The Permanente journal最新文献

{"title":"Squamous Cell Carcinoma of the Nail Bed.","authors":"Aisha S Chaudhry, Jane W Shiu, Nivia S Varela, George W Newton, Edward J Durant","doi":"10.7812/TPP/23.138","DOIUrl":"10.7812/TPP/23.138","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"103-106"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296127","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":"A Comparison of In-Person and Telemedicine Triage in Otolaryngology.","authors":"Jacob E Hoerter, Peter M Debbaneh, Kalena Liu, Swapnil Shah, Miranda Weintraub, Nancy Jiang","doi":"10.7812/TPP/24.077","DOIUrl":"10.7812/TPP/24.077","url":null,"abstract":"<p><strong>Introduction: </strong>The integration of virtual visits has been met with skepticism by many surgical specialties, including otolaryngology, due to the lack of a complete physical exam. Analysis of differences in the workup between patients triaged virtually or in-person is warranted.</p><p><strong>Methods: </strong>A chart review was performed for a cohort of adults undergoing septoplasty (January 2021-May 2022). Groups (telemedicine, in-person) were compared by 2-sample <i>t</i>-test and chi-square test to determine the difference in the number of preoperative visits and to assess the variation in patients with preoperative laboratory testing, imaging, or referrals.</p><p><strong>Results: </strong>Of 338 patients, initial evaluation was in-person for 225 (66.5%) and via telemedicine for 113 (33.5%). The groups were similar in demographics (mean age 39.1 years for telemedicine vs 38.8 years for in-person, female 28.9% vs male 37.7%, <i>P</i> = 0.088). The telemedicine group had a significantly higher number of preoperative visits (3.03) compared to the in-person group (2.38, <i>P</i> = 0.001). There was no significant difference in patients who underwent preoperative laboratory testing, imaging, or referrals. Patients triaged via telemedicine experienced a shorter time to surgery compared to those triaged in person (434 vs 208, <i>P</i> = 0.003).</p><p><strong>Discussion: </strong>In this cohort, triage by telemedicine allowed otolaryngology patients to have an expedited path to surgery despite having more visits. There is no evidence to suggest that otolaryngologists had an overreliance on diagnostic modalities when triaging by telemedicine.</p><p><strong>Conclusion: </strong>Among patients undergoing septoplasty, those initially evaluated by telemedicine were more likely to have more preoperative visits and shorter time to surgery than those evaluated in person. Telemedicine can serve as an effective method for triaging surgical patients without excess diagnostics.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"31-37"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296123","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":"Impact of the Graphic Memoir <i>My Degeneration: A Journey Through Parkinson's</i> on Patients With Parkinson's Disease: A Mixed Methods Study.","authors":"Michael J Green, Sol De Jesus, Daniel R George, Margaret Hopkins, Erik Lehman, Lauren Van Scoy, Bethany Snyder, Kimberly R Myers","doi":"10.7812/TPP/23.184","DOIUrl":"10.7812/TPP/23.184","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding the lived experience of illness is important for empowering patients and informing health care practitioners. This study investigated the impact of a book-length comic memoir, <i>My Degeneration: A Journey Through Parkinson's</i>, by Peter Dunlap-Shohl, on patients' mental health, knowledge, and attitudes about living with Parkinson's disease (PD). The authors further explored which patients found the book to be beneficial and why.</p><p><strong>Methods: </strong>In this convergent mixed methods study, patients with PD were recruited from a multidisciplinary movement disorders clinic in 2019-2020 and were eligible if cognitively intact; English-speaking; had stage I, II, or III PD; and < 12 months had elapsed since diagnosis. Participants received <i>My Degeneration</i> to read at home, measures were obtained pre- and postintervention, and participants were interviewed within approximately 1 month.</p><p><strong>Results: </strong>Thirty participants completed the study (13 males and 17 female; mean age = 59 years). Four qualitative themes emerged: Reading <i>My Degeneration</i> 1) validated the experience of living with PD, 2) reinforced practical behaviors that support well-being, 3) provided insight about the illness experience, and 4) was emotionally and physically taxing. There were no statistically significant pre-/postintervention changes in knowledge, self-efficacy, hope, or emotional distress. Book \"endorsers\" appreciated Dunlap-Shohl's dark humor and resonated with his experience; \"detractors\" found the book to be blunt and sometimes frightening.</p><p><strong>Discussion/conclusion: </strong>Participants who liked the book-the \"endorsers\"-revealed that it deeply resonated with them and helped them realize they were not alone with the disease. Many commented that Dunlap-Shohl's story was in some ways their story-and that this was both practically and emotionally reassuring. <i>My Degeneration</i> has the potential to benefit patients who appreciate comics, enjoy dark humor, and are not overly pessimistic.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"65-76"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141185","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":"Cervical Cancer Screening: Patient Perspectives on Transitioning to Primary High-Risk Human Papillomavirus Testing Alone.","authors":"Larissa L White, Shauna R Goldberg, Alison G Escobar, Brian Hixon, Chun R Chao, Erin E Hahn, Devansu Tewari, Brian S Mittman, Heather Spencer Feigelson","doi":"10.7812/TPP/24.076","DOIUrl":"10.7812/TPP/24.076","url":null,"abstract":"<p><strong>Introduction: </strong>In 2018, the US Preventive Services Task Force updated cervical cancer screening recommendations to allow for screening every 5 years with primary human papillomavirus (HPV) testing in combination with cytology (cotesting) or every 5 years with primary HPV screening alone. Despite these changes, the uptake of primary HPV screening has been lower than expected. The purpose of this study was to evaluate the patient perspective of an integrated health system transition from cotesting to primary HPV testing among a 30- to 65-year-old cohort.</p><p><strong>Methods: </strong>Semistructured phone interviews were conducted from July to December 2023 at Kaiser Permanente Colorado with 16 members aged 30-65 years. Interviews asked about reactions to the forthcoming change in cervical cancer screening, personal concern about cervical cancer risk, feedback on patient-facing education materials, and preference on communication timing and modality.</p><p><strong>Results: </strong>Participants reported concerns about cervical cancer screening intervals, primarily the reduction in frequency leading to underdiagnosis of sexually transmitted infections (STIs). Participants recommended defining the rationale for the change to primary HPV testing in the patient education materials. Participants preferred communication about the change in-clinic between practitioner and patient.</p><p><strong>Discussion: </strong>The interviews identified key themes, including the differentiation between cervical cancer and STI screening methodologies, potential underdiagnosis of STI and cervical cancer, and the rationale supporting primary HPV testing and associated screening intervals.</p><p><strong>Conclusion: </strong>These qualitative findings can inform health systems of potential patient concerns to address when considering the transition from cotesting every 3 years to primary HPV testing every 5 years for cervical cancer screening.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"57-64"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508516","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":"Use of Obesity Medications in the Era of GLP-1 Agonists: An Expert Panel Discussion.","authors":"Jamy Ard, Lydia Alexander, Daniel Bessesen, Karlijn Burridge, Sean Hasan Hashmi","doi":"10.7812/TPP/24.176","DOIUrl":"10.7812/TPP/24.176","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"7-19"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802231","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":"Delusional Parasitosis in a Patient With a History of COVID-19 and Substance Use Disorder.","authors":"Jami Wang, Brian Kato, Samantha Li, Davin A Agustines","doi":"10.7812/TPP/24.006","DOIUrl":"10.7812/TPP/24.006","url":null,"abstract":"<p><p>Delusional parasitosis is a psychotic disorder that manifests as a belief that the skin is infested with parasites. This case report documents the association between COVID-19 infection and new-onset delusional parasitosis superimposed on preexisting psychosis, which has not been previously documented in the current literature. A 28-year-old male presented with new-onset delusional parasitosis superimposed on existing psychosis following COVID-19 infection. Computed tomography scan of the head was unremarkable. He was treated with olanzapine, which appeared to lessen the intensity of the delusions. This case report should encourage increased monitoring of COVID-positive patients with psychosis.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"100-102"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296124","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":"Rare Intravascular Involvement of Pleomorphic Dermal Sarcoma Seen During Mohs Micrographic Surgery.","authors":"Cristo Armando Carrasco Mendoza, Jason Robert Castillo","doi":"10.7812/TPP/24.078","DOIUrl":"10.7812/TPP/24.078","url":null,"abstract":"<p><p>Pleomorphic dermal sarcoma (PDS) and atypical fibroxanthoma (AFX) are rare mesenchymal tumors that share similar clinical, histological, and immunohistochemical characteristics. Careful histopathological examination of a biopsy specimen that includes subcutaneous fat remains the preferred way to differentiate between these tumors. AFX is limited to dermal invasion, whereas PDS demonstrates deeper invasion. Moreover, PDS may present with tumor necrosis and high-grade histological findings, such as lymphovascular and perineural invasion, features absent in AFX. However, like PDS, AFX is a diagnosis of exclusion, and an exhaustive immunohistochemistry panel is recommended to distinguish these tumors from other spindled cell tumors in the differential diagnosis. The authors present the case of an 86-year-old man with biopsy-suspected AFX who was referred for Mohs micrographic surgery for tumor excision. During Mohs, the tumor was observed to have invaded deeply into the subcutaneous tissue and galeal aponeurosis, aligning more closely with a PDS. The diagnosis of PDS was confirmed using en face processing during Mohs surgery, which captured the intravascular involvement of a solitary vessel. Differentiating between PDS and AFX is important because PDS is a more aggressive tumor, with a higher rate of local recurrence and metastasis, and requires closer monitoring.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"95-99"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296126","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":"Kaiser Permanente Los Angeles Annual Research Week 2023: Research as a Pillar for Well-Being in Graduate Medical Education and Beyond.","authors":"Joon S Park, Davida Becker, John J Sim","doi":"10.7812/TPP/23.144","DOIUrl":"10.7812/TPP/23.144","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"3-6"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354312","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":"Zero-Dollar Copayment Impact on Adherence Scores for Centers for Medicare and Medicaid Services Star Ratings Generic Medications.","authors":"Abigail Wedoff, Jocelyn McDougal, Karan Patel, Naomi Y Yates, Rachana J Patel, Thomas Delate","doi":"10.7812/TPP/24.103","DOIUrl":"10.7812/TPP/24.103","url":null,"abstract":"<p><strong>Introduction: </strong>The Centers for Medicare & Medicaid Services (CMS) Star Ratings system pushes Medicare Advantage health plans to achieve ever greater attainments in key metrics, including adherence to hydroxymethylglutaryl-CoA reductase inhibitor (statins), renin-angiotensin system (RAS) antagonist, and noninsulin antihyperglycemic (DM) medications. The purpose of this observational study was to evaluate the impact of expanding a $0 copayment (copay) benefit from mail order-only to mail order plus retail pharmacies on adherence to statin, RAS, and DM medications.</p><p><strong>Methods: </strong>Medicare beneficiaries with and without a $0 copay expansion who received ≥ 1 dispensing of a generic, CMS Star Ratings RAS, statin, and/or DM medication during both 2021 and 2022 were included. Outcomes included changes in proportion of days covered (PDC) from 2021 to 2022 and proportions of patients with a PDC ≥ 0.8 in 2022.</p><p><strong>Results: </strong>Overall (N = 65,716), patients had a high (> 0.930) mean baseline PDC. Patients with $0 copay expansion had a statistically significant greater mean PDC increase for statin (adjusted <i>P</i> = 0.038), reduction for RAS (adjusted <i>P</i> = 0.036), and no difference for DM (adjusted <i>P</i> = 0.696). Patients with a $0 copay expansion had statistically significant higher proportions of beneficiaries with a PDC ≥ 0.8 for statin (adjusted <i>P</i> = 0.003) and RAS (adjusted <i>P</i> = 0.003) but not DM (adjusted <i>P</i> = 0.256).</p><p><strong>Discussion: </strong>An expanded $0 copay was associated with minor increased generic statin medication adherence.</p><p><strong>Conclusion: </strong>In populations with a high baseline PDC, expanding a $0 copay benefit on generic statin, RAS, and DM medications to dispensing outside of mail order may only contribute slightly to an increase or sustainment of a health plan's CMS Star Ratings.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"20-30"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508525","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":"Impact of Race and Ethnicity on Clinical Outcomes of Collagenase <i>Clostridium histolyticum</i> in Patients With Peyronie's Disease Across Kaiser Permanente Southern California Database.","authors":"Michael O Okene, Priyanka Achalu, Tung-Chin Hsieh, Hossein Mirheydar","doi":"10.7812/TPP/24.111","DOIUrl":"https://doi.org/10.7812/TPP/24.111","url":null,"abstract":"<p><strong>Introduction: </strong>Intralesional collagenase <i>Clostridium histolyticum</i> (CCH) injection is an effective intervention for treatment of Peyronie's disease (PD). While CCH efficacy has been demonstrated in White populations, little is known about treatment efficacy in Black and Hispanic populations.</p><p><strong>Methods: </strong>This study examined efficacy of intralesional CCH in a racially diverse population in a large integrated health care system over 15 years. Treatment efficacy was defined as percent change in penile curvature abnormality from baseline after up to 4 treatment cycles.</p><p><strong>Results: </strong>Of the 112 patients with PD who underwent CCH therapy, 66.1% of men were White, 22.3% were Hispanic, and 9.8% were Black. Additionally, 63.4% of men had a baseline penile curvature of 30°-59°. There were no significant differences in treatment response to CCH across different racial and ethnical groups (<i>P</i> = .96). There was a statistically significant difference in number of cycles completed across different ethnicities (<i>P</i> = .022). When adjusted for completing a full 4-cycle treatment, the Hispanic subgroup had the most patients complete fewer than 4 cycles (<i>P</i> = .0004). Almost half of the Hispanic subgroup (48%) reported needing an interpreter for health appointments.</p><p><strong>Discussion: </strong>This is the largest postmarket analysis of CCH treatment outcomes in a racially diverse PD population. Though there were no significant differences in treatment outcomes by race and ethnicity, Hispanic men were significantly less likely to complete 4 cycles of injection therapy. One possible explanation is a language barrier, which prevented future follow-up treatment.</p><p><strong>Conclusion: </strong>The use of CCH treatment for PD is an effective option for racially diverse patient populations.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814165","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}