Retention of knowledge on blood pressure measurement among medical students within preparation for primary accreditation

Aim. To assess the retained knowledge of sixth year medical students on noninvasive blood pressure (BP) measurement.Material and methods. The study included 148 6th year medical students. According to the curriculum, in the fall semester, students studied the procedure of BP measurement according to checklists developed based on ROSOMED. In the spring semester, as part of the preparation course for accreditation, the retained knowledge of students was assessed. A completed skill was assessed at 1 point, not completed — 0 points. Thus, each student can score a maximum of 50 points. The teacher assessed the manipulations during their performing by filling in the checklist items for each student.Results. None of the students completed the full range of manipulations. The number of completed skills ranged from 15 (30%) to 49 (98%) and averaged 33 points on the checklist (66%). In addition, 74% of students (n=109) completed more than half of the required skills. Almost the only item completed by all students (99%, n=146) was a greeting, which was comparable with self-presentation (92%, n=136) and identification of a patient’s personal data (surname and first names) (80%, n=118). The rest of checklist items was performed in the range from 39% (n=57) for “remeasurement of BP on the other hand” to 87% (n=129) for “finding a radial pulse”. Thus, the average fulfillment rate was 67% (n=99). There were following most common mistakes in BP measurement: 39% of students did not measure a patient’s upper arm diameter and did not select the cuff size; every second student (51%) placed the phonendoscope diaphragm under the cuff; 40% of students reduced the cuff pressure with inadequate rate.Conclusion. The retention of knowledge on measuring BP within six months after a detailed analysis and passing a test remains insufficient, but comparable with foreign studies. The data obtained indicate the need for additional trainings both using simulators and in conditions closer to real ones, including with simulated patients

Prediction of perioperative cardiac complications in patients with proximal femoral fracture

Background. Prediction of cardiac complications following orthopaedic and trauma surgery is necessary to improve the quality of treating the elderly patients. Objective. To assess the effectiveness of prognostic scores of perioperative cardiac risk in patients with proximal femoral fracture. Material and Methods. We retrospectively reviewed 918 hospital patients with proximal hip fracture from January, 1 2018 to December, 31 2019. Perioperative cardiac risks were assessed using the Goldman Risk Index, Revised Cardiac Risk Index (Lee Index) and Gupta Perioperative Cardiac Risk Index. Results. Cardiac complications occurred in 7 (0.76%) of 918 patients, 6 (0.65%) patients developed acute myocardial infarction, 1 (0.11%) patient suffered from complete atrioventricular block. Receiver operating characteristic (ROC) curve analysis of the relationship between the time from injury to surgery and cardiovascular complications did not give statistically significant results (AUC (area under a curve) = 0.574, 95% CI (confidence interval): 0.352–0.796). When compared the presence of cardiac complications with the Lee Criteria predictions, significant differences were revealed (p = 0.007), and the Goldman Index data were not statistically significant (p = 0.151). The area under the ROC curve of the corresponding relationship between the prognosis of cardiac complications and the Gupta Index was 0.782 with 95% CI: 0.574–0.991 (p = 0.017), the sensitivity and specificity of the model were 83.3% and 70.4%, respectively. Conclusion. The Goldman Index and Lee Index have no significant value for predicting perioperative cardiac complications in patients with proximal femoral fracture. The Gupta Index has an acceptable level of sensitivity and specificity in predicting cardiac complications