Time to TAVI: streamlining the pathway to treatment.

INTRODUCTION: Severe aortic stenosis is a major cause of morbidity and mortality. The existing treatment pathway for transcatheter aortic valve implantation (TAVI) traditionally relies on tertiary Heart Valve Centre workup. However, this has been associated with delays to treatment, in breach of British Cardiovascular Intervention Society targets. A novel pathway with emphasis on comprehensive patient workup at a local centre, alongside close collaboration with a Heart Valve Centre, may help reduce the time to TAVI. METHODS: The centre performing local workup implemented a novel TAVI referral pathway. Data were collected retrospectively for all outpatients referred for consideration of TAVI to a Heart Valve Centre from November 2020 to November 2021. The main outcome of time to TAVI was calculated as the time from Heart Valve Centre referral to TAVI, or alternative intervention, expressed in days. For the centre performing local workup, referral was defined as the date of multidisciplinary team discussion. For this centre, a total pathway time from echocardiographic diagnosis to TAVI was also evaluated. A secondary outcome of the proportion of referrals proceeding to TAVI at the Heart Valve Centre was analysed. RESULTS: Mean±SD time from referral to TAVI was significantly lower at the centre performing local workup, when compared with centres with traditional referral pathways (32.4±64 to 126±257 days, p<0.00001). The total pathway time from echocardiographic diagnosis to TAVI for the centre performing local workup was 89.9±67.6 days, which was also significantly shorter than referral to TAVI time from all other centres (p<0.003). Centres without local workup had a significantly lower percentage of patients accepted for TAVI (49.5% vs 97.8%, p<0.00001). DISCUSSION: A novel TAVI pathway with emphasis on local workup within a non-surgical centre significantly reduced both the time to TAVI and rejection rates from a Heart Valve Centre. If adopted across the other centres, this approach may help improve access to TAVI.

Specificity of cognitive distortions to antisocial behaviours.

INTRODUCTION/BACKGROUND: Cognitive distortions have long been posited to facilitate antisocial behaviours, but the specificity of such distortions has rarely been studied. AIMS: To replicate findings of specificity between particular cognitions and externalizing or internalizing behaviours; to test for specificity of relationship between particular cognitions and different types of externalizing behaviours. METHODS: The participants were 239 male youths aged 10 to 19 years (mean (M) = 14.22, standard deviation (SD) = 1.64) from schools on the island of Curaçao. Their cognitive distortions and problem behaviours were investigated through self-report. Results In controlled analyses, self-serving cognitive distortions were associated with externalizing behaviours whereas self-debasing cognitive distortions were associated with internalizing behaviours. Within the externalizing domain, self-serving distortions with overt behavioural referents were linked to aggressive behaviour while self-serving distortions with covert behavioural referents were linked to delinquent behaviour. Within the aggression domain, distortions with opposition-defiance referents related to verbal aggression whereas distortions with physical aggression referents related to physically aggressive behaviour. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The degree of cognitive-behavioural specificity documented by this study was remarkable. The observed pattern suggests that cognitive interventions designed for externalizing versus internalizing behaviours should differ in therapeutic approach.

Flexible cofacial binuclear metal complexes derived from alpha,alpha-bis(salicylimino)-m-xylene.

The tetradentate Schiff-base ligand SIXH2 (alpha,alpha-bis(salicylimino)-m-xylene), prepared from salicylaldehyde and m-xylylenediamine, forms cofacial binuclear complexes with Pd and Cu. Of the two isomers possible (trans-syn and trans-anti) for M2(SIX)2, these complexes crystallize exclusively as the trans-anti isomer. In ansolvous Pd2(SIX)2, the metal-containing planes are approximately parallel, with PdPd 4.416(1) A. Pd2(SIX)2 also forms a crystalline solvate, in which the molecules adopt a more open conformation with longer metal-metal distances (5.109(1) and 5.112(1) A). The M...M distance is significantly longer in Cu2(SIX)2 (6.653(1) A), because of conformational changes in the m-xylylene moieties and substantial tetrahedral distortion about Cu.