Pilot Implementation of Guiando Buenas Decisiones, an Evidence-Based Parenting Program for Spanish-Speaking Families, in Pediatric Primary Care in a Large, U.S. Health System: A Qualitative Interview Study.

Adolescent substance use is a significant public health problem in the United States and Hispanic youth engage in substance use services at lower rates than other groups. For this under-served group, prevention services delivered in non-stigmatized, non-specialty care settings may increase access to the services. We describe findings from a feasibility pilot of the implementation of a virtual version of Guiando Buenas Decisiones (GBD), a universal, group-based substance use prevention program for parents. It was conducted with Spanish-speaking families and delivered, virtually, in pediatric primary care in a large healthcare system in the U.S. Through qualitative interviews with pediatricians (n =7) and parents (n = 26), we explored potential barriers and facilitators of GBD enrollment and engagement. Parents and pediatricians alike noted the dearth of universal prevention programming in Spanish and that GBD could help address the need for linguistically appropriate programming. Parents liked the curriculum content, materials and videos; they felt the focus on strengthening family bonds, setting clear expectations and guidelines, the use of family meetings, and the positive tools provided for navigating family conflict were well-aligned with their cultural and family values. Feedback from parents was helpful for informing more personalized and attentive approaches to program outreach and recruitment methods, and for adaptation of recruitment fliers and letters. In this pediatric primary care context serving an underserved population, we found virtual GBD feasible to implement, acceptable and appealing to parents, and judged by pediatricians as a promising, much-needed addition to their prevention armamentarium.

Transesophageal echocardiographic monitoring of percutaneous mitral balloon valvulotomy.

This study was designed to evaluate the usefulness of performing transesophageal echocardiography (TEE) during percutaneous mitral balloon valvulotomy (PMBV). TEE was performed in 35 consecutive patients with symptomatic severe mitral stenosis during PMBV (group A). Another group of 27 patients with mitral stenosis who underwent PMBV without TEE was used for comparison (group B). TEE was most helpful in guiding transseptal puncture, aiding in proper positioning of the balloon during the dilatation procedure and enabling early detection of complications. The results show that PMBV when aided by TEE has a tendency to decrease the frequency of significant mitral regurgitation without compromising the final mitral valve area. TEE decreased the x-ray exposure time and was well-tolerated. Thus, TEE provides information that makes this interventional catheterization procedure safer and easier to perform.

Clinical, anatomic, and echocardiographic characteristics of aneurysms of the mitral valve.

This study describes the clinical, anatomic, echocardiographic, and Doppler features of 13 patients with mitral valve aneurysms. Eleven patients had definitive criteria for infective endocarditis. Transesophageal echocardiography was superior to conventional echocardiography in detecting and assessing aneurysms. Patients with heart failure required surgery. Echocardiographic detection of this lesion should not be, by itself, an immediate surgical indication.

DIAVAL, a Bayesian expert system for echocardiography.

DIAVAL is an expert system for the diagnosis of heart diseases, including several kinds of data, mainly from echocardiography. The first part of this paper is devoted to the causal probabilistic model which constitutes the knowledge base of the expert system in the form of a Bayesian network, emphasizing the importance of the OR gate. The second part deals with the process of diagnosis, which consists of computing the a posteriori probabilities, selecting the most probable and most relevant diagnoses, and generating a written report. It also describes the results of the evaluation of the program.

[The usefulness of transesophageal echocardiography in the diagnosis of pulmonary thromboembolism]. / Utilidad de la ecocardiografía transesofágica en el diagnóstico del tromboembolismo pulmonar.

Three cases with suspected pulmonary artery embolism are presented, in which transesophageal echocardiography showed a mass in the right pulmonary artery consistent with thrombus. The relevant diagnostic contributions of transesophageal echocardiography are discussed.

[Intravenous leiomyomatosis with cardiac extension]. / Leiomiomatosis intravenosa con extensión a cavidades cardíacas.

Intravenous leiomyomatosis is a very rare uterine neoplasm, characterized by histological benignity. In some cases, it could extend through the ovaric or iliac veins up to the vena cava and the right chambers of the heart. We report a patient with symptoms of right heart failure, who was diagnosed by transesophagic echocardiography of intravenous leiomyomatosis with extension to the right ventricle. Complete excision was achieved employing simultaneous sternotomy and laparotomy with echocardiographic intraoperative monitorization.

[Mitral valve aneurysm. Its diagnosis by transesophageal echocardiography]. / Aneurisma de la válvula mitral. Diagnóstico por ecocardiografía transesofágica.

Aneurysm of the mitral valve is a rare complication of infectious endocarditis. We report a 65-years-old woman with left heart failure and mitral regurgitation secondary to a mitral valve aneurysm. The diagnosis was made by transesophageal echocardiography.

[The rupture of a cardiac hydatid cyst located in the right ventricle]. / Rotura de un quiste hidatídico cardíaco situado en ventrículo derecho.

Heart involvement in echinococcal disease is rare, but it is more infrequent the location of cysts in the right ventricle. We report a case of a male 35 years old with hydatid cysts located in the right ventricle. The condition was diagnosed by two-dimensional echocardiogram performed after the rupture of the cysts leading to massive pulmonary embolism and subsequently right heart failure. Early diagnosis appears mandatory in an attempt to modify, applying the appropriate therapy, the natural evolution of this potentially lethal condition.

Usefulness of transesophageal echocardiography for diagnosis of infected transvenous permanent pacemakers.

BACKGROUND: Transesophageal echocardiography is superior to transthoracic echocardiography in detecting left-sided valvular vegetations. There are no data on the value of transesophageal echocardiography in the diagnosis of infected transvenous permanent pacemakers. METHODS AND RESULTS: Transthoracic and transesophageal echocardiography was performed in 10 patients for whom there was clinical suspicion of infected permanent transvenous pacemakers. Transthoracic echocardiography detected pacemaker lead vegetations in 2 patients, whereas transesophageal echocardiography visualized pacemaker lead vegetations in 7 patients. Surgical confirmation was obtained in 6 of these 7 patients. Most patients had more than one pacemaker electrode in place. Local complications at the generator pocket were present in 6 patients. Staphylococcus was the predominant causative organism. CONCLUSIONS: Transesophageal echocardiography is superior to transthoracic echocardiography in the detection of pacemaker lead vegetations.