Evidence Rounds
@evidencerounds.bsky.social
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.
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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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
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
A meta-analysis of 5 contemporary trials found no improvement in outcomes with beta blocker therapy after myocardial infarction with normal EF (≥50%)
November 21, 2025 at 4:12 PM
A meta-analysis of 5 contemporary trials found no improvement in outcomes with beta blocker therapy after myocardial infarction with normal EF (≥50%)
November 20, 2025 at 8:25 PM
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
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
November 20, 2025 at 8:14 PM
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
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
Should we target K >4 in high-risk ventricular arrhythmia?
The answer may hinge far more on MRAs than repletion
The answer may hinge far more on MRAs than repletion
November 19, 2025 at 7:00 PM
Should we target K >4 in high-risk ventricular arrhythmia?
The answer may hinge far more on MRAs than repletion
The answer may hinge far more on MRAs than repletion
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
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
November 17, 2025 at 1:41 PM
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
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
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
Waymo’s safety data was released with an estimated 80-90% reductions in injuries from crashes vs human benchmark data
November 16, 2025 at 4:08 PM
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
Waymo’s safety data was released with an estimated 80-90% reductions in injuries from crashes vs human benchmark data
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
Whether this price can be sustained without ongoing subsidies is to be determined
November 15, 2025 at 6:35 PM
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
Whether this price can be sustained without ongoing subsidies is to be determined
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
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
November 14, 2025 at 2:23 PM
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
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
November 13, 2025 at 8:11 PM
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
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
November 13, 2025 at 8:09 PM
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
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
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
VEXAS is a newly discovered genetic syndrome, predominantly affecting older men (~1 in 4,000)
presents with rheumatologic or hematologic features
November 12, 2025 at 4:40 PM
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
VEXAS is a newly discovered genetic syndrome, predominantly affecting older men (~1 in 4,000)
presents with rheumatologic or hematologic features
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...
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...
November 9, 2025 at 4:25 PM
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...
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...
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
While broader labels can extend access, absolute benefits may be smaller or absent altogether, especially for sicker & more impaired hospitalized patients
November 8, 2025 at 5:54 PM
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
While broader labels can extend access, absolute benefits may be smaller or absent altogether, especially for sicker & more impaired hospitalized patients
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
The lack of a substantial rise in deaths, despite significant rising incidence strongly suggests increased diagnostic scrutiny & overdiagnosis
November 5, 2025 at 3:35 PM
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
The lack of a substantial rise in deaths, despite significant rising incidence strongly suggests increased diagnostic scrutiny & overdiagnosis
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
Was primarily driven by fewer MI & less urgent revascularization
Had similar bleeding rates & death
November 4, 2025 at 3:13 PM
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
Was primarily driven by fewer MI & less urgent revascularization
Had similar bleeding rates & death
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November 3, 2025 at 4:54 PM
Interested in archived evidence rounds?
Visit the website
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Grows weekly
Visit the website
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Grows weekly
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
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
November 3, 2025 at 3:10 PM
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
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
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
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
October 31, 2025 at 2:37 PM
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
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
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
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
October 30, 2025 at 3:01 PM
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
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
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
It’s increasingly implicated in overdoses across the West
Reversal may require higher or repeated doses of naloxone
October 29, 2025 at 3:31 PM
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
It’s increasingly implicated in overdoses across the West
Reversal may require higher or repeated doses of naloxone
Following the topline SNAP trial results, a new multicenter trial found cefazolin noninferior to cloxacillin for MSSA bacteremia, with fewer adverse events
Given its safety, convenience, and lower cost, cefazolin should be considered first-line therapy for MSSA bacteremia
Given its safety, convenience, and lower cost, cefazolin should be considered first-line therapy for MSSA bacteremia
October 28, 2025 at 5:04 PM
Following the topline SNAP trial results, a new multicenter trial found cefazolin noninferior to cloxacillin for MSSA bacteremia, with fewer adverse events
Given its safety, convenience, and lower cost, cefazolin should be considered first-line therapy for MSSA bacteremia
Given its safety, convenience, and lower cost, cefazolin should be considered first-line therapy for MSSA bacteremia
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
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
October 28, 2025 at 4:58 PM
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
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