Patient Safety & Quality
Cohort study: Higher Telehealth Use Linked to Lower Rates of Select Low-Value Services in Medicare
3 Jan, 2025 | 09:30h | UTCBackground: Telehealth has rapidly expanded in recent years, potentially transforming how primary care is delivered. However, questions remain regarding its impact on low-value services—tests or procedures that confer minimal benefit and might be wasteful. Previous research raised concerns that virtual encounters could either reduce or increase unnecessary care, but rigorous data on this matter have been limited.
Objective: To assess whether a primary care practice’s adoption of telehealth is associated with changes in the rate of eight established low-value services, comprising office-based procedures, laboratory tests, imaging studies, and mixed-modality interventions.
Methods: This retrospective cohort study used Medicare fee-for-service claims from 2019 through 2022 for 577,928 beneficiaries attributed to 2,552 primary care practices in Michigan. Practices were grouped into low, medium, or high tertiles of telehealth volume in 2022. A difference-in-differences approach was performed, comparing annualized low-value service rate changes between the prepandemic (2019) and postpandemic (2022) periods.
Results: Overall, high-telehealth practices demonstrated reduced rates of certain office-based low-value services, specifically cervical cancer screening (−2.9 services per 1000 beneficiaries, 95% CI −5.3 to −0.4) among older women. Additionally, high-telehealth practices showed lower rates of select low-value thyroid tests (−40 per 1000 beneficiaries, 95% CI −70 to −9). For five other measures—including imaging for low back pain, imaging for uncomplicated headache, and PSA tests in older men—no significant association was observed between greater telehealth use and low-value service rates. Notably, telehealth volume increased markedly from 2019 to 2022, while in-person visits generally decreased.
Conclusions: These findings suggest that widespread telehealth adoption in Michigan primary care was not associated with elevated low-value service use. In fact, certain office-based low-value tests appeared to decline, possibly owing to fewer face-to-face opportunities to perform unnecessary interventions. Nonetheless, caution is warranted in generalizing these findings, as telehealth’s effects may vary across different clinical contexts.
Implications for Practice: Health care systems should consider structured telehealth protocols that encourage judicious testing and minimize overuse. While telehealth can broaden access, clinicians must remain vigilant to avoid missing necessary care. Clear guidelines, effective triage, and patient education might help balance convenience with quality.
Study Strengths and Limitations: Strengths include a large Medicare population and established low-value service metrics, enhancing the study’s validity. Limitations include a single-state focus (Michigan) and reliance on claims data without detailed clinical information, restricting the scope of outcomes assessed.
Future Research: Further investigation is needed to verify whether these trends extend to other states, different insurance models, and additional low-value services (including medications). Evaluations of telehealth’s role in both low-value and high-value care could offer deeper insights into its broader effects on cost and quality.
Reference: Liu T, Zhu Z, Thompson MP, et al. Primary Care Practice Telehealth Use and Low-Value Care Services. JAMA Network Open. 2024;7(11):e2445436. DOI: http://doi.org/10.1001/jamanetworkopen.2024.45436
Cohort Study: Higher Telehealth Intensity May Reduce Certain Office-Based Low-Value Services in Medicare Primary Care
2 Jan, 2025 | 08:00h | UTCBackground: The rapid expansion of telehealth has raised concerns about its potential to foster wasteful services, especially in primary care. While telehealth can eliminate certain in-person interventions, it might also increase unnecessary laboratory or imaging requests, given the more limited physical exam. Evaluating how telehealth intensity affects the provision of low-value care is crucial for guiding future policy and clinical practice.
Objective: To determine whether higher telehealth utilization at the practice level is associated with changes in the rates of common low-value services among Medicare fee-for-service beneficiaries in Michigan.
Methods: Using Medicare claims data from January 1, 2019, to December 31, 2022, this retrospective cohort employed a difference-in-differences design. A total of 577,928 beneficiaries attributed to 2,552 primary care practices were included. Practices were stratified into low, medium, or high telehealth tertiles based on the volume of virtual visits per 1,000 beneficiaries in 2022. Eight low-value services relevant to primary care were grouped into four main categories: office-based (e.g., cervical cancer screening in women older than 65), laboratory-based, imaging-based, and mixed-modality services.
Results: Among the 577,928 beneficiaries (332,100 women; mean age, 76 years), practices with high telehealth utilization had a greater reduction in office-based cervical cancer screening (−2.9 [95% CI, −5.3 to −0.4] services per 1,000 beneficiaries) and low-value thyroid testing (−40 [95% CI, −70 to −9] tests per 1,000 beneficiaries), compared with low-utilization practices. No significant association emerged for other laboratory- or imaging-based low-value services, including PSA testing for men over 75 or imaging for uncomplicated low back pain. These findings suggest that while telehealth can lower certain office-based low-value services, it does not appear to substantially increase other types of wasteful care.
Conclusions: High telehealth intensity was linked to reductions in specific low-value procedures delivered in-office, without raising the overall rates of other potentially unnecessary interventions. These data may alleviate some policy concerns that telehealth drives excessive or wasteful care due to its convenience. Instead, substituting certain in-person visits with virtual encounters might curtail opportunities for procedures with minimal clinical benefit.
Implications for Practice: For clinicians and policymakers, these results underscore the possibility that carefully implemented telehealth may reduce some low-value services. Nonetheless, sustained monitoring is needed to confirm whether telehealth encourages or discourages appropriate clinical decision-making across a broader range of interventions.
Study Strengths and Limitations: Strengths include a sizable cohort, a pre- versus post-pandemic time frame, and comprehensive analysis of multiple low-value outcomes. Limitations involve the exclusive focus on beneficiaries in Michigan, the inability to capture prescription-related low-value practices (e.g., antibiotic overuse), and the reliance on claims-based measures, which lack clinical details.
Future Research: Subsequent studies should expand to different geographic areas, assess additional low-value endpoints such as overtreatment with medications, and explore whether demographic or socioeconomic factors modify telehealth’s impact on care quality.
Reference: Liu T, Zhu Z, Thompson MP, et al. Primary Care Practice Telehealth Use and Low-Value Care Services. JAMA Netw Open. 2024;7(11):e2445436. DOI: http://doi.org/10.1001/jamanetworkopen.2024.45436
Large Language Models for Structured Reporting in Radiology: Past, Present, and Future
21 Dec, 2024 | 14:12h | UTCIntroduction/Context: Structured reporting (SR) has been a topic of discussion for decades as a way to standardize and improve the quality of radiology reports. Although there is evidence that SR can reduce errors and enhance guideline adherence, widespread adoption remains limited. Large language models (LLMs), transformer-based and trained on large volumes of text, have emerged as a promising solution to automate and facilitate structured radiology reporting. This narrative review provides an overview of LLM-based SR, while also discussing limitations, regulatory challenges, and future applications.
Key Points/Findings/Recommendations:
- Application of LLMs in Structured Reporting: Studies focus on models such as GPT-3.5 and GPT-4, showing promising results in converting free-text radiology reports into structured formats, including multilingual capabilities.
- Main Advantages:
- Consistency and improved standardization of reports.
- Potential to reduce errors and enhance comprehensiveness.
- Streamlining the use of predefined templates and formats.
- Multilingual and Translational Capabilities: Research shows that several LLMs can process reports in different languages, promoting broader global collaboration.
- Technical Limitations: Hallucination (fabricated content), terminology inconsistencies, and misinterpretations remain hurdles to large-scale adoption.
- Regulatory and Privacy Challenges: Proprietary model opacity and a lack of regulated pathways pose difficulties for safely integrating these systems into clinical practice.
Implications for Practice:
- Automation and Efficiency: LLMs can streamline the reporting process, reduce typing effort, and facilitate standardized descriptions, offering efficiency gains.
- System Integration: Incorporation of LLMs into radiology systems (PACS, RIS) could help with documentation and report formatting, improving communication across teams.
- Broader Clinical Perspective: Standardized reports may enhance information sharing and potentially patient safety, especially in multidisciplinary settings.
Limitations/Considerations:
- Hallucination: Even advanced models may generate inaccurate or fictitious content unrelated to the evidence.
- Lack of Transparency: Proprietary models often do not disclose their training data or algorithms, hindering external validation.
- Evolving Regulations: The European Union and other countries are developing AI-specific legal frameworks. Meeting safety, reliability, and transparency requirements is critical for clinical use.
- Availability of Open-Source Models: While open-source models offer more regulatory flexibility, they still require significant validation and refinement for clinical application.
Conclusion: LLMs have significant potential to transform structured radiology reporting, offering increased efficiency and accuracy. However, regulatory issues, model opacity, and current technical limitations must be addressed before these tools can be safely and effectively integrated into clinical practice. Future research should explore clinical acceptance of LLM-generated reports, compare them to radiologist-produced reports, and investigate how these models can be best integrated into existing systems.
Sources and Links:
- Busch, F., Hoffmann, L., dos Santos, D.P. et al. Large language models for structured reporting in radiology: past, present, and future. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-11107-6
RCT: 7-Day Antibiotic Therapy Noninferior to 14-Day for Bloodstream Infections
20 Nov, 2024 | 18:19h | UTCBackground: Bloodstream infections are a significant cause of morbidity and mortality worldwide. Early and appropriate antibiotic therapy is essential, but the optimal duration remains uncertain. Prolonged antibiotic use can lead to adverse events, Clostridioides difficile infection, antimicrobial resistance, and increased healthcare costs.
Objective: To determine whether a 7-day course of antibiotic treatment is noninferior to a 14-day course in hospitalized patients with bloodstream infections regarding 90-day all-cause mortality.
Methods: In this multicenter, noninferiority randomized controlled trial, 3,608 hospitalized patients from 74 hospitals in seven countries were enrolled. Eligible patients had bloodstream infections but were excluded if they had severe immunosuppression, infections requiring prolonged therapy, possible contaminants, or Staphylococcus aureus bacteremia. Participants were randomized to receive either 7 days (n=1,814) or 14 days (n=1,794) of adequate antibiotic therapy, with antibiotic selection at the clinicians’ discretion. The primary outcome was death from any cause by 90 days post-diagnosis, with a noninferiority margin of 4 percentage points.
Results: At 90 days, mortality was 14.5% in the 7-day group and 16.1% in the 14-day group (difference: –1.6 percentage points; 95.7% CI, –4.0 to 0.8), demonstrating noninferiority of the shorter duration. Noninferiority was confirmed in per-protocol and modified intention-to-treat analyses. Secondary outcomes, including relapse rates, adverse events, and hospital length of stay, were similar between groups. Findings were consistent across subgroups based on infection source, pathogen type, and patient characteristics.
Conclusions: A 7-day antibiotic regimen is noninferior to a 14-day regimen for treating hospitalized patients with bloodstream infections, without increasing mortality or relapse rates.
Implications for Practice: Implementing a 7-day antibiotic course could reduce antibiotic exposure, minimize adverse events, and potentially limit antimicrobial resistance development. Clinicians should consider individual patient factors, such as infection severity and comorbidities, before universally adopting shorter treatment durations.
Study Strengths and Limitations: Strengths include a large, diverse patient population and inclusion of critically ill patients, enhancing generalizability. Limitations involve the open-label design and nonadherence to assigned durations in some cases (23.1% in the 7-day group continued antibiotics longer). Exclusion of S. aureus bacteremia limits applicability to that subgroup. The study may not have been powered to detect differences in rare adverse outcomes like C. difficile infection or antimicrobial resistance emergence.
Future Research: Further studies should explore the efficacy of even shorter antibiotic durations, individualized treatment strategies based on patient response, and the long-term impact on antimicrobial resistance and healthcare costs.
Cohort Study: High Rate of Preventable Adverse Events in Surgical Inpatients
16 Nov, 2024 | 17:29h | UTCBackground: Adverse events during hospital admissions, particularly in surgical settings, remain a significant cause of patient harm despite efforts to improve patient safety since the “To Err is Human” report. Advances in surgical techniques and patient care necessitate an updated assessment of the current state of perioperative safety.
Objective: To estimate the frequency, severity, and preventability of adverse events associated with perioperative care in surgical inpatients and to identify the settings and healthcare professionals involved.
Methods: A multicenter retrospective cohort study was conducted across 11 US hospitals in Massachusetts. A weighted random sample of 1,009 patients was selected from 64,121 adults admitted for surgery in 2018. Trained nurses reviewed electronic health records to identify adverse events, which were then adjudicated by physicians. Adverse events were classified by type, severity, preventability, setting, and professions involved.
Results: Adverse events occurred in 38.0% of patients (95% CI, 32.6–43.4%), with major adverse events in 15.9% (12.7–19.0%). Among 593 adverse events identified, 59.5% were potentially preventable, and 20.7% were definitely or probably preventable. The most common events were surgery-related (49.3%), adverse drug events (26.6%), healthcare-associated infections (12.4%), and patient care events (11.2%). Adverse events most frequently occurred in general care units (48.8%) and involved attending physicians (89.5%) and nurses (58.9%).
Conclusions: More than one-third of surgical inpatients experienced adverse events, with nearly half classified as major and most potentially preventable. These findings highlight the critical need for ongoing improvement in patient safety throughout perioperative care involving all healthcare professionals.
Implications for Practice: Healthcare providers should enhance patient safety protocols across all perioperative settings, not just in operating rooms. Emphasis should be placed on preventing surgery-related complications, adverse drug events, and healthcare-associated infections by fostering teamwork and continuous monitoring.
Study Strengths and Limitations: Strengths include a comprehensive review of medical records and systematic classification of adverse events by trained professionals. Limitations involve the study’s confinement to Massachusetts hospitals in 2018, potential variability in documentation practices, and limited sample size affecting generalizability and specialty-specific estimates.
Future Research: Further studies are needed to assess adverse event rates in diverse geographic locations and healthcare systems, explore effective interventions to reduce preventable harm, and evaluate long-term trends in surgical patient safety.
RCT: Nonstandard Arm Positions Overestimate Blood Pressure Readings in Adults
12 Oct, 2024 | 22:55h | UTCBackground: Accurate blood pressure (BP) measurement is crucial for the diagnosis and management of hypertension, a leading cause of cardiovascular disease and mortality worldwide. Guidelines recommend measuring BP with the arm supported on a desk at heart level. However, in clinical practice, nonstandard arm positions—such as resting the arm on the lap or having it unsupported at the side—are commonly used, potentially leading to inaccurate readings.
Objective: To determine the effect of commonly used nonstandard arm positions on BP measurements compared to the standard, recommended position.
Methods: In a crossover randomized clinical trial from August 2022 to June 2023, 133 adults aged 18 to 80 years were recruited. Participants were randomly assigned to receive sets of triplicate BP measurements with the arm in three positions: (1) supported on a desk with the midcuff at heart level (desk 1; reference), (2) hand supported on the lap (lap), and (3) arm unsupported at the side (side). To account for intrinsic BP variability, all participants underwent a fourth set of BP measurements with the arm supported on a desk (desk 2). The primary outcomes were the difference in differences in mean systolic BP (SBP) and diastolic BP (DBP) between the reference BP (desk 1) and the two nonstandard arm positions (lap and side).
Results: Among 133 participants (mean age 57 years; 53% female), 36% had SBP ≥130 mm Hg, and 41% had a body mass index ≥30 kg/m². Compared to the reference position, the lap and side positions resulted in significantly higher BP readings. The difference in differences for the lap position was an increase in SBP of 3.9 mm Hg (95% CI, 2.5-5.2) and DBP of 4.0 mm Hg (95% CI, 3.1-5.0). For the side position, the increases were SBP 6.5 mm Hg (95% CI, 5.1-7.9) and DBP 4.4 mm Hg (95% CI, 3.4-5.4). These patterns were consistent across subgroups.
Conclusions: Commonly used nonstandard arm positions during BP measurements, such as resting the arm on the lap or having it unsupported at the side, significantly overestimate BP readings compared to the standard recommended position. This overestimation may lead to misdiagnosis and overestimation of hypertension.
Implications for Practice: Clinicians should adhere to guideline-recommended arm positioning during BP measurements to ensure accurate readings. Proper arm support with the midcuff at heart level is necessary to avoid overestimation of BP, which can result in unnecessary follow-up and overtreatment due to hypertension overdiagnosis.
Study Strengths and Limitations: Strengths include the randomized crossover design ideal for studying BP differences, a larger sample size than previous studies, and focus on arm positions commonly used in clinical practice with an automated BP device. Limitations include unequal randomization due to the randomization function used, small sample sizes in some subgroups, and uncertain generalizability to other settings or devices.
Future Research: Further studies are needed to investigate strategies to improve adherence to guideline-recommended arm positions in clinical practice, assess the impact of educational interventions on BP measurement accuracy, and explore the effects of arm position on BP readings using different devices or in diverse populations.
RCT: Tele-ICU Intervention Did Not Significantly Reduce ICU Length of Stay in Critically Ill Patients
10 Oct, 2024 | 17:40h | UTCBackground: Telemedicine in critical care, particularly through tele-ICU interventions, has gained traction as a potential solution to the global shortage of intensivists. These systems, which include remote intensivist-led care, have shown promise in improving outcomes, but robust evidence from randomized clinical trials is lacking. The TELESCOPE trial was conducted to assess whether daily remote multidisciplinary rounds combined with monthly audit and feedback meetings could reduce ICU length of stay (LOS) compared with standard care.
Objective: The primary objective of the TELESCOPE trial was to determine if a tele-ICU intervention, involving remote daily multidisciplinary rounds and monthly performance audits led by a board-certified intensivist, could reduce ICU LOS compared to usual care.
Methods: This was a cluster randomized clinical trial involving 30 general ICUs in Brazil, enrolling all consecutive adult patients admitted between June 2019 and April 2021. A total of 17,024 patients were included, with 15 ICUs receiving the tele-ICU intervention and 15 receiving standard care. The intervention consisted of daily remote rounds led by an intensivist, monthly audit meetings, and the provision of evidence-based protocols. The primary outcome was ICU LOS, and secondary outcomes included hospital mortality, ICU efficiency, and various infection rates.
Results: There was no statistically significant difference in ICU LOS between the intervention and control groups (mean LOS: 8.1 days in the tele-ICU group vs. 7.1 days in the usual care group; percentage change, 8.2%; 95% CI, −5.4% to 23.8%; P = .24). Hospital mortality was also similar (41.6% vs. 40.2%; odds ratio, 0.93; 95% CI, 0.78-1.12). No significant differences were found in secondary outcomes, including rates of central line-associated bloodstream infections, ventilator-associated events, or ventilator-free days at 28 days.
Conclusions: The tele-ICU intervention did not reduce ICU LOS in critically ill patients. The lack of observed benefit may be due to suboptimal implementation, variable adherence by local teams, and the high severity of illness in the patient population.
Implications for Practice: While tele-ICU models hold potential, this study suggests that remote intensivist-led care, as implemented in the TELESCOPE trial, may not be sufficient to improve outcomes in high-resource ICU settings with critically ill patients.
Study Strengths and Limitations: The study’s strengths include its pragmatic design, the large number of patients enrolled, and its reflection of real-world ICU settings. However, limitations include the unblinded nature of the trial, suboptimal adherence to the tele-ICU protocol in some centers, and the strain on ICU resources during the COVID-19 pandemic, which may have affected the trial’s outcomes.
Future Research: Further studies should explore how tele-ICU interventions can be optimized, with a focus on identifying the ICU environments and patient populations most likely to benefit. Trials should also address potential barriers to effective implementation, such as staff engagement and local resource constraints.
Meta-Analysis: ERAS Protocols Improve Recovery and Reduce Complications After Emergency Laparotomy – Am J Surg
18 Aug, 2024 | 19:32h | UTCStudy Design and Population: This systematic review and meta-analysis assessed the effects of Enhanced Recovery After Surgery (ERAS) protocols compared to standard care (SC) in patients undergoing emergency laparotomy. The analysis included six randomized clinical trials (RCTs) with a total of 509 patients.
Main Findings: The ERAS group showed a reduction in length of hospital stay (mean difference: -2.92 days) and quicker recovery milestones, such as time to ambulation (mean difference: -1.67 days) and first bowel opening (mean difference: -1.26 days). The ERAS protocols were also associated with lower rates of pulmonary complications (odds ratio [OR]: 0.43) and surgical site infections (OR: 0.33). Mortality rates were similar between the ERAS and SC groups.
Implications for Practice: These findings suggest that ERAS protocols may enhance recovery and reduce complications in patients undergoing emergency laparotomy. Implementation of these protocols could be beneficial in emergency surgical settings, where feasible.
Review: Prevention and Management of Device-Associated Complications in the Intensive Care Unit – The BMJ
17 Aug, 2024 | 20:04h | UTCIntroduction:
This review article, published by experts from the David Geffen School of Medicine at UCLA, focuses on the complications associated with invasive devices commonly used in the Intensive Care Unit (ICU). While these devices are essential for managing critically ill patients, they also pose significant risks, necessitating a thorough understanding of their potential complications and strategies for prevention and management.
Key Points:
1 – Central Venous Catheters (CVCs):
– CVCs are widely used in ICU patients but carry risks like vascular injury, pneumothorax, thrombosis, and infection.
– Use of real-time ultrasound guidance and careful operator technique are crucial for minimizing these risks.
– Prompt removal of unnecessary CVCs is essential to reduce the risk of complications.
2 – Arterial Catheters:
– Commonly used for hemodynamic monitoring, these catheters can lead to complications such as vascular occlusion, nerve injury, and infection.
– Ultrasound guidance is recommended to reduce the risk of complications, and catheters should be discontinued as soon as clinically feasible.
3 – Airway Devices (Endotracheal Tubes and Tracheostomies):
– Complications include laryngeal injury, tracheal stenosis, and tracheomalacia.
– Strategies to reduce these risks include minimizing intubation attempts, ensuring proper tube placement, and managing cuff pressures carefully.
4 – Extracorporeal Membrane Oxygenation (ECMO):
– ECMO is associated with significant complications, including bleeding, thromboembolic events, and neurologic injuries.
– Proper cannulation technique and vigilant monitoring are essential to mitigate these risks.
5 – Infection Control:
– Strict adherence to aseptic techniques and the use of chlorhexidine-impregnated dressings are recommended to prevent device-associated infections.
Conclusion:
This review underscores the importance of judicious use and timely removal of invasive devices in the ICU to minimize complications. Healthcare professionals must remain vigilant and employ best practices to prevent and manage these complications effectively.
Retrospective Analysis: 7% of outpatients in Massachusetts experience adverse events, predominantly drug-related – Ann Intern Med
25 May, 2024 | 19:37h | UTCThis retrospective study reviewed electronic health records from 11 outpatient sites in Massachusetts during 2018 to assess the incidence and nature of adverse events (AEs) in 3,103 patients. AEs were identified in 7.0% of the patients, translating to 8.6 events per 100 patients annually. Adverse drug events were the most frequent type of AE, constituting 63.8% of events, followed by healthcare-associated infections (14.8%) and surgical or procedural events (14.2%). The severity of these events was notable, with 17.4% being serious and 2.1% life-threatening, though none were fatal. Notably, 23.2% of these events were deemed preventable. The risk of experiencing at least one AE varied significantly by age and race, with higher rates observed among older adults and Black patients compared to other demographics. The study highlights the pressing need for targeted interventions to reduce AEs in outpatient settings.
Reference (link to abstract – $ for full-text):
Cluster-Randomized Trial: No reduction in hospitalization rates with EHR-based algorithm in chronic kidney disease patients
30 Apr, 2024 | 13:16h | UTCThis study evaluates the effectiveness of a personalized EHR-based algorithm combined with practice facilitators to reduce hospitalization rates among patients with chronic kidney disease, type 2 diabetes, and hypertension. Conducted as an open-label, cluster-randomized trial across 141 primary care clinics, 11,182 patients were divided into two groups: the intervention group (5,690 patients) and the usual-care group (5,492 patients). After one year, the hospitalization rate was slightly lower in the intervention group (20.7%) compared to the usual-care group (21.1%), but this difference was not statistically significant (p=0.58). Secondary outcomes, including emergency department visits, readmissions, cardiovascular events, dialysis, and death rates were similar between the groups, except for a slightly higher rate of acute kidney injury in the intervention group. The study concludes that the EHR-based intervention did not significantly decrease hospitalizations at one year.
Commentary on X:
Original Article: Pragmatic Trial of Hospitalization Rate in Chronic Kidney Disease (ICD-Pieces trial) https://t.co/aJ0Ao0uf90 #Nephrology pic.twitter.com/l4xc54Buxy
— NEJM (@NEJM) April 8, 2024
Reference (link to abstract – $ for full-text):
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