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

: ComparativeEvidenceReport: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort) - JSON Representation

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{
  "resourceType" : "Composition",
  "id" : "178426",
  "meta" : {
    "versionId" : "85",
    "lastUpdated" : "2024-11-19T18:07:59.375Z",
    "profile" : [
      🔗 "http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence-report"
    ]
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  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Composition 178426</b></p><a name=\"178426\"> </a><a name=\"hc178426\"> </a><a name=\"178426-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: 85; Last updated: 2024-11-19 18:07:59+0000</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-comparative-evidence-report.html\">ComparativeEvidenceReport</a></p></div><p><b>Artifact Description</b>: </p><div><p>This example of a ComparativeEvidenceReport Profile shows a report from a single observational study with 2 baseline measures, 2 participant flow measures, and 4 outcome measures.</p>\n</div><p><b>url</b>: <a href=\"https://fevir.net/resources/Composition/178426\">https://fevir.net/resources/Composition/178426</a></p><p><b>identifier</b>: FEvIR Object Identifier/https://fevir.net/FOI/178426</p><p><b>status</b>: Final</p><p><b>type</b>: <span title=\"Codes:{https://fevir.net/resources/CodeSystem/179423 ComparativeEvidenceReport}\">Comparative Evidence Report</span></p><p><b>date</b>: 2024-11-19 18:07:59+0000</p><p><b>author</b>: </p><ul><li>Brian S. Alper</li><li>Khalid Shahin</li><li>Joanne Dehnbostel</li></ul><p><b>title</b>: ComparativeEvidenceReport: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)</p><p><b>custodian</b>: <a href=\"Organization-118079.html\">Computable Publishing LLC</a></p><h3>RelatesTos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td><td><b>Label</b></td><td><b>Citation</b></td><td><b>ResourceReference</b></td></tr><tr><td style=\"display: none\">*</td><td>Cite As</td><td> </td><td>Cite as</td><td><div><p>ComparativeEvidenceReport: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort) [Database Entry: FHIR Composition Resource]. Contributors: Brian S. Alper, Khalid Shahin, Joanne Dehnbostel [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 178426. Revised 2024-08-21. Available at: https://fevir.net/resources/Composition/178426. Computable resource at: https://fevir.net/FLI/DocumentForComposition178426.</p>\n</div></td><td> </td></tr><tr><td style=\"display: none\">*</td><td>Derived From</td><td> </td><td>Derived from</td><td> </td><td><a href=\"Citation-104116.html\">JournalArticleCitation: Association of Bariatric Surgery with Complications and Comorbidities JAMA 2018 Norwegian Cohort</a></td></tr><tr><td style=\"display: none\">*</td><td>Composed Of</td><td><span title=\"Codes:{https://fevir.net/resources/CodeSystem/179423 GroupAssignment}\">GroupAssignment</span></td><td>Group Assignment</td><td> </td><td><a href=\"EvidenceVariable-183637.html\">GroupAssignment: ExposureDefinition: Bariatric Surgery (RYGB, VSG, LAGB, BPD) vs. ComparatorDefinition: NOT Bariatric Surgery (RYGB, VSG, LAGB, BPD)</a></td></tr></table></div>"
  },
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      "valueMarkdown" : "This example of a ComparativeEvidenceReport Profile shows a report from a single observational study with 2 baseline measures, 2 participant flow measures, and 4 outcome measures."
    }
  ],
  "url" : "https://fevir.net/resources/Composition/178426",
  "identifier" : [
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        "text" : "FEvIR Object Identifier"
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      "system" : "urn:ietf:rfc:3986",
      "value" : "https://fevir.net/FOI/178426",
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  "status" : "final",
  "type" : {
    "coding" : [
      {
        "system" : "https://fevir.net/resources/CodeSystem/179423",
        "code" : "ComparativeEvidenceReport",
        "display" : "ComparativeEvidenceReport"
      }
    ],
    "text" : "Comparative Evidence Report"
  },
  "subject" : [
    {
      🔗 "reference" : "Group/179633",
      "type" : "Group",
      "display" : "ComparativeEvidenceReportSubject: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)"
    }
  ],
  "date" : "2024-11-19T18:07:59.375Z",
  "author" : [
    {
      "type" : "Practitioner",
      "display" : "Brian S. Alper"
    },
    {
      "type" : "Practitioner",
      "display" : "Khalid Shahin"
    },
    {
      "type" : "Practitioner",
      "display" : "Joanne Dehnbostel"
    }
  ],
  "title" : "ComparativeEvidenceReport: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)",
  "custodian" : {
    🔗 "reference" : "Organization/118079",
    "type" : "Organization",
    "display" : "Computable Publishing LLC"
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  "relatesTo" : [
    {
      "type" : "cite-as",
      "label" : "Cite as",
      "citation" : "ComparativeEvidenceReport: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort) [Database Entry: FHIR Composition Resource]. Contributors: Brian S. Alper, Khalid Shahin, Joanne Dehnbostel [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 178426. Revised 2024-08-21. Available at: https://fevir.net/resources/Composition/178426. Computable resource at: https://fevir.net/FLI/DocumentForComposition178426."
    },
    {
      "type" : "derived-from",
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      "resourceReference" : {
        🔗 "reference" : "Citation/104116",
        "type" : "Citation",
        "display" : "JournalArticleCitation: Association of Bariatric Surgery with Complications and Comorbidities JAMA 2018 Norwegian Cohort"
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    },
    {
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      ],
      "label" : "Group Assignment",
      "resourceReference" : {
        🔗 "reference" : "EvidenceVariable/183637",
        "type" : "EvidenceVariable",
        "display" : "GroupAssignment: ExposureDefinition: Bariatric Surgery (RYGB, VSG, LAGB, BPD) vs. ComparatorDefinition: NOT Bariatric Surgery (RYGB, VSG, LAGB, BPD)"
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  ],
  "section" : [
    {
      "title" : "Introduction",
      "code" : {
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            "code" : "introduction",
            "display" : "Introduction"
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      },
      "text" : {
        "status" : "empty",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">[No data.]</div>"
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    {
      "title" : "Population",
      "code" : {
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            "display" : "Population"
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        ],
        "text" : "Population"
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>StudyGroup: Severely Obese Adults 2018 Norwegian Cohort</b> Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n\u2009=\u20092109) with severe obesity assessed (221 patients excluded and 1888 patients included). (1888 participants)</div>"
      },
      "entry" : [
        {
          🔗 "reference" : "Group/178427",
          "type" : "Group",
          "display" : "StudyGroup: Severely Obese Adults 2018 Norwegian Cohort"
        }
      ]
    },
    {
      "title" : "Intervention",
      "code" : {
        "coding" : [
          {
            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "intervention",
            "display" : "Intervention"
          }
        ],
        "text" : "Intervention"
      },
      "text" : {
        "status" : "empty",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">[No data.]</div>"
      },
      "section" : [
        {
          "title" : "Intervention Description",
          "code" : {
            "coding" : [
              {
                "system" : "https://fevir.net/resources/CodeSystem/179423",
                "code" : "intervention-description",
                "display" : "Intervention Description"
              }
            ],
            "text" : "Intervention Description"
          },
          "text" : {
            "status" : "additional",
            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Bariatric surgery, mostly gastric bypass (92%) or sleeve gastrectomy (7%)</div>"
          },
          "entry" : [
            {
              🔗 "reference" : "Group/172423",
              "type" : "Group",
              "display" : "ExposureDefinition: Bariatric Surgery (RYGB, VSG, LAGB, BPD)"
            }
          ]
        },
        {
          "title" : "Intervention Group",
          "code" : {
            "coding" : [
              {
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                "code" : "intervention-group",
                "display" : "Intervention Group"
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            ],
            "text" : "Intervention Group"
          },
          "text" : {
            "status" : "additional",
            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">932 patients opted for bariatric surgery</div>"
          },
          "entry" : [
            {
              🔗 "reference" : "Group/172934",
              "type" : "Group",
              "display" : "InterventionGroup: JAMA 2018 Norwegian cohort study Surgery cohort"
            }
          ]
        }
      ]
    },
    {
      "title" : "Comparator Section",
      "code" : {
        "coding" : [
          {
            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "comparator",
            "display" : "Comparator"
          }
        ],
        "text" : "Comparator"
      },
      "text" : {
        "status" : "empty",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">[No data.]</div>"
      },
      "section" : [
        {
          "title" : "Comparator Description",
          "code" : {
            "coding" : [
              {
                "system" : "https://fevir.net/resources/CodeSystem/179423",
                "code" : "comparator-description",
                "display" : "Comparator Description"
              }
            ],
            "text" : "Comparator Description"
          },
          "text" : {
            "status" : "additional",
            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">medical treatment without surgery</div>"
          },
          "entry" : [
            {
              🔗 "reference" : "Group/172424",
              "type" : "Group",
              "display" : "ComparatorDefinition: NOT Bariatric Surgery (RYGB, VSG, LAGB, BPD)"
            }
          ]
        },
        {
          "title" : "Comparator Group",
          "code" : {
            "coding" : [
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                "code" : "comparator-group",
                "display" : "Comparator Group"
              }
            ],
            "text" : "Comparator Group"
          },
          "text" : {
            "status" : "additional",
            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">956 opted for medical management without surgery</div>"
          },
          "entry" : [
            {
              🔗 "reference" : "Group/172939",
              "type" : "Group",
              "display" : "ComparatorGroup: JAMA 2018 Norwegian cohort study Control cohort"
            }
          ]
        }
      ]
    },
    {
      "title" : "Research Study",
      "code" : {
        "coding" : [
          {
            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "research-study",
            "display" : "Research Study"
          }
        ]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Title:</b> Norwegian Cohort Study Comparing Bariatric Surgery vs Medical Obesity Treatment for Long-term Medical Complications and Obesity-Related Comorbidities</p><br/><p><b>Description:</b> The main purpose of this study is, in combination with data from the Register and Biobank study and follow-up data from the Norwegian Prescription Database, to compare the long-term effects (4-10 years) of surgical and non-surgical treatment of morbid obesity on obesity\nrelated comorbidities by studying changes in medicine usage after treatment.\n\nHypotheses\n1. Primary hypothesis: As compared to non-surgical treatment, bariatric surgery will be associated with higher rates of remission, and lower rates of new-onset drug treated hypertension during a follow-up period of ≤ 10 years.\n2. Secondary hypotheses: Changes in the usage of other drugs, particularly drugs related to obesity related comorbidities, will differ significantly between patients undergoing bariatric surgery or non-surgical treatment during the follow-up period. </p><br/><p><b>Study Design:</b> Observational research (coded as: SEVCO:01002 from https://fevir.net/sevco); Parallel cohort design (coded as: SEVCO:01011 from https://fevir.net/sevco); Longitudinal data collection (coded as: SEVCO:01028 from https://fevir.net/sevco)</p></div>"
      },
      "entry" : [
        {
          🔗 "reference" : "ResearchStudy/208285",
          "type" : "ResearchStudy",
          "display" : "Norwegian Cohort Study Comparing Bariatric Surgery vs Medical Obesity Treatment for Long-term Medical Complications and Obesity-Related Comorbidities"
        }
      ]
    },
    {
      "title" : "Methods Section",
      "code" : {
        "coding" : [
          {
            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "methods",
            "display" : "Methods"
          }
        ]
      },
      "text" : {
        "status" : "empty",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">[No data.]</div>"
      },
      "emptyReason" : {
        "coding" : [
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            "system" : "http://terminology.hl7.org/CodeSystem/list-empty-reason",
            "code" : "notstarted",
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        ]
      }
    },
    {
      "title" : "Baseline Measures",
      "code" : {
        "coding" : [
          {
            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "baseline-measures",
            "display" : "Baseline Measures"
          }
        ],
        "text" : "Baseline Measures"
      },
      "text" : {
        "status" : "additional",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">As compared with medical patients, surgically treated patients were significantly younger with a higher BMI. Mean age 41.2 in Surgical Group vs. 45.7 in Medical Group (p &lt; 0.001). Mean BMI 45.4 in Surgical Group vs. 42.9 in Medical Group (p &lt; 0.001).</div>"
      },
      "entry" : [
        {
          🔗 "reference" : "Composition/235365",
          "type" : "Composition",
          "display" : "Baseline Measure Report: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)"
        }
      ]
    },
    {
      "title" : "Participant Flow",
      "code" : {
        "coding" : [
          {
            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "participant-flow",
            "display" : "Participant Flow"
          }
        ],
        "text" : "Participant Flow"
      },
      "text" : {
        "status" : "additional",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">2109 patients included in baseline registry, 221 patients excluded, 1888 patients included in analysis (932 had opted for bariatric surgery, 956 had opted for medical treatment)</div>"
      },
      "entry" : [
        {
          🔗 "reference" : "Composition/247499",
          "type" : "Composition",
          "display" : "Participant Flow Report: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)"
        }
      ]
    },
    {
      "title" : "Outcomes",
      "code" : {
        "coding" : [
          {
            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "outcome-measures",
            "display" : "Outcome Measures"
          }
        ],
        "text" : "Outcomes"
      },
      "text" : {
        "status" : "additional",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Risk of Remission of diabetes in control group was 14.8%. Risk of Remission of diabetes in intervention group was 57.5%. Greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]<br/>Compared with specialized medical treatment, bariatric surgery appears to induce remission of diabetes.<br/><br/>Risk of New onset depression in control group was 6.5%. Risk of New onset depression in intervention group was 8.9%. Greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7].<br/>Compared with specialized medical treatment, bariatric surgery may slightly increase the incidence of depression.<br/><br/>Risk of Treatment with opioids in control group was 15.8%. Risk of Treatment with opioids in intervention group was 19.4%. Greater risk of treatment with opioids: AR, 19.4% vs 15.8%, RD, 3.6% [95% CI, 2.3%-4.9%], RR, 1.3 [95% CI, 1.2-1.4].<br/>Compared with specialized medical treatment, bariatric surgery may slightly increase the use of opioids.<br/><br/>Risk of additional GI surgical procedure in control group was 15.5%. Risk of additional GI surgical procedure in intervention group was 31.3%. Surgical patients had a greater risk for undergoing at least 1 additional gastrointestinal surgical procedure (AR, 31.3% vs 15.5%; RD, 15.8% [95% CI, 13.1%-18.5%]; RR, 2.0 [95% CI, 1.7-2.4]).<br/>Compared with specialized medical treatment, bariatric surgery appears to increase the rate of additional gastrointestinal surgical procedures.</div>"
      },
      "entry" : [
        {
          🔗 "reference" : "Composition/247500",
          "type" : "Composition",
          "display" : "Outcome Measure Report: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)"
        }
      ]
    },
    {
      "title" : "Summary of Findings",
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      "text" : {
        "status" : "empty",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>[No data.]</p></div>"
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        "coding" : [
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            "code" : "notstarted",
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      "title" : "Discussion Section",
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            "code" : "discussion",
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      "title" : "References Section",
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            "code" : "references",
            "display" : "References"
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        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">[No data.]</div>"
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    {
      "title" : "Competing Interests Section",
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        "coding" : [
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            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "competing-interests",
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      "text" : {
        "status" : "empty",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">[No data.]</div>"
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      "title" : "Acknowledgements Section",
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      "title" : "Appendices Section",
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}