Conflicts of interest and agenda review

Information only:

Please see the updated definition (+ agreed upon proximal primitive parents and modelling considerations) and summary of discussion on each topic. Please let me know if I can post these on the meeting notes.

1) Definition and proximal primitive parent:

• Poisoning:

• EGA proposed definition: “Interference in normal bodily functions caused by exposure through ingestion, inhalation, absorption, or injection to a substance (e.g. medicinal product, household product, industrial chemical, or plant or animal derivatives) in quantities that are harmful to health.”

• Is a: Clinical finding

• Overdose

  • EGA proposed definition: “The act of consuming a greater amount than intended (e.g. heroin) or greater than recommended by therapeutic guidelines resulting in a potential for adverse effect.”

  • Is a: Clinical finding

• Intoxication

• EGA proposed definition: ““Diminished control of mental or physical functioning caused by a substance”

• Is a: Poisoning

2) Allowed attributes (all optional, additional attributes may become required once the review and content update is underway):

• Causative agent (substance or pharmaceutical and biologic product)

• Clinical course (Acute, Chronic)

• Due to

Summary of discussion:

• Poisoning

• "Fatal" to be omitted from the definition as it is a subtype of harmful. Exposure needs to be a better defined; there should be an interference with bodily function as result of exposure.

• Do we need to consider it an injury? It is not always an injury: we need to distinguish whether it is only a metabolic effect or physiological damage

• Do we need to indicate quantity? It is not related to quantity, but rather the effect it has on individuals. Later it was noted in the comments “enough of a hazardous substance (poison)” as per WHO definition might be helpful: “Exposure to amount adequate to cause interference in normal bodily functions” → change the proposed definition to indicate: “in quantities that are harmful to health”

• WHO: Poisoning occurs when people drink, eat, breathe, inject, or touch enough of a hazardous substance (poison) to cause illness or death. Some poisons can cause illness or injury in very small amounts. Illness may occur very quickly after exposure to a poison, or it may develop over several years with long-term exposure.

• We may still need something to the effect that it has to occur in all individuals (unlike allergy that occurs some individuals), but it requires further review

• Overdose

• We require to specify Excess of recommended dosage + dangerous (not necessarily causing damage)

• Intoxication

• Is it a child of or a sibling of poisoning? If we consider “Diminished control of mental or physical functioning” an adverse effect, then it is poisoning.

• We may need to refine the definition later to accommodate cases related to “do not operate machinery”: e.g. severity of diminished control or lack of ability to perform normally, but those are all shades of grey.

• Poisoning synonyms: other

• Agreed with the proposal on these. In the first 3 cases, keep FSN as is.

• Due to

• If required (after review of existing concepts), we may need to divide intentional and accidental intent to new concepts of type: “self administered” and “externally administered”.

• Do we need undetermined as a grouper or sibling to the two others? As a sibling because it implies we explicitly say we don’t know.

Options for modeling concepts containing the term "without" in the absence of negation in the DL profile.

Prior discussions suggested that these terms may have clinical utility and should be retained in spite of their limitations.  The CMAG has been asked to provide usage data to see if they are of actual use.  

Based on a discussion at the Anesthesia CRG there is a requirement to add more content to express Glasgow coma scores. 

Please see full discussion here: https://confluence.ihtsdotools.org/display/ACRGT/Glasgow+Coma+Score

References to Standarization of the GCS:

https://zibs.nl/wiki/GlasgowComaScale-v3.2(2020EN)

https://ckm.openehr.org/ckm/archetypes/1013.1.137/printable

https://www.glasgowcomascale.org/

Draft document from Anesthesia CRG: https://drive.google.com/file/d/1lZJlarREeIIRPk5E1zVtZUktLQlPH3G5/view?usp=sharing

Discussion: