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5. Changes in cardiac output, rhythm regularity, and symptom severity after electrical cardioversion of atrial fibrillation.

Author

Klavebäck, Sofia, Skúladóttir, Helga, Olbers, Joakim, Östergren, Jan, and Braunschweig, Frieder

Abstract

Symptoms in atrial fibrillation (AF) range from none to disabling. The physiological correlates of AF symptoms are not well characterized. This study investigated the association between physiological parameters and symptom severity before and after electrical cardioversion (EC) of AF. We studied 44 patients with persistent AF (age 66.2 ± 7.9 years, 16% females) 4 ± 2 days before and 5 ± 2 days after EC. Physiological parameters included cardiac output (CO; non-invasive inert gas rebreathing), heart rate (HR), RR variability and resting and ambulatory blood pressure (BP). Symptoms and quality of life (QoL) were assessed by the modified European Heart Rhythm Association score (mEHRA), the Atrial Fibrillation Effect on Quality of Life (AFEQT) and the Symptom Checklist for frequency and severity of symptoms (SCL). 28 of 44 patients were still in sinus rhythm (SR) at post EC evaluation. Those in SR had a decreased HR (-15.4 ± 13.1 bpm, p < 0.001), and an increased CO (+0.8 ± 0.7 L/min, p < 0.001) as compared to those with recurrent AF. Changes in CO after EC correlated with symptom improvement as scored by AFEQT (r = 0.36; p < 0.05), AFEQT symptoms subscore (r = 0.46; p < 0.01), SCL for frequency (r = 0.62; p < 0.01) and severity (r = 0.33; p < 0.05) of symptoms, and the mEHRA score (r = 0.50; p < 0.01). A decrease in RR variability showed similar correlations with these measures of symptom improvement. Improvements in symptoms and quality of life experienced by patients after electrical conversion of atrial fibrillation are correlated with an increase in CO and a decreased RR variability. [ABSTRACT FROM AUTHOR]

Published
2023
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13. Prevention of Coronary and Stroke Events with Atorvastatin in Hypertensive Patients who have Average or Lower-than-Average Cholesterol Concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial— Lipid Lowering Arm (ASCOT-LLA): A Multicentre Randomised Controlled Trial

Author

Sever, Peter S, Dahlöf, Björn, Poulter, Neil R, Wedel, Hans, Beevers, Gareth, Caulfield, Mark, Collins, Rory, Kjeldsen, Sverre E, Kristinsson, Arni, McInnes, Gordon T, Mehlsen, Jesper, Nieminen, Markku, O’Brien, Eoin, Östergren, Jan, and ASCOT investigators

Published
2004
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19. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial

Author

Dahlöf, Björn, Sever, Peter S, Poulter, Neil R, Wedel, Hans, Beevers, D Gareth, Caulfield, Mark, Collins, Rory, Kjeldsen, Sverre E, Kristinsson, Arni, McInnes, Gordon T, Mehlsen, Jesper, Nieminen, Markku, O'Brien, Eoin, and Östergren, Jan

Published
2005
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25. †Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)

Author

Rydén, Lars, Standl, Eberhard, Bartnik, Małgorzata, Van den Berghe, Greet, Betteridge, John, de Boer, Menko-Jan, Cosentino, Francesco, Jönsson, Bengt, Laakso, Markku, Malmberg, Klas, Priori, Silvia, Östergren, Jan, Tuomilehto, Jaakko, Thrainsdottir, Inga, Vanhorebeek, Ilse, Stramba-Badiale, Marco, Lindgren, Peter, Qiao, Qing, Priori, Silvia G., Blanc, Jean-Jacques, Budaj, Andrzej, Camm, John, Dean, Veronica, Deckers, Jaap, Dickstein, Kenneth, Lekakis, John, McGregor, Keith, Metra, Marco, Morais, João, Osterspey, Ady, Tamargo, Juan, Zamorano, José Luis, Deckers, Jaap W., Bertrand, Michel, Charbonnel, Bernard, Erdmann, Erland, Ferrannini, Ele, Flyvbjerg, Allan, Gohlke, Helmut, Juanatey, Jose Ramon Gonzalez, Graham, Ian, Monteiro, Pedro Filipe, Parhofer, Klaus, Pyörälä, Kalevi, Raz, Itamar, Schernthaner, Guntram, Volpe, Massimo, and Wood, David

Published
2007

31. Why Medical Students Choose to Use or Not to Use a Web-Based Electrocardiogram Learning Resource : Mixed Methods Study

Author

Nilsson, Mikael, Fors, Uno, Östergren, Jan, Bolinder, Gunilla, Edelbring, Samuel, Nilsson, Mikael, Fors, Uno, Östergren, Jan, Bolinder, Gunilla, and Edelbring, Samuel

Abstract

Background: Electrocardiogram (ECG) interpretation is a core competence and can make a significant difference to patient outcomes. However, ECG interpretation is a complex skill to learn, and research has showed that students often lack enough competence. Web-based learning has been shown to be effective. However, little is known regarding why and how students use Web-based learning when offered in a blended learning situation. Objective: The aim of this paper was to study students’ use of Web-based ECG learning resources which has not previously been studied in relation to study strategies. Methods: A qualitative explanatory design using mixed methods was adopted to explore how medical students reason around their choice to use or not to use a Web-based ECG learning resource. Overall, 15 of 33 undergraduate medical students attending a course in clinical medicine were interviewed. Data on usage of the resource were obtained via the learning management system for all students. At the final examination, all the students answered a questionnaire on study strategies and questions about internet access and estimated their own skills in ECG interpretation. Furthermore, study strategies and use patterns were correlated with results from an ECG Objective Structured Clinical Examination (OSCE) and a written course examination. Results: In total, 2 themes were central in the students’ reasoning about usage of Web-based ECG: assessment of learning needs and planning according to learning goals. Reasons for using the Web resource were to train in skills, regarding it as a valuable complement to books and lectures. The main reasons for not using the resource were believing they already had good enough skills and a lack of awareness of its availability. Usage data showed that 21 students (63%) used the Web resource. Of these, 11 were minimal users and 10 were major users based on usage activity. Large variations were found in the time spent in different functional parts of the r

Published
2019
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37. Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting?

Author

Nilsson Mikael, Östergren Jan, Fors Uno, Rickenlund Anette, Jorfeldt Lennart, Caidahl Kenneth, and Bolinder Gunilla

Subjects
Special aspects of education, LC8-6691, Medicine
Abstract

Abstract Background The compressed curriculum in modern knowledge-intensive medicine demands useful tools to achieve approved learning aims in a limited space of time. Web-based learning can be used in different ways to enhance learning. Little is however known regarding its optimal utilisation. Our aim was to investigate if the individual learning styles of medical students influence the choice to use a web-based ECG learning programme in a blended learning setting. Methods The programme, with three types of modules (learning content, self-assessment questions and interactive ECG interpretation training), was offered on a voluntary basis during a face to face ECG learning course for undergraduate medical students. The Index of Learning Styles (ILS) and a general questionnaire including questions about computer and Internet usage, preferred future speciality and prior experience of E-learning were used to explore different factors related to the choice of using the programme or not. Results 93 (76%) out of 123 students answered the ILS instrument and 91 the general questionnaire. 55 students (59%) were defined as users of the web-based ECG-interpretation programme. Cronbach's alpha was analysed with coefficients above 0.7 in all of the four dimensions of ILS. There were no significant differences with regard to learning styles, as assessed by ILS, between the user and non-user groups; Active/Reflective; Visual/Verbal; Sensing/Intuitive; and Sequential/Global (p = 0.56-0.96). Neither did gender, prior experience of E-learning or preference for future speciality differ between groups. Conclusion Among medical students, neither learning styles according to ILS, nor a number of other characteristics seem to influence the choice to use a web-based ECG programme. This finding was consistent also when the usage of the different modules in the programme were considered. Thus, the findings suggest that web-based learning may attract a broad variety of medical students.

Published
2012
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43. Evaluation of a web-based ECG-interpretation programme for undergraduate medical students

Author

Johansson Bo-Lennart, Held Claes, Bolinder Gunilla, Nilsson Mikael, Fors Uno, and Östergren Jan

Subjects
Special aspects of education, LC8-6691, Medicine
Abstract

Abstract Background Most clinicians and teachers agree that knowledge about ECG is of importance in the medical curriculum. Students at Karolinska Institutet have asked for more training in ECG-interpretation during their undergraduate studies. Clinical tutors, however, have difficulties in meeting these demands due to shortage of time. Thus, alternative ways to learn and practice ECG-interpretation are needed. Education offered via the Internet is readily available, geographically independent and flexible. Furthermore, the quality of education may increase and become more effective through a superior educational approach, improved visualization and interactivity. Methods A Web-based comprehensive ECG-interpretation programme has been evaluated. Medical students from the sixth semester were given an optional opportunity to access the programme from the start of their course. Usage logs and an initial evaluation survey were obtained from each student. A diagnostic test was performed in order to assess the effect on skills in ECG interpretation. Students from the corresponding course, at another teaching hospital and without access to the ECG-programme but with conventional teaching of ECG served as a control group. Results 20 of the 32 students in the intervention group had tested the programme after 2 months. On a five-graded scale (1- bad to 5 – very good) they ranked the utility of a web-based programme for this purpose as 4.1 and the quality of the programme software as 3.9. At the diagnostic test (maximal points 16) by the end of the 5-month course at the 6th semester the mean result for the students in the intervention group was 9.7 compared with 8.1 for the control group (p = 0.03). Conclusion Students ranked the Web-based ECG-interpretation programme as a useful instrument to learn ECG. Furthermore, Internet-delivered education may be more effective than traditional teaching methods due to greater immediacy, improved visualisation and interactivity.

Published
2008
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