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)

Semaglutide for Peripheral Artery Disease (STRIDE)

Semaglutide for MASH (ESSENCE)

Semaglutide vs Tirzepatide for Obesity (SURMOUNT-5)

Normal Saline vs Lactated Ringers (FLUID)

Conservative Oxygen Targets in Mechanically Ventilated Patients (UK-ROX)

Platelet Transfusion Guidelines

Apixaban vs Rivaroxaban vs Warfarin 

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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. 

Hydrocortisone for Severe CAP (REMAP-CAP)

Predicting Benefit of Corticosteroids in Pneumonia

Intensive BP Control in Patients with Diabetes (BPROAD)

Lorundrostat for Uncontrolled Hypertension (ADVANCE-HTN)

Reduced Dose Apixaban for Cancer Associated Thrombosis (API-CAT)

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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 learning models predict when to start vasopressin in patients with septic shock? What is the risk of resuming anticoagulation in patients with atrial fibrillation and prior intracerebral hemorrhage? Is high flow nasal cannula as good as non-invasive ventilation for different types of respiratory failure? We answer all these questions and more!

Half Dose DOAC for Long Term VTE Prevention (RENOVE)

Biomarker-Guided Antibiotic Duration (ADAPT-Sepsis)

GPT-4 Assistance for Physician Performance

Optimal Vasopressin Initiation for Septic Shock (OVISS)

DOACs for A fib after ICH (PRESTIGE-AF)

High Flow Nasal Cannula vs NIV for Respiratory Failure (RENOVATE)

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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 Rivaroxaban for Atrial Fibrillation (AZALEA-TIMI-71)

Asenduxian vs Apixaban for Atrial Fibrillation (OCEANIC-AF)

ACEi or ARB Discontinuation Before Surgery (STOP or NOT)

Tirzepatide for HFpEF and Obesity (SUMMIT)

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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 acute PE? Should we still be using beta blockers in patients with acute MI? Does finerenone improve outcomes in HFpEF? Is continuous infusion of antibiotics better than intermittent? And will the cefepime vs piperacillin-tazobactam battle ever end?

Apixaban, Rivaroxaban and Warfarin in Cirrhosis for AF

Anticoagulation Trends for Acute PE

Beta Blockers for Acute MI with Normal EF

Finerenone for HFpEF FINEARTS-HF

Continuous vs Intermittent Infusion of Beta-Lactams BLING III

Prolonged vs Intermittent Infusions of Beta-Lactams Meta-analysis

Piperacillin-Tazobactam vs Cefepime for Sepsis

Recurrent SBP in Patients on Secondary Prophylaxis

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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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