Last Week in Medicine

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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1. 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





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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)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)