Evidence Rounds

News you can use in hospital medicine

[Evidence Rounds @EvidenceRounds]

Welcome to Evidence Rounds!

You might be an Evidence Rounder if you drown in literature that rarely helps and want trustworthy, curated evidence

Follow for weekly updates featuring practice-changing studies and the most promising ideas that shape hospital medicine

[Evidence Rounds @EvidenceRounds]

In a double-blind RCT of 108 obese AUD pts motivated for sobriety, semaglutide reduced heavy drinking days by 13% (absolute) vs placebo

Reduction in drinking strongly correlated w/ weight los

Suggests shared mechanism or functional unblinding, which might exaggerate benefits

[Evidence Rounds @EvidenceRounds]

Study link here

#EvidenceRounds
#Diagnosis

https://t.co/T2g4ZSAWnT

[Evidence Rounds @EvidenceRounds]

In a proof-of-concept AI second opinion study of 76 ED visits, an LLM exceeded 2 independent MD reviewers on diagnostic performance at 3 touchpoints (ER triage, ER physician & admit)

Whether it outperforms physicians in real-world practice is yet to be determined

[Evidence Rounds @EvidenceRounds]

Proof of concept trial here. Larger ones are underway

#EvidenceRounds
#Addiction
#GLP1

https://t.co/D6zqBOGblt

[Evidence Rounds @EvidenceRounds]

In a double-blind RCT of 108 obese AUD pts motivated for sobriety, semaglutide reduced heavy drinking days by 13% (absolute) vs placebo

Reduction in drinking strongly correlated w/ weight los

Suggests shared mechanism or functional unblinding, which might exaggerate benefits

[Evidence Rounds @EvidenceRounds]

Study link

#EvidenceRounds
#HospitalMedicine
#Endocrinology

https://t.co/Nix5zT5VRs

[Evidence Rounds @EvidenceRounds]

Do patients on a low dose of levothyroxine truly have hypothyroidism?

In a multicenter longitudinal descriptive study, 64% on a levothyroxine dose of 50 µg/d or lower were able to successfully discontinue treatment, suggesting that very low doses more often reflect overtreatment

[Evidence Rounds @EvidenceRounds]

Prior small proof of concept trial of larger fluid intake

https://t.co/UDEnbj52mY

[Evidence Rounds @EvidenceRounds]

Does hydration reduce kidney stones?

A behavioral intervention ↑ fluid intake ~300 mL (w/ slight ↑ urinary symptoms) but did NOT ↓ recurrence or improve outcomes

Intake difference may have been too small, as a prior small trial showed benefit w larger separation (~2.5 vs 1L)

[Evidence Rounds @EvidenceRounds]

PUSH trial here

#EvidenceRounds
#HospitalMedicine
#Endocrinology
#Urology

https://t.co/XQLBibXXLG

[Evidence Rounds @EvidenceRounds]

Study link here

#EvidenceRounds
#Neurology

https://t.co/uWQ35uPONm

[Evidence Rounds @EvidenceRounds]

Minocycline for acute ischemic stroke?

In a multicenter RCT, oral minocycline within 72h of an ischemic stroke (NIHSS 4–25) improved functioning at 90 days (mRS 0–1: 52.6% vs 47.4%; ~5% absolute; RR 1.11), supporting a modest neuroprotective benefit

[Evidence Rounds @EvidenceRounds]

COBRA trial link

#EvidenceRounds
#HospitalMedicine
#Cardiology
#Hematology

https://t.co/Dz0TmxoAu6

[Evidence Rounds @EvidenceRounds]

In a head-to-head trial for VTE treatment, apixaban was safer than rivaroxaban with similar effecacy at 90 days, with ~4% less clinically relevant bleeding (RR 0.5)

Since the safety advantage was confined to the loading-dose phase, its not relevant for atrial fibrillation

[Evidence Rounds @EvidenceRounds]

SOHO trial link

#EvidenceRounds
#HospitalMedicine
#PulmCrit

https://t.co/La9BiPMIbn

[Evidence Rounds @EvidenceRounds]

The SOHO trial confirms the use of high-flow nasal cannula for acute hypoxic respiratory failure with less intubation (NNT ~17; benefit by day 1, plateaus by day 4) and less dyspnea (NNT ~7; ~5-point improvement on a 100-point scale)

[Evidence Rounds @EvidenceRounds]

Even if the primary outcome of mortality didn't improve, avoiding intubation and improving breathlessness are meaningful benefits

https://t.co/10XET4lObJ

[Anil Makam @AnilMakam]

John is right. Its uncommon to celebrate secondary outcomes as a win

This is why appraisal & EBM aren't rote

5 reasons to reframe it as 'positive'

1. Its a pragmatic trial of two established ways to oxygenate, at least in well resourced hospitals. Not a new fangled intervention or risky safety profile

2. Patients, nurses & clinicians ALREADY favor HFNC for comfort, ease of use, less worry about aspiration. A "negative" trial on mortality wont overcome these obvious benefits of HFNC unless it was clearly harmful (narrator: its not)

3. Bad study design to choose mortality as primary outcome. Anyone paying attention to critical care understands few things move the needle to extending life when that sick, and this ain't one of them

4. Preventing intubations is a clear win. This isnt just delay either. Close to 6% avoided intubation. Benefits are near immediate too. At scale this is huge. Cheaper. Frees up limited ICU capacity. Avoids subsequent ICU harms like VAP, sedation harms, lines, pressors from sedation/MV related hypotension, stress ulcer bleeds, and the over medicalization of being in the ICU (constant beeping, many labs, daily imaging, empiric vanc/zosyn just cause you move from floor to ICU). At population level would see mortality benefits IMO

5. Less dyspnea matters, especially when people are struggling to breathe. We are here to make people feel better or live longer. Many things we prescribe may do neither.

[Evidence Rounds @EvidenceRounds]

TAPER-V trial link here

#EvidenceRounds
#HospitalMedicine
#InfectiousDisease

https://t.co/rixylk2h2k

[Evidence Rounds @EvidenceRounds]

Should longer vanc courses be prescribed for first episodes of C diff?

In a Bayesian RCT, a 4-week pulse+taper reduced recurrence vs standard 2-week course at 1 month (RRR 43%, 99% probability of superiority) and at 2 mos (RRR 16%, 74% prob)

But 3-month recurrence was similar

[Evidence Rounds @EvidenceRounds]

Trial link here

#EvidenceRounds
#HospitalMedicine
#Nephrology

https://t.co/rQWOvcBEHN

[Evidence Rounds @EvidenceRounds]

Does correcting chronic hyponatremia improve outcomes? In an RCT of hospitalized adults with Na <130, a targeted correction algorithm did not improve 30-day death/rehospitalization (20.5% vs 21.8%) or neurocognitive outcomes...

[Evidence Rounds @EvidenceRounds]

However, findings may be biased toward the null because the intervention only increased eunatremia by 14% (60% vs 46%), 30-day hyponatremia rates were similar, and the algorithm relied heavily on investigator phenotyping (chronicity/etiology/volume status)