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”

Sometimes it’s NOT just a sore throat – adolescents and young adults are different

Written by Dr. Robert Centor, creator of the Centor Score. Twitter: @medrants

In medical school we spend little time learning Pharyngalgiaabout sore throats. After all, it’s just a sore throat.

Group A beta-hemolytic streptococcal (GAS) tonsillitis dominates our sore throat concern, because it can cause acute rheumatic fever and peritonsillar abscess. We have rapid antigen tests for GAS so that we can treat patients with that infection. Continue reading “Sometimes it’s NOT just a sore throat – adolescents and young adults are different”

“Doc, do I really need this operation? What are the TRUE risks?” Improving the conversation around surgical risk using evidence-based medicine

A 70-year-old woman with peptic ulcer disease comes to the ED with sudden severe abdominal pain. She also has a history of diabetes and hypertension, both well controlled with oral medication. Her vitals at triage show low-grade tachycardia but are otherwise within normal limits. She is peritoneal on exam and an upright chest x-ray reveals free air. While labs are pending, she is made NPO and started on IV fluid resuscitation.

You are the general surgeon called to see the patient, and your history and Continue reading ““Doc, do I really need this operation? What are the TRUE risks?” Improving the conversation around surgical risk using evidence-based medicine”

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”

Don’t Forget the Zebras: Familial Hypercholesterolemia

Did you know that FH is very treatable but missed in 90% of cases, and leads to early cardiac death? We’ve added some calculators to try to address it:

Unless you’re an endocrinologist, FH is one of those diseases you probably memorized in medical school, brought up on rounds when the Continue reading “Don’t Forget the Zebras: Familial Hypercholesterolemia”

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.