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Perm J [journal]
- The treatment of angiocentric glioma: case report and literature review. [Journal Article]
- Perm J 2013; 17(1):e100-2.
Angiocentric glioma is a recently described tumor recognized since 2007 by the World Health Organization Classification of Tumours of the Central Nervous System. We present the only case of angiocentric glioma at our institution in the last 15 years and review the literature in an attempt to establish prognostic parameters. Our search revealed only 27 cases of angiocentric glioma in the literature. The most common presenting symptom of angiocentric glioma was seizures. Gross total resection of the lesion was curative, without need for radiation or chemotherapy.
- Transforming Care Delivery through Health Information Technology. [Journal Article]
- Perm J 2013; 17(1):81-6.
The slow but progressive adoption of health information technology (IT) nationwide promises to usher in a new era in health care. Electronic health record systems provide a complete patient record at the point of care and can help to alleviate some of the challenges of a fragmented delivery system, such as drug-drug interactions. Moreover, health IT promotes evidence-based practice by identifying gaps in recommended treatment and providing clinical decision-support tools. In addition, the data collected through digital records can be used to monitor patient outcomes and identify potential improvements in care protocols. Kaiser Permanente continues to advance its capability in each of these areas.
- The renal palliative care program. [Journal Article]
- Perm J 2013; 17(1):78-9.
A 75-year-old man with a 25-year history of type 2 diabetes presents for long-term treatment options. His estimated glomerular filtration rate is 16 mL per minute per 1.73 m(2) of body-surface area. His history is remarkable for ischemic coronary artery disease, congestive heart failure, peripheral artery disease, mild dementia, and colon cancer. He has been admitted to the hospital 4 times in the last 6 months. How should his case be managed?
- Meta-analysis of the use of narrative exposure therapy for the effects of trauma among refugee populations. [Journal Article]
- Perm J 2013; 17(1):70-6.
Narrative therapies, especially narrative exposure therapy, are used to treat the effects of trauma in refugees and to prevent psychiatric illness. These methods involve helping the person to tell the story of what happened to them until it no longer elicits anxiety.We reviewed all quantitative studies related to narrative exposure methods for treating trauma or posttraumatic stress disorder in refugees. We focused on studies with sufficient information to calculate effect sizes and statistical power.We found 7 quantitative studies for which effect size and power could be calculated. The total average effect size for all interventions was 0.63 (medium). The average effect size for studies in which interventions were administered by physicians, adequately trained graduate students, or both was 0.53. The effect size for studies in which the counselors were themselves refugees was 1.02. The 95% confidence intervals for the effect sizes of narrative exposure therapy did not reach below 0.Studies demonstrating the effectiveness of narrative methods have adequate effect sizes and statistical power. Empowering lay counselors to treat their fellow refugees in future studies is warranted.
- ECG Diagnosis: Hyperkalemia. [Journal Article]
- Perm J 2013; 17(1):69.
- Images in emergency medicine: phlegmasia cerulea dolens. [Journal Article]
- Perm J 2013; 17(1):68.
- Transprocessing: neurobiologic mechanisms of changeduring psychotherapy-a proposal based on a case report. [Journal Article]
- Perm J 2013; 17(1):63-7.
This article proposes transprocessing (as in "transduction" and "processing") as a term to denote mechanisms by which the brain processes information in psychotherapy and develops solutions that have a lasting, curative effect. The case of a woman with a history of posttraumatic conversions, who recovered after long-term psychotherapy, is presented as the basis for a discussion on psychotherapeutic changes of the brain. Psychological healing and change, in general, is seen here as a result of a large variety of neurobiologic processes that reframe complex or multimodal memories. Through transprocessing, multimodal memories are deconstructed along the different axes of the brain tissue and restored through memory mechanisms at the synaptic, cellular level. Transprocessing requires a sustained interplay between the extended projections of the "language brain" and the repeated, alternating activation and deactivation of the midline structures associated with the self, to form pathways through long-term therapeutic experiences. We propose three separate stages of transprocessing by which new implicit and explicit memories of the therapeutic narrative are internalized into a first-person experience. Those stages are 1) evaluation, 2) acquisition, and 3) contextualization.
- Temporal arteritis: improving patient evaluation with a new protocol. [Journal Article]
- Perm J 2013; 17(1):56-62.
The process of diagnosing temporal arteritis remains controversial. Although temporal artery biopsy has long been the standard tool of evaluation, its poor sensitivity has prompted investigation of other methods to aid in diagnosis. Improved clinical evaluation and various imaging techniques have been suggested as ways to establish the diagnosis through noninvasive means and to improve biopsy yield.To retrospectively report and evaluate the process and experience of the Kaiser Permanente Northwest Region in implementing a new protocol that includes an enhanced clinical evaluation as well as the incorporation of color duplex ultrasonography in addition to biopsy when appropriate for temporal arteritis evaluation.A 38% reduction in the number of temporal artery biopsies performed was achieved through the new protocol, which was created by a multidisciplinary process, including stakeholders from all departments involved. The percentage of abnormal biopsy results rose from 8.5% at baseline to 24%. No cases of the disease were missed after careful evaluation of clinical and medical-legal records.Adding specialist clinical evaluation and color duplex ultrasonography to the standard diagnostic workup for temporal arteritis creates a rapid, noninvasive, resource-sensible means to diagnose giant cell arteritis, to improve temporal artery biopsy yield, and to decrease the total number of biopsies done. The diagnosis can be made in some cases by clinical evaluation and color duplex ultrasonography alone, thereby saving the patient an unnecessary surgical procedure. Protocols such as this can be implemented by multidisciplinary cooperation in a patient-centered, integrated system.
- Inpatient palliative care consultation: describing patient satisfaction. [Journal Article]
- Perm J 2013; 17(1):53-5.
This study identified and measured common patterns of patients' positive care experiences during inpatient palliative consultation, and helped better understand how the journey of discovery experienced by both patients and life-care consult teams can be used to improve the quality of care.We administered questionnaires to a convenience sample of 25 patients who were referred to inpatient palliative care for a goals-of-treatment consult between April 2010 and May 2012.The codified responses to questionnaires revealed the perspectives of our patients rather than predicting outcomes. Respondents identified six areas of satisfaction: treatment with dignity and respect by the hospital health care team; after life-care planning consultation, patients felt they were better informed of their illness and medical context; 95% of all patients who responded felt their overall experience was excellent; all respondents felt the life-care planning consultation helped them form a treatment plan; all patients who responded believed their cultural beliefs and values were respected; and all responding patients noted that the inpatient palliative care team adequately addressed pain and symptom control.WE WERE ENCOURAGED BY OUR FINDINGS: the feedback from patients and families showed us we were effective, from their perspective, in helping them shape their treatment journey. It also emphasized where we could have been even more effective in improving our communication.
- Televisitation: virtual transportation of family to the bedside in an acute care setting. [Journal Article]
- Perm J 2013; 17(1):50-2.
Televisitation is the virtual transportation of a patient's family to the bedside, regardless of the patient's location within an acute care setting. This innovation in the Telemedicine Program at Thunder Bay Regional Health Sciences Centre (TBRHSC) in Ontario, Canada, embraces the concept of patient- and family-centered care and has been identified as a leading practice by Accreditation Canada. The need to find creative ways to link patients to their family and friend supports hundreds of miles away was identified more than ten years ago. The important relationship between health outcomes and the psychosocial needs of patients and families has been recognized more recently. TBRHSC's patient- and family-centered model of care focuses on connecting patients with their families. First Nations renal patients with family in remote communities were some of the earliest users of videoconferencing technology for this purpose.