Remote monitoring and follow-up of cardiovascular implantable electronic devices in the Netherlands: An expert consensus report of the Netherlands Society of Cardiology

Remote monitoring of cardiac implanted electronic devices (CIED: pacemaker, cardiac resynchronisation therapy device and implantable cardioverter defibrillator) has been developed for technical control and follow-up using transtelephonic data transmission. In addition, automatic or patient-triggered alerts are sent to the cardiologist or allied professional who can respond if necessary with various interventions. The advantage of remote monitoring appears obvious in impending CIED failures and suspected symptoms but is less likely in routine follow-up of CIED. For this follow-up the indications, quality of care, cost-effectiveneness and patient satisfaction have to be determined before remote CIED monitoring can be applied in daily practice. Nevertheless remote CIED monitoring is expanding rapidly in the Netherlands without professional agreements about methodology, responsibilities of all the parties involved and that of the device patient, and reimbursement. The purpose of this consensus document on remote CIED monitoring and follow-up is to lay the base for a nationwide, uniform implementation in the Netherlands. This report describes the technical communication, current indications, benefits and limitations of remote CIED monitoring and follow-up, the role of the patient and device manufacturer, and costs and reimbursement. The view of cardiology experts and of other disciplines in conjunction with literature was incorporated in a preliminary series of recommendations. In addition, an overview of the questions related to remote CIED monitoring that need to be answered is given. This consensus document can be used for future guidelines for the Dutch profession

Cumulative subgroup analysis to reduce waste in clinical research for individualised medicine

Background: Although subgroup analyses in clinical trials may provide evidence for individualised medicine, their conduct and interpretation remain controversial. Methods: Subgroup effect can be defined as the difference in treatment effect across patient subgroups. Cumulative subgroup analysis refers to a series of repeated pooling of subgroup effects after adding data from each of related trials chronologically, to investigate the accumulating evidence for subgroup effects. We illustrated the clinical relevance of cumulative subgroup analysis in two case studies using data from published individual patient data (IPD) meta-analyses. Computer simulations were also conducted to examine the statistical properties of cumulative subgroup analysis. Results: In case study 1, an IPD meta-analysis of 10 randomised trials (RCTs) on beta blockers for heart failure reported significant interaction of treatment effects with baseline rhythm. Cumulative subgroup analysis could have detected the subgroup effect 15 years earlier, with five fewer trials and 71% less patients, than the IPD meta-analysis which first reported it. Case study 2 involved an IPD meta-analysis of 11 RCTs on treatments for pulmonary arterial hypertension that reported significant subgroup effect by aetiology. Cumulative subgroup analysis could have detected the subgroup effect 6 years earlier, with three fewer trials and 40% less patients than the IPD meta-analysis. Computer simulations have indicated that cumulative subgroup analysis increases the statistical power and is not associated with inflated false positives. Conclusions: To reduce waste of research data, subgroup analyses in clinical trials should be more widely conducted and adequately reported so that cumulative subgroup analyses could be timely performed to inform clinical practice and further research

Mouse models of neurodegenerative disease: preclinical imaging and neurovascular component.

Neurodegenerative diseases represent great challenges for basic science and clinical medicine because of their prevalence, pathologies, lack of mechanism-based treatments, and impacts on individuals. Translational research might contribute to the study of neurodegenerative diseases. The mouse has become a key model for studying disease mechanisms that might recapitulate in part some aspects of the corresponding human diseases. Neurode- generative disorders are very complicated and multifacto- rial. This has to be taken in account when testing drugs. Most of the drugs screening in mice are very di cult to be interpretated and often useless. Mouse models could be condiderated a ‘pathway models’, rather than as models for the whole complicated construct that makes a human disease. Non-invasive in vivo imaging in mice has gained increasing interest in preclinical research in the last years thanks to the availability of high-resolution single-photon emission computed tomography (SPECT), positron emission tomography (PET), high eld Magnetic resonance, Optical Imaging scanners and of highly speci c contrast agents. Behavioral test are useful tool to characterize di erent ani- mal models of neurodegenerative pathology. Furthermore, many authors have observed vascular pathological features associated to the di erent neurodegenerative disorders. Aim of this review is to focus on the di erent existing animal models of neurodegenerative disorders, describe behavioral tests and preclinical imaging techniques used for diagnose and describe the vascular pathological features associated to these diseases

Ci?ncia e realidade : estudo de caso de uma proposta interdisciplinar na p?s-gradua??o

Made available in DSpace on 2015-04-14T14:13:14Z (GMT). No. of bitstreams: 1 393037.pdf: 1710860 bytes, checksum: c000b330dbd181ec4336f2c19f6f4178 (MD5) Previous issue date: 2007-03-29Este estudo de caso analisa os impactos e avan?os provocados pela disciplina Ci?ncia e Realidade na vida pessoal e profissional de alunos de mestrado, do Programa de P?s-gradua??o em Ci?ncias e Matem?tica da PUCRS. A disciplina em estudo ? apresentada sob uma viv?ncia interdisciplinar, baseada nos princ?pios do educar pela pesquisa, propondo por meio da constru??o de Unidades de Aprendizagem (UA) e o ensino de valores, propostas inovadoras para a Educa??o em Ci?ncias. Por meio da an?lise textual discursiva realizada em depoimentos individuais e question?rios respondidos pelos mestrandos, as respostas foram organizadas em uma categoria emergente, compreens?o da interdisciplinaridade e sete categorias a priori: impactos profissionais e pessoais, avan?os nas unidades escolares, rela??es interpessoais, contribui??o em conte?dos espec?ficos, modifica??es na avalia??o de aprendizagem, obst?culos nas unidades escolares, e a??o interdisciplinar. Estas categorias procuraram detectar os tipos de avan?os e impactos que a disciplina provocou naqueles que estiveram envolvidos. Destaca-se nesta proposta de Ci?ncia e Realidade, a vis?o de um novo paradigma em educa??o, o qual valoriza as concep??es que o indiv?duo traz consigo, juntamente com sua historicidade e valores ampliando seu perfil de conceitos quanto a teorias, valores pessoais e profissionais

A proposal to facilitate the effective use of textbooks to future mathematics teachers

20th Annual Symposium of the Spanish-Society-of-Research-in-Mathematical-Education (SEIEM