Will Preston

5 pearls is such a great series because even when it’s covering a topic I think I know well, there’s always something important I learn — many such moments in this excellent episode.

PARAGON-HF was a negative trial but I’m seeing the subgroup analysis being used to justify changing ACE or ARB to ARNI all the time without consideration of other patient-centered factors

DOTS: Optimism Around a “Negative” Dalbavancin Trial The DOTS randomized clinical trial of dalbavancin versus standard-of-care for Staph aureus bacteremia (SAB) just landed in JAMA, where it undoubtedly will be featured in numerous ID, hospitalist, and ...

What the DOTS trial of Staph bacteremia tells us:
• Dalbavancin d1 and d8 vs daily IVs for WEEKS
• No left-sided IE/CNS/prosthetics
• Dalba not superior by DOOR endpoint, but similar clinical outcomes.
Big implications for inpt care. More here! #IDSky tinyurl.com/3hjzkt96

I’d like to nominate this case for a pulitzer prize

Initial imaging studies.

Case Record of the MGH: A 36-year-old man was admitted because of fever, hypoxemia, and bacteremia. Imaging revealed pulmonary opacities, thickening of the duodenal wall, and a thrombus in the right renal vein. A diagnosis was made. Full case details: nej.md/3KYBaAE

#MedSky

The NEJM case records this week is an all timer with Dr Dhaliwal. They do a Watson on jeopardy! style challenge where his answers are compared to an AI’s - should definitely read for yourself but just want to be the first to say humanity’s still got it baby!

5/6🧵Unauthorized immigrants contribute billions to the U.S. health system — more than they receive in care.
In 2017 alone, net contributions totaled:
$20.8B to Medicare

$21.3B to Medicaid

$14.7B to private insurance

They are net funders, not burdens.

Almost like people want socialized healthcare! Best we can do is cut the largest public insurance, replace vaccines with crank science, gut our research institutions, and prevent any new HCWs from coming here but here’s an AI video of our demented president saying he’ll make you live forever.

There’s a great one on thickened liquids. Also over using RPP.

Trump: don’t take acepitoemponoene

RFK Jr: *moth crawls out of mouth*

A nude man is in the background, only referred to as “the colonel”

Person watching on tv: well if they say so

Reading the blog awhile but turns out scrolling right past the podcast lol. Great ep. I guess even tho the 2mm in all 4 leads has LR 16, it’s from a case-control with only 4 such cases so is it really enough to go by? Seems straightforward enough to repeat a similar study tho maybe I’ll try.

RSV Vaccine Effectiveness Against Hospitalization Among US Adults Aged 60 Years or Older During 2 Seasons This study investigates respiratory syncytial virus vaccine effectiveness against hospitalization among US adults aged 60 years or older during 2 seasons.

Just off the press

You should go to the hospital if you break your spine

Always has been meme with the caption “wait it’s all volume status”

I am loath to report the most parsimonious diagnosis is scurvy. I recommend continued palliation with poultices as seen here or perhaps cauterization of the most severe lesions, as well as an extra portion each of hardtack and grog for the remainder of his voyage.

Substance Use Disorder Program Availability in US Hospitals This cross-sectional study examines differences in the delivery of different substance use disorder programs in safety-net hospitals vs non–safety-net hospitals across the US and evaluates whether the...

Every hospital in the US had immediate access to expert toxicologists (via poison control).

Most hospitals *lack* access to inpatient addiction medicine services.

Structurally, we’re great at resus, but then we often fail at chronic tx of substance use disorders.

jamanetwork.com/journals/jam...

This is correct. Any candidate cynically “triangulating” on trans kids is a non-starter, and now is the time to say so. There’s still so much time to advance candidates that DON’T suck.

As clinicians there is little we can do about radiology interpretations, but should try to stick to the diagnostic algorithms and avoid relying on hunches. Missed PE has <5% risk of recurrence and mortality which is probably less than major bleeding risk from cumulative years on an unnecessary DOAC.

Overdiagnosis of Pulmonary Embolism by Pulmonary CT Angiography | AJR OBJECTIVE. The purpose of this study is to evaluate the rate of overdiagnosis of pulmonary embolism (PE) by pulmonary CT angiography (CTA) in a tertiary-care university hospital. MATERIALS AND METHODS...

Writing up a case with my residents and shocked at what I'm learning about diagnosis of PE. PIOPED II the last RCT of CTA had a PPV of only 58% in the low risk group; more recent retrospective had 25% of all positive scans deemed false positive on expert review (including 16% of lobar PE).

ID doesn’t want us to read the forbidden trial

jamanetwork.com/journals/jam...

I’ve never wanted be embroiled in online cancel culture and I really hate to say this as a fan, but last night at the NY Liberty game I didn’t feel John Turturro was clapping with adequate enthusiasm during the Big Ellie Stomp.

Two and a half years from the last ep but at its best. Such great reflections on how we reason and how to improve. I’ll never conclude a case conference with “high index of suspicion” ever again.

New hoofbeats let’s goooooo 😎🤙

YouTube video by NPR Music PUP: Tiny Desk Concert

Folk's...... The Tiny Desk

www.youtube.com/watch?v=Gh9p...

It’s too bad she won’t live! But then again, who does?

Diagnostic schema to help remember the causes of dyspnea organized hierarchically by organ system (lung, heart, blood, acid/base) now including a corner labeled "accidental aspiration of king cake baby to R mainstem."

Actually, I fixed it.

To help remind that ~20% starting the drug experience dyspnea (only 5% require stopping). Obvi some omissions on this schema.. pulmonary hypertension, neuromuscular weakness, other embolic sources like fat emboli or endocarditis, tense ascites, hepatopulm, aspiration of king cake baby to R mainstem

A diagnostic schema to help recall the causes of dyspnea arranged hierarchically by organ system (lung, heart, blood, acid/base) with another corner drawn on labeled ticagrelor

Major innovation in medical education: the dyspnea pyramid is now the dyspnea rhombus

You know things are bad when trauma surgeons are talking about Stoic philosophy.

Seriously, though, this is an interesting article. #EMIMCC

1/ 🚨 NEW #5Pearls: Pleural Effusions 🌊

Did you know up to 30% of pleural effusions of have more than one etiology?

Let’s dive in!

🖥️: www.coreimpodcast.com/2025/07/09/p...
Sponsor: Oakstone CME
Featuring: @pulmpeeps.bsky.social