Last Week in Medicine – Details, episodes & analysis

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 

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

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)

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

We're back with Season 4! Sorry for the unplanned hiatus.

Today we talk about the CLOVERS trial, which tested the hypothesis that early vasopressors and restrictive fluid would be superior to liberal fluids plus rescue vasopressors. We also looked at the TRANSFORM-HF study, which compared torsemide and furosemide in congestive heart failure, the PREVENT CLOT study, which compared aspirin to enoxaparin for VTE prophylaxis after a traumatic fracture, and the AID-ICU study, which compared haloperidol to placebo in the treatment of ICU delirium.

CLOVERS trial
Torsemide vs Furosemide in CHF
Aspirin vs Enoxaparin for VTE ppx after Fracture
IV Haloperidol in ICU Delirium

We also quickly review some papers we missed in 2022:

Apixaban for VTE in ESRD
Acetazolamide for Congestive Heart Failure
Moderate or Aggressive IV Fluids for Pancreatitis
Perioperative Management of Anticoagulation
CRISTAL study (aspirin vs enoxaparin after TKA/THA)






Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Today we have a couple special guests under the age of 2. Birdie and Gus!

Do SGLT2 inhibitors improve diuresis in acute heart failure? Are they better than metformin for reducing cardiovascular mortality? Is high dose dexamethasone better than standard dose in ICU patients with COVID?

We also talk about outcomes in patients with isolated distal DVT compared to proximal DVT, a large case series of patients with monkeypox infection, blood donor outcomes and the outcomes for surgeons who operated the night before. Check it out!


SGLT2-Inhibitors for Acute Heart Failure
Cardiovascular Outcomes for SGLT-2 Inhibitors vs Metformin
COVIDICUS Trial
Isolated Distal DVT Outcomes
Monkeypox Case Series
Mortality in Patients Undergoing Blood Transfusion
Perioperative Outcomes for Surgeons Who Operated the Night Before





Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Today we are joined by Dr. Brian Locke to talk about multiple new critical care trials, including the CLASSIC trial of a restrictive vs standard fluid strategy, the LOVIT trial of vitamin C in septic shock, and the PREPARE-II trial of fluid bolus at the time of intubation to prevent cardiovascular collapse. We also look at whether 72 hours of antibiotics are safe in patients with neutropenic fever, whether hospitalist workload affects patient length of stay, and what kind of careers general internists are pursuing over the last decade.

Restrictive Fluids for Septic Shock
Short vs Standard Antibiotics for Neutropenic Fever
IV Vitamin C for Septic Shock
Vitamin C Meta-analysis
Hospitalist Workload and Patient Length of Stay
Fluid Bolus for Intubation
General Internist Practice Choices
Genetically Modified Porcine to Human Cardiac Xenotransplantation







Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Today we had Dr. Patricia Liu to talk about a new study from Journal of Hospital Medicine on the management of opioid use disorder in the hospital. And then we got a little carried away covering way too many articles! 

Inpatient Management of Opioid Use Disorder
Hepatitis C Care for People Who Inject Drugs
Final SOLIDARITY trial results for Remdesivir
TAVI for Moderate Risk Severe Aortic Stenosis
Mediterranean Diet vs Low Fat Diet for Secondary Prevention of CVD
Steroids for IgA Nephropathy
GLP-1 Agonists and Gallbladder Disease
Pig to Human Kidney Xenotransplantation
Aspirin for Primary Prevention of CVD





Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Today, Dr. James Fang, Chief of Cardiovascular Medicine at the University of Utah, and AHA/ACC/HFSA Heart Failure Guideline Committee Member, joins us to talk about the new heart failure guidelines, published in April 2022.  We talk about the new classifications, including HF with improved EF and HF with mildly reduced EF, and new recommendations for medical therapy for all the heart failure types. How do you start someone on GDMT? Who should get SGLT-2 inhibitors? How can we get more people on ARNIs? Dr. Fang provides lots of clinical pearls and practical wisdom for applying these new recommendations. Check it out!

2022 Heart Failure Guidelines








Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

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




Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

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







Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Music from Uppbeat (free for Creators!):

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

License 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-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






Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R

Music from Uppbeat (free for Creators!):

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

License code: NP8HLP5WKGKXFW2R