#91 Hotcakes: Fluid Wars, Barbershops, HTN, Aromatherapy, Coffee

April 16, 2018 | By Chris Chiu

Keep up-to-date with this fast moving discussion of recent journal articles and thought-provoking headlines in medicine. Welcome to the first-ever Curbsiders journal club covering landmark articles from March to April 2018, plus rapid fire hot takes and the unveiling of our new hotcake based rating system. Please let us know what you liked, didn’t like and how we can make this better next month. Topics: Resident work hours, saline versus balanced IV fluids, barber shops and hypertension, coffee causes cancer, Twitter based medicine, clonidine versus spironolactone, opioids versus nonopioids and aromatherapy for nausea!

Written by: Chris J Chiu, MD; Producer: Sarah Phoebe Roberts MPH; Edited by: Matthew Watto, MD

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Part 1: Main article reviews

Each host hand-picked one article to discuss during this month’s episode. Our summaries hit the top points from each study, including the clinical question addressed, the patient populations targeted, strengths and weaknesses, and the bottom line.

• Stuart: Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine

• Paul: A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

• Matt: Balanced Crystalloids vs Saline in Noncritically Ill Adults (SALT-ED trial)

See also:

• NephJC summary: http://www.nephjc.com/news/smartsalted)

• Swapnil’s excellent post on The Fluid Wars: http://www.nephjc.com/news/smartsalted

• FLUID trial may give us an answer: https://clinicaltrials.gov/ct2/show/NCT02721485

Part 2: Hot Takes

“Hot Takes” are bite-sized summaries of recent articles and news headlines we thought listeners might find interesting. These six are the ones we discussed on the podcast, but many other thought-provoking recent articles are included below, so please check them out!

Article by Dr. Milton Packer about Twitter-Based Medicine

New York Times article on California ruling re: coffee and cancer risk, and a more positive take, from 2015. What does the literature say?

Rubbing alcohol helps nausea: Inhaled Isopropyl Alcohol Superior to Oral Ondansetron as an Antiemetic. A similar study can be found here.

Opioids no better than non-opioids for chronic pain

Surgeon General releases guidance on use of/training for naloxone. Check out this video demonstrating how to administer naloxone

Spironolactone vs Clonidine for resistant HTN

Honorable Hot-Take Mentions

These didn’t make it into the podcast but are worth a read! Note: “Hot take” does not equal endorsement.

1. NephMadness 2018 Winner: Keri Cavanaugh’s editorial; Fedric Finkelstein’s editorial
2. 2017 IDSA Clinical Practice Guideline for C-diff infections
3. ACS evaluation using CCTA vs standard of care
4. Procalcitonin Testing to Guide Abx Therapy in Acute Upper and Lower Respiratory Tract Infections
5. Liberal Glucose Control in ICU patients with diabetes: before and after study.
6. Should stress tests be done urgently in low-risk patients with suspected ACS?
7. Core IM’s recent episode on Latent TBI: https://www.clinicalcorrelations.org/?p=16783
8. NYT article on why tPA should be used more in stroke.
9. ACP suggests new Hemoglobin A1C targets!!! (stay tuned for a future full episode about this)

Time stamps

• 00:00 Disclaimer

• 00:35 Host intros, featuring special guest and correspondent Chris Chiu, MD

• 01:30 Introducing a new Curbsiders segment!

• 03:20 First article: Duty-Hour Flexibility Trial

• 08:55 Second article: Trial of Blood-Pressure Reduction in Black Barbershops

• 14:27 Third article: SALT-ED Trial

• 20:00 Hot takes—intro

• 20:36 Hot take #1, Dr. Milton Packer and Twitter-based medicine

• 24:07 Hot take #2, Coffee and cancer risk

• 26:24 Hot take #3 Aromatherapy for nausea

• 28:10 Hot take #4 Opiates vs. non-opiates for chronic pain

• 29:00 Hot take #5, Surgeon general’s statement on naloxone

• 29:46 Hot take #6, Spironolactone vs clonidine for resistant HTN

• 31:54 Outro & announcements