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BackgroundArtificial intelligence–enabled electronic health record (EHR) analysis can revolutionize medical practice from the diagnosis and prediction of complex diseases to making recommendations in patient care, especially for chronic conditions such as chronic kidney disease (CKD), which is one of the most frequent complications in patients with diabetes and is associated with substantial morbidity and mortality. ObjectiveThe longitudinal prediction of health outcomes requires effective representation of temporal data in the EHR. In this study, we proposed a novel temporal-enhanced gradient boosting machine (GBM) model that dynamically updates and ensembles learners based on new events in patient timelines to improve the prediction accuracy of CKD among patients with diabetes. MethodsUsing a broad spectrum of deidentified EHR data on a retrospective cohort of 14,039 adult patients with type 2 diabetes and GBM as the base learner, we validated our proposed Landmark-Boosting model against three state-of-the-art temporal models for rolling predictions of 1-year CKD risk. ResultsThe proposed model uniformly outperformed other models, achieving an area under receiver operating curve of 0.83 (95% CI 0.76-0.85), 0.78 (95% CI 0.75-0.82), and 0.82 (95% CI 0.78-0.86) in predicting CKD risk with automatic accumulation of new data in later years (years 2, 3, and 4 since diabetes mellitus onset, respectively). The Landmark-Boosting model also maintained the best calibration across moderate- and high-risk groups and over time. The experimental results demonstrated that the proposed temporal model can not only accurately predict 1-year CKD risk but also improve performance over time with additionally accumulated data, which is essential for clinical use to improve renal management of patients with diabetes. ConclusionsIncorporation of temporal information in EHR data can significantly improve predictive model performance and will particularly benefit patients who follow-up with their physicians as recommended.

Background There are many types of vestibular function examination, each with different targets and positive rates. Clinical opinions vary on how to appropriately select examination methods for vertigo patients. Objective To explore the application value of vestibular function combined with audiological examination in peripheral vertigo diseases, and provide a reference basis for the diagnosis and differential diagnosis of clinical vertigo diseases. Methods Patients with dizziness or vertigo as the main complaint were selected from January 2021 to January 2022 in the Vertigo Clinic of the First People's Hospital of Yibin. All patients finished the examination within 7 days including pure tone audiometry (PTA), caloric test, video head impulse test (vHIT) and head-shaking test (HST). The vestibular function examination and audiological examination results were compared. Results A total of 120 patients with vertigo who met the inclusion and exclusion criteria had complete case data, there were 40 cases of sudden deafness with vertigo (SDV), benign paroxysmal positional vertigo (BPPV), and vestibular migraine (VM). The PTA in SDV patients was sensorineural deafness, 25 cases with caloric test abnormalities (62.50%), 16 cases with vHIT abnormalities (40.00%), 28 cases with HST abnormalities (70.00%). Nine BPPV patients had PTA abnormalities (22.50%), including 7 ears with sensorineural deafness, 2 ears with conduction deafness, 18 cases with caloric test abnormalities (45.00%), 21 cases with vHIT abnormalities (52.50%), and 20 cases with HST abnormalities (50.00%). There were 21 cases (52.50%) of PTA abnormalities in VM patients, all with sensorineural deafness, of which 26 ears had high-frequency hearing-light-moderate decline and 7 ears had low-frequency light-moderate decline. There were 16 cases with caloric test abnormalities (40.00%), 17 cases with vHIT abnormalities (42.50%), and 27 cases with HST abnormalities (67.50%). The proportion of hearing abnormalities in the three groups was statistically significant difference (χ2=50.26, P0.05) . Conclusion The vestibular function combined with audiological examination is helpful to the localization diagnosis of peripheral vertigo and to improve the detection rate and differential diagnosis of vertigo diseases.

OBJECTIVE: We aimed to characterize seasonal variation in US population-based blood pressure (BP) control and BP-related metrics and evaluate the association between outdoor temperature and BP control variation. METHODS: We queried electronic health records (EHRs) from 26 health systems, representing 21 states, to summarize BP metrics by quarters of 12-month periods from January 2017 to March 2020. Patients with at least one ambulatory visit during the measurement period and a hypertension diagnosis during the first 6 months or prior to the measurement period were included. Changes in BP control, BP improvement, medication intensification, average SBP reduction after medication intensification across quarters and association with outdoor temperature were analyzed using weighted generalized linear models with repeated measures. RESULTS: Among 1 818 041 people with hypertension, the majority were more than 65 years of age (52.2%), female (52.1%), white non-Hispanic (69.8%) and had stage 1/2 hypertension (64.8%). Overall, BP control and process metrics were highest in quarters 2 and 3, and lowest in quarters 1 and 4. Quarter 2 had the highest percentage of improved BP (31.95 ± 0.90%) and average SBP reduction after medication intensification (16 ± 0.23 mmHg). Quarter 3 had the highest percentage of BP controlled (62.25 ± 2.55%) and lowest with medication intensification (9.73 ± 0.60%). Results were largely consistent in adjusted models. Average temperature was associated with BP control metrics in unadjusted models, but associations were attenuated following adjustment. CONCLUSION: In this large, national, EHR-based study, BP control and BP-related process metrics improved during spring/summer months, but outdoor temperature was not associated with performance following adjustment for potential confounders.

ObjectiveTo explore trends in blood pressure (BP) control before and during the COVID-19 pandemic.Patients and methodsHealth systems participating in the National Patient-Centered Clinical Research Network (PCORnet) Blood Pressure Control Laboratory Surveillance System responded to data queries, producing 9 BP control metrics. Averages of the BP control metrics (weighted by numbers of observations in each health system) were calculated and compared between two 1-year measurement periods (January 1, 2019, through December 31, 2019, and January 1, 2020, through December 31, 2020).ResultsAmong 1,770,547 hypertensive persons in 2019, BP control to

Recurrent urinary tract infections (rUTI) are common in kidney transplant recipients (KTR) and are associated with multidrug resistance and increased morbidity/mortality. Novel antibiotic alternatives to reduce UTI recurrence are critically needed. We describe a case of rUTI due to extended spectrum beta lactamase (ESBL) Klebsiella pneumoniae in a KTR that was treated successfully with 4 weeks of adjunctive intravenous bacteriophage therapy alone, without concomitant antibiotics, and with no recurrence in a year of follow-up.