This discussion thread was created to share some initial findings and start a discussion about how we might make concepts related to assessment scales and score more fit-for-use in clinical care (and research to accelerate knowledge discovery to improve clinical care).
Assessment Scores
There are currently many, many concepts in the observable entity (OE) hierarchy for assessment scores.
Some concepts are child concepts of | Assessment score (observable entity) |
Other concepts are chil
pranallo
The representation on survey instruments in the LOINC extension was discussed at our last face to face meeting in March. The consensus was that the LOINC extension will subscribe to the proposed policy for assessments for the International release, for which the LOINC extension itself would only represent the name of the assessment and the score. If LOINC has obtained permission for the individual questions from an instrument to be added, then those would also be added to the extension as would the value sets associated with each question. However, what would not be added to the extension would be anything related to the structure of the instrument (i.e. order of questions) or any related logical structure (e.g. skip logic). Thus it would not be possible, using the extension alone, to recreate the native instrument. This was determined to be an implementation issue outside of the purview of a terminology.
Aside from what already exists in the International release of SNOMED CT, all additional survey content will reside in the LOINC extension. It has been recognized that we may need a "new" concept model to represent assessments and surveys and that is a future effort in the LOINC extension project as we are currently working on getting a more comprehensive transform of laboratory LOINC terms for the first release. So, both "how" and "when" are not yet determined.
Do thoughts have "content?" Well, thoughts (all forms of cognition) emerge from brain activity. However:
What about when people are consciously unaware of the content of thoughts that are sub/unconscious? How can they become aware?
What about when they are only aware of the emotional sensations they feel that are associated with a thought, and what if those feelings are suppressed out of awareness (e.g., as a defense mechanism)?
What if the only things observable are bodily expressions of such emotion thoughts (e.g., tension, agitation, tears), other behaviors such as avoidant eye-contact and changing the subject, and/or a history of maladaptive coping mechanisms? Can the observer then infer the existence of thoughts and feelings?
How can a thought that is associated with an emotion can be measured in terms of emotional valance, activation level, intensity, frequency, and duration?
I pose these questions because they have been studying them the past 35 years through my involvement in developing a therapeutic tool that helps answers.
Thanks for posting this sprior.
I'm curious about your thoughts on how to approach descriptions (synonyms) for the concepts.
Defining the concept and coming up with a clear FSN seems much more straightforward than making decisions about which terms are appropriate SYN for which concepts. Do you assign a the term as a synonym if there is evidence that any group of clinicians use the term when expressing the idea, or does it need to be some sufficiently large number of groups?
It starts to feel like an overwhelming task with the mental health concepts. There are so many different training programs and types of degrees in this field. Each "camp" develops its own term for the same idea, and uses the same term to express multiple ideas (per our discussion about mood, emotion and affect).
Piper
Adding document with proposed definition of social norms. Includes verbatim definition of 'social norms' from UMLS source terminologies and other sources.
Social Norms - Definitions.docx
Question from terminologists:
We have received an inquiry from one of our members regarding the semantic difference between
248062006 | Self-injurious behavior (finding) | and 1157096002 |Self destructive behavior (finding)| (which was just added in 2021). Going through the literature, these are sometimes conflated and sometimes treated as separate. Can the MBH group give some insight? It appears that ICD and DSM do not use the notion of 1157096002 |Self destructive behavior (finding)|
S
Agree with the above, that it looks like "deliberate self harm" is primarily about physical harm, whereas "self destructive behavior" can also include behaviours with social consequences.
Also, some behaviours may not be necessarily deliberate..
So the current arrangement of these concepts in SNOMED is consistent with this.
Following some requests for changes to the hierarchy 83507006 |Finding of thought content (finding)| on discussion with Piper it would be useful to look at this hierarchy.
We have received this query from Natasha Krul at the Netherlands NRC:
During the translation of SNOMED we have come across something typical; the phobia (finding) and the phobic disorder (disorder). 70691001 |Agoraphobia (disorder)| is a disorder that sits under phobic disorder, that is very understandable but 19887002 |Claustrophobia (finding)| is a finding that sits under phobia (finding) we believe that claustrophobia is a disorder as well, like many other children of phobia (finding)
As we can see from the discussion, this differentiation between "finding" and "disorder" has been problematic for decades. There are those that feel that the distinction is important enough to specifically instantiate within the terminology and others that think it is in the eye of the beholder(i.e. clinician). I think there is general consensus that these both represent a clinical "condition" of the patient, but the question is how much context do we want to put around these explicitly in the terminology. A single blood glucose measurement above the normal reference range is certainly of interest, but it does not imply necessarily that the patient has diabetes. A fear of spiders, or heights, or snakes may have reasonable foundations, but do not really represent a "phobia disorder". There are lots of contextual knowledge needed to make that determination.
SNOMED provides the atoms for clinicians to record both objective observations (findings) and summary interpretation of the clinical condition of a patient (disease). A "diagnosis" is really the summary of the clinical interpretation of the supporting facts and gives it a reference to a named disease. However, it might not be correct (presumptive diagnosis), or the only one (differential diagnosis) or a subtype (i.e. pathological diagnosis, laboratory diagnosis, clinical diagnosis). This why I like to stay away from the use of the term "diagnosis" as a synonym of "Disease".
Having said all that, it is important that we are able to make the distinction between an objective finding at a point in time and an actual disease. Both need to be followed up and managed. Unfortunately, SNOMED CT has been rather undisciplined in assigning things as findings or disorders due to both the lack of clarity of the distinction and historical modeling (thus a freckle becomes a disorder because it has an ASSOCIATED MORPHOLOGY). We are continuing to discuss this at the EAG, but as Matt stated, it has become stalled as we try to decide how much churn any change to the current structure would have on members, and how much they might be able to tolerate.
We have received a request to review the synonyms of 111475002 |Neurosis (disorder)|.
Current synonyms include:
Neurotic disorder
Nonpsychotic mental disorder
The requestor suggests that these synonyms are not true synonyms and that they should be inactivated and 2 new concepts of |Nonpsychotic mental disorder (disorder)| and |Neurotic disorder (disorder| should be added as subtypes of 111475002 |Neurosis (disorder)|.
We would be grateful for the views of yourself and the CRG.
We have had the following query from our Dutch translation colleagues. Please could you bring this to the group for discussion and proposal for resolution.
From Feikje Hielkema-Raadsveld:
"A psychiatric disorder is a stronger term than a 'mere' mental disorder. They are often used interchangeably in English (not in Dutch), so we understand why 74732009 | Mental disorder (disorder) | has the synonym psychiatric disorder. But it is not correct, and in this situation concept ( 161464003 |
Hi pranallo, I have a response from Feikje stating that they have been unable to get further clarification from their domain specialists and therefore are content for this query to be closed.
Best wishes, Paul
Jim Case