Citations

Abstract Background Computational phenotyping from electronic health records (EHRs) is essential for clinical research, decision support, and quality/population health assessment, but the proliferation of algorithms for the same conditions makes it difficult to identify which algorithm is most appropriate for reuse. Objective To develop a framework for assessing phenotyping algorithm fitness for purpose and reuse. Fitness for Purpose Phenotyping algorithms are fit for purpose when they identify the intended population with performance characteristics appropriate for the intended application. Fitness for Reuse Phenotyping algorithms are fit for reuse when the algorithm is implementable and generalizable—that is, it identifies the same intended population with similar performance characteristics when applied to a new setting. Conclusions The PhenoFit framework provides a structured approach to evaluate and adapt phenotyping algorithms for new contexts increasing efficiency and consistency of identifying patient populations from EHRs.

This Viewpoint discusses care denial for transgender youth forced by law and how health systems will need to invest resources to adjust to the expected emergence of mental health concerns, for which psychiatrists can play a key role in developing and implementing such programs locally.

Importance Total pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile. Objective To define reference values for TP based on a low-risk cohort treated at expert centers. Design, Setting, and Participants This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities. Exposures TP. Main Outcomes and Measures Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy. Results Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29). Conclusions and Relevance This case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.

ABSTRACT Background Abdominal arterial calcification (AAC) is a common comorbidity in patients with end‐stage kidney disease (ESKD) and a predictor of cardiovascular events post‐kidney transplant. However, prior studies lacked a standardized approach to evaluate AAC and its impact on post‐transplant outcomes. This study aimed to correlate AAC score values with post‐kidney transplant outcomes using a modified scoring system traditionally applied to coronary artery calcification. Methods This retrospective study included 14 339 adult patients listed for kidney transplant between 2002 and 2023 at three transplant centers. Among them, 3683 patients met the criteria of undergoing a kidney transplant and an abdominal computed tomography (CT) scan pre‐transplant. We modified the coronary calcium score software by adjusting intake data points to quantify calcification in the abdominal aorta, common iliac, external iliac, and internal iliac arteries. Outcomes focused on post‐transplant mortality. Results In 3683 kidney transplant recipients, higher AAC scores were significantly associated with increased mortality. Each 1000‐unit increase in AAC score elevated hazard ratios (HRs) across arterial regions, including 1.116 for the aorta and 1.389 for the internal iliac (all p < 0.001). Adjusted analyses confirmed AAC as an independent risk factor for mortality. Kaplan–Meier curves demonstrated lower survival with increasing AAC quartiles. Conclusions AAC, measured by a standardized score, is a significant mortality risk factor in kidney transplant recipients. Integrating AAC scores into pre‐transplant evaluations could enhance risk stratification and improve outcomes. Prospective studies are needed to validate these findings and explore interventions to reduce AAC and improve survival.

Background: Fecal microbiota, live-jslm (RBL) is approved in the United States and Canada for prevention of recurrent Clostridioides difficile infection (rCDI) in adults following standard-of-care (SOC) antibiotic treatment. Objectives: Provide an updated integrated safety analysis, incorporating final safety data from Punch CD3-OLS. Design: Safety data were combined from five RBL trials: three phase II and two phase III trials. Methods: Adult participants had documented rCDI and completed SOC therapy before receiving one or two doses of RBL or placebo, rectally administered as one treatment course. Treatment-emergent adverse events (TEAEs) were recorded for ⩽6 months. Results: TEAEs were reported in 70.9% (845/1192) of RBL recipients; most TEAEs were mild to moderate and gastrointestinal in nature. Most serious TEAEs were related to preexisting conditions or CDI. There was no clustering of serious TEAEs. Most TEAEs leading to death were related to preexisting conditions. Conclusion: Overall, data demonstrate RBL has a favorable 6-month safety profile. Trial registration: ClinicalTrials.gov: NCT01925417; NCT02299570; NCT02589847; NCT03244644; NCT03931941.