Last Week in Medicine

Today we do a round-up of some of the recent semaglutide trials. Does semaglutide ever miss? But what about tirzepatide, which causes even more weight loss?We also review two new critical care trials, FLUID and the UK-ROX, new platelet transfusion guidelines, and a new retrospective study of apixaban vs rivaroxaban vs warfarin. Oral Semaglutide for Diabetes with Cardiovascular Disease or CKD (SOUL)Semaglutide for Peripheral Artery Disease (STRIDE)Semaglutide for MASH (ESSENCE)Semaglutide vs Tirzepatide for Obesity (SURMOUNT-5)Normal Saline vs Lactated Ringers (FLUID)Conservative Oxygen Targets in Mechanically Ventilated Patients (UK-ROX)Platelet Transfusion GuidelinesApixaban vs Rivaroxaban vs Warfarin Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R

What do you do when most trials suggest benefit for an intervention, but then a new trial suggests harm? We thought steroids in pneumonia was a settled question, but REMAP-CAP had other plans!We also review a new RCT for BP targets in patients with hypertension and diabetes, a new aldosterone synthase inhibitor for hypertension, and reduced dose apixaban for cancer-associated thrombosis. Hydrocortisone for Severe CAP (REMAP-CAP)Predicting Benefit of Corticosteroids in PneumoniaIntensive BP Control in Patients with Diabetes (BPROAD)Lorundrostat for Uncontrolled Hypertension (ADVANCE-HTN)Reduced Dose Apixaban for Cancer Associated Thrombosis (API-CAT)Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R

For this episode we are joined by EBM guru, Dr. Brian Locke, who deftly breaks down all of our statistics questions. Is half dose DOAC as good as full dose DOAC for preventing VTE, and does it reduce bleeding risk? Can procalcitonin reduce duration of antibiotics for infections without compromising mortality rates? Can LLMs like GPT-4 help physicians manage patients better? Can reinforcement learning models predict when to start vasopressin in patients with septic shock? What is the risk of resuming anticoagulation in patients with atrial fibrillation and prior intracerebral hemorrhage? Is high flow nasal cannula as good as non-invasive ventilation for different types of respiratory failure? We answer all these questions and more!Half Dose DOAC for Long Term VTE Prevention (RENOVE)Biomarker-Guided Antibiotic Duration (ADAPT-Sepsis)GPT-4 Assistance for Physician PerformanceOptimal Vasopressin Initiation for Septic Shock (OVISS)DOACs for A fib after ICH (PRESTIGE-AF)High Flow Nasal Cannula vs NIV for Respiratory Failure (RENOVATE)Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R

We're back, after a brief hiatus! Today we talk about duration of therapy for bacteremia, Factor XI inhibition for atrial fibrillation, whether to stop ACEi or ARB before elective surgery, and whether GLP-1 agonists are beneficial in heart failure with preserved ejection fraction. Go to minute 7:30 to skip the banter. 7 vs 14 Days of Antibiotics for Bacteremia (BALANCE)Abelacimab vs Rivaroxaban for Atrial Fibrillation (AZALEA-TIMI-71)Asenduxian vs Apixaban for Atrial Fibrillation (OCEANIC-AF)ACEi or ARB Discontinuation Before Surgery (STOP or NOT)Tirzepatide for HFpEF and Obesity (SUMMIT)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

It's been a long time, but we are back!Apologies on the audio quality from Dr. Jenkins. Apparently he was recording from inside a cardboard box.Today we talk about important, practice changing studies in internal medicine from the last several months. What's the best anticoagulant in patients with cirrhosis and atrial fibrillation? Why do doctors use so much unfractionated heparin for acute PE? Should we still be using beta blockers in patients with acute MI? Does finerenone improve outcomes in HFpEF? Is continuous infusion of antibiotics better than intermittent? And will the cefepime vs piperacillin-tazobactam battle ever end?Apixaban, Rivaroxaban and Warfarin in Cirrhosis for AFAnticoagulation Trends for Acute PEBeta Blockers for Acute MI with Normal EF Finerenone for HFpEF FINEARTS-HFContinuous vs Intermittent Infusion of Beta-Lactams BLING IIIProlonged vs Intermittent Infusions of Beta-Lactams Meta-analysisPiperacillin-Tazobactam vs Cefepime for SepsisRecurrent SBP in Patients on Secondary Prophylaxis

Today we are joined by Dr. Brian Locke, recently graduated pulmonary-critical care fellow, who takes us on a journey of avoiding statistical fallacies. Does metformin reduce the likelihood of long COVID? Should we give platelet transfusions to thrombocytopenic patients before central line placement? Did the CANVAS trial change practice in cancer associated thrombosis? Should patients with a stroke due to atrial fibrillation start oral anticoagulation earlier or later? We discuss all these questions on more on today's episode. Check it out! Metformin for Long COVIDDefinition of Post Acute Sequelae of Sars-CoV-2 InfectionPlatelet Transfusion before CVC Placement in Thrombocytopenia DOACs vs LMWH in Cancer Associated VTEEarly vs Late Anticoagulation for Stroke with AFMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we have a special guest, Dr. Joel Topf, board-certified nephrologist and medical educator extraordinaire. Our listeners will likely recognize Dr. Topf from his prolific tweeting @Kidney_boy, as well as his numerous appearances on the Curbsiders podcast. He is a co-founder of the NephJC on Twitter, and host and founder of the NephJC podcast Freely Filtered. He is also host of the podcast Channel Your Enthusiasm, a deep dive monthly recap of the nephrology textbook Clinical Physiology of Acid Base and Electrolyte Disorders by Dr. Burton Rose (who, incidentally, is the creator of the original UpToDate). Dr. Topf wrote his own book on fluids, electrolytes and acid-base homeostasis.  He's the co-editor for the fourth edition of Nephrology Secrets and the first edition of The Handbook of Critical Care Nephrology. Dr. Topf joined us to talk about a new paper he co-authored on osmotic demyelination syndrome and hyponatremia. I'm also joined by Dr. Mita Hoppenfeld, hospitalist at the University of Utah, to talk about a new DOAC vs warfarin trial in On-X aortic valves, whether it's better to avoid hypertension or hypotension around time of surgery, and the diagnostic accuracy of CT abdomen scans without contrast. Check it out! Osmotic Demyelination and HyponatremiaApixaban vs Warfarin for On-X Aortic ValvePerioperative Blood Pressure Strategies Diagnostic Accuracy of CT Abdomen Without ContrastMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

This week we have special guest, Dr. Adam Spivak, to talk about the new study on doxycycline post-exposure prophylaxis for STIs. Dr. Spivak is an infectious disease expert and works in both an HIV clinic and a free PrEP clinic. I also review the latest COVID-19 anticoagulation trial and a paper looking at rates of fracture non-union in people who receive bisphosphonates. Check it out! Doxycycline Post-exposure Prophylaxis for STIsHigh dose prophylactic anticoagulation in COVID-19Bisphosphonate and Rates of Fracture Non-unions Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we have special guest, Dr. Sarah Gilligan, a nephrologist, to talk about the new study of thiazides for kidney stones. We all learn in medical school that thiazides reduce urinary excretion of calcium, but does that really translate to fewer kidney stones? We also have Dr. Brian Locke on to talk about the CAPE COD trial, a big new critical care paper on using hydrocortisone in severe pneumonia, as well as the latest COPD guidelines and a retrospective study of oral antibiotics for infective endocarditis. Check it out! Hydrochlorothiazide for Kidney StonesSteroids for Pneumonia Meta-analysisHydrocortisone for Severe CAP (CAPE COD)2023 GOLD COPD GuidelinesReal World Use of Oral Antibiotics for EndocarditisMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we welcome special guest and fellow EBM lover Dr. Mita Hoppenfeld to talk about a new randomized controlled trial evaluating the best duration of antibiotics for febrile UTI in men. Is 7 days as good as 14 days? We also review the latest guidelines for lower GI bleeding and a new retrospective study on renal outcomes in patients with AKI who receive IV contrast. 7 vs 14 days of antibiotics for Febrile UTI in MenLower GI Bleeding GuidelinesIV Contrast in patients with AKI Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

We're back with Season 4! Sorry for the unplanned hiatus. Today we talk about the CLOVERS trial, which tested the hypothesis that early vasopressors and restrictive fluid would be superior to liberal fluids plus rescue vasopressors. We also looked at the TRANSFORM-HF study, which compared torsemide and furosemide in congestive heart failure, the PREVENT CLOT study, which compared aspirin to enoxaparin for VTE prophylaxis after a traumatic fracture, and the AID-ICU study, which compared haloperidol to placebo in the treatment of ICU delirium. CLOVERS trialTorsemide vs Furosemide in CHFAspirin vs Enoxaparin for VTE ppx after FractureIV Haloperidol in ICU DeliriumWe also quickly review some papers we missed in 2022:Apixaban for VTE in ESRD Acetazolamide for Congestive Heart FailureModerate or Aggressive IV Fluids for PancreatitisPerioperative Management of AnticoagulationCRISTAL study (aspirin vs enoxaparin after TKA/THA)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we have a couple special guests under the age of 2. Birdie and Gus! Do SGLT2 inhibitors improve diuresis in acute heart failure? Are they better than metformin for reducing cardiovascular mortality? Is high dose dexamethasone better than standard dose in ICU patients with COVID? We also talk about outcomes in patients with isolated distal DVT compared to proximal DVT, a large case series of patients with monkeypox infection, blood donor outcomes and the outcomes for surgeons who operated the night before. Check it out! SGLT2-Inhibitors for Acute Heart FailureCardiovascular Outcomes for SGLT-2 Inhibitors vs MetforminCOVIDICUS Trial Isolated Distal DVT OutcomesMonkeypox Case SeriesMortality in Patients Undergoing Blood TransfusionPerioperative Outcomes for Surgeons Who Operated the Night BeforeMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we are joined by Dr. Brian Locke to talk about multiple new critical care trials, including the CLASSIC trial of a restrictive vs standard fluid strategy, the LOVIT trial of vitamin C in septic shock, and the PREPARE-II trial of fluid bolus at the time of intubation to prevent cardiovascular collapse. We also look at whether 72 hours of antibiotics are safe in patients with neutropenic fever, whether hospitalist workload affects patient length of stay, and what kind of careers general internists are pursuing over the last decade. Restrictive Fluids for Septic ShockShort vs Standard Antibiotics for Neutropenic FeverIV Vitamin C for Septic ShockVitamin C Meta-analysisHospitalist Workload and Patient Length of StayFluid Bolus for IntubationGeneral Internist Practice ChoicesGenetically Modified Porcine to Human Cardiac XenotransplantationMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we had Dr. Patricia Liu to talk about a new study from Journal of Hospital Medicine on the management of opioid use disorder in the hospital. And then we got a little carried away covering way too many articles!  Inpatient Management of Opioid Use DisorderHepatitis C Care for People Who Inject DrugsFinal SOLIDARITY trial results for RemdesivirTAVI for Moderate Risk Severe Aortic StenosisMediterranean Diet vs Low Fat Diet for Secondary Prevention of CVDSteroids for IgA NephropathyGLP-1 Agonists and Gallbladder DiseasePig to Human Kidney XenotransplantationAspirin for Primary Prevention of CVDMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today, Dr. James Fang, Chief of Cardiovascular Medicine at the University of Utah, and AHA/ACC/HFSA Heart Failure Guideline Committee Member, joins us to talk about the new heart failure guidelines, published in April 2022.  We talk about the new classifications, including HF with improved EF and HF with mildly reduced EF, and new recommendations for medical therapy for all the heart failure types. How do you start someone on GDMT? Who should get SGLT-2 inhibitors? How can we get more people on ARNIs? Dr. Fang provides lots of clinical pearls and practical wisdom for applying these new recommendations. Check it out! 2022 Heart Failure GuidelinesMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Dr. Brian Locke is back to talk about that "nonrandomized" proning trial.  We also talk about the new oral carbapenem for UTI trial, whether 1-2 months of DAPT is non-inferior to 12 months of DAPT, whether less than 1500 mg of sodium reduces heart failure hospitalizations, the risk of anaphylaxis from IV iron, and whether pickle juice is effective for treating cramps in cirrhosis. Check it out! Oral Tebipenem vs IV Ertapenem for Complicated UTIAwake Proning for Hospitalized COVID-19 Patients1-2 Months of DAPT vs 12 months of DAPT vs ACSLow Sodium Diet for Heart FailureEstimating Excess Mortality due to COVID-19Risk of Anaphylaxis from IV Iron Pickle Juice for Cramps in CirrhosisMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we have Dr. Brian Locke back on to talk about asthma management and a new trial  of reliever-triggered inhaled glucocorticoids for Black and Latinx patients with asthma. Other questions we try to answer: Does methenamine prevent recurrent UTIs in women? Should CT coronary scan be done before invasive coronary angiography? Does melatonin prevent delirium in ICU patients? How good are patients at interpreting home COVID tests? What is the most common cause of type 2 NSTEMI? Give it a listen and find out! Reliever Triggered Inhaled Glucocorticoid Therapy in Black and Latinx Asthma PatientsMethenamine vs Antibiotics for Urinary Tract Infection Prophylaxis CT vs Invasive Coronary Angiography for Stable Chest Pain Melatonin for Delirium Prevention in ICU Patients Consumer Interpretation for At-Home COVID TestsBinax Rapid Test vs PCR for Sars-CoV-2 InfectionCharacteristics of Type 2 NSTEMIsMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

We finally have the published trial results for Paxlovid! We also look at the latest trial showing the ivermectin is ineffective in treating COVID-19 and one year outcomes in ICU COVID-19 patients.  We also look at a meta-analysis of trials looking at different diagnostic strategies for ruling out PE, a retrospective study of thiamine use in ICU patients with alcohol use disorder, and a new study on pulse oximetry in people with different skin color. Check it out! Paxlovid for High Risk, Nonhospitalized Patients with COVID-19Ivermectin for Mild to Moderate COVID-19 County-Level Prescriptions for Hydroxychloroquine and Ivermectin and Presidential 2020 Voting Patterns Diagnostic Strategies for Ruling out PEThiamine Use in ICU Patients with Alcohol Use DisorderRacial Disparities in Hypoxemia Detection with Pulse Oximetry Vitamin D and MortalityMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we are joined by Dr. Brian Locke to talk about the newest big trial on IV fluids in critically ill patients and a meta-analysis that looks at all the similar trials. Is this question finally settled?We also look at PICC lines vs midlines, IV L-ornithine L-aspartate in acute treatment of hepatic encephalopathy, a new ward-based program for delirium prevention in older inpatients, post-discharge thromboprophylaxis for high risk COVID patients, and whether mindfulness training can help burnout in residents.Balanced Multielectrolyte Solution vs Normal Saline in Critically Ill Patients (PLUS)Balanced Crystalloid vs Normal Saline Meta-analysisPICC lines vs MidlinesApixaban vs Rivaroxaban for Recurrent VTE LOLA for Hepatic EncephalopathyEat-Walk-Engage in Older Inpatients (CHERISH)Rivaroxaban for Post-discharge Prophylaxis in High Risk COVID patients (MICHELLE)Mindfulness Training and BurnoutMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

It's our last episode in 2021! This episode we have Dr. Libo Wang and Dr. Jon Harrison on to talk about their new paper in the Annals of Internal Medicine about ultrasound JVP for estimating CVP, validated with right heart catheterization. We also ask them their thoughts on a new meta-analysis looking at metoprolol vs diltiazem for atrial fibrillation with RVR. We also look at a new large retrospective study of apixaban vs rivaroxaban for stroke prevention, a study looking at reducing sleep interruptions in the hospital, and two new outpatient therapies for COVID-19 infection. Happy New Year! Ultrasound JVP for estimating CVPIV Diltiazem vs Metoprolol for A fib with RVRMajor Ischemic and Hemorrhagic Events in Apixaban vs Rivaroxaban for AFReducing Sleep Interruptions in Hospitalized Patients Early Remdesivir for Outpatient COVID-19Molnupiravir for Outpatient COVID-19Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Somehow we got through 7 articles today, and none of them are about COVID-19! Happy Thanksgiving! Chlorthalidone in CKDMilvexian for VTE PreventionRisk of Recurrent VTE in Subsegmental PERivaroxaban associated with higher rates of GI bleedingDepression and ResidencyMental-Stress Induced Myocardial IschemiaPatient Outcomes for Part Time HospitalistsMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we talk about the effect of eliminating the race coefficient from the estimated GFR calculators, the risk of bleeding from anticoagulation after first unprovoked VTE, another trial looking at therapeutic anticoagulation in COVID-19, and whether 12 mg of dexamethasone is better than 6 mg for severe COVID-19 infections. New GFR Equations without RaceRace, Genetic Ancestry and Estimating Kidney FunctionLong Term Bleeding Risk from Oral AC after First Unprovoked VTETherapeutic Heparin for COVID-19 (HEP-COVID)High Dose Dexamethasone for Severe COVID-19Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

We're back after a nice relaxing summer taking care of a surge of COVID-19 patients.  To start off season 3 we decided to do a rapid review of some of the best articles over the last three months.  Dr. Brian Locke returns to help us break down some critical care papers, we talk about the miracle of SGLT-2 inhibitors, the treatment of UTIs in men, and the latest in COVID-19 literature. Hypothermia vs Normothermia after Cardiac ArrestEmpagliflozin for Heart Failure with Preserved EFAntibiotic Duration for Afebrile UTIs in MenNormal Saline vs Balanced Solution in ICU patients Baricitinib for COVID-19Therapeutic Anticoagulation for COVID-19Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today is our season 2 finale, and we have a master class on prosthetic joint infections from Dr. Laura Certain.  Is 6 weeks as good as 12 weeks for prevent recurrent infections?  How does the surgeon decide what kind of surgery to do?  Should we use oral or IV antibiotics?  When should you use rifampin??  Dr. Certain answers all these questions and more. We also talk about the new colon cancer screening guidelines from USPSTF, hospital admission for chest pain after ACS ruled out in the ED, whether morning discharges improve patient throughput, and a study looking at personalized steroid dose for COPD exacerbations. We will be back in the fall of 2021! Antibiotics for Prosthetic Joint InfectionsColorectal Cancer ScreeningHospital Admission for Chest Pain after ACS Ruled OutMorning Discharges and LOSPersonalized Steroid Regimen for COPD exacerbation Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

How long can you delay antibiotics in patients with suspected sepsis before the risk of hospital mortality increases?  What proportion of patients with suspected sepsis end up having actual sepsis?  Dr. Devin Horton joins us to review a paper in Critical Care Medicine that tries to answer these questions. Antibiotic Delay Intervals and Hospital Mortality for Patients with Suspected SepsisHigh Flow Nasal OxygenPOCUS for Acute DyspneaScreening of Atrial Fibrillation in Older PatientsMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we have special guest Dr. Natalie Como to talk about Hospital at Home and what it's like to practice hospital medicine at a rural critical access hospital.  We also look at a retrospective paper on ACE/ARBs in veterans with pulmonary hypertension and talk about vaccine-induced immune thrombotic thrombocytopenia (VITT).  Check it out! Hospital at Home with Comprehensive Geriatric Assessment RAAS Inhibition and Pulmonary HypertensionVaccine-Induced Immune Thrombotic Thrombocytopenia Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we are joined by heavy hitter Dr. Brian Locke to talk about the new paper on 3 vs 8 days of antibiotics for pneumonia, a clever new paper looking at whether there is any association between IV contrast and kidney function, and a new retrospective study on DOAC use for valvular atrial fibrillation.  Check it out! Three Days of Antibiotics for PneumoniaIV Contrast and Kidney FunctionDOACs for Valvular Atrial FibrillationMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we are doing double duty: podcasting and parenting.  Fortunately our babies were well-behaved.  We talk about three trials for semaglutide and weight loss and a new 4 level pre-test probability rule for diagnosing PE.  We also talk about a retrospective study of cefazolin vs nafcillin for epidural abscess, a ferritin/procalcitonin ratio for differentiating bacterial from COVID pneumonia, and a new randomized controlled trial of intermediate thromboprophylaxis for ICU patients with COVID19.  Check it out! Semaglutide for Weight Loss (STEP 1)Semaglutide for Weight Loss in Diabetics (STEP 2)Semaglutide + Intensive Calorie Restriction for Weight Loss (STEP 3)4PEPS for Pulmonary EmbolismNafcillin vs Cefazolin for Epidural AbscessFerritin/Procalcitonin Ratio for COVID-19 vs Bacterial PneumoniaIntermediate Thromboprophylaxis for COVID-19 (INSPIRATION) Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/) Hall of the Mountain King Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 3.0 Licensehttp://creativecommons.org/licenses/by/3.0/

Today has a nice liver disease theme. Does targeting a serum albumin above 3 g/dL reduce death, infections and kidney failure in patients with decompensated cirrhosis? Does terlipressin work in hepatorenal syndrome? Albumin Infusion for Decompensated CirrhosisTerlipressin for Type 1 Hepatorenal Syndrome

Today I am joined by Infectious Disease expert Dr. Emily Spivak to talk about the latest batch of tocilizumab trials for COVID-19 and a meta-analysis of all the convalescent plasma trials. Check it out! Tocilizumab in Hospitalized Patients with COVID-19 (COVACTA)IL-6 Receptor Antagonists in Critically Ill Patients with COVID-19 (REMAP-CAP)RECOVERY Tocilizumab pre-printMeta-analysis of Convalescent Plasma for COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we have special guests Dr. Emily Signor and Dr. Amanda Breviu, two hospitalists, to talk about a survey published in JHM on gender-based discrimination among hospitalists. We also discuss a survey published in JGIM on educational resources used by internal medicine residents. Check it out! Gender Based Discrimination and Harassment Among HospitalistsEducational Resource Utilization Among Internal Medicine ResidentsLiberal vs Restrictive Transfusion Threshold for Patients with ACS and AnemiaDOACs for VTE prevention in CKDMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we have a special guest, Dr. Jared Bunch, an international expert in atrial fibrillation and ablation, to talk about the state of atrial fibrillation and which patients benefit from early catheter ablation based on two new trials published last week in the NEJM. We also talk about whether you should stop ACEi or ARBs in patients admitted with COVID-19, whether oral antibiotics are adequate for uncomplicated appendicitis, and whether you should target a high (90 mmHg) or low (60 mmHg) paO2 in patients with respiratory failure. STOP-AF First trialEARLY-AF trialACEi and ARBs in COVID-19IV vs Oral Antibiotics for AppendicitisRifaximin after TIPS to Prevent HEReimagining Endocarditis Care in an Opioid EpidemicLower vs Higher Oxygen TargetsMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today I am joined by pulmonary hypertension and heart failure expert, Dr. John Ryan, to talk about inhaled treprostinil for pulmonary hypertension due to ILD, and a new cardiac myosin activator, omecamtiv mecarbil, for treatment of systolic heart failure. Check it out! Treprostinil for Pulmonary Hypertension due to ILDOmecamtiv Mecarbil for Systolic Heart FailureMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

WARNING: This episode is long on banter. If you would like to skip the intro conversation and get right to the articles, skip ahead to 12:13. Today we are joined by Dr. Jason Carr, pulmonary-critical care all-star, to talk about how often PE is present in patients with acute COPD exacerbations. We also review more tocilizumab RCTs because they just keep coming. Prevalence of Pulmonary Embolism in Acute COPD ExacerbationSTOP-IT COVID trialRCT-TCZ-COVID-19 trialCORIMUNO-TOCI-1 trialREMAP-CAP trial pre-printMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

The president's supporters may have stormed the capitol and attempted a coup today, but the show must go on. Today I'm joined by Dr. Dani Babbel to talk about treatment of hypertension in the hospital, as well as testing for primary aldosteronism in patients with resistant hypertension. Check it out! Treatment and Outcomes in Inpatient Hypertension Testing for Primary Aldosteronism and MRA Use Among US VeteransTocilizumab in Hospitalized Patients with COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today I do a quick review of the COVID-19 thrombosis literature from the last year to try to answer some of the following questions: Why does COVID-19 cause thrombosis? How many patients with COVID-19 develop thrombotic complications? Why do patients with COVID-19 on VTE prophylaxis still develop blood clots? Should we use intermediate dosing of anticoagulation for prophylaxis? What about full dose therapeutic anticoagulation (no!) What do the guidelines say? Lots of papers:JAMA IM Review Autopsy Findings and VTE in Patients with COVID-19Klok et al Helms et alShah et alPiazza et alPorfidia et alKunutsor et alDutt et alStessel et alParanjpe et alFraisse et alMusoke et alPatel et alISTH GuidelinesACCP GuidelinesTake home points:COVID-19 is associated with an elevated risk of thrombosis. Observational data suggests that ICU patients are likely to develop thrombotic complications even on standard VTE prophylaxis. This number seems to be round 25%. Ward patients are also at higher risk (around 8-9%). Critically ill patients commonly develop heparin resistance, and this may partially explain why some patients with COVID develop thrombotic complications despite prophylaxis. Some have suggested intermediate dosing of anticoagulation for prophylaxis, but there are no randomized controlled trials published at this time, and observational data are limited. Some have suggested therapeutic dosing of anticoagulation for critically ill patients, but observational data show high rates of bleeding and other complications, and the three largest randomized controlled trials have stopped enrolling critically ill patients into the therapeutic anticoagulation arm due to safety concerns and futility. Some have suggested targeting a certain anti-Xa activity level, but no one really knows what that should be, and there aren’t any guidelines recommending it. ISTH and ACCP have both put out guidelines which are overall pretty similar.Make sure your patient has VTE prophylaxis, preferably a LMWH, and keep an eye out for thrombotic complications so you can treat them in a timely manner. Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we have special guest Dr. Valerie Vaughn to talk about her new paper in Open Forum Infectious Diseases about inappropriate treatment and testing for asymptomatic bacteriuria. Then we talk about the new ACTT-2 trial results of baricitinib plus remdesivir for COVID-19. We also review the BioNTech/Pfizer vaccine safety and efficacy results, a noninvasive respiratory protocol to reduce intubations in COVID-19, and iron deficiency in acute heart failure. Testing and Treating Asymptomatic Bacteriuria Initiated in the EDBaricitinib Plus Remdesivir for COVID-19 (ACTT-2 trial)Safety and Efficacy of the BNT162b2 mRNA Covid-19 VaccineNon-invasive respiratory protocol for COVID-19Ferric Carboxymaltose for Acute HFrEF and Iron Deficiency

Today we have special guests Dr. Claire Ciarkowski and Dr. Stacy Johnson to talk about two recent papers they published, as well as the new SOLIDARITY trial results. Are patient outcomes the same for resident, APC and solo hospitalist teams? How do you get doctors to switch to oral antibiotics faster when treating pneumonia? And with the new SOLIDARITY results showing no benefits for remdesivir, should we still be using it for COVID-19? Resident, APC and Solo Hospitalist Team OutcomesRapid Conversion to Oral Antibiotics for PneumoniaSOLIDARITY trial for COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

We're back with our second episode of the new season. Dr. Rupp is sporting a new mustache, and we discuss the mysterious monolith discovered in the Utah desert. If you want to skip the banter, go to 6:56. This week we try to figure out what that Danish Mask Study really showed. Is it safe to use rivaroxaban in patients with a bioprosthetic mitral valve and A fib? Does convalescent plasma improve outcomes in COVID-19? Danish Mask StudyCDC Report on Kansas Mask MandatesRivaroxaban for A fib and Bioprosthetic Mitral ValveConvalescent Plasma for COVID-19Semaglutide and NASHWeekly Icodec InsulinStatin Nocebo EffectMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

We're back after a prolonged hiatus, ready to break down the latest and greatest in the medical literature. Today's episode will get you caught up on the newest treatments for COVID-19. We promise to talk about something else next time :) If you want to skip all the banter about Baby Yoda and politics, go to 8:36. Remdesivir for COVID-19 Final ReportTocilizumab for Hospitalized COVID-19 PatientsBamlanivimabPfizer VaccineModerna VaccineMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we are joined by a special guest, Dr. Lawanda Jim, chief of internal medicine at Northern Navajo Medical Center, to talk about what it's been like taking care of patients during the pandemic in Shiprock, NM. Check it out! Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we're back with a spirited discussion of a pre-print publication for the dexamethasone arm of the RECOVERY trial. Should hospitalized COVID19 patients receive dexamethasone? Take a listen and decide for yourself. Dexamethasone in Hospitalized Patients with COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

We're back with another episode. We cover the latest highlights in COVID, including the exciting new results on remdesivir from the ACTT-1 trial. We also talk about whether you can use CRP to guide duration of antibiotic therapy in patients with gram negative bacteremia, and whether NT-pro-BNP can help you risk-stratify patients with syncope. Check it out! Remdesivir Shortens Time to Recovery in COVID19 (ACTT-1)CRP Guided Antibiotics or 7 Days vs 14 Days for Gram Negative Bacteremia NT-pro-BNP in SyncopeMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

We're back with some of the latest updates on COVID-19! Are hydroxychloroquine or azithromycin associated with increased risk of mortality or cardiac arrest? Does triple combination antiviral therapy shorten time to a negative viral swab? Does remdesivir shorten time to clinical improvement? Should we be giving patients convalescent plasma? If you were the patient with severe COVID-19, which therapies would you want?Hydroxychloroquine and Azithromycin in New York CityTriple Combination Therapy for COVID-19 in Hong KongRemdesivir in adults with Severe COVID-19Treatment of 5 Patients with Convalescent PlasmaMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Dylan Sings Quarantine by Raffihttps://www.youtube.com/watch?v=xeEBcmkcJm8

It's been a while! We took a short hiatus while our lives were upended by the pandemic. But we couldn't stay away forever. Today we review some of the big trials published in the last month on Covid-19. We look at the large case series on New York patients published in JAMA, three hydroxychloroquine studies, the lopinavir-ritonavir study and the compassionate use of remdesivir study. Buckle up! 5700 Patients Hospitalized with COVID-19 in New York CityLopinavir-Ritonavir in Severe COVID-19Hydroxychloroquine in FranceHydroxychloroquine in China Hydroxychloroquine in Veterans Compassionate Use of Remdesivir Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Seems like a lot has happened in just one week! The whole world is different. Today we talk about some of the most recent articles published about the ongoing COVID-19 pandemic. We also discuss whether gabapentin can be used to treat people with alcohol use disorder, and whether apixaban is better than rivaroxaban for preventing strokes in people with atrial fibrillation. Incubation Period for COVID-19Risk Factors for Mortality in COVID-19Risk Factors for ARDS and Death in COVID-19Caring for Critically Ill Patients with COVID-19Detection of COVID-19 in ChildrenGabapentin for Alcohol Use Disorder Apixaban versus Rivaroxaban for Atrial FibrillationMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Austin finally returns to the podcast with harrowing tales of almost being eaten by a wolf. Today we discuss a new NEJM paper about long acting injectable therapy for HIV and a new JAMA paper about pregnenolone, a neurosteroid that may help treat the scourge of primary care: chronic low back pain. Long Acting Cabotegravir and Rilpivirine for HIV-1Pregnenolone vs Placebo for Chronic Low Back Pain in Veterans Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we had Dr. Dani Babbel back on the show to talk about the latest COVID-19 updates, whether gastric acid suppression increases your risk of MDRO colonization, and how to improve care to patients boarding in the emergency department. Check it out! Characteristics of Covid-19 in ChinaCovid-19 Report from CDC of China Gastric Acid Suppression and MDRO Colonization Hospitalist Care of ED Boarders and Length of Stay Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we had the pleasure of talking to Dr. Barbara Jones, first author on a new paper in JAMA IM about the outcomes in veterans treated with empirical anti-MRSA therapy vs standard therapy. She gives us a master class in propensity weighted analysis and instrumental variable analysis. We also look at whether outcomes are different in patients who are cared for by hospitalists who call more consults than their colleagues, and how much money we could save with a single payer system in the United States. Empirical Anti-MRSA vs Standard Antibiotic Therapy in Pneumonia High Consulting Hospitalists and Patient OutcomesMedicare for All in the USMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we have the venerable EBM guru Dr. Brian Locke on the show to talk PLEX and DEX. Does plasma exchange for ANCA-vasculitis really work? Do steroids make any difference in patients with ARDS? Also, have you ever wondered which Hogwarts house your medical specialty belongs to? Plasma Exchange and Glucocorticoids for ANCA-Vasculitis Dexamethasone for Acute Respiratory Distress SyndromeThe Sorting Hat of Medicine: Why Hufflepuffs Wear Stethoscopes and Slytherins Carry ScalpelsMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Today we are joined by the man, the myth, and the legend, Dr. Stacy Johnson, to talk about a new meta-analysis of using aspirin for DVT prophylaxis after a total hip or knee replacement. We also review a new retrospective cohort study from Cleveland Clinic on whether it's safe to give the recommended 30 ml/kg fluid bolus to patients with sepsis who also have CHF, cirrhosis or ESRD. Check it out! Aspirin for VTE Prophylaxis after THA or TKA Fluid Management for Sepsis in Patients with ESRD, Cirrhosis and CHF Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)