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Primary care providers practice patterns regarding female pelvic floor disorders

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Family Medicine and Community Health 2024年第1期12卷 9-15页

作者： Anna Weimer Jennifer L Hallock Chi Chiung Grace Chen Magee-Women's Hospital of UPMC PittsburghPennsylvaniaUSA kaiser permanente Northern California SacramentoCaliforniaUSA Johns Hopkins medical Institutions Campus BaltimoreMarylandUSA

Introduction Pelvic floor disorders(PFDs)pose substantial physical and psychological burdens for a growing number of *** the ubiquity of these conditions and known patient reluctance to seek care,primary care providers(PCPs)have a unique opportunity to increase treatment and provide appropriate referrals for these *** An online survey was administered to PCPs to assess provider practices,knowledge,comfort managing and ease of referral for *** regression was used to assess the association between demographic/practice characteristics of PCPs and two primary outcomes of interest:discomfort with management and difficulty with referral of *** Of the 153 respondents to the survey,more felt comfortable managing stress urinary incontinence(SUI)and overactive bladder(OAB),compared with pelvic organ prolapse(POP)and faecal incontinence(FI)and were less likely to refer patients with urinary *** providers elicited symptoms for POP and FI as compared with SUI and *** variables that were significantly associated with discomfort with management varied by PFD,but tended to correlate with less exposure to PFDs(eg,those with fewer years of practice,and internal medicine and family physicians as compared with geriatricians);whereas the factors that were significantly associated with difficulty in referral,again varied by PFD,but were related to practice characteristics(eg,specialist network,type of practice,practice setting and quantity of patients).Conclusion These findings highlight the need to increase PCPs awareness of PFDs and develop effective standardised screening protocols,as well as collaboration with pelvic floor specialists to improve screening,treatment and referral for patients with PFDs.

关键词： bladder floor difficulty

CT Thresholds for Spinal Bone Mineral Attenuation to Prioritize Eligible Older Women for Osteoporosis Screening

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Open Journal of Radiology 2024年第2期14卷 92-101页

作者： Seo Yeon K. Orite Bryn Higuchi Hyo-Chun Yoon Lana H. Gimber St. Elizabeths medical center Brighton MA USA University of California Irvine CA USA kaiser permanente Division of Research Oakland CA USA Department of Diagnostic Imaging Hawaii Permanente Medical Group Honolulu HI USA

Introduction: Computed tomography (CT) measurements of bone mineral attenuation may be a useful means to identify older women who should be prioritized for bone mineral density screening. Methods: We compared bone mineral attenuation as measured in the L1 vertebra of CT studies to the results of dual-energy x-ray absorptiometry (DEXA) studies to determine what CT attenuation thresholds might yield a reasonable combination of sensitivity and specificity for the detection of osteoporosis. The study was limited to women between the ages of 65 and 75 years who had a DEXA study and a CT that included the L1 or adjacent vertebra performed within 3 years of the DEXA study. Results: There were 1226 women in this study, of whom 452 (38%) had osteoporosis based on a T-score ≤ −2.5 by DEXA. There were 830 CT studies performed with contrast and 396 studies which were performed without contrast. There was a statistically significant difference in the mean HU of those studies performed without contrast compared to those with contrast (unenhanced mean 103 HU versus 125 HU, p < 0.001). Different CT attenuation thresholds provided the most appropriate combination of sensitivity and specificity for the detection of osteoporosis when comparing CT studies performed without or with IV contrast and when all the CT data were used in aggregate. Conclusion: Different thresholds appear necessary when using the mean CT vertebral attenuation to identify older women for preferential referral for DEXA studies.

关键词： Osteoporosis Bone Mineral Attenuation CT Threshold

Storylines of family medicine Ⅹ:standing up for diversity,equity and inclusion

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Family Medicine and Community Health 2024年第S3期12卷 89-98页

作者： William B Ventres Leslie A Stone Wayne W Bryant Jr Mario F Pacheco Edgar Figueroa Francis N Chu Shailendra Prasad David N Blane Na'amah Razon Ranit Mishori Robert L Ferrer Garrett S Kneese Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA Family and Community Medicine University of New Mexico School of MedicineAlbuquerqueNew MexicoUSA Medicine Weill Cornell Medical CollegeNew YorkNew YorkUSA San Jose Family Medicine Residency Kaiser PermanenteSan JoseCaliforniaUSA Family Medicine and Community Health University of Minnesota Medical School—Twin Cities CampusMinneapolisMinnesotaUSA School of Health and Wellbeing University of GlasgowGlasgowUK Family and Community Medicine University of CaliforniaDavisSacramentoCaliforniaUSA Family Medicine Georgetown University School of MedicineWashingtonDistrict of ColumbiaUSA Family and Community Medicine UT Health San Antonio Long School of MedicineSan AntonioTexasUSA UC San Diego Family Medicine Residency Program San DiegoCaliforniaUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅹ:standing up for diversity,equity and inclusion’,authors address the following themes:‘The power of diversity—why inclusivity is essential to equity in healthcare’,‘medical education for whom?’,‘Growing a diverse and inclusive workforce’,‘Therapeutic judo—an inclusive approach to patient care’,‘Global family medicine—seeing the world“upside down”’,‘The inverse care law‘,‘Social determinants of health as a lens for care’,‘Why family physicians should care about human rights’and‘Toward health equity—the opportunome’.May the essays that follow inspire readers to promote change.

关键词： illustration education family

Effect of a region-wide incorporation of an algorithm based on the 2012 international consensus guideline on the practice pattern for the management of pancreatic cystic neoplasms in an integrated health system

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World Journal of Clinical Cases 2018年第13期6卷 624-631页

作者： Andrew Khoi Nguyen Agathon Girgis Timnit Tekeste Karen Chang Mopelola Adeyemo Armen Eskandari Emilio Alonso Priyanka Yaramada Charles Chaya Albert Ko Edmund Burke Isaiah Roggow Rebecca Butler Aniket Kawatkar Brian S Lim School of Medicine University of California Department of Gastroenterology Kaiser Permanente Riverside Medical Center Department of Surgery Kaiser Permanente Riverside Medical Center Department of Research and Evaluation Southern California Permanente Medical Group

AIM To examine the practice pattern in kaiser permanente Southern California(KPSC), i.e., gastroenterology(GI)/surgery referrals and endoscopic ultrasound(EUS), for pancreatic cystic neoplasms(PCNs) after the regionwide dissemination of the PCN management *** Retrospective review was performed; patients with PCN diagnosis given between April 2012 and April 2015(18 mo before and after the publication of the algorithm) in KPSC(integrated health system with 15 hospitals and 202 medical offices in Southern California) were ***2558(1157 pre-and 1401 post-algorithm) received a new diagnosis of PCN in the study period. There was no difference in the mean cyst size(pre-19.1 mm vs post-18.5 mm, P = 0.119). A smaller percentage of PCNs resulted in EUS after the implementation of the algorithm(pre-45.5% vs post-34.8%, P < 0.001). A smaller proportion of patients were referred for GI(pre-65.2% vs post-53.3%, P < 0.001) and surgery consultations(pre-24.8% vs post-16%, P < 0.001) for PCN after the implementation. There was no significant change in operations for PCNs. Cost of diagnostic care was reduced after the implementation by 24%, 18%, and 36% for EUS, GI, and surgery consultations, respectively, with total cost saving of 24%.CONCLUSION In the current healthcare climate, there is increased need to optimize resource utilization. Dissemination of an algorithm for PCN management in an integrated health system resulted in fewer EUS and GI/surgery referrals, likely by aiding the physicians ordering imaging studies in the decision making for the management of PCNs. This translated to cost saving of 24%, 18%, and 36% for EUS, GI, and surgical consultations, respectively, with total diagnostic cost saving of 24%.

关键词： Pancreatic cyst Algorithm incorporation Pancreas Optimization of resource utilization Fukuoka criteria Sendai criteria Pancreatic cancer Intraductal papillary mucinous neoplasm Practice management Algorithm

Microscopic colitis:A large retrospective analysis from a health maintenance organization experience

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World Journal of Gastroenterology 2009年第25期15卷 3122-3127页

作者： Kevin T Kao Benito A Pedraza Amy C McClune David A Rios Yi-Qiong Mao Robert H Zuch Michael H Kanter Sony Wirio Chris N Conteas Department of Gastroenterology Kaiser PermanenteLos Angeles Medical Center Los Angeles California 90027United States Department of Internal Medicine Kaiser Permanente Los Angeles Medical Center Los Angeles California 90027 United States Department of Pathology Southern California Kaiser Permanente Medical Group California 90027 United States

AIM： To examine the demographic data on a large multi-ethnic population of patients with microscopic colitis （MC） in Southern California and to determine the association of MC with inflammatory bowel disease （IBD） and colorectal cancer. METHODS： All patients diagnosed with MC by co- Ionic biopsy from 1996-2005 were identified utilizing a pathology database. All biopsies were reviewed by experienced pathologists utilizing standard histologic criteria. Patients＇ medical records were reviewed and data regarding patient age, co-morbidities, sex, ethnic- ity, and medications were analyzed. An age- and sex- matched standard control group was also generated. Chi-square test was used to evaluate the associations of co-morbidities between lymphocytic colitis （LC）, col- lagenous colitis （CC） and the control group. RESULTS： A total of 547 cases of MC were identified, 376 patients with LC and 171 patients with CC. The fe- male/male ratio was 3：1 in CC and 2.7：1 in LC patients. Celiac disease （P 〈 0.001）, irritable bowel syndrome （IBS）（P 〈 0.001）, and thyroid diseases （P 〈 0.001） were found to have a higher occurrence in MC com- pared to the control group. No statistical differences in the occurrence of colorectal cancer, diabetes and IBD were found between the MC group and the control group. CONCLUSION： This is the largest group of patients with MC known to the authors that has been studied to date. Conditions such as celiac disease, IBS, and thyroid diseases were found to be related to MC. Fur- thermore, neither an increased risk of colorectal cancer nor IBD was associated with MC in this study.

关键词： Collagenous colitis Inflammatory bowel disease Lymphocytic colitis Microscopic colitis

Heterogeneity of clinical features, EEG and brain imaging findings in anti‑leucine‑rich glioma‑inactivated protein 1 autoimmune encephalitis: a retrospective case series study and review of the literature

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Acta Epileptologica 2023年第3期6卷 173-184页

作者： Emily Yixuan Huang Hongfeng Gao Ning Zhong Department of Molecular and Cell Biology University of CaliforniaBerkeleyCA 94720USA Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute University of CaliforniaBerkeleyCA 94720USA Department of Neurology Kaiser Permanente Sacramento Medical CenterSacramentoCA 95825USA North Valley Regional Epilepsy center Kaiser Permanente Sacramento Medical CenterSacramentoCA 95825USA

Background Anti-leucine-rich glioma-inactivated 1(LGI-1)autoimmune encephalitis(AE),characterized by rapid decline of memory,seizures,and neuropsychiatric abnormalities,is a rare but devastating *** diagnosis and treatment are essential to prevent long-term *** this report,we provide a detailed description of clinical characteristics,laboratory test results,imaging,and electroencephalography(EEG)findings,as well as treatment responses of eight patients with anti-LGI-1 AE treated at our *** presentation At the onset,all eight patients presented with confusion/memory deterioration,seizures(including faciobrachial dystonic seizures or other types of seizure),and behavioral changes such as hallucination,paranoia,and *** patients were found with severe ***-LGI1 antibodies were detected in the cerebrospinal fluid and/or serum of all *** patients with faciobrachial dystonic seizures,no discernible scalp EEG change was detected,while EEG recording of patients experiencing other types of seizure showed focal slowing,focal epileptiform discharges,and focal onset *** patients showed abnormal brain magnetic resonance imaging signals,mainly involving the mesial temporal lobe and the *** addition,one patient also experienced fulminant cerebral edema during the acute phase of the *** patients received immunotherapy and anti-seizure medications and achieved good seizure ***,these patients continued to experience cognitive impairment during their long-term *** The care of anti-LGI1 AE patients requires rapid evaluation,prompt initiation of immunotherapy,and long-term *** long-term presence of neurocognitive complications observed in these patients underline the importance of developing reliable biomarkers that can distinguish between different subtypes of this disease with heterogeneous clinico-electrographico-radiological *** research is

关键词： Anti-leucine-rich glioma-inactivated 1 Autoimmune encephalitis Faciobrachial dystonic seizures Epilepsy

New insights in diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

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World Journal of Gastroenterology 2022年第17期28卷 1751-1767页

作者： Feng Yin Zi-Hao Wu Jin-Ping Lai Department of Pathology and Anatomical Sciences University of MissouriColumbiaMO 65212United States Department of Surgery University of MissouriColumbiaMO 65212United States Department of Pathology Kaiser Permanente Sacramento Medical CenterSacramentoCA 95825United States

Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)are rare epithelial neoplasms derived from pluripotent endocrine cells along the gastrointestinal tract and ***-NENs are classified into well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine *** overlapping morphological features,GEP-NENs vary in molecular biology,epigenetic,clinical behavior,treatment response,and prognosis features and remain an unmet clinical *** this review,we introduce recent updates on the histopathologic classification,including the tumor grading and staging system,molecular genetics,and systemic evaluation of the diagnosis and treatment of GEP-NENs at different anatomic sites,together with some insights into the diagnosis of challenging and unusual *** also discuss the application of novel therapeutic approaches for GEP-NENs,including peptide receptor radionuclide therapy,targeted therapy,and immunotherapy with immune checkpoint *** findings will help improve patient care with precise diagnosis and individualized treatment of patients with GEP-NENs.

关键词： Gastroenteropancreatic neuroendocrine neoplasms Neuroendocrine tumours Neuroendocrine carcinoma World Health Organization classification Diagnosis Treatment

Protocol for electrophysiological monitoring of carotid endarterectomies

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The Journal of Biomedical Research 2010年第6期24卷 460-466页

作者： Hong Liu Anthony M Di Giorgio Eric S Williams William Evans Michael J Russell Department of Anesthesiology University of California Davis Medical CenterSacramentoCA 95817USA Active Diagnostics Inc.DavisCA 95616USA kaiser permanente sacramento medical center SacramentoCA 95825USA Aaken Laboratories Inc.DavisCA 95616USA

Near zero stroke rates can be achieved in carotid endarterectomy （CEA） surgery with selective shunting and electrophysiological *** false negative rates as high as 40% have been *** sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers,and determine if other factors could contribute to the differences in *** and raw beta band （12.5-30 Hz） electroencephalogram （EEG） and median and tibial nerve somatosensory evoked potentials （SSEP） were monitored in 668 CEA cases at six surgical centers.A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol.A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 *** patient showed signs of a cerebral infarct after *** shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized *** also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate.

关键词： intraoperative monitoring somatosensory evoked potentials electroencephalogram carotid endarterectomy carotid

Unusual presentations of eosinophilic gastroenteritis:Case series and review of literature

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World Journal of Gastroenterology 2009年第17期15卷 2156-2161页

作者： Rafiq A Sheikh Thomas P Prindiville R Erick Pecha Boris H Ruebner Department of Gastroenterology Kaiser Permanente Medical Center 6600 Bruceville Road SacramentoCA 95823 United States Department of Gastroenterology University of California Davis 4150 V Street Sacramento CA95917 United States Department of Gastroenterology Marshall Medical Center 1100 Marshall Way Placerville CA 95667 United States Department of Pathology University of California Davis 4150 V Street Sacramento CA 95917 United States

Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.

关键词： Gastroenteritis Eosinophilic Gastrointestinal obstruction Eosinophilic esophagitis Eosinophilic colitis Eosinophilic pancreatitis