Comparison of transcatheter leaflet-approximation and direct annuloplasty in tricuspid regurgitation.

BACKGROUND: Transcatheter repair emerges as a treatment option in patients with tricuspid regurgitation (TR) and high surgical risk. AIMS: This study aimed to compare leaflet-based and annuloplasty-based transcatheter repair in patients with TR. METHODS: In a retrospective analysis consecutive patients undergoing either transcatheter edge-to-edge repair (TEER) or direct annuloplasty (AP) for relevant TR at 2 centers were compared with respect to baseline characteristics, procedural efficacy and safety (death, myocardial infarction, procedure or device-related cardiothoracic surgery, or stroke at 30 days). RESULTS: 161 patients (57% female, median age 79 [75-82] years) with comparable clinical baseline characteristics in the TEER (n = 87) and AP (n = 74) group were examined. Baseline TR grade was significantly less severe in the TEER compared to the AP group (torrential 9.2 vs. 31.1%, p = 0.001). Technical success and improvement of TR grades were not significantly different across groups. In analysis matched for baseline TR severity, reduction of TR grade to less than moderate was significantly more common in the AP group (47.8 vs. 26.1%, p = 0.031). Major or more severe bleeding occurred in 9.2% of TEER and 20.3% of AP patients (p = 0.049) without any fatal bleedings. Major adverse events (MAE) were similar across groups with four patients (4.7%) in the TEER group and five patients (6.9%) in the AP group (p = 0.733) and 6-month survival did not differ significantly. CONCLUSIONS: Differences observed between patients treated with TEER and AP provide first evidence for tailoring distinct transcatheter treatment techniques to individual patient characteristics.

[Centrally and non-centrally designed exams in nursing: Comparisons of the final exams in 2008 to 2013 in Berlin focusing on different concepts of professional nursing education]. / Zentral und dezentral verortete Prüfungen in der Krankenpflege. Vergleich der Abschlussnoten der Jahre 2008 ­ 2013 im Land Berlin unter Berücksichtigung unterschiedlicher Ausbildungskonzepte.

INTRODUCTION: In Germany, nursing education ends with a final written, oral and practical exam. In the federal state of Berlin, Germany, all nursing students take centrally standardized written exams, while the practical and oral exams are developed by each individual nursing school or university and conducted without standardized protocols (non-central). Comparability might be seriously limited by this procedure. Since there is no official statistics available, the objective of this study is to compare the results of the final written, oral and practical exams of different nursing education institutions with an additional focus on different educational concepts. METHODS: In a secondary data analysis, the final grades (written, oral, practical) of 4,342 nursing students in all 16 educational institutions in Berlin from 2008 to 2013 were analyzed. RESULTS: The mean (SD) of all written, oral and practical exams taken was 2.9 (0.7), 2.6 (1.1) and 2.2 (1.0), respectively. In each type of exam, the trend in grades was stable over the observation period. There was a statistically significant increase in the prevalence of initially failed exams from 2008 (7.9 %) to 2013 (12.0 %). In institutions following a traditional concept of education, the difference in grades between oral/practical exams on the one hand and written exams on the other ranged from 0.1 to 0.9, while in generalist (academic) institutions it ranged between -0.1 and 0.3 (-0.1 to 0). CONCLUSION: In nursing schools with a traditional approach to education, there was a big difference in grades between written and oral/practical exams. Standardization of oral and practical exams should be initiated to ensure greater comparability between different educational institutions.