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

• Narrative Content
• XML
• JSON
• TTL

: Recommendation: ADA Obesity Management Recommendation 8.16-adapted - XML Representation

Raw xml | Download

<Composition xmlns="http://hl7.org/fhir">
  <id value="179699"/>
  <meta>
    <versionId value="14"/>
    <lastUpdated value="2024-12-13T10:57:37.978Z"/>
    <profile
             value="http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Composition 179699</b></p><a name="179699"> </a><a name="hc179699"> </a><a name="179699-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: 14; Last updated: 2024-12-13 10:57:37+0000</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-recommendation.html">Recommendation</a></p></div><p><b>Artifact Approval Date</b>: 2023-11-15</p><p><b>Artifact Last Review Date</b>: 2023-12-01</p><p><b>Artifact Effective Period</b>: 2024-01-01 --&gt; 2024-12-31</p><p><b>Artifact Description</b>: </p><div><p>This example of adapting a Recommendation (removing the A from the end of the Recommendation Statement) shows the use of an Adaptation Profile of ArtifactAssessment and the use of the extensions: artifact-approvalDate, arifact-lastReviewDate, and artifact-effectivePeriod.</p>
</div><p><b>url</b>: <a href="https://fevir.net/resources/Composition/179699">https://fevir.net/resources/Composition/179699</a></p><p><b>identifier</b>: FEvIR Object Identifier/https://fevir.net/FOI/179699</p><p><b>status</b>: Final</p><p><b>type</b>: <span title="Codes:{https://fevir.net/resources/CodeSystem/179423 Recommendation}">Recommendation</span></p><p><b>date</b>: 2024-12-13 10:57:37+0000</p><p><b>author</b>: Joanne Dehnbostel</p><p><b>title</b>: Recommendation: ADA Obesity Management Recommendation 8.16-adapted</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>Derived From</td><td><span title="Codes:">Original Recommendation</span></td><td>Derived from</td><td> </td><td><a href="Composition-179466.html">Recommendation: ADA Obesity Management Recommendation 8.16</a></td></tr><tr><td style="display: none">*</td><td>Derived From</td><td><span title="Codes:">Adaptation Report</span></td><td>Derived from</td><td> </td><td><a href="ArtifactAssessment-179698.html">Joanne Dehnbostel's Adaptation Report of Recommendation: ADA Obesity Management Recommendation 8.16</a></td></tr><tr><td style="display: none">*</td><td>Cite As</td><td> </td><td>Cite as</td><td><div><p>Recommendation: ADA Obesity Management Recommendation 8.16-adapted [Database Entry: FHIR Composition Resource]. Contributors: Joanne Dehnbostel [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179699. Revised 2024-07-18. Available at: https://fevir.net/resources/Composition/179699. Computable resource at: https://fevir.net/FLI/DocumentForComposition179699.</p>
</div></td><td> </td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/artifact-approvalDate">
    <valueDate value="2023-11-15"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/artifact-lastReviewDate">
    <valueDate value="2023-12-01"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/artifact-effectivePeriod">
    <valuePeriod>
      <start value="2024-01-01"/>
      <end value="2024-12-31"/>
    </valuePeriod>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/artifact-description">
    <valueMarkdown
                   value="This example of adapting a Recommendation (removing the A from the end of the Recommendation Statement) shows the use of an Adaptation Profile of ArtifactAssessment and the use of the extensions: artifact-approvalDate, arifact-lastReviewDate, and artifact-effectivePeriod."/>
  </extension>
  <url value="https://fevir.net/resources/Composition/179699"/>
  <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/179699"/>
    <assigner>
      <display value="Computable Publishing LLC"/>
    </assigner>
  </identifier>
  <status value="final"/>
  <type>
    <coding>
      <system value="https://fevir.net/resources/CodeSystem/179423"/>
      <code value="Recommendation"/>
      <display value="Recommendation"/>
    </coding>
  </type>
  <date value="2024-12-13T10:57:37.978Z"/>
  <author>
    <type value="Practitioner"/>
    <display value="Joanne Dehnbostel"/>
  </author>
  <title
         value="Recommendation: ADA Obesity Management Recommendation 8.16-adapted"/>
  <custodian>🔗 
    <reference value="Organization/118079"/>
    <type value="Organization"/>
    <display value="Computable Publishing LLC"/>
  </custodian>
  <relatesTo>
    <type value="derived-from"/>
    <classifier>
      <text value="Original Recommendation"/>
    </classifier>
    <label value="Derived from"/>
    <resourceReference>🔗 
      <reference value="Composition/179466"/>
      <type value="Composition"/>
      <display
               value="Recommendation: ADA Obesity Management Recommendation 8.16"/>
    </resourceReference>
  </relatesTo>
  <relatesTo>
    <type value="derived-from"/>
    <classifier>
      <text value="Adaptation Report"/>
    </classifier>
    <label value="Derived from"/>
    <resourceReference>🔗 
      <reference value="ArtifactAssessment/179698"/>
      <type value="ArtifactAssessment"/>
      <display
               value="Joanne Dehnbostel's Adaptation Report of Recommendation: ADA Obesity Management Recommendation 8.16"/>
    </resourceReference>
  </relatesTo>
  <relatesTo>
    <type value="cite-as"/>
    <label value="Cite as"/>
    <citation
              value="Recommendation: ADA Obesity Management Recommendation 8.16-adapted [Database Entry: FHIR Composition Resource]. Contributors: Joanne Dehnbostel [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179699. Revised 2024-07-18. Available at: https://fevir.net/resources/Composition/179699. Computable resource at: https://fevir.net/FLI/DocumentForComposition179699."/>
  </relatesTo>
  <section>
    <title value="Summary Section"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="summary"/>
        <display value="Summary"/>
      </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="Introduction Section"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="introduction"/>
        <display value="Introduction"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</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="Recommendation Specification"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="recommendation-specification"/>
        <display value="Recommendation Specification"/>
      </coding>
    </code>
    <section>
      <title value="Recommendation Statement"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="recommendation-statement"/>
          <display value="Recommendation Statement"/>
        </coding>
        <text value="overallSummary"/>
      </code>
      <text>
        <status value="additional"/>
        <div xmlns="http://www.w3.org/1999/xhtml">8.16 Metabolic surgery should be a recommended option to treat type 2 diabetes in screened surgical candidates with BMI ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian Americans) and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.</div>
      </text>
      <entry>🔗 
        <reference value="ArtifactAssessment/179469"/>
        <type value="ArtifactAssessment"/>
      </entry>
    </section>
    <section>
      <title value="Recommendation Ratings"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="ratings"/>
          <display value="Ratings"/>
        </coding>
        <text value="overallRatings"/>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">A</div>
      </text>
      <entry>🔗 
        <reference value="ArtifactAssessment/179469"/>
        <type value="ArtifactAssessment"/>
      </entry>
    </section>
    <section>
      <title value="Population"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="population"/>
          <display value="Population"/>
        </coding>
        <text value="population"/>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Inclusion Criteria: [[1]] Adults. [[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. [[4]] Screened surgical candidates.</div>
      </text>
      <entry>🔗 
        <reference value="Group/32139"/>
        <type value="Group"/>
        <display
                 value="RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)"/>
      </entry>
    </section>
    <section>
      <title value="Action"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="action"/>
          <display value="Action"/>
        </coding>
        <text value="action"/>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Metabolic surgery is recommended.</div>
      </text>
      <entry>🔗 
        <reference value="PlanDefinition/179468"/>
        <type value="PlanDefinition"/>
        <display
                 value="PlanDefinition for Recommendation: ADA Obesity Management Recommendation 8.16"/>
      </entry>
    </section>
    <section>
      <title value="Opposite Action"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="opposite-action"/>
          <display value="Opposite Action"/>
        </coding>
        <text value="oppositeAction"/>
      </code>
      <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="Justification"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="justification"/>
        <display value="Justification"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</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="Considerations"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="considerations"/>
        <display value="Considerations"/>
      </coding>
    </code>
    <section>
      <title value="Overall Considerations Summary"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="summary"/>
          <display value="Summary"/>
        </coding>
        <text value="overallConsiderationsSummary"/>
      </code>
      <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="Subgroup Considerations Summary"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="subgroup-considerations"/>
          <display value="Subgroup Considerations"/>
        </coding>
        <text value="subgroupConsiderationsSummary"/>
      </code>
      <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="Implementation Considerations Summary"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="implementation-considerations"/>
          <display value="Implementation Considerations"/>
        </coding>
        <text value="implementationConsiderationsSummary"/>
      </code>
      <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="Monitoring Considerations Summary"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="monitoring-considerations"/>
          <display value="Monitoring Considerations"/>
        </coding>
        <text value="monitoringConsiderationsSummary"/>
      </code>
      <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="Competing Interests Summary"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="competing-interests"/>
          <display value="Competing Interests"/>
        </coding>
        <text value="competingInterestsSummary"/>
      </code>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">All members of the PPC are required to disclose potential conflicts of interest with industry and other relevant organizations. These disclosures are discussed at the outset of each Standards of Care revision meeting. Members of the committee, their employers, and their disclosed conflicts of interest are listed in 'Disclosures: Standards of Medical Care in Diabetes—2021' (https://doi.org/10.2337/dc21-SPPC). The ADA funds development of the Standards of Care out of its general revenues and does not use industry support for this purpose. NOTE: The disclosed conflicts of interest was not found at the suggested URL</div>
      </text>
      <entry>🔗 
        <reference value="ArtifactAssessment/179469"/>
        <type value="ArtifactAssessment"/>
      </entry>
    </section>
    <section>
      <title value="Research Priorities Summary"/>
      <code>
        <coding>
          <system value="https://fevir.net/resources/CodeSystem/179423"/>
          <code value="research-considerations"/>
          <display value="Research Considerations"/>
        </coding>
        <text value="researchConsiderationsSummary"/>
      </code>
      <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="Methods Section"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="methods"/>
        <display value="Methods"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</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="Evidence"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="evidence"/>
        <display value="Evidence"/>
      </coding>
    </code>
    <text>
      <status value="additional"/>
      <div xmlns="http://www.w3.org/1999/xhtml">ADA Level of Evidence A. A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions.</div>
    </text>
    <entry>🔗 
      <reference value="ArtifactAssessment/179469"/>
      <type value="ArtifactAssessment"/>
    </entry>
  </section>
  <section>
    <title value="Discussion"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="discussion"/>
        <display value="Discussion"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</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="References Section"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="references"/>
        <display value="References"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</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="Competing Interests Section"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="competing-interests"/>
        <display value="Competing Interests"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</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="Acknowledgements Section"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="acknowledgements"/>
        <display value="Acknowledgements"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</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="Appendices Section"/>
    <code>
      <coding>
        <system value="https://fevir.net/resources/CodeSystem/179423"/>
        <code value="appendices"/>
        <display value="Appendices"/>
      </coding>
    </code>
    <text>
      <status value="empty"/>
      <div xmlns="http://www.w3.org/1999/xhtml">[No data.]</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>