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
{
"resourceType" : "Evidence",
"id" : "104121",
"meta" : {
"versionId" : "12",
"lastUpdated" : "2023-12-06T00:53:26.196Z",
"profile" : [
🔗 "http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence"🔗 ,
"http://hl7.org/fhir/uv/ebm/StructureDefinition/single-study-evidence"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Evidence 104121</b></p><a name=\"104121\"> </a><a name=\"hc104121\"> </a><a name=\"104121-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: 12; Last updated: 2023-12-06 00:53:26+0000</p><p style=\"margin-bottom: 0px\">Profiles: <a href=\"StructureDefinition-comparative-evidence.html\">ComparativeEvidence</a>, <a href=\"StructureDefinition-single-study-evidence.html\">SingleStudyEvidence</a></p></div><p><b>url</b>: <a href=\"https://fevir.net/resources/Evidence/104121\">https://fevir.net/resources/Evidence/104121</a></p><p><b>identifier</b>: FEvIR Object Identifier/104121</p><p><b>name</b>: ComparativeEvidence_Bypass_surgery_effects_on_Remission_of_diabetes_in_JAMA_2018_Norwegian_cohort_study</p><p><b>title</b>: ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study</p><p><b>status</b>: Active</p><p><b>date</b>: 2022-09-19 21:16:23+0000</p><p><b>publisher</b>: Computable Publishing LLC</p><p><b>contact</b>: <a href=\"mailto:support@computablepublishing.com\">support@computablepublishing.com</a></p><p><b>author</b>: Brian S. Alper: </p><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"CodeSystem-179423.html#179423-evidence-communication\">Evidence Based Medicine on FHIR Implementation Guide Code System evidence-communication</a>: Evidence Communication</td><td><span title=\"Codes:{https://fevir.net/resources/CodeSystem/179423 ComparativeEvidence}\">ComparativeEvidence</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"CodeSystem-179423.html#179423-evidence-communication\">Evidence Based Medicine on FHIR Implementation Guide Code System evidence-communication</a>: Evidence Communication</td><td><span title=\"Codes:{https://fevir.net/resources/CodeSystem/179423 SingleStudyEvidence}\">SingleStudyEvidence</span></td></tr></table><p><b>copyright</b>: </p><div><p>https://creativecommons.org/licenses/by-nc-sa/4.0/</p>\n</div><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: Derived From</p><h3>Documents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"https://jamanetwork.com/journals/jama/fullarticle/2669729\">https://jamanetwork.com/journals/jama/fullarticle/2669729</a></td></tr></table></blockquote><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: Cite As</p><p><b>citation</b>: </p><div><p>ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study [Evidence]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104121. Revised 2022-09-19. Available at: https://fevir.net/resources/Evidence/104121. Computable resource at: https://fevir.net/resources/Evidence/104121.</p>\n</div></blockquote><p><b>description</b>: </p><div><p>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]</p>\n</div><p><b>assertion</b>: </p><div><p>Compared with specialized medical treatment, bariatric surgery appears to induce remission of diabetes.</p>\n</div><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>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).</p>\n</div><p><b>variableRole</b>: Population</p><p><b>observed</b>: <a href=\"Group-178427.html\">StudyGroup: Severely Obese Adults 2018 Norwegian Cohort</a></p></blockquote><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>bariatric surgery vs. specialized medical treatment without bariatric surgery</p>\n</div><p><b>variableRole</b>: Exposure</p><p><b>comparatorCategory</b>: no bariatric surgery</p><p><b>intended</b>: <a href=\"EvidenceVariable-172427.html\">GroupAssignment: Bariatric Surgery vs. no bariatric surgery</a></p></blockquote><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>Remission of diabetes</p>\n</div><p><b>variableRole</b>: Outcome</p><p><b>observed</b>: <a href=\"EvidenceVariable-104117.html\">OutcomeVariable: Remission of diabetes</a></p></blockquote><p><b>synthesisType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/synthesis-type NotApplicable}\">not applicable</span></p><p><b>studyDesign</b>: <span title=\"Codes:{http://hl7.org/fhir/study-design SEVCO:01002}\">Observational research</span>, <span title=\"Codes:{http://hl7.org/fhir/study-design SEVCO:01011}\">Parallel cohort design</span>, <span title=\"Codes:{http://hl7.org/fhir/study-design SEVCO:01028}\">Longitudinal data collection</span></p><blockquote><p><b>statistic</b></p><p><b>description</b>: </p><div><p>Relative risk 3.9; 95% CI 2.8 to 5.4</p>\n</div><p><b>note</b>: Result observed without bariatric surgery was 14.8%, result observed with bariatric surgery was 57.5%</p><p><b>statisticType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/statistic-type C93152}\">Relative Risk</span></p><p><b>quantity</b>: 3.9</p><h3>SampleSizes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>NumberOfStudies</b></td><td><b>NumberOfParticipants</b></td><td><b>KnownDataCount</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>1888</td><td>1888</td></tr></table><h3>AttributeEstimates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Description</b></td><td><b>Type</b></td><td><b>Level</b></td><td><b>Range</b></td></tr><tr><td style=\"display: none\">*</td><td><div><p>95% CI 2.8 to 5.4</p>\n</div></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/attribute-estimate-type C53324}\">Confidence interval</span></td><td>0.95</td><td>2.8-5.4</td></tr></table></blockquote><h3>Certainties</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Description</b></td><td><b>Type</b></td><td><b>Rating</b></td></tr><tr><td style=\"display: none\">*</td><td><div><p>rated down 2 levels due to observational study, rated up 1 level due to large effect size</p>\n</div></td><td><span title=\"Codes:{http://hl7.org/fhir/certainty-type Overall}\">Overall certainty</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/certainty-rating moderate}\">Moderate quality</span></td></tr></table></div>"
},
"url" : "https://fevir.net/resources/Evidence/104121",
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "ACSN",
"display" : "Accession ID"
}
],
"text" : "FEvIR Object Identifier"
},
"system" : "https://fevir.net",
"value" : "104121",
"assigner" : {
"display" : "Computable Publishing LLC"
}
}
],
"name" : "ComparativeEvidence_Bypass_surgery_effects_on_Remission_of_diabetes_in_JAMA_2018_Norwegian_cohort_study",
"title" : "ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study",
"status" : "active",
"date" : "2022-09-19T21:16:23.435Z",
"publisher" : "Computable Publishing LLC",
"contact" : [
{
"telecom" : [
{
"system" : "email",
"value" : "support@computablepublishing.com"
}
]
}
],
"author" : [
{
"name" : "Brian S. Alper"
}
],
"useContext" : [
{
"code" : {
"system" : "https://fevir.net/resources/CodeSystem/179423",
"code" : "evidence-communication",
"display" : "Evidence Communication"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fevir.net/resources/CodeSystem/179423",
"code" : "ComparativeEvidence",
"display" : "ComparativeEvidence"
}
]
}
},
{
"code" : {
"system" : "https://fevir.net/resources/CodeSystem/179423",
"code" : "evidence-communication",
"display" : "Evidence Communication"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fevir.net/resources/CodeSystem/179423",
"code" : "SingleStudyEvidence",
"display" : "SingleStudyEvidence"
}
]
}
}
],
"copyright" : "https://creativecommons.org/licenses/by-nc-sa/4.0/",
"relatedArtifact" : [
{
"type" : "derived-from",
"document" : {
"url" : "https://jamanetwork.com/journals/jama/fullarticle/2669729"
}
},
{
"type" : "cite-as",
"citation" : "ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study [Evidence]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104121. Revised 2022-09-19. Available at: https://fevir.net/resources/Evidence/104121. Computable resource at: https://fevir.net/resources/Evidence/104121."
}
],
"description" : "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]",
"assertion" : "Compared with specialized medical treatment, bariatric surgery appears to induce remission of diabetes.",
"variableDefinition" : [
{
"description" : "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).",
"variableRole" : "population",
"observed" : {
🔗 "reference" : "Group/178427",
"type" : "Group",
"display" : "StudyGroup: Severely Obese Adults 2018 Norwegian Cohort"
}
},
{
"description" : "bariatric surgery vs. specialized medical treatment without bariatric surgery",
"variableRole" : "exposure",
"comparatorCategory" : "no bariatric surgery",
"intended" : {
🔗 "reference" : "EvidenceVariable/172427",
"type" : "EvidenceVariable",
"display" : "GroupAssignment: Bariatric Surgery vs. no bariatric surgery"
}
},
{
"description" : "Remission of diabetes",
"variableRole" : "outcome",
"observed" : {
🔗 "reference" : "EvidenceVariable/104117",
"type" : "EvidenceVariable",
"display" : "OutcomeVariable: Remission of diabetes"
}
}
],
"synthesisType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/synthesis-type",
"code" : "NotApplicable",
"display" : "not applicable"
}
]
},
"studyDesign" : [
{
"coding" : [
{
"system" : "http://hl7.org/fhir/study-design",
"code" : "SEVCO:01002",
"display" : "Observational research"
}
]
},
{
"coding" : [
{
"system" : "http://hl7.org/fhir/study-design",
"code" : "SEVCO:01011",
"display" : "Parallel cohort design"
}
]
},
{
"coding" : [
{
"system" : "http://hl7.org/fhir/study-design",
"code" : "SEVCO:01028",
"display" : "Longitudinal data collection"
}
]
}
],
"statistic" : [
{
"description" : "Relative risk 3.9; 95% CI 2.8 to 5.4",
"note" : [
{
"text" : "Result observed without bariatric surgery was 14.8%, result observed with bariatric surgery was 57.5%"
}
],
"statisticType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/statistic-type",
"code" : "C93152",
"display" : "Relative Risk"
}
]
},
"quantity" : {
"value" : 3.9
},
"sampleSize" : {
"numberOfStudies" : 1,
"numberOfParticipants" : 1888,
"knownDataCount" : 1888
},
"attributeEstimate" : [
{
"description" : "95% CI 2.8 to 5.4",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/attribute-estimate-type",
"code" : "C53324",
"display" : "Confidence interval"
}
]
},
"level" : 0.95,
"range" : {
"low" : {
"value" : 2.8
},
"high" : {
"value" : 5.4
}
}
}
]
}
],
"certainty" : [
{
"description" : "rated down 2 levels due to observational study, rated up 1 level due to large effect size",
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/certainty-type",
"code" : "Overall",
"display" : "Overall certainty"
}
]
},
"rating" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code" : "moderate",
"display" : "Moderate quality"
}
]
}
}
]
}