Evidence Based Medicine on FHIR Implementation Guide
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Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions

: 27222544 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. - TTL Representation

Active as of 2024-12-19

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@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

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fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Citation 33089</b></p><a name=\"33089\"> </a><a name=\"hc33089\"> </a><a name=\"33089-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">version: 9; Last updated: 2024-07-18 18:00:38+0000</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-journal-article-citation.html\">JournalArticleCitation</a></p></div><p><b>url</b>: <a href=\"Citation-33089.html\">Citation 27222544 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.</a></p><p><b>identifier</b>: FEvIR Object Identifier/33089, <code>https://pubmed.ncbi.nlm.nih.gov</code>/27222544, <a href=\"http://terminology.hl7.org/6.1.0/NamingSystem-uri.html\" title=\"As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt \r\n\r\nThis oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: \r\n\r\nNote that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.\r\n\r\nThis OID may also be used in CD.codeSystem.\">Uniform Resource Identifier (URI)</a>/urn:oid:2.16.840.1.113883.4.642.40.44.15.41</p><p><b>version</b>: 2.0.0-ballot</p><p><b>title</b>: 27222544 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.</p><p><b>status</b>: Active</p><p><b>date</b>: 2024-12-19 14:29:51+0000</p><p><b>publisher</b>: HL7 International / Clinical Decision Support</p><p><b>contact</b>: HL7 International / Clinical Decision Support: <a href=\"http://www.hl7.org/Special/committees/dss\">http://www.hl7.org/Special/committees/dss</a></p><p><b>description</b>: </p><div><p>This Citation Resource is referenced in an example for the EBMonFHIR Implementation Guide.</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://hl7.org/fhir/R5/codesystem-citation-classification-type.html#citation-classification-type-fevir-platform-use\">Citation Classification Type fevir-platform-use</a>: FEvIR Platform Use</td><td><span title=\"Codes:{http://hl7.org/fhir/citation-artifact-classifier medline-base}\">Medline Base</span></td></tr></table><p><b>jurisdiction</b>: <span title=\"Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}\">World</span></p><p><b>copyright</b>: </p><div><p>https://creativecommons.org/licenses/by-nc-sa/4.0/</p>\n</div><p><b>approvalDate</b>: 2017-09-28</p><p><b>lastReviewDate</b>: 2022-04-08</p><p><b>author</b>: Computable Publishing®: MEDLINE-to-FEvIR Converter: </p><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-classification-type citation-source}\">Citation Source</span></p><p><b>classifier</b>: <span title=\"Codes:\">MEDLINE</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-classification-type medline-owner}\">MEDLINE Citation Owner</span></p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/bsd/licensee/elements_descriptions.html#owner_value NLM}\">National Library of Medicine, Index Section</span></p></blockquote><p><b>currentState</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-status-type medline-medline}\">Medline Citation Status of Medline</span>, <span title=\"Codes:{http://hl7.org/fhir/citation-status-type pubmed-publication-status-ppublish}\">PubMed PublicationStatus of ppublish</span></p><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-entrez}\">PubMed Pubstatus of Entrez</span></p><p><b>period</b>: ?? --&gt; 2016-05-26 06:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-pubmed}\">PubMed Pubstatus of Pubmed</span></p><p><b>period</b>: ?? --&gt; 2016-05-26 06:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-medline}\">PubMed Pubstatus of Medline</span></p><p><b>period</b>: ?? --&gt; 2017-09-29 06:00:00+0000</p></blockquote><blockquote><p><b>citedArtifact</b></p><p><b>identifier</b>: <code>https://pubmed.ncbi.nlm.nih.gov</code>/27222544, <code>https://doi.org</code>/10.2337/dc16-0236, pii/39/6/861</p><h3>Titles</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Language</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://hl7.org/fhir/title-type primary}\">Primary title</span></td><td><span title=\"Codes:{urn:ietf:bcp:47 en}\">English</span></td><td><div><p>Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.</p>\n</div></td></tr></table><h3>Abstracts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Text</b></td><td><b>Copyright</b></td></tr><tr><td style=\"display: none\">*</td><td><div><p><strong>BACKGROUND:</strong> Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options.\n<strong>AIM:</strong> The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D.\n<strong>METHODS:</strong> A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee.\n<strong>RESULTS:</strong> Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients.\n<strong>CONCLUSIONS:</strong> Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.</p>\n</div></td><td><div><p>© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.</p>\n</div></td></tr></table><blockquote><p><b>relatesTo</b></p><p><b>type</b>: comment-in</p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Nat Rev Endocrinol. 2016 Sep;12(9):500-2. doi: 10.1038/nrendo.2016.111</p>\n</div><h3>Documents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"https://pubmed.ncbi.nlm.nih.gov/27388983/\">https://pubmed.ncbi.nlm.nih.gov/27388983/</a></td></tr></table><p><b>resourceReference</b>: Identifier: <code>https://pubmed.ncbi.nlm.nih.gov</code>/27388983</p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: comment-in</p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Diabetes Care. 2016 Nov;39(11):e201. doi: 10.2337/dc16-1416</p>\n</div><h3>Documents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"https://pubmed.ncbi.nlm.nih.gov/27926899/\">https://pubmed.ncbi.nlm.nih.gov/27926899/</a></td></tr></table><p><b>resourceReference</b>: Identifier: <code>https://pubmed.ncbi.nlm.nih.gov</code>/27926899</p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: comment-in</p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Diabetes Care. 2016 Nov;39(11):e202-e203. doi: 10.2337/dci16-0031</p>\n</div><h3>Documents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"https://pubmed.ncbi.nlm.nih.gov/27926900/\">https://pubmed.ncbi.nlm.nih.gov/27926900/</a></td></tr></table><p><b>resourceReference</b>: Identifier: <code>https://pubmed.ncbi.nlm.nih.gov</code>/27926900</p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: comment-in</p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Diabetes Care. 2017 Jul;40(7):e90-e91. doi: 10.2337/dc16-2403</p>\n</div><h3>Documents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"https://pubmed.ncbi.nlm.nih.gov/28637891/\">https://pubmed.ncbi.nlm.nih.gov/28637891/</a></td></tr></table><p><b>resourceReference</b>: Identifier: <code>https://pubmed.ncbi.nlm.nih.gov</code>/28637891</p></blockquote><blockquote><p><b>publicationForm</b></p><blockquote><p><b>publishedIn</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/published-in-type D020492}\">Periodical</span></p><p><b>identifier</b>: Electronic ISSN Type/1935-5548, ISOAbbreviation/Diabetes Care, ISSN Linking/0149-5992, Medline Title Abbreviation/Diabetes Care, NLM Unique ID/7805975</p><p><b>title</b>: Diabetes care</p><p><b>publisherLocation</b>: United States</p></blockquote><p><b>citedMedium</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-medium internet}\">Internet</span></p><p><b>volume</b>: 39</p><p><b>issue</b>: 6</p><p><b>articleDate</b>: 2016-06</p><p><b>publicationDateText</b>: 2016-Jun</p><p><b>language</b>: <span title=\"Codes:{urn:ietf:bcp:47 en}\">English</span></p><p><b>pageString</b>: 861-77</p></blockquote><blockquote><p><b>webLocation</b></p><p><b>classifier</b>: <span title=\"Codes:{http://hl7.org/fhir/artifact-url-classifier abstract}\">Abstract</span></p><p><b>url</b>: <a 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resource</a></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type publication-type}\">Publication type</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D016446}\">Consensus Development Conference</span>, <span title=\"Codes:{https://meshb.nlm.nih.gov/ D016428}\">Journal Article</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type knowledge-artifact-type}\">Knowledge Artifact Type</span></p><p><b>classifier</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}\">Journal Article</span></p><p><b>artifactAssessment</b>: Classifier added by Computable Publishing LLC</p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type 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CO.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor3\">Schauer PR</a></p><p><b>forenameInitials</b>: PR</p><p><b>affiliation</b>: Cleveland Clinic, Cleveland, OH.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor4\">Alberti KG</a></p><p><b>forenameInitials</b>: KG</p><p><b>affiliation</b>: Imperial College London, London, U.K.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor5\">Zimmet PZ</a></p><p><b>forenameInitials</b>: PZ</p><p><b>affiliation</b>: Monash University, Melbourne, Victoria, Australia.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor6\">Del Prato S</a></p><p><b>forenameInitials</b>: S</p><p><b>affiliation</b>: University of Pisa, Pisa, Italy.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor7\">Ji L</a></p><p><b>forenameInitials</b>: L</p><p><b>affiliation</b>: Peking University, Beijing, China.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor8\">Sadikot SM</a></p><p><b>forenameInitials</b>: SM</p><p><b>affiliation</b>: Diabetes India, Mumbai, India.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor9\">Herman WH</a></p><p><b>forenameInitials</b>: WH</p><p><b>affiliation</b>: University of Michigan, Ann Arbor, MI.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor10\">Amiel SA</a></p><p><b>forenameInitials</b>: SA</p><p><b>affiliation</b>: King's College London, London, U.K.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor11\">Kaplan LM</a></p><p><b>forenameInitials</b>: LM</p><p><b>affiliation</b>: Harvard Medical School, Boston, MA.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor12\">Taroncher-Oldenburg G</a></p><p><b>forenameInitials</b>: G</p><p><b>affiliation</b>: Philadelphia, PA.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor13\">Cummings DE</a></p><p><b>forenameInitials</b>: DE</p><p><b>affiliation</b>: University of Washington, Seattle, WA francesco.rubino@kcl.ac.uk davidec@u.washington.edu.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc33089/contributor14\">Delegates of the 2nd Diabetes Surgery Summit</a></p></blockquote></blockquote></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor0</b></p><a name=\"33089/contributor0\"> </a><a name=\"hc33089/contributor0\"> </a><a name=\"33089/contributor0-en-US\"> </a><p><b>name</b>: Francesco Rubino </p></blockquote><hr/><blockquote><p 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</a><p><b>name</b>: K George M M Alberti </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor5</b></p><a name=\"33089/contributor5\"> </a><a name=\"hc33089/contributor5\"> </a><a name=\"33089/contributor5-en-US\"> </a><p><b>name</b>: Paul Z Zimmet </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor6</b></p><a name=\"33089/contributor6\"> </a><a name=\"hc33089/contributor6\"> </a><a name=\"33089/contributor6-en-US\"> </a><p><b>name</b>: Stefano Del Prato </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor7</b></p><a name=\"33089/contributor7\"> </a><a name=\"hc33089/contributor7\"> </a><a name=\"33089/contributor7-en-US\"> </a><p><b>name</b>: Linong Ji </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor8</b></p><a name=\"33089/contributor8\"> </a><a name=\"hc33089/contributor8\"> </a><a name=\"33089/contributor8-en-US\"> </a><p><b>name</b>: Shaukat M Sadikot </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor9</b></p><a name=\"33089/contributor9\"> </a><a name=\"hc33089/contributor9\"> </a><a name=\"33089/contributor9-en-US\"> </a><p><b>name</b>: William H Herman </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor10</b></p><a name=\"33089/contributor10\"> </a><a name=\"hc33089/contributor10\"> </a><a name=\"33089/contributor10-en-US\"> </a><p><b>name</b>: Stephanie A Amiel </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor11</b></p><a name=\"33089/contributor11\"> </a><a name=\"hc33089/contributor11\"> </a><a name=\"33089/contributor11-en-US\"> </a><p><b>name</b>: Lee M Kaplan </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor12</b></p><a name=\"33089/contributor12\"> </a><a name=\"hc33089/contributor12\"> </a><a name=\"33089/contributor12-en-US\"> </a><p><b>name</b>: Gaspar Taroncher-Oldenburg </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor13</b></p><a name=\"33089/contributor13\"> </a><a name=\"hc33089/contributor13\"> </a><a name=\"33089/contributor13-en-US\"> </a><p><b>name</b>: David E Cummings </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Organization #contributor14</b></p><a name=\"33089/contributor14\"> </a><a name=\"hc33089/contributor14\"> </a><a name=\"33089/contributor14-en-US\"> </a><p><b>name</b>: Delegates of the 2nd Diabetes Surgery Summit</p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ArtifactAssessment #meshHeading0</b></p><a name=\"33089/meshHeading0\"> </a><a name=\"hc33089/meshHeading0\"> </a><a name=\"33089/meshHeading0-en-US\"> </a><p><b>artifact</b>: <a href=\"#hc33089\">Citation 27222544 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.</a></p><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D000465}\">Algorithms</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">qualifier</span></td><td><span title=\"Codes:\">is Major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D050110}\">Bariatric Surgery</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:\">is not a major topic</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ Q000592}\">standards</span></p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">is Major topic</span></td><td><span title=\"Codes:{https://ncithesaurus.nci.nih.gov/ncitbrowser C49488}\">Yes</span></td></tr></table></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D002318}\">Cardiovascular Diseases</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:\">is not a major topic</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ Q000517}\">prevention &amp; control</span></p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">is Major topic</span></td><td><span title=\"Codes:{https://ncithesaurus.nci.nih.gov/ncitbrowser C49487}\">No</span></td></tr></table></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D032921}\">Consensus</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">qualifier</span></td><td><span title=\"Codes:\">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D003299}\">Cooperative Behavior</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">qualifier</span></td><td><span title=\"Codes:\">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D003924}\">Diabetes Mellitus, Type 2</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:\">is not a major topic</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ Q000601}\">surgery</span></p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">is Major topic</span></td><td><span title=\"Codes:{https://ncithesaurus.nci.nih.gov/ncitbrowser C49488}\">Yes</span></td></tr></table></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D004704}\">Endocrinology</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:\">is not a major topic</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ Q000458}\">organization &amp; administration</span></p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">is Major topic</span></td><td><span title=\"Codes:{https://ncithesaurus.nci.nih.gov/ncitbrowser C49487}\">No</span></td></tr></table></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ Q000592}\">standards</span></p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">is Major topic</span></td><td><span title=\"Codes:{https://ncithesaurus.nci.nih.gov/ncitbrowser C49488}\">Yes</span></td></tr></table></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D006801}\">Humans</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">qualifier</span></td><td><span title=\"Codes:\">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D038622}\">Internationality</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">qualifier</span></td><td><span title=\"Codes:\">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D009765}\">Obesity</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:\">is not a major topic</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ Q000601}\">surgery</span></p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">is Major topic</span></td><td><span title=\"Codes:{https://ncithesaurus.nci.nih.gov/ncitbrowser C49487}\">No</span></td></tr></table></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D017410}\">Practice Guidelines as Topic</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">qualifier</span></td><td><span title=\"Codes:\">is Major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D012307}\">Risk Factors</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">qualifier</span></td><td><span title=\"Codes:\">is not a major topic</span></td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: Classifier</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ D012955}\">Societies, Medical</span></p><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:\">is not a major topic</span></p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ Q000458}\">organization &amp; administration</span></p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">is Major topic</span></td><td><span title=\"Codes:{https://ncithesaurus.nci.nih.gov/ncitbrowser C49487}\">No</span></td></tr></table></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: <span title=\"Codes:\">qualifier</span></p><p><b>classifier</b>: <span title=\"Codes:{https://meshb.nlm.nih.gov/ Q000592}\">standards</span></p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:\">is Major topic</span></td><td><span title=\"Codes:{https://ncithesaurus.nci.nih.gov/ncitbrowser C49487}\">No</span></td></tr></table></blockquote></blockquote></blockquote></div>"
  ] ; # 
  fhir:contained ( [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor0" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Rubino" ] ;
      ( fhir:given [ fhir:v "Francesco" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor1" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Nathan" ] ;
      ( fhir:given [ fhir:v "David M" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor2" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Eckel" ] ;
      ( fhir:given [ fhir:v "Robert H" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor3" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Schauer" ] ;
      ( fhir:given [ fhir:v "Philip R" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor4" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Alberti" ] ;
      ( fhir:given [ fhir:v "K George M M" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor5" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Zimmet" ] ;
      ( fhir:given [ fhir:v "Paul Z" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor6" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Del Prato" ] ;
      ( fhir:given [ fhir:v "Stefano" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor7" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Ji" ] ;
      ( fhir:given [ fhir:v "Linong" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor8" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Sadikot" ] ;
      ( fhir:given [ fhir:v "Shaukat M" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor9" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Herman" ] ;
      ( fhir:given [ fhir:v "William H" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor10" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Amiel" ] ;
      ( fhir:given [ fhir:v "Stephanie A" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor11" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Kaplan" ] ;
      ( fhir:given [ fhir:v "Lee M" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor12" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Taroncher-Oldenburg" ] ;
      ( fhir:given [ fhir:v "Gaspar" ] )     ] )
  ] [
a fhir:Practitioner ;
fhir:id [ fhir:v "contributor13" ] ;
    ( fhir:name [
fhir:family [ fhir:v "Cummings" ] ;
      ( fhir:given [ fhir:v "David E" ] )     ] )
  ] [
a fhir:Organization ;
fhir:id [ fhir:v "contributor14" ] ;
fhir:name [ fhir:v "Delegates of the 2nd Diabetes Surgery Summit" ]
  ] [
a fhir:ArtifactAssessment ;
fhir:id [ fhir:v "meshHeading0" ] ;
fhir:artifact [
a fhir:Reference ;
fhir:reference [ fhir:v "#" ] ;
fhir:type [ fhir:v "Citation"^^xsd:anyURI ]     ] ;
    ( fhir:content [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
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fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D000465" ] ;
fhir:display [ fhir:v "Algorithms" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
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fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
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fhir:text [ fhir:v "is Major topic" ]         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D050110" ] ;
fhir:display [ fhir:v "Bariatric Surgery" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
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fhir:text [ fhir:v "is not a major topic" ]         ] )       ] [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
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fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Q000592" ] ;
fhir:display [ fhir:v "standards" ]           ] )         ] ) ;
        ( fhir:component [
fhir:type [
fhir:text [ fhir:v "is Major topic" ]           ] ;
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fhir:system [ fhir:v "https://ncithesaurus.nci.nih.gov/ncitbrowser"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C49488" ] ;
fhir:display [ fhir:v "Yes" ]             ] )           ] )         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
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fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D002318" ] ;
fhir:display [ fhir:v "Cardiovascular Diseases" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
          ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Q000517" ] ;
fhir:display [ fhir:v "prevention & control" ]           ] )         ] ) ;
        ( fhir:component [
fhir:type [
fhir:text [ fhir:v "is Major topic" ]           ] ;
          ( fhir:classifier [
            ( fhir:coding [
fhir:system [ fhir:v "https://ncithesaurus.nci.nih.gov/ncitbrowser"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C49487" ] ;
fhir:display [ fhir:v "No" ]             ] )           ] )         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D032921" ] ;
fhir:display [ fhir:v "Consensus" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D003299" ] ;
fhir:display [ fhir:v "Cooperative Behavior" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D003924" ] ;
fhir:display [ fhir:v "Diabetes Mellitus, Type 2" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
          ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Q000601" ] ;
fhir:display [ fhir:v "surgery" ]           ] )         ] ) ;
        ( fhir:component [
fhir:type [
fhir:text [ fhir:v "is Major topic" ]           ] ;
          ( fhir:classifier [
            ( fhir:coding [
fhir:system [ fhir:v "https://ncithesaurus.nci.nih.gov/ncitbrowser"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C49488" ] ;
fhir:display [ fhir:v "Yes" ]             ] )           ] )         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D004704" ] ;
fhir:display [ fhir:v "Endocrinology" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
          ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Q000458" ] ;
fhir:display [ fhir:v "organization & administration" ]           ] )         ] ) ;
        ( fhir:component [
fhir:type [
fhir:text [ fhir:v "is Major topic" ]           ] ;
          ( fhir:classifier [
            ( fhir:coding [
fhir:system [ fhir:v "https://ncithesaurus.nci.nih.gov/ncitbrowser"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C49487" ] ;
fhir:display [ fhir:v "No" ]             ] )           ] )         ] )       ] [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
          ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Q000592" ] ;
fhir:display [ fhir:v "standards" ]           ] )         ] ) ;
        ( fhir:component [
fhir:type [
fhir:text [ fhir:v "is Major topic" ]           ] ;
          ( fhir:classifier [
            ( fhir:coding [
fhir:system [ fhir:v "https://ncithesaurus.nci.nih.gov/ncitbrowser"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C49488" ] ;
fhir:display [ fhir:v "Yes" ]             ] )           ] )         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D006801" ] ;
fhir:display [ fhir:v "Humans" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D038622" ] ;
fhir:display [ fhir:v "Internationality" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D009765" ] ;
fhir:display [ fhir:v "Obesity" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
          ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Q000601" ] ;
fhir:display [ fhir:v "surgery" ]           ] )         ] ) ;
        ( fhir:component [
fhir:type [
fhir:text [ fhir:v "is Major topic" ]           ] ;
          ( fhir:classifier [
            ( fhir:coding [
fhir:system [ fhir:v "https://ncithesaurus.nci.nih.gov/ncitbrowser"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C49487" ] ;
fhir:display [ fhir:v "No" ]             ] )           ] )         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D017410" ] ;
fhir:display [ fhir:v "Practice Guidelines as Topic" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is Major topic" ]         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D012307" ] ;
fhir:display [ fhir:v "Risk Factors" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] )     ] [
fhir:informationType [ fhir:v "classifier" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/cited-artifact-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "mesh-heading" ] ;
fhir:display [ fhir:v "MeSH heading" ]         ] ) ;
fhir:text [ fhir:v "components (if present) include qualifier codings" ]       ] ;
      ( fhir:classifier [
        ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "D012955" ] ;
fhir:display [ fhir:v "Societies, Medical" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]         ] )       ] ) ;
fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ;
      ( fhir:component [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
fhir:text [ fhir:v "is not a major topic" ]         ] )       ] [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
          ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Q000458" ] ;
fhir:display [ fhir:v "organization & administration" ]           ] )         ] ) ;
        ( fhir:component [
fhir:type [
fhir:text [ fhir:v "is Major topic" ]           ] ;
          ( fhir:classifier [
            ( fhir:coding [
fhir:system [ fhir:v "https://ncithesaurus.nci.nih.gov/ncitbrowser"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C49487" ] ;
fhir:display [ fhir:v "No" ]             ] )           ] )         ] )       ] [
fhir:type [
fhir:text [ fhir:v "qualifier" ]         ] ;
        ( fhir:classifier [
          ( fhir:coding [
fhir:system [ fhir:v "https://meshb.nlm.nih.gov/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Q000592" ] ;
fhir:display [ fhir:v "standards" ]           ] )         ] ) ;
        ( fhir:component [
fhir:type [
fhir:text [ fhir:v "is Major topic" ]           ] ;
          ( fhir:classifier [
            ( fhir:coding [
fhir:system [ fhir:v "https://ncithesaurus.nci.nih.gov/ncitbrowser"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C49487" ] ;
fhir:display [ fhir:v "No" ]             ] )           ] )         ] )       ] )     ] )
  ] ) ; # 
  fhir:url [ fhir:v "https://fevir.net/resources/Citation/33089"^^xsd:anyURI] ; # 
  fhir:identifier ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ACSN" ] ;
fhir:display [ fhir:v "Accession ID" ]       ] ) ;
fhir:text [ fhir:v "FEvIR Object Identifier" ]     ] ;
fhir:system [ fhir:v "https://fevir.net"^^xsd:anyURI ] ;
fhir:value [ fhir:v "33089" ] ;
fhir:assigner [
fhir:display [ fhir:v "Computable Publishing LLC" ]     ]
  ] [
fhir:system [ fhir:v "https://pubmed.ncbi.nlm.nih.gov"^^xsd:anyURI ] ;
fhir:value [ fhir:v "27222544" ]
  ] [
fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.40.44.15.41" ]
  ] ) ; # 
  fhir:version [ fhir:v "2.0.0-ballot"] ; # 
  fhir:title [ fhir:v "27222544 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations."] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:date [ fhir:v "2024-12-19T14:29:51+00:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "HL7 International / Clinical Decision Support"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "HL7 International / Clinical Decision Support" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/dss" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "This Citation Resource is referenced in an example for the EBMonFHIR Implementation Guide."] ; # 
  fhir:useContext ( [
fhir:code [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "fevir-platform-use" ] ;
fhir:display [ fhir:v "FEvIR Platform Use" ]     ] ;
fhir:value [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-artifact-classifier"^^xsd:anyURI ] ;
fhir:code [ fhir:v "medline-base" ] ;
fhir:display [ fhir:v "Medline Base" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]       ] )     ]
  ] ) ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]     ] )
  ] ) ; # 
  fhir:copyright [ fhir:v "https://creativecommons.org/licenses/by-nc-sa/4.0/"] ; # 
  fhir:approvalDate [ fhir:v "2017-09-28"^^xsd:date] ; # 
  fhir:lastReviewDate [ fhir:v "2022-04-08"^^xsd:date] ; # 
  fhir:author ( [
fhir:name [ fhir:v "Computable Publishing®: MEDLINE-to-FEvIR Converter" ]
  ] ) ; # 
  fhir:classification ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "citation-source" ] ;
fhir:display [ fhir:v "Citation Source" ]       ] )     ] ;
    ( fhir:classifier [
fhir:text [ fhir:v "MEDLINE" ]     ] )
  ] [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-classification-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "medline-owner" ] ;
fhir:display [ fhir:v "MEDLINE Citation Owner" ]       ] )     ] ;
    ( fhir:classifier [
      ( fhir:coding [
fhir:system [ fhir:v "https://www.nlm.nih.gov/bsd/licensee/elements_descriptions.html#owner_value"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NLM" ] ;
fhir:display [ fhir:v "National Library of Medicine, Index Section" ] ;
fhir:userSelected [ fhir:v "false"^^xsd:boolean ]       ] )     ] )
  ] ) ; # 
  fhir:currentState ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-status-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "medline-medline" ] ;
fhir:display [ fhir:v "Medline Citation Status of Medline" ]     ] )
  ] [
    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-status-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "pubmed-publication-status-ppublish" ] ;
fhir:display [ fhir:v "PubMed PublicationStatus of ppublish" ]     ] )
  ] ) ; # 
  fhir:statusDate ( [
fhir:activity [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-status-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "pubmed-pubstatus-entrez" ] ;
fhir:display [ fhir:v "PubMed Pubstatus of Entrez" ]       ] )     ] ;
fhir:period [
fhir:end [ fhir:v "2016-05-26T06:00:00.000Z"^^xsd:dateTime ]     ]
  ] [
fhir:activity [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-status-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "pubmed-pubstatus-pubmed" ] ;
fhir:display [ fhir:v "PubMed Pubstatus of Pubmed" ]       ] )     ] ;
fhir:period [
fhir:end [ fhir:v "2016-05-26T06:00:00.000Z"^^xsd:dateTime ]     ]
  ] [
fhir:activity [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/citation-status-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "pubmed-pubstatus-medline" ] ;
fhir:display [ fhir:v "PubMed Pubstatus of Medline" ]       ] )     ] ;
fhir:period [
fhir:end [ fhir:v "2017-09-29T06:00:00.000Z"^^xsd:dateTime ]     ]
  ] ) ; # 
  fhir:citedArtifact [
    ( fhir:identifier [
fhir:system [ fhir:v "https://pubmed.ncbi.nlm.nih.gov"^^xsd:anyURI ] ;
fhir:value [ fhir:v "27222544" ]     ] [
fhir:system [ fhir:v "https://doi.org"^^xsd:anyURI ] ;
fhir:value [ fhir:v "10.2337/dc16-0236" ]     ] [
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ACSN" ] ;
fhir:display [ fhir:v "Accession ID" ]         ] ) ;
fhir:text [ fhir:v "pii" ]       ] ;
fhir:value [ fhir:v "39/6/861" ]     ] ) ;
    ( fhir:title [
      ( fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/title-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "primary" ] ;
fhir:display [ fhir:v "Primary title" ]         ] )       ] ) ;
fhir:language [
        ( fhir:coding [
fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ;
fhir:code [ fhir:v "en" ] ;
fhir:display [ fhir:v "English" ]         ] )       ] ;
fhir:text [ fhir:v "Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations." ]     ] ) ;
    ( fhir:abstract [
fhir:text [ fhir:v "**BACKGROUND:** Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options.\n**AIM:** The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D.\n**METHODS:** A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee.\n**RESULTS:** Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients.\n**CONCLUSIONS:** Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies." ] ;
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