The Pulse - March 2026

Greetings Readers! In this monthly edition, we examine 3 practice changing studies.

Do you know which DOAC is safest?

The study answering this question was covered this month in Premium Pulse.

For less than a cup of coffee each month, get access.

1. Shaking the Habit: Why It’s Time to Ease Up on Sodium Limits in HF

   The Pulse first flagged the original research on this topic back in November 2025 when it was published in the Journal of Hospital Medicine—and now Things We Do For No Reason is back to tap the salt shaker. Despite decades of habit, randomized trials and a larger meta-analysis show that aggressive sodium restriction in acute heart failure does not improve congestion, weight loss, readmissions, or mortality. What it does reliably do is reduce caloric intake—hardly ideal in a population where malnutrition is already lurking in the background. The takeaway isn’t to green-light a fast-food diet, but to abandon the reflexive <1 g sodium order in favor of a more pragmatic “normal” intake. In other words: stop treating sodium like the enemy when the real risk might be what patients aren’t eating.

   Things We Do For No Reason, Original Research 

2. Bone Dry Results: Biopsy Doesn’t Add Much in DFO Management

   In this multicenter, double-blind trial of patients with diabetic foot osteomyelitis (DFO), choosing antibiotics based on bone biopsy cultures—long considered the “gold standard”—did not improve remission rates compared with ulcer bed cultures (31% vs 39% at 12 months). Notably, bone cultures were negative in a striking 39% of cases, yet this rarely altered management, as clinicians understandably didn’t withhold antibiotics. Ulcer bed cultures, often dismissed as second-tier, performed just as well in guiding therapy, with most regimens effectively covering common culprits like S. aureus and streptococci. The study quietly challenges the reflex to pursue invasive sampling when a well-obtained superficial culture may suffice in treatment-naive, non-immunocompromised patients. In practice, it suggests we may not need to drill down to the bone to make sound antibiotic decisions—sometimes, the surface tells the story just fine. Lagrand RS et al. Clin Inf Dis 2026 March.

   Study Type: multi center, double-blind RCT of 84 adults patients with DFO, who all underwent percutaneous bone biopsy and ulcer bed biopsy

   Link

3. A Vein Attempt at Efficiency: Rethinking the Timing of Morning Labs

   A small but telling inpatient study quantifies the disruptive effect of 4 a.m. “vampire rounds” (aka phlebotomy). Among 128 general medicine patients, shifting routine labs from 4 a.m. to 6 a.m. improved both sleep quality (53 → 62 on a 100-point scale) and sleep duration (6.1 → 7.1 hours), despite similar ambient noise levels. Importantly, these gains held after adjusting for common sleep disruptors like OSA, depression, and cardiometabolic disease. The findings sharpen the trade-off between operational convenience and patient-centered care. Chakabva MS et al. J Hosp Med 2026 Feb

   Study Type: quasi-experimental study of 128 patients admitted to 2 similar acute care medical units, assigned to 4 AM vs 6 AM phlebotomy

   Link 

Thank you for reading! If you enjoyed this newsletter, please consider sharing with your colleagues.