15.8.2011

Data Submission stage

Syncope - use 'syncope' code, not 'loss of consciousness'. Leg Pain on Walking - add "(Claudication)" to clarify questionnaire. Use 'claudication' SNOMED CT code. BUT --- do we make any effort to verify a cause at this point? If not, a much more general 'pain on walking' 426899007 might be appropriate. Left or Right sided weakness - 50582007, can't distinguish which side. Slurred speech - 289195008 Other - need mechanism to review the free text entries and consider adding to q'aire and also to ontology retrospectively

Diagnosis STEMI - 401303003 (because it's a disorder code, rather than the more specific 'ECG finding' codes) ACS - 394659003 (with additional code - 444931001 - if troponin positive) * note this is relevant only for as long as the test we use is trop I. There's an alternative UK specific code for 'cardiac troponin positive' - 372851000000101 - in TB's spreadsheet, which might be better. There's also a 'cardiac troponin negative code - 372901000000105. Stent thrombosis - 421327009 - not a clear mechanism for differentiating between acute and chronic, and no mention in q'aire of the 'immediate' phase. Perhaps best to just group all thromboses and leave the differentiation for the study Intermittent claudication - 63491006 Arterial occlusion - 2929001 (very general code) Cardiac arrest - 410429000 Done as far as ruptured aortic aneurysm. Start next meeting at ventricular ectopics.

23.8.2011 Vent ectopics: 17338001 - disorder, rather than finding Atrial ectopics: 406461004 Infective endocarditis is 233850007, need additional codes post-coordinated for specific structure: aortic valve (34202007 - structure - or 8722008 - disorder), mitral (91134007 or 11851006) or pulmonary (39057004 or 76267008). So, structure or disorder? Refer to John May for advice. Also, worth considering adding 'infective endocarditis - unknown location' to the questionnaire. Viral pericarditis 70189005 Bacterial pericarditis 233883000 post-infarction pericarditis 233885007 - i.e. early post-infarction not Dressler's syndrome other pericarditis 3238004 SVT: 6456007 VT: 25569003 VF: 71908006 Thrombotic Stroke or CVA 371040005 Haemorrhagic stroke 230706003 Restrictive cardiomyopathy 415295002 Ischaemic Cardiomyopathy 426856002 Dilated Cardiomyopathy 20529002 Valve surgery 73544002 TAVI - 174988008 PPCI: 414089002 Pacemaker: 307280005 ICD implantation: 395218007 thrombolysis: 426347000 ablation of lesion of heart: 10683007 coronary angiography 33367005 height: 50373000

Med Hx Stage Question: Separate heirarchy / ontology for interview Med Hx and notes Med Hx? So that we can review both sets of data separately? Note: no need for separate date facts, associate dates with the primary fact. chol: 13644009 chronic renal failure: 236425005 cabg: 232717009 valve surgery: 73544002 TAVI - 174988008 PPCI: 414089002 Other PCI 415070008 Pacemaker: 307280005 ICD implantation: 395218007 thrombolysis: 426347000 ablation of lesion of heart: 10683007 bare metal stent: 36969009 (parent code of below, maybe needs an additional child code for 'bare metal') drug eluting stent: 414509005 heart transplant: 32413006

Risk factor stage

228512004 for 'never chewed tobacco' if NO to first question (i.e. add two codes: never smoked AND never chewed) Don't add codes for the 'which' questions. just move on to categories for each smoking type cigs on most days ever - no - 266920004 (trivial cigaretter smoker) cigs on most days ever - yes - no answer, move on currently smoking - no - 281018007 (or, possibly, use the 'how many' answer below, to categorise from the children of this code) currently smoking - yes - no code, move on how many - number - 1-9: light 160603005, 10 - 20 moderate 160604004, 20-39 heavy 160605003, 40+ very heavy 160606002 how many when smoking the most - categories as above, but no date to attach. oops. maybe use this for pack year calculation? or not? age at starting smoking 228488005 (doesn't specify cigarettes, does it need to?) age at stopping smoking - not a snomed code for that, but there is a code for 'date stopped smoking' - 160625004 so could calculate that MAYBE SUBMIT A SNOMED REQUEST FOR 'age stopped smoking'?? Could then add in a number of other snomed codes / facts such as "total time smoked", "pack years" and so on, from the answers provided. Time of last cigarette? NO SMOMED code relevant to this.

Currently smokes cigars - 59978006 Ex-cigar smoker 160621008 How many? No SNOMED codes for differentiating quantities of cigar smoking 230057008