In reviewing some recent requests for amputation procedures, I have run up against a conundrum that I would like input on. There are currently several procedures representing amputations of lateralized body structures, but without specifying the precise laterality. Back in 2015-16 we inactivated concepts that specified "unilateral" procedures as being both ambiguous and a threat to patient safety if added to an EHR. While the existing procedures that do not specify laterality act as org
Presumably the "threat to patient safety" posed by non-lateralised procedures relates to their potential contribution to instances of "wrong site surgery" (as an example of a "never event").
As such my suggestion would be that SI considers how SNOMED CT can play its part in a more complete risk management approach rather than simply looking to suppress/remove particular content from the reference data.
It is also not clear what the scope of the concern is. The suggestion seems to be that disorders are of lesser concern than procedures (but no evidence is given to support this - and what about, for example, specimens) and the nature of the in-scope procedures is left open. Is it only amputations, or does it include any 'destructive' or 'excising' surgical action, or is it, in fact, any action at all?
Likewise, is the concern limited to bilateral symmetrical structures or could it include any class of body structure which can be specifically described or can be referred to in a more abstract way (teeth, vertebrae, ribs etc.)?
I imagine that retaining non-lateralised content is also of considerable value for text-entity matching in NLP use cases where explicit mention of sidedness may not be available or required.
It is also worth noting that, even if we limited scope to amputations and considered only the set of concepts specified by...
<< 81723002 | Amputation |:
{405813007 | Procedure site - Direct | = ^ 723264001 | Lateralisable body structure reference set |}
...of the 120-or-so international concepts returned nearly half are found at least once in the UK primary care usage data for 2022/3 (the most frequently used being the 'doubly abstract' 371186005 |Amputation of toe|).
We have noticed an inconsistency in our review of nontraumatic vs. spontaneous injury. In some cases we make a distinction between them:
1296953008 |Nontraumatic rupture of extensor tendon of left hand (disorder)|
321371000119100 |Spontaneous rupture of extensor tendon of left hand (disorder)|
whereas in other cases we treat them as synonymous:
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In determining the meaning of nontraumatic vs. spontaneous, we have found that nontraumatic means injury not caused by an exter
In looking again at the subtle differences between "nontraumatic" and "spontaneous", the consistent distinction that is mentioned is that spontaneous injuries occur unexpectedly, without any external forces, and without any premonitory signs (this was mentioned in the first comments of this thread), while nontraumatic injuries occur without external forces but may or may not have premonitory signs. Thus "nontraumatic" injuries are a supertype of spontaneous injury.
The clinical usefulness of this distinction is related to any further evaluation of a patient after the injury occurs. In spontaneous injuries, this may result in additional testing to try and identify any unknown underlying cause for the event. In nontraumatic injuries with premonitory signs, preventive recommendations can be made to address future injuries of the same type.
If the consensus is that this distinction is useful enough to maintain, nontraumatic and spontaneous descriptions should not appear on the same concept. It also suggests that for injuries, where a spontaneous concept exists, a nontraumatic parent concept should also be present, but not vice versa. This, however, does not hold true in non-injury concepts that are spontaneous, (e.g. miscarriage).
There are 199 concepts that use the DUE TO = Spontaneous event relationship, of which only 75 are subtypes of nontraumatic injury. Spreadsheet showing the 301 subtypes of 1119219007 |Nontraumatic injury (disorder)| , which also shows which concepts have both nontraumatic and spontaneous descriptions in included (download to review). A review of these concepts raises a number of questions regarding what qualifies a disorder to be assigned the primitive parent 1119219007 |Nontraumatic injury (disorder)|.
A number of diseases exist in which the literature describes the potential for there to exist a recognised set of associated "systemic manifestations". In an attempt to model these systemic manifestations there has been a requirement to identify a modelling pattern which lies somewhere between the concepts of "Co-occurrent" and "Due to".
The issue arose from a discussion on how we should model the systemic manifestation of Sjögren's syndrome and the thread relating to this has been inclu
To summarize the issues as I see it, we want to distinguish between two types of disorder associations, one in which a finding or disorder is a manifestation of a multi system disorder for which the manifestation and the underlying disorder may share a common pathological process and morphology and the other in which there are 2 discrete disorders that are found together more than would be expected by chance alone and may be related by a common predisposition. I think you are suggesting to use associated with for the former and simple co-occurrence for the latter. Jim seems to be suggesting to use simple co-occurrence for the former and temporally related to for the latter. In a separate e-mail, I expressed my concern about using temporally related to which is essentially a symmetric property to relate two conditions where neither one is secondary to the other. I would like to propose the following solution:
For the situation where a disorder or finding is a manifestation of a multisystem disorder, create a new attribute, is manifestation of (note there is currently a link assertion “417318003 |Is manifestation of (link assertion)|”.
Another option would be to use as Jim suggested temporally related to where the manifestation is temporally related to the underlying systemic disorder. A manifestation may precede and/or occur during the underlying disorder but would never as far I know occur after the underlying disorder has resolved.
For two distinct disorders that may share a common predisposition, represent as simple co-occurrence with a due to relationship to the predisposing factor which may be one or more findings or disorders such as a mutation, substance, organism, physical force or event or some combination of the above. If the predisposing factor is unknown, then a due to relationship would not be included.
The semantics of historical associations, quality of the corpus of already authored associations, and future editorial guidance in their authoring and end-user processing.
Hi jrogers, many thanks. I will copy this across into the subproject page.
PS - Anne is away on annual leave for 3 weeks so she has suggested we progress without her. I will send round a further doodle poll for the next couple of weeks.
Ad item 7 from the Jan 2018 EAG meeting: Data on the range of 'procedure without procedure' type codes and their actual utilisation rates within UK primary care settings
The majority of X absent concepts are in the findings hierarchy rather than the situation hierarchy. If we think it is appropriate to keep these as findings then Jeff's suggestion might work.
Discussion surrounding the proposal to retire from use the WAS-A historical attribute and the inactivation of the existing relationships. The issue originated when a concept slated for inactivation served as a destination concept for a WAS-A relationship to a limited status concept. The tooling required reconciliation of the WAS-A relationship to an active concept. It was reported that historically there was some push back inactivation of a WAS A from a limited inactive concept pointing
A summary of a discussion with JTC/GRE/JRO can be found at:
https://docs.google.com/document/d/17dOZwNITk0cZIqalSbXvG_702lsWlLOhS-FPNSGOv8o/edit https://docs.google.com/document/d/17dOZwNITk0cZIqalSbXvG_702lsWlLOhS-FPNSGOv8o/edit
Until the batch fix to the issue is applied, the following steps should be taken when the target of a WAS A relationship is inactivated:
Assign the next proximal parent as the target of the WAS A relationship
Do not make changes to the inactivation status or add additional historical relationships.
At the Wellington meeting it was determined that the current definition of "Product" was both too broad and included terms that were not universally useful. It was determined that to address the needs of the new Drug Concept Model and to make sure that the definition of products in the International release is consistent with the content.
Current definition Editorial Guide July 2016: "This hierarchy was introduced as a top-level hierarchy in order to clearly distinguish drug products (products) from their chemical constituents (substances). It contains concepts that represent the multiple levels of granularity required to support a variety of uses cases such as computerized provider order entry (CPOE), e-prescribing, decision support and formulary management. The levels of drug products represented in the International Release include Virtual Medicinal Product (VMP), Virtual Therapeutic Moiety (VTM), and Product Category.”
Ed Cheetham