[Cardiac Resynchronization Therapy in the Treatment of Heart Failure in Children].

Cardiac resynchronizing therapy (CRT) is currently a leading approach to the treatment of heart failure in adults. However, data regarding application of CRT in children remain limited and indications for CRT are unclear. There is evidence that the best treatment outcomes result from the administration of CRT to the group of children whose heart failure is caused by dyssynchrony mediated by traditional stimulation of the right ventricle in patient with complete atrioventricular block. On the contrary, the presence of dilated cardiomyopathy and functional class III-IV heart failure are the predictors of ineffective CRT. Implantation of CRT devices in children has many peculiarities and challenges associated with anatomic and physiological characteristics of childhood age. Taking into consideration the expected length of treatment, one should admit that epicardial biventricular stimulation should be preferred. In the present paper the authors discuss pathophysiology of the electromechanical dyssynchrony, analyze their own experience with CRT, and suggest indications for this kind of treatment.

Internet supported standardized patient information for selfcare.

BACKGROUND: An informed patient is a better partner for the physician than an uninformed one. Such a patient will be more likely to practice effective selfcare, appropriately utilize the health care system, and be prepared to seek and obtain health care services that meet his needs. Objectives. To develop a system of presenting standardized medical information for the general population based on guidelines developed for general practitioners (GPs). METHODS: Guidelines are instruments to be used by GPs to assure comprehensive and consistent enhancement of the quality of care. At the same time, guidelines describe the actions which could be expected by patients in various clinical situations. These materials establish a good basis for the patient's understanding of health care procedures and when and how to utilize health services. These materials will have to be adapted in form, content, and nomenclature in order to be understandable with the background knowledge of the average "citizen". This information for patients is currently being developed in various forms of presentations and applications. The use of web-oriented tools is a priority, because web content offers the patient a very simple and easy way of browsing and searching for the latest relevant information on both basic and advanced/detailed levels, including supporting pictures and animations. Materials are also being developed in other formats such as printed leaflets, audio presentations and videoclips. RESULTS: Web content and printed materials based on clinical guidelines have been created. Focus groups of health professionals and non-professionals were used for evaluation of the materials. General practitioners have tested written materials in practices. CONCLUSIONS: The development and preparation of information and materials for patients has become an integral part of the GP practical guideline development cycle.