Spring 2001

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Spring 2001 - Volume 5 Number 2

Original Research

Financing Clinical Trials Research at Kaiser Permanente.
Steve Stoller, PhD, MPH
KP is in a unique position to engage in industry-sponsored clinical trials because of its large, diverse, and representative population, access to that population, excellent data systems, and quality of patient care. Determining actual research costs is complex, and negotiating with industry takes time and experience. Kaiser Foundation Research Institute (KFRI) has developed a comprehensive system for costing clinical and research services and is prepared to provide support that includes budgeting for proposals and negotiating clinical research contracts.

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Clinical Contributions

Vohs Award Winner: Southern California West Los Angeles Sickle Cell Medical Care Program
Amy J Brotzman, MHA, RD; Osbourne A Blake, MD; Manuel L Myers, MD; Kimberly C Reece, MD; Nancy A Shinno, MD, MPH; Elaine M Smith, MD, FAAP; and Joseph L Whittaker Jr, MPH
Now that most sickle cell disease victims survive into adulthood, guidelines are needed for optimal management of the condition throughout adulthood. This article describes such a program, extrapolated from management plans for children. Favorable outcome data are presented.
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Vohs Honorable Mention: The Kaiser Permanente Therapy Management Strategy.
Beth A Martin, RN, MBA; Reg Warren, PhD; Carol Barnes, MS, PT, GCS; Glenn Gade, MD; Paul Barrett, MD; and Robin Gunning, MD
Because of perceived inconsistency in several aspects of care in skilled nursing facilities and in other long-term care institutions, measures of function and quality were applied to patients in a number of these facilities. Outcome measures showed improved quality with no increase in amount of care.
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Sleep-Eating and The Dynamics of Morbid Obesity, Weight Loss, and Regain of Weight in Five Patients
Vincent J Felitti, MD
Starting with five vivid case histories, the underlying psychodynamics of this uncommon, fascinating phenomenon are explored. Practical implications for management of morbid obesity are discussed.

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Patients Prefer Simple, Visual Asthma Self-Management Plan Forms
Harold J Farber MD; Karen Smith-Wong, RN, NP; Lynn Nichols, RRT; and Barbara Langham, RN
Written management protocols are an established component of childhood asthma self-management. The authors explored various formats in terms of patient and parent comprehension and preference, concluding that pictures, color, and ease of reading were important components of preference.

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The Five Choices: State-of-the-Art Choices in Medical Therapy
Ronald R Louie, MD
A personal, practical approach to advising patients is described. The choices range from "standard" (closest to evidence-based) choices through "alternative" and strictly "palliative" treatment. Derived from experience with cancer patients, the approach has universal applicability.

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Health Systems

Addressing the Challenge of New Medical Technologies: One Permanente Clinician's View--Part II
Paul Wallace, MD
Dr Wallace continues his informative discussion from the last edition of The Journal by presenting guidelines for clinicians on the integration of new technology into their practice.
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CPC Corner--Positive Results from Clinician-Patient Communication Programs at Kaiser Permanente: A Physician's View
Steven M Levine, MD
Dr Levine presents a personal testimony on the favorable impact that the clinician-patient communication programs have had on his internal medicine practice.
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Hospitalist Practice: An Increasingly Popular Model for Inpatient Care
Diane Craig, MD
Dr Diane Craig's summary of learnings from a national KP Hospitalist Conference is an excellent "state-of-the-art" update on the hospitalist speciality, an exciting innovation.
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Editors' Comments

High Overall Satisfaction: 2000/2001 Survey Results, and People Visiting TPJ Web Site in Thousands Each Month.
Tom Janisse, MD, Editor-in-Chief
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Changes in Caregiving: Transitioning from Working Independently to Working Together.
Lee Jacobs, MD, Associate Editor
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A Word From the Medical Directors

What Business Are We In?
Al Weiland, MD
Dr Al Weiland's experience last year in the Mid-Atlantic Region gave him insight into the importance of answering the question "What Business Are We In?" He describes the importance of the Kaiser Foundation Health Plans and the Permanente Medical Groups having a shared vision in this personal recounting of his experience in Mid-Atlantic and its parallels with the KPPG journey of the past five years.

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External Affairs

A New Front in the Battle to Preserve Our Reputation
Allan Mann
In the past, critics questioned our ability to deliver quality health care and we responded by publicizing our research, our clinical excellence and our many awards and honors. Allan Mann describes our current task: to promote our integrity. He offers practical methods by which each of us can, in our day-to-day interactions, maintain our integrity and promote a positive image of KP.
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Abstracts of Articles authored or coauthored by Permanente clinicians
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Book Reviews

"Elder Rage or Take My Father Please! How To Survive Caring For Aging Parents"
Jacqueline Marcell
Review by Elliot S Eisenberg, MD

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"Field Guide to the Difficult Patient Interview"
Frederic W Platt, Geoffrey H Gordon
Review by Vincent J Felitti, MD
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"Infectious Disease Pearls"
Burke A Cunha, editor
Review by Vincent J Felitti, MD
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Soul of the Healer

The Body Fable
Kelly Sievers, CRNA

Kelly Sievers, CRNA

"10 degrees south"
Nandini Bakshi, MD

Late August
Kelly Sievers, CRNA

Harry Shragg, MD

"Succulent Supremacy"
Wendy Ray, MPH

"Clay Pots"
Nandini Bakshi, MD

Maternity Ward
Kelly Sievers, CRNA

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