The Permanente journal最新文献

{"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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141185","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":"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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802231","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":"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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296124","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":"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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508525","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":"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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296126","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":"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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354312","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":"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}

{"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":"https://doi.org/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":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795103","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":"Impact of the Advent of Collagenase <i>Clostridium histolyticum</i> on the Surgical Management of Peyronie's Disease: A Population-Based Analysis.","authors":"Kavenpreet Singh Bal, Priyanka Achalu, Michael O Okene, Aaron Krug, Tung-Chin Hsieh, Hossein Mirheydar","doi":"10.7812/TPP/24.135","DOIUrl":"https://doi.org/10.7812/TPP/24.135","url":null,"abstract":"<p><strong>Background: </strong>Peyronie's disease (PD) is a progressive fibrotic disorder of the penis that can induce pain and erectile dysfunction and has various treatment modalities, including surgical, pharmaceutical, and <i>Clostridium histolyticum</i> injection therapies.</p><p><strong>Methods: </strong>The authors used electronic medical records from Kaiser Permanente Southern California, an integrated health care system that consists of 15 medical centers, and identified patients diagnosed with stable PD without concomitant erectile dysfunction from January 1, 2004, to December 31, 2020. Baseline characteristics between surgical and injection groups were compared using Chi-squared and Kruskal-Wallis tests. Multivariable logistic regression with adjustment of confounders was implemented to identify which variables may influence whether patients received injection or surgical therapy.</p><p><strong>Results: </strong>A total of 11,706 patients with PD were identified. The rate of new PD diagnosis per 100,000 patients increased by 0.37 every year, <i>P</i> < .05. The incident rate (per 1000 eligible patients) of surgical management declined on average by 0.40 each year (<i>P</i> < .001), although there was an increase rate of 1.19 for injection therapy (<i>P</i> < .001). On multivariable modeling, patients 45-54 years of age were more likely to receive injection therapy as the primary treatment for PD (adjusted odds ratio = 2.77; <i>P</i> = .002; confidence interval = 1.34-5.73).</p><p><strong>Conclusion: </strong>This study illustrates that pentoxifylline is now more frequently used than colchicine and vitamin E as oral treatments for PD, while collagenase <i>C. histolyticum</i> injection therapy is now more prevalently employed than surgical intervention as the therapeutic approach for PD.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787198","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":"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":"https://doi.org/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":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781057","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}