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Compound Expression
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Constraints
Expression constraints can be built up from smaller parts using conjunction (i.e. AND) and disjunction (i.e. OR). The simplest example of this is where the conjunction or disjunction is used between two simple expressions. For example, the following expression constraint is satisfied only by clinical findings which are both a disorder of the lung and an edema of the trunk. This gives the same result as a mathematical intersection between the set of
term descendants and the set of
ShowPartsterm descendants.
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< 19829001 Disorder of lung AND < 301867009 Edema of trunk 
Please note that all keywords are case insensitive, so the following two expression constraints are equivalent to the above:
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< 19829001 Disorder of lung and < 301867009 Edema of trunk 
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< 19829001 Disorder of lung And < 301867009 Edema of trunk 
The next expression constraint is satisfied only by clinical findings which are either a disorder of the lung or an edema of the trunk. This gives the same result as a mathematical union of the set of
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descendants and the set of
scgexpression descendants. For this reason, an
OR operator will usually allow more valid clinical meanings than an
AND operator.
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< 19829001 Disorder of lung OR < 301867009 Edema of trunk 
Conjunction and disjunction operators may also be combined with the use of the 'member of' function, as shown below:
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< 19829001Disorder of lung AND ^ 700043003 Example problem list concepts reference set 
This expression constraint is satisfied only by concepts that belong to the
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hierarchy
and are also members of the
scgexpression .
When more than one conjunction or more than one disjunction is used, round brackets can be optionally applied. For example, the following expression constraints are all valid and equivalent to each other:
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< 19829001 Disorder of lung AND < 301867009 Edema of trunk AND
^ 700043003 Example problem list concepts reference set 
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(< 19829001 Disorder of lung AND < 301867009 Edema of trunk) AND
^ 700043003 Example problem list concepts reference set 
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However, where a conjunction and disjunction are both used together, it is mandatory to use round brackets to disambiguate the meaning of the expression constraint. For example, the following expression constraint is not valid:
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< 19829001 Disorder of lung AND < 301867009 Edema of trunk OR
^ 700043003 Example problem list concepts reference set 
And must be expressed (depending on the intended meaning) as either:
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(< 19829001 Disorder of lung AND < 301867009 Edema of trunk) OR
^ 700043003 Example problem list concepts reference set 
Or as:
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< 19829001 Disorder of lung AND (< 301867009 Edema of trunk OR
^ 700043003 Example problem list concepts reference set) 
Attribute Conjunction and Disjunction
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For example, the expression constraint below, in which the comma between the two attributes represents conjunction, is satisfied only by clinical findings which have both a finding site of pulmonary valve structure (or subtype) and an associated morphology of stenosis (or subtype).
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< 404684003 Clinical finding:
363698007 Finding site = << 39057004 Pulmonary valve structure,
116676008 Associated morphology = << 415582006 Stenosis 
This expression constraint can equivalently be expressed as:
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< 404684003 Clinical finding:
363698007 Finding site = << 39057004 Pulmonary valve structure AND
116676008 Associated morphology = << 415582006 Stenosis 
The following example uses the disjunction operator (OR) to represent the disjunction of two attributes. This constraint is satisfied only by clinical findings which have either an associated morphology of 'infarct' (or subtype) or are due to a myocardial infarction (or subtype).
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< 404684003 Clinical finding:
116676008 Associated morphology = << 55641003 Infarct OR
42752001 Due to = << 22298006 Myocardial infarction 
When more than one conjunction or more than one disjunction is used in a refinement, round brackets can be optionally applied. For example, the following expression constraints are all valid and equivalent to each other:
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< 404684003 Clinical finding:
363698007 Finding site = << 39057004 Pulmonary valve structure AND
116676008 Associated morphology = << 415582006 Stenosis AND
42752001 Due to = << 445238008Malignant carcinoid tumor 
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< 404684003 Clinical finding:
(363698007 Finding site = << 39057004 Pulmonary valve structure AND
116676008 Associated morphology = << 415582006 Stenosis ) AND
42752001 Due to = << 445238008Malignant carcinoid tumor 
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For example, the following expression constraint is not valid:
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< 404684003 Clinical finding :
363698007 Finding site = << 39057004 Pulmonary valve structure AND
116676008 Associated morphology = << 415582006 Stenosis OR
42752001 Due to = << 445238008Malignant carcinoid tumor 
And must be expressed (depending on the intended meaning) as either:
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< 404684003 Clinical finding :
(363698007 Finding site = << 39057004 Pulmonary valve structure AND
116676008 Associated morphology = << 415582006 Stenosis) OR
42752001 Due to = << 445238008Malignant carcinoid tumor 
Or as:
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< 404684003 Clinical finding :
363698007 Finding site = << 39057004 Pulmonary valve structure AND
(116676008 Associated morphology = << 415582006 Stenosis OR
42752001 Due to = << 445238008Malignant carcinoid tumor ) 
Attribute Group Conjunction and Disjunction
Similarly, conjunction and disjunction may be defined between attribute groups. The following expression constraint is satisfied only by clinical findings which either have a finding site of pulmonary valve structure (or subtype) and an associated morphology of stenosis (or subtype), OR have a finding site of right ventricular structure (or subtype) and an associated morphology of hypertrophy (or subtype).
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< 404684003 Clinical finding:
{363698007 Finding site = << 39057004 Pulmonary valve structure,
116676008 Associated morphology = << 415582006 Stenosis} OR
{363698007 Finding site = << 53085002 Right ventricular structure,
116676008 Associated morphology = << 56246009 Hypertrophy} 
Attribute Value Conjunction and Disjunction
Conjunction and disjunction can also be applied to attribute values. The example below is satisfied only by members of the adverse drug reactions reference set for GP/FP health issue, which have a causative agent that is either a subtype of pharmaceutical / biologic product or a subtype of substance.
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^ 450990004 Adverse drug reactions reference set for GP/FP health issue:
246075003 Causative agent = (< 373873005 Pharmaceutical / biologic product OR < 105590001 Substance) 
Similarly, attribute values can also use conjunction. The following expression constraint is satisfied only by clinical findings with an associated morphology whose value is both a subtype (or self) of ulcer and a subtype (or self) of hemorrhage.
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< 404684003 Clinical finding: 116676008 Associated morphology =
(<< 56208002Ulcer AND << 50960005Hemorrhage) 
For more information about nested attribute values and nested compound expression constraints, please refer to 6.7 Nested Expression Constraints.