Efficacy and Safety of High-Dose Intracoronary Adenosine Injection in Fractional Flow Reserve Assessment.

Background: The recommended dosage of intracoronary adenosine in fractional flow reserve (FFR) assessment is controversial. High-dose adenosine may overcome the biological variability of adenosine response in hyperemia. Objectives: We aimed to test the efficacy and safety of a high-dose escalation protocol at our institute. Methods: Using the adenosine dose escalation protocol, the percentages of FFR ≤ 0.75 and 0.80 after high-dose escalation were compared with those at conventional doses. The chi-squared test was used to evaluate the accuracy of FFR values with the tested doses by comparing them with the results of a non-invasive pretest. Results: A total of 87 patients (130 vessels) were included, and protocol adherence was 93.1%. High-dose intracoronary adenosine was injected in 78.5% of the vessels. The dose escalation strategy was well-tolerated without serious complications. The positive rate increased significantly after conducting the protocol compared to that with a conventional dose (28.2% vs. 23.6% with an FFR threshold of 0.75, and 48.7% vs. 42.5% with a threshold of 0.80, both p < 0.05). In the validation cohort, only FFR ≤ 0.75 was associated with the binary result of the non-invasive pretest (p < 0.01 vs. p = 0.37). The high-dose adenosine escalation strategy did not increase the accuracy of FFR (77.8% vs. 75.6% in conventional dose and high-dose adenosine, respectively). Conclusions: The use of a high-dose escalation strategy increased the positive rate in FFR assessments.

Fostering revision of argumentative writing through structured peer assessment.

This quasi-experimental study investigated the effect of structured peer assessment on revision of an argumentative writing. Two intact classes (N = 22, 26) were randomly assigned to be the trained and control groups. The latter received no facilitative resources, while the former participated in structured peer assessment based on Calibrated Peer Review, a web-based program purposefully designed for students to receive peer-assessment training, assess their peers' writing, and make written commentary online. At the end of the treatment, both groups revised their writing. The trained group revised their writing more extensively, outperforming the control group on frequency and type of revision, as well as the holistic quality of argumentative writing. After structured peer assessment, participants of the trained group became critical of their own work and invested more effort in spontaneous revision to produce higher-quality argumentative writing.