The Rounds Table

Send us Fan Mail Amol and Reena want you to understand the following: 1. When added to moderate dose statin, the IMPROVE-IT randomized trial showed that ezetimibe improved clinical outcomes in patients after acute coronary syndrome. 2. A network meta-analysis showed that no blood pressure lowering therapy improved mortality in patients with diabetes and chronic kidney disease. The combination of A...

Send us Fan Mail Originally aired May 22, 2015. Amol and Janice want you to understand the following: 1. Several RCTs and observational studies suggest that Transcatheter Aortic Valve Replacement reduces mortality and improves symptoms in frail, elderly patients. 2. A historical analysis demonstrates that the sugar industry had heavy influence in setting national dental research priorities in the...

Send us Fan Mail Amol and Nathan want you to understand the following: 1. A large randomized evaulation of a quality improvement intervention demonstrated a modest but significant reduction in rates of cesarean-section in Quebec. 2. A large double-blind randomized-controlled-trial of over 1100 patients showed that pentoxifylline is not beneficial in the treatment of alcoholic hepatitis and prednis...

Send us Fan Mail Aired April 23: Empiric antibiotic choices for community acquired pnuemonia and clindamycin versus trimethoprim-sulfamethoxazole for skin and soft tissue infections. Fahad and Amol want you to understand the following: 1. A large, high quality RCT showed that there was no significant difference between an empiric treatment strategy of beta-lactam vs beta-lactam plus macrolide vs r...

Send us Fan Mail Fahad and Amol want you to recognize that: 1. Idarucizumab as an agent that specifically reverses the hemostatic effects of dabigatran.  2. A post-hoc analysis of the ROCKET-AF study showed that digoxin is associated with increased mortality in patients with atrial fibrillation. The papers Idaracizumab for Dabigatran reversal. Digoxin use and mortality in ROCKET-AF. Good stuff htt...

Send us Fan Mail Amol wants you to: 1. Consider how the evidence helps us decide whether to prescribe a patient warfarin or a novel oral anticoagulant for stroke prevention in atrial fibrillation. Continuing Medical Education Internists can receive 0.5 hours of Continuing Medical Education credit for each podcast they listen to through the Canadian Society of Internal Medicine (MOC Category 1) ......

Send us Fan Mail Originally Published December 5, 2014: Travis and Amol want you to recognize that: 1. Recognize whole exome sequencing is an important new method of identifying genetic mutations associated with disease. 2. Understand that the 4-year follow-up of the PROTECT AF study showed that left atrial appendage closure devices may be superior to warfarin in preventing strokes in patients ......

Send us Fan Mail Amol and Reena want you to understand the following: 1. When added to moderate dose statin, the IMPROVE-IT randomized trial showed that ezetimibe improved clinical outcomes in patients after acute coronary syndrome. 2. A network meta-analysis showed that no blood pressure lowering therapy improved mortality in patients with diabetes and chronic kidney disease. The combination of A...

Send us Fan Mail Amol and Nathan want you to understand the following: 1. A short duration (4 days) of antibiotics for intra-abdominal sepsis was equivalent to a longer duration (approx. 8 days) of antibiotics for intra-abdominal sepsis after an appropriate source control procedure. 2. A population-based cohort study of elderly patients showed that lipid lowering therapy for primary prevention was...

Send us Fan Mail Amol and Fahad want you to understand the following: 1. There are dramatic hospital-level variations in the care of extremely pre-term infants. 2. A randomized trial showed that an electronic alert to identify hospital patients with acute kidney injury was not effective in improving patient outcomes. Continuing Medical Education Internists can receive 0.5 hours of Continuing Medic...

Send us Fan Mail Amol and Janice want you to understand the following: 1. Several RCTs and observational studies suggest that Transcatheter Aortic Valve Replacement reduces mortality and improves symptoms in frail, elderly patients. 2. A historical analysis demonstrates that the sugar industry had heavy influence in setting national dental research priorities in the 1970s, which is relevant for in...

Send us Fan Mail Originally Aired Jan 30: Eosinophilic esophagitis, outbreaks associated with duodenoscopy, and the rise of private endoscopy clinics Samir and Amol want you to understand the following: 1. Eosinophilic esophagitis is an important and under-recognized clinical condition that causes significant symptoms and is very treatable. 2. Endoscopy, and particularly duodenoscopy, is an import...

Send us Fan Mail Amol and Nathan want you to understand the following: 1. A large randomized evaulation of a quality improvement intervention demonstrated a modest but significant reduction in rates of cesarean-section in Quebec. 2. A large double-blind randomized-controlled-trial of over 1100 patients showed that pentoxifylline is not beneficial in the treatment of alcoholic hepatitis and prednis...

Send us Fan Mail This week: The MARQUIS study of interventions to reduce medication errors in hospital, super-utilizer patients, and the potential of community health workers for population health and medical education. Amol and Shail want you to understand the following: 1. Medication errors are an important problem in hospital and a multi-faceted intervention can be effective in addressing this...

Send us Fan Mail Effects of participation in the National Surgical Quality Improvement Program and Prednisone in Community Acquired Pneumonia Nathan and Amol want you to understand the following: 1. Participation in the National Surgical Quality Improvement Program has not appeared to improve overall patient outcomes or cost. 2. Adjunct prednisone treatment in community acquired pneumonia reduces...

Send us Fan Mail This week: Empiric antibiotic choices for community acquired pnuemonia and clindamycin versus trimethoprim-sulfamethoxazole for skin and soft tissue infections. Fahad and Amol want you to understand the following: 1. A large, high quality RCT showed that there was no significant difference between an empiric treatment strategy of beta-lactam vs beta-lactam plus macrolide vs respir...

Send us Fan Mail This week: A Randomized Controlled Trial of Resident Call Schedules in the ICU and The Natural History of Benign Thyroid Nodules. Nathan and Amol want you to understand the following: 1. There was no significant difference between three different call schedules in the ICU in terms of resident sleepiness or patient outcomes. 2. Benign thyroid nodules are ... The post Take me to the...

Send us Fan Mail Originally aired September 3, 2014: Perioperative AFib and Long-Term Risk of Ischemic Stroke; Paracetamol not more effective than placebo in acute low back pain Nathan and Amol want you to: 1. Understand that perioperative atrial fibrillation is associated with increased long-term risk of ischemic stroke. 2. Recognize that a high quality Randomized Controlled Trial demonstrates th...

Send us Fan Mail This week: The TITRE2 trial about hemoglobin transfusion strategies after cardiac surgery and the RETRACE study about intracranial bleeding in patients on warfarin. Nathan and Amol want you to understand the following: 1. In cardiac surgery patients, a restrictive transfusion strategy was no different than liberal transfusion in terms of combined clinical outcomes of infectious an...

Send us Fan Mail This week: New studies of PCSK9 inhibitors for lipid lowering and a randomized controlled trial of early peanut exposure to prevent allergy Fahad and Amol want you to understand the following: 1. PCSK9 inhibitors are new cholesterol-lowering monoclonal antibodies that have been shown to reduce LDL beyond standard therapy with statins and have been associated with reduced ... The p...

Send us Fan Mail Originally aired March 11, 2014: obesity, palliative care, hepatitis c Amol, Fahad, and Travis want you to: 1. Understand trends in obesity prevalence in adults and children. 2. Appreciate the effect of early palliative care on quality of life in patients with advanced cancer. 3. Recognize new therapeutic options in chronic Hepatitis C infection and their associated cost ... The p...

Send us Fan Mail VOICE: Tenofovir and Emtricitabine for HIV pre-exposure prophylaxis in African women and SARAH: Hand exercises in Rheumatoid Arthritis Fahad and Amol want you to understand the following: 1. Pre-exposure prophylaxis was not effective in a population of African women. Medication adherence was apparently excellent based on self-report and pill counting, however serum drug levels dem...

Send us Fan Mail The CHIPS trial of Hypertension in Pregnancy and TIPPS trial of Thrombophilia in Pregnancy Janice and Amol want you to understand the following: 1. Tight blood pressure control in pregnancy does not affect fetal outcomes in pregnancy compared with loose blood pressure control. The only difference in maternal outcomes is a reduced risk of severe hypertension ... The post Obstetrica...

Send us Fan Mail Effects of participation in the National Surgical Quality Improvement Program and Prednisone in Community Acquired Pneumonia Nathan and Amol want you to understand the following: 1. Participation in the National Surgical Quality Improvement Program has not appeared to improve overall patient outcomes or cost. 2. Adjunct prednisone treatment in community acquired pneumonia reduces...

Send us Fan Mail Originally aired July 2, 2014: Cryptogenic Stroke and Atrial Fibrillation, Naloxegol for Opioid-Induced Constipation Fahad and Amol want you to: 1. Appreciate the importance of subclinical atrial fibrillation in cryptogenic stroke and consider longer monitoring to detect it. 2. Recognize Naloxegol as a targeted therapy for opioid-induced constipation that is more effective than pl...