Re: [Gnumed-devel] terminology question

[Jim Busser]

I confess I am not yet trying the software enough but hope to catch  
up soon. Even so

On 2-Apr-09, at 5:55 AM, Sebastian Hilbert wrote:

> Patient suffers from AV-Block III° and receives a dual chamber  
> pacemaker.
> Health issue/Grunderkrankung would be AV-Block III° I assume.  
> Pacemaker
> implant procedure would be what in that context ?

I see no way to avoid granting that the pacemaker is its own health  
issue. The patient had a procedure done, which was an insertion, and  
can have been a progress note attached under AV-blockIII. However at  
the same time that the progress note is made, I see no escape to  
adding a new health
issue

        status post-pacemaker insertion

(I would abbreviate s/p) with the details of the pacemaker. This  
issue would remain active and relevant. If the pacemaker was later  
removed it would be set inactive but perhaps always relevant because  
it could be important to not miss this in a later inspection of all  
things irrelevant like minor self-limited conditions like viral  
infections

> If patient comes in for a pacemaker checkup and I want to write a  
> soap note I
> would select av-block as health issue. What am I supposed to put in  
> to reflect
> that the reason for encounter was a pacemaker checkup (not a  
> problem in that
> case).

You would instead put it under

        status post-pacemaker insertion

> What if the patient suffers from device associated infection. Is  
> this a
> seperate health issue or is the issue AV-Block III° and the active  
> problem the
> device associated infection ?

The infection becomes a new problem until it is resolved, after which  
it becomes inactive but stays relevant.

I do not think we yet have dependency among health issues so I might  
consider a brief duplication by entering under the pacemaker issue a  
text cross-reference

        "Staph bacteremia - see issue"

The AV-block does not need to be touched unless the pacemaker has to  
be removed and replaced with some temporary treatment in between.

Just my 0.02 :-)