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From patient perspectives, facilitators to repeat screening were making screening personalized and convenient; offering consistent messages and reminders in different modes; increasing patient knowledge about benefits, harms, and expectations of LDCT; and providing nonfinancial and financial incentives for adherence. From a storyboard exercise, we identified 10 design features for lung cancer screening interventions, including versatility of communication, social support, and knowledge.

We identified clear gaps in adherence to lung cancer screenings, organizational and clinical barriers to care, and design features for patient-centered interventions to improve lung cancer screening in US settings.

We identified clear gaps in adherence to lung cancer screenings, organizational and clinical barriers to care, and design features for patient-centered interventions to improve lung cancer screening in US settings.

The role of intracranial pressure (ICP) monitoring in improving outcomes after severe traumatic brain injury especially at level II trauma centers remains controversial. A retrospective analysis was undertaken to assess the impact of ICP monitoring on mortality and long-term functional outcome in adults after severe traumatic brain injury at level II trauma centers.

The data were extracted from the Kaiser Permanente trauma database. Inclusion criteria were adults (≥ 18 years) with severe traumatic brain injury (Glasgow Coma Scale score, < 9) admitted to 2 level II trauma centers in Northern California from 2014 to 2019.

Of 199 patients, 58 (29.1%) underwent ICP monitoring. The monitored subgroup was significantly younger (< 65 years), had lower Glasgow Coma Scale scores (3-5), underwent cranial procedures (craniotomy or decompressive craniectomy) more often, and had greater injury severity scores (≥ 15). Despite monitored patients being more severely injured, there was no significant difference inand our findings may serve as a benchmark for future studies.

Continuity is valued by patients, clinicians, and health systems for its association with higher-value care and satisfaction. Continuity is a commonly cited reason for entering primary care; however, it is difficult to achieve in residency settings. We sought to determine the effect of transitioning from a traditional "block" (13 4-week rotations per year) to a "clinic-first" (priority on outpatient continuity) curriculum on measures of continuity in our family medicine residency.

For the 3 years prior to and the 4 years following the transition from block to clinic-first curriculum (July 2011-June 2018, n = 51 block resident-years and n = 72 clinic-first resident-years), we measured resident panel size, clinic time, office visits, and both resident- and patient-sided continuity measures. We also defined a new longitudinal continuity measure, "familiar faces," which is the number of patients that a resident saw at least 3 times during residency.

The transition from block to clinic-first curriculum increased panel size, clinic time for first- and second-year residents, overall total visits, and total number of clinic visits with paneled patients. Continuity measures demonstrated an increased resident-sided continuity at all training levels, an increase (first-year residents) or unchanged (second- and third-year residents) continuity from the patient perspective, and a near doubling of longitudinal continuity.

Redesigning our family medicine residency curriculum from a traditional block schedule to a clinic-first curriculum improved our residents' continuity experience.

Redesigning our family medicine residency curriculum from a traditional block schedule to a clinic-first curriculum improved our residents' continuity experience.

The Centers for Disease Control and Prevention (CDC) has reported downward trends in life expectancy and racial/ethnic differences between 2014 and 2017.

To determine the life expectancy of the Kaiser Permanente Mid-Atlantic States (KPMAS) insured population as compared to the CDC National Vital Statistics data from 2014 to 2017. We also aimed to highlight the utilization of membership data to inform population statistical estimates such as life expectancy. We examine whether national trends in life expectancy are reflected in an insured population with relatively uniform access to care.

This retrospective, data only study examined life expectancy between 2014 and 2017. Data from electronic medical records and the National Death Index were combined to construct complete life tables by race and sex for the KPMAS population, which was compared to the CDC National Vital Statistics data.

From 2014 to 2017, the overall KPMAS population life expectancy at birth varied between 84.6 and 85.2 years compared to the CDC reported national average of 78.6-78.9 years (p < 0.001). While the CDC dataset reported a 3.5- to 3.7-year life expectancy gap between non-Hispanic White and non-Hispanic Black populations, in the KPMAS population, this gap was significantly smaller (0.0-0.9 years). The gap in life expectancy between males and females was consistent across KPMAS and the CDC data; however, overall KPMAS male and female patient life expectancy was extended in comparison.

Among members who disclosed their race/ethnicity, KPMAS Hispanic, non-Hispanic Black, and non-Hispanic White members had significantly higher life expectancies than the CDC dataset in all years reported.

Among members who disclosed their race/ethnicity, KPMAS Hispanic, non-Hispanic Black, and non-Hispanic White members had significantly higher life expectancies than the CDC dataset in all years reported.

Childhood trauma is widespread and contributes to clinical, behavioral, and social health consequences. Despite more than 2 decades of research from the Centers for Disease Control and Prevention-Kaiser Adverse Childhood Experiences (ACEs) Study, ACEs science is still not fully integrated into medical school curricula. Therefore, we conducted a pilot study to assess the level of awareness about ACEs and trauma-informed care (TIC) curricula among medical students.

A cross-sectional study was conducted at the Medical College of Georgia using a sample of convenience. Enrolled first-, second-, and third-year students were invited to complete a survey during the Spring 2020 semester. A total of 194 students responded to specific questions about training on and knowledge of ACEs and principles of TIC.

The majority of students (80%) indicated they heard of the ACEs Study, and 70% reported they received information about ACEs. Regarding TIC, findings indicated less knowledge on cultural context related to stress and trauma. In addition, first-year students were less likely to know about TIC principles than third-year students.

This preliminary study is the first of its kind in the state of Georgia, where recent surveillance data indicate that 60% of adults have experienced at least one ACE. Given that ACEs are widespread, effective educational practices to increase knowledge about ACEs science, and skills to carry out TIC practices may benefit future practicing physicians by introducing ACEs in the first-year curriculum.

This preliminary study is the first of its kind in the state of Georgia, where recent surveillance data indicate that 60% of adults have experienced at least one ACE. click here Given that ACEs are widespread, effective educational practices to increase knowledge about ACEs science, and skills to carry out TIC practices may benefit future practicing physicians by introducing ACEs in the first-year curriculum.

The Southern California region of Kaiser Permanente developed a COVID-19 Home Monitoring program as an alternative to hospital admission to decrease hospital bed days and mitigate the adverse effects of a surge. To date, more than 15,000 patients have been enrolled and approximately 10% of enrolled patients have been escalated to hospital care for timely treatment. Our objective is to describe our COVID-19 Home Monitoring program and present early results.

We conducted an observational retrospective study of all patients enrolled in the COVID-19 Home Monitoring program between April 13, 2020 through February 12, 2021. Data analysis conducted includes patient demographics, enrollment, entry points, length of stay, mortality, additional treatment, utilization, adherence, satisfaction, and alert triggers.

A total of 12,461 of 13,055 patients (95.5%) recovered and completed the program, 1387 patients (10.6%) were admitted to the hospital, and 20 patients (0.2%) died while they were being monitored at home. The mortality rate at 30 days from enrollment was 1.6%. Hospital length of stay for ambulatory patients receiving oxygen only was 5.4 days compared to 3.1 days for those ambulatory patients receiving oxygen, dexamethasone, and remdesivir.

COVID-19 home monitoring appears to be safe and effective. Initial data suggest it can serve as an alternative to hospitalization, decreasing hospital length of stay when patients receive therapies in the ambulatory setting otherwise reserved for the hospital. Initial results of this Home Monitoring program appear to be promising, and a longer term prospective study is warranted.

COVID-19 home monitoring appears to be safe and effective. Initial data suggest it can serve as an alternative to hospitalization, decreasing hospital length of stay when patients receive therapies in the ambulatory setting otherwise reserved for the hospital. Initial results of this Home Monitoring program appear to be promising, and a longer term prospective study is warranted.Seizure is a common presenting symptom for those with brain tumor due to its unique pathogenesis. Several choices of antiepileptic drug are available to use, but some patients can still go on to develop tumor-related refractory epilepsy. Vagus nerve stimulation is becoming a popular option for those with medical refractory epilepsy but no brain tumor due to its effectiveness. There are very few studies available that address the topic of using vagus nerve stimulation for tumor-related epilepsy. Here we discuss the evidence of using vagus nerve stimulation for refractory tumor-related epilepsy and its challenges and gaps moving forward.

The recent systematic adoption of intracameral antibiotic injection during cataract surgery in Sweden, India, and the US serves as a model for the successful transitioning of local quality improvement initiatives to organization-wide implementation. Although the delivery of eye care in the 3 countries is distinctly organized with differing governances and technological infrastructure, each contains elements of a learning organization (ie, an organization that has adopted a culture of creating, acquiring, and transferring knowledge into practice through system-level and clinician-level change).

We describe a retrospective and organizational implementation study of intracameral antibiotic injection in Sweden, through the efforts of the National Cataract Registry; in the US by Kaiser Permanente; and in India by the Aravind Eye Hospital System. Leadership structure, training in problem solving, benchmarking, sharing of technical knowledge, and data and workforce engagement are compared.

Each of the 3 organizations share the key elements of effective leadership, which values the exchange of ideas in the workforce, training and resourcing for change, and information management in the form of benchmarking and data sharing.