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Permanente Journal

Satvinder S Bakshi
No abstract text is available yet for this article.
July 19, 2018: Permanente Journal
Sarah Beekley
No abstract text is available yet for this article.
July 19, 2018: Permanente Journal
G Todd Alonso, Raquel Hink, Michael R De Georgeo, Katherine Vidal, Sarah Thomas, David Swaschnig, Gail Spiegel, Susan Owen, Jessica Thurston, Laura Pyle, Robert Slover
CONTEXT: Our pediatric diabetes center initiated insulin pump therapy for more than 250 patients with type 1 diabetes in 2014, but onboarding was inefficient. OBJECTIVE: To decrease time from the decision to initiate pump therapy to the ambulatory encounter after pump start (lead time) for new pump users from 132.5 days to less than 110 days within 5 months. DESIGN: Define, Measure, Analyze, Improve, Control method. We identified key problems: Long wait for training classes, unclear metrics, complicated scheduling, and nonstandardized processes...
July 12, 2018: Permanente Journal
Harry Bramley, Kathryn C Foley, Ronald Williams, Mechelle M Lewis, Lan Kong, Matthew Silvis
CONTEXT: Adolescent obesity and sports-related concussion are rising in prevalence, yet there is minimal research exploring the relationship between these two conditions. OBJECTIVE: To assess the impact of body mass index (BMI) percentile on duration of recovery and reported symptoms after sports-related concussion in adolescents. DESIGN: Retrospective chart review at a regional concussion program located at an academic medical center. Medical records of all patients aged 13 to 18 years treated from March 2006 through January 2012 were reviewed...
July 12, 2018: Permanente Journal
Antonette A Ajayi, Stephanie V Commins, David E Clarke
INTRODUCTION: Angiosarcomas are rare, malignant vascular tumors that affect endothelial cells of blood vessels. Angiosarcomas most commonly occur on the scalp or face of elderly individuals and are highly aggressive, with a 5-year survival rate below 15%. Cutaneous angiosarcomas often metastasize to the lung, where they can present with cystic lesions, solid lesions, pneumothorax, and/or hemothorax. CASE PRESENTATION: We report the case of an 83-year-old woman who presented with a scalp lesion, which was initially thought to be caused by scalp trauma but was later found to be an angiosarcoma...
July 5, 2018: Permanente Journal
Jakub Sikora-Klak, Steven J Narvy, Justin Yang, Eric Makhni, F Daniel Kharrazi, Nima Mehran
Vitamin D is a lipophilic prohormone integral to musculoskeletal, autoimmune, oncologic, cardiovascular, and mental health. Of particular importance to the orthopedic surgeon is the role of vitamin D in the regulation of bone mass, muscle strength, and physical performance. Although vitamin D-related skeletal pathologies are rare in industrialized nations, emerging research in the field has shown that most American adults have inadequate levels of vitamin D. Even among athletes, there is a high prevalence of vitamin D deficiency, which may place competitors at risk of stress fractures, illness, and delayed muscle recovery...
July 5, 2018: Permanente Journal
Fred Kleinsinger
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions such as diabetes or hypertension. This nonadherence to prescribed treatment is thought to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year. Despite this, the medical profession largely ignores medication nonadherence or sees it as a patient problem and not a physician or health system problem...
July 5, 2018: Permanente Journal
Ramez Awad, Juan Camilo Barreto Andrade, Heba Mousa, Fade Mahmoud
INTRODUCTION: Basal cell carcinoma (BCC) is the most common skin cancer. It is primarily a local disease, and it very rarely causes metastatic disease. Chemotherapeutic agents had limited success in management of metastatic disease until the introduction of vismodegib. In this case report, we describe the presentation of a metastatic BCC that was not amenable to surgical resection or local treatment options and was treated successfully with vismodegib. CASE PRESENTATION: A 69-year-old white man was referred to our surgical clinic for evaluation of an erosive left shoulder lesion...
June 28, 2018: Permanente Journal
Tan Duong, Shahin Shahbazi, Sung Lee
INTRODUCTION: Endogenous endophthalmitis is a rare condition that is caused by hematogenous spread of bacteria or fungi and is usually seen in patients with predisposed medical conditions. We are reporting an unusual case of group A streptococcal infection causing endogenous endophthalmitis and septic arthritis in a healthy 42-year-old man. CASE PRESENTATION: A previously healthy 42-year-old man presented to the Emergency Department with chills, fever, left wrist pain, left eye pain, and vision loss...
June 26, 2018: Permanente Journal
Richard Bruce Hovey, Valerie Curro Khayat, Eugene Feig
This article explores the efficacy of writing and reading poetry as a means to help people living with chronic pain to explore and express their narratives in their own unique way. Throughout our narrative we have interwoven poems from Eugene Feig, one of the authors of this article. His poetry is sent out almost weekly to the members of our pain support group as a method of sharing his own experiences of living with pain, as well as to support and to inspire hope in others. The style of poetry we are presenting is that of a person who is not knowledgeable about poetry in a formal sense but who has an understanding of how it has helped him learn to live with his own chronic pain and suffering...
June 25, 2018: Permanente Journal
Mitsuro Chiba, Kunio Nakane, Tsuyotoshi Tsuji, Satoko Tsuda, Hajime Ishii, Hideo Ohno, Kenta Watanabe, Mai Ito, Masafumi Komatsu, Koko Yamada, Takeshi Sugawara
CONTEXT: No known published study has focused on a plant-based diet (PBD) in the treatment of ulcerative colitis (UC). OBJECTIVE: To investigate relapse prevention in UC after consumption of a PBD during educational hospitalization in Japan. DESIGN: Prospective study of patients with mild UC or UC in remission who did not need immediate treatment. A PBD and dietary guidance were provided during a two-week hospitalization. MAIN OUTCOME MEASURES: The primary end point was relapse (a flare-up that required more aggressive treatment) during the follow-up period...
June 21, 2018: Permanente Journal
Sara Dawoud, Rachele J Solomon, Stephanie A Eyerly-Webb, Neil A Abrahams, Fernando Pedraza, Juan D Arenas, Tjasa Hranjec
Xanthogranulomatous inflammation, characterized by destruction and replacement of tissues with chronic inflammatory cells, including foamy histiocytes and hemosiderin-laden macrophages, is uncommon. In patients with xanthogranulomatous pyelonephritis, inflammation may extend from the kidney to the overlying duodenum, creating a pyeloduodenal fistula that further complicates medical and surgical management. We present two cases with recurrent kidney infections who each ultimately received a nephrectomy and repair of their duodenal fistula...
June 20, 2018: Permanente Journal
Seena Safavy, Emmanuel Mitsinikos, Bradford Tropea, Allen Chang, Hetal Patel
INTRODUCTION: Inguinoscrotal bladder hernia is a very rare pathology, occurring in up to 4% of all inguinal hernias in the general population. We present a case of an inguinoscrotal bladder hernia causing obstructive uropathy and sepsis. CASE PRESENTATION: A 59-year-old obese man presented with left-sided flank and abdominal pain that radiated to his left groin. On initial clinical examination, there was no evidence of an inguinal hernia. A computed tomography scan revealed a left inguinoscrotal bladder hernia with associated left-sided upper tract urinary obstruction...
June 18, 2018: Permanente Journal
Puneet Chhabra, Hunny Khurana
No abstract text is available yet for this article.
June 18, 2018: Permanente Journal
Aparna Sai Ajjarapu, Ann Broderick
An estimated 1.5 billion people across the globe live with chronic pain, and an estimated 61 million people worldwide experience unrelieved serious health-related suffering. One-sixth of the global population lives in India, where approximately 10 million people endure unrelieved serious health-related suffering. The state of Kerala is home to Pallium India, one of the most sophisticated palliative care programs in the country. This private organization in Trivandrum provides palliative and hospice care to underresourced populations and emphasizes holistic pain treatment...
June 14, 2018: Permanente Journal
Scott Abramson
No abstract text is available yet for this article.
June 11, 2018: Permanente Journal
Elizabeth B Blankenship, Mary Elizabeth Goff, Jinging Yin, Zion Tsz Ho Tse, King-Wa Fu, Hai Liang, Nitin Saroha, Isaac Chun-Hai Fung
INTRODUCTION: Social media platforms are important channels through which health education about the utility and safety of vaccination is conducted. OBJECTIVE: To investigate if tweets with different sentiments toward vaccination and different contents attract different levels of Twitter users' engagement (retweets). METHODS: A stratified random sample (N = 1425) of 142,891 #vaccine tweets (February 4, 2010, to November 10, 2016) was manually coded...
June 11, 2018: Permanente Journal
Sarah M Greene, Susan Brandzel, Karen J Wernli
The Patient-Centered Outcomes Research Institute (PCORI) in Washington, DC, has catalyzed a meaningful shift in the composition of research project teams since its initial research funding cycle in 2011. Despite the influx of funding in the research community for patient-centered research, research on how to effectively engage patients and stakeholders in the research process is still relatively nascent. Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle, WA, was an early recipient of PCORI research funding and, as of December 2017, has received 8 PCORI research awards totaling nearly $15 million...
June 6, 2018: Permanente Journal
Leif I Solberg, Kris A Ohnsorg, Emily D Parker, Robert Ferguson, Sanne Magnan, Robin R Whitebird, Claire Neely, Emily Brandenfels, Mark D Williams, Mark Dreskin, Todd Hinnenkamp, Jeanette Y Ziegenfuss
INTRODUCTION: There are few proven strategies to reduce the frequency of potentially preventable hospitalizations and Emergency Department (ED) visits. To facilitate strategy development, we documented these events among complex patients and the factors that contribute to them in a large care-improvement initiative. METHODS: Observational study with retrospective audits and selective interviews by the patients' care managers among 12 diverse medical groups in California, Minnesota, Pennsylvania, and Washington that participated in an initiative to implement collaborative care for patients with both depression and either uncontrolled diabetes, uncontrolled hypertension, or both...
June 4, 2018: Permanente Journal
Carina Mendoza
This article defines empathy as the conveyed expression of awareness, understanding, and sensitivity to the experiences, feelings, and emotions of a patient with a medical condition. This article is a reflective short story addressing empathy through the eyes of Maria (a fictitious patient), who is confronted with the challenges of negotiating her first encounter at a medical facility, and through the actions of Dr Jones (a fictitious physician) who, at a critical juncture, fails to engage empathically with her patient donning the ubiquitous hospital gown...
May 30, 2018: Permanente Journal
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