Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
What are best practices for taking care of lung cancer patients during the COVID-19 pandemic?
This is a great question, and as always there is no one size fits all. For patients on active treatment for lung cancer such as chemoimmunotherapy, I continue to stress the importance of hand washing, social distancing, and to work on reducing wait times in the waiting room to limit exposure, etc. I...
What is your view on the potential role of immune-targeted therapies in Parkinson’s disease?
In my opinion, the role of immune-targeted therapies in Parkinson’s disease remains uncertain at this time. While both activated microglial cells and various cytokines associated with immune activation have been detected in Parkinson’s patients, it remains unclear whether these are pathologically si...
How do you decide when to use acid-suppressive medications for GI prophylaxis when patients are on prolonged corticosteroid therapy?
Consideration of risk factors is important. Routinely, someone without these risk factors, and if getting a short burst of steroids, the GI prophylaxis is not given. PPIs carry certain risks, including increased risk of C. Diff infection or even pneumonia. So, they should be avoided if not indicated...
How do you decide when to use acid-suppressive medications for GI prophylaxis when patients are on prolonged corticosteroid therapy?
Consideration of risk factors is important. Routinely, someone without these risk factors, and if getting a short burst of steroids, the GI prophylaxis is not given. PPIs carry certain risks, including increased risk of C. Diff infection or even pneumonia. So, they should be avoided if not indicated...
What is your approach to using pegloticase in patients with congestive heart failure?
Clinical trial data show developing CHF exacerbation in 2% of patients while on Pegloticase treatment, while real-world data show higher numbers (6.4%), so careful patient selection and stabilization of CHF are necessary before starting treatment, and need close monitoring while receiving treatment....
For patients admitted while taking chronic outpatient opioids, how do you decide whether to resume their baseline opioid regimen at discharge versus tapering or modifying therapy during hospitalization?
I'm not sure there's a single right answer here. My only recommendation is for patients who are on chronic outpatient opiates: please talk to their ambulatory clinician before making any significant changes. Their ambulatory doctor knows them over time and can give you advice regarding what's happen...
For patients admitted while taking chronic outpatient opioids, how do you decide whether to resume their baseline opioid regimen at discharge versus tapering or modifying therapy during hospitalization?
I'm not sure there's a single right answer here. My only recommendation is for patients who are on chronic outpatient opiates: please talk to their ambulatory clinician before making any significant changes. Their ambulatory doctor knows them over time and can give you advice regarding what's happen...
How do you approach initial anticoagulant selection in hemodynamically stable hospitalized patients with newly diagnosed pulmonary embolism?
Low-molecular-weight heparin demonstrates the greatest benefit in patients with cancer-associated pulmonary embolism, intermediate-risk PE, and those requiring outpatient management. While LMWH shows superior efficacy and safety compared to unfractionated heparin across most patient populations, cer...
Do you recommend restarting GLP-1RA after bariatric surgery if they tolerated it before the surgery?
While there are no clear recommendations on whether/when to resume GLP-1 RA after bariatric surgery, current 2025 guideline statements (ASMBS, ADA, AACE, Obesity Society) and expert consensus documents suggest the following approach: Hold GLP-1RA in the acute perioperative period. For daily-dosed ...
Do you recommend restarting GLP-1RA after bariatric surgery if they tolerated it before the surgery?
While there are no clear recommendations on whether/when to resume GLP-1 RA after bariatric surgery, current 2025 guideline statements (ASMBS, ADA, AACE, Obesity Society) and expert consensus documents suggest the following approach: Hold GLP-1RA in the acute perioperative period. For daily-dosed ...