We&apos;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 ArrestEmpagliflozin for Heart Failure with Preserved EFAntibiotic Duration for Afebrile UTIs in MenNormal Saline vs Balanced Solution in ICU patients Baricitinib for COVID-19Therapeutic Anticoagulation for COVID-19Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Last Week in Medicine

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

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 InfectionsColorectal Cancer ScreeningHospital Admission for Chest Pain after ACS Ruled OutMorning Discharges and LOSPersonalized Steroid Regimen for COPD exacerbation Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

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

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 Nasal OxygenPOCUS for Acute DyspneaScreening of Atrial Fibrillation in Older PatientsMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

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

Today we have special guest Dr. Natalie Como to talk about Hospital at Home and what it&apos;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 Assessment RAAS Inhibition and Pulmonary HypertensionVaccine-Induced Immune Thrombotic Thrombocytopenia Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Hospital at Home for Geriatric Patients, RAAS Inhibition and Pulmonary Hypertension, Vaccine Induced Immune Thrombotic Thrombocytopenia (VITT)

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 Valvular Atrial FibrillationMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Three Days of Antibiotics for Pneumonia, IV Contrast and Kidney Function, DOACs for Valvular Atrial Fibrillation

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 a new randomized controlled trial of intermediate thromboprophylaxis for ICU patients with COVID19.  Check it out! Semaglutide for Weight Loss (STEP 1)Semaglutide for Weight Loss in Diabetics (STEP 2)Semaglutide + Intensive Calorie Restriction for Weight Loss (STEP 3)4PEPS for Pulmonary EmbolismNafcillin vs Cefazolin for Epidural AbscessFerritin/Procalcitonin Ratio for COVID-19 vs Bacterial PneumoniaIntermediate Thromboprophylaxis for COVID-19 (INSPIRATION) Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/) Hall of the Mountain King Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 3.0 Licensehttp://creativecommons.org/licenses/by/3.0/

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

Albumin Infusion for Decompensated Cirrhosis (ATTIRE trial), Terlipressin for Type 1 Hepatorenal Syndrome (CONFIRM trial)

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 Convalescent Plasma for COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

IL-6 Receptor Antagonists Reduce Mortality in Critically Ill COVID-19 Patients (REMAP-CAP, RECOVERY), Convalescent Plasma Fails to Improve Mortality

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 Internal Medicine ResidentsLiberal vs Restrictive Transfusion Threshold for Patients with ACS and AnemiaDOACs for VTE prevention in CKDMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

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 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 for uncomplicated appendicitis, and whether you should target a high (90 mmHg) or low (60 mmHg) paO2 in patients with respiratory failure. STOP-AF First trialEARLY-AF trialACEi and ARBs in COVID-19IV vs Oral Antibiotics for AppendicitisRifaximin after TIPS to Prevent HEReimagining Endocarditis Care in an Opioid EpidemicLower vs Higher Oxygen TargetsMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

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 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"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Inhaled Treprostinil for Pulmonary Hypertension due to Interstitial Lung Disease, Omecamtiv Mecarbil for Systolic Heart Failure (HFrEF)

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 in Acute COPD ExacerbationSTOP-IT COVID trialRCT-TCZ-COVID-19 trialCORIMUNO-TOCI-1 trialREMAP-CAP trial pre-printMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Prevalence of Pulmonary Embolism in Acute COPD Exacerbation, Tocilizumab for COVID-19 Round 3

The president&apos;s supporters may have stormed the capitol and attempted a coup today, but the show must go on.  Today I&apos;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 and MRA Use Among US VeteransTocilizumab in Hospitalized Patients with COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Treatment of Inpatient Hypertension, Testing and Treatment of Primary Aldosteronism in Patients with Resistant Hypertension, Tocilizumab for COVID-19 Round 2

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 dose therapeutic anticoagulation (no!) What do the guidelines say? Lots of papers:JAMA IM Review Autopsy Findings and VTE in Patients with COVID-19Klok et al Helms et alShah et alPiazza et alPorfidia et alKunutsor et alDutt et alStessel et alParanjpe et alFraisse et alMusoke et alPatel et alISTH GuidelinesACCP GuidelinesTake home points:COVID-19 is associated with an elevated risk of thrombosis. Observational data suggests that ICU patients are likely to develop thrombotic complications even on standard VTE prophylaxis.  This number seems to be round 25%.  Ward patients are also at higher risk (around 8-9%). Critically ill patients commonly develop heparin resistance, and this may partially explain why some patients with COVID develop thrombotic complications despite prophylaxis. Some have suggested intermediate dosing of anticoagulation for prophylaxis, but there are no randomized controlled trials published at this time, and observational data are limited. Some have suggested therapeutic dosing of anticoagulation for critically ill patients, but observational data show high rates of bleeding and other complications, and the three largest randomized controlled trials have stopped enrolling critically ill patients into the therapeutic anticoagulation arm due to safety concerns and futility. Some have suggested targeting a certain anti-Xa activity level, but no one really knows what that should be, and there aren’t any guidelines recommending it. ISTH and ACCP have both put out guidelines which are overall pretty similar.Make sure your patient has VTE prophylaxis, preferably a LMWH, and keep an eye out for thrombotic complications so you can treat them in a timely manner.  Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Thrombosis and COVID-19

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 intubations in COVID-19, and iron deficiency in acute heart failure. Testing and Treating Asymptomatic Bacteriuria Initiated in the EDBaricitinib Plus Remdesivir for COVID-19 (ACTT-2 trial)Safety and Efficacy of the BNT162b2 mRNA Covid-19 VaccineNon-invasive respiratory protocol for COVID-19Ferric Carboxymaltose for Acute HFrEF and Iron DeficiencyMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

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

Wouldn't it be nice if someone reviewed all the latest internal medicine literature and distilled it into a 20 minute, weekly podcast? Get updates from the New England Journal of Medicine, JAMA Network, Annals of Internal Medicine, Journal of Hospital Medicine, Journal of General Internal Medicine, Lancet and more.

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Last Week in Medicine

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