The Permanente journal最新文献

Background: Patients with limited English proficiency that are hospitalized without regular access to professional medical interpreters have a longer length of stay (LOS).¹ The authors studied the difference in LOS between English-speaking patients and patients with limited English proficiency in New Hampshire's only academic trauma medical center. The authors also examined race, ethnicity, and distance of residence from hospital.

Methods: Retrospective data were queried from EPIC, the electronic medical record system used by the authors. Queried data focused on inpatient hospitalizations between January 1, 2019, and December 31, 2021. Patient primary language was grouped into English, Spanish, and other non-English language.

Results: Spanish-speaking patients live on average 39.6 miles farther from a hospital than English-speaking patients and have a 0.34 lower case mix index. After English, Spanish is the second-most frequently spoken language. Regression analyses found language to be a significant factor in LOS, LOS variance, and case mix index.

Discussion: A 2.34-day longer LOS for Spanish-speaking patients demonstrates an important health care disparity warranting further attention.

Transient hyperphosphatasemia (TH) is a benign condition observed among healthy infants and children < 5 years old. It is characterized by an elevation in serum alkaline phosphatase (ALP) in the absence of other signs of organ disease. Prognosis is excellent, and ALP levels stabalize within 4 months. The aim of this case report is to promote broader awareness of TH so further unnecessary workup is avoided. The patient was a 12-month-old girl who presented with pale stools, a single episode of bloody stool, and elevation (incidentally found) in her ALP of 2379 IU/L. A small anal fissure was present, and the remainder of her physical examination was typical. The differential diagnosis included biliary atresia, liver disease, bone disease, and TH. Further testing was typical and included complete blood count (CBC, consisting of hemoglobin, hematocrit, white blood cell count, and platelet count), comprehensive metabolic panel (CMP, consisting of glucose, creatinine, BUN, electrolytes, and liver function markers), calcium, phosphate, parathyroid hormone, gamma-glutamyl transferase, and 25-hydroxy vitamin D. Liver ultrasound was also typical without evidence of biliary atresia. The diagnosis of TH was made. The patient was monitored clinically. Repeat blood work was completed 2 months later, with ALP levels returning to the typical range. Overall, TH is a benign self-limiting condition that can be managed by observation and serial measurement of ALP without further unnecessary investigations.

Background: The prevalence of physician burnout increased notably during the COVID-19 pandemic, but whether measures of burnout differed based on physician specialty is unknown. The authors sought to determine the prevalence of burnout, worklife conflict, and intention to quit among physicians from different specialties.

Methods: This is a cross-sectional online survey of physicians working at 2 urban hospitals in Vancouver, Canada, from August to October 2021. Responses were categorized by specialty (including surgical and nonsurgical), and data about whether physicians provided frontline patient care during COVID-19 were also included. Physician burnout was measured using the Maslach Burnout Inventory.

Results: The survey response rate was 42% (209/498). The overall prevalence of burnout was 69%. Burnout was not significantly different by specialty or between frontline COVID-19 specialties compared with other specialties. Physicians in surgical specialties were more likely to report work-life conflict than those in nonsurgical specialties (p = 0.012). Differences in intention to quit among specialties were not statistically significant.

Conclusion: During the COVID-19 pandemic, physician burnout was high across physicians, without significant differences between specialties, highlighting the need to support all physicians.

Background: In the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members' roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities.

Methods: Utilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities.

Results: Thematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model.

Conclusions: This study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.

The majority of dermatitis cases in adults result from chronic or relapsing atopic dermatitis in childhood. Adult-onset atopic dermatitis, also known as idiopathic chronic eczematous eruption of aging (CEEA), is a phenomenon seen in adults 50 years and older with no prior history of atopic dermatitis. CEEA is often a diagnosis of exclusion after ruling out more serious causes of dermatitis including bullous pemphigoid (BP), allergic conditions, and hematologic malignancies. This report details the case of a 67-year-old woman with no history of atopy who presented with a persistent, eczematous dermatitis not responsive to traditional therapy, consistent with CEEA, but was later identified as BP.