Agnieszka Skrzypek

Trauma-induced acute myocardial infarction due to delayed dissection of the left anterior descending coronary artery

Acute myocardial infarction is a very rare, life-threatening complication of blunt chest trauma. A 27-year-old man with no previous medical history was admitted to the emergency department due to multiple trauma following a car accident. After 48h following the accident, the patients condition rapidly deteriorated, with severe dyspnea at rest, tachycardia, and increasing chest pain. A 12-lead ECG showed a sinus tachycardia at 120bpm with significant ST-segment elevation in leads V1 to V5, pathologic Q wave in I, aVL, and QS complex in leads V1 to V4. Bedside echocardiography disclosed akinesis of the anterior and lateral walls, apex, and anterior septum with severely decreased left ventricular ejection fraction of 30%. Urgent coronary angiography revealed an occlusive dissection of the proximal left anterior descending coronary artery. Primary percutaneous coronary intervention with a Biolimus A9™-eluting stent implantation were successfully performed. The further course was uneventful. At 12-month follow-up, the patient has remained asymptomatic with no recurrence of cardiovascular symptoms.

Implementation of the modified four-step approach method for teaching echocardiography using the FATE protocol-A pilot study

Peytons four‐step approach is well‐known and commonly used in medical education. It is a practical and useful method which is simple to apply. The study presents the implementation of the modified four‐step approach method to teach how to perform the emergency echocardiographic assessment according to FATE (Focus‐Assessed Transthoracic Echo) protocol. The aim of the study was to determine the feasibility and utility of this method FATE protocol teaching.

Effect of Night Shift-Related Tiredness on Eye Saccades

Parameters of saccades (latency, amplitude, duration, and velocity) were measured using a saccadometer in 32 nurses (30 women and 2 men) before and after a night shift. The mean latency of saccades was found to significantly increase after this period (209.6 ± 6.84 vs. 188.6 ± 6.08 msec, P = 0.002); the same was found with respect to the saccade duration (55.0 ± 0.97 vs. 54.2 ± 1.23 msec, P < 0.05). Thus, stress and sleep deprivation noticeably influence the parameters of saccades; the latter, nonetheless, remain within a physiological range. Considering that a number of brain structures are involved in the control of saccade parameters, the above-described modulations of saccades can be potentially used as generalized indices characterizing the level of brain tiredness.

How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school

Objective As a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs. Design Analysis of routinely collected data. Setting One Polish medical school. Participants Complete OSCE records for 462 second-year students and 445 third-year students. Outcome measures OSCE scores by matriculation year. Results In comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG — tasks which had not been included in the second-year preclinical training. Conclusion Our results suggest the importance of preclinical training in a CS laboratory to improve students’ competence in physical examination at the completion of introductory clinical clerkships during the first clinical year.