The Permanente journal最新文献

{"title":"Hyperaldosteronism Screening and Findings From a Large Diverse Population With Resistant Hypertension Within an Integrated Health System.","authors":"Victor Kim, Jiaxiao Shi, Jaejin An, Simran Bhandari, Jeffrey W Brettler, Michael H Kanter, John J Sim","doi":"10.7812/TPP/23.096","DOIUrl":"10.7812/TPP/23.096","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperaldosteronism (HA) is a common cause of secondary hypertension and may contribute to resistant hypertension (RH). The authors sought to determine and characterize HA screening, positivity rates, and mineralocorticoid receptor antagonist (MRA) use among patients with RH.</p><p><strong>Methods: </strong>A cross-sectional study was performed within Kaiser Permanente Southern California (7/1/2012-6/30/2017). Using contemporary criteria, RH was defined as blood pressure uncontrolled (≥ 130/80) on ≥ 3 medications or requiring ≥ 4 antihypertensive medications. The primary outcome was screening rate for HA defined as any aldosterone and plasma renin activity measurement. Secondary outcomes were HA screen positive rates and MRA use among all patients with RH. Multivariable logistic regression analysis was used to estimate odds ratio (with 95% confidence intervals) for factors associated with HA screening and for patients that screened positive.</p><p><strong>Results: </strong>Among 102,480 patients identified as RH, 1977 (1.9%) were screened for HA and 727 (36.8%) screened positive for HA. MRA use was 6.5% among all patients with RH (22.5% among screened, 31.2% among screened positive). Black race, potassium < 4, bicarbonate > 29, chronic kidney disease, obstructive sleep apnea, and systolic blood pressure were associated with HA screening, but only Black race (1.55 [1.20-2.01]), potassium (1.82 [1.48-2.24]), bicarbonate levels (1.39 [1.10-1.75]), and diastolic blood pressure (1.15 [1.03-1.29]) were associated with positive screenings.</p><p><strong>Conclusion: </strong>The authors' findings demonstrate low screening rates for HA among patients with difficult-to-control hypertension yet a high positivity rate among those screened. Factors associated with screening did not always correlate with screening positive. Screening and targeted use of MRA may lead to improved blood pressure control and outcomes among patients with RH.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"3-13"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446331","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":"Medical Students' Knowledge, Attitudes Toward, and Identification of Adverse Childhood Experiences and Trauma-Informed Care.","authors":"Rachel Piszczor, Courtney Barry, Constance Gundacker, Carly Wallace, Jineane Shibuya, Jonathan Perle","doi":"10.7812/TPP/23.108","DOIUrl":"10.7812/TPP/23.108","url":null,"abstract":"<p><strong>Introduction: </strong>Adverse childhood experiences (ACEs) are traumatic experiences that occur prior to age 18 years and can have a long-term impact on adult physical and mental health. Knowledge of ACEs, including the link between ACEs and health, and trauma-informed care (TIC), is essential for medical professionals to ensure respectful and compassionate care for those with a history of childhood adversity. This study examined medical students' knowledge, attitudes toward, and identification of ACEs and TIC to inform curricular efforts.</p><p><strong>Methods: </strong>Using a cross-sectional design, students were recruited from 2 medical schools, one allopathic (medical degree) and one osteopathic (doctor of osteopathic medicine degree) to complete an electronic needs assessment survey. The survey included a patient vignette to assess students' ability to identify ACEs as contributing factors to patient health. The students were blind to the full purpose of the study to obtain an objective measurement of their ability to identify ACEs as contributors to patient health. Additional questions targeting knowledge and attitudes of ACEs and TIC were devised from previously published surveys with supplemental study-designed questions.</p><p><strong>Results: </strong>Two hundred forty students completed the survey. Results demonstrated variable ability to identify ACEs; strong general knowledge of ACEs, with less developed practical knowledge; and overall positive attitudes toward ACEs and TIC. No differences were found between the medical degree and doctor of osteopathic medicine degree, or year in program.</p><p><strong>Conclusions: </strong>Medical students would benefit from curricular efforts that help to increase knowledge of the link between ACEs and health, increase practical application of ACEs and TIC, and improve their ability to identify ACEs in clinical scenarios.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"91-99"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571439","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":"Hospital Readmissions Among Patients Experiencing Homelessness: An Electronic Health Record Data Study.","authors":"Somalee Banerjee, Maher Yassin, Wendy T Dyer, Tainayah W Thomas, Luis A Rodriguez, Julie Schmittdiel","doi":"10.7812/TPP/23.075","DOIUrl":"10.7812/TPP/23.075","url":null,"abstract":"<p><strong>Background: </strong>Population-level tracking of hospital use patterns with integrated care organizations in patients experiencing homelessness has been difficult. A California law implemented in 2019 (Senate Bill 1152) aimed to ensure safety for this population after discharge from the hospital by requiring additional documentation for patients experiencing homelessness, which provides an opportunity to evaluate hospital use by this population.</p><p><strong>Methods: </strong>In a large integrated health system in California, patients experiencing homelessness were identified through documentation change requirements associated with this law and compared with a matched group from the general population.</p><p><strong>Results: </strong>Patients experiencing homelessness had increased rates of hospital readmission after discharge compared to the general population matched on demographics and medical comorbidity in 2019 and 2020. Any address change in the prior year for patients was associated with increased odds of emergency department readmission. Patients experiencing homelessness, both enrolled in an integrated delivery system and not, were successfully identified as having higher readmission rates compared with their housed counterparts.</p><p><strong>Conclusion: </strong>Documentation of housing status following Senate Bill 1152 has enabled improved study of hospital use among those with housing instability. Understanding patterns of hospital use in this vulnerable group will help practitioners identify timely points of intervention for further social and health care support.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"55-61"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801418","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":"2023 Reviewer Acknowledgment.","authors":"","doi":"10.7812/TPP/24.014","DOIUrl":"https://doi.org/10.7812/TPP/24.014","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"28 1","pages":"86-87"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132579","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":"Time to Move Forward: Resilience and Trauma-Informed Care.","authors":"Laurie Leitch, Brigid McCaw","doi":"10.7812/TPP/23.076","DOIUrl":"10.7812/TPP/23.076","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"188-192"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49682592","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":"Nurses' Experience After First Wave of COVID-19: Implications for a Trauma-Informed Workforce.","authors":"Annie Lewis-O'Connor, Pamela Brown Linzer, Ellen Goldstein","doi":"10.7812/TPP/23.117","DOIUrl":"10.7812/TPP/23.117","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic impacted nurses worldwide, increasing their risk of burnout and compassion fatigue. Although the literature on nurse deployment has been limited, this study describes nurses' experience and assesses their professional quality of life after the first phase of the pandemic and redeployment efforts.</p><p><strong>Methods: </strong>In 2020, nurses returning from their deployment to COVID-19 treatment units were invited to complete the Professional Quality of Life Survey and gather for debrief sessions, referred to as campfires, in which semistructured questions about their experiences were administered among clinical nurses and nurse leaders. Employing a mixed methods design, the authors conducted descriptive statistics for survey responses and inductive thematic analysis to identify emergent themes from open-ended questions.</p><p><strong>Results: </strong>A total of 19 campfires were held with 278 nurse participants. Of the 278 participants, 220 completed surveys. Of these, 194 (88%) represented 30 nurse leaders and 164 staff nurses. The majority of surveyed nurses in both groups reported compassion satisfaction despite reporting moderate levels of burnout and secondary traumatic stress. Qualitative themes from campfires with clinical nurses and nurse leaders revealed similarities, such as concern for safety and lack of choices and transparency, although each group faced unique challenges.</p><p><strong>Conclusions: </strong>Findings related to post deployment and adverse psychological health suggest that a trauma-informed approach (ie, staff autonomy, physical and psychological safety, transparency, offering choices, leveraging voices, and collaboration) by leaders could enhance a culture of wellness, build resilience, and mitigate empathic burnout and also proactively and strategically thinking about preventive measures for future catastrophic events.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"124-134"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296041","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":"Effectiveness of Trauma-Informed Care Implementation in Health Care Settings: Systematic Review of Reviews and Realist Synthesis.","authors":"Ellen Goldstein, Binny Chokshi, G J Melendez-Torres, Anna Rios, Martina Jelley, Annie Lewis-O'Connor","doi":"10.7812/TPP/23.127","DOIUrl":"10.7812/TPP/23.127","url":null,"abstract":"<p><strong>Purpose: </strong>Given the ubiquity of traumatic exposures and the profound impact of trauma on health, a trauma-informed care (TIC) approach in health care is critical. TIC seeks to promote safety within health care and prevent retraumatization. The lack of systems-level data has been a major barrier to TIC implementation. This study aimed to understand the mechanisms and outcomes effective in implementing TIC across health systems using a systematic review of reviews and realist synthesis.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Applied Social Science Index & Abstracts identified reviews addressing TIC in health care published in the last 10 years in peer-reviewed journals. Realist synthesis methodology was used to develop context-mechanism-outcome configurations. Thematic analysis was performed to generate a framework for the mechanisms of implementation that produce successful TIC outcomes.</p><p><strong>Results: </strong>Sixteen articles featuring varied review types were included. The results, highlighting the strategies that lead to improved outcomes for patients and systems, were mapped to SAMHSA's 10 TIC implementation domains, including engagement and involvement; training and workforce development; cross-sector collaboration; screening, assessment, and treatment services; governance and leadership; policy; evaluation; progress monitoring and quality assurance; financing; and physical environment.</p><p><strong>Conclusion: </strong>The findings support the use of SAMHSA's 10 implementation domains in varied health care contexts to facilitate effective TIC processes. Future work should continue to evaluate the effectiveness of TIC approaches and may consider how health equity and strengths-based approaches fit within SAMHSA's framework.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"135-150"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040386","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":"Mental Health Effects of the COVID-19 Pandemic on Aging Lesbian, Gay, Bisexual, Transgender, and Queer Populations.","authors":"Iliza Minaya, Samuel Raine, Arkene Levy, Chasity B O'Malley","doi":"10.7812/TPP/23.050","DOIUrl":"10.7812/TPP/23.050","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic affected numerous subpopulations of people in unique ways. This study evaluated the impact of the COVID-19 pandemic on the mental health status of Broward County's aging lesbian, gay, bisexual, transgender, and queer (LGBTQ) seniors and identified strengths, weaknesses, and opportunities for interventions to enhance positive mental health outcomes. The study was performed from April 2021 through July 2021.</p><p><strong>Methods: </strong>Online surveys measuring anxiety, depression, social support, and resilience were delivered by email to 47 residents of Wilton Manors, Florida. Study data were collected and collated using research electronic data capture tools with bivariate analysis using the Mann-Whitney test and generalized linear regression.</p><p><strong>Results: </strong>Bivariate analysis showed that males scored significantly higher on the social interactions subscale of the Duke Social Support Index, indicating greater social support, yet there was not a significant difference with sexual orientation or living situation. Multivariate analysis revealed differences for several dependent variables including anxiety and depression reporting being lower in LGBTQ individuals.</p><p><strong>Discussion: </strong>This study provides important insight into specific mental health challenges faced by Broward County's LGBTQ seniors, which can be applied to other LGBTQ populations across the globe.</p><p><strong>Conclusion: </strong>Using the results, targeted interventions can be developed to help improve mental health outcomes during periods of isolation for all individuals.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"14-21"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058724","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":"Toward Integration of Trauma, Resilience, and Equity Theory and Practice: A Narrative Review and Call for Consilience.","authors":"Stan Sonu, Kimberly Mann, Jennifer Potter, Patricia Rush, Audrey Stillerman","doi":"10.7812/TPP/23.105","DOIUrl":"10.7812/TPP/23.105","url":null,"abstract":"<p><p>Investigating the roots of health and illness has inspired unprecedented growth in research on trauma and adversity across academic and scientific disciplines. Can this science achieve its potential? How? Much of this research remains siloed and fragmented, limiting integrative approaches to translating science into a unified paradigm. From age-old traditions to the health, social, and basic sciences, this established and rapidly growing body of work has overwhelmingly found that experiences, both positive and negative, profoundly influence life course health. Such convergence across disciplines highlights the complex, intersectional nature and impact of experiences and reveals consilience: agreement of findings across diverse fields. This narrative review explored 400 sources to curate a representative sample of 98 tracing the evolution of trauma theory and practice from the 19th century to the present. It emphasizes research from 1970 to 2022, with a specific focus on adverse childhood experiences, everyday discrimination, sexual and gender minority stress, acculturative stress, and positive childhood experiences. This research reveals how experiences are a cause, catalyst, and key ingredient of health or of illness, disability, and disparities. The review also proposes steps toward a unified paradigm and showcases innovative integrated models and applications. These examples provide a more comprehensive and nuanced understanding and lead to more effective solutions. Recognition of consilience can connect multidimensional insights on trauma, resilience, and equity to spark further cross-sector innovations toward health, prevention, and justice. Realizing the promise of consilience will require a new era of radical intentionality, ongoing dialogue, and interdisciplinary collaboration to achieve necessary system transformation.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"151-168"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425595","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":"Concurrent Sexually Transmitted Infections with Mpox Infections: A Brief Review.","authors":"Jenna M Wick, Alex Pelliccione, H Nicole Tran, Jacek Skarbinski","doi":"10.7812/TPP/23.072","DOIUrl":"10.7812/TPP/23.072","url":null,"abstract":"<p><p>Mpox is a viral zoonotic infection endemic to countries in Central and West Africa. The outbreak that began in May 2022 is novel for its global spread and transmission through sexual encounters. Research of this outbreak shows a high rate of concurrent sexually transmitted infections (STIs) in patients with mpox, highlighting the need to consider STIs in mpox management, and to raise awareness of historically high levels of STIs caused by inadequacies in sexual health care. It is critical to prioritize sexual health and address health disparities to control current transmission of infections and prevent future outbreaks.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"42-45"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404504","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}