Percutaneous revascularization for ischemic left ventricular dysfunction: Cost-effectiveness analysis of the REVIVED-BCIS2 trial

BACKGROUND: Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone. METHODS: REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors. RESULTS: Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: −0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0. CONCLUSIONS: A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom

Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

Social Discourses on the Teacher Performance Assessment: Media Tales, Twitter Tweets and Leadership Surveys

This paper explores the introduction of the new Teacher Performance Assessment (TPA) for graduate teachers in Australia. We investigate how the broader discussion around TPAs has been understood by multiple agents during an eight-month period from January 2019 to August 2019. Data includes legacy media, social media tweets and a survey of school leaders. The analysis draws on Bernsteinian (1975) theory about the way particular social relations produce differing sentiments of social unity. While eschewing a strict binary, legacy media was characterised by a mechanical solidarity which promoted the TPA as akin to a test. Contributions to social media and responses to the survey suggested an orientation to organic solidarity and a recognition of the complex inter-dependence of specialised roles within initial teacher education. These diverse social discourses carry the potential to influence the broader commission of what counts as graduate teacher quality

Self-Efficacy in a 3-Dimensional Virtual Reality Classroom-Initial Teacher Education Students’ Experiences

This study explores initial teacher education (ITE) university students’ experiences of work-integrated-learning (WiL) placements in a virtual reality environment. The COVID-19 pandemic was the catalyst for this study when schools around the world were inaccessible to ITE students. Undertaking WiL, which is typically a mandated component of ITE programs, became challenging, if not impossible. In this uncertain environment and the broader context of a nation-wide teacher shortage in Australia, the need to pivot and consider alternatives became a high priority. This study reports on a simulated experimental space as an alternative WiL for ITE students in a virtual classroom environment, exploring the impact on the self-efficacy of the participants. The ITE students explored the platform as a teaching space, designing, delivering and participating in lessons. Data about their experiences were collected utilising a multi-methods design comprised of self-efficacy surveys and self-reflections. The findings reveal: (i) an increase in self-efficacy upon completion of the experience, with a small decline post program; and (ii) reported development of technological and pedagogical confidence. These findings contribute to the field as low teacher self-efficacy is identified as one of the inhibitors for the integration of technology in teacher education. This study provides an insight into the transformative potential of enhancing ITE students’ self-efficacy in simulated, virtual environments.</p

learning@home Wil Initiative Evaluation

The learning@home Work Integrated Learning (WiL) Initiative (hereafter WiL Initiative) was introduced as an alternative to graduate stage Professional Experience (PEx) placements for final year Initial Teacher Education (ITE) students during April 2020. The WiL Initiative was introduced due to the COVID-19 restrictions which interrupted PEx placements in schools. Five Queensland Universities and a total of 211 ITE students engaged in the WiL Initiative comprising: Griffith University (105 students), Australian Catholic University (54), University of the Sunshine Coast (23), James Cook University (20), and Central Queensland University (9)

learning@home WIL Initiative Evaluation

The learning@home Work Integrated Learning (WiL) Initiative (hereafter WiL Initiative) was introduced as an alternative to graduate stage Professional Experience (PEx) placements for final year Initial Teacher Education (ITE) students during April 2020. The WiL Initiative was introduced due to the COVID-19 restrictions which interrupted PEx placements in schools. Five Queensland Universities and a total of 211 ITE students engaged in the WiL Initiative comprising: Griffith University (105 students), Australian Catholic University (54), University of the Sunshine Coast (23), James Cook University (20), and Central Queensland University (9).The WiL Initiative was led by a partnership between the Queensland Council of Deans of Education (QCDE), a network of ten Queensland based universities, and the Queensland Department of Education (DoE), in collaboration with key stakeholders. The WiL Initiative was prompted by the opportunity to make a positive contribution to an initiative already underway. The WiL Initiative consisted of graduate stage activities and assessments delivered in an online teaching environment that complemented the Queensland Department of Education (DoE) learning@home platform. The notion of providing sequences of supplementary materials to enhance learning at home was a key foundation for the collaboration. ITE students worked closely with - and were supported by - university academic teams and DoE mentors.This evaluation is based on surveys that were administered to the population of ITE students, mentors and academic staff participants in order to understand the impact and success of the WiL Initiative and to inform future models. Fifty-three students, representing a 28% response rate; seven mentors, representing a 100% response rate; and 14 academic staff, representing a 79% response rate participated in the survey.The findings reveal the initiative was well-received by each of the three groups. ITE student survey results reveal that aspects of the initiative such as collaborating with fellow students, department mentors and university staff were a highlight. In addition, the opportunity to develop and use skills in technology for online classroom delivery was identified as a positive outcome. The academic staff survey results also reveal that opportunities for collaboration were positive experiences, as were the foci of the initiative on professional learning and the assessment of authentic deliverables (i.e. video and audio tasks to support the learning@home platform). Similarly, mentors identified the positives as working closely with Initial Teacher Education students, the opportunity for professional learning, and the provision of feedback to ITE students’ scripts and audios. Both ITE student and academic staff.School of Education and Professional Studies, Griffith University, 2020 5respondents rated the collaboration with parent groups and sector representatives less highly, and this area of collaboration was not applicable to Department of Education mentors. This is an area that could be further developed in future related initiatives and it is noteworthy that for the purposes of this evaluation, no data were collected to establish feedback from other stakeholders, including parent groups and the Queensland College of Teachers.The surveys included a future vision component, specifically seeking feedback from ITE students, the academic staff and mentors with the view to continually improving the initiative. Academic staff provided feedback on some of these challenges, including understanding requirements (4 mentions) and timeframes (7 mentions). Some mentors reported that the student-to-mentor ratio was challenging (3 mentions), and clearer guidance on lesson sequencing (3 mentions) was required. More than half of the ITE students surveyed indicated they felt the ‘in-person’ PEx opportunities usually undertaken in schools remain the most effective learning environment for initial teacher education.In summary, this evaluation reveals that the approach facilitated the development of additional skills for all participants involved, and achieved the aim of providing a structured, graduate stage PEx learning initiative for ITE students in their final semester of study, in readiness to join the teaching profession when they otherwise might not have had the opportunity to do so. The themes identified in the six key learnings acknowledge the strengths of the initiative and the points of process that warrant attention in any future offering and are related to:• Use of technology• Working collaboratively• Demonstrating the achievement of the Australian Professional Standards for Teachers• The nature of professional experience• Process and product• Feedback and reflectio

Spaces to care and places to share : Fostering a sense of belonging during the global pandemic through digitally mediated activity

In this chapter, the authors use the sensitivities and awareness encouraged by visual ethnographers to provide snapshots of various moments in time experienced by the people in our work community during the pandemic. They present still life images offering proof that there was, indeed, still life in our community, despite our circumstances. Collecting visual artefacts as part of a research project is a well-established practice. Researchers conducting ethnography or case studies, for example, have long embraced visual texts for their capacity to enhance “the richness” of other forms of qualitative or quantitative data, allowing researchers to exceed the boundaries of the written word when attempting to capture and communicate insights in different, and often challenging ways. Self-care refers to intentional actions that foster protective factors for both individual and collective wellbeing. Self-care can change the behaviour and frames of mind that are actioned with the conscious intention to build resilience, confidence, self-reliance and a sense of wellbeing.</p

Oracle ® Database High Availability Overview 11g Release 2 (11.2)

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Mass spectrometry and potentiometry studies of Al( iii

Here we have studied the complexation of naringin with Al(iii) under physiological conditions (i.e., at 37 °C and in 0.16 mol L−1NaCl)

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction