Fall 2008 - Volume 12 Number 4
Associations of Psoriatic Arthritis and Cardiovascular Conditions in a Large Population
Among a multiethnic population of 76,465 men and women, none of the 99 persons with a confirmed outpatient diagnosis of psoriatic arthritis exhibited more atherothrombotic disease (coronary and cerebrovascular) or diabetes mellitus than two control groups, but all 99 persons did have an increased prevalence of systemic hypertension and heart failure, and a higher mean body mass index.
Augmentation of Conventional Medical Management of Moderately Severe or Severe Asthma with Acupuncture and Guided Imagery/Meditation
Lewis Mehl-Madrona, MD, PhD
Patients with moderately severe or severe asthma who, when visiting a complementary and alternative medicine clinic, selectively chose to add a combination of acupuncture and guided imagery/meditation to their maximal medical management, experienced respiratory improvement--decreased symptoms, decreased Emergency Department visits, and decreased number of days of hospitalization, while taking less medications than before--and at a lower cost of care.
Counseling and Wellness Services Integrated with Primary Care: A Delivery System That Works
Ken Van Beek, LMSW; Steve Duchemin, PA-C; Geniene Gersh, MA, LLP; Susanne Pettigrew, PA-C; Pamela Silva; Barb Luskin
By colocating behavioral health counselors and nutritionists alongside primary care physicians. Grand Valley Health Plan established the national benchmark for patients using ambulatory services for mental health, and ranked first in Michigan on all six HEDIS "effectiveness of care" measures for behavioral health. One result was a 54% decrease in mental health hospitalization. Up to 70% of primary care visits are driven by psychosocial factors, with 25% of patients having a diagnosable mental disorder, and comorbidity occurring in up to 80% of patients.
Are Foot Abnormalities More Common in Adults with Diabetes? A Cross-Sectional Study in Basrah, Iraq
In a study population of 100 patients with type 2 diabetes and 100 patients without diabetes, researchers found 13 foot abnormalities--prominent metatarsal head, high medial arch, hammertoe, wasting, joint stiffness, amputation, fissures, nail changes, ulcers, blisters, dryness, sclerosis, and dermopathy--statistically more frequent in study participants with diabetes; however only wasting, ulcer, and dryness were strongly associated with diabetes.
The Role of B-Type and Other Natriuretic Peptides in Health and Disease
B-type natriuretic peptide (BNP) levels are specifically useful in differentiating the etiology of shortness of breath between left ventricular (LV) dysfunction, acute congestive heart failure (CHF), and pulmonary dysfunction without CHF. The primary responsibility of natriuretic peptides (NP) is the maintenance of sodium and water homeostasis and vasomotor tone. Both atrial NP and BNP decrease plasma volume and blood pressure in response to an increased tension of the atrium or ventricle, respectively, but reflect LV function, mass, and load more than volume status.
Mohammad Sami Walid, MD, PhD
Long-term survivors of glioblastoma are rare. Several variables besides tumor size and location determine a patient's survival chances: age at diagnosis, where younger patients often receive more aggressive multimodal treatment; functional status, which has a significant negative correlation with age; and histologic and genetic markers.
An Unusual Case of a Cervical Mass Due to Nontuberculous Mycobacterium Fortuitum Infection
This case of an infected submandibular mass is unique because prompt recognition of the infection and treatment with antimicrobials averted surgery. The varied presentations of nontuberculous mycobacterial disease in immunocompetent patients is a trend important to recognize in a woman, aged 60 years, with stage 1 breast cancer for which she had received radiation and chemotherapy.
Diagnoses are Stereotypes: Go Where They Are
What if clinicians accompanied a homeless person for a day, as the author did? Would they also learn how to inquire about sensitive issues, high-risk behaviors, or lifestyle? Would they learn that individuals don't fit stereotypes?
Image Diagnosis: Abdominal Aortic Aneurysm
Gus M Garmel, MD, FACEP, FAAEM
Three sets of radiographic and computed tomography images depict pulmonary embolism (and popliteal venous source), radial head fracture, and leaking abdominal aortic aneurysm.
The Changing Face of HIV Infection
Since the first report, in 1981, of AIDS in five men who have sex with men (MSM) in Los Angeles, the AIDS epidemic has swept the world. It now increasingly affects women, younger adults, is again increasing in MSM, and disproportionately affects people of color. Older age no longer predicts faster progression.
Information Technology Innovation
Yan Chow, MD, MBA, FAAP
Information technology innovations are assessed for physician and patient use. A large-scale example is Kaiser Permanente's Sidney R Garfield Center for Health Care Innovation--a care delivery simulation laboratory. On a small scale is a trial of the use of a 1-lead electrocardiogram rhythm strip transmitter in the form of a wallet placed against the chest and connected to a cell phone that tracks rhythm disturbances. Relationship of a Physician's Well-Being to Interactions with Patients: Practices of the Highest Performing Physicians on the Art of Medicine Patient Survey
Tom Janisse, MD
In a trusting relationship, physicians who, according to patient surveys, satisfy their patients best described that as doctors they are "part of the medicine" through several empathetic activities: respect, attention and presence, listening, connection, reassurance and support, touch, knowledge, explanation and education. This medicine has a powerful therapeutic treatment effect and is responsible for physicians' sense of feeling valued, making an important contribution, making a difference, and creating personal and professional well-being.
Walking labyrinths, recently opened at Kaiser Permanente (KP) Sunnyside and Antioch Medical Center hospitals, are intended to let those who enter find their way along a single, clear path. Modeled on the labyrinth of Chartres Cathedral in France, the labyrinths were first tested, through a KP innovation grant, on "finger labyrinths"--boards with the paths grooved into the wood. Surveys of users' stress levels revealed that most felt more relaxed afterward.
The story of a five-year-old boy named Cody who was cared for by Urology Intern, Dr Cody, after fracturing his kidney in a car crash that killed his parents.
A stone comes alive and recounts its journey through the renal system to expulsion from a woman's urethra.
Original Visual Art
Sal Iaquinta, MD
Evelyn Zlomke, RN, MPH
Original Literary Art
Jonathon W Gietzen, MS, PA-C
Mary Dowd, MD
In the Pod
Mary Dowd, MD
On the Cover
Fred M Freedman, MD