The Permanente journal最新文献

{"title":"Predictive Value of LACE Scores for Pediatric Readmissions.","authors":"Jelena Douillard, Sarah Lentz, Shaina Ganjian, Sherill Agdeppa, Ngoc Ho, Jane Chieh Lin, Paul Han","doi":"10.7812/TPP/23.114","DOIUrl":"10.7812/TPP/23.114","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital readmissions are recognized as a prevalent, yet potentially preventable, personal and economic burden. Length of stay, Acuity of admission, Comorbidities, and number of Emergency Department visits in the preceding 6 months can be quantified into one score, the LACE score. LACE scores have previously been identified to correlate with hospital readmissions within 30 days of discharge, but research specific to the pediatric population is scant. The objective of the present study was to investigate if LACE scores, in addition to other factors, can be utilized to create a predictive pediatric hospital readmission model that may ultimately be used to decrease readmission rates.</p><p><strong>Methods: </strong>This study included 25,616 hospitalizations of patients under the age of 18 years. Data were extracted from a hospital network electronic medical record. Demographics included LACE scores, age, gender, race/ethnicity, median household income, and medical centers. The primary exposure variable was LACE score. The main outcome measures were readmissions within 7, 14, and 30 days. The area under the curve (AUC) was used to assess the predictive capability of the regression model on patient 30-day admission.</p><p><strong>Results: </strong>LACE scores, age, gender, race/ethnicity, median household income, and medical centers were examined in a multivariable model to assess patient risk of a 30-day readmission. Only age and LACE score were observed to be statistically significant. The AUC for the combined model was 0.69.</p><p><strong>Discussion: </strong>As only age and LACE score were observed to be statistically significant and the AUC for the combined model was 0.69, this model is considered to have poor predictive capability.</p><p><strong>Conclusions: </strong>In this study, LACE scores, as well the other factors, had a poor predictive capability for pediatric readmissions.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"9-15"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933024","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":"Exploring Sociodemographic Factors in Allergic Fungal Rhinosinusitis in a Northern California Patient Population.","authors":"Peter Debbaneh, Priyanka Singh, Austin R Swisher, Julia C Wei, Jonathan Liang","doi":"10.7812/TPP/23.165","DOIUrl":"10.7812/TPP/23.165","url":null,"abstract":"<p><strong>Background: </strong>Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis (CRS) that has previously been associated with younger age and Black patients. However, the role of demographic and socioeconomic factors in AFRS severity remains to be fully elucidated.</p><p><strong>Objective: </strong>The objective of this study was to determine whether demographic and socioeconomic factors are associated with incidence of AFRS, as well as with disease severity in Northern California.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of adult patients with AFRS and CRS from 2010 to 2019. AFRS was determined by the Bent and Kuhn criteria, and severity was assessed by radiographic evidence of cranioorbital invasion and other clinical parameters. Chi-square and t-test were used to assess demographic and socioeconomic differences between AFRS and CRS cohorts, and multivariable logistic regression was used to assess risk factors for severe AFRS.</p><p><strong>Results: </strong>Black patients represented 26.2% (55/210 patients) of the AFRS group and 4.9% (842/17,300 patients) of the CRS group, with pairwise comparison of race/ethnicity categories showing that the AFRS group had significantly higher proportions of Black race/ethnicity compared with other race/ethnicities (p < 0.01). AFRS and CRS groups differed significantly by age, with mean ages of 48.7 and 51.0 years, respectively (p = 0.04). There were no significant differences in gender, Medicaid status, comorbidities, and socioeconomic status measures. Multivariate logistic regression showed that Black patients had higher odds of having severe AFRS (adjusted odds ratio = 2.29; 95% confidence interval: 1.18-4.45).</p><p><strong>Conclusion: </strong>AFRS has a unique predilection for Black patients, and severe disease is also more likely in this population.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"78-85"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923254","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":"Narrative Medicine: The Power of Shared Stories to Enhance Inclusive Clinical Care, Clinician Well-Being, and Medical Education.","authors":"Michelle Loy, Rachel Kowalsky","doi":"10.7812/TPP/23.116","DOIUrl":"10.7812/TPP/23.116","url":null,"abstract":"<p><p>The COVID-19 pandemic exacerbated the problem of secondary trauma and moral injury for health care workers. This reality, together with the epidemic of social isolation and loneliness, has brought the mental health of health care practitioners and patients to the forefront of the national conversation. Narrative medicine is an accessible, diversity-honoring, low-cost, underutilized pedagogical framework with potentially revolutionary benefits for enhancing patient care, supporting the underserved, mitigating clinician burnout, and improving team dynamics. Herein, the authors review the literature on these benefits and then discuss methods for integrating narrative medicine into clinical care and medical education at the undergraduate and graduate levels as well as continuing medical education.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"93-101"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472901","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":"COVID-19 Vaccine Information and Infertility Posts on X: Insights on a Misinformation Pandemic.","authors":"Morgan S Levy, Kelby N Hunt, Sarah Rinehart, Alyssa D Brown, Amelia G Kelly, Padmaja Sundaram, Alisha Crump, Tiffany J Sinclair, Kally Dey, Alexander Zoroufy, Alberto J Caban-Martinez, Torie Comeaux Plowden","doi":"10.7812/TPP/23.142","DOIUrl":"10.7812/TPP/23.142","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate misinformation surrounding infertility and the COVID-19 vaccine on X (formerly known as Twitter) by analyzing the prevalence and content of this misinformation across a sample of posts on X.</p><p><strong>Methods: </strong>This study is a retrospective review of posts on X (formerly known as tweets) from the COVID-19-TweetIDs dataset from July 2021 and November 2021. Included posts were from crucial time points in the COVID-19 vaccine discourse and contained at least one word related to COVID-19 vaccination and fertility. Posts were analyzed and categorized based on factuality, common words, and hashtags. Descriptive statistics on total followers, account verification status, and engagement were obtained. Differences between posts on X classified as factual and misinformation were examined using analysis of variance or χ² tests. Sentiment analysis determined if post content was generally positive, neutral, or negative.</p><p><strong>Results: </strong>A total of 17,418 relevant posts on X were reviewed: 11,436 from timeframe 1 (July 2021) and 5982 from timeframe 2 (December 2021). Misinformation posts rose from 29.9% in July 2021 to 45.1% in November 2021. In both timeframes, accounts sharing factual information had more followers (p < 0.001), and verified users were more likely to share accurate posts (p ≤ 0.001). Factual and misinformation posts had similar engagement. Sentiment analysis identified that real posts were more positive and misinformation posts were more negative (p < 0.001).</p><p><strong>Conclusions and relevance: </strong>Misinformation about the COVID-19 vaccine and fertility is highly prevalent on X and threatens vaccine uptake in patients desiring future fertility. Accounts sharing factual information were likely to have more followers and be verified; therefore, verifying more physicians sharing accurate information is critical.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"47-54"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871282","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":"Codesigning Online Continuing Medical Education on Social Health Integration and Social Risk-Informed Care for Primary Care Providers.","authors":"Meagan C Brown, Andrea R Paolino, Katheen A Barnes, Dea Papajorgji-Taylor, Loel S Solomon, Cara C Lewis, Elizabeth Bojkov, Katie F Coleman","doi":"10.7812/TPP/23.113","DOIUrl":"10.7812/TPP/23.113","url":null,"abstract":"<p><strong>Introduction: </strong>Adapting clinical care decisions for patient-reported social risks is essential to social health integration and patient-centered care. Most research in this area focuses on awareness and assistance (social-needs-targeted care), such as screening and referral to food, financial, and other resources. Limited evidence for adjustment strategies (social risk-informed care) or adapting care for social risks made it difficult for Kaiser Permanente to implement new initiatives. This article describes a codesign process to build a novel, adjustment-focused continuing medical education course.</p><p><strong>Methods: </strong>The authors codeveloped the online continuing medical education course with patients and clinicians using user-centered design. Transcripts from codesign activities were coded and analyzed by thematic analysis to identify major themes, including perceptions of social risk-informed care and barriers to care adjustment.</p><p><strong>Results: </strong>Practical hurdles for implementing social risk-informed care emerged, including clinicians' concerns about the ethics of adjustment as substandard care, particularly without robust assistance activities. However, patients expressed a desire for their care to be adapted to their social circumstances, to allow for more realistic care plans.</p><p><strong>Discussion: </strong>Implementation barriers identified from the codesign were addressed through an interactive, case-study approach. Existing evidence on contextualized care and shared decision making informed a general framework for primary care providers to engage in awareness and adjustment activities, paired with 3 interactive case studies based on real-world, clinician-supplied scenarios.</p><p><strong>Conclusion: </strong>The authors recommend that multiple stakeholder perspectives be incorporated during the development of social health integration initiatives, particularly adjustment. Education complemented by active, nuanced, flexible implementation strategies may be necessary for the successful uptake of care-delivery-based social health integration activities.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"26-35"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899543","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":"Analyzing Potential Interactions Between Complementary and Alternative Therapies, Over-the-Counter, and Prescription Medications in the Older Population.","authors":"Ecler Ercole Jaqua, Jody Gonzalez, Khaled Bahjri, Shasta Erickson, Clarissa Garcia, Montinee Santhavachart, Van Nguyen, Wessam Labib, Rasha Abdrabou","doi":"10.7812/TPP/23.183","DOIUrl":"10.7812/TPP/23.183","url":null,"abstract":"<p><strong>Background: </strong>The escalating use of complementary and alternative medicine (CAM) raises concerns, particularly among geriatric patients taking multiple medications. Notably, the doubled chance of major drug interactions between prescription and over-the-counter (OTC) drugs in older adults underscores the need for further research. This study aimed to evaluate clinically significant CAM and prescription medication interactions in a geriatric clinic, emphasizing the growing importance of understanding CAM implications in health care.</p><p><strong>Methods: </strong>A 2-year cross-sectional study, approved by the Institutional Review Board, enrolled 420 participants aged 65 and older from a geriatric primary care clinic. Participants completed a survey, and pharmacy students conducted chart reviews to evaluate potential CAM products and prescription medication interactions.</p><p><strong>Results: </strong>Among the 420 participants-who were predominantly White females and who were taking supplements, OTC medications, or both-15.6% experienced potential drug interactions. <i>Ginkgo biloba</i>, garlic, and calcium were common contributors to major, moderate, and minor interactions, respectively, among supplements. Meanwhile, ibuprofen was among the contributors to major and moderate interactions among OTC medications. Most supplements and OTC medications were disclosed to health care professionals. However, there was a lack of investigation by health care professionals regarding CAM use, emphasizing a discrepancy between patient-reported and physician-inquired CAM usage.</p><p><strong>Conclusion: </strong>This study highlighted the significant use of CAM and/or OTC medications, particularly among vulnerable older adults, revealing a concerning 15.6% rate of potential drug interactions. The findings emphasized the need for awareness among health care practitioners and standardized CAM surveys to enhance accuracy and patient safety.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"28 2","pages":"70-77"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564425","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 28:2 by the Editor-in-Chief.","authors":"G Richard Holt","doi":"10.7812/TPP/24.090","DOIUrl":"10.7812/TPP/24.090","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"28 2","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564426","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 ChatGPT's Utility in Medicine Guidelines Through Web Search Analysis.","authors":"J. Dubin, Sandeep S Bains, Daniel Hameed, Zhongming Chen, Erica Gaertner, James Nace, Michael A. Mont, R. Delanois","doi":"10.7812/TPP/23.126","DOIUrl":"https://doi.org/10.7812/TPP/23.126","url":null,"abstract":"INTRODUCTION\u0000With the rise of machine learning applications in health care, shifts in medical fields that rely on precise prognostic models and pattern detection tools are anticipated in the near future. Chat Generative Pretrained Transformer (ChatGPT) is a recent machine learning innovation known for producing text that mimics human conversation. To gauge ChatGPT's capability in addressing patient inquiries, the authors set out to juxtapose it with Google Search, America's predominant search engine. Their comparison focused on: 1) the top questions related to clinical practice guidelines from the American Academy of Family Physicians by category and subject; 2) responses to these prevalent questions; and 3) the top questions that elicited a numerical reply.\u0000\u0000\u0000METHODS\u0000Utilizing a freshly installed Google Chrome browser (version 109.0.5414.119), the authors conducted a Google web search (www.google.com) on March 4, 2023, ensuring minimal influence from personalized search algorithms. Search phrases were derived from the clinical guidelines of the American Academy of Family Physicians. The authors prompted ChatGPT with: \"Search Google using the term '(refer to search terms)' and document the top four questions linked to the term.\" The same 25 search terms were employed. The authors cataloged the primary 4 questions and their answers for each term, resulting in 100 questions and answers.\u0000\u0000\u0000RESULTS\u0000Of the 100 questions, 42% (42 questions) were consistent across all search terms. ChatGPT predominantly sourced from academic (38% vs 15%, p = 0.0002) and government (50% vs 39%, p = 0.12) domains, whereas Google web searches leaned toward commercial sources (32% vs 11%, p = 0.0002). Thirty-nine percent (39 questions) of the questions yielded divergent answers between the 2 platforms. Notably, 16 of the 39 distinct answers from ChatGPT lacked a numerical reply, instead advising a consultation with a medical professional for health guidance.\u0000\u0000\u0000CONCLUSION\u0000Google Search and ChatGPT present varied questions and answers for both broad and specific queries. Both patients and doctors should exercise prudence when considering ChatGPT as a digital health adviser. It's essential for medical professionals to assist patients in accurately communicating their online discoveries and ensuing inquiries for a comprehensive discussion.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"3 3","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652598","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":"Return to Sports After Anterior Cruciate Ligament Reconstruction.","authors":"Aditya Manoharan, Andrew Fithian, V. Xie, Kurt Hartman, William Schairer, Najeeb Khan","doi":"10.7812/TPP/23.132","DOIUrl":"https://doi.org/10.7812/TPP/23.132","url":null,"abstract":"Anterior cruciate ligament (ACL) tears are one of the most common orthopedic injuries among athletes. Although a small proportion of patients with isolated tears can return to sports after completing a nonsurgical rehabilitation program, ACL reconstruction is frequently recommended for young athletes, especially those with concomitant knee injuries or symptomatic knee instability. Alongside emerging evidence for the effect of prehabilitation, the current standard of care for postoperative ACL physical therapy includes pain control, range of motion, quadriceps strengthening, weight bearing, postoperative bracing, and dynamic limb stabilization and control. The early rehabilitation period includes non-weight-bearing exercises and passive range of motion, which is followed by a longer period of gradual strengthening focused on regaining preinjury strength, proprioception, and control with progressively more demanding dynamic movements. The total rehabilitation period is expected to take around 9 months, during which the patient should be evaluated at frequent intervals by a licensed physical therapist in addition to a daily home exercise program. Prior to discharge from the rehabilitation program, patients should be evaluated by both the surgeon and physical therapist. Patients are encouraged to return to sports once they meet a set of perceptual, subjective, objective, neuromuscular, functional, sport-specific drills, and load management testing criteria.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"27 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140653234","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":"The Added Value of Prostate Magnetic Resonance Imaging to Patient Selection.","authors":"Erin M Jyo, Hyo-Chun Yoon, Bradford Burton","doi":"10.7812/TPP/23.178","DOIUrl":"https://doi.org/10.7812/TPP/23.178","url":null,"abstract":"INTRODUCTION\u0000There has been a rapid increase in the utilization of magnetic resonance imaging (MRI) for prostate cancer detection. The objective of this study was to measure the increase in utilization of MRI before prostate biopsy and the effects on the distribution of Prostate Imaging Reporting and Data System (PI-RAD) scores and Gleason grades over a 5-year interval in an integrated health system.\u0000\u0000\u0000METHODS\u0000The authors conducted a retrospective analysis of prostate MRI studies prior to biopsy in the calendar years of 2017 and 2022. Peak PI-RADS score, peak Gleason grade of suspected prostatic lesions, and the number of biopsy cores were collected from radiology reports and pathology reports from patients' electronic health records, respectively. All statistical tests were 2-tailed with a significance level set at p < 0.05. Categorical data analyses were performed using Mann-Whitney tests. Continuous data analyses were performed using t-tests.\u0000\u0000\u0000RESULTS\u0000The total number of prostate MRIs and the number of MRIs with subsequent biopsy respectively increased by 178% and 215% over a 5-year interval (2017-2022). There was a higher proportion of MRI studies with an associated biopsy given a PI-RADS score of ≥ 3 (91%) and a Gleason grade of ≥ 7 (61%) in 2022 than in 2017 (PI-RADS: 75%; Gleason: 28%).\u0000\u0000\u0000CONCLUSIONS\u0000Increased utilization of prostate MRI has been associated with a higher proportion of biopsies with high PI-RADS and Gleason scores consistent with improved patient selection in this integrated health system.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"61 3","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140664909","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}