Declining skills in auscultation of the heart prompted an evaluation of teaching methods for medical students. A comparison of classroom teaching and computer-aided independent learning of auscultation was carried out with two groups of approximately 20 second-year medical students. Both groups used approximately 20 recorded normal and abnormal heart sounds and murmurs, chosen to illustrate learning issues. For the classroom group a cardiologist presented each case through multiple stethophones and led the discussion. The individual study group used a new CD-ROM collection of cases and recordings in quiz format, with a hypertext link to a comprehensive text on auscultation and additional recordings. Students were tested with 16 multiple choice and 5 open questions on eight selected recordings, and evaluated the teaching by questionnaire. The classroom-taught students scored higher on open questions than the CD-ROM-taught group, but in general performance by both groups was satisfactory and equivalent. Students of both groups repeatedly had difficulty classifying regurgitant and ejection murmurs and identifying characteristics of the second heart sound. Both CD-ROM and classroom teaching methods were highly rated by students but most students preferred a combination.

The cardiac auscultation skills of a group of volunteer family physicians showed low initial scores that improved significantly after self-study with a CD-ROM instructional program. The program was a valuable self-instructional aid, and physicians used it as a resource in clinical practice. However, only 50% of the initial group completed the self-study and returned for final assessment. Providing more support and assistance in the initial phase, especially with computer use, may enable completion of similar computerized self-study programs.

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In four young infants with symptomatic coarctation of the aorta the narrow aortic segment was dilated with a balloon angioplasty catheter. Three of the infants also had appreciable heart defects and one infant had undergone surgery before and had had one previous dilatation. Dilatation was well tolerated and good femoral pulses appeared in all cases, but these disappeared over one to seven days. Despite this, two patients showed some symptomatic improvement over four months. One patient died after perforation of the aorta by an angiographic catheter after dilatation. Relieving coarctation in young infants by catheter dilatation appears incomplete, but it may give symptomatic improvement. Further trial of the procedure will determine whether patients who have undergone surgery and those who have not may benefit. Careful attention to technique and avoidance of manipulations after dilatation are essential if complications are to be avoided.

Evaluation of an in situ spatial resolution instrument for fixed beds through the assessment of the invasiveness of probes and a comparison with a micro kinetic model.