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Evidence Rounds

@evidencerounds.bsky.social
11 followers 1 following 119 posts

News you can use in hospital medicine Medical literature is doubling rapidly, but knowledge isn't. Too many studies fail to answer the questions that matter most. We find and appraise the rare practice-changing evidence and cutting edge ideas.

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Evidence Rounds @evidencerounds.bsky.social · 27/08/2026
Two recent trials challenged the historical preference for anti-staphylococcal penicillin. For MSSA bacteremia, cefazolin should be first-line, and when the isolate is penicillin susceptible, benzylpenicillin is the preferred narrow-spectrum option
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Evidence Rounds @evidencerounds.bsky.social · 18/05/2026
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
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Evidence Rounds @evidencerounds.bsky.social · 14/05/2026
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
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Evidence Rounds @evidencerounds.bsky.social · 24/04/2026
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
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Evidence Rounds @evidencerounds.bsky.social · 22/04/2026
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)
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Evidence Rounds @evidencerounds.bsky.social · 11/04/2026
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
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Evidence Rounds @evidencerounds.bsky.social · 26/03/2026
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
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Evidence Rounds @evidencerounds.bsky.social · 24/03/2026
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)
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Evidence Rounds @evidencerounds.bsky.social · 19/03/2026
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
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Evidence Rounds @evidencerounds.bsky.social · 17/03/2026
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...
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Evidence Rounds @evidencerounds.bsky.social · 09/03/2026
Treating addiction is hard In a pragmatic RCT of patients with nonfatal opioid overdose, ED peer navigators did not reduce 1-year outcomes This builds on a prior step-wedge cluster RCT: addiction consult increased med use, but 6-month retention was low & similar (2.4% vs 3.2%)
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Evidence Rounds @evidencerounds.bsky.social · 05/03/2026
Mild predialysis hyperkalemia may not warrant treatment Among ESRD patients with a pre-dialysis K≥5.5, Lokelma improved long-term potassium control but did NOT reduce arrhythmia-related cardiovascular events (8.8% vs 8.9%) The trial was stopped early for low event rates
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Evidence Rounds @evidencerounds.bsky.social · 23/02/2026
In a nationally representative sample of adults 41–76, almost all had abnormal shoulder MRI findings, including ~51% of asymptomatic individuals with partial-thickness rotator cuff tears Like spine, knee, & hip imaging, this high prevalence suggests these are normal age-related
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Evidence Rounds @evidencerounds.bsky.social · 20/02/2026
Long-acting monthly injectable cabotegravir/rilpivirine was superior to oral ART in the LATITUDE trial among people with nonadherence, with an 18% absolute reduction in regimen failure A prior small economic analysis from a safety-net clinic suggests it is cost-effective
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Evidence Rounds @evidencerounds.bsky.social · 10/02/2026
Up to 40% of hospitalized adults discharge to post-acute care at home or in a facility This review demystifies post-acute care with a practical framework to match the right setting to a patient’s needs and plan for a smoother transition
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Evidence Rounds @evidencerounds.bsky.social · 06/02/2026
In an open-label RCT of HIV-related sepsis in endemic TB regions, immediate anti-TB therapy reduced 28-day mortality in the subgroup with later microbiologically confirmed tuberculosis This suggests, as with sepsis, that time to initiate anti-TB therapy might also matter
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Evidence Rounds @evidencerounds.bsky.social · 30/01/2026
Consider single-dose amphotericin for cryptococcal meningitis In a US safety-net hospital, the AMBITION regimen established in LMICs (single-dose liposomal ampho+flucy/fluc) achieved same outcomes with fewer severe adverse events in a pre-post analysis vs standard 14-day course
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Evidence Rounds @evidencerounds.bsky.social · 29/01/2026
Antibiotics hold up for more than half of patients with uncomplicated appendicitis, but decision to avoid upfront surgery is in the eye of the beholder At 10-year follow-up, 44% eventually underwent an appendectomy Greatest risk was in the first 12-18 months
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Evidence Rounds @evidencerounds.bsky.social · 24/01/2026
A 2023 narrative review challenges the centrality of dual-process models, arguing that diagnostic expertise matters more Improving clinical reasoning may depend less on debiasing & more on richer problem representations, illness scripts & better access to the right knowledge
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Evidence Rounds @evidencerounds.bsky.social · 23/01/2026
For older adults w/ newly diagnosed afib during hospitalization the 1-yr stroke risk w/o anticoag was low: 0.7% for CHA2DS2VASc 1-4 & 1.8% for 5-8 Given consensus of ≥2%/year, anticoag may be less compelling in hospital-detected AF but should still be individualized by risk
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Evidence Rounds @evidencerounds.bsky.social · 15/01/2026
Best of Hospital Medicine in 2025 In article format...
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Evidence Rounds @evidencerounds.bsky.social · 10/01/2026
Age-adjusted d-dimer cutoffs can safely exclude DVT A multicenter prospective cohort found that 7% of imaging could be avoided by using this strategy over the standard d-dimer cutoffs
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Evidence Rounds @evidencerounds.bsky.social · 09/01/2026
Prebiopsy steroids don’t reduce diagnostic yield in lymphoma (DLBCL) A retrospective study confirmed biopsy type mattered most for yield (excisional > core >>> FNA)
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Evidence Rounds @evidencerounds.bsky.social · 20/12/2025
Shunting in idiopathic NPH helps gait but with notable risks In a placebo-controlled RCT of patients who improved with CSF drainage, shunting improved gait & reduced falls at 3 mos (24% vs 46%) BUT more positional headaches (NNH 3), subdural bleeds (NNH 10) & hygromas (NNH 17)
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Evidence Rounds @evidencerounds.bsky.social · 09/12/2025
In a small but compelling proof-of-concept RCT in AUD, semaglutide reduced alcohol consumed vs placebo in a controlled setting where participants were presented with their preferred beverage Also reduced several measures of self-reported consumption Confirmatory trials needed
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Evidence Rounds @evidencerounds.bsky.social · 07/12/2025
In a sham-controlled trial with an active control, compression garments did not significantly reduce recurrent vasovagal syncope (orthostasis excluded) But a meaningful benefit wasn't excluded (underpowered?) & fewer syncopal episodes occurred when participants actively wore it
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Evidence Rounds @evidencerounds.bsky.social · 03/12/2025
In a pragmatic trial, RSV vaccine reduced RSV hospitalizations for respiratory illness in older adults by 83% But was rare (NNT ~1800) with similar total hospitalizations & death (numerically favored placebo) DANFLU-2 showed no benefit of high-dose vs standard influenza vax
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Evidence Rounds @evidencerounds.bsky.social · 02/12/2025
Aspirin’s decline continues In high-risk stable CAD patients already on anticoagulation (all post-PCI, 70% with prior MI; mostly on DOACs for Afib), adding aspirin increased death, CV events, and major bleeding in a multicenter trial, prompting early termination
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Evidence Rounds @evidencerounds.bsky.social · 26/11/2025
For provoked VTE, standard therapy is 3 months, but what about patients with ongoing risk (ie autoimmune disease, obesity)? In a single-center RCT, extended low-dose apixaban (2.5mg BID) reduced recurrent VTE vs placebo at 1 year (HR 0.13, NNT=10), with KM curves still diverging
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Evidence Rounds @evidencerounds.bsky.social · 24/11/2025
Is GDMT for heart failure coming full circle? In a double-blind multicenter trial of advanced HFrEF, digitoxin—a safer digoxin analog not available in the US—reduced both mortality and hospitalizations A Dutch trial of digoxin is underway, with results expected soon
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Evidence Rounds @evidencerounds.bsky.social · 21/11/2025
A meta-analysis of 5 contemporary trials found no improvement in outcomes with beta blocker therapy after myocardial infarction with normal EF (≥50%)
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Evidence Rounds @evidencerounds.bsky.social · 20/11/2025
Two new evidence rounds updates dropped! Check em out evidence-rounds.verc...
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Evidence Rounds @evidencerounds.bsky.social · 20/11/2025
Conservative dialysis strategy shows promise for AKI-D The LIBERATE-D trial found that this approach led to better renal recovery at discharge vs thrice-weekly dialysis (64% vs 50%) Although adjusted CIs were nonsignificant and deaths were numerically higher
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Evidence Rounds @evidencerounds.bsky.social · 19/11/2025
Should we target K >4 in high-risk ventricular arrhythmia? The answer may hinge far more on MRAs than repletion
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Evidence Rounds @evidencerounds.bsky.social · 17/11/2025
Is less always more? In an RCT of older nursing home residents with controlled HTN (mean age 90, MMSE 13, ~40% severely frail), deprescribing antihypertensives neither helped or harmed Yet, still warrants consideration to stop BP meds for patients with limited life expectancies
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Evidence Rounds @evidencerounds.bsky.social · 16/11/2025
Could autonomous vehicles be the single most effective public health intervention to decrease road traffic injuries? Waymo’s safety data was released with an estimated 80-90% reductions in injuries from crashes vs human benchmark data
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Evidence Rounds @evidencerounds.bsky.social · 15/11/2025
Starting in 2026, California will sell a 5-pack of glargine insulin pens for $55, about half the ~$100 GoodRx price, through its state-subsidized CalRx program Whether this price can be sustained without ongoing subsidies is to be determined
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Evidence Rounds @evidencerounds.bsky.social · 14/11/2025
Tranexamic acid should be considered for patients undergoing noncardiac surgery at risk of bleeding In a multicenter double-blinded RCT, periop tranexamic acid (1g IV before & after) reduced major bleeding by 24% (ARR 2.6%, NNT 38) without increasing cardiovascular events
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Evidence Rounds @evidencerounds.bsky.social · 13/11/2025
3 new evidence rounds dropped today Check em out evidence-rounds.verc...
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Evidence Rounds @evidencerounds.bsky.social · 13/11/2025
A new drug therapy emerges to reduce pancreatitis risk from severe hypertriglyceridemia In two RCTs, olezarsen lowered TGs by ~60% and reduced acute pancreatitis by 85% (NNT 20 at 1 year) For high risk patients (TG >880 mg/dL and prior pancreatitis), the NNT was just 4
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Evidence Rounds @evidencerounds.bsky.social · 12/11/2025
Update your illness scripts for recurrent, unexplained inflammation VEXAS is a newly discovered genetic syndrome, predominantly affecting older men (~1 in 4,000) presents with rheumatologic or hematologic features
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Evidence Rounds @evidencerounds.bsky.social · 09/11/2025
ICIs for NSCLC illustrates caution in broadening trial eligibility In ECOG 0-1, trials show overall survival gain (65% vs 50% alive at 18 mos w/ chemo) In ECOG 2+, excluded in trials & typical of hospitalized adults, survival is just ~4 mos x.com/EvidenceRounds...
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Evidence Rounds @evidencerounds.bsky.social · 08/11/2025
Many FDA-approved drugs receive indications broader than pivotal clinical trials, most notably for patient fitness While broader labels can extend access, absolute benefits may be smaller or absent altogether, especially for sicker & more impaired hospitalized patients
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Evidence Rounds @evidencerounds.bsky.social · 05/11/2025
The rise in early-onset cancer in the US, including colon cancer, is less an epidemic of disease & more an epidemic of diagnosis The lack of a substantial rise in deaths, despite significant rising incidence strongly suggests increased diagnostic scrutiny & overdiagnosis
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Evidence Rounds @evidencerounds.bsky.social · 04/11/2025
In a multicenter RCT, using a personalized DAPT score based on risk (3, 6, or 24 mos) vs standard DAPT (12 mos) had an absolute 3.5% lower composite outcome at 2 years (NNT=29) Was primarily driven by fewer MI & less urgent revascularization Had similar bleeding rates & death
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Evidence Rounds @evidencerounds.bsky.social · 03/11/2025
Interested in archived evidence rounds? Visit the website Filterable by topic Searchable Grows weekly
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Evidence Rounds @evidencerounds.bsky.social · 03/11/2025
In a double-blind RCT of healthy adults given CBD for 28 days at doses representative of consumer use, 6% had LFT elevations most met potential DILI criteria & also had eosinophilia LFT rise began ~3 weeks after daily use & returned to normal within 1-2 weeks of discontinuation
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Evidence Rounds @evidencerounds.bsky.social · 31/10/2025
Can DOACs be stopped after successful AF ablation? Stopping DOACs had slightly better outcomes (stroke, embolism, bleeding) in an open-label RCT of patients w/o AF recurrence ≥1 yr after ablation (avg 3.6 yrs) ~10% had AF recurrence over 2 years, prompting DOAC reinitiation
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Evidence Rounds @evidencerounds.bsky.social · 30/10/2025
Routine use of gabapentin for postoperative pain is not supported by evidence In a large multicenter double-blind RCT of patients undergoing major surgery, gabapentin did NOT improve pain, opioid use, length of stay, or quality of life confirms a prior meta-analysis
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Evidence Rounds @evidencerounds.bsky.social · 29/10/2025
The DEA San Francisco Division recently seized pills containing carfentanil, a fentanyl analog ~100× more potent It’s increasingly implicated in overdoses across the West Reversal may require higher or repeated doses of naloxone
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