Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
Do you recommend restarting a GLP-1RA after bariatric surgery if the patient 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 a GLP-1RA after bariatric surgery if the patient 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 ...
What imaging do you recommend for patients with suspected CSF leak?
MR brain is usually the best place to start, but if you have a high clinical suspicion and unrevealing results, there are a few other imaging methods to consider. CT myelogram is the gold standard for spinal leaks, and a combination of high-resolution CT and CT cisternography can be useful for crani...
When do you refer patients back to their PCP for the predominant management of their medical care following completion of oncologic or BMT treatment?
Transitions of care are always challenging, especially for patients with complex medical histories, including cancer or stem cell transplantation. There are many different models for how and when to transition patients back to primary care or shared care. The ongoing, often complex needs of survivor...
What would be your advice to providers who are wary of QTc prolongation after starting an amiodarone load and wish to discontinue it?
Amiodarone has been studied in patients with prior TDP patients and found to be safe (small paper from Mattioni et al., PMID 2774388 at Northwestern at the time of my EP fellowship). Amiodarone has been found to be more effective when it prolongs the QT, and the 500 mS limit does not apply to it as ...
How often do you rely on using the C1 inhibitor functional assay versus the quantitative level alone to diagnose HAE?
We have seen a significant increase in lab costs billed to well-insured patients for some of the more "esoteric", detailed testing associated with immune/inflammatory disorders such as HAE. The cheapest screen is a C4 level, which, if normal during an active angioedema episode, makes C1 inhibitor de...
How do you approach the treatment of eosinophilic fasciitis refractory to glucocorticoids and methotrexate?
As rheumatologists, we are accustomed to managing people with rare diseases. Eosinophilic fasciitis (EF) ranks among the rarest of the rare, so it is understandable that there are no carefully designed trials assessing the efficacy of the various immune-modulating drugs. Clearly, corticosteroids are...
Are there clinical scenarios in which you might use buspirone on an as-needed basis for older adult patients?
I have not generally used buspirone as an as-needed medication for older adults experiencing anxiety. I will use it as an adjunct to other medication management, SSRIs, if needed [1]. However, its effect is generally seen with consistent dosing, and even then, the effect may not be realized for many...
How, if at all, have you changed your approach to the use of escitalopram for agitation in Alzheimer's dementia based on results from the S-CitAD RCT?
The S-CitAD trial results have changed preference from escitalopram over citalopram to citalopram over escitalopram. Citalopram is R-enatiomer and escitalopram is the S-enantiomer. This study was underpowered due to difficulty in recruitment and randomized only 173 patients rather than the intended ...
What is your approach to a situation where DILI is suspected secondary to an important medication (e.g., anticoagulation, antibiotics, etc.), but the diagnosis is uncertain and the liver injury is relatively mild?
If the drug suspected to induce liver injury causes symptoms and ALT is >3 times the upper limit of normal (ULN), I would stop the drug and find an alternative. Even if no symptoms are present, I would stop if ALT is >5 times ULN. Any level increase of ALT below the above parameters would still requ...