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Permanente Journal

Sandra Hoyt Stenmark, John F Steiner, Sanjana Marpadga, Marydale Debor, Kathleen Underhill, Hilary Seligman
Traditionally, health care systems have addressed gaps in patients' diet quality with programs that provide dietary counseling and education, without addressing food security. However, health care systems increasingly recognize the need to address food security to effectively support population health and the prevention and management of diet-sensitive chronic illnesses. Numerous health care systems have implemented screening programs to identify food insecurity in their patients and to refer them to community food resources to support food security...
October 5, 2018: Permanente Journal
Alyssa Finger, Mark Harris, Emily Nishimura, Hyo-Chun Yoon
CONTEXT: As the use of computed tomography (CT) scans, which are expensive and result in considerable radiation exposure to the patient, continues to increase, communication between physicians and radiologists remains vital to explain the clinical context for the examination. However, the clinical information provided to the radiologist is often lacking. OBJECTIVE: To determine whether the clinical information provided in CT scan requests meets minimum criteria for requesting the examination...
October 5, 2018: Permanente Journal
Julie A Schmittdiel, Wendy T Dyer, Cassondra J Marshall, Roberta Bivins
CONTEXT: Research on predictors of clinical outcomes usually focuses on the impact of individual patient factors, despite known relationships between neighborhood environment and health. OBJECTIVE: To determine whether US census information on where a patient resides is associated with diabetes development among patients with prediabetes. DESIGN: Retrospective cohort study of all 157,752 patients aged 18 years or older from Kaiser Permanente Northern California with laboratory-defined prediabetes (fasting plasma glucose, 100 mg/dL-125 mg/dL, and/or glycated hemoglobin, 5...
October 5, 2018: Permanente Journal
Kumara Raja Sundar
CONTEXT: Kaiser Permanente's Care Management Institute created a screening tool, Your Current Life Situation (YCLS), which primarily is used to identify social needs for populations at risk of high health care utilization. OBJECTIVE: This frontline improvement project was designed to address key stakeholder concerns about implementing universal screening for social needs using the YCLS in a primary care clinic. METHODS: I conducted a rapid stakeholder analysis through informal conversations to identify the most important concerns...
October 5, 2018: Permanente Journal
David Cawthorpe, Brian Marriott, Jaime Paget, Iraj Moulai, Sandra Cheung
CONTEXT: Developmental psychopathology theory suggests a relationship between early childhood adversity and mental disorder. OBJECTIVE: To examine the relationship between the specific items on the Adverse Childhood Experiences (ACE) survey and the International Classification of Diseases, Tenth Revision (ICD-10) categories of psychiatric diagnoses in a pediatric sample. DESIGN: The sample included patients enrolled in the Child and Adolescent Addiction Mental Health and Psychiatry Program with both a completed ACE survey and at least 1 diagnosis of record (per admission)...
October 5, 2018: Permanente Journal
Laura M Gottlieb, Damon E Francis, Andrew F Beck
Health care leaders in the US are actively exploring strategies to identify and address patients' social and economic hardships as part of high-quality clinical care. The result has been a proliferation of screening tools and interventions related to patients' social determinants of health, but little guidance on effective strategies to implement them. Some of these tools rely on patient- or household-level screening data collected from patients during medical encounters. Other tools rely on data available at the neighborhood-level that can be used to characterize the environment in which patients live or to approximate patients' social or economic risks...
September 13, 2018: Permanente Journal
Lauren O'brien, Jennifer Duong, Tessa Winterton, Anna Haring, Zachary Kuhlmann
INTRODUCTION: Preeclampsia with severe hypertension, which occurs in 5% to 8% of pregnancies, is a leading cause of maternal and perinatal morbidity and mortality in the US. Early recognition and treatment of hypertensive crises can significantly reduce poor outcomes. A protocol to ensure prompt treatment with antihypertensive medication (intravenous labetalol) was implemented at our institution. OBJECTIVE: To determine adherence to this protocol on the Labor and Delivery Unit...
September 13, 2018: Permanente Journal
Ching Soong Khoo
No abstract text is available yet for this article.
September 10, 2018: Permanente Journal
Debbie Postlethwaite, Justine Lee, Maqdooda Merchant, Amy Alabaster, Tina Raine-Bennett
CONTEXT: Optimizing access to effective contraception at the time of abortion can reduce repeated unintended pregnancies. OBJECTIVE: To assess contraception initiation and repeated unintended pregnancies among women receiving abortions in Kaiser Permanente Northern California (KPNC) facilities and through outside contracted facilities. DESIGN: A retrospective cohort study was conducted using a randomized proportional sample of women aged 15 to 44 years having abortions in KPNC, to determine contraception initiation within 90 days...
September 10, 2018: Permanente Journal
Ruth Madievsky
Type 2 diabetes mellitus often goes hand in hand with cardiovascular and renal comorbidities. Stroke, myocardial infarction, heart failure, and chronic kidney disease are high-risk complications of type 2 diabetes that contribute to morbidity and mortality. Recent clinical trials have uncovered evidence that certain antidiabetic agents may confer cardiovascular and/or renal benefits such as reduced cardiovascular and all-cause mortality and reduced need for renal replacement therapy. Two landmark trials in particular, EMPA-REG OUTCOME (Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes) and LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results), demonstrated the cardioprotective and/or renoprotective effects of empagliflozin and liraglutide, respectively...
September 10, 2018: Permanente Journal
Alex Battaglia
No abstract text is available yet for this article.
September 6, 2018: Permanente Journal
Harshal S Mandavdhare, Vishal Sharma, Pankaj Gupta
No abstract text is available yet for this article.
September 6, 2018: Permanente Journal
Ali Rafik Shukor, Sandra Edelman, Dean Brown, Cheryl Rivard
INTRODUCTION: Designing, delivering, and evaluating high-performing primary health care services for complex and vulnerable subpopulations are challenging endeavors. However, there is a relative paucity of research evidence available to support such work. OBJECTIVE: To provide a case study using HealthConnection Clinic, a public primary care center located in Metropolitan Vancouver's North Shore. METHODS: Developmental evaluation approach operationalizing the 10 Building Blocks of High-Performing Primary Care framework using qualitative and quantitative methods...
September 6, 2018: Permanente Journal
Kumara Raja Sundar
Using a patient story, this narrative demonstrates why health care organizations, specifically primary care clinics, should strive to identify and to address social needs. This story demonstrates how Kaiser Permanente Washington, by using community resource specialists, has empowered primary care clinics to address social needs in a health care setting to improve patient care and experience.
October 1, 2018: Permanente Journal
Felicitas Livaudais
No abstract text is available yet for this article.
October 1, 2018: Permanente Journal
Scott Abramson
No abstract text is available yet for this article.
October 1, 2018: Permanente Journal
Farzad A Masroor, Jason Gilde, Jonathan Liang
INTRODUCTION: Vidian nerve schwannomas are exceedingly rare, with only 7 cases reported since 2006. Patients presenting with ocular symptoms have been reported in only 1 case. CASE PRESENTATION: A 54-year-old woman presented with a 3-month history of right periorbital pressure, third cranial nerve palsy, and visual field defect. Imaging results showed a right sphenoid skull-base mass with obliteration of the vidian canal that extended into the pterygopalatine fossa...
October 1, 2018: Permanente Journal
Ko Un Park, Michael Eichenhorn, Bruno Digiovine, Jennifer Ritz, Jack Jordan, Ilan Rubinfeld
BACKGROUND: Institutional harm reduction campaigns are essential in improving safe practice in critical care. Our institution embarked on an aggressive project to measure harm. We hypothesized that critically ill surgical patients were at increased risk of harm compared with medical intensive care patients. METHODS: Three years of administrative data for patients with at least 1 Intensive Care Unit day at an urban tertiary care center were assembled. Data were accessed from the Henry Ford Health System No Harm Campaign in Detroit, MI...
September 27, 2018: Permanente Journal
Shawn R Criswell, Richard Sherman, Stanley Krippner
OBJECTIVE: To test the effectiveness of a mental health therapy designed to reduce noncombat-related persistent posttraumatic stress disorder (PTSD) symptoms in 30 adult outpatients with a diagnosis of PTSD. The individual treatment offered modules to address PTSD nightmare distress, dissociation, general core skills, alterations in arousal and reactivity, avoidance, intrusion, and negative alternations in cognitions and mood. The therapeutic approach centered on cognitive behavioral therapy and heart rate variability biofeedback...
September 27, 2018: Permanente Journal
Courtnee Hamity, Ana Jackson, Lunarosa Peralta, Jim Bellows
CONTEXT: Assessment of social needs is expanding at Kaiser Permanente (KP), but little is known about how members and clinicians experience the incorporation of social needs into health care. OBJECTIVE: To assess how KP members and clinicians experience social needs assessments incorporated into care. DESIGN: Qualitative and descriptive analysis of data from member and clinician focus groups, interviews, and surveys among 68 members and family caregivers who had participated in social needs assessment programs and 90 clinicians and staff in the KP Colorado, Georgia, Northern California, Northwest, and Southern California Regions...
September 27, 2018: Permanente Journal
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