The Permanente journal最新文献

{"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}

{"title":"Disparities in Maternal Health Visits Between Rural and Urban Communities in the United States, 2016-2018.","authors":"Burcu Bozkurt, A. Planey, Monisa Aijaz, Joshua M Weinstein, Dorothy Cilenti, Christopher M Shea, Saif S. Khairat","doi":"10.7812/TPP/23.067","DOIUrl":"https://doi.org/10.7812/TPP/23.067","url":null,"abstract":"OBJECTIVE\u0000The objective was to estimate the rural-urban differences in the receipt of prepregnancy, prenatal, and postpartum services.\u0000\u0000\u0000METHODS\u0000The authors conducted a cross-sectional data analysis using data from the Pregnancy Risk Assessment and Monitoring System from 2016 to 2018 to analyze rural-urban differences in the receipt of medical visits and care content delivery during the prepregnancy year, as well as the prenatal and postpartum periods among birthing people in the US, using survey-weighted multivariable logistic regression models.\u0000\u0000\u0000RESULTS\u0000Rural-dwelling birthing people were significantly less likely to attend a medical visit in the prepregnancy year or postpartum period, even when controlled for sociodemographic and clinical characteristics. Compared to their urban counterparts, they were also less likely to receive comprehensive screening and counseling in the prepregnancy and postpartum maternity phases.\u0000\u0000\u0000CONCLUSION\u0000Efforts to ameliorate rural-urban differences in maternal care access and quality should explicitly adopt multilevel, systemic approaches to policy and program implementation and evaluation. Policymakers and practitioners should consider telehealth as a potential complementary tool to minimize gaps in quality of care which disproportionately impact rural-dwelling birthing people.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"4 3","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671358","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":"Prophylactic Biosynthetic Retrorectus Mesh Placement During Stoma Reversal Reduces the Rate of Stoma Site Incisional Hernia.","authors":"Brandon K Vu, Jessica Lam, Matthew J Sherman, Michael S Tam","doi":"10.7812/TPP/23.115","DOIUrl":"https://doi.org/10.7812/TPP/23.115","url":null,"abstract":"INTRODUCTION\u0000Stoma site incisional hernias (SSIHs) are associated with substantial long-term morbidity, and the rate can be as high as 30% to 40%. Recent efforts using prophylactic mesh reinforcement (PMR) to reduce the development of hernias have shown encouraging outcomes. The objective of this study was to assess the use of prophylactic biosynthetic mesh at the time of stoma reversal on the overall SSIH rate.\u0000\u0000\u0000METHODS\u0000This is an observational retrospective cohort study. A review of 101 consecutive patients who underwent PMR in the retrorectus plane from 2015 to 2020 was compared to 73 consecutive patients who underwent primary stoma closure without mesh from 2011 to 2014. The primary endpoint was the presence of SSIH on clinical examination or computed tomography after ostomy takedown.\u0000\u0000\u0000RESULTS\u0000In total, 174 cases were analyzed with 101 patients in the treatment group (median follow-up 45.2 months) and 73 patients in the control group (median follow-up 43.2 months). There were no major differences in preoperative characteristics between the groups. Fourteen patients developed SSIHs with 1 (1.0%) in the treatment arm and 13 (17.8%) in the control arm (p = 0.001). The majority of stomas were loop ileostomies and end colostomies, and stoma type did not affect hernia rates. On univariate analysis, body mass index (p = 0.029) and chronic kidney disease < 3 (p = 0.003) were independent predictors of hernia formation, while mesh was significantly protective (p = 0.000057).\u0000\u0000\u0000DISCUSSION\u0000PMR with biosynthetic mesh at the time of stoma reversal and closure is an effective procedure to reduce the incidence of SSIHs and does not seem to be associated with an increased risk of complications.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"78 6","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140670552","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":"Combined Rupture of the Diaphragm and Urinary Bladder in Blunt Trauma Abdomen.","authors":"D. Dugar, Debajyoti Mohanty, Suhail Muhammed","doi":"10.7812/TPP/23.156","DOIUrl":"https://doi.org/10.7812/TPP/23.156","url":null,"abstract":"The authors examined a 25-year-old man with a combined rupture of the diaphragm and urinary bladder following blunt trauma to the abdomen. The presence of hematuria, suprapubic tenderness, and elevated serum urea and creatinine levels in this patient raised suspicion of urinary bladder rupture. Documentation of bowel gas shadows on the chest x-ray suggested underlying diaphragm injury. A computed tomogram of the thorax and abdomen confirmed the tear in the left hemidiaphragm with intrathoracic herniation of abdominal contents; however, it failed to detect the intraperitoneal urinary bladder rupture. Both the defects were identified and repaired during laparotomy. The sudden increase in intraabdominal pressure in blunt trauma to the abdomen often resulted in full-thickness tears of the diaphragm and the urinary bladder. Although radiological investigations were pivotal for assessing the damage to the internal organs, a methodical and thorough exploratory laparotomy was invaluable for successfully managing patients with blunt abdominal trauma.","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" 5","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691100","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":"Introduction to the Special Section on Innovations in Trauma-Informed Health Care.","authors":"Ellen Goldstein, Audrey Stillerman, Martina Jelley, Brigid McCaw","doi":"10.7812/TPP/23.140","DOIUrl":"10.7812/TPP/23.140","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"88-90"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120634","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":"Clinic Readiness for Trauma-Informed Health Care Is Associated With Uptake of Screening for Adverse Childhood Experiences.","authors":"Edward L Machtinger, Nicole K Eberhart, J Scott Ashwood, Maggie Jones, Monika Sanchez, Marguerita Lightfoot, Anda Kuo, Nipher Malika, Nicole Vu Leba, Stephanie Williamson, Brigid McCaw","doi":"10.7812/TPP/23.085","DOIUrl":"10.7812/TPP/23.085","url":null,"abstract":"<p><strong>Introduction: </strong>Adverse childhood experiences (ACEs) are strongly correlated with many of the most common causes of preventable illness, preventable death, and health disparities. In January 2020, California launched the first statewide initiative to integrate ACE screening throughout its Medicaid system. A key element of the initiative was the California ACEs Learning and Quality Improvement Collaborative, a 48-clinic, 16-month learning collaborative. This evaluation aimed to determine whether developing a trauma-informed environment of care was associated with uptake of ACE screening.</p><p><strong>Methods: </strong>Participants included 40 of 48 clinics that participated in the statewide learning collaborative. Clinics completed an assessment of progress in 5 essential components of trauma-informed health care at baseline and 1-year follow-up. Clinics tracked data on ACE screens completed on an ongoing basis and submitted data quarterly. A hierarchical linear model was used to examine the association between change in readiness for trauma-informed health care and change in quarterly screens.</p><p><strong>Results: </strong>Readiness for trauma-informed health care increased for all participating clinics over the course of the learning collaborative. The average number of quarterly screens also increased, with considerable variability among clinics. Clinics with larger increases in readiness for trauma-informed health care had larger increases in quarterly screens.</p><p><strong>Discussion: </strong>The findings align with long-standing recommendations for trauma screening to occur in the context of trauma-informed environments of care.</p><p><strong>Conclusion: </strong>A trauma-informed clinic is the foundation for successful adoption of ACE screening. ACE screening initiatives should include education and sufficient support for clinics to embrace a trauma-informed systems change process.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"100-110"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139485935","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":"Rate Versus Rhythm Control for Atrial Fibrillation.","authors":"Edward D Shin, H Nicole Tran, Nirmala D Ramalingam, Taylor Liu, Eugene Fan","doi":"10.7812/TPP/23.151","DOIUrl":"10.7812/TPP/23.151","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is an arrhythmia characterized by disorganized atrial activity with an associated unevenly irregular ventricular response on an electrocardiogram. It is the most common sustained arrhythmia, with a lifetime risk of 25% in patients older than 40 years old. The incidence of AF increases with age and is associated with an increased risk for heart failure, stroke, adverse cardiac events, and dementia. The 2 main aims of AF treatment include anticoagulation for thromboembolism prophylaxis as well as rate vs rhythm control. The focus of this article will be on the treatment strategies in managing AF. Rate control refers to the use of atrioventricular nodal blocking medications, including beta blockers and calcium channel blockers, to maintain a goal heart rate. Rhythm control, on the other hand, refers to a treatment strategy focused on the use of antiarrhythmic drugs (AAD), cardioversion, and ablation to restore and to maintain a patient in sinus rhythm. Currently, the ideal treatment strategy remains greatly debated. Thus, we hope to compare the risks and benefits of rate to rhythm control to highlight how patients with AF are managed here at Kaiser Permanente Northern California.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"81-85"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801808","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}