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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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A (re)Visit to an Old-Fashioned Doctor

Sensible Medicine

A thoughtful H&P can avoid unnecessary tests that in turn produce false positive results that then demand further evaluation. Old-fashioned doctors routinely seek all of the patient's previous medical records, not just the discharge summaries. You make a hypothesis - a possible diagnosis - and then you test that hypothesis.

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Friday Reflection 41: Sometimes I Just Need to Complain

Sensible Medicine

She is discharged on dual-antiplatelet agents and an increased statin dose. They also repeated all the tests that the community hospital had done. Fortunately, healthcare is free, and the patient was not harmed by the testing. The initial pathology was inconclusive, so further genetic testing was done on the sample.

Follow-Up 264
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What I Read This Week

Sensible Medicine

We so desperately need RCT data for our screening tests. In this group, medications were up-titrated to recommended doses within 2 weeks of discharge and four scheduled outpatient visits were completed in the 2 months after discharge. We should not conclude that patients should be started on 3-4 new meds prior to discharge.

Follow-Up 286
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Are you protecting your career? 5 essential questions about your NP liability insurance

KevinMD.com

Initial testing and symptoms suggested a concussion, leading to discharge. A nurse practitioner (NP) in urgent care saw a patient with a severe headache following a fall. However, when the patient’s worsening condition later revealed an elevated white blood cell count, they were rushed for further evaluationbut it was too late.

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Universal Depression Screening Leads to Unnecessary Harm

Sensible Medicine

None of these trials adequately test or quantify the benefit of postpartum depression screening, not to mention universal depression screening. Fortunately, she was discharged the next morning. After COVID lockdowns, she struggled to readjust to in-person schooling. She had overdosed on her antidepressants.

Follow-Up 360
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Highs and Lows

Sensible Medicine

Luciana Luciana’s discharge day was getting close. I’ll have it done by the time I discharge.” Sandra had been admitted weeks before Luciana and would not be discharged for a few more weeks to come. ” “Wonderful, we’ll coordinate transportation and plan for discharge tomorrow morning.”