Wijziging naamgeving ZIB's en logo's door andere opzet van beheer
Concept
Important parts of the brain’s general mental functions are intellectual functions, orientation and consciousness.
If there is a disorder in the intellectual functions as a result of a mental disability, it is not described in this information model but is recorded as a medical diagnosis.
Disorders in orientation and consciousness combined with disorders in attention, memory and observation are seen as important symptoms for the potential presence of a delirium. The latter disorders are recorded in the SpecificMentalFunctions information model.
Purpose
Together, consciousness, orientation and intellectual functions provide a good insight into a patient’s mental condition.
This information is essential in drawing up the healthcare plan. The availability of this information allows you to take into account the patient’s wishes and capabilities. Furthermore, it offers a handle in approaching and supporting the patient.
Having this information available earlier on for a transfer enables procedures to be promptly initiated to continue the care as well as possible.
Evidence Base
This information model assumes that if the patient has a disorder in intellectual functions as a result of a mental disability, this disorder is to be included on the problem list in the medical transfer (if possible using the DSM classification).
The aforementioned assumes the following definition of a mental disability: “A patient with a mental disability has a congenital disability or a disability which occurred at a later developmental stage in intellectual function. They have an IQ of 70/75 or lower. This is accompanied by limitations in social (self-)reliance. This diagnosis is partially based on the need for support."
(Source: Meijer S (RIVM). Verstandelijke beperking samengevat. In: Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. Bilthoven: RIVM.)
The need for support involved can be described in the relevant information model.
The definitions of the concepts were (partially) taken from the ICF definitions.
Information Model
Type
Id
Concept
Card.
Definition
DefinitionCode
Reference
NL-CM:18.1.1
GeneralMentalFunctions
Root concept of the GeneralMentalFunctions information model. This concept contains all data elements of the GeneralMentalFunctions information model.
NL-CM:18.1.2
Consciousness
0..1
General mental function relating to the extent of consciousness and alertness including the lucidity and continuity of being awake.
Contains: the extent of consciousness, continuity of consciousness, and quality of consciousness. Examples of disorders that may occur include: loss of consciousness, coma, vegetative state, dissociative fugue, trance, frenzy, altered consciousness caused by drugs, delirium and stupor.
Orientation in location describes a patient being aware of their physical location, such as their immediate surroundings or their city or country of residence.
Intellectual functions describe general mental functions needed for the ability to understand things and to constructively integrate different mental functions, including all cognitive functions and development, for the duration of the patient’s life.
Contains: intellectual growth and intellectual growth disorders such as those that occur in intellectual retardation and dementia.
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
AlgemeneMentaleFuncties
Bewustzijn
Lichte stoornis (5-24%)
IntellectueleFuncties
Lichte stoornis (5-24%)
Orientatie
OrientatieInTijd
Matige stoornis (25-49%)
OrientatieInPlaats
Ernstige stoornis (50-95%)
OrientatieInPersoon
Lichte stoornis (5-24%)
VerpleegkundigeActie
Activiteit
Ondersteuning dagstructuur aan de hand van programma, lag op een eenpersoonskamer.
Toelichting
Patiënt is na operatie acuut verward geweest, gaat al wel beter, maar is soms nog weg kwijt. Heeft wel door dat hij soms in de war is en vindt dit erg vervelend.
References
1. International Classification of Functioning Disability and Health (ICF) [Online] Beschikbaar op:http:/www.rivm.nl/who-fic/icf.htm [Geraadpleegd: 13 februari 2015]
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
The information in this wikipage is based on Release summer 2016
Conditions for use are located on the mainpage
This page is generated on 21/12/2018 16:26:48 with ZibExtraction v. 3.0.6929.24609
GeneralMentalFunctions
Consciousness
or as spreadsheet 