Insights from Dr. Gregory Lip, Creator of the CHA2DS2-VASc Score

The CHA2DS2-Vasc Score is one of the most widely-used clinical risk scores for stroke. It’s arguably the best validated and is consistently in the top five most popular calcs on MDCalc. Professor Gregory Lip, the newest member of MDCalc’s Scientific Advisory Board, gave us an interview on developing and using the CHA₂DS₂-VASc Score.

dr-gregory-lip.jpeg

Dr. Gregory Lip

Why did you develop the CHA₂DS₂-VASc Score? Was there a clinical experience that inspired you to create this tool for clinicians?

The availability of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), previously referred to as new or novel oral anticoagulants, has led to a major change in the landscape for stroke prevention in atrial fibrillation (AF). Clinicians are also getting better at understanding how to manage warfarin, recognizing the importance of the average time in therapeutic range (TTR). New data are also re-emerging on the poor evidence for the efficacy and safety of aspirin for stroke prevention in AF. Continue reading “Insights from Dr. Gregory Lip, Creator of the CHA2DS2-VASc Score”

Insights from Dr. Christopher Seymour, Creator of the qSOFA Score

Ah, sepsis. You can’t solve a problem without defining it, and sepsis has been notoriously difficult to define, let alone treat. The body of data on sepsis is growing, as well as laypeople’s awareness of the disease. Yet it still manages to elude clinicians in many ways. We talked to Dr. Christopher Seymour, Sepsis-3 investigator and creator of the qSOFA Score, about using qSOFA to help in the management of sepsis.

Bonus: We also asked Dr. Seymour about his thoughts on vitamin C in sepsis. Come back to Paging MDCalc next week to see what he (and other critical care docs) had to say! Continue reading “Insights from Dr. Christopher Seymour, Creator of the qSOFA Score”

Tricks Up our New Website’s Sleeve: Version 3.1 is Here!

After a lot of hard work from MDCalc’s development team, we released Version 3.0 of MDCalc.com in January and just this past weekend we launched a few updates with Version 3.1. The new site offers a lot of great new features and customization that make using MDCalc even easier. Let’s jump into it! Continue reading “Tricks Up our New Website’s Sleeve: Version 3.1 is Here!”

Insights from Dr. Sofia Barbar – Creator of the Padua Prediction Score for Risk of VTE

The Padua Prediction Score is one of several validated venous thromboembolism (VTE)-related risk scores. It’s particularly useful in helping to determine whether hospitalized inpatients, who often have multiple comorbidities and thus multiple VTE risk factors, would benefit from pharmacologic prophylaxis over mechanical prophylaxis. We interviewed the first author on the derivation study, Dr. Sofia Barbar, for her insights on developing and using the Padua Prediction Score. Continue reading “Insights from Dr. Sofia Barbar – Creator of the Padua Prediction Score for Risk of VTE”

Deciphering Cryptogenic Stroke with Dr. David Thaler, Creator of the RoPE Score

Paradoxical embolism via patent foramen ovale (PFO) is a rare cause of stroke, but it’s not uncommon to find PFOs in patients without traditional stroke risk factors (about 1 in 4 people in the general population have a PFO). How should patients with no other convincing cause of stroke be counseled, especially if invasive PFO closure is being considered? We talked to Dr. David Thaler, creator of the Risk of Paradoxical Embolism (RoPE) Score, about his research and experience with taking care of patients with cryptogenic stroke.

dr-david-thaler

Dr. David Thaler

Why did you develop the RoPE Score? Was there a clinical experience that inspired you to create this tool for clinicians?

PFOs have interested and frustrated me for years. They’re so common in the general population, and we find them all the time in stroke patients, old ones and young ones. And paradoxical embolism is definitely a thing—there’s no question that it happens—but because the prevalence is so high in the general population, there’s also no question that a lot of the PFOs that we find are incidental. That’s where this started from in my mind: Continue reading “Deciphering Cryptogenic Stroke with Dr. David Thaler, Creator of the RoPE Score”

About the ASCVD and ACC/AHA 2013 Calculators

With the launch of the ASCVD Calculator and the ASCVD algorithm we recently added to MDCalc (The difference? I’ll explain further down) we thought it might be nice to review the 2013 guideline. Let’s start at the beginning.

Before the ASCVD

A long time ago, in a galaxy far, far away, (2002) there were the ATP-III Guidelines — short for the “Adult Treatment Panel,” a group of cholesterol and lipid experts that attempted to figure out what the heck to do with patients with lipid issues. It really focused on LDL cholesterol and addressed trying to aggressively reduce it. Find high risk people with high LDL, and get that LDL down! Continue reading “About the ASCVD and ACC/AHA 2013 Calculators”

Dr. Suzanne Rosenfeld on the Dos and Don’ts of Vaccines

Dr. Suzanne Rosenfeld, MDSuzanne Rosenfeld, MD, is co-founder of West End Pediatrics, a private practice in New York City. Formerly, she directed the Pediatric Emergency Room and also supervised in the Adolescent Medicine training of pediatric residents at The New York Hospital/Cornell Medical Center. Dr. Rosenfeld maintains an active teaching career at Cornell Medical Center and Columbia College of Physicians and Surgeons.

She sat down with us to give our users a some expert advice on the difficulties of vaccinations and some tips to use with patients.

MDCalc: What are some of the challenges you face when trying to vaccinate patients? How do you overcome these challenges?

Suzanne Rosefeld: The vast majority of my patients understand the importance of childhood vaccines. Before vaccinating each child I explain what the vaccine I am recommending is for. In the cases where there is hesitancy I make sure I answer every one of their questions. I listen to their concerns and address, using hard scientific evidence in terms of risk/benefit, each issue.

MDC: What are some of the most common cases in which you do not vaccinate patients?

SR: I do not vaccinate a child if they are at the beginning of an illness, even if its “just a cold”. Vaccines do not “make one sick” (with the exception of the live virus vaccines) but can “distract” the immune system. I am privileged by having a very responsible parent body and find that they 1) appreciate my considerations and, more importantly, 2) return at the recommended time to get the deferred vaccines. Continue reading “Dr. Suzanne Rosenfeld on the Dos and Don’ts of Vaccines”

Dr. Gina Choi on Taking Care of Patients with Hepatitis

Dr. Gina Choi, MDDr. Gina Choi specializes in general and transplant hepatology at UCLA Medical Center. She focuses on treating patients with the complications of cirrhosis, and manages their evaluation and care before and after liver transplant. She is well versed in the newest approaches to non-interferon based therapies for hepatitis C. Her research interests include hepatitis B and hepatocellular carcinoma. She is part of a multi-disciplinary team employing the latest treatments for hepatocellular carcinoma.

She was kind enough to sit down for an interview to provide some insight into the practice and treatment of hepatitis patients, considering May is Hepatitis Awareness Month.

MDCalc: It has been an exciting couple years in your field, with the discovery of a Hepatitis C cure, an area of your research (PMID: 27047770). What should docs know about these cures?

Gina Choi:  The new treatments for hepatitis C are very safe and effective with minimal side effects. Treatment duration is also short, ranging from 8-24 weeks, depending on the type of hepatitis C, or genotype, and the presence of cirrhosis.

MDC: Who should doctors screen and refer for Hepatitis C? What’s the best way for them to do so?

Continue reading “Dr. Gina Choi on Taking Care of Patients with Hepatitis”

Dr. David Oslin Speaks on Practice with Alcoholic Patients

Dr. David Oslin, MDDavid Oslin, MD, is a professor of psychiatry at the University of Pennsylvania and the Director of VISN 4 Mental Illness, Research, Education and Clinical Center (MIRECC). He is also a staff physician and chief of behavioral health at Corporal Michael J. Crescenz Veterans Administration Medical Center. He is an active researcher focused on alcohol and drug addiction, addiction treatment, and severe mental illness.

He took some time out of his busy schedule to provide some insight into the practice and treatment of alcoholic patients, considering April is Alcohol Awareness Month.

MDCalc: What are some of the challenges in working with alcoholic patients? Are there any rules you live by when evaluating patients?

David Oslin:  Trust but verify. It’s important that patients understand that being honest with their provider will have the best results but I also realize that part of their illness makes honesty and openness difficult.

Challenges are like many chronic debilitating illness. Addiction is life-threatening and not all patients do well with treatment. Like any other illness, we aren’t always successful in helping patients.

Another rule that I keep in mind is to be open to patients who want to try no matter how often they have set backs.

MD: What are the most promising aspects of recent and past alcoholic research? Are there any areas you would like to see more advancement in?

DOThere is a growing understanding of the neuroscience of addiction, and this is beginning to pay off with new medications that are effective in treatment. We also seem to be finally turning the corner in having providers realize that one treatment doesn’t fit all patients and that multiple treatment options are often warranted. This is also where I would like to see more progress.

MD: What advice would you offer busy clinicians on the best way they can (a) screen for alcohol abuse, and (b) help patients who may suffer from alcoholism?

DO: Use self reported but structured assessments such as the AUDIT-C which is only 3 questions. It is very useful in primary care practices or general psychiatry practices.

MD: Other comments? Any words of wisdom when seeing alcoholic or intoxicated patients? What research are you doing currently and what is next in the pipeline for you?

DOTreatment works!

To view Dr. Oslin’s publications, visit PubMed.