Inpatient Update delivers short, practical reviews of new studies and guidelines that matter to hospitalists — focused on what actually changes decisions on rounds tomorrow.
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In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Austin White to tackle two everyday controversies that affect nearly every admission:
Asymptomatic inpatient hypertension — are PRN antihypertensives helping… or harming?
Antibiotics for pneumonia with a positive viral panel — do these patients actually benefit?
Practical take-homes, real-world night shift scenarios, and what to change on rounds tomorrow.
Articles & PubMed Links:
As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals
JAMA Internal Medicine (2025)
Retrospective cohort of hospitalized patients comparing:
Received PRN antihypertensives vs
No PRN treatment
Key Findings
↑ Acute kidney injury (HR ~1.23)
↑ Rapid BP drops >25% (HR ~1.5)
↑ Composite outcome (MI, stroke, death) (HR ~1.6)
IV meds worse than oral
Interpretation
Treating asymptomatic inpatient hypertension is associated with harm, not benefit
Likely mechanism: overcorrection → hypoperfusion
Takeaway
For asymptomatic hypertension, especially overnight: → Don’t reflexively treat the number → Focus on symptoms and underlying cause
Pubmed: https://pubmed.ncbi.nlm.nih.gov/39585709/
Antibiotics for Pneumonia with Positive Viral Testing
Multicenter Retrospective Study (2015–2024)
Compared:
Minimal antibiotics (0–1 day) vs
Standard CAP treatment (5–7 days)
In patients with:
Positive viral assay
Clinical pneumonia (hypoxia, tachypnea, imaging)
Key Findings
No difference in:
Mortality
ICU admission
Length of stay
No clear harm signal either
Interpretation
Many patients with “pneumonia” + viral panel likely have pure viral illness
Routine antibiotics do not improve outcomes
Takeaway
→ If viral etiology fits the clinical picture, don’t routinely continue antibiotics
Pubmed: https://pubmed.ncbi.nlm.nih.gov/41378862/
Practice-Changing Takeaways
Hypertension:
Treat the patient, not the number
PRN antihypertensives for asymptomatic BP may cause harm
Viral pneumonia:
Positive viral panel + consistent story → hold antibiotics
Reassess if clinical course worsens
Both topics highlight: → We often overtreat out of habit, not evidence
Clinical Pearls from the Episode
The body tolerates transient high BP better than rapid drops
Overcorrection → ↓ cerebral perfusion → bad outcomes
Viral infections (even “mild” ones like rhino/adenovirus) can cause severe illness
Antibiotic stewardship = patient safety, not just resistance
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Simple, High-Impact Changes Hospitalists Are Missing (SHM 2026 Takeaways)
mercredi 8 avril 2026 • Durée 59:35
With Special Guest Dr. Emily Reams
In this special episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Emily Reams to break down the most practice-changing takeaways from SHM Converge 2026.
No fluff — just what you can start doing on rounds tomorrow.
Topics include:
Flu shots in heart failure — real mortality benefit
Stopping aspirin in patients on DOACs
Anticoagulation in AFib despite fall risk
Naltrexone for alcohol use disorder — start inpatient
Phenobarbital for withdrawal — coming soon
Metformin in the hospital — dogma challenged
Transfusion thresholds in MI
“Things We Do for No Reason” highlights
Practical take-homes and what to actually change this week.
Practice-Changing Highlights
💉 Flu shots in heart failure NNT ≈ 17 for death/readmission → Vaccinate before discharge during flu season
💊 Stop aspirin with DOACs ↑ bleeding and mortality without benefit → Stop aspirin ~6–12 months post-stent (most patients)
🧠 AFib + fall risk Benefit >> risk (would need >450 falls/year to offset) → Don’t withhold anticoagulation for falls alone
🍺 Alcohol use disorder
Naltrexone: start before discharge → ↓ cravings, ↓ readmissions
Phenobarbital: increasing use, likely future standard
💊 Metformin inpatient May be safe in select patients → Consider if GFR ≥30 and no lactic acidosis
🩸 Transfusion in MI Target Hgb ~10 may reduce mortality → Evolving — keep on radar
💊 Anticoagulation updates
De-escalating Sepsis Antibiotics & When to Pull the IV (w/ Nicholas Linde, PA)
jeudi 26 mars 2026 • Durée 39:01
Episode 5: De-escalating Sepsis Antibiotics & When to Pull the IV w/ Nicholas Linde, PA
With Special Guest Nicholas Linde, PA
In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist PA Nick Linde to tackle two everyday decisions that impact nearly every inpatient service:
De-escalating broad-spectrum antibiotics in sepsis — is it safe to stop vancomycin and zosyn earlier than we think?
Routine peripheral IV use — are we leaving IVs in too long and causing harm?
Practical take-homes, real-world cases, and what to change on rounds tomorrow.
Articles & PubMed Links
Antibiotic De-escalation in Adults Hospitalized With Community-Onset Sepsis
JAMA Internal Medicine (2026)
Compared:
Continue broad-spectrum antibiotics beyond day 4 vs
De-escalate at day 4
Key Findings
No difference in 90-day mortality (OR ≈ 1.0)
Shorter hospital length of stay
~1 day shorter (MRSA de-escalation)
~2 days shorter (pseudomonal de-escalation)
No clear harm signal with de-escalation
Takeaway
In clinically improving patients with negative or non-MDR cultures, early de-escalation at day 4 is safe and reduces hospital stay.
In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Kevin Baker to discuss two studies that challenge long-held dogma in inpatient medicine:
Faster correction of hypernatremia — is the traditional “go slow” rule actually harming patients?
Dalbavancin for Staph aureus bacteremia (DOTS Trial) — can two long-acting antibiotic injections replace weeks of IV therapy and PICC lines?
Practical take-homes, real-world discussion, and what to change on rounds tomorrow (with a couple of bourbons).
Articles & PubMed Links
Clinical outcomes of early fast compared to slow sodium correction rate in adults with severe hypernatremia: A comparative effectiveness study
Journal of Critical Care (2025)
Key Findings
Faster correction associated with lower 30-day mortality
Shorter ICU length of stay
Shorter hospital length of stay
No signal for neurologic complications from rapid correction
Supporting data from prior studies:
2023 JAMA observational cohort Faster correction associated with lower mortality No neurologic complications reported
2025 Journal of Critical Care meta-analysis Faster correction not associated with worse outcomes
Takeaway
For adult hypernatremia, especially in critically ill patients, more aggressive correction appears safe and may improve outcomes.
Pubmed: https://pubmed.ncbi.nlm.nih.gov/41240509/
Dalbavancin for Treatment of Staphylococcus aureus Bacteremia: The DOTS Randomized Clinical Trial
Stop the Aspirin in CAD? Shorter Antibiotics for Bacteremia? (with Dr. Andres Ospina)
Saison 1 · Épisode 1
mercredi 25 février 2026 • Durée 25:37
In this episode of Inpatient Update, Dr. Mason Turner is joined by Dr. Andres Ospina, fellow hospitalist, to discuss two recent trials with immediate impact on hospital practice:
Aspirin plus anticoagulation in chronic coronary disease (AQUATIC Trial) — does keeping aspirin help or harm when long-term anticoagulation is started?
Seven vs fourteen days of antibiotics for bloodstream infection (BALANCE Trial) — can we safely cut bacteremia treatment in half?
Practical take-homes, clear links to the evidence, and what to change on rounds tomorrow.
Articles & PubMed Links
Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation (AQUATIC Trial)
New England Journal of Medicine (October 2025)
Key Findings:
Higher morbidity and mortality with dual therapy (HR 1.53)
Bottom Line: In stable CAD >6 months from revascularization, if anticoagulation is started, stop the aspirin.
Pilot Episode 2: Phenobarbital for DTs, Conservative Dialysis for AKI, and Postop Transfusion Thresholds
jeudi 12 février 2026 • Durée 28:11
In Episode 2 of Inpatient Update, your host, Dr. Mason Turner, breaks down three studies that could change what you do on rounds tomorrow:
Phenobarbital for alcohol withdrawal — fewer admissions and shorter ED stays during the IV lorazepam shortage natural experiment.
Conservative dialysis in AKI requiring RRT (LIBERATE-D) — less routine dialysis, more kidney recovery?
Postoperative transfusion thresholds in high–cardiac-risk patients (TOP Trial) — is 7 still enough?
Articles & PubMed Links
Fewer Admissions, Shorter Stays: Phenobarbital Use for Alcohol Withdrawal in the Emergency Department Academic Emergency Medicine (2025) PubMed: https://pubmed.ncbi.nlm.nih.gov/41147831/
A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney Injury (LIBERATE-D Trial) JAMA ( 2026) PubMed: https://pubmed.ncbi.nlm.nih.gov/41201895/
Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk: The TOP Randomized Clinical Trial JAMA (2025) PubMed: https://pubmed.ncbi.nlm.nih.gov/41205227/
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Pilot Episode: ERCP Antibiotics, Apixaban Dose in Cancer, and Early Beta-Blockers in Cirrhosis
mardi 3 février 2026 • Durée 17:44
In this pilot episode of Inpatient Update, your host, Dr. Mason Turner, breaks down three clinically relevant studies that could change how you practice tomorrow on the wards:
Pre-ERCP antibiotic prophylaxis — does it reduce post-procedure infections in biliary obstruction?
Reduced-dose apixaban after 6 months in cancer-associated VTE — noninferior and potentially safer?
Early initiation of beta-blockers in cirrhosis with uncomplicated ascites — early signals of benefit.
Practical take-homes, clear links to evidence, and what to tell your team on rounds.
Articles & PubMed Links
Is Antibiotic Prophylaxis Warranted in All Patients With Biliary Obstruction Undergoing Endoscopic Retrograde Cholangiopancreatography?: A Systematic Review and Meta-Analysis PubMed: https://pubmed.ncbi.nlm.nih.gov/40961256/
Efficacy and Safety of Carvedilol in Cirrhosis Patients With New-Onset Uncomplicated Ascites Without High-Risk Esophageal Varices (CARVE-AS Trial) PubMed: https://pubmed.ncbi.nlm.nih.gov/40689908/
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Semi-Annual Takeaways: 5 Practice-Changing Updates for Hospitalists
jeudi 18 juin 2026 • Durée 33:43
Semi-Annual Recap Episode
In this special episode of Inpatient Update, Dr. Mason Turner looks back at the first 10 episodes and distills the biggest practice-changing lessons from more than 25 recent studies.
If you're new to the show, this is the fastest way to understand what Inpatient Update is all about: practical evidence that changes what hospitalists do on rounds tomorrow.
From pneumonia treatment and antibiotic duration to anticoagulation, flu vaccination, and asymptomatic inpatient hypertension, these are the five changes most likely to improve patient care right now.
#5 Pneumonia Care Should Be More Deliberate
The theme: stop reflexive treatment decisions and individualize care.
Featured Article
Short Versus Longer Antibiotic Duration for Community-Acquired Pneumonia: A Multicenter Target Trial Emulation Annals of Internal Medicine, 2026
Original Episode: Shorter CAP Antibiotics + The Cipro QTc Myth — with Dr. Ernest Murray
Supporting Articles
Predicting Benefit from Adjuvant Therapy with Corticosteroids in Community-Acquired Pneumonia: A Data-Driven Analysis of Randomized Trials Lancet Respiratory Medicine, 2025
Original Episode: Apixaban vs Rivaroxaban + Steroids in Community-Acquired Pneumonia — with Dr. Adam Jaffe
Associations Between Antibiotic Use and Outcomes in Patients Hospitalized with Community-Acquired Pneumonia and Positive Respiratory Viral Assays Clinical Infectious Diseases, 2026
Original Episode: Asymptomatic Inpatient Hypertension + Viral Pneumonia Antibiotics — with Dr. Austin White
Takeaway
For carefully selected, clinically improving patients with community-acquired pneumonia:
#4 Give Your Heart Failure Patients the Flu Shot Before Discharge#3 With Blood Thinners, Sometimes Less Is More#2 We Are Entering an Era of Shorter Antibiotic Durations#1 Stop Treating Asymptomatic Inpatient Blood Pressure NumbersBottom Line
Too Cautious? Rethinking Hyponatremia Correction and DVT Prophylaxis
jeudi 4 juin 2026 • Durée 40:43
With Special Guest Dr. Bianca Farley
In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Bianca Farley to examine two practices driven largely by fear of rare but devastating complications:
Are we correcting severe hyponatremia too cautiously?
Does pharmacologic DVT prophylaxis improve outcomes that actually matter to patients?
Two common hospitalist decisions. Two deeply ingrained habits. Two areas where the evidence may be more nuanced than many of us were taught.
Articles & PubMed Links
Sodium Correction Rates and Outcomes Among Patients With Severe Hyponatremia
Annals of Internal Medicine (2026)
Retrospective cohort study of nearly 14,000 hospitalized patients with severe hyponatremia (Na ≤120 mEq/L).
Compared:
Slow correction: <8 mEq/L per 24 hours
Moderate correction: 8–12 mEq/L per 24 hours
Fast correction: >12 mEq/L per 24 hours
Primary Outcome
Composite of:
90-day mortality
Delayed neurologic complications
Key Findings
Slow correction had the worst outcomes
Moderate correction reduced adverse outcomes
Fast correction reduced adverse outcomes even further
Primary outcome occurred in 21% of patients overall
Faster correction was associated with significantly lower risk of death or delayed neurologic events compared with slow correction.
What About Osmotic Demyelination Syndrome?
The traditional fear of overcorrection continues to matter, particularly in high-risk populations, but this study suggests that aggressively avoiding correction may also cause harm.
Shorter CAP Antibiotics + The Cipro QTc Myth
mercredi 20 mai 2026 • Durée 27:35
With Special Guest Dr. Ernest Murray
In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Ernest Murray to challenge two common antibiotic reflexes in hospital medicine:
Do hospitalized patients with community-acquired pneumonia really need 5–7 days of antibiotics?
Do we need to panic about QT prolongation every time we prescribe ciprofloxacin?
Two everyday prescribing decisions. Two long-standing assumptions. Two areas where the evidence may support a more precise approach.
Articles & PubMed Links
3–4 Days vs ≥5 Days of Antibiotics for Community-Acquired Pneumonia
Annals of Internal Medicine (2026)
Target trial emulation using >55,000 CAP hospitalizations across 60+ hospitals.
Compared:
3–4 days antibiotics vs
≥5 days antibiotics
After strict inclusion/exclusion criteria, ~5,600 clinically stable patients were analyzed.
Excluded:
Immunocompromised patients
Severe chronic lung disease
Drug-resistant organisms
ICU-level illness
COVID-19
Primary Outcomes
30-day mortality
Readmissions / urgent visits
Antibiotic-associated C. difficile
Key Findings
No significant difference in:
Mortality
Readmissions
Urgent visits
C. difficile infection
Interpretation
In carefully selected, clinically stable CAP patients: → 3 days may be enough
pubmed: https://pubmed.ncbi.nlm.nih.gov/41974005/
Practice-Changing TakeawaysClinical PearlsBottom Line
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Takeaway
→ Avoiding overcorrection remains important. → But correcting severe hyponatremia too slowly may also worsen outcomes. → A reasonable target may be 8–10 mEq/L/day rather than reflexively aiming for the lowest possible correction rate.
Pubmed: https://pubmed.ncbi.nlm.nih.gov/41587479/
Pharmacologic Thromboprophylaxis in Medical Inpatients
JAMA Network Open (2026)
Systematic review and network meta-analysis of 22 randomized trials involving 43,840 medical inpatients.
Compared:
Low-molecular-weight heparin (LMWH)
Unfractionated heparin (UFH)
Direct oral anticoagulants (DOACs)
No pharmacologic prophylaxis
Key Findings
Symptomatic VTE
Baseline risk without prophylaxis:
1.7% at 90 days
LMWH:
Reduced symptomatic VTE
RR 0.68 (95% CI 0.49–0.94)
Clinically Relevant VTE
LMWH RR 0.57
DOAC RR 0.58
UFH RR 0.66
Mortality
No mortality benefit with any regimen.
Major Bleeding
DOACs increased major bleeding
UFH increased major bleeding
LMWH showed no statistically significant increase in major bleeding.
→ DVT prophylaxis works, but mostly by preventing relatively uncommon events. → Benefits are greatest in appropriately selected high-risk patients. → LMWH appears to offer the best balance of efficacy and safety.
Pubmed: https://pubmed.ncbi.nlm.nih.gov/42138924/
Practice-Changing Takeaways
Severe Hyponatremia
Fear of osmotic demyelination has likely pushed many clinicians toward overly conservative correction.
Emerging evidence suggests slow correction may itself be harmful.
Consider targeting meaningful correction rather than simply avoiding overcorrection.
DVT Prophylaxis
Prevents VTE.
Does not appear to reduce mortality.
Absolute benefit is smaller than many clinicians assume.
Risk-benefit assessment remains essential.
Clinical Pearls
The most feared complication is not always the most common complication.
Many hospital practices persist because of rare catastrophic outcomes rather than aggregate patient outcomes.
The best question is often not "Can this happen?" but "What happens most often?"
Bottom Line
If you change nothing else this week:
Reconsider whether your severe hyponatremia patients are being corrected too slowly.
Remember that DVT prophylaxis prevents clots, but has never clearly been shown to save lives in general medical inpatients.
Sometimes the greater danger isn't doing too much—it's doing too little.
