Patient Safety & Quality
Meta-Analysis: Effectiveness of therapist-guided remote vs. in-person cognitive behavioral therapy
20 Mar, 2024 | 19:32h | UTCStudy Design and Population: This systematic review and meta-analysis investigated the efficacy of therapist-guided remote cognitive behavioral therapy (CBT) compared to traditional in-person CBT. The authors conducted a comprehensive search across several databases, including MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials, up to July 4, 2023. A total of 54 randomized controlled trials (RCTs) were included, encompassing 5463 adult patients presenting with various clinical conditions. The study meticulously assessed the risk of bias and extracted data using a standardized approach, and outcomes were analyzed using a random-effects model.
Main Findings: The primary analysis focused on patient-important outcomes, comparing the effectiveness of remote and in-person CBT across diverse conditions such as anxiety and related disorders, depressive symptoms, insomnia, chronic pain or fatigue syndromes, body image or eating disorders, tinnitus, alcohol use disorder, and mood and anxiety disorders. The meta-analysis, based on moderate-certainty evidence, found little to no difference in effectiveness between remote and in-person CBT (standardized mean difference [SMD] −0.02, 95% confidence interval −0.12 to 0.07), suggesting that both delivery methods are comparably effective across a range of disorders.
Implications for Practice: The findings indicate that therapist-guided remote CBT is nearly as effective as in-person CBT for treating a variety of mental health and somatic disorders. This supports the potential for remote CBT to significantly increase access to evidence-based care, especially in settings where in-person therapy is not feasible or is limited by geographic, economic, or social barriers. Future research should explore optimizing remote CBT delivery methods to further enhance accessibility and efficacy.
Reference: Zandieh, S. et al (2024). Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. CMAJ, 196(10), E327-E340. [Link]
Crossover RCT | Using one-size cuff results in major inaccuracy in BP readings across varying arm sizes
11 Aug, 2023 | 15:41h | UTCEffects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial – JAMA Internal Medicine (free for a limited period)
Commentaries:
When it comes to blood pressure cuffs, size matters – MedicalResearch.com
One-size-fits-all blood pressure cuffs ‘strikingly inaccurate,’ study says – CNN
Related:
Commentary on Twitter
Using a regular blood pressure (BP) cuff regardless of individual’s arm size resulted in 3.6 mmHg lower systolic BP when a regular cuff was one size too-large, and 4.8 and 19.5 mmHg higher when a regular cuff was one and two sizes too small. https://t.co/ZKnGfWc9fy
— JAMA Internal Medicine (@JAMAInternalMed) August 7, 2023
Study | The high financial and human cost of quality metric reporting in hospitals
11 Aug, 2023 | 15:36h | UTCThe Volume and Cost of Quality Metric Reporting – JAMA (link to abstract – $ for full-text)
Author Interview: The Costs of Quality Reporting – JAMA
Commentaries:
The Cost of “Quality” – Emergency Medicine Literature of Note
How John Hopkins spent $5m and 108,478 hours on quality reporting in one year – HealthLeaders
The cost of quality metric reporting – Becker’s Hospital Review
Study | Uncovering the potential overuse of laboratory tests by combining cost, abnormal result proportion, and physician variation
11 Aug, 2023 | 15:34h | UTC
Perspective | An AI-enhanced electronic health record could boost primary care productivity
9 Aug, 2023 | 15:36h | UTCAn AI-Enhanced Electronic Health Record Could Boost Primary Care Productivity – JAMA (free for a limited period)
M-A | Nearly 37% of elderly outpatients are at risk due to potentially inappropriate medication use
8 Aug, 2023 | 13:37h | UTC
M-A | Approximately 25 min/day of walking can boost function and cut adverse events in acutely hospitalized elders
8 Aug, 2023 | 13:35h | UTC
M-A | Significant QOL and mental health improvements in caregivers via targeted interventions
3 Aug, 2023 | 13:28h | UTC
Position Paper | Prioritizing deprescribing in fall prevention strategies
28 Jul, 2023 | 14:12h | UTCOriginal Guideline: World guidelines for falls prevention and management for older adults: a global initiative – Age and Ageing
Giving a voice to patients at high risk of dying in the intensive care unit: a multiple source approach
26 Jul, 2023 | 13:20h | UTCGiving a voice to patients at high risk of dying in the intensive care unit: a multiple source approach – Intensive Care Medicine (free for a limited period)
Commentary on Twitter
? Giving voice to critically ill patients! ⬇️ visual abstract including 15 concerns expressed by conscious patients at high risk of dying in #ICU to
➡️improve communication/support
➡️better meet needs
➡️support research on EoL & quality of dying/death
?️ https://t.co/pQK5B77eCW pic.twitter.com/BCRDkmD7SG— Intensive Care Medicine (@yourICM) July 24, 2023
Research Findings | US annual serious harms from misdiagnosis estimated at 795K in recent study
25 Jul, 2023 | 13:57h | UTCBurden of serious harms from diagnostic error in the USA – BMJ Quality & Safety (link to abstract – $ for full-text)
News Release: Report Highlights Public Health Impact of Serious Harms From Diagnostic Error in U.S. – Johns Hopkins Medicine
Commentaries:
Misdiagnoses cost the U.S. 800,000 deaths and serious disabilities every year, study finds – STAT
Review | Research on prescribing cascades
24 Jul, 2023 | 12:53h | UTCResearch on prescribing cascades: a scoping review – Frontiers in Pharmacology
Self-measured blood pressure telemonitoring programs: a pragmatic how-to guide
19 Jul, 2023 | 14:33h | UTC
Survey Study | ChatGPT’s performance in simulated patient-provider interactions
19 Jul, 2023 | 14:28h | UTCPutting ChatGPT’s Medical Advice to the (Turing) Test: Survey Study – JMIR Medical Education
Related: ChatGPT’s responses to patient questions rated higher for quality and empathy than physicians
Systematic Review | An evidence-base for the implementation of hospital-based palliative care programs in routine cancer practice
19 Jul, 2023 | 14:23h | UTC
Review | Infection prevention and control in the medical imaging environment
18 Jul, 2023 | 13:31h | UTC
What are effective strategies to reduce low-value care? An analysis of 121 randomized deimplementation studies
17 Jul, 2023 | 13:55h | UTC
Retrospective Analysis | Inconsistencies in pediatric drug dosing found in over half of prehospital emergency drug administrations
17 Jul, 2023 | 13:50h | UTCCommentaries:
Children and Drug Dosing Variations When in Transit to the Hospital – AAP Journals Blog
Variation Seen in Dosing of Meds at Prehospital Pediatric Encounters – HealthDay
Review | A health systems approach to critical care delivery in low-resource settings
17 Jul, 2023 | 13:29h | UTC
Commentary on Twitter (thread – click for more)
1/ @yourICM's highlights:
?OPEN ACCESS~ Health systems approach to #CriticalCare delivery in low-resource settings? https://t.co/W7d3q7UP1D
?OPEN ACCESS~ #ICU #Sepsis-associated #AKI? https://t.co/gLCXjcH2ah
?Myocarditis: a primer for intensivists? https://t.co/UUga5lYX0q pic.twitter.com/tB8am5zEny— ESICM (@ESICM) July 14, 2023
Consensus Paper | Implementing strategies to prevent infections in acute-care settings
14 Jul, 2023 | 13:03h | UTCNews Release: New guidance for infection prevention in acute care settings – Society for Healthcare Epidemiology of America
Related:
Practice Recommendation | Strategies to prevent MRSA transmission and infection in hospitals
Consensus Paper | Strategies to prevent surgical site infections in acute-care hospitals
Consensus Paper | Strategies to prevent Clostridioides difficile infections in acute-care hospitals
Quality Improvement Study | Improved asymptomatic bacteriuria management by reduction of unnecessary urine culture requests
14 Jul, 2023 | 12:54h | UTCRelated:
Study: Hospital Intervention Resulted in a 45% Reduction in the Urine Cultures Ordered
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
IDSA Guideline for the Management of Asymptomatic Bacteriuria
Commentary on Twitter
???Powerful message from our new study in @JAMAInternalMed: diagnostic stewardship (better use of diagnostic tests) was responsible for ALL the⬇️in unnecessary antibiotic use for ASB. ➕results??nudge to action. Time to??upstream to improve care! https://t.co/yO4UpA6ZKK pic.twitter.com/hXZGvNmVJP
— Valerie Vaughn (@ValerieVaughnMD) July 11, 2023
AHA Policy Statement | Value-based payment for clinicians treating cardiovascular disease
13 Jul, 2023 | 13:13h | UTCNews Release: Policy guidance offers strategies to shift to value-based health care and payment – American Heart Association
Commentary: AHA Reviews Value-Based Payment Systems and Proposes Next Steps – TCTMD
RCT| Exercise during hemodialysis improves physical function in chronic kidney failure patients
13 Jul, 2023 | 13:01h | UTCExercise during Hemodialysis in Patients with Chronic Kidney Failure – NEJM Evidence
Practice Guidance | Six steps to better care for older people in acute hospitals
12 Jul, 2023 | 14:00h | UTCSix steps to better care for older people in acute hospitals – British Geriatrics Society
News Release: New guidance outlines ‘Six steps to better care for older people in hospital’ – British Geriatrics Society
Intervention Study | Pharmacist review may reduce antibiotic overuse at discharge
12 Jul, 2023 | 13:37h | UTCCommentary: Pharmacist review identifies improper antibiotic prescriptions – CIDRAP