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

: SummaryOfFindings: Bariatric Surgery Summary of Findings Example for GIN 2022 - XML Representation

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<Composition xmlns="http://hl7.org/fhir">
  <id value="104215"/>
  <meta>
    <versionId value="33"/>
    <lastUpdated value="2024-12-05T14:14:39.128Z"/>
    <profile
             value="http://hl7.org/fhir/uv/ebm/StructureDefinition/summary-of-findings"/>
  </meta>
  <text>
    <status value="empty"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>[No data.]</p></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/artifact-description">
    <valueMarkdown
                   value="Example of SummaryOfFindings Profile of Composition Resource."/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/artifact-copyright">
    <valueMarkdown
                   value="https://creativecommons.org/licenses/by-nc-sa/4.0/"/>
  </extension>
  <url value="https://fevir.net/resources/Composition/104215"/>
  <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/104215"/>
    <assigner>
      <display value="Computable Publishing LLC"/>
    </assigner>
  </identifier>
  <status value="final"/>
  <type>
    <coding>
      <system value="https://fevir.net/resources/CodeSystem/179423"/>
      <code value="SummaryOfFindings"/>
      <display value="SummaryOfFindings"/>
    </coding>
    <text value="Summary of Findings"/>
  </type>
  <subject>🔗 
    <reference value="Group/179562"/>
    <type value="Group"/>
    <display
             value="EvidenceReportSubject: Clinical Outcomes for Effects of Bariatric Surgery"/>
  </subject>
  <date value="2024-12-05T14:14:39.128Z"/>
  <author>
    <type value="Practitioner"/>
    <display value="Brian S. Alper"/>
  </author>
  <title
         value="SummaryOfFindings: Bariatric Surgery Summary of Findings Example for GIN 2022"/>
  <custodian>
    <display value="Computable Publishing LLC"/>
  </custodian>
  <relatesTo>
    <type value="cite-as"/>
    <label value="Cite as"/>
    <citation
              value="SummaryOfFindings: Bariatric Surgery Summary of Findings Example for GIN 2022 [Database Entry: FHIR Composition Resource]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104215. Revised 2024-10-31. Available at: https://fevir.net/resources/Composition/104215. Computable resource at: https://fevir.net/FLI/DocumentForComposition104215."/>
  </relatesTo>
  <section>
    <title value="Column Headers"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="column-headers"/>
        <display value="Column Headers"/>
      </coding>
    </code>
    <entry>🔗 
      <reference value="Composition/104213"/>
      <type value="Composition"/>
      <display
               value="EvidenceMap: Bariatric Surgery Summary of Findings Example for GIN 2022"/>
    </entry>
    <section>
      <title value="Outcome"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="outcome-measure"/>
          <display value="Outcome Measure"/>
        </coding>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Outcome</div>
      </text>
    </section>
    <section>
      <title value="Sample Size"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="sample-size"/>
          <display value="Sample Size"/>
        </coding>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Sample size: # studies, # participants, # counted, # events</div>
      </text>
    </section>
    <section>
      <title value="Result Without Treatment"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="result-with-comparator-alone"/>
          <display value="Result with comparator alone"/>
        </coding>
      </code>
      <text>
        <status value="additional"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Result without bariatric surgery</div>
      </text>
    </section>
    <section>
      <title value="Result With Treatment--Observed"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="result-with-intervention-alone"/>
          <display value="Result with intervention alone"/>
        </coding>
      </code>
      <text>
        <status value="additional"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Result with bariatric surgery</div>
      </text>
    </section>
    <section>
      <title value="Result With Treatment--Derived"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="result-with-intervention-alone-calculated"/>
          <display value="Result with intervention alone (calculated)"/>
        </coding>
        <text
              value="calculated value derived from the control group and effect estimate"/>
      </code>
      <text>
        <status value="additional"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Result with bariatric surgery (calculated)</div>
      </text>
    </section>
    <section>
      <title value="Effect Estimate"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="result-with-intervention-vs-comparator"/>
          <display value="Result with intervention vs. comparator"/>
        </coding>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Effect Estimate (Relative effect)</div>
      </text>
    </section>
    <section>
      <title value="Certainty of Evidence"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="certainty-of-evidence"/>
          <display value="Certainty of Evidence"/>
        </coding>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Certainty of finding (Quality of evidence)</div>
      </text>
    </section>
    <section>
      <title value="Assertion"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="assertion"/>
          <display value="Assertion"/>
        </coding>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">What this means</div>
      </text>
    </section>
  </section>
  <section>
    <title value="Summary of Findings"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="summary-of-findings"/>
        <display value="Summary of Findings"/>
      </coding>
    </code>
    <section>
      <title value="All-cause mortality"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="summary-of-findings-entry-for-a-single-outcome"/>
          <display value="Summary of findings entry for a single outcome"/>
        </coding>
      </code>
      <focus>🔗 
        <reference value="EvidenceVariable/49217"/>
        <type value="EvidenceVariable"/>
        <display value="OutcomeVariable: All-cause mortality"/>
      </focus>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</div>
      </text>
      <section>
        <title value="Outcome"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="outcome-measure"/>
            <display value="Outcome Measure"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">All-cause mortality</div>
        </text>
        <entry>🔗 
          <reference value="EvidenceVariable/49217"/>
          <type value="EvidenceVariable"/>
          <display value="OutcomeVariable: All-cause mortality"/>
        </entry>
      </section>
      <section>
        <title value="Sample Size"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="sample-size"/>
            <display value="Sample Size"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">21 studies, 397002 participants</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/49328"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: All-cause mortality effect of bariatric surgery in 2022 meta-analysis"/>
        </entry>
      </section>
      <section>
        <title value="Result Without Treatment"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-comparator-alone"/>
            <display value="Result with comparator alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">5% (estimated); specific summary evidence not reported</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104384"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: All-cause mortality without bariatric surgery in 2022 meta-analysis"/>
        </entry>
      </section>
      <section>
        <title value="Result With Treatment--Observed"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone"/>
            <display value="Result with intervention alone"/>
          </coding>
        </code>
        <text>
          <status value="empty"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Not reported</div>
        </text>
      </section>
      <section>
        <title value="Result With Treatment--Derived"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone-calculated"/>
            <display value="Result with intervention alone (calculated)"/>
          </coding>
          <text
                value="calculated value derived from the control group and effect estimate"/>
        </code>
        <text>
          <status value="empty"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Not reported</div>
        </text>
      </section>
      <section>
        <title value="Effect Estimate"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-vs-comparator"/>
            <display value="Result with intervention vs. comparator"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Hazard Ratio 0.55 (95% confidence interval 0.49 to 0.62)</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/49328"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: All-cause mortality effect of bariatric surgery in 2022 meta-analysis"/>
        </entry>
      </section>
      <section>
        <title value="Certainty of Evidence"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="certainty-of-evidence"/>
            <display value="Certainty of Evidence"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Low quality</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/49328"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: All-cause mortality effect of bariatric surgery in 2022 meta-analysis"/>
        </entry>
      </section>
      <section>
        <title value="Assertion"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="assertion"/>
            <display value="Assertion"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">The present systematic review and meta-analysis suggests that bariatric surgery is associated with reduced all-cause and CV mortality.</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/49328"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: All-cause mortality effect of bariatric surgery in 2022 meta-analysis"/>
        </entry>
      </section>
    </section>
    <section>
      <title value="Nonfatal myocardial infarction or stroke"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="summary-of-findings-entry-for-a-single-outcome"/>
          <display value="Summary of findings entry for a single outcome"/>
        </coding>
      </code>
      <focus>🔗 
        <reference value="EvidenceVariable/104097"/>
        <type value="EvidenceVariable"/>
        <display
                 value="OutcomeVariable: Nonfatal myocardial infarction or stroke"/>
      </focus>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</div>
      </text>
      <section>
        <title value="Outcome"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="outcome-measure"/>
            <display value="Outcome Measure"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Nonfatal myocardial infarction or stroke</div>
        </text>
        <entry>🔗 
          <reference value="EvidenceVariable/104097"/>
          <type value="EvidenceVariable"/>
          <display
                   value="OutcomeVariable: Nonfatal myocardial infarction or stroke"/>
        </entry>
      </section>
      <section>
        <title value="Sample Size"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="sample-size"/>
            <display value="Sample Size"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">1 study, 4,047 participants, 4,047 counted, 359 events</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104098"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study"/>
        </entry>
      </section>
      <section>
        <title value="Result Without Treatment"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-comparator-alone"/>
            <display value="Result with comparator alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">188 out of 2,037 observed with percentage of: 9.2%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104397"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: Myocardial infarction or stroke without bariatric surgery (Control Group) in Swedish Obese Subjects (SOS) study"/>
        </entry>
      </section>
      <section>
        <title value="Result With Treatment--Observed"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone"/>
            <display value="Result with intervention alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">171 out of 2,010 observed with percentage of: 8.5%</div>
        </text>
      </section>
      <section>
        <title value="Result With Treatment--Derived"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone-calculated"/>
            <display value="Result with intervention alone (calculated)"/>
          </coding>
          <text
                value="calculated value derived from the control group and effect estimate"/>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">6.2%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104397"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: Myocardial infarction or stroke without bariatric surgery (Control Group) in Swedish Obese Subjects (SOS) study"/>
        </entry>
        <entry>🔗 
          <reference value="Evidence/104098"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study"/>
        </entry>
      </section>
      <section>
        <title value="Effect Estimate"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-vs-comparator"/>
            <display value="Result with intervention vs. comparator"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Hazard Ratio 0.67 (95% CI  0.54 to 0.83)</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104098"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study"/>
        </entry>
      </section>
      <section>
        <title value="Certainty of Evidence"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="certainty-of-evidence"/>
            <display value="Certainty of Evidence"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Low quality</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104098"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study"/>
        </entry>
      </section>
      <section>
        <title value="Assertion"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="assertion"/>
            <display value="Assertion"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104098"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study"/>
        </entry>
      </section>
    </section>
    <section>
      <title value="Remission of diabetes"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="summary-of-findings-entry-for-a-single-outcome"/>
          <display value="Summary of findings entry for a single outcome"/>
        </coding>
      </code>
      <focus>🔗 
        <reference value="EvidenceVariable/104117"/>
        <type value="EvidenceVariable"/>
        <display value="OutcomeVariable: Remission of diabetes"/>
      </focus>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</div>
      </text>
      <section>
        <title value="Outcome"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="outcome-measure"/>
            <display value="Outcome Measure"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Remission of diabetes</div>
        </text>
        <entry>🔗 
          <reference value="EvidenceVariable/104117"/>
          <type value="EvidenceVariable"/>
          <display value="OutcomeVariable: Remission of diabetes"/>
        </entry>
      </section>
      <section>
        <title value="Sample Size"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="sample-size"/>
            <display value="Sample Size"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">1 study, 1,888 participants, 1,888 counted</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104121"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Result Without Treatment"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-comparator-alone"/>
            <display value="Result with comparator alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">141 out of 956 observed with percentage of: 14.8%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104396"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: Remission of diabetes without bariatric surgery (Control Group) in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Result With Treatment--Observed"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone"/>
            <display value="Result with intervention alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">536 out of 932 observed with percentage of: 57.5%</div>
        </text>
      </section>
      <section>
        <title value="Result With Treatment--Derived"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone-calculated"/>
            <display value="Result with intervention alone (calculated)"/>
          </coding>
          <text
                value="calculated value derived from the control group and effect estimate"/>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">57.7%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104396"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: Remission of diabetes without bariatric surgery (Control Group) in JAMA 2018 Norwegian cohort study"/>
        </entry>
        <entry>🔗 
          <reference value="Evidence/104121"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Effect Estimate"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-vs-comparator"/>
            <display value="Result with intervention vs. comparator"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Relative Risk 3.9 (95% CI  2.8 to 5.4)</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104121"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Certainty of Evidence"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="certainty-of-evidence"/>
            <display value="Certainty of Evidence"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Moderate quality</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104121"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Assertion"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="assertion"/>
            <display value="Assertion"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Compared with specialized medical treatment, bariatric surgery appears to induce remission of diabetes.</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104121"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
    </section>
    <section>
      <title value="New onset depression"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="summary-of-findings-entry-for-a-single-outcome"/>
          <display value="Summary of findings entry for a single outcome"/>
        </coding>
      </code>
      <focus>🔗 
        <reference value="EvidenceVariable/104118"/>
        <type value="EvidenceVariable"/>
        <display value="OutcomeVariable: New onset depression"/>
      </focus>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</div>
      </text>
      <section>
        <title value="Outcome"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="outcome-measure"/>
            <display value="Outcome Measure"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">New onset depression</div>
        </text>
        <entry>🔗 
          <reference value="EvidenceVariable/104118"/>
          <type value="EvidenceVariable"/>
          <display value="OutcomeVariable: New onset depression"/>
        </entry>
      </section>
      <section>
        <title value="Sample Size"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="sample-size"/>
            <display value="Sample Size"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">1 study, 1,888 participants, 1,888 counted</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104155"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Result Without Treatment"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-comparator-alone"/>
            <display value="Result with comparator alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">62 out of 956 observed with percentage of: 6.5%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104395"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: New onset depression without bariatric surgery (Control Group) in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Result With Treatment--Observed"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone"/>
            <display value="Result with intervention alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">83 out of 932 observed with percentage of: 8.9%</div>
        </text>
      </section>
      <section>
        <title value="Result With Treatment--Derived"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone-calculated"/>
            <display value="Result with intervention alone (calculated)"/>
          </coding>
          <text
                value="calculated value derived from the control group and effect estimate"/>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">9.75%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104395"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: New onset depression without bariatric surgery (Control Group) in JAMA 2018 Norwegian cohort study"/>
        </entry>
        <entry>🔗 
          <reference value="Evidence/104155"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Effect Estimate"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-vs-comparator"/>
            <display value="Result with intervention vs. comparator"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Relative Risk 1.5 (95% CI 1.4 to 1.7)</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104155"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Certainty of Evidence"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="certainty-of-evidence"/>
            <display value="Certainty of Evidence"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Low quality</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104155"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Assertion"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="assertion"/>
            <display value="Assertion"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Compared with specialized medical treatment, bariatric surgery may slightly increase the incidence of depression.</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104155"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
    </section>
    <section>
      <title value="Treatment with opioids"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="summary-of-findings-entry-for-a-single-outcome"/>
          <display value="Summary of findings entry for a single outcome"/>
        </coding>
      </code>
      <focus>🔗 
        <reference value="EvidenceVariable/104119"/>
        <type value="EvidenceVariable"/>
        <display value="OutcomeVariable: Treatment with opioids"/>
      </focus>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</div>
      </text>
      <section>
        <title value="Outcome"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="outcome-measure"/>
            <display value="Outcome Measure"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Treatment with opioids</div>
        </text>
        <entry>🔗 
          <reference value="EvidenceVariable/104119"/>
          <type value="EvidenceVariable"/>
          <display value="OutcomeVariable: Treatment with opioids"/>
        </entry>
      </section>
      <section>
        <title value="Sample Size"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="sample-size"/>
            <display value="Sample Size"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">1 study, 1,888 participants, 1,888 counted</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104156"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Treatment with opioids in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Result Without Treatment"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-comparator-alone"/>
            <display value="Result with comparator alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">151 out of 956 observed with percentage of: 15.8%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104394"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: Treatment with opioids without bariatric surgery (Control Group) in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Result With Treatment--Observed"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone"/>
            <display value="Result with intervention alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">181 out of 932 observed with percentage of: 19.4%</div>
        </text>
      </section>
      <section>
        <title value="Result With Treatment--Derived"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone-calculated"/>
            <display value="Result with intervention alone (calculated)"/>
          </coding>
          <text
                value="calculated value derived from the control group and effect estimate"/>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">20.5%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104394"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: Treatment with opioids without bariatric surgery (Control Group) in JAMA 2018 Norwegian cohort study"/>
        </entry>
        <entry>🔗 
          <reference value="Evidence/104156"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Treatment with opioids in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Effect Estimate"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-vs-comparator"/>
            <display value="Result with intervention vs. comparator"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Relative Risk 1.3 (95% CI 1.2 to 1.4)</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104156"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Treatment with opioids in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Certainty of Evidence"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="certainty-of-evidence"/>
            <display value="Certainty of Evidence"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Low quality</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104156"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Treatment with opioids in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Assertion"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="assertion"/>
            <display value="Assertion"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Compared with specialized medical treatment, bariatric surgery may slightly increase the use of opioids.</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104156"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Treatment with opioids in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
    </section>
    <section>
      <title value="Additional GI surgical procedure"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="summary-of-findings-entry-for-a-single-outcome"/>
          <display value="Summary of findings entry for a single outcome"/>
        </coding>
      </code>
      <focus>🔗 
        <reference value="EvidenceVariable/104120"/>
        <type value="EvidenceVariable"/>
        <display value="OutcomeVariable: Additional GI surgical procedure"/>
      </focus>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</div>
      </text>
      <section>
        <title value="Outcome"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="outcome-measure"/>
            <display value="Outcome Measure"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Additional GI surgical procedure</div>
        </text>
        <entry>🔗 
          <reference value="EvidenceVariable/104120"/>
          <type value="EvidenceVariable"/>
          <display value="OutcomeVariable: Additional GI surgical procedure"/>
        </entry>
      </section>
      <section>
        <title value="Sample Size"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="sample-size"/>
            <display value="Sample Size"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">1 study, 1,888 participants, 1,888 counted</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104157"/>
          <type value="Evidence"/>
          <display
                   value="StudyOutcomeEvidence: Bypass surgery effects on Additional GI surgical procedure in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Result Without Treatment"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-comparator-alone"/>
            <display value="Result with comparator alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">148 out of 956 observed with percentage of: 15.5%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104385"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: Additional GI surgical procedure without bariatric surgery (Control Group) in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Result With Treatment--Observed"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone"/>
            <display value="Result with intervention alone"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <div xmlns="http://www.w3.org/1999/xhtml">292 out of 932 observed with percentage of: 31.3%</div>
        </text>
      </section>
      <section>
        <title value="Result With Treatment--Derived"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-alone-calculated"/>
            <display value="Result with intervention alone (calculated)"/>
          </coding>
          <text
                value="calculated value derived from the control group and effect estimate"/>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">31%</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104385"/>
          <type value="Evidence"/>
          <display
                   value="ComparatorOnlyEvidence: Additional GI surgical procedure without bariatric surgery (Control Group) in JAMA 2018 Norwegian cohort study"/>
        </entry>
        <entry>🔗 
          <reference value="Evidence/104157"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Additional GI surgical procedure in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Effect Estimate"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="result-with-intervention-vs-comparator"/>
            <display value="Result with intervention vs. comparator"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Relative Risk 2.0 (95% CI 1.7 to 2.4)</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104157"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Additional GI surgical procedure in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Certainty of Evidence"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="certainty-of-evidence"/>
            <display value="Certainty of Evidence"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Moderate quality</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104157"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Additional GI surgical procedure in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
      <section>
        <title value="Assertion"/>
        <code>
          <coding>
            <system value="https://fevir.net/resources/CodeSystem/179423"/>
            <code value="assertion"/>
            <display value="Assertion"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Compared with specialized medical treatment, bariatric surgery appears to increase the rate of additional gastrointestinal surgical procedures.</div>
        </text>
        <entry>🔗 
          <reference value="Evidence/104157"/>
          <type value="Evidence"/>
          <display
                   value="ComparativeEvidence: Bypass surgery effects on Additional GI surgical procedure in JAMA 2018 Norwegian cohort study"/>
        </entry>
      </section>
    </section>
  </section>
  <section>
    <title value="Groups"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="groups"/>
        <display value="Groups"/>
      </coding>
    </code>
    <section>
      <title value="Total Group"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="population"/>
          <display value="Population"/>
        </coding>
      </code>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p>[No data.]</p></div>
      </text>
      <emptyReason>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/list-empty-reason"/>
          <code value="notstarted"/>
          <display value="Not Started"/>
        </coding>
      </emptyReason>
    </section>
    <section>
      <title value="Intervention Group"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="intervention-group"/>
          <display value="Intervention Group"/>
        </coding>
      </code>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p>[No data.]</p></div>
      </text>
      <emptyReason>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/list-empty-reason"/>
          <code value="notstarted"/>
          <display value="Not Started"/>
        </coding>
      </emptyReason>
    </section>
    <section>
      <title value="Comparator Group"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="comparator-group"/>
          <display value="Comparator Group"/>
        </coding>
      </code>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p>[No data.]</p></div>
      </text>
      <emptyReason>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/list-empty-reason"/>
          <code value="notstarted"/>
          <display value="Not Started"/>
        </coding>
      </emptyReason>
    </section>
    <section>
      <title value="Group Assignment"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="GroupAssignment"/>
          <display value="GroupAssignment"/>
        </coding>
      </code>
      <text>
        <status value="empty"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p>[No data.]</p></div>
      </text>
      <emptyReason>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/list-empty-reason"/>
          <code value="notstarted"/>
          <display value="Not Started"/>
        </coding>
      </emptyReason>
    </section>
  </section>
  <section>
    <title value="Variables (Measures)"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="variables"/>
        <display value="Variables"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml"><p>[No data.]</p></div>
    </text>
    <emptyReason>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/list-empty-reason"/>
        <code value="notstarted"/>
        <display value="Not Started"/>
      </coding>
    </emptyReason>
  </section>
</Composition>