Virtual simulation might be effective for enhancing nursing students’ learning. We conducted an integrative review to identify the educational characteristics of virtual simulation in nursing ...education.
We used Whittemore and Knafl’s (2005) integrative review method. We searched for studies in PubMed, Medline, and CINAHL, and 40 studies met the inclusion criteria.
We identified the general and virtual-specific characteristics of virtual simulation. The educational effects of virtual simulation were achieved through integration of virtual and general simulation strategies to promote learner engagement.
Virtual simulation might be an effective educational strategy for increasing learner engagement. To promote learner achievement, we recommend designing virtual simulations using the characteristics we identified.
•Educational characteristics of virtual simulation in nursing need to be clarified for constructing effective educational strategies.•There were general simulation characteristics and virtual-specific characteristics in virtual nursing simulation. The educational effects of virtual simulation were achieved through the integration of virtual and general simulation strategies to promote learner engagement.•Nursing educators designing integrative learning can use virtual nursing simulation for their educational platform.•Educational characteristics for virtual simulation should be selected based on the evidence to support effective educational strategies.•Effectively designed virtual simulation focused on learner engagement can lead to successful learning outcomes.
Theoretical models capture very precisely the behaviour of magnetic materials at the microscopic level. This makes computer simulations of magnetic materials, such as spin dynamics simulations, ...accurately mimic experimental results. New approaches to efficient spin dynamics simulations are limited by integration time step barrier to solving the equations-of-motions of many-body problems. Using a short time step leads to an accurate but inefficient simulation regime whereas using a large time step leads to accumulation of numerical errors that render the whole simulation useless. In this paper, we use a Deep Learning method to compute the numerical errors of each large time step and use these computed errors to make corrections to achieve higher accuracy in our spin dynamics. We validate our method on the 3D Ferromagnetic Heisenberg cubic lattice over a range of temperatures. Here we show that the Deep Learning method can accelerate the simulation speed by 10 times while maintaining simulation accuracy and overcome the limitations of requiring small time steps in spin dynamic simulations.
We hypothesized that spatial heterogeneity exists between recurrent and non-recurrent regions within a tumor. The aim of this study was to determine if there is a difference between radiomics ...features derived from recurrent versus non recurrent regions within the tumor based on pre-treatment MRI. A total of 14 T4NxM0 NPC patients with histologically proven "in field" recurrence in the post nasal space following curative intent IMRT were included in this study. Pretreatment MRI were co-registered with MRI at the time of recurrence for the delineation of gross tumor volume at diagnosis(GTV) and at recurrence(GTVr). A total of 7 histogram features and 40 texture features were computed from the recurrent(GTVr) and non-recurrent region(GTV-GTVr). Paired t-tests and Wilcoxon signed-rank tests were carried out on the 47 quantified radiomics features. A total of 7 features were significantly different between recurrent and non-recurrent regions. Other than the variance from intensity-based histogram, the remaining six significant features were either from the gray-level size zone matrix (GLSZM) or the neighbourhood gray-tone difference matrix (NGTDM). The radiomic features extracted from pre-treatment MRI can potentially reflect the difference between recurrent and non-recurrent regions within a tumor and has a potential role in pre-treatment identification of intra-tumoral radio-resistance for selective dose escalation.
Objective
We aimed to determine whether methotrexate (MTX) treatment in patients with rheumatoid arthritis (RA) leads to the development of non-alcoholic fatty liver (NAFL).
Method
Data were derived ...from records of all patients with RA who underwent abdominal ultrasonography at the Jeonbuk National University Hospital. Patients with ultrasound-proven NAFL were identified, and those without NAFL were matched by age and sex using the propensity score matching method at 1:3 ratio. We also analyzed the Health Insurance Review and Assessment Service-National Patient Samples, a nationwide cohort database, to determine the association between MTX use and NAFL in a large number of patients (
n
= 24,653).
Results
In the hospital cohort, 92 patients with NAFL did not show significant differences in the cumulative MTX dose when compared with the no-NAFL group (
n
= 276) (1908.5 ± 1757.5 vs. 1948.6 ± 2118.8 mg,
p
= 0.911). The prevalence of NAFL was not significantly different across strata of cumulative MTX dose. Multiple logistic analyses identified hypertriglyceridemia (OR, 4.88 95% CI, 1.13–20.93) and higher body mass index (OR, 1.22 95% CI, 1.05–1.41) as being associated with an increased risk of NAFL. In the nationwide cohort, the MTX exposure rate between the NAFL and no-NAFL groups was not significantly different.
Conclusions
Collectively, no significant association between NAFL development and administration of MTX was detected in this study. Our results suggest that it is more efficient to adjust for individualized risk factors for NAFL prevention rather than discontinuation of MTX in patients with RA.
Key Points
• NAFLD has been highlighted with increasing prevalence worldwide and possible progression to end-stage liver disease.
• Cumulative dose or exposure history of MTX does not show a significant association with NAFLD prevalence.
• Modifying well-established risk factors is more efficient in NAFLD prevention rather than discontinuation of MTX.
Concomitant percutaneous transluminal angioplasty (PTA) at the time of percutaneous coronary intervention (PCI) is often performed because lower extremity artery disease (LEAD) commonly coincides ...with coronary artery disease. We investigated the impact of concomitant PTA on both cardiovascular and limb outcomes in the Korean National Health Insurance Service registry. Among 78,185 patients undergoing PCI, 6563 patients with stable LEAD without limb ischemia were included. After 1:5 propensity score matching was conducted, 279 patients in the PTA + PCI group and 1385 patients in the PCI group were compared. Multivariate Cox proportional hazard models showed that the risk of all-cause death was higher in the PTA + PCI group than in the PCI group, whereas the risks of myocardial infarction, repeat revascularization, stroke, cardiovascular death and bleeding events were not different between the 2 groups. In contrast, the risks of end-stage renal disease and unfavorable limb outcomes were higher in the PTA + PCI group. Mediation analyses revealed that amputation and PTA after discharge significantly mediated the association between concomitant PTA and all-cause death. Concomitant PTA was not associated with an increased risk of cardiovascular events but may increase the risk of all-cause death mediated by unfavorable renal and limb outcomes in patients with stable LEAD.
Background:
To compare the incidences of aortic regurgitation, atrial fibrillation (AF), and atrioventricular (AV) block II–III between radiographic axial spondyloarthritis (r-axSpA) patients and the ...general population (GP).
Methods:
National Health Insurance Services data were used. R-axSpA patients (N = 8877) and the age- and sex-matched GP (N = 26,631) were followed from August 2006 to December 2019. Incidence rates and standardized incidence ratios (SIRs) of aortic regurgitation, AF, and AV block II–III were compared between these groups. Ten-year incidence rates and hazard ratios (HRs) were calculated by the Kaplan–Meier method and Cox regression analysis.
Results:
Incidence rates of aortic regurgitation, AV block II–III, and AF in the r-axSpA group were 0.42, 0.21, and 4.0 per 1000 person-years (PYs), respectively. In the r-axSpA group, the SIR for aortic regurgitation was highest among 40- to 49-year-old men (4.11). Incidence rates of aortic regurgitation and AF were higher in the r-axSpA group than in the GP group (0.42 versus 0.18 per 1000 PYs 4.00 versus 3.13 per 1000 PYs, both p < 0.001, respectively), whereas the difference was insignificant for AV block II–III (0.21 versus 0.14 per 1000 PYs, p = 0.222). In multivariate analysis, r-axSpA was associated with a higher hazard (risk) for the development of aortic regurgitation and AF HR (95% confidence interval) = 2.55 (1.49–4.37) and 1.20 (1.04–1.39), respectively, but the difference was insignificant for AV block II–III HR (95% confidence interval) = 1.17 (0.59–2.31).
Conclusions:
Compared with the GP, r-axSpA patients are at increased risk of aortic regurgitation and AF, but not AV block II–III. These patients should be carefully monitored for occurrence of aortic regurgitation and AF.
Background
Limited data are available on intracranial hemorrhage (ICH) in patients undergoing antithrombotic therapy after percutaneous coronary intervention (PCI).
Methods and Results
Using the ...Korean National Health Insurance Service database, we identified 219 274 patients without prior ICH and who underwent a first PCI procedure between 2007 and 2016 and analyzed nontraumatic ICH and all‐cause mortality. ICH after PCI occurred in 4171 patients during a median follow‐up of 5.6 years (overall incidence rate: 3.32 cases per 1000 person‐years). The incidence rate of ICH showed an early peak of 21.66 cases per 1000 person‐years within the first 30 days, followed by a sharp decrease to 3.68 cases per 1000 person‐years between 30 days and 1 year, and to <1 case per 1000 patient‐years from the second year until 10 years after PCI. The 1‐year mortality rate was 38.2% after ICH, with most deaths occurring within 30 days (n=999, mortality rate: 24.2%). No significant difference in mortality risk was observed between patients who had ICH within and after 1 year following PCI (adjusted hazard ratio, 1.04; 95% CI, 0.95–1.14;
P
=0.43). The predictors of post‐PCI ICH were age ≥75 years, hypertension, atrial fibrillation, end‐stage renal disease, history of stroke or transient ischemic attack, dementia, and use of vitamin K antagonists.
Conclusions
New ICH most frequently occurs in the early period after PCI and is associated with a high risk of early death, regardless of the occurrence time of ICH. Careful implementation of antithrombotic strategies is needed in patients at an increased risk for ICH, particularly in the peri‐PCI period.
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