The Permanente journal最新文献

{"title":"Comparative Effectiveness of Text + Video vs Text Alone to Prompt Stool-Based Testing for Colorectal Cancer Screening.","authors":"Amanda F Petrik, David Mosen, Christine Singh, Priyanka Gautom, John F Dickerson, Elizabeth Shuster, Michalah K Tandy, Jessica K Gonzalez, Annie Thibault, Jamie H Thompson, Gloria D Coronado","doi":"10.7812/TPP/25.069","DOIUrl":"https://doi.org/10.7812/TPP/25.069","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths in the United States. Screening for CRC can be accomplished by mailed fecal immunochemical testing (FIT) outreach. Text-based mailed FIT outreach reminders have been shown to improve FIT return rates, but research is lacking in determining if the addition of instructional videos to text messages could boost FIT return.</p><p><strong>Methods: </strong>The study took place at Kaiser Permanente Northwest. Eligible patients included those 45-75 years old who were due or becoming due for CRC screening. Patients were randomized into 2 groups: 1) text alone: received a standard written text message only, and 2) text + video: received a standard written text and a link to a short instructional video. Patient demographic data, including age, sex, CRC screening status, language, race and ethnicity, and length of Health Plan enrollment, were collected. Cox regression analysis was used to compare completion of FIT 90 and 180 days after randomization between both groups.</p><p><strong>Results: </strong>A total of 12,346 patients were included in this study, with 6156 randomized in the text alone group and 6190 in the text + video group. Patient demographic data were nearly identical in both groups. No differences were found in the FIT return rates between the text alone group (reference) vs text + video group at 90 days (hazard ratio, 1.02; 95% CI, 0.96-1.07; <i>P</i> = .54) and 180 days (hazard ratio, 1.00; 95% CI, 0.96-1.06; <i>P</i> = .78).</p><p><strong>Conclusions: </strong>Future research should determine ways of assessing patients' receipt of video + text messages to optimize the effectiveness of text message outreach for CRC.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213845","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}

{"title":"Electrocardiogram Diagnosis: ST-Depression With T Wave Inversion in Lead Augmented Vector Left as Harbinger of Inferior ST-Elevation Myocardial Infarction.","authors":"Grace V Heringer, Cole J Florio, Aidan R Campbell, David R Vinson, Joel T Levis","doi":"10.7812/TPP/25.093","DOIUrl":"https://doi.org/10.7812/TPP/25.093","url":null,"abstract":"<p><p>A 53-year-old male presented to the emergency department (ED) after waking up with retrosternal chest discomfort. An initial prehospital 12-lead electrocardiogram (ECG) obtained by emergency medical services indicated sinus rhythm with ST-segment depression and T wave inversion in lead augmented vector left (aVL) but without significant ST-segment elevations. Upon ED arrival, a repeat ECG demonstrated minimal ST-segment elevation in the inferior leads, raising concern for an evolving inferior ST-segment elevation myocardial infarction (STEMI) and prompting cardiac catheterization laboratory activation. A repeat ECG obtained 18 minutes after the initial ED ECG confirmed acute inferior STEMI. Coronary angiography revealed 70% ulcerated stenosis in the mid right coronary artery (RCA) and 100% thrombotic occlusion of the distal RCA. Successful percutaneous coronary intervention to the occluded RCA was undertaken with restoration of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. The patient was discharged on hospital day 3. This case underscores the significance of reciprocal changes in lead aVL as an early marker of inferior STEMI, as well as the importance of serial ECGs and timely intervention to optimize patient outcomes in acute coronary syndrome.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193159","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}

{"title":"Peripandemic Utilization of Primary Anterior Cruciate Ligament Reconstruction in a United States-Based Integrated Health Care System, 2017-2023.","authors":"Hansel E Ihn, Heather A Prentice, Gregory B Maletis","doi":"10.7812/TPP/25.061","DOIUrl":"https://doi.org/10.7812/TPP/25.061","url":null,"abstract":"<p><strong>Introduction: </strong>Prior studies reporting the utilization of anterior cruciate ligament reconstruction (ACLR) was limited to pediatric populations or lacked accounting for the impact of the COVID-19 pandemic. In this study, the authors sought to compare the annual incidence of primary ACLR following the COVID-19 pandemic shutdown to see if utilization has rebounded to pre-pandemic levels.</p><p><strong>Methods: </strong>The number of ACLRs performed per year from 2017 through 2023 was identified from the authors' health care system's ACLR interregional registry, and average membership per year was identified from membership records. Incidence rates per 100,000 members were calculated for each year. Poisson regression was used to evaluate year-to-year trends overall and across graft selection, age, and gender. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) are presented.</p><p><strong>Results: </strong>In total, 23,082 ACLRs were performed from 2017 to 2023. Pre-pandemic, annual ACLR incidence increased from 47.0 per 100,000 in 2017 to 50.2 in 2019. During the pandemic (2020), this dropped by 33.9% to 33.2 per 100,000 (IRR, 0.66; 95% CI, 0.63-0.70). Post-pandemic, annual incidence increased from 38.6 to 42.3 per 100,000 from 2021 to 2023, respectively (2020 to 2021: IRR, 1.16; 95% CI, 1.10 -1.23; 2021 to 2022: IRR, 1.11; 95% CI, 1.06-1.16). However, this was still lower than the pre-pandemic incidence. In both genders, patients in the pediatric age groups had the biggest declines during the shutdown (drop off of 57% in the 10- to 14-year-old group and 40% in the 15- to 19-year-old group).</p><p><strong>Discussion: </strong>The COVID-19 pandemic shutdown of elective orthopedic procedures led to a sharp drop in the numbers of ACLRs performed, and the United States is still in the recovery period.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138717","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}

{"title":"Increasing Access to Immediate Postpartum Long-Acting Reversible Contraception on Pregnancy and Contraceptive Outcomes in Patients Seeking Permanent Contraception Postpartum.","authors":"Rebecca Tsai, Elijah Wade, Lue-Yen S Tucker, Cynthia Triplett, Karrie Murphy","doi":"10.7812/TPP/24.172","DOIUrl":"https://doi.org/10.7812/TPP/24.172","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the impact of increasing access to immediate postpartum (IPP) long-acting reversible contraceptions (LARCs) on pregnancy and contraceptive outcomes in patients that desired permanent contraception prior to delivery.</p><p><strong>Methods: </strong>This retrospective cohort study compared patients aged <u>></u> 18 years at gestational age 24 weeks 0 days and above, who desired permanent contraception before and after an organization-wide intervention to increase access to IPP LARCs. The authors collected demographic information, birth control method documented at discharge, LARC usage within 3 months of delivery, LARC type, and unintended pregnancy 1 year after delivery. Patients specified whether their pregnancies were unintended at time of first pregnancy-related care. Patients who obtained permanent contraception during their delivery encounter were excluded. Mann-Whitney and χ² tests were used to assess group differences.</p><p><strong>Results: </strong>The authors reviewed 1607 patient records (846 preintervention; 761 postintervention). The cohorts were similar in age, body mass index, parity, and gestational age at delivery. Out of the 846 preintervention patients, 183 (22%) underwent LARC placement (39 [21%] arm implant; 144 [79%] intrauterine device), and 16 (1.9%) patients had a 1-year interval unintended pregnancy. Out of the 761 postintervention patients, 190 (25%) underwent LARC placement (54 [28%] arm implant; 136 [72%] intrauterine device), and 7 (0.9%) patients had a 1-year interval unintended pregnancy.</p><p><strong>Discussion: </strong>With increased access to IPP LARCs, patients who did not obtain desired permanent contraception were more likely to utilize LARCs at 3 months postpartum and less likely to have another pregnancy within 1 year.</p><p><strong>Conclusion: </strong>Patients unable to receive requested postpartum permanent contraception appear to benefit from increased access to IPP LARCs.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125806","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}

{"title":"A Brief Review of the Mediterranean Diet's Role in Mediating Inflammation and in Management of Rheumatoid Arthritis.","authors":"John L Chen, H Nicole Tran, Lucy Liu","doi":"10.7812/TPP/25.038","DOIUrl":"https://doi.org/10.7812/TPP/25.038","url":null,"abstract":"<p><p>The Mediterranean diet (MD) is a dietary pattern for which the health benefits in prevention of cardiovascular disease, cancer, and metabolic disorders have been well-substantiated. However, emerging clinical literature has shown its promise in reducing risk and disease activity in many autoimmune diseases. This review focuses on literature about components of the MD and their role in modulating inflammatory pathways implicated in autoimmune disease. This review also focuses on literature assessing the MD's associations with clinical outcomes in rheumatoid arthritis (RA), a systemic autoimmune condition primarily affecting one's joints. The core components of the MD (such as whole grains, fish, olive oil, yogurt, cheese, and moderate red wine consumption) have been seen to reduce laboratory and clinical markers of inflammation through a number of mechanisms. Recent population-based cohort studies and randomized clinical trials have been more equivocal in their findings. This suggests that although the MD may have statistically significant impacts on RA risk and symptom severity, these effects are of uncertain clinical significance. This highlights the ongoing need for high-quality clinical research on lifestyle interventions in RA and other autoimmune diseases, along with the continued importance of emphasizing lifestyle-based interventions in the management of chronic disease.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114105","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}

{"title":"Spirituality in Serious Illness Education: A Narrative Review of Medical School Curricula From 2000 to 2024.","authors":"Luke Okamuro, Meachelle Lum, January Turner, Christine Liu, Janet Ma, Christopher Ahn, Bethia Kwok, David Larson, Andre Cipta","doi":"10.7812/TPP/25.009","DOIUrl":"https://doi.org/10.7812/TPP/25.009","url":null,"abstract":"<p><strong>Introduction: </strong>Spirituality is increasingly recognized as an integral component of patient-centered care in serious illness. Despite substantial evidence supporting its benefits, the integration of spiritual care into medical education remains inconsistent. This narrative review examines how spiritual care is incorporated into serious illness curricula in medical schools and evaluates its impact on student learning.</p><p><strong>Methods: </strong>Articles published between 2000 and 2024 describing medical school curricula addressing spiritual care in palliative care, serious illness, hospice, or end-of-life care were reviewed. Studies were categorized using the Kirkpatrick 4-tier framework to evaluate educational outcomes.</p><p><strong>Results: </strong>Among the 1974 studies screened, 85 met the inclusion criteria. Of these, 31 (36.5%) explicitly mentioned spirituality as part of the curricula. Only 16 studies (18.8%) assessed student growth in spiritual care competencies, focusing primarily on student reactions (n = 9), followed by changes in self-reported efficacy (n = 5), knowledge gains (n = 2), and skill gains (n = 1).</p><p><strong>Conclusion: </strong>Despite evidence linking spirituality to improved health outcomes in serious illness, spiritual care remains underrepresented in medical school curricula. Substantial variability in teaching methods and assessment strategies highlights the need for structured, evidence-informed frameworks to better prepare future physicians to address the spiritual needs of patients facing serious illness.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087313","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}

{"title":"Surgeon Learning Curve With Selection of New Total Knee Arthroplasty Implants and Risk of Revision: A Registry-Based Cohort Study.","authors":"Tesfaye H Leta, Brian H Fasig, Adrian D Hinman, Nithin C Reddy, Matthew P Kelly, Elizabeth W Paxton, Heather A Prentice","doi":"10.7812/TPP/25.017","DOIUrl":"https://doi.org/10.7812/TPP/25.017","url":null,"abstract":"<p><strong>Introduction: </strong>Prior studies have reported learning curves as surgeons adopt new technology/techniques. The authors sought to evaluate revision risk following primary total knee arthroplasty (TKA) to assess whether a learning curve was observed as surgeons transitioned to 1) a new implant from the same manufacturer and 2) a new implant from a new manufacturer.</p><p><strong>Methods: </strong>Patients ≥ 18 years of age who underwent primary fixed bearing, posterior stabilized, fully cemented TKA with patella resurfacing were identified using a US integrated health care system's total joint replacement registry (2009-2023). The exposure groups were categorized in these groups: baseline implant (reference), first 50 TKA with new implant (≤ 50), second 50 (51-100), third 50 (101-150), and the remainder (> 150). A multiple Cox proportional hazard regression was used to evaluate revision risk with adjustment for confounders.</p><p><strong>Results: </strong>The intra-manufacturer cohort comprised 42,743 TKA. A higher revision risk was observed for the ≤ 50 group compared to the baseline group (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.01-1.86); no other differences were observed after the first 50 TKA (51-100: HR, 0.98; 95% CI, 0.71-1.34; 101-150: HR, 0.95; 95% CI, 0.69-1.32; > 150: HR, 0.99; 95% CI, 0.79-1.34). However, the association was no longer significant after excluding the TKA performed with the Attune fixed bearing tray, which has been associated with a higher risk of revision in the total joint replacement registry. The inter-manufacturer cohort comprised 19,817 TKA. No differences were observed when comparing a new manufacturer to the baseline manufacturer.</p><p><strong>Discussion: </strong>Surgeons should be cautious for the first several TKA when transitioning to a new implant given the relationship between surgeon and implant on revision risk.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070345","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}

{"title":"Long-Term Survivor of Laryngeal Small Cell Neuroendocrine Carcinoma.","authors":"Melisa Bayrak, Laura Wright Powers, Juliana Robledo, Jay Ferrell","doi":"10.7812/TPP/24.182","DOIUrl":"10.7812/TPP/24.182","url":null,"abstract":"<p><p>Small cell neuroendocrine carcinoma (SCNC) of the larynx is an exceptionally rare subset of laryngeal carcinoma with a clinically aggressive course and poor prognosis. Long-term survival is rare, and treatment strategies remain nonstandardized due to limited data. In this report, the authors present a case of a 51-year-old male who presented with stage IVa laryngeal SCNC and no distant metastasis, treated with a combination of platinum-based chemotherapy and radiation, who has survived for more than 5 years. This case represented 1 of few reported instances of extended disease-free survival in laryngeal SCNC, highlighting the potential benefit of aggressive multimodal treatment, even in advanced-stage disease. In addition to diagnosis and management, this case may prompt further discussion about the role of surgery in select patients and the need for individualized, patient-centered survivorship care for management of posttreatment sequalae. Although limited to a single case, these findings underscore the need for further research into effective treatment and surveillance strategies for this rare malignancy.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12485241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485850","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}

{"title":"Comparing Care Delivery Efficiency Between Emergency Department and Oncology Urgent Care.","authors":"Arthur S Hong, Sadaf Charania, Angela Bazzell, Mark Courtney, John W Sweetenham, Jason Fleming, Simon J Craddock Lee, Ethan A Halm","doi":"10.7812/TPP/24.195","DOIUrl":"10.7812/TPP/24.195","url":null,"abstract":"<p><strong>Introduction: </strong>Adults often visit the emergency department (ED) for complications from cancer treatment. Oncology urgent care clinics (UCCs) can manage nonemergent issues, but little is known about how UCC care compares with ED care.</p><p><strong>Methods: </strong>The authors' university hospital ED and UCC visits (January 1, 2023, through June 30, 2023) were analyzed after coding the Emergency Severity Index (ESI) for UCC visits to make them comparable to ED visits, where ESI was already regularly assigned. ESI ranges from levels 1 to 5 (1 = highest severity). Coarsened exact matching and multivariate models were used to compare the proportion of patients discharged home, the length of stay, and advanced imaging use. Marginally adjusted outcomes were stratified by ESI.</p><p><strong>Results: </strong>Prior to matching, 31.7% of UCC and 64.0% of ED visits were ESI level 2 severity; 61.0% of UCC and 33.4% of ED visits were ESI level 3. Matching resulted in 1033 UCC and 2782 ED visits (61.0% of patients > age 65; 47.8% female; 65.9% non-Hispanic White). In adjusted analyses, for ESI level 2 visits, the UCC discharged patients home 32.0% more often than the ED (95% confidence interval [CI], 27.5-36.4), with a 7.0-hour shorter length of stay (95% CI, 6.5-7.5), and used advanced imaging 30.3% less often (95% CI, 26.0-34.7). Findings were similar for ESI level 3 visits.</p><p><strong>Discussion: </strong>The UCC managed a high level of severity and may be more efficient than the ED for nonemergent care.</p><p><strong>Conclusion: </strong>Future work should more broadly investigate care delivery at each site, including the cost of care.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"32-39"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12485248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498082","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}

{"title":"Introduction to Issue 29:3 by the Editor-in-Chief.","authors":"G Richard Holt","doi":"10.7812/TPP/25.156","DOIUrl":"10.7812/TPP/25.156","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"29 3","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065376","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}