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STRONG HF – A Positive Trial that Does Not Help Clinical Medicine

Sensible Medicine

Trials select their patients, test the drugs in run-in periods and use research coordinators to help patients navigate complex health systems. The Trial STRONG-HF studied two treatment strategies after a patient was discharged from the hospital after treatment for heart failure. In the real-world, there is none of that.

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What I Read This Week

Sensible Medicine

We so desperately need RCT data for our screening tests. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial I’ve come out pretty strongly against GDMT. It also shows us how hard it is to up-titrate GDMT.

Follow-Up 284
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Friday Reflection 41: Sometimes I Just Need to Complain

Sensible Medicine

What there was -- courtesy of colleagues from across the country – were cases illustrating needless excess, careless follow-up, poor commitment to clinical care, and the devaluation of primary care that undermines our entire system. She is discharged on dual-antiplatelet agents and an increased statin dose.

Follow-Up 265
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Universal Depression Screening Leads to Unnecessary Harm

Sensible Medicine

The USPSTF claims "screening interventions" decrease the prevalence of depression at six-month follow-up by an odds ratio of 0.60. This number is surprising when we consider the following: A meta-analysis of six RCTs found the benefit of SSRIs, compared to placebo, to be small and statistically insignificant at six months.

Follow-Up 360
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Doctor’s Failure to Follow Up on Medical Test Leads to Large Settlement

Pulmonology Advisor - Practice Management

Ordering diagnostic tests is a standard procedure for physicians; yet if the test results aren’t reviewed and acted upon, what was the point of ordering the test? Case Facts Mr W, the patient, was a veteran who had been honorably discharged after serving 9 years in the Army, working as a mechanic.

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Highs and Lows

Sensible Medicine

Luciana Luciana’s discharge day was getting close. Her outpatient follow-up appointments were scheduled; we had reviewed her safety plan; she felt well and ready to leave the hospital. ” Seizing the interruption before I turned this into a full-blown therapy session, I got up and brought the tray over to her desk.

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Preparing for CERT Audits and Practicing Compliant Documentation

EvidenceCare

Regulatory Standards CERT (comprehensive error rate testing) is a program administered by the Centers for Medicare & Medicaid Services (CMS) that utilizes Recovery Audit Contractors (RACs) to review medical records and identify potential billing errors. The goal for the compliance measure is to have over 95% of discharges compliant.