The Permanente journal最新文献

{"title":"Retirement Matching for Resident Physicians: Financial Modeling and Institutional Implications.","authors":"Krittika Joshi, Benjamin Theisen, Manan Nath, Murad Almasri, Amna Qasim, Joshua Daily","doi":"10.7812/TPP/25.221","DOIUrl":"https://doi.org/10.7812/TPP/25.221","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575337","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":"Successful Outcome of Rhino-Orbital-Cerebral Mucormycosis With Extensive Intracranial Disease in a Patient With Poorly Controlled Diabetes.","authors":"James Dorroh, Cw David Chang, Eric Y Du, D Matthew Shoemaker, Tabitha Galloway, Carisa Petris, Sachin Patil, Mohammed Alnijoumi, Hariharan Regunath","doi":"10.7812/TPP/25.229","DOIUrl":"https://doi.org/10.7812/TPP/25.229","url":null,"abstract":"<p><p>Rhino-orbital-cerebral mucormycosis is a life-threatening infection typically requiring complete surgical debridement of necrotic tissue for survival. The authors have reported a case of invasive mucormycosis in a 22-year-old female with severe diabetic ketoacidosis and recent COVID-19 infection. The patient developed extensive intracranial disease, including cavernous sinus thrombosis and internal carotid artery occlusion, which precluded complete surgical source control without extensive morbidity. Facing such circumstance, a multidisciplinary team pursued an aggressive, individualized multimodal strategy. This included high-dose liposomal amphotericin B, targeted serial endoscopic debridements of extracranial disease, and adjunctive therapies comprising iron chelation (deferasirox), hyperbaric oxygen, and combination antifungal therapy with caspofungin and posaconazole. Despite the inability to achieve complete surgical clearance, this regimen halted disease progression and resulted in clinical and radiological regression. This case illustrated that a coordinated, multimodal approach utilizing aggressive medical management can achieve favorable outcomes in select patients with otherwise inoperable, extensive intracranial mucormycosis.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499714","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":"Celebrating the 30th Anniversary Year of the Founding of <i>The Permanente Journal</i>.","authors":"G Richard Holt","doi":"10.7812/TPP/26.036","DOIUrl":"10.7812/TPP/26.036","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"3-5"},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391027","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":"Thyroid Storm-Induced Respiratory Failure Requiring Venovenous Extracorporeal Membrane Oxygenation.","authors":"Tatiana Getman, Joseph Vu, Hekmat Nasiri","doi":"10.7812/TPP/25.096","DOIUrl":"10.7812/TPP/25.096","url":null,"abstract":"<p><p>Thyroid storm is a life-threatening endocrine emergency that can result in multiorgan failure, including severe respiratory compromise. Although venoarterial extracorporeal membrane oxygenation (ECMO) has been used in some cases, the role of venovenous ECMO is even more rare. The authors reported a case of a 41-year-old female with a history of uncontrolled hypertension who presented with thyroid storm complicated by respiratory failure requiring venovenous ECMO. This case highlighted the critical management strategies, the role of extracorporeal support, and outcomes in severe thyroid storm.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"81-83"},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851018","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 Note From the Publisher: Building the Next Decade of <i>The Permanente Journal</i>.","authors":"Jennifer Kuhn","doi":"10.7812/TPP/26.041","DOIUrl":"10.7812/TPP/26.041","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"6-8"},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435693","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":"Evaluating Student and Faculty Perspectives About the Integration of Trauma-Informed Care in Undergraduate Medical Education.","authors":"Lauren Oliver, Alice Moon, Juliana Meireles, Rachel Bright, Braden Bayless, Julie Miller-Cribbs, Andrew Liew, Liz Kollaja, Michealyn Everitt, Martina Jelley","doi":"10.7812/TPP/25.078","DOIUrl":"10.7812/TPP/25.078","url":null,"abstract":"<p><strong>Background: </strong>Trauma-informed care (TIC) provides a framework for understanding and mitigating trauma's impact on health. Integrating TIC principles into medical school education equips physicians with the skills necessary for delivering compassionate, patient-centered care.</p><p><strong>Methods: </strong>A survey regarding experiences with TIC education was emailed to medical students and faculty at the University of Oklahoma College of Medicine. Qualitative and standard quantitative analysis of the results was performed.</p><p><strong>Results: </strong>A significant majority of faculty (83.7%) and students (92.5%) recognized the relevance of TIC to clinical practice. However, only 37.0% of faculty reported incorporating TIC into their teaching. Despite its acknowledged importance, only 20.4% of students felt satisfied with how TIC was taught. On a Likert scale of 1-5, students reported a comfort level of 1-2 for trauma-informed screenings (31.5%) and physical examinations (62.9%). Proposed solutions to increase TIC education included the implementation of longitudinal curricula, workshops, and conversations about trauma when interacting with patients.</p><p><strong>Conclusions: </strong>TIC is perceived as relevant to medical education and practice among students and faculty. However, its integration into the undergraduate medical education curriculum is sporadic. Although certain courses incorporate TIC, a cohesive teaching approach throughout the curriculum is lacking. There is uncertainty among faculty regarding the definition of TIC and what aspects may be lacking in the curriculum, highlighting a gap in knowledge and application. The intermittent teaching of TIC affects students' ability to fully understand the impact of trauma in the clinical setting. The authors' results supported the integration of a more comprehensive TIC education in undergraduate medical curricula.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"39-51"},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834574","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":"Informing the Development of a High-Quality Emergency Department Discharge Process: Insights From Patients and Practitioners.","authors":"Karanvir Gill, Emily Stewart, Sandra Ketler, Julian Marsden, Elizabeth Stacy","doi":"10.7812/TPP/25.111","DOIUrl":"10.7812/TPP/25.111","url":null,"abstract":"<p><strong>Background: </strong>The emergency department (ED) discharge process in British Columbia (BC), Canada is inconsistent across multiple health authorities, leading to variability in patient experiences and outcomes. This study aimed to identify key factors for a high-quality ED discharge process across BC.</p><p><strong>Methods: </strong>A qualitative study was conducted with 21 patient participants and ED health care practitioners through semistructured Zoom interviews. Transcripts were thematically analyzed.</p><p><strong>Results: </strong>Key recommendations included providing standardized discharge resources in multiple languages, generating automated discharge summaries, involving caregivers for continuity of care, ensuring time to answer patient questions, integrating follow-up reminders via text, and improving connections to social resources. A cultural shift emphasizing collaboration among ED leaders, clinicians, patient participants, and electronic health record developers is needed to enhance discharge practices.</p><p><strong>Conclusion: </strong>Insights from diverse partners highlight actionable steps to improve ED discharge in BC. Health care authorities and hospitals should support the adoption of best practices to enhance patient care and outcomes. Several actionable items were identified for implementation and/or further investigation.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"52-59"},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953062","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":"Erratum to Exploratory Study: Survey of Digital and Physical Threats and Assaults by Patients on American Psychiatry Resident Doctors.","authors":"","doi":"10.7812/TPP/26.029","DOIUrl":"10.7812/TPP/26.029","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"93"},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214236","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":"Patient Characteristics Associated With Telehealth Use in a Large Federally Qualified Health Center.","authors":"Priyanka Gautom, Cara L Eckhardt, Lisa K Marriott, Cirila Estela Vasquez Guzman, Gloria D Coronado","doi":"10.7812/TPP/25.165","DOIUrl":"10.7812/TPP/25.165","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic rapidly expanded telehealth services when in-person care was limited. Using primary care data from a large federally qualified health center in Washington state, this study aimed to: 1) describe trends in telehealth use among adult patients, and 2) provide disaggregated patient characteristic data associated with telehealth use, with a focus on patients speaking Asian Indian languages.</p><p><strong>Methods: </strong>The authors conducted a retrospective cross-sectional study using electronic health data from adult patients seen at the partner health center between January 1, 2020 and December 31, 2022. Multivariable logistic models for each year generated adjusted odds ratios and 95% confidence intervals for characteristics associated with completing a telehealth visit (video or phone). A subgroup analysis on telehealth use among patients speaking languages commonly spoken in India was also completed.</p><p><strong>Results: </strong>The study included 653,378 primary care encounters from 127,146 unique adults (mean age 50; 56% female; nearly one-third Hispanic or Latino). Top 5 languages spoken were English, Spanish, Russian, Punjabi, and Vietnamese. Telehealth use peaked in 2020 and declined in subsequent years, while in-person visits were highest in 2021. Lower odds of telehealth use associated with being younger, identifying as a racial or ethnic minority, preferring a language other than English, residing in a rural county, identifying as male or Gender X, and lacking insurance.</p><p><strong>Discussion: </strong>The findings highlighted disparities in telehealth use across demographic and linguistic lines, including among Asian Indian language speakers, echoing concerns of inequitable access.</p><p><strong>Conclusion: </strong>Findings can guide strategies to improve telehealth services for underrepresented groups.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"18-29"},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158356","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":"Gender Discrimination Against Women in Surgery Is Due to Implicit Bias Rather Than Quantifiable Differences in Clinical Performance.","authors":"Shamir O Cawich, Marlon Mencia, Robyn Cabral, Shaneeta Johnson, Vijay Naraynsingh","doi":"10.7812/TPP/25.231","DOIUrl":"https://doi.org/10.7812/TPP/25.231","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple publications have shown that there is gender-based discrimination in surgery, aimed against surgeons who are women. The authors theorize that it was not due to a difference in clinical competence, but due to implicit bias: a subconscious prejudice that traditionally assigned women to homemaker roles. The authors designed this study to determine whether gender discrimination was due to implicit bias or a quantifiable difference in clinical competence.</p><p><strong>Methods: </strong>This questionnaire study investigated prevailing attitudes among a professional association of surgeons in the Anglophone Caribbean. The authors collected data on gender discrimination and 4 parameters as proxies for clinical competence: judgment, thoroughness, surgical skill, and task completion. The SPSS version 20 was used to perform statistical analyses.</p><p><strong>Results: </strong>A total of 140 questionnaires were distributed and 95 (68%) respondents observed gender discrimination in the workplace, with surgeons who are women significantly more likely to be victims of discrimination (64.2% vs 4.2%; <i>z</i> -8.7165; <i>P</i> < .0001). There was no difference between genders in clinical judgment nor surgical skill. There was a significant difference in thoroughness (47.4% vs 2.1%; <i>P</i> < .0001) and task completion (60% vs 24.2%; <i>P</i> < .0001), favoring surgeons who are women.</p><p><strong>Conclusion: </strong>Gender discrimination is still prevalent in surgical disciplines as the second quarter of the 21st century begins. The authors have demonstrated that surgeons who are women are substantially more likely to be the victims, likely due to implicit gender bias. The surgical community must address this urgently, because impeding full participation by women creates the chance for undermining the expansion of the workforce needed for the next generations' surgical care.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445197","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}