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This study aimed to explore the extent to which health visitors who trained and qualified in both Greater London and the South West of England between September 2011 and January 2016 were employed in health visiting posts and have remained in the profession.
In 2011, the UK Government launched the Health Visitor Implementation Plan ‘A Call to Action’ (Department of Health, 2011) to develop the health visitor workforce by training 4200 health visitors over a four-year period. By April 2015, 4000 additional health visitors were trained, but the total workforce has since fallen back to pre-Implementation Plan size.
Data were collected using a survey, completed online by participants. All participants had undertaken a health visitor education programme at one of two participating universities. The survey was distributed in January 2017 and completed by 180 individuals. Quantitative data were analysed using SPSS; association was assessed using individual chi-square tests or Fisher’s exact test. Free-text responses were thematically analysed.
Most (153; 87%) participants were still working as health visitors. Length of time spent working in the community prior to completing health visitor training was associated with staying in the role ( χ2 (with Fisher’s exact test = 7.998, P = .027). Current pay was associated with attrition from the health visitor workforce ( χ2 (with Fisher’s exact test) = 67.559, P < .001.). The majority who had left the health visitor role were on higher pay bands in their new post compared to those that had stayed (12; 60%). Bronfenbrenner’s (1979) theory of socio-ecological development was used as a framework to interpret the results. While participants made an active choice to join the profession, leaving was influenced more by factors outside their control. To influence health visitor retention, both local and strategic changes are required.
Evaluation was not a thing when the first author was a graduate student in the late 1970s. There was an Artificial Intelligence (AI) boom then, but that boom was quickly followed by a bust and a long AI Winter. Charles Wayne restarted funding in the mid-1980s by emphasizing evaluation. No other sort of program could have been funded at the time, at least in America. His program was so successful that these days, shared tasks and leaderboards have become common place in speech and language (and Vision and Machine Learning). It is hard to remember that evaluation was a tough sell 25 years ago. That said, we may be a bit too satisfied with current state of the art. This paper will survey considerations from other fields such as reliability and validity from psychology and generalization from systems. There has been a trend for publications to report better and better numbers, but what do these numbers mean? Sometimes the numbers are too good to be true, and sometimes the truth is better than the numbers. It is one thing for an evaluation to fail to find a difference between man and machine, and quite another thing to pass the Turing Test. As Feynman said, “the first principle is that you must not fool yourself–and you are the easiest person to fool.”
This chapter presents the landscape of ancient Trimithis, a polis in the fourth century AD, and a synthesis of its urban layout. The settlement extends over an irregular area in which moving sand dunes determined living spaces and the availability of water. Archaeological evidence attests the presence of a settlement at least from the Old Kingdom below the central hill on which the temple of Thoth stood from the New Kingdom to the Roman period. Our knowledge of the settlement life, history, and layout is still incomplete,but the fourth-century AD phase allows some comparisons with other cities of the Empire. The study of the buildings visible on the surface, of the excavated areas, and of the street layout suggests an imperial regular pattern of streets, with impressive public buildings like the thermae. The layout and architecture of Trimithis as they appear today resemble in several aspects the later Islamic medieval settlements of the oasis: vernacular architecture, compact organization of space, high density of buildings, labyrinthine layout, shaded or semi-shaded streets and alleys, sometimes closed with doors, and a certain disposition to close spaces to avoid exposure to sun and winds.
The comparison of two small oases of the Kharga and Dakhla depressions, in the Western Desert of Egypt, confirmed that spring-fed oases have been attractive after the onset of aridity, ca 4500 BC, but irrigated agriculture has not been proved yet before the Intermediate Period. Irrigated areas were suject to harsh constraints despite the wealth of underground water during millennia: wind-induced dune shifting and soil erosion in Amheida and El-Deir, while flash floods destroyed most of the El-Deir oasis during the Roman period. Recovery was more difficult because artesian springs, which relied on water stored during the wet phase of the Holocene, were progressively exhausted by irrigation practices and could no longer compensate for the drying up of the oasis environment. If natural factors are not the unique causes of economic decay in the oases, they may have some responsibility in the progressive abandonment of agriculture during the third and fourth centuries. Amheida disappeared to the benefit of El-Kasr fortress, while El-Deir retained some importance for caravan trade between Hibis and the Nile Valley thanks to a well secured by a newly built fortress from 288 to the sixth century AD.
Agronomic surveys of summer weed species are necessary to identify future research directions for optimal weed control, but usually focus on agricultural fields in a single season. To survey all species in the absence of weed control measures and determine species variability between seasons, a survey of 133 sites was conducted on roadsides adjoining agricultural fields throughout the Western Australian grainbelt in early 2015 and repeated in 2016 and 2017. The survey identified 144 species, but only 19 species were evident at more than 10% of sites. The most common species were weeping lovegrass [Eragrostis curvula (Schrad.) Nees], fleabane (Erigeron sp.), windmillgrass (Chloris truncata R. Br.), and wild radish (Raphanus raphanistrum L). The survey highlighted that weed species incidence varied between years. For example, C. truncata incidence was 30% in 2015 and 55% in 2016, while stinkgrass [Eragrostis cilianensis (All.) Vignolo ex Janch.] ranged from 20% in 2015 to 50% of sites in 2017. Conversely, density of individual species on the roadside was usually low, and density remained consistent between years. The survey highlighted multiple weed species that will require further research to optimize management programs. Raphanus raphanistrum and wild oat (Avena fatua L.) in particular are an issue for growers, as these species are highly detrimental winter weeds, and the survey demonstrates that they can also be common summer weeds. Control of these species with nonselective herbicides in summer as well as winter is likely to exacerbate the development of herbicide resistance.
Many local breeds have become endangered due to their substitution by high-yielding breeds. To conserve local breeds, effective development strategies need to be investigated. The aim of this study was to explore conservation and development strategies based on quantified strengths, weaknesses, opportunities and threats (SWOT) for two local cattle breeds from Northern Germany, namely the German Angler (GA) and Red Dual-Purpose cattle (RDP). The data comprised 158 questionnaires regarding both breeds’ SWOT, which were answered by 78 farmers of GA and 80 farmers of RDP. First, data were analysed using the SWOT-Analytic Hierarchy Process (AHP) method, which combines the qualitative strategic decision tool of SWOT analysis and the quantitative tool of AHP. Second, prioritised SWOT factors were discussed with stakeholders in order to form final conservation and development strategies at breed level. For GA prioritised strengths were daily gain, meat quality, milk production and the usage of new biotechnologies, weaknesses were genetic gain in milk production and inbreeding, opportunities were organic farming and breed-specific characteristics and threats were milk prices and dependency regarding the dairy business. Consequently, three conservation and development strategies were formed: (1) changing relative weights and the relevant breeding goal to drift from milk to meat, (2) increasing genetic gain and control the rate of inbreeding by the implementation of specific selection programs and (3) selection of unique and breed characteristic components on product level, that is, milk-fat and fine muscle fibers. For RDP defined strengths were robustness, high adaptability for different housing systems and a balanced dual-purpose of milk and meat, weaknesses were inbreeding, breed extinction, genomic selection with young bulls and milk yield, opportunities were organic farming and dual-purpose aspects and threats were milk and decreasing beef cattle prices. Thus, three conservation and development strategies were identified: (1) adjust relative weights and the relevant breeding goal to balance milk and meat yield, (2) increasing genetic gain and avoid extinction by implementing targeted selection programs and (3) selection of unique and breed characteristic traits on breed level, that is, environmental robustness. Quantified SWOT establish a basis for the exploration of conservation and development strategies at breed level. Explored strategies are promising even if the stakeholder approach was limited for small populations regarding a small number of stakeholder groups. The used approach reflects farmers’ individual convenience better than existing quantitative strategy decision tools on their own.
Patients’ experience of the quality of care received throughout their continuum of care can be used to direct quality improvement efforts in areas where they are most needed. This study aims to establish validity and reliability of the Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ) – a tool that collects patients’ experience that quantifies aspect of care used to make judgments about quality from the perspective of the Alberta Quality Matrix for Health (AQMH).
The AQMH is a framework that can be used to assess and compare the quality of care in different healthcare settings. The AQMH provides a common language, understanding, and approach to assessing quality. The HAPSQ is one tool that is able to assess quality of care according to five of six AQMH’s dimensions.
This was a prospective methodologic study. Between March and October 2015, a convenience sample of patients presenting with chronic full-thickness rotator cuff tears was recruited prospectively from the University of Calgary Sport Medicine Centre in Calgary, Alberta, Canada. Reliability of the HAPSQ was assessed using test–retest reliability [interclass correlation coefficient (ICC)>0.70]. Validity was assessed through content validity (patient interviews, floor and ceiling effects), criterion validity (percent agreement >70%), and construct validity (hypothesis testing).
Reliability testing was completed on 70 patients; validity testing occurred on 96 patients. The mean duration of symptoms was three years (SD: 5.0, range: 0.1–29). Only out-of-pocket utilization possessed an ICC<0.70. Patients reported that items were relevant and appropriate to measuring quality of care. No floor or ceiling effects were present. Criterion validity was reached for all items assessed. A priori hypotheses were confirmed. The HAPSQ represents an inexpensive, reliable, and valid approach toward collecting clinical information across a patient’s continuum of care.
A comparative analysis of emotional taxation was conducted to investigate the affective cost of entering the political process among 1,019 lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) activists in the United States (n = 355), the United Kingdom (n = 230), South Africa (n = 228), and Australia (n = 206). Four consistent trends were identified across these four contexts, with important implications for the study of social movements, youth activism, gender, sexuality, and race. First, levels of emotional taxation resulting from LGBTQI activist work were consistently very high. Second, emotional burdens were systematically greater for young, nonwhite, and transgender activists. Third, emotional taxation was compounded for activists whose identities crossed multiple marginalized groups. This finding supports the validity and importance of intersectional approaches to LGBTQI issues. Fourth, the sources of emotional taxation varied greatly among activists, and transgender activists were particularly stressed by public engagements such as major events and marches. Transgender nonwhite activists also indicated relatively high levels of emotional stress related to online forms of engagement, such as posting on Twitter and Facebook. These findings could help identify the kinds of activists who participate, the kinds of issues advocated for, and why certain tactics are used.
Data from surveys are used to help quantitatively diagnose the relative importance of chemical and nonchemical management practices, identify weed problems, and provide potential solutions. However, to our knowledge, such surveys have not been conducted in Argentina. In 2016, advisors and crop producers from cropping areas across Argentina were surveyed through email with the objectives to identify the main weed species problems and assess the use of chemical and nonchemical weed management practices in different crop production areas in Argentina. Fleabane, pigweed, johnsongrass, fingergrass, goosegrass, barnyardgrass, and ryegrass were considered the most important weeds. More than 53% of the producers used only chemical options; 86% used chemical fallow (i.e., keeping weed free with chemical application); 62% used full herbicide rates; 46% used proper herbicide timing; 41% used multiple modes of action; and 32% used rotation of herbicide modes of action. The main nonchemical practices used were crop rotation (45%); avoiding seed production during (31%) and after (25%) the crop cycle; narrow row spacing (19%); and cultivars with greater competitive ability (18%). Less than 15% of the people surveyed used increased crop densities or altered date of sowing. There is a high dependence on chemical control in the main crops grown in Argentina. Extension efforts are needed to emphasize the importance of integrated weed management.
The purpose of this study was to assess laypersons’ attitudes and completion of advance care planning (ACP) and to examine associations with sociodemographic characteristics and health beliefs on Alzheimer's disease.
A cross-sectional telephone survey was conducted during April and May 2017, with a sample of 514 Israeli adults, aged 18 years and above. A structured, pretested questionnaire assessing participants’ awareness, attitudes, and completion of ACP, as well as health beliefs on Alzheimer's disease (subjective knowledge, susceptibility, and worry), and sociodemographic factors, was used.
Two-fifths of the participants had heard of at least one of the terms: advance directives or durable power of attorney. Overall, participants expressed positive attitudes toward ACP. Results of regression models showed that gender, religiosity, and subjective knowledge of Alzheimer's disease were statistically significant correlates of attitudes toward ACP. Adding health beliefs on Alzheimer's disease doubled the amount of the variance explained, from 3% to 6%.
Significance of results
Our results support the use of cognitive models of health behavior by assessing intra-personal beliefs and knowledge to understand ACP attitudes and completion. Specifically, we demonstrated the importance of knowledge of Alzheimer's disease for ACP attitudes, suggesting the importance of including a module on the topic to ACP interventions.
Introduction: The number of seniors presenting to emergency departments after a fall is increasing. Head injury concerns in this population often leads to a head CT scan. The CT rate among physicians is variable and the reasons for this are unknown. This study examined the role of patient characteristics and country of practice in the decision to order a CT. Methods: This study used a case-based survey of physicians across multiple countries. Each survey included 9 cases pertaining to an 82-year old man who falls. Each case varied in one aspect compared to a base case (aspirin, warfarin, or rivaroxaban use, occipital hematoma, amnesia, dementia, and fall with no head trauma). For each case, participants indicated how “likely” they were to order a head CT scan, measured on a 100-point scale. A response of 80 or more was defined a priori as ‘likely to order a CT scan’. The survey was piloted among emergency residents for feedback on design and comprehension, and was published in French and English. Recruitment was through the Canadian Association of Emergency Physicians, Twitter and CanadiEM. For each case we compared the proportion of physicians who were ‘likely to scan’ with relative to the base case. We also compared the proportion of participants who were ‘likely to scan’ each case in the USA, UK and Australia, relative to Canada. Results: Data was collected from 484 respondents (Canada-308, USA-64, UK-67, Australia-27, and 18 from other countries). Social media distribution limited our ability to estimate of the response rate. Physicians were most likely to scan in the anticoagulation cases (90% likely to order a scan compared to 36% for the base case (p = <0.001)). Other features associated with increased scans were occipital hematoma (48%), multiple falls (68%), and amnesia (68%) (all p < 0.005). Compared to Canada, US physicians were more likely to order CT scans for all cases (p = <0.05). Compared to Canada, UK physicians were significantly less likely to order CT for patients in every case except in the patient with amnesia. Finally, Australian physicians differed from Canada only for the occipital hematoma case where they were significantly more likely to order CT scan. Conclusion: Anticoagulation, amnesia and a history of multiple falls appear to drive the ordering a head CT scan in elderly patients who had fallen. We observed variations in practice between countries. Future clinical decision rules will likely have variable impact on head CT scan rates depending on baseline practice variation.
Introduction: In order to better characterize procedural skills curricula in Canada, a national survey was conducted. The objectives of the survey were: (i) to characterize procedural skills education currently employed in pre-clerkship and clerkship curricula; (ii) to determine what skills physician-educators think medical students should know upon graduation; and (iii) to identify physician-educator perceptions regarding the development of pre-clerkship procedural curriculum. Methods: A web-based survey was distributed to 201 clinician-educators across Canada's 17 medical schools. Respondents were directed to an individualized survey based on their self-identified roles at their institution. Respondents were asked demographic questions, what procedural skills are being taught and in what setting at their institution, and their opinions on the value of a pre-clerkship procedural curriculum. Results: From the 17 school's surveyed, 12 schools responded, with 8 schools responding “yes” that they had a clerkship procedural curriculum. For a pre-clerkship procedural curriculum, only 4 schools responded “yes”. The 5 of the top 10 procedurals skills identified that medical students should know upon graduation, in order, are: IV Access, Airway Management/Ventilator Management, Local anesthesia/field block, Casting, Spontaneous Vaginal Delivery. On a Likert scale, clinician-educators strongly supported a pre-clerkship procedural curriculum (median = 4.00/5.00, mode = 5.00/5.00), and they believed it would decrease anxiety (median = 4.00/5.00), increase confidence (median = 4.00/5.00), and increase technical ability (median = 3.00/5.00) in incoming clerks. Conclusion: Across Canada, the state of undergraduate medical education procedural skills education is inconsistent. With the identification of the Top 10 procedural skills medical students should know upon graduation, the learning objectives of a formal curriculum can be developed. With overwhelming support from physician-educators, a formal pre-clerkship procedural curriculum is poised to redefine the landscape of procedural care for a whole new generation of physicians.
As healthcare decision makers continue to face challenges in health services delivery to their patients, disinvestment programs are being established for a sustainable healthcare system. This study aimed to collect data and information by means of a survey of disinvestment candidates and ongoing disinvestment projects in the health technology assessment (HTA) community.
An online survey was conducted to collect information on disinvestment candidates and activities from members of the Health Technology Assessment International Disinvestment & Early Awareness Interest Group, the EuroScan International Network and International Network of Agencies for Health Technology Assessment.
Among the 362 invitees, twenty-four unique responses were received, and almost 70 percent were involved in disinvestment initiatives. The disinvestment candidates identified represented a range of health technologies. Evidence or signaling of clinical ineffectiveness or inappropriate use typically led to the nomination of disinvestment candidates. Health technology assessments and reassessments were usually conducted to evaluate the technology in question, and decisions usually led to the limited use of the technology. Barriers to disinvestment decisions included the strength of interest and advocacy groups, insufficient data for assessments, a systematic decision process and political challenges, while obstacles to their implementation were clinicians’ reluctance and insufficient funding and incentives.
The survey results suggested that disinvestment activities are occurring in the HTA community, especially in the public sector. Future research can further investigate the processes and methods used to reach and implement disinvestment decisions from our survey respondents and explore to form closer ties between the HTA and clinical communities.
Through use of a unique, multi-year public opinion survey, this paper seeks to measure changes in self-reported governmental satisfaction among Chinese citizens between 2003 and 2016. Despite the persistence of vast socio-economic and regional inequalities, we find evidence that low-income citizens and residents living in China's less-developed inland provinces have actually reported comparatively greater increases in satisfaction since 2003. These results, which we term the “income effect” and “region effect” respectively, are more pronounced at the county and township levels of government, which are most responsible for public service provision. Our findings also show that the satisfaction gap between privileged and more marginalized populations in China is beginning to close, in large part owing to efforts by the Hu Jintao and Xi Jinping administrations to rebalance the gains of economic growth and shift resources towards the populations most overlooked during China's first few decades of reform.
The second Singapore Mental Health Study (SMHS) – a nationwide, cross-sectional, epidemiological survey - was initiated in 2016 with the intent of tracking the state of mental health of the general population in Singapore. The study employed the same methodology as the first survey initiated in 2010. The SMHS 2016 aimed to (i) establish the 12-month and lifetime prevalence and correlates of major depressive disorder (MDD), dysthymia, bipolar disorder, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol use disorder (AUD) (which included alcohol abuse and dependence) and (ii) compare the prevalence of these disorders with reference to data from the SMHS 2010.
Door-to-door household surveys were conducted with adult Singapore residents aged 18 years and above from 2016 to 2018 (n = 6126) which yielded a response rate of 69.0%. The subjects were randomly selected using a disproportionate stratified sampling method and assessed using World Health Organization Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0). The diagnoses of lifetime and 12-month selected mental disorders including MDD, dysthymia, bipolar disorder, GAD, OCD, and AUD (alcohol abuse and alcohol dependence), were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.
The lifetime prevalence of at least one mood, anxiety or alcohol use disorder was 13.9% in the adult population. MDD had the highest lifetime prevalence (6.3%) followed by alcohol abuse (4.1%). The 12-month prevalence of any DSM-IV mental disorders was 6.5%. OCD had the highest 12-month prevalence (2.9%) followed by MDD (2.3%). Lifetime and 12-month prevalence of mental disorders assessed in SMHS 2016 (13.8% and 6.4%) was significantly higher than that in SMHS 2010 (12.0% and 4.4%). A significant increase was observed in the prevalence of lifetime GAD (0.9% to 1.6%) and alcohol abuse (3.1% to 4.1%). The 12-month prevalence of GAD (0.8% vs. 0.4%) and OCD (2.9% vs. 1.1%) was significantly higher in SMHS 2016 as compared to SMHS 2010.
The high prevalence of OCD and the increase across the two surveys needs to be tackled at a population level both in terms of creating awareness of the disorder and the need for early treatment. Youth emerge as a vulnerable group who are more likely to be associated with mental disorders and thus targeted interventions in this group with a focus on youth friendly and accessible care centres may lead to earlier detection and treatment of mental disorders.
This article explores two fundamental dimensions in sociolinguistics: the dynamics of linguistic variation and change in international languages and the exploitation of data proceeding from significant countries. These issues will be addressed through examination of a particular syntactic feature and a possible change in progress: the occurrence of null direct objects in Spanish. It is shown that for Spanish, a widely used international language, social factors have not been decisive in explaining the distribution of the phenomenon under investigation. This study shows that while direct object omission is not conditioned by typical social variables such as sex, age, and gender, it is unevenly spread throughout the Spanish-speaking world: Mexico and the continental Caribbean use it more than other countries, such as Spain or Chile. Besides the relevance of geography, some semantic, discourse, and contextual factors are shown as determinant for the direct object omission. Finally, this paper reflects on methodology, specifically the use of a macroregional sociolinguistic method for data analysis as well as the advantages and shortcomings of a specific data collection technique that capitalizes on technological tools with global reach: the internet survey in an international scenario.
This short report exploits a unique opportunity to investigate the implications of response bias in survey questions about voter turnout and vote choice in new democracies. We analyze data from a field experiment in Benin, where we gathered official election results and panel survey data representative at the village level, allowing us to directly compare average outcomes across both measurement instruments in a large number of units. We show that survey respondents consistently overreport turning out to vote and voting for the incumbent, and that the bias is large and worse in contexts where question sensitivity is higher. This has important implications for the inferences we draw about an experimental treatment, indicating that the response bias we identify is correlated with treatment. Although the results using the survey data suggest that the treatment had the hypothesized impact, they are also consistent with social desirability bias. By contrast, the administrative data lead to the conclusion that the treatment had no effect.
To assess and compare the favourability of healthy public policy options to promote healthy eating from the perspective of members of the general public and policy influencers in two Canadian provinces.
The Chronic Disease Prevention Survey, administered in 2016, required participants to rank their level of support for different evidence-based policy options to promote healthy eating at the population level. Pearson’s χ2 significance testing was used to compare support between groups for each policy option and results were interpreted using the Nuffield Council on Bioethics’ intervention ladder framework.
Alberta and Québec, Canada.
Members of the general public (n 2400) and policy influencers (n 302) in Alberta and Québec.
General public and policy influencer survey respondents were more supportive of healthy eating policies if they were less intrusive on individual autonomy. However, in comparing levels of support between groups, we found policy influencers indicated significantly stronger support overall for healthy eating policy options. We also found that policy influencers in Québec tended to show more support for more restrictive policy options than their counterparts from Alberta.
These results suggest that additional knowledge brokering may be required to increase support for more intrusive yet impactful evidence-based policy interventions; and that the overall lower levels of support among members of the public may impede policy influencers from taking action on policies to promote healthy eating.
The Endangered Asian elephant Elephas maximus comes into widespread conflict with agrarian communities, necessitating active management. The species’ distribution is of primary importance for management planning. However, data-based countrywide distribution maps have not been available for any of the 13 Asian elephant range states. We conducted a 5 × 5 km grid-based questionnaire survey in Sri Lanka to produce an island-wide elephant distribution map. Elephants occur over 59.9% of Sri Lanka and people are resident in 69.4% of elephant range, indicating the challenge of separating people and elephants at a landscape scale. Elephants in Sri Lanka have lost 16.1% of their range since 1960 but their current distribution remains largely contiguous. We found the range of adult males was 15.1% greater, and less seasonal, than that of herds, possibly because males have a higher tolerance for conflict with people. The distribution of conflict coincided with the co-occurrence of humans and elephants. We conclude that a human–elephant coexistence model is the only viable option for effectively mitigating human–elephant conflict and conserving elephants in Sri Lanka. The findings are currently being used to effect a paradigm change in elephant conservation and management in the country.
A wide variety of surgical strategies are used in tetralogy of Fallot repair. We sought to describe the international contemporary practice patterns for surgical management of tetralogy of Fallot.
Surgeons from 18 international paediatric cardiac surgery centres (representing over 1800 tetralogy of Fallot cases/year) completed a Research Electronic Data Capture-based survey. Participating countries include: China (4), India (2), Nepal (1), Korea (1), Indonesia (1), Saudi Arabia (3), Japan (1), Turkey (1), Australia (1), United States of America (2), and Canada (1). Summary measures were reported as means and counts (percentages). Responses were weighted based on case volume/centre.
Primary repair is the prevalent strategy (83%) with variation in age at elective repair (range). Approximately 47% of sites use patient age as a factor in determining the strategy, with age <3 months being the common cut-off for staged repair. In addition, patient weight of <3 kg is an indication for staged repair in 80% of participating institutions. Trans-atrial ventricular septal defect closure is the preferred approach in 62% of sites. Approximately 70% of responders reported using pulmonary valve z-score to guide right ventricular outflow tract management technique with the most prevalent cut-off for annulus preservation being a z-score of −3. Estimated incidence of annulus preservation is 53%. Minimal trans-annular incision is performed in >90% of all trans-annular repairs.
In this cohort representing 11 countries, there is variation in tetralogy of Fallot surgical management with no consensus on standard of practice. A large international prospective cohort study would allow analysis of impact of underlying anatomy and repair strategy on early and late outcomes.