Summer 2008 - Volume 12 Number 3

Original Articles

2007 James A Vohs Award for Quality

Collaborative Cardiac Care Service: A Multidisciplinary Approach to Caring for Patients with Coronary Artery Disease
Brian G Sandhoff, PharmD; Susan Kuca, RN; Jon Rasmussen, PharmD; John A Merenich, MD
A Collaborative Care Service has, through lifestyle modification, medication initiation and adjustment, patient education, laboratory monitoring, and management of adverse events improved cholesterol screening, and reduced low-density lipoprotein cholesterol level and all-cause mortality associated with CAD, and has improved patient and physician satisfaction.

2007 James A Vohs Award for Quality -- Multiregion

The Kaiser Permanente National Total Joint Replacement Registry
Elizabeth W Paxton, MA; Maria Inacio, MS; Tamara Slipchenko, PhD; Donald C Fithian, MD
As of March 31, 2007, the Total Joint Replacement Registry recorded 16,945 primary total hip arthroplasties (THA) and 2144 revisions (11.2%); and 30,815 total knee arthroplasties (TKA) and 1794 revisions (5.5%). Statistically significant findings include: older age, and higher American Society of Anesthesiology risk scores for revision THAs. Osteoarthritis is the most common diagnosis for THA and TKA, and aseptic loosening and instability are most common for revision THAs and TKAs.

Incidence Rate of Anterior Cruciate Ligament Reconstructions
Rick P Csintalan, MD; Maria C S Inacio, MS; Tadashi T Funahashi, MD
In a retrospective analysis of 4485 anterior cruciate ligament reconstructions, the incident rate rose significantly in females, especially ages 14 to 17 and 45 to 49. Previous US studies of only elite athlete populations lack the ethnic and socioeconomic diversity of the Kaiser Permanente patient population.

Computed Tomography Findings of Unanticipated Prolonged Ileocolic Intussusception in Children
Devin Puapong, MD; Steven L Lee, MD, FACS, FAAP; Gary Radner, MD; Peter I Tsai, MD; Douglas S Katz, MD; Maher A Abbas, MD, FACS, FASCRS; Harry Applebaum, MD
Attempted nonsurgical reduction of ileocolic intussusception after 48 hours is controversial because of the low probability of reduction and increased risk of perforation. CT findings of bowel-wall edema of the intussuscipiens and partial small-bowel obstruction were associated at surgery with intussusception that was nonreducible or difficult to reduce.

A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?
Ann Hendrich, RN, MSN, FAAN; Marilyn P Chow, DNSc, RN, FAAN; Boguslaw A Skierczynski, PhD; Zhenqiang Lu, PhD
In the first hospital environmental study to quantify how nurses spend their time, 767 nurses were randomized to two protocols at 36 hospital medical-surgical units within 17 health care systems and 15 states. Documentation consumed most nursing practice time (35.3%), followed by medication administration (17.2%), and care coordination (20.6%). Patient care activities only accounted for 19.3%.

Weight Loss and Psychologic Gain in Obese Women--Participants in a Supported Exercise Intervention
James J Annesi, PhD; Ann C Whitaker, RD, LD, CDE
A randomized trial of a behaviorally based exercise support protocol, The Coach Approach--with and without a group-based nutrition education program--significantly lowered exercise dropout rates and improved attendance rates (which was significantly associated with reduction in body fat and BMI). Psychologic improvements were even more pronounced than the decreases in body fat and BMI.

Where Do Teens Go to Get the 411 on Sexual Health? A Teen Intern in Clinical Research with Teens
Yana Reznik; Kathleen Tebb, PhD
Teens who perceived that their clinician communicated with respect, explained information in ways that they could understand, and had time alone (confidentiality) with a clinician who asked about sex (at least for males) were more likely to cite their clinician as a source of sexual health information.

Review Articles

Special Report

Integrating Herbs and Supplements in Managed Care: A Pharmacy Perspective
Charles Elder, MD, MPH, FACP; Pat Mossbrucker, RPh; Carrie M Davino-Ramaya, MD; Ileana Bez, RD, LD, CDE; Margaret M Lin, MD; Theresa A Terry, PharmD; Emily A Thomas, PharmD; Sean Jones, MD
The Kaiser Permanente Northwest Natural Products Advisory Committee--limiting its review to randomized, controlled trials, meta-analyses data, and reviews of single-ingredient supplements --developed a comprehensive and systematic approach to managing and stocking herbal supplements; serving as a model for conventional and managed care organizations, which can improve clinical outcomes, patient convenience, and quality control.

Case Studies

Hyperthyroid-Induced Cardiomyopathy in an Adolescent
Peter N Mattar, MD, MPH; Eugene Y Hwang, MD

Presented with vague symptoms of palpitations, headaches, lower-extremity swelling, and dyspnea on exertion, a girl, age 11 years, was found to have congestive heart failure secondary to hyperthyroidism.

New Lives--Latinos, Cancer, and Spirituality: An Ethnographic History
Stephen T Magill
Through an in-depth ethnographic history the medical student author sees his Latino patients as a product of a defunct health care system, which misses its goal in name and function. The stories that emerge bring deep understanding necessary for diagnosis and treatment.

Clinical Medicine

Image Diagnosis: Appendicitis and Appendicolith
Gus M Garmel, MD, FACEP, FAAEM
The images from a Computed Tomography scan with oral and IV contrast demonstrates a large, distended tubular structure in the right lower abdomen consistent with an inflamed appendix and an appendicolith within the center.

Corridor Consult

Do Patients Understand?
Suzanne Graham, RN, PhD; John Brookey, MD

Limited literacy skills are one of the strongest predictors of poor health outcomes for patients; however, patients do not need to have limited literacy skills to have low health literacy.

A Clinical Communication Strategy to Enhance Effectiveness and CAHPS Scores: The ALERT Model
James T Hardee, MD; Ilene K Kasper, MS
The US Agency for Healthcare Research and Quality surveys patients and rates health plans on metrics, including four questions assessing the patients impression of the physician's communication skills: listened carefully, explained things understandably, respected what the patient said, and spent enough time. The authors detail how to improve communication in these areas to achieve the established beneficial clinical results of effective communication.

Commentary

Dissemination of Innovation: The Will to Change an Organization
James W Dearing, PhD

For an innovative organization to become a learning organization requires innovation dissemination. The top ten dissemination mistakes in organizational change are cited, including: assuming that information alone will influence decision making, and advocating single interventions as the solution to a problem.

Alcohol Abuse in the Workplace: When You Smell It, Do You Ask?
Peter Washburn, MD
In excerpts from his memoir, the physician-author describes two scenarios that demonstrate, through actual clinical experiences, appropriate actions recommended by Addiction Medicine specialists.

Editorials

Rosie the Riveter's Wartime Medical Records
Morris F Collen, MD; Bryan Culp; Tom Debley
This review of the 1942-1945 published case reports from the medical records of women who worked in the Kaiser Shipyards in Richmond, CA, found that the women who helped build ships for the war effort suffered many of the same medical problems as the men with whom they worked.

Narrative Medicine

Educational Theatre Program: Promoting Health
Nancy H Stevens, PhD; Stan Foote; Philip Wu, MD
To expand beyond the 15-minute visit, this program engages children in interactive theatre productions to guide the choices that affect their health in areas such as: poor self-esteem, obesity, diabetes, sexually transmitted diseases, drug abuse, suicide and bullying.

Book Reviews

The Courage to Heal How Doctors Think

Soul of the Healer

Original Visual Art

Flowers and Space

On the Cover