Release 5 Snapshot #1
Clinical ReasoningThis page is part of the FHIR Specification (v5.0.0-snapshot1: Release 5 Snapshot #1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
| Clinical Decision Support Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Not linked to any defined compartments |
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Systematic Meta Review
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fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div><p>Resource "citation-example-systematic-meta-review" </p></div><p><b>url</b>: <code>http://hl7.org/fhir/Citation/citation-example-systematic-meta-review</code></p><p><b>identifier</b>: FEvIR Object Identifier: 27121</p><p><b>title</b>: SMR Sterne JAC JAMA 32876694</p><p><b>status</b>: active</p><p><b>description</b>: A systematic review included in the Steroids SMR Project</p><p><b>copyright</b>: https://creativecommons.org/licenses/by-nc-sa/4.0/</p><p><b>author</b>: Brian S. Alper: </p><h3>Summaries</h3><table><tr><td>-</td><td><b>Style</b></td><td><b>Text</b></td></tr><tr><td>*</td><td>Computable Publishing <span> (citation-summary-style#comppub)</span></td><td>Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis [Journal Article]. Contributors: The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group Authors and Members of the Writing Committee: Jonathan A. C. Sterne, MA, MSc, PhD; Srinivas Murthy, MD, MSc; Janet V. Diaz, MD; Arthur S. Slutsky, CM, MD; Jesús Villar, MD, PhD; Derek C. Angus, MD, MPH; Djillali Annane, MD, PhD; Luciano Cesar Pontes Azevedo, MD, PhD; Otavio Berwanger, MD, PhD; Alexandre B. Cavalcanti, MD, PhD; Pierre-Francois Dequin, MD, PhD; Bin Du, MD; Jonathan Emberson, PhD; David Fisher, MSc; Bruno Giraudeau, PhD; Anthony C. Gordon, MBBS, MD; Anders Granholm, MD; Cameron Green, MSc; Richard Haynes, DM; Nicholas Heming, MD, PhD; Julian P. T. Higgins, BA, PhD; Peter Horby, PhD; Peter Jüni, MD; Martin J. Landray, PhD; Amelie Le Gouge, MSc; Marie Leclerc, MSc; Wei Shen Lim, BMedSci, BMBS, DM; Flávia R. Machado, MD, PhD; Colin McArthur, MBChB; Ferhat Meziani, MD, PhD; Morten Hylander Møller, MD, PhD; Anders Perner, MD, PhD; Marie Warrer Petersen, MD; Jelena Savović, BPharm, MSc, PhD; Bruno Tomazini, MD; Viviane C. Veiga, MD, PhD; Steve Webb, MBBS, MPH, PhD; John C. Marshall, MD. In: JAMA, PMID 32876694. Accessed February 15, 2021. Available at: http://doi.org/10.1001/jama.2020.17023.</td></tr></table><h3>Classifications</h3><table><tr><td>-</td><td><b>Type</b></td><td><b>Classifier</b></td></tr><tr><td>*</td><td>FEvIR Platform Use <span> (<a>CitationClassificationType</a>#fevir-platform-use)</span></td><td>Project Specific <span> (<a>CitationArtifactClassifier</a>#project-specific)</span></td></tr></table><blockquote><p><b>statusDate</b></p><p><b>activity</b>: ROB assessment <span> ()</span></p><p><b>actual</b>: true</p><p><b>period</b>: ?? --> 2021-06-07</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: Author contact <span> ()</span></p><p><b>actual</b>: true</p><p><b>period</b>: 2021-06-07 --> (ongoing)</p></blockquote><blockquote><p><b>citedArtifact</b></p><p><b>identifier</b>: id: 32876694, pii: 2770279, id: 10.1001/jama.2020.17023, id: PMC7489434</p><p><b>relatedIdentifier</b>: id: CRD42020197242</p><p><b>dateAccessed</b>: 2021-02-15</p><h3>Titles</h3><table><tr><td>-</td><td><b>Type</b></td><td><b>Language</b></td><td><b>Text</b></td></tr><tr><td>*</td><td>primary-human-use <span> ()</span></td><td>English <span> (<a>Tags for the Identification of Languages</a>#en)</span></td><td>Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis.</td></tr></table><h3>Abstracts</h3><table><tr><td>-</td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td>*</td><td>Primary human use <span> (<a>CitedArtifactAbstractType</a>#primary-human-use)</span></td><td><AbstractText Label="Importance">Effective therapies for patients with coronavirus disease 2019 (COVID-19) are needed, and clinical trial data have demonstrated that low-dose dexamethasone reduced mortality in hospitalized patients with COVID-19 who required respiratory support.</AbstractText><AbstractText Label="Objective">To estimate the association between administration of corticosteroids compared with usual care or placebo and 28-day all-cause mortality.</AbstractText><AbstractText Label="Design, Setting, and Participants">Prospective meta-analysis that pooled data from 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19. The trials were conducted in 12 countries from February 26, 2020, to June 9, 2020, and the date of final follow-up was July 6, 2020. Pooled data were aggregated from the individual trials, overall, and in predefined subgroups. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I2 statistic. The primary analysis was an inverse variance-weighted fixed-effect meta-analysis of overall mortality, with the association between the intervention and mortality quantified using odds ratios (ORs). Random-effects meta-analyses also were conducted (with the Paule-Mandel estimate of heterogeneity and the Hartung-Knapp adjustment) and an inverse variance-weighted fixed-effect analysis using risk ratios.</AbstractText><AbstractText Label="Exposures">Patients had been randomized to receive systemic dexamethasone, hydrocortisone, or methylprednisolone (678 patients) or to receive usual care or placebo (1025 patients).</AbstractText><AbstractText Label="Main Outcomes and Measures">The primary outcome measure was all-cause mortality at 28 days after randomization. A secondary outcome was investigator-defined serious adverse events.</AbstractText><AbstractText Label="Results">A total of 1703 patients (median age, 60 years [interquartile range, 52-68 years]; 488 [29%] women) were included in the analysis. Risk of bias was assessed as "low" for 6 of the 7 mortality results and as "some concerns" in 1 trial because of the randomization method. Five trials reported mortality at 28 days, 1 trial at 21 days, and 1 trial at 30 days. There were 222 deaths among the 678 patients randomized to corticosteroids and 425 deaths among the 1025 patients randomized to usual care or placebo (summary OR, 0.66 [95% CI, 0.53-0.82]; P < .001 based on a fixed-effect meta-analysis). There was little inconsistency between the trial results (I2 = 15.6%; P = .31 for heterogeneity) and the summary OR was 0.70 (95% CI, 0.48-1.01; P = .053) based on the random-effects meta-analysis. The fixed-effect summary OR for the association with mortality was 0.64 (95% CI, 0.50-0.82; P < .001) for dexamethasone compared with usual care or placebo (3 trials, 1282 patients, and 527 deaths), the OR was 0.69 (95% CI, 0.43-1.12; P = .13) for hydrocortisone (3 trials, 374 patients, and 94 deaths), and the OR was 0.91 (95% CI, 0.29-2.87; P = .87) for methylprednisolone (1 trial, 47 patients, and 26 deaths). Among the 6 trials that reported serious adverse events, 64 events occurred among 354 patients randomized to corticosteroids and 80 events occurred among 342 patients randomized to usual care or placebo.</AbstractText><AbstractText Label="Conclusions and Relevance">In this prospective meta-analysis of clinical trials of critically ill patients with COVID-19, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality.</AbstractText></td></tr></table><blockquote><p><b>publicationForm</b></p><h3>PublishedIns</h3><table><tr><td>-</td><td><b>Type</b></td><td><b>Identifier</b></td><td><b>Title</b></td><td><b>PublisherLocation</b></td></tr><tr><td>*</td><td>Periodical <span> (<a>PublishedInType</a>#D020492)</span></td><td>ISSN Type: 1538-3598, ISOAbbreviation: JAMA, ISSN Linking: 0098-7484, Medline Title Abbreviation: JAMA, NLM Unique ID: 7501160</td><td>JAMA</td><td>United States</td></tr></table><blockquote><p><b>periodicRelease</b></p><p><b>citedMedium</b>: Internet <span> (journal-issue-medium#Internet)</span></p><p><b>volume</b>: 324</p><p><b>issue</b>: 13</p><h3>DateOfPublications</h3><table><tr><td>-</td><td><b>Date</b></td><td><b>Year</b></td><td><b>Month</b></td><td><b>Day</b></td></tr><tr><td>*</td><td>2020-10-06</td><td>2020</td><td>10</td><td>06</td></tr></table></blockquote><p><b>language</b>: English <span> (<a>Tags for the Identification of Languages</a>#en)</span></p><p><b>pageString</b>: 1330-1341</p></blockquote><blockquote><p><b>webLocation</b></p><p><b>classifier</b>: DOI Based <span> (<a>ArtifactUrlClassifier</a>#doi-based)</span></p><p><b>url</b>: <a>http://doi.org/10.1001/jama.2020.17023</a></p></blockquote><blockquote><p><b>webLocation</b></p><p><b>classifier</b>: on PubMed <span> (<a>ArtifactUrlClassifier[5.0.0-snapshot1]</a>#abstract "Abstract")</span></p><p><b>url</b>: <a>https://pubmed.ncbi.nlm.nih.gov/32876694/</a></p></blockquote><blockquote><p><b>webLocation</b></p><p><b>classifier</b>: on JAMA <span> (<a>ArtifactUrlClassifier[5.0.0-snapshot1]</a>#full-text "Full-Text")</span></p><p><b>url</b>: <a>https://jamanetwork.com/journals/jama/fullarticle/2770279</a></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: Steroids SMR project use <span> ()</span></p><p><b>classifier</b>: primary article <span> ()</span>, Unclear risk of bias <span> ()</span></p><h3>WhoClassifieds</h3><table><tr><td>-</td><td><b>Person</b></td><td><b>FreeToShare</b></td></tr><tr><td>*</td><td><span>: Brian S. 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LLC</span></td><td>https://creativecommons.org/licenses/by-nc-sa/4.0</td><td>true</td></tr></table></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: Publishing Model <span> (<a>CitedArtifactClassificationType</a>#publishing-model)</span></p><p><b>classifier</b>: Print <span> (<a>CitationArtifactClassifier</a>#Print)</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: Chemical <span> (<a>CitedArtifactClassificationType</a>#chemical)</span></p><p><b>classifier</b>: Adrenal Cortex Hormones <span> (chemical-substances#0; #D000305)</span>, Glucocorticoids <span> (chemical-substances#0; #D005938)</span>, Dexamethasone <span> (chemical-substances#7S5I7G3JQL; #D003907)</span>, Hydrocortisone <span> (chemical-substances#WI4X0X7BPJ; #D006854)</span>, Methylprednisolone <span> (chemical-substances#X4W7ZR7023; #D008775)</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: MeSH heading <span> (<a>CitedArtifactClassificationType</a>#mesh-heading)</span></p><p><b>classifier</b>: Adrenal Cortex Hormones <span> (#D000305; #Q000627 "therapeutic use"; [not stated]#Y)</span>, Betacoronavirus <span> (#D000073640)</span>, COVID-19 <span> (#D000086382)</span>, Cause of Death <span> (#D002423)</span>, Coronavirus Infections <span> (#D018352; #Q000188 "drug therapy"; [not stated]#Y; #Q000401 "mortality"; [not stated]#N)</span>, Critical Illness <span> (#D016638)</span>, Dexamethasone <span> (#D003907; #Q000627 "therapeutic use"; [not stated]#N)</span>, Glucocorticoids <span> (#D005938; #Q000627 "therapeutic use"; [not stated]#Y)</span>, Humans <span> (#D006801)</span>, Hydrocortisone <span> (#D006854; #Q000627 "therapeutic use"; [not stated]#N)</span>, Methylprednisolone <span> (#D008775; #Q000627 "therapeutic use"; [not stated]#N)</span>, Pandemics <span> (#D058873)</span>, Pneumonia, Viral <span> (#D011024; #Q000188 "drug therapy"; [not stated]#Y; #Q000401 "mortality"; [not 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Sírio-Libanês, São Paulo, Brazil.</p></blockquote><blockquote><p><b>affiliationInfo</b></p><p><b>affiliation</b>: Department of Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil.</p></blockquote></blockquote><blockquote><p><b>entry</b></p><p><b>name</b>: Viviane C Veiga </p><p><b>initials</b>: VC</p><h3>AffiliationInfos</h3><table><tr><td>-</td><td><b>Affiliation</b></td></tr><tr><td>*</td><td>BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.</td></tr></table></blockquote><blockquote><p><b>entry</b></p><p><b>name</b>: Steve Webb </p><p><b>initials</b>: S</p><blockquote><p><b>affiliationInfo</b></p><p><b>affiliation</b>: Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.</p></blockquote><blockquote><p><b>affiliationInfo</b></p><p><b>affiliation</b>: St John of God Healthcare, Subiaco, Australia.</p></blockquote></blockquote><blockquote><p><b>entry</b></p><p><b>name</b>: John C Marshall </p><p><b>initials</b>: JC</p><h3>AffiliationInfos</h3><table><tr><td>-</td><td><b>Affiliation</b></td></tr><tr><td>*</td><td>Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.</td></tr></table></blockquote><h3>Summaries</h3><table><tr><td>-</td><td><b>Type</b></td><td><b>Source</b></td><td><b>Value</b></td></tr><tr><td>*</td><td>Author string <span> (<a>ContributorSummaryType[5.0.0-snapshot1]</a>#author-string)</span></td><td>articleCopy <span> ()</span></td><td>The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group Authors and Members of the Writing Committee: Jonathan A. 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fhir:index 8;
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fhir:index 9;
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fhir:index 14;
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fhir:index 15;
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fhir:index 16;
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fhir:index 17;
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fhir:index 22;
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fhir:index 23;
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fhir:index 24;
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fhir:index 25;
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fhir:CodeableConcept.text [ fhir:value "articleCopy" ]
];
fhir:Citation.citedArtifact.contributorship.summary.value [ fhir:value "The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group Authors and Members of the Writing Committee: Jonathan A. C. Sterne, MA, MSc, PhD; Srinivas Murthy, MD, MSc; Janet V. Diaz, MD; Arthur S. Slutsky, CM, MD; Jesús Villar, MD, PhD; Derek C. Angus, MD, MPH; Djillali Annane, MD, PhD; Luciano Cesar Pontes Azevedo, MD, PhD; Otavio Berwanger, MD, PhD; Alexandre B. Cavalcanti, MD, PhD; Pierre-Francois Dequin, MD, PhD; Bin Du, MD; Jonathan Emberson, PhD; David Fisher, MSc; Bruno Giraudeau, PhD; Anthony C. Gordon, MBBS, MD; Anders Granholm, MD; Cameron Green, MSc; Richard Haynes, DM; Nicholas Heming, MD, PhD; Julian P. T. Higgins, BA, PhD; Peter Horby, PhD; Peter Jüni, MD; Martin J. Landray, PhD; Amelie Le Gouge, MSc; Marie Leclerc, MSc; Wei Shen Lim, BMedSci, BMBS, DM; Flávia R. Machado, MD, PhD; Colin McArthur, MBChB; Ferhat Meziani, MD, PhD; Morten Hylander Møller, MD, PhD; Anders Perner, MD, PhD; Marie Warrer Petersen, MD; Jelena Savović, BPharm, MSc, PhD; Bruno Tomazini, MD; Viviane C. Veiga, MD, PhD; Steve Webb, MBBS, MPH, PhD; John C. Marshall, MD." ]
]
]
] .
<http://hl7.org/fhir/Citation/87> a fhir:Citation .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/Citation/citation-example-systematic-meta-review.ttl> a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI <http://build.fhir.org/Citation/citation-example-systematic-meta-review.ttl> .
# -------------------------------------------------------------------------------------
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R5 Draft Ballot hl7.fhir.core#5.0.0-snapshot1 generated on Sun, Dec 19, 2021 08:19+1100.
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