Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot2 - STU 1 ballot
Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot2 - STU 1 ballot
This page is part of the Evidence Based Medicine on FHIR Implementation Guide (v1.0.0-ballot2: STU1 Ballot 2) based on FHIR (HL7® FHIR® Standard) v6.0.0. No current official version has been published yet. For a full list of available versions, see the Directory of published versions
| Page standards status: Informative |
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🔗 "http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence-report"
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Composition 178426</b></p><a name=\"178426\"> </a><a name=\"hc178426\"> </a><a name=\"178426-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">version: 101; Last updated: 2025-03-25 22:17:24+0000</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-comparative-evidence-report.html\">ComparativeEvidenceReport</a></p></div><p><b>Artifact Description</b>: </p><div><p>This example of a ComparativeEvidenceReport Profile shows a report from a single observational study with 2 baseline measures, 2 participant flow measures, and 4 outcome measures.</p>\n</div><p><b>url</b>: <a href=\"https://fevir.net/resources/Composition/178426\">https://fevir.net/resources/Composition/178426</a></p><p><b>identifier</b>: FEvIR Object Identifier/https://fevir.net/FOI/178426</p><p><b>status</b>: Final</p><p><b>type</b>: <span title=\"Codes:{https://fevir.net/resources/CodeSystem/179423 ComparativeEvidenceReport}\">Comparative Evidence Report</span></p><p><b>date</b>: 2025-03-25 22:17:24+0000</p><p><b>author</b>: </p><ul><li>Brian S. Alper</li><li>Khalid Shahin</li><li>Joanne Dehnbostel</li></ul><p><b>title</b>: ComparativeEvidenceReport: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)</p><p><b>custodian</b>: <a href=\"Organization-118079.html\">Computable Publishing LLC</a></p><h3>RelatesTos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>Cite As</td></tr><tr><td style=\"display: none\">*</td><td/><td>Derived From</td></tr></table></div>"
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🔗 "reference" : "Group/179633",
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"date" : "2025-03-25T22:17:24.583Z",
"author" : [
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"type" : "Practitioner",
"display" : "Brian S. Alper"
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{
"type" : "Practitioner",
"display" : "Khalid Shahin"
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{
"type" : "Practitioner",
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"title" : "ComparativeEvidenceReport: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)",
"custodian" : {
🔗 "reference" : "Organization/118079",
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"valueMarkdown" : "ComparativeEvidenceReport: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort) [Database Entry: FHIR Composition Resource]. Contributors: Brian S. Alper, Khalid Shahin, Joanne Dehnbostel [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 178426. Revised 2025-03-01. Available at: https://fevir.net/resources/Composition/178426. Computable resource at: https://fevir.net/FLI/DocumentForComposition178426."
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"section" : [
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{
"title" : "Population",
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"text" : {
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>StudyGroup: Severely Obese Adults 2018 Norwegian Cohort</b> Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n\u2009=\u20092109) with severe obesity assessed (221 patients excluded and 1888 patients included). (1888 participants)</div>"
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"entry" : [
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🔗 "reference" : "Group/178427",
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"section" : [
{
"title" : "Screened Group",
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"status" : "empty",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">[No data.]</div>"
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"title" : "Intervention Description",
"code" : {
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],
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"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Bariatric surgery, mostly gastric bypass (92%) or sleeve gastrectomy (7%)</div>"
},
"entry" : [
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🔗 "reference" : "Group/172423",
"type" : "Group",
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{
"title" : "Intervention Group",
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"text" : {
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">932 patients opted for bariatric surgery</div>"
},
"entry" : [
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🔗 "reference" : "Group/172934",
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{
"title" : "Comparator Section",
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"text" : {
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"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">medical treatment without surgery</div>"
},
"entry" : [
{
🔗 "reference" : "Group/172424",
"type" : "Group",
"display" : "ComparatorDefinition: NOT Bariatric Surgery (RYGB, VSG, LAGB, BPD)"
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{
"title" : "Comparator Group",
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">956 opted for medical management without surgery</div>"
},
"entry" : [
{
🔗 "reference" : "Group/172939",
"type" : "Group",
"display" : "ComparatorGroup: JAMA 2018 Norwegian cohort study Control cohort"
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]
},
{
"title" : "Group Assignment (EvidenceVariable) Section",
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"code" : "GroupAssignment",
"display" : "GroupAssignment"
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"text" : {
"status" : "empty",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>[No data.]</p></div>"
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"entry" : [
{
🔗 "reference" : "EvidenceVariable/312202",
"type" : "EvidenceVariable",
"display" : "GroupAssignment: ExposureDefinition: Bariatric Surgery (RYGB, VSG, LAGB, BPD) vs. ComparatorDefinition: NOT Bariatric Surgery (RYGB, VSG, LAGB, BPD)"
}
]
}
]
},
{
"title" : "Research Study",
"code" : {
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Title:</b> Norwegian Cohort Study Comparing Bariatric Surgery vs Medical Obesity Treatment for Long-term Medical Complications and Obesity-Related Comorbidities</p><br/><p><b>Description:</b> The main purpose of this study is, in combination with data from the Register and Biobank study and follow-up data from the Norwegian Prescription Database, to compare the long-term effects (4-10 years) of surgical and non-surgical treatment of morbid obesity on obesity\nrelated comorbidities by studying changes in medicine usage after treatment.\n\nHypotheses\n1. Primary hypothesis: As compared to non-surgical treatment, bariatric surgery will be associated with higher rates of remission, and lower rates of new-onset drug treated hypertension during a follow-up period of ≤ 10 years.\n2. Secondary hypotheses: Changes in the usage of other drugs, particularly drugs related to obesity related comorbidities, will differ significantly between patients undergoing bariatric surgery or non-surgical treatment during the follow-up period. </p><br/><p><b>Study Design:</b> Observational research (coded as: SEVCO:01002 from https://fevir.net/sevco); Parallel cohort design (coded as: SEVCO:01011 from https://fevir.net/sevco); Longitudinal data collection (coded as: SEVCO:01028 from https://fevir.net/sevco)</p></div>"
},
"entry" : [
{
🔗 "reference" : "ResearchStudy/208285",
"type" : "ResearchStudy",
"display" : "Norwegian Cohort Study Comparing Bariatric Surgery vs Medical Obesity Treatment for Long-term Medical Complications and Obesity-Related Comorbidities"
}
]
},
{
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{
"title" : "Baseline Measures",
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"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">As compared with medical patients, surgically treated patients were significantly younger with a higher BMI. Mean age 41.2 in Surgical Group vs. 45.7 in Medical Group (p < 0.001). Mean BMI 45.4 in Surgical Group vs. 42.9 in Medical Group (p < 0.001).</div>"
},
"entry" : [
{
🔗 "reference" : "Composition/312203",
"type" : "Composition",
"display" : "Baseline Measure Report: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)"
},
{
🔗 "reference" : "List/312201",
"type" : "List",
"display" : "BaselineVariablesList: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)"
}
]
},
{
"title" : "Participant Flow",
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"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">2109 patients included in baseline registry, 221 patients excluded, 1888 patients included in analysis (932 had opted for bariatric surgery, 956 had opted for medical treatment)</div>"
}
},
{
"title" : "Outcomes",
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"code" : "outcome-measures",
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"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Risk of Remission of diabetes in control group was 14.8%. Risk of Remission of diabetes in intervention group was 57.5%. Greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]<br/>Compared with specialized medical treatment, bariatric surgery appears to induce remission of diabetes.<br/><br/>Risk of New onset depression in control group was 6.5%. Risk of New onset depression in intervention group was 8.9%. Greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7].<br/>Compared with specialized medical treatment, bariatric surgery may slightly increase the incidence of depression.<br/><br/>Risk of Treatment with opioids in control group was 15.8%. Risk of Treatment with opioids in intervention group was 19.4%. Greater risk of treatment with opioids: AR, 19.4% vs 15.8%, RD, 3.6% [95% CI, 2.3%-4.9%], RR, 1.3 [95% CI, 1.2-1.4].<br/>Compared with specialized medical treatment, bariatric surgery may slightly increase the use of opioids.<br/><br/>Risk of additional GI surgical procedure in control group was 15.5%. Risk of additional GI surgical procedure in intervention group was 31.3%. Surgical patients had a greater risk for undergoing at least 1 additional gastrointestinal surgical procedure (AR, 31.3% vs 15.5%; RD, 15.8% [95% CI, 13.1%-18.5%]; RR, 2.0 [95% CI, 1.7-2.4]).<br/>Compared with specialized medical treatment, bariatric surgery appears to increase the rate of additional gastrointestinal surgical procedures.</div>"
},
"entry" : [
{
🔗 "reference" : "Composition/318262",
"type" : "Composition",
"display" : "Outcome Measure Report: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)"
},
{
🔗 "reference" : "List/312205",
"type" : "List",
"display" : "OutcomeVariablesList: Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities (2018 Norwegian Cohort)"
}
]
},
{
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{
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IG © 2024+ HL7 International / Clinical Decision Support. Package hl7.fhir.uv.ebm#1.0.0-ballot2 based on FHIR 6.0.0-ballot2. Generated 2025-03-28
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