Fall 2007 - Volume 11 Number 4

Original Articles

2007 James A Vohs Award for Quality First-Place Selection
A Multidisciplinary Approach to Transition Care: A Patient Safety Innovation Study
Jeryl McGaw, MS, RN, ND; Douglas A Conner, PhD; Thomas M Delate, PhD, MS; Elizabeth A Chester, PharmD; Carol Ann Barnes, MS, PT, GCS
This article describes a description of a systematic and comprehensive program for dealing with the problems inherent in a complex health system necessitating frequent transfers of responsibility among providers. There is concentration on avoidance of medication errors and coordination of outpatient care.

Penicilloyl-Polylysine Stability and Clinical Use Over Time
Eric Macy, MD; CK Lin, PhD; Bruce Goldberg, MD, PhD
Because of unavailability of a commercial product, outdated material was used to test for penicillin allergy. Results were satisfactory and comparable to those with materials previously used before the stated expiration date.

Introducing Narrative Practices in a Locked, Inpatient Psychiatric Unit
Lewis Mehl-Madrona, MD, PhD
A trial program of innovative, daily one-hour group therapy sessions emphasizes storytelling as a technique for obtaining emotional rapport with involuntarily confined psychiatric patients. The interesting positive results are potentially useful. Expressing your current story, then constructing a new one, is powerful self-treatment.

Fetal Heart Rate Pattern Notification Guidelines and Suggested Management Algorithm for Intrapartum Electronic Fetal Heart Rate Monitoring
Thomas Downs, MD; Evelyn Zlomke, RN, MPH
Variability in the use of FHR guidelines may account for past trials showing lack of efficacy. The proof of effectiveness of a practice guideline is day-to-day use through a management algorithm.

A Decade of Experience with a Multiday Residential Communication Skills Intensive: Has the Outcome Been Worth the Investment?
Terry Stein, MD
This study of videotaped, role-play practice with actors for 525 physicians cites significant effects: change in habits, patient satisfaction, and physician satisfaction--all sustained over time.

Whole Person Health for the Whole Population: One-Year Evaluation of Health Coaching
Melodi Licht, RN, MSN; Jeffrey M Davis, MD, MPH; Allison Scripps, MS, RD, CDE; Juanita Cone, MD, MPH
This article reports on the positive impact of personal health coaching on quality outcomes --improved glycemic control-- and overall patient satisfaction.

Clostridium difficile Colitis: Reduced Time to Diagnosis in a Community-Based Outpatient Setting Between 1997 and 2004
Charles S Salemi, MD, MPH; Timothy D Jenkins, MD, FACP; Andres Aguirre, MPH; Annie Cao, PharmD; Gisela Villaruel; John Morgan, DrPH; Andrew Simental, PharmD
A study of two time periods about 7-8 years apart showed that there was substantial shortening of time to diagnosis of Clostridium difficile colitis in outpatients. The major risk factor is antecedent antibiotic use, including metronidazole.

Which Chronic Obstructive Pulmonary Disease Patients Will Be Likely to Attend Consistently a Pulmonary Rehabilitation Program?
Salwa E Hassanein, PhD, RN; Georgia L Narsavage, PhD, APRN, FAAN; Sherrie Dixon Williams, MD, MHS; Mary K Anthony, PhD, RN; Lisaann S Gittner, MSc
With a view of optimizing use of limited resources, this study examines a variety of traits potentially predictive of good attendance at specialized pulmonary rehabilitation classes. Several are identified. Continued smoking is the greatest predictor of low attendance.

Review Articles

The Argument for Use of Epidural Steroid Injections in Management of Acute Radicular Pain
James P Rathmell, MD
Studies fail to show that epidural steroid injections reduce long-term pain. Their role is simply to facilitate earlier pain relief and return to full function.

Case Studies

Finding the Words: Literacy and Traditional Vietnamese Medicine
Emily King
Through an ethnographic interview, a medical student understands the issues facing a Vietnamese patient and states her resolve for her future in medicine.

Clinical Medicine

Corridor Consult
Anal Fissure: A Common Cause of Anal Pain
Herman Villalba, MD; Sabrina Villalba, MD; Maher A Abbas, MD, FACS, FASCRS


Katrina: Health Care System Recovery, Reform, and Renaissance
Julie C Morial, MD, MPH
Two years after Katrina a disturbing portrait of Louisiana health care emerges. After a review of the current health system, the primary recommendation is to promote primary and preventive care delivery.

Continuing Medical Education and Maintenance of Certification: Essential Links
Eric S Holmboe, MD; Christine Cassel, MD
Leaders of the American Board of Internal Medicine explain that physicians' active self-assessment, and evaluation of their daily clincial behaviors, are required learning to improve their practice.

Story-Based Health Policy: An Interview with Fitzhugh Mullan, MD
Jon Stewart, Editor
Dr Mullan's story of the death of his father in a system of uncoordinated care exemplifies the power of personal narrative to strongly influence health policy.


The Importance of Graduate Medical Education for Permanente Physicians, Kaiser Permanente, and American Medicine
Scott Rasgon, MD, Senior Editor
KP GME leaders highlight a six-decade experience and its future impact on American medicine through training in an integrated system, with a comprehensive electronic patient database, and preventive care.

Social Science Interventions in Medicine Produce Medical Science Outcomes
Tom Janisse, MD, Editor-in-Chief
Scientific disciplines like psychology, sociology, and anthropology contribute significantly to medical practice and to the objective outcomes sought through medical science.

Letters to the Editor

Dear Editor
My name is Dr Richard Sattilaro. My cousin, who was president of Methodist Hospital in Philadelphia, wrote a book Recalled By Life [referenced in J Horowitz, M Tomita. The Macrobiotic Diet as treatment for cancer: review of the evidence. Perm J 2002 Fall;6(4):34-7].

Book Reviews

Family and Friends' Guide to Domestic Violence: How to Listen, Talk and Take Action When Someone You Care About is Being Abused
Elaine Weiss, EdD
Review by Brigid McCaw, MD, MPH, MS

Clinical Problem-Solving
Editors: Sanjay Saint MD, Jeffrey Drazen MD, Caren Solomon MD
Review by Vincent J Felitti, MD, FACP

Soul of the Healer

Original Visual Art

Tulip Study

Carefree Days

Central Park in Spanish Harlem

Early Fall Maples

Original Literary Art


On the Cover

Three Flowers
Frances Matthews, RT(R)(M)


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