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Full Issue Download Indexed in MEDLINE, PubMed, and PubMed Central PRSRT STD US POSTAGE National Library of Medicine PAID 500 NE Multnomah St, Suite 100 PORTLAND OR PERMIT NO 1452 Portland, Oregon 97232 2016 20 No. 4 — Fall Volume Change Service Requested Fall 2016 Volume 20 No. 4 A peer-reviewed journal of medical science, social science in medicine, and medical humanities Original Research & Contributions 4 Diagnostic Prevalence of Ankylosing Spondylitis Using Computerized Health Care Data, 1996 to 2009: Underrecognition in a US Health Care Setting 11 Safe and Effective Implementation of Telestroke in a US Community Hospital Setting 16 Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis 22 Preferential Use of Total Thyroidectomy without THE PERMANENTE JOURNAL Prophylactic Central Lymph Node Dissection for Early-Stage Papillary Thyroid Cancer: Oncologic Outcomes in an Integrated Health Plan 27 Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units 34 The Kaiser Permanente Northern California Adult Member Health Survey 43 Reduced Trauma Symptoms and Perceived Stress in Male Prison Inmates through the Transcendental Meditation Program: A Randomized Controlled Trial 49 Voices of the “99 Percent”: The Role of Online Narrative to Improve Health Care 56 Trend of Decreased Length of Stay in the Intensive Care Unit (ICU) and in the Hospital with Palliative Care Integration into the ICU 62 Development and Application of a Plant-Based Diet Scoring System for Japanese Patients with Inflammatory Bowel Disease Special Reports 74 Anal Health Care Basics 102 Integrated Research and the Garfield Memorial National Research Fund—An Unobstructed View Case Reports 104 Refractory Depression, Fatigue, Irritable Bowel Syndrome, and Chronic Pain: A Functional Medicine Case Report 108 Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report Commentary Follow @PermanenteJ 116 Ethical Analysis for Physicians Considering the Printed on acid-free paper. Provision of Life-Ending Medication in Compliance with the California End of Life Option Act The Permanente Journal Fall 2016 See inside for 12 additional articles Volume 20 No. 4 including 4 found only online at: ISSN 1552-5767 www.thepermanentejournal.org BOOKS PUBLISHED BY Fall 2016/ Volume 20 No. 4 PERMANENTE AUTHORS: The ORIGINAL RESEARCH incidence of mortality. Among patients who PermanenteJournal underwent unplanned reintubation, older For the Sake of Hugh Manatee: & CONTRIBUTIONS Maddie and Hugh’s BIG Adventure Sponsored by the National Permanente and more frail patients had an increased 4 Diagnostic Prevalence of Ankylosing risk of mortality. Pete Hodgson; Udo Wahn, MD Medical Groups Spondylitis Using Computerized Health Care Data, 1996 to 2009: Underrecog- 22 Preferential Use of Total Thyroidec- ISBN-10: 0983384150 Mission: The Permanente Journal advances nition in a US Health Care Setting. tomy without Prophylactic Central ISBN-13: 978-0983384151 knowledge in scientific research, clinical Jeffrey R Curtis, MD; Leslie R Harrold, Lymph Node Dissection for Early-Stage Del Mar, CA: caboandcoral.com medicine, and innovative health care delivery. MD, MPH; Maryam M Asgari, MD, Papillary Thyroid Cancer: Oncologic MPH; Atul Deodhar, MD; Craig Salman; Outcomes in an Integrated Health Plan. Publishing; 2013 Joel M Gelfand, MD, MSCE; Jashin J Wu, Meena Said, MD; Michele Fujimoto, Hardcover: 32 pages Circulation: 25,000 print readers per MD; Lisa J Herrinton, PhD MD; Cara Franken, MD; Sunee Woo, $17.95 quarter, 6900 eTOC readers, and in 2015, In the computerized data, 5568 adults MD; Brooke Vuong, MD; Philip I Haigh, TPJ 1.4 million page views on articles had diagnostic codes indicating axial MD, MSc, FRCSC, FACS in PubMed from a broad international spondyloarthritis (axSpA). Observed preva- This retrospective cohort study of patients readership. lence in the Kaiser Permanente Northern with clinically node-negative papillary From Chaos to Care: California population, compared with na- thyroid cancer who underwent total thyroid- The Promise of tional estimates for axSpA and ankylosing ectomy with or without prophylactic central Team-Based Medicine spondylitis, suggests there is substantial lymph node dissection (pCLND) in Kaiser David Lawrence, MD underrecognition of these conditions in Permanente Southern California Region routine clinical practice. However, use of hospitals, between January 1996 and ISBN-10: 0738208590 computerized data is able to identify true December 2008, identified 864 patients, ISBN-13: 978-0738208596 cases of ankylosing spondylitis, facilitating 34 (3.9%) of whom underwent pCLND. population-based research. The TNM (tumor, node, metastasis) stages Cambridge, MA: Horsetail Fall for the 2 groups were not significantly dif- Da Capo Press; 2003 11 Safe and Effective Implementation of photograph ferent (p = 0.18). There were 23 (2.8%) Paperback: 208 pages Telestroke in a US Community Hospital by Sapna Reddy, MD recurrences in the no-pCLND group and $15.95 Setting. Kori Sauser-Zachrison, MD, MSc; 1 (2.9%) recurrence in the pCLND group Horsetail Fall cascades down Ernest Shen, PhD; Navdeep Sangha, (p = 0.95. Presently, routine pCLND is dif- the surface of El Capitan, MD; Zahra Ajani, MD; William P Neil, ficult to advocate in our medical system. in Yosemite National Park MD; Michael K Gould, MD, MS; Dustin in CA, when there is an Ballard, MD; Adam L Sharp, MD, MS 27 Standardizing Management of Adults If you are a Permanente author and would like your book cited here, adequate snow accumula- A stepped-wedge cluster randomized trial with Delirium Hospitalized on Medical- send an e-mail to [email protected]. tion combined with warmer of 10 community hospitals connected to Surgical Units. Clay Angel, MD; Kristen temperatures. For only two 2 tertiary care centers via telestroke was Brooks, MD; Julie Fourie weeks in February the angle implemented at each hospital incrementally Delirium, common among inpatients aged of the setting sun on clear over a 1-year period. Among 2657 patients, 65 and older, is associated with multiple days illuminates the waterfall, utilization of tissue plasminogen activa- adverse consequences, including in- transforming its color to that tor (tPA) increased from 6.3% to 10.9%, creased length of stay (LOS). However, de- of flaming lava. The phenomenon attracts tens without a significant change in complication lirium is frequently unrecognized and poor- of thousands of visitors every year. Yosemite rates. Postintervention patients were more ly understood. During a pilot from 9/2010 to National Park is a national treasure and must be likely to receive tPA than were preinterven- 7/2012 (including 470 patients), a delirium protected as such for future generations. tion patients. Before implementation, 8 of management team included a redesigned the 10 community hospitals were signifi- role for consulting psychiatrists and a new Dr Reddy is a Radiologist at the Walnut Creek cantly less likely to administer tPA than the clinical nurse specialist role. Electronic Medical Center in CA and is pursuing a second highest-volume tertiary care center; how- health record functions supported accurate career as a landscape/nature photographer. More ever, after implementation, 9 of 10 were at problem list coding, referrals to the team, of her work can be seen at: www.sapnareddy.com. least as likely to administer tPA. and standardized documentation. Average LOS decreased (8.5 to 6.5 days; p = 0.001) 16 Association of Unplanned Reintubation while average LOS for the Medical Center with Higher Mortality in Old, Frail remained stable. The delirium team is an Patients: A National Surgical Quality- effective model that can be quickly imple- Improvement Program Analysis. mented with few additional resources. Efstathios Karamanos, MD; Nathan Schmoekel, DO; Dionne Blyden, MD; 34 The Kaiser Permanente Northern Anthony Falvo, DO; Ilan Rubinfeld, MD California Adult Member Health Survey. 128 CME EVALUATION FORM Unplanned postoperative reintubation in- Nancy Gordon, ScD; Teresa Lin, MPH creases the risk of mortality, but associated Between 1999 and 2011 the adult Health factors are unclear. In this retrospective Plan membership became better educated study, patients older than age 40 years and less non-Hispanic white. Compared who underwent unplanned reintubation with 1999, in 2011, the prevalence of from 2005 to 2010 were identified using self-reported diabetes and hypertension the American College of Surgeons National significantly increased in most age groups. Surgical Quality Improvement Program There was a significant increase in the database. A total of 17,051 postoperative percentage of those age 25-64 years who The Permanente Journal reintubations in adults were analyzed. considered their health to be very good 500 NE Multnomah St, Suite 100 Overall mortality was 29.4% (n = 5009). or excellent, primarily among those with As American Society of Anesthesiology higher education. There was an increase Portland, Oregon 97232 score increased from 1 to 5, reintubation in the percentage of adults who indicated www.thepermanentejournal.org was associated with a mortality of 12.1% that physical or emotional health problems ISSN 1552-5767 to 41.6%, respectively. Similarly, increasing interfered at least moderately with their age decile was associated with increasing daily activities. Follow @PermanenteJ For information and/or
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