Internal Medicine Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped internal medicine practice.

IV Fluid Selection

The end of normal saline dominance

NS default → SMART/SALT-ED balanced (2018) → BaSICS/PLUS → context-specific

Right prophylaxis for the right patient

Universal → Padua score → IMPROVE → extended (MARINER/APEX) → net clinical benefit

Beyond sliding scale

Sliding scale → RABBIT 2 basal-bolus (2007) → CGM in hospital → technology

De-escalation and shorter courses

Broad-spectrum-all → culture-guided → shorter courses → HAP/VAP refinement

From passive to proactive

No intervention → KDIGO bundles → IV optimization → biomarker-guided → nephrotoxin stewardship