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Permanente Journal

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https://www.readbyqxmd.com/read/28333613/collaborative-management-of-neurocognitive-disorders-in-primary-care-explorations-of-an-attempt-at-culture-change
#1
Lewis Mehl-Madrona, Barbara Mainguy
INTRODUCTION: Minor neurocognitive disorder (MiND; previously mild cognitive impairment) is a transitional zone between normal cognitive function and early stages of major neurocognitive disorder (previously called dementia). Of people with MiND, 5% to 10% progress to major neurocognitive disorder. Simple interventions such as memory activities, balance exercises, and anti-inflammatory diets have been shown to improve cognitive ability. Also, education and support in group settings have proved beneficial for patients with MiND...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333612/practicing-healing-cleaning-the-back-of-an-elderly-tibetan-woman
#2
James Lake
No abstract text is available yet for this article.
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333611/transcendental-meditation-and-reduced-trauma-symptoms-in-female-inmates-a-randomized-controlled-study
#3
Sanford Nidich, Angela Seng, Blaze Compton, Tom O'connor, John W Salerno, Randi Nidich
CONTEXT: Compared with the general population, trauma experiences are higher among incarcerated women. OBJECTIVE: To evaluate the effects of Transcendental Meditation (TM) on trauma symptoms in female offenders. DESIGN: Twenty-two inmates at the Coffee Creek Correctional Facility in Wilsonville, OR, with at least 4 months left of incarceration were enrolled in this randomized controlled pilot study. Subjects were randomly assigned to either the TM group (n = 11) or a wait-list control group (n = 11)...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333610/on-the-shoulders-of-giants
#4
Tom Paluch
No abstract text is available yet for this article.
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333609/fundamental-use-of-surgical-energy-fuse-an-essential-educational-program-for-operating-room-safety
#5
Stephanie B Jones, Malcolm G Munro, Liane S Feldman, Thomas N Robinson, L Michael Brunt, Steven D Schwaitzberg, Daniel B Jones, Pascal R Fuchshuber
Operating room (OR) safety has become a major concern in patient safety since the 1990s. Improvement of team communication and behavior is a popular target for safety programming at the institutional level. Despite these efforts, essential safety gaps remain in the OR and procedure rooms. A prime example is the use of energy-based devices in ORs and procedural areas. The lack of fundamental understanding of energy device function, design, and application contributes to avoidable injury and harm at a rate of approximately 1 to 2 per 1000 patients in the US...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333608/morbidity-in-pregnant-women-associated-with-unverified-penicillin-allergies-antibiotic-use-and-group-b-streptococcus-infections
#6
Shilpa H Desai, Michael S Kaplan, Qiaoling Chen, Eric M Macy
CONTEXT: The morbidity potentially associated with unverified penicillin allergy in pregnant women, with and without group B streptococcus (GBS) infections, is unknown. Penicillin allergy testing is safe during pregnancy but is done infrequently. OBJECTIVE: To determine morbidity associated with antibiotic use in a large cohort of pregnant women, with and without an unverified history of penicillin allergy, and with and without GBS. DESIGN: Retrospective...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333607/understanding-faculty-and-trainee-needs-related-to-scholarly-activity-in-a-large-nonuniversity-graduate-medical-education-program
#7
Davida Becker, Hanna Garth, Rachel Hollander, Felice Klein, Marc Klau
CONTEXT: Graduate medical education (GME) programs must develop curriculum to ensure scholarly activity among trainees and faculty to meet accreditation requirements and to support evidence-based medicine. OBJECTIVE: Test whether research-related needs and interests varied across four groups: primary care trainees, specialty trainees, primary care faculty, and specialty faculty. DESIGN: We surveyed a random sample of trainees and faculty in Kaiser Permanente Southern California's GME programs...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333606/patterns-of-multiple-emergency-department-visits-do-primary-care-physicians-matter
#8
Daniel D Maeng, Jing Hao, John B Bulger
CONTEXT: Overutilization and overreliance on Emergency Departments (EDs) as a usual source of care can lead to unnecessarily high costs and undesirable consequences, such as a gap in care coordination and inadequate provision of preventive care. OBJECTIVE: To identify factors associated with multiple ED visits by patients, in particular, the impact of primary care physicians (PCPs) on their patients' multiple ED visit rates. DESIGN: Geisinger Health Plan claims data among adult patients who averaged more than 1 ED visit within a 12-month period between 2013 and 2014 were obtained (N = 20,351)...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333605/can-all-doctors-be-like-this-seven-stories-of-communication-transformation-told-by-physicians-rated-highest-by-patients
#9
Tom Janisse, Karen Tallman
INTRODUCTION: The top predictors of patient satisfaction with clinical visits are the quality of the physician-patient relationship and the communications contributing to their relationship. How do physicians improve their communication, and what effect does it have on them? This article presents the verbatim stories of seven high-performing physicians describing their transformative change in the areas of communication, connection, and well-being. METHODS: Data for this study are based on interviews from a previous study in which a 6-question set was posed, in semistructured 60-minute interviews, to 77 of the highest-performing Permanente Medical Group physicians in 4 Regions on the "Art of Medicine" patient survey...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333604/patient-preferences-for-discussing-childhood-trauma-in-primary-care
#10
Ellen Goldstein, Ninad Athale, Andrés F Sciolla, Sheryl L Catz
CONTEXT: Exposure to traumatic events is common in primary care patients, yet health care professionals may be hesitant to assess and address the impact of childhood trauma in their patients. OBJECTIVE: To assess patient preferences for discussing traumatic experiences and posttraumatic stress disorder (PTSD) with clinicians in underserved, predominantly Latino primary care patients. DESIGN: Cross-sectional study. MAIN OUTCOME MEASURE: We evaluated patients with a questionnaire assessing comfort to discuss trauma exposure and symptoms using the Adverse Childhood Experiences (ACE) Study questionnaire and the Primary Care-PTSD screen...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333603/focal-segmental-glomerulosclerosis-in-a-patient-with-ambiguous-genitalia-a-diagnostic-dilemma
#11
Oliver E Ross, Dean A Kujubu, John J Sim
The renal condition referred to as focal segmental glomerulosclerosis (FSGS) presents a diagnostic dilemma for the clinician. It encompasses and displays a nonspecific histologic appearance on a kidney biopsy specimen, rather than a unique disease entity. This characteristic of FSGS often makes treatment decisions and prognostication difficult. A 34-year-old man, who was born with ambiguous genitalia, had received a diagnosis of FSGS in young adulthood and now had advanced kidney disease. He underwent genetic testing to determine whether a genetic disorder was underlying his kidney disease and to ascertain his risk of FSGS recurrence if he were to receive a kidney transplant...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333602/bilateral-basaloid-squamous-cell-carcinoma-of-the-parotid-gland-a-case-report-and-review-of-the-literature
#12
Alexander Rivero, Christopher G Tang, Barry M Rasgon
INTRODUCTION: We describe the first known case of bilateral basaloid squamous cell carcinoma of the parotid gland, and we review existing literature. CASE PRESENTATION: A previously healthy, 70-year-old white man presented with a 2-cm enlarging mass in the tail of the right parotid gland. Magnetic resonance imaging and computed tomography showed ipsilateral pathologic adenopathy. Results of fine-needle aspiration revealed a high-grade malignancy with squamous features...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333601/simultaneous-occurrence-of-varicella-zoster-virus-induced-pancreatitis-and-hepatitis-in-a-renal-transplant-recipient-a-case-report-and-review-of-literature
#13
Puneet Chhabra, Priyadarshi Ranjan, Deepak K Bhasin
INTRODUCTION: Gastrointestinal complications are common after renal transplantation, including oral lesions, esophagitis, gastritis, diarrhea, and colon carcinoma. The differential diagnosis is difficult in this scenario because multiple factors such as drugs, infections, and preexisting gastrointestinal disease come into play. CASE PRESENTATION: We report a case of varicella zoster virus-induced pancreatitis and hepatitis in a renal transplant recipient. The patient underwent renal transplantation 3 years earlier and now presented with severe pain in the epigastrium radiating to his back and had raised serum lipase levels and skin lesions characteristic of varicella...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241915/the-evolution-of-the-medical-school-deanship-from-patriarch-to-ceo-to-system-dean
#14
Danny A Schieffler, Philip M Farrell, Marc J Kahn, Richard A Culbertson
Medical school deanship in the US has evolved during the past 200 years as the complexity of the US health care system has evolved. With the introduction of Medicare and Medicaid and the growth of the National Institutes of Health, the 19th-century and first half of the 20th-century role of the medical school dean as guild master transformed into that of resource allocator as faculty practice plans grew in scope and grew as an important source of medical school and university revenue. By 2000, the role of the medical school dean had transformed into that of CEO, with the dean having control over school mission and strategy, faculty practice plans, education, research dollars, and philanthropy...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241914/comprehensive-description-of-comorbidity-for-autism-spectrum-disorder-in-a-general-population
#15
David Cawthorpe
CONTEXT: Few published studies of autism spectrum disorder (ASD) and comorbidity are population based. OBJECTIVE: To describe the comorbidity of ASD and disorders listed in the main classes of the International Classification of Diseases, Ninth Revision (ICD-9) in a general population. DESIGN: Direct physician billing data for the city of Calgary, Alberta, Canada, for the treatment of any presenting concern in the Calgary Health Zone (n = 763,449) from 1994 to 2009 were extracted...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241913/fundamental-use-of-surgical-energy-fuse-an-essential-educational-program-for-operating-room-safety
#16
Stephanie B Jones, Malcolm G Munro, Liane S Feldman, Thomas N Robinson, L Michael Brunt, Steven D Schwaitzberg, Daniel B Jones, Pascal R Fuchshuber
Operating room (OR) safety has become a major concern in patient safety since the 1990s. Improvement of team communication and behavior is a popular target for safety programming at the institutional level. Despite these efforts, essential safety gaps remain in the OR and procedure rooms. A prime example is the use of energy-based devices in ORs and procedural areas. The lack of fundamental understanding of energy device function, design, and application contributes to avoidable injury and harm at a rate of approximately 1 to 2 per 1000 patients in the US...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241912/end-stage-renal-disease-outcomes-among-the-kaiser-permanente-southern-california-creatinine-safety-program-creatinine-surenet-opportunities-to-reflect-and-improve
#17
John J Sim, Michael Batech, Kim N Danforth, Mark P Rutkowski, Steven J Jacobsen, Michael H Kanter
OBJECTIVES: The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. METHODS: Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241911/the-grateful-aging-program-a-naturalistic-model-of-transformation-and-healing-into-the-second-half-of-life
#18
Marilyn Schlitz
OBJECTIVES: Understanding and managing the process of aging is a central issue in modern society. This is a critical factor given the demographic shift toward an aging population and the negative stereotypes around aging that can limit people's worldview on aging with gratitude and well-being. METHODS: Building on three decades of qualitative and quantitative studies on positive worldview transformation at the California-based Institute of Noetic Sciences, this article applies an empirically derived naturalistic model of transformation to aging...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241910/image-diagnosis-zinc-induced-copper-deficiency-causing-pancytopenia-recognized-on-bone-marrow-examination
#19
Joyce Johnsrud, Al-Ola Abdallah, Steven A Schichman, Zhifu Xiang
No abstract text is available yet for this article.
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241909/reducing-unnecessary-postoperative-complete-blood-count-testing-in-the-pediatric-intensive-care-unit
#20
Maya Dewan, Jorge Galvez, Tracey Polsky, Genna Kreher, Blair Kraus, Luis Ahumada, John Mccloskey, Heather Wolfe
CONTEXT: Complete blood count (CBC) testing commonly occurs to determine the need for blood transfusions after surgical procedures. Many clinicians believe postoperative CBCs are "routine." OBJECTIVE: To decrease unnecessary routine CBC testing in a low-risk cohort of postoperative patients in the pediatric intensive care unit (PICU) at The Children's Hospital of Philadelphia by 50% in 6 months. DESIGN: Quality-improvement study. Data from our institution regarding frequency of ordering laboratory studies and transfusion requirements were collected for prior quality-improvement work demonstrating the safety and feasibility of avoiding routine postoperative CBCs in this cohort...
2017: Permanente Journal
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