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Example ArtifactAssessment/example-justification-for-recommendation (XML)

Clinical Decision Support Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: No defined compartments

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Justification for Recommendation: ADA Obesity Management Recommendation (id = "example-justification-for-recommendation")

<?xml version="1.0" encoding="UTF-8"?>

<ArtifactAssessment xmlns="http://hl7.org/fhir">
  <id value="example-justification-for-recommendation"/> 
  <meta> 
    <versionId value="22"/> 
    <lastUpdated value="2025-03-17T22:12:11.071Z"/> 
    <profile value="http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation-justification"/> 
  </meta> 
  <text> 
    <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Title: </b> Justification for Recommendation: ADA Obesity Management Recommendation 8.16</p> <br/>  <p> <b> Justification for Recommendation: </b> Recommendation: ADA Obesity Management Recommendation 8.16</p> <br/>  <table> <tr> <th> Concept</th> <th> Summary</th> <th> Rating</th> </tr> <tr> <td> Recommendation Specification (coded as: RJCS-content0 from https://fevir.net/resources/CodeSy
            stem/27834); Recommendation Rating (coded as: recommendation-rating from https://fevir.net/res
            ources/CodeSystem/179423)</td> <td> 8.16 Metabolic surgery should be a recommended option to treat type 2 diabetes
             in screened surgical candidates with BMI ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian Americans)
             and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) who
             do not achieve durable weight loss and improvement in comorbidities (including
             hyperglycemia) with nonsurgical methods. A</td> <td> undefined</td> </tr> <tr> <td> Rating System (coded as: rating-system from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> ADA Level of Evidence</td> </tr> <tr> <td> Strength of Recommendation (coded as: RJCS-1000 from https://fevir.net/resources/CodeSystem/2
            7834); Strength of Recommendation (coded as: strength-of-recommendation from https://fevir.net
            /resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Direction of Recommendation (coded as: RJCS-1014 from https://fevir.net/resources/CodeSystem/
            27834); Direction of Recommendation (coded as: direction-of-recommendation from
             https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> Favors intervention (coded as: RJCS-2021 from https://fevir.net/resources/CodeSystem/27834)</td> </tr> <tr> <td> Ratings (coded as: ratings from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> A</td> </tr> <tr> <td> Evidence (coded as: RJCS-content1 from https://fevir.net/resources/CodeSystem/27834);
             Evidence (coded as: evidence from https://fevir.net/resources/CodeSystem/179423)</td> <td> ADA Level of Evidence A. A substantial body of evidence has now been accumulated,
             including data from numerous randomized controlled (nonblinded) clinical trials,
             demonstrating that metabolic surgery achieves superior glycemic control and reduction
             of cardiovascular risk factors in patients with type 2 diabetes and obesity compared
             with various lifestyle/medical interventions.</td> <td> undefined</td> </tr> <tr> <td> Summary of Findings (coded as: summary-of-findings from https://fevir.net/resources/CodeSyste
            m/179423)</td> <td> ADA Level of Evidence A. A substantial body of evidence has now been accumulated,
             including data from numerous randomized controlled (nonblinded) clinical trials,
             demonstrating that metabolic surgery achieves superior glycemic control and reduction
             of cardiovascular risk factors in patients with type 2 diabetes and obesity compared
             with various lifestyle/medical interventions.</td> <td> undefined</td> </tr> <tr> <td> Desirable Effects (coded as: RJCS-1004 from https://fevir.net/resources/CodeSystem/27834);
             Desirable Effects (coded as: desirable-effects from https://fevir.net/resources/CodeSystem/17
            9423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Undesirable Effects (coded as: RJCS-1005 from https://fevir.net/resources/CodeSystem/27834);
             Undesirable Effects (coded as: undesirable-effects from https://fevir.net/resources/CodeSyste
            m/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Discussion (coded as: discussion from https://fevir.net/resources/CodeSystem/179423)</td> <td> A substantial body of evidence has now been accumulated, including data from numerous
             randomized controlled (nonblinded) clinical trials, demonstrating that metabolic
             surgery achieves superior glycemic control and reduction of cardiovascular risk
             factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical
             interventions.<br/>  In extended follow-up of obese adults with type 2 diabetes randomized to adding
             gastric bypass compared with lifestyle and intensive medical management alone,
             there remained a significantly better composite triple end point in the surgical
             group at 5 years. However, because the effect size diminished over 5 years, further
             follow-up is needed to understand the durability of the improvement.</td> <td> undefined</td> </tr> <tr> <td> Net Effect (coded as: RJCS-1007 from https://fevir.net/resources/CodeSystem/27834);
             Net Effect (coded as: net-effect from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Values/Preferences (coded as: RJCS-1006 from https://fevir.net/resources/CodeSystem/27834);
             Preferences (coded as: preferences from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Discussion (coded as: discussion from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Judgments (coded as: RJCS-content2 from https://fevir.net/resources/CodeSystem/27834);
             Judgments (coded as: judgments from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Justification (coded as: justification from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Problem Importance (coded as: RJCS-1003 from https://fevir.net/resources/CodeSystem/27834);
             Problem Importance (coded as: problem-importance from https://fevir.net/resources/CodeSystem/
            179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Resources/Costs (coded as: RJCS-1008 from https://fevir.net/resources/CodeSystem/27834);
             Costs (coded as: costs from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Cost-effectiveness (coded as: RJCS-1009 from https://fevir.net/resources/CodeSystem/27834);
             Cost-effectiveness (coded as: cost-effectiveness from https://fevir.net/resources/CodeSystem/
            179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Equity (coded as: RJCS-1010 from https://fevir.net/resources/CodeSystem/27834);
             Equity (coded as: equity from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Acceptability (coded as: RJCS-1011 from https://fevir.net/resources/CodeSystem/27834);
             Acceptability (coded as: acceptability from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Feasibility (coded as: RJCS-1012 from https://fevir.net/resources/CodeSystem/27834);
             Feasibility (coded as: feasibility from https://fevir.net/resources/CodeSystem/179423)</td> <td> undefined</td> <td> undefined</td> </tr> <tr> <td> Competing Interests (coded as: RJCS-1002 from https://fevir.net/resources/CodeSystem/27834);
             Competing Interests (coded as: competing-interests from https://fevir.net/resources/CodeSyste
            m/179423)</td> <td> All members of the PPC are required to disclose potential conflicts of interest
             with industry and other relevant organizations. These disclosures are discussed
             at the outset of each Standards of Care revision meeting. Members of the committee,
             their employers, and their disclosed conflicts of interest are listed in 'Disclosures:
             Standards of Medical Care in Diabetes—2021' (https://doi.org/10.2337/dc21-SPPC).
             The ADA funds development of the Standards of Care out of its general revenues
             and does not use industry support for this purpose. NOTE: The disclosed conflicts
             of interest was not found at the suggested URL</td> <td> undefined</td> </tr> </table> <br/>  </div> 
  </text> 
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    <valueUri value="https://fevir.net/resources/ArtifactAssessment/179469"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/artifact-description">
    <valueMarkdown value="An example using the ArtifactAssessment Resource for representation of the many
     judgments and concepts used to justify a recommendation."/> 
  </extension> 
  <identifier> 
    <type> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/> 
        <code value="ACSN"/> 
        <display value="Accession ID"/> 
      </coding> 
      <text value="FEvIR Object Identifier"/> 
    </type> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="https://fevir.net/FOI/179469"/> 
    <assigner> 
      <display value="Computable Publishing LLC"/> 
    </assigner> 
  </identifier> 
  <title value="Justification for Recommendation: ADA Obesity Management Recommendation 8.16"/> 
  <artifactReference> 
    <reference value="Composition/179466"/> 
    <type value="Composition"/> 
    <display value="Recommendation: ADA Obesity Management Recommendation 8.16"/> 
  </artifactReference> 
  <content> 
    <summary value="8.16 Metabolic surgery should be a recommended option to treat type 2 diabetes
     in screened surgical candidates with BMI ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian Americans)
     and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) who
     do not achieve durable weight loss and improvement in comorbidities (including
     hyperglycemia) with nonsurgical methods. A"/> 
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        <code value="RJCS-content0"/> 
        <display value="Recommendation Specification"/> 
      </coding> 
      <coding> 
        <system value="https://fevir.net/resources/CodeSystem/179423"/> 
        <code value="recommendation-rating"/> 
        <display value="Recommendation Rating"/> 
      </coding> 
    </type> 
    <relatesTo> 
      <type value="derived-from"/> 
      <targetReference> 
        <reference value="Citation/32137"/> 
        <type value="Citation"/> 
        <display value="JournalArticleCitation: ADA 2021 Standards of Medical Care 8. Obesity Management
         for the Treatment of Type 2 Diabetes"/> 
      </targetReference> 
    </relatesTo> 
    <freeToShare value="true"/> 
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          <system value="https://fevir.net/resources/CodeSystem/179423"/> 
          <code value="rating-system"/> 
          <display value="Rating System"/> 
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          <display value="Direction of Recommendation"/> 
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          <code value="ratings"/> 
          <display value="Ratings"/> 
        </coding> 
      </type> 
      <classifier> 
        <text value="A"/> 
      </classifier> 
      <freeToShare value="true"/> 
    </component> 
  </content> 
  <content> 
    <summary value="ADA Level of Evidence A. A substantial body of evidence has now been accumulated,
     including data from numerous randomized controlled (nonblinded) clinical trials,
     demonstrating that metabolic surgery achieves superior glycemic control and reduction
     of cardiovascular risk factors in patients with type 2 diabetes and obesity compared
     with various lifestyle/medical interventions."/> 
    <type> 
      <coding> 
        <system value="https://fevir.net/resources/CodeSystem/27834"/> 
        <code value="RJCS-content1"/> 
        <display value="Evidence"/> 
      </coding> 
      <coding> 
        <system value="https://fevir.net/resources/CodeSystem/179423"/> 
        <code value="evidence"/> 
        <display value="Evidence"/> 
      </coding> 
    </type> 
    <relatesTo> 
      <type value="justification"/> 
      <targetReference> 
        <reference value="Citation/33089"/> 
        <type value="Citation"/> 
        <display value="JournalArticleCitation: Metabolic Surgery in the Treatment Algorithm for Type 2
         Diabetes: A Joint Statement by International Diabetes Organizations"/> 
      </targetReference> 
    </relatesTo> 
    <relatesTo> 
      <type value="justification"/> 
      <targetReference> 
        <reference value="Evidence/33244"/> 
        <type value="Evidence"/> 
        <display value="ComparativeEvidence: Mean difference in HbA1c effect of bariatric surgery in 2016
         meta-analysis"/> 
      </targetReference> 
    </relatesTo> 
    <freeToShare value="true"/> 
    <component> 
      <summary value="ADA Level of Evidence A. A substantial body of evidence has now been accumulated,
       including data from numerous randomized controlled (nonblinded) clinical trials,
       demonstrating that metabolic surgery achieves superior glycemic control and reduction
       of cardiovascular risk factors in patients with type 2 diabetes and obesity compared
       with various lifestyle/medical interventions."/> 
      <type> 
        <coding> 
          <system value="https://fevir.net/resources/CodeSystem/179423"/> 
          <code value="summary-of-findings"/> 
          <display value="Summary of Findings"/> 
        </coding> 
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      <freeToShare value="true"/> 
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    <component> 
      <type> 
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          <code value="RJCS-1004"/> 
          <display value="Desirable Effects"/> 
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        <coding> 
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          <code value="desirable-effects"/> 
          <display value="Desirable Effects"/> 
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      <freeToShare value="true"/> 
    </component> 
    <component> 
      <type> 
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          <display value="Undesirable Effects"/> 
        </coding> 
        <coding> 
          <system value="https://fevir.net/resources/CodeSystem/179423"/> 
          <code value="undesirable-effects"/> 
          <display value="Undesirable Effects"/> 
        </coding> 
      </type> 
      <freeToShare value="true"/> 
    </component> 
    <component> 
      <summary value="A substantial body of evidence has now been accumulated, including data from numerous
       randomized controlled (nonblinded) clinical trials, demonstrating that metabolic
       surgery achieves superior glycemic control and reduction of cardiovascular risk
       factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical
       interventions.&lt;br/&gt;In extended follow-up of obese adults with type 2 diabetes
       randomized to adding gastric bypass compared with lifestyle and intensive medical
       management alone, there remained a significantly better composite triple end point
       in the surgical group at 5 years. However, because the effect size diminished over
       5 years, further follow-up is needed to understand the durability of the improvement."/> 
      <type> 
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          <code value="discussion"/> 
          <display value="Discussion"/> 
        </coding> 
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      <relatesTo> 
        <type value="justification"/> 
        <targetMarkdown value="Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with
         long-term remission of type 2 diabetes and with microvascular and macrovascular
         complications. JAMA 2014;311:2297–2304"/> 
      </relatesTo> 
      <relatesTo> 
        <type value="justification"/> 
        <targetReference> 
          <reference value="Evidence/32144"/> 
          <type value="Evidence"/> 
          <display value="ComparativeEvidence: Bariatric Surgery effect for ADA triple outcome at 5 years
           (Diabetes Surgery Study)"/> 
        </targetReference> 
      </relatesTo> 
      <freeToShare value="true"/> 
    </component> 
  </content> 
  <content> 
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        <code value="RJCS-1007"/> 
        <display value="Net Effect"/> 
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      <coding> 
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        <display value="Net Effect"/> 
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          <display value="Values/Preferences"/> 
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        <coding> 
          <system value="https://fevir.net/resources/CodeSystem/179423"/> 
          <code value="preferences"/> 
          <display value="Preferences"/> 
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        <display value="Judgments"/> 
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          <display value="Feasibility"/> 
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      <freeToShare value="true"/> 
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  </content> 
  <content> 
    <summary value="All members of the PPC are required to disclose potential conflicts of interest
     with industry and other relevant organizations. These disclosures are discussed
     at the outset of each Standards of Care revision meeting. Members of the committee,
     their employers, and their disclosed conflicts of interest are listed in 'Disclosures:
     Standards of Medical Care in Diabetes—2021' (https://doi.org/10.2337/dc21-SPPC).
     The ADA funds development of the Standards of Care out of its general revenues
     and does not use industry support for this purpose. NOTE: The disclosed conflicts
     of interest was not found at the suggested URL"/> 
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        <code value="RJCS-1002"/> 
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      <coding> 
        <system value="https://fevir.net/resources/CodeSystem/179423"/> 
        <code value="competing-interests"/> 
        <display value="Competing Interests"/> 
      </coding> 
    </type> 
    <freeToShare value="true"/> 
  </content> 
</ArtifactAssessment> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.