archetype (adl_version=1.4; uid=87a68f1a-346d-46cf-b637-61f7f5a68561)
	openEHR-EHR-OBSERVATION.has_bled.v0

concept
	[at0000]	-- HAS-BLED score
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"] = <"Konstantinos Kalliamvakos">
		["organisation"] = <"Cambio Healthcare Systems">
		["email"] = <"models@cambiocds.com">
		["date"] = <"2014-05-16">
	>
	details = <
		["sv"] = <
			language = <[ISO_639-1::sv]>
			purpose = <"Att registrera resultat i enlighet med HAS-BLED och därigenom få stöd i bedömning av blödningsrisk hos patienter med behandlat förmaksflimmer.">
			use = <"Använd för registrering av resultat i enlighet med HAS-BLED och därigenom få stöd i bedömning av blödningsrisk hos patienter med behandlat (antikoagulantia) förmaksflimmer.

Instrumentet baseras på nio faktorer:
- Hypertoni: definieras i detta fall som systoliskt blodtryck >160 mmHg.
- Njurpåverka: förekomst av kronisk dialys, njurtransplantation eller ett kreatininvärde om >200 umol/L.
- Leverpåverkan: kronisk leversjukdom, bilirubin >2x övre referensvärde, ASAT/ALAT >3x övre referensvärde
- Tidigare genomgången stroke
- Tidigare blödning, anemi eller blödningsrisk
- Riskvärde PK(INR): instabilt/högt värde, inom teurapeutiskt intervall <60% av tiden
- Patienten är 65 år gammal eller äldre
- Koagulationshämmande läkemedel: trombocythämmande läkemedel, NSAID
- Bruk av alkohol: ≥ 8 glas alkohol per vecka">
			keywords = <"HAS-BLED", "stroke", "förmaksflimmer", "antikoagulantia", "blödning">
			misuse = <"Ej avsedd för att användas isolerat och är ej att betrakta som diagnostisk.">
			copyright = <"© Cambio Healthcare Systems, openEHR Foundation">
		>
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record the results for each component parameter and their total sum for the HAS-BLED bleeding risk score.">
			use = <"Use to record the results for each component parameter and their total sum for the HAS-BLED bleeding risk score.">
			keywords = <"HAS-BLED", "stroke", "atrial fibrillation", "anticoagulants", "hemorrhage", "bleeding">
			misuse = <"">
			copyright = <"© Cambio Healthcare Systems, openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <"Syeeda S Farruque", "Heather Leslie, Atomica Informatics, Australia">
	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"] = <"Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol. 2011;57(2):173–180. doi:10.1016/j.jacc.2010.09.024.

Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093–1100. doi:10.1378/chest.10-0134.">
		["current_contact"] = <"Konstantinos Kalliamvakos, Cambio Healthcare Systems, Konstantinos.Kalliamvakos@cambio.se">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"2CE7DDC5C50105D9B2A10F956FB1CB2B">
		["build_uid"] = <"b28941ca-a52d-4e4d-aae6-0c4aeea79e81">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {    -- HAS-BLED score
		data matches {
			HISTORY[at0001] matches {    -- Event Series
				events cardinality matches {1..*; unordered} matches {
					EVENT[at0002] occurrences matches {0..1} matches {    -- Any point in time event
						data matches {
							ITEM_TREE[at0003] matches {    -- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0004] occurrences matches {0..1} matches {    -- Hypertension
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0005] occurrences matches {0..1} matches {    -- Abnormal renal function
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0006] occurrences matches {0..1} matches {    -- Abnormal liver function
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0007] occurrences matches {0..1} matches {    -- Stroke
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0008] occurrences matches {0..1} matches {    -- Bleeding history or predisposition
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0009] occurrences matches {0..1} matches {    -- Labile INR
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0010] occurrences matches {0..1} matches {    -- Elderly
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0011] occurrences matches {0..1} matches {    -- Drugs concomitantly
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0012] occurrences matches {0..1} matches {    -- Alcohol concomitantly
										value matches {
											0|[local::at0014],
											1|[local::at0015]
										}
									}
									ELEMENT[at0013] occurrences matches {0..1} matches {    -- Total score
										value matches {
											DV_COUNT matches {
												magnitude matches {|0..9|}
											}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0017] matches {    -- Item tree
				items cardinality matches {0..*; unordered} matches {
					allow_archetype CLUSTER[at0018] occurrences matches {0..*} matches {    -- Extension
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"HAS-BLED score">
					description = <"A risk assessment score to assess the bleeding risk in individuals with atrial fibrillation.">
					comment = <"The HAS-BLED mnemonic represents each risk factor:
- Hypertension,
- Abnormal renal/liver function, 
- Stroke, 
-Bleeding history or predisposition, 
- Labile INR, 
- Elderly (>65), and
- Drugs/alcohol concomitantly.">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Any point in time event">
					description = <"Default, unspecified point in time event which may be explicitly defined in a template or at run-time.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Hypertension">
					description = <"The systolic blood pressure is >160 mmHg.">
				>
				["at0005"] = <
					text = <"Abnormal renal function">
					description = <"The presence of chronic dialysis or renal transplantation or serum creatinine ≥200µmol/L.">
				>
				["at0006"] = <
					text = <"Abnormal liver function">
					description = <"Chronic hepatic disease (eg. cirrhosis) or biochemical evidence of significant hepatic derangement (eg. bilirubin >2x upper limit of normal, in association with AST/ALT/ALP >3x upper limit normal, etc).">
				>
				["at0007"] = <
					text = <"Stroke">
					description = <"A previous history of stroke, particularly lacunar.">
				>
				["at0008"] = <
					text = <"Bleeding history or predisposition">
					description = <"A previous bleeding history and/or predisposition to bleeding .">
					comment = <"For example: bleeding diathesis, anaemia, etc.">
				>
				["at0009"] = <
					text = <"Labile INR">
					description = <"Unstable/high INRs or poor time in therapeutic range.">
					comment = <"For example: <60%.">
				>
				["at0010"] = <
					text = <"Elderly">
					description = <"Age >65 yrs.">
				>
				["at0011"] = <
					text = <"Drugs concomitantly">
					description = <"The concomitant use of drugs, such as antiplatelet agents, non-steroidal anti-inflammatory drugs, etc.">
				>
				["at0012"] = <
					text = <"Alcohol concomitantly">
					description = <"Alcohol consumption ≥ 8 units per week.">
				>
				["at0013"] = <
					text = <"Total score">
					description = <"Sum of points assigned for each of the component parameters.">
				>
				["at0014"] = <
					text = <"No">
					description = <"The risk factor is not present.">
				>
				["at0015"] = <
					text = <"Yes">
					description = <"The risk factor is present.">
				>
				["at0017"] = <
					text = <"Item tree">
					description = <"@ internal @">
				>
				["at0018"] = <
					text = <"Extension">
					description = <"Additional information required to extend the model with local content or to align with other reference models/formalisms.">
					comment = <"For example: local information requirements; or additional metadata to align with FHIR.">
				>
			>
		>
		["sv"] = <
			items = <
				["at0000"] = <
					text = <"*HAS-BLED score(en)">
					description = <"*A risk assessment score to assess the bleeding risk in individuals with atrial fibrillation.

">
					comment = <"*The HAS-BLED mnemonic represents each risk factor:
- Hypertension,
- Abnormal renal/liver function, 
- Stroke, 
-Bleeding history or predisposition, 
- Labile INR, 
- Elderly (>65), and
- Drugs/alcohol concomitantly. (en)">
				>
				["at0001"] = <
					text = <"*Event Series(en)">
					description = <"*@ internal @(en)">
				>
				["at0002"] = <
					text = <"*Any point in time event(en)">
					description = <"*Default, unspecified point in time event which may be explicitly defined in a template or at run-time.">
				>
				["at0003"] = <
					text = <"*Tree(en)">
					description = <"*@ internal @(en)">
				>
				["at0004"] = <
					text = <"Hypertoni">
					description = <"*The systolic blood pressure is >160 mmHg. (en)">
				>
				["at0005"] = <
					text = <"Njurpåverkan">
					description = <"*The presence of chronic dialysis or renal transplantation or serum creatinine ≥200µmol/L. 
 (en)">
				>
				["at0006"] = <
					text = <"Leverpåverkan">
					description = <"*Chronic hepatic disease (eg. cirrhosis) or biochemical evidence of significant hepatic derangement (eg. bilirubin >2x upper limit of normal, in association with AST/ALT/ALP >3x upper limit normal, etc). (en)">
				>
				["at0007"] = <
					text = <"Tidigare stroke">
					description = <"*(previous history, particularly lacunar) (en)">
				>
				["at0008"] = <
					text = <"Tidigare blödning eller blödningsrisk">
					description = <"*A previous bleeding history and/or predisposition to bleeding eg. bleeding diathesis, anaemia, etc.  (en)">
				>
				["at0009"] = <
					text = <"*Labile INR (en)">
					description = <"*Unstable/high INRs or poor time in therapeutic range
(eg. <60%). (en)">
				>
				["at0010"] = <
					text = <"Ålder > 65 år">
					description = <"*Age >65 yrs. (en)">
				>
				["at0011"] = <
					text = <"Koagulationshämmande läkemedel">
					description = <"*The concomitant use of drugs, such as antiplatelet agents, non-steroidal anti-inflammatory drugs, etc.  (en)">
				>
				["at0012"] = <
					text = <"Bruk av alkohol">
					description = <"*Alcohol consumption ≥ 8 units per week. (en)">
				>
				["at0013"] = <
					text = <"Resultat">
					description = <"*Sum of points assigned for each of the component parameters. (en)">
				>
				["at0014"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0015"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0017"] = <
					text = <"*Item tree (en)">
					description = <"@ internal @">
				>
				["at0018"] = <
					text = <"*Extension (en)">
					description = <"*Additional information required to capture local content or to align with other reference models/formalisms.
 (en)">
					comment = <"*For example: local information requirements; or additional metadata to align with FHIR. (en)">
				>
			>
		>
	>