Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study.

International audienceBACKGROUND: Cardiac resynchronization therapy (CRT) decreases mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure. We aimed to assess the impact of baseline QRS duration and morphology and the change in QRS duration with pacing on CRT outcomes in mild heart failure. METHODS AND RESULTS: Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) was a multicenter randomized trial of CRT among 610 patients with mild heart failure. Baseline and CRT-paced QRS durations and baseline QRS morphology were evaluated by blinded core laboratories. The mean baseline QRS duration was 151±23 milliseconds, and 60.5% of subjects had left bundle-branch block (LBBB). Patients with LBBB experienced a 25.3-mL/m(2) mean reduction in left ventricular end-systolic volume index (P<0.0001), whereas non-LBBB patients had smaller decreases (6.7 mL/m(2); P=0.18). Baseline QRS duration was also a strong predictor of change in left ventricular end-systolic volume index with monotonic increases as QRS duration prolonged. Similarly, the clinical composite score improved with CRT for LBBB subjects (odds ratio, 0.530; P=0.0034) but not for non-LBBB subjects (odds ratio, 0.724; P=0.21). The association between clinical composite score and QRS duration was highly significant (odds ratio, 0.831 for each 10-millisecond increase in QRS duration; P<0.0001), with improved response at longer QRS durations. The change in QRS duration with CRT pacing was not an independent predictor of any outcomes after correction for baseline variables. CONCLUSION: REVERSE demonstrated that LBBB and QRS prolongation are markers of reverse remodeling and clinical benefit with CRT in mild heart failure. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00271154

De publieke sector: ontwikkeling en waardevorming

Political Scienc

Dutch medical disciplinary law cases concerning psychiatry, 2015-2019

Achtergrond De kwaliteit van medische beroepsbeoefening wordt bewaakt via het tuchtrecht. Kwantitatieve gegevens over Nederlandse tuchtrechtspraak zijn beperkt beschikbaar: weinig is bekend over aard, aantal en uitkomst van klachten tegen psychiaters(-psychotherapeuten) of artsen in opleiding tot psychiater (aiossen).Doel Inzicht krijgen in de Nederlandse tuchtrechtspraak, met name aantal en soort tuchtzaken tegen psychiaters(-psychotherapeuten) en a(n)iossen.Methode Descriptief retrospectief onderzoek. Alle uitspraken in eerste aanleg van regionale tuchtcolleges uit de periode 2015-2019 betreffende psychiaters(-psychotherapeuten) en aiossen werden onderzocht. Bestudeerd werden: jaar van uitspraak, aantal en aard van de klachten, soort klagers, categorieën van de aangeklaagde beroepsbeoefenaar (psychiater(-psychotherapeut), a(n)ios).Resultaten De regionale tuchtcolleges behandelden in de onderzoeksperiode 353 unieke tuchtklachten; 70,6 gemiddeld per jaar. 321 waren gericht tegen psychiaters(-psychotherapeuten), 32 tegen aiossen. De klachtendichtheid was 1,74 per 100 psychiaters en 0,37 per 100 aiossen. De meeste klachten betroffen ‘onjuiste diagnose’, ‘onjuist beleid’ en ‘onjuiste communicatie’. Gemiddeld 31% resulteerde in een maatregel: het merendeel betrof een waarschuwing (49%), berisping (30%) of voorwaardelijke schorsing (5%). In totaal werd in 17 (15%) zaken besloten tot gedeeltelijke ontzegging of doorhaling in het BIG-register.Conclusie Binnen de psychiatrie is weinig aandacht voor tuchtrecht, ondanks dat psychiaters regelmatig geconfronteerd worden met tuchtklachten. Deze exploratieve analyse van tuchtklachten geeft aanleiding voor vervolgonderzoek, met name om de gevonden verschillen te verklaren tussen mannelijke-vrouwelijke beklaagden, en internationale vergelijking in de gegrondverklaring van klachten over (seksueel) grensoverschrijdend gedrag.BACKGROUND: The aim of medical disciplinary law (as part of the Dutch law 'Wet BIG') is to safeguard the quality of professional practice in the health services. Quantitative data about Dutch medical disciplinary law is sparse: little is known about the nature, quantity and the verdicts of disciplinary law complaints against psychiatrists and residents.AIM: Gaining insight in Dutch medical disciplinary law, in particular with regard to number and nature of disciplinary law complaints against psychiatrists(-psychotherapist) and psychiatry residents.METHOD: Descriptive retrospective study. We examined all medical disciplinary law cases against psychiatrists(-psychotherapist) and psychiatry residents in the period 2015-2019.RESULTS: In the study period the regional medical disciplinary courts handled 353 cases against psychiatrists(-psychotherapist) and residents psychiatry, on average 70.6 per year. 321 of these cases were against psychiatrists and 32 against residents. Complaint density was 1.74 for psychiatrists and 0.37 for residents. Subject of most cases was 'wrong diagnosis', followed by 'wrong therapeutic plan' and 'incorrect communication'. The number of cases resulting in a disciplinary measure was on average 31%: warning (49%), reprimand (30%), (conditional) suspension (15%). In 17 cases the professional was (partially) denied to practice. CONCLUSIONS Within Dutch psychiatry little attention is paid to disciplinary law, despite the fact that psychiatrists are relatively often confronted with disciplinary law complaints. The current explorative analysis underlines the need for further research, especially on the difference between male/female psychiatrists and an international comparison with respect to complaints about (sexual) misconduct.</p