The Permanente journal最新文献_第8页

Lower Use of and Potential Barriers to Using Patient Portals Among Limited English Proficient Latino and Chinese American Adults: A Health Techquity Concern. 在英语水平有限的拉丁裔和华裔美国成年人中，使用患者门户网站的低使用率和潜在障碍：一个健康技术问题。

The Permanente journal Pub Date : 2025-03-14 Epub Date: 2025-02-12 DOI: 10.7812/TPP/24.119

Nancy P Gordon, Antonia Torreblanca, Rachelle G Ford, Sharon Ou, Mark W Lin

{"title":"Lower Use of and Potential Barriers to Using Patient Portals Among Limited English Proficient Latino and Chinese American Adults: A Health Techquity Concern.","authors":"Nancy P Gordon, Antonia Torreblanca, Rachelle G Ford, Sharon Ou, Mark W Lin","doi":"10.7812/TPP/24.119","DOIUrl":"10.7812/TPP/24.119","url":null,"abstract":"Introduction: Patient portals are increasingly becoming the primary channel for communicating health information, raising concerns about the potential worsening of health care access disparities among limited English proficient (LEP) patients. The authors studied the use of a health plan patient portal and potential barriers to use by comparing LEP Latino and Chinese Health Plan members to those with English language preference (non-LEP).Methods: The authors used health record data for 480,833 Latino (31.8% LEP) and 137,904 Chinese (31.6% LEP) adult Kaiser Permanente Northern California members 25-85 years of age to study portal use during 2019. Clinic-collected survey data for 489 Latino and 1037 Chinese LEP patients was compared with data for 849 Latino and 426 Chinese non-LEP Kaiser Permanente Northern California 2020 Member Health Survey respondents to identify factors potentially inhibiting portal use. The authors used chi-square tests to assess differences in portal use and potential influencing factors across ethnic, language, and age subgroups.Results: During 2019, LEP Latino and Chinese adults were less likely than non-LEP adults to have a portal account and, among those with a portal account, to have sent secure messages and viewed laboratory results online. Portal use was lower among LEP Latino than LEP Chinese adults. Patient surveys identified lower educational attainment, health literacy, and access to and use of digital tools among LEP vs non-LEP Latino and Chinese adults.Conclusions: Patient portal use is lower among LEP than non-LEP Latino and Chinese patients. Health care systems should take action to decrease barriers to use, but they also should consider patient communication preferences.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-22"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399967","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}

引用次数: 0

A Challenging Case of Eosinophilic Fasciitis Without Classic Histopathological Findings. 嗜酸性筋膜炎一例，无典型组织病理学表现。

The Permanente journal Pub Date : 2025-03-14 Epub Date: 2025-02-03 DOI: 10.7812/TPP/24.124

Cristo Armando Carrasco Mendoza, Alexander Rolando Gomez-Lara, Brian Matthew Kleker

{"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":"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.","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}

引用次数: 0

2024 Reviewer Acknowledgment. 2024审稿人致谢。

The Permanente journal Pub Date : 2025-02-10 DOI: 10.7812/TPP/25.011

引用次数: 0

2024 Reviewer Acknowledgment. 2024审稿人致谢。

The Permanente journal Pub Date : 2025-02-10 DOI: 10.7812/TPP/25.011

引用次数: 0

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. 在初级保健诊所中使用面板管理识别高风险代谢功能障碍相关性脂肪肝/代谢功能障碍相关性脂肪性肝炎纤维化的成人患者：一项试点研究。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-10-24 DOI: 10.7812/TPP/24.094

Sarah Householder, Andrew J Loza, Vikas Gupta, Benjamin R Doolittle

{"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":"Background: 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.Materials and methods: 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.Results: 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.Conclusion: 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.","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}

引用次数: 0

Erratum to Vitamin D Deficiency-Associated Neuropathic Pain Examined in a Chronic Pain Management Program. 在慢性疼痛管理计划中对维生素 D 缺乏相关神经性疼痛的研究》的勘误。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-09-20 DOI: 10.7812/TPP/24.152

引用次数: 0

Clinical Evaluation of the Cannabis-Using Patient: A Moving Target. 对使用大麻患者的临床评估：一个移动的目标。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-10-28 DOI: 10.7812/TPP/24.088

Sina Radparvar

{"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":"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.","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}

引用次数: 0

Immunoglobulin A Nephropathy: A Review. 免疫球蛋白 A 肾病：综述。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-11-05 DOI: 10.7812/TPP/24.089

Sulaiman Aseem, Sijie Zheng

引用次数: 0

Introduction to Issue 28:4 by the Editor-in-Chief. 主编对第28:4期的介绍。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-12-13 DOI: 10.7812/TPP/24.188

G Richard Holt

引用次数: 0

Relativity, Rank, and the US News Health's Cardiology, Heart, and Vascular Surgery Best Hospitals. 相对性、排名以及 US News Health 的心脏病学、心脏和血管外科最佳医院。

The Permanente journal Pub Date : 2024-12-16 Epub Date: 2024-10-21 DOI: 10.7812/TPP/24.116

Alexandra Kats, Gordon H Morewood, George Moser, Eric Wilkens, Huaqing Zhao, Abul Kashem, Yoshiya Toyoda, Suyog Mokashi

{"title":"Relativity, Rank, and the US News Health's Cardiology, Heart, and Vascular Surgery Best Hospitals.","authors":"Alexandra Kats, Gordon H Morewood, George Moser, Eric Wilkens, Huaqing Zhao, Abul Kashem, Yoshiya Toyoda, Suyog Mokashi","doi":"10.7812/TPP/24.116","DOIUrl":"10.7812/TPP/24.116","url":null,"abstract":"Objective: Virtually anything can be ranked; the US News and World Report (USNWR or US News) ranks the top 50 hospitals specializing in cardiology, heart, and vascular surgery. Here the authors propose validating the effectiveness of rankings by comparing differences among the USNWR metrics across the top 50 hospitals.Methods: The ranking system for the top 50 hospitals specializing in cardiology, heart, and vascular surgery was derived from 16 variant scores. Each hospital's scores were collected from the USNWR. Hospitals were categorized into quintiles consisting of 10 institutions (1-10, 11-20, etc). An analysis of variance/χ2 comprehensive statistical analysis was run alongside a Wilcoxon/Kruskal-Wallis test to compare statistical outcomes. A significant threshold was deemed to be P < 0.05.Results: Significant differences were noted between quintiles for advanced technologies (P = 0.05), US News specialty score (P < 0.001), number of patient referrals (P = 0.004), and expert opinion (P < 0.001). Non-statistically significant differences were found among patient experience, public transparency, Society of Thoracic Surgery transparency, American College of Cardiology transparency, recognition as a magnet hospital, and nursing staffing. Interestingly, a large variance was noted in the average number of referrals between the first quintile (13,371) and the last (6690).Conclusions: Expert opinion plays a critical role in the reputation of the USNWR's top 10 hospitals in cardiology, heart, and vascular surgery. Although many have argued about the merits of USNWR hospital rankings, taken together, rankings fill a strong customer demand and are sticky.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"48-56"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475434","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}

引用次数: 0