The Permanente journal最新文献

A Challenging Case of Eosinophilic Fasciitis Without Classic Histopathological Findings.

The Permanente journal Pub Date : 2025-02-03 DOI: 10.7812/TPP/24.124

Cristo Armando Carrasco Mendoza, Alexander Rolando Gomez-Lara, Brian Matthew Kleker

{"title":"A Challenging Case of Eosinophilic Fasciitis Without Classic Histopathological Findings.","authors":"Cristo Armando Carrasco Mendoza, Alexander Rolando Gomez-Lara, Brian Matthew Kleker","doi":"10.7812/TPP/24.124","DOIUrl":"https://doi.org/10.7812/TPP/24.124","url":null,"abstract":"Eosinophilic fasciitis (EF) is a rare dermatologic disease with clinical similarities to localized scleroderma and systemic sclerosis (SSc). Diagnosing EF is challenging due to overlapping clinical features among these conditions. Differentiating EF from localized scleroderma and SSc can be aided by laboratory tests, histopathological examination, and imaging studies. The diagnosis of EF specifically requires the exclusion of SSc and typically requires magnetic resonance imaging or en bloc fascial biopsy of affected areas. Here, the authors present a 75-year-old woman with a painful, violaceous rash on the legs and abdomen, leg swelling, and tightness around her upper abdomen. Review of systems revealed decreased appetite, unintentional weight loss, and shortness of breath on exertion. Physical examination showed a faint violaceous rash on the abdomen and legs as well as abdominal distention. The patient's clinical picture was complicated by worsening of the rash, development of chronic cough, continued unintentional weight loss, decreased appetite, early satiety, dry eyes, and dry mouth. An autoimmune process was considered, and the patient was seen by rheumatology, where an appropriate workup excluded localized scleroderma and SSc. EF was suspected and supported by magnetic resonance imaging findings showing fascial edema. En bloc fascial biopsy of the right thigh did not reveal classic EF findings.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Role of the Veterans Health Administration's LGBTQ+ Veteran Care Coordinators in Facilitating Care for Transgender and Gender-Diverse Veterans. 退伍军人健康管理局的 LGBTQ+ 退伍军人护理协调员在促进变性和性别多样化退伍军人护理方面的作用》（Veterans Health Administration's LGBTQ+ Veteran Care Coordinators in Facilitating Care for Transgender and Gender-Diverse Veterans.

The Permanente journal Pub Date : 2025-01-28 DOI: 10.7812/TPP/24.161

Joy L Lee, Claire E Donnelly, Adam T Hirsh, Michael Weiner, Heather A Sperry, Masheka R Fuqua, Diana Natividad, Marianne S Matthias

{"title":"Role of the Veterans Health Administration's LGBTQ+ Veteran Care Coordinators in Facilitating Care for Transgender and Gender-Diverse Veterans.","authors":"Joy L Lee, Claire E Donnelly, Adam T Hirsh, Michael Weiner, Heather A Sperry, Masheka R Fuqua, Diana Natividad, Marianne S Matthias","doi":"10.7812/TPP/24.161","DOIUrl":"https://doi.org/10.7812/TPP/24.161","url":null,"abstract":"Introduction: Transgender and gender-diverse (TGD) individuals frequently encounter discrimination in health care settings. The Veterans Health Administration (VA) is committed to addressing the health disparities experienced by TGD veterans. The purpose of this study was to explore the experiences of TGD veterans with LGBTQ+ veteran care coordinators.Methods: The authors conducted semi-structured interviews with TGD veterans with depression between January and March 2022. Participants were recruited with assistance from the VA's network of LGBTQ+ veteran care coordinators. Interviews were recorded, transcribed, and analyzed.Results: Twenty-six TGD veterans participated in the study, with a range of experiences, both positive and negative, with LGBTQ+ veteran care coordinators. Veterans spoke of the role of coordinators in educating both patients and clinicians about TGD health care needs. Participants who expressed dissatisfaction with their coordinators highlighted the need for a clearer definition and communication of coordinator duties.Conclusions: This study highlights the important roles played by the VA LGBTQ+ care coordinators in addressing the needs of TGD veterans. The study also points to an immense need for clinician education in TGD care. Further training and education are recommended to improve equitable care for TGD veterans.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Psychotic-Spectrum Disorders With Comorbid Anxiety are Predisposing Factors for Parkinson's Disease in a Case-Control Study. 在一项病例对照研究中，伴有焦虑的精神障碍是帕金森病的诱发因素。

The Permanente journal Pub Date : 2025-01-12 DOI: 10.7812/TPP/24.131

Anna Shvartsur, Kelli Peterman, Nirmala D Ramalingam, Roy Eyal, Suketu Khandhar, Michel Medina, Matthew E Hirschtritt

{"title":"Psychotic-Spectrum Disorders With Comorbid Anxiety are Predisposing Factors for Parkinson's Disease in a Case-Control Study.","authors":"Anna Shvartsur, Kelli Peterman, Nirmala D Ramalingam, Roy Eyal, Suketu Khandhar, Michel Medina, Matthew E Hirschtritt","doi":"10.7812/TPP/24.131","DOIUrl":"10.7812/TPP/24.131","url":null,"abstract":"Background: Multiple studies have demonstrated associations between psychiatric conditions and Parkinson's disease (PD) development; fewer have examined psychotic-spectrum disorders and PD development.Objective: The objective was to assess the prevalence of psychotic-spectrum disorders with and without depression and anxiety preceding a PD diagnosis.Methods: In this retrospective, case-control study of adults > 60 years of age, cases were identified by PD diagnosis and controls were identified in a 3:1 ratio by ambulatory encounter from 2015 to 2020. Psychiatric conditions were identified by diagnosis code up to 5 years prior to the index date. Conditional logistic regression was conducted to assess associations.Results: Among 13,998 patients, the odds of PD were 76% (95% confidence interval = 1.39-2.22) higher among those with psychotic-spectrum diagnoses. An additional anxiety diagnosis was associated with 166% (95% confidence interval = 1.35-5.25) higher odds of PD.Conclusions: Awareness of psychiatric conditions, including psychotic-spectrum disorders with comorbid anxiety, can stratify individuals at higher risk of developing PD.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Survey of Orthopedic Surgeons' Perceptions of Adopting an Initiative With Cemented Hip Hemiarthroplasties for Fractures. 骨科医生对主动采用骨水泥髋关节半关节置换术治疗骨折的看法调查。

The Permanente journal Pub Date : 2024-12-27 DOI: 10.7812/TPP/24.140

Ivette T Curiel, Ronald A Navarro, Norman W Gill

{"title":"Survey of Orthopedic Surgeons' Perceptions of Adopting an Initiative With Cemented Hip Hemiarthroplasties for Fractures.","authors":"Ivette T Curiel, Ronald A Navarro, Norman W Gill","doi":"10.7812/TPP/24.140","DOIUrl":"https://doi.org/10.7812/TPP/24.140","url":null,"abstract":"Introduction: Hip hemiarthroplasty is a surgical procedure that requires the adhesion of the prosthetic implant by utilizing a fixation technique, either cemented or noncemented. The current literature does not provide a clear recommendation on a superior technique, although many countries outside the US have guidelines recommending cemented over noncemented procedures. Further, surgeon perceptions and beliefs related to the cemented and noncemented techniques in hip arthroplasty fractures are generally unknown.Methods: Orthopedic surgeon leaders adopted a quality assurance initiative to increase the rate of cemented cases within their practice. A survey was developed to capture the surgeons' perceptions related to fixation technique, affordability, and potential barriers and facilitators. Likert scale data were analyzed with descriptive statistics and chi-square tests.Results: Sixty-one total joint surgeons throughout 13 locations were invited to participate in the study via email. A total of 38 of the 61 total joint surgeons completed the survey, representing a 62% response rate. Most responses were neutral or disagreed with the use of cement for femoral fixation in hemiarthroplasty.Conclusion: Although some questions elicited strong opinions, many surgeons expressed hesitancy to change their current fixation technique and their desire for autonomy within their clinical practices. However, the large number of neutral responses suggests the potential to engage, educate, and shift the surgeons' perception to adopt the quality assurance initiative and increase the rate of cemented cases.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Erratum to Vitamin D Deficiency-Associated Neuropathic Pain Examined in a Chronic Pain Management Program. 在慢性疼痛管理计划中对维生素 D 缺乏相关神经性疼痛的研究》的勘误。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-09-20 DOI: 10.7812/TPP/24.152

引用次数: 0

Using Panel Management to Identify Adult Patients With High-Risk Metabolic Dysfunction-Associated Steatotic Liver Disease/Metabolic Dysfunction-Associated Steatohepatitis Fibrosis in a Primary Care Clinic: A Pilot Study. 在初级保健诊所中使用面板管理识别高风险代谢功能障碍相关性脂肪肝/代谢功能障碍相关性脂肪性肝炎纤维化的成人患者：一项试点研究。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-10-24 DOI: 10.7812/TPP/24.094

Sarah Householder, Andrew J Loza, Vikas Gupta, Benjamin R Doolittle

{"title":"Using Panel Management to Identify Adult Patients With High-Risk Metabolic Dysfunction-Associated Steatotic Liver Disease/Metabolic Dysfunction-Associated Steatohepatitis Fibrosis in a Primary Care Clinic: A Pilot Study.","authors":"Sarah Householder, Andrew J Loza, Vikas Gupta, Benjamin R Doolittle","doi":"10.7812/TPP/24.094","DOIUrl":"10.7812/TPP/24.094","url":null,"abstract":"Background: As rates of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) rise, national organizations have released new guidance for primary care-driven detection of patients with advanced fibrosis who are most likely to have clinically relevant morbidity. Yet time constraints, workflow, and practitioner awareness limit integration of risk identification into clinical care.Materials and methods: At the authors' primary care clinic, they implemented a panel management strategy that utilized the electronic health record to identify patients older than 35 years of age at risk for MASLD fibrosis with abnormal Fibrosis-4 (Fib-4) scores. Using a proactive model, these patients were offered elastography-based screening and follow-up appointments focused on metabolic health, with referrals to subspecialty care when indicated.Results: Of 855 patients older than 35 years of age, 384 were identified as having risk factors for MASLD/MASH. Of these, 53 had abnormal Fib-4 scores with no prior work-up; 29 patients consented to a shear wave elastography; 16 underwent shear wave elastography; and 6 had moderate or high results concerning for at-risk fibrosis. Twenty patients attended MASLD-focused appointments. Reluctance to pursue testing was driven by skepticism surrounding preventative medicine, perceived cost, and desire to focus on other medical problems, some of which were life-limiting.Conclusion: Panel management represents a scalable strategy to quickly identify patients in primary care most likely to experience complications from MASLD/MASH and provides a targeted intervention to direct further management. Limitations include access to care, medical complexity, and patient acceptance.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"38-47"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Evaluation of the Cannabis-Using Patient: A Moving Target. 对使用大麻患者的临床评估：一个移动的目标。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-10-28 DOI: 10.7812/TPP/24.088

Sina Radparvar

{"title":"Clinical Evaluation of the Cannabis-Using Patient: A Moving Target.","authors":"Sina Radparvar","doi":"10.7812/TPP/24.088","DOIUrl":"10.7812/TPP/24.088","url":null,"abstract":"The prevalence of cannabis use has been increasing among both adolescents and adults worldwide. New trends in cannabis legalization and enhanced social media marketing have led to the availability of multiple high-potency cannabis products with hundreds of new and powerful delivery systems. Over the last decade, there have been drastic changes in cannabis formulations, potency, routes of consumption, and device technology, with increased complexity and sophistication among growers, suppliers, and consumers. Patterns of cannabis use among patients can have important clinical implications, including acute neurocognitive effects, chronic multiorgan toxicity, psychiatric, behavioral, social, and economic impact. However, assessment of medical or surgical patients who use cannabis either recreationally or problematically has become challenging for the clinician due to the changing patterns of cannabis consumption. This review provides information on the clinical evaluation of patients who use cannabis in a problematic fashion, with the focus on tetrahydrocannabinol. It provides the clinician with knowledge regarding cannabis terminology, sources, pharmacology, routes of administration, formulations, dosing, and toxicities. Using these components, an assessment approach for diagnosing cannabis use disorder is synthesized at the conclusion of the article.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"77-86"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Immunoglobulin A Nephropathy: A Review. 免疫球蛋白 A 肾病：综述。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-11-05 DOI: 10.7812/TPP/24.089

Sulaiman Aseem, Sijie Zheng

引用次数: 0

Introduction to Issue 28:4 by the Editor-in-Chief. 主编对第28:4期的介绍。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-12-13 DOI: 10.7812/TPP/24.188

G Richard Holt

引用次数: 0

Relativity, Rank, and the US News Health's Cardiology, Heart, and Vascular Surgery Best Hospitals. 相对性、排名以及 US News Health 的心脏病学、心脏和血管外科最佳医院。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-10-21 DOI: 10.7812/TPP/24.116

Alexandra Kats, Gordon H Morewood, George Moser, Eric Wilkens, Huaqing Zhao, Abul Kashem, Yoshiya Toyoda, Suyog Mokashi

{"title":"Relativity, Rank, and the US News Health's Cardiology, Heart, and Vascular Surgery Best Hospitals.","authors":"Alexandra Kats, Gordon H Morewood, George Moser, Eric Wilkens, Huaqing Zhao, Abul Kashem, Yoshiya Toyoda, Suyog Mokashi","doi":"10.7812/TPP/24.116","DOIUrl":"10.7812/TPP/24.116","url":null,"abstract":"Objective: Virtually anything can be ranked; the US News and World Report (USNWR or US News) ranks the top 50 hospitals specializing in cardiology, heart, and vascular surgery. Here the authors propose validating the effectiveness of rankings by comparing differences among the USNWR metrics across the top 50 hospitals.Methods: The ranking system for the top 50 hospitals specializing in cardiology, heart, and vascular surgery was derived from 16 variant scores. Each hospital's scores were collected from the USNWR. Hospitals were categorized into quintiles consisting of 10 institutions (1-10, 11-20, etc). An analysis of variance/χ2 comprehensive statistical analysis was run alongside a Wilcoxon/Kruskal-Wallis test to compare statistical outcomes. A significant threshold was deemed to be P < 0.05.Results: Significant differences were noted between quintiles for advanced technologies (P = 0.05), US News specialty score (P < 0.001), number of patient referrals (P = 0.004), and expert opinion (P < 0.001). Non-statistically significant differences were found among patient experience, public transparency, Society of Thoracic Surgery transparency, American College of Cardiology transparency, recognition as a magnet hospital, and nursing staffing. Interestingly, a large variance was noted in the average number of referrals between the first quintile (13,371) and the last (6690).Conclusions: Expert opinion plays a critical role in the reputation of the USNWR's top 10 hospitals in cardiology, heart, and vascular surgery. Although many have argued about the merits of USNWR hospital rankings, taken together, rankings fill a strong customer demand and are sticky.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"48-56"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0