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.
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”
By Jeff Russ, MD, PhD – Pediatric/Child Neurology Resident, UCSF
A major task of any pediatric ward provider is to regularly assess a patient’s appearance, vital signs, labs, and risk factors, and integrate these data into a cohesive clinical picture to determine the patient’s acuity and potential need for intervention. This can be especially challenging on busy services or night shifts, where, for example, nurses may divide their time among up to four patients, and a single physician may care for 10–20 patients. Particularly with children, a lot can change between sporadic assessments, making it difficult to triage acuity.
When the MDCalc team isn’t scouring PubMed for studies to help our patients (and yours), we also like to read other stuff related to digital health, evidence, and the healthcare industry. It’s always hard to keep up with all the interesting articles on healthcare, and this year medicine has been a popular topic for journalists. So, we thought we’d share some of our favorite articles. Happy reading!
On Digital Health
- A.I. VERSUS M.D. What happens when diagnosis is automated? – By Siddhartha Mukherjee, The New Yorker
- NHS to start prescribing health apps that help manage conditions – By Matt Reynolds, New Scientist
- A digital revolution in health care is speeding up – The Economist
- Future challenges for digital healthcare – By Linda Brookes, M.Sc., Medical News Today
- Bypassing Clinical Decision Support Tools for Imaging in the ED – By Hossein Jadvar, Medscape
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.
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”
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”
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”
Suzanne 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”
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?
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?
DO: There 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?
DO: Treatment works!
To view Dr. Oslin’s publications, visit PubMed.