StrongKidsScore-v1.0(2018EN): verschil tussen versies

Huidige versie van 13 mrt 2019 om 01:52

Attention!! This is not the most recent version of this information model. You can find the most recent version ''here''.

General information

Name: nl.zorg.StrongKidsScore
Version: 1.0
HCIM Status:Final
Release: 2018
Release status: Prepublished
Release date: 26-02-2019

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Metadata

DCM::CoderList	Werkgroep RadB Verpleegkundige Gegevens
DCM::ContactInformation.Address	*
DCM::ContactInformation.Name	*
DCM::ContactInformation.Telecom	*
DCM::ContentAuthorList	Werkgroep RadB Verpleegkundige Gegevens
DCM::CreationDate	28-7-2016
DCM::DeprecatedDate
DCM::DescriptionLanguage	nl
DCM::EndorsingAuthority.Address
DCM::EndorsingAuthority.Name	zorg
DCM::EndorsingAuthority.Telecom
DCM::Id	2.16.840.1.113883.2.4.3.11.60.40.3.4.28
DCM::KeywordList	Ondervoeding, ondervoedingsscore, StrongKids, malnutrition
DCM::LifecycleStatus	Final
DCM::ModelerList	Werkgroep RadB Verpleegkundige Gegevens
DCM::Name	nl.zorg.StrongKidsScore
DCM::PublicationDate	26-02-2019
DCM::PublicationStatus	Prepublished
DCM::ReviewerList	Projectgroep RadB Verpleegkundige Gegevens & Kerngroep Registratie aan de Bron
DCM::RevisionDate	31-12-2017
DCM::Superseeds
DCM::Version	1.0
HCIM::PublicationLanguage	EN

Revision History

Only available in Dutch

Publicatieversie 1.0 (04-09-2017).

Concept

The StrongKids score is a (validated) measuring tool for determining the extent of a child’s malnutrition.
StrongKids is developed to recognize and treat malnutrition in children aged > 1 month to 18 years in a hospital setting.
The tool comprises four questions, each of which is assigned a score. The total score determines the extent of malnutrition.
(STRONGkids= Screening Tool Risk On Nutritional Status and Growth)

Purpose

The StrongKids score is used to determine the extent of malnutrition or the risk of malnutrition. To treat malnutrition quickly and effectively, it is important to identify the malnutrition at an early stage.

Evidence Base

To determine the extent of malnutrition, SNAQ has a number of tools, validated for different settings:

The SNAQ was developed foe adults admitted to hospital
The SNAQ65+ was developed for the group of seniors (> over 65) who live at home and who may make use of care at home.
The SNAQrc (Short Nutritional Assessment Questionnaire for Residential Care) is available for screening for malnutrition in nursing and retirement homes.
The STRONGkids tool is available for screening for malnutrition among children.

Patient Population

The StrongKids screening is meant for patients aged 1 month to 18 years of age who are admitted to the hospital.

Information Model

Type

Id

Concept

Card.

Definition

DefinitionCode

Reference

NL-CM:4.28.1

StrongKidsScore

Root concept of the StrongKidsScore information model. This root concept contains all data elements of the StrongKidsScore information model.

NL-CM:4.28.2

TotalScore

0..1

The total score is the sum of all the individual scores. The total score has a range from 0 - 5.

NL-CM:4.28.6

ScoreDateTime

1

The date and time at which the StrongKids score was determined.

NL-CM:4.28.7

Comment

0..1

A comment on the circumstances during the measurement.

48767-8 Annotation comment [Interpretation] Narrative

NL-CM:4.28.3

WeightLossScore

0..1

The score based on undesired weight loss or arrest in growth or weight gain over the past weeks to month(s).

SKWeightLossScoreCodelist

NL-CM:4.28.4

ConditionScore

0..1

The score based on the presence of a condition that can cause an increased risk of malnutrition. A list with conditions with increased risk is given is reference [1]

SKConditionScoreCodelist

NL-CM:4.28.5

NutritionScore

0..1

The score based on the presence of aspects that indicate a deteriorated nutrition status:

- excessive diarrhea and/or vomiting - use of fluid or enteral nutrition - reduced intake of food during the past 1-3 days - obstruction of food intake by pain

SKNutritionScoreCodelist

NL-CM:4.28.8

NutritionStatusScore

0..1

The score gives an indication of the nutrition status of the patient based on the professional opinion of the healthcare professional.

SKNutritionStatusScoreCodelist

Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page

Example Instances

Only available in Dutch

StrongKidsScore
ScoreDatumTijd	12-12-2016
GewichtsverliesScore	0 (Geen gewichtverlies of stilstand in groei/ gewicht)
ZiektebeeldScore	2 (Ziektebeeld met verhoogd risico aanwezig)
VoedingsScore	0 (Normale voedselinname)
VoedingstoestandScore	0 (Goede voedingstoestand)
TotaalScore	2
Toelichting	-

References

1. StrongKids, Stuurgroep Ondervoeding [Online] Beschikbaar op:http://www.stuurgroepondervoeding.nl/toolkits/screeningsinstrument [Geraadpleegd: 28 juli 2016]

Valuesets

SKConditionScoreCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.4.28.2	Binding: Required

Conceptname	Conceptcode	Conceptvalue	Codesystem name	Codesystem OID	Description
NoRisk	R0	0	SK_Ziektebeeld	2.16.840.1.113883.2.4.3.11.60.40.4.17.2	Geen ziektebeeld met verhoogd risico
IncreasedRisk	R1	2	SK_Ziektebeeld	2.16.840.1.113883.2.4.3.11.60.40.4.17.2	Ziektebeeld met verhoogd risico aanwezig

SKNutritionScoreCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.4.28.3	Binding: Required

Conceptname	Conceptcode	Conceptvalue	Codesystem name	Codesystem OID	Description
Normaal	Z0	0	SK_Voeding	2.16.840.1.113883.2.4.3.11.60.40.4.17.3	Normale voedselinname
Verminderd	Z1	1	SK_Voeding	2.16.840.1.113883.2.4.3.11.60.40.4.17.3	Verminderde voedselinname

SKNutritionStatusScoreCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.4.28.4	Binding: Required

Conceptname	Conceptcode	Conceptvalue	Codesystem name	Codesystem OID	Description
Goed	T0	0	SK_Voedingstoestand	2.16.840.1.113883.2.4.3.11.60.40.4.17.4	Goede voedingstoestand
Slecht	T1	1	SK_Voedingstoestand	2.16.840.1.113883.2.4.3.11.60.40.4.17.4	Slechte voedingstoestand

SKWeightLossScoreCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.4.28.1	Binding: Required

Conceptname	Conceptcode	Conceptvalue	Codesystem name	Codesystem OID	Description
NoLoss	G0	0	SK_Gewichtsverlies	2.16.840.1.113883.2.4.3.11.60.40.4.17.1	Geen gewichtsverlies of stilstand in groei/ gewicht
LossOfWeight	G2	1	SK_Gewichtsverlies	2.16.840.1.113883.2.4.3.11.60.40.4.17.1	Gewichtsverlies of stilstand in groei/ gewicht aanwezig

This information model in other releases

Information model references

This information model refers to

--

This information model is used in

--

Technical specifications in HL7v3 CDA and HL7 FHIR

To exchange information based on health and care information models, additional, more technical specifications are required.
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:

HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment
HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR

Downloads

This information model is also available as pdf file or as spreadsheet

About this information

The information in this wikipage is based on Prerelease 2018-2
SNOMED CT and LOINC codes are based on:

SNOMED Clinical Terms version: 20180731 [R] (July 2018 Release)
LOINC version 2.64

Conditions for use are located on the mainpage
This page is generated on 12/03/2019 17:18:27 with ZibExtraction v. 3.0.7010.25883

Back to HCIM list

@@ Regel 8: / Regel 8: @@
 Release<!--hdPublication-->: '''2018''' <br>
 Release status<!--hdPublicationStatus-->: Prepublished<br>
-Release date<!--hdPublicationDate-->: 01-10-2018
+Release date<!--hdPublicationDate-->: 26-02-2019
 -----
 <div style="text-align: right; direction: ltr; margin-left: 1em;" >[[Bestand: Back 16.png| link= HCIM_Release<!--wikiReleasePage-->_2018(EN)]] [[HCIM_Release<!--wikiReleasePage-->_2018(EN) |Back to HCIM list<!--hdBackToMainPage--> ]]</div>
@@ Regel 47: / Regel 47: @@
 |style="width:250px; "|DCM::Name||nl.zorg.StrongKidsScore
 |-
-|style="width:250px; "|DCM::PublicationDate||01-10-2018
+|style="width:250px; "|DCM::PublicationDate||26-02-2019
 |-
 |style="width:250px; "|DCM::PublicationStatus||Prepublished
@@ Regel 93: / Regel 93: @@
 <BR>
 <imagemap> Bestand:StrongKidsScore-v1.0Model(2018EN).png | center
-rect 549 52 667 122 [[#11040]]
+rect 560 52 678 122 [[#11040]]
-rect 535 466 695 516 [[#SKVoedingsScoreCodelijst]]
+rect 546 466 706 516 [[#SKNutritionScoreCodelist]]
-rect 549 361 667 431 [[#11043]]
+rect 560 361 678 431 [[#11043]]
-rect 358 43 477 145 [[#11047]]
+rect 369 43 488 145 [[#11047]]
-rect 348 466 520 516 [[#SKZiektebeeldScoreCodelijst]]
+rect 359 466 531 516 [[#SKConditionScoreCodelist]]
-rect 549 157 667 227 [[#11045]]
+rect 560 157 678 227 [[#11045]]
-rect 362 361 480 431 [[#11042]]
+rect 373 361 491 431 [[#11042]]
-rect 360 191 480 271 [[#11048]]
+rect 371 191 491 271 [[#11048]]
-rect 736 358 861 428 [[#11052]]
+rect 747 358 872 428 [[#11052]]
-rect 724 466 898 516 [[#SKVoedingstoestandCodelijst]]
+rect 735 466 909 516 [[#SKNutritionStatusScoreCodelist]]
-rect 175 360 293 430 [[#11039]]
+rect 186 360 304 430 [[#11039]]
-rect 136 466 333 516 [[#SKGewichtsverliesScoreCodelijst]]
+rect 147 466 344 516 [[#SKWeightLossScoreCodelist]]
 desc none
 </imagemap>
@@ Regel 114: / Regel 114: @@
 |style = "text-align:center" |[[Bestand: block.png| 20px | link=]]
 ||NL-CM:4.28.1
-|colspan ="6" style ="padding-left: 0px"|<span Id=11048 Title="EN: StrongKidsScore">[[Bestand: arrowdown.png | 10px | link=]]StrongKidsScore</span>
+|colspan ="6" style ="padding-left: 0px"|<span Id=11048 Title="NL: StrongKidsScore">[[Bestand: arrowdown.png | 10px | link=]]StrongKidsScore</span>
 |
 |Root concept of the StrongKidsScore information model. This root concept contains all data elements of the StrongKidsScore information model.
@@ Regel 123: / Regel 123: @@
 ||NL-CM:4.28.2
 |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" |
-|colspan ="5" style ="padding-left: 0px"|<span Id=11047 Title="EN: TotalScore">[[Bestand: arrowright.png | 10px | link=]]TotaalScore</span>
+|colspan ="5" style ="padding-left: 0px"|<span Id=11047 Title="NL: TotaalScore">[[Bestand: arrowright.png | 10px | link=]]TotalScore</span>
 |0..1
 |The total score is the sum of all the individual scores. The total score has a range from 0 - 5.
@@ Regel 132: / Regel 132: @@
 ||NL-CM:4.28.6
 |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" |
-|colspan ="5" style ="padding-left: 0px"|<span Id=11040 Title="EN: ScoreDateTime">[[Bestand: arrowright.png | 10px | link=]]ScoreDatumTijd</span>
+|colspan ="5" style ="padding-left: 0px"|<span Id=11040 Title="NL: ScoreDatumTijd">[[Bestand: arrowright.png | 10px | link=]]ScoreDateTime</span>
 |1
 |The date and time at which the StrongKids score was determined.
@@ Regel 141: / Regel 141: @@
 ||NL-CM:4.28.7
 |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" |
-|colspan ="5" style ="padding-left: 0px"|<span Id=11045 Title="EN: Comment">[[Bestand: arrowright.png | 10px | link=]]Toelichting</span>
+|colspan ="5" style ="padding-left: 0px"|<span Id=11045 Title="NL: Toelichting">[[Bestand: arrowright.png | 10px | link=]]Comment</span>
 |0..1
 |A comment on the circumstances during the measurement.
@@ Regel 154: / Regel 154: @@
 ||NL-CM:4.28.3
 |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" |
-|colspan ="5" style ="padding-left: 0px"|<span Id=11039 Title="EN: WeightLossScore">[[Bestand: arrowright.png | 10px | link=]]GewichtsverliesScore</span>
+|colspan ="5" style ="padding-left: 0px"|<span Id=11039 Title="NL: GewichtsverliesScore">[[Bestand: arrowright.png | 10px | link=]]WeightLossScore</span>
 |0..1
 |The score based on undesired weight loss or arrest in growth or weight gain over the past weeks to month(s).
@@ Regel 161: / Regel 161: @@
 {|
 |-
-|[[Bestand: List2.png | link=#SKGewichtsverliesScoreCodelijst]]||[[#SKGewichtsverliesScoreCodelijst|SKGewichtsverliesScoreCodelijst]]
+|[[Bestand: List2.png | link=#SKWeightLossScoreCodelist]]||[[#SKWeightLossScoreCodelist|SKWeightLossScoreCodelist]]
 |}
 |-style="vertical-align:top; background-color: transparent; "
@@ Regel 167: / Regel 167: @@
 ||NL-CM:4.28.4
 |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" |
-|colspan ="5" style ="padding-left: 0px"|<span Id=11042 Title="EN: ConditionScore">[[Bestand: arrowright.png | 10px | link=]]ZiekteBeeldScore</span>
+|colspan ="5" style ="padding-left: 0px"|<span Id=11042 Title="NL: ZiekteBeeldScore">[[Bestand: arrowright.png | 10px | link=]]ConditionScore</span>
 |0..1
 |The score based on the presence of a condition that can cause an increased risk of malnutrition. A list with conditions with increased risk is given is reference [1]
@@ Regel 174: / Regel 174: @@
 {|
 |-
-|[[Bestand: List2.png | link=#SKZiektebeeldScoreCodelijst]]||[[#SKZiektebeeldScoreCodelijst|SKZiektebeeldScoreCodelijst]]
+|[[Bestand: List2.png | link=#SKConditionScoreCodelist]]||[[#SKConditionScoreCodelist|SKConditionScoreCodelist]]
 |}
 |-style="vertical-align:top; background-color: transparent; "
@@ Regel 180: / Regel 180: @@
 ||NL-CM:4.28.5
 |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" |
-|colspan ="5" style ="padding-left: 0px"|<span Id=11043 Title="EN: NutritionScore">[[Bestand: arrowright.png | 10px | link=]]VoedingsScore</span>
+|colspan ="5" style ="padding-left: 0px"|<span Id=11043 Title="NL: VoedingsScore">[[Bestand: arrowright.png | 10px | link=]]NutritionScore</span>
 |0..1
 |The score based on the presence of aspects that indicate a deteriorated nutrition status:
@@ Regel 191: / Regel 191: @@
 {|
 |-
-|[[Bestand: List2.png | link=#SKVoedingsScoreCodelijst]]||[[#SKVoedingsScoreCodelijst|SKVoedingsScoreCodelijst]]
+|[[Bestand: List2.png | link=#SKNutritionScoreCodelist]]||[[#SKNutritionScoreCodelist|SKNutritionScoreCodelist]]
 |}
 |-style="vertical-align:top; background-color: transparent; "
@@ Regel 197: / Regel 197: @@
 ||NL-CM:4.28.8
 |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" |
-|colspan ="5" style ="padding-left: 0px"|<span Id=11052 Title="EN: NutritionStatusScore">[[Bestand: arrowright.png | 10px | link=]]VoedingstoestandScore</span>
+|colspan ="5" style ="padding-left: 0px"|<span Id=11052 Title="NL: VoedingstoestandScore">[[Bestand: arrowright.png | 10px | link=]]NutritionStatusScore</span>
 |0..1
 |The score gives an indication of the nutrition status of the patient based on the professional opinion of the healthcare professional.
@@ Regel 204: / Regel 204: @@
 {|
 |-
-|[[Bestand: List2.png | link=#SKVoedingstoestandCodelijst]]||[[#SKVoedingstoestandCodelijst|SKVoedingstoestandCodelijst]]
+|[[Bestand: List2.png | link=#SKNutritionStatusScoreCodelist]]||[[#SKNutritionStatusScoreCodelist|SKNutritionStatusScoreCodelist]]
 |}
 |}
@@ Regel 243: / Regel 243: @@
 == Valuesets ==
-=== SKGewichtsverliesScoreCodelijst===
+=== SKConditionScoreCodelist===
 {| class="wikitable" width="60%"
 |-style='vertical-align:top; background-color: #E8D7BE;'
-|Valueset OID<!--vsValuesetOID-->: 2.16.840.1.113883.2.4.3.11.60.40.2.4.28.1
+|Valueset OID<!--vsValuesetOID-->: 2.16.840.1.113883.2.4.3.11.60.40.2.4.28.2
 |Binding<!--vsBindingTag-->: Required
 |}
@@ Regel 257: / Regel 257: @@
 |Description<!--vsDescription-->
 |-style="vertical-align:top; "
-|NoLoss
+|NoRisk
-|G0
+|R0
 |0
-|SK_Gewichtsverlies
+|SK_Ziektebeeld
-|2.16.840.1.113883.2.4.3.11.60.40.4.17.1
+|2.16.840.1.113883.2.4.3.11.60.40.4.17.2
-|Geen gewichtsverlies of stilstand in groei/ gewicht
+|Geen ziektebeeld met verhoogd risico
 |-style="vertical-align:top; "
-|LossOfWeight
+|IncreasedRisk
-|G2
+|R1
-|1
+|2
-|SK_Gewichtsverlies
+|SK_Ziektebeeld
-|2.16.840.1.113883.2.4.3.11.60.40.4.17.1
+|2.16.840.1.113883.2.4.3.11.60.40.4.17.2
-|Gewichtsverlies of stilstand in groei/ gewicht aanwezig
+|Ziektebeeld met verhoogd risico aanwezig
 |}
-=== SKVoedingsScoreCodelijst===
+=== SKNutritionScoreCodelist===
 {| class="wikitable" width="60%"
 |-style='vertical-align:top; background-color: #E8D7BE;'
@@ Regel 299: / Regel 299: @@
 |Verminderde voedselinname
 |}
-=== SKVoedingstoestandCodelijst===
+=== SKNutritionStatusScoreCodelist===
 {| class="wikitable" width="60%"
 |-style='vertical-align:top; background-color: #E8D7BE;'
@@ Regel 327: / Regel 327: @@
 |Slechte voedingstoestand
 |}
-=== SKZiektebeeldScoreCodelijst===
+=== SKWeightLossScoreCodelist===
 {| class="wikitable" width="60%"
 |-style='vertical-align:top; background-color: #E8D7BE;'
-|Valueset OID<!--vsValuesetOID-->: 2.16.840.1.113883.2.4.3.11.60.40.2.4.28.2
+|Valueset OID<!--vsValuesetOID-->: 2.16.840.1.113883.2.4.3.11.60.40.2.4.28.1
 |Binding<!--vsBindingTag-->: Required
 |}
@@ Regel 341: / Regel 341: @@
 |Description<!--vsDescription-->
 |-style="vertical-align:top; "
-|NoRisk
+|NoLoss
-|R0
+|G0
 |0
-|SK_Ziektebeeld
+|SK_Gewichtsverlies
-|2.16.840.1.113883.2.4.3.11.60.40.4.17.2
+|2.16.840.1.113883.2.4.3.11.60.40.4.17.1
-|Geen ziektebeeld met verhoogd risico
+|Geen gewichtsverlies of stilstand in groei/ gewicht
 |-style="vertical-align:top; "
-|IncreasedRisk
+|LossOfWeight
-|R1
+|G2
-|2
+|1
-|SK_Ziektebeeld
+|SK_Gewichtsverlies
-|2.16.840.1.113883.2.4.3.11.60.40.4.17.2
+|2.16.840.1.113883.2.4.3.11.60.40.4.17.1
-|Ziektebeeld met verhoogd risico aanwezig
+|Gewichtsverlies of stilstand in groei/ gewicht aanwezig
 |}
@@ Regel 369: / Regel 369: @@
 Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:<!--ftReferenceIntro-->
 <ul>
-<li>HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment<!--ftArtDecorReference--> [http://decor.nictiz.nl/art-decor/decor-scenarios--zib2018bbr-?id=2.16.840.1.113883.2.4.3.11.60.8.4.2.4.28&effectiveDate=2018-10-01T00:00:00&language=en-US&scenariotree=false [[File:artdecor.jpg|16px|link=]]]</li>
+<li>HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment<!--ftArtDecorReference--> [http://decor.nictiz.nl/art-decor/decor-scenarios--zib2018bbr-?id=2.16.840.1.113883.2.4.3.11.60.8.4.2.4.28&effectiveDate=2019-02-26T00:00:00&language=en-US&scenariotree=false [[File:artdecor.jpg|16px|link=]]]</li>
 <li>HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR<!--ftSimplifierReference--> {{SimplefierLinks|2018}}</li>
 </ul>
@@ Regel 375: / Regel 375: @@
 This information model is also available as [[Media:nl.zorg.StrongKidsScore-v1.0(2018EN).pdf|pdf file]] [[File:PDF.png|link=]] or as [[Media:nl.zorg.StrongKidsScore-v1.0(2018EN).xlsx|spreadsheet]] [[File:xlsx.png|link=]]<!--ftDownloads-->
 ==About this information<!--ftHeader2-->==
-The information in this wikipage is based on<!--ftInfoBase--> Prerelease 2018 #1 <BR>
+The information in this wikipage is based on<!--ftInfoBase--> Prerelease 2018-2 <BR>
 SNOMED CT and LOINC codes are based on:
 <ul>
@@ Regel 382: / Regel 382: @@
 </ul>
 Conditions for use are located on the mainpage<!--ftConditions--> [[Bestand:list2.png|link=HCIM_Mainpage<!--wikiMainpage-->]]<BR>
-This page is generated on 23/12/2018 01:09:03 with ZibExtraction v. 3.0.6929.24609<!--ftDate--> <BR>
+This page is generated on 12/03/2019 17:18:27 with ZibExtraction v. 3.0.7010.25883<!--ftDate--> <BR>
 -----
 <div style="text-align: right; direction: ltr; margin-left: 1em;" >[[Bestand: Back 16.png| link= HCIM_Release<!--wikiReleasePage-->_2018(EN)]] [[HCIM_Release<!--wikiReleasePage-->_2018(EN) |Back to HCIM list<!--hdBackToMainPage--> ]]</div>

StrongKidsScore-v1.0(2018EN): verschil tussen versies

Huidige versie van 13 mrt 2019 om 01:52

Inhoud

General information

Metadata

Revision History

Concept

Purpose

Evidence Base

Patient Population

Information Model

Example Instances

References