DISCLOSURES: No funding was received for this commentary. The author has nothing to disclose.

Background Nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV). The aim was to investigate the use of NOACs and warfarin in ECV in a real-life setting and to assess how the chosen regimen affected the delay to ECV and rate of complications. Methods Consecutive AF patients undergoing ECVs in the city hospitals of Helsinki between January 2015 and December 2016 were studied. Data on patient characteristics, delays to cardioversion, anticoagulation treatment, acute (<30 days) complications, and regimen changes within one year were evaluated. Results Nine hundred patients (59.2% men; mean age, 68.0 ± 10.0) underwent 992 ECVs, of which 596 (60.0%) were performed using NOACs and 396 (40.0%) using warfarin. The mean CHA 2 DS 2 -VASc score was 2.5 (±1.6). In patients without previous anticoagulation treatment, NOACs were associated with a shorter mean time to cardioversion than warfarin (51 versus. 68 days, respectively; p  < .001). Six thromboembolic events (0.6%) occurred: 4 (0.7%) in NOAC-treated patients and 2 (0.5%) in warfarin-treated patients. Clinically relevant bleeding events occurred in seven patients (1.8%) receiving warfarin and three patients (0.5%) receiving NOACs. Anticoagulation treatment was altered for 99 patients (11.0%) during the study period, with the majority (88.2%) of changes from warfarin to NOACs. Conclusions In this real-life study, the rates of thromboembolic and bleeding complications were low in AF patients undergoing ECV. Patients receiving NOAC therapy had a shorter time to cardioversion and continued their anticoagulation therapy more often than patients on warfarin.

Since more than a decade, all kinds of businesses and organisations are intensively exploring enterprise-level information systems to better integrate their business processes, information flows and people. Consequently, the industry demands for technically skilled, but also “business-savvy” IT professionals are permanently growing. To meet this need, more and more computing education programs try to incorporate enterprise-level information systems into their curricula. While there is some computing education research done to investigate the need for this new type of IT-business professional and to analyse general implications for higher education, only very few research works or practice papers exist which report on concrete attempts to design and deliver higher education computing courses which intensively use enterprise-level systems. In this paper, the author reports on a series of experiences made within the Bachelor of Science (Information Systems Management) degree program offered by the School of Information Systems (SIS) at the Singapore Management University (SMU). The primary focus of this paper is put on establishing a working set of best practices for the design of an effective structure of the face-to-face teaching sessions for courses which use enterprise-level systems and applications in their curricula. While this paper is principally based on education experiences made within the frame of an Information Systems program, the best practices presented in this paper are equally applicable to any other computing education field or even to the engineering education in general.

Background Noninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter-defibrillator (ICD). Methods The EUTrigTreat clinical study was a prospective multicenter trial including ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease. Left ventricular ejection fraction ≤40% (LVEF), premature ventricular complexes >400/24 hr (PVC), non-negative microvolt T-wave alternans (MTWA), and abnormal heart rate turbulence (HRT) were considered high risk. Tests were repeated within 12 months after inclusion. Adjusted Cox regression analysis was performed for mortality and appropriate ICD shocks. Results In total, 635 patients had analyzable baseline data with a median follow-up of 4.4 years. Worsening of LVEF was associated with increased mortality (HR 3.59, 95% CI 1.17–11.04), as was consistent abnormal HRT (HR 8.34, 95%CI 1.06–65.54). HRT improvement was associated with improved survival when compared to consistent abnormal HRT (HR 0.10, 95%CI 0.01–0.82). For appropriate ICD shocks, a non-negative MTWA test or high PVC count at any moment was associated with increased arrhythmic risk independent of the evolution of test results (worsening: HR 3.76 (95%CI 1.43–9.88) and HR 2.50 (95%CI 1.15–5.46); improvement: HR 2.80 (95%CI 1.03–7.61) and HR 2.45 (95%CI 1.07–5.62); consistent: HR 2.47 (95%CI 0.95–6.45) and HR 2.40 (95%CI 1.33–4.33), respectively). LVEF improvement was associated with a lower arrhythmic risk (HR 0.34, 95%CI 0.12–0.94). Conclusions Repeating LVEF and HRT improved the prediction of mortality, whereas stratification of ventricular arrhythmias may be improved by repeating LVEF measurements, MTWA and ECG Holter monitoring.

Presently, higher education programmes are being assessed at several different levels, locally, or even countrywide. In this paper, we propose a template for the description of each curricular unit in higher education programmes that seeks to promote reflective teaching, widely acknowledged as fundamental to improve practices leading to improved student learning, while being advantageous and convenient for programme assessment by external entities. To this end, we take as a starting point the template that all Portuguese higher education institutions have to fill for each curricular unit, for programme assessment purposes. Based on the literature, we argue this new template format fosters teacher reflection and provides additional and easier to compare data for accreditation boards, and the whole education community, most notably, students. Finally, we argue that it can and should be used to improve syllabuses.

In the present work, a hybrid educational methodology has been developed for approaching the cognitive domain of Built Heritage Protection in an interdisciplinary and integrated way. This domain was selected as a pilot one, presenting various remarkable characteristics, such as bringing together STEM subjects with social and human sciences, proving concrete concepts, being attractive for youth, and demanding combination of technical solutions with social aspects. The methodology had the scope to interconnect secondary with tertiary level education for the achievement of the best possible results, as the latter possesses the needed specialised knowledge, expertise and infrastructure. The methodology incorporates problem - based learning, aiming at the effective solution of real and extremely complex problems encountered in monument scale, which is combined with traditional teaching methods, such as lectures, as well as contemporary elements, such as class exercise laboratory experiments, in situ field work, promoting hands - on experience of students. The pilot application and evaluation of the hybrid methodology proved to be a valuable experience for students of secondary level education, which needs to be further exploited and optimised in order to meet the expectations of the interested parties.