Recommendation: ADA Obesity Management Recommendation 8.16 - TTL Representation - Evidence Based Medicine on FHIR Implementation Guide v1.0.0-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
: Recommendation: ADA Obesity Management Recommendation 8.16 - 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:Composition ;
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fhir:lastUpdated [ fhir:v "2023-12-06T10:26:45.890Z"^^xsd:dateTime ] ;
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fhir:v "http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/uv/ebm/StructureDefinition/recommendation>     ] )
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  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Composition</b><a name=\"179466\"> </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 Composition &quot;179466&quot; Version &quot;17&quot; Updated &quot;2023-12-06 10:26:45+0000&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-recommendation.html\">Recommendation</a></p></div><p><b>Artifact Description</b>: Example of Recommendation Profile of Composition Resource.</p><p><b>url</b>: <a href=\"https://fevir.net/resources/Composition/179466\">https://fevir.net/resources/Composition/179466</a></p><p><b>identifier</b>: FEvIR Object Identifier: 179466</p><p><b>status</b>: final</p><p><b>type</b>: EvidenceReport <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>#EvidenceReport)</span></p><p><b>category</b>: Recommendation <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)</span></p><p><b>date</b>: 2023-12-06 10:26:45+0000</p><p><b>author</b>: <span>: Brian S. Alper</span></p><p><b>title</b>: Recommendation: ADA Obesity Management Recommendation 8.16</p><p><b>custodian</b>: <a href=\"Organization-118079.html\">Organization/118079: Computable Publishing LLC</a> &quot;Computable_Publishing_LLC&quot;</p><h3>RelatesTos</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>cite-as</td><td> </td><td>Recommendation: ADA Obesity Management Recommendation 8.16 [Composition]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179466. Revised 2023-11-24. Available at: https://fevir.net/resources/Composition/179466. Computable resource at: https://fevir.net/resources/Composition/179466.</td><td> </td></tr><tr><td style=\"display: none\">*</td><td>derived-from</td><td>PlanDefinition <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td><td> </td><td><a href=\"PlanDefinition-179468.html\">PlanDefinition/179468: PlanDefinition for Recommendation: ADA Obesity Management Recommendation 8.16</a></td></tr><tr><td style=\"display: none\">*</td><td>derived-from</td><td>RecommendationJustification <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></td><td> </td><td><a href=\"ArtifactAssessment-179469.html\">ArtifactAssessment/179469: Justification for Recommendation: ADA Obesity Management Recommendation 8.16</a></td></tr></table></div>"
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fhir:citation [ fhir:v "Recommendation: ADA Obesity Management Recommendation 8.16 [Composition]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 179466. Revised 2023-11-24. Available at: https://fevir.net/resources/Composition/179466. Computable resource at: https://fevir.net/resources/Composition/179466." ]
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fhir:title [ fhir:v "Recommendation Specification" ] ;
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fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">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</div>"       ] ;
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fhir:reference [ fhir:v "ArtifactAssessment/179469" ] ;
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fhir:code [
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fhir:code [ fhir:v "rating-system" ] ;
fhir:display [ fhir:v "Rating System" ]         ] )       ] ;
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">ADA Level of Evidence</div>"       ] ;
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fhir:code [ fhir:v "strength-of-recommendation" ] ;
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fhir:code [ fhir:v "direction-of-recommendation" ] ;
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fhir:code [ fhir:v "ratings" ] ;
fhir:display [ fhir:v "Ratings" ]         ] ) ;
fhir:text [ fhir:v "overallRatings" ]       ] ;
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">A</div>"       ] ;
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fhir:code [
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fhir:code [ fhir:v "related-items" ] ;
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fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">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.</div>"       ] ;
      ( fhir:entry [
fhir:reference [ fhir:v "Group/32139" ] ;
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fhir:display [ fhir:v "RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)" ]       ] )     ] [
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fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">Metabolic surgery is recommended.</div>"       ] ;
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fhir:type [ fhir:v "PlanDefinition"^^xsd:anyURI ] ;
fhir:display [ fhir:v "PlanDefinition for Recommendation: ADA Obesity Management Recommendation 8.16" ]       ] )     ] [
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fhir:title [ fhir:v "Structured Data" ] ;
fhir:code [
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  ] [
fhir:title [ fhir:v "Evidence" ] ;
fhir:code [
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fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
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fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">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.</div>"       ] ;
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fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">JournalArticleCitation: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations</div>"         ] ;
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fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">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.</div>"       ] ;
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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:text [ fhir:v "subgroupConsiderationsSummary" ]       ] ;
fhir:emptyReason [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]         ] )       ] ;
      ( fhir:section [
fhir:title [ fhir:v "Subgroup Considerations Ratings" ] ;
fhir:code [
          ( 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:text [ fhir:v "subgroupConsiderationsRatings" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] [
fhir:title [ fhir:v "Subgroup Considerations Related Items" ] ;
fhir:code [
          ( fhir:coding [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
fhir:code [ fhir:v "related-items" ] ;
fhir:display [ fhir:v "Related Items" ]           ] ) ;
fhir:text [ fhir:v "subgroupConsiderationsRelatedItems" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] )     ] [
fhir:title [ fhir:v "Implementation Considerations Summary" ] ;
fhir:code [
        ( fhir:coding [
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:text [ fhir:v "implementationConsiderationsSummary" ]       ] ;
fhir:emptyReason [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]         ] )       ] ;
      ( fhir:section [
fhir:title [ fhir:v "Implementation Considerations Ratings" ] ;
fhir:code [
          ( 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:text [ fhir:v "implementationConsiderationsRatings" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] [
fhir:title [ fhir:v "Implementation Considerations Related Items" ] ;
fhir:code [
          ( fhir:coding [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
fhir:code [ fhir:v "related-items" ] ;
fhir:display [ fhir:v "Related Items" ]           ] ) ;
fhir:text [ fhir:v "implementationConsiderationsRelatedItems" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] )     ] [
fhir:title [ fhir:v "Monitoring Considerations Summary" ] ;
fhir:code [
        ( fhir:coding [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
fhir:code [ fhir:v "monitoring-considerations" ] ;
fhir:display [ fhir:v "Monitoring Considerations" ]         ] ) ;
fhir:text [ fhir:v "monitoringConsiderationsSummary" ]       ] ;
fhir:emptyReason [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]         ] )       ] ;
      ( fhir:section [
fhir:title [ fhir:v "Monitoring Considerations Ratings" ] ;
fhir:code [
          ( 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:text [ fhir:v "monitoringConsiderationsRatings" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] [
fhir:title [ fhir:v "Monitoring Considerations Related Items" ] ;
fhir:code [
          ( fhir:coding [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
fhir:code [ fhir:v "related-items" ] ;
fhir:display [ fhir:v "Related Items" ]           ] ) ;
fhir:text [ fhir:v "monitoringConsiderationsRelatedItems" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] )     ] [
fhir:title [ fhir:v "Competing Interests Summary" ] ;
fhir:code [
        ( fhir:coding [
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:text [ fhir:v "competingInterestsSummary" ]       ] ;
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns =\"http://www.w3.org/1999/xhtml\">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</div>"       ] ;
      ( fhir:entry [
fhir:reference [ fhir:v "ArtifactAssessment/179469" ] ;
fhir:type [ fhir:v "ArtifactAssessment"^^xsd:anyURI ]       ] ) ;
      ( fhir:section [
fhir:title [ fhir:v "Competing Interests Ratings" ] ;
fhir:code [
          ( 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:text [ fhir:v "competingInterestsRatings" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] [
fhir:title [ fhir:v "Competing Interests Related Items" ] ;
fhir:code [
          ( fhir:coding [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
fhir:code [ fhir:v "related-items" ] ;
fhir:display [ fhir:v "Related Items" ]           ] ) ;
fhir:text [ fhir:v "competingInterestsRelatedItems" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] )     ] [
fhir:title [ fhir:v "Research Priorities Summary" ] ;
fhir:code [
        ( fhir:coding [
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:text [ fhir:v "researchConsiderationsSummary" ]       ] ;
fhir:emptyReason [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]         ] )       ] ;
      ( fhir:section [
fhir:title [ fhir:v "Research Priorities Ratings" ] ;
fhir:code [
          ( 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:text [ fhir:v "researchConsiderationsRatings" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] [
fhir:title [ fhir:v "Research Priorities Related Items" ] ;
fhir:code [
          ( fhir:coding [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/179423"^^xsd:anyURI ] ;
fhir:code [ fhir:v "related-items" ] ;
fhir:display [ fhir:v "Related Items" ]           ] ) ;
fhir:text [ fhir:v "researchConsiderationsRelatedItems" ]         ] ;
fhir:emptyReason [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/list-empty-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "notstarted" ] ;
fhir:display [ fhir:v "Not Started" ]           ] )         ]       ] )     ] )
  ] ) . #