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Permanente Journal

Lisa Hawthornthwaite, Taylor Roebotham, Lauren Lee, Mim O'dowda, Lorelei Lingard
BACKGROUND: There is a growing recognition that patient engagement is necessary for the cultivation of patient- and family-centered care (PFCC) in the hospital setting. Acting on the emerging understanding that hearing stories from our patients gives valuable insight about our ability to provide compassionate PFCC, we developed an educational patient experience curriculum at our acute care teaching hospital. OBJECTIVES: To understand the benefits and consequences of patient storytelling and to explore the impact of our curriculum on participants...
April 20, 2018: Permanente Journal
Tiffany Wesley, Diana Hamer, George Karam
INTRODUCTION: Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum's impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education. METHODS: Six sessions were implemented throughout one academic year to expose first-year internal medicine residents (interns) to narrative medicine...
April 18, 2018: Permanente Journal
Steven Schwartz, Shahrzad Bazargan-Hejazi, Deyu Pan, David Ruiz, Anaheed Shirazi, Eleby Washington
CONTEXT: Psychiatric comorbidity is common in orthopedic injury, but the effects on hospital care outcomes have been identified only generally. OBJECTIVE: To quantify psychiatric comorbidity and its outcome effects in a large, multicenter population of inpatients with orthopedic injuries. DESIGN: Retrospective analysis of patient discharge data from 507 California hospitals from 2001 to 2010. Study sample included orthopedic diagnoses using International Classification of Diseases codes for major pelvic and lower extremity injuries in patients older than age 17 years...
April 16, 2018: Permanente Journal
Kelly Isbill
As a practicing obstetrician/gynecologist for more than 18 years, I have realized the importance of sexual health as well as the embarrassing lack of training in this very important part of our patients' overall mental and physical health. If anyone should be expected to be not only comfortable but knowledgeable about sex, it should be us. Unfortunately, many of us had little or no education in sexual health during medical school or residency. I have been on a journey to educate myself so I might better help my patients...
April 16, 2018: Permanente Journal
Lisa Schuman
No abstract text is available yet for this article.
April 13, 2018: Permanente Journal
Patricia Lynes
No abstract text is available yet for this article.
April 13, 2018: Permanente Journal
Patrick Van Winkle, Raoul Burchette, Raymond Kim, Rukmani Raghunathan, Naveen Qureshi
CONTEXT: Children with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) experience hypogammaglobulinemia and are at risk of sepsis during maintenance chemotherapy. Intravenous immunoglobulin (IVIG) has been used to try to circumvent this risk, but no data exist regarding its safety and prevalence in a health maintenance organization. OBJECTIVE: To evaluate the prevalence and safety of IVIG in children with ALL in CR1 during maintenance chemotherapy...
April 9, 2018: Permanente Journal
Efstathios Karamanos, Ilya Rakitin, Sophie Dream, Aamir Siddiqui
CONTEXT: Nerve transfer surgery is an option for repair of penetrating injuries of the upper extremity. In the right setting, it has advantages over tendon transfers and nerve grafting. OBJECTIVE: To review our experience since 2006 of nerve transfer surgery in the upper extremities. DESIGN: We included cases performed to repair penetrating trauma within three months of injury with at least three years' follow-up. MAIN OUTCOME MEASURES: Preoperative and postoperative muscle strength of the affected extremity...
April 9, 2018: Permanente Journal
Venetia Young, Lewis Mehl-Madrona, Barbara Mainguy
CONTEXT: A general practice in rural UK (Cumbria) was overwhelmed by staff burnout. OBJECTIVE: To present a case study for how the staff of a practice came together, used data, agreed on a plan for improvement, implemented the plan, improved subjective distress, and objectively evaluated the intervention. DESIGN: We conducted an audit using the electronic health record for patients coming to the practice 5 or more times annually from 2008 to 2012 (frequent attenders)...
April 5, 2018: Permanente Journal
Christine A Moore, Aaysha Kapila
INTRODUCTION: Pirfenidone was approved in 2014 for the treatment of idiopathic pulmonary fibrosis. Pirfenidone inhibits several factors such as tissue growth factor-β and platelet-derived growth factor, leading to decreased epithelial and fibroblast proliferation and collagen synthesis. The drug improves progression-free survival and is well tolerated, with minimal side effects. However, data on its long-term effects are lacking. CASE PRESENTATION: We present a rare case in which an undifferentiated pleomorphic sarcoma developed in a 59-year-old man with idiopathic pulmonary fibrosis who was treated with pirfenidone for more than a year...
April 4, 2018: Permanente Journal
Katie E Raffel, Leila Y Beach, John Lin, Jacob E Berchuck, Shelly Abram, Elizabeth Markle, Shalini Patel
CONTEXT: Naloxone distribution has historically been implemented in a community-based, expanded public health model; however, there is now a need to further explore primary care clinic-based naloxone delivery to effectively address the nationwide opioid epidemic. OBJECTIVE: To create a general medicine infrastructure to identify patients with high-risk opioid use and provide 25% of this population with naloxone autoinjector prescription and training within a 6-month period...
March 30, 2018: Permanente Journal
James J Annesi
CONTEXT: Increased intake of fruits and vegetables (FV) may be useful for weight loss. OBJECTIVE: This study was designed to evaluate the effects of changes in FV intake on the overall diet and to determine if self-regulation affects the association between changes in FV intake and weight. METHODS: Women with obesity (N = 74, mean age = 47.7 years) participating in a year-long behavioral weight-loss treatment were assessed regarding changes in consumption of various food groups, physical activity, and eating self-regulation over 6, 12, and 24 months...
March 30, 2018: Permanente Journal
Minggui Pan, Mubarika Alavi, Lisa J Herrinton
INTRODUCTION: We investigated the effect of inflammatory biomarkers (neutrophil, platelet, and lymphocyte counts) on risk of progression in patients with metastatic melanoma treated with an immune checkpoint inhibitor targeting programmed cell death protein-1 (PD-1). METHODS: This retrospective cohort study included 108 patients with malignant melanoma treated with an anti-PD-1 checkpoint inhibitor from August 2014 through December 2015. The outcome was disease progression noted on imaging or clinical examination...
March 30, 2018: Permanente Journal
Christine A Moore, Moayed Ibrahim, Aaysha Kapila, Kailash Bajaj
INTRODUCTION: Lenalidomide is an immunomodulatory drug approved by the US Food and Drug Administration in 2006 for the treatment of multiple myeloma. In 2012, the Food and Drug Administration issued a statement warning physicians of the increased risk with lenalidomide treatment of the following secondary primary malignancies: Acute myelogenous leukemia, myelodysplastic syndromes, and Hodgkin lymphoma. The statement did not mention glioblastoma multiforme, a Grade 4 astrocytoma, or other high-grade astrocytomas that have been reported on rare occasions in the setting of multiple myeloma...
March 30, 2018: Permanente Journal
Kevin H Wang, Brian H Song, Jason E Gilde, Jeanne A Darbinian, Miranda L Ritterman Weintraub, Tara J Wu, Eleanor L Yang, James W Salazar, Deepak Gurushanthaiah
CONTEXT: Survival for patients with oral cavity squamous cell carcinoma (OCSCC) has remained relatively stagnant despite advances in treatment. Few studies have examined why advanced-stage disease is diagnosed in 40% of patients with OCSCC nationally. OBJECTIVE: To characterize the diagnostic pathway of OCSCC in an integrated health care system. DESIGN: Retrospective study of patients with OCSCC (2007-2010). MAIN OUTCOME MEASURES: Referral patterns and demographic, clinical, and tumor characteristics associated with time to diagnosis (diagnostic interval)...
March 30, 2018: Permanente Journal
Daniel T Linnen, John Kornak, Caroline Stephens
CONTEXT: Evidence suggests an association between rurality and decreased life expectancy. OBJECTIVE: To determine whether rural hospitals have higher hospital mortality, given that very sick patients may be transferred to regional hospitals. DESIGN: In this ecologic study, we combined Medicare hospital mortality ratings (N = 1267) with US census data, critical access hospital classification, and National Center for Health Statistics urban-rural county classifications...
March 28, 2018: Permanente Journal
Kathryn A Teng
Empanelment is an important step toward managing population health. Achieving empanelment in a fee-for-service world necessitates organizational support for panel size measurement and creativity regarding use of panel size to inform access decisions. Empanelment efforts and access must be balanced to create sustainable, high-quality care models and to improve practitioner and patient experiences.
March 23, 2018: Permanente Journal
Sarah Nicole Dunkerley
In this reflection on being both a physician and a patient, I consider the events that happened to me as a patient with cancer and how this will change my practice as a doctor in the future.
March 23, 2018: Permanente Journal
Ami Kapadia
Mindfulness meditation has vast physiologic benefits that can reduce physician burnout and improve physician well-being. Collective meditation and mindfulness practices with organized continuity among physician groups can synergistically elevate the practice of primary care by fostering creativity and innovation needed for sustainable solutions. A cohesive frontline physician voice rooted in higher purpose cultivated by meditation and mindfulness practices in a platform directly linked to quality improvement can lead to meaningful change in primary care for all...
March 16, 2018: Permanente Journal
Thomas H Gildea, Joel T Levis
No abstract text is available yet for this article.
March 16, 2018: Permanente Journal
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