Objectives

To estimate risk of comorbid depression on all-cause mortality over time among individuals with diabetes.

Methods

The Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase and Science Direct databases were searched through September 30, 2012. We limited our search to longitudinal or prospective studies reporting all-cause mortality among those having depression and diabetes, compared with those having diabetes alone that used hazard ratios (HRs) as the main outcome. Two reviewers independently extracted primary data and evaluated the quality of studies using predetermined criteria. The pooled random effects adjusted HRs were estimated using meta-analysis. The impact of moderator variables on study effect size was examined with meta-regression.

Results

A total of 42,363 respondents from 10 studies were included in the analysis. Depression was significantly associated with risk of mortality (pooled HR=1.50, 95% confidence interval=1.35-1.66). Little evidence for heterogeneity was found across the studies (Cochran Q=13.52, P=.20, I(2)=26.03). No significant possibility of publication bias was detected (Egger's regression intercept=0.98, P=.23).

Conclusion

Depression significantly increases the risk of mortality among individuals with diabetes. Early detection and treatment of depression may improve health outcomes in this population.

Introduction

The integration of new evidence into clinical practice can be a prolonged process, with delays of years or even decades. One approach to speed this integration is through the use of online provider education.

Problem

Venous thromboembolism (VTE) is a serious patient safety issue. Prevention requires coordinated care and adherence to evidence-based guidelines, supported by provider education.

Purpose

This study reports how an interdisciplinary team developed and piloted an online provider training program for the prevention of VTE.

Hypothesis

If providers use the online educational training, they will demonstrate increased mastery of key content areas related to VTE prophylaxis.

Methods

We used a prospective test-retest study design in which medical residents and fellows served as their own controls. All participants were given a pretest followed by educational content and then a posttest. We also assessed 2 different types of learning content (ie, with and without case studies/questions) and randomized participants to each type prior to assessment.

Results

Using the McNemar test we found a trend for knowledge gains related to VTE guidelines on the posttest for clinicians (n = 67) with a 14.5% improvement in content mastery (P = .05, 2-tailed). We did not find any significant differences between training modalities. Clinicians overall reported high levels of satisfaction with the application.

Conclusion

Our online education efforts indicate the potential for increasing mastery of VTE prophylaxis concepts. If resources are limited, we suggest a static approach to content delivery and an exploration of standardized methods for portability of online curriculums across learning management systems.