Risk of stroke and bleeding in relation to hypertension in anticoagulated patients with atrial fibrillation: a meta-analysis of randomised controlled trials.

Background and purpose Hypertension is common in patients with atrial fibrillation (AF) and carries an additional risk for complications, most notably stroke and bleeding. We assessed the history of hypertension, level of blood pressure control, and an interaction with the choice of oral anticoagulants on clinical outcomes. Methods We performed a systematic review and meta-analysis of studies that randomised patients to novel oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) and reported outcomes stratified by presence of hypertension. Collected outcomes were: ischaemic stroke or systemic embolism (SE), haemorrhagic stroke, intracranial haemorrhage and major bleeding. Log adjusted hazard ratios (HR) and corresponding standard error were calculated, and HRs were compared using Mantel-Haenszel random effects. Quality of the evidence was assessed with Cochrane risk of bias tool. Results Five high-quality studies were eligible, including 71.527 participants who received NOACs (apixaban, dabigatran, edoxaban, rivaroxaban) or VKAs, with median follow-up of 1.8-2.8 years. Compared with patients without hypertension, those with hypertension had higher adjusted risk for ischaemic stroke/SE (HR: 1.25, 95%-CI:1.09, 1.43) and haemorrhagic stroke (HR:1.98, 1.24-3.16). On a continuous scale, the risk of ischaemic stroke/SE increased 6-7% per 10 mmHg increase in systolic blood pressure. No interactions were found between the efficacy or safety of NOACs versus VKAs in the presence or absence of hypertension. In both groups, the use of NOACs led to a lower risk of ischaemic stroke/SE, haemorrhagic stroke and intracranial haemorrhage compared with patients that used VKAs. Conclusions Adequate blood pressure management is vital to optimally reduce the risk of stroke in patients with atrial fibrillation. The benefits of NOACs over VKAs, also apply to patients with elevated blood pressure

Video instruction with explanation to another person for intellectually disabled students

Intellectually disabled (ID) students in secondary education are often taught in an individual setting where video instruction is used. Especially, when the instruction is about complex assignments, many students may forget parts of it. In this study, we tried to find out if prompting ID students to explain video instruction would help them to improve their performance. Research with regular students indicated that explaining instructional materials can be effective (Roy & Chi, 2005). In a first experiment with 41 ID students in Dutch secondary education, we varied the complexity of assignments and compared students who first watched and then explained video instruction of assignments (n=21) with students who watched twice but were not required to explain (n=20). It turned out that only for complex assignments, explaining to another person was more effective for students' task performance than just watch video instruction. In the second experiment with 58 ID students, we repeated the study with complex assignments. The students in the experimental group (n=29) improved more after explaining video instructions than the students who only watched videos (n=29). The experimental group also had a more complete mental representation of an assignment and could better assess how well they had performed it

Developing classroom formative assessment in dutch primary mathematics education

In the last two decades Dutch primary school students scored below expectation in international mathematics tests. An explanation for this may be that teachers fail to adequately assess their students’ understanding of learning goals and provide timely feedback. To improve the teachers’ formative assessment practice, researchers, curriculum experts and teachers worked together to develop a model for classroom formative assessment (CFA). In three pilot studies, six teachers from three different schools implemented the CFA-model and evaluated its feasibility together with the researchers by means of checklists. The CFA-model was primarily changed with regard to the assessment techniques. Teachers indicated that classroom management and preparation time were preconditions for an optimal implementation. Analysis of covariance was used to explore students’ learning outcomes. The results showed that a correct implementation of the CFA-model might result in the enhancement of students’ mathematical performance. The implications of the three pilots for the implementation of the CFA-model on a larger scale are discussed

Factors contributing to the distress, concerns, and needs of UK Neuroscience health care workers during the COVID-19 pandemic

COVID‐19 research from China suggests health care workers are at risk of distress, have specific concerns, and need support. It remains unknown whether findings are applicable to UK health care staff and whether psychological support based on generic approaches is effective. We administered an online survey at a leading neuroscience hospital in the UK to examine how individual staff characteristics contribute to distress, concerns, and interventions most valued during the COVID‐19 pandemic. We found a high incidence of distress, particularly in females and staff with previous mental health history. Concerns fell into three factors: ‘risk of infection’, ‘work challenges’, and ‘social change’, and were affected by professional role and contact with COVID‐19 patients. These three factors predicted distress. Psychological support and clear updates were deemed most useful, with specific needs affected by age, professional role, and contact with COVID‐19 patients. This is the first documentation of a high incidence of psychological distress predicted by three types of concerns in health care workers of a neuroscience hospital. Distress, concerns, and interventions most valued were all affected by individual staff characteristics. These findings highlight the importance of providing stratified, one to one support interventions, tailored to professional group, and background, rather than more generic approaches