Causality and possible causality

Bonjour stefan and thanks
1 i am doing a relation between the CLP and Combined Clinical Finding for the reason that in the presentation done by Bruce Goldberg he addressed the 2 issues succesfully and i interpret that as stating that in the EHR what is entered is a statement on a CLP AND NOT on Combined Conditions.
If i overinterpreted my question is off
2 If i am right in 1  what i mean principally  is that if we considered that the FSN described a CLP we shall not go to a due to/caused by discussion for at that time we cannot know the strength of the relation between the 2 conditions:what can be stated is either co occurent or after except when there is a certainty as meningitis caused by meningococcus 
3 i can participate to the ECE monthly meeting if Bruce wishes

hope to have clarified

PR JEAN MARIE RODRIGUES UNIVERSITE JEAN MONNET SAINT ETIENNE/LYON INSERM U 1142 LIMICS UPMC UP 13 PARIS WHO CC for International Classifications en Langue Française PRESIDENT AIM :www.france-aim.org/contact

Le 25/02/2016 17:32, Stefan Schulz a écrit :

Dear Jean-Marie,

now I am a bit confused,

 

What you wrote seems to be a comment about the clinical life phase approach, as underlying the combined disorders, as elaborated by the IHTSDO ECE paper

http://icbo2015.fc.ul.pt/regular6.pdf 

am I right? 

The ECE group plans to expand this paper to a journal publication, therefore your input is highly welcome.

extension

which contradiction exactly?

 

extension

Otherwise numerous is-a relations would have to be questioned.

 

3 i understand that it is very difficult to separate co-occurent, due to

extension

Especially if the only thing that guides us is a fully specified name. Often, whether something is also co-occurrent apart from being caused by (or not), this implies knowledge of the domain; it cannot be drived from the wording.

 

extension

my interpretation is that whoever uses a concept of the type  "A due to B"  is sure about causality. Otherwise he would use the two codes for A and B separately, or possibly A and history of B

What about participating in the monthly ECE calls? I think you input would be very welcome.

Cheers

Stefan

I am back on my previous message which was not clear

what i mean is that the subtypes of associated with shall be related to
CLP model:
Co occurrent and After are ok for representing what is active during
this life phase of the person
Due to and Caused by are in favour of a statement on the relation
between different CONDITIONS which overpass the CLP model.

thanks

PR JEAN MARIE RODRIGUES
UNIVERSITE JEAN MONNET SAINT ETIENNE/LYON
INSERM U 1142 LIMICS UPMC UP 13 PARIS
WHO CC for International Classifications en Langue Française
PRESIDENT AIM :www.france-aim.org/contact

Le 23/02/2016 23:36, Rodrigues Jean marie a écrit :
> Bonjour
>
> sorry to have not been able to speak but i followed the presentation
> which was quite good
>
> my question is as following
> 1 I find a contradiction between the first part on the Condition/CLP
> issue and the second part trying to clarify combined clinical finding
> 2 I fully agree and co authored that what can be shared between ICD
> and SCT is the representation of CLP for what is written in the
> medical record is a statement on the status of a person during an
> episode or a life phase and not a condition per se with a fully
> explicit definition.
> 3 i understand that it is very difficult to separate co-occurent, due
> to associated to and before after: I would add ontologically not
> possible for the causality link is in most of the cases fuzzy in
> medicine.
> 4 My interpretation of the distinction Condition/CLP is that CLP must
> be defined by has_condition 1,has_condition_2, has-condition_n
> without assuming anything on the causality but describing what are the
> conditions assessed during this life phase and when a retrieval is
> done to know that during this patient CLP several conditions were
> present and if the combination is frequent it can be in favor of a
> kind of causality
>
> thank you

One of the underlying goals of the combined disorder model was to remove the observed inconsistency between applying associated with and due to based on how one interprets causation.  Thus we considered 2 combined disorders as either causally associated or not causally associated. Thus for non-causal associations we would use pattern 1 (simple co-occurrence) or pattern 4 (follows). The issue then becomes deciding on what is causal and therefore this recapitulates the due to/associated with conundrum.  This is illustrated by 709471005 |Periodontitis co-occurrent with leukemia (disorder)|which is fully defined as a descendant of  both periodontitis and leukemia.  This model was chosen because the submitter was not willing to assert definite causality between leukemia and periodontitis.  The problem is that Periodontitis co-occurrent with leukemia (disorder)|cannot be fully defined as just a subtype of its constituent CLPs/conditions. The fact that leukemia and periodontitis are combined in a single statement differentiates these co-occurrent life phases from e.g. pre-existing periodontitis due to poor dental hygiene now co-occurrent with leukemia. The combined statement is indicative of an association in addition to co-occurrence that may not be definable at this time.  By relaxing the definition of due to, to include indirect causality, one can reason that the periodontitis is an infection which is indirectly due to decreased leukocyte number or function. The advantage of this approach is that |Periodontitis co-occurrent and due to  leukemia (disorder)| can now be defined. Most of the current concepts containing associated with in the FSN or modeled with the associated with role have at least some degree of implied causality. Modeling  these with due to will lead to increased consistency of modelling and will enable easy retrieval in case we decide to enhance the model by adding additional types of non-causal association such as predisposes to. I am OK with removing possibly causal from the proposed redefinition of due to as long as it is clear that due to can apply to a range of  causal associations rather than direct causality.