<?xml version="1.0" encoding="UTF-8"?><Evidence xmlns="http://hl7.org/fhir">
  <id value="example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2"/>
  <meta>
    <security>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="HTEST"/>
      <display value="test health data"/>
    </security>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      
      <p>
        "Effect of Alteplase vs No alteplase on mRS 0-2 at 90 days in Stroke 3-4.5 hours prior" is a comparative effect estimate.
      </p>
	
    </div>
  </text>
  <url value="http://hl7.org/fhir/Evidence/example-stroke-3-4half-alteplase-vs-no-alteplase-mRS0-2"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.10.3"/>
  </identifier>
  <name value="EffectOfAlteplaseVsNoAlteplaseOnMRS02At90DaysInStroke345HoursPrior"/>
  <title value="Effect of Alteplase vs No alteplase on mRS 0-2 at 90 days in Stroke 3-4.5 hours prior"/>
  <status value="draft"/>
  <relatedArtifact>
    <type value="citation"/>
    <label value="Lees 2016"/>
    <display value="Figure 2 Lees 2016"/>
    <citation value="Lees KR, Emberson J, Blackwell L, Bluhmki E, Davis SM, Donnan GA, et al; Stroke Thrombolysis Trialists’ Collaborators Group. Effects of alteplase for acute stroke on the distribution of functional outcomes: a pooled analysis of 9 trials. Stroke. 2016;47:2373-2379. PMID 27507856"/>
    <document>
      <url value="https://doi.org/10.1161/STROKEAHA.116.013644"/>
    </document>
  </relatedArtifact>
  <description value="mRS 0-2 at 90 days Odds Ratio 1.2 for Alteplase vs. No Alteplase in patients with acute ischemic stroke 3-4.5 hours prior"/>
  <variableDefinition>
    <variableRole>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/>
        <code value="population"/>
        <display value="population"/>
      </coding>
    </variableRole>
    <observed>
      <reference value="EvidenceVariable/Stroke-Thrombolysis-Trialists-2014-2016-IPD-MA-Cohort"/>
      <type value="EvidenceVariable"/>
      <display value="Stroke Thrombolysis Trialists’ 2014-2016 IPD-MA Cohort"/>
    </observed>
    <intended>
      <reference value="Group/AcuteIschemicStroke3-4halfHours"/>
      <type value="Group"/>
      <display value="stroke at 3-4.5 hours"/>
    </intended>
    <directnessMatch>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/directness"/>
        <code value="moderate"/>
        <display value="Moderate quality match"/>
      </coding>
    </directnessMatch>
  </variableDefinition>
  <variableDefinition>
    <variableRole>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/>
        <code value="measuredVariable"/>
        <display value="measured variable"/>
      </coding>
    </variableRole>
    <observed>
      <reference value="EvidenceVariable/example-mRS0-2-at-90days"/>
      <type value="EvidenceVariable"/>
      <display value="mRS 0-2 at 90 days"/>
    </observed>
    <intended>
      <reference value="EvidenceVariable/example-alive-independent-90day"/>
      <type value="EvidenceVariable"/>
      <display value="Alive and not functionally dependent at 90 days"/>
    </intended>
  </variableDefinition>
  <variableDefinition>
    <variableRole>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/>
        <code value="exposure"/>
        <display value="exposure"/>
      </coding>
    </variableRole>
    <observed>
      <reference value="EvidenceVariable/example-alteplase-for-stroke"/>
      <type value="EvidenceVariable"/>
      <display value="Alteplase for Stroke"/>
    </observed>
    <intended>
      <reference value="EvidenceVariable/example-alteplase-for-stroke"/>
      <type value="EvidenceVariable"/>
      <display value="Alteplase for Stroke"/>
    </intended>
  </variableDefinition>
  <variableDefinition>
    <variableRole>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/variable-role"/>
        <code value="referenceExposure"/>
        <display value="reference exposure"/>
      </coding>
    </variableRole>
    <observed>
      <reference value="EvidenceVariable/example-no-alteplase"/>
      <type value="EvidenceVariable"/>
      <display value="no alteplase"/>
    </observed>
    <intended>
      <reference value="EvidenceVariable/example-no-alteplase"/>
      <type value="EvidenceVariable"/>
      <display value="no alteplase"/>
    </intended>
  </variableDefinition>
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    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/synthesis-type"/>
      <code value="IPD-MA"/>
      <display value="individual patient data meta-analysis"/>
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  </synthesisType>
  <studyDesign>
    <coding>
      <system value="http://hl7.org/fhir/study-design"/>
      <code value="SEVCO:01003"/>
      <display value="randomized assignment"/>
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  </studyDesign>
  <statistic>
    <statisticType>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/statistic-type"/>
        <code value="C16932"/>
        <display value="Odds Ratio"/>
      </coding>
    </statisticType>
    <quantity>
      <value value="1.2"/>
    </quantity>
    <sampleSize>
      <numberOfStudies value="9"/>
    </sampleSize>
    <attributeEstimate>
      <description value="95% CI 1.06 to 1.3"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/attribute-estimate-type"/>
          <code value="C53324"/>
          <display value="Confidence interval"/>
        </coding>
      </type>
      <level value="0.95"/>
      <range>
        <low>
          <value value="1.06"/>
        </low>
        <high>
          <value value="1.3"/>
        </high>
      </range>
    </attributeEstimate>
  </statistic>
  <certainty>
    <description value="Very low certainty due to risk of bias, inconsistency, imprecision, and indirectness"/>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/certainty-type"/>
        <code value="Overall"/>
        <display value="Overall quality"/>
      </coding>
    </type>
    <rating>
      <coding>
        <system value="http://hl7.org/fhir/certainty-rating"/>
        <code value="very-low"/>
        <display value="Very low quality"/>
      </coding>
    </rating>
    <subcomponent>
      <type>
        <coding>
          <system value="http://hl7.org/fhir/certainty-type"/>
          <code value="PublicationBias"/>
          <display value="Publication bias"/>
        </coding>
      </type>
      <rating>
        <coding>
          <system value="http://hl7.org/fhir/certainty-rating"/>
          <code value="no-concern"/>
          <display value="no serious concern"/>
        </coding>
      </rating>
    </subcomponent>
    <subcomponent>
      <note>
        <text value="IST-3 had inconsistent results and contributed large proportion of data"/>
      </note>
      <type>
        <coding>
          <system value="http://hl7.org/fhir/certainty-type"/>
          <code value="Inconsistency"/>
          <display value="Inconsistency"/>
        </coding>
      </type>
      <rating>
        <coding>
          <system value="http://hl7.org/fhir/certainty-rating"/>
          <code value="serious-concern"/>
          <display value="serious concern"/>
        </coding>
      </rating>
    </subcomponent>
    <subcomponent>
      <note>
        <text value="results derived from figure with limited data reported to support the specific effect estimate; derived odds ratio in figure does not match results from rates of mRS 0-2 reported in Supplementary Figure 3b"/>
      </note>
      <type>
        <coding>
          <system value="http://hl7.org/fhir/certainty-type"/>
          <code value="Imprecision"/>
          <display value="Imprecision"/>
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      </type>
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        <coding>
          <system value="http://hl7.org/fhir/certainty-rating"/>
          <code value="serious-concern"/>
          <display value="serious concern"/>
        </coding>
      </rating>
    </subcomponent>
    <subcomponent>
      <note>
        <text value="resuts derived for 3 - 4.5 hours assume data from 0 - 6 hours is informative"/>
      </note>
      <type>
        <coding>
          <system value="http://hl7.org/fhir/certainty-type"/>
          <code value="Indirectness"/>
          <display value="Indirectness"/>
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      </type>
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        <coding>
          <system value="http://hl7.org/fhir/certainty-rating"/>
          <code value="serious-concern"/>
          <display value="serious concern"/>
        </coding>
      </rating>
    </subcomponent>
    <subcomponent>
      <note>
        <text value="results largely influenced by IST-3 trial which was unblinded and ECASS III which had baseline imbalances"/>
      </note>
      <type>
        <coding>
          <system value="http://hl7.org/fhir/certainty-type"/>
          <code value="RiskOfBias"/>
          <display value="Risk of bias"/>
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      </type>
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        <coding>
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          <code value="serious-concern"/>
          <display value="serious concern"/>
        </coding>
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  </certainty>
</Evidence>