Generalizability of an Automatic Explanation Method for Machine Learning Prediction Results on Asthma-Related Hospital Visits in Patients With Asthma: Quantitative Analysis.

Background: Asthma exerts a substantial burden on patients and health care systems. To facilitate preventive care for asthma management and improve patient outcomes, we recently developed two machine learning models, one on Intermountain Healthcare data and the other on Kaiser Permanente Southern California (KPSC) data, to forecast asthma-related hospital visits, including emergency department visits and hospitalizations, in the succeeding 12 months among patients with asthma. As is typical for machine learning approaches, these two models do not explain their forecasting results.

Text-Based Identification of Herpes Zoster Ophthalmicus With Ocular Involvement in the Electronic Health Record: A Population-Based Study.

Background: Diagnosis codes are inadequate for accurately identifying herpes zoster ophthalmicus (HZO). Manual review of medical records is expensive and time-consuming, resulting in a lack of population-based data on HZO.

Methods: We conducted a retrospective cohort study, including 87 673 patients aged ≥50 years who had a new HZ diagnosis and associated antiviral prescription between 2010 and 2018.

Can You Escape Sepsis? Using a Healthcare Escape Room as an Innovative Approach to Nursing Education.

Purpose/objectives: The purpose of this article is to provide the clinical nurse specialist with an interactive, creative, and fun approach using an escape room to increase the retention and application of knowledge about caring for patients with sepsis and improve patient care outcomes.

Description Of The Project: This project involved the design of a healthcare-based escape room, where clinical nurses and interprofessional learners engaged in a series of puzzles and problem-solving experiences to apply clinical judgment and critical thinking about patient care.

Theory And Frameworks: Knowles' theory of adult learning guided the development of this gamified learning.

Evaluation of a Transitional Care Program After Hospitalization for Heart Failure in an Integrated Health Care System.

Importance: Prompted by null findings from several care transition trials and practice changes for heart failure in recent years, leaders from a large integrated health care system aimed to reassess the outcomes of its 10-year multicomponent transitional care program for heart failure (HF-TCP).

Objective: To examine the association of the individual HF-TCP components and their bundle with the primary outcome of all-cause 30-day inpatient or observation stay readmissions.

Design, Setting, And Participants: This retrospective cohort study included patients enrolled in the HF-TCP during an inpatient encounter for heart failure at 13 Kaiser Permanente Southern California hospitals from January 1, 2013, to October 31, 2018, who were followed up from discharge until 30 days, readmission, or death.

A Roadmap for Institutionalizing Collaborative Care for Depression in a Large Integrated Healthcare System.

Background: Collaborative models for depression have not been widely adopted throughout the USA, possibly because there are no successful roadmaps for implementing these types of models.

Objective: To provide such a roadmap through a case study of the institutionalization of a depression care management (DCM) initiative for adult depression in a large healthcare system serving over 300,000 adults with depression.

Design: A retrospective observational program evaluation.

Does Knee Arthroscopy for Treatment of Meniscal Damage with Osteoarthritis Delay Knee Replacement Compared to Physical Therapy Alone?

Backgroud: To determine patient factors that lead to treatment of meniscal tears with osteoarthritis (OA) with knee arthroscopy (KA) or physical therapy only (PT-only); and to assess differences in clinical outcomes including the time to knee arthroplasty.

Methods: Patients aged ≥ 45 years with OA at meniscal tear diagnosis were followed up from the date of surgery (KA) or first PT visit (PT-only) until partial/total knee replacement surgery, death, disenrollment, or end of study. Demographic and clinical characteristics were compared and used to derive propensity scores.

Emergency department patients' perceptions of the efficacy and safety of opioid analgesics.

Introduction: Emergency department (ED) providers are on the forefront of the prescription drug crisis and understand-ing patient's perceptions of opioids may allow physicians to better address misconceptions. The aim was to determine the perceptions of ED patients regarding the efficacy and safety of opioid analgesics.

Methods: Cross-sectional study of a convenience sample of adults at a single urban academic ED.

Universal SARS-Cov-2 Screening in Women Admitted for Delivery in a Large Managed Care Organization.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has created a need for data regarding the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women. After implementing universal screening for COVID-19 in women admitted for delivery, we sought to describe the characteristics of COVID-19 in this large cohort of women.

Study Design: An observational study of women admitted to labor and delivery units in Kaiser Permanente Southern California (KPSC) hospitals between April 6 and May 11, 2020 who were universally offered testing for SARS-CoV-2 infection ( = 3,963).

Opportunities to Improve Antibiotic Appropriateness in U.S. ICUs: A Multicenter Evaluation.

Objectives: To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities.

Design: Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017.

Setting: ICUs in 12 U.

Effectiveness of Gastric Bypass Versus Gastric Sleeve for Cardiovascular Disease: Protocol and Baseline Results for a Comparative Effectiveness Study.

Background: When compared with conventional weight loss strategies, bariatric surgery results in substantially greater durable weight loss and rates of disease remission.

Objective: The ENGAGE CVD (Effectiveness of Gastric Bypass versus Gastric Sleeve for Cardiovascular Disease) cohort study aimed to provide population-based, comprehensive, rigorous evidence for clinical and policy decision making regarding the choice between gastric bypass and gastric sleeve for overall cardiovascular disease (CVD) risk reduction, risk factor remission, and safety.

Methods: The cohort had 22,095 weight loss surgery patients from a large integrated health care system in Southern California assembled from 2009 to 2016 who were followed up through 2018.

Refining the Definition of Polypharmacy and Its Link to Disability in Older Adults: Conceptualizing Necessary Polypharmacy, Unnecessary Polypharmacy, and Polypharmacy of Unclear Benefit.

The term polypharmacy in older adults is generally used in a pejorative context in the medical literature. Because of its link to geriatric syndromes and disability, the avoidance of polypharmacy is usually recommended in older adults as a strategy to optimize functional status. However, there are many polypharmacy regimens based on high-quality trials that clearly reduce the risk of disability in older adults.

Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data.

Recently, there has been an increase in prescription drug abuse and related fatalities. Although opioid analgesics are commonly implicated, there have been significant increases in the prevalence of benzodiazepine exposures and overdoses. To describe national trends in pediatric benzodiazepine exposures from 2000 to 2015.

Rapid detection of invasive Mycobacterium chimaera disease via a novel plasma-based next-generation sequencing test.

Background: There is an ongoing outbreak of Mycobacterium chimaera infections among patients exposed to contaminated heater-cooler devices used during cardiac surgery. Recognition of M. chimaera infection is hampered by its long latency and non-specific symptoms.

Development of a pediatric asthma predictive index for hospitalization.

Background: Variation in emergency department (ED) management for asthma exacerbation leads to disparities in care. Current asthma severity scores are insufficient to be used for hospitalization decisions.

Objective: To develop and internally validate an asthma predictive index for hospitalization (APIH) to guide practitioners in their admission decision for children with asthma exacerbations.

Two-year outcomes of a pilot glaucoma suspect telemedicine monitoring program.

Purpose: The purpose of this study was to characterize a pilot program using e-health to monitor glaucoma suspects in a large integrated health system.

Methods: A retrospective chart review of patients enrolled in the first 2 years of a new glaucoma suspect telemedicine monitoring program was conducted. Patients were enrolled in the program after being diagnosed as glaucoma suspects in the regular clinic setting and were eligible for the program if they had better than 20/40 vision, intraocular pressure (IOP) <25 mmHg, a normal baseline visual field, and an optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) without clear evidence of glaucomatous optic nerve damage.

When a Mother Changes Her Mind About a DNR.

Generally, wide latitude is granted to parents when making decisions for their child on the basis of the wide acceptance of the special relationship between parent and child and the important role played by parents in the lives of children. However, when high-risk decisions are made, health care teams serve as an important societal safeguard that questions whether a parent is an appropriate decision-maker for their child. Child advocacy is an essential function of the pediatric health care team.

Using natural language processing for identification of herpes zoster ophthalmicus cases to support population-based study.

Importance: Diagnosis codes are inadequate for accurately identifying herpes zoster (HZ) ophthalmicus (HZO). There is significant lack of population-based studies on HZO due to the high expense of manual review of medical records.

Background: To assess whether HZO can be identified from the clinical notes using natural language processing (NLP).

Cervical spine disease in surgeons performing arthroscopy or laparoscopy.

Minimal research exists regarding cervical spine disorders in surgeons who perform endoscopy. A confidential on-line survey regarding neck pain (NP), spine disease (SD), and radiculopathy/myelopathy (R/M) was sent to 722 surgeons from a managed, group-based health care system. 415 responded.

Raised in Darkness: A 7-Month-Old With Nystagmus From Severe Visual Deprivation.

Child neglect is the most common form of child maltreatment and accounts for 60% of all cases reported to child protective services. Whereas physical and emotional neglect account for a quarter of the reported cases of child neglect, educational neglect accounts for half of the cases. We describe a 7-month-old infant with several manifestations of physical and emotional neglect including excessive quietness, failure to thrive, global developmental delay, and a gastric lactobezoar.

An Ethics of Permission: A Response to the California End of Life Option Act.

An ethics of permission can be helpful in framing a response to the ethical differences surrounding the California End of Life Option Act. Law does not define morality, and reaching a moral understanding demands thorough reflection. An ethics of permission examines the ethical demands of a permissive law for both clinician and patient.