NSTEMI or Not: A 59-Year-Old Man with Chest Pain and Troponin Elevation

Schleifer, J. William; Centor, Robert M.; Heudebert, Gustavo R.; Estrada, Carlos A.; Morris, Jason

doi:10.1007/s11606-012-2236-9

Cited by 7 publications

(5 citation statements)

References 13 publications

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“… 28 Our findings may reflect female Veterans’ familiarity with non-VA settings or may signal continued sex disparities in acute care services for female Veterans. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Community Urgent Care Use Following Implementation of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act

Vashi

Urech

et al. 2021

Medical Care

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Background: Effective June 6, 2019, Veterans Affairs (VA) began offering a new urgent care (UC) benefit that provides eligible Veterans with greater choice and access to care for the treatment of minor injuries and illnesses in their local communities. Objectives: The aim was to describe trends in UC use, identify predictors of UC benefit use, and understand the factors associated with community UC use versus VA emergency department (ED) or urgent care center (UCC) use. Study Design: Using VA administrative data, this was a retrospective cross-sectional study of Veterans that were enrolled in VA in FY19. Veterans were classified into 3 groups: UC benefit users, benefit non-users, and VA ED/UCC users. Methods: We used summary statistics to compare population characteristics across user groups. To determine whether predisposing, enabling, and need factors predicted UC benefit use and setting choice (community UCC vs. VA ED/UCC), 2 logistic regression models were fitted to assess odds of UC use. Results: From June 6, 2019 through February 29, 2020, 138,305 Veterans made 175,821 community UC visits. The majority of visits were made by White males who were not subject to co-pays. The average cost to VA for UC visits was $132 (SD=$135). Upper respiratory infections were the most common reason for UC use. Being younger, female, and living farther from a VA ED/UCC was associated with greater UC benefit use compared with both benefit non-users and VA ED/UCC users. Conclusions: The new benefit expands Veteran access to UC services for low-acuity conditions.

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“… 28 Our findings may reflect female Veterans’ familiarity with non-VA settings or may signal continued sex disparities in acute care services for female Veterans. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Community Urgent Care Use Following Implementation of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act

Vashi

Urech

et al. 2021

Medical Care

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“…Students completed the CDI test prior to the first session. Students worked in small groups on a computer-based case presentation of an Exercise in Clinical Reasoning [22]. The case paused twice for students to input a working differential diagnosis and plan.…”

Section: Data Collectionmentioning

confidence: 99%

Empirical comparison of three assessment instruments of clinical reasoning capability in 230 medical students

Covin¹,

Longo²,

Wick³

et al. 2020

BMC Med Educ

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Background: Several instruments intend to measure clinical reasoning capability, yet we lack evidence contextualizing their scores. The authors compared three clinical reasoning instruments [Clinical Reasoning Task (CRT), Patient Note Scoring rubric (PNS), and Summary Statement Assessment Rubric (SSAR)] using Messick's convergent validity framework in pre-clinical medical students. Scores were compared to a validated clinical reasoning instrument, Clinical Data Interpretation (CDI). Method: Authors administered CDI and the first clinical case to 235 students. Sixteen randomly selected students (four from each CDI quartile) wrote a note on a second clinical case. Each note was scored with CRT, PNS, and SSAR. Final scores were compared to CDI. Results: CDI scores did not significantly correlate with any other instrument. A large, significant correlation between PNS and CRT was seen (r = 0.71; p = 0.002). Conclusions: None of the tested instruments outperformed the others when using CDI as a standard measure of clinical reasoning. Differing strengths of association between clinical reasoning instruments suggest they each measure different components of the clinical reasoning construct. The large correlation between CRT and PNS scoring suggests areas of novice clinical reasoning capability, which may not be yet captured in CDI or SSAR, which are weighted toward knowledge synthesis and hypothesis testing.

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“…1 A 59-year-old man with cardiovascular disease presented with sudden-onset chest pain. The diagnosis of acute coronary syndrome quickly changed to aortic dissection after the resident noted that the blood pressure was different between the arms.…”

Section: Published Online October 31 2016mentioning

confidence: 99%

“…An early JGIM ECR case describes this change in thinking when a middle-aged patient presented with sudden chest pain. 1 The clinician deliberately works through the different causes of chest pain when certain pieces of information don't fit his initial diagnosis illness script.…”

mentioning

confidence: 99%