An innovative strategy for radical-mediated, bidirectional controlled disulfide exchange.

Metathesis reactions that operate cleanly and reversibly under biocompatible conditions are crucial in diverse fields such as drug development, chemical biology, and dynamic combinatorial chemistry. This paper introduces an innovative strategy using the commercially available and cost-effective hydroxy(tosyloxy)iodobenzene (HTIB) as a radical initiator, enabling clean and bidirectional disulfide metathesis under biocompatible conditions. Our method facilitates efficient forward reactions by utilizing an excess of one disulfide to shift the equilibrium toward unsymmetrical disulfides, while also ensuring clean reverse reactions by the removal of low boiling point dimethyl disulfide.

Computer Adaptive vs. Non-adaptive Medical Progress Testing: Feasibility, Test Performance, and Student Experiences.

Background: Computerized adaptive testing tailors test items to students' abilities by adapting difficulty level. This more efficient, and reliable assessment form may provide advantages over a conventional medical progress test (PT). Prior to our study, a direct comparison of students' performance on a computer adaptive progress test (CA-PT) and a conventional PT, which is crucial for nationwide implementation of the CA-PT, was missing.

Guideline implementation, drug sequencing, and quality of care in heart failure: design and rationale of TITRATE-HF.

Aims: Current heart failure (HF) guidelines recommend to prescribe four drug classes in patients with HF with reduced ejection fraction (HFrEF). A clear challenge exists to adequately implement guideline-directed medical therapy (GDMT) regarding the sequencing of drugs and timely reaching target dose. It is largely unknown how the paradigm shift from a serial and sequential approach for drug therapy to early parallel application of the four drug classes will be executed in daily clinical practice, as well as the reason clinicians may not adhere to new guidelines.

Telerehabilitation in patients with recent hospitalisation due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial.

Background: Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers.

The Effect of Information Presentation Order on Residents' Diagnostic Accuracy of Online Simulated Patients With Chest Pain.

Background: Physicians may receive diagnostic information in different orders, and there is a lack of empirical evidence that the order of presentation may influence clinical reasoning.

Objective: We investigated whether diagnostic accuracy of chest pain cases is influenced by the order of presentation of the history and electrocardiogram (EKG) to cardiology residents.

Methods: We conducted an experimental study during a resident training in 2019.

Electrocardiogram-based mortality prediction in patients with COVID-19 using machine learning.

Background And Purpose: The electrocardiogram (ECG) is frequently obtained in the work-up of COVID-19 patients. So far, no study has evaluated whether ECG-based machine learning models have added value to predict in-hospital mortality specifically in COVID-19 patients.

Methods: Using data from the CAPACITY-COVID registry, we studied 882 patients admitted with COVID-19 across seven hospitals in the Netherlands.

Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure.

Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients.

COVID-19-mediated patient delay caused increased total ischaemic time in ST-segment elevation myocardial infarction.

Background: The current study aimed to evaluate changes in treatment delay and outcome for ST-segment elevation myocardial infarction (STEMI) in the Netherlands during the first coronavirus disease 2019 (COVID-19) outbreak, thereby comparing regions with a high and low COVID-19 hospitalisation rate.

Methods: Clinical characteristics, STEMI timing variables, 30-day all-cause mortality and cardiovascular complications of all consecutive patients admitted for STEMI from 1 January to 30 June in 2020 and 2019 to six hospitals performing a high volume of percutaneous coronary interventions were collected retrospectively using data from the Netherlands Heart Registry, hospital records and ambulance report forms. Patient delay, pre-hospital delay and door-to-balloon time before and after the outbreak of COVID-19 were compared to the equivalent periods in 2019.

Association between public media and trends in new acute coronary syndrome presentations during the first COVID‑19 wave in the Netherlands.

Background: We aimed to evaluate the association between public media and trends in new presentations of acute coronary syndrome (ACS) during the first wave of the coronavirus disease 2019 (COVID‑19) in the Netherlands.

Methods: New ACS presentations per week in 73 hospitals during the first half of 2019 and 2020 were retrieved from the national organisation Dutch Hospital Data and incidence rates were calculated. Stratified analyses were performed by region, type of ACS and patient characteristics.

How often and to what extent do admitted COVID-19 patients have signs of cardiac injury?

Background: COVID-19 can cause myocardial injury in a significant proportion of patients admitted to the hospital and seems to be associated with worse prognosis. The aim of this review was to study how often and to what extent COVID-19 causes myocardial injury and whether this is an important contributor to outcome with implications for management.

Methods: A literature search was performed in Medline and Embase.

Added Value of Transluminal Attenuation Gradient to Qualitative CCTA Ischemia Detection as Determined by N-ammonia PET Quantitative Myocardial Perfusion.

Unlabelled: Transluminal attenuation gradient (TAG) represents the slope of intraluminal contrast that decreases along a coronary vessel during coronary computed tomography angiography (CCTA). The aim of this study was to determine the added value of TAG to qualitative CCTA assessment of significant stenosis (>50%) detecting ischemia as determined by stress myocardial blood flow (MBF) or myocardial flow reserve (MFR) measured by positron emission tomography (PET). Individual contributions of TAG, qualitative assessment and the impact of calcium score were also investigated.

The Effects of Expert and Augmented Feedback on Learning a Complex Medical Skill.

Many medical skills are complex due to their requirements for integration of declarative (biomedical) knowledge with perceptual-motor and perceptual-cognitive proficiency. While feedback generally helps learners guide their actions, it is unclear how feedback supports the integration of declarative knowledge with skills. Thus, we investigated the effect of expert and augmented feedback on acquisition and retention of a complex medical skill (acquiring a transthoracic echocardiogram) in a simulation study.

Investigating possible causes of bias in a progress test translation: an one-edged sword.

Purpose: Assessment in different languages should measure the same construct. However, item characteristics, such as item flaws and content, may favor one test-taker group over another. This is known as item bias.

Twelve tips for implementing a community of practice for faculty development.

Teaching and learning practices often fail to incorporate new concepts in the ever-evolving field of medical education. Although medical education research provides new insights into curricular development, learners' engagement, assessment methods, professional development, interprofessional education, and so forth, faculty members often struggle to modernize their teaching practices. Communities of practice (CoP) for faculty development offer an effective and sustainable approach for knowledge management and implementation of best practices.

Comparison of level of cognitive process between case-based items and non-case-based items of the interuniversity progress test of medicine in the Netherlands.

Purpose: It is assumed that case-based questions require higher order cognitive processing, whereas questions that are not case-based require lower order cognitive processing. In this study, we investigated to what extent case-based questions and questions that are not case-based, relate to Bloom's taxonomy.

Methods: In this article, 4800 questions of the Progress Test were classified whether it was a case-based question and the level of Bloom's taxonomy.

Long-term prognostic value of quantitative myocardial perfusion in patients with chest pain and normal coronary arteries.

Background: Patients with chest pain and no obstructive coronary artery disease have shown a high incidence of major adverse cardiovascular events (MACE). We evaluated the role of absolute myocardial perfusion quantification in predicting all-cause mortality and MACE during long-term follow-up in this group of patients.

Methods: We studied 79 patients who underwent Nitrogen-13 ammonia PET for quantification of global myocardial blood flow (MBF) and myocardial flow reserve (MFR) due to suspected impaired myocardial perfusion.

Myocardial bridging of the left anterior descending coronary artery is associated with reduced myocardial perfusion reserve: a N-ammonia PET study.

Myocardial Bridging (MB) refers to the band of myocardium that abnormally overlies a segment of a coronary artery. This paper quantitatively evaluates the influence of MB of the left anterior descending artery (LAD) on myocardial perfusion of the entire left ventricle. We studied 131 consecutive patients who underwent hybrid rest/stress N-ammonia positron emission tomography (PET) and coronary computed tomography angiography (CCTA) due to suspected myocardial ischemia.

Additional simulation training: does it affect students' knowledge acquisition and retention?

Introduction: Teaching medical skills during clinical rotation is a complex challenge, which often does not allow students to practise their skills. Nowadays, the use of simulation training has increased to teach skills to medical students. However, transferring the learnt skills from one setting to the other is challenging.

Quantitative myocardial perfusion evaluation with positron emission tomography and the risk of cardiovascular events in patients with coronary artery disease: a systematic review of prognostic studies.

Aims: To evaluate the prognostic value of quantitative myocardial perfusion imaging with positron emission tomography (PET) for adverse cardiovascular outcomes in patients with known or suspected coronary artery disease (CAD).

Methods And Results: A search in MEDLINE and Embase was conducted for studies that evaluated (i) myocardial perfusion in absolute terms with PET, (ii) prognostic value for the development of major adverse cardiovascular events (MACE), cardiac death, and/or all-cause mortality, and (iii) patients with known or suspected CAD. Studies were divided according to the radiotracer utilized and their included population (patients with and without previous infarction).

Comparison of formula and number-right scoring in undergraduate medical training: a Rasch model analysis.

Background: Progress testing is an assessment tool used to periodically assess all students at the end-of-curriculum level. Because students cannot know everything, it is important that they recognize their lack of knowledge. For that reason, the formula-scoring method has usually been used.

Avoiding Surgical Skill Decay: A Systematic Review on the Spacing of Training Sessions.

Objective: Spreading training sessions over time instead of training in just 1 session leads to an improvement of long-term retention for factual knowledge. However, it is not clear whether this would also apply to surgical skills. Thus, we performed a systematic review to find out whether spacing training sessions would also improve long-term retention of surgical skills.

The Impact of Curriculum Design in the Acquisition of Knowledge of Oncology: Comparison Among Four Medical Schools.

Over the past 5 years, cancer has replaced coronary heart disease as the leading cause of death in the Netherlands. It is thus paramount that medical doctors acquire a knowledge of cancer, since most of them will face many patients with cancer. Studies, however, have indicated that there is a deficit in knowledge of oncology among medical students, which may be due not only to the content but also to the structure of the curriculum.

The Impact of Massed and Spaced-Out Curriculum in Oncology Knowledge Acquisition.

Starting in 2009, cancer has been the leading cause of death in the Netherlands. Oncology is therefore an important part of the medical curriculum in undergraduate education. It is crucial that medical students know about cancer, since doctors will encounter many cases of oncology.

Investigation into cardiac sympathetic innervation during the commencement of haemodialysis in patients with chronic kidney disease.

Background: Patients with chronic kidney disease (CKD) who undergo chronic haemodialysis (HD) show altered sympathetic tone, which is related to a higher cardiovascular mortality. The purpose of this study was to investigate the effect of transition from pre-HD to HD on cardiac sympathetic innervation.

Methods: Eighteen patients aged 58 ± 18 years (mean ± standard deviation [SD]), 13 males and five females, with stage 5 CKD and nine healthy control subjects aged 52 ± 17 (mean ± SD), three males and six females, were included in this prospective study between May 2010 and December 2013.