Recognising, assessing and managing chest pain

Chest pain is a common medical symptom that paramedics attend to in the out-of-hospital environment. The causes of chest pain and the signs and symptoms are explained in this article, alongside tools that could be useful in diagnosis, such as clinical risk scores and troponin testing. Finally, pain management strategies that use a balanced approach for optimal patient care are referred to, with some specificity for cardiac chest pain explained.

Use and Users of the Web-Based Omaolo Covid-19 Symptom Self-Assesment Tool in Finland Since March 16, 2020

In Finland, it is possible to quickly produce medical symptom self-assessment tools within the existing infrastructure. The Finnish Omaolo Covid-19 web-based symptom self-assessment tool (symptom checker) was launched on March 16, 2020 after a 6-day development period. By using the web-based Omaolo Covid-19 symptom checker during the second wave of the epidemic, some 1.72 million questionnaires were recorded, out of which 1.55 million from symptomatic persons. Some 15% of the responses (245,500) were directed to seek emergency medical care based on the online screening by respondent response profiles.

A Known-Groups Validation of the Medical Symptom Validity Test and Analysis of the Genuine Memory Impairment Profile

This study cross-validated the Medical Symptom Validity Test (MSVT) in a mixed neuropsychiatric sample and examined its accuracy for identifying invalid neuropsychological performance using a known-groups design. Cross-sectional data from 129 clinical patients who completed the MSVT were examined. Validity groups were established using six, independent criterion performance validity tests, which yielded 98 patients in the valid group and 31 in the invalid group. All MSVT subtest scores were significantly lower in the invalid group (η p2=.22-.39). Using published cut-scores, sensitivities of 42% to 71% were found among the primary effort subtests, and 74% sensitivity/90% specificity was observed for the overall MSVT. Among this sample, the MSVT component validity scales produced areas under the curve of .78-.86, suggesting moderate classification accuracy. At optimal cut-scores, the MSVT primary effort validity scales demonstrated 55% to 71% sensitivity/91% to 93% specificity, with the Consistency subtest exhibiting the strongest psychometric properties. The MSVT exhibited relatively robust sensitivity and specificity, supporting its utility as a briefer freestanding performance validity test to its predecessor, the Word Memory Test. Finally, the Genuine Memory Impairment Profile appears promising for patients with Major Neurocognitive Disorder, but is cautioned against for those without significant functional decline in activities of daily living at this time.

A-224 Clinical Utility of Grooved Pegboard as an Additional Embedded Measure of Performance Validity

Objective Previously, the Grooved Pegboard Test (GPB) has shown potential as an embedded measure of performance validity (PVT) using a T-score cutoff for either hand (≤ 29) or both hands (≤ 31). This study sought to validate these cutoffs with established PVTs (Medical Symptom Validity Test [MSVT], Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS]). Method Subjects (N = 190) were primarily Caucasian (85%) and male (81%). Average age and education were 41 (SD = 11.62) and 16 years (SD = 2.35), respectively. Participants were stratified as GPB “pass or fail” based on previously proposed cutoff criteria. MSVT, NV-MSVT, and RDS were also dichotomized as pass or fail based on manual or conventional recommendations. Results Chi-Square analyses revealed significant associations between GPB “fails” for both hands and MSVT, NV-MSVT, and RDS (χ2 (1, n = 190) ranging from 5.80 to 15.98, Phi ranging from .18 to .29, p ranging from < .05 to < .0001). Similar findings were observed for dominant hand “fails”; however, non-dominant hand was only related to the MSVT. Sensitivity and specificity values from the GPB measures ranged from .47 to .58 and from .89 to .92, respectively. Positive and negative predictive power ranged from .38 to .45 and .93 to .94, respectively. Conclusion These data demonstrate the relative utility of the GPB as an embedded PVT. In particular, dominant and both hand cutoffs are likely to be more clinically useful in determining sub-optimal performance. However, as sensitivity is relatively low, this measure should not be employed as the sole PVT administered.

The Impact of Self-Efficacy and Health Locus of Control on Performance Validity Testing

Objective Recent research has examined potential influences to performance validity testing beyond intentional feigning. The current study sought to examine the hypothesized relationships of two psychological constructs (self-efficacy and health locus of control) with performance validity testing (PVT). Method Retrospective review of 158 mild traumatic brain injury (mTBI) cases referred to an Army outpatient clinic for neuropsychological evaluation. The mTBI cases were classified according to passing or failing the Medical Symptom Validity Test (MSVT) or Non-Verbal Medical Symptom Validity Test (NV-MSVT). Group comparisons were performed utilizing one-way ANOVA to evaluate the differences between the PVT-Pass and PVT-Fail groups on self-efficacy (MMPI-2-RF Inefficacy scale) and locus of control (Multi-Dimensional Health Locus of Control). Results There was no relationship between self-efficacy or health locus of control and passing/failing PVTs. Conclusions Further research is warranted to explore potential influences on PVT performance, which we conceptualize as analogous to experimental nuisance variables that may be amenable to intervention.

A-75 Predicting neurocognitive impairment using the Green’s Medical Symptom Validity Test dementia profile formula

Objective The Green’s Medical Symptom Validity Test (MSVT) is a measure of performance validity and has a formula to help distinguish genuine cognitive impairment from suboptimal engagement. The current study used the MSVT “dementia profile” formula to discriminate patients with no neurocognitive disorder (no NCD), mild neurocognitive disorder (mild NCD), and major neurocognitive disorder (major NCD). Method 198 patients who were seen for comprehensive outpatient neuropsychological testing and passed all MSVT validity measures were included in the study. Specifically, participants included 103 persons with no NCD, 62 diagnosed with a mild NCD, and 33 with major NCD, who were collectively 58% male, with a mean age of 52-years-old (SD = 16.1) and mean education of 14.5 years (SD = 2.5). Results The difference score between easy and hard MSVT subtests predicted group assignment (r = .57, p < .001) and effectively differentiated the three groups (p < .001). Mean difference scores of both groups with diagnosed NCD exceeded recommended criteria suggestive of genuine cognitive impairment, with the differences score of major NCD being greater (p < .01) than the mild NCD. Group differences remained significant (p < .001) after adjusting for the effects of age and education. When the NCD groups were compared to the no diagnosis group, ROC curve analysis produced an AUC of .84, with a sensitivity of .72 and specificity of .83. Conclusions Findings from this study validate the established difference score between easy and hard subtests of the MSVT, and suggest that the difference score on a valid MSVT profile yields diagnostically relevant information pertaining to the level of an individual’s neurocognitive impairment.

Internet Searches for Medical Symptoms Before Seeking Information on 12-Step Addiction Treatment Programs: A Web-Search Log Analysis

Background Brief intervention is a critical method for identifying patients with problematic substance use in primary care settings and for motivating them to consider treatment options. However, despite considerable evidence of delay discounting in patients with substance use disorders, most brief advice by physicians focuses on the long-term negative medical consequences, which may not be the best way to motivate patients to seek treatment information. Objective Identification of the specific symptoms that most motivate individuals to seek treatment information may offer insights for further improving brief interventions. To this end, we used anonymized internet search engine data to investigate which medical conditions and symptoms preceded searches for 12-step meeting locators and general 12-step information. Methods We extracted all queries made by people in the United States on the Bing search engine from November 2016 to July 2017. These queries were filtered for those who mentioned seeking Alcoholics Anonymous (AA) or Narcotics Anonymous (NA); in addition, queries that contained a medical symptom or condition or a synonym thereof were analyzed. We identified medical symptoms and conditions that predicted searches for seeking treatment at different time lags. Specifically, symptom queries were first determined to be significantly predictive of subsequent 12-step queries if the probability of querying a medical symptom by those who later sought information about the 12-step program exceeded the probability of that same query being made by a comparison group of all other Bing users in the United States. Second, we examined symptom queries preceding queries on the 12-step program at time lags of 0-7 days, 7-14 days, and 14-30 days, where the probability of asking about a medical symptom was greater in the 30-day time window preceding 12-step program information-seeking as compared to all previous times that the symptom was queried. Results In our sample of 11,784 persons, we found 10 medical symptoms that predicted AA information seeking and 9 symptoms that predicted NA information seeking. Of these symptoms, a substantial number could be categorized as nonsevere in nature. Moreover, when medical symptom persistence was examined across a 1-month time period, a substantial number of nonsevere, yet persistent, symptoms were identified. Conclusions Our results suggest that many common or nonsevere medical symptoms and conditions motivate subsequent interest in AA and NA programs. In addition to highlighting severe long-term consequences, brief interventions could be restructured to highlight how increasing substance misuse can worsen discomfort from common medical symptoms in the short term, as well as how these worsening symptoms could exacerbate social embarrassment or decrease physical attractiveness.