103 research outputs found
Effect of transannular patching on outcome after repair of tetralogy of Fallot
No full textAmong 814 patients undergoing repair of tetralogy of Fallot with pulmonary stenosis between 1967 and May 1986, transannular patching in the current era was a weak risk factor for death early postoperatively (predicted 30-day mortality, 4\% with a transannular patch and 1.4\% without) and is not a risk factor for instantaneous risk of death late postoperatively (predicted 20-year survival including early death, 94\% with a transannular patch and 96.5\% without). Ninety-six percent of surviving patients were in New York Heart Association functional class I at last follow-up, and the slight decline in this percentage as the interval between operation and last follow-up lengthened could have been due to chance alone (p = 0.24) and was no different in patients with a transannular patch. Transannular patching was a risk factor for reoperation for pulmonary regurgitation late postoperatively, but only a 7\% incidence within 20 years is predicted when mild residual stenoses are beyond the patch: the incidence rises to about 20\% with important distal stenoses. Inferences from the study are relevant to the indications for transannular patching and insertion of allograft semilunar valves at the time of repair
A comprehensive analysis, classification and synthesis of research findings and professional periodical literature pertaining to the teaching of accounting, bookkeeping and recordkeeping, 1966 through 1975
No full textVolumes I & II. The problem. There have been many advances in technology in the past decade which have had their effect on the business community and eventuate as changes in the business education program. This is particularly true in the accounting, bookkeeping, and recordkeeping programs at all educational levels. The primary problem of this study was to determine the findings of research and thought expressed in the professional periodical literature on the teaching of accounting, bookkeeping, and recordkeeping for the years 1966 through 1975 to ascertain the changes which may have occurred in these programs as a result of changes in technology and business practices. Another problem of this study was to determine what changes, if any, have occurred in the university-collegiate accounting program as a result of the recommendations made in the Gordon-Howell and Pierson reports. Research procedures. A preliminary bibliography was prepared from various indexes of the research studies completed and professional periodical articles published from January 1, 1966, through December 31, 1975. A total of 185 research studies had been completed and 538 periodical articles had been published; 165 research studies and 521 periodical articles were available for use in this study. Copies of the research studies were obtained and abstracted; copies of the periodical articles were obtained and summarized. The studies and articles were classified into seven major categories: (1) History and Current Status, (2) Course Content, Textbooks and Internship Programs, (3) Classroom Management and Instructional Methods, (4) Instructional Materials and Facilities, (5) Prognosis, Guidance and Follow-Up, (6) Evaluation, and (7) Employment Characteristics. A synthesis was prepared for each category. The research studies were also classified as to research level and research method. The periodicals were also classified according to author and intended educational level. Findings. Accounting records have been kept since ancient times and the present system of double-entry accounting was formalized in 1494. Bookkeeping instruction has been a part of the educational system since colonial times. Bookkeeping instruction is offered today for its vocational use and personal use values. Accounting education at the university- collegiate level, beyond the introductory course, is for the preparation of professional accountants. [...]Education, College o
Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy
No full textObjectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis.
Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-generation devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field.
Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (.2 percent) for devices costing as much as £60,000. Sensitivity of the conclusions to both device cost and QALY valuation is examined.
Conclusions: In the event that the price of the device in use would reduce to £40,000, the value of the survival information can readily justify investment in further trials
Death and other time-related events after valve replacement.
No full textA total of 1533 patients received primary aortic and/or mitral valve replacement, with or without tricuspid valve surgery or other associated cardiac procedures, from January 1, 1975, to July 1, 1979. Actuarial survival at 5 years was 74%. The hazard function (instantaneous risk) of death was highest immediately after operation. Among the incremental risk factors for premature death from any cause were preoperative NYHA class, any valve lesion other than aortic stenosis, aortic cross-clamp time, and combined aortic and mitral valve replacement. Ten modes of death were identified, each with its unique hazard function and risk factors. The commonest mode was cardiac failure. Sudden death was the next commonest, and the early phase of its hazard function peaked about 3 weeks after operation. Seventy-five patients (6.7% of the 1533) had 103 valve reoperations in the follow-up period. Actuarial survival after reoperation was less than that after the primary operation; whether the reoperation was the first, second, or third was a risk factor. Actuarial freedom from prosthetic valve endocarditis (PVE) was 97% at 1 year, and that of periprosthetic leakage without evident infection was 98.8%; the hazard function for the event PVE had an early phase peaking at about 6 weeks and a constant low phase throughout, whereas that of periprosthetic leakage had a single early peaking phase. After reoperations, the actuarial freedom from PVE and periprosthetic leakage was less than that after the original operation. The risk factors for the development of periprosthetic leakage without evident infection were similar but not identical to those for PVE. Among patients receiving a bioprosthesis, 91% were free of bioprosthetic degeneration 5 years after operation. The hazard function was single and continuously rising, and young age and female gender were risk factors. Actuarial freedom from acute prosthetic thrombosis was 97.9% at 5 years. The single hazard function for this event peaked at 10 months. The risk of thrombosis was higher in female patients. The uses of this integrated study, and the inferences from it, are described.</jats:p
Pulmonic Stenosis with Intact Ventricular Septum: Treatment Utilizing Extracorporeal Circulation
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