathy

Cathy Richardson and Bruce Goldberg ,

I am just getting around to reviewing this again after some months and have a few questions.

1) The proposed format for the FSN and PT includes forward slashes, which are not allowed except under specific circumstances.  Was the intent to make these implicit "and/or", "or" or "and" connections?

2) The RG cardinality in the template is 1:1, so all three are required (i.e. explicit "and").  Is that what is intended as well?

3) There are only about 10 concepts that would fit the template as written now.  Is there an intention to generalize it to allow more concepts to be used by this template?

Is this template supposed to be applied to the current "X ulcer without Y, Z, A"?  

Jim Case That would depend on the final decision re. the retention of thee concepts containing "without". If we want to model concepts containing "without" as primitive and not assert absence, this template could work. Your comments about the problems that will ensue with those concepts containing more than 2 conditions with multiple with and without statements are important. I think this template should only be applied to concepts containing 2 conditions.