Promotion of US extension content in conflict with International concepts

After the first call, the consensus was that dietary intake is a more specific term, needed for clinical recording.  It was also determined that a general reorganization of the top level of 300893006 Nutritional finding (finding) be revised to more accurately represent the types of nutrition concepts currently used by the profession. new discussion on the revision of this hierarchy will be started as that must be cleaned up before we can add the US extension content to the International release.

All of the requested concepts from the US extension have been promoted to the International release for the July 2018 International release.  The proposed changes to dietary intake have been made as well as some slight reorganization as a result of the movement of 41829006|Dietary finding under 300893006|Nutritional finding.  Some additional cleanup of the top level hierarchies is still needed, but the project group is now in a position to begin reviewing the current structure and content for coverage and accuracy

Hey all,

I guess the issue here has to do with the context.  The majority of nutrient intake within healthy individuals is oral, this is what would be regarded as normal dietary intake.  However within the hospital setting the intake of nutrients can be via feeding tube (enteral), or via intravenous (parenteral) in this situation looking at the overall intake of individuals.  

So to answer your questions

• Are the "Inadequate dietary intake" and "Inadequate intake" terms truly non-equivalent? 

They are the same but different. It depends on how you define "dietary intake" if this is to mean nutrient absorbed by the gut only (oral and enteral)  then they are not equivalent.  If dietary intake includes intravenous intake  of nutrients then they are the same.  It would depend on the context  in question eg fast food vs Sodium intake
There is potential for ambiguity here and it would make sense for "dietary intake" to be removed or better defined i.e is this just oral intake (food that is swallowed) / or enteral intake (i.e via feeding tube) / or intake of all nutrients (oral, enteral and intravenous).  
Furthermore I think it is important to appreciate that the route of delivery of nutrient and whether this is in excess of deficit could in fact be defined qualifier values (i.e.

• • 260378005 | Excessive (qualifier value) |      vs        260372006 | Deficient (qualifier value) |
  • 260548002 | Oral (qualifier value) |                vs       26643006 | Oral route (qualifier value) |
  • 225770002 | Enteral (qualifier value) |            vs      417985001 | Enteral route (qualifier value) |

So I guess is there need to look at how quantifier values are Is the work being under taken to look at the post co-ordination of the terms like intake to quantify route and whether in excess or deficient

• Should the International "dietary" concepts be converted to primitive concepts so they classify as sub types of the US extension concepts?
  As mentioned above "dietary" needs to be better defined if this can be done then  it could remain fully defined and if not then it would most definitely need to be converted to a primitive concept
  
  
• Should the international concepts be inactivated as the intent is intake from any source?
  Again sort of what is the alternative to define route of nutrient intake.   The route of intake is as important as the quantity of intake and removing the ability to quantify it would be problematic if intake was meant to be intake from any source.  I.e you would not need to worry about providing dietary advice to someone with insufficient intake if they were dyshpagic and nil by mouth and were receiving all their nutrition via a enteral feeding tube.  
  If we are clear on being able to define how nutrients are being consumed when taking a diet history by utilising qualifier values then this should not be a problem
  
  
• Should new Observable entities specifying "Dietary X intake (observable entity) be created to appropriately model the international concepts?
  We come back to what is meant by "dietary" here  i.e. is this oral only or oral and enteral.  

I think it is important to look at utilizing the fields that are already within the international edition and look at using these to better define these terms, rather than splitting hairs and creating more terms that will lead to confusion.

I hope that is some useful feedback and makes sense, please get back to me

All the best,

Nathan

I was wondering if excessive intakes would be handled the same way as inadequate intakes. Nathan seems to have approached that topic above. Needs to be a part of the nutrition diagnosis discussions.