Summer 2012/ Volume 16 No. 3 Thrme anenteJournal … · Summer 2012/ Volume 16 No. 3 Thrme...
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Mission: The Permanente Journal advances knowledge in scientific research, clinical medicine, and innovative health care delivery. Circulation: 25,000 print readers per quarter, and 1 million Internet hits in 2011 from 150 countries. Permanente Journal The Summer 2012/ Volume 16 No. 3 ON THE COVER “Lower Falls” a photograph by Gary Larsen, MS, was taken at Artist Point in the Grand Canyon of the Yellowstone in Yellowstone National Park. The mist rainbow can be seen every day around 9:50 am and is just one of the stunning sights to see in this magnificent place. Mr Larsen is a Clinical Microbiologist in the Bacteriology Department of the Northern California Regional Laboratory in Berkeley, CA. He uses photography as a refreshing excuse to get away from the busy laboratory to peaceful locations and to indulge in his re-energizing hobby. ORIGINAL RESEARCH & CONTRIBUTIONS 4 Prostate Cancer Screening Trends in a Large, Integrated Health Care System. Lauren Wallner, PhD, MPH; Stanley Frencher, MD; Jin-Wen Hsu, PhD; Ronald Loo, MD; Joice Huang, PharmD, MBA; Michael Nichol, PhD; Steven Jacobsen, MD, PhD In a retrospective cohort study (1998- 2007) of 2,061,047 men (older than 35 years) within a large integrated health care system, 572,306 (28%) had pros- tate-specific antigen (PSA) screening. Patterns of screenings varied modestly by age, race, and physician. The low- est frequencies were in men younger than 45 years (19%) and older than 85 years (13%). PSA screening was most common in white men (33.5%) and in men seen by physicians of the same race/ethnicity (32%), compared with men with physicians of disparate race/ ethnicity (26%, p < 0.001). 10 A Colorectal “Care Bundle” to Reduce Surgical Site Infections in Colorectal Surgeries: A Single-Center Experience. Waleed Lutfiyya, MD, FASCRS; David Parsons, MD, FASCRS; Juliann Breen, RN, CPHQ In a retrospective analysis of infection rates at Kaiser Sunnyside Medical Cen- ter, from the National Surgical Quality Improvement Program (NSQIP) database, the authors reviewed overall, superficial, deep, and organ/space surgical site infec- tions (SSIs). As a baseline there were 430 colorectal cases from January 2006 to December 2009. After a colorectal care bundle of interventions was implemented January 2010 through June 2011, there were 13 infections in 195 cases, a 6.67% overall rate. The overall decrease of 14.49% from baseline, and the decrease of superficial SSI from 15.12% to 3.59%, were both significant (p <0.0001). The rates for deep and organ/space SSIs showed a nonsignificant decrease. The NSQIP observed-to-expected ratio for colorectal SSI decreased from a range of 1.27 to 1.83 before implementation to 0.54 after implementation. 18 Reductions in Pain Medication Use Associated with Traditional Chinese Medicine for Chronic Pain. Charles Elder, MD, MPH, FACP; Cheryl Ritenbaugh, PhD, MPH; Mikel Aickin, PhD; Richard Hammerschlag, PhD; Samuel Dworkin, DDS, PhD; Scott Mist, PhD, MAcOM; Richard E Harris, PhD Participants (168) in a randomized trial of traditional Chinese medicine (TCM) for temporomandibular joint dysfunction had a linear decline in pain over 16 TCM visits. This article reports an observational analysis of the average pain outcomes and medication use reported at every TCM visit. Among the heaviest non- steroidal anti-inflammatory drug (NSAID) users, there was a short-term reduction in NSAID use—sustained as visits became less frequent. There was no indication that pain reduction during TCM treat- ment was influenced by drug use. 25 Ultrasound Measurements in Hyper- trophic Pyloric Stenosis: Don’t Let the Numbers Fool You. Meena Said, MD; Donald B Shaul, MD; Michele Fuji- moto, MD; Gary Radner, MD; Roman M Sydorak, MD; Harry Applebaum, MD In a retrospective analysis of 189 patients with hypertrophic pyloric stenosis (means of: 4.6 weeks, 3.9 kg, 0.42 cm muscle thickness, and 1.89 cm muscle length) that were treated at a single institution over a 5-year period (2005-2010), analysis showed a signifi- cant relationship between both age and weight and the muscle thickness. No significant relationship existed between pyloric length and age or weight. 28 Living With Advanced Illness: Longi- tudinal Study of Patient, Family, and Caregiver Needs. Karen Tallman, PhD; Ruth Greenwald, MS, MA; Alice Reide- nouer, SM; Laurel Pantel Little is known about how the needs of patients with advanced illness and the needs of their families and caregivers evolve, or how effectively those needs are addressed. A video-ethnographic ap- proach was conducted to observe and interview 12 patients and their families before, during, and after an inpatient palliative care consult at 3 urban Medi- cal Centers. This longitudinal approach highlighted areas for improvement, which include clear, integrated com- munications in the hospital and coor- dinated, comprehensive postdischarge support for patients not under hospice care and for their caregivers. 37 Sociodemographic Characteristics of Members of a Large, Integrated Health Care System: Comparison with US Census Bureau Data. Corinna Koebnick, PhD, MS; Annette M Langer-Gould, MD, PhD, MS; Michael K Gould, MD, MS; Chun R Chao, PhD, MS; Rajan L Iyer, MPH; Ning Smith, PhD; Wansu Chen, MS; Steven J Jacobsen, MD, PhD On review of sociodemographic char- acteristics of 3,328,579 members of Kaiser Permanente Southern California (KPSC) in 2000 and 3,357,959 members in 2010, compared with those of the underlying population in the coverage area based on US Census Bureau data; similarities included: neighborhood edu- cational levels, household incomes, sex, age, and the proportion of Hispanics/La- tinos; however, KPSC members included more blacks. These findings suggest that this setting may provide valid inference for clinical, epidemiologic, and health services research. The Permanente Journal 500 NE Multnomah St, Suite 100 Portland, Oregon 97232 www.thepermanentejournal.org ISSN 1552-5767 The Permanente Journal/ Summer 2012/ Volume 16 No. 3 78 BOOK REVIEW 80 CME EVALUATION FORM
Transcript of Summer 2012/ Volume 16 No. 3 Thrme anenteJournal … · Summer 2012/ Volume 16 No. 3 Thrme...
Mission: The Permanente Journal advances knowledge in scientific research, clinical medicine, and innovative health care delivery.
Circulation: 25,000 print readers per quarter, and 1 million Internet hits in 2011 from 150 countries.
PermanenteJournalThe
Summer 2012/ Volume 16 No. 3
ON THE COVER “Lower Falls” a photograph by Gary Larsen, MS, was taken at Artist Point in the Grand Canyon of the Yellowstone in Yellowstone National Park. The mist rainbow can be seen every day around 9:50 am and is just one of the stunning sights to see in this magnificent place.
Mr Larsen is a Clinical Microbiologist in the Bacteriology Department of the Northern California Regional Laboratory in Berkeley, CA. He uses photography as a refreshing excuse to get away from the busy laboratory to peaceful locations and to indulge in his re-energizing hobby.
ORIGINAL RESEARCH & CONTRIBUTIONS 4 Prostate Cancer Screening Trends in a
Large, Integrated Health Care System.Lauren Wallner, PhD, MPH; Stanley Frencher, MD; Jin-Wen Hsu, PhD; Ronald Loo, MD; Joice Huang, PharmD, MBA; Michael Nichol, PhD; Steven Jacobsen, MD, PhD
In a retrospective cohort study (1998-2007) of 2,061,047 men (older than 35 years) within a large integrated health care system, 572,306 (28%) had pros-tate-specific antigen (PSA) screening. Patterns of screenings varied modestly by age, race, and physician. The low-est frequencies were in men younger than 45 years (19%) and older than 85 years (13%). PSA screening was most common in white men (33.5%) and in men seen by physicians of the same race/ethnicity (32%), compared with men with physicians of disparate race/ethnicity (26%, p < 0.001).
10 A Colorectal “Care Bundle” to Reduce Surgical Site Infections in Colorectal Surgeries: A Single-Center Experience.Waleed Lutfiyya, MD, FASCRS; David Parsons, MD, FASCRS; Juliann Breen, RN, CPHQ
In a retrospective analysis of infection rates at Kaiser Sunnyside Medical Cen-ter, from the National Surgical Quality Improvement Program (NSQIP) database, the authors reviewed overall, superficial, deep, and organ/space surgical site infec-tions (SSIs). As a baseline there were 430 colorectal cases from January 2006 to December 2009. After a colorectal care bundle of interventions was implemented January 2010 through June 2011, there were 13 infections in 195 cases, a 6.67% overall rate. The overall decrease of 14.49% from baseline, and the decrease of superficial SSI from 15.12% to 3.59%, were both significant (p <0.0001). The rates for deep and organ/space SSIs showed a nonsignificant decrease. The NSQIP observed-to-expected ratio for colorectal SSI decreased from a range of 1.27 to 1.83 before implementation to 0.54 after implementation.
18 Reductions in Pain Medication Use Associated with Traditional Chinese Medicine for Chronic Pain.Charles Elder, MD, MPH, FACP; Cheryl Ritenbaugh, PhD, MPH; Mikel Aickin, PhD; Richard Hammerschlag, PhD; Samuel Dworkin, DDS, PhD; Scott Mist, PhD, MAcOM; Richard E Harris, PhD
Participants (168) in a randomized trial of traditional Chinese medicine (TCM) for temporomandibular joint dysfunction had a linear decline in pain over 16 TCM visits. This article reports an observational analysis of the average pain outcomes and medication use reported at every TCM visit. Among the heaviest non-steroidal anti-inflammatory drug (NSAID)
users, there was a short-term reduction in NSAID use—sustained as visits became less frequent. There was no indication that pain reduction during TCM treat-ment was influenced by drug use.
25 Ultrasound Measurements in Hyper-trophic Pyloric Stenosis: Don’t Let the Numbers Fool You. Meena Said, MD; Donald B Shaul, MD; Michele Fuji-moto, MD; Gary Radner, MD; Roman M Sydorak, MD; Harry Applebaum, MD
In a retrospective analysis of 189 patients with hypertrophic pyloric stenosis (means of: 4.6 weeks, 3.9 kg, 0.42 cm muscle thickness, and 1.89 cm muscle length) that were treated at a single institution over a 5-year period (2005-2010), analysis showed a signifi-cant relationship between both age and weight and the muscle thickness. No significant relationship existed between pyloric length and age or weight.
28 Living With Advanced Illness: Longi-tudinal Study of Patient, Family, and Caregiver Needs. Karen Tallman, PhD; Ruth Greenwald, MS, MA; Alice Reide-nouer, SM; Laurel Pantel
Little is known about how the needs of patients with advanced illness and the needs of their families and caregivers evolve, or how effectively those needs are addressed. A video-ethnographic ap-proach was conducted to observe and interview 12 patients and their families before, during, and after an inpatient palliative care consult at 3 urban Medi-cal Centers. This longitudinal approach highlighted areas for improvement, which include clear, integrated com-munications in the hospital and coor-dinated, comprehensive postdischarge support for patients not under hospice care and for their caregivers.
37 Sociodemographic Characteristics of Members of a Large, Integrated Health Care System: Comparison with US Census Bureau Data. Corinna Koebnick, PhD, MS; Annette M Langer-Gould, MD, PhD, MS; Michael K Gould, MD, MS; Chun R Chao, PhD, MS; Rajan L Iyer, MPH; Ning Smith, PhD; Wansu Chen, MS; Steven J Jacobsen, MD, PhD
On review of sociodemographic char-acteristics of 3,328,579 members of Kaiser Permanente Southern California (KPSC) in 2000 and 3,357,959 members in 2010, compared with those of the underlying population in the coverage area based on US Census Bureau data; similarities included: neighborhood edu-cational levels, household incomes, sex, age, and the proportion of Hispanics/La-tinos; however, KPSC members included more blacks. These findings suggest that this setting may provide valid inference for clinical, epidemiologic, and health services research.
The Permanente Journal 500 NE Multnomah St, Suite 100 Portland, Oregon 97232 www.thepermanentejournal.org
ISSN 1552-5767
The Permanente Journal/ Summer 2012/ Volume 16 No. 3
78 BOOK REVIEW
80 CME EVALUATION FORM
Books published by Permanente authors:
The Power of Prana: Breathe Your Way to Health and Vitality
Master Stephen Co; Eric B Robins, MD; John Merryman
ISBN-10: 160407440X ISBN-13: 978-1604074406
Boulder, CO: Sounds True, Inc; 2011
Paperback: 189 pages $15.95
Silicone
Carlos Meza
ISBN: 978-0-61533-859-0 ISBN: 978-0-98260-510-3
Tamarac, FL: Roatan Press; 2010
Paperback: 270 pages $14.95
A Soldier’s Story: World War II and the Battle at Sessenheim, France
John T “Jack” Scannell; Kate Scannell, MD, editor
ISBN-10: 1467990116 ISBN-13: 978-1467990110
Scotts Valley, CA: CreateSpace; 2011
Paperback: 104 pages $8.99
Pfenninger & Fowler’s Procedures for Primary Care; Third Edition
John L Pfenninger, Gran C Fowler; Special Editors: Haneef Alibhai, Jamie Broomfield, Joe Esherick, Grant C Fowler, Theodore O’Connell, Dale Patterson, Mike Petrizzi
ISBN-10: 0323052673 ISBN-13: 978-0323052672
Philadelphia, PA: Elsevier Mosby; 2011
Hardcover: 1776 pages $162.95
42 EngagingPatientsinManagingTheirHealthCare:PatientPerceptionsoftheEffectofaTotalJointReplacementPresurgicalClass.Mary-Louise Lane-Carlson, EdD, MPH, RD, CDE; John Kumar, MD
Most research studies on presurgical education are quantitative in nature, preventing patients’ voices from being heard. Using a success-case, narrative design, 24 patients (from the Kaiser Permanente Downey Medical Center) were interviewed regarding their pre- and postsurgical experiences. Patient education, in the form of classes, with recognition of the participants’ physical needs, social needs, concrete supports, and psychological needs, as well as the willingness of the participants to work with their health care team, can promote patient engagement and improved quality of life.
Special Report 49 AFrameworkforMakingPatient-
CenteredCareFrontandCenter.Sarah M Greene, MPH; Leah Tuzzio, MPH; Dan Cherkin, PhD
The concept of patient-centered care is now considered an essential aspiration of high-quality health care systems. Historically, those advocating patient-centered care have focused on the relationship between the patient and the physician or care team. Changes to the health care system suggest that a multidimensional conceptualization of patient-centered care illustrates how clinical, structural, and interpersonal attributes can collectively influence the patient’s experience.
REVIEW ARTICLE 54 WomeninSurgery:Bright,Sharp,
Brave,andTemperate.Elisabeth C McLemore, MD; Sonia Ramamoorthy, MD; Carrie Y Peterson, MD; Barbara L Bass, MD
In drastic contrast to the 1970s, nearly half of first-time applicants to medical schools in 2011 were women. Less than 20% of full professor, tenured faculty, and departmental head positions are currently held by women. The aim of this article is to review the history of women in surgery and to highlight individual and institutional creative modifications that can promote the advancement of women in surgery.
CASE STUDIES 60 LymphoepithelialCarcinoma:
ACaseofaRareParotidGlandTumor.Christopher G Tang, MD; Thomas M Schmidtknecht, MD; Grace Y Tang; Luke J Schloegel, MD; Barry Rasgon, MD
A 29-year-old woman presented with a 10-month history of an enlarging left-sided facial mass. The patient received a total left parotidectomy and a selective neck dissection. A lymphoepithelial carcinoma of the parotid is a rare salivary gland tumor accounting for less than 1% of all salivary gland tumors. Complete resection of this poorly differentiated carcinoma followed by postoperative radiation is essential for local control.
63 NeurothekeomainthePosteriorFossa:CaseReportandLiteratureReview.Daniela Alexandru, MD; Radha Satyadev, MD; William So, MD
Neurothekeoma is a benign nerve sheath tumor (myxoma), though intracranial neurothekeoma is an extremely rare entity (only 3 cases reported in the literature): A case is presented of a 40-year-old man with a very large neurothekeoma present in the posterior fossa who had no neurologic deficit on presentation.
CLINICAL MEDICINE 65 NailingtheDiagnosis:Koilonychia.
Vivek Kumar, MD; Sourabh Aggarwal, MD; Alka Sharma, MD; Vishal Sharma, MD
Koilonychia is an abnormality of the nails that is also called spoon-shaped (concave) nails. It is primarily recognized as a manifestation of chronic iron deficiency, resulting from malnutrition, gastrointestinal blood loss, worms, gastrointestinal malignancy, and celiac disease. Other causes of koilonychia are high altitude, trauma, exposure to petroleum products, and heredity.
66 ImageDiagnosis:FootPainandFever.William C Krauss, MD, FACEP
Necrotizing fasciitis is characterized by widespread necrosis of the subcutaneous tissue and fascia (as evidenced by air on this patient’s plain films). Typical sites for this infection are the lower extremities, abdomen and perineum. The incidence of such infections, in the US, is estimated at 500 to 1500 cases per year, with a case-fatality rate of 24% and is more commonly associated with injection drug use, diabetes mellitus, immunosuppression, and obesity.
67 DevelopmentofaComputerizedIntravenousInsulinApplication(AutoCal)atKaiserPermanenteNorthwest,IntegratedintoKaiserPermanenteHealthConnect:ImpactonSafetyandNursingWorkload.Christine Olinghouse, MPH/MSN, FNP-BC, BC-ADM, CDE
A review of 35 patient charts using a computerized insulin infusion tool indicated 100% accuracy in computations with a reduction of nursing workload from 2 minutes to 30 seconds per calculation. Development and operationalization of an integrated intravenous insulin calculator into HealthConnect was successfully completed at the Kaiser Sunnyside Medical Center, with 97% nursing satisfaction scores, and a promise to generate data on intravenous insulin therapy to refine the protocol.
COMMENTARY 71 SolvingtheEmergencyCareCrisis
inAmerica:ThePoweroftheLawandStorytelling.John Maa, MD
An Emergency Department visit that ended tragically prompted a yearlong journey to Washington, DC, to explore the current crisis in emergency room care. A three-part solution includes 1) nation-ally standardizing and coordinating care, 2) prioritizing resources and incentives in the delivery of emergency care, and 3) inspiring young clinicians to careers in emergency care. Physicians across America should now harness the power of storytelling to strengthen both the delivery of patient care and health care reform efforts on Capitol Hill.
NARRATIVE MEDICINE 75 Trifecta:RunningonHope.
Carol Redding, MA
With excerpts from physicians’ notes, a patient-author recounts the physical and emotional history of personal illness that began in 1983.
1The Permanente Journal/ Summer 2012/ Volume 16 No. 3
SOUL OF THE HEALEROriginal Visual Art 17 “KayaksontheSuwannee”
Mark M Cohen, MD
24 “TheHealingTouch” Mohamed Osman, MD
36 “TheVirginRiver”Fred M Freedman, MD
48 “StarFerry,HongKong,1961”J Richard Gaskill, MD
CME credits are available online at www.thepermanentejournal.org. The mail-in CME form can be found on page 80.
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