Last Week in Medicine

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/)

Music from Uppbeat (free for Creators!):

https://uppbeat.io/t/soundroll/dope

License code: NP8HLP5WKGKXFW2R