British randomised controlled trial of AV and VV optimization ("BRAVO") study:rationale, design, and endpoints

Background Echocardiographic optimization of pacemaker settings is the current standard of care for patients treated with cardiac resynchronization therapy. However, the process requires considerable time of expert staff. The BRAVO study is a non-inferiority trial comparing echocardiographic optimization of atrioventricular (AV) and interventricular (VV) delay with an alternative method using non-invasive blood pressure monitoring that can be automated to consume less staff resources. Methods/Design BRAVO is a multi-centre, randomized, cross-over, non-inferiority trial of 400 patients with a previously implanted cardiac resynchronization device. Patients are randomly allocated to six months in each arm. In the echocardiographic arm, AV delay is optimized using the iterative method and VV delay by maximizing LVOT VTI. In the haemodynamic arm AV and VV delay are optimized using non-invasive blood pressure measured using finger photoplethysmography. At the end of each six month arm, patients undergo the primary outcome measure of objective exercise capacity, quantified as peak oxygen uptake (VO2) on a cardiopulmonary exercise test. Secondary outcome measures are echocardiographic measurement of left ventricular remodelling, quality of life score and N-terminal pro B-type Natriuretic Peptide (NT-pro BNP). The study is scheduled to complete recruitment in December 2013 and to complete follow up in December 2014. Discussion If exercise capacity is non-inferior with haemodynamic optimization compared with echocardiographic optimization, it would be proof of concept that haemodynamic optimization is an acceptable alternative which has the potential to be more easily implemented

Standard of Practice for the Endovascular Treatment of Thoracic Aortic Aneurysms and Type B Dissections

Thoracic endovascular aortic repair (TEVAR) represents a minimally invasive technique alternative to conventional open surgical reconstruction for the treatment of thoracic aortic pathologies. Rapid advances in endovascular technology and procedural breakthroughs have contributed to a dramatic transformation of the entire field of thoracic aortic surgery. TEVAR procedures can be challenging and, at times, extraordinarily difficult. They require seasoned endovascular experience and refined skills. Of all endovascular procedures, meticulous assessment of anatomy and preoperative procedure planning are absolutely paramount to produce optimal outcomes. These guidelines are intended for use in quality-improvement programs that assess the standard of care expected from all physicians who perform TEVAR procedures

A implementação do programa Bolsa Família: as experiências de São Francisco de Itabapoana e Duque de Caxias Implementation of Brazil's Family Allowance Program: experiences at São Francisco de Itabapoana and Duque de Caxias

O artigo discute os resultados da pesquisa "Implementação do Programa Bolsa Família no Estado do Rio de Janeiro: as experiências de São Francisco de Itabapoana e Duque de Caxias" realizada durante os anos de 2004 e 2005 com o apoio do CNPQ e que envolveu pesquisadores e alunos da ENSP/FIOCRUZ, UFF e UERJ. O objetivo do estudo foi analisar a implementação e a gestão local do programa Bolsa Família, identificando os principais contornos desta intervenção pública nos municípios selecionados. A aproximação com a dinâmica política e institucional local e com os mecanismos de responsabilização dos gestores, conformação de coordenações integradas e intersetoriais, oferta e acompanhamento das ações de saúde e educação e definição dos papéis dos diferentes entes federativos na operacionalização do programa contribuiu para identificar as principais tensões e os desafios ligados ao alcance de maior eqüidade e justiça social no campo das políticas de transferência condicionada de renda no país.<br>This paper discuss the findings of a study examining the Implementation of Brazil's Family Allowance Program in Rio de Janeiro at São Francisco de Itabapoana and Duque de Caxias, conducted in 2004 - 2005 with the support of the Brazilian Science and Technology Research and Development Council (CNPq) and collaboration among ENSP-FIOCRUZ, UFF and UERJ. Its purpose is to analyze this implementation process and local management practices, identifying the main contours of this program. An examination of its political and institutional dynamics, accountability mechanisms, intersectoral arenas, investments in healthcare and education, and intergovernmental arrangements helps outline some of the conflicts, tensions and challenges associated with conditional cash transfers as a core policy in the battle against poverty and social inequalities