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Modern techniques of medical imaging may produce astounding pictures of the body and its functions, but such images are not necessarily any better for purposes of diagnosis than those produced by more conventional techniques. The true value of any imaging technique can only be established by careful experimental evaluation. Just such an evaluation has been performed to compare two techniques of magnetic resonance imaging (MRI) with conventional angiography (X-ray of the blood vessels) for the examination of the carotid artery. Since angiography is an invasive technique requiring the insertion of catheter, MRI might be a significant improvement if its capabilities are also comparable. Stenosis, or narrowing, of the carotid artery carrying blood to the head is a major risk factor for stroke, and observation of this stenosis may lead to potentially preventive measures. The carotid bifurcations, where the carotid artery splits into the internal and external carotid arteries, were evaluated in 31 patients in whom carotid artery disease was suspected. The results provided by the established technique of invasive angiography were accepted as the correct diagnosis for purposes of comparison. Overall, the sensitivity of the MRI methods was 86 percent, meaning that 86 percent of the carotid artery abnormalities were actually detected by the MRI techniques. The specificity of the MRI methods was 92 percent, indicating that a negative indication by MRI will be right about 92 percent of the time. While these figures are close to the range which may make MRI suitable, it was also found that the errors which did occur happened because of difficulties experienced in the interpretation of the image, not the image quality. Furthermore, the physicians who read the images felt confident of their interpretations for 74 percent of the angiograms but for only 28 percent of the MR images. The MR images were apparently more difficult to read, and took 15 to 20 minutes, compared to the five minutes required to interpret a conventional angiogram. It would be advantageous to be able to use a noninvasive technique such as MRI for the evaluation of carotid stenosis, and, indeed, improvements in MRI technology may bring this to pass. At present, however, any adoption of the MRI technique for this purpose should be only with great care and strict adherence to evaluation methodology. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement of health care quality and patient safety is rapidly evolving, in response to long-term needs and more recent efforts to reform the US health system around "value." Development and choice of quality measures is now guided by a national quality strategy and priorities, with a public-private partnership, the National Quality Forum, helping determine the most worthwhile measures for evaluating and rewarding quality and safety of patient care. Yet there remain a number of challenges, including diverse purposes for quality measurement, limited availability of true clinical measures leading to frequent reliance on claims data with its flaws in determining quality, fragmentation of measurement systems with redundancy and conflicting conclusions, few high-quality comprehensive measurement systems and registries, and rapid expansion of required measures with hundreds of measures straining resources. The proliferation of quality measures at the clinician, hospital, and insurer level has created challenges and logistical problems. Recommendations include raising the bar for quality measurements to achieve transformational rather than incremental change in the US quality measurement system, promoting a logical set of measures for the various levels of the health system, leaving room for internal organizational improvement, harmonizing the various national and local quality measurement systems, anchoring on National Quality Forum additions and subtractions of measures to be applied, reducing reliance on and retiring claims-based measures as quickly as possible, promoting comprehensive measurement such as through registries with deep understanding of patient risk factors and outcomes, reducing attention to proprietary report cards, prompt but careful transition to measures from electronic health records, and allocation of sufficient resources to accomplish the goals of an efficient, properly focused measurement system. [ABSTRACT FROM AUTHOR]

Objective: To quantify effects of aviation-based crew resource management training on patient safety-related behaviors and perceived personal empowerment. Design: Prospective study of checklist use, error selfreporting, and a 10-point safety empowerment survey after participation in a crew resource management training intervention. Setting: Seven hundred twenty-two-bed university hospital; 247-bed affiliated community hospital. Participants: There were 857 participants, the majority of whom were nurses (50%), followed by ancillary personnel (28%) and physicians (22%). Main Outcome Measures: Preoperative checklist use over time; number and type of entries on a Web-based incident reporting system; and measurement of degree of empowerment (1-5 scale) on a 10-point survey of safety attitudes and actions given prior to, immediately after, and a minimum of 2 months after training. Results: Since 2003, 10 courses trained 857 participants in multiple disciplines. Preoperative checklist use rose (75% in 2003, 86% in 2004, 94% in 2005, 98% in 2006, and 100% in 2007). Self-initiated reports increased from 709 per quarter in 2002 to 1481 per quarter in 2008. The percentage of reports related to environment as opposed to actual events increased from 15.9% prior to training to 20.3% subsequently (P<.01). Perceived self-empowerment, creating a culture of safety, rose by an average of 0.5 point in all 10 realms immediately posttraining (mean [SD] rating, 3.0 [0.07] vs 3.5 [0.05]; P<.05). This was maintained after a minimum of 2 months. There was a trend toward a hierarchical effect with participants less comfortable confronting incompetence in a physician (mean [SD] rating, 3.1 [0.8]) than in nurses or technicians (mean [SD] rating, 3.4 [0.7] for both) (P<.05). Conclusions: Crew resource management programs can influence personal behaviors and empowerment. Effects may take years to be ingrained into the culture. [ABSTRACT FROM AUTHOR]