Risk Stratification in Acute Exacerbation of COPD: Interview with Dr. Andrew Shorr, BAP-65 Score Creator

Dr. Andrew Shorr (headshot)

Dr. Andrew Shorr

Andrew Shorr, MD, MPH, is an associate director of pulmonary and critical care medicine and the chief of the Pulmonary Clinic at MedStar Washington Hospital Center in Washington, DC. Dr. Shorr’s research interests include resistant pathogens and healthcare-associated bacteremia, and he has published more than 140 original studies.

Why did you develop the BAP-65 Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

I think we were interested in developing the score for two reasons: one, as a purely academic exercises, given that we have risk scores for PE and risk scores for pneumonia, clearly one of the pulmonary disease states where patients are sicker than they look is in COPD. So it was a clear hole in the range of pulmonary-critical care disease states that didn’t have some pulmonary risk stratification tool. And when you tie that together with the fact that COPD is a leading reason for admission in general, you can understand.

Continue reading “Risk Stratification in Acute Exacerbation of COPD: Interview with Dr. Andrew Shorr, BAP-65 Score Creator”

Predicting Mortality in Community Acquired Pneumonia – Dr. Robert Centor Interviews PSI Creator Dr. Michael Fine

Centaur Centor3 (1)

Centor’s Corner

Dr. Michael Fine, professor of medicine at the University of Pittsburgh, led the team that developed the Pneumonia Severity Index (PSI) and began studying the prognosis and other clinical aspects of community-acquired pneumonia (CAP) in the early 1990s.

His interest in predicting mortality in CAP started while he served as chief resident in internal medicine at the University of Pittsburgh. His mentor, Dr. Wishwa Kapoor, then hired him after his general internal medicine fellowship in the Harvard Generalist Faculty Development Program.  At the time Dr. Fine transitioned from fellowship to faculty at the University of Pittsburgh, the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality, AHRQ) had a well-funded portfolio of research projects called PORT (Patient Outcome Research Teams) studies.   Continue reading “Predicting Mortality in Community Acquired Pneumonia – Dr. Robert Centor Interviews PSI Creator Dr. Michael Fine”

Diabetes Management: Why Can’t We Do This with Lifestyle Alone?


Dr. Kate Rowland

Counseling patients with diabetes on lifestyle change during primary care office visits is motivated by good intentions. We as primary care doctors are interested in prevention, lifestyle changes can positively affect many patients with diabetes, and patients do best when engaged in managing their disease1. But it’s difficult to show with data that brief physician encounters are effective at producing any of these outcomes. Continue reading “Diabetes Management: Why Can’t We Do This with Lifestyle Alone?”

Interview with Cambridge Diabetes Risk Creator Prof. Simon Griffin


Prof. Simon Griffin

Simon J. Griffin, DM, is professor of general practice at the University of Cambridge, Group Leader in the MRC Epidemiology Unit and an assistant general practitioner at Lensfield Medical Practice in Cambridge, UK. He leads the Prevention of Diabetes and Related Metabolic Disorders Programme. Professor Griffin’s research interests include prevention and early detection of chronic conditions such as diabetes.

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How I Do It: Callus Debridement and the Diabetic Foot


Dr. Haywan Chiu

Haywan Chiu, DPM, is a practicing podiatrist in Albuquerque, New Mexico. He has a special interest in the diabetic foot. Haywan runs Diabetic Foot Guardian, an easily digestible resource for patients regarding feet and diabetes.


Callus Debridement Can Be Diagnostic

Calluses form when shear forces and pressure induce the epidermis to reinforce itself. In patients with diminished pain sensation such as in diabetic neuropathy, continued friction from shear forces and pressure evolves the callus into a blister, then a blood blister (figure 1). When I see a bloody foot callus, I know that at some point, there was a break in the dermis. I don’t know if it has healed on its own or if it has expanded into a full blown ulcer because I can’t see past the callus. In fact, some calluses can be so thick I can’t even see the blood underneath! The only way to find out what’s hiding is to debride the callus.

Continue reading “How I Do It: Callus Debridement and the Diabetic Foot”

Centor’s Corner: The Story of FENa

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Centor’s Corner

September, 1976: I was a 2nd year internal medicine resident at the Medical College of Virginia.

My attending physician, Dr. Carlos Espinel, had just published a now-classic article: The FENa test.

So that month, I had the wonderful opportunity to understand the rationale behind a test that I now have used for over 40 years.

Continue reading “Centor’s Corner: The Story of FENa”

Interview with MELD Score Creator Dr. Patrick Kamath


Dr. Patrick S. Kamath

Patrick S. Kamath, MD, is a professor of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota. His research interests include acute-on-chronic liver failure, nonalcoholic fatty liver disease, polycystic liver disease, Budd-Chiari syndrome and hereditary hemorrhagic telangiectasia. Dr. Kamath is internationally renowned as a leading researcher in hepatology and has also won numerous awards as an educator.

Why did you develop the MELD Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
Following a trans-jugular intrahepatic portosystemic shunt (TIPS) procedure for complications of portal hypertension, some patients do well and others fare poorly. My colleague in statistics, Mike Malinchoc, and I studied laboratory variables prior to the procedure and identified INR, serum creatinine, serum bilirubin and etiology of cirrhosis being predictive of survival. We developed a score based on these variables and demonstrated it predicted survival in a wide variety of patients with cirrhosis not undergoing TIPS. The score was originally called the Mayo End-Stage Liver Disease (MELD) model and was shown to be superior to the Child-Turcotte-Pugh score. Continue reading “Interview with MELD Score Creator Dr. Patrick Kamath”

Interview with MDCalc Co-Founder Dr. Joe Habboushe [VIDEO]

Dr. John Bedolla is the assistant director of research education and assistant professor of emergency medicine at the Dell Medical School at the University of Texas at Austin. He is also editor-in-chief of ED CLEAR, an evidence-based medical risk reduction program. Dr. Joe Habboushe is MDCalc’s co-founder and CEO. Earlier this year, the two sat down and talked about MDCalc’s content development process and future plans.

Dr. John Bedolla (JB): Hello, I’m Dr. John Bedolla. I am assistant professor of medicine and I’m also the director of risk management for a large EM group. Continue reading “Interview with MDCalc Co-Founder Dr. Joe Habboushe [VIDEO]”

From Evidence to Practice: Managing Pain, Agitation and Delirium in the ICU


Dr. Kim Medlej

Kamal (Kim) Medlej, MD, is an attending physician in the department of emergency medicine at Massachusetts General Hospital and fellowship-trained in critical care, and a longtime contributor to MDCalc. Here’s Dr. Medlej’s take on applying evidence on managing pain, agitation, and delirium to his patients in the ICU.

Pain, agitation, and delirium (the ICU triad) are common in critically ill patients, and can be challenging for clinicians to manage, both in (1) ruling out and treating potential underlying causes, and (2) choosing appropriate sedatives and analgesics in those patients who need them.

This is a fascinating area of critical care medicine, although it can also be difficult and frustrating. While our insight and screening tools have improved, the management of patients with pain, agitation, and/or delirium remains difficult. This is a large topic with a significant amount of literature and opinions. This brief overview is in no way comprehensive, but more a personal view, approach and practice.

Continue reading “From Evidence to Practice: Managing Pain, Agitation and Delirium in the ICU”

Centor’s Corner: FeverPAIN versus Centor Score

Centaur Centor3 (1)

Centor’s Corner

Editor’s note: Centor’s Corner is a new Paging MDCalc column featuring our favorite pharyngitis guru, blogger extraordinaire, and Scientific Advisory Board member Dr. Robert Centor, with regular insights from Dr. Centor on the applications of evidence to practice and musings from an experienced clinician. To comment on Centor’s Corner articles, please e-mail the editor at rachel@mdcalc.com or tweet directly to Dr. Centor @medrants.

On Twitter recently, several British tweeters discussed whether they should use the FeverPAIN Score or the Centor Score.  Obviously I have a bias here, but I will try to discuss this issue dispassionately.

Continue reading “Centor’s Corner: FeverPAIN versus Centor Score”