Managing large-enrollment courses in hybrid instruction mode

This essay addresses the hitches and glitches in the hybrid instruction system of teaching and learning for large-enrollment courses. This new instructional methodology asks facilitators to redesign their entire traditional teaching and learning practices. The nature of subject to be taught via the hybrid mode further affects the success rate of the modules from the time of inception to launch to actual delivery and completion of the course. The entire process involves undoing the old habits and methodologies and instructors picking up new skills, along with the right motivation to take up the task. The course planning and delivery require a substantial commitment in terms of hours from the instructors catering to large-enrollment courses, along with pursuing their routine roles at the campuses. From the pupil’s perspective, the response varies, as hybrid learning seeks self-discipline and time management skills from the learner. After the initial roadblocks, students enjoy hybrid learning if the course structure and instructions are simple and the course content flexible and varied. We will study the problems and possible solutions to the success of the hybrid teaching–learning system at each stage where large number of students enrolled for a specific course.

Conservative management in very elderly patients with severe aortic stenosis: Time to change?

Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. Consecutive patients with severe aortic stenosis diagnosed at 48 centers during January 2014 were included. Baseline clinical characteristics, echocardiographic data, Charlson index, and EuroSCORE-II were registered, including vital status and performance of valve intervention during one-year follow-up. For the purpose of this substudy we assessed symptomatic patients undergoing conservative management, including them in 5 groups according to the reason for performing conservative management [I: comorbidity/frailty (128, 43.8%); II: dementia 18 (6.2%); III: advanced age 34 (11.6%); IV: patients’ refusal 62 (21.2%); and V: other reasons 50 (17.1%)]. We included 292 patients aged 81.5 ± 9 years. Patients from group I had higher Charlson index (4 ± 2.3), higher EuroSCORE-II (7.5 ± 6), and a higher overall (42.2%) and non-cardiac mortality (16.4%) than the other groups. In contrast, patients from group III had fewer comorbidities, lower EuroSCORE-II (4 ± 2.5), and low overall (20.6%) and non-cardiac mortality (5.9%). Patients with severe symptomatic aortic stenosis managed conservatively have different baseline characteristics and clinical course according to the reason for performing conservative management. A prospective assessment of comorbidity and other geriatric syndromes might contribute to improve therapeutic strategy in this clinical setting.