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Treatment guidelines can improve population health; however, their implementation within electronic health records (EHRs) can be challenging. We aimed to create an implementable framework using the American Diabetes Association (ADA) Standards of Care (SOC) for people with type 2 diabetes and cardiovascular or renal disease as an example. A multidisciplinary team used agile methods to translate the text-based ADA SOC into structured elements within the EHR, including logic-driven algorithms and ontology groupers for diagnoses, laboratory values, and medications, leveraging standard terminologies such as SNOMED CT, LOINC, and RxNorm. The structured elements were used to implement 3 tools in the EHR: a real-time patient registry and 2 clinical decision support (CDS) instruments. The real-time registry enables dynamic, ongoing identification of patients eligible for guideline-directed medical therapy, supports more advanced analytics, and can be filtered to evaluate treatment gaps at the population and individual provider levels. The CDS tools allow clinicians to address these gaps directly within their EHR workflows. Transforming clinical guidelines into executable constructs within the EHR is feasible but remains complex and labor-intensive. Broader and more consistent implementation could be achieved if guideline organizations provided technical frameworks, regular updates (through addenda or shared interfaces), and collaborated with EHR vendors to support the distribution and maintenance of implementable algorithms. The integration of executable logic into clinical guidelines, using deterministic frameworks such as Unified Modeling Language and standardized ontologies, would simplify guideline implementation across EHR platforms.

To describe patient characteristics and teprotumumab treatment patterns among patients with thyroid eye disease (TED), using large-scale, linked clinical and claims data. This was an observational, retrospective cohort study using linked data from the American Academy of Ophthalmology IRIS&#xae; Registry (Intelligent Research in Sight) and Komodo Health Research Dataset (KRD; 2019-2024). Adult (&#x2265;18 years) patients with a confirmed TED diagnosis in the IRIS Registry who initiated teprotumumab (ie, received &#x2265;1 teprotumumab infusion in KRD) after its approval, and met continuous health plan enrollment requirements before and after treatment initiation were included. Outcomes were examined overall and stratified by TED duration at index (<24 months vs &#x2265;24 months). Outcomes included demographics (eg, age, sex at birth, race) and baseline disease burden (eg, clinical activity score [CAS], intraocular pressure, proptosis, eye signs and symptoms), as well as teprotumumab infusion patterns. A total of 2,886 patients were included (mean age: 59 years; 77% female). At baseline, 79% had &#x2265;1 eye sign or symptom (proptosis: 45%; diplopia: 29%). Among 356 patients with CAS recorded, 91% had active disease (CAS &#x2265;3/7 or 4/10). Teprotumumab was initiated within 12 months of TED diagnosis in 70% of patients. Among patients assessed for teprotumumab infusion patterns, 65% completed the 8-infusion course (median time to completion: 5 months); 35% discontinued (mean number of infusions received: 4); discontinuation peaked at the seventh infusion. Retreatment with teprotumumab occurred in 10% of patients completing the first course, 26% of whom completed the second course. This large real-world analysis reveals high baseline TED burden, teprotumumab adoption within one year of diagnosis, and adherence to FDA-indicated dosing. The findings reflect evolving clinical practice in TED management and support the need for ongoing research to assess how teprotumumab may influence the natural history of disease over time.

Obesity exacerbates asthma, resulting in more severe symptoms, poor disease control, and a reduced quality of life. With the increasing use of biologic therapies, achieving clinical remission (CR) has become an important treatment goal. This study evaluated the prevalence and impact of obesity on biologic response and CR in severe asthma patients. This prospective observational study included 525 patients enrolled in the Kuwait Severe Asthma Registry (KSAR). This prospective observational study included 525 patients enrolled in the Kuwait Severe Asthma Registry (KSAR). Patients were categorized according to body mass index (BMI) into normal weight, overweight, mild-to-moderate obesity, and morbid obesity groups. Demographic, clinical, and biomarker data, including blood eosinophil count (BEC), total immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), and IL4 and IL6 gene polymorphisms, were collected. Patients treated with biologics for at least 12 months were followed. CR was defined as absence of exacerbations, no oral corticosteroid (OCS) use, Asthma Control Test (ACT) score &#x2265;20, Asthma Control Questionnaire (ACQ-6) score &#x2264;0.75, and predicted forced expiratory volume in one second (FEV1) &#x2265;80%. Overweight and obesity were highly prevalent, with only 15.4% of patients having normal weight. Morbidly obese patients were older, had longer disease duration, worse asthma control, lower lung function, and higher rates of diabetes and allergic rhinitis. Biologic therapy significantly improved ACT, ACQ-6, exacerbation frequency, OCS use, and lung function across all BMI groups (p<0.001). However, morbidly obese patients continued to demonstrate poorer asthma control, lower FEV1 and FVC, and higher exacerbation and OCS rates. No significant changes were observed in BEC, total IgE, or FeNO. CR was achieved in 17.3% of patients overall, with higher rates in normal-weight individuals (25%) and lower rates in morbid obesity (11%). Younger age and the IL4 CC genotype were associated with greater likelihood of CR. Obesity was highly prevalent among severe asthma patients and was associated with poorer disease outcomes and lower CR rates despite biologic therapy. These findings highlight the importance of weight management and personalized treatment strategies in severe asthma.

Treatment of breast cancer in female patients has evolved over the past 20 years to improve outcomes, however it is unclear to what extent treatment has evolved in male patients. This bi-national registry observational study examined the disease burden and treatment landscape for new diagnoses of male breast cancer undergoing surgical management in Australia and New Zealand in comparison to females. A twenty-year study of male breast cancer patients compared to females was conducted for the period of 2003-2022 using the Breast Surgeons of Australia and New Zealand Quality Audit (BQA) database. Demographic, histological and treatment data was analysed according to biological sex and decade of breast cancer diagnosis (2003-2012 versus 2013-2022). Data from 258,246 patients (1542 males, 256,704 females) were analysed. Treatment of male breast cancer was largely unchanged in the later decade compared to the earlier decade apart from sentinel lymph node biopsy uptake which was significantly higher in the later decade (66% vs 47%, p&#x202f;<&#x202f;0.001). In contrast, significant differences in both surgical and adjuvant therapies were noted in the female group for every domain except post-mastectomy radiotherapy. Females treated early in the study period were associated with higher rates of adjuvant chemotherapy use than those treated in the later decade (OR 1.10, 95%CI 1.10; 1.11, p&#x202f;<&#x202f;0.001), while adjuvant chemotherapy use was stable over time in the male group. In Australia and New Zealand there has been a de-escalation in axillary surgery for male breast cancer during the multimodality era. This evolution has been modest compared to the extensive changes in therapy for female breast cancer in line with formalised treatment guidelines.

Frailty is a dynamic condition associated with increased vulnerability to adverse health outcomes in older adults. While previous research has primarily focused on deficit-based mental health factors, such as depression and loneliness, less is known about the role of positive mental health determinants, including wellbeing, resilience and social connectedness, in the development and progression of frailty. Understanding both risk and protective factors is essential for informing public health strategies aimed at promoting healthy aging. This study aims to examine the longitudinal relationship between mental health and frailty in a nationally sampled population of adults aged 50 years and older in Slovenia. This longitudinal observational cohort study will collect data at four time points over a 2-year period (January 2026-March 2028). A stratified random sample of community-dwelling adults aged 50-84 years will be drawn from the national population registry, with 5,000 individuals invited to participate in the first wave. Frailty, mental health and a set of social, psychological, and health-related factors will be assessed. Data will be analyzed using a combination of descriptive, inferential and longitudinal statistical methods to examine associations between frailty and mental health over time. Potential explanatory factors will also be explored within the longitudinal framework, and additional analyses will assess the impact of attrition.

To describe pregnancy-related experiences, complications and leave among gynecologic oncologists. Secondarily, to explore the institutional policy landscape pertaining to workload adjustments during pregnancy. We sent an anonymous, elective survey to all active physicians within the Society of Gynecologic Oncology (SGO) registry from September to December 2024. The survey explored family planning goals, pregnancy outcomes, pregnancy complications, leave after pregnancy, and work hours during pregnancy. Respondents were allowed but not required to offer open-ended comments, which were thematically analyzed. 276 respondents reported on 480 pregnancies, 385 of which were carried by the respondent. Of live births carried by gynecologic oncologists, more than half experienced a major complication and 1 in 4 delivered preterm. Working more than 60&#xa0;h per week in the third trimester (66% vs 50%, p&#xa0;=&#xa0;0.02), taking more than seven nights of call per month in the third trimester (45% vs 31%, p&#xa0;=&#xa0;0.04) and experiencing a major complication of pregnancy (87% vs 38%, p&#xa0;<&#xa0;0.001) were associated with reporting that workload negatively impacted a pregnancy. Very few pregnancies involved work-hour reductions or institutional policies for work-hour reduction. A majority of respondents reported delaying childbearing for training; most (76%) regretted this delay. Gynecologic oncologists reported high rates of pregnancy complications, most strikingly a preterm delivery rate of 25%. Very few adjusted work hours in pregnancy or had access to institutional policies for work hour reduction. This study provides insight into the experiences of pregnant gynecologic oncologists and highlights a need for explicit policies to support pregnancy.

We descriptively analyzed the trauma care outcomes of combat casualties arriving at the Walter Reed National Military Medical Center (WRNMMC) following the 2021 Afghanistan withdrawal as part of process improvement (PI) initiatives and quality assurance. A retrospective review of casualty records within the trauma registry at WRNMMC was conducted. The review included all patients who required definitive surgical intervention or critical care at WRNMMC from injuries sustained during the Afghanistan withdrawal. Data abstraction involved a detailed review of electronic medical records to document patient demographics, injury mechanisms, Injury Severity Scores (ISSs), operative reports, perioperative complications, and outcomes. A total of 50 casualties were received at WRNMMC after the Afghanistan withdrawal, including 17 US military service members and 33 Afghan evacuees (20 adults and 13 pediatric). The mean ISS for US service members was 16.3&#xb1;14.3. The mean ISS of Afghan evacuees was 10.7&#xb1;6.1 for adults and 16.6&#xb1;13.3 for pediatric evacuees. Polytrauma was common, with a majority of casualties sustaining injuries to multiple body regions. A total of 234 injuries were seen, with an average of 4.68&#xb1;3.8 injuries per casualty. 264 operations were performed, averaging 5.2&#xb1;5.6 per casualty. 23 postsurgical complications occurred in 10 casualties. 28 PI filters were initiated on 22 casualties. Caring for the casualties required multidisciplinary cooperation led by the trauma and acute care surgery service. The trauma care provided at WRNMMC following the Afghanistan withdrawal demonstrated institutional readiness and effective multidisciplinary coordination, but with a sizable burden of postoperative complications and PI filters. Lessons from this experience highlight the importance of continuous PI to optimize care delivery and outcomes, and underscore the need to sustain WRNMMC and strengthen other casualty-receiving Military Treatment Facilities to preserve trauma care readiness for future conflict. Therapeutic/care management; level V.

Economic uncertainty negatively impacts employment and production. However, little is known about the associations between uncertainty shocks and health over time. We employ a time-series econometric model to analyze the propagation patterns of uncertainty shocks on mortality, using daily data from the Economic Policy Uncertainty Index and the UK national death registry. We observe immediate increases in suicide, drug poisoning deaths, and in cardiovascular mortality at weekly horizons. Suicide and drug poisoning deaths rise by up to 2.3%, with the positive association persisting for three weeks before returning to baseline by week six. Cardiovascular mortality rises by 0.9%, persists for one week, and increases modestly again during weeks five and six. Our results demonstrate transmission patterns of uncertainty shocks across causes of death, reflecting both individual and systemic responses during uncertain times.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is more often diagnosed in men than in women but sex-specific data remain limited. The objective of the study was to characterize sex-related differences in presentation and outcomes in patients with ATTR-CM. Consecutive prospective patients with confirmed ATTR-CM enrolled in the multicenter Swiss-CARE registry (February 2018-March 2025) were analyzed. Clinical data were obtained at diagnosis, 6 months postdiagnosis, and yearly thereafter. The primary endpoint was first major adverse cardiac event (MACE) (ie composite of heart failure hospitalization and all-cause mortality). Kaplan-Meier and Cox proportional hazards models were employed. Among 567 patients with ATTR-CM (age 77 &#xb1; 7 years, 52 [9%] women), women were older at diagnosis (80.3 &#xb1; 6.1 vs 76.9 &#xb1; 6.9 years; P < 0.001), had a higher NYHA functional class (P < 0.001), higher N-terminal pro-B-type natriuretic peptide (2,574 vs 1,632 pg/mL; P = 0.006), and shorter 6-minute walking distance (320 &#xb1; 111 vs 411 &#xb1; 114 m; P = 0.001). Tafamidis was less frequently prescribed in women (50.0% vs 69.7%; P = 0.004). Women had a higher incidence of MACE (HR: 1.86; 95% CI: 1.13-3.04; P = 0.014), driven by increased heart failure hospitalizations within the first 2 years (HR: 2.21; 95% CI: 1.17-4.19; P = 0.015) and a trend toward higher all-cause mortality (HR: 1.82; 95% CI: 0.97-3.43; P = 0.06). In multivariable analyses, sex was not independently associated with MACE (P = 0.23). Women exhibited a higher risk of MACE after diagnosis; however, sex was not an independent predictor of outcomes in multivariable analysis. This disadvantage in women may be partly explained by older age at diagnosis, higher NT-proBNP levels, greater symptom burden, and a higher prevalence of comorbidities, rather than intrinsic sex-specific differences in ATTR-CM progression.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual incretin agonists are now familiar drugs in obesity, diabetes, heart failure, and cardiovascular prevention. At the same time, a clinically relevant but molecule-specific human literature suggests that selected incretin-based therapies, particularly semaglutide for alcohol-related outcomes, may also modify alcohol use, tobacco use, and selected acute substance-related events. Alcohol currently has the strongest signal. Small randomized studies suggest semaglutide can reduce laboratory alcohol self-administration and craving, whereas an earlier exenatide trial was neutral overall but suggested benefit in participants with obesity. Large registry and EHR studies further associate GLP-1RA exposure with lower alcohol-related hospitalization, lower incident or recurrent alcohol use disorder, and lower alcohol-related event rates. Tobacco evidence is more limited but now includes a pilot smoking-cessation trial with exenatide and a target-trial emulation linking semaglutide with fewer tobacco use disorder-related healthcare encounters. Evidence beyond alcohol and tobacco, and tirzepatide specific evidence, remains preliminary, although lower rates of opioid overdose, alcohol intoxication, and cannabis use disorder have been reported in observational analyses. For cardiologists, the key question is not whether incretin therapies should be viewed as addiction drugs, but whether established cardiometabolic therapies may also modify cardiovascular relevant risk behaviors.

Robotic platforms, proprietary registries, and advanced analytics have transformed total joint arthroplasty into a data-intensive subspecialty. Contemporary procedures generate granular operative metrics that are increasingly linked to longitudinal outcomes, benchmarking systems, predictive analytics, and artificial intelligence algorithm development. Yet governance structures defining analytic access, publication rights, secondary data use, and transparency to patients remain incompletely articulated. Surgeons generate operative data, but vendors frequently warehouse and structure these data sets within proprietary ecosystems, while registry governance and contractual agreements may influence analytic access and dissemination. These challenges extend beyond privacy concerns. Arthroplasty data sets increasingly inform quality measurement, reimbursement models, public reporting, and future algorithm development. Without clear governance standards, control over data stewardship, analytic framing, and scientific dissemination may progressively shift away from practicing surgeons and patients. This Viewpoint article examines emerging governance-related challenges within arthroplasty data ecosystems and proposes a framework centered on transparency to patients, data portability, publication protections, and independent oversight. The goal is not to impede innovation, but to ensure that the expanding digital architecture of arthroplasty evolves within transparent, ethically grounded, and academically independent governance structures.

The advanced Lung Cancer Inflammation Index (ALI) is a novel composite marker integrating nutritional, metabolic, and inflammatory status. This study aimed to investigate the prognostic significance of admission ALI for long-term mortality in patients with acute myocardial infarction (AMI) and concomitant diabetes. A total of 571 diabetic AMI patients were retrospectively enrolled from the NOAFCAMI-SH registry. Patients were stratified into ALI tertiles (T1-T3). The primary and secondary outcomes were all-cause and cardiovascular mortality, respectively, evaluated over a median follow-up of 2.5 years. Associations were assessed using Kaplan-Meier survival curves, Cox proportional hazards regression, and restricted cubic spline (RCS) models. Compared to the lowest tertile (T1), patients in the highest tertile (T3) exhibited markedly lower rates of all-cause (7.9% vs. 27.8%) and cardiovascular mortality (7.4% vs. 23.6%). In fully adjusted Cox models, higher ALI (T3 vs. T1) was independently associated with a 67% reduction in the risk of all-cause mortality (HR&#xa0;=&#xa0;0.33, 95% CI: 0.18-0.61, P < 0.001) and a similar significant decrease in cardiovascular mortality. RCS analysis revealed a significant non-linear, L-shaped relationship between continuous ALI and both mortality outcomes (both P for non-linearity < 0.05), with mortality risk rising precipitously below a specific threshold. Furthermore, adding ALI to the established GRACE score modestly improved individual-level risk reclassification and discrimination for all-cause mortality (continuous NRI: 0.228, P&#xa0;=&#xa0;0.047; IDI: 0.027, P&#xa0;=&#xa0;0.020). A lower admission ALI independently associated with long-term all-cause and cardiovascular mortality in diabetic AMI patients.As a readily accessible composite biomarker, ALI offers valuable prognostic information that could assist in the early risk stratification of this high-risk population.

Socialdeprivation, which is exaggerated by lower household income, shortens life expectancy and worsens cancer survival. In pancreatic adenocarcinoma, novel treatment strategies aim to extend survival and centralization of care has increased distance to hospital. The effect of distance to hospital and different treatment regimens on survival stratified by household income remains unexplored. A nationwide retrospective study using Netherlands Cancer Registry data (2017-2022) included patients with localized pancreatic adenocarcinoma. Patients were categorized into three groups based on household income (lowest, intermediate and highest income) and two distance groups based on median distance to hospital. Multivariable logistic and Cox regression analyses assessed the effect of lower household income and distance on treatment and survival. Kaplan-Meier curves were used for univariable survival analysis. Among 5926 patients, individuals from lower household income received less anti-cancer treatment (44% lowest vs. 63% highest, P&#x202f;<&#x202f;0.001). Living within 14&#x202f;km increased the likelihood of resection (Odds ratio (OR) 1.44, 95%CI 1.28-1.63, P&#x202f;<&#x202f;0.001) and adjuvant chemotherapy (OR 1.29, 95%CI 1.18-1.71, P&#x202f;<&#x202f;0.001). Median survival was 7 months (lowest income), 9 months (intermediate), and 11 months (highest income) (P&#x202f;<&#x202f;0.001). In the multivariable analysis, worse survival in the lowest income group persisted after case-mix adjustment (HR (highest vs lowest): 0.92, 95% CI 0.86-0.98, P&#x202f;<&#x202f;0.001). However, after additional adjustment for treatment differences, survival differences between income groups disappeared (P&#x202f;=&#x202f;0.180). Lower household income negatively impacts the likelihood of receiving treatment for patients with pancreatic adenocarcinoma. Additionally, distance to hospital is negatively associated with the probability of receiving resection and subsequent treatment.