A total of 1,431 patients (mean age 63.4 +/- 14.1) with pacemakers (96.2% VVI) primoimplanted between 1967 and 1985 were followed for a mean duration of 78.2 +/- 40 pacing months, with 0.6% loss to follow-up. Cumulative survival for 1, 3, and 10 years was 0.9427, 0.9136, and 0.7536, respectively. There was no significant difference in survival between atrioventricular block (AVB) and sick sinus syndrome (SSS) patients. In addition to age and gender, factors existent prior to implantation that independently affected prognosis included manifest coronary heart disease (CHD), congenital/acquired heart lesions, heart failure, noncardiac internal disease, syncope, and generalized fatigue. After implantation, the most important factor was generalized fatigue, then age, stroke, myocardial infarct (MI), gender (male), heart failure, and syncope. Patients with no underlying disease showed an extremely high cumulative survival (0.9173 at 10 years). Compared to the general population of Yugoslavia, the pacemaker patients showed a similar yearly mortality rate until 1981. After that, elderly males (70+) had a significantly lower yearly mortality than the matched population. Thus, in this large series of pacemaker patients followed into the most recent period with an extremely low loss to follow-up, short- and long-term survival was very high. Pacemaker patients of any age who are otherwise in good health have an excellent prognosis.
Cardiac resynchronization therapy (CRT) has important role in the contemporary treatment of heart failure, systolic dysfunction and mechanical disynchrony. Classical indications for CRT are severe heart failure (NYHA class IlI or IV), a broad QRS (more than 120 ms) and left ejection fraction less than 35% despite optimal medical therapy. Several have studies demonstrated the important role of echocardiography in patient selection for CRT, follow up and estimation of CRT effects, as well as the optimization of biventricular pacemaker. Basically, there are three types of cardiac asynchrony: interventricular asynchrony, between the right and left ventricle, intraventricular asynchrony, between the myocardial segments within the left ventricle and atrioventricular asynchrony, between the atria and ventricles. Although many echocardiographic techniques are used in patient selection for CRT, no ideal approach has yet been found.There are several techniques and parameters used in the assessment of myocardial asynchrony: two dimensional (2D) echocardiography, one dimensional echocardiography (M-mode), Doppler echocardiography, different modalities of tissue Doppler including Colour Coded Tissue Doppler Imaging--TDI, measurements of local tissue deformation indices (strain and strain rate), speckle tracking, 3D echocardiography, semiquantitative assessment of myocardial border, vector velocity imaging. Each of these techniques has advantages and limitations. A special accent in this revue is on the consensus report from the American Society of Echocardiography Dyssynchrony Writing group. According to this consensus report colour coded tissue Doppler is the most appropriate technique for myocardial asynchrony estimation and patients selection for CRT. The same group recommended that definitive decision for CFT implantation should not be based only on echocardiographic analysis, but rather on the whole clinical aspect of the patient.
The increased BNP levels can be valuable for early screening of patients with higher risk of heart failure. In patients with increased BNP at the time of pacemaker implantation, DDD pacing is a modality of choice.
Optimal management of patients treated with CRT integrate both clinical and echocardiographic follow-up with, if needed, echocardiographically guided optimization of AV and VV delays, which offers the possibility of additional clinical improvement in such patients.
Significant HRV reduction is a precursor to incipient heart failure (NYHA I). In heart failure progression, total power as well as the power of all spectral components is progressively reduced. LF and Tot Power are the most prominent parameters for discriminating between the different stages of heart failure. These results could promote HRV as an important decision-making tool in heart failure treatment as well as in monitoring the results of that treatment.
U ovom istraživanju prikazana je eksperimentalna primjena OBN modela učenja u nastavi. Radi se o odvajanju bitnog od nebitnog, OBN modelu koji je primijenjen u eksperimentu sa rotacijom grupa. Naime, prvo su tri odjeljenja drugog, trećeg i četvrtog razreda vježbala primjenu OBN modela na 12 časova, a tri paralelna odjeljenja predstavljala su K-grupu i radila po tradicionalnom nastavnom modelu. Nakon 12 časova mjereni su efekti primjene OBN modela u E-grupi i tradiocionalne nastave u K-grupi. Potom su učenici K-grupe radili 12 časova uz primjenu OBN modela, a E-grupa je radila po tracionalnom nastavnom modelu. Nakon toga izvršena su ponovna mjerenja. Mjerena je motivisanost učenika, zatim kako oni vrednuju gradivo i koliko su zapamtili najbitnije činjenice iz gradiva koje rade. Pokazalo se da OBN model daje bolje efekte u motivaciji, vrednovanju gradiva te u pamćenju činjenica.
SUMMARYThe present study shows an experimental application of the SRI model of studying in teaching. We are talking about separating the relevant from the irrelevant, i.e. the SRI model which was applied in a group rotation experiment. Namely, the first group, which included the second, the third and the fourth class, applied the mentioned model for twelve lessons, and three parallel classes represented group K, which applied traditional teaching models. After the twelve lessons the effects of the SRI model in group E and traditional teaching in group K were measured. Then, the students from group K applied the SRI model for twelve lessons, and group E applied traditional teaching models. Again, with the completion of both, measurements were conducted once again. The measurement included students' motivation, the way they evaluated the material and how many important facts they memorized from the material. The results show that the application of the SRI model gives better effects when it comes to motivation, evaluation of the material and memorizing facts.
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