Inpatient Update

Mason Turner, MD
  • 5.0 (8)
  • Medicine

Inpatient Update delivers short, practical reviews of new studies and guidelines that matter to hospitalists — focused on what actually changes decisions on rounds tomorrow. Get the key takeaways, cited article links, and episode summaries by email: subscribe.inpatientupdate.com Efficient, evidence-based, and built for the working hospitalist.

  1. 1d ago

    News Flash: Cyclospora Outbreak — What Hospitalists Need to Know

    With Special Guest Dr. Scott Curry In this Inpatient Update News Flash, Dr. Mason Turner is joined by infectious disease physician and hospital epidemiologist Dr. Scott Curry to examine the sharp rise in cyclosporiasis cases across the United States—and what it should change in clinical practice. Thousands of confirmed cases have been reported across more than 40 states, with hundreds of hospitalizations and additional clusters still under investigation. So what should hospitalists do differently? What Is Cyclospora?Cyclospora is a foodborne parasite that infects the small intestine and commonly causes: Prolonged watery diarrheaFrequent or urgent bowel movementsBloating and gasPoor oral intakeHypovolemia, AKI, and electrolyte abnormalitiesUnlike many other gastrointestinal infections, illness may relapse and persist for a month or longer without treatment. Person-to-person transmission is not expected because the organism must mature in the environment before becoming infectious. When Should Hospitalists Suspect It?Think about cyclosporiasis when a patient has: Prolonged or relapsing diarrheaRecent consumption of uncooked produceRestaurant or grocery-store exposuresSymptoms lasting longer than expected for viral gastroenteritisHypovolemia, AKI, or hyponatremia associated with ongoing diarrheaThe incubation period may be 7–14 days, so the food history needs to extend well beyond the last meal. Ask about: Fresh produce and saladsRestaurants and shared mealsGrocery stores and product brandsTravelWell waterWhether anyone else who shared the meal became illDocument those details. They may become important during a public-health investigation. How Should We Test?For patients admitted with acute or prolonged gastrointestinal symptoms: Order and collect a GI multiplex PCR early, ideally at admission.Do not wait until the patient has been hospitalized for several days.Interpret results in the context of the clinical syndrome because false positives can occur.Avoid reflexively ordering a traditional stool ova and parasite examination. It is labor-intensive, low yield, and may miss Cyclospora unless special testing is performed. A positive result that does not fit the clinical picture should prompt discussion with microbiology or infectious disease rather than automatic treatment. How Is It Treated?For an immunocompetent adult with clinically convincing cyclosporiasis: Trimethoprim-sulfamethoxazole double strength twice daily for 7–10 days Treatment usually shortens what can otherwise become a prolonged and miserable illness. Consult infectious disease when the patient: Has a serious sulfa allergyIs significantly immunocompromisedHas severe, relapsing, or complicated illnessHas testing that conflicts with the clinical pictureThere is currently no clearly proven, equally effective alternative for patients with a serious sulfa allergy. Isolation and ReportingCyclospora does not require special isolation beyond standard precautions once the diagnosis is known. However, patients presenting with undifferentiated vomiting or diarrhea should initially be approached with appropriate gown and glove precautions because norovirus and other highly contagious infections remain much more common. Laboratories generally report confirmed cases to public-health authorities. Clinicians should also consider contacting their health department when a detailed food history suggests a specific restaurant, product, or shared exposure. Practice-Changing TakeawaysTake a real food history—and go back up to two weeks.Order GI PCR early in the hospitalization when clinically appropriate.Stop reflexively ordering stool ova and parasite examinations.Treat convincing cyclosporiasis with TMP-SMX.Recognize that a positive multiplex PCR does not override a clinical picture that does not fit.Call microbiology or ID when the diagnosis or treatment is uncertain.Bottom LineThe Cyclospora outbreak does not require a completely new approach. It should sharpen the approach hospitalists already use for gastrointestinal illness: Ask earlier. Test earlier. Interpret thoughtfully. Treat the patient in front of you. Support the show Want the cited articles and key takeaways? Join the email list: https://subscribe.inpatientupdate.com/

  2. Jul 2

    Don’t Leave Fluids on Autopilot: Pancreatitis and LR vs Normal Saline

    In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Daniel Hardgrove to rethink two common fluid decisions: Acute pancreatitis — should aggressive IV fluids still be the default?LR vs normal saline — does balanced crystalloid actually improve outcomes?Practical take-homes, real-world discussion, and what to change on rounds tomorrow. Articles & PubMed Links Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis New England Journal of Medicine, 2022 WATERFALL Trial Compared: Aggressive fluids: 20 mL/kg bolus + 3 mL/kg/hrModerate fluids: bolus only if hypovolemic + 1.5 mL/kg/hrKey Findings No improvement in moderately severe/severe pancreatitisMore fluid overload with aggressive fluidsTrial stopped early for harmShorter length of stay with moderate fluidsTakeaway For acute pancreatitis, stop reflexively flooding patients. Give fluids if hypovolemic.  Start moderate.  Reassess early.  Stop when no longer needed. Pubmed: https://pubmed.ncbi.nlm.nih.gov/36103415/  A Crossover Trial of Hospital-Wide Lactated Ringer’s Solution vs Normal Saline New England Journal of Medicine, 2025 FLUID Trial Hospital-wide crossover trial comparing: Lactated Ringer’sNormal salineKey Findings No significant difference in: Death or readmission at 90 daysMortalityDialysisLength of stayED visitsTakeaway LR is reasonable.  Normal saline is reasonable. For most hospitalized patients, the choice probably matters less than we thought. Pubmed: https://pubmed.ncbi.nlm.nih.gov/40503714/  Practice-Changing Takeaways Pancreatitis: moderate, reassessed fluids beat automatic aggressive hydration.Crystalloid choice: LR is not clearly superior to saline for broad hospital use.Fluids are treatment, not autopilot. Bottom Line If you change nothing else this week: Don’t automatically flood pancreatitis patients.Put a stop time or reassessment point on maintenance fluids.Use LR or saline thoughtfully based on the patient.Treat the patient. Not the reflex.   Support the show Want the cited articles and key takeaways? Join the email list: https://subscribe.inpatientupdate.com/

  3. Jun 18

    Semi-Annual Takeaways: 5 Practice-Changing Updates for Hospitalists

    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 DeliberateThe 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: Three days of antibiotics may be enoughCRP may help identify who benefits from steroidsA positive viral panel should make us pause before reflexively prescribing antibioticsThe lesson is not "do less." The lesson is to be more deliberate. #4 Give Your Heart Failure Patients the Flu Shot Before DischargeFeatured Article Influenza Vaccination to Improve Outcomes for Patients with Acute Heart Failure (PANDA II) Lancet, 2025 Original Episode: SHM Converge 2026 Recap — with Dr. Emily Reams Takeaway A one-time intervention that many hospitalized patients still miss. For patients admitted with heart failure during flu season: Reduced mortalityReduced readmissionsNumber needed to treat ≈ 17Hospitalization creates an opportunity that should not be missed. If they're eligible and willing, vaccinate before discharge. #3 With Blood Thinners, Sometimes Less Is MoreFeatured Article Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation (AQUATIC Trial) New England Journal of Medicine, 2025 Original Episode: Aspirin Plus Anticoagulation + 7 vs 14 Days for Bacteremia — with Dr. Andres Ospina Supporting Articles Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism (API-CAT Trial) New England Journal of Medicine, 2025 Original Episode: Pilot Episode — Solo Bleeding Risk with Apixaban vs Rivaroxaban in Acute Venous Thromboembolism New England Journal of Medicine, 2026 Original Episode: Apixaban vs Rivaroxaban + Steroids in Community-Acquired Pneumonia — with Dr. Adam Jaffe Takeaway Several recent studies point in the same direction: Stop aspirin when stable CAD patients begin long-term anticoagulationConsider reduced-dose apixaban for extended VTE treatment in selected patientsApixaban appears safer than rivaroxaban for bleedingLess anticoagulation is not always better. But less unnecessary anticoagulation often is. #2 We Are Entering an Era of Shorter Antibiotic DurationsFeatured Article Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections (BALANCE Trial) New England Journal of Medicine, 2025 Original Episode: Aspirin Plus Anticoagulation + 7 vs 14 Days for Bacteremia — with Dr. Andres Ospina Supporting Articles Antibiotic De-escalation in Adults Hospitalized for Community-Onset Sepsis JAMA Internal Medicine, 2026 Original Episode: De-escalating Sepsis Antibiotics + When to Pull the IV — with Nicholas Linde, PA Dalbavancin for Treatment of Staphylococcus aureus Bacteremia: The DOTS Randomized Clinical Trial JAMA, 2025 Original Episode: Faster Hypernatremia Correction + Long-Acting Antibiotics for Staph Bacteremia — with Dr. Kevin Baker Takeaway Across multiple infections, the trend is consistent: Seven days often beats fourteenEarlier de-escalation appears safeLong-acting antibiotics may help some patients avoid prolonged IV therapy and hospitalizationThe question is no longer: "Can we shorten antibiotics?" The question is: "Why are we still giving so many patients long courses?" #1 Stop Treating Asymptomatic Inpatient Blood Pressure NumbersFeatured Article As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals JAMA Internal Medicine, 2025 Original Episode: Asymptomatic Inpatient Hypertension + Viral Pneumonia Antibiotics — with Dr. Austin White Takeaway This was the most practice-changing study discussed on the show so far. For hospitalized patients with: Elevated blood pressureNo symptomsNo evidence of end-organ damageThe reflexive response should not be: "What PRN should I give?" Instead ask: Why is the blood pressure elevated?Is the patient in pain?Anxious?Post-operative?Does this patient actually need acute treatment?Acute treatment of asymptomatic inpatient hypertension was associated with: More AKIMore large blood pressure dropsWorse clinical outcomesTreat the patient. Not the number. Bottom LineIf you change nothing else from the first six months of Inpatient Update: Stop treating asymptomatic inpatient hypertension.Shorten antibiotics when the evidence supports it.Reconsider aspirin when starting anticoagulation.Give eligible heart failure patients a flu shot before discharge.Be more deliberate in your pneumonia management.Small changes. Huge reach. Real impact. Support the show Want the cited articles and key takeaways? Join the email list: https://subscribe.inpatientupdate.com/

  4. Jun 4

    Too Cautious? Rethinking Hyponatremia Correction and DVT Prophylaxis

    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: 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.  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. Interpretation Pharmacologic prophylaxis reduces VTE events, but: Absolute VTE risk is relatively low Mortality is unchanged Bleeding risk must be considered Patient selection matters Takeaway → 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. Support the show Want the cited articles and key takeaways? Join the email list: https://subscribe.inpatientupdate.com/

  5. May 20

    Shorter CAP Antibiotics + The Cipro QTc Myth

    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 Links3–4 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 antibioticsAfter 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/ Ciprofloxacin and QTc Prolongation Journal of Antimicrobial Chemotherapy (2026) Prospective study evaluating QTc before and after standard-dose ciprofloxacin.  Baseline ECG obtained  Repeat ECG after reaching steady-state ciprofloxacin levels Key Findings  No statistically significant change in QTc  Mean QTc remained essentially unchanged (~415 ms)  Patients with significant QT prolongation had:  Multiple competing risk factors  Concurrent QT-prolonging medications  Electrolyte abnormalities Interpretation For most stable patients:  → Ciprofloxacin alone does not meaningfully prolong QTc The real danger appears to be:  Polypharmacy  Electrolyte derangements  Critical illness  Multiple simultaneous QT-prolonging factors pubmed: https://pubmed.ncbi.nlm.nih.gov/41628197/ Practice-Changing TakeawaysCommunity-acquired pneumonia: Stable patients may only need 3 days of antibiotics  “Minimum 5 days” is no longer absolute dogma Ciprofloxacin: QT concern should be contextual, not reflexive  Don’t deny patients effective oral therapy solely out of generalized QT fear Clinical Pearls Antibiotics may not need to “eradicate” infection completely — just shift the balance enough for the immune system to finish the job  Lung microbiome preservation may become increasingly important in future stewardship strategies  Most dangerous QT events are multifactorial, not caused by a single medication in isolation  Ciprofloxacin remains an extremely valuable oral option for:  Gram-negative bacteremia  Pseudomonas coverage  Avoiding PICC lines and prolonged IV therapy Bottom LineIf you change nothing else this week:  Consider stopping CAP antibiotics after 3 days in carefully selected stable patients  Use ciprofloxacin thoughtfully — but don’t reflexively fear the QTcSupport the show Want the cited articles and key takeaways? Join the email list: https://subscribe.inpatientupdate.com/

  6. May 6

    Fewer Bleeds, Smarter Steroids: Apixaban vs Rivaroxaban and CRP-Guided Steroids for Pneumonia

    With Special Guest Dr. Adam Jaffe In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Adam Jaffe to tackle two high-impact clinical questions: Is there a clear winner among DOACs? Who actually benefits from steroids in community-acquired pneumonia? Two common decisions. New data. Practice-changing implications.  Articles & PubMed Links Apixaban vs Rivaroxaban for VTE (Head-to-Head RCT) New England Journal of Medicine (2026) Randomized trial (n=2,760) comparing: Apixaban vs Rivaroxaban Population: Acute VTE Excluded: active cancer, extreme obesity, other anticoagulation indications Key Findings ↓ Clinically significant bleeding with apixaban ~54% relative risk reduction NNT ≈ 27 ↓ Major bleeding (0.4% vs 2.4%) No difference in: Recurrent VTE Mortality Interpretation Same efficacy Less bleeding with apixaban Takeaway → For new starts: Apixaban is the preferred DOAC pubmed: https://pubmed.ncbi.nlm.nih.gov/41812192/ Corticosteroids in Community-Acquired Pneumonia (IPD Meta-analysis) Lancet Large meta-analysis (n=3,224 across 8 RCTs) Compared: Steroids vs Placebo Primary Outcome: 30-day mortality Absolute risk reduction: 2.2% NNT = 46 🔑 The Key Insight: CRP Matters When stratified by inflammation: CRP >200 Mortality: 13% → 6% Absolute risk reduction ≈ 7% NNT ≈ 14 CRP 200) → Routine use in all pneumonia is not supported pubmed: https://pubmed.ncbi.nlm.nih.gov/39892408/ Practice-Changing Takeaways DOACs: Apixaban > rivaroxaban for bleeding Same clot prevention → choose apixaban for new starts Pneumonia: Steroids may reduce mortality — but only in the right patient CRP can help identify who benefits Clinical Pearls The difference between DOACs is no longer “vibes” — we now have head-to-head data Most steroid benefit in pneumonia appears inflammatory-driven, not severity-driven CRP — often ignored — may actually guide meaningful decisions here Bottom Line If you change nothing else this week: Start apixaban for new VTE patients In pneumonia, check a CRP — and consider steroids if >200 Fewer bleeds. Smarter steroids. Better outcomes. Support the show Want the cited articles and key takeaways? Join the email list: https://subscribe.inpatientupdate.com/

  7. Apr 22

    Asymptomatic Hypertension & Viral Pneumonia — Stop Overtreating

    With Special Guest Dr. Austin White 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 treatmentKey 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 → hypoperfusionTakeaway 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 outcomesTakeaway → If viral etiology fits the clinical picture,  don’t routinely continue antibiotics Pubmed: https://pubmed.ncbi.nlm.nih.gov/41378862/  Practice-Changing TakeawaysHypertension: 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 evidenceClinical 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 Bottom LineIf you change nothing else this week:  Stop reflexively treating asymptomatic inpatient hypertension  Stop reflexively continuing antibiotics for viral pneumonia Less intervention. Better outcomes. Support the show Want the cited articles and key takeaways? Join the email list: https://subscribe.inpatientupdate.com/

  8. Apr 8

    Simple, High-Impact Changes Hospitalists Are Missing (SHM 2026 Takeaways)

    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  Apixaban preferred over rivaroxaban  Reduce dose after 3–6 months for VTE  → Reassess dosing routinelyBig Picture  Biggest wins = simple changes Often: stop meds or use basics better Hospitalists have high-impact touchpoints If You Change Nothing Else This Week  Give flu shots in heart failure  Stop aspirin in DOAC patients (when appropriate)  Anticoagulate AFib despite fall risk  Start naltrexone before discharge Small changes. Massive reach. Real impact. Support the show Want the cited articles and key takeaways? Join the email list: https://subscribe.inpatientupdate.com/

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About

Inpatient Update delivers short, practical reviews of new studies and guidelines that matter to hospitalists — focused on what actually changes decisions on rounds tomorrow. Get the key takeaways, cited article links, and episode summaries by email: subscribe.inpatientupdate.com Efficient, evidence-based, and built for the working hospitalist.

Information

  • Creator
    Mason Turner, MD
  • Years Active
    2026
  • Episodes
    13
  • Rating
    Clean
  • Copyright
    © 2026 Inpatient Update
  • Show Website
    Inpatient Update

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