Age

[Thomas Beale]

Elkin, Peter L., M.D. wrote:

>I agree with using date of birth for making the determination of an 
>individual's age, as long as we have support for relative age for concepts 
>such as puberty, menopause, at an age of risk given their family history of a 
>malignance with a first degree relative whose onset of illness was at a 
>certain age.  Relative age also includes number of years since an event like 
>an MI or a CABG which are both medically relevant relative periods of time 
>which are a type of age (years since event) with clinical relevance.
>
>  
>
Peter,

can there be multiple relative ages for one person, relating to 
different life events? Do current clinical systems try to model this?

- thomas


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Age

[Kevin Coonan, MD]

Perhaps:
if (dead) age=dod-dob; 
else age=today-dob;
if (age<=myAge) ageGroup="young";


For time intervals, etc. this is not a terminology problem, but should be
handled at the application interval, and I suggest that the context of the
interval will determine membership (i.e. I still consider myself to be a
'young adult').  

The same argument partially applies about post-conceptional age.  If all you
have is LMP, the most accurate estimation of post-conceptual (or
gestational) age your application could come up with is going to be based
upon this, and certainly will have a "fuzzy" value (or at least a point
estimate w/ defined confidence intervals).  Again, the need for/meaning of
this is going to be very contextual and probably best handled at the
application level.  

However, there is a determination of gestational age that is made based on
maternal LMP, ultrasound, and physical examination of the newborn that is a
clinical conclusion, and that has intrinsic meaning and must be recorded
like other observations about the patient.  There is inherent error and
imprecision in all of our clinical observations, but this is not a
terminology problem, but rather an ontology/application layer issue.

I.e. you don't record if a person had an MI as a "young adult" since this is
not an observation, and the validity is completely derived from the context
of what "young adult" is.  E.g. in the clinical context of testicular cancer
v. stroke there are very different concepts of what "young" is.

A terminology sans context is just data w/o information.

Kevin
___
Kevin M. Coonan, M.D.
kevin.coonan at utah.edu
Adjunct Assistant Professor, Division of Emergency Medicine
NLM Fellow, Department of Medical Informatics
University of Utah School of Medicine


-Original Message-
From: owner-openehr-techni...@openehr.org
[mailto:owner-openehr-technical at openehr.org] On Behalf Of William E Hammond
Sent: Monday, January 31, 2005 11:11 AM
To: USM Bish
Cc: OpenEHR Technical
Subject: Re: Age

For an age, I agree that the date of birth is adequate as long as you
remember people do not age after they die.  It is also convenient to have a
reference time mark for many things, including conception, start of a course
of treatment.  Adjectives and nouns are difficult to put into algorithms
unless the definitions are precise.

Ed Hammond





USM Bish @openehr.org on 01/29/2005 07:12:55 AM

Please respond to USM Bish 

Sent by:owner-openehr-technical at openehr.org


To:OpenEHR Technical 
cc:

Subject:Re: Age

On Sat, Jan 29, 2005 at 05:26:45PM +0530, USM Bish wrote:
> On Sat, Jan 29, 2005 at 01:07:06AM +0000, Thomas Beale wrote:
>
> I think it's a given that we assume that "age" is not literally 
> recorded in the db  - the question is whether date  of birth is good 
> enough.
>

If  the EHR  is  designed is  to be  developed  for a  'patient centric'
database  where  data  is  appended  from  the  first registration onwards
to ad-infinetum till  his/ her death,  the only thing needed is DOB.

If the objective of the EHR  is institution or episode centric, then
ofcourse amendments  as per the need may be  thought of as per the setting.

>
> Clearly for  many paediatric cases it  is not, since  birth can come 
> at a nearly arbitrary time these days (20 weeks?).
>

Prematurity  and  postmaturity  are  concepts  in  relation  to gestational
age  (being one of  the component factors)  and not chronological 'age' per
se (viz. 'age' as we percieve in common medical parliance).

> To avoid  working with negative ages,  the one proper  point of 
> reference we  have is (estimated)  date of conception,  but for most  
> patients  we  probabl  dont'  need  this.  I  suspect  an application 
> level type is needed that generates age_since_birth
> and  age_since_conception   from  recorded  expected   date  of
> delivery,  which   should  presumably  be  estimated   date  of
> conception + 38 weeks (Sam tells me that actually recording the date 
> of conception can get people into trouble!)..

I am  of the view, that  things like 'age since  conception' is too variable
a  thing to be included in  an objective database.
In  cases  of  conception  within  the  period  of  gestational amenorrhoea,
or  worse still,  spotting after  conception, more often than  not,
gestatonal age is  determined from  ultrasound findings and  other methods.
It is  best to leave these  to the discretion of the practitioner.

>
> In  the case  of neonatal  work (as  I understand  it from  the
> physicians) there are certain rules of  thumb they use based on the 
> (estimated) date  of conception compared with  the due date and again 
> co

Age

[Karsten Hilbert]

> Age=: Time since an reference event took place and is expressed as: 
> lightyears, years, months, days, minutes, seconds (and parts thereof) 
Lightyears is a measure of distance, not time. And not
constant either, at that.

Karsten
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Age

[David Guest]

Karsten Hilbert wrote:

>>Age=: Time since an reference event took place and is expressed as: 
>>lightyears, years, months, days, minutes, seconds (and parts thereof) 
>>
>>
>Lightyears is a measure of distance, not time. 
>
In fact it is *the*  measurement of distance.

>And not
>constant either, at that.
>  
>
Bugger.
http://www.everything2.com/index.pl?node_id=29831&lastnode_id=11221

David

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Age

[lakew...@copper.net]

Hi All,

Light has successfully been slowed and stopped, i.e., encapsulated in a 
material) for a
significant period of time. Lasers are used to send it on its way. 
Destroyed a niche
in my memory banks when it was announced. Do not see a substitute for 
the 'old-light',
aka the 'new-light'.

Regards!

-Thomas Clark

David Guest wrote:

> Karsten Hilbert wrote:
>
>>> Age=: Time since an reference event took place and is expressed as: 
>>> lightyears, years, months, days, minutes, seconds (and parts 
>>> thereof)   
>>
>> Lightyears is a measure of distance, not time.
>
> In fact it is *the*  measurement of distance.
>
>> And not
>> constant either, at that.
>>  
>>
> Bugger.
> http://www.everything2.com/index.pl?node_id=29831&lastnode_id=11221
>
> David
>
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
>
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Age

[Karsten Hilbert]

>> And not constant either, at that.
> Bugger.
> http://www.everything2.com/index.pl?node_id=29831&lastnode_id=11221
I stand corrected as I was being imprecise. I was referring to
a) the speed of light is depending an material, and b) the
speed of light seems to not be constant over time even in a
given material.

However, the *definition* of a lightyear certainly *is*
constant so you are correct.

Karsten
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Age

[lakew...@copper.net]

Hi Karsten,

The *definition* of a lightyear is *fixed*, i.e., the 'distance light 
travels in a year',
and not directly measurable, e.g., tag a photon and measure its progress 
thoughout
one year.

The problem is that the *distance* each photon travels in a year may not 
be the
same. You are correct re 'speed of light'. The *definition* of a 
lightyear was
created and agreed upon to facilitate measurement. The 'trap' is trying 
to turn this
'convenience' into a physical constant..

Regards!

-Thomas Clark

Karsten Hilbert wrote:

>>>And not constant either, at that.
>>>  
>>>
>>Bugger.
>>http://www.everything2.com/index.pl?node_id=29831&lastnode_id=11221
>>
>>
>I stand corrected as I was being imprecise. I was referring to
>a) the speed of light is depending an material, and b) the
>speed of light seems to not be constant over time even in a
>given material.
>
>However, the *definition* of a lightyear certainly *is*
>constant so you are correct.
>
>Karsten
>  
>
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Age

[Gerard Freriks]

Hi,

Age=: Time since an reference event took place and is expressed as: 
lightyears, years, months, days, minutes, seconds (and parts thereof)
There is one fixed reference point and one changing (non-fixed) 
reference point in time.

e.g.
Event: big bang of our universe -> age of the universe
Event: birth of a person -> age of a person

Puberty=: ???
What is the reference event? Start of sexual development? Certain 
hormonal changes? Or is this the time of birth?
We have two fixed reference points (two fixed referenced events) in 
time and no non-fixed point in time.
This type of concept is clearly different from the 'Age' concept as 
defined above.

My point is:
Concepts like these are expressed in the same manner as 'Age'.
But are different.
Question to be answered: How will we name these two distinct types of 
concepts?
Peter is using the term 'relative age' to indicate things like puberty, 
or menopause.
Both types of concepts are relative since any time measurement is 
relative.
So we need a better term.

In my system of concepts
'Age of a person' is just one  of the  co-ordinates to place an object 
in time-space with its birthdate as reference event

'Age at which a person entered the state of puberty' is not placing a 
person in time-space co-ordinates. It is indicating a change of state 
of the person and the time at which this took place expressed using the 
concept 'age of a person'. It is expressing a functional aspect 
belonging to the person.

Gerard



--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 01 Feb 2005, at 02:45, Elkin, Peter L., M.D. wrote:

> I agree with using date of birth for making the determination of an 
> individual's age, as long as we have support for relative age for 
> concepts such as puberty, menopause, at an age of risk given their 
> family history of a malignance with a first degree relative whose 
> onset of illness was at a certain age.  Relative age also includes 
> number of years since an event like an MI or a CABG which are both 
> medically relevant relative periods of time which are a type of age 
> (years since event) with clinical relevance.
>
> Warm regards,
>
> Peter
>
> Peter L. Elkin, MD
> Professor of Medicine
> Director, Laboratory of Biomedical Informatics
> Department of Internal Medicine
> Mayo Clinic, College of Medicine
> Mayo Clinic, Rochester
> (507) 284-1551
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Age

[Sam Heard]

Tom and others

The idea of age as a complex notion - post-conception, gestational (LMP) 
ie it can involve pre-birth periods - even well into life. This apperas 
to be important for decision support.

I wonder if we need to model this as an archetype for demographics - but 
it needs to be in the EHR - age crops up in lots of evaluations 
(problem, family history) so we might need to have it as a formal TYPE! 
That is - we can use it consistently in various settings.


I would argue that gender is of the same nature - with social gender, 
physical gender and genetic gender as the key concepts.

No doubt there are others but these two are worth thinking about carefully.

Sam

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Age

[Puvanendran SenthilRuban]

I too agree on this. We need to consider about these. 
--- Sam Heard  wrote:

> Tom and others
> 
> The idea of age as a complex notion -
> post-conception, gestational (LMP) 
> ie it can involve pre-birth periods - even well into
> life. This apperas 
> to be important for decision support.
> 
> I wonder if we need to model this as an archetype
> for demographics - but 
> it needs to be in the EHR - age crops up in lots of
> evaluations 
> (problem, family history) so we might need to have
> it as a formal TYPE! 
> That is - we can use it consistently in various
> settings.
> 
> 
> I would argue that gender is of the same nature -
> with social gender, 
> physical gender and genetic gender as the key
> concepts.
> 
> No doubt there are others but these two are worth
> thinking about carefully.
> 
> Sam
> 
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
> 


=
P.Senthilruban B.Sc Eng. (Hons), MIEEE, AMABE.
Senior Software Engineer
Sri Lanka.

TP: +94-777-667296



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Age

[Gerard Freriks]

Hi,

There are two concepts with the name 'age'.

Age as a number. Age=56
Age as a process. baby, youth, post conception, gestational,

As with many concepts we have two different concepts with the same name 
in daily life.

Gerard


--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 26 Jan 2005, at 17:58, Sam Heard wrote:

> Tom and others
>
> The idea of age as a complex notion - post-conception, gestational 
> (LMP) ie it can involve pre-birth periods - even well into life. This 
> apperas to be important for decision support.
>
> I wonder if we need to model this as an archetype for demographics - 
> but it needs to be in the EHR - age crops up in lots of evaluations 
> (problem, family history) so we might need to have it as a formal 
> TYPE! That is - we can use it consistently in various settings.
>
>
> I would argue that gender is of the same nature - with social gender, 
> physical gender and genetic gender as the key concepts.
>
> No doubt there are others but these two are worth thinking about 
> carefully.
>
> Sam
>
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
>
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Age

[lakew...@copper.net]

Hi All,

One should include mental age as well. EHRs should not presume a 
Patient's mental
capabilities  closely track their physical age. This would be a recipe 
for disaaster
under its own terms since 'young' physical age and 'senior' physical age 
represent
gray areas regarding mental competence, etc. These gray areas are 
recognized in
most legal systems.

Regards!

-Thomas Clark

Gerard Freriks wrote:

> Hi,
>
> There are two concepts with the name 'age'.
>
> Age as a number. Age=56
> Age as a process. baby, youth, post conception, gestational,
>
> As with many concepts we have two different concepts with the same 
> name in daily life.
>
> Gerard
>
>
> --  --
> Gerard Freriks, arts
> Huigsloterdijk 378
> 2158 LR Buitenkaag
> The Netherlands
>
> +31 252 544896
> +31 654 792800
> On 26 Jan 2005, at 17:58, Sam Heard wrote:
>
> Tom and others
>
> The idea of age as a complex notion - post-conception, gestational
> (LMP) ie it can involve pre-birth periods - even well into life.
> This apperas to be important for decision support.
>
> I wonder if we need to model this as an archetype for demographics
> - but it needs to be in the EHR - age crops up in lots of
> evaluations (problem, family history) so we might need to have it
> as a formal TYPE! That is - we can use it consistently in various
> settings.
>
>
> I would argue that gender is of the same nature - with social
> gender, physical gender and genetic gender as the key concepts.
>
> No doubt there are others but these two are worth thinking about
> carefully.
>
> Sam
>
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
>
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Age

[USM Bish]

On Thu, Jan 27, 2005 at 01:23:53AM -0800, lakewood at copper.net wrote:
> 
> One should include mental age as  well. EHRs should not presume
> a Patient's  mental capabilities  closely track  their physical
> age. This would  be a recipe for disaaster under  its own terms
> since 'young' physical age and  'senior' physical age represent
> gray areas regarding  mental competence, etc. These  gray areas
> are recognized in most legal systems.
> 
> Gerard Freriks wrote:
> 
> >Hi,
> >
> >There are two concepts with the name 'age'.
> >
> >Age as a number. Age=56
> >Age as a process. baby, youth, post conception, gestational,
> >
> >As with many concepts we have two different concepts with the same 
> >name in daily life.
> >
> >Gerard
> >
> >On 26 Jan 2005, at 17:58, Sam Heard wrote:
> >
> >Tom and others
> >
> >The idea of age as a complex notion - post-conception, gestational
> >(LMP) ie it can involve pre-birth periods - even well into life.
> >This apperas to be important for decision support.
> >
> >I wonder if we need to model this as an archetype for demographics
> >- but it needs to be in the EHR - age crops up in lots of
> >evaluations (problem, family history) so we might need to have it
> >as a formal TYPE! That is - we can use it consistently in various
> >settings.
> >
> >
> >I would argue that gender is of the same nature - with social
> >gender, physical gender and genetic gender as the key concepts.
> >
> >No doubt there are others but these two are worth thinking about
> >carefully.
> >
> >Sam
> >
---end quoted text---

I am of the  view, that there is no requirement  of age at all.
What is  needed is  the date  of birth  in the  initial record.
After that  every time  the patient/  individual seeks  medical
attendance, the  age is  automatically calculated.  This is  of
special relevance in paediatric practice.

The concept of  'age' varies with context and usage,  and it is
best to avoid anything arbitrary or non-specific.

It is  true, that there  are millions who  may not be  aware of
their date of  birth (specially in a country  like mine, India)
but more  often than  not they can  furnish dates  in alternate
calendars, or can give you an approximation to go by.

Dr USM Bish
Bangalore
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Age

[Tim Cook]

On Thu, 2005-01-27 at 05:09, USM Bish wrote:

> 
> I am of the  view, that there is no requirement  of age at all.
> What is  needed is  the date  of birth  in the  initial record.
> After that  every time  the patient/  individual seeks  medical
> attendance, the  age is  automatically calculated.  This is  of
> special relevance in paediatric practice.
> 
> The concept of  'age' varies with context and usage,  and it is
> best to avoid anything arbitrary or non-specific.


Interesting discussion.  The above comments are very close to my own
thoughts on this when I first read Sam's proposal. The ideas presented
in the other replies are certainly valid. 

In the case of neonatal work (as I understand it from the physicians)
there are certain rules of thumb they use based on the (estimated) date
of conception compared with the due date and again compared with the
actual date of birth, modified by factors such as IVF, AI, multiple
births etc..to determine level of prematurity.

My point in that paragraph is to augment my argument that the concept of
'age' should NOT be in the model.  While date of birth and estimated
date of conception SHOULD be in the model.  Any further handling of the
concept of age is an application specific problem.  As has been
identified by other posts in this thread, age is a very context
sensitive idea.

-- 
Sincerely,
Tim Cook
Key ID 9ACDB673 @ http://www.keyserver.net/en/

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Age

[Philippe AMELINE]

Hi,

In Odyssee, we have made the choice of :

1) defining the concept "Age" as an ellapsed time value
2) defining age related concepts (like "child", "old person"...) as
fuzzy sets

I think that it is the only way you can manage this kind of thinks.

We also have a (quite) good model for cyclic events ; I can describe it
further if you want.

Cheers,

Philippe

Tim Cook wrote:

>On Thu, 2005-01-27 at 05:09, USM Bish wrote:
>
>  
>
>>I am of the  view, that there is no requirement  of age at all.
>>What is  needed is  the date  of birth  in the  initial record.
>>After that  every time  the patient/  individual seeks  medical
>>attendance, the  age is  automatically calculated.  This is  of
>>special relevance in paediatric practice.
>>
>>The concept of  'age' varies with context and usage,  and it is
>>best to avoid anything arbitrary or non-specific.
>>
>>
>
>
>Interesting discussion.  The above comments are very close to my own
>thoughts on this when I first read Sam's proposal. The ideas presented
>in the other replies are certainly valid. 
>
>In the case of neonatal work (as I understand it from the physicians)
>there are certain rules of thumb they use based on the (estimated) date
>of conception compared with the due date and again compared with the
>actual date of birth, modified by factors such as IVF, AI, multiple
>births etc..to determine level of prematurity.
>
>My point in that paragraph is to augment my argument that the concept of
>'age' should NOT be in the model.  While date of birth and estimated
>date of conception SHOULD be in the model.  Any further handling of the
>concept of age is an application specific problem.  As has been
>identified by other posts in this thread, age is a very context
>sensitive idea.
>
>  
>

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Age

[Ergin Soysal]

Hi,

About age;
A notice: Gestational age is a part of obstetrical records (e.i. of
mother, or at least strongly related), and usually started by the 1st day
of last mensturation, although real ovulation (thus conception) is about 2
weeks later. So, a simple date data type would be ok.
After birth, time to delivery is a part of personal history of the person.
 e.g. borned at 41st week, 3300gr, ...
Keeping date of birth as a datetime field would be enough to calculate the
both age and age group whenever required, even some pediatrical
requirements like 3/365 (3 days old), 2/12 (2 months old), and so on..

About sex, I believe, standard records must only include M/F/Indetermined
as it's written on the passport of the person.

Any other details other than above for sex and age, will express something
different (like diagnosis or classification..) than our intension: data.

Ergin Soysal, MD.


> Tom and others
>
> The idea of age as a complex notion - post-conception, gestational (LMP)
> ie it can involve pre-birth periods - even well into life. This apperas
> to be important for decision support.
>
> I wonder if we need to model this as an archetype for demographics - but
> it needs to be in the EHR - age crops up in lots of evaluations
> (problem, family history) so we might need to have it as a formal TYPE!
> That is - we can use it consistently in various settings.
>
>
> I would argue that gender is of the same nature - with social gender,
> physical gender and genetic gender as the key concepts.
>
> No doubt there are others but these two are worth thinking about
> carefully.
>
> Sam
>
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
>


Pleksus Bili?im Teknolojileri
http://www.pleksus.com.tr
Tel: +90 (312) 435 5343
Fax: +90 (312) 435 4006

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Age

[Gerard Freriks]

Dear Philippe,

Thank you for your reaction.

I'm interested in your model for cyclic events.

Gerard


--   --
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Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 27 Jan 2005, at 20:15, Philippe AMELINE wrote:

> Hi,
>
> In Odyssee, we have made the choice of :
>
> 1) defining the concept "Age" as an ellapsed time value
> 2) defining age related concepts (like "child", "old person"...) as
> fuzzy sets
>
> I think that it is the only way you can manage this kind of thinks.
>
> We also have a (quite) good model for cyclic events ; I can describe it
> further if you want.
>
> Cheers,
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Age

[Philippe AMELINE]

Hi Gerard,

We have found that we could represent anything cyclic with two concepts 
: regular cycle and unregular cycle

For regular cycle, you have just to specify the cycle length (say P) and 
the event duration (say D) ; time between events is P-D.
Natural langage expression is of the kind "ten minutes every two hours"

For unregular cycle, you need to specify a third parameter : the number 
of events inside a cycle (say N).
Natural langage expression could be : "one hour three times a day"

That way, you just need 5 semantic concepts to express any cyclic 
pattern of an event :
regular cycle
unregular cycle
cycle length
event duration
number of events inside a cycle

Of course, you can add some concepts such as starting time, ending time 
and overall duration.

Well, it seems very simple ; however, we started a project with a lot of 
pre-elaborated sentences samples provided by MDs, and we discovered that 
natural langage is very un-accurate because the same sentence can be 
understood very differently if you think of it as a regular cycle or an 
unregular one.
So we fumbled nearly one month before I was able to discover that the 
underlying model was so simple.

Cheers,

Philippe

Gerard Freriks wrote:

> Dear Philippe,
>
> Thank you for your reaction.
>
> I'm interested in your model for cyclic events.
>
> Gerard
>
>
> --   --
> Gerard Freriks, arts
> Huigsloterdijk 378
> 2158 LR Buitenkaag
> The Netherlands
>
> +31 252 544896
> +31 654 792800
> On 27 Jan 2005, at 20:15, Philippe AMELINE wrote:
>
>> Hi,
>>
>> In Odyssee, we have made the choice of :
>>
>> 1) defining the concept "Age" as an ellapsed time value
>> 2) defining age related concepts (like "child", "old person"...) as
>> fuzzy sets
>>
>> I think that it is the only way you can manage this kind of thinks.
>>
>> We also have a (quite) good model for cyclic events ; I can describe it
>> further if you want.
>>
>> Cheers,
>

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Age

[Isabel Román Martínez]

Hello every body,

Sorry for my intrusion. I?m working with demographic models, so this
discussion about the concept "age" is interesting for me.

I think that the only demographic valid concept of "age" is the difference
between the actual date and the birth date. We can include a very close
concept "aproximate age", when the birth date is not very clear, as Dr USM
Bish comment in his mail. All this can be reduced to include the birth date
in the model, with an additional field "confidence". This new field is
between 0 and 1. And only have value 1 when the birth date is sure. You
don?t have to include the "age" concept if you have "birth date" concept...
of course is better use birth date because this parameter doesn?t change but
age change every second Unfortunately!

All the other concepts are not demographic but clinical and must be
registered (I think) in international codes and included as this in our
archetypes.

Sorry again if this is a nonsense.
Isabel Rom?n

- Original Message -
From: "Philippe AMELINE" 
To: "Gerard Freriks" 
Cc: "OpenEHR Technical" 
Sent: Friday, January 28, 2005 12:37 AM
Subject: Re: Age


> Hi Gerard,
>
> We have found that we could represent anything cyclic with two concepts
> : regular cycle and unregular cycle
>
> For regular cycle, you have just to specify the cycle length (say P) and
> the event duration (say D) ; time between events is P-D.
> Natural langage expression is of the kind "ten minutes every two hours"
>
> For unregular cycle, you need to specify a third parameter : the number
> of events inside a cycle (say N).
> Natural langage expression could be : "one hour three times a day"
>
> That way, you just need 5 semantic concepts to express any cyclic
> pattern of an event :
> regular cycle
> unregular cycle
> cycle length
> event duration
> number of events inside a cycle
>
> Of course, you can add some concepts such as starting time, ending time
> and overall duration.
>
> Well, it seems very simple ; however, we started a project with a lot of
> pre-elaborated sentences samples provided by MDs, and we discovered that
> natural langage is very un-accurate because the same sentence can be
> understood very differently if you think of it as a regular cycle or an
> unregular one.
> So we fumbled nearly one month before I was able to discover that the
> underlying model was so simple.
>
> Cheers,
>
> Philippe
>
> Gerard Freriks wrote:
>
> > Dear Philippe,
> >
> > Thank you for your reaction.
> >
> > I'm interested in your model for cyclic events.
> >
> > Gerard
> >
> >
> > --   --
> > Gerard Freriks, arts
> > Huigsloterdijk 378
> > 2158 LR Buitenkaag
> > The Netherlands
> >
> > +31 252 544896
> > +31 654 792800
> > On 27 Jan 2005, at 20:15, Philippe AMELINE wrote:
> >
> >> Hi,
> >>
> >> In Odyssee, we have made the choice of :
> >>
> >> 1) defining the concept "Age" as an ellapsed time value
> >> 2) defining age related concepts (like "child", "old person"...) as
> >> fuzzy sets
> >>
> >> I think that it is the only way you can manage this kind of thinks.
> >>
> >> We also have a (quite) good model for cyclic events ; I can describe it
> >> further if you want.
> >>
> >> Cheers,
> >
>
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org

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Age

[Thomas Beale]

b.cohen wrote:

>This is actually a 'type refinement'.
>You already have a type 'number' whose instances are values that may be 
>operated
>on and stand in various relations, particularly ordering and equality.
>Now you want to refine it so that two instances of the refined type with the
>same 'value' are not necessarily equal.
>The main question that must be asked in these circumstances is:
>Will the definitions of the operations and relations in which the new type is 
>to
>participate violate any of the definitions that applied to the old type?
>If so, then all instances of usage of the old type must be reexamined and
>brought back into line.
>This is known as the 'frame problem'.
>Good luck.
>
>  
>
This thread is probably touching on multiple requirements, but my gut 
feeling is that there is a requirement for a "fuzzy band" data type 
which does the following:
- can accept data input in numeric ("I had mumps when I was 13") or word 
("I had mumps in my adolescence") form
- has a definition of its fuzzy bands in terms of names and limits; 
e.g.  infancy:0-3; childhood: 4-11; adolescence: 12-17; etc
- can be queried in terms of the names of the bands or values
- has solid definitions for mathematical operations

To be properly "fuzzy", the bands are not adjacent blocks but may 
overlap (usually drawn as trapezoids in a graph rendition); the utility 
of this (I think) is to allow outer numeric range defintions for word 
forms of the datum. E.g. "childhood" might be equated to 4-13 and 
"adolescence" equated to 12-18 etc. I'm not sure that this is useful 
without proper statistical models to drive it.

Nevertheless, it occurs so often in clinical medicine that clinicians 
want to enter the same thing in different circumstances using either 
names (which really represent bands of values), or actual precise values 
(or sometimes, a precise interval).
Examples:
- age: sometimes doctors and/or patients only think in terms of "phase 
of life" and use terms like "early adolescence"; other times they use 
the precise age in years. The paediatric ages Sam mentions seem like an 
example of this. But I think there is additionally a need to know "age 
since conception" as Sam has been told by people the HL7 meeting.
- timing: terms like "morning", "afternoon", "evening" are often used to 
tell patients when to take medication, or by patients to say when 
somehting happened. When a doctor says "3 times a day" she usually means 
"3 times a day, spread apart as evenly and far as reasonable for you". 
If you question them further, they would probably say that the patient 
should take one table in the "morning" band, one in the "afternoon" band 
and so on. Pushed further, they could nominate reasonable ranges for 
these bands of time

Currently, information systems really struggle with this simple 
requirements - they usually record the values as different types, and 
have to do some messy processing to be able to handle them for 
statistical purposes. But a two-level modelling approach would suggest 
archetyping the meaning (i.e. the names and interval definitions) of 
such types on a per-archetype basis, and also defining a new data type 
that could handle either a coded term or a quantity value, and function 
sensibly in terms of mathematical operations.

Maybe Bernie Cohen or other mathematicians here can provide some more 
precise ideas here.

- thomas beale


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Age

[Thomas Beale]

Tim Cook wrote:

>On Thu, 2005-01-27 at 05:09, USM Bish wrote:
>
>  
>
>>I am of the  view, that there is no requirement  of age at all.
>>What is  needed is  the date  of birth  in the  initial record.
>>After that  every time  the patient/  individual seeks  medical
>>attendance, the  age is  automatically calculated.  This is  of
>>special relevance in paediatric practice.
>>
>>The concept of  'age' varies with context and usage,  and it is
>>best to avoid anything arbitrary or non-specific.
>>
>>
>
>
>Interesting discussion.  The above comments are very close to my own
>thoughts on this when I first read Sam's proposal. The ideas presented
>in the other replies are certainly valid. 
>  
>
I think it's a given that we assume that "age" is not literally recorded 
in the db - the question is whether date of birth is good enough. 
Clearly for many paediatric cases it is not, since birth can come at a 
nearly arbitrary time these days (20 weeks?). To avoid working with 
negative ages, the one proper point of reference we have is (estimated) 
date of conception, but for most patients we probabl dont' need this. I 
suspect an application level type is needed that generates 
age_since_birth and age_since_conception from recorded expected date of 
delivery, which should presumably be estimated date of conception + 38 
weeks (Sam tells me that actually recording the date of conception can 
get people into trouble!).. So "expected date of delivery" (assuming 
normal ful-term pregnancy) seems to me to be the reliable raw datum that 
paediatricians and other peri-natal carers might be interested in; 
coupled with a smart "age" class, it should be possble to get the 
desired effect.

>In the case of neonatal work (as I understand it from the physicians)
>there are certain rules of thumb they use based on the (estimated) date
>of conception compared with the due date and again compared with the
>actual date of birth, modified by factors such as IVF, AI, multiple
>births etc..to determine level of prematurity.
>  
>
yes - the smart "age" type could incorporate some of this knowledge , or 
else ask some knowledge base to generate "effective biologic ages" of 
various kinds (are different systems' development retarded 
differentially depending on the 'problem'? I.e. premature birth versus 
IVF,, etc as Tim mentions? This all suggest strongly to me "knowledge 
layer" not "information model layer"!

- thomas


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Age

[Gerard Freriks]

Thomas,

What you wrote with respect to age, is absolutely true.
It is a notion defined at the knowledge layer.
But expressed at an information model layer.

On the level of the knowledge layer 'age' is more than a set of numbers 
indicating the time past since an arbitrary point in time.

Next to 'age' there will be more notions that warrant the same 
discussions we have had.

Gerard




--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 29 Jan 2005, at 02:07, Thomas Beale wrote:

> This all suggest strongly to me "knowledge layer" not "information 
> model layer"!
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Age

[USM Bish]

On Sat, Jan 29, 2005 at 05:26:45PM +0530, USM Bish wrote:
> On Sat, Jan 29, 2005 at 01:07:06AM +, Thomas Beale wrote:
> 
> I think it's a given that we assume that "age" is not literally
> recorded in the db  - the question is whether date  of birth is
> good enough.
>

If  the EHR  is  designed is  to be  developed  for a  'patient
centric'  database  where  data  is  appended  from  the  first
registration onwards to ad-infinetum till  his/ her death,  the 
only thing needed is DOB.
 
If the objective of the EHR  is institution or episode centric,
then ofcourse amendments  as per the need may be  thought of as
per the setting.
 
>
> Clearly for  many paediatric cases it  is not, since  birth can
> come at a nearly arbitrary time these days (20 weeks?).
>

Prematurity  and  postmaturity  are  concepts  in  relation  to
gestational age  (being one of  the component factors)  and not
chronological 'age' per se (viz. 'age' as we percieve in common
medical parliance).
 
> To avoid  working with negative ages,  the one proper  point of
> reference we  have is (estimated)  date of conception,  but for
> most  patients  we  probabl  dont'  need  this.  I  suspect  an
> application level type is needed that generates age_since_birth
> and  age_since_conception   from  recorded  expected   date  of
> delivery,  which   should  presumably  be  estimated   date  of
> conception + 38 weeks (Sam tells me that actually recording the
> date of conception can get people into trouble!)..
 
I am  of the view, that  things like 'age since  conception' is
too variable a  thing to be included in  an objective database.
In  cases  of  conception  within  the  period  of  gestational
amenorrhoea, or  worse still,  spotting after  conception, more
often than  not, gestatonal age is  determined from  ultrasound
findings and  other methods. It is  best to leave these  to the
discretion of the practitioner.
 
> 
> In  the case  of neonatal  work (as  I understand  it from  the
> physicians) there are certain rules of  thumb they use based on
> the (estimated) date  of conception compared with  the due date
> and again compared  with the actual date of  birth, modified by
> factors such as IVF, AI,  multiple births etc..to determine
> level of prematurity.
>
 
There is actually little guess work here. If the last menstural
period   is   known,   the  calculations   are   quite   simple
(irrespective  of  the  method  of  conception).  Even  without
accurate  LMP, a  fairly  good  estimation of  the  development
process can  be obtained (while the  baby is in the  womb) with
invesigation methods available today.
 
Normally, in medical practice, the  term 'age' is chronological
age in  years as  on last  birthday (except  in paed  practice,
where it may be in days, weeks or months). If credence is to be
given to  gestational age,  mental age and  other ages  used in
various sub-disciplines  of medicine, the  implementation would
go into  all sorts  of tangents  and unnecessary  complexities.
Yes, alternate age definitions may  find a place in specialised
scenerios, but not in a generic medical database setting.
 
I would suggest, to clearly  define 'age' as chronological age,
and proceed accordingly.

 
 
Dr USM Bish
Bangalore
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Age

[Bill Walton]

USM Bish wrote:

> > On Sat, Jan 29, 2005 at 01:07:06AM +, Thomas Beale wrote:
> >
> > I think it's a given that we assume that "age" is not literally
> > recorded in the db  - the question is whether date  of birth is
> > good enough.
> >
>
> If  the EHR  is  designed is  to be  developed  for a  'patient
> centric'  database  where  data  is  appended  from  the  first
> registration onwards to ad-infinetum till  his/ her death,  the
> only thing needed is DOB.

It seems to me, although I'm not a physician, that there are, or we might
learn that, there are medical problems that crop up later in life that are
related to whether or not a person was born full-term or not.  If so, or it
it's a possibility, then perhaps that needs to be recorded.  Is there some
sort of problem, either technical or philosophical, with recording both DOB
and [estimated] DOC?

Best regards,
Bill

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Age

[Thomas Beale]

Bill Walton wrote:

>
>
>It seems to me, although I'm not a physician, that there are, or we might
>learn that, there are medical problems that crop up later in life that are
>related to whether or not a person was born full-term or not.  If so, or it
>it's a possibility, then perhaps that needs to be recorded.  Is there some
>sort of problem, either technical or philosophical, with recording both DOB
>and [estimated] DOC?
>  
>
Sam says that rather than estimated DOC, estimated date of delivery 
should be actually recorded, since if a DOC is estimated then recorded 
and it turns out that e.g. the father was known to still be in Canada 
that week on business, it can create all kinds of problems - when the 
explanation is probably compltely innocent. So he suggests that 
estimated DOC should be always computed from estimated DOD, rather than 
being stored. But the result is the same at the application level - a 
0-offset age from the (approximate) moment of conception (for those 
patients for whom this is relevant obviously).

- thomas


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Age

[Bill Walton]

Hi Thomas,

Thomas Beale:


> Bill Walton wrote:
>
> >It seems to me, although I'm not a physician, that there are, or we might
> >learn that, there are medical problems that crop up later in life that
are
> >related to whether or not a person was born full-term or not.  If so, or
it
> >it's a possibility, then perhaps that needs to be recorded.  Is there
some
> >sort of problem, either technical or philosophical, with recording both
DOB
> >and [estimated] DOC?
> >
> >
> Sam says that rather than estimated DOC, estimated date of delivery
> should be actually recorded, since if a DOC is estimated then recorded
> and it turns out that e.g. the father was known to still be in Canada
> that week on business, it can create all kinds of problems - when the
> explanation is probably compltely innocent. So he suggests that
> estimated DOC should be always computed from estimated DOD, rather than
> being stored. But the result is the same at the application level - a
> 0-offset age from the (approximate) moment of conception (for those
> patients for whom this is relevant obviously).

Please forgive my density ;-)

I understand what Sam's saying, but I don't see how that provides the
information to which I was referring.  Specifically, how would it be
recorded that a person was born at something (perhaps significantly) less
than full-term?

Thanks,
Bill

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Age

[Ergin Soysal]

I'm not sure if it makes sense. Because:

Calcution DOC using DOD is not a secret. So the father can easily
calculate DOC back, if your intention is to provide some level of privacy.
And you are assuming, father will not see this information at the
application level, but at the raw data level.
Also, you must keep conceptional age confidential, since it's expressed in
weeks for a long time.

Ergin Soysal, MD


> Bill Walton wrote:
>
>>
>>
>>It seems to me, although I'm not a physician, that there are, or we might
>>learn that, there are medical problems that crop up later in life that
>> are
>>related to whether or not a person was born full-term or not.  If so, or
>> it
>>it's a possibility, then perhaps that needs to be recorded.  Is there
>> some
>>sort of problem, either technical or philosophical, with recording both
>> DOB
>>and [estimated] DOC?
>>
>>
> Sam says that rather than estimated DOC, estimated date of delivery
> should be actually recorded, since if a DOC is estimated then recorded
> and it turns out that e.g. the father was known to still be in Canada
> that week on business, it can create all kinds of problems - when the
> explanation is probably compltely innocent. So he suggests that
> estimated DOC should be always computed from estimated DOD, rather than
> being stored. But the result is the same at the application level - a
> 0-offset age from the (approximate) moment of conception (for those
> patients for whom this is relevant obviously).
>
> - thomas
>
>
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
>


Pleksus Bili?im Teknolojileri
http://www.pleksus.com.tr
Tel: +90 (312) 435 5343
Fax: +90 (312) 435 4006

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Age

[Thomas Beale]

Bill Walton wrote:

> Please forgive my density ;-)
>
>I understand what Sam's saying, but I don't see how that provides the
>information to which I was referring.  Specifically, how would it be
>recorded that a person was born at something (perhaps significantly) less
>than full-term?
>  
>
well I assume that EDD and DOB are both recorded. So EDD might be 15 sep 
2000 (implying conception on 1/1/2000 - sorry to the obstetricians if I 
am a bit off  here!); DOB might be 1 aug 2000, implying a 6-week 
premature birth. Then an application Age object could compute or provide:
- date_of_birth : Date
- estimated_date_of_delivery: Date
- estimated_date_of_conception : Date
- prematurity: Duration (days/weeks ?)
- biological_age: Duration
- other special concepts.

I don;t know what specialists call the last two - I am just inventing 
here - but presumably there is a concept representing "age of organism 
since conception".

- thomas beale



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Age

[Thomas Beale]

Isabel Rom?n Mart?nez wrote:

>Hello every body,
>
>Sorry for my intrusion. I?m working with demographic models, so this
>discussion about the concept "age" is interesting for me.
>
>I think that the only demographic valid concept of "age" is the difference
>between the actual date and the birth date. We can include a very close
>concept "aproximate age", when the birth date is not very clear, as Dr USM
>Bish comment in his mail. All this can be reduced to include the birth date
>in the model, with an additional field "confidence". This new field is
>between 0 and 1. And only have value 1 when the birth date is sure. You
>don?t have to include the "age" concept if you have "birth date" concept...
>of course is better use birth date because this parameter doesn?t change but
>age change every second Unfortunately!
>
>All the other concepts are not demographic but clinical and must be
>registered (I think) in international codes and included as this in our
>archetypes.
>
>  
>
I think you are at least partly right here - for other values which need 
to be stored but are not date of birth should be archetyped. In fact, in 
the openEHR demographic model, not even date of birth (or date of death 
by the way) are hard-modelled - it is all archetyped.

- thomas


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Age

[Sam Heard]

Philippe

I would suggest that the duration of the event is not included - rather 
modelled in instructions themselves as there are many different ideas of 
event duration. The time to give a dose of intravenous agent may be very 
specific and I believe needs to be modelled explicitly - not as part of 
a time specification. That is, it is necessary to say that the dose must 
be given over at least 20 minutes. Rather than the medication is given 
for 20 min twice a day.

The other point is that the model you have come up with is part of 
workflow - but theirs are more complex as events are related and timing 
of relations is also important.

Cheers, Sam

> Hi Gerard,
> 
> We have found that we could represent anything cyclic with two concepts 
> : regular cycle and unregular cycle
> 
> For regular cycle, you have just to specify the cycle length (say P) and 
> the event duration (say D) ; time between events is P-D.
> Natural langage expression is of the kind "ten minutes every two hours"
> 
> For unregular cycle, you need to specify a third parameter : the number 
> of events inside a cycle (say N).
> Natural langage expression could be : "one hour three times a day"
> 
> That way, you just need 5 semantic concepts to express any cyclic 
> pattern of an event :
> regular cycle
> unregular cycle
> cycle length
> event duration
> number of events inside a cycle
> 
> Of course, you can add some concepts such as starting time, ending time 
> and overall duration.
> 
> Well, it seems very simple ; however, we started a project with a lot of 
> pre-elaborated sentences samples provided by MDs, and we discovered that 
> natural langage is very un-accurate because the same sentence can be 
> understood very differently if you think of it as a regular cycle or an 
> unregular one.
> So we fumbled nearly one month before I was able to discover that the 
> underlying model was so simple.
> 
> Cheers,
> 
> Philippe
> 
> Gerard Freriks wrote:
> 
>> Dear Philippe,
>>
>> Thank you for your reaction.
>>
>> I'm interested in your model for cyclic events.
>>
>> Gerard
>>
>>
>> --   --
>> Gerard Freriks, arts
>> Huigsloterdijk 378
>> 2158 LR Buitenkaag
>> The Netherlands
>>
>> +31 252 544896
>> +31 654 792800
>> On 27 Jan 2005, at 20:15, Philippe AMELINE wrote:
>>
>>> Hi,
>>>
>>> In Odyssee, we have made the choice of :
>>>
>>> 1) defining the concept "Age" as an ellapsed time value
>>> 2) defining age related concepts (like "child", "old person"...) as
>>> fuzzy sets
>>>
>>> I think that it is the only way you can manage this kind of thinks.
>>>
>>> We also have a (quite) good model for cyclic events ; I can describe it
>>> further if you want.
>>>
>>> Cheers,
>>
>>
> 
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
> 
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Age

[William E Hammond]

For an age, I agree that the date of birth is adequate as long as you
remember people do not age after they die.  It is also convenient to have a
reference time mark for many things, including conception, start of a
course of treatment.  Adjectives and nouns are difficult to put into
algorithms unless the definitions are precise.

Ed Hammond





USM Bish @openehr.org on 01/29/2005 07:12:55 AM

Please respond to USM Bish 

Sent by:owner-openehr-technical at openehr.org


To:OpenEHR Technical 
cc:

Subject:Re: Age

On Sat, Jan 29, 2005 at 05:26:45PM +0530, USM Bish wrote:
> On Sat, Jan 29, 2005 at 01:07:06AM +, Thomas Beale wrote:
>
> I think it's a given that we assume that "age" is not literally
> recorded in the db  - the question is whether date  of birth is
> good enough.
>

If  the EHR  is  designed is  to be  developed  for a  'patient
centric'  database  where  data  is  appended  from  the  first
registration onwards to ad-infinetum till  his/ her death,  the
only thing needed is DOB.

If the objective of the EHR  is institution or episode centric,
then ofcourse amendments  as per the need may be  thought of as
per the setting.

>
> Clearly for  many paediatric cases it  is not, since  birth can
> come at a nearly arbitrary time these days (20 weeks?).
>

Prematurity  and  postmaturity  are  concepts  in  relation  to
gestational age  (being one of  the component factors)  and not
chronological 'age' per se (viz. 'age' as we percieve in common
medical parliance).

> To avoid  working with negative ages,  the one proper  point of
> reference we  have is (estimated)  date of conception,  but for
> most  patients  we  probabl  dont'  need  this.  I  suspect  an
> application level type is needed that generates age_since_birth
> and  age_since_conception   from  recorded  expected   date  of
> delivery,  which   should  presumably  be  estimated   date  of
> conception + 38 weeks (Sam tells me that actually recording the
> date of conception can get people into trouble!)..

I am  of the view, that  things like 'age since  conception' is
too variable a  thing to be included in  an objective database.
In  cases  of  conception  within  the  period  of  gestational
amenorrhoea, or  worse still,  spotting after  conception, more
often than  not, gestatonal age is  determined from  ultrasound
findings and  other methods. It is  best to leave these  to the
discretion of the practitioner.

>
> In  the case  of neonatal  work (as  I understand  it from  the
> physicians) there are certain rules of  thumb they use based on
> the (estimated) date  of conception compared with  the due date
> and again compared  with the actual date of  birth, modified by
> factors such as IVF, AI,  multiple births etc..to determine
> level of prematurity.
>

There is actually little guess work here. If the last menstural
period   is   known,   the  calculations   are   quite   simple
(irrespective  of  the  method  of  conception).  Even  without
accurate  LMP, a  fairly  good  estimation of  the  development
process can  be obtained (while the  baby is in the  womb) with
invesigation methods available today.

Normally, in medical practice, the  term 'age' is chronological
age in  years as  on last  birthday (except  in paed  practice,
where it may be in days, weeks or months). If credence is to be
given to  gestational age,  mental age and  other ages  used in
various sub-disciplines  of medicine, the  implementation would
go into  all sorts  of tangents  and unnecessary  complexities.
Yes, alternate age definitions may  find a place in specialised
scenerios, but not in a generic medical database setting.

I would suggest, to clearly  define 'age' as chronological age,
and proceed accordingly.



Dr USM Bish
Bangalore
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Age

[Gerard Freriks]

Dear all,

It is fine for me when we can agree that we mean by 'Age' time after 
birth.

How will we name and define concepts like: youth, post conception, post 
gestation, middel aged, elderly?

Gerard
--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 31 Jan 2005, at 19:10, William E Hammond wrote:

> For an age, I agree that the date of birth is adequate as long as you
> remember people do not age after they die.  It is also convenient to 
> have a
> reference time mark for many things, including conception, start of a
> course of treatment.  Adjectives and nouns are difficult to put into
> algorithms unless the definitions are precise.
>
> Ed Hammond
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Age

[Philippe AMELINE]

Gerard,

 From all the messages, it seems to me we can define 3 kind of values :

1) Values with a genuine relationship with date of birth : youth, middle 
age, elderly...
Those who can manage fuzzy sets will do it that way, while others will 
have to use simple time intervals based on date of birth.
Can we define these fuzzy sets or intervals as standards ? Maybe we 
should work on it.

2) Values somewhat related to age, but with a non linear/standard 
relationship : date of conception, date of first flue, date of first walk...
These dates should be recorded somewhere, as unrelated informations.

3) Values whose name includes the term "age", but are, in fact, ratios : 
mental age, growth age...
These informations are neither dates, nor time intervals, but only some 
comparisons versus a "standard developpement" ; from my point of view, 
they are some kind of ratios and have little to do with this discussion.

Cheers,

Philippe

> Dear all,
>
> It is fine for me when we can agree that we mean by 'Age' time after 
> birth.
>
> How will we name and define concepts like: youth, post conception, 
> post gestation, middel aged, elderly?
>
> Gerard
> --   --
> Gerard Freriks, arts
> Huigsloterdijk 378
> 2158 LR Buitenkaag
> The Netherlands
>
> +31 252 544896
> +31 654 792800
> On 31 Jan 2005, at 19:10, William E Hammond wrote:
>
>> For an age, I agree that the date of birth is adequate as long as you
>> remember people do not age after they die.  It is also convenient to 
>> have a
>> reference time mark for many things, including conception, start of a
>> course of treatment.  Adjectives and nouns are difficult to put into
>> algorithms unless the definitions are precise.
>>
>> Ed Hammond
>

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Age

[William E Hammond]

Who are you calling elderly?

I still hold out for age, even if it is fuzzy.

Ed




Gerard Freriks @openehr.org on 01/31/2005 04:25:17 PM

Please respond to Gerard Freriks 

Sent by:owner-openehr-technical at openehr.org


To:William E Hammond 
cc:OpenEHR Technical , USM Bish
   

Subject:Re: Age

Dear all,

It is fine for me when we can agree that we mean by 'Age' time after
birth.

How will we name and define concepts like: youth, post conception, post
gestation, middel aged, elderly?

Gerard
--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 31 Jan 2005, at 19:10, William E Hammond wrote:

> For an age, I agree that the date of birth is adequate as long as you
> remember people do not age after they die.  It is also convenient to
> have a
> reference time mark for many things, including conception, start of a
> course of treatment.  Adjectives and nouns are difficult to put into
> algorithms unless the definitions are precise.
>
> Ed Hammond


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Age

[Elkin, Peter L., M.D.]

I agree with using date of birth for making the determination of an 
individual's age, as long as we have support for relative age for concepts such 
as puberty, menopause, at an age of risk given their family history of a 
malignance with a first degree relative whose onset of illness was at a certain 
age.  Relative age also includes number of years since an event like an MI or a 
CABG which are both medically relevant relative periods of time which are a 
type of age (years since event) with clinical relevance.

Warm regards,

Peter

Peter L. Elkin, MD
Professor of Medicine 
Director, Laboratory of Biomedical Informatics
Department of Internal Medicine
Mayo Clinic, College of Medicine
Mayo Clinic, Rochester
(507) 284-1551
Fax: (507) 284-5370
 
 

-Original Message-
From: owner-openehr-technical at openehr.org 
[mailto:owner-openehr-techni...@openehr.org] On Behalf Of William E Hammond
Sent: Monday, January 31, 2005 6:32 PM
To: Gerard Freriks
Cc: OpenEHR Technical; USM Bish
Subject: Re: Age

Who are you calling elderly?

I still hold out for age, even if it is fuzzy.

Ed




Gerard Freriks @openehr.org on 01/31/2005 04:25:17 PM

Please respond to Gerard Freriks 

Sent by:owner-openehr-technical at openehr.org


To:William E Hammond 
cc:OpenEHR Technical , USM Bish
   

Subject:    Re: Age

Dear all,

It is fine for me when we can agree that we mean by 'Age' time after
birth.

How will we name and define concepts like: youth, post conception, post
gestation, middel aged, elderly?

Gerard
--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 31 Jan 2005, at 19:10, William E Hammond wrote:

> For an age, I agree that the date of birth is adequate as long as you
> remember people do not age after they die.  It is also convenient to
> have a
> reference time mark for many things, including conception, start of a
> course of treatment.  Adjectives and nouns are difficult to put into
> algorithms unless the definitions are precise.
>
> Ed Hammond


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Age - a summary

[Sam Heard]

Ergin, and all

ERGIN: Thanks - there is no problem working from date of birth forward 
to age group - it is when you are working back and times are fuzzy. In 
family history when the DOB is not known it is even more of an issue.

The issue of FUZZY ages (and other quantities)

I believe we need a means of representing quantities in a named band - 
even if the naming varies. So data can be entered as 'adolescent' and 
the age entered as a range from 13-20 yrs (or some other range). In 
family history 'young adult' may be a requirement (18-20 yrs). The 
important thing is that a textural representation of the data, plus a 
range is entered.

In the future the timing phrase 'last night' might need to be computable 
- so the time range of 2200 - 0600 might be entered for computational 
purposes.

Another example of when the text is important is 'three times each day' 
and 'every eight hours'. Using iCal times it is possible to 
differentiate these but once actual times for taking the medication have 
been agreed then, if the timing is exactly 8 hours apart the 
differentiation is lost.

Three times a day may be represented in iCal as:

FREQ=DAILY;OCCURRENCES=3

Eight hourly is

FREQ=HOURLY;INTERVAL=8

But, in a setting where administration is controlled both of these 
timing rules may be transformed into:

0600;1400;2200

Recommendation:
We consider a formal way of representing verbal statements of quantity 
and the quantity or quantity range they represent.

The issue of Age for Paediatrics

On the paediatric front - it is the age from conception that the 
clinicians work from in decision support and protocols - as the children 
are often born very early and their DoB does not provide the details 
necessary. For instance, the dose of a drug will be represented as mg/kg 
in age ranges post conception in a neonatal intensive care unit.

I agree with a number of statements that we need to record 2 date/times

The first is the date of birth - just as we have always done.

The second is to record a date time that allows us to estimate the date 
of development since conception.

As LMP is not an appropriate measure (it is not reliable), the two 
possibilities are:

1. Approximate date of conception
2. Expected Date of birth (based on 38 week gestation)

You can then calculate one from the other quite safely. One could allow 
either - but I would suggest for interoperability issues we should have 
one modelled concisely in the demographic model.

The advantage of the first is that it gives an anchor date for the sort 
of calculations without any computation. The advantage of the second 
(EDB) is that this data is usually in the mothers record (EDD) and also 
that giving a date of conception can cause great anguish to people (as 
they were not together at that time e.g. the  partner who returns from 
military service and the approximate date of conception is calculated as 
7 days before he returned).

What I am sure of is that we need (at least) one of these modelled as 
part of the openEHR demographic model.

Cheers, Sam



> Hi,
> 
> About age;
> A notice: Gestational age is a part of obstetrical records (e.i. of
> mother, or at least strongly related), and usually started by the 1st day
> of last mensturation, although real ovulation (thus conception) is about 2
> weeks later. So, a simple date data type would be ok.
> After birth, time to delivery is a part of personal history of the person.
>  e.g. borned at 41st week, 3300gr, ...
> Keeping date of birth as a datetime field would be enough to calculate the
> both age and age group whenever required, even some pediatrical
> requirements like 3/365 (3 days old), 2/12 (2 months old), and so on..
> 
> About sex, I believe, standard records must only include M/F/Indetermined
> as it's written on the passport of the person.
> 
> Any other details other than above for sex and age, will express something
> different (like diagnosis or classification..) than our intension: data.
> 
> Ergin Soysal, MD.
> 
> 
> 
>>Tom and others
>>
>>The idea of age as a complex notion - post-conception, gestational (LMP)
>>ie it can involve pre-birth periods - even well into life. This apperas
>>to be important for decision support.
>>
>>I wonder if we need to model this as an archetype for demographics - but
>>it needs to be in the EHR - age crops up in lots of evaluations
>>(problem, family history) so we might need to have it as a formal TYPE!
>>That is - we can use it consistently in various settings.
>>
>>
>>I would argue that gender is of the same nature - with social gender,
>>physical gender and genetic gender as the key concepts.
>>
>>No doubt there are others but these two are worth thinking about
>>carefully.
>>
>>Sam
>>
>>-

Age and named quantities

[Gerard Freriks]

Sam,

You mean the 'age of a person' and not 'age'.

Gerard


--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 31 Jan 2005, at 23:30, Sam Heard wrote:

> Age is time after birth - we are not going to change that.
>
> We have agreed that we need to record one more date in the demographic 
> model - which is 'approximate date of conception', or 'expected date 
> of birth'
>
> Which do people prefer - I chose the latter as it will probably be a 
> cut and paste from the mothers record and does not get into the when 
> did I conceive stuff.
>
> What do others think?
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Age and named quantities

[USM Bish]

On Tue, Feb 01, 2005 at 08:00:39AM +0930, Sam Heard wrote:
> 
> Age is time after birth - we are not going to change that.
>

That's fine ... now for the second ...

> We have agreed that we need to record one more date in the demographic 
> model - which is 'approximate date of conception', or 'expected date of 
> birth'

We should  confine ourselves with available  recommendations of
the WHO, which  is based on LMP only. All  other parameters are
derived from this. Besides, LMP is a fixed recordable event.

>From the  XML, I understand,  you may  be thinking in  terms of
some gestational history  for the newborn. Calculations  can be
done from  the mother's  obstretic history,  as per  parameters
defined by the WHO. This is the current recommendations:

o LMP = first day of the Last Menstrual Period
o Prematurity  = birth < (LMP + 37 wk) gestation
o Normal gestation = birth > (LMP + 38 wk) < (LMP + 41 wk)
o Postmaturity = birth > (LMP + 42 wk) gestation

Please note the hazy zones between 37-38th week and 41-42nd wk.
We can expand the band of normalcy from 37 to 42, and eliminate
this vagueness without significant real-life issues.

Date of Conception is normally not used because it depends upon
the periodicity of the menstural cycle of the mother and  other
factors. The variations are too many to be correctly instituted
as a measure.

If you are thinking of an additional  DV_Textual_ordered  class
as seen from the XML (quoted below) then:

> 
>   "Birth"
>   
>   0
>   "days"
>   
> 
>

o The 'magnitude' would obviously have to be taken from the EDD
  (Expected Date of Delivery). Since the  'normal range' itself
  is a wide band, with the midian point at (LMP + 274 days) the  
  above representation would have to be re-structured.

o Incidentally, there is also an alternate 'prematurity' defini-
  tion based on weight - the original WHO recommendation of 1948
  (viz birth weight < 2500 gm). This covers the "small-for-date"
  newborns, burn within normal gestation period. This  is  still
  in use in several countries (mainly developing countries).This
  should not be ignored.

o Postmaturity is another factor which would  need  inclusion in
  such a textual class. To keep it simple and  self explanatory,
  I suppose, the following should do:

  
  "Gestation_period"
  
  0
  "weeks"
  
  

  
  "Birth_weight"
  
  0
  "grams"
  
  

Keeping the gestational period kept as an absolute number leaves
things like  normal range,  prematurity,  postmaturity etc  as a
search/ derived parameter. Any changes in WHO criteria would not
affect the database.

Just a suggestion ...

Dr USM Bish
Bangalore

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Age and named quantities

[Thomas Beale]

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URL: 

Age and named quantities

[USM Bish]

On Tue, Feb 01, 2005 at 04:03:04PM +, Thomas Beale wrote:
>
[some snipped]
>
> I would like  to discourage people from using raw  XML in posts
> meant  for  humans to  read  (i.e.  any  post). XML  is  pretty
> unreadable at the best of times,  and usually obscures the data
> with the tags.
>

Valid point. Even worse, when using  a HTML mailer, where white
space  formatting in  mails from  vanilla text  mailers may  be
'chomped' and the indenting also goes ...

> A better  way of presenting data  is just indented  attribute =
> value form (effectively textual UML instance form)

Accepted. UML would be the defacto for me (in future) ...

Cheers

Dr USM Bish
Bangalore
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Age, gender and more

[Sam Heard]

Hi

Gerard has raised other issues - there are names for age-ranges or 
phases such as adolescence, neonatal, toddler. It may be too much for us 
to deal with but age is certainly not just a number - you just have to 
ask the mother of a small baby - it has units like days, weeks, months.

I think Gerard missed the point of post-conceptual age - it is the time 
since conception and if a child is born very early, remains the basis on 
which dosing and milestones are based - sometimes for years after birth.

This was raised as a key issue in systems for paediatricians.

So I was wondering if we should model a class specifically for date of 
birth.which handles date of birth and age as a function, and which 
takes arguments like date of conception, date of mothers LMP, Expected 
Date of Delivery and stores the normal gestational birthdate as well. 
The class then has a feature called post-conception age as well.

The advantage is that we could even deal with things like 'post-natal' 
as a function (actual birth to day 28) and other phases in future if 
appropriate. It would mean that in family history you could enter 'young 
adulthood' as an age which might be better than guessing 22.

Further, I think in our DateTime class we should store text as well as 
the date if people want - this would allow us to store "4.30 yesterday" 
if a transcription tool wanted to - and the actual date time. This can 
make observational data much easier to read when scanning back.

It also means that we can deal with almost impossible fuzzy times like 
'last night' in some reasonable fuzzy way without losing the key 
information.

In our timing specification for workflow the same will have the same 
issue ie we may need the text as well as the computable data - three 
times a day might be at 08:00, 16:00 and 00:00, but it is a different 
instruction than 8 hourly (where there is no flexibility on spacing of 
doses).

Thats enough for now...but I am thinking of putting a change request 
together if there is enough interest. The DateOfBirth issue will win a 
lot of friends in paediatrics...they are really concerned that their 
absolute requirements are never addressed in systems!

Cheers, Sam




Any more thoughts?

Sam

b.cohen wrote:
> This is actually a 'type refinement'.
> You already have a type 'number' whose instances are values that may be 
> operated
> on and stand in various relations, particularly ordering and equality.
> Now you want to refine it so that two instances of the refined type with the
> same 'value' are not necessarily equal.
> The main question that must be asked in these circumstances is:
> Will the definitions of the operations and relations in which the new type is 
> to
> participate violate any of the definitions that applied to the old type?
> If so, then all instances of usage of the old type must be reexamined and
> brought back into line.
> This is known as the 'frame problem'.
> Good luck.
> 
> Quoting Sam Heard :
> 
> 
>>Tom and others
>>
>>The idea of age as a complex notion - post-conception, gestational (LMP) 
>>ie it can involve pre-birth periods - even well into life. This apperas 
>>to be important for decision support.
>>
>>I wonder if we need to model this as an archetype for demographics - but 
>>it needs to be in the EHR - age crops up in lots of evaluations 
>>(problem, family history) so we might need to have it as a formal TYPE! 
>>That is - we can use it consistently in various settings.
>>
>>
>>I would argue that gender is of the same nature - with social gender, 
>>physical gender and genetic gender as the key concepts.
>>
>>No doubt there are others but these two are worth thinking about carefully.
>>
>>Sam
>>
>>-
>>If you have any questions about using this list,
>>please send a message to d.lloyd at openehr.org
>>
> 
> 
> 
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Age, gender and more

[Gerard Freriks]

Hi,

We need a third type of concept dealing with Age.

-3- After life :-)

Gerard


--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

+31 252 544896
+31 654 792800
On 27 Jan 2005, at 13:32, Sam Heard wrote:

> Hi
>
> Gerard has raised other issues - there are names for age-ranges or 
> phases such as adolescence, neonatal, toddler. It may be too much for 
> us to deal with but age is certainly not just a number - you just have 
> to ask the mother of a small baby - it has units like days, weeks, 
> months.
>
> I think Gerard missed the point of post-conceptual age - it is the 
> time since conception and if a child is born very early, remains the 
> basis on which dosing and milestones are based - sometimes for years 
> after birth.
>
> This was raised as a key issue in systems for paediatricians.
>
> So I was wondering if we should model a class specifically for date of 
> birth.which handles date of birth and age as a function, and which 
> takes arguments like date of conception, date of mothers LMP, Expected 
> Date of Delivery and stores the normal gestational birthdate as well. 
> The class then has a feature called post-conception age as well.
>
> The advantage is that we could even deal with things like 'post-natal' 
> as a function (actual birth to day 28) and other phases in future if 
> appropriate. It would mean that in family history you could enter 
> 'young adulthood' as an age which might be better than guessing 22.
>
> Further, I think in our DateTime class we should store text as well as 
> the date if people want - this would allow us to store "4.30 
> yesterday" if a transcription tool wanted to - and the actual date 
> time. This can make observational data much easier to read when 
> scanning back.
>
> It also means that we can deal with almost impossible fuzzy times like 
> 'last night' in some reasonable fuzzy way without losing the key 
> information.
>
> In our timing specification for workflow the same will have the same 
> issue ie we may need the text as well as the computable data - three 
> times a day might be at 08:00, 16:00 and 00:00, but it is a different 
> instruction than 8 hourly (where there is no flexibility on spacing of 
> doses).
>
> Thats enough for now...but I am thinking of putting a change request 
> together if there is enough interest. The DateOfBirth issue will win a 
> lot of friends in paediatrics...they are really concerned that their 
> absolute requirements are never addressed in systems!
>
> Cheers, Sam
>
>
>
>
> Any more thoughts?
>
> Sam
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Age and named quantities

[Sam Heard]

Dear All

Age is time after birth - we are not going to change that.

We have agreed that we need to record one more date in the demographic 
model - which is 'approximate date of conception', or 'expected date of 
birth'

Which do people prefer - I chose the latter as it will probably be a cut 
and paste from the mothers record and does not get into the when did I 
conceive stuff.

What do others think?


FinallyI am proposing that we think about a new class (?datatype) 
such as 'DV_Textural_Ordered' for dealing with named quantities - which 
have DV_ORDERED or DV_INTERVAL as their value - a fuzzy quantity.

Examples in XML might be something like:


"Birth"

0
"days"




"Adolescence"


12
"years"


18
"years"





"Three times a day"

"FREQ=BYDAY;OCCURRENCES=3"





"Three times a day"

"0800;1400;2000"





"Last night"


20:00


06:00





The problem is that they would not be available through inheritence - so 
the possibility of entering these classes would have to be constrained.

This is just thinking out loud.

Cheers, Sam


Gerard Freriks wrote:
> Dear all,
> 
> It is fine for me when we can agree that we mean by 'Age' time after birth.
> 
> How will we name and define concepts like: youth, post conception, post 
> gestation, middel aged, elderly?
> 
> Gerard
> --  --
> Gerard Freriks, arts
> Huigsloterdijk 378
> 2158 LR Buitenkaag
> The Netherlands
> 
> +31 252 544896
> +31 654 792800
> On 31 Jan 2005, at 19:10, William E Hammond wrote:
> 
> For an age, I agree that the date of birth is adequate as long as you
> remember people do not age after they die. It is also convenient to
> have a
> reference time mark for many things, including conception, start of a
> course of treatment. Adjectives and nouns are difficult to put into
> algorithms unless the definitions are precise.
> 
> Ed Hammond
> 
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Antw: Re: Age, gender and more

[USM Bish]

On Sat, Jan 29, 2005 at 02:45:38PM +, Thomas Beale wrote:
> Williamtfgoossen at cs.com wrote:
> >
> > I know that a lot of  this material has already been classified
> > and  coded  in  the international  classification  for  nursing
> > practice of  ICN (Geneva).  This kind of  referring to  age and
> > time is  quite usual  in nursing  practice, (after  birth, post
> > operative, young), infant)
> >
> 
> what vocabularies and  reference ranges should we  be using? It
> appears that we need not just sets of terms like "after birth",
> "post operative" etc,  but age ranges for them;  and then there
> will probably be a similar  set for different disciplines. E.g.
> I imagine that in perinatology "infant" might be defined as one
> range, while for psychiatry it will  be defined another way. So
> a single vocabulary won't do it.
>

This is an attempt to address the vocab and ranges issue.

This is  a difficult  issue. There are  numerous terms  in use,
which  may  be  modulated  by local  factors  and  language  of
communication. There are no WHO definitions here. Variations in
terminologies are large.

The International Paed Assn accepts the following only:

o Neonate   :   > 0 days   <= 28 days (4 wks)
o Infant:   > 4 weeks  <= 1 year 
o Child :   > 1 year   <= Adult   (18 yr)

This adult  is a  'legal' definition (in most countries) rather
than a biological entity. There is no biological definition for
the term 'adult'.

IOW, only the terms 'neonatal' and 'infant' are defined, and is
accepted by ALL  medical disciplines. The problem  comes in the
huge age  group of 'child' encompassing  17 years ! I  have not
come  across  any  clear definition  by  any  international  or
professional body  to things  like 'adolescence',  'puberty' or
other things brought out on the list (though they are in common
use everywhere).

In India, an age-group range for  acceptance of terms are noted
below.  This   is  after  discussions   with  a  dozen   or  so
paediatricians to direct  questions like 'what do  you infer or
mean  by the  term  toddler?'.  This can  at  best  serve as  a
starting point to  work from. It may be prudent  to get further
opinions of practitiones in  other countries before formalising
these terms since these would have to be defined 'by the EHR'.

o Toddler  > 1 yr   <= 2.5 yr (not yet learnt verbal commn)
o Pre-school   > 2.5 yr <= 5 yr   (happiness !)
o year-old ... e.g. 6 year old ... 9 year old child  
o Pre-teen > 9 yr   <= 13 yr  (occasionally used)
o Adolescent   > 12 yr  <= 16 yr  (infrequently used)
o Teenager > 13 yr  <= 19 yr  (commonly used)

The term  'puberty' is normally  avoided because  of individual
and sex  dependent variances,  though sometime  used by  an odd
practitioner here and  there (mainly in Obs &  Gynae). The term
'adolescence' is not in common usage here, this normally refers
to the 12-16  year age group. The pre-teen term  is seldom used
and the 'year-old' nomenclature is used right through 6-12 yrs.
(viz. 11 year old boy/ girl/ child).

As stated above,  there would be regional variations  in use of
these terms,  and a  consensus needs to  be reached  for ranges
after studying  all terms  used for  this sub-18  age group  in
different countries.

This may serve the purpose of getting on track though ...

Dr USM Bish
Bangalore

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Antw: Re: Age, gender and more

[Sam Heard]

Hi

Thanks USM, it is clear there are a lot of labels, the point is that I 
do not want to determine what they are, rather allow them to be used 
with an appropriate quantity or quantity range stored in the class.

My proposal is that we have a 'named quantity' class that displays a 
term, a quantity or a quantity range (as quantity range already has the 
interface for quantity).

Cheers, Sam

> On Sat, Jan 29, 2005 at 02:45:38PM +, Thomas Beale wrote:
> 
>>Williamtfgoossen at cs.com wrote:
>>
>>>I know that a lot of  this material has already been classified
>>>and  coded  in  the international  classification  for  nursing
>>>practice of  ICN (Geneva).  This kind of  referring to  age and
>>>time is  quite usual  in nursing  practice, (after  birth, post
>>>operative, young), infant)
>>>
>>
>>what vocabularies and  reference ranges should we  be using? It
>>appears that we need not just sets of terms like "after birth",
>>"post operative" etc,  but age ranges for them;  and then there
>>will probably be a similar  set for different disciplines. E.g.
>>I imagine that in perinatology "infant" might be defined as one
>>range, while for psychiatry it will  be defined another way. So
>>a single vocabulary won't do it.
>>
> 
> 
> This is an attempt to address the vocab and ranges issue.
> 
> This is  a difficult  issue. There are  numerous terms  in use,
> which  may  be  modulated  by local  factors  and  language  of
> communication. There are no WHO definitions here. Variations in
> terminologies are large.
> 
> The International Paed Assn accepts the following only:
> 
> o Neonate   :   > 0 days   <= 28 days (4 wks)
> o Infant:   > 4 weeks  <= 1 year 
> o Child :   > 1 year   <= Adult   (18 yr)
> 
> This adult  is a  'legal' definition (in most countries) rather
> than a biological entity. There is no biological definition for
> the term 'adult'.
> 
> IOW, only the terms 'neonatal' and 'infant' are defined, and is
> accepted by ALL  medical disciplines. The problem  comes in the
> huge age  group of 'child' encompassing  17 years ! I  have not
> come  across  any  clear definition  by  any  international  or
> professional body  to things  like 'adolescence',  'puberty' or
> other things brought out on the list (though they are in common
> use everywhere).
> 
> In India, an age-group range for  acceptance of terms are noted
> below.  This   is  after  discussions   with  a  dozen   or  so
> paediatricians to direct  questions like 'what do  you infer or
> mean  by the  term  toddler?'.  This can  at  best  serve as  a
> starting point to  work from. It may be prudent  to get further
> opinions of practitiones in  other countries before formalising
> these terms since these would have to be defined 'by the EHR'.
> 
> o Toddler  > 1 yr   <= 2.5 yr (not yet learnt verbal commn)
> o Pre-school   > 2.5 yr <= 5 yr   (happiness !)
> o year-old ... e.g. 6 year old ... 9 year old child  
> o Pre-teen > 9 yr   <= 13 yr  (occasionally used)
> o Adolescent   > 12 yr  <= 16 yr  (infrequently used)
> o Teenager > 13 yr  <= 19 yr  (commonly used)
> 
> The term  'puberty' is normally  avoided because  of individual
> and sex  dependent variances,  though sometime  used by  an odd
> practitioner here and  there (mainly in Obs &  Gynae). The term
> 'adolescence' is not in common usage here, this normally refers
> to the 12-16  year age group. The pre-teen term  is seldom used
> and the 'year-old' nomenclature is used right through 6-12 yrs.
> (viz. 11 year old boy/ girl/ child).
> 
> As stated above,  there would be regional variations  in use of
> these terms,  and a  consensus needs to  be reached  for ranges
> after studying  all terms  used for  this sub-18  age group  in
> different countries.
> 
> This may serve the purpose of getting on track though ...
> 
> Dr USM Bish
> Bangalore
> 
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
> 
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Antw: Re: Age, gender and more

[USM Bish]

On Fri, Feb 04, 2005 at 08:45:15AM +0930, Sam Heard wrote:
> 
> My  proposal is  that we  have  a 'named  quantity' class  that
> displays a  term, a quantity or  a quantity range  (as quantity
> range already has the interface for quantity).
>

Sam, I second this proposal of a 'named qty class' with the qty
range defined.  Don't know  if there  is any  alternate way  of
approaching this type  of issue sensibly. The  question here is
the defn of terms and quantity ranges for each of the classes.

Secondly, could  we have a  dADL/ UML to  know what is  in your
mind ? (take the example of 'infant', range 29-364 days). Once,
the idea is clear, we can  use this method for other situations
where named quantities  may be necessary (e.g.  mild anaemia or
borderline hypertension etc).


Dr USM Bish
Bangalore

PS: Thanks List Admin, [Reply] now points to the list ;-)

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Antw: Re: Age, gender and more

[williamtfgoos...@cs.com]

In een bericht met de datum 27-1-2005 13:39:00 West-Europa (standaardtijd), 
schrijft sam.heard at bigpond.com:


> So I was wondering if we should model a class specifically for date of 
> birth.which handles date of birth and age as a function, and which 
> takes arguments like date of conception, date of mothers LMP, Expected 
> Date of Delivery and stores the normal gestational birthdate as well. 
> The class then has a feature called post-conception age as well.
> 
> The advantage is that we could even deal with things like 'post-natal' 
> as a function (actual birth to day 28) and other phases in future if 
> appropriate. It would mean that in family history you could enter 'young 
> adulthood' as an age which might be better than guessing 22.

I know that a lot of this material has already been classified and coded in 
the international classification for nursing practice of ICN (Geneva). This 
kind of referring to age and time is quite usual in nursing practice, (after 
birth, post operative, young), infant)

I am now at an airport lounge and have no access to all, but do not start 
double work on this please.

William
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Antw: Re: Age, gender and more

[Thomas Beale]

Williamtfgoossen at cs.com wrote:

> In een bericht met de datum 27-1-2005 13:39:00 West-Europa 
> (standaardtijd), schrijft sam.heard at bigpond.com:
>
>
> I know that a lot of this material has already been classified and 
> coded in the international classification for nursing practice of ICN 
> (Geneva). This kind of referring to age and time is quite usual in 
> nursing practice, (after birth, post operative, young), infant)
>
> I am now at an airport lounge and have no access to all, but do not 
> start double work on this please.

William,
what vocabularies and reference ranges should we be using? It appears 
that we need not just sets of terms like "after birth", "post operative" 
etc, but age ranges for them; and then there will probably be a similar 
set for different disciplines. E.g. I imagine that in perinatology 
"infant" might be defined as one range, while for psychiatry it will be 
defined another way. So a single vocabulary won't do it.

- thomas beale


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GDL rules with "age-dependent" reference ranges

[Birger Haarbrandt]

Hi there,

besides of our core acitivities, we recently fiddled a little with GDL 
to evaluate, if it might be of use for a decision support project in the 
context of a pediatric ICU. One challenge with guidelines in pediatric 
patients is that the reference ranges of variables depent on the age of 
a patient at the time of the clinical event.


In SPARQL/SWRL (as in XML) I can easily calculate the number of days 
between the birth of a patient and the clinical event by simply subtract 
the datetime of the event from the datetime of the birth. The result is 
of type "duration".


In the data types information model specs it says:

"For example, two dates can be subtracted, but the result is a duration, 
not another date. For this reason, the operations add, subtract and diff 
are defined rather than ‘+’ or ‘-’. Date/time types, as well as the relative

concept duration, are defined in the Date Time Package on page 54." and

"The DV_DURATION class is used for expressing durations of clinical 
phenomena and differences

between absolute times"

So I expect this to work identically.

If I try this operation using the test function of the GDL Editor, the 
result test set for any example data entry is empty. I made a CDS 
archetype with an element of type Duration to store the result. In GDL 
it looks as follows:


rules = <
["gt0025"] = (RULE) <
when = <"$gt0024!=null",...>
then = 
<"$gt0026.create($gt0028.value=($gt0024.value-$gt0019.value))",...>

priority = <1>
>

Is this a bug or did I miss something?

Any help is really appreciated.

Best,

--
*Birger Haarbrandt, M.Sc.*

Peter L. Reichertz Institut für Medizinische Informatik
Technische Universität Braunschweig und
Medizinische Hochschule Hannover
Mühlenpfordtstraße 23
D-38106 Braunschweig

T +49 (0)531 391-2129
F +49 (0)531 391-9502
birger.haarbra...@plri.de
http://www.plri.de

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RE: GDL rules with "age-dependent" reference ranges

[Rong Chen]

Hi Birger

We use DV_DATETIME for patient's birthday and use GDL rule to calculate the 
actual age at any give point of time. It works in our decision support systems.

I think the operation on DV_DURATION should work too. The actual operation is 
done by the underlying java library. If you report the issue to the tracker, 
https://openehr.atlassian.net/projects/GDLED/issues/GDLED-17?filter=allopenissues,
 we will look into it.

One more thing, you probably want to use .value assignment instead of create 
operator in your then statement.

Regards,
/Rong


From: openEHR-technical [openehr-technical-boun...@lists.openehr.org] on behalf 
of Birger Haarbrandt [birger.haarbra...@plri.de]
Sent: Monday, February 29, 2016 4:58 PM
To: For openEHR technical discussions
Subject: GDL rules with "age-dependent" reference ranges

Hi there,

besides of our core acitivities, we recently fiddled a little with GDL to 
evaluate, if it might be of use for a decision support project in the context 
of a pediatric ICU. One challenge with guidelines in pediatric patients is that 
the reference ranges of variables depent on the age of a patient at the time of 
the clinical event.

In SPARQL/SWRL (as in XML) I can easily calculate the number of days between 
the birth of a patient and the clinical event by simply subtract the datetime 
of the event from the datetime of the birth. The result is of type "duration".

In the data types information model specs it says:

"For example, two dates can be subtracted, but the result is a duration, not 
another date. For this reason, the operations add, subtract and diff are 
defined rather than ‘+’ or ‘-’. Date/time types, as well as the relative
concept duration, are defined in the Date Time Package on page 54." and

"The DV_DURATION class is used for expressing durations of clinical phenomena 
and differences
between absolute times"

So I expect this to work identically.

If I try this operation using the test function of the GDL Editor, the result 
test set for any example data entry is empty. I made a CDS archetype with an 
element of type Duration to store the result. In GDL it looks as follows:

rules = <
["gt0025"] = (RULE) <
when = <"$gt0024!=null",...>
then = 
<"$gt0026.create($gt0028.value=($gt0024.value-$gt0019.value))",...>
priority = <1>
>

Is this a bug or did I miss something?

Any help is really appreciated.

Best,

--
Birger Haarbrandt, M.Sc.

Peter L. Reichertz Institut für Medizinische Informatik
Technische Universität Braunschweig und
Medizinische Hochschule Hannover
Mühlenpfordtstraße 23
D-38106 Braunschweig

T +49 (0)531 391-2129
F +49 (0)531 391-9502
birger.haarbra...@plri.de<mailto:birger.haarbra...@plri.de>
http://www.plri.de
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