Clinical impact of repolarization changes in supine versus upright body position

Background: The impact of postural changes on various electrocardiography (ECG) characteristics has only been assessed in a few small studies. This large prospective trial was conducted to confirm or refute preliminary data and add important results with immediate impact on daily clinical practice. Methods: ECGs in supine and upright position from 1028 patients were analyzed. Evaluation was made according to changes in T-wave vector and direction, ST-segment deviation, heart rate, QT interval and QTc interval was performed. Findings were correlated with the medical history of patients. Results: Positional change from supine to upright resulted in a significantly increased heart rate (8.05 ± 7.71 bpm) and a significantly increased QTc interval after Bazetts (18 ± 23.45 ms) and Fridericas (8.84 ± 17.30) formula. In the upright position significantly more T-waves turned negative (14.7%) than positive (5.7%). ST elevation was recorded in only 0.4% and ST depression in not more than 0.2% of all patients. Conclusions: The majority of the patients do not show significant morphological changes in their ECG by changing the body position from supine to upright. Changes of QTc time instead, are significant and the interval might be overestimated in upright. Therefore assessment of the QTc interval should strictly be done in a supine position

Problem-solving in virtual environment simulations prior to direct instruction for differential diagnosis in medical education: An experimental study

Background Despite acquiring vast content knowledge about the functioning of the human body through university teaching, medical students struggle to transfer that knowledge to one of the core disciplinary practices – differential diagnosis. The authors aimed to overcome this problem by implementing computer-based virtual environment simulations in medical education courses. Methods In an experimental study, the authors compared problem-solving in medical computer-based virtual environment simulations prior to instruction with an instruction-first approach. They compared the effects on isomorphic testing and transfer performance of clinical knowledge and clinical reasoning skills as well as evoked learning mechanisms. The study took place in spring 2021 with undergraduate medical students in the scope of a medical trajectory course. Due to Corona-Virus-19 measures participants completed all study activities remotely from home. Results The authors did not find any learning activity sequence to be superior to the other. However, when looking at the two learning activities individually, they found that problem-solving in computer-based virtual environment simulations and direct instruction might be equally effective for learning content knowledge. Nevertheless, problem-solving in computer-based virtual environment simulations with formative feedback might be more effective for learning clinical reasoning skills than mere instruction. Conclusions The findings indicate that problem-solving in computer-based virtual environment simulations might be more effective for learning clinical reasoning skills than mere theoretical instruction. The present study has a high level of ecological validity because it took place in a realistic setting where students had to perform all learning and testing tasks autonomously

Moderne Rehabilitation

Risikomodifikation durch Lebensstil ist ein zentrales Element in der Prävention und Behandlung kardiovaskulärer und zerebraler Erkrankungen. Durch eine optimale Kontrolle der klassischen beeinflussbaren kardiovaskulären Risikofaktoren kann das Risiko effizient reduziert werden. Für den Hirnschlag stellt die arterielle Hypertonie den mit Abstand wichtigsten behandelbaren Risikofaktor dar; bei jüngeren Patienten gehören Nikotinkonsum und Adipositas dazu. Eine Minimierung des Risikos für kardiovaskuläre und zerebrale Ereignisse kann durch zusätzliche «Lifestyle-Faktoren», wie etwa eine gesunde, ausgewogene Ernährung und regelmässige körperliche Aktivität erreicht werden. Ergänzend wird gesunder, tiefer Schlaf als Präventionsmassnahme diskutiert, da chronisch gestörter Schlaf mit Neurodegeneration, Gehirnstörungen, und kardiovaskulären Ereignissen assoziiert wird. Schon relativ kleine Veränderungen einzelner, verhaltensbezogener Risikofaktoren können das Gesamtrisiko für kardiovaskuläre Ereignisse minimieren und die Gehirngesundheit verbessern. = Risk modification through lifestyle is a key element in the prevention and treatment of cardiovascular and cerebral diseases. By optimally controlling the classical, modifiable cardiovascular risk factors the risk can be reduced efficiently. As to stroke, arterial hypertension is by far the most important treatable risk factor; in younger patients smoking and obesity are among the most important ones. Minimizing the risk of cardiovascular and cerebral events can be achieved through additional «lifestyle factors», such as a healthy, balanced diet and regular physical activity. In addition, healthy, deep sleep is discussed as a preventive measure, since chronically disturbed sleep is associated with neurodegeneration, brain disorders and cardiovascular events. Even relatively small changes in individual, behavioral risk factors can minimize the overall risk of cardiovascular events and improve brain health. = La modification du risque grâce au style de vie est un élément clé pour prévenir et traiter les affections cardio- et cérébro-vasculaires. En contrôlant optimalement les facteurs de risque classiques et modifiables, le risque peut être diminué de façon efficace. Pour l’accident vasculaire cérébral, l’hypertension artérielle représente de loin le facteur de risque traitable le plus important ; chez les malades plus jeunes le tabagisme et l’obésité appartiennent aux facteurs de risque prédominants. Il est possible de diminuer au maximum les événements cardio- et cérébro-vasculaires en intervenant au niveau de facteurs de risque liés au style de vie, notamment en suivant une diète balancée et une activité physique régulière. De plus, un sommeil sain et profond est discuté comme une mesure préventive puisqu’un sommeil perturbé chroniquement est associé à une dégénération neuronale et à des troubles cérébraux et cardiovasculaires. Même de petits changements des facteurs de risque individuels liés au comportement peuvent minimiser le risque cardiovasculaire global et améliorer la santé du cerveau

Clinical impact of repolarization changes in supine versus upright body position

BACKGROUND The impact of postural changes on various electrocardiography (ECG) characteristics has only been assessed in a few small studies. This large prospective trial was conducted to confirm or refute preliminary data and add important results with immediate impact on daily clinical practice. METHODS ECGs in supine and upright position from 1028 patients were analyzed. Evaluation was made according to changes in T-wave vector and direction, ST-segment deviation, heart rate, QT interval and QTc interval was performed. Findings were correlated with the medical history of patients. RESULTS Positional change from supine to upright resulted in a significantly increased heart rate (8.05 ± 7.71 bpm) and a significantly increased QTc interval after Bazetts (18 ± 23.45 ms) and Fridericas (8.84 ± 17.30) formula. In the upright position significantly more T-waves turned negative (14.7%) than positive (5.7%). ST elevation was recorded in only 0.4% and ST depression in not more than 0.2% of all patients. CONCLUSIONS The majority of the patients do not show significant morphological changes in their ECG by changing the body position from supine to upright. Changes of QTc time instead, are significant and the interval might be overestimated in upright. Therefore assessment of the QTc interval should strictly be done in a supine position