Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot - ballot
Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot - ballot
This page is part of the Evidence Based Medicine on FHIR Implementation Guide (v1.0.0-ballot: STU1 Ballot 1) based on FHIR (HL7® FHIR® Standard) v5.0.0. . For a full list of available versions, see the Directory of published versions
@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:ArtifactAssessment ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "179469"] ; # fhir:meta [ fhir:versionId [ fhir:v "14" ] ; fhir:lastUpdated [ fhir:v "2023-12-06T11:04:06.230Z"^^xsd:dateTime ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation-justification"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation-justification> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ArtifactAssessment</b><a name=\"179469\"> </a></p><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\">Resource ArtifactAssessment "179469" Version "14" Updated "2023-12-06 11:04:06+0000" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-recommendation-justification.html\">RecommendationJustification</a></p></div><p><b>Artifact URL</b>: <a href=\"https://fevir.net/resources/ArtifactAssessment/179469\">https://fevir.net/resources/ArtifactAssessment/179469</a></p><p><b>Artifact Description</b>: An example using the ArtifactAssessment Resource for representation of the many judgments and concepts used to justify a recommendation.</p><p><b>identifier</b>: FEvIR Object Identifier: 179469</p><p><b>title</b>: Justification for Recommendation: ADA Obesity Management Recommendation 8.16</p><p><b>citeAs</b>: Justification for Recommendation: ADA Obesity Management Recommendation 8.16 [ArtifactAssessment]. Contributors: In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179469. Revised 2023-11-24. Available at: https://fevir.net/resources/ArtifactAssessment/179469. Computable resource at: https://fevir.net/resources/ArtifactAssessment/179469.</p><p><b>artifact</b>: <a href=\"PlanDefinition-179468.html\">PlanDefinition/179468: PlanDefinition for Recommendation: ADA Obesity Management Recommendation 8.16</a></p><blockquote><p><b>content</b></p><p><b>informationType</b>: container</p><p><b>summary</b>: 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. A</p><p><b>type</b>: Recommendation Specification <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-content0; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#recommendation-specification)</span></p><h3>RelatedArtifacts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td><td><b>Citation</b></td><td><b>ResourceReference</b></td></tr><tr><td style=\"display: none\">*</td><td>derived-from</td><td>Guideline <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span>, Citation Resource <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td><td>8. Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2021 [Journal Article]. Contributors: American Diabetes Association. In: Diabetes care, PMID 33298419. Published January 2021. Available at: https://pubmed.ncbi.nlm.nih.gov/33298419/.</td><td><a href=\"Citation-32137.html\">Citation/32137: JournalArticleCitation: ADA 2021 Standards of Medical Care 8. Obesity Management for the Treatment of Type 2 Diabetes</a></td></tr></table><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>informationType</b>: comment</p><p><b>summary</b>: 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. A</p><p><b>type</b>: Recommendation Statement <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#recommendation-statement)</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>informationType</b>: classifier</p><p><b>type</b>: Rating System <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#rating-system)</span></p><p><b>classifier</b>: ADA Level of Evidence <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: Strength of Recommendation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1000; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#strength-of-recommendation)</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: Direction of Recommendation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1014; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#direction-of-recommendation)</span></p><p><b>classifier</b>: Favors intervention <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-2021)</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: Ratings <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#ratings)</span></p><p><b>classifier</b>: A <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: Discussion <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#discussion)</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>summary</b>: 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.</p><p><b>type</b>: Population <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1015; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#population)</span></p><blockquote><p><b>relatedArtifact</b></p></blockquote><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: Action <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1016; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#action)</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: Opposite Action <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1017; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#opposite-action)</span></p><p><b>freeToShare</b>: true</p></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: container</p><p><b>summary</b>: 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.</p><p><b>type</b>: Evidence <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-content1; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#evidence)</span></p><h3>RelatedArtifacts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Classifier</b></td><td><b>Citation</b></td><td><b>ResourceReference</b></td></tr><tr><td style=\"display: none\">*</td><td>justification</td><td>Guideline <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span>, Citation Resource <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td><td>Rubino F, Nathan DM, Eckel RH, et al.; Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016;39:861–877</td><td><a href=\"Citation-33089.html\">Citation/33089: JournalArticleCitation: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations</a></td></tr><tr><td style=\"display: none\">*</td><td>justification</td><td>Evidence Resource <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td><td>derived from Figure 2C of: Rubino F, Nathan DM, Eckel RH, et al.; Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016;39:861–877</td><td><a href=\"Evidence-33244.html\">Evidence/33244: ComparativeEvidence: Mean difference in HbA1c effect of bariatric surgery in 2016 meta-analysis</a> "MeanDiffA1c2016metaAnalysis"</td></tr></table><p><b>freeToShare</b>: true</p><blockquote><p><b>component</b></p><p><b>summary</b>: 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.</p><p><b>type</b>: Summary of Findings <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#summary-of-findings)</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: Desirable Effects <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1004; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#desirable-effects)</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>type</b>: Undesirable Effects <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1005; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#undesirable-effects)</span></p><p><b>freeToShare</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>summary</b>: 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.<br/>In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. However, because the effect size diminished over 5 years, further follow-up is needed to understand the durability of the improvement.</p><p><b>type</b>: Discussion <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#discussion)</span></p><blockquote><p><b>relatedArtifact</b></p></blockquote><blockquote><p><b>relatedArtifact</b></p></blockquote><blockquote><p><b>relatedArtifact</b></p></blockquote><p><b>freeToShare</b>: true</p></blockquote></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: container</p><p><b>type</b>: Net Effect <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1007; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#net-effect)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>FreeToShare</b></td></tr><tr><td style=\"display: none\">*</td><td>Values/Preferences <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1006; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#preferences "Preferences")</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td>Discussion <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#discussion)</span></td><td>true</td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: container</p><p><b>type</b>: Judgments <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-content2; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#judgments)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>FreeToShare</b></td></tr><tr><td style=\"display: none\">*</td><td>Justification <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#justification)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td>Problem Importance <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1003; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#problem-importance)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td>Resources/Costs <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1008; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#costs "Costs")</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td>Cost-effectiveness <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1009; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#cost-effectiveness)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td>Equity <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1010; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#equity)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td>Acceptability <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1011; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#acceptability)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td>Feasibility <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1012; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#feasibility)</span></td><td>true</td></tr></table></blockquote><blockquote><p><b>content</b></p><p><b>informationType</b>: container</p><p><b>type</b>: Considerations <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-content3; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#considerations)</span></p><p><b>freeToShare</b>: true</p><h3>Components</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Summary</b></td><td><b>Type</b></td><td><b>FreeToShare</b></td></tr><tr><td style=\"display: none\">*</td><td> </td><td>Subgroup Considerations <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1019; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#subgroup-considerations)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td> </td><td>Implementation Considerations <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1020; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#implementation-considerations)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td> </td><td>Monitoring Considerations <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1021; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#monitoring-considerations)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td>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</td><td>Competing Interests <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1002; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#competing-interests)</span></td><td>true</td></tr><tr><td style=\"display: none\">*</td><td> </td><td>Research Priorities <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-27834.html\">Recommendation Justification Code System</a>#RJCS-1022; <a href=\"CodeSystem-179423.html\">Evidence Based Medicine on FHIR Implementation Guide Code System</a>#research-considerations "Research Considerations")</span></td><td>true</td></tr></table></blockquote></div>" ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/artifact-url"^^xsd:anyURI ] ; fhir:value [ fhir:v "https://fevir.net/resources/ArtifactAssessment/179469"^^xsd:anyURI ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/artifact-description"^^xsd:anyURI ] ; fhir:value [ fhir:v "An example using the ArtifactAssessment Resource for representation of the many judgments and concepts used to justify a recommendation." ] ] ) ; # 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 "179469" ] ; fhir:assigner [ fhir:display [ fhir:v "Computable Publishing LLC" ] ] ] ) ; # fhir:title [ fhir:v "Justification for Recommendation: ADA Obesity Management Recommendation 8.16"] ; # fhir:citeAs [ fhir:v "Justification for Recommendation: ADA Obesity Management Recommendation 8.16 [ArtifactAssessment]. Contributors: In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179469. Revised 2023-11-24. Available at: https://fevir.net/resources/ArtifactAssessment/179469. Computable resource at: https://fevir.net/resources/ArtifactAssessment/179469."] ; # fhir:artifact [ a fhir:Reference ; fhir:reference [ fhir:v "PlanDefinition/179468" ] ; fhir:type [ fhir:v "PlanDefinition"^^xsd:anyURI ] ; fhir:display [ fhir:v "PlanDefinition for Recommendation: ADA Obesity Management Recommendation 8.16" ] ] ; # fhir:content ( [ fhir:informationType [ fhir:v "container" ] ; fhir:summary [ fhir:v "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. A" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-content0" ] ; fhir:display [ fhir:v "Recommendation Specification" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "recommendation-specification" ] ; fhir:display [ fhir:v "Recommendation Specification" ] ] ) ] ; ( fhir:relatedArtifact [ fhir:type [ fhir:v "derived-from" ] ; ( fhir:classifier [ fhir:text [ fhir:v "Guideline" ] ] [ fhir:text [ fhir:v "Citation Resource" ] ] ) ; fhir:citation [ fhir:v "8. Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2021 [Journal Article]. Contributors: American Diabetes Association. In: Diabetes care, PMID 33298419. Published January 2021. Available at: https://pubmed.ncbi.nlm.nih.gov/33298419/." ] ; fhir:resourceReference [ fhir:reference [ fhir:v "Citation/32137" ] ; fhir:type [ fhir:v "Citation"^^xsd:anyURI ] ; fhir:display [ fhir:v "JournalArticleCitation: ADA 2021 Standards of Medical Care 8. Obesity Management for the Treatment of Type 2 Diabetes" ] ] ] ) ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ; ( fhir:component [ fhir:informationType [ fhir:v "comment" ] ; fhir:summary [ fhir:v "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. A" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "recommendation-statement" ] ; fhir:display [ fhir:v "Recommendation Statement" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:informationType [ fhir:v "classifier" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "rating-system" ] ; fhir:display [ fhir:v "Rating System" ] ] ) ] ; ( fhir:classifier [ fhir:text [ fhir:v "ADA Level of Evidence" ] ] ) ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1000" ] ; fhir:display [ fhir:v "Strength of Recommendation" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "strength-of-recommendation" ] ; fhir:display [ fhir:v "Strength of Recommendation" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1014" ] ; fhir:display [ fhir:v "Direction of Recommendation" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "direction-of-recommendation" ] ; fhir:display [ fhir:v "Direction of Recommendation" ] ] ) ] ; ( fhir:classifier [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-2021" ] ; fhir:display [ fhir:v "Favors intervention" ] ] ) ] ) ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "ratings" ] ; fhir:display [ fhir:v "Ratings" ] ] ) ] ; ( fhir:classifier [ fhir:text [ fhir:v "A" ] ] ) ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "discussion" ] ; fhir:display [ fhir:v "Discussion" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:summary [ fhir:v "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." ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1015" ] ; fhir:display [ fhir:v "Population" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "population" ] ; fhir:display [ fhir:v "Population" ] ] ) ] ; ( fhir:relatedArtifact [ fhir:type [ fhir:v "specification-of" ] ; fhir:resourceReference [ fhir:reference [ fhir:v "Group/32139" ] ; fhir:type [ fhir:v "Group"^^xsd:anyURI ] ; fhir:display [ fhir:v "RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)" ] ] ] ) ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1016" ] ; fhir:display [ fhir:v "Action" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "action" ] ; fhir:display [ fhir:v "Action" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1017" ] ; fhir:display [ fhir:v "Opposite Action" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "opposite-action" ] ; fhir:display [ fhir:v "Opposite Action" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] ) ] [ fhir:informationType [ fhir:v "container" ] ; fhir:summary [ fhir:v "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." ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-content1" ] ; fhir:display [ fhir:v "Evidence" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "evidence" ] ; fhir:display [ fhir:v "Evidence" ] ] ) ] ; ( fhir:relatedArtifact [ fhir:type [ fhir:v "justification" ] ; ( fhir:classifier [ fhir:text [ fhir:v "Guideline" ] ] [ fhir:text [ fhir:v "Citation Resource" ] ] ) ; fhir:citation [ fhir:v "Rubino F, Nathan DM, Eckel RH, et al.; Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016;39:861–877" ] ; fhir:resourceReference [ fhir:reference [ fhir:v "Citation/33089" ] ; fhir:type [ fhir:v "Citation"^^xsd:anyURI ] ; fhir:display [ fhir:v "JournalArticleCitation: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations" ] ] ] [ fhir:type [ fhir:v "justification" ] ; ( fhir:classifier [ fhir:text [ fhir:v "Evidence Resource" ] ] ) ; fhir:citation [ fhir:v "derived from Figure 2C of: Rubino F, Nathan DM, Eckel RH, et al.; Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016;39:861–877" ] ; fhir:resourceReference [ fhir:reference [ fhir:v "Evidence/33244" ] ; fhir:type [ fhir:v "Evidence"^^xsd:anyURI ] ; fhir:display [ fhir:v "ComparativeEvidence: Mean difference in HbA1c effect of bariatric surgery in 2016 meta-analysis" ] ] ] ) ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ; ( fhir:component [ fhir:summary [ fhir:v "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." ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "summary-of-findings" ] ; fhir:display [ fhir:v "Summary of Findings" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1004" ] ; fhir:display [ fhir:v "Desirable Effects" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "desirable-effects" ] ; fhir:display [ fhir:v "Desirable Effects" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1005" ] ; fhir:display [ fhir:v "Undesirable Effects" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "undesirable-effects" ] ; fhir:display [ fhir:v "Undesirable Effects" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:summary [ fhir:v "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.<br/>In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. However, because the effect size diminished over 5 years, further follow-up is needed to understand the durability of the improvement." ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "discussion" ] ; fhir:display [ fhir:v "Discussion" ] ] ) ] ; ( fhir:relatedArtifact [ fhir:type [ fhir:v "justification" ] ; ( fhir:classifier [ fhir:text [ fhir:v "Citation" ] ] ) ; fhir:citation [ fhir:v "Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 2014;311:2297–2304" ] ] [ fhir:type [ fhir:v "justification" ] ; ( fhir:classifier [ fhir:text [ fhir:v "Citation" ] ] ) ; fhir:citation [ fhir:v "Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA 2019;322:1271–1282" ] ] [ fhir:type [ fhir:v "justification" ] ; ( fhir:classifier [ fhir:text [ fhir:v "Evidence Resource" ] ] ) ; fhir:resourceReference [ fhir:reference [ fhir:v "Evidence/32144" ] ] ] ) ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] ) ] [ fhir:informationType [ fhir:v "container" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1007" ] ; fhir:display [ fhir:v "Net Effect" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "net-effect" ] ; fhir:display [ fhir:v "Net Effect" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ; ( fhir:component [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1006" ] ; fhir:display [ fhir:v "Values/Preferences" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; 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fhir:code [ fhir:v "RJCS-1019" ] ; fhir:display [ fhir:v "Subgroup Considerations" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "subgroup-considerations" ] ; fhir:display [ fhir:v "Subgroup Considerations" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1020" ] ; fhir:display [ fhir:v "Implementation Considerations" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "implementation-considerations" ] ; fhir:display [ fhir:v "Implementation Considerations" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1021" ] ; fhir:display [ fhir:v "Monitoring Considerations" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; 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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" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1002" ] ; fhir:display [ fhir:v "Competing Interests" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "competing-interests" ] ; fhir:display [ fhir:v "Competing Interests" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/27834"^^xsd:anyURI ] ; fhir:code [ fhir:v "RJCS-1022" ] ; fhir:display [ fhir:v "Research Priorities" ] ] [ fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ; fhir:code [ fhir:v "research-considerations" ] ; fhir:display [ fhir:v "Research Considerations" ] ] ) ] ; fhir:freeToShare [ fhir:v "true"^^xsd:boolean ] ] ) ] ) . #
IG © 2022+ HL7 International / Clinical Decision Support. Package hl7.fhir.uv.ebm#1.0.0-ballot based on FHIR 5.0.0. Generated 2023-12-17
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