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The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 ± 9 vs 64 ± 10 years, P <.001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 ± 1.2 vs 2.4 ± 1.3, P <.001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, P <.001) and more often the retrograde approach (23 vs 20%, P <.001) and antegrade dissection/reentry (20% vs 16%, P <.001). Technical success was similar between the 2 study groups (84% vs 87%, P =.127), but procedural success was lower for patients with PAD (81% vs 85%, P =.015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, P =.046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success. [ABSTRACT FROM AUTHOR]

Background. The use of game-based learning strategies in higher education has shown promise to increase student motivation and achievement. Little is known about which game mechanics are most appropriate and effective for learners at different academic levels.Aim. This article examines teacher selection and implementation of game mechanics in 27 courses from middle school to higher education designed with game-based learning.Method. 27 educators participated in an open-ended survey on the design of their course. Measures included an open response survey on patterns and design of game mechanics with results validated through member checking.Results. Findings included different choices of game attritubes and game elements in courses in middle school, high school, and higher education. Teacher selection and inclusion of game mechanics changed over time to better meet the needs of students.Conclusions. The structure of game-based learning at different levels will vary to meet the developmental and academic needs of students, but more work is needed in determining which strategies are most effective for learning. [ABSTRACT FROM AUTHOR]

The use of games and game structures in educational contexts is growing in popularity. An increasing number of technologies have been developed to meet the needs of designing a course as a game. This article discussed the design process in game-based learning and reviewed the research on structuring a course with a focus on feedback, goals, and interaction. In addition, we presented the best practices and technologies to support the integration of badges and leaderboards into game-based learning. With the intentional and systematic design of game-based learning, instructors and designers will increase the impact of game attributes and elements on student achievement and motivation. Further investigation of game-based learning attributes and elements is needed to provide detailed knowledge on the compatibility with current technological tools. [ABSTRACT FROM AUTHOR]

Presents a medical case of a female patient diagnosed with diabetes type 1 and associated diseases. How the patient was diagnosed; Description of the disease; Discussion on the treatment.