William Dunn

Visualization of diaphragmatic fenestration associated with catamenial pneumothorax

Catamenial pneumothorax is a rare entity of unknown etiology characterized by recurrent accumulation of air in the thoracic space during or preceding menstruation. We documented the presence of a diaphragmatic fenestration during thoracoscopy, lending support for hypotheses involving diaphragmatic defects as possible avenues of air collection in the thorax.

Should Intensive Care Medicine Itself Be on the Critical List

survival. Chest 2007; 132:1954-1961 7 Hadjiliadis D, AhyaVN, Christie JD, et al. Early results oflung transplantation after implementation of the new lung allocation score [abstract]. J Heart Lung Transplant 2006; 25:S173 8 Kozower BD, Meyers BF, Smith MA, et al. The impact of the lung allocation score on short-term transplantation outcomes: a multicenter study. J Thorac CardiovascSurg 2008; 135:166-171 9 Hachem RR, Trulock EP. The new lung allocation system and its impact on waitlist characteristics and post-transplant outcomes. Semin Thorac Cardiovasc Surg 2008; 20:139-142 10 McCue JD, Mooney J, Quail J, et al. Ninety-day mortality and major complications are not affected by use oflung allocation score. J Heart Lung Transplant 2008; 27:192-196 11 Organ Procurement and Transplantation Network. Home page. Available at: http://www.optn.orgiJatestDatalrptData.asp.Accessed December 26, 2008

Iatrogenic Delirium and Coma: A “Near Miss”

A 66-year-old woman was cared for at two referral institutions following a witnessed cardiac arrest in a local emergency department. Despite aggressive initial care, she failed to regain consciousness during a 28-day course. Based on an erroneous neurologic diagnosis of anoxic encephalopathy, pessimism regarding likelihood of improvement existed, prompting clinical consideration of withdrawal of care. The correct diagnosis of iatrogenic drug-induced coma alternating with drug-induced delirium only became apparent after the IV administration of repeated doses of a benzodiazepine antagonist. The patient and husband (co-authors) provide insights often unheard within care circles.

Transparency in health care: an issue throughout US history.

218 23 Mayo PH, Hackney JE, Mueck JT, et al. Achieving house staff competence in emergency airway management: results of a teaching program using a computerized patient simulator. Crit Care Med 2004; 32:2422–2427 24 Blum MG, Powers TW, Sundaresan S. Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy. Ann Thorac Surg 2004; 78:287–291 25 Colt HG, Crawford SW, Galbraith O III. Virtual reality bronchoscopy simulation: a revolution in procedural training. Chest 2001; 120:1333–1339 26 Patel AD, Gallagher AG, Nicholson WJ, et al. Learning curves and reliability measures for virtual reality simulation in the performance assessment of carotid angiography. J Am Coll Cardiol 2006; 47:1796–1802 27 Edmond CV Jr. Impact of the endoscopic sinus surgical simulator on operating room performance. Laryngoscope 2002; 112:1148–1158 28 Berkenstadt H, Ziv A, Gafni N, et al. Incorporating simulation-based objective structured clinical examination into the Israeli National Board Examination in Anesthesiology. Anesth Analg 2006; 102:853–858 29 Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA 2005; 293:2384–2390

Transparency in Health Care: Case ReportIatrogenic Delirium and Coma

A 66-year-old woman was cared for at two referral institutions following a witnessed cardiac arrest in a local emergency department. Despite aggressive initial care, she failed to regain consciousness during a 28-day course. Based on an erroneous neurologic diagnosis of anoxic encephalopathy, pessimism regarding likelihood of improvement existed, prompting clinical consideration of withdrawal of care. The correct diagnosis of iatrogenic drug-induced coma alternating with drug-induced delirium only became apparent after the IV administration of repeated doses of a benzodiazepine antagonist. The patient and husband (co-authors) provide insights often unheard within care circles.

How Many Unjustifiable Lectures Are Worth

In November 2007, the Josiah Macy, Jr. Foundation convened a conference to address a number of complex issues concerning continuing education (CE) in the health professions. Participants concluded that CE, as currently practiced, does not focus adequately on improving clinician performance and patient care, is too dependent on lectures and too removed from the daily practice of clinicians, does not encourage or emphasize newer technologies and point-of-care learning, is poorly integrated across disciplines, and is inappropriately financed. Recommendations concerning educational methods, metrics, responsibilities, research in CE, financing, and oversight are reviewed. The relationship between the goals of improving clinician performance and patient care, while maintaining high standards of accountability and transparency, are reviewed.