Last Week in Internal Medicine: Recent Episodes
Stephen Jenkins, MD, Austin Rupp, MD
Wouldn't it be nice if someone reviewed all the latest internal medicine literature and distilled it into a brief weekly podcast you could listen to on your way to work? Get updates from the New England Journal of Medicine, JAMA Network, Annals of Internal Medicine, Journal of Hospital Medicine, Journal of General Internal Medicine, Lancet and more.
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 COVID
Definition of Post Acute Sequelae of Sars-CoV-2 Infection
Platelet Transfusion before CVC Placement in Thrombocytopenia
DOACs vs LMWH in Cancer Associated VTE
Early vs Late Anticoagulation for Stroke with AF
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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 Hyponatremia
Apixaban vs Warfarin for On-X Aortic Valve
Perioperative Blood Pressure Strategies
Diagnostic Accuracy of CT Abdomen Without Contrast
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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 STIs
High dose prophylactic anticoagulation in COVID-19
Bisphosphonate and Rates of Fracture Non-unions
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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 Stones
Steroids for Pneumonia Meta-analysis
Hydrocortisone for Severe CAP (CAPE COD)
2023 GOLD COPD Guidelines
Real World Use of Oral Antibiotics for Endocarditis
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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 Men
Lower GI Bleeding Guidelines
IV Contrast in patients with AKI
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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 trial
Torsemide vs Furosemide in CHF
Aspirin vs Enoxaparin for VTE ppx after Fracture
IV Haloperidol in ICU Delirium
We also quickly review some papers we missed in 2022:
Apixaban for VTE in ESRD
Acetazolamide for Congestive Heart Failure
Moderate or Aggressive IV Fluids for Pancreatitis
Perioperative Management of Anticoagulation
CRISTAL study (aspirin vs enoxaparin after TKA/THA)
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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 Failure
Cardiovascular Outcomes for SGLT-2 Inhibitors vs Metformin
COVIDICUS Trial
Isolated Distal DVT Outcomes
Monkeypox Case Series
Mortality in Patients Undergoing Blood Transfusion
Perioperative Outcomes for Surgeons Who Operated the Night Before
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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 Shock
Short vs Standard Antibiotics for Neutropenic Fever
IV Vitamin C for Septic Shock
Vitamin C Meta-analysis
Hospitalist Workload and Patient Length of Stay
Fluid Bolus for Intubation
General Internist Practice Choices
Genetically Modified Porcine to Human Cardiac Xenotransplantation
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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 Disorder
Hepatitis C Care for People Who Inject Drugs
Final SOLIDARITY trial results for Remdesivir
TAVI for Moderate Risk Severe Aortic Stenosis
Mediterranean Diet vs Low Fat Diet for Secondary Prevention of CVD
Steroids for IgA Nephropathy
GLP-1 Agonists and Gallbladder Disease
Pig to Human Kidney Xenotransplantation
Aspirin for Primary Prevention of CVD
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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 Guidelines
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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 UTI
Awake Proning for Hospitalized COVID-19 Patients
1-2 Months of DAPT vs 12 months of DAPT vs ACS
Low Sodium Diet for Heart Failure
Estimating Excess Mortality due to COVID-19
Risk of Anaphylaxis from IV Iron
Pickle Juice for Cramps in Cirrhosis
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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 Patients
Methenamine 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 Tests
Binax Rapid Test vs PCR for Sars-CoV-2 Infection
Characteristics of Type 2 NSTEMIs
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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-19
Ivermectin for Mild to Moderate COVID-19
County-Level Prescriptions for Hydroxychloroquine and Ivermectin and Presidential 2020 Voting Patterns
Diagnostic Strategies for Ruling out PE
Thiamine Use in ICU Patients with Alcohol Use Disorder
Racial Disparities in Hypoxemia Detection with Pulse Oximetry
Vitamin D and Mortality
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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-analysis
PICC lines vs Midlines
Apixaban vs Rivaroxaban for Recurrent VTE
LOLA for Hepatic Encephalopathy
Eat-Walk-Engage in Older Inpatients (CHERISH)
Rivaroxaban for Post-discharge Prophylaxis in High Risk COVID patients (MICHELLE)
Mindfulness Training and Burnout
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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 CVP
IV Diltiazem vs Metoprolol for A fib with RVR
Major Ischemic and Hemorrhagic Events in Apixaban vs Rivaroxaban for AF
Reducing Sleep Interruptions in Hospitalized Patients
Early Remdesivir for Outpatient COVID-19
Molnupiravir for Outpatient COVID-19
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Somehow we got through 7 articles today, and none of them are about COVID-19!
Happy Thanksgiving!
Chlorthalidone in CKD
Milvexian for VTE Prevention
Risk of Recurrent VTE in Subsegmental PE
Rivaroxaban associated with higher rates of GI bleeding
Depression and Residency
Mental-Stress Induced Myocardial Ischemia
Patient Outcomes for Part Time Hospitalists
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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 Race
Race, Genetic Ancestry and Estimating Kidney Function
Long Term Bleeding Risk from Oral AC after First Unprovoked VTE
Therapeutic Heparin for COVID-19 (HEP-COVID)
High Dose Dexamethasone for Severe COVID-19
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- 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 Arrest
Empagliflozin for Heart Failure with Preserved EF
Antibiotic Duration for Afebrile UTIs in Men
Normal Saline vs Balanced Solution in ICU patients
Baricitinib for COVID-19
Therapeutic Anticoagulation for COVID-19
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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 Infections
Colorectal Cancer Screening
Hospital Admission for Chest Pain after ACS Ruled Out
Morning Discharges and LOS
Personalized 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 Sepsis
High Flow Nasal Oxygen
POCUS for Acute Dyspnea
Screening of Atrial Fibrillation in Older Patients
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
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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 Hypertension
Vaccine-Induced Immune Thrombotic Thrombocytopenia
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"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
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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 Pneumonia
IV Contrast and Kidney Function
DOACs for Valvular Atrial Fibrillation
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
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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 Embolism
Nafcillin vs Cefazolin for Epidural Abscess
Ferritin/Procalcitonin Ratio for COVID-19 vs Bacterial Pneumonia
Intermediate 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 License
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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 Cirrhosis
Terlipressin for Type 1 Hepatorenal Syndrome
Music 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 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-print
Meta-analysis of Convalescent Plasma for COVID-19
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 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 Hospitalists
Educational Resource Utilization Among Internal Medicine Residents
Liberal vs Restrictive Transfusion Threshold for Patients with ACS and Anemia
DOACs for VTE prevention in CKD
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 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 trial
EARLY-AF trial
ACEi and ARBs in COVID-19
IV vs Oral Antibiotics for Appendicitis
Rifaximin after TIPS to Prevent HE
Reimagining Endocarditis Care in an Opioid Epidemic
Lower vs Higher Oxygen Targets
Music 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 ILD
Omecamtiv Mecarbil for Systolic Heart Failure
Music 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 Exacerbation
STOP-IT COVID trial
RCT-TCZ-COVID-19 trial
CORIMUNO-TOCI-1 trial
REMAP-CAP trial pre-print
Music 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 Veterans
Tocilizumab in Hospitalized Patients with COVID-19
Music 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-19
Klok et al
Helms et al
Shah et al
Piazza et al
Porfidia et al
Kunutsor et al
Dutt et al
Stessel et al
Paranjpe et al
Fraisse et al
Musoke et al
Patel et al
ISTH Guidelines
ACCP Guidelines
Take 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 ED
Baricitinib Plus Remdesivir for COVID-19 (ACTT-2 trial)
Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine
Non-invasive respiratory protocol for COVID-19
Ferric Carboxymaltose for Acute HFrEF and Iron Deficiency
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 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 Outcomes
Rapid Conversion to Oral Antibiotics for Pneumonia
SOLIDARITY trial for COVID-19
Music 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 Study
CDC Report on Kansas Mask Mandates
Rivaroxaban for A fib and Bioprosthetic Mitral Valve
Convalescent Plasma for COVID-19
Semaglutide and NASH
Weekly Icodec Insulin
Statin Nocebo Effect
Music 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 Report
Tocilizumab for Hospitalized COVID-19 Patients
Bamlanivimab
Pfizer Vaccine
Moderna Vaccine
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 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-19
Music 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 Syncope
Music 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 City
Triple Combination Therapy for COVID-19 in Hong Kong
Remdesivir in adults with Severe COVID-19
Treatment of 5 Patients with Convalescent Plasma
Music 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 Raffi
https://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 City
Lopinavir-Ritonavir in Severe COVID-19
Hydroxychloroquine in France
Hydroxychloroquine 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-19
Risk Factors for Mortality in COVID-19
Risk Factors for ARDS and Death in COVID-19
Caring for Critically Ill Patients with COVID-19
Detection of COVID-19 in Children
Gabapentin for Alcohol Use Disorder
Apixaban versus Rivaroxaban for Atrial Fibrillation
Music 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-1
Pregnenolone 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 China
Covid-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 Outcomes
Medicare for All in the US
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 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 Syndrome
The Sorting Hat of Medicine: Why Hufflepuffs Wear Stethoscopes and Slytherins Carry Scalpels
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 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/)
Today we are joined by the very smart Dr. Jason Carr, a pulmonary/critical care fellow, to talk about two big papers from the wonderful world of lungs. Does CT screening for lung cancer save lives? Do you have to put a chest tube in every patient with a spontaneous pneumothorax? Check it out!
CT Screening for Lung Cancer, AKA NELSON
Conservative vs Interventional Treatment for Spontaneous Pneumothorax
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)
It's our tenth episode! Thanks for getting us this far. Today we discuss the new coronavirus outbreak, what to do with high sensitivity troponins, whether hydroxyethyl starch should be used in abdominal surgery (spoiler alert: it shouldn't) and the appropriate use of testosterone therapy.
Novel Coronavirus in China
High Sensitivity Troponins and the Fourth Universal Definition of MI
Hydroxyethyl Starch versus Saline in Major Abdominal Surgery
Efficacy and Safety of Testosterone Treatment in Men
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 the wonderful Dr. Emily Signor to talk about new therapeutic approaches to DVT prophylaxis, how much time physicians spend using the EHR in clinic, and whether that Vitamin C cocktail works for septic shock. Check it out!
Effect of Osocimab in Preventing VTE in Patients Undergoing TKA
Physician Time Spent Using the EHR During Outpatient Encounters
Vitamin C, Thiamine and Hydrocortisone for Septic Shock
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 try something a little different -- three co-hosts! Dr. Dani Babbel joins Jenkins and Rupp for some lively discussion about hotspotting, very severe aortic stenosis and whether adherence improves when medications are free. Check it out!
Health Care Hotspotting
Early Surgery for Asymptomatic Aortic Stenosis
Effect on Treatment Adherence of Distributing Essential Medicines at No Charge
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)
Happy New Year and welcome to the first episode of 2020! We've got some great articles to review today. Can we save money by taking care of some acutely ill patients in their own homes? Are patients admitted for "social" reasons at the same risk for adverse events as acutely ill patients? Can NT-ProBNP level predict cardiovascular death and myocardial injury after non-cardiac surgery? Does limiting alcohol intake reduce atrial fibrillation recurrence? Listen to find out!
Hospital Level Care at Home for the Acutely Ill
Adverse Events in Patients Hospitalized Without Definite Medical Acuity
Preoperative NT-ProBNP before Non-Cardiac Surgery
Alcohol Abstinence and Atrial Fibrillation
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)
Dr. Rupp is back! Today we talk about whether it's safe to give group 2 gadolinium based contrast agents to patients with CKD stage 4 and 5 and whether metoprolol can be used to prevent COPD exacerbations. We also shine some more sunlight on the sunshine vitamin's inability to change any meaningful outcomes, and discuss some interesting data from the Intern Health Study.
Risk of Nephrogenic Systemic Fibrosis in Patients with Stage 4 or 5 CKD Receiving Group II Gadolinium Based Contrast Agent
Metoprolol for the Prevent of Acute Exacerbations of COPD
Early High-Dose Vitamin D3 for Critically Ill, Vitamin D-Deficient Patients
Political events and mood among young physicians
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)
This week we have a special guest host, Dr. Dani Babbel. We talk about the new guidelines on upper GI bleeding, a new study on E-VALI, and the possible association of beta blockers with heart failure hospitalizations in heart failure with EF > 50%.
Management of Upper GI Bleeding Guidelines
Clinical presentation, treatment and short term outcomes of E-VALI
Association of Beta-Blocker Use with Heart Failure Hospitalizations in HFpEF
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)
Can you get away with a higher d-dimer value in patients with a low pre-test probability for PE? Does working more days in a row improve patient outcomes? How often are people inappropriately prescribing fluoroquinolones? How often are people using systemic lytics vs catheter directed lytics in acute PE, and what are the outcomes?
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 talk about the effects of vitamin D in progression of CKD in people with diabetes, and whether SGLT-2 inhibitors like dapagliflozin can be used to treat heart failure with reduced ejection fraction in people without diabetes. We also talk about ticagrelor monotherapy after three months of DAPT, rivaroxaban for the treatment of APS (don't do it!) and LDL targets for stroke prevention.
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)
Lots of cardiology to discuss this week with the Apple Heart and COLCOT studies, both published in the New England Journal of Medicine. We also talk about the 3 Wishes Project, the net clinical benefit of oral anticoagulation with aging over 75, the benefits of non-pharmaceutical treatment of agitation, and getting blood cultures before you give antibiotics.
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)
Should we add blood pressure medications or increase the dose while patients are in the hospital? What are the risk factors and outcomes for people who receive antibiotics for asymptomatic bacteriuria? And how does the DRIP score stack up against previous tools for identifying patients at high risk for drug resistant pneumonia?
Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)