One or more refinements may be added to a concept to qualify it. This is done by putting the concept to be qualified before a colon and the qualifying expression after. The qualifying expression is of the form "attribute = value". The example below describes an operation to remove an ovary (i.e. an 'oophorectomy') using a laser.
83152002 |oophorectomy|:
405815000|procedure device| = 122456005 |laser device|
The next example, shown below, describes the right hip joint.
182201002 |hip joint|:
272741003 |laterality| = 24028007 |right|
Where more than one qualifying attribute is required, these can be separated using a comma. The example below describes the removal of an ovarian structure using a laser device.
71388002 |procedure|:
405815000|procedure device| = 122456005 |laser device|,
260686004 |method| = 129304002 |excision - action|,
405813007 |procedure site - direct| = 15497006 |ovarian structure|
A further example, below, describes the emergency removal of the appendix:
65801008 |excision|:
405813007 |procedure site - direct| = 66754008 |appendix structure|,
260870009 |priority| = 25876001 |emergency|
Refinements may also be applied to a conjoined concept. For example, the following two expressions are equivalent (because an 'ulna' is a bone in an 'upper limb'):
313056006 |epiphysis of ulna|: 272741003 |laterality| = 7771000 |left|
119189000 |ulna part| + 312845000 |epiphysis of upper limb|:
272741003 |laterality| = 7771000 |left|
Note that there are no brackets round "119189000 |ulna part| + 312845000 |epiphysis of upper limb|" in the above example, as the refinement automatically applies to the conjoined concept.
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