The Permanente journal
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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 2017
Review Comparative StudyUse of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases.
Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common. ⋯ Use of epidural analgesia in patients undergoing abdominal wall reconstruction may result in longer hospital stay and higher incidence of complications while having no measurable positive clinical impact on pain control.
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A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. ⋯ Intensivists working these systems are able to more effectively treat ICU patients, providing better clinical outcomes for patients at lower costs compared with hospitals without a tele-ICU.
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The Permanente journal · Jan 2014
Review Case ReportsThoracic endometriosis syndrome: case report and review of the literature.
Thoracic endometriosis syndrome is the presence of endometrial tissue in or around the lung. Thoracic endometriosis syndrome consists of four distinct clinical entities: catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules. ⋯ Current treatments include hormone therapy and, where warranted, surgical intervention. We report the case of a 48-year-old woman with endometriosis causing bowel obstruction and concurrent catamenial pneumothorax.
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Intestinal microbiota play an important role in health and disease. The gut-liver axis provides for an interaction between bacterial components like lipopolysaccharide and hepatic receptors (Toll-like receptors). ⋯ Administration of health-promoting microbial strains may help ameliorate these harmful interactions and hepatic disorders. This review focuses on changes in gut microbiota in the context of liver disease and possible roles of probiotics, prebiotics, and synbiotics in liver disease.