Last Week in Medicine
Last Week in Medicine is a brief podcast that reviews recent internal medicine literature. Hosts Stephen Jenkins, MD, and Austin Rupp, MD summarize studies from major journals such as the New England Journal of Medicine, JAMA Network, Annals of Internal Medicine, Journal of Hospital Medicine, Journal of General Internal Medicine, and The Lancet. It is designed as a concise update for clinicians, residents, and students to listen to on the way to work.
Episodes
Catheter Directed Fibrinolysis for Acute PE (HI-PEITHO), NEWS2 Plus Procalcitonin Reduces Mortality (PRONTO)
Extra, extra, read all about it! We have two "NEWS" studies to talk about in this episode (bad pun). Does catheter directed thrombolysis improve outcomes in acute intermediate risk PE? Does adding procalcitonin to NEWS2 screening of ED patients really reduce mortality in patients with suspected sepsis?? The results may surprise you. Biostatistics ninja and critical care physician Dr. Br
Bleeding Risk with Apixaban vs Rivaroxaban for Acute VTE (COBRRA), Left Atrial Appendage Closure vs Medical Therapy for Atrial Fibrillation (CLOSURE-AF)
We are back with a landmark trial -- COBRRA was finally published! Apixaban wins again, but is rivaroxaban done for good?? Also, is left atrial appendage occlusion safer than oral anticoagulation in patients with a high risk of stroke and a high risk of bleeding? Check it out!Apixaban vs Rivaroxaban for Acute VTE (COBRRA)Left Atrial Appendage Closure vs Medical Management (CLOSURE-AF)Music from Up
2026 ACC/AHA Guidelines for Acute Pulmonary Embolism
The ACC/AHA published new guidelines for managing acute PE on February 19, 2026. Today I'm joined by Dr. Scott Woller, MD, MACP, FCCP, who was co-chair of the American College of Chest Physicians Clinical Practice Guideline for antithrombotic therapy for venous thromboembolism, last updated in 2021. He also served as co-chair for the peer review committee for these new guidelines, and has lot
Hematopoietic Stem Cell Gene Therapy for Cystinosis
In this episode I'm joined by senior author Dr. Stephanie Cherqui to talk about her recent publication in the New England Journal of Medicine on gene therapy for cystinosis. This is a very personal episode for me, because two of my children have cystinosis. The article is linked below. Thanks for listening!Hematopoietic Stem Cell Gene Therapy for CystinosisDonate to the Cystinosis Research Fo
Extended Apixaban for Provoked VTE (HI-PRO), Coffee and Atrial Fibrillation (DECAF), Age-Adjusted D-dimer for DVT, Beta Blockers after MI with Normal EF, Fish Oil for Dialysis (PISCES), Conservative Dialysis for AKI (LIBERATE-D)
In this episode, Dr. Austin Rupp and I try to answer the following questions:Should patients with provoked VTE be offered long term anticoagulation if they have persistent risk factors, like obesity? Does coffee make atrial fibrillation worse (or better??)? Is age-adjusted d-dimer safe to use in DVT? Should we prescribe beta blockers after acute MI if the EF is normal?Does fish oil improve cardiov
Semaglutide for CVD in Diabetes, PAD, and MASH, Semaglutide vs Tirzepatide, Normal Saline vs Lactated Ringer's, Oxygen Targets for Intubated Patients, Platelet Transfusion Guidelines, Apixaban vs Rivaroxaban
Today we do a round-up of some of the recent semaglutide trials. Does semaglutide ever miss? But what about tirzepatide, which causes even more weight loss?We also review two new critical care trials, FLUID and the UK-ROX, new platelet transfusion guidelines, and a new retrospective study of apixaban vs rivaroxaban vs warfarin. Oral Semaglutide for Diabetes with Cardiovascular Disease or CKD (SOUL
Hydrocortisone for Severe Pneumonia (REMAP-CAP), Intensive BP Control in Diabetes (BPROAD), Aldosterone Synthase Inhibitors for Hypertension (ADVANCE-HTN), Reduced-dose Apixaban for Cancer Associated Thrombosis (API-CAT)
What do you do when most trials suggest benefit for an intervention, but then a new trial suggests harm? We thought steroids in pneumonia was a settled question, but REMAP-CAP had other plans!We also review a new RCT for BP targets in patients with hypertension and diabetes, a new aldosterone synthase inhibitor for hypertension, and reduced dose apixaban for cancer-associated thrombosis. Hydrocort
Half Dose DOAC for Long Term VTE Prevention, Biomarker Guided Antibiotics for Sepsis, GPT-4 Assistance for Physicians, Optimal Vasopressin Initiation for Shock, DOAC vs No AC for A fib After Intracerebral Hemorrhage, HFNC vs NIV for Respiratory Failure
For this episode we are joined by EBM guru, Dr. Brian Locke, who deftly breaks down all of our statistics questions. Is half dose DOAC as good as full dose DOAC for preventing VTE, and does it reduce bleeding risk? Can procalcitonin reduce duration of antibiotics for infections without compromising mortality rates? Can LLMs like GPT-4 help physicians manage patients better? Can reinforcement learn
7 vs 14 Days of Antibiotics for Bacteremia, Factor XI Inhibition for Atrial Fibrillation, ACEi or ARB Before Elective Surgery, GLP-1 Agonist for HFpEF and Obesity
We're back, after a brief hiatus! Today we talk about duration of therapy for bacteremia, Factor XI inhibition for atrial fibrillation, whether to stop ACEi or ARB before elective surgery, and whether GLP-1 agonists are beneficial in heart failure with preserved ejection fraction. Go to minute 7:30 to skip the banter. 7 vs 14 Days of Antibiotics for Bacteremia (BALANCE)Abelacimab vs Rivaroxab
Anticoagulation in AF with Cirrhosis, Trends in Anticoagulation for Acute PE, Beta Blockers for Acute MI with Normal EF, Finerenone for HFpEF, Continuous vs Intermittent Infusion for Antibiotics, Cefepime vs Piperacillin-Tazobactam for Sepsis
It's been a long time, but we are back!Apologies on the audio quality from Dr. Jenkins. Apparently he was recording from inside a cardboard box.Today we talk about important, practice changing studies in internal medicine from the last several months. What's the best anticoagulant in patients with cirrhosis and atrial fibrillation? Why do doctors use so much unfractionated heparin for ac
Metformin and Long COVID, Central Lines and Thrombocytopenia, DOACs vs LMWH in Cancer Associated Thrombosis, Early vs Late Anticoagulation after Stroke with Atrial Fibrillation
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
Osmotic Demyelination Syndrome and Hyponatremia with Dr. Joel Topf, Apixaban vs Warfarin for On-X Aortic Valve, Perioperative Blood Pressure Strategies, Diagnostic Accuracy of CT Abdomen Without Contrast
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 Chan
Doxycycline Post-Exposure Prophylaxis for STIs (DoxyPEP), High Dose Prophylactic Anticoagulation for COVID-19 (ANTICOVID), Rates of Fracture Non-union and Bisphosphonates
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
Thiazides for Kidney Stones, Hydrocortisone for Severe Pneumonia (CAPE COD), 2023 GOLD COPD Guidelines, Real World Use of Oral Antibiotics for Infective Endocarditis
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 pneumon
Antibiotic Duration for Febrile UTI in Males, Lower GI Bleeding Guidelines, Intravenous Contrast in Patients with Acute Kidney Injury
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 f
Early Vasopressors and Restrictive Fluids in Septic Shock (CLOVERS), Furosemide vs Torsemide in Heart Failure (TRANSFORM-HF), Aspirin vs Enoxaparin after Extremity Fracture (PREVENT CLOT), Haloperidol for ICU Delirium (AID-ICU)
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 e
SGLT2 Inhibitors for Acute Heart Failure, SGLT2 Inhibitors vs Metformin, High Dose Dexamethasone for COVID-19 in ICU, Isolated Distal DVT, Monkeypox, Blood Donor Sex and Mortality, Outcomes in Surgeons Who Operate the Night Before
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
Restrictive Fluids in Septic Shock, Short vs Standard Antibiotics in Neutropenic Fever, IV Vitamin C for Septic Shock, Hospitalist Workload and Patient LOS, Fluid Bolus for Intubation, General Internist Practice Choices
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
Inpatient Management of Opioid Use Disorder, Hep C Treatment in IVDU, Final SOLIDARITY Results for Remdesivir, TAVI for Moderate Risk Severe AS, Mediterranean Diet vs Low Fat Diet, Steroids for IgA Nephropathy, GLP-1s and Gallbladder Disease
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 DisorderHepatitis C Care for People Who Inject DrugsFinal SOLIDARITY trial results for RemdesivirTAVI for Moderate Risk Severe Aortic StenosisMedi
2022 AHA/ACC/HFSA Heart Failure Guidelines with Dr. James Fang, Guideline Committee Member
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
Oral Carbapenem for Complicated UTIs, Awake Proning for COVID-19, 1-2 Months DAPT vs 12 Months DAPT, Low Sodium Diet for Heart Failure, Excess Mortality From COVID-19, IV Iron and Anaphylaxis, Pickle Juice for Cramps in Cirrhosis
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
Reliever-Triggered ICS Therapy for Asthma, Methenamine for UTI Prevention, CT vs Invasive Coronary Angiography, Melatonin for Delirium Prevention, Interpretation of Home COVID Tests, Characteristics of Type 2 MI
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
Paxlovid for COVID-19, Ivermectin Ineffective for COVID-19, One Year Outcomes for ICU COVID-19 Patients, Diagnostic Strategies for Ruling Out PE, Thiamine for Alcohol Use Disorder, Skin Color and Pulse Oximetry
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
Balanced Crystalloid vs Normal Saline (PLUS trial), Midline vs PICC, LOLA for Hepatic Encephalopathy, Eat-Walk-Engage Program for Older Inpatients, Post-Discharge Thromboprophylaxis for COVID-19, Mindfulness Training and Burnout
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-dischar
Ultrasound JVP to Estimate CVP, IV Metoprolol vs Diltiazem for Atrial Fibrillation with RVR, Ischemic Stroke and Bleeding Risk with Apixaban vs Rivaroxaban, Reducing Sleep Interruptions in Hospital, Outpatient Remdesivir, Molnupiravir for COVID-19
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 ret
Chlorthalidone in CKD, Factor XI Inhibition for VTE Prevention, Untreated Subsegmental PE and Risk of Recurrent VTE, Rivaroxaban and GI Bleeding, Mental Stress Induced Ischemia, Depression and Residency, Patient Outcomes for Part Time Hospitalists
Somehow we got through 7 articles today, and none of them are about COVID-19! Happy Thanksgiving! Chlorthalidone in CKDMilvexian for VTE PreventionRisk of Recurrent VTE in Subsegmental PERivaroxaban associated with higher rates of GI bleedingDepression and ResidencyMental-Stress Induced Myocardial IschemiaPatient Outcomes for Part Time HospitalistsMusic from Uppbeat (free for Creators!):https://up
Race and Estimated GFR, Bleeding Risk in Oral Anticoagulation after First VTE, HEP-COVID trial, High Dose Dexamethasone for COVID-19
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 RaceRace, Genetic Ancestry and Estimating Kidney
Empagliflozin for HFpEF, Antibiotic Duration for UTIs in Men, Targeted Temperature after Cardiac Arrest, Normal Saline vs Balanced Solution in ICU Patients, Baricitinib and Therapeutic Anticoagulation for Hospitalized COVID-19 Patients
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. Hypothe
Antibiotic Duration for Prosthetic Joint Infections, Colorectal Cancer Screening Guidelines, Hospital Observation after ACS Ruled Out in ED, Morning Discharges, Personalized Steroid Regimen for COPD Exacerbation
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
Antibiotic Delay Intervals and Hospital Mortality for Patients with Suspected Sepsis, Guidelines for High Flow Nasal Oxygen and Point of Care Ultrasound for Acute Dyspnea, Screening for Atrial Fibrillation in Older Patients
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 SepsisHigh Flow
Hospital at Home for Geriatric Patients, RAAS Inhibition and Pulmonary Hypertension, Vaccine Induced Immune Thrombotic Thrombocytopenia (VITT)
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
Three Days of Antibiotics for Pneumonia, IV Contrast and Kidney Function, DOACs for Valvular Atrial Fibrillation
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 PneumoniaIV Contrast and Kidney FunctionDOACs for
Weekly Semaglutide for Weight Loss (STEP 1, 2 and 3 Trials), 4PEPS Rule for Pulmonary Embolism, Nafcillin vs Cefazolin for Epidural Abscess, Ferritin/Procalcitonin Ratio for COVID19, Intermediate Thromboprophylaxis for COVID19
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
Albumin Infusion for Decompensated Cirrhosis (ATTIRE trial), Terlipressin for Type 1 Hepatorenal Syndrome (CONFIRM trial)
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 CirrhosisTerlipressin for Type 1 Hepatorenal Syndrome Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompete
IL-6 Receptor Antagonists Reduce Mortality in Critically Ill COVID-19 Patients (REMAP-CAP, RECOVERY), Convalescent Plasma Fails to Improve Mortality
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-printMeta-analysis of Convalescen
Gender-Based Discrimination and Harassment Among Hospitalists, Educational Resource Utilization in Internal Medicine Residents, Transfusion Thresholds for ACS, DOACs for VTE prevention in CKD
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 HospitalistsEducational Resource Utilization Among I
Early Ablation vs Medications for Atrial Fibrillation (STOP-AF First, EARLY-AF), ACEi and ARBs in COVID-19, IV vs Oral Antibiotics for Appendicitis, Rifaximin after TIPS, Low vs High Oxygen Targets
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
Inhaled Treprostinil for Pulmonary Hypertension due to Interstitial Lung Disease, Omecamtiv Mecarbil for Systolic Heart Failure (HFrEF)
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 ILDOmecamtiv Mecarbil for Systolic Heart FailureMusic from https://filmmusic.io&qu
Prevalence of Pulmonary Embolism in Acute COPD Exacerbation, Tocilizumab for COVID-19 Round 3
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
Treatment of Inpatient Hypertension, Testing and Treatment of Primary Aldosteronism in Patients with Resistant Hypertension, Tocilizumab for COVID-19 Round 2
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
Thrombosis and COVID-19
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
Inappropriate Testing and Treating of Asymptomatic Bacteriuria, Baricitinib Plus Remdesivir for COVID-19 (ACTT-2), COVID-19 Vaccine, Noninvasive Respiratory Protocol for COVID-19, Iron Supplementation in Acute Heart Failure
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
Patient Outcomes in Resident, APC and Solo Hospitalist Teams, Rapid Conversion to Oral Antibiotics in Pneumonia, SOLIDARITY trial for COVID-19
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
Danish Mask Study, Rivaroxaban for Atrial Fibrillation and Bioprosthetic Mitral Valve, Convalescent Plasma Fails, Semaglutide in NASH, Once Weekly Insulin, Statin Nocebo Effect
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
Remdesivir Redux, Tocilizumab Fails, Bamlanivimab gets EUA and mRNA Vaccines for COVID-19
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 ReportTocilizumab for Hospitalized COVID-1
Caring for COVID-19 Patients in the Navajo Nation
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/)Music f
Dexamethasone Reduces Mortality in COVID-19: The RECOVERY Trial
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-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://
Remdesivir Shortens Time to Recovery in COVID19 (ACTT-1), CRP-Guided Antibiotics for Gram Negative Bacteremia, NT-pro-BNP in Syncope
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
Triple Antiviral Therapy for COVID-19, Remdesivir for Severe COVID-19, Convalescent Plasma, Hydroxychloroquine and Azithromycin in New York
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
COVID-19 in New York City, Lopinavir-Ritonavir in Severe COVID-19, The French Hydroxychloroquine Study, Chinese Hydroxychloroquine RCT, VA Hydroxychloroquine Study, Compassionate Use of Remdesivir
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.
COVID-19 Update, Gabapentin for Alcohol Use Disorder, Apixaban versus Rivaroxaban for Atrial Fibrillation
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 C
Long Acting Injectable Therapy for HIV and Pregnenolone for Chronic Low Back Pain
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-1Pregnenolone vs Placebo for Chronic Low Back Pain
COVID-19, PPI Use and MDRO Colonization, Hospitalist Care of ED Boarders
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 ChinaCovid-19 Report from CDC of China Gastric Acid Suppression and MDRO Colonization Hospitalist Care of ED Boarder
Empirical Anti-MRSA vs Standard Antibiotic Therapy in Pneumonia, High Consulting Hospitalists, Medicare for All
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 cons
Plasma Exchange and Glucocorticoids for ANCA-Vasculitis and Dexamethasone for ARDS, aka the PLEX and DEX episode
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 SyndromeThe Sor
Aspirin for VTE Prophylaxis after THA or TKA, Fluid Management for Sepsis in Patients with ESRD, Cirrhosis and CHF
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
CT Screening for Lung Cancer, Conservative vs Interventional Treatment for Spontaneous Pneumothorax
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 Pneum
Novel Coronavirus, High Sensitivity Troponins, Hydroxyethyl Starch for Abdominal Surgery and Testosterone Therapy in Men
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 MIHydr
Factor XIa Inhibition for VTE Prophylaxis, Physician Time Using EHR in Outpatient Encounters, Vitamin C and Thiamine for Septic Shock
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 EncountersVitamin C, Thiamine and Hyd
Health Care Hotspotting, Valve Replacement in Asymptomatic Very Severe Aortic Stenosis, Free Medications and Treatment Adherence
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 HotspottingEarly Surgery for Asymptomatic Aortic Stenosis Effect on Treatment Adherence of Distributing Essential Medicines at No ChargeMusi
Hospital Care at Home, Adverse Events in “Social" Admissions, NT-ProBNP Before Non-Cardiac Surgery, Alcohol Abstinence in Drinkers with Atrial Fibrillation
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 su
Gadolinium in CKD Stage 4 and 5, Metoprolol and COPD Exacerbations, Vitamin D in Critically Ill Patients, Politics and Mood in Young Physicians
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 Nephrog
Upper GI Bleeding Guidelines, E-cigarette and Vaping Associated Lung Injury, Beta Blockers and HFpEF Exacerbations
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 GuidelinesClinical presentation, treatment and short term outcomes of E-VALIAssociation of Beta-Blocker Use with He
D-dimer Adjusted for Clinical Probability of PE, Work Schedules of Hospitalists, Inappropriate Fluoroquinolone Prescribing, Utilization and Outcomes of Lytics in Acute PE
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
Vitamin D in Diabetic Kidney Disease and SGLT-2 Inhibitors for Heart Failure Reduced Ejection Fraction
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
The Apple Heart Study, Colchicine after MI
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"S
Intensifying Blood Pressure Therapy in the Hospital, Asymptomatic Bacteriuria, DRIP score in Pneumonia
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 Ma
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