Spring 2003 - Volume 7 Number 2


The James A Vohs Award for Quality—The Fifth Annual Permanente Journal Special Issue
Arthur L Klatsky, MD
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Clinical Contributions

Vohs Award Winner: Single-Region Category: The Palliative Care Program
Richard D Brumley, MD; Susan Enguidanos, MPH; Kristine Hillary, RN, MSN
With the aging of the American population and the additional burden it has created on the health care system, it is important to develop cost-effective, patient-centered palliative care at the end of life. This article describes the Vohs Award winning program that demonstrates effectiveness in improving symptom management, in offering psychosocial support and in reducing overall costs.
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Vohs Award Winner: Multiple-Region Category: Improving Appropriate Prescription Drug Use to Best Practice: Supporting Evidence-Based Drug Use
Joel D Hyatt, MD; Timothy J Batchelder, MD; Richard Wagner, PharmD
To address quickly rising pharmaceutical costs and to provide optimal clinical outcomes, it was decided to establish a new drug use management program. The program initially targeted antibiotic, allergy and arthritis medications. This article describes the program, its application to each medication, and its results.

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Implementing a Diagnostic Algorithm for Deep Venous Thrombosis
Joel Handler, MD; Michael Hedderman, RN, MHP, CPHQ; Diana Davodi, CLS, ASCP, BS; Deborah Chantry, CLS, ASCP, BS; Curt Anderson, RT, CNMT; Jim Moore, RVT, RDMS, BA
A ten-month experience demonstrates that protest clinical evaluation and rapid quantitative ELISA D-dimer assay in outpatients with leg complaints suggestive of DVT can safely reduce the need for ultrasonography.
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Clinical Vignettes

Coronary Artery Disease
Richard Wise, MD; Michelle Wong, MPH, MPP; Leslee Budge, MBA
This Vignette uses a case history to illustrate a concise overview of the Care Management Institute’s Guidelines for the Secondary Prevention of Coronary Artery Disease. Appropriate medical and lifestyle interventions are reviewed and all common clinical variations are discussed.
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Corridor Consult

How Can I Counsel Adults and Children About Weight Management and Physical Activity?
Margaret McDonough Becker, MPH; Veenu Aulakh, MPH; Sandra Roberts, RN
By counseling patients on weight management and related lifestyle factors, physicians can play an important role in patients’ health. This article offers guidelines for effectively discussing this emotionally difficult topic
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Special Feature: Weight Management and Obesity Symposium

This first of a two-part symposium is created from material taken from the Care Management Institute and Centers for Disease Control-cosponsored symposia and the Northwest Permanente Physicians and Surgeons-sponsored symposium on weight management and obesity. Each presenter spoke, answered questions, and participated in panel discussions in individual areas of expertise, including nutrition, physical activity, cultural competence, cardiovascular implication, etc. The edited transcripts of each
speaker along with the panel discussions and questions from the audience are excerpted in this special feature

The Epidemic of Obesity: Challenges and Opportunities for Kaiser Permanente
William Caplan, MD
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Approaches to the Epidemic of Weight Management and Obesity
William Dietz, MD, PhD
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Energy Density and Nutrition in Weight Control Management
Barbara Rolls, PhD
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Promoting Physical Activity and Exercise
Paul O Jacobs, MD
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One Step at a Time--The 10,000 Steps Program Increases Physical Activity
Nico Pronk, PhD
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Preventing Obesity in Children and Adolescents
Thomas N Robinson, MD, MPH
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Weight Control in Children and Adolescents Proves Successful in a Family-Based Program
Lawrence Hammer, MD
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Cultural Competence in the Prevention and Treatment of Obesity: Latino Americans
John P Foreyt, PhD
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Cultural Competence in the Prevention and Treatment of Obesity: African Americans
Njeri Karanja, PhD
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Severe Obesity
Sasha Stiles, MD
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CPC Corner:

Dealing With The Angry Patient
Edward C Wang, MD

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The Importance of Keeping Cool with Angry Patients A Lesson Taught by My Patient
Scott Abramson, MD
Anger is one of the most challenging emotions confronting a clinician, because of the often irrational aspect of anger and the individual clinician’s reaction to anger. This article offers a brief personal recollection of an interaction involving anger and a “Quick Guide” to dealing with the angry patient.
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External Affairs

Everyday Heroes Make a Difference in California
Janet Howard
A Northern and Southern California program that applauds exceptional physicians and staff members is profiled in this overview of the program along with some of the honored “Everyday Heroes.”
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Letters to the Editor

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Book Reviews

The Secure Child: Helping Children Feel Safe and Confident in a Changing World
Stanley I Greenspan, MD
Review by Paul Jay Fink, MD
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Inscribed Bodies: Health Impact of Childhood Sexual Abuse
Anna Luise Kirkengen, MD, PhD
Review by Vincent J Felitti, MD
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The Latino Patient: A Cultural Guide for Health Care Providers
Nilda Chong, MD, DrPH, MPH
Review by Edwin H Cabrera, MD
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Soul of the Healer

Wuhoa (Taki) Tu, MD

Christmas Face
David Bovill, MD

Wuhoa (Taki) Tu, MD

Write Around Portland

The Northwest Severe Weight Management Program joined with the non-profit organization Write Around Portland to place a pen in the hand of patients preparing for bariatric surgery. Exploring their feelings, patients wrote the poems and stories collected here. A general surgeon in the Severe Weight Management Program and the co-ordinator for Write Around Portland discuss their programs, this experience, and the outcomes. 25 Approaches to the Epidemic of Weight Management
and Obesity

What Do We Gain? What Do We Lose?
David Moiel, MD
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Sometimes the First Step is All You Need
Liza Halley, MA
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