Access to Specialized Care Across the Lifespan in Tetralogy of Fallot
Bibliographic record
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications.However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population.Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist.Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it.These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting.These factors may coexist and have compounding effects.In R ESUM EPour les personnes qui vivent avec la t etralogie de Fallot, des soins sp ecialis es en cardiopathie cong enitale (CC) sont n ecessaires pour surveiller et prendre en charge toute complication tardive eventuelle.Toutefois, l'accès à des soins en cardiologie demeure difficile pour de nombreux patients, tout comme aux services en sant e mentale, aux soins dentaires, aux soins obst etriques et à d'autres soins sp ecialis es dont cette population a besoin.Des in egalit es dans l'accès aux soins de sant e ont et e mises en lumière lors de la pand emie de COVID-19 et continuent d'exister.Paradoxalement, de nombreux facteurs sociaux agissent sur les besoins d'une personne en matière de soins, et limitent en même temps son accès à ces soins.Le sexe et le genre, l'appartenance à un groupe racial ou ethnique ayant v ecu une exclusion par le pass e, un niveau de scolarit e ou un niveau socioeconomique plus faible, l' eloignement g eographique des centres de Timely access to appropriate health care has become a pressing concern for Canadians, Americans, and people all over the world in recent years.Problems pertaining to inadequate access to family doctors as well as long wait times and overcrowding in emergency departments are regularly identified by the media, patients, and health care professionals.1,2 The COVID-19 pandemic amplified inequities within health care systems 3,4 as well as urgent issues regarding health care worker burnout and retention, 5 both of which can further undermine access to primary care and subspecialty services.Access to care is defined as "the timely use of personal health services to achieve the best possible health outcomes."6 This paper, as part of a focused issue from the Canadian Journal of CardiologydPediatric and Congenital Heart Disease, addresses issues relevant to access to specialized care among individuals with one of the more common forms of congenital heart disease (CHD), namely tetralogy of Fallot (ToF).Despite excellent outcomes from surgical repair that are typically achieved in infancy, late complications are common, and timely diagnosis allows for effective interventions.These include but are not limited to pulmonary regurgitation requiring pulmonary valve replacement, branch pulmonary artery stenosis requiring balloon dilation and/or stenting, endocarditis, and tachyarrhythmias requiring catheter ablation. 7Individuals with ToF require access to a primary care clinician, typically a physician or nurse practitioner, who can serve as the medical home, in addition to lifelong specialized CHD care.8 Several other health care services are also relevant CJC Pediatric and Congenital Heart Disease 2 (2023) 267e282
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".