Myocardial Infarction in a 23-year-old Post-Collegiate Athlete

CASE HISTORY: The patient is a 23-year-old post-collegiate football player who was playing a recreational basketball game when his chest started hurting. The patient reported he was in a great amount of pain, and he felt it was not with his breathing but rather with his heartbeat. The patient had EMS contacted and awaited their arrival where they originally evaluated him. The patient’s health at the time of arrival was good according to the emergency personnel, so the patient opted to return home. The patient went home and was still in discomfort making him unable to sleep. He then decided to go the emergency room where he was taken in for further examination. PHYSICAL EXAM: Upon the arrival of the EMS, the patient’s blood pressure and heart rhythm were checked and seemed normal to the paramedics. When the patient went to the emergency room, they took blood samples and found that his troponin levels were high and admitted him into the hospital for further evaluation. DIFFERENTIAL DIAGNOSES: Severe indigestion, rib contusion, pericarditis, aortic stenosis, myocarditis. TESTS & RESULTS: Upon examination the patient had an electrocardiogram done which came back normal. However, the patient had elevated troponin levels which required the patient to receive an angiogram. The angiogram showed a 75% blockage of a left ventricle. DIAGNOSIS: Acute anterior NSTEMI (non-ST-elevation myocardial infarction) type 1. DISCUSSION: Acute Anterior NSTEMI type 1 is a myocardial infarction that is on the lower spectrum of diagnosis. Type 2 or 3 would have been more severe and have the potential to leave life-long lasting effects. Myocardial infarctions are more common in patients who are of older age and are rarely seen in patients who are collegiate athletes or just out of college athletics. Factors that could contribute to a myocardial infarction are genetic predisposition, dietary lifestyle, and activity level. OUTCOME OF THE CASE: The patient completed his angiogram and was admitted into the catheter lab to insert a stent into the ventricle with that was blocked. Once the procedure was complete, another angiogram was completed to ensure proper blood flow. The patient was held in the hospital until the following day and was released with pain medication subscriptions. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient was scheduled a one-month follow up and was able to return to work the following week. He did not experience any worsening of pain or discomfort after the surgery and is now living a normal lifestyle

Preferences for peer-reviewed versus other publication sources: a survey of general dentists in the National Dental PBRN

Abstract Background Medical professionals have access to a broad range of resources to address clinical information needs. While much attention is given to new sources of data such as those available on the internet, it is less clear how clinicians choose between peer-reviewed research literature and other publication-based sources. This analysis distinguishes between possible drivers of publication type preference (namely, practice setting, advanced training, professional development experiences). Dentists enrolled in the National Dental Practice-Based Research Network (PBRN) are the population for this study. Theories of human and intellectual capital and institutional logics theory are used to understand how advanced training and other clinical experiences may explain the choices that dentists make when faced with clinical questions. Methods An online questionnaire was implemented with general dentists in the US National Dental PBRN. A series of logistic and Ordinary Least Squares (OLS) regression models were used to explain the use of peer-reviewed and other publications. Measures of knowledge-based human capital distinctions (advanced clinical training and research engagement, advanced professional status, personal motivation for professional advancement) were used to explain preferences for research literature as a clinical resource. Results General dentists with advanced training, as well as those with a skill advancement motivation, show a preference for peer-reviewed materials. General dentists who have been practicing longer tend to favor other dental publications, preferring those sources as a resource when faced with clinical challenges. Human capital and professional motivation distinguish the information preferences among general dentists. Further, these factors explain more variance in use of peer-reviewed materials than practice setting does. Few differences by demographic groups were evident. Conclusions Results point to a distinct variation in the general dentistry professional community. Advanced training among general dentists, as well as the types of procedures typically conducted in their practice, distinguishes their information preferences from other general dentists, including those with more years of clinical experience