Problem Concept Inactivations:

I had a procedure concept that had literature only from the 1950's; the procedure had failed repeatedly and was subsequently abandoned from being performed. When I inactivated the concept, the Outdated inactivation reason would require a replacement. What replacement concept should be used in a situation like this (or does it make sense to require one)?

Krista Lilly, I think we need a bit more info on this.  There are a couple of options based on the particulars of the procedure.

General comment - in the Medicinal product hierarchy, we would have liked to have had the option to use Non-conformance with editorial policy (for concepts that were out of scope) in combination with the Possibly equivalent to historical relationship (1 or more but generally only 1). 

1. See GC-641 - Getting issue details... STATUS

Many complex issues including initially to decide if Ambiguous concepts (ambiguous can have multiple replacement targets, also ambiguity issues of abortion disorder v abortion procedure) v Outdated with a single replacement also discussion around what Outdated means in this context (e.g. are these outdated terminology concepts: abortion, also legal and illegal abortion) and whether to create new replacement concept(s). Decision to inactivate the yellow atrophy concepts as outdated e.g. 5792004 |Legal abortion with acute yellow atrophy of liver (disorder)|and point to parent 609454008 |Induced termination of pregnancy complicated by acute necrosis of liver (disorder)| without creating replacements.

Hi Paul Amos

I cannot remember any specific concepts at this time. However, I can think of a couple of hypothetical scenarios that may require further consideration:

• Currently there are ~2500 concepts (legacy content) in the organism hierarchy related to various breeds. Based on the editorial guidelines, breeds are primarily restricted to the veterinary domain. If/when we decide to move these concepts to the veterinary extension, the reason for inactivation will be specified primarily as “component moved elsewhere”. But we may also consider specifying the reason for the move. Do we need to have an additional inactivation reason such as “non-conformant to editorial policy”? 
• Concepts of type “Condition caused by substance” are currently being reviewed to identify the ones where the causative agent is in fact a product e.g. 292826004 |Antiviral drug adverse reaction (disorder)|. This concept will likely be replaced by a new concept: “Adverse reaction to medicinal product acting as antiviral agent (disorder)|. What would be the reason for inactivation? If we consider “non-conformant to editorial policy” as the reason, we need a way to refer to the new concept as the replacement, but this functionality doesn’t exist at the moment.

Thanks,

Farzaneh

Hi Paul Amos,

Here are some examples of concepts which will be inactivated in the near future:

• A large number of device use frequency concepts such as 462635001 |Ankle binder, single-use (physical object)| which are now considered out of scope of the International release of SNOMED CT. We would ideally like to inactivate them as “Nonconformance to editorial policy" and in some cases refer to another concept such as the device concept without frequency use, e.g., "Ankle binder (physical object)." Since this is not currently possible, we will have to inactivate them as ambiguous to be able to refer to another concept. 
  
  • Note that we would still like the option of being able to use “Nonconformance to editorial policy" when inactivating concepts that will not point to a replacement, e.g., 738405008 |Airway device cleaning utensil, noninvasive, single-use (physical object)|.
• Device concepts including a size or dimension such as 411525004 |Foley 5mL balloon 2-way all silicone female length urethral catheter (physical object)| are now considered out of scope of the International release of SNOMED CT. As above, we would like to inactivate these as “Nonconformance to editorial policy" and refer to a concept without the size. Since this is not currently possible, we will have to inactivate them with another reason type that does allow for a referral.

Here is an example:102471002 |Absence of therapeutic response (finding)| vs 266721009 |Absent response to treatment (situation)|

I want to inactivate the former as dup to latter. Can I say that when one is finding and other a situation. Both concepts are dated 2002... so can't really use outdated. In my mind, this should be erroneous or non-conformance with a note and replacement. 

Hi Paul,

Not sure if you are still looking for examples but check out these very similar concepts all meaning same procedure but worded differently. It illustrates the difficulty authors face and why even with good guidance, choices may be varied. And although they mean the same, I would not want to use them as synonyms... 

Having been charge nurse in a chest hospital, (Scots folks are plagued with chesty conditions!) I am very familiar with this procedure but here is a good definition just in case for those not familiar: https://www.merckmanuals.com/professional/pulmonary-disorders/how-to-do-pulmonary-procedures/how-to-do-thoracentesis

KEEP THIS although not the oldest, point others here - 709787009 |Thoracentesis using computed tomography guidance (procedure)| - this is modelled correctly with Pleural cavity

Maybe keep this but am not convinced... 417911000 |Computed tomography and aspiration of chest (procedure)| - is this the same as CT guided or 2 separate procedures?

Inactivate - 440497001 |Percutaneous aspiration of thorax using computed tomography guidance (procedure)| - I want to inactivate as ambiguous and point to  CT guided Thoracentesis 709787009 and not create another term. It is ambiguous since the procedure is an aspiration of the pleural cavity. 

Inactivate - 16551341000119105 |Puncture aspiration of lung using computed tomography guidance (procedure)| - modelled with Lung structure so could argue it is duplicate to the Thorancentesis. 

thanks, Monica

Hi Monica Harry, many thanks. Always looking for examples.