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The field of health services research is broad and seeks to answer questions about the health care system. It is inherently interdisciplinary, and epidemiologists have made crucial contributions. Parametric regression techniques remain standard practice in health services research with machine learning techniques currently having low penetrance in comparison. However, studies in several prominent areas, including health care spending, outcomes and quality, have begun deploying machine learning tools for these applications. Nevertheless, major advances in epidemiological methods are also as yet underleveraged in health services research. selleck chemicals llc This article summarizes the current state of machine learning in key areas of health services research, and discusses important future directions at the intersection of machine learning and epidemiological methods for health services research. © The Author(s) 2020; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.OBJECTIVES The Geriatric Nutritional Risk Index (GNRI) based on serum albumin and body weight helps predict the risk of malnutrition and mortality in hospitalized elderly patients. However, its significance for patients with malignancy is unclear. We analysed the ability of GNRI to assess this risk in patients with lung cancer undergoing surgery. METHODS We retrospectively analysed the clinical characteristics and surgical outcomes of 739 patients with primary lung cancer who underwent surgery from 2006 to 2017 in a single institution. RESULTS GNRI values were ≤98 for 112 patients and >98 for 627 patients; 532 patients had pathological stage I disease, 114 patients had stage II disease and 93 patients had stage III disease. Cox proportional hazards models revealed that age, GNRI value ≤98 and stages II and III diseases (all Ps  less then  0.05) were significant negative prognostic factors for overall survival and that carcinoembryonic antigen level (P = 0.03), GNRI value ≤98 (P = 0.005) and stages II and III diseases (both Ps  less then  0.001) were significant negative prognostic factors for cancer-specific survival. Rates of overall survival and cancer-specific survival stratified by lower and higher GNRI score were significantly different among patients aged 70 and older (P = 0.001 and P = 0.004, respectively) but not among patients aged 69 and younger (P = 0.09 and P = 0.12, respectively). CONCLUSIONS GNRI could help in predicting survival after lung cancer surgery, especially in older patients, and perioperative active nutritional support might improve the survival. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.OBJECTIVES In revised 2018 American Heart Association/American College of Cardiology guideline for the management of adults with congenital heart disease (ACHD), the committee introduced a classification that combines lesion anatomy and physiological status ACHD anatomic physiological (AP) classification. Anatomy is described as of simple (I), moderate (II) or great (III) complexity, whereas physiology is listed in 4 categories of increasing severity (A, B, C and D). Can this classification predict early postoperative mortality? METHODS ACHD AP classification was determined for 339 adults who underwent open-heart surgery between September 2012 and August 2018. In addition, the adult congenital heart surgery (ACHS) and Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery (STAT) mortality scores were calculated. A model based on binary logistic regression was applied. The event was early postoperative death. Mortality scores were estimated for each ACHD AP class. RESULTS All patients could be categorized by the ACHD AP classification. The 354 procedures were performed with an early mortality of 3.4% (12/354). The mortality risk for the new mortality score, simply called ACAP score, ranged from 0.2% (95% confidence interval 0.08-0.41%) for ACHD AP class IA to 20% (16.04-24.64%) for IIID class. Observed over expected ratios of early mortality amounted to 0.87, 1.54 and 1.14, whereas areas under the curve of receiver operator characteristic were found to be 0.78, 0.64 and 0.88 for STAT, ACHS and ACAP scores, respectively. CONCLUSIONS ACHD AP classification could embrace all procedures. In our setting, the ACAP score was more predictive of early mortality than the ACHS and STAT mortality scores. It should be validated by further studies and other centres. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.OBJECTIVES The objective of this study was to analyse clinical characteristics, survival and adverse events of patients with advanced heart failure supported using the Abbott HeartMate 3 left ventricular assist device (LVAD). METHODS We retrospectively reviewed 42 consecutive HeartMate 3 recipients implanted in our centre between 1 November 2015 and 31 October 2019. RESULTS Our series comprised 39 males, aged 56.7 ± 11.8 years. Eleven (26%) patients had preimplant INTERMACS clinical profiles of 1 or 2. The mean duration support was 14.0 ± 10.6 months (range 0.69-44 months). During follow-up, 4 (10%) patients died while on support, 13 (35%) patients received a heart transplant and 25 patients are still ongoing. Actuarial survival after LVAD implantation was 88.4 ± 5.5% and 84.4 ± 6.6% at 1 and 2 years, respectively. There were no cases of pump thrombosis or technical malfunction. Seven (17%) patients required post-implant temporary right ventricular support. Adverse events included bleeding requiring surgery in 13 (31%) patients, gastrointestinal bleeding in 6 (14%) patients, LVAD-specific infections in 19 (45%) patients and non-disabling ischaemic stroke in 5 (12%) patients. The incidence of ischaemic stroke was significantly higher in patients where the outflow graft was anastomosed to the descending aorta as compared to those where it was anastomosed to the ascending aorta (P  less then  0.003). CONCLUSIONS We have observed satisfactory survival rates using the HeartMate 3 LVAD for long-term mechanical circulatory support. The absence of technical failure, pump thrombosis, haemolysis or need for pump exchange during our 4-year experience confirms its technical reliability and improved haemocompatibility, but bleeding complications and infections remain a concern. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.