ABSTRACT
OBJECTIVE: We sought to assess the efficacy and safety of amiodarone for restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation in a prospective, randomized, double blind trial. BACKGROUND: Restoration and preservation of sinus rhythm is difficult in patients with chronic atrial fibrillation. The efficacy of oral amiodarone has not been conclusively established. METHODS: Ninety-five patients with chronic atrial fibrillation, lasting an average of 35.6 months, were randomized to either amiodarone (600 mg/d) (47 patients) or placebo (48 patients) during four weeks. Nonresponders underwent electric cardioversion, and those who reverted continued with amiodarone (200 mg/d) or placebo. End-points were successful cardioversion and sinus rhythm maintenance. RESULTS: Sixteen patients (34.04%) in the amiodarone group reverted within 27.28 +/- 8.85 days in comparison with 0% in the placebo group (P < 0.000009). The conversion rate rose to 51.72% in patients with chronic atrial fibrillation lasting less than 12 months. Twenty-eight patients in the amiodarone group and 39 in the placebo group underwent electric cardioversion, which was successful in 19 patients (67.8%) of the amiodarone group and in 15 (38.46%) of the placebo group (P = 0.017). Altogether, conversion was obtained in 79.54% of the amiodarone group patients and in 38.46% of the placebo group patients (P < 0.0001). During follow-up, atrial fibrillation relapsed in 13 (37.14%) of 35 patients of the amiodarone group within 8.84 +/- 8.57 months and in 12 (80%; P = 0.009) of 15 patients of the placebo group within 2.74 +/- 3.41 months. CONCLUSIONS: Oral amiodarone restored sinus rhythm in one third of patients with chronic atrial fibrillation, increased the success rate of electric cardioversion, decreased the number of relapses and delayed their occurrence.
Subject(s)
Amiodarone/therapeutic use , Atrial Fibrillation/drug therapy , Adult , Aged , Amiodarone/adverse effects , Chronic Disease , Double-Blind Method , Electric Countershock , Female , Follow-Up Studies , Humans , Male , Middle Aged , Risk Assessment , Treatment OutcomeABSTRACT
These observations center on the context of development that is the evaluation process. When the approach of education shifts from teaching to learning, the object to be evaluated changes too. Not only the quantity of what has been learned must be measured, but its quality as well. The student's performance must be evaluated, particularly in situations which present problems. Evaluation is a process that begins when the school sets its objectives and shapes the image of the health professional it desires to produce. The evaluation is a culmination of that process. There are evaluation techniques that are essentially observational, reactive, and mixed. The neutrality and objectivity of tests are discussed. Techniques must be used as instruments for learning and not be ends in themselves.
Subject(s)
Education, Medical/standards , Educational Measurement , Curriculum , Humans , Learning , Students, Medical/psychology , TeachingABSTRACT
With the advent of the computer as an educational tool, new avenues have been opened in the teaching of biology. The development of instructional techniques using a variety of mathematical models has assisted and stimulated the study of genetics, particularly that of populations. This article refers to an instructional program by simulation of the genetic drift phenomenon, which enables the student to utilize results that would otherwise take a long time to observe. The authors feel that this teaching method is the only efficient way to teach the phenomenon, since its very complexity makes it very difficult to explain in the postgraduate classroom or through the conventional practical task. The program is being used in a graduate course in genetics; however it is felt that it can be applied to other health sciences fields and adopted to the levels of understanding of the students.
Subject(s)
Computer-Assisted Instruction/methods , Education, Medical , Genetics/education , BrazilABSTRACT
With the advent of the computer as an educational tool, new avenues have been opened in the teaching of biology. The development of instructional techniques using a variety of mathematical models has assisted and stimulated the study of genetics, particularly that of populations. This article refers to an instructional program by simulation of the genetic drift phenomenon, which enables the student to utilize results that would otherwise take a long time to observe. The authors feel that this teaching method is the only efficient way to teach the phenomenon, since its very complexity makes it very difficult to explain in the postgraduate classroom or through the conventional practical task. The program is being used in a graduate course in genetics; however it is felt that it can be applied to other health sciences fields and adopted to the levels of understanding of the students (Au)
