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Permanente Journal

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https://www.readbyqxmd.com/read/27213488/refining-reporting-mechanisms-in-oregon-s-patient-centered-primary-care-home-program-to-improve-performance
#1
Sherril Gelmon, Billie Sandberg, Nicole Merrithew, Rebekah Bally
INTRODUCTION: As part of its strategy to achieve the Triple Aim, the Oregon Health Authority implemented the Patient-Centered Primary Care Home (PCPCH) Program in 2009. In 2014, the program recognized more than 500 primary care practices and had become an essential component of Oregon's strategy for transforming health services delivery. To assist the Oregon Health Authority with evaluating practices' achievement of the PCPCH model along its 6 core attributes (access, accountability, comprehensive care, continuity, coordination, and person-centered care), the research team developed an innovative scoring method...
May 20, 2016: Permanente Journal
https://www.readbyqxmd.com/read/27828774/ethical-analysis-for-physicians-considering-the-provision-of-life-ending-medication-in-compliance-with-the-california-end-of-life-option-act
#2
D Malcolm Shaner
The End of Life Option Act in California, effective June 9, 2016, permits physicians to prescribe lethal medication to patients confirmed to be terminally ill and capable of independently making and carrying out a decision to ingest deadly medication. Medicine has traditionally excluded the provision of deadly medication from proper practice. Physicians reasonably may hold to that limit. However, honoring a repeated request from a capable, terminally ill patient to receive life-ending medication still can be considered to be a moral and permissible approach to relieve suffering...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27828773/implementation-of-the-ymca-diabetes-prevention-program-throughout-an-integrated-health-system-a-translational-study
#3
Ron Adams, Christopher J Hebert, Linda Mcvey, Roger Williams
CONTEXT: HealthSpan Physicians (HSP), an integrated medical system in Northeast Ohio, partnered with the Young Men's Christian Association (YMCA) of Greater Cleveland to implement a referral system for the evidence-based Diabetes Prevention Program (DPP) throughout HSP. The YMCA of USA employs a cost-effective, customized version of the original DPP in which coaches take the place of in-house clinical staff. Efficacy of the YMCA DPP was shown earlier in the DEPLOY Study. OBJECTIVE: To improve outcomes of metrics used in the DEPLOY Study...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27768570/effectiveness-of-cannabidiol-oil-for-pediatric-anxiety-and-insomnia-as-part-of-posttraumatic-stress-disorder-a-case-report
#4
Scott Shannon, Janet Opila-Lehman
INTRODUCTION: Anxiety and sleep disorders are often the result of posttraumatic stress disorder and can contribute to an impaired ability to focus and to demonstration of oppositional behaviors. CASE PRESENTATION: These symptoms were present in our patient, a ten-year-old girl who was sexually abused and had minimal parental supervision as a young child under the age of five. Pharmaceutical medications provided partial relief, but results were not long-lasting, and there were major side effects...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27768569/refractory-depression-fatigue-irritable-bowel-syndrome-and-chronic-pain-a-functional-medicine-case-report
#5
Gregory Plotnikoff, Melissa Barber
INTRODUCTION: Single-disorder or single-organ-system clinical practice guidelines are often of limited usefulness in guiding effective management of patients with chronic multidimensional signs and symptoms. The presence of multiple long-standing medical problems in a given patient despite intensive medical effort suggests that addressing systemic core imbalances could complement more narrowly focused approaches. CASE PRESENTATION: A 72-year-old man experiencing longstanding depression, fatigue, irritable bowel syndrome, and chronic pain in the context of additional refractory illnesses was assessed and treated, guided by a system-oriented approach to underlying core imbalances termed functional medicine...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27768568/association-of-unplanned-reintubation-with-higher-mortality-in-old-frail-patients-a-national-surgical-quality-improvement-program-analysis
#6
Efstathios Karamanos, Nathan Schmoekel, Dionne Blyden, Anthony Falvo, Ilan Rubinfeld
BACKGROUND: Unplanned postoperative reintubation increases the risk of mortality, but associated factors are unclear. OBJECTIVE: To elucidate factors associated with increased mortality risk in patients with unplanned postoperative reintubation. DESIGN: Retrospective study. Patients older than 40 years who underwent unplanned reintubation from 2005 to 2010 were identified using the American College of Surgeons National Surgical Quality Improvement Program database...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27768567/form-follows-function-a-functional-medicine-overview
#7
EDITORIAL
Patrick Hanaway
No abstract text is available yet for this article.
2016: Permanente Journal
https://www.readbyqxmd.com/read/27768566/development-and-application-of-a-plant-based-diet-scoring-system-for-japanese-patients-with-inflammatory-bowel-disease
#8
Mitsuro Chiba, Kunio Nakane, Yuko Takayama, Kae Sugawara, Hideo Ohno, Hajime Ishii, Satoko Tsuda, Tsuyotoshi Tsuji, Masafumi Komatsu, Takeshi Sugawara
CONTEXT: Plant-based diets (PBDs) are a healthy alternative to westernized diets. A semivegetarian diet, a PBD, has been shown to prevent a relapse in Crohn disease. However, there is no way to measure adherence to PBDs. OBJECTIVE: To develop a simple way of evaluating adherence to a PBD for Japanese patients with inflammatory bowel disease (IBD). DESIGN: PBD scores were assigned according to the frequency of consumption provided on a food-frequency questionnaire, obtained on hospitalization for 159 patients with ulcerative colitis and 70 patients with Crohn disease...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27768565/accreditation-council-for-graduate-medical-education-core-competencies-at-a-community-teaching-hospital-is-there-a-gap-in-awareness
#9
Mohammed Al-Temimi, Michael Kidon, Samir Johna
CONTEXT: Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. OBJECTIVE: Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. DESIGN: Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27723447/anal-health-care-basics
#10
Jason Chang, Elisabeth Mclemore, Talar Tejirian
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27723446/assessing-the-value-of-high-quality-care-for-work-associated-carpal-tunnel-syndrome-in-a-large-integrated-health-care-system-study-design
#11
Craig Conlon, Steven Asch, Mark Hanson, Andrew Avins, Barbara Levitan, Carol Roth, Michael Robbins, Michael Dworsky, Seth Seabury, Teryl Nuckols
CONTEXT: Little is known about quality of care for occupational health disorders, although it may affect worker health and workers' compensation costs. Carpal tunnel syndrome (CTS) is a common work-associated condition that causes substantial disability. OBJECTIVE: To describe the design of a study that is assessing quality of care for work-associated CTS and associations with clinical outcomes and costs. DESIGN: Prospective observational study of 477 individuals with new workers' compensation claims for CTS without acute trauma who were treated at 30 occupational health clinics from 2011 to 2013 and followed for 18 months...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27723445/preferential-use-of-total-thyroidectomy-without-prophylactic-central-lymph-node-dissection-for-early-stage-papillary-thyroid-cancer-oncologic-outcomes-in-an-integrated-health-plan
#12
Meena Said, Michele Fujimoto, Cara Franken, Sunee Woo, Brooke Vuong, Philip I Haigh
CONTEXT: The oncologic benefit of prophylactic central lymph node dissection (pCLND) in node-negative papillary thyroid cancer has been debated. OBJECTIVE: To determine the use of pCLND in an integrated health care system and to evaluate recurrence in the cohort. DESIGN: Retrospective cohort study of patients with clinically node-negative papillary thyroid cancer who underwent total thyroidectomy with or without pCLND in Kaiser Permanente Southern California Region hospitals between January 1996 and December 2008...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27723444/reduced-trauma-symptoms-and-perceived-stress-in-male-prison-inmates-through-the-transcendental-meditation-program-a-randomized-controlled-trial
#13
Sanford Nidich, Tom O'connor, Thomas Rutledge, Jeff Duncan, Blaze Compton, Angela Seng, Randi Nidich
CONTEXT: Trauma events are four times more prevalent in inmates than in the general public and are associated with increased recidivism and other mental and physical health issues. OBJECTIVE: To evaluate the effects of Transcendental Meditation (TM) on trauma symptoms in male inmates. DESIGN: One hundred eighty-one inmates with a moderate- to high-risk criminal profile were randomly assigned to either the TM program or to a usual care control group...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27673708/consideration-of-personal-adverse-childhood-experiences-during-implementation-of-trauma-informed-care-curriculum-in-graduate-health-programs
#14
Joshua Strait, Tiffany Bolman
CONTEXT: Scientific findings of adverse childhood experiences (ACEs) and their lifelong graded relationship with leading causes of death are well established. Many health care practitioners, however, have yet to implement ACEs screening in clinical practice. Furthermore, ACEs screening and trauma-informed care (TIC) are not part of standard graduate-level training. OBJECTIVE: To 1) implement trauma-informed curriculum for multiple graduate health programs, 2) determine student understanding of and willingness to address ACEs, and 3) assess the relationship between students voluntarily evaluating their individual ACE Score and their attitude toward ACEs and TIC...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27668451/her-glistening-eyes
#15
Ahmed Z Obeidat
No abstract text is available yet for this article.
2016: Permanente Journal
https://www.readbyqxmd.com/read/27644049/image-diagnosis-hemorrhagic-bullae-in-a-primary-varicella-zoster-virus-infection
#16
Cátia Canelas, João M Carvas, Cristiana Sevivas, Dina Carvalho
No abstract text is available yet for this article.
2016: Permanente Journal
https://www.readbyqxmd.com/read/27644048/trend-of-decreased-length-of-stay-in-the-intensive-care-unit-icu-and-in-the-hospital-with-palliative-care-integration-into-the-icu
#17
Eluned Mun, Clementina Ceria-Ulep, Lillian Umbarger, Craig Nakatsuka
CONTEXT: Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU? OBJECTIVE: Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS. DESIGN: A program was developed that followed recommendations from the Center to Advance Palliative Care's Improving Palliative Care in the ICU project...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27644047/integrated-research-and-the-garfield-memorial-national-research-fund-an-unobstructed-view
#18
Ed Thomas
The idea of integrated care has been discussed for many years. It is the belief of those supporting and managing the Garfield Memorial National Research Fund that a similar idea, integrated research, needs to be discussed and tested. This process begins with rethinking the proposal format. This article elaborates on the enhanced proposal format and presents powerful patient stories to demonstrate how integrated research can help deliver better patient care.
2016: Permanente Journal
https://www.readbyqxmd.com/read/27644046/a-general-pediatrics-and-integrative-medicine-approach-to-pervasive-refusal-syndrome-a-case-report
#19
Tido Von Schoen-Angerer, Elisabeth Helmschmidt, René Madeleyn, Reinhard Kindt, Christoph Möller, Gunver Sophia Kienle, Jan Vagedes
INTRODUCTION: Pervasive refusal syndrome (PRS) describes children with social withdrawal who become unable to walk, eat, or care for themselves. This case report examines whether an integrative medicine approach is useful for treating PRS. CASE PRESENTATION: A seven-year-old girl with symptoms most consistent with PRS and depression was admitted to a pediatric ward in Germany that integrates conventional pediatric and psychosomatic care with anthroposophic medicine...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27644045/standardizing-management-of-adults-with-delirium-hospitalized-on-medical-surgical-units
#20
Clay Angel, Kristen Brooks, Julie Fourie
CONTEXT: Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. OBJECTIVE: To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units...
2016: Permanente Journal
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