Health & FitnessAlternative HealthMedicineMental Health

Last Week in Medicine

Stephen Jenkins, MD, Austin Rupp, MD

Wouldn't it be nice if someone reviewed all the latest internal medicine literature and distilled it into a brief podcast you could listen to on your way to work? 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.

Play

Open in

20 episodes
Avg 57 min
English

Episodes 20

Newest Oldest Longest

All20 Unplayed20 In progress0 Played0

#67
April 7 · 1 hr 1 min
Catheter Directed Fibrinolysis for Acute PE (HI-PEITHO), NEWS2 Plus Procalcitonin Reduces Mortality (PRONTO)
Extra, extra, read all about it! We have two "NEWS" studies to talk about in this episode (bad pun). Does catheter directed thrombolysis improve outcomes in acute intermediate risk PE? Does adding procalcitonin to NEWS2 screening of ED patients really reduce mortality in patients with suspected sepsis?? The results may surprise you. Biostatistics ninja and critical care physician Dr. Brian Locke joins us to discuss! Ultrasound Facilitated Catheter Directed Fibrinolysis for Acute PE (HI-PEITHO) NEWS2 Plus Procalcitonin for Sepsis Screening (PRONTO) Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R
#66
March 28 · 35 min
Bleeding Risk with Apixaban vs Rivaroxaban for Acute VTE (COBRRA), Left Atrial Appendage Closure vs Medical Therapy for Atrial Fibrillation (CLOSURE-AF)
We are back with a landmark trial -- COBRRA was finally published! Apixaban wins again, but is rivaroxaban done for good?? Also, is left atrial appendage occlusion safer than oral anticoagulation in patients with a high risk of stroke and a high risk of bleeding? Check it out! Apixaban vs Rivaroxaban for Acute VTE (COBRRA) Left Atrial Appendage Closure vs Medical Management (CLOSURE-AF) Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R
#65
March 11 · 48 min
2026 ACC/AHA Guidelines for Acute Pulmonary Embolism
The ACC/AHA published new guidelines for managing acute PE on February 19, 2026. Today I'm joined by Dr. Scott Woller, MD, MACP, FCCP, who was co-chair of the American College of Chest Physicians Clinical Practice Guideline for antithrombotic therapy for venous thromboembolism, last updated in 2021. He also served as co-chair for the peer review committee for these new guidelines, and has lots of great insights into how to use them in clinical practice and research. 2026 ACC/AHA Guidelines for Diagnosis and Managing Acute PE Some highlights from the guidelines: New categories of PE: A: asymptomatic B: symptomatic, low risk C: symptomatic, high risk D: incipient shock E: cardiogenic shock PE response teams (PERTs) are ascendant Use enoxaparin instead of heparin drip! Advanced therapies for category D and E Half dose DOACs for extended treatment Shared decision making for clots provoked by minor risk factors Patients with persistent symptoms need evaluation for CTEPD Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R
#64
March 3 · 41 min
Hematopoietic Stem Cell Gene Therapy for Cystinosis
In this episode I'm joined by senior author Dr. Stephanie Cherqui to talk about her recent publication in the New England Journal of Medicine on gene therapy for cystinosis. This is a very personal episode for me, because two of my children have cystinosis. The article is linked below. Thanks for listening! Hematopoietic Stem Cell Gene Therapy for Cystinosis Donate to the Cystinosis Research Foundation Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/sky-toes/industry-leaders License code: EBP4TMGNANGDJM1R Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R
#63
February 25 · 1 hr 11 min
Extended Apixaban for Provoked VTE (HI-PRO), Coffee and Atrial Fibrillation (DECAF), Age-Adjusted D-dimer for DVT, Beta Blockers after MI with Normal EF, Fish Oil for Dialysis (PISCES), Conservative Dialysis for AKI (LIBERATE-D)
In this episode, Dr. Austin Rupp and I try to answer the following questions: Should patients with provoked VTE be offered long term anticoagulation if they have persistent risk factors, like obesity? Does coffee make atrial fibrillation worse (or better??)? Is age-adjusted d-dimer safe to use in DVT? Should we prescribe beta blockers after acute MI if the EF is normal? Does fish oil improve cardiovascular outcomes in patients on dialysis? What's the best approach for dialysis in patients with acute kidney injury? The articles: Extended Apixaban for Provoked VTE (HI-PRO) Coffee and Atrial Fibrillation (DECAF) Age-Adjusted D-dimer for DVT (ADJUST-DVT) Beta-blockers after MI with normal EF Fish Oil in Dialysis Patients (PISCES) Conservative Dialysis in AKI (LIBERATE-D) Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R
#62
Jun 17, 2025 · 1 hr 5 min
Semaglutide for CVD in Diabetes, PAD, and MASH, Semaglutide vs Tirzepatide, Normal Saline vs Lactated Ringer's, Oxygen Targets for Intubated Patients, Platelet Transfusion Guidelines, Apixaban vs Rivaroxaban
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
#61
Apr 24, 2025 · 56 min
Hydrocortisone for Severe Pneumonia (REMAP-CAP), Intensive BP Control in Diabetes (BPROAD), Aldosterone Synthase Inhibitors for Hypertension (ADVANCE-HTN), Reduced-dose Apixaban for Cancer Associated Thrombosis (API-CAT)
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
#60
Mar 27, 2025 · 1 hr 32 min
Half Dose DOAC for Long Term VTE Prevention, Biomarker Guided Antibiotics for Sepsis, GPT-4 Assistance for Physicians, Optimal Vasopressin Initiation for Shock, DOAC vs No AC for A fib After Intracerebral Hemorrhage, HFNC vs NIV for Respiratory Failure
For this episode we are joined by EBM guru, Dr. Brian Locke, who deftly breaks down all of our statistics questions. Is half dose DOAC as good as full dose DOAC for preventing VTE, and does it reduce bleeding risk? Can procalcitonin reduce duration of antibiotics for infections without compromising mortality rates? Can LLMs like GPT-4 help physicians manage patients better? Can reinforcement learning models predict when to start vasopressin in patients with septic shock? What is the risk of resuming anticoagulation in patients with atrial fibrillation and prior intracerebral hemorrhage? Is high flow nasal cannula as good as non-invasive ventilation for different types of respiratory failure? We answer all these questions and more! Half Dose DOAC for Long Term VTE Prevention (RENOVE) Biomarker-Guided Antibiotic Duration (ADAPT-Sepsis) GPT-4 Assistance for Physician Performance Optimal Vasopressin Initiation for Septic Shock (OVISS) DOACs for A fib after ICH (PRESTIGE-AF) High Flow Nasal Cannula vs NIV for Respiratory Failure (RENOVATE) Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R
#59
Feb 7, 2025 · 1 hr 6 min
7 vs 14 Days of Antibiotics for Bacteremia, Factor XI Inhibition for Atrial Fibrillation, ACEi or ARB Before Elective Surgery, GLP-1 Agonist for HFpEF and Obesity
We're back, after a brief hiatus! Today we talk about duration of therapy for bacteremia, Factor XI inhibition for atrial fibrillation, whether to stop ACEi or ARB before elective surgery, and whether GLP-1 agonists are beneficial in heart failure with preserved ejection fraction. Go to minute 7:30 to skip the banter. 7 vs 14 Days of Antibiotics for Bacteremia (BALANCE) Abelacimab vs Rivaroxaban for Atrial Fibrillation (AZALEA-TIMI-71) Asenduxian vs Apixaban for Atrial Fibrillation (OCEANIC-AF) ACEi or ARB Discontinuation Before Surgery (STOP or NOT) Tirzepatide for HFpEF and Obesity (SUMMIT) 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
#58
Sep 23, 2024 · 1 hr 5 min
Anticoagulation in AF with Cirrhosis, Trends in Anticoagulation for Acute PE, Beta Blockers for Acute MI with Normal EF, Finerenone for HFpEF, Continuous vs Intermittent Infusion for Antibiotics, Cefepime vs Piperacillin-Tazobactam for Sepsis
It's been a long time, but we are back! Apologies on the audio quality from Dr. Jenkins. Apparently he was recording from inside a cardboard box. Today we talk about important, practice changing studies in internal medicine from the last several months. What's the best anticoagulant in patients with cirrhosis and atrial fibrillation? Why do doctors use so much unfractionated heparin for acute PE? Should we still be using beta blockers in patients with acute MI? Does finerenone improve outcomes in HFpEF? Is continuous infusion of antibiotics better than intermittent? And will the cefepime vs piperacillin-tazobactam battle ever end? Apixaban, Rivaroxaban and Warfarin in Cirrhosis for AF Anticoagulation Trends for Acute PE Beta Blockers for Acute MI with Normal EF Finerenone for HFpEF FINEARTS-HF Continuous vs Intermittent Infusion of Beta-Lactams BLING III Prolonged vs Intermittent Infusions of Beta-Lactams Meta-analysis Piperacillin-Tazobactam vs Cefepime for Sepsis Recurrent SBP in Patients on Secondary Prophylaxis Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R
#57
Jun 27, 2023 · 59 min
Metformin and Long COVID, Central Lines and Thrombocytopenia, DOACs vs LMWH in Cancer Associated Thrombosis, Early vs Late Anticoagulation after Stroke with Atrial Fibrillation
Today we are joined by Dr. Brian Locke, recently graduated pulmonary-critical care fellow, who takes us on a journey of avoiding statistical fallacies. Does metformin reduce the likelihood of long COVID? Should we give platelet transfusions to thrombocytopenic patients before central line placement? Did the CANVAS trial change practice in cancer associated thrombosis? Should patients with a stroke due to atrial fibrillation start oral anticoagulation earlier or later? We discuss all these questions on more on today's episode. Check it out! Metformin for Long COVID Definition of Post Acute Sequelae of Sars-CoV-2 Infection Platelet Transfusion before CVC Placement in Thrombocytopenia DOACs vs LMWH in Cancer Associated VTE Early vs Late Anticoagulation for Stroke with AF 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
#56
May 25, 2023 · 1 hr 8 min
Osmotic Demyelination Syndrome and Hyponatremia with Dr. Joel Topf, Apixaban vs Warfarin for On-X Aortic Valve, Perioperative Blood Pressure Strategies, Diagnostic Accuracy of CT Abdomen Without Contrast
Today we have a special guest, Dr. Joel Topf, board-certified nephrologist and medical educator extraordinaire. Our listeners will likely recognize Dr. Topf from his prolific tweeting @Kidney_boy, as well as his numerous appearances on the Curbsiders podcast. He is a co-founder of the NephJC on Twitter, and host and founder of the NephJC podcast Freely Filtered. He is also host of the podcast Channel Your Enthusiasm, a deep dive monthly recap of the nephrology textbook Clinical Physiology of Acid Base and Electrolyte Disorders by Dr. Burton Rose (who, incidentally, is the creator of the original UpToDate). Dr. Topf wrote his own book on fluids, electrolytes and acid-base homeostasis. He's the co-editor for the fourth edition of Nephrology Secrets and the first edition of The Handbook of Critical Care Nephrology. Dr. Topf joined us to talk about a new paper he co-authored on osmotic demyelination syndrome and hyponatremia. I'm also joined by Dr. Mita Hoppenfeld, hospitalist at the University of Utah, to talk about a new DOAC vs warfarin trial in On-X aortic valves, whether it's better to avoid hypertension or hypotension around time of surgery, and the diagnostic accuracy of CT abdomen scans without contrast. Check it out! Osmotic Demyelination and Hyponatremia Apixaban vs Warfarin for On-X Aortic Valve Perioperative Blood Pressure Strategies Diagnostic Accuracy of CT Abdomen Without Contrast 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
S4 · E4
Apr 27, 2023 · 46 min
Doxycycline Post-Exposure Prophylaxis for STIs (DoxyPEP), High Dose Prophylactic Anticoagulation for COVID-19 (ANTICOVID), Rates of Fracture Non-union and Bisphosphonates
This week we have special guest, Dr. Adam Spivak, to talk about the new study on doxycycline post-exposure prophylaxis for STIs. Dr. Spivak is an infectious disease expert and works in both an HIV clinic and a free PrEP clinic. I also review the latest COVID-19 anticoagulation trial and a paper looking at rates of fracture non-union in people who receive bisphosphonates. Check it out! Doxycycline Post-exposure Prophylaxis for STIs High dose prophylactic anticoagulation in COVID-19 Bisphosphonate and Rates of Fracture Non-unions 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
S4 · E3
Mar 25, 2023 · 1 hr 19 min
Thiazides for Kidney Stones, Hydrocortisone for Severe Pneumonia (CAPE COD), 2023 GOLD COPD Guidelines, Real World Use of Oral Antibiotics for Infective Endocarditis
Today we have special guest, Dr. Sarah Gilligan, a nephrologist, to talk about the new study of thiazides for kidney stones. We all learn in medical school that thiazides reduce urinary excretion of calcium, but does that really translate to fewer kidney stones? We also have Dr. Brian Locke on to talk about the CAPE COD trial, a big new critical care paper on using hydrocortisone in severe pneumonia, as well as the latest COPD guidelines and a retrospective study of oral antibiotics for infective endocarditis. Check it out! Hydrochlorothiazide for Kidney Stones Steroids for Pneumonia Meta-analysis Hydrocortisone for Severe CAP (CAPE COD) 2023 GOLD COPD Guidelines Real World Use of Oral Antibiotics for Endocarditis 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
S4 · E2
Feb 25, 2023 · 45 min
Antibiotic Duration for Febrile UTI in Males, Lower GI Bleeding Guidelines, Intravenous Contrast in Patients with Acute Kidney Injury
Today we welcome special guest and fellow EBM lover Dr. Mita Hoppenfeld to talk about a new randomized controlled trial evaluating the best duration of antibiotics for febrile UTI in men. Is 7 days as good as 14 days? We also review the latest guidelines for lower GI bleeding and a new retrospective study on renal outcomes in patients with AKI who receive IV contrast. 7 vs 14 days of antibiotics for Febrile UTI in Men Lower GI Bleeding Guidelines IV Contrast in patients with AKI 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
S4 · E1
Jan 31, 2023 · 51 min
Early Vasopressors and Restrictive Fluids in Septic Shock (CLOVERS), Furosemide vs Torsemide in Heart Failure (TRANSFORM-HF), Aspirin vs Enoxaparin after Extremity Fracture (PREVENT CLOT), Haloperidol for ICU Delirium (AID-ICU)
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
S3 · E12
Jul 22, 2022 · 44 min
SGLT2 Inhibitors for Acute Heart Failure, SGLT2 Inhibitors vs Metformin, High Dose Dexamethasone for COVID-19 in ICU, Isolated Distal DVT, Monkeypox, Blood Donor Sex and Mortality, Outcomes in Surgeons Who Operate the Night Before
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
S3 · E11
Jun 24, 2022 · 54 min
Restrictive Fluids in Septic Shock, Short vs Standard Antibiotics in Neutropenic Fever, IV Vitamin C for Septic Shock, Hospitalist Workload and Patient LOS, Fluid Bolus for Intubation, General Internist Practice Choices
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
S3 · E10
May 25, 2022 · 58 min
Inpatient Management of Opioid Use Disorder, Hep C Treatment in IVDU, Final SOLIDARITY Results for Remdesivir, TAVI for Moderate Risk Severe AS, Mediterranean Diet vs Low Fat Diet, Steroids for IgA Nephropathy, GLP-1s and Gallbladder Disease
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
S3 · E9
May 4, 2022 · 32 min
2022 AHA/ACC/HFSA Heart Failure Guidelines with Dr. James Fang, Guideline Committee Member
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

Showing 1–20 of 20 episodes