The Permanente journal最新文献

{"title":"A Challenging Case of Eosinophilic Fasciitis Without Classic Histopathological Findings.","authors":"Cristo Armando Carrasco Mendoza, Alexander Rolando Gomez-Lara, Brian Matthew Kleker","doi":"10.7812/TPP/24.124","DOIUrl":"10.7812/TPP/24.124","url":null,"abstract":"<p><p>Eosinophilic fasciitis (EF) is a rare dermatologic disease with clinical similarities to localized scleroderma and systemic sclerosis (SSc). Diagnosing EF is challenging due to overlapping clinical features among these conditions. Differentiating EF from localized scleroderma and SSc can be aided by laboratory tests, histopathological examination, and imaging studies. The diagnosis of EF specifically requires the exclusion of SSc and typically requires magnetic resonance imaging or en bloc fascial biopsy of affected areas. Here, the authors present a 75-year-old woman with a painful, violaceous rash on the legs and abdomen, leg swelling, and tightness around her upper abdomen. Review of systems revealed decreased appetite, unintentional weight loss, and shortness of breath on exertion. Physical examination showed a faint violaceous rash on the abdomen and legs as well as abdominal distention. The patient's clinical picture was complicated by worsening of the rash, development of chronic cough, continued unintentional weight loss, decreased appetite, early satiety, dry eyes, and dry mouth. An autoimmune process was considered, and the patient was seen by rheumatology, where an appropriate workup excluded localized scleroderma and SSc. EF was suspected and supported by magnetic resonance imaging findings showing fascial edema. En bloc fascial biopsy of the right thigh did not reveal classic EF findings.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"114-118"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081106","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":"Reliability of Hip and Shoulder Measurements Assessed via Telehealth Versus a Standard In-Person Visit Modality.","authors":"Erin Nicholas, Campbell Goldsmith, Audrey Wimberly, Jennifer Cheng, Alexander Shafiro, Peter Moley","doi":"10.7812/TPP/24.167","DOIUrl":"10.7812/TPP/24.167","url":null,"abstract":"<p><strong>Introduction: </strong>Restricted in-person interaction throughout the pandemic coincided with increased reliance on telehealth for patient evaluation and treatment. However, few studies have investigated telehealth efficacy and accuracy compared with in-person musculoskeletal physical examination. Importantly, this virtual platform can be challenging for practitioners whose care relies on physical examination measurements. This study evaluated the validity and accuracy of measuring hip and shoulder strength and range of motion (ROM) via telehealth examination.</p><p><strong>Methods: </strong>In this cross-sectional study, 45 participants without hip or shoulder pain underwent an in-person physical examination and a telehealth examination. Hip and shoulder ROM were measured from in-person and telehealth examinations, using Halo goniometers (Halo Medical Devices) and virtual goniometers, respectively. Hip and shoulder strength were also assessed. Measures obtained from in-person and telehealth examinations were compared, and percent agreements were calculated.</p><p><strong>Results: </strong>The mean age of participants was 32.0 ± 7.2 years; 67% (n = 30) were female. Hip flexion strength, right hip abduction, and right shoulder strength had the strongest percent agreement (91.1%-100.0%) across in-person and telehealth modalities. Left hip abduction, left shoulder active abduction, shoulder internal ROM, and shoulder external ROM showed moderate-to-high agreement (26.7%-77.8%). Left (2.2%) and right hip (8.9%) external ROM showed poor agreement.</p><p><strong>Discussion: </strong>Measurements with the greatest agreement between telehealth and in-person examinations included hip flexion, shoulder strength, hip abduction, and shoulder active abduction.</p><p><strong>Conclusion: </strong>Certain strength and ROM tests can be accurately assessed via telehealth examination. Future research is needed to expand upon these findings and to develop a reliable, standardized protocol for the telehealth musculoskeletal physical examination.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617175","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":"Assessment of Misinterpretation of Regulation by Compliance Professionals: A Multimethod Study.","authors":"Jeffrey Panzer, Lindsey E Carlasare, Maggie Hamielec, Christine A Sinsky, Jodi Simon","doi":"10.7812/TPP/24.086","DOIUrl":"10.7812/TPP/24.086","url":null,"abstract":"<p><strong>Background: </strong>The volume and complexity of administrative regulations, standards, and associated tasks contribute to administrative burden in health care. Misinterpretation and misapplication of regulations impede efficiency and contribute to professional dissatisfaction.</p><p><strong>Objectives: </strong>The authors aimed to 1) understand the compliance professional role, training, and background; 2) uncover their perspectives toward documentation and administrative burden; and 3) identify common regulatory misconceptions by compliance professionals.</p><p><strong>Methods: </strong>In June 2023, the authors surveyed a sample of professionals serving in compliance roles listed within the directory of a national network of federally qualified health centers. Data were collected through REDCap. Follow-up interviews were completed with 4 participants between September and November of 2023. Descriptive statistics were calculated for all quantitative variables; interview transcripts were analyzed using rapid qualitative analysis. Methodological triangulation was employed to identify themes across survey and interview responses.</p><p><strong>Results: </strong>About one-third (5/16, 31%) of compliance professionals had formal training. The majority (15/16, 94%) agreed or strongly agreed that \"If a clinician's action is not documented it is not 'done.'\" Compliance professionals' perceptions of regulatory adherence in clinical scenarios showed high variability, with some participants noting noncompliance in situations where there were no regulatory infractions. Participants perceived administrative burden and waste in health care but diverged in their views of whether they have a role in protecting clinicians from administrative burden.</p><p><strong>Conclusions: </strong>This study reveals inaccuracies in compliance professionals' interpretations of regulations and standards and suggests a gap between written regulations and interpretation at the organizational level. This overinterpretation may create unnecessary work for physicians and their teams.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543545","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":"2024 Reviewer Acknowledgment.","authors":"","doi":"10.7812/TPP/25.011","DOIUrl":"https://doi.org/10.7812/TPP/25.011","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383343","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":"2024 Reviewer Acknowledgment.","authors":"","doi":"10.7812/TPP/25.011","DOIUrl":"https://doi.org/10.7812/TPP/25.011","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469310","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":"Erratum to Vitamin D Deficiency-Associated Neuropathic Pain Examined in a Chronic Pain Management Program.","authors":"","doi":"10.7812/TPP/24.152","DOIUrl":"10.7812/TPP/24.152","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"107"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296125","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":"Using Panel Management to Identify Adult Patients With High-Risk Metabolic Dysfunction-Associated Steatotic Liver Disease/Metabolic Dysfunction-Associated Steatohepatitis Fibrosis in a Primary Care Clinic: A Pilot Study.","authors":"Sarah Householder, Andrew J Loza, Vikas Gupta, Benjamin R Doolittle","doi":"10.7812/TPP/24.094","DOIUrl":"10.7812/TPP/24.094","url":null,"abstract":"<p><strong>Background: </strong>As rates of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) rise, national organizations have released new guidance for primary care-driven detection of patients with advanced fibrosis who are most likely to have clinically relevant morbidity. Yet time constraints, workflow, and practitioner awareness limit integration of risk identification into clinical care.</p><p><strong>Materials and methods: </strong>At the authors' primary care clinic, they implemented a panel management strategy that utilized the electronic health record to identify patients older than 35 years of age at risk for MASLD fibrosis with abnormal Fibrosis-4 (Fib-4) scores. Using a proactive model, these patients were offered elastography-based screening and follow-up appointments focused on metabolic health, with referrals to subspecialty care when indicated.</p><p><strong>Results: </strong>Of 855 patients older than 35 years of age, 384 were identified as having risk factors for MASLD/MASH. Of these, 53 had abnormal Fib-4 scores with no prior work-up; 29 patients consented to a shear wave elastography; 16 underwent shear wave elastography; and 6 had moderate or high results concerning for at-risk fibrosis. Twenty patients attended MASLD-focused appointments. Reluctance to pursue testing was driven by skepticism surrounding preventative medicine, perceived cost, and desire to focus on other medical problems, some of which were life-limiting.</p><p><strong>Conclusion: </strong>Panel management represents a scalable strategy to quickly identify patients in primary care most likely to experience complications from MASLD/MASH and provides a targeted intervention to direct further management. Limitations include access to care, medical complexity, and patient acceptance.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"38-47"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508524","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":"Clinical Evaluation of the Cannabis-Using Patient: A Moving Target.","authors":"Sina Radparvar","doi":"10.7812/TPP/24.088","DOIUrl":"10.7812/TPP/24.088","url":null,"abstract":"<p><p>The prevalence of cannabis use has been increasing among both adolescents and adults worldwide. New trends in cannabis legalization and enhanced social media marketing have led to the availability of multiple high-potency cannabis products with hundreds of new and powerful delivery systems. Over the last decade, there have been drastic changes in cannabis formulations, potency, routes of consumption, and device technology, with increased complexity and sophistication among growers, suppliers, and consumers. Patterns of cannabis use among patients can have important clinical implications, including acute neurocognitive effects, chronic multiorgan toxicity, psychiatric, behavioral, social, and economic impact. However, assessment of medical or surgical patients who use cannabis either recreationally or problematically has become challenging for the clinician due to the changing patterns of cannabis consumption. This review provides information on the clinical evaluation of patients who use cannabis in a problematic fashion, with the focus on tetrahydrocannabinol. It provides the clinician with knowledge regarding cannabis terminology, sources, pharmacology, routes of administration, formulations, dosing, and toxicities. Using these components, an assessment approach for diagnosing cannabis use disorder is synthesized at the conclusion of the article.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"77-86"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508517","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":"Immunoglobulin A Nephropathy: A Review.","authors":"Sulaiman Aseem, Sijie Zheng","doi":"10.7812/TPP/24.089","DOIUrl":"10.7812/TPP/24.089","url":null,"abstract":"<p><p>Immunoglobulin A nephropathy is a primary glomerulopathy, with prevalence ranking highest in the Pacific region, followed closely by Europe, but rare in Africa. Although practice patterns likely have contributed to its prevalence, there are genetic and environmental factors that contribute as well. Management has evolved over the past decade, with recent rapid advances in diagnosis, prognosis, and therapies. This review summarizes the history, pathogenesis, and diagnosis of immunoglobulin A nephropathy and also cites relevant clinical trials, latest treatment options, and unanswered questions.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"87-94"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583606","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":"Introduction to Issue 28:4 by the Editor-in-Chief.","authors":"G Richard Holt","doi":"10.7812/TPP/24.188","DOIUrl":"10.7812/TPP/24.188","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"28 4","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830001","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}