When Can Broad-Spectrum Antibiotics Be Avoided?

dr-brandon-webb

Dr. Brandon Webb

Brandon Webb, MD, is an infectious disease physician in the division of epidemiology and infectious diseases at Intermountain Healthcare in Utah. He has also served as an adjunct assistant professor at the University of Utah School of Medicine. Dr. Webb’s research interests include bacterial pneumonia, antimicrobial stewardship, and transplant infectious diseases.

Why did you develop the DRIP Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians? Continue reading “When Can Broad-Spectrum Antibiotics Be Avoided?”

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”

Interview with Cambridge Diabetes Risk Creator Prof. Simon Griffin

dr-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.

Continue reading “Interview with Cambridge Diabetes Risk Creator Prof. Simon Griffin”

Interview with MELD Score Creator Dr. Patrick Kamath

dr-patrick-s-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]”

Interview with Dr. Ilene Claudius, Part 2 of 2: Pediatric Mass Casualty and Systemic Failures in Child Abuse

dr-ilene-claudius

Dr. Ilene Claudius

Can you tell us about your research in pediatric mass casualty incidents (MCI)? How did you develop an interest in pediatric mass casualty? Was there a particular patient experience that you had?

I haven’t had a personal experience with it, necessarily—we’ve certainly had some overwhelming car accidents, but nothing to the level that I would call a true pediatric mass casualty incident. These are always tragic events, and especially after Sandy Hook, it became clear that kids could make up a sizable portion if not the entirety of the victim population of an MCI.

We’ve done a lot of work in the PEM [pediatric emergency medicine] community on general community hospitals being ready to see a lot of kids in general. I work with an organization called COPEM [Committee on Pediatric Emergency Medicine] that looks at our pediatric receiving hospitals and makes sure they’re up to standard in terms of delivering pediatric care and having the appropriate supplies. And that’s just for a single routine pediatric patient. So the thought of how a group of very traumatized pediatric patients simultaneously is going to be handled is something we discuss a lot. Continue reading “Interview with Dr. Ilene Claudius, Part 2 of 2: Pediatric Mass Casualty and Systemic Failures in Child Abuse”

Interview with Dr. Ilene Claudius, Part 1 of 2: Managing Suspected Child Abuse in an Emergency Setting

dr-ilene-claudius

Dr. Ilene Claudius

Ilene Claudius, MD, is an associate professor of clinical emergency medicine and chief of pediatric emergency medicine at the Keck School of Medicine of the University of Southern California. She is editor-in-chief of Pediatric Emergency Medicine Practice, and her clinical research interests include pediatric mass casualty, non-accidental trauma (child abuse), and pediatric mental health.

Dr. Claudius has also studied apparent life-threatening events (ALTE) and brief resolved unexplained events (BRUE). She has authored or co-authored dozens of studies in peer-reviewed journals, and is an active contributor to the EM:RAP podcast. We talked to Dr. Claudius about her research and clinical expertise in pediatric emergency medicine.

Continue reading “Interview with Dr. Ilene Claudius, Part 1 of 2: Managing Suspected Child Abuse in an Emergency Setting”

Insights from Dr. Lise Nigrovic, Creator of the Bacterial Meningitis Score for Children

Bacterial meningitis is a rare but serious disease, with mortality approaching 100% when left untreated. On the flip side, many children with mild viral illness are admitted with questionable benefit. The Bacterial Meningitis Score can help support a clinician’s decision to discharge a child safely. We talked with Dr. Lise Nigrovic, first author on the derivation and validation studies.

doctor-lise-e-nigrovic-pediatrician

Dr. Lise Nigrovic

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

When I was a resident in pediatrics, I found myself admitting well-appearing children who had meningitis, spent two days in the hospital, and then went home after their cultures were negative. Doing that over and over again made me wonder if we could do better and distinguish between children who

Continue reading “Insights from Dr. Lise Nigrovic, Creator of the Bacterial Meningitis Score for Children”

Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis

Antibiotic overuse and misuse is a growing public health concern, and foregoing the administration of antibiotics in cases where they are not needed can be a challenging decision to defend without good evidence to back it up. The Centor Score for Strep Pharyngitis is one of the most practical and useful evidence-based decision tools that helps support clinicians in making those decisions. We interviewed Dr. Robert Centor on developing and using the Centor Score.

dr-robert-m-centor

Why did you develop the Centor Score? Was there a clinical experience that inspired you to create a this tool for clinicians?
In 1979, while working in the “non-acute” adult emergency room, a resident asked me how to evaluate a sore throat patient. Having just finished my residency, I started to give a definitive answer, but had a moment of humility and told him that I did not know. We made a treatment decision at the time, and I went to the library to learn more. Continue reading “Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis”

Insights from Dr. Jeffrey Perry, Creator of the Ottawa Subarachnoid Hemorrhage Rule

Subarachnoid hemorrhage, if undiagnosed, can have devastating consequences. While headache is a common presenting complaint in emergency departments, only about 1% of these patients are diagnosed with SAH. The Ottawa SAH Rule helps rule out SAH with 100% sensitivity, to better identify which patients do and do not need further workup. We talked with Dr. Jeffrey Perry, first author of the Ottawa SAH Rule derivation study.

dr-jeffrey-j-perry

Dr. Jeffrey J. Perry

How did you develop the Ottawa SAH Rule? Was there a particular patient or clinical experience you had?

Two things: One was the apparent subjectivity I noticed as a resident in evaluating patients for SAH, where the criteria for which patients we would investigate seemed to be very different. Some of the patients I thought were very low risk, other physicians would want to still investigate them for SAH, including doing a CT, which didn’t bother me too much, but then they would go on to do an LP, which is very uncomfortable, and time-consuming, and it seemed to contribute to already very prevalent ED overcrowding. So that was the clinical side of things. Continue reading “Insights from Dr. Jeffrey Perry, Creator of the Ottawa Subarachnoid Hemorrhage Rule”