The Permanente journal最新文献

{"title":"Erratum to <i>Latissimus Dorsi</i> Tendon Repair Through Single-Incision Axillary Approach Using All-Suture Anchor Tension Slide.","authors":"","doi":"10.7812/TPP/25.085","DOIUrl":"10.7812/TPP/25.085","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"99"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182595","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 Humanistic Approach to Improvement: The Multiple Sclerosis Continuous Quality Improvement Collaborative Coaching Approach.","authors":"Randall Scott Messier, Brant J Oliver","doi":"10.7812/TPP/24.054","DOIUrl":"10.7812/TPP/24.054","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is a costly, chronic, complex condition, which requires customization of care at the system level to achieve better outcomes. The authors describe a cluster-randomized, coach-supported quality improvement (QI) intervention in the MS continuous QI (MS-CQI) Collaborative, which was a multicenter learning health system (LHS) study to improve MS outcomes (2018-2022).</p><p><strong>Methods: </strong>The authors developed a coach-supported QI intervention within the MS-CQI LHS, which included aspects of standard QI approaches utilized in health care. This included a 12-step standardized QI Toolkit; team coaching twice monthly; team capability assessments; and patient-reported and clinical feedback data provided by the MS-CQI data registry. Assessments helped the coach understand clinic culture, readiness for change, QI skills and knowledge, and progress over time. The coach monitored and guided team activity and assured general adherence to the 12-step improvement process. Teams selected local QI activities within those constraints.</p><p><strong>Results: </strong>A total of 3 out of the 4 MS-CQI centers were cluster randomized to the intervention and completed the study. Initial QI assessments revealed that teams perceived QI as important but had low initial skill and knowledge levels. Improved QI skills, knowledge, and engagement in the intervention improved, as teams realized ownership and perceived benefits.</p><p><strong>Conclusions: </strong>The coach-supported QI intervention demonstrated basic feasibility, acceptability, QI skill advancement, and utility in the MS-CQI study. It is an example of an LHS-enabled humanistic (QI team-focused) intervention, which invests in developing capability of people involved in QI work.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"76-83"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049373","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":"Navigating Psychiatric Concerns in a Veteran Reporting Gulf War Illness: A Case Report.","authors":"Christian Alan Botz-Zapp, Jami Wang, Eric Kazangian, Jennifer Ferrer","doi":"10.7812/TPP/24.071","DOIUrl":"10.7812/TPP/24.071","url":null,"abstract":"<p><p>Gulf War illness (GWI) is a chronic condition affecting nearly a third of Gulf War veterans and is characterized by persistent symptoms across a number of physical and neuropsychiatric domains. This case study examined a 52-year-old veteran admitted on a psychiatric hold for danger to others. The patient's symptoms, including chronic migraine, widespread musculoskeletal pain, skin sensitivities, environmental allergies, and mood and cognitive disturbances, met criteria for GWI according to 2 accepted case definitions. Initial misdiagnosis of psychosis was corrected upon evaluation, which identified severe anxiety consistent with generalized anxiety disorder. Treatment focused on providing validation of the patient's chronic symptoms and managing his anxiety through pharmacologic intervention. This case underscored the importance of recognizing GWI to ensure accurate diagnoses and targeted care for veterans.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"84-87"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027135","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":"Call for Papers: Advancing the Health in Our Communities With Value-Based Care.","authors":"","doi":"10.7812/TPP/25.066","DOIUrl":"https://doi.org/10.7812/TPP/25.066","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"29 2","pages":"100-101"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302827","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":"Call for Papers: Advancing the Health in Our Communities With Value-Based Care.","authors":"","doi":"10.7812/TPP/25.066","DOIUrl":"https://doi.org/10.7812/TPP/25.066","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111978","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":"Assessing BE FASTER, a Community of Practice Among Ryan White Part A Clinics in Houston, to Increase Rapid Initiation of Antiretroviral Therapy: A Qualitative, Longitudinal Study.","authors":"Meheret Adera, Bich N Dang, Caleb Brown, Naomi Sequeira, Melanie Goebel, Monisha Arya, Avishek Ghosh-Hajra, Kathryn Fergus, Shital Patel","doi":"10.7812/TPP/24.128","DOIUrl":"10.7812/TPP/24.128","url":null,"abstract":"<p><strong>Background: </strong>Rapid initiation of antiretroviral therapy (Rapid ART) is a key strategy for the <i>Ending the HIV Epidemic</i> inititative. In Harris County, Texas, a priority <i>Ending the HIV Epidemic</i> jurisdiction, 57% of persons with HIV receive care at 1 of 5 public agencies that receive funding from the Ryan White HIV/AIDS Program. The Ryan White HIV/AIDS Program is administered by the US Department of Health and Human Services, Health Resources and Services Administration, and HIV/AIDS Bureau. This program administers grants to clinics and local/state programs to deliver medical and support services (Part A) for low-income persons with HIV. In 2019, 39% of recently diagnosed persons with HIV in Houston took > 1 month to start ART. Herein, the authors evaluate the acceptability of the Baylor College of Medicine ECHO Facilitating Antiretroviral StART Earlier (BE FASTER) program, a community of practice collaborative among 5 Ryan White Part A Clinics, to increase Rapid ART in Harris County, Texas.</p><p><strong>Methods: </strong>Semistructured interviews across 4 time points were conducted among health care workers participating in the BE FASTER program. Interviews took place from November 2021 through February 2023 and were analyzed using rapid qualitative analysis.</p><p><strong>Results: </strong>A total of 29 participants were interviewed. Analyses revealed 6 themes: 1) Rapid ART protocols varied between clinics; 2) participants were interested in getting to know Rapid ART staff at other Ryan White clinics; 3) participants enjoyed the active components of BE FASTER and asked for more opportunities to engage; 4) at the end of BE FASTER, participants reported that they had streamlined their processes for Rapid ART, but barriers to long-term retention remained an ongoing challenge; 5) participants reported an increased sense of community from participating in the BE FASTER program; and 6) overall, participants had a positive experience with BE FASTER.</p><p><strong>Conclusions: </strong>Participants found BE FASTER valuable and reported a positive impact on their cross-agency interactions. The BE FASTER program using the ECHO model can augment the creation of cross-organizational networks for Rapid ART.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658693","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":"Implementing Screening and Treatment Pathways for Teens Who Vape in a Community-Based Pediatrics Clinic in Northern California.","authors":"Daisy Albarran Garcia, Brooke Harris, Alex Tsang, Thomas Tsang, Karen Cerrato, Chynna I Bantug, Wynnyee Tom","doi":"10.7812/TPP/24.087","DOIUrl":"10.7812/TPP/24.087","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this report was to summarize implementation of universal screening and treatment pathways for youth vaping in a large, community-based health care system in the United States.</p><p><strong>Methods: </strong>Data were obtained as a part of routine clinical care and were extracted from medical records weekly for 4 years. Variables reported include number of teens screened, teens who tested positive, referrals, and quit rates, as well as gender and race or ethnicity.</p><p><strong>Results: </strong>Of the 16,671 visits, 12,165 (73%) teens were screened, 632 (5.2%) teens screened positive, and of those who screened positive, 128 (20%) referrals were placed. For those who were referred, 40 teens (31.3%) quit vaping (abstinence for at least 3 weeks) and 21 (16%) decided to receive nicotine replacement therapy (nicotine patches, gum, or lozenges).</p><p><strong>Conclusions: </strong>This study outlines a screening and intervening pathway that can be used in other health care systems in the United States and beyond. Teen vaping can be addressed before it becomes a serious addiction. Institutions can experience cost-saving benefits in that increasing outreach efforts and education would ultimately reduce the number of inpatient/emergency department visits/hospitalizations related to vaping.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"23-26"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772624","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 Review of the Food and Drug Administration Pipeline and Proposed California Legislation on Medicinal Psychedelics.","authors":"Jack R Watson, Laura Halpin, Violeta Barroso, George Dahdouh, Jacqueline Bursalyan, Saahil Mohta, Michelle Flores, Natalie Gonzalez, John Gordineer, Germain Medina, Crystal Oseguera, Jailene Lazaro Serrano","doi":"10.7812/TPP/24.171","DOIUrl":"10.7812/TPP/24.171","url":null,"abstract":"<p><p>Psychedelic and empathogenic compounds show promise for a variety of conditions. However, studying these compounds can be highly complex, be very expensive, and have substantial patient safety concerns. Here, the authors will review 8 late-phase medicinal psychedelic studies in the Food and Drug Adminisration (FDA) approval pipeline. The authors will include a review of the FDA's recent denial of the New Drug Application for 3-4-methylenedioxymethamphetamine with adjuvant psychotherapy for posttraumatic stress disorder from Lykos Therapeutics of San Jose, California (formerly the Multidisciplinary Association for Psychedelic Studies Public Benefit Corporation). Additionally, the authors will discuss the parallel legislative proposals in California to legalize psychedelic compounds for adult use. These legislative efforts reflect an alternative and less expensive pathway, but they do not make as thorough of an evaluation for drug safety. The authors will propose that the FDA remains the appropriate agency to evaluate and approve the use of this class of proposed therapeutics.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"89-101"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469317","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 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":"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":"43-49"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787198","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":"Survey of Orthopedic Surgeons' Perceptions of Adopting an Initiative With Cemented Hip Hemiarthroplasties for Fractures.","authors":"Ivette T Curiel, Ronald A Navarro, Norman W Gill","doi":"10.7812/TPP/24.140","DOIUrl":"10.7812/TPP/24.140","url":null,"abstract":"<p><strong>Introduction: </strong>Hip hemiarthroplasty is a surgical procedure that requires the adhesion of the prosthetic implant by utilizing a fixation technique, either cemented or noncemented. The current literature does not provide a clear recommendation on a superior technique, although many countries outside the US have guidelines recommending cemented over noncemented procedures. Further, surgeon perceptions and beliefs related to the cemented and noncemented techniques in hip arthroplasty fractures are generally unknown.</p><p><strong>Methods: </strong>Orthopedic surgeon leaders adopted a quality assurance initiative to increase the rate of cemented cases within their practice. A survey was developed to capture the surgeons' perceptions related to fixation technique, affordability, and potential barriers and facilitators. Likert scale data were analyzed with descriptive statistics and chi-square tests.</p><p><strong>Results: </strong>Sixty-one total joint surgeons throughout 13 locations were invited to participate in the study via email. A total of 38 of the 61 total joint surgeons completed the survey, representing a 62% response rate. Most responses were neutral or disagreed with the use of cement for femoral fixation in hemiarthroplasty.</p><p><strong>Conclusion: </strong>Although some questions elicited strong opinions, many surgeons expressed hesitancy to change their current fixation technique and their desire for autonomy within their clinical practices. However, the large number of neutral responses suggests the potential to engage, educate, and shift the surgeons' perception to adopt the quality assurance initiative and increase the rate of cemented cases.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"69-76"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898209","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}