Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial.

Context: Lorazepam is currently recommended for sustained sedation of mechanically ventilated intensive care unit (ICU) patients, but this and other benzodiazepine drugs may contribute to acute brain dysfunction, ie, delirium and coma, associated with prolonged hospital stays, costs, and increased mortality. Dexmedetomidine induces sedation via different central nervous system receptors than the benzodiazepine drugs and may lower the risk of acute brain dysfunction.

Objective: To determine whether dexmedetomidine reduces the duration of delirium and coma in mechanically ventilated ICU patients while providing adequate sedation as compared with lorazepam.

Behind-the-scenes of patient-centered care: content analysis of electronic messaging among primary care clinic providers and staff.

Background: Transitions to patient-centered health care, the increasing complexity of care, and growth in self-management have all increased the frequency and intensity of clinical services provided outside office settings and between visits. Understanding how electronic messaging, which is often used to coordinate care, affects care is crucial. A taxonomy for codifying clinical text messages into standardized categories could facilitate content analysis of work performed or enhanced via electronic messaging.

A cost analysis of colonoscopy using microcosting and time-and-motion techniques.

Background: The cost of an individual colonoscopy is an important determinant of the overall cost and cost-effectiveness of colorectal cancer screening. Published cost estimates vary widely and typically report institutional costs derived from gross-costing methods.

Objective: Perform a cost analysis of colonoscopy using micro-costing and time-and-motion techniques to determine the total societal cost of colonoscopy, which includes direct health care costs as well as direct non-health care costs and costs related to patients' time.

Assessment of adverse drug events among patients in a tertiary care medical center.

Purpose: Specific patient and clinical characteristics associated with an increased risk of sustaining an adverse event (AE) were identified.

Methods: AE reports for patients in a 658-bed tertiary care medical center between January 1, 2000, and June 30, 2002, were analyzed. The data collected from each report included medical record number, patient sex, patient age, clinical service, date of occurrence, diagnoses, type of error, suspected medication, and severity of the AE.

The impact of aviation-based teamwork training on the attitudes of health-care professionals.

Background: Both the Institute of Medicine and the Agency for Healthcare Research and Quality suggest patient safety can be enhanced by implementing aviation Crew Resource Management (CRM) in health care. CRM emphasizes six key areas: managing fatigue, creating and managing teams, recognizing adverse situations (red flags), cross-checking and communication, decision making, and performance feedback. This study evaluates participant reactions and attitudes to CRM training.

Reduced heart rate volatility: an early predictor of death in trauma patients.

Objective: To determine if using dense data capture to measure heart rate volatility (standard deviation) measured in 5-minute intervals predicts death.

Background: Fundamental approaches to assessing vital signs in the critically ill have changed little since the early 1900s. Our prior work in this area has demonstrated the utility of densely sampled data and, in particular, heart rate volatility over the entire patient stay, for predicting death and prolonged ventilation.

Suboptimal statin adherence and discontinuation in primary and secondary prevention populations.

Objectives: To compare statin nonadherence and discontinuation rates of primary and secondary prevention populations and to identify factors that may affect those suboptimal medication-taking behaviors.

Design: Retrospective cohort utilizing pharmacy claims and administrative databases.

Setting: A midwestern U.

Costs associated with delirium in mechanically ventilated patients.

Objective: To determine the costs associated with delirium in mechanically ventilated medical intensive care unit patients.

Design: Prospective cohort study.

Setting: A tertiary care academic hospital.

Impact of transaction costs on healthcare outcomes.

This article reviews transaction cost economics to frame a discussion of how inefficiencies in healthcare delivery processes affect clinical outcomes and differentiate between inefficiencies that are tractable from those that are transitional or intractable. Recognizing and quantifying these effects improves the ability of organizations to calculate returns on investment in quality improvement, research and development and related value enhancing, but it is subject to high-risk undertakings.

For the record.

The author relates her personal journey toward understanding her role as an academic and as a practitioner. She ponders what, exactly, is the nature of her role and her conclusion is: "For me, the answer is that I am first and foremost an advocate, and the roots of my advocacy run deep."