{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T11:43:19Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 20.1, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a0956c-ce32-7320-9d9c-d1ee4b27bd7a\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: Ogilvie syndrome\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 044: 100", "usd": 0.0, "recall": true }, "codex": { "seconds": 68.9, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a0956c-ce3f-7860-9542-c133f8d55682\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: Ogilvie syndrome\nRegistry id: vr.tr.ogilvie-syndrome\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry:" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:44:00+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:26+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q1464904", "registryId": "vr.tr.ogilvie-syndrome", "name": "Ogilvie syndrome", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q1464904/", "model": { "registry_id": "vr.tr.ogilvie-syndrome", "name": "Ogilvie syndrome", "purpose": "Enable an agent to recognise Ogilvie syndrome, track the evidence and trajectory of an acute episode, and support clinician-reviewed decisions about observation, decompression and escalation.", "definition": "Ogilvie syndrome, also called acute colonic pseudo-obstruction, is acute dilatation of the colon without a mechanical blockage, usually occurring in association with serious illness, surgery or trauma.", "scope_statement": "This model owns the condition-level identity and episode-specific assessment of Ogilvie syndrome, also called acute colonic pseudo-obstruction, under vr.tr.ogilvie-syndrome in XCT / XCT.STA; patient identity, diagnostic assertions and care encounters remain linked entities.", "in_scope": [ "Acute colonic dilatation and evidence excluding a mechanical cause", "Diagnostic uncertainty and differentiation from other causes of bowel dilatation", "Associated illnesses, procedures, medications and physiological disturbances", "Serial distension measurements, clinical trajectory and complication assessment", "Eligibility for treatment pathways, response and recurrence", "Versioned diagnostic guidance and terminology mappings" ], "out_of_scope": [ "The patient's complete health record", "Mechanical bowel obstruction and volvulus as independent conditions", "Chronic intestinal pseudo-obstruction and chronic megacolon", "Inflammatory or infectious colitis and toxic megacolon as independent conditions", "Drug prescribing specifications and procedural technique", "Encounter administration, billing and hospital workflow" ], "distinguishing_features": [ "Require evidence of acute colonic dilatation without a mechanical obstructing cause; abdominal distension alone is insufficient. [ASCRS guideline, 2021](https://www.ascrsu.com/ascrs/repview?name=2_2851057_PDF&type=784-113)", "Check for bowel twisting or another obstructing lesion before distinguishing pseudo-obstruction from volvulus or mechanical obstruction. [ASGE guideline, 2020](https://www.asge.org/home/resources/publications/guidelines/american-society-for-gastrointestinal-endoscopy-guideline-on-the-role-of-endoscopy-in-the-management-of-acute-colonic-pseudo-obstruction-and-colonic-volvulus)", "Compare the current onset with baseline bowel function and prior dilatation before classifying the presentation as acute rather than chronic.", "Record colonic versus small-bowel involvement when distinguishing the presentation from generalised ileus.", "Explicitly assess whether colitis with systemic toxicity better explains the dilatation before accepting the Ogilvie label." ], "characteristics": [ { "name": "Diagnostic assertion status", "kind": "state", "unit_or_values": "suspected | supported | disputed | excluded; timestamp and assessor", "why_it_matters": "Separates the condition from the certainty of a particular diagnosis." }, { "name": "Mechanical obstruction assessment", "kind": "category", "unit_or_values": "not assessed | unresolved | excluded on documented investigation | identified", "why_it_matters": "Makes the central diagnostic exclusion explicit." }, { "name": "Dilatation distribution", "kind": "category", "unit_or_values": "named colonic segments; accompanying small-bowel involvement; imaging modality", "why_it_matters": "Supports comparison with competing bowel-dilatation patterns." }, { "name": "Cecal diameter", "kind": "measurement", "unit_or_values": "cm; imaging timestamp, modality and measurement method", "why_it_matters": "Provides a reproducible measure for serial assessment." }, { "name": "Duration of dilatation", "kind": "measurement", "unit_or_values": "hours or days from estimated onset; uncertainty interval", "why_it_matters": "Distinguishes prolonged disease from a newly observed finding." }, { "name": "Potential precipitant", "kind": "relation", "unit_or_values": "linked illness, operation, trauma, medication exposure or metabolic disturbance; timing and attribution confidence", "why_it_matters": "Supports investigation of reversible contributors without asserting causation." }, { "name": "Complication assessment", "kind": "state", "unit_or_values": "ischaemia and perforation each: not assessed | suspected | demonstrated | no current evidence", "why_it_matters": "Keeps urgent complications distinct from uncomplicated dilatation." }, { "name": "Episode trajectory", "kind": "state", "unit_or_values": "worsening | stable | improving | resolved | recurrent | indeterminate", "why_it_matters": "Supports time-sensitive reassessment without inventing formal disease stages." }, { "name": "Classification mapping", "kind": "relation", "unit_or_values": "code, label, terminology system, release, jurisdiction and mapping confidence", "why_it_matters": "Prevents an unverified or outdated code from defining the condition." } ], "affordances": [ "Assemble an evidence-linked diagnostic assessment and identify missing exclusions.", "Compare serial colonic measurements and clinical observations.", "Identify potentially reversible contributors for clinician review.", "Flag deterioration against an explicitly selected clinical guideline.", "Prepare a clinician-reviewed comparison of treatment eligibility and constraints.", "Distinguish persistent disease, documented resolution and a subsequent recurrence." ], "agent_conduct": { "may": [ "Explain the condition in general terms from reputable medical sources.", "Alert clinical staff, where authorized, when a hospital patient's records show a swelling abdomen and absent bowel movements." ], "must_not": [ "Diagnose the condition or rule out mechanical bowel blockage.", "Recommend medicines, decompression or surgery for a specific patient.", "Ignore or delay escalating signs of a worsening abdomen.", "Disclose patient records beyond the care team." ], "requires_human": [ "Any treatment, including procedures to decompress the colon." ] }, "ethics": { "considerations": [ "The condition strikes people already seriously ill, who depend on attentive care.", "Delayed recognition can turn a treatable problem into a fatal one." ], "affected_parties": [ "Hospital patients", "Their families", "Nursing staff" ] }, "owners": { "steward": "Nobody owns the condition; patients and their clinicians answer for care.", "master_systems": [] }, "visual_identification": [ "A greatly swollen abdomen in a patient recovering from surgery or serious illness.", "On X-ray, a widely dilated colon without a visible blockage." ], "failure_modes_and_hazards": [ "The colon can perforate if it stretches too far.", "Perforation carries a high risk of death." ], "what_it_is_for": [ "Ogilvie syndrome is encountered mainly in hospital care, often in people with serious illness or following surgery or trauma.", "It is considered during clinical assessment of acute abdominal distension when the colon is enlarged without a mechanical obstruction.", "Recognizing the condition supports clinical monitoring for complications such as impaired bowel blood supply or perforation." ], "standards_and_regulation": [ "The International Classification of Diseases, issued by the World Health Organization, provides the official disease classification framework for recording intestinal pseudo-obstruction, including Ogilvie syndrome." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q1464904: Ogilvie syndrome", "url": "https://www.wikidata.org/wiki/Q1464904", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Ogilvie syndrome", "url": "https://en.wikipedia.org/wiki/Ogilvie_syndrome", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "diagnostic-boundaries", "name": "Diagnostic boundaries", "description": "Establish whether the presentation belongs to acute colonic pseudo-obstruction.", "rationale": "The absence of a mechanical cause must be evidenced, and the registry label must not substitute for diagnosis.", "layers": [ { "id": "acute-colonic-pattern", "name": "Acute colonic pattern", "description": "Locate the dilatation and establish its temporal character.", "findings": [ { "id": "documented-acute-dilatation", "name": "Documented acute dilatation", "description": "Record the imaging interpretation, affected segments and baseline comparison supporting an acute colonic presentation.", "questions": [ { "text": "Which colonic segments are dilated, and what imaging report documents this?", "kind": "measurement", "id": "documented-acute-dilatation-q01" }, { "text": "What establishes an acute change rather than longstanding dilatation or chronic pseudo-obstruction?", "kind": "boundary", "id": "documented-acute-dilatation-q02" } ] } ] }, { "id": "exclusions-and-assertion", "name": "Exclusions and assertion", "description": "Make competing explanations and diagnostic authority inspectable.", "findings": [ { "id": "supported-pseudo-obstruction-assessment", "name": "Supported pseudo-obstruction assessment", "description": "Connect the diagnostic assertion to investigations, unresolved alternatives and the issuing body's dated guidance.", "questions": [ { "text": "How were an obstructing lesion and volvulus excluded, and what uncertainty remains?", "kind": "boundary", "id": "supported-pseudo-obstruction-assessment-q01" }, { "text": "What evidence distinguishes this presentation from generalised ileus or toxic megacolon?", "kind": "boundary", "id": "supported-pseudo-obstruction-assessment-q02" }, { "text": "Who asserted the diagnosis, using which diagnostic guidance and terminology release?", "kind": "provenance", "id": "supported-pseudo-obstruction-assessment-q03" } ] } ] } ] }, { "id": "precipitants-and-applicability", "name": "Precipitants and applicability", "description": "Describe the episode's clinical setting and candidate contributors.", "rationale": "Associated exposures and population context affect interpretation without proving a specific mechanism.", "layers": [ { "id": "clinical-setting", "name": "Clinical setting", "description": "Capture the circumstances in which the acute dilatation developed.", "findings": [ { "id": "episode-context", "name": "Episode context", "description": "Link recent surgery, trauma or acute illness and record age and care setting; these are recognised contexts, not diagnostic requirements. [ASCRS guideline, 2021](https://www.ascrsu.com/ascrs/repview?name=2_2851057_PDF&type=784-113)", "questions": [ { "text": "Which illnesses, operations or injuries preceded the bowel changes, and by how long?", "kind": "provenance", "id": "episode-context-q01" }, { "text": "Does the evidence being applied cover this person's age group and clinical setting?", "kind": "boundary", "id": "episode-context-q02" } ] } ] }, { "id": "reversible-contributors", "name": "Reversible contributors", "description": "Separate candidate contributors from established causes.", "findings": [ { "id": "contributor-attribution", "name": "Contributor attribution", "description": "Record medication exposures, electrolyte results and other proposed contributors with timing and confidence.", "questions": [ { "text": "Which medication exposures or physiological disturbances are proposed contributors, and what supports each attribution?", "kind": "provenance", "id": "contributor-attribution-q01" }, { "text": "Which contributors have been addressed, and how did the episode change afterward?", "kind": "action", "id": "contributor-attribution-q02" } ] } ] } ] }, { "id": "distension-and-complications", "name": "Distension and complications", "description": "Track dilatation over time and assess bowel compromise.", "rationale": "ACPO can progress to ischaemia and perforation, so assessment must capture change and complications. [ASCRS guideline, 2021](https://www.ascrsu.com/ascrs/repview?name=2_2851057_PDF&type=784-113)", "layers": [ { "id": "serial-distension", "name": "Serial distension", "description": "Build a comparable sequence of measurements and symptoms.", "findings": [ { "id": "diameter-duration-trajectory", "name": "Diameter and duration trajectory", "description": "Pair cecal measurements with observation times, estimated onset and symptom changes.", "questions": [ { "text": "What are the latest and previous cecal diameters, and are their measurement methods comparable?", "kind": "measurement", "id": "diameter-duration-trajectory-q01" }, { "text": "How long has dilatation persisted, and how uncertain is its onset?", "kind": "measurement", "id": "diameter-duration-trajectory-q02" }, { "text": "How have distension, pain, vomiting and stool or flatus passage changed between assessments?", "kind": "measurement", "id": "diameter-duration-trajectory-q03" } ] } ] }, { "id": "bowel-compromise", "name": "Bowel compromise", "description": "Keep suspected complications visible independently of diameter.", "findings": [ { "id": "urgent-complication-assessment", "name": "Urgent complication assessment", "description": "Record examination, physiological, laboratory and imaging evidence concerning ischaemia or perforation, with review status.", "questions": [ { "text": "What current findings support or weaken concern for ischaemia, perforation or peritonitis?", "kind": "measurement", "id": "urgent-complication-assessment-q01" }, { "text": "Does the assessment require urgent surgical review under the selected guideline, and has that review occurred?", "kind": "action", "id": "urgent-complication-assessment-q02" } ] } ] } ] }, { "id": "management-response-and-recurrence", "name": "Management response and recurrence", "description": "Connect treatment decisions to eligibility, observed response and episode closure.", "rationale": "A record of treatment alone cannot show whether dilatation resolved or further assessment is required.", "layers": [ { "id": "treatment-decision", "name": "Treatment decision", "description": "Represent the rationale for the selected management pathway.", "findings": [ { "id": "pathway-eligibility", "name": "Pathway eligibility", "description": "Document the clinician's assessment of supportive care, neostigmine, colonoscopic decompression or surgical management, including contraindications and monitoring requirements. [ASCRS guideline, 2021](https://www.ascrsu.com/ascrs/repview?name=2_2851057_PDF&type=784-113)", "questions": [ { "text": "Which pathway was selected, under which guideline version, and what findings justify it?", "kind": "action", "id": "pathway-eligibility-q01" }, { "text": "What contraindications, monitoring needs or resource constraints affect the proposed intervention?", "kind": "action", "id": "pathway-eligibility-q02" }, { "text": "What response deadline or deterioration finding triggers reassessment of this choice?", "kind": "action", "id": "pathway-eligibility-q03" } ] } ] }, { "id": "resolution-and-return", "name": "Resolution and return", "description": "Distinguish immediate response from sustained episode resolution.", "findings": [ { "id": "documented-episode-outcome", "name": "Documented episode outcome", "description": "Record symptom and imaging response, adverse events and the evidence used to close or reopen an episode.", "questions": [ { "text": "What objective and symptomatic changes followed treatment, and when were they measured?", "kind": "measurement", "id": "documented-episode-outcome-q01" }, { "text": "What documented criteria establish resolution rather than temporary improvement?", "kind": "definition", "id": "documented-episode-outcome-q02" }, { "text": "If dilatation returns, what supports recurrence after resolution rather than persistence or an underlying chronic disorder?", "kind": "boundary", "id": "documented-episode-outcome-q03" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is an unverified recall summary; exact ICD-10 national subcodes, ICD-11 identifiers and SNOMED CT concepts require checking.", "Guideline editions, intervention thresholds and diagnostic recommendations should be checked against the issuing bodies' current publications.", "Autonomic dysregulation is a proposed mechanism; the pathophysiology is not completely established." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of Ogilvie syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "Category K59.8", "note": "Other specified functional intestinal disorders; this is a broad category, not a unique identifier for Ogilvie syndrome, and national modifications require verification." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of Ogilvie syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "American Society for Gastrointestinal Endoscopy guidelines address the endoscopic management of acute colonic pseudo-obstruction.", "American Society of Colon and Rectal Surgeons clinical practice guidelines address acute colonic pseudo-obstruction." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of Ogilvie syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "A diagnostic consideration when a hospitalized or postoperative patient develops marked abdominal distension.", "Clinical assessment and imaging distinguish functional colonic dilatation from mechanical obstruction.", "Recognition informs correction of contributing illness, electrolyte disturbances and medication effects.", "Severity and complications guide decisions about monitoring, pharmacological decompression, endoscopic decompression or surgery." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of Ogilvie syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Progressive dilatation can lead to colonic ischaemia and perforation, particularly involving the caecum.", "Perforation may cause peritonitis, sepsis and death.", "Mistaking mechanical obstruction or toxic megacolon for Ogilvie syndrome can delay appropriate treatment.", "Colonic dilatation can recur after initially successful decompression.", "Treatments carry risks, including bradycardia with neostigmine and perforation during colonoscopic decompression." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of Ogilvie syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Diagnostic coding varies between the WHO ICD classification and national clinical modifications; the jurisdiction and revision must accompany a code." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of Ogilvie syndrome this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Mechanical large-bowel obstruction", "difference": "A physical obstructing lesion or structural blockage is present; Ogilvie syndrome lacks a mechanical blockage." }, { "name": "Toxic megacolon", "difference": "Colonic dilatation accompanies acute colitis and systemic toxicity; dilatation alone does not establish toxic megacolon." }, { "name": "Paralytic ileus", "difference": "Typically involves more generalized gastrointestinal hypomotility, often including the small bowel; Ogilvie syndrome predominantly affects the colon." }, { "name": "Chronic intestinal pseudo-obstruction", "difference": "Produces persistent or recurrent obstructive symptoms over a chronic course, rather than the acute presentation defining Ogilvie syndrome." }, { "name": "Colonic volvulus", "difference": "Twisting of the colon creates mechanical obstruction and may compromise blood supply." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of Ogilvie syndrome this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which ICD-10 national modification, ICD-11 release and SNOMED CT edition provide verified mappings for this registry concept, and are those mappings exact or broader?", "What newer guidance, if any, supersedes the reviewed ASCRS 2021 and ASGE 2020 documents, and which operational diagnostic and escalation criteria should this model adopt?", "What incidence or prevalence estimates are defensible for specified populations, settings, geographical areas and years, with explicit denominators?", "How should adult-derived assessment and management guidance be adapted for paediatric, pregnant or postpartum populations?", "Which evidence-based definitions of resolution and recurrence best distinguish repeated acute episodes from chronic intestinal pseudo-obstruction?" ], "statistics": { "bundles": 5, "layers": 9, "findings": 15, "questions": 27 } }