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When Trials Find Implausible Results—The SCOT-HEART trial

Sensible Medicine

An imaging test. One group of patients with chest pain received standard stress testing; the other received standard stress testing plus a coronary CT scan (CCTA). Here is the 5-year survival curves for the composite endpoint of CV death and MI: How can a diagnostic test lead to this much benefit? Not a drug.

Tests 302
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Sepsis Screening Decreases Mortality. Well, not really.

Sensible Medicine

If sepsis screening was shown to be beneficial in one hospital, would it be beneficial in another, with an entirely different set of caregivers? Article Background With all that as background, I was excited when I saw the article Electronic Sepsis Screening Among Patients Admitted to Hospital Wards in JAMA.

Hospital 245
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Nurses Mourn the End of California’s Mask Mandate in Hospital Settings

Scrubs

Patients and staff are no longer required to wear face masks in hospitals and long-term care facilities, but it is still highly recommended. “It just doesn’t follow the science. . “It just doesn’t follow the science. California’s mask mandate for all healthcare settings came to end on Monday.

Hospital 352
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Coronary Artery Calcium Trial Fails to Impress

Sensible Medicine

As a skeptic of this imaging test, I saw the headline and thought: finally, we will learn whether patients who have their chest radiated have better outcomes. Same with imaging tests. This was a prospective randomized open-label trial done in 7 hospitals in Australia. I will come back to this.)

Tests 213
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Friday Reflection 41: Sometimes I Just Need to Complain

Sensible Medicine

A 76-year-old woman presents to a community hospital after waking with garbled speech and right-sided weakness. Case 1: Excess An elderly woman is admitted to a community hospital with a minor stroke. The hospital does an excellent job. By the time she leaves the hospital, she has no residual symptoms. I love my job.

Follow-Up 263
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Spreadsheets, Meetings, Lunches, and Paychecks

Sensible Medicine

” However, if I complained to my colleagues that I had to do normal hospital things and, further, noted that I resented these same colleagues because my proximity to bodily fluids makes my job nobler than theirs, no one would want to work with me. We know more about hospital governance than most doctors do.

Hospital 165
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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. But trials are best case scenarios.