[Problem based learning in the teaching of physics to medical students. Comparison with traditional teaching]

BACKGROUND

Problem based learning, integrating basic science with clinical problems, is one of the most recommended forms of teaching for medical schools.

AIM

To compare a problem based learning program for physics with traditional teaching methods.

MATERIAL AND METHODS

In the physics course, first year medical students were separated in groups with traditional learning and problem based teaching. Both groups were subjected to the same knowledge and qualitative evaluations.

RESULTS

At the end of the course, cognitive performance in both groups was similar (60.8 and 61.3% among traditional teaching and problem based learning groups respectively). However, students assigned to the problem based learning group evaluated significantly better the teaching methodology and process.

CONCLUSIONS

Physics education, using problem based learning, obtains the same cognitive results but a higher degree of satisfaction than traditional teaching among students.

[Antihypertensive efficacy of monotherapy in increasing doses versus therapy associated in low doses]

BACKGROUND

When hypertension treatment does not achieve the expected reduction in blood pressure levels, experts recommended increasing the dose of the initially used drug or the addition of a new medication.

AIM

To compare the efficacy of increasing doses of losartan or the addition of hydrochlorothiazide to achieve adequate blood pressure levels in patients with hypertension.

PATIENTS AND METHODS

Seventy- three patients aged 64.4 +/- 5.3 years, with stage 1 or 2 essential hypertension were studied. If after four weeks of treatment with losartan 50 mg od, blood pressure levels were still high, the dose was increased to 100 mg od. After four weeks with this new schedule, the treatment was switched to losartan 50 mg and hydrochlorothiazide 12.5 mg for another four weeks.

RESULTS

Thirty- seven patients normalized blood pressure with losartan 50 mg od. Of the 36 patients that did not respond, 69% achieved a normal blood pressure with losartan 100 mg od and 81% did so with the combination of losartan and hydrochlorothiazide. Combination therapy resulted in a better blood pressure lowering than monotherapy (33.2 +/- 3.2 and 29.5 +/- 3.4 mm Hg for systolic blood pressure respectively, 16.4 +/- 3.2 and 13.2 +/- 3.4 mm Hg for diastolic blood pressure, p < 0.05). No changes in blood glucose, total and HDL cholesterol, triglycerides, urea nitrogen and uric acid were observed with the combination therapy.

CONCLUSIONS

In this group of patients, combination therapy achieved better blood pressure levels than monotherapy in high doses.

[Assessment of educational performance of different teaching methodologies applied to medical students in the area of arterial hypertension]

BACKGROUND

Modernization of medical teaching includes the use of new teaching methodologies and among these, computer assisted tutorials. Previous experience has shown that this type of methodology is associated with better student performances.

AIM

To assess the cognitive performance of fourth year medical students using different teaching methodologies.

MATERIAL AND METHODS

During the hypertension course, medical students were allowed to choose to receive a printed booklet (group A), to receive the booklet and attend lectures (group B), to receive the booklet and use a multimedial educational program (group C) and to use all three methodologies (group D). Cognitive performance was evaluated with a multiple choice test scored from 0 to 100.

RESULTS

The mean scores obtained by students were 84.5 in group A, 82.4 in group B, 88.9 in group C and 84.4 in group D. This overall score of 83.6 in hypertension was significantly better than the mean score of 72.5 obtained in the cardiology test.

CONCLUSIONS

Allowing students to choose the most suitable method to learn according to their personal preferences, results in a better cognitive performance.

[Assessment of the feasibility of a distance medical education program]

BACKGROUND

Continuing medical education is essential to cope with the accelerated evolution of medical knowledge.

AIM

To assess the feasibility of a distance medical education program prepared in a written format.

SUBJECTS AND METHODS

Ninety physicians, aged 25 to 29 years old and with 1 to 4 years of medical practice, working mostly in rural locations, participated in the program. The sending of 10 issues with medical topics was programmed. The topics were selected according to the results of an survey done among physicians of the region. Each issue contained an evaluation that had to be returned to the authors.

RESULTS

Eighty two physicians completed the program and 59 returned the evaluations. The mean obtained score in the cognitive evaluation was 80 +/- 6 points (range 68 to 97 points) of a scale from 0 to 100. The qualitative survey revealed a high degree of approval of the issue's format, contents and evaluation system. The favorable effect on patient's management and on the detection and control of chronic diseases was emphasized.

CONCLUSIONS

This distance medical education program had a good receipt and compliance among physicians and contributed to continuing medical training.

[Clinical effectiveness of and tolerance to ramipril in the treatment of essential arterial hypertension phase 1 and 2. Results of a multicenter study]

BACKGROUND

In the last two decades, angiotensin converting enzyme inhibitors have become first line medications in the treatment of hypertension.

AIM

To assess the tolerance and effectiveness of ramipril as monotherapy in the treatment of essential hypertension.

PATIENTS AND METHODS

One hundred eighty eight hypertensive patients, aged 21 to 80 years-old, coming from 4 Chilean hospitals were studied. Using an open non controlled design; they were treated with placebo for two weeks and with the active drug during eight weeks, in initial doses of 2.5 mg/day that were adjusted to 5 mg/day if diastolic blood pressure did not drop below 90 mm Hg or if its reduction was less than 10 mm Hg.

RESULTS

During the active drug treatment period, systolic blood pressure decreased from 164.8 +/- 7.2 to 147.3 +/- 4.8 mm Hg. Diastolic blood pressure dropped from 102.3 +/- 3.1 to 87.8 +/- 3.0 mm Hg. Seventy percent of patients achieved a diastolic blood pressure of less than 90 mm Hg, 56.9% with 2.5 mg/day and 13.8% with 5 mg/day. Dizziness, cough and headache were the main adverse reactions, observed in 3.7, 3.2 and 2.1% of patients respectively. Adherence to treatment was 98%. There were no changes in laboratory values during the treatment period.

CONCLUSIONS

Ramipril is effective and well tolerated in the treatment of essential hypertension.

[Felodipine in the treatment of essential arterial hypertension in elderly patients]

BACKGROUND

Felodipine is a calcium channel inhibitor with high vascular selectivity.

AIM

To study the effectiveness of felodipine in the treatment of essential hypertension in subjects older than 64 years old.

PATIENTS AND OUTCOME

Fifty subjects were studied. After a washout period of four weeks, subjects received a placebo for two weeks followed by the active drug given in an initial dose of 5 mg/day, adjusted to 10 and 20 mg every 21 days if normal blood pressure levels were not attained.

RESULTS

Compared to the placebo period, Felodipine treatment reduced blood pressure from 173 +/- 7.5/102 +/- 3.3 mm Hg to 158 +/- 6.3/91 +/- 4.2 mm Hg. There was no orthostatic reduction of blood pressure, and 87% of subjects attained systolic and diastolic pressure levels below 140 and 90 mm Hg respectively. Adverse reactions (edema, cephalea and flushing) were reported by 38% of subjects and in three, the drug was discontinued. There were no changes in laboratory parameters during the treatment period. Quality of life improved during treatment in the items of concentration, health status perception, mood, physical condition, depression, effects of hypertension on life events and initiative.

CONCLUSIONS

Felodipine is effective in the treatment of elders with essential hypertension.

[Evaluation of a computer-based independent study program applied to fourth year medical students]

The aim of this work was to assess an independent study program on hypertension using a computer multimedia program developed by the authors. Twenty-four randomly chosen students participated in the program and 76 students that continued to attend to classical lectures were used as controls. At the end of the program, a cognitive test with 40 multiple choice questions and an opinion questionnaire were applied. The experimental group had higher grades in the test than controls (71.4 and 64.6% respectively p < 0.001) and a highly favourable opinion of the program. It is concluded that computer based teaching programs are a useful and feasible alternative to lectures.

[A controlled study of the effect of oral contraceptives on blood pressure]

The possible hypertensive effect of oral contraceptives is a controversial issue. We studied 371 women, admitted to the family planning program of a state funded outpatient clinic, that were followed during 12 months. These women were divided in four groups: Group 1 was constituted by 98 women that used intrauterine devices. Group 2 by 98 women taking 30 micrograms of estrogen and 300 micrograms of progestogen. Group 3 by 83 women taking 35 micrograms of estrogen and 500 micrograms of progestogen and Group 4 by 92 puerperal women taking 30 micrograms of levonorgestrel, that after six months started to use an intrauterine device (n = 35) or the contraceptives of group 2 (n = 38) or group 3 (n = 19). Age, initial blood pressure and weight were similar in the four groups. There was no significant change in blood pressure after 6 or 12 months of follow up in any group. It is concluded that contraceptives containing estrogen concentrations up to 35 micrograms and progestogen concentrations between 300 and 500 micrograms do not induced changes in blood pressure.

[Results of a problem-based learning experience applied to first year medical students]

The aim of this work was to study the feasibility of applying problem-based learning methodologies to first year medical students. During 1992, they participated in tutorial groups composed by ten students, that undertook the study of three clinical problems from a biological, psychological and social perspective. Cognitive tests that included multiple choice and developmental questions were used for assessment. An anonymous enquiry about the students opinion towards the educational experience was also applied. Students achieved 76% of the predetermined goals for each problem. Scoring was better for developmental than multiple choice questions. The experience had a great acceptance among students, that considered as positive features the learning motivation, the stimulus for active participation, the achievement of personal expectancies, the integration of knowledge areas and the encouragement of team work and information seeking.

[Long-term results of an independent study program of electrocardiography applied to medical students]

In medical education, programs that promote independent study are favored over traditional teaching methodologies. Aiming to assess the long term results of this pedagogic approach, fifth year medical students were assigned to receive self instruction modules or expositive lectures on electrocardiography. The knowledge and opinions of these two groups were evaluated two years later. Knowledge assessment was significantly better among students receiving self instruction modules (75.3 +/- 9.3 vs 65.4 +/- 12.9 points, in a scale ranging from 1 to 100 (p < 0.001). The self instruction method and traditional lectures were qualified as very useful by 86.8 and 38.9% of students respectively. It is concluded that self instruction methods have good long term results, when applied to medical students.

[Hypertension in rural communities. Study in the VIII Region, Chile]

The aim of this work was to study the prevalence of hypertension in rural populations of the VIII region of Chile. Six thousand twenty four non institutionalized subjects. 14 years old or older, coming from eight randomly chosen rural communities were studied. Blood pressure was measured by trained personnel in two occasions within 30 minutes; in those classified as hypertensive, a third measurement was performed within 24 hours, eliminating alcohol intake and medications. Results show prevalence rates in the first, second and third measurement of 38.5, 30.8 and 22.8% respectively. The elimination of alcohol intake and medications decreased the prevalence in 3.9%. All the chosen communities has similar rates (19.8 to 21.2%) except Arauco, that had a significantly higher frequency of 31.9%. Zones of extreme ruralness had higher rates than small towns (23.8 vs 21.7%). There was a secular increase in the prevalence of hypertension from 4.9 in the 15 to 24 years old group to 57.8% among people 75 years old or older. Forty three percent of hypertensives were aware of such condition, 26.1% were receiving treatment and in 8.2% it was successful; all these figures were slightly better among women.

[Antihypertensive effect of isradipine: blood pressure determination with continuous ambulatory monitoring]

A 24 hr blood pressure monitoring system (Medilog ABP) was used to evaluate the efficacy of isradipine, 2.5 mg q 12 hr for 2 weeks, in 26 hypertensive patients. During a pretreatment control period of 4 weeks a diastolic pressure above 95 mmHg on non pharmacologic measures was verified in each patient. A significant decrease in systolic and diastolic blood pressures compared at 2 hr intervals was observed after treatment with isradipine. Treatment was not associated to modification of the circadian rythm in blood pressures.

[Percutaneous mitral valvuloplasty as a treatment of choice for mitral stenosis. Immediate results and long-term follow-up]

We evaluated 77 patients with symptomatic mitral stenosis for balloon valvuloplasty. Five patients were excluded from the procedure due to the presence of intra-atrial thrombi or mitral valve endocarditis as detected by 2D echocardiography. The mean age of the 72 treated patients was 38 +/- 11 years, 68 were NYHA functional class II or IV: only 6 patients had valvular calcification. Three patients had severe liver failure, 2 were chronic alcoholics, one had liver cirrhosis, 2 had severe weight loss and 13 had pulmonary hypertension at systemic levels. 69 patients had a technically adequate procedure, one patient died, 1 developed cardiac tamponade and 1 failed. Mitral valve area increased from 0.93 +/- 0.34 to 2.38 +/- 0.67 cm2. Mitral incompetence increased in only 16 patients. After a mean follow up period of 15 +/- 5 months (range 8 to 27), 56 patients remained in FC I or II. Mitral valve area remained satisfactory in 54 patients. Mitral valve anatomy evaluated by echocardiography is helpful to predict immediate and late outcome. We conclude that balloon mitral valvuloplasty is the first choice for patients with severe symptomatic mitral stenosis.