Jim Case

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Jim Case

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Jim Case 

SNOMED currently has extensive editorial guidance on terming patterns for disease combinations that involve the distinction of causal and temporal relationships between conditions.  One scenario that has not been adequately addressed is the representation of variably present clinical manifestations of a syndrome.  Syndromes often have multiple associated clinical manifestations that are variably present during the disease process or progression.  It is important to be able to specifically call out these conditions as being extant at the time of recording, i.e. they are not definitional for the syndrome in general, but are definitional at the time of clinical presentation.  An example is Bechet's disease, for which the pathognomic clinical presentation is oral ulcers, but other inflammatory conditions can occur with the disease (e.g. skin rashes, uveitis, arthritis, etc.).   

Current editorial guidance (Disorder Combination Modeling) suggests the use of "X with Y" as the FSN terming pattern.  Prior discussions have suggested that the use of terms such as "X with Y" and "X in Y" are too vague to represent the association of the condition with the syndrome.  The use of "X due to Y" has also been considered inappropriate as the condition is not caused by the syndrome, but is a variably presetn component of the syndrome.

Jim Case 

Exacerbations of a specific disease are currently mostly primitive concepts that are subtypes of the associated disease.  In developing a model for exacerbations, many definitions do not specify that an exacerbation of a chronic disease is a subtype of the disease, but simply a finding associated with the underlying disease, i.e. a worsening of an already present condition, while others look at exacerbations as part of the clinical course of a disease.  We have looked at two different models for representing exacerbations:

1. Create new clinical course concepts: Exacerbation, Mild exacerbation, Moderate exacerbation, severe exacerbation as subtypes of 255212004 |Acute-on-chronic (qualifier value)|, with the following definitions:
   1. 255212004 |Acute-on-chronic (qualifier value)| - An acute (sudden onset) event superimposed on a pre-existing chronic condition. This be either a sudden worsening of a chronic condition itself (an exacerbation) or the development of a new, separate acute illness on top of a chronic disease.
   2. Exacerbation - A sudden worsening of symptoms or an increase in the severity of a chronic disease above what would be expected.
   3. These new clinical course concepts were added to concepts that explicitly stated "Exacerbation" in the FSN.
   4. Example:
2. Create a new primitive grouper concept - "Exacerbation of disease" that would be used as the parent to all exacerbation concepts.  The relationship to the underlying chronic disease would be handled through an ASSOCIATED WITH relationship.  
   1. Example:

In the first approach, Exacerbations would classify as subtypes of the underlying disease.

In the second approach, the exacerbations would classify as 

Nicola Ingram 

An updated Briefing note for transplantation procedures of both solid organs and tissues is provided.

Discussion:

Questions to be sent to Nicola Ingram and Jim Case for discussion and clarification at a future EAG call

Decision:

Monica Harry 

A proposed re-terming of angioplasty concepts due to inconsistencies that have lead to the creation of duplicate concepts.

https://docs.google.com/presentation/d/1_Zv9sasfB-elzwNiZgUC-nrdmgx-Sew74pchOxqsyVM/edit?usp=sharinghttps://docs.google.com/presentation/d/1_Zv9sasfB-elzwNiZgUC-nrdmgx-Sew74pchOxqsyVM/edit?usp=sharing

Discussion: Need consistent FSNs to represent variations. 

Decision:

Victor Medina 

Jim Case 

At the March 2024 EAG call, the group asked for an impact analysis of the change from Surgical approach to a more general Procedure approach.  The results of that analysis were presented at the April 2024 meeting.  At the April face-to-face meeting a list of non-surgical procedures that might benefit from this change was requested and is attached (download to view as spreadsheet).  

Discussion:

Decision:

2024-04-16: Request to distribute list of non-surgical procedures affected by this change

2024-06-03:

• Victor Medina to distribute a list of non-surgical procedures affected by the proposed change

Victor Medina 

Jim Case 

As requested from the EAG, a list of definitions has been developed that will guide content authors in the correct modeling of concepts related to bypass, bypass graft, shunt, etc.:

Proposal for definition of concepts under 48537004 |Bypass graft (procedure)|.
Proposal for Definitions.

• CONSTRUCTION OF BYPASS. Surgical creation of a passage to carry contents
  around a part of a structure in its normal route and back to a structure in its
  normal route.
• CONSTRUCTION OF BYPASS USING GRAFT. Surgical creation of a passage, using a
  biological or synthetic material, to carry contents around a part of a structure in its
  normal route and back to a structure in its normal route.
• CONSTRUCTION OF SHUNT. Surgical creation of a passage allowing contents to
  move from one structure to another, not following its normal route.
• CONSTRUCTION OF SHUNT USING GRAFT (SYN: INTERPOSITION SHUNT). Surgical
  creation of a passage using a biological or synthetic material, allowing contents to
  move from one structure to another, not following its normal route.
• INTERPOSITION GRAFT. A surgical repair, using a biological or synthetic graft, of a
  structural defect that does not allow tension-free anastomosis.
• ANASTOMOSIS. Surgical procedure to create a cross-connection between
  channels, tubes, fibers, or other parts of a network.

Discussion:

Decision:

2024-03-11 Comments will be added to the document by the EAG members. 

2024-04-16: Proposed definitions will be revised based on input and resubmitted to the EAG for review.  

2024-06-03:

• Victor Medina to revise definitions based on input from the EAG

Jim Case 

Victor Medina 

Following discussion at the last EAG meeting and the document provided by Monique van Berkum (attached), new proposed definitions and examples for:

USING DEVICE

DIRECT DEVICE 

USING ACCESS DEVICE

will be presented to the EAG for discussion at a future meeting

Discussion:

Decision:

• Jim Case to provide new definitions for review

Jim Case 

July 22, 2024 - pending availability of members