Failure of Guideline Adherence for Intervention in Patients With Severe Mitral Regurgitation

ObjectivesThis study sought to evaluate the incidence with which adult patients with significant mitral regurgitation (MR) do not undergo surgical intervention despite guideline recommendations, and the associated considerations resulting in no intervention.BackgroundDespite the existence of accepted guidelines, many patients with severe symptomatic heart valve disease might not undergo intervention.MethodsAt a single large tertiary medical center, patients were retrospectively identified who had moderate-to-severe or severe MR on echocardiographic imaging during 2005. Clinical data were reviewed to determine indications for intervention and whether surgery was performed.ResultsDuring 2005, 300 patients were identified with significant MR, including 188 with functional MR and 112 with organic MR. Mitral surgery was performed in 30 of 188 patients with functional MR, mostly to treat heart failure or during another cardiac surgical procedure. Mitral surgery was performed in 59 (53%) of 112 patients with organic MR. Among unoperated patients with organic MR, common reasons included stable left ventricular size or function, absence of symptoms, and prohibitive comorbidities. Using American College of Cardiology/American Heart Association guidelines, 1 or more indication for intervention was present in 39 (74%) of 53 unoperated patients. Perioperative mortality risk was not higher for patients who did not undergo surgery (median 1.2%, interquartile range [IQR] 0.4% to 3.3%) than for those who did (median 1.1%, IQR 0.6% to 5.3%; p = 0.71). During follow-up, there were 12 cardiac and 2 unexplained deaths.ConclusionsAmong patients with severe organic MR, surgical intervention occurred in approximately one-half. However, accepted guideline indications for intervention were present in the majority of unoperated patients. Objectively assessed operative risk was not prohibitive in many unoperated patients

Attachment and intervention in adoptive families with and without biological children

Wetensch. publ. refereedFaculteit der Sociale Wetenschappe

The mesencephalic root of the fifth nerve. A comparative anatomical study

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49899/1/900460202_ftp.pd

Terrible ones? Assessment of externalizing behaviors in infancy with the Child Behavior Checklist

Background: This study investigated the occurrence, cross-informant agreement, 1-year stability, and context characteristics of externalizing behaviors in 12-month-old children, as compared to 24- and 36-month-olds. Method: In a general population sample of 786 12-month-olds, 720 24-month-olds, and 744 36-month-olds, the CBCL/11/2-5 was obtained from mothers and fathers and again one year later for a subsample of 307 children. Mothers of 1,831 children also provided complete data on child, mother, and family characteristics. Results: Over three-fourths of the externalizing behaviors occurred in more than 10% of 12-month-olds, over one-third of the items in more than 25%. For almost all externalizing behaviors, the occurrence was significantly lower in 12-month-olds compared to 24- and 36-month-old children. Mother-father agreement and 1-year stability of externalizing behaviors in 12-month-old children were significant, but generally somewhat lower than in 24- and 36-month-olds. Context characteristics were related to externalizing behaviors in 12-month-olds as well as in older children. Some associations were less pronounced in 12-month-old children, but the overall pattern of correlates was similar across age groups. Conclusions: The results of this study show that externalizing behaviors in 12-month-old children merit further research and can be assessed with the CBCL in a valid way. © 2006 The Authors Journal compilation © 2006 Association for Child and Adolescent Mental Health

Five types of personality continuity in childhood and adolescence.

This study examines 5 types of personality continuity - structural, mean-level, individual-level, differential, and ipsative - in a representative population (N=498) and a twin and sibling sample (N=548) of children and adolescents. Parents described their children on 2 successive occasions with a 36-month interval using the Hierarchical Personality Inventory for Children (I. Mervielde & F. De Fruyt, 1999). There was evidence for structural continuity in the 2 samples, and personality was shown to be largely differentially stable. A large percentage had a stable trait profile indicative of ipsative stability, and mean-level personality changes were generally small in magnitude. Continuity findings were explained mainly by genetic and nonshared environmental factors. Copyright 2006 by the American Psychological Association

Differentiation of the bulbar motor nuclei and the coincident development of associated root fibers in the rabbit

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49922/1/900720104_ftp.pd