Conflicts of interest and agenda review

Search of the literature yielded very few references with a consensus naming for this type of fracture.  Search terms included:

• "Neoplastic fracture"
• "Neoplastic pathologic fracture"
• "Metastatic fracture" 

As was agreed, these are not fractures DUE TO the neoplastic disease and have been modeled as co-occurrent. As there is no consensus naming for these, potential terming includes:

• "Fracture of X with neoplastic disease"
• "Fracture of X in neoplastic disease"
• "Fracture of X co-occurrent with neoplastic disease"
• "Neoplastic disease with pathologic fracture of X"
• "Neoplastic fracture of X"
• Other...

Discussion:

Consider "Fracture of X with neoplastic bone disease".  Is the neoplasm the cause of the weakened bone or is it possible that treatment or extranous condition resulted in the fracture? Prior uses implied that the neoplasm was in the bone.  Suggesed "Fracture of X with neoplasm of X ".  Treatments leading to osteoporosis could be classified under osteoporotic fractures.  Additional discussion  "Fracture of X at site of neoplasm" or "Pathologic fracture of X at site of neoplasm".

Decision:

Group consensus is to use "Pathologic fracture of X at site of neoplasm".

A presentation summarising the proposals detailed in the document 'Concept Inactivation - Proposed Amendments

A request for the members to review and feedback on the  document found on the Confluence web page: Concept Inactivation - Proposed Amendments

A short discussion on 'where do we go from here'

Discussion:

Presentation covered and EAG tasked with review of the document and comments for the next EAG Call.

Based on a discussion at the Anesthesia CRG and Observables Project there is a requirement to add more content for Glasgow Coma Scale

Please see full discussion here: https://confluence.ihtsdotools.org/display/ACRGT/Glasgow+Coma+Score

Presentation included with this agenda item suggesting common observables definitions.

References to Standarization of the GCS:

https://zibs.nl/wiki/GlasgowComaScale-v3.2(2020EN)

https://ckm.openehr.org/ckm/archetypes/1013.1.137/printable

https://www.glasgowcomascale.org/

Draft document from Anesthesia CRG: https://drive.google.com/file/d/1lZJlarREeIIRPk5E1zVtZUktLQlPH3G5/view?usp=sharing

Discussions within Observables Project Group and and review of assessment scores deployed at Nebraska have proceeded with extended proposal for inclusion of assessment scales in use in Sweden as well as US.   

Modelling proposal added to Attachment s summarizing Assessment Scale Score Observables development: Clinical Scale Scores_20210224.pptx.  Proposal promotes expanding content model for full definition of scales such as co-morbidity, Glasgow Coma Scale and SOFA scores.

Anesthesia CRG wishes to explore further the best model for including definitions/explanations of Ordinal Scale score Value sets used in calculated scores.

Discussion:

Ongoing discussions with anesthesia and Observables groups.  Scope expanded.  Continued to the nest meeting.

• Additional considerations for disorder association modeling
• Updated model for contact dermatitis

Discussion: 

Suggested that the use of DUE TO be constrained to the immediate cause as opposed to the entire causal chain. Combined disorders would always be considered co-occurrent. 

Modeling of multiple CLINICAL COURSE:  For concepts where there are two clinical courses required, suggest adding the clinical course to each of the RGs representing the combined disorders.   Some issues are whether the existing terms actually represent a proper term, such as an acute disorder due to a recurrent disorder. (Presentation is always acute).

Including CLINICAL COURSE in the RG would require remodeling of many thousands of existing concepts. 

Question regarding adding the DUE TO relationship to RGs as well.  This requires additional discussion. 

Contact dermatitis discussion continued to next call in March 2021

Decision:

Combined disorders would be modeled as co-occurrent and a DUE TO relationship will be added for the immediate cause, if applicable.

• Proposal for transfer of concepts from <<Evaluation Procedures to Observable entities under going model development in Protege for Phase 1 (Lab testing procedures) in order to test hierarchy build and revisions.

Issues observed with inferences based on the original proposal have arisen that require a revised modeling pattern.  Discussion located at: 

Re: Proposed remodeling of Congenital absence concepts - For discussion (revised)

• EAG members to review changes and comment.

March 24, 2021