Conflicts of interest and agenda review

Information only:

Please see the updated definition (+ agreed upon proximal primitive parents and modelling considerations) and summary of discussion on each topic:

1) Definition and proximal primitive parent:

• Poisoning:

• EGA proposed definition: “Interference in normal bodily functions caused by exposure through ingestion, inhalation, absorption, or injection of a substance (e.g. medicinal product, household product, industrial chemical, or plant or animal derivatives) in quantities that are harmful to health.”

• Is a: Clinical finding

• Overdose

  • EGA proposed definition: “The act of consuming a greater amount than intended (e.g. heroin) or greater than recommended by therapeutic guidelines resulting in a potential for adverse effect.”

  • Is a: Clinical finding

• Intoxication

• EGA proposed definition: “Diminished control of mental or physical functioning caused by a substance”

• Is a: Poisoning

2) Allowed attributes (all optional, additional attributes may become required once the review and content update is underway):

• Causative agent (substance or pharmaceutical and biologic product)

• Clinical course (Acute, Chronic)

• Due to

Summary of discussion:

• Poisoning

• "Fatal" to be omitted from the definition as it is a subtype of harmful. Exposure needs to be a better defined; there should be an interference with bodily function as result of exposure.

• Do we need to consider it an injury? It is not always an injury: we need to distinguish whether it is only a metabolic effect or physiological damage

• Do we need to indicate quantity? It is not related to quantity, but rather the effect it has on individuals. Later it was noted in the comments “enough of a hazardous substance (poison)” as per WHO definition might be helpful: “Exposure to amount adequate to cause interference in normal bodily functions” → change the proposed definition to indicate: “in quantities that are harmful to health”

• WHO: Poisoning occurs when people drink, eat, breathe, inject, or touch enough of a hazardous substance (poison) to cause illness or death. Some poisons can cause illness or injury in very small amounts. Illness may occur very quickly after exposure to a poison, or it may develop over several years with long-term exposure.

• We may still need something to the effect that it has to occur in all individuals (unlike allergy that occurs some individuals), but it requires further review

• Overdose

• We require to specify Excess of recommended dosage + dangerous (not necessarily causing damage)

• Intoxication

• Is it a child of or a sibling of poisoning? If we consider “Diminished control of mental or physical functioning” an adverse effect, then it is poisoning.

• We may need to refine the definition later to accommodate cases related to “do not operate machinery”: e.g. severity of diminished control or lack of ability to perform normally, but those are all shades of grey.

• Poisoning synonyms: other

• Agreed with the proposal on these. In the first 3 cases, keep FSN as is.

• Due to

• If required (after review of existing concepts), we may need to divide intentional and accidental intent to new concepts of type: “self administered” and “externally administered”.

• Do we need undetermined as a grouper or sibling to the two others? As a sibling because it implies we explicitly say we don’t know.

  • It is difficult to see this as a grouper, but "undetermined" is a slippery slope. This reflects the notion of "NOS".  It is unclear what this means (i.e. not asked, refused to answer, unable to answer, etc.).  Leave as is or remove as classification artifacts? Group feels they should be inactivated.  Inactivation reason = Duplicate to the unspecified parent.

Discussion 2020-01-27:

The EAG members identified issues with concepts referring to "unintentional intent" as it was hard to know how that determination was made (e.g. not asked, patient unable to respond, patient would not answer) and so it did not add any new information over and above the agnostic parent concept.

KCA: (with regard to concepts of "unintentional intent") It is adding no information beyond the parent, so they are duplicates.

Current status of project to coalesce evaluation procedures and Observable entities

Attachment summarizing project added: Migration of Evaluation Procedures to Observables Inception-Elaboration.docx

Discussion:

Looking at common laboratory procedures.  Around 7,000 measurement concepts are being looked at (those with "Measurement - action") . A template is being developed to allow for an automated or batch process to convert existing evaluation procedures to Observable entities.

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

Based on a discussion at the Anesthesia CRG there is a requirement to add more content to express Glasgow coma scores. 

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

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

Attachment added summarizing Assessment Scale Score Observables development with Observables Project and Deployment at Nebraska: Clinical Scale Scores_20210121.pptx

Does the fourth Wednesday of the month at 10:30 for 90 minutes work for members.

Discussion: 

Yes...