Booster Shots

No episode today. Just a brief call to listeners!

We are looking for people to join our team in one of several areas:

1. Content generation: come push your Medical Education agenda and develop episode structure, summarize guidelines and develop content. Record your own clinical updates!
2. Be a guest-host: interview consultants, or summarize information from a conference you attend. Be that informative disembodied voice!
3. Earn the title of Producer: work with us to master your own episodes, collect residents to develop a new resident-driven segment.

If you find one of those interesting, or would like to discuss other opportunities, e-mail us at boostershots@ucsf.edu to introduce yourself and what strikes your fancy!

In the sequel to last week’s episode, we are back with Dr. Jonathan Davis, Director of the Heart Failure program from San Francisco General. We continue our tour of GDMT for HF, by covering SGLT2-i, MRAs, as well as some AKI and outpatient considerations. This is part 1 of 2 parts which will cover an overview of GDMT medications, and dive into Beta-blockers and ARNIs. Part 2 to come out next week!

| 00.33 - Previously on Booster Shots |

| 01.31 - Chapter 3: SGLT2-i |

• The now famous EMPA-REG OUTCOME trial [NEJM 2015]

• Empagliflozin in HFpEF (not discussed in this episode [NEJM 2021]

| 04.24 - Chapter 4: MRAs |

• RALES trial demonstrating benefit in Morbidity/Mortality [NEJM 1999]

| 10.04 - Organizing follow up |

| 11.51 - Issues with AKI |

| 15.10 - Some fun questions about Fun questions |

| 16.54 - Summary of All The Things! |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Medical Heart Vectors by Vecteezy

We talk to Cardiologist Dr. Jonathan Davis, Director of the Heart Failure program from San Francisco General about goal directed medical therapy in heart failure with reduced ejection fraction (HFrEF). This is part 1 of 2 parts which will cover an overview of GDMT medications, and dive into Beta-blockers and ARNIs. Part 2 to come out next week!

| 00.34 - Introduction |

| 01.55 - Consult Q: GDMT for HF |

• Heart failure outcomes

| 05.20 - GDMT medication summary and overview |

| 07.17 - Effect on blood pressure and relative risk reduction for each drug |

| 10.59 - What order to start in |

• Hint: ALL AT ONCE… if you can

| 11.53 - Beta-blockers |

• When not to start (new HF in VOL), and when to re/start (almost all other times)
• Tartrate vs Succinate: duration of action

| 15.40 - ARNI (Sacubitril-Valsartan) |

• Potent natriuresis effect
• Balancing the orthostatics

| 20.37 - Outro |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Medical Heart Vectors by Vecteezy

Medicines gonna med, surgeons gonna surge. What do we change and do in the perioperative period? Join us for some bites from the MHP 2023 talk on Perioperative management updates, a few JHM articles around NPO status and buprenorphine continuation, and the start of a summary series on SPAQI position papers on what to do with various medications in the perioperative period.

| 00.22 - TOC |

| 01.17 - MHP-1 Post-operative AFib and Anticoagulation [Siontis 2022 - Associations of POAF w/ subsequent outcomes] [AHA 2023 guidelines] |

| 02.50 - MHP-2 ASA for DVT ppx in Ortho trauma cases [METRC study - large multi-center trial of ASA vs LMWH] [ICS-VTE position papers by location of surgery] |

| 04.20 - MHP-3 Post-op delirium [AGS Guidlines] [Kim 2022- Haldol vs atypicals] |

| 05.11 - Perioperative NPO status: When should we start? [JHM 2021] |

| 06.37 - Buprenorphine in the acute pain and perioperative settings [JHM 2019] |

| 07.18 - SPAQI position paper on Endocrine, Hormonal, and Urological meds |

| 09.56 - Summary |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Surgery Vectors by Vecteezy

ID consult questions with Dr. Sarah Doernberg - today she will discuss the court case Latent v Active TB in patients with planned immunosuppression, the effects of BCG treatment for bladder cancer, and when to think about “treatment failure” for complex bone/joint infections.

| 00.34 - Introduction to Dr. Sarah Doernberg |

| 01.29 - TB associated eConsults: Latent v Active TB in patients planning immunosuppression |

| 07.20 - TB prevalence in SF and testing|

| 09.52 - A case of disseminated BCG in a patient with previous malignancy history and bone disease |

| 15.33 - Possibly silly question about BCG inoculation |

| 16.49 - Sarah’s idea of a running parter |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. *Image generated through my experimentation with Image Designer by Microsoft.*

Happy to have you with us! Ring in the New Year with clinical updates around piperacillin-tazobactam vs cefepime in AKI, corticosteroids in severe CAP with a clinical trial and several meta-analyses, perioperative management of ACEI/ARBs, and AE in inpatient medicine.

| 00.33 - Introduction |

| 01.00 - ACORN trial [JAMA 2023] - In 2500 patients presenting to the ED with sepsis, there was no statistically significant difference in AKI or death @ 14 days with pip/tazo vs cefepime, but cefepime did cause a decrease in delirium or coma free days |

| 01.55 - CAPE COD with Dequin et al. in France? trial [NEJM 2023] In 800 patients admitted to the ICU with severe CAP, hydrocortisone administration was associated with reduced death from any cause at 90 days and reduced need for intubation |

• 02.54 - PROSPERO [CHEST 2023] - Doesn’t include Dequin’s study. Concludes that there was a reduced incidence of intubation, but no reduced mortality.

• 03.26 - CID meta-analysis including the CAPE COD study by Dequin et al. [CID 2023] many studies similar to the PROSPERO study, but including Dequin et al. Therefore resulting in the conclusion of decreased mortality on top of reduced intubation.

| 04.21 - POISE-3 - hypotension avoidant vs hypertension avoidant strategies in properties ACEI/ARB management [ AIM 2023] |

| 05.58 - Adverse events in Massachusetts hospitals. What can we focus on for the future? [NEJM 2023] |

| 07.15 - Happy new year! |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. *Image by rawpixel.com on Freepik.*

Just a quick update on the state of the podcast, including things we have discussed so far, and plans for the future. We hope you have a safe, healthy, up to date, and happy holidays!

Booster Shots team

[edited 12/21 for several non-clinical content associated issues]

For part II with Dr. Madhu Rao from Endocrinology, we talk about more consult pearls. Part II of II.

| 00.03 - Intro |

| 00:34 - Common consult questions: |

• 01:02 - Aggressively starting insulin
• 01:49 - Daily adjustment
• 02:15 - Unexplained hypoglycemia

| 02:46 - Diagnostics in pituitary or hypothalamic concerns |

| 03:44 - Steroids and Insulin going home |

| 04:46 - Pituitary case discussion and types of imaging|

| 09.23 - Adrenal insufficiency |

| 11.34 - RCC adrenal concerns |

| 12.38 - Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

In this episode we talk with Dr. Madhu Rao, endocrinologist at UCSF on common consult questions and various other topics including TFTs, DEXA scans, what new oral glycemic agents to start, and making sure the PCP stays in the loop. Part I of II.

| 00.33 - Intro |

| 01:16 - Common Consult questions in endocrinology - when to get thyroid function tests |

| 05:42 - Repeat DEXA scans not needed in patients on bisphosphonate therapy that are adherent to medication regimen (JGIM 2017) |

| 07.46 - Oral glycemic agents in the hospital, and on discharge |

| 10.46 - Following up with the PCP |

| 12.17 - Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

In this episode, Our guest host Avromi talks about pushing GDMT via the STRONG-HF trial. We also start our MHP2023 recap series with some pearls from Dr. Zier’s cardiology update session.

| 00.33 - TOC |

| 01.19 - MHP2023 Afib updates |

• AFFIRM 2002 (rate and rhythm non-inferior)
• EAST-AFNET 4 - using dofetilide
• CABANA - using ablation and evaluating HF patients
• ESC commentary - impact of AFFIRM and changes in management to today

| 03.04 - Guest host Avromi and STRONG-HF [Lancet 2022]. Click here for a slide deck overview of the study. |

| 08.49 - MHP2023 high-sensitivity Troponin and AMI management |

• COMPASS-MI - using hs-cTnT for early rule out
• PLATO (lower primary outcome w/ ticagrelor v clopidogrel, equivalent bleeding), TRITON-TIMI 38 (lower primary outcome w/ prasugrel v clopidogrel, equivalent bleeding), ISAR-REACT 5 (lower mortality w/prasugrel v ticagrelor w/ similar bleeding risks)
• RAPID CABG (NOT PEER REVIEWED YET)- similar rates of bleeding waiting off ticagrelor 2-3d vs 5-7d
• REVERSE-IT - bentracimab for reversal of ticagrelor
• 2023 ESC Guidelines for ACS

| 11.17 - Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

png image from pngtree.com

This episode covers some of the activities presented by UCSF faculty and staff at the SGIM 2023 conference in Golden, CA in May 2023. We have interviewed many of the presenting individuals. There are no specific clinical updates in this episode.

Abstracts can be obtained @ JGIM. Other links in the show notes are provided by the authors themselves.

Posters and talks

| 01.03 - Dr. Alex Beagle: Sepsis associated IVF use in HF vs non-HF |

| 02.55 - Dr. Ritu Bansal: Post-retirement planning for Hospitalists |

| 04.23 - Dr. Timothy Judson: AI-powered chatbot for monitoring chemo patients’ symptoms |

| 07.34 - Lorraine Pereira: Using Human Centered Design to evaluate geriatric interventions | 

| 09.13 - Dr. James Harrison: Understanding resident knowledge around Skilled Nursing Facilities | 

| 10.56 - Dr. Himali Weerahandi: Using Intersectional analysis to address inequity in academic research | 

Case presentations

| 12.42 - Dr. Ritu Bansal: Working with a patient with bad healthcare experiences |

| 14.04 - Dr. Natalie Sohn: A differential for cost-associated medicatio non-adherence | 

| 15.40 - Dr. Anand Habib: The use of medical respite |

|17.45 - Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Today we have one tip for shocky patients on the floor supplemented by some info from the Management of the Hospitalized Patient 2023 (more coming in the future!), and a bunch of tips including TIPS for managing upper GI bleeds, Ascites, SBP, and HRS.

| 00.00 Opening & TOC |
| 01.02 Consider vasopressors via PIV - JHM 2022, Surviving Sepsis 2021 |
| 04.15 Upper GI bleeding - ACG 2021 |
| 05.26 Ascites, SBP - AASLD 2021 |
| 07.32 Hepatorenal Syndrome |
| 08.04 Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Additional Credits: Contents by the Clinical Knowledge Communicty Dispatch. Music by Amit Apte.

Drip Vectors by Vecteezy

And now, the conclusion…

An interview with Dr. Sam Brondfield, from the Oncology consult service at UCSF. In Part II we discuss appropriate times to consult oncology, preliminary workup of new masses, cancer of unknown primary, and mediastinal germ cell tumors. We also find out Sam’s favorite Star Trek series!

| 00:00 Intro & TOC |
| 00:32 Initial Hospitalist workup |
| 03:23 Cancer of unknown primary |
| 05:07 Mediastinal Germ Cell Tumors - lab recap, and The Olympics of Gay Singing |
| 09:18 STAR TREK |
| 09:55 Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Cancer Vectors by Vecteezy

An interview with Dr. Sam Brondfield, from the Oncology consult service at UCSF. In Part I we discuss some clinical pearls for hospitalists about the value of pathology, infectious mimickers, and how far Hospitalists could take workup. We also hear a little bit about Sam’s time on the San Francisco Gay Men’s Chorus.

| 00:00 Intro & TOC |
| 00:32 Introduction to Dr. Sam Brondfield |
| 01:22 The importance of pathology: waiting for final path and infectious mimickers |
| 06:08 Sissi’s example of cytology negative pleural fluid with a lung mass |
| 07:35 Hospitalist workup - talk to path or rads vs. consult onc? |
| 09:02 Sam in the SFGMC |
| 10:14 Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Cancer Vectors by Vecteezy

| 00:00 Intro |
| 00:38 TOC |
| 01:18 CT vs ICA in intermediate chest pain (NEJM 2021) |
| 02:59 TWDFNR - functional testing vs CCTA (JHM 2023, ACC 2022) |
| 04:50 CAP review (IDSA 2019) |
| 07:42 Antithrombotic therapy in VTE (Chest 2021) |
| 11:22 Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Review content summarized by UCSF DHM CKC. Music by Amit Apte. Icon Vectors by Vecteezy.

Part 2, in which we chat with Dr. Thiara about a recent study by Jastreboff et al. involving the efficacy of tirzepatide for weight loss published in the NEJM.

| 00.00 Intro |
| 00.25 TOC - Talking tirzy |
| 01.27 Dr. Thiara's many hats, including culinary medicine |
| 02.34 Foundations of weight management & challenges of papers in the media |
| 05.03 Selection criteria |
| 08.38 What to do before tirzepatide, or other options |
| 12.18 "vanity meds" |
| 14.28 Why were there no clinical effects detected? |
| 16.26 Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

In which we chat with Dr. Thiara about two new papers: a positive but flawed study in JAMA and null but more rigorous study in NEJM involving  early Time Restricted Eating, a form of 

| 00.00 Intro |
| 00.25 TOC - Going over the two papers |
| Jamshed 2022, JAMA | | Liu 2022, NEJM |
| 02.08 Getting to know Dr. Diana Thiara |
| 03.07 Jama paper findings |
| 05.56 Challenges of diet |
| 07.33 Talking to patients bout IMF |
| 13.22 So does IMF work? What are patients' options? |
| 14.57 Cultural difference |
| 18.21 Inpatient recommendations | 
| 20.21 Great summary Neal. Good job. |
| 21.44 Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Time To Master Tartgeted Temperature Management w/ some help from Dr. Vanja Douglas

| 00:00 Intro |
| 00:32 Abstract summary (NEJM Dankiewicz 2021) |
| 01:48 Getting Chill with Vanja |
| 03:28 Hot or not? |
| 13:39 Closing statements |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness.]

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness.]

In this edition, we look at an article from the upcoming March 2022 CKC dispatch involving the use of FDG-PET/CT in the workup of S. aureus bacteremia. Dr. Sissi Chen recruits the help of Infectious Disease consultant Dr. Chambers from ZSFGH. 00:00 - Intro
00:35 - A look at the article | Ghanem-Zoubi CID 2021
03:37 - Sissi's discussion w/ Dr. Chambers
08:06 - Outro