Last Week in Medicine

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 Music from Uppbeat (free for Creators!): ht...

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 Kidne...

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.  Hypoth...

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 scr...

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 Fl...

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 Assessm...

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 fo...

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...

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://incomp...

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 Convales...

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...

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...

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...

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...

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 an...

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...

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 intubat...

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...

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...

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-...

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/) Mus...

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...

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 Recov...

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, w...

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....