archetype (adl_version=1.4; uid=5de4453a-8c11-4e39-9a3e-2fbb97118ad4)
	openEHR-EHR-OBSERVATION.cow_score.v0

concept
	[at0000]	-- Clinical Opiate Withdrawal Scale (COWS)
language
	original_language = <[ISO_639-1::en]>
	translations = <
		["sv"] = <
			language = <[ISO_639-1::sv]>
			author = <
				["name"] = <"Dennis Forslund">
				["organisation"] = <"Cambio Healthcare Systems">
			>
		>
	>
description
	original_author = <
		["name"] = <"Syeeda S Farruque">
		["organisation"] = <"Cambio Healthcare Systems">
		["email"] = <"models@cambiocds.com">
		["date"] = <"2017-02-20">
	>
	details = <
		["sv"] = <
			language = <[ISO_639-1::sv]>
			purpose = <"*To record individual COWS parameters and total score. (en)">
			use = <"*Use to record individual COWS parameters and total score as part of an objective and subjective opiate withdrawal assessment. (en)">
			misuse = <"">
			copyright = <"© Cambio Healthcare Systems, openEHR Foundation">
		>
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record individual COWS parameters and total score.">
			use = <"Use to record individual COWS parameters and total score as part of an objective and subjective opiate withdrawal assessment.">
			misuse = <"">
			copyright = <"© Cambio Healthcare Systems, openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <>
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["references"] = <"Tompkins DA, Bigelow GE, Harrison JA, Johnson RE, Fudala PJ, Strain EC. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009 Nov 1;105(1-2):154-9. doi: 10.1016/j.drugalcdep.2009.07.001. Epub 2009 Aug 3. PMID: 19647958; PMCID: PMC2774236.

Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003 Apr-Jun;35(2):253-9. doi: 10.1080/02791072.2003.10400007. PMID: 12924748.">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"4BC979782EEC8BA1B81546657C76C1A3">
		["build_uid"] = <"c5af18fe-4674-4058-a8c1-852b861091c2">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {    -- Clinical Opiate Withdrawal Scale (COWS)
		data matches {
			HISTORY[at0001] matches {    -- Event Series
				events cardinality matches {1..*; unordered} matches {
					EVENT[at0002] occurrences matches {0..1} matches {    -- Any event
						data matches {
							ITEM_TREE[at0003] matches {    -- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0004] occurrences matches {0..1} matches {    -- Resting pulse rate (BPM)
										value matches {
											0|[local::at0017],
											1|[local::at0018],
											2|[local::at0019],
											4|[local::at0020]
										}
									}
									ELEMENT[at0005] occurrences matches {0..1} matches {    -- Sweating
										value matches {
											0|[local::at0021],
											1|[local::at0022],
											2|[local::at0023],
											3|[local::at0024],
											4|[local::at0025]
										}
									}
									ELEMENT[at0006] occurrences matches {0..1} matches {    -- Restlessness observation during assessment
										value matches {
											0|[local::at0026],
											1|[local::at0027],
											3|[local::at0028],
											5|[local::at0029]
										}
									}
									ELEMENT[at0007] occurrences matches {0..1} matches {    -- Pupil size
										value matches {
											0|[local::at0030],
											1|[local::at0031],
											2|[local::at0032],
											5|[local::at0033]
										}
									}
									ELEMENT[at0008] occurrences matches {0..1} matches {    -- Bone or joint aches
										value matches {
											0|[local::at0034],
											1|[local::at0035],
											2|[local::at0036],
											4|[local::at0037]
										}
									}
									ELEMENT[at0009] occurrences matches {0..1} matches {    -- Runny nose or tearing
										value matches {
											0|[local::at0038],
											1|[local::at0039],
											2|[local::at0040],
											4|[local::at0041]
										}
									}
									ELEMENT[at0010] occurrences matches {0..1} matches {    -- GI upset
										value matches {
											0|[local::at0042],
											1|[local::at0043],
											2|[local::at0044],
											3|[local::at0045],
											5|[local::at0046]
										}
									}
									ELEMENT[at0011] occurrences matches {0..1} matches {    -- Tremor observation of outstretched hands
										value matches {
											0|[local::at0047],
											1|[local::at0048],
											2|[local::at0049],
											4|[local::at0050]
										}
									}
									ELEMENT[at0012] occurrences matches {0..1} matches {    -- Yawning observation during assessment
										value matches {
											0|[local::at0051],
											1|[local::at0052],
											2|[local::at0053],
											4|[local::at0054]
										}
									}
									ELEMENT[at0013] occurrences matches {0..1} matches {    -- Anxiety or irritability
										value matches {
											0|[local::at0055],
											1|[local::at0056],
											2|[local::at0057],
											4|[local::at0058]
										}
									}
									ELEMENT[at0014] occurrences matches {0..1} matches {    -- Gooseflesh skin
										value matches {
											0|[local::at0059],
											3|[local::at0060],
											5|[local::at0061]
										}
									}
									ELEMENT[at0015] occurrences matches {0..1} matches {    -- Total score
										value matches {
											DV_COUNT matches {
												magnitude matches {|0..48|}
											}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0062] matches {    -- Item tree
				items cardinality matches {0..*; unordered} matches {
					allow_archetype CLUSTER[at0063] occurrences matches {0..*} matches {    -- Extension
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Clinical Opiate Withdrawal Scale (COWS)">
					description = <"Assessment tool used to measures the severity of opiate withdrawal.">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Any event">
					description = <"Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Resting pulse rate (BPM)">
					description = <"Measure pulse rate after patient is sitting or lying down for 1 minute.">
				>
				["at0005"] = <
					text = <"Sweating">
					description = <"Sweating not accounted for by room temperature or patient activity over the last 0.5 hours.">
				>
				["at0006"] = <
					text = <"Restlessness observation during assessment">
					description = <"">
				>
				["at0007"] = <
					text = <"Pupil size">
					description = <"">
				>
				["at0008"] = <
					text = <"Bone or joint aches">
					description = <"If patient was having pain previously, only the additional component attributed to opiate withdrawal is scored.">
				>
				["at0009"] = <
					text = <"Runny nose or tearing">
					description = <"Not accounted for by cold symptoms or allergies.">
				>
				["at0010"] = <
					text = <"GI upset">
					description = <"Over last 0.5 hours.">
				>
				["at0011"] = <
					text = <"Tremor observation of outstretched hands">
					description = <"">
				>
				["at0012"] = <
					text = <"Yawning observation during assessment">
					description = <"">
				>
				["at0013"] = <
					text = <"Anxiety or irritability">
					description = <"">
				>
				["at0014"] = <
					text = <"Gooseflesh skin">
					description = <"">
				>
				["at0015"] = <
					text = <"Total score">
					description = <"The total sum of each component parameter for COWS.">
				>
				["at0017"] = <
					text = <"≤ 80">
					description = <"">
				>
				["at0018"] = <
					text = <"81-100">
					description = <"">
				>
				["at0019"] = <
					text = <"101-120">
					description = <"">
				>
				["at0020"] = <
					text = <"> 120">
					description = <"">
				>
				["at0021"] = <
					text = <"No report of chills or flushing">
					description = <"">
				>
				["at0022"] = <
					text = <"Subjective report of chills or flushing">
					description = <"">
				>
				["at0023"] = <
					text = <"Flushed or observable moistness on face">
					description = <"">
				>
				["at0024"] = <
					text = <"Beads of sweat on brow or face">
					description = <"">
				>
				["at0025"] = <
					text = <"Sweat streaming off face">
					description = <"">
				>
				["at0026"] = <
					text = <"Able to sit still">
					description = <"">
				>
				["at0027"] = <
					text = <"Reports difficulty sitting still, but is able to do so">
					description = <"">
				>
				["at0028"] = <
					text = <"Frequent shifting or extraneous movements of legs/arms">
					description = <"">
				>
				["at0029"] = <
					text = <"Unable to sit still for more than a few seconds">
					description = <"">
				>
				["at0030"] = <
					text = <"Pupils pinned or normal size for room light">
					description = <"">
				>
				["at0031"] = <
					text = <"Pupils possibly larger than normal for room light">
					description = <"">
				>
				["at0032"] = <
					text = <"Pupils moderately dilated">
					description = <"">
				>
				["at0033"] = <
					text = <"Pupils so dilated that only the rim of the iris is visible">
					description = <"">
				>
				["at0034"] = <
					text = <"Not present">
					description = <"">
				>
				["at0035"] = <
					text = <"Mild diffuse discomfort">
					description = <"">
				>
				["at0036"] = <
					text = <"Patient reports severe diffuse aching of joints/ muscles">
					description = <"">
				>
				["at0037"] = <
					text = <"Patient is rubbing joints or muscles and is unable to sit still because of discomfort">
					description = <"">
				>
				["at0038"] = <
					text = <"Not present">
					description = <"">
				>
				["at0039"] = <
					text = <"Nasal stuffiness or unusually moist eyes">
					description = <"">
				>
				["at0040"] = <
					text = <"Nose running or tearing">
					description = <"">
				>
				["at0041"] = <
					text = <"Nose constantly running or tears streaming down cheeks">
					description = <"">
				>
				["at0042"] = <
					text = <"No GI symptoms">
					description = <"">
				>
				["at0043"] = <
					text = <"Stomach Cramps">
					description = <"">
				>
				["at0044"] = <
					text = <"Nausea or loose stool">
					description = <"">
				>
				["at0045"] = <
					text = <"Vomiting or diarrhea">
					description = <"">
				>
				["at0046"] = <
					text = <"Multiple episodes of vomiting or diarrhea">
					description = <"">
				>
				["at0047"] = <
					text = <"No tremor">
					description = <"">
				>
				["at0048"] = <
					text = <"Tremor can be felt, but not observed">
					description = <"">
				>
				["at0049"] = <
					text = <"Slight tremor observable">
					description = <"">
				>
				["at0050"] = <
					text = <"Gross tremor or muscle twitching">
					description = <"">
				>
				["at0051"] = <
					text = <"No yawning">
					description = <"">
				>
				["at0052"] = <
					text = <"Yawning once or twice during assessment">
					description = <"">
				>
				["at0053"] = <
					text = <"Yawning three or more times during assessment">
					description = <"">
				>
				["at0054"] = <
					text = <"Yawning several times/minute">
					description = <"">
				>
				["at0055"] = <
					text = <"None">
					description = <"">
				>
				["at0056"] = <
					text = <"Patient reports increasing irritability or anxiousness">
					description = <"">
				>
				["at0057"] = <
					text = <"Patient obviously irritable/anxious">
					description = <"">
				>
				["at0058"] = <
					text = <"Patient so irritable or anxious that participation in the assessment is difficult">
					description = <"">
				>
				["at0059"] = <
					text = <"Skin is smooth">
					description = <"">
				>
				["at0060"] = <
					text = <"Piloerection of skin can be felt or hairs standing up on arms">
					description = <"">
				>
				["at0061"] = <
					text = <"Prominent piloerection">
					description = <"">
				>
				["at0062"] = <
					text = <"Item tree">
					description = <"@ internal @">
				>
				["at0063"] = <
					text = <"Extension">
					description = <"Additional information required to extend the model with local content or to align with other reference models or formalisms.">
					comment = <"For example: local information requirements; or additional metadata to align with FHIR.">
				>
			>
		>
		["sv"] = <
			items = <
				["at0000"] = <
					text = <"*Clinical Opiate Withdrawal Scale (COWS) (en)">
					description = <"*Assessment tool used to measures the severity of opiate withdrawal. (en)">
				>
				["at0001"] = <
					text = <"*Event Series(en)">
					description = <"*@ internal @(en)">
				>
				["at0002"] = <
					text = <"*Any event(en)">
					description = <"*Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time. (en)">
				>
				["at0003"] = <
					text = <"*Tree(en)">
					description = <"*@ internal @(en)">
				>
				["at0004"] = <
					text = <"*Resting pulse rate (BPM) (en)">
					description = <"*Measure pulse rate after patient is sitting or lying down for 1 minute. (en)">
				>
				["at0005"] = <
					text = <"Svettning">
					description = <"*Sweating not accounted for by room temperature or patient activity over the last 0.5 hours. (en)">
				>
				["at0006"] = <
					text = <"Rastlöshet under utvärdering">
					description = <"">
				>
				["at0007"] = <
					text = <"Pupillstorlek">
					description = <"">
				>
				["at0008"] = <
					text = <"Ben- eller ledvärk">
					description = <"*If patient was having pain previously, only the additional component attributed to opiate withdrawal is scored. (en)">
				>
				["at0009"] = <
					text = <"Rinnande näsa eller tårande ögon">
					description = <"*Not accounted for by cold symptoms or allergies. (en)">
				>
				["at0010"] = <
					text = <"*GI upset (en)">
					description = <"Magbesvär senaste halvtimmen.">
				>
				["at0011"] = <
					text = <"Tremor vid utsträckta händer">
					description = <"">
				>
				["at0012"] = <
					text = <"Gäspning under utvärdering">
					description = <"">
				>
				["at0013"] = <
					text = <"Ångest eller irritabilitet">
					description = <"">
				>
				["at0014"] = <
					text = <"Piloerektion">
					description = <"">
				>
				["at0015"] = <
					text = <"Total poäng">
					description = <"*The total sum of each component parameter for COWS. (en)">
				>
				["at0017"] = <
					text = <"≤ 80">
					description = <"Slag per minut">
				>
				["at0018"] = <
					text = <"81-100">
					description = <"Slag per minut">
				>
				["at0019"] = <
					text = <"101-120">
					description = <"Slag per minut">
				>
				["at0020"] = <
					text = <"> 120">
					description = <"Slag per minut">
				>
				["at0021"] = <
					text = <"Ingen frossa eller flush">
					description = <"">
				>
				["at0022"] = <
					text = <"Subjektiv frossa eller flush">
					description = <"">
				>
				["at0023"] = <
					text = <"Flush eller synlig fuktighet i ansikte">
					description = <"">
				>
				["at0024"] = <
					text = <"Svettpärlor i panna eller ansikte">
					description = <"">
				>
				["at0025"] = <
					text = <"Rinnande svett">
					description = <"">
				>
				["at0026"] = <
					text = <"Sitter still">
					description = <"">
				>
				["at0027"] = <
					text = <"Säger sig ha svårt att sitta still men kan göra det">
					description = <"">
				>
				["at0028"] = <
					text = <"Frekvent skiftning av position eller överdrivet rörelsemönster med armar/ben">
					description = <"">
				>
				["at0029"] = <
					text = <"Oförmögen att sitta still längre än ett par sekunder">
					description = <"">
				>
				["at0030"] = <
					text = <"Nålstora eller av rimlig storlek med tanke på ljus i rummet">
					description = <"">
				>
				["at0031"] = <
					text = <"Möjligen förstorade givet ljus i rummet">
					description = <"">
				>
				["at0032"] = <
					text = <"Måttligt dilaterade">
					description = <"">
				>
				["at0033"] = <
					text = <"Dilaterade till den grad att endast kanten av iris synd">
					description = <"">
				>
				["at0034"] = <
					text = <"Ingen värk">
					description = <"">
				>
				["at0035"] = <
					text = <"Lindrigt diffust obehag">
					description = <"">
				>
				["at0036"] = <
					text = <"Patienten rapporterar svår diffus ben- eller ledvärk">
					description = <"">
				>
				["at0037"] = <
					text = <"Patienten gnider ben eller leder alternativt är oförmögen att sitta still på grund av värk">
					description = <"">
				>
				["at0038"] = <
					text = <"Ej förekommande">
					description = <"">
				>
				["at0039"] = <
					text = <"Nästäppa eller abnormalt vattniga ögon">
					description = <"">
				>
				["at0040"] = <
					text = <"Rinnande näsa eller tårande ögon">
					description = <"">
				>
				["at0041"] = <
					text = <"Konstant rinnande näsa eller flödande tårar">
					description = <"">
				>
				["at0042"] = <
					text = <"Ej förekommande">
					description = <"">
				>
				["at0043"] = <
					text = <"Magkramp">
					description = <"">
				>
				["at0044"] = <
					text = <"Illamående eller lös avföring">
					description = <"">
				>
				["at0045"] = <
					text = <"Kräkning eller diarré">
					description = <"">
				>
				["at0046"] = <
					text = <"Flertal kräkningar eller diarrér">
					description = <"">
				>
				["at0047"] = <
					text = <"Ingen tremor">
					description = <"">
				>
				["at0048"] = <
					text = <"Tremor kan kännas men ej observeras">
					description = <"">
				>
				["at0049"] = <
					text = <"Lätt synlig tremor">
					description = <"">
				>
				["at0050"] = <
					text = <"Kraftig tremor eller muskelspasm">
					description = <"">
				>
				["at0051"] = <
					text = <"Ingen gäspning">
					description = <"">
				>
				["at0052"] = <
					text = <"Gäspar en eller två gånger under utvärdering">
					description = <"">
				>
				["at0053"] = <
					text = <"Gäspar tre eller fyra gånger under utvärdering">
					description = <"">
				>
				["at0054"] = <
					text = <"Gäspar flera gånger per minut">
					description = <"">
				>
				["at0055"] = <
					text = <"Ej förekommande">
					description = <"">
				>
				["at0056"] = <
					text = <"Patienten rapporterar ökande irritabilitet eller ångest">
					description = <"">
				>
				["at0057"] = <
					text = <"Patienten är uppenbart irritabel eller ängslig">
					description = <"">
				>
				["at0058"] = <
					text = <"Irritabel eller ängslig till den grad att medverkan är svår">
					description = <"">
				>
				["at0059"] = <
					text = <"Slät hud.">
					description = <"">
				>
				["at0060"] = <
					text = <"Piloerektion kan kännas, alternativt stående hårstrån">
					description = <"">
				>
				["at0061"] = <
					text = <"Tydlig piloerektion">
					description = <"">
				>
				["at0062"] = <
					text = <"*Item tree (en)">
					description = <"@ internal @">
				>
				["at0063"] = <
					text = <"*Extension (en)">
					description = <"*Additional information required to extend the model with local content or to align with other reference models or formalisms. (en)">
					comment = <"*For example: local information requirements; or additional metadata to align with FHIR. (en)">
				>
			>
		>
	>