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: [email protected]
[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 <bish at hathway.com>@openehr.org on 01/29/2005 07:12:55 AM
Please respond to USM Bish <bish at hathway.com>
Sent by: owner-openehr-technical at openehr.org
To: OpenEHR Technical <openehr-technical at openehr.org>
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
> 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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