The Permanente journal最新文献

{"title":"National Survey of Airway Management Practices and Training Among Emergency Medicine Residency Programs in the United States.","authors":"Jonathan Kei, Nathan Jang, Matthew Silver","doi":"10.7812/TPP/24.118","DOIUrl":"10.7812/TPP/24.118","url":null,"abstract":"<p><strong>Introduction: </strong>As airway management becomes more complex with the adoption of new technologies and strategies, it is important to ensure that emergency medicine residents, the future of the specialty, receive extensive training. This study was designed to understand the prevailing airway management practices and training within emergency medicine residency programs.</p><p><strong>Methods: </strong>A survey consisting of 19 multiple-choice questions was sent to program directors of 258 emergency medicine residency programs in the United States.</p><p><strong>Results: </strong>A total of 63 emergency medicine residency programs completed the airway survey, a response rate of 24%. Programs from all regions of the country are represented, most of them from university-based teaching hospitals (40%) and 3-year programs (78%). The majority of programs provide their residents with 50-100 intubations (50.8%) during their training. Pediatric intubations remain scarce with 54.1% of programs having only 5-10 pediatric intubations per resident. The emergency medicine team manages 93.6% of all trauma intubations, and residents complete 81% to 100% of all the department's intubations 88.9% of the time. Video laryngoscopy is on the rise, with GlideScope^® (93.7%) and C-Mac^® (55.6%) being the most common devices available. Overall, programs use both succinylcholine and rocuronium equally, but there is a trend toward using rocuronium more frequently than succinylcholine. By employing different teaching modalities, multiple times a year, residency programs expose residents to a variety of backup tools and surgical airway techniques.</p><p><strong>Conclusions: </strong>Emergency medicine residents are exposed to multiple advanced airway adjuncts and comprehensive airway curriculums as emergency airway management practices evolve and become more complex.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"50-60"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795103","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":"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":"10.7812/TPP/24.161","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"77-83"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053690","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":"Comparative Analysis of Biopsy Techniques for Cervical Lymphoma: A Retrospective Cohort Review.","authors":"Jacob Edward Hoerter, Andrew D Lynch, Bruce F Folck, Meredith Anderson, Rijul S Kshirsagar, Jason Gilde, David Baer, Joan C Lo, Kevin H Wang","doi":"10.7812/TPP/24.096","DOIUrl":"10.7812/TPP/24.096","url":null,"abstract":"<p><strong>Introduction: </strong>Lymphoma is the most common neck mass malignancy in adults but can present diagnostic challenges due to controversy surrounding the best initial biopsy approach. In this study, the authors characterize the diagnostic pathway in adults with lymphoma (or leukemia) presenting initially as a neck mass and examine the biopsy procedures required for diagnosis in a large community-based practice setting.</p><p><strong>Methods: </strong>Using data from a retrospective cohort of 4103 adults referred to otolaryngology with a neck mass (5% found to be malignant), the authors identified the subset with lymphoma (or leukemia) and examined the time to diagnosis and the number and type of biopsies required for diagnosis.</p><p><strong>Results: </strong>Among 73 adults with lymphoma or leukemia that initially presented with a neck mass (25% diffuse large B-cell lymphoma, 32% Hodgkin lymphoma, 18% follicular lymphoma, and 25% other lymphoma/leukemia), 70% required repeated biopsies for diagnosis. Overall, 93% required a core-needle biopsy (CNB) or an excisional biopsy for diagnosis, although 64% of patients underwent fine-needle aspiration (FNA) for their first biopsy. Patients undergoing initial FNA were diagnosed a median of 19 days after presentation (95% required additional biopsy), whereas those undergoing initial CNB were diagnosed a median of 5 days after presentation (only 25% required additional biopsy).</p><p><strong>Discussion: </strong>These data highlight the limited diagnostic utility of FNA for lymphoma presenting as a neck mass and support consideration of CNB when lymphoma is suspected in a neck mass to minimize repeat biopsy and time to diagnosis.</p><p><strong>Conclusion: </strong>Lymphoma represents a diagnostic challenge. CNB represents an opportunity to improve diagnostic efficiency, although additional research is needed to ascertain impacts on cost and side effects in various health care environments.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"108-113"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190720","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":"Association of Vaccination in Pregnancy With Newborn Hepatitis B Vaccine Receipt.","authors":"Zeva Young Graf, Ramya Kolagani, Christina Stetter, Bernice L Hausman, Amy T Cruz, Stephanie J Lambert","doi":"10.7812/TPP/24.061","DOIUrl":"10.7812/TPP/24.061","url":null,"abstract":"<p><strong>Introduction: </strong>The authors evaluated factors associated with neonatal hepatitis B vaccination (HepB), including prenatal vaccinations, race, ethnicity, neonatal disposition, parity, and maternal age to identify potential areas of engagement to improve maternal and child health.</p><p><strong>Methods: </strong>The authors conducted a retrospective cohort study of patients who received prenatal care and delivered at an academic tertiary care hospital in central Pennsylvania from 2015-2020. A multiple logistic regression model was used to assess factors associated with newborn receipt of HepB.</p><p><strong>Results: </strong>Prenatal vaccination was significantly (<i>P</i> < .0001) associated with subsequent neonatal HepB vaccination in the hospital following birth. Race, Hispanic ethnicity, age at delivery, neonatal disposition, and parity were not shown to be associated with HepB vaccine uptake.</p><p><strong>Conclusion: </strong>Prenatal vaccination was significantly associated with neonatal in-hospital HepB vaccine uptake.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"84-88"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557471","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":"Tuberculosis Osteomyelitis of the Wrist.","authors":"Grace Kim, Kate E Lee, Anand Shah, Jessica Seidelman, Kevin A Wu, Diana M Cardona, Lana Wahid","doi":"10.7812/TPP/24.025","DOIUrl":"10.7812/TPP/24.025","url":null,"abstract":"<p><p>Wrist <i>Mycobacterium tuberculosis</i> (TB) complex osteomyelitis is rare, with polymicrobial TB osteomyelitis even more uncommon. The authors describe an unusual case of polymicrobial TB wrist osteomyelitis. The case patient presented with a 2.5-year history of 2 insidiously growing nodules on his wrist. He underwent debridement, and tissue cultures grew methicillin-resistant <i>Staphylococcus aureus</i>, <i>Enterococcus faecalis</i>, and, later, TB complex. He was started on vancomycin, rifampin, isoniazid, pyrazinamide, and ethambutol with improvement in symptoms. This case emphasizes the importance of a broad differential and thorough workup for atypical presentations of osteomyelitis. Diagnosis of uncommon etiologies is essential for definitive treatment.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"119-123"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451620","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 In-Person, Telephonic, and Video-Based Treatment of Depression in Adult Primary Care During the COVID-19 Pandemic.","authors":"Benjamin Metrikin, Rebecca L Hill, Jialuo Liu, John Adams, Mark C Duggan, Sabrina Perlman, Karen J Coleman","doi":"10.7812/TPP/24.117","DOIUrl":"10.7812/TPP/24.117","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic forced a rapid shift toward virtual modalities for the treatment of depression in primary care.</p><p><strong>Methods: </strong>Participants were adults 18 years and older with a new episode of depression diagnosed in primary care between March 1, 2020, and May 21, 2021, and moderate-to-severe symptoms of depression at the time of diagnosis (N = 9619). Outcomes were 1) antidepressant medications prescribed and dispensed (referred to as received), as well as adherence to those medications; 2) referrals made to depression-related services and the receipt of those services; and 3) a follow-up visit completed with the diagnosing practitioner regardless of treatment actions.</p><p><strong>Results: </strong>Patients were 42.4 ± 17.8 years old, and 77.6% had moderate-to-severe symptoms at diagnosis. Most patients were women (70.4%), 48.2% were Hispanic, and 8.4% were Black. Telephone visits were associated with 64% increased odds of having an antidepressant prescribed when compared to in-person visits. However, patients prescribed an antidepressant during a telephone visit were 52% less likely to receive this prescription when compared to patients who were prescribed an antidepressant during an in-person visit. Telephone and video visits were associated with 48% and 37% decreased odds, respectively, of having a follow-up visit with the prescribing practitioner when compared to an in-person visit.</p><p><strong>Conclusion: </strong>Telemedicine for depression in adult primary care may result in greater antidepressant prescribing than in-person care, but these medications are less likely to be received. This study's findings suggest that health systems should adjust electronic decision support tools (such as mail-order pharmacies) to ensure virtual care decisions are implemented.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"27-42"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781057","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":"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":"61-68"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814165","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":"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":"<p><strong>Background: </strong>Multiple studies have demonstrated associations between psychiatric conditions and Parkinson's disease (PD) development; fewer have examined psychotic-spectrum disorders and PD development.</p><p><strong>Objective: </strong>The objective was to assess the prevalence of psychotic-spectrum disorders with and without depression and anxiety preceding a PD diagnosis.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Awareness of psychiatric conditions, including psychotic-spectrum disorders with comorbid anxiety, can stratify individuals at higher risk of developing PD.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"102-107"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971957","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":"Lower Use of and Potential Barriers to Using Patient Portals Among Limited English Proficient Latino and Chinese American Adults: A Health Techquity Concern.","authors":"Nancy P Gordon, Antonia Torreblanca, Rachelle G Ford, Sharon Ou, Mark W Lin","doi":"10.7812/TPP/24.119","DOIUrl":"10.7812/TPP/24.119","url":null,"abstract":"<p><strong>Introduction: </strong>Patient portals are increasingly becoming the primary channel for communicating health information, raising concerns about the potential worsening of health care access disparities among limited English proficient (LEP) patients. The authors studied the use of a health plan patient portal and potential barriers to use by comparing LEP Latino and Chinese Health Plan members to those with English language preference (non-LEP).</p><p><strong>Methods: </strong>The authors used health record data for 480,833 Latino (31.8% LEP) and 137,904 Chinese (31.6% LEP) adult Kaiser Permanente Northern California members 25-85 years of age to study portal use during 2019. Clinic-collected survey data for 489 Latino and 1037 Chinese LEP patients was compared with data for 849 Latino and 426 Chinese non-LEP Kaiser Permanente Northern California 2020 Member Health Survey respondents to identify factors potentially inhibiting portal use. The authors used chi-square tests to assess differences in portal use and potential influencing factors across ethnic, language, and age subgroups.</p><p><strong>Results: </strong>During 2019, LEP Latino and Chinese adults were less likely than non-LEP adults to have a portal account and, among those with a portal account, to have sent secure messages and viewed laboratory results online. Portal use was lower among LEP Latino than LEP Chinese adults. Patient surveys identified lower educational attainment, health literacy, and access to and use of digital tools among LEP vs non-LEP Latino and Chinese adults.</p><p><strong>Conclusions: </strong>Patient portal use is lower among LEP than non-LEP Latino and Chinese patients. Health care systems should take action to decrease barriers to use, but they also should consider patient communication preferences.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399967","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":"Corrigendum to A Review of the Food and Drug Administration Pipeline and Proposed California Legislation on Medicinal Psychedelics.","authors":"","doi":"10.7812/TPP/25.033","DOIUrl":"10.7812/TPP/25.033","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"126"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543547","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}