When Can Broad-Spectrum Antibiotics Be Avoided?

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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”

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

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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”

Interview with Cambridge Diabetes Risk Creator Prof. Simon Griffin

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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

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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”

The PEWS Score: Can an Algorithm Predict Worsening Illness in a Hospitalized Child?

By Jeff Russ, MD, PhD – Pediatric/Child Neurology Resident, UCSF

Dr. Jeff Russ

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.

Continue reading “The PEWS Score: Can an Algorithm Predict Worsening Illness in a Hospitalized Child?”

Our Favorite Reads So Far in 2017

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

  1. A.I. VERSUS M.D. What happens when diagnosis is automated? – By Siddhartha Mukherjee, The New Yorker
  2. NHS to start prescribing health apps that help manage conditions – By Matt Reynolds, New Scientist
  3. A digital revolution in health care is speeding upThe Economist
  4. Future challenges for digital healthcare – By Linda Brookes, M.Sc., Medical News Today
  5. Bypassing Clinical Decision Support Tools for Imaging in the ED – By Hossein Jadvar, Medscape

On Evidence Continue reading “Our Favorite Reads So Far in 2017”

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.

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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”