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

In which we talk about management of intermediate chest pain (including Cardiac CT Angiography vs Invasive Coronary Angiography, as well as Functional Stress testing), and review CKC pulmonary topics involving IDSA guidelines for Community Aquired Pneumonia treatment and Antithrombotics in VTE.

| 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.