Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Considering User Knowledge In The Evaluation Of Training System Usability

A variety of software-based systems are being used as training media. There is not, however, an accepted approach to evaluating the usability of these systems. Traditional usability approaches can be employed with some effectiveness, but they may lack appropriate specificity for use in training. In this paper, we evaluate whether assessing, and remediating, gaps in learner knowledge might be an important addition to training system evaluation. The results suggest that remediating knowledge gaps might lead to more accurate usability conclusions. © 2009 Springer Berlin Heidelberg

Pulse!!: Designing Medical Learning In Virtual Reality

Pulse!! The Virtual Clinical Learning Lab is designed to transfer and further develop state-of-the-art game design and technology to create subject matter for teaching critical thinking skills in experiential medical learning in virtual reality. The underlying design principles of Pulse!! include real-time feedback, repetitive practice, controlled environment, individualized learning, defined outcomes and educational validity. Pulse!! development incorporated evaluation issues early in the design cycle. The Pulse!! evaluation process ensures that the learning platform meets standards as rigorous as that required by military simulation systems and educational accrediting bodies. The Pulse!! method of case and technology development indicates that virtual-world educational platforms must be not only user-friendly, visually effective, interactively immersive and fluid but also procedurally rooted in curriculum, rich in readily-accessible information and cognizant of actual practice in the real world. © 2010, IGI Global

Using Virtual Worlds To Assist Distributed Teams

Virtual worlds and massively multiplayer online games are becoming a useful tool for distributed teams. From providing a common working place, to allowing members of the team to interact in a physical albeit virtual form, virtual worlds are setting a new standard for tools to facilitate interactions between members of distributed teams. This chapter explores the ways in which virtual worlds could support interactive teams at a greater fidelity then that of the previous generation of groupware tools using a popular virtual world, Second Life as an example. While providing specific examples of how Second Life\u27s current and planned feature sets could already support distributed teams, that is, teams whose members are geographically disbursed. New features that would provide additional support for these types of teams are also discussed. © 2008, IGI Global

Using Virtual Reality With And Without Gaming Attributes For Academic Achievement

A subcategory of computer-assisted instruction (CAI), games have additional attributes such as motivation, reward, interactivity, score, and challenge. This study used a quasi-experimental design to determine if previous findings generalize to non simulation-based game designs. Researchers observed significant improvement in the overall population for math skills in the non-game CAI control condition, but not in the game-based experimental condition. The study found no meaningful significant differences in language arts skills in any of the conditions. This finding has implications for the design of future learning games, suggesting that a simulation-based approach should be integrated into the gaming technology. © 2006 Taylor & Francis Group, LLC. All rights reserved