Last Week in Medicine

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 PatientsMethenamine 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 TestsBinax Rapid Test vs PCR for Sars-CoV-2 InfectionCharacteristics of Type 2 NSTEMIsMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2RMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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-19Ivermectin for Mild to Moderate COVID-19 County-Level Prescriptions for Hydroxychloroquine and Ivermectin and Presidential 2020 Voting Patterns Diagnostic Strategies for Ruling out PEThiamine Use in ICU Patients with Alcohol Use DisorderRacial Disparities in Hypoxemia Detection with Pulse Oximetry Vitamin D and MortalityMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2RMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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-analysisPICC lines vs MidlinesApixaban vs Rivaroxaban for Recurrent VTE LOLA for Hepatic EncephalopathyEat-Walk-Engage in Older Inpatients (CHERISH)Rivaroxaban for Post-discharge Prophylaxis in High Risk COVID patients (MICHELLE)Mindfulness Training and BurnoutMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2RMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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 CVPIV Diltiazem vs Metoprolol for A fib with RVRMajor Ischemic and Hemorrhagic Events in Apixaban vs Rivaroxaban for AFReducing Sleep Interruptions in Hospitalized Patients Early Remdesivir for Outpatient COVID-19Molnupiravir for Outpatient COVID-19Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2RMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2RMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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 FunctionLong Term Bleeding Risk from Oral AC after First Unprovoked VTETherapeutic Heparin for COVID-19 (HEP-COVID)High Dose Dexamethasone for Severe COVID-19Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2RMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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 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: NP8HLP5WKGKXFW2RMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

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 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/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R