Acute kidney injury (AKI) is a frequent complication in ST-elevation myocardial infarction (STEMI) patients. Factors other than contrast exposure have been suggested as major contributors to renal dysfunction in patients undergoing primary percutaneous coronary intervention (PPCI). Our aim was to assess the incidence and risk factors of AKI in high-risk STEMI patients, mostly treated by PPCI with implemented measures to prevent contrast-induced AKI. We retrospectively analyzed data of 245 STEMI patients (165 men, mean age 63.9 ± 11.9 years) admitted to the Department of Medical Intensive Care Unit. Demographic, clinical, and mortality data were compared between AKI and non-AKI group. AKI was defined as a 1.5-fold increase in serum creatinine from baseline level within 24–48 hours. AKI developed in 34/245 (13.9%) patients. PPCI was performed in 226/245 (92.2%) of all STEMI cases, with no difference between AKI and non-AKI group. There were significant differences between AKI and non-AKI group in diabetes mellitus (41.2% vs. 20.9%), prior MI (26.5% vs. 11.8%), prior resuscitation (38.2% vs. 12.4%), admission acute heart failure [AHF] (44.1% vs. 12.8%), in-hospital AHF (70.6% vs. 17.5%), and hospital-acquired infection [HAI] (79.4% vs. 18.0%). Significantly more AKI patients had increased admission CRP ≥25 mg/L (38.2% vs. 11.8%), peak CRP ≥50 mg/L (91.2% vs. 36%), admission troponin I ≥10 mg/L (44.1% vs. 24.6%), peak troponin I ≥50 mg/L (64.7% vs. 44.1%), peak NT-proBNP ≥400 pmol/L (82.4% vs. 27.5%), and ejection fraction <45% (76.5% vs. 33.6%). Mortality was significantly increased in AKI group, including in-hospital (52.9% vs. 7.1%), 30-day (64.7% vs. 10.7%) and 6-month mortality (70.6% vs. 13.7%). Significant independent predictors of AKI were prior resuscitation (OR 4.171, 95% CI 1.088–15.998), HAI (OR 7.974, 95% CI 1.992–31.912), and peak NT-proBNP (OR 21.261, 95% CI 2.357–191.795). To reduce the risk of AKI in STEMI patients, early diagnosis and treatment of AHF and HAIs are advisable.

BACKGROUNDOphthalmological procedures are difficult to master due to the complexity of ophthalmological skills. Simulation offers a great opportunity for unlimited practice in a controlled environment. Therefore, simulation is becoming an important part of novel medical curricula. We conducted a prospective randomized controlled study to demonstrate the effects of structured cataract surgery training on the development of eye-hand coordination. METHODSTwenty-eight medical students were randomized to experimental and control groups. Each student completed 4-week structured training on The Eyesi Ophthalmic Surgical Simulator. The control group performed one training the 1st and the 4th week of the study (2 training sessions) and the experimental group completed one training each week of the study (4 training sessions). Every training was composed of 5 different tasks (3 abstract and 2 clinical). In task 1 students practiced basic instrument navigation and in task 2 microsurgical forceps manipulation. In task 3 they performed antitremor training. In clinical tasks, students performed capsulorhexis with premade flap in task 4. In task 5 they had to create a flap themselves. RESULTSThere was no statistical difference in performance between the groups on the first training. Control group improved their score for 16.6 % on their last (second) training and experimental group improved their score for 38.7 % on their last (fourth) training.Comparing last trainings, control group improved their result in tasks 1 and 2, whereas experimental group improved their result in all tasks.CONCLUSIONSWe showed that structured training on a cataract surgery simulator improves students’ microsurgical skills. Both groups improved their performance on the last training. Experimental group with more repetitions surpassed control group with fewer training sessions. Two training sessions were enough to achieve significant improvement in abstract tasks only. However, four repetitions were enough to significantly improve in all tasks. Our study certifies the positive impact of simulator training on microsurgical skills needed in cataract surgery. Furthermore, it shows that such skills could be achieved in students with no preceding cataract training in vivo.

Namen: Objektivni strukturirani klinični izpit (OSKI) je postal vodilna metoda za ocenjevanje izvedbe kliničnih veščin. Njegova pogosta težava je neskladje med oceno na ocenjevalnem obrazcu in splošno oceno ocenjevalca. V preteklosti neskladij niso uspešno reševali z obteževanjem posameznih korakov. Sistematičnega diferencialnega obteževanja, ki podeljuje točke glede na izračun časovnih in težavnostnih uteži, še niso raziskali. Namen študije je bil: a) tvoriti formule za izračun težavnostnih in časovnih uteži, b) tvoriti eksperimentalni obrazec z upoštevanjem izračunanih uteži in c) oceniti uspešnost metode pri izboljšanju kazalnikov kakovosti OSKI. Metode: Najprej smo tvorili formule za izračun časovnih in težavnostih uteži posameznih korakov. Nato smo s pomočjo uteži obtežili posamezni korak v eksperimentalnem obrazcu. Kontrolni obrazec so neodvisno od raziskave obtežili klinični mentorji. Uspešnost obrazcev smo preverili med rednim izpitom OSKI za študente 3. letnika. Študente (n = 55) je z obema ocenjevalnima obrazcema in splošnim obrazcem ocenilo deset ocenjevalcev. Rezultate smo analizirali s t-testom za odvisna vzorca, enostavno linearno regresijo in psihometričnim testiranjem. Rezultati: V primerjavi s kontrolnim obrazcem smo na eksperimentalnem obrazcu ugotovili višjo povezavo med oceno na ocenjevalnem obrazcu in splošno oceno (r = 0,622, p < 0,001 vs. r = 0,496, p < 0,001) in pomembno nižje rezultate (p < 0,001). Zaključek: Ugotovili smo, da diferencialno obteževanje korakov s časovnimi in težavnostnimi utežmi lahko izboljša kazalnike kakovosti OSKI in zmanjša neskladje med oceno na ocenjevalnem obrazcu in splošno oceno.