Risk stratification in diabetic patients with a previous myocardial infarction

We used Kaplan-Meier 2-year survival analysis on CAST registry patients to estimate prognostic power of VPC frequency (≥10/hr), presence of nonsustained ventricular tachycardia (NSVT), left ventricular ejection fraction, and presence of diabetes. We also used meta-analysis of reports in the literature to estimate prognostic power of signal-averaged electrocardiogram (SAECG) and electrophysiological tests (EPS) as well as VPCs, NSVT, and LVEF. Combined results from CAST analysis and literature meta-analysis yielded sensitivity and specificity for VPCs, NSVT, SAECG, LVEF, Diabetes, and EPS. The overall 2 year event rate for life-threatening arrhythmias or death was 7.88% for 51,144 cases in the combined CAST and literature data. After segmenting the population 21.3% were diabetic with a predicted 2 yr event rate of 13.5% and 78.7% were nondiabetic event rate of 6.4%. We defined low risk as <10% and high risk as ≥30%. Otherwise predicted event rate was classified as “unstratified.” When all possible combination of noninvasive tests were applied, a prominent difference in the proportions of cases at risk between the diabetics and nondiabetics was revealed. When the unstratified cases were subsequently tested with EPS, the difference between the two groups was even more marked.     

The effectiveness of humanoid diagram teaching strategy on care capacity and retention in novice nurses

AimTo examine the effectiveness of a Humanoid Diagram Teaching Strategy (HDTS) on care capabilities and retention of novice nurses.BackgroundGuiding novice nurses in clinical practice is a matter of concern and the use of diagrams in assisting the learning process and to promote learning efficiency has been acknowledged.DesignThis is a quasi-experimental study with asynchronous repeated measurements for the experimental and control groups.MethodsThe study was conducted in a medical centre in southern Taiwan with 24 novice nurses. The intervention, Humanoid Diagrams Teaching Strategy, contained three parts: the head and neck; trunk; and limbs. The HDTS was applied three time weekly. Each session lasted approximately 30 min and the training lasted 4 weeks. The effectiveness of HDTS was measured using Mini-CEX, CbD and retention rates in the 3rd and 6th months of novice nurses’ experience.ResultsAfter the HDTS, although increases in mini-CEX and CbD scores in the experimental group were greater than the control group, these differences were not statistically significant after considering the time interaction. But the 3rd month and 6th month novice nurses’ retention rates were statistically significantly different by comparing the differences under the time interaction effects in both groups.ConclusionsThe Humanoid Diagram Teaching Strategy is an effective tool for preceptors to use in assisting novice nurses in learning, improving their nursing care knowledge and technical skills and to increase their retention rate.     

Composite Behavior of Insulated Concrete Sandwich Wall Panels Subjected to Wind Pressure and Suction

A full-scale experimental test was conducted to analyze the composite behavior of insulated concrete sandwich wall panels (ICSWPs) subjected to wind pressure and suction. The experimental program was composed of three groups of ICSWP specimens, each with a different type of insulation and number of glass-fiber-reinforced polymer (GFRP) shear grids. The degree of composite action of each specimen was analyzed according to the load direction, type of the insulation, and number of GFRP shear grids by comparing the theoretical and experimental values. The failure modes of the ICSWPs were compared to investigate the effect of bonds according to the load direction and type of insulation. Bonds based on insulation absorptiveness were effective to result in the composite behavior of ICSWP under positive loading tests only, while bonds based on insulation surface roughness were effective under both positive and negative loading tests. Therefore, the composite behavior based on surface roughness can be applied to the calculation of the design strength of ICSWPs with continuous GFRP shear connectors.