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

: ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Evidence ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "104121"] ; # 
  fhir:meta [
fhir:versionId [ fhir:v "12" ] ;
fhir:lastUpdated [ fhir:v "2023-12-06T00:53:26.196Z"^^xsd:dateTime ] ;
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence>     ] [
fhir:v "http://hl7.org/fhir/uv/ebm/StructureDefinition/single-study-evidence"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/uv/ebm/StructureDefinition/single-study-evidence>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir: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 = 2109) 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>"
  ] ; # 
  fhir:url [ fhir:v "https://fevir.net/resources/Evidence/104121"^^xsd:anyURI] ; # 
  fhir:identifier ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ACSN" ] ;
fhir:display [ fhir:v "Accession ID" ]       ] ) ;
fhir:text [ fhir:v "FEvIR Object Identifier" ]     ] ;
fhir:system [ fhir:v "https://fevir.net"^^xsd:anyURI ] ;
fhir:value [ fhir:v "104121" ] ;
fhir:assigner [
fhir:display [ fhir:v "Computable Publishing LLC" ]     ]
  ] ) ; # 
  fhir:name [ fhir:v "ComparativeEvidence_Bypass_surgery_effects_on_Remission_of_diabetes_in_JAMA_2018_Norwegian_cohort_study"] ; # 
  fhir:title [ fhir:v "ComparativeEvidence: Bypass surgery effects on Remission of diabetes in JAMA 2018 Norwegian cohort study"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:date [ fhir:v "2022-09-19T21:16:23.435Z"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "Computable Publishing LLC"] ; # 
  fhir:contact ( [
    ( fhir:telecom [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "support@computablepublishing.com" ]     ] )
  ] ) ; # 
  fhir:author ( [
fhir:name [ fhir:v "Brian S. Alper" ]
  ] ) ; # 
  fhir:useContext ( [
fhir:code [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
fhir:code [ fhir:v "evidence-communication" ] ;
fhir:display [ fhir:v "Evidence Communication" ]     ] ;
fhir:value [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ComparativeEvidence" ] ;
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fhir:code [ fhir:v "evidence-communication" ] ;
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fhir:display [ fhir:v "SingleStudyEvidence" ]       ] )     ]
  ] ) ; # 
  fhir:copyright [ fhir:v "https://creativecommons.org/licenses/by-nc-sa/4.0/"] ; # 
  fhir:relatedArtifact ( [
fhir:type [ fhir:v "derived-from" ] ;
fhir:document [
fhir:url [ fhir:v "https://jamanetwork.com/journals/jama/fullarticle/2669729"^^xsd:anyURI ]     ]
  ] [
fhir:type [ fhir:v "cite-as" ] ;
fhir:citation [ fhir:v "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." ]
  ] ) ; # 
  fhir:description [ fhir:v "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]"] ; # 
  fhir:assertion [ fhir:v "Compared with specialized medical treatment, bariatric surgery appears to induce remission of diabetes."] ; # 
  fhir:variableDefinition ( [
fhir:description [ fhir:v "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 = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included)." ] ;
fhir:variableRole [ fhir:v "population" ] ;
fhir:observed [
fhir:reference [ fhir:v "Group/178427" ] ;
fhir:type [ fhir:v "Group"^^xsd:anyURI ] ;
fhir:display [ fhir:v "StudyGroup: Severely Obese Adults 2018 Norwegian Cohort" ]     ]
  ] [
fhir:description [ fhir:v "bariatric surgery vs. specialized medical treatment without bariatric surgery" ] ;
fhir:variableRole [ fhir:v "exposure" ] ;
fhir:comparatorCategory [ fhir:v "no bariatric surgery" ] ;
fhir:intended [
fhir:reference [ fhir:v "EvidenceVariable/172427" ] ;
fhir:type [ fhir:v "EvidenceVariable"^^xsd:anyURI ] ;
fhir:display [ fhir:v "GroupAssignment: Bariatric Surgery vs. no bariatric surgery" ]     ]
  ] [
fhir:description [ fhir:v "Remission of diabetes" ] ;
fhir:variableRole [ fhir:v "outcome" ] ;
fhir:observed [
fhir:reference [ fhir:v "EvidenceVariable/104117" ] ;
fhir:type [ fhir:v "EvidenceVariable"^^xsd:anyURI ] ;
fhir:display [ fhir:v "OutcomeVariable: Remission of diabetes" ]     ]
  ] ) ; # 
  fhir:synthesisType [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/synthesis-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NotApplicable" ] ;
fhir:display [ fhir:v "not applicable" ]     ] )
  ] ; # 
  fhir:studyDesign ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/study-design"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SEVCO:01002" ] ;
fhir:display [ fhir:v "Observational research" ]     ] )
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    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/study-design"^^xsd:anyURI ] ;
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fhir:code [ fhir:v "SEVCO:01028" ] ;
fhir:display [ fhir:v "Longitudinal data collection" ]     ] )
  ] ) ; # 
  fhir:statistic ( [
fhir:description [ fhir:v "Relative risk 3.9; 95% CI 2.8 to 5.4" ] ;
    ( fhir:note [
fhir:text [ fhir:v "Result observed without bariatric surgery was 14.8%, result observed with bariatric surgery was 57.5%" ]     ] ) ;
fhir:statisticType [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/statistic-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C93152" ] ;
fhir:display [ fhir:v "Relative Risk" ]       ] )     ] ;
fhir:quantity [
fhir:value [ fhir:v "3.9"^^xsd:decimal ]     ] ;
fhir:sampleSize [
fhir:numberOfStudies [ fhir:v "1"^^xsd:nonNegativeInteger ] ;
fhir:numberOfParticipants [ fhir:v "1888"^^xsd:nonNegativeInteger ] ;
fhir:knownDataCount [ fhir:v "1888"^^xsd:nonNegativeInteger ]     ] ;
    ( fhir:attributeEstimate [
fhir:description [ fhir:v "95% CI 2.8 to 5.4" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/attribute-estimate-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C53324" ] ;
fhir:display [ fhir:v "Confidence interval" ]         ] )       ] ;
fhir:level [ fhir:v "0.95"^^xsd:decimal ] ;
fhir:range [
fhir:low [
fhir:value [ fhir:v "2.8"^^xsd:decimal ]         ] ;
fhir:high [
fhir:value [ fhir:v "5.4"^^xsd:decimal ]         ]       ]     ] )
  ] ) ; # 
  fhir:certainty ( [
fhir:description [ fhir:v "rated down 2 levels due to observational study, rated up 1 level due to large effect size" ] ;
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/certainty-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Overall" ] ;
fhir:display [ fhir:v "Overall certainty" ]       ] )     ] ;
fhir:rating [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/certainty-rating"^^xsd:anyURI ] ;
fhir:code [ fhir:v "moderate" ] ;
fhir:display [ fhir:v "Moderate quality" ]       ] )     ]
  ] ) . #