Susan A. Bruce

Background: Visceral fat has been shown to be an important predictor of metabolic alterations that lead to increased cardiovascular disease (CVD) risk factors, morbidity, and mortality. Objective: The aim of this study was to investigate the association between central fat distribution and the risk of recurrent coronary events among a cohort of female myocardial infarction (MI) survivors. Methods: Participants included 356 women (mean ± SD age, 55 ± 8.71 years) discharged alive after an incident MI from hospitals in Erie and Niagara (New York) counties between 1996 and 2004. A recurrent cardiovascular event was any nonfatal or fatal International Classification of Diseases, Ninth Revision–coded diagnosis between 390 and 450. The mean ± SD follow-up time was 4.01 ± 2.6 years. Interviews and self-administered follow-up surveys were used to collect pertinent information, and a search of the National Death Index Plus database was completed. Results: Eighty-five women experienced a recurrent cardiovascular event. Using Cox proportional hazards analyses, the crude model for body mass index suggested that after incident MI, women had a 39% risk of a recurrent CVD event (hazard ratio [HR], 1.39; confidence interval [CI], 0.76–2.54; P = .293), whereas crude models for waist circumference and sagittal abdominal distention showed the risk to be more than twice as high (HR, 2.12; CI, 1.08–4.16; P = .010; and HR, 2.16; CI, 1.09–4.28; P = .037, respectively). Both measures of central fat distribution appeared to be better predictors of recurrent cardiovascular events when compared with body mass index, whereas sagittal abdominal distention was the better predictor compared with waist circumference, even after multivariate adjustment. After adjusting for secondary prevention interventions—statin, aspirin, β-blocker use, and physical activity—the risk of recurrent event was observed to decrease by about 1%. Conclusions: These results suggest that central fat distribution is positively associated with a recurrence of cardiovascular events after incident MI in women. The absence of decreased risk with secondary prevention interventions suggests that more investigation into the association of central abdominal fat and secondary prevention management is warranted.

Faculty at the University at Buffalo designed and implemented a mock cardiac arrest that involved joint participation by both undergraduate and graduate students. Various instruments were developed to evaluate the effectiveness of this teaching modality, including scales that measured pre- and postsimulation knowledge and confidence. Students were also asked to evaluate the strengths and weaknesses of the experience especially regarding teamwork during an emergency situation. Management of the arrest by the graduate students was evaluated using a scale that included competency criteria related to assessment, diagnosis, treatment, and resource management. Undergraduate students' performance was also evaluated. Using paired t-test statistics, postsimulation knowledge scores were significantly higher than presimulation scores (p = .000), while postsimulation confidence scores were not statistically significant (p = .177). Students at both levels reported high satisfaction with the experience and with the opportunity to participate in a simulated cardiac arrest as a member of the health team. The use of a computer-assisted human patient simulator involving different levels of nursing students appears to be an effective teaching method; more investigation into specific outcomes is needed.

The study was designed to compare the efficacy of controlled simulation mannequin (SM) assisted learning and case study presentation on knowledge and confidence of nurse practitioner (NP) students in managing a cardiac event. Twenty-three volunteer students were randomly assigned to the experimental (simulation) or control (case study presentation) group. All participants were instructed on atrial arrhythmias, were pre- and post-tested on knowledge and confidence, and completed an evaluation of the experience. There were no statistically significant differences in knowledge test scores, although the control group scored significantly higher on post- test confidence (p=.040). Both groups rated their experience as valuable. The simulation and case study presentation had similar outcomes. Additional research is needed to determine the effectiveness of this teaching modality.

Full-body patient simulators have been used for a number of years to educate nurse anesthetists and anesthesiologists. These lifelike mannequins operate from a sophisticated computerized system with the ability to generate multiple physiologic events and respond to numerous pharmacologic stimuli. The authors recently integrated the use of the patient simulator into the curriculum to educate their acute care nurse practitioner students. The learning process was divided into three steps: the presimulation experience, the simulation experience, and the postsimulation experience. These steps are described as well as important principles that need to be integrated into each phase of the process. A case scenario on respiratory failure provides an example of the simulation experience. In addition, the advantages and disadvantages of this teaching method, as identified by faculty and students, are discussed.