From Jeremy Rogers, UKTC:

On your main question, I would agree that it’s a mistake to universally retire all ‘following diet X’ findings codes in preference of ‘diet X regime’ codes that can then be wrapped up in a situation wrapper in order to give them e.g a procedure status of ‘started’

243796009|Situation with explicit context|:

                363589002|Associated procedure|=425458000|Lactose-free diet|

{408730004|Procedure context|=385652002|Started|,

                408732007|Subject relationship context|=410604004|Subject of record|,

                408731000|Temporal context|=410512000|Current or specified|}

…bearing in mind that the correct interpretation of the unadorned code 425458000|Lactose-free diet (regime/therapy)| in a patient EPR would be ‘done’, ie that the patient was no longer on the regime because it had been completed. A much more complicated and postcoordinated solution is required for regimes that continue indefinitely, like diets. So the finding codes to record when a patient is on a particular diet, and without ever having to datestamp when that regime started, looks rather attractive given where the world is at.

You might therefore want to duplicate more of them so that they exist as both, but I wouldn’t retire them. But the dieticians need to be aware of the default procedure context issue outlined above.

Plenty of patients put themselves on a particular diet without it ever being a formal dietician-controlled therapeutic intervention. It would be odd to be only able to code that as that the patient was submitting to a self-imposed non-therapeutic regime, especially as it seems likely that the subsequent observations that a patient could not tolerate or was otherwise non-compliant with a particular regime would, I assume, be coded as findings? So it would be odd to exceptionally encode compliance as a procedure and non-compliance etc still as a finding.

Meanwhile…

 Looks to me very much as though whoever cooked up this candidate list of 331 ‘dietician’ codes did so by the predictably naïve approach of (1) scour SNOMED CT for all codes with a semantic tag of ‘(finding)’ and an FSN containing the substring ‘diet’, and (2) review the resulting list as a flat list in a spreadsheet and kick out any you don’t like.

 One consequence of that unsophisticated approach is that they’ve inadvertently sucked into the subset, and missed kicking out, the code 247703006|Lysergic acid diethylamide reaction (finding)|

 Another more serious effect, however, is that the approach arbitrarily and inexplicably misses out things like 24930006|Vegan (finding)| from within the subhierarchy below, and from which all other concepts shown ARE members of the draft refset:

..whilst in this one the only thing they have picked up is the highlighted ‘Vegan dietary’

 They’ve also missed a number of corners of SNOMED that talk about nutritional status rather than the diet by which that status is achieved e.g.

A possibly more accurate encoding, therefore, might be the 383 concepts encoded for by:

--------------------------------------------------------------------------------------------------------------------------------------------

SCT INTENSIONAL CLUSTER DEFINITION (1.1) FOR NUTRITION

--------------------------------------------------------------------------------------------------------------------------------------------

INCLUDE:

   << 709014002 Compliance with prescribed diet (code and all its descendants)

   << 704343001 Conflicting attitude towards dietary regime (code and all its descendants)

   << 129863004 Deficient knowledge of dietary regimen (code and all its descendants)

   << 170745003 Diabetic on diet only (code and all its descendants)

   << 413987005 Did not attend dietetic clinic (code and all its descendants)

    = 364828006 Diet followed - finding (code only and NOT also its descendants)

   << 57260004 Dietary amenorrhoea (code and all its descendants)

   << 41829006 Dietary finding (code and all its descendants)

   << 405241002 Dietary indiscretion (code and all its descendants)

    = 284648005 Dietary intake finding (code only and NOT also its descendants)

    < 366363005 Dietary potassium intake - finding (descendants only but NOT also code itself)

   << 284655007 Dietary requirement finding (code and all its descendants)

    < 366361007 Dietary sodium intake - finding (descendants only but NOT also code itself)

   << 324984006 Dietetic proteinuria (code and all its descendants)

   << 705051002 Difficulty managing dietary regimen (code and all its descendants)

   << 449894006 Tolerating normal diet (code and all its descendants)

  << 364828006 Diet followed - finding (code and all its descendants)

   << 366364004 Finding of nutritional status (code and all its descendants)

EXCLUDE:

    < 88202002 Alteration in nutrition: less than body requirements (descendants only but NOT also code itself)

   << 39908000 Food exchange list (code and all its descendants)

   << 408511001 Meal substitute used (code and all its descendants)

   << 89571002 Premature infant diet: vitamin E at 10 days and iron at 3 weeks (code and all its descendants)

   << 52659007 Vitamin K restricted diet during anticoagulation therapy (code and all its descendants)

   << 33861001 Weight maintenance regimen (code and all its descendants)

…but noting that this would still exclude all the following other diet and nutrition related content:

  @<< 161035003 Not on a special diet (code and all its descendants)

  @<< 449360002 On special diet (code and all its descendants)

  @<< 278846007 Dietetic procedures (code and all its descendants)

  @<< 61310001 Nutrition education (code and all its descendants)

  @<< 185495006 In-house dietetics (code and all its descendants)

  @<< 386373004 Nutrition therapy (code and all its descendants)

  @<< 418471000 Propensity to adverse reactions to food (code and all its descendants)

  @<< 2492009 Nutritional disorder (code and all its descendants)

  @<< 76118001 Dietetic ileitis (code and all its descendants)

  @<< 72547003 Dietetic colitis (code and all its descendants)

  @<< 159033005 Dietitian (code and all its descendants)

  @<< 384760004 Feeding and dietary regime (code and all its descendants)

  @<< 49464009 Dietetic sigmoiditis (code and all its descendants)

  @<< 310243009 Nutritional assessment (code and all its descendants)

  @<< 410175003 Dietary regime management (code and all its descendants)

  @<< 33687004 Dietetic gastroenteritis (code and all its descendants)

  @<< 54538006 Dietetic microangiopathy (code and all its descendants)

  @<< 410173005 Dietary regime assessment (code and all its descendants)

  @<< 370540009 Adverse reaction to food (code and all its descendants)

  @<< 197028009 Dietetic gastritis (code and all its descendants)

  @<< 20759009 Dietetic jejunitis (code and all its descendants)

  @<< 83134002 Dietetic diarrhoea (code and all its descendants)

  @<< 30719001 Dietetic enteritis (code and all its descendants)

  @<< 197030006 Dietetic enterocolitis (code and all its descendants)

  @<< 331987008 Mild dietary indigestion (code and all its descendants)

  @<< 363246002 Nutritional deficiency associated condition (code and all its descendants)

  @<< 66612000 Nutritional anaemia (code and all its descendants)

  @<< 364393001 Nutritional observable (code and all its descendants)

  @<< 243862009 Obesity monitoring status (code and all its descendants)

  @<< 230126006 Finding relating to infant feeding (code and all its descendants)

  @<< 185284002 Seen by dietitian (code and all its descendants)

  @<< 305602008 Under care of dietitian (code and all its descendants)

  @<< 306068001 Referral by dietitian (code and all its descendants)

  @<< 306540009 Discharge by dietitian (code and all its descendants)

  @<< 185176006 Seen in dietician clinic (code and all its descendants)

  @<< 171054004 Pregnancy diet education (code and all its descendants)

  @<< 419155003 Recommendation to change diet (code and all its descendants)

  @<< 710847006 Assessment of dietary need (code and all its descendants)

  @<< 473361004 Not tolerating normal diet (code and all its descendants)

  @<< 62014003 Adverse reaction to drug (code and all its descendants)

  @<< 47563007 Nutritional deficiency state (code and all its descendants)

  @<< 129844000 Alteration in nutrition (code and all its descendants)

  @<< 39403002 Decreased nutritional requirement (code and all its descendants)

  @<< 698859001 Impaired nutrient utilisation (code and all its descendants)

  @<< 1881003 Increased nutritional requirement (code and all its descendants)

   @= 300893006 Nutritional finding (code only and NOT also its descendants)

  @<< 306163007 Referral to dietetics service (code and all its descendants)

  @<< 712555000 Liaising about dietary regime (code and all its descendants)

  @<< 410403000 Nutritionist surveillance (code and all its descendants)

  @<< 408285001 Refer to paediatric dietitian (code and all its descendants)

  @<< 103699006 Patient referral to dietitian (code and all its descendants)

  @<< 430182009 Excessive dietary caloric intake (code and all its descendants)

  @<< 430186007 Excessive dietary carbohydrate intake (code and all its descendants)

  @<< 430174009 Excessive dietary mineral intake (code and all its descendants)

  @<< 430300005 Excessive dietary vitamin intake (code and all its descendants)

  @<< 430188008 Excessive dietary intake of protein (code and all its descendants)

  @<< 430171001 Inadequate dietary mineral intake (code and all its descendants)

  @<< 430175005 Inadequate dietary vitamin intake (code and all its descendants)

  @<< 391024003 Osteoporosis dietary education (code and all its descendants)

  @<< 366360008 Dietary fibre intake - finding (code and all its descendants)

  @<< 366359003 Dietary fat intake - finding (code and all its descendants)

  @<< 716618008 Therapy Outcome Measure score (code and all its descendants)

  @<< 18168004 Raw-milk associated diarrhoea (code and all its descendants)

  @<< 305849009 Seen by dietetics service (code and all its descendants)

  @<< 416098002 Drug allergy (code and all its descendants)

  @<< 710795007 Inadequate dietary energy intake (code and all its descendants)

  @<< 707844006 Inconsistent carbohydrate intake (code and all its descendants)

  @<< 410113003 Assessment of dietary compliance (code and all its descendants)

  @<< 306626002 Discharge from dietetics service (code and all its descendants)

  @<< 129832003 Noncompliance with dietary regimen (code and all its descendants)

  @<< 161449003 H/O: nutritional disorder (code and all its descendants)

  @<< 430183004 Inadequate dietary intake of protein (code and all its descendants)

  @<< 430185006 Inadequate dietary carbohydrate intake (code and all its descendants)

  @<< 424928005 Dietary management surveillance (code and all its descendants)

  @<< 385769008 Encouragement of dietary compliance (code and all its descendants)

  @<< 234358000 Megaloblastic anaemia due to dietary causes (code and all its descendants)

  @<< 804641000000101 Dietary surveillance in hypercholesterolaemia (code and all its descendants)

  @<< 88202002 Alteration in nutrition: less than body requirements (code and all its descendants)

  @<< 129689002 At risk for nutritional problem (code and all its descendants)