Jelena Douillard, Sarah Lentz, Shaina Ganjian, Sherill Agdeppa, Ngoc Ho, Jane Chieh Lin, Paul Han
INTRODUCTION: 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...
February 23, 2024: Permanente Journal
(no author information available yet)
No abstract text is available yet for this article.
February 20, 2024: Permanente Journal
Edward L Machtinger, Alicia F Lieberman, Christina D Bethell, Marguerita Lightfoot
No abstract text is available yet for this article.
February 16, 2024: Permanente Journal
Cristina Ortiz Sobrinho Valete, Aline Albuquerque, Esther Angelica Luiz Ferreira
Clinical empathy is a multidimensional ability to feel the patient's suffering, branched into components such as cognitive, emotional, and action, which results in benefits for patients, parents, health professionals, medical students, and others. The authors performed a critical review of the literature about empathy in neonatal care, in 2 databases, and analyzed the co-occurrence of keywords in the last 10 years. Nine articles were included in the qualitative synthesis. They highlight the interconnection between empathy, communication, ethics, and palliative care...
February 9, 2024: Permanente Journal
Sadie Elisseou, Andrea Shamaskin-Garroway, Avi Joshua Kopstick, Jennifer Potter, Amy Weil, Constance Gundacker, Alisha Moreland-Capuia
No abstract text is available yet for this article.
February 9, 2024: Permanente Journal
Rachel Piszczor, Courtney Barry, Constance Gundacker, Carly Wallace, Jineane Shibuya, Jonathan Perle
INTRODUCTION: Adverse childhood experiences (ACEs) are traumatic experiences that occur prior to age 18 years and can have a long-term impact on adult physical and mental health. Knowledge of ACEs, including the link between ACEs and health, and trauma-informed care (TIC), is essential for medical professionals to ensure respectful and compassionate care for those with a history of childhood adversity. This study examined medical students' knowledge, attitudes toward, and identification of ACEs and TIC to inform curricular efforts...
January 29, 2024: Permanente Journal
Carey R Watson, Kelly C Young-Wolff, Sonya Negriff, Kelly Dumke, Mercie DiGangi
BACKGROUND: Screening for adverse childhood experiences (ACEs) in prenatal and pediatric populations is recommended by the California ACEs Aware initiative and is a promising practice to interrupt ACEs in children and mitigate ACEs-related health complications in children and families. Yet, integrating ACEs screening into clinical practice poses several challenges. OBJECTIVE: The objective of this report was to evaluate the Kaiser Permanente Northern California and Kaiser Permanente Southern California pilots and implementation of ACEs screening into routine prenatal (Kaiser Permanente Northern California) and pediatric (Kaiser Permanente Southern California) care...
January 29, 2024: Permanente Journal
Ellen Goldstein, Jillian S Merrick, Renee C Edwards, Yudong Zhang, Brianna Sinche, Julia Raven, Stephanie Krislov, Daniela Robledo, Roger L Brown, Judith T Moskowitz, S Darius Tandon, Lauren S Wakschlag
BACKGROUND: Maternal history of trauma is a risk factor for distress during pregnancy. The purpose of this paper was to examine the theorized differential impact of a cognitive behavioral intervention (Mothers and Babies Personalized; MB-P) on maternal distress and emotional regulation for those with ≥ 1 adverse childhood experiences (ACEs; vs no ACEs) from pregnancy to 3 months postpartum. METHODS: Between August 2019 and August 2021, eligible pregnant individuals aged ≥ 18 years, < 22 weeks' gestation, and English-speaking were recruited from 6 university-affiliated prenatal clinics...
January 24, 2024: Permanente Journal
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
INTRODUCTION: 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...
January 18, 2024: Permanente Journal
Michelle Loy, Rachel Kowalsky
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...
January 16, 2024: Permanente Journal
Jenna M Wick, Alex Pelliccione, H Nicole Tran, Jacek Skarbinski
Mpox is a viral zoonotic infection endemic to countries in Central and West Africa. The outbreak that began in May 2022 is novel for its global spread and transmission through sexual encounters. Research of this outbreak shows a high rate of concurrent sexually transmitted infections (STIs) in patients with mpox, highlighting the need to consider STIs in mpox management, and to raise awareness of historically high levels of STIs caused by inadequacies in sexual health care. It is critical to prioritize sexual health and address health disparities to control current transmission of infections and prevent future outbreaks...
January 9, 2024: Permanente Journal
Iliza Minaya, Samuel Raine, Arkene Levy, Chasity B O'Malley
INTRODUCTION: The COVID-19 pandemic affected numerous subpopulations of people in unique ways. This study evaluated the impact of the COVID-19 pandemic on the mental health status of Broward County's aging lesbian, gay, bisexual, transgender, and queer (LGBTQ) seniors and identified strengths, weaknesses, and opportunities for interventions to enhance positive mental health outcomes. The study was performed from April 2021 through July 2021. METHODS: Online surveys measuring anxiety, depression, social support, and resilience were delivered by email to 47 residents of Wilton Manors, Florida...
December 29, 2023: Permanente Journal
Michael L Parchman, Kelsey Stefanik-Guizlo, Robert B Penfold, Erika Holden, Avni C Shah
INTRODUCTION: People enrolled in Medicaid managed care who struggle with diabetes control often have complex medical, behavioral, and social needs. Here the authors report the results of a program designed to partner with primary care teams to address those needs. METHODS: A nonprofit organization partnered with a Medicaid managed care plan and a Federally Qualified Health Center in California to enroll people with A1cs <u>></u>9% in a 12-month program...
December 20, 2023: Permanente Journal
Somalee Banerjee, Maher Yassin, Wendy T Dyer, Tainayah W Thomas, Luis A Rodriguez, Julie Schmittdiel
BACKGROUND: Population-level tracking of hospital use patterns with integrated care organizations in patients experiencing homelessness has been difficult. A California law implemented in 2019 (Senate Bill 1152) aimed to ensure safety for this population after discharge from the hospital by requiring additional documentation for patients experiencing homelessness, which provides an opportunity to evaluate hospital use by this population. METHODS: In a large integrated health system in California, patients experiencing homelessness were identified through documentation change requirements associated with this law and compared with a matched group from the general population...
December 18, 2023: Permanente Journal
Arsheeya Mashaw, Helen Byelyakova, Danielle Desrochers
INTRODUCTION: Advanced Care at Home is a clinical model that delivers hospital-level care in a patient's home. This model of care has been studied for decades, but there have been difficulties scaling the model to a higher census because of poor physician participation. Kaiser Permanente at Home, an Advanced Care at Home model created by Kaiser Permanente Northwest, was able to quickly increase its patient census by using several different change management interventions. The aim of this study was to describe the specific physician change management interventions used and to determine their relative impacts on physician participation with Kaiser Permanente at Home...
December 13, 2023: Permanente Journal
Madhusmita Misra, Grace C Huang, Anne E Becker, Carol K Bates
INTRODUCTION: For academic promotion, clinical faculty are expected to excel in clinical care, teaching, and scholarship. Ensuring adequate protected time and resources to engage in scholarly work in the face of competing clinical responsibilities is critical. The authors examined academic leaders' perspectives across affiliate hospitals of a large medical school regarding the definition of clinical full-time effort and academic time, best practices to enable academic success, and barriers to faculty advancement...
December 11, 2023: Permanente Journal
Edward D Shin, H Nicole Tran, Nirmala D Ramalingam, Taylor Liu, Eugene Fan
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...
December 11, 2023: Permanente Journal
G Richard Holt
No abstract text is available yet for this article.
December 15, 2023: Permanente Journal
Lindsay A Mazotti, Delores A Amorelli, Ronald A Navarro, Abbas A Hyderi, Michael H Kanter, Carla S Lupi
INTRODUCTION: Ambulatory clerkships, including longitudinal integrated clerkships (LICs), face challenges to assessment, including time pressure and clinical demands on preceptors. High-quality clinical assessment is critical to implementing competency-based medical education, generating valid grades, and supporting learning. This importance is further heightened with the new pass/fail scoring for US Medical Licensing Exam Step 1, discontinuation of US Medical Licensing Exam Step 2 Clinical Skills, and the growing concern for bias in assessment...
December 1, 2023: Permanente Journal
Nancy E Gin, Richard J Baron, Ann Greiner, Joshua M Liao
No abstract text is available yet for this article.
November 28, 2023: Permanente Journal
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