Events, Conditions, Episodes Project Group meeting agenda 06-12-2017
Date
2017-06-12
Time: 20:00 UTC
GoToMeeting Details
https://snomed.zoom.us/j/7065698062
Recording of previous meeting
meeting not recorded
Invitees
Ed Cheetham
Yongsheng Gao
Jim Case
stefan.schulz (Unlicensed)
Former user (Deleted)
Rob Hausam
Penni Hernandez (Unlicensed)
Krista Lilly
Former user (Deleted)
Phil Brown
Former user (Deleted)
Penni Hernandez (Unlicensed)
Former user (Deleted)
Ed Cheetham
Former user (Deleted)
Daniel Karlsson
Former user (Deleted)
Robert McClure (Unlicensed)
Apologies
General Comments
See agenda below
Item | Description | Owner | Item | Comments/Files |
|---|---|---|---|---|
1 | Welcome and role call | BGO, all |
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2 | Allergy/hypersensitivity editorial guidelines
| BGO
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3 | Intolerance to substance | BGO |
| Intolerance to substance is a disposition. A model is needed to associate the substance to this disposition if we are not going to use the allergy/hypersensitivity model due to the inability to define an intolerance pathological process |
4 | Complications and sequela | BGO |
| |
5 | During and/or after | BGO |
|
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6 | Follow-up from London April business meeting | BGO |
| |
7 | Modeling of CVAs due to thrombosis/embolus - follow-up | BGO |
| |
8 | AOB, adjourn | ALL |
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Previous Meetings
Comments
Hello, Ed. This is a good point. I will work on providing more documentation around the definitions of the new roles. With regard to “during and/or after”, I seem to remember this was created to support some specific use cases we had in mind. Can you recall what these were?
Thanks,
Bruce
Thanks
I think this goes back to pre-confluence discussions, so any materials are likely to be buried in "migrated items". The strongest recollection I have relates to 'reactive arthritis' (i.e. not a surgical complication). My concern was that the current formal approach to these concepts (plus a strict interpretation of 'after') is that the provoking infection has necessarily 'ended' before the arthritis begins. Whilst this may well often be the case 'during and/or after' seemed to describe better the partial overlap ("a life phase where the patient definitely had an infection-related arthritis and may also have had the tail end of the infection causing it"). I'm not sure how popular this approach would be (effectively equating 'during' with 'possibly is_a') but the alternative is insisting that nobody with reactive arthritis can still have some presence of the original infection.
I note that the domain & range constraints include '<<finding:during and/or after=<<finding' and would therefore sanction such a construct, but you may wish to state that this can't be done yet.
Regarding surgical complications, whilst many can legitimately be interpreted as truly 'after' the surgical procedure has ended, there are examples where the boundary is less clear:
An unintended burn from a laser or a diathermy plate would 'happen during' the procedure (the 'burn event') but the effect (the 'burn disordered structure') would continue afterwards ("a life phase where the patient definitely had a procedure-related burn and may have also been undergoing that procedure").
Post-operative atelectatsis may be the continuation of inevitable intraoperative atelectasis - the 'atelectasis disordered structure' began 'during' the procedure and continued 'after' ("a life phase where the patient definitely had procedure-related atelectasis and may also have been undergoing that procedure")
I suspect there is a greater appetite to 'keep it simple', using 'during' for intraoperative complications and 'after' for post-operative, but this simplicity is an approximation, comes at a price, and needs to be explained and understood.
Ed
Thanks, Ed. The issue that I have with using during and/or after for representing complications such as reactive arthritis is that it implies that the complication (arthritis) can occur during as well as after the cause (infection), after but not during the cause and also during and not after the cause. The latter situation I think is incorrect for reactive arthritis. A question that has arisen is whether during and/or after should be used whenever the temporal relationship between a complication and its cause is unclear or unspecified. My inclination (and supported by the group at Monday’s call) was to not add a temporal relationship unless the nature of the relationship of the complication to its cause is clear. For sequelae, an after relationship is always present. If it is clear that a complication starts during its cause but may continue after the cause has resolved, as is the case of the laser burns, think maybe during and after relationships can be added individually. I realize this may be an oversimplification but it might be the best we can do.
Bruce
Bruce
Apologies once again as I shall not be able to attend this call. I wonder if I might ask, in relation to the 'during and/or after' item, what documentation is being produced to accompany the new temporal attributes? I see that 'temporally related' has a short text definition, and note that they are included in the draft MRCM, but other than that I haven't seen any materials that explain them. 6.1.5 of the editorial guide still has them as draft and they are not yet listed in 6.1.2.
Thanks
Ed