Hi Andrew,
The clusters have been part of recent archetype design evolution,
particularly because experience in modelling history and examination
archetypes indicated we needed an additional level of flexibility to capture
clinical data well.
My current understanding of CLUSTERS is as follows:
- Clusters are reusable archetypes for use in any ENTRY, and particularly of
value where recursiveness is important. As an example, consider a history
OBSERVATION archeype which can contain a Symptom CLUSTER (eg to capture data
about a presenting complaint of Headache), which can in turn contain further
symptom clusters to capture associated symptom details(eg vomiting or
photophobia).
- Clusters have no inherent event/timing, protocol or state attributes -
these come from the ENTRY archetype that contains the given cluster, where
appropriate.
- CLUSTERS tend to represent common and fundamental domain patterns that are
required in many archetypes and clinical scenarios such as size, symptom,
inspection and relative location. In recording clinical examination and
history details, they are useful in capturing those ubiquitous 'first
principles' of examination and history, and could often be best sourced from
a first year clinical student's textbook eg a checklist for a thorough
inspection would consist of size, shape, location, texture, edge,
temperature, surface, surrounds, etc etc - a re-usable component for
capturing inspection detail in many, if not most, clinical examination
scenarios.
Your question about the Glasgow scale as a Cluster archetype is very
pertinent and if you download again you will see it has indeed been
re-developed as an OBSERVATION. As part of some recent rapid development of
archetypes I explored GCS as a cluster, uploaded it for some sharing and
feedback, and only a few hours later revised it - you obviously downloaded
it in that window of a few hours!!!
In my opinion Glasgow Coma Scale are best captured as OBSERVATION archetypes
where it may be used for serial measurements, such as regular recording
during a period of neuro observations post-Head injury. In addition they
are effectively standalone concepts where the need for recursiveness is
lower.
Hope this helps
Heather