Dtsch Arztebl Int
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More than 90% of children with congenital heart defects now survive into adulthood; just a few decades ago, survival was rare, particularly among patients with complex defects. The new population of adults with congenital heart disease presents a special challenge to physicians from all of the involved specialties. ⋯ A complete cure of the congenital heart defect in childhood is exceptional, and most adult patients continue to suffer from residual problems and sequelae. Further surgery or catheter interventions may be needed. Potential late complications include arrhythmias, heart failure, pulmonary hypertension, endocarditis, and thromboembolic events. The management of these patients during pregnancy or non-cardiac surgery remains a challenge. If this evolving patient population is to receive the best possible care, the adequate provision of specialized medical services is a necessary, but not sufficient, condition: patients and their referring physicians will also need to be aware that these services are available, and then actually make use of them. Moreover, optimal communication among all of the involved physicians is essential.
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Recent years have seen a rise in overall anesthesia-related mortality. ⋯ A recent increase in the percentage of older and multimorbid patients among persons undergoing surgery, along with the advent of newer types of operation that would have been unthinkable in the past, has led to an apparent rise in anesthesia-associated mortality, even though the quality of anesthesiological care is no worse now than in the past. On the contrary, in recent years, better anesthetic management has evidently played an important role in improving surgical outcomes.
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Comparative Study
Concordance analysis: part 16 of a series on evaluation of scientific publications.
In this article, we describe qualitative and quantitative methods for assessing the degree of agreement (concordance) between two measuring or rating techniques. An assessment of concordance is particularly important when a new measuring technique is introduced. ⋯ Concordance analysis is needed to establish the validity of a new diagnostic measuring or rating technique or to demonstrate the near-equivalence of multiple measuring or rating techniques. Erroneous approaches to concordance analysis can lead to false conclusions.
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Editorial Comment
Be prepared!: hospital planning for major public events.