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

Прогностическое значение перипроцедурной динамики фракции выброса левого желудочка у пациентов с первым инфарктом миокарда и чрескожным коронарным вмешательством

Aim. To assess periprocedural dynamics of left ventricular ejection fraction (LVEF) in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) without heart failure (HF) in the medical history, as well as its prognostic value in the development of cardiovascular complications in the postinfarction period.Materials and methods. A prospective, single-center observational study included 131 patients with first AMI without HF in the past medical history and successful PCI. LVEF was assessed before PCI at admission and before discharge. In patients with reduced baseline LVEF of less than 50%, the criteria for its periprocedural improvement were chosen: 1) LVEF ≥ 50%; 2) ΔLVEF of more than 5%, but EF < 50%. The endpoints were hospitalization for the development of HF and death from cardiovascular disease in combination with the development of HF. The average follow-up period was 2.5 years.Results. At admission, LVEF was < 50% in 74 (56.5%) patients. At discharge, according to the criteria for LVEF improvement, the proportion of patients in this group was 40.5 and 14.9%, respectively. In 44.6% of cases, no increase in LVEF was noted. The predictors of the absence of periprocedural dynamics in LFEF included impaired regional contractility index > 1.94, left ventricular end-systolic volume > 57 ml, left ventricular end-diastolic diameter > 5.1 cm, pulmonary artery systolic pressure >27 mm Hg, NT-proBNP > 530 pg / ml, and E / A ratio > 1.06. During the follow-up period, 28 (21.4%) patients were hospitalized for the development of HF, 33 (25.2%) patients had a combined endpoint. The absence of periprocedural improvement in left ventricular contractility was independently associated with higher odds of hospitalization for HF (relative risk (RR) 3.5; 95% confidence interval (CI) 1.63–7.55; p = 0.001) and the combined endpoint (RR 2.6; 95% CI 1.28–5.48; p = 0.009) in the postinfarction period.Conclusion. In patients with first AMI and left ventricular systolic dysfunction, periprocedural evaluation of LVEF is reasonable to stratify the risk of adverse cardiovascular outcomes.Цель исследования. Оценка перипроцедурной динамики фракции выброса левого желудочка (ФВ ЛЖ) у пациентов с первым острым инфарктом миокарда (ОИМ) и чрескожным коронарным вмешательством (ЧКВ) без анамнеза сердечной недостаточности (СН) и ее прогностическое значение в развитии сердечно-сосудистых осложнений в постинфарктный период.Материалы и методы. В проспективное одноцентровое наблюдательное исследование включен 131 пациент с первым ОИМ без анамнеза СН и успешным ЧКВ. ФВ ЛЖ оценивалась до ЧКВ при поступлении и перед выпиской. У пациентов с исходно сниженной ФВ ЛЖ менее 50% были выбраны критерии перипроцедурного ее улучшения: 1) ФВ ЛЖ ≥ 50%; 2) ΔФВ ЛЖ более 5%, но ФВ < 50%. Конечными точками являлись госпитализация по поводу развития СН и смерть от сердечно-сосудистых заболеваний в комбинации с развитием СН. Средний период наблюдения составил 2,5 года.Результаты. При поступлении у 74 (56,5%) пациентов отмечена ФВ ЛЖ менее 50%. При выписке в этой группе по критериям улучшения ФВ ЛЖ доля пациентов составила 40,5 и 14,9% соответственно. В 44,6% случаев прирост ФВ ЛЖ отсутствовал. Предикторами перипроцедурного отсутствия динамики ФВ ЛЖ явились индекс нарушения локальной сократимости >1,94, конечно-систолический объем ЛЖ >57 мл, конечно-диастолический размер ЛЖ >5,1 см, систолическое давление легочной артерии >27 мм рт. ст, уровень NT-proBNP > 530 пг/мл, соотношение скоростей трансмитрального кровотока в фазу раннего наполнения к кровотоку в систолу предсердий >1,06. За период наблюдения 28 (21,4%) пациентов были госпитализированы по поводу развития СН, у 33 (25,2%) зарегистрирована комбинированная конечная точка. Отсутствие перипроцедурного улучшения сократительной способности ЛЖ независимо ассоциировано с более высокой вероятностью госпитализации по поводу СН (относительный риск (ОР) 3,5; 95%-й доверительный интервал (ДИ) 1,63–7,55; р = 0,001) и наступления комбинированной конечной точки (ОР 2,6; 95%-й ДИ 1,28–5,48; р = 0,009) в постинфарктном периоде.Заключение. У пациентов с первым ИМ и систолической дисфункцией ЛЖ целесообразна перипроцедурная оценка ФВ ЛЖ для стратификации риска развития неблагоприятных сердечно-сосудистых исходов