This review discusses the historical aspects, current state of the art, and potential future advances in the areas of nomenclature and databases for the analysis of outcomes of treatments for patients with congenitally malformed hearts. We will consider the current state of analysis of outcomes, lay out some principles which might make it possible to achieve life-long monitoring and follow-up using our databases, and describe the next steps those involved in the care of these patients need to take in order to achieve these objectives. In order to perform meaningful multi-institutional analyses, we suggest that any database must incorporate the following six essential elements: use of a common language and nomenclature, use of an established uniform core dataset for collection of information, incorporation of a mechanism of evaluating case complexity, availability of a mechanism to assure and verify the completeness and accuracy of the data collected, collaboration between medical and surgical subspecialties, and standardised protocols for life-long follow-up.

During the 1990s, both The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons created databases to assess the outcomes of congenital cardiac surgery. Beginning in 1998, these two organizations collaborated to create the International Congenital Heart Surgery Nomenclature and Database Project. By 2000, a common nomenclature, along with a common core minimal dataset, were adopted by The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons, and published in the Annals of Thoracic Surgery. In 2000, The International Nomenclature Committee for Pediatric and Congenital Heart Disease was established. This committee eventually evolved into the International Society for Nomenclature of Paediatric and Congenital Heart Disease. The working component of this international nomenclature society has been The International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease, also known as the Nomenclature Working Group. By 2005, the Nomenclature Working Group crossmapped the nomenclature of the International Congenital Heart Surgery Nomenclature and Database Project of The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons with the European Paediatric Cardiac Code of the Association for European Paediatric Cardiology, and therefore created the International Paediatric and Congenital Cardiac Code, which is available for free download from the internet at [http://www.IPCCC.NET].

This common nomenclature, the International Paediatric and Congenital Cardiac Code, and the common minimum database data set created by the International Congenital Heart Surgery Nomenclature and Database Project, are now utilized by both The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons. Between 1998 and 2007 inclusive, this nomenclature and database was used by both of these two organizations to analyze outcomes of over 150,000 operations involving patients undergoing surgical treatment for congenital cardiac disease.

Two major multi-institutional efforts that have attempted to measure the complexity of congenital heart surgery are the Risk Adjustment in Congenital Heart Surgery-1 system, and the Aristotle Complexity Score. Current efforts to unify the Risk Adjustment in Congenital Heart Surgery-1 system and the Aristotle Complexity Score are in their early stages, but encouraging. Collaborative efforts involving The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons are under way to develop mechanisms to verify the completeness and accuracy of the data in the databases. Under the leadership of The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease, further collaborative efforts are ongoing between congenital and paediatric cardiac surgeons and other subspecialties, including paediatric cardiac anaesthesiologists, via The Congenital Cardiac Anesthesia Society, paediatric cardiac intensivists, via The Pediatric Cardiac Intensive Care Society, and paediatric cardiologists, via the Joint Council on Congenital Heart Disease and The Association for European Paediatric Cardiology.

In finalising our review, we emphasise that analysis of outcomes must move beyond mortality, and encompass longer term follow-up, including cardiac and non cardiac morbidities, and importantly, those morbidities impacting health related quality of life. Methodologies must be implemented in these databases to allow uniform, protocol driven, and meaningful, long term follow-up.

This article investigates two types of preference organization in interaction: in response to a question that selects a next speaker in multi-party interaction, the preference for answers over non-answer responses as a category of a response; and the preference for selected next speakers to respond. It is asserted that the turn allocation rule specified by Sacks, Schegloff & Jefferson (1974) which states that a response is relevant by the selected next speaker at the transition relevance place is affected by these two preferences once beyond a normal transition space. It is argued that a “second-order” organization is present such that interactants prioritize a preference for answers over a preference for a response by the selected next speaker. This analysis reveals an observable preference for progressivity in interaction.Thank you to Nick Enfield, Steve Levinson and Manny Schegloff for useful discussions about the phenomena discussed in this article, and to John Heritage for his careful reading and comments on earlier drafts. Portions of this article were presented at the 2002 Western States Communication Association convention, Long Beach, California, and at the Workshop on Feedback in Interaction at the Max Planck Institute for Psycholinguistics, Nijmegen, in February 2004.

Since its introduction by Malinowski in the 1920s, “phatic communion” has often been appealed to as a concept in sociolinguistics, semantics, stylistics, and communication, typically taken to designate a conventionalized and desemanticized discourse mode or “type.” But a negotiation perspective, following the conversation analysis tradition of research on greetings and troubles telling, fits the discursive realities better. Phaticity is a multidimensional potential for talk in many social settings, where speakers' relational goals supercede their commitment to factuality and instrumentality. We then analyze phatic processes in elderly people's responses to a scripted how are you? opening in interviews about their medical experiences. Discourse analyses of phatic communion can raise important issues for gerontological and medical research. (Phatic communion, small talk, greetings, elderly talk, medical talk, preference structure)