Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence.

Background: Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up.

The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations.

Object: Resection of brainstem cavernous malformations (BSCMs) may reduce the risk of stepwise neurological deterioration secondary to hemorrhage, but the morbidity of surgery remains high. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are neuroimaging techniques that may assist in the complex surgical planning necessary for these lesions. The authors evaluate the utility of preoperative DTI and DTT in the surgical management of BSCMs and their correlation with functional outcome.

Association of 3.0-T brain magnetic resonance imaging biomarkers with cognitive function in the Dallas Heart Study.

Importance: Understanding the relationships between age-related changes in brain structure and cognitive function has been limited by inconsistent methods for assessing brain imaging, small sample sizes, and racially/ethnically homogeneous cohorts with biased selection based on risk factors. These limitations have prevented the generalizability of results from brain morphology studies.

Objective: To determine the association of 3.

Instituting a culture of professionalism: the establishment of a center for professionalism and peer support.

Background: There is growing recognition that an environment in which professionalism is not embraced, or where expectations of acceptable behaviors are not clear and enforced, can result in medical errors, adverse events, and unsafe work conditions.

Methods: The Center for Professionalism and Peer Support (CPPS) was created in 2008 at Brigham and Women's Hospital (BWH), Boston, to educate the hospital community regarding professionalism and manage unprofessional behavior. CPPS includes the professionalism initiative, a disclosure and apology process, peer and defendant support programs, and wellness programs.

Fully automated tool to identify the aorta and compute flow using phase-contrast MRI: validation and application in a large population based study.

Purpose: To assess if fully automated localization of the aorta can be achieved using phase contrast (PC) MR images.

Materials And Methods: PC cardiac-gated MR images were obtained as part of a large population-based study. A fully automated process using the Hough transform was developed to localize the ascending aorta (AAo) and descending aorta (DAo).

Automated quantification of white matter disease extent at 3 T: comparison with volumetric readings.

Purpose: To develop and validate an algorithm to automatically quantify white matter hyperintensity (WMH) volume.

Materials And Methods: Images acquired as part of the Dallas Heart Study, a multiethnic, population-based study of cardiovascular health, were used to develop and validate the algorithm. 3D magnetization prepared rapid acquisition gradient echo (MP-RAGE) and 2D fluid-attenuated inversion recovery (FLAIR) images were acquired from 2082 participants.

Effect of bar-code technology on the safety of medication administration.

Background: Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR).

Methods: We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR.

Cerebral atrophy after traumatic white matter injury: correlation with acute neuroimaging and outcome.

Traumatic brain injury (TBI) is a pathologically heterogeneous disease, including injury to both neuronal cell bodies and axonal processes. Global atrophy of both gray and white matter is common after TBI. This study was designed to determine the relationship between neuroimaging markers of acute diffuse axonal injury (DAI) and cerebral atrophy months later.

Diffusion tensor tractography of traumatic diffuse axonal injury.

Background: Diffuse axonal injury is a common consequence of traumatic brain injury that frequently involves the parasagittal white matter, corpus callosum, and brainstem.

Objective: To examine the potential of diffusion tensor tractography in detecting diffuse axonal injury at the acute stage of injury and predicting long-term functional outcome.

Design: Tract-derived fiber variables were analyzed to distinguish patients from control subjects and to determine their relationship to outcome.

Validation of non-rigid registration between functional and anatomical magnetic resonance brain images.

This paper presents a set of validation procedures for nonrigid registration of functional EPI to anatomical MRI brain images. Although various registration techniques have been developed and validated for high-resolution anatomical MRI images, due to a lack of quantitative and qualitative validation procedures, the use of nonrigid registration between functional EPI and anatomical MRI images has not yet been deployed in neuroimaging studies. In this paper, the performance of a robust formulation of a nonrigid registration technique is evaluated in a quantitative manner based on simulated data and is further evaluated in a quantitative and qualitative manner based on in vivo data as compared to the commonly used rigid and affine registration techniques in the neuroimaging software packages.

Computed tomography in the diagnosis of occult open-globe injuries.

Purpose: To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury.

Design: Retrospective chart review.

Participants: Forty-eight eyes (of 46 patients), 34 of which were found to have an occult open-globe injury on surgical exploration.

Magnetic resonance imaging of diffuse axonal injury: quantitative assessment of white matter lesion volume.

Diffuse axonal injury (DAI) is a common mechanism of traumatic brain injury (TBI) for which there is no well-accepted anatomic measures of injury severity. The present study aims to quantitatively assess DAI by measuring white matter lesion volume visible in fluid-attenuated inversion recovery (FLAIR) weighted images and to determine whether higher lesion volumes are associated with unfavorable functional outcome 6 months after injury. Twenty-four patients who experienced moderate to severe TBI without extra-axial or major cortical contusions were included in this study.

Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy.

Background: Many dispensing errors made in hospital pharmacies can harm patients. Some hospitals are investing in bar code technology to reduce these errors, but data about its efficacy are limited.

Objective: To evaluate whether implementation of bar code technology reduced dispensing errors and potential adverse drug events (ADEs).

Closing the loop: follow-up and feedback in a patient safety program.

Background: As health care organizations establish patient safety agendas, attention has focused on creating less cumbersome systems for reporting errors. However, experience at Brigham and Women's Hospital (Boston) suggests that more emphasis needs to be placed on what happens after a report is submitted. FOLLOW-UP AND FEEDBACK: Follow-up includes prioritizing opportunities and actions, assigning responsibility and accountability, and implementing the action plan.

Comparative analysis of autogenous infrainguinal bypass grafts in African Americans and Caucasians: the association of race with graft function and limb salvage.

Objective: African Americans (AAs) are at risk for developing diabetes mellitus and atherosclerosis. Whether race influences the results of infrainguinal arterial reconstruction is unclear. The purpose of this study was to compare the results of autogenous infrainguinal bypasses in AAs and Caucasians to determine the association of race with graft function and limb salvage.

Specialized staff and equipment for weight loss surgery patients: best practice guidelines.

Objective: To provide evidence-based guidelines on the specialized personnel, equipment, and physical plant required for safe and effective care of severely obese weight loss surgery (WLS) patients.

Research Methods And Procedures: We examined MEDLINE (Ovid and PubMed) and the Cumulative Index of Nursing and Allied Health Literature for articles on facilities resources for care of WLS patients published in English between January 1980 and March 2004. We queried several web sites for appropriate references; these included the Agency for Healthcare Research and Quality and the American College of Surgeons.

Infrainguinal vein bypass graft revision: factors affecting long-term outcome.

Objectives: We sought to determine the long-term results of revision procedures performed for repair of stenotic lesions in infrainguinal vein bypass grafts.

Methods: A retrospective review of 188 vein grafts, from a total series of 1260 bypasses, undergoing revision of stenotic lesions between January 1, 1987, and December 31, 2002, at Brigham & Women's Hospital was undertaken. Lesions were identified by recurrence of symptoms, change in examination findings, or with routine duplex ultrasound graft surveillance.

Statin therapy is associated with improved patency of autogenous infrainguinal bypass grafts.

Objective: HMG-CoA reductase inhibitors (statins) broadly reduce cardiovascular events, effects that are only partly related to cholesterol lowering. Recent studies suggest important anti-inflammatory and antiproliferative properties of these drugs. The purpose of this study was to determine the influence of statin therapy on graft patency after autogenous infrainguinal arterial reconstructions.

Thoracovisceral segment aneurysm repair after previous infrarenal abdominal aortic aneurysm surgery.

Objective: Repair of thoracovisceral aortic aneurysms (TVAA) after previous open repair of an infrarenal abdominal aortic aneurysm (AAA) poses significant challenges. We sought to better characterize such recurrent aneurysms and to evaluate their operative outcome.

Methods: We reviewed the records and radiographs of 49 patients who underwent repair of TVAAs between 1988 and 2002 after previous repair of an AAA.

Early adaptation of human lower extremity vein grafts: wall stiffness changes accompany geometric remodeling.

Objective: To quantitatively describe the temporal changes in elastic properties and wall dimensions in lower-extremity vein grafts after implantation.

Design Of Study: This is a prospective study of patients (N = 38) undergoing lower extremity bypass grafts (N = 41) with autologous veins. Pulse wave velocity (PWV), luminal diameter, and wall thickness measurements were obtained by duplex ultrasound scan intraoperatively and at 1, 3, and 6 months postoperatively for assessment of graft dimensions and wall stiffness.