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Aims This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery.Methods and results Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen's d=1.4, 95% confidence interval (CI) 0.9-1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen's d=0.8, 95% CI 0.6-1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen's d=1.4, 95% CI 1.0-1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease.Conclusion This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients.

Aims This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery.Methods and results Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen's d=1.4, 95% confidence interval (CI) 0.9-1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen's d=0.8, 95% CI 0.6-1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen's d=1.4, 95% CI 1.0-1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease.Conclusion This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients.

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This chapter discusses the ‘effects’ of recent public sector managerial reforms in Italy. It arises, inter alia, that the country has adopted managerial tools to a significant extent, yet not up to the point to have changed in any fundamental way the overall administrative system. The portrait of the Italian public sector that emerges is one in which the layering of managerial tools and logics combine with persistent, underlying Weberian elements: this frame can be interpreted along the lines of the Neo-Weberian model as outlined by Pollitt and Bouckaert (2011). The basic idea of the Neo-Weberian model is that a layer of managerial instruments get to be systematically employed by public sector organizations, but rather than this phenomenon leading to displacing the logic of accountability and organization of the public sector (as seems to be predicted by some NPM doctrinal argumentations), this layer of managerial tools combines with the previous Weberian elements in a consistent way. The data collected through the COCOPS Top Executive Survey enable an interpretation of the Italian reform trajectory along the lines of the Neo-Weberian model which aims to show that the Neo-Weberian model may be an apt description of trajectories of administrative reform also in Southern European countries.

Contains fulltext : 95457.pdf (publisher's version ) (Closed access)

Contains fulltext : 95457.pdf (publisher's version ) (Closed access)

Contains fulltext : 95457.pdf (publisher's version ) (Closed access)