Background. Step-down oral antibiotic therapy (SDO) is commonly used to treat uncomplicated gram-negative bacteremia (GNB), but real-world treatment outcomes and risk factors for failure remain unclear. Methods. We conducted a retrospective cohort study of hospitalized adults with uncomplicated GNB within a large integrated healthcare system from 2018 to 2022, stratifying patients by antibiotic route: complete course of intravenous antibiotic (CIV) or initial intravenous followed by SDO. The primary outcome was a composite of 90-day all-cause mortality, all-cause readmission, or recurrent GNB. Secondary analysis identified risk factors for adverse outcomes using multivariable Cox regression. Results. We included 9164 patients, of whom 8263 received SDO and 901 received CIV therapy. All-cause mortality was 1.1% overall, with no significant difference between groups (CIV 1.4% vs SDO 1.0%, P = .3). All-cause readmission and recurrent GNB were more frequent in the CIV group than SDO group (33% vs 18%, and 5.8% vs 2.4%, respectively; both P < .001). A high Charlson Comorbidity Index (CCI) was independently associated with all adverse outcomes in the full cohort and in both treatment groups. Among SDO patients, fluoroquinolones were associated with a lower GNB recurrence rate (1.6%), whereas beta-lactams were linked to a higher recurrence rate (3.2%). Conclusions. Step-down oral antibiotic therapy appears as effective as CIV for treating uncomplicated GNB, with comparable mortality. A high CCI score is a strong predictor of adverse outcomes. Fluoroquinolones remain a favorable SDO option, though further research is warranted to evaluate alternative oral antibiotic agents.
Frontline nurse leaders are pivotal in advancing safety, quality, and engagement, yet many transition into leadership roles with limited preparation and structured support. To address this gap, Kaiser Permanente Northern California established the Assistant Nurse Manager (ANM) Community of Practice (CoP) in 2019, a Caring Science-based leadership development model uniting more than 800 ANMs across 21 medical centers. Guided by Jean Watson's Theory of Human Caring, the CoP integrates leadership formation, wellness practices, and professional development through monthly sessions featuring centering rituals, reflective dialogue, and mentorship. Over 5 years, the ANM CoP has evolved into a regionwide movement that strengthens relational leadership, psychological safety, and collective resilience. Leadership micropractices such as HeartMath for self-regulation, equine-assisted leadership for relational awareness, and mindfulness for presence translate Caring Science from theory into practice. Evaluation demonstrates a 26% improvement in first-year retention (23.5%-17.3%) and a 50% reduction in turnover within 2 years. Qualitative findings highlight increased moral resilience, belonging, and trust. Now entering its sixth year, the ANM CoP represents a replicable model for cultivating psychologically safe, caring, and high-performing leadership cultures that bridge evidence and empathy, advancing both organizational outcomes and human flourishing.
This reflective manuscript highlights the lived experiences of 7 nurse scholars whose educational journeys and professional development were supported by the Kaiser Permanente (KP) Scholars Academy over the past decade. Their narratives describe how academic progression, leadership development, and Caring Science-informed wellness programs (eg, Healing Circles, HeartMath, and Caritas Coach Education) shaped their leadership identities, influenced local systems change, and strengthened a culture of inquiry and evidence‑based practice (EBP). These stories are framed within contemporary scholarship on lifelong learning, equity‑centered nursing leadership, and evidence‑based leadership development. Intended contribution: to offer nurse leaders practical insights on how health system-supported scholarship pipelines can catalyze measurable improvements in professional governance, EBP adoption, and leader well‑being, thereby advancing organizational goals and health equity.
INTRODUCTION:Chronic kidney disease (CKD) affected > 35 million US adults in 2023. Effective therapies exist to reduce CKD progression and risk of cardiovascular events. However, whether population-level management strategies are effective is not known. The authors evaluated a program that proactively identified and referred high-risk patients to a structured CKD management approach aimed at improving guideline-direct care. METHODS:Within a large, integrated health care delivery system, the authors enrolled adults with high-risk CKD identified from electronic health records between June 2021 and March 2022 who were not receiving nephrology care into a structured CKD management program based on a multidisciplinary, nephrologist-led model of care. These patients were compared to a matched cohort of high-risk patients with CKD receiving usual care. The authors evaluated feasibility and differences in targeted process measures over a 3-month follow-up period. RESULTS:Among 120 eligible patients with CKD enrolled in the program and 120 matched patients with CKD receiving usual care, mean (standard deviation) age was 73.9 (8.4) years, 57.8% were women, and demographic characteristics and comorbidity burden were well matched. Despite the COVID-19 pandemic, implementing the structured CKD management program was feasible. During the 3-month follow-up period, those enrolled in the CKD management program experienced a higher rate of estimated glomerular filtration (58% vs 43%, P = .02) and urinary protein (38% vs 11%, P < .0001) testing. CONCLUSION:Proactive referral to structured CKD management was feasible and led to increased short-term surveillance of kidney function. Future studies should assess whether engagement at earlier stages of CKD and longer systematic care and follow-up can improve outcomes and inform broader implementation of population-level CKD management strategies.
BACKGROUND:Prior studies have found that women with HIV (WWH) have similar or lower breast cancer risk than women without HIV (WWoH). Detection of breast cancer relies on regular screening, but previous studies comparing mammogram rates between WWH and WWoH have had mixed results. SETTING:This study was conducted within Kaiser Permanente Northern California, a large, integrated health care system. METHODS:We conducted a cross-sectional study of WWH and 20:1 demographically matched WWoH aged 50-74 years in December 2019. Mammogram data were abstracted from the electronic health record for the prior 27 months, consistent with a 2-year recommendation for breast cancer screening with a 3-month grace period. We compared mammogram prevalence by HIV status using Poisson regression models, with adjustment for demographic and clinical factors. We then evaluated factors associated with receipt of mammograms in WWH and WWoH. RESULTS:Three hundred forty-five WWH and 6573 WWoH meeting study eligibility were included (demographically matched, mean age: 60.3 vs 60.4 years; White race: 38% for both groups). Mammogram prevalence was high in both groups (86% for WWH, 87% for WWoH), with an adjusted prevalence ratio of 0.95 (confidence interval: 0.91 to 0.99). Among WWH, factors associated with reduced mammogram use included smoking, fewer outpatient encounters, and no HIV RNA measurement within prior year. CONCLUSIONS:Mammogram prevalence was high in WWH and WWoH at Kaiser Permanente Northern California, exceeding national averages. Lower patient engagement with the health care system and smoking emerged as the most significant factors associated with reduced mammograms among WWH.
