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 1.0.0-ballot3 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

: 14-day mortality remdesivir vs placebo meta-analysis (ACTT-1, Wang et al, WHO SOLIDARITY)

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

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

<http://hl7.org/fhir/Evidence/55> a fhir:Evidence ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "55"] ; # 
  fhir:meta [
     fhir:versionId [ fhir:v "41" ] ;
     fhir:lastUpdated [ fhir:v "2025-11-04T15:33:09.522Z"^^xsd:dateTime ]
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
     fhir:status [ fhir:v "empty" ] ;
     fhir:div [ fhir:v "<div xml:lang=\"en\" xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en\"><p>[No data.]</p></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:extension ( [
     fhir:url [
       fhir:v "http://hl7.org/fhir/uv/ebm/StructureDefinition/artifact-publication-status"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/uv/ebm/StructureDefinition/artifact-publication-status>
     ] ;
     fhir:value [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/cited-artifact-status-type"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/cited-artifact-status-type>
         ] ;
         fhir:code [ fhir:v "active" ] ;
         fhir:display [ fhir:v "Active" ]
       ] )
     ]
  ] ) ; # 
  fhir:url [
     fhir:v "https://fevir.net/resources/Evidence/55"^^xsd:anyURI ;
     fhir:l <https://fevir.net/resources/Evidence/55>
  ] ; # 
  fhir:identifier ( [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>
         ] ;
         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/FOI"^^xsd:anyURI ;
       fhir:l <https://fevir.net/FOI>
     ] ;
     fhir:value [ fhir:v "55" ] ;
     fhir:assigner [
       fhir:display [ fhir:v "Computable Publishing LLC" ]
     ]
  ] ) ; # 
  fhir:version [ fhir:v "4"] ; # 
  fhir:name [ fhir:v "Fourteen_day_mortality_remdesivir_vs_placebo_meta_analysis_ACTT_1_Wang_et_al_WHO_SOLIDARITY"] ; # 
  fhir:title [ fhir:v "14-day mortality remdesivir vs placebo meta-analysis (ACTT-1, Wang et al, WHO SOLIDARITY)"] ; # 
  fhir:citeAs [ fhir:v "14-day mortality remdesivir vs placebo meta-analysis (ACTT-1, Wang et al, WHO SOLIDARITY) [Database Entry: FHIR Evidence Resource]. Contributors: Brian S. Alper, Joanne Dehnbostel, Khalid Shahin [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 55. Published 2020-12-17. Revised 2021-08-23. Available at: https://fevir.net/resources/Evidence/55. Computable resource at: https://fevir.net/resources/Evidence/55#json."] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:date [ fhir:v "2021-08-23T12:33:29.572Z"^^xsd:dateTime] ; # 
  fhir:approvalDate [ fhir:v "2020-12-17"^^xsd:date] ; # 
  fhir:lastReviewDate [ fhir:v "2020-12-21"^^xsd:date] ; # 
  fhir:author ( [
     fhir:name [ fhir:v "Brian S. Alper" ]
  ] [
     fhir:name [ fhir:v "Joanne Dehnbostel" ]
  ] [
     fhir:name [ fhir:v "Khalid Shahin" ]
  ] ) ; # 
  fhir:publisher [ fhir:v "Computable Publishing LLC"] ; # 
  fhir:contact ( [
     fhir:telecom ( [
       fhir:system [ fhir:v "email" ] ;
       fhir:value [ fhir:v "support@computablepublishing.com" ]
     ] )
  ] ) ; # 
  fhir:copyright [ fhir:v "https://creativecommons.org/licenses/by-nc-sa/4.0/"] ; # 
  fhir:relatesTo ( [
     fhir:type [ fhir:v "derived-from" ] ;
     fhir:target [
       a fhir:Markdown ;
       fhir:v "Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial"
     ]
  ] [
     fhir:type [ fhir:v "derived-from" ] ;
     fhir:target [
       a fhir:Markdown ;
       fhir:v "Remdesivir for the Treatment of Covid-19 - Final Report"
     ]
  ] [
     fhir:type [ fhir:v "derived-from" ] ;
     fhir:target [
       a fhir:Markdown ;
       fhir:v "Repurposed Antiviral Drugs for Covid-19 — Interim WHO Solidarity Trial Results"
     ]
  ] ) ; # 
  fhir:description [ fhir:v "COVID-19 pneumonia remdesivir vs. placebo 14-day mortality (779 events among 6,744 participants, 3 randomized trials)\nRisk ratio 0.85 (95% CI 0.74 to 0.96) in fixed-effect analysis\nRisk ratio 0.81 (95% CI 0.60 to 1.08) in random-effects analysis"] ; # 
  fhir:assertion [ fhir:v "Remdesivir might reduce 14-day mortality, but this finding has not been repeated in a second trial (Low certainty)"] ; # 
  fhir:variableDefinition ( [
     fhir:description [ fhir:v "Adults with COVID-19 pneumonia admitted to hospital" ] ;
     fhir:variableRole [ fhir:v "population" ] ;
     fhir:observed [
       fhir:l <http://hl7.org/fhir/Group/179799> ;
       fhir:reference [ fhir:v "Group/179799" ] ;
       fhir:type [
         fhir:v "Group"^^xsd:anyURI ;
         fhir:l fhir:Group
       ] ;
       fhir:display [ fhir:v "MetaanalysisStudyGroup: Effect Estimates for Mortality at 14 days from COVID19 Remdesivir vs. Placebo RCTs (Biegel 2020 data 35/541 vs. 61/521) (Wang 2020 data 15/153 vs. 7/78) (SOLIDARITY data 219/2743 vs. 219/2708)" ]
     ] ;
     fhir:intended [
       fhir:l <http://hl7.org/fhir/Group/12714> ;
       fhir:reference [ fhir:v "Group/12714" ] ;
       fhir:type [
         fhir:v "Group"^^xsd:anyURI ;
         fhir:l fhir:Group
       ] ;
       fhir:display [ fhir:v "COVID-19PneumoniaHospitalizedAdult" ]
     ] ;
     fhir:directnessMatch [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/directness"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/directness>
         ] ;
         fhir:code [ fhir:v "high" ] ;
         fhir:display [ fhir:v "High quality match between observed and intended variable" ]
       ] )
     ]
  ] [
     fhir:description [ fhir:v "Remdesivir IV 200 mg once then 100 mg once daily for 9 days" ] ;
     fhir:variableRole [ fhir:v "exposure" ] ;
     fhir:observed [
       fhir:l <http://hl7.org/fhir/Group/179783> ;
       fhir:reference [ fhir:v "Group/179783" ] ;
       fhir:type [
         fhir:v "Group"^^xsd:anyURI ;
         fhir:l fhir:Group
       ] ;
       fhir:display [ fhir:v "Remdesivir IV 200 mg once then 100 mg once daily for 9 days" ]
     ] ;
     fhir:intended [
       fhir:l <http://hl7.org/fhir/EvidenceVariable/12717> ;
       fhir:reference [ fhir:v "EvidenceVariable/12717" ] ;
       fhir:type [
         fhir:v "EvidenceVariable"^^xsd:anyURI ;
         fhir:l fhir:EvidenceVariable
       ] ;
       fhir:display [ fhir:v "Remdesivir" ]
     ]
  ] [
     fhir:description [ fhir:v "Placebo" ] ;
     fhir:note ( [
       fhir:text [ fhir:v "SOLIDARITY trial did not use placebo in control group" ]
     ] ) ;
     fhir:variableRole [ fhir:v "exposure" ] ;
     fhir:roleSubtype [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/variable-role"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/variable-role>
         ] ;
         fhir:code [ fhir:v "referenceExposure" ] ;
         fhir:display [ fhir:v "reference exposure" ]
       ] )
     ] ;
     fhir:observed [
       fhir:l <http://hl7.org/fhir/EvidenceVariable/12718> ;
       fhir:reference [ fhir:v "EvidenceVariable/12718" ] ;
       fhir:type [
         fhir:v "EvidenceVariable"^^xsd:anyURI ;
         fhir:l fhir:EvidenceVariable
       ] ;
       fhir:display [ fhir:v "Placebo" ]
     ] ;
     fhir:intended [
       fhir:l <http://hl7.org/fhir/EvidenceVariable/12718> ;
       fhir:reference [ fhir:v "EvidenceVariable/12718" ] ;
       fhir:type [
         fhir:v "EvidenceVariable"^^xsd:anyURI ;
         fhir:l fhir:EvidenceVariable
       ] ;
       fhir:display [ fhir:v "Placebo" ]
     ]
  ] [
     fhir:description [ fhir:v "Mortality at 14 days" ] ;
     fhir:variableRole [ fhir:v "outcome" ] ;
     fhir:observed [
       fhir:l <http://hl7.org/fhir/EvidenceVariable/12719> ;
       fhir:reference [ fhir:v "EvidenceVariable/12719" ] ;
       fhir:type [
         fhir:v "EvidenceVariable"^^xsd:anyURI ;
         fhir:l fhir:EvidenceVariable
       ] ;
       fhir:display [ fhir:v "Mortality at 14 days" ]
     ] ;
     fhir:intended [
       fhir:l <http://hl7.org/fhir/EvidenceVariable/12719> ;
       fhir:reference [ fhir:v "EvidenceVariable/12719" ] ;
       fhir:type [
         fhir:v "EvidenceVariable"^^xsd:anyURI ;
         fhir:l fhir:EvidenceVariable
       ] ;
       fhir:display [ fhir:v "Mortality at 14 days" ]
     ]
  ] ) ; # 
  fhir:studyDesign ( [
     fhir:coding ( [
       fhir:system [
         fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
         fhir:l <https://fevir.net/sevco>
       ] ;
       fhir:code [ fhir:v "SEVCO:01003" ] ;
       fhir:display [ fhir:v "randomized assignment" ]
     ] )
  ] ) ; # 
  fhir:statistic ( [
     fhir:description [ fhir:v "risk ratio 0.85 (95% CI 0.74 to 0.96) in fixed-effect meta-analysis; Test for overall effect Z = 2.52 (p = 0.01); Heterogeneity Chi-squared = 7.33, df = 2 (p 0.03), I-squared = 73%" ] ;
     fhir:statisticType [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
           fhir:l <https://fevir.net/sevco>
         ] ;
         fhir:code [ fhir:v "STATO:0000245" ] ;
         fhir:display [ fhir:v "risk ratio" ]
       ] )
     ] ;
     fhir:quantity [
       fhir:value [ fhir:v 0.85 ]
     ] ;
     fhir:numberOfEvents [ fhir:v "779"^^xsd:nonNegativeInteger ] ;
     fhir:numberAffected [ fhir:v "779"^^xsd:nonNegativeInteger ] ;
     fhir:sampleSize [
       fhir:numberOfStudies [ fhir:v "3"^^xsd:nonNegativeInteger ] ;
       fhir:numberOfParticipants [ fhir:v "6774"^^xsd:nonNegativeInteger ] ;
       fhir:knownDataCount [ fhir:v "6744"^^xsd:nonNegativeInteger ]
     ] ;
     fhir:attributeEstimate ( [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000196" ] ;
           fhir:display [ fhir:v "confidence interval" ]
         ] )
       ] ;
       fhir:level [ fhir:v 0.95 ] ;
       fhir:range [
         fhir:low [
           fhir:value [ fhir:v 0.74 ]
         ] ;
         fhir:high [
           fhir:value [ fhir:v 0.96 ]
         ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000104" ] ;
           fhir:display [ fhir:v "z-score" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 2.52 ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000700" ] ;
           fhir:display [ fhir:v "p-value" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 0.01 ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000420" ] ;
           fhir:display [ fhir:v "I-squared" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 0.73 ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000419" ] ;
           fhir:display [ fhir:v "Cochran's Q" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 7.33 ]
       ] ;
       fhir:attributeEstimate ( [
         fhir:type [
           fhir:coding ( [
             fhir:system [
               fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
               fhir:l <https://fevir.net/sevco>
             ] ;
             fhir:code [ fhir:v "STATO:0000069" ] ;
             fhir:display [ fhir:v "degrees of freedom" ]
           ] )
         ] ;
         fhir:quantity [
           fhir:value [ fhir:v "2"^^xsd:decimal ]
         ]
       ] [
         fhir:type [
           fhir:coding ( [
             fhir:system [
               fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
               fhir:l <https://fevir.net/sevco>
             ] ;
             fhir:code [ fhir:v "STATO:0000700" ] ;
             fhir:display [ fhir:v "p-value" ]
           ] )
         ] ;
         fhir:quantity [
           fhir:value [ fhir:v 0.03 ]
         ]
       ] )
     ] ) ;
     fhir:modelCharacteristic ( [
       fhir:code [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/statistic-model-code"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/statistic-model-code>
           ] ;
           fhir:code [ fhir:v "effectsFixed" ] ;
           fhir:display [ fhir:v "Fixed-effects" ]
         ] )
       ] ;
       fhir:applied [ fhir:v true ]
     ] [
       fhir:code [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/statistic-model-code"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/statistic-model-code>
           ] ;
           fhir:code [ fhir:v "metaAnalysis" ] ;
           fhir:display [ fhir:v "Meta-analysis" ]
         ] )
       ] ;
       fhir:applied [ fhir:v true ]
     ] )
  ] [
     fhir:description [ fhir:v "risk ratio 0.81 (95% CI 0.60 to 1.08) in random-effects meta-analysis; Test for overall effect Z = 1.44 (p = 0.15); Heterogeneity Chi-squared = 7.33, df = 2 (p 0.03), I-squared = 73%; Tau-squared = 0.04" ] ;
     fhir:note ( [
       fhir:text [ fhir:v "We consider the random-effects model more appropriate for interpretation as the true effect of remdesivir is likely different across the different populations represented in each trial." ]
     ] ) ;
     fhir:statisticType [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
           fhir:l <https://fevir.net/sevco>
         ] ;
         fhir:code [ fhir:v "STATO:0000245" ] ;
         fhir:display [ fhir:v "risk ratio" ]
       ] )
     ] ;
     fhir:quantity [
       fhir:value [ fhir:v 0.81 ]
     ] ;
     fhir:numberOfEvents [ fhir:v "779"^^xsd:nonNegativeInteger ] ;
     fhir:numberAffected [ fhir:v "779"^^xsd:nonNegativeInteger ] ;
     fhir:sampleSize [
       fhir:numberOfStudies [ fhir:v "3"^^xsd:nonNegativeInteger ] ;
       fhir:numberOfParticipants [ fhir:v "6774"^^xsd:nonNegativeInteger ] ;
       fhir:knownDataCount [ fhir:v "6744"^^xsd:nonNegativeInteger ]
     ] ;
     fhir:attributeEstimate ( [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000196" ] ;
           fhir:display [ fhir:v "confidence interval" ]
         ] )
       ] ;
       fhir:level [ fhir:v 0.95 ] ;
       fhir:range [
         fhir:low [
           fhir:value [ fhir:v 0.6 ]
         ] ;
         fhir:high [
           fhir:value [ fhir:v 1.08 ]
         ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000104" ] ;
           fhir:display [ fhir:v "z-score" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 1.44 ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000700" ] ;
           fhir:display [ fhir:v "p-value" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 0.15 ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000421" ] ;
           fhir:display [ fhir:v "tau squared" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 0.04 ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000420" ] ;
           fhir:display [ fhir:v "I-squared" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 0.73 ]
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
             fhir:l <https://fevir.net/sevco>
           ] ;
           fhir:code [ fhir:v "STATO:0000419" ] ;
           fhir:display [ fhir:v "Cochran's Q" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v 7.33 ]
       ] ;
       fhir:attributeEstimate ( [
         fhir:type [
           fhir:coding ( [
             fhir:system [
               fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
               fhir:l <https://fevir.net/sevco>
             ] ;
             fhir:code [ fhir:v "STATO:0000069" ] ;
             fhir:display [ fhir:v "degrees of freedom" ]
           ] )
         ] ;
         fhir:quantity [
           fhir:value [ fhir:v "2"^^xsd:decimal ]
         ]
       ] [
         fhir:type [
           fhir:coding ( [
             fhir:system [
               fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
               fhir:l <https://fevir.net/sevco>
             ] ;
             fhir:code [ fhir:v "STATO:0000700" ] ;
             fhir:display [ fhir:v "p-value" ]
           ] )
         ] ;
         fhir:quantity [
           fhir:value [ fhir:v 0.03 ]
         ]
       ] )
     ] ) ;
     fhir:modelCharacteristic ( [
       fhir:code [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/statistic-model-code"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/statistic-model-code>
           ] ;
           fhir:code [ fhir:v "effectsRandom" ] ;
           fhir:display [ fhir:v "Random-effects" ]
         ] )
       ] ;
       fhir:applied [ fhir:v true ]
     ] [
       fhir:code [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/statistic-model-code"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/statistic-model-code>
           ] ;
           fhir:code [ fhir:v "metaAnalysis" ] ;
           fhir:display [ fhir:v "Meta-analysis" ]
         ] )
       ] ;
       fhir:applied [ fhir:v true ]
     ] [
       fhir:code [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/statistic-model-code"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/statistic-model-code>
           ] ;
           fhir:code [ fhir:v "tauDersimonianLaird" ] ;
           fhir:display [ fhir:v "Dersimonian-Laird method" ]
         ] )
       ] ;
       fhir:applied [ fhir:v true ]
     ] )
  ] ) ; # 
  fhir:certainty ( [
     fhir:description [ fhir:v "Low certainty due to inconsistency and risk of bias" ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/certainty-type"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/certainty-type>
         ] ;
         fhir:code [ fhir:v "Overall" ] ;
         fhir:display [ fhir:v "Overall certainty" ]
       ] )
     ] ;
     fhir:rating [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/certainty-rating"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/certainty-rating>
         ] ;
         fhir:code [ fhir:v "low" ] ;
         fhir:display [ fhir:v "Low quality" ]
       ] )
     ] ;
     fhir:subcomponent ( [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-type"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-type>
           ] ;
           fhir:code [ fhir:v "PublicationBias" ] ;
           fhir:display [ fhir:v "Publication bias" ]
         ] )
       ] ;
       fhir:rating [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-rating"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-rating>
           ] ;
           fhir:code [ fhir:v "no-concern" ] ;
           fhir:display [ fhir:v "no serious concern" ]
         ] )
       ]
     ] [
       fhir:note ( [
         fhir:text [ fhir:v "There is a high degree of heterogeneity (I-squared = 73%).  There is also inconsistency in findings between the fixed-effect and random-effects statistical models." ]
       ] ) ;
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-type"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-type>
           ] ;
           fhir:code [ fhir:v "Inconsistency" ] ;
           fhir:display [ fhir:v "Inconsistency" ]
         ] )
       ] ;
       fhir:rating [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-rating"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-rating>
           ] ;
           fhir:code [ fhir:v "serious-concern" ] ;
           fhir:display [ fhir:v "serious concern" ]
         ] )
       ]
     ] [
       fhir:note ( [
         fhir:text [ fhir:v "Although the random-effects analysis finds an estimate without statistical significance, this imprecision is explained by the inconsistency (heterogeneity) and thus not further downrated  in certainty assessment." ]
       ] ) ;
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-type"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-type>
           ] ;
           fhir:code [ fhir:v "Imprecision" ] ;
           fhir:display [ fhir:v "Imprecision" ]
         ] )
       ] ;
       fhir:rating [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-rating"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-rating>
           ] ;
           fhir:code [ fhir:v "no-concern" ] ;
           fhir:display [ fhir:v "no serious concern" ]
         ] )
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-type"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-type>
           ] ;
           fhir:code [ fhir:v "Indirectness" ] ;
           fhir:display [ fhir:v "Indirectness" ]
         ] )
       ] ;
       fhir:rating [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-rating"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-rating>
           ] ;
           fhir:code [ fhir:v "no-concern" ] ;
           fhir:display [ fhir:v "no serious concern" ]
         ] )
       ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-type"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-type>
           ] ;
           fhir:code [ fhir:v "RiskOfBias" ] ;
           fhir:display [ fhir:v "Risk of bias" ]
         ] )
       ] ;
       fhir:rating [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/certainty-rating"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/certainty-rating>
           ] ;
           fhir:code [ fhir:v "serious-concern" ] ;
           fhir:display [ fhir:v "serious concern" ]
         ] )
       ] ;
       fhir:subcomponent ( [
         fhir:note ( [
           fhir:text [ fhir:v "No blinding (no placebo control) in the largest trial" ]
         ] ) ;
         fhir:type [
           fhir:coding ( [
             fhir:system [
               fhir:v "https://fevir.net/sevco"^^xsd:anyURI ;
               fhir:l <https://fevir.net/sevco>
             ] ;
             fhir:code [ fhir:v "SEVCO:00035" ] ;
             fhir:display [ fhir:v "Inadequate blinding of participants" ]
           ] ) ;
           fhir:text [ fhir:v "Lack of blinding" ]
         ] ;
         fhir:rating [
           fhir:coding ( [
             fhir:system [
               fhir:v "http://hl7.org/fhir/certainty-rating"^^xsd:anyURI ;
               fhir:l <http://hl7.org/fhir/certainty-rating>
             ] ;
             fhir:code [ fhir:v "present" ] ;
             fhir:display [ fhir:v "present" ]
           ] )
         ]
       ] )
     ] )
  ] ) . # 

<http://hl7.org/fhir/Group/179799> a fhir:Group .

<http://hl7.org/fhir/Group/12714> a fhir:Group .

<http://hl7.org/fhir/Group/179783> a fhir:Group .

<http://hl7.org/fhir/EvidenceVariable/12717> a fhir:EvidenceVariable .

<http://hl7.org/fhir/EvidenceVariable/12718> a fhir:EvidenceVariable .

<http://hl7.org/fhir/EvidenceVariable/12719> a fhir:EvidenceVariable .