The Permanente Journal

The Permanente Journal The Permanente Journal advances knowledge in scientific research, clinical medicine and innovative health care delivery. The Permanente Journal is a peer-reviewed journal of medical science, social science in medicine, and medical humanities.
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Free full-text access is available online. The Permanente Journal (ISSN 1552-5767) is published quarterly by The Permanente Press. The Permanente Journal is available online (ISSN 1552-5775) at www.thepermanentejournal.org.

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In celebration of #WomeninMedicine month, TPJ is thrilled to have partnered with the American Medical Women's Associatio...
09/21/2020

In celebration of #WomeninMedicine month, TPJ is thrilled to have partnered with the American Medical Women's Association / AMWA to publish a special Women in Medicine issue. Read more here: http://ow.ly/pzZC50BwWMX

Intravascular Large B-cell Lymphoma with HLH is a rare entity that is typically seen in persons of Asian origin. This ca...
03/27/2020

Intravascular Large B-cell Lymphoma with HLH is a rare entity that is typically seen in persons of Asian origin. This case challenges us to bring together a constellation of neurological symptoms into a unifying diagnosis of malignancy-associated HLH. #winter2020 #casereport #tpj http://bit.ly/2U6ZnrX

Situated between Laguna Beach, CA, and Corona del Mar, CA, just off the Pacific Coast Highway, Crystal Cove State Park i...
03/26/2020

Situated between Laguna Beach, CA, and Corona del Mar, CA, just off the Pacific Coast Highway, Crystal Cove State Park is home to more than 3 miles of beaches and tide pools, 2400 acres of backcountry wilderness, and a 12.3-acre historic district with dozens of cottages, all built between the 1930s and the 1950s. This photograph was taken from a cave at the north end of the park. #soulofthehealer #tpj http://bit.ly/2wcf8EQ

Myeloma and Common Variable Immune Deficiency both manifest abnormal immune systems, but pathogenesis is different. A pa...
03/25/2020

Myeloma and Common Variable Immune Deficiency both manifest abnormal immune systems, but pathogenesis is different. A patient with myeloma, numerous infections and profound immunodeficiency mimicking CVID is presented. A hypothetical connection between the two diseases is discussed and their recognition recommended. http://bit.ly/3a09Bj8

Neoplastic perineural spread occurs through the movement of neoplastic cells into the neural space, affecting predominan...
03/24/2020

Neoplastic perineural spread occurs through the movement of neoplastic cells into the neural space, affecting predominantly the trigeminal and facial nerves. Given the anatomic proximity to these nerve terminations, it is typically associated with cutaneous and salivary glands tumors. The perineural spread can be detected by magnetic resonance imaging as an obliteration of the fat planes around the nerve branches and an enhancement and/or enlargement of the nerve. http://bit.ly/2J18WCg

This first-person perspective offers instructive anecdotes and tips for health care practitioners on working with patien...
03/23/2020

This first-person perspective offers instructive anecdotes and tips for health care practitioners on working with patients who have an almost invisible trauma-related diagnosis such as a dissociative disorder - and they’re more common than you may think. #winter2020 #narrativemedicine http://bit.ly/33u96LI

Metal hypersensitivity is concerning for treating surgeons and patients, which is present in 10% to 17% of the general p...
03/19/2020

Metal hypersensitivity is concerning for treating surgeons and patients, which is present in 10% to 17% of the general population. Preoperative patch-testing may influence surgical practice, especially in cases of persistently painful or aseptic loosening of arthroplasties. #winter2020 #tpj http://bit.ly/3dcCNFJ

After reading the book, participants’ confidence in understanding patients’ experiences with Parkinson Disease increased...
03/18/2020

After reading the book, participants’ confidence in understanding patients’ experiences with Parkinson Disease increased significantly in the areas of stigma and disease impact on patients and families. #graphicmedicine #winter2020 #tpj http://ow.ly/tZl850yKhFn

Practitioner Education and Feedback to Decrease Ciprofloxacin Prescriptions in Patients with Acute Uncomplicated Cystiti...
03/16/2020

Practitioner Education and Feedback to Decrease Ciprofloxacin Prescriptions in Patients with Acute Uncomplicated Cystitis #winter2020 #tpj http://bit.ly/2Q9JUoe

Ceftriaxone is a commonly used antibiotic. Rarely the clinician encounters any adverse reaction during its use. This is ...
03/13/2020

Ceftriaxone is a commonly used antibiotic. Rarely the clinician encounters any adverse reaction during its use. This is a case report of hemolytic anemia due to ceftriaxone, which was also DAT negative. It is a rare phenomenon. #winter2020 #tpj http://bit.ly/2vRZChd

Golden Light: “This macro rose photograph was taken in my SW Portland, OR, rose garden.” #winter2020 #tpj #souloftheheal...
03/12/2020

Golden Light: “This macro rose photograph was taken in my SW Portland, OR, rose garden.” #winter2020 #tpj #soulofthehealer http://bit.ly/2Q8AKIX

Those who treat child maltreatment victims are at risk for secondary traumatic stress and burnout. This article demonstr...
03/11/2020

Those who treat child maltreatment victims are at risk for secondary traumatic stress and burnout. This article demonstrates the psychological strength of hope and meaningfulness of work are important coping resources against secondary traumatic stress and burnout among a national sample of child abuse pediatricians. #winter2020 #tpj http://bit.ly/2TT36Ia

"A theory is the more impressive the greater the simplicity of its premises, the more different kinds of things it relat...
03/09/2020

"A theory is the more impressive the greater the simplicity of its premises, the more different kinds of things it relates, and the more extended its area of applicability”– Einstein. Here are the universal, fundamental rules that drive burnout, successful leadership, & learning. #winter2020 http://bit.ly/2VCjDmc

A retrospective cohort study was conducted at an integrated health care delivery system with computerized provider order...
03/06/2020

A retrospective cohort study was conducted at an integrated health care delivery system with computerized provider order entry. A total of 2704 patients were included: 1373 (50.8%) and 1331 (49.2%) in the dispensed and nondispensed groups, respectively. There was no difference in the rate of cognitive impairment between the groups. No association was identified between potentially inappropriate medication dispensing, after a prescriber was alerted with a best practice alert, and reduced rates of falls/fractures/injuries and cognitive impairment. #winter2020 http://bit.ly/2VE7EVq

We report a post vasectomy syndrome of delayed onset of pain with the simultaneous appearance of blood in the semen (hem...
03/05/2020

We report a post vasectomy syndrome of delayed onset of pain with the simultaneous appearance of blood in the semen (hematospermia). The sperm count rapidly returned to normal. This combination of pain with hematospermia can be a harbinger of vasectomy failure (recanalization). #winter2020 http://bit.ly/2TzJQz6

The clinic day was busy. As often happens, I get to run when, by my precise calculations, there is just enough time befo...
03/04/2020

The clinic day was busy. As often happens, I get to run when, by my precise calculations, there is just enough time before sunset. I check the outside temperature, change into gear, stretch (joints creaking)—the usual routine—some variation of what I have done since I was a kid in some sport or other, while perusing 10 minutes of the news, or weather channel. I grab my phone, keys, a collar, and a leash. I get Kayla, who barks and bounds around in excitement at the sound of me hastily lacing my trail shoes. #winter2020 http://bit.ly/38jXiwq

Decision aids can serve to educate patients and assist them in making values-congruent choices. This review explores the...
03/03/2020

Decision aids can serve to educate patients and assist them in making values-congruent choices. This review explores the design features and implementation factors that might best support the creation of high quality, well-used decision aids. #winter2020 #tpj http://bit.ly/2woYMbG

Outcomes of Robotic Hysterectomy for Treatment of Benign Conditions: Influence of Patient Complexity #winter2020 #tpj #o...
03/02/2020

Outcomes of Robotic Hysterectomy for Treatment of Benign Conditions: Influence of Patient Complexity #winter2020 #tpj #originalresearch http://bit.ly/2PHtxiF

Health Care Providers and Families Writing Together: The Three-Minute Mental Makeover. The 3MMM, the first writing tool ...
02/28/2020

Health Care Providers and Families Writing Together: The Three-Minute Mental Makeover. The 3MMM, the first writing tool for use in clinical practice, reduced stress in patients/families and practitioners (p

“The day I was fortunate enough to photograph this mom and her cubs it was snowing and -40°F. I stood out in the weather...
02/27/2020

“The day I was fortunate enough to photograph this mom and her cubs it was snowing and -40°F. I stood out in the weather for 5 hours photographing while the cubs slept, nursed, and played. There were guests who had been at the lodge for 2 weeks and went home never having seen a bear.” #winter2020 #tpj #soulofthehealer http://bit.ly/32vkuGW

Does narrative medicine offers a clear ethical framework for medical practice? In this new article, Drs. Murphy and Fran...
02/26/2020
Ethics in Narrative Health Interventions

Does narrative medicine offers a clear ethical framework for medical practice? In this new article, Drs. Murphy and Franz argue that narrative medicine provides a new basis for medical ethics based on dialogue between patients and physicians. http://bit.ly/3a2aNlI

John W Murphy, PhD1; Berkeley A Franz, PhD2 Perm J...

Fall prevention improves health outcomes for older adults, but trainees don’t learn enough about it. @kpnorcal engages t...
02/25/2020

Fall prevention improves health outcomes for older adults, but trainees don’t learn enough about it. @kpnorcal engages trainees to learn #fallprevention with video, games, lectures, and small group practice. #KPResearch #fallprevention @kpeastbayarea http://bit.ly/2T8RKPX

Kaiser Oakland Department of Psychiatry has specific programs to help our members manage work stress. Another way we are...
02/24/2020

Kaiser Oakland Department of Psychiatry has specific programs to help our members manage work stress. Another way we are helping our members THRIVE at work and in life. #winter2020 #thrive #tpj http://bit.ly/2STUnGa

Recent case report documents psychiatrist & health/wellness coach collaboration supporting a grad student in attaining i...
02/19/2020

Recent case report documents psychiatrist & health/wellness coach collaboration supporting a grad student in attaining improved self-efficacy, self-management, & academic success that had been hampered by ADHD symptoms; coaching interventions and outcomes detailed. #winter2020 http://bit.ly/39Oh98j

This is the first US study to evaluate incidence of pancreatic cancer in chronic pancreatitis on the basis of a national...
02/17/2020

This is the first US study to evaluate incidence of pancreatic cancer in chronic pancreatitis on the basis of a national database of 120 million patients. This is also the first study to evaluate factors associated with the diagnosis of pancreatic adenocarcinoma in CP. #winter2019 http://bit.ly/31Wf7jx

This photograph was created during the Taos Writing and Wellness Retreat for Health Professionals. It is one of many ima...
02/14/2020

This photograph was created during the Taos Writing and Wellness Retreat for Health Professionals. It is one of many images I captured during the retreat. #leaflet #tpp #photography http://bit.ly/2vj1UVO

Book Review: Picture of Health is a practical and user-friendly guide for patients and clinicians to promote health and ...
02/12/2020

Book Review: Picture of Health is a practical and user-friendly guide for patients and clinicians to promote health and wellness through a complementary and integrative approach. It aims for coordinated care between conventional and ayurvedic systems that is patient-centered and treats the whole person. #fall2019 #tpj http://bit.ly/2Ohftfm

As time went by, we noticed a strange pattern. Snowball would be very engaging with specific patients—jumping up on the ...
02/10/2020

As time went by, we noticed a strange pattern. Snowball would be very engaging with specific patients—jumping up on the bed, playful and interactive—and with other patients he would remain distant. There was no obvious pattern, disorder, or common denominator among patients except one: Each patient he played with would have a life-threatening event in the next 24 hours. #narrativemedicine #tpj #fall2019 http://bit.ly/3btTOKs

The Mindful Doctor: Mindfulness can make every patient encounter, every day, and every moment as good as it can be, and ...
02/07/2020

The Mindful Doctor: Mindfulness can make every patient encounter, every day, and every moment as good as it can be, and could bring back the joy in medicine and life to physicians and their patients. #fall2019 #tpj #mindfulness http://ow.ly/85Ip50ydtPY

This photograph of a young bird was taken in Mr Allencherril’s backyard with a digital camera. Mr Allencherril is a four...
02/06/2020

This photograph of a young bird was taken in Mr Allencherril’s backyard with a digital camera. Mr Allencherril is a fourth-year medical student at the University of Texas Medical Branch in Galveston. Photography has become a passion of his during the last several years. In college, he majored in film, photography, and chemistry. #fall2019 #soulofthehealer http://bit.ly/31rS3c4

The Winter issue is here! Check out our articles on #adversechildhoodexperiences #prostatecancerprevention and #robotich...
02/05/2020

The Winter issue is here! Check out our articles on #adversechildhoodexperiences #prostatecancerprevention and #robotichysterectomy and so much more. #winter2020 #orginalresearch #graphicmedicine ow.ly/tNna50ydsnQ

I look forward to Lucy’s appointments. Lucy is friendly, full of life and energy, and endlessly enthusiastic. She used t...
02/04/2020

I look forward to Lucy’s appointments. Lucy is friendly, full of life and energy, and endlessly enthusiastic. She used to be a chef but now teaches cooking at a community college. I ask her about her class: how she goes about her work, and why she loves it so much. Her stories are endless. It happens that another patient once told me he had been a student at the community college where he learned how to run a restaurant. #fall2019 #narrativemedicine http://bit.ly/2GSywZ3

Chest Pain - "The story is personal and, I hope, thought provoking. I believe there is still a significant disconnect be...
02/03/2020

Chest Pain - "The story is personal and, I hope, thought provoking. I believe there is still a significant disconnect between understanding and handling the effects of mental illness, particularly among the general populous. The stigma still exists, making it easier to ignore that it is a real disease." #leaflet #tpp http://bit.ly/2Sa4FAA

Health literacy rates of individuals with disabilities are rarely and adequately assessed. Using a nationally representa...
01/31/2020

Health literacy rates of individuals with disabilities are rarely and adequately assessed. Using a nationally representative sample, we found that precise and better measurement is necessary to identify and address the unique concerns of this population. #fall2019 #tpj http://ow.ly/kwnn50xXtB6

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