The Permanente journal
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The Permanente journal · May 2021
Multicenter StudyChanges in Emergency Department Patient Volume and Acuity Associated with Early Stages of the COVID-19 Pandemic in a Unique Environment.
Hospitals and emergency departments (EDs) faced profound uncertainty during the COVID-19 pandemic. Early concerns regarding demand far exceeding capacity were balanced by anecdotal reports of decreased patient visits, including those for specific high-acuity conditions. This study sought to identify changes in ED volume and acuity, within a specific managed care environment, associated with the onset of the pandemic. ⋯ Patient volume in 2 EDs dropped significantly in association with a statewide response to the COVID-19 pandemic. There was also a shift in acuity as measured by the proportion of patients admitted to the hospital, but overall admissions declined, suggesting sicker patients also did not seek care.
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The Permanente journal · Sep 2020
Inequity and Women Physicians: Time to Change Millennia of Societal Beliefs.
Gender inequities date back thousands of years, with women expected to be caregivers at home and men expected to be leaders with occupations outside the home. In more recent history, women have trained in various professions, including medicine. Although the number of female physicians has risen consistently over the past several decades and half of US medical students now are women, gender inequities persist and are due, at least in part, to implicit (unconscious) biases held by doctors, other health care professionals, and patients and their families. ⋯ Strategies include implicit bias training for doctors and other staff; development of a transparent and equitable compensation plan; and transparent processes for promotion and hiring, mentorship, and sponsorship of women physicians for grand rounds, lectureships, committees, leadership positions, and awards. Achievement of equity for women physicians requires effort and ultimately a culture change. Gender equity in the medical profession will lead to improved physician wellness, retention of women physicians, and improved access to and quality of health care.
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The Permanente journal · Jan 2020
ReviewMore Than Words: Reflections to Build Resilience during the COVID-19 Pandemic.
Physicians often forget to reflect or take time to process challenging patient encounters, which can ultimately contribute to burnout. This is even more relevant given the increased stressors on patients, families, and health care providers during the coronavirus disease 2019 (COVID-19) pandemic. ⋯ It touches on the ramifications of health care institutions' COVID-19 policies in relation to key geriatric syndromes including loneliness, mental health in older adults, and processing of our own emotions and feelings through narrative medicine. As part of the future health care workforce, we are motivated and optimistic about our future contributions, all the while practicing compassion and empathy.
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The Permanente journal · Jan 2019
Case ReportsAcute Influenza Infection Presenting with Cardiac Tamponade: A Case Report and Review of Literature.
Cardiac complications associated with influenza infection can occur either via a direct effect of the virus on the heart or through exacerbation of preexisting cardiovascular disease. We present a case of a 57-year-old man with acute influenza infection complicated by pericardial effusion and cardiac tamponade. ⋯ Pericardial involvement is a rare and perhaps underreported complication of influenza infection. Early recognition of cardiac symptoms and appropriate diagnostic workup in a patient presenting with influenza-like symptoms is important to avoid life-threatening complications.
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The Permanente journal · Jan 2019
Resident and Faculty Perspectives on Prevention of Resident Burnout: A Focus Group Study.
The high prevalence and negative implications of resident physicians' burnout is well documented, yet few effective interventions have been identified. ⋯ We engaged residents and core faculty across specialties in the identification of factors contributing to burnout and possible targets for interventions. Our results highlight potential focus areas for future burnout interventions and point to the importance of interventions targeted at the social environments in which residents' work and learn.