VA Palo Alto Healthcare System

About: VA Palo Alto Healthcare System is a healthcare organization based out in Palo Alto, California, United States. It is known for research contribution in the topics: Population & Health care. The organization has 2548 authors who have published 4605 publications receiving 209938 citations.

In pursuit of truth: A critical examination of meta-analyses of cognitive behavior therapy

Abstract: Objective: Three recent meta-analyses have made the claim, albeit with some caveats, that cognitive-behavioral treatments (CBT) are superior to other psychotherapies, in general or for specific disorders (e.g., social phobia). Method: The purpose of the present article was to examine four issues in meta-analysis that mitigate claims of CBT superiority: (a) effect size, power, and statistical significance, (b) focusing on disorder-specific symptom measures and ignoring other important indicators of psychological functioning, (c) problems inherent in classifying treatments provided in primary studies into classes of treatments, and (d) the inclusion of problematic trials, which biases the results, and the exclusion of trials that fail to find differences among treatments. Results: When these issues are examined, the effects demonstrating the superiority of CBT are small, nonsignificant for the most part, limited to targeted symptoms, or are due to flawed primary studies. Conclusion: Meta-analytic ev...

A simulator-based tool that assesses pediatric resident resuscitation competency.

Abstract: BACKGROUND. Competency in pediatric resuscitation is an essential goal of pediatric residency training. Both the exigencies of patient care and the Accreditation Council for Graduate Medical Education require assessment of this competency. Although there are standard courses in pediatric resuscitation, no published, validated assessment tool exists for pediatric resuscitation competency. OBJECTIVE. The purpose of this work was to develop a simulation-based tool for the assessment of pediatric residents9 resuscitation competency and to evaluate the tool9s reliability and preliminarily its validity in a pilot study. METHODS. We developed a 72-question yes-or-no questionnaire, the Tool for Resuscitation Assessment Using Computerized Simulation, representing 4 domains of resuscitation competency: basic resuscitation, airway support, circulation and arrhythmia management, and leadership behavior. We enrolled 25 subjects at each of 5 different training levels who all participated in 3 standardized code scenarios using the Laerdal SimMan universal patient simulator. Performances were videotaped and then reviewed by 2 independent expert raters. RESULTS. The final version of the tool is presented. The intraclass correlation coefficient between the 2 raters ranged from 0.70 to 0.76 for the 4 domain scores and was 0.80 for the overall summary score. Between the 2 raters, the mean percent exact agreement across items in each domain ranged from 81.0% to 85.1% and averaged 82.1% across all of the items in the tool. Across subject groups, there was a trend toward increasing scores with increased training, which was statistically significant for the airway and summary scores. CONCLUSIONS. In this pilot study, the Tool for Resuscitation Assessment Using Computerized Simulation demonstrated good interrater reliability within each domain and for summary scores. Performance analysis shows trends toward improvement with increasing years of training, providing preliminary construct validity.