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N 1917 ERNEST CODMAN, MD, A Massachusetts surgeon, described his view of a quality evaluation system for medicine, in which clinicians assessed outcomes and the processes that led to those outcomes. 1 The modern iteration of Codman's quality system for medicine is continuous quality improvement (CQI). 2,3 Adapted from industrial manufacturing principles in Japan and the United States, 4 CQI in medicine is the repetitive cycle of process and outcomes measurement, design and implementation of interventions to improve the processes of care, and remeasurement to determine the effect on quality of care. Successful CQI programs in medicine have been difficult to achieve, in part due to a lack of appropriate information technology 5 and organizational infrastructure. 6 Randomized trials testing the effectiveness of CQI as an approach to quality improvement in medicine to date have yielded mixed results. A report by Soumerai et al 7 documenting the im

We conclude that, at the dosages given, recombinant bovine aprotinin decreases surgical blood loss and transfusion requirements in patients undergoing coronary artery bypass grafting, but its use requires appropriate monitoring of heparin use during bypass. Whether higher dosages of aprotinin increase the risk of graft thrombosis must be further assessed with a larger patient sample.