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Deep learning transformer-based models using longitudinal electronic health records (EHRs) have shown a great success in prediction of clinical diseases or outcomes. Pretraining on a large dataset can help such models map the input space better and boost their performance on relevant tasks through finetuning with limited data. In this study, we present TransformEHR, a generative encoder-decoder model with transformer that is pretrained using a new pretraining objective—predicting all diseases and outcomes of a patient at a future visit from previous visits. TransformEHR's encoder-decoder framework, paired with the novel pretraining objective, helps it achieve the new state-of-the-art performance on multiple clinical prediction tasks. Comparing with the previous model, TransformEHR improves area under the precision–recall curve by 2% (p < 0.001) for pancreatic cancer onset and by 24% (p = 0.007) for intentional self-harm in patients with post-traumatic stress disorder. The high performance in predicting intentional self-harm shows the potential of TransformEHR in building effective clinical intervention systems. TransformEHR is also generalizable and can be easily finetuned for clinical prediction tasks with limited data. Using AI to predict disease can improve interventions slow down or prevent disease. Here, the authors show that generative AI models built on the framework of Transformer, the model that also empowers ChatGPT, can achieve state-of-the-art performance on disease predictions based on longitudinal electronic records. [ABSTRACT FROM AUTHOR]

INTRODUCTION Ureteropelvic junction (UPJ) obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 1000-2000 newborns. Widespread use of antenatal ultrasonography and the advent of modern imaging techniques have resulted in earlier and more common diagnosis of hydronephrosis. Before the advent of ultrasonography, congenital hydronephrosis presented throughout childhood and even adulthood with various symptoms such as abdominal or flank pain, recurrent urinary tract infections (UTIs), abdominal mass, renal stones, and hematuria. AIMS AND OBJECTIVES the safety and efficacy of lateral flank pycloplasty in comparison with the dorsal lumbotomypycloplasty in management of pelviureteric junction obstruction, good operative procedure in respect of post-operative complication. post-operative complications and its management. Know which procedure is suitable for which group of patient. MATERIALS AND METHODS It was a prospective randomized study performed to patients, presenting with pelviureteric junction obstruction. IPGME& R, SSKM HOSPITAL KOLKATA-700020. In the present study, 100 cases were included. Analysis was made on the basis of percentages, mean values, standard deviation, t-test and proportion/chisquare test of significance. The study comprises of 100 patients of pelviureteric junction obstruction admitted to indoors, OPD and casualty of IPGME& R, SSKM HOSPITAL, and KOLKATA. Preoperative History, investigations, operative data and postoperative course were recorded prospectively in a computerized database and in standardized data format. RESULT In our study showed that association between Post-op abdominal Distension in two groups was statistically significant. (P-value: 0.02699). Difference between Hospital Stay in two groups was statistically significant. (P-value: <0.0001). Association between Wound Infection in two groups was statistically significant. (P-value: 0.00268). Association between Seroma formation in two groups was statistically significant. (P-value: 0.0117). Association between Persistance of Abdominal lump in two groups was not statistically significant. (P-value: 0.09212). CONCLUSION Post-operative morbidity, wound infection and seroma formation all are low in dorsal lumbotomy approach. Overall, the complication rates were not significantly different for the 2 approaches .Further evaluation of cosmesis and pain control, and future studies with larger numbers of patients and longer follow up may show more divergent outcomes. [ABSTRACT FROM AUTHOR]

Background: Clear guidelines exist to guide the dosing of direct-acting oral anticoagulants (DOACs). It is not known how consistently these guidelines are followed in practice.Methods: We studied patients from the Veterans Health Administration (VA) with non-valvular atrial fibrillation who received DOACs (dabigatran, rivaroxaban, apixaban) between 2010 and 2016. We used patient characteristics (age, creatinine, body mass) to identify which patients met guideline recommendations for low-dose therapy and which for full-dose therapy. We examined how often patient dosing was concordant with these recommendations. We examined variation in guideline-concordant dosing by site of care and over time. We examined patient-level predictors of guideline-concordant dosing using multivariable logistic models.Results: A total of 73,672 patients who were prescribed DOACS were included. Of 5837 patients who were recommended to receive low-dose therapy, 1331 (23%) received full-dose therapy instead. Of 67,935 patients recommended to receive full-dose therapy, 4079 (6%) received low-dose therapy instead. Sites varied widely on guideline discordant dosing; on inappropriate low-dose therapy, sites varied from 0 to 15%, while on inappropriate high-dose therapy, from 0 to 41%. Guideline discordant therapy decreased by about 20% in a relative sense over time, but its absolute numbers grew as DOAC therapy became more common. The most important patient-level predictors of receiving guideline-discordant therapy were older age and creatinine function being near the cutoff value.Conclusions: A substantial portion of DOAC prescriptions in the VA system are dosed contrary to clinical guidelines. This phenomenon varies widely across sites of care and has persisted over time. [ABSTRACT FROM AUTHOR]