NCAL Residency


About Kaiser Permanente Division of Research Resident Wellness Life in Northern California Facilities and Locations Hayward Oakland San Francisco Santa Clara Vallejo Commitment to Education Emergency Medicine Family Medicine Internal Medicine Oakland San Francisco Santa Clara Obstetrics & Gynecology Oakland San Francisco Santa Clara Otolaryngology Pediatrics Podiatric Surgery Hayward SF Bay Area Sacramento Santa Clara Vallejo Psychology and Mental Health Internships Residencies Surgery Fellowships General Policies and Information Internal Medicine Oakland San Francisco Santa Clara Obstetrics & Gynecology Oakland San Francisco Santa Clara Otolaryngology Pediatrics Pediatric Inpatient Subinternship Pediatric Outpatient Subinternship Intensive Care Nursury Subinternship Scholarships Scholarship Application Scholarship PDF Come See Us Residency Open House Residency Video Resident Research University Affiliations Community Outreach Our Graduates New Interns & Residents Leadership Course Fellowships Rotating Residents Research Course
Expand All \| Collapse All Why Choose Kaiser Permanente Division of Research Resident Wellness Life in Northern California + Our Locations Hayward Oakland San Francisco Santa Clara Vallejo Commitment to Education About Kaiser Permanente + Prospective Residents Come See Us Our Graduates Residency Open House Residency Video Community Outreach Research University Affiliations	Division of Research The Division of Research conducts, publishes, and disseminates high-quality epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well being and to improve the quality and cost-effectiveness of health care. To accomplish these goals, the Division of Research is committed to providing a supportive research environment that fosters independent thinking, creativity, continued learning and adherence to the highest scientific standards. About the DOR: The Division of Research, formerly called Medical Methods Research, was established in 1961 by Dr. Morris Collen to conduct research aimed at improving methods for delivery of health care to subscribers of the Kaiser Permanente Medical Care Program, Northern California Region. DOR pioneered automated multiphasic health testing systems to provide cost-effective health checkups. DOR also piloted a computer-based medical record system, which resulted in the accumulation of a large volume of medical data that could be used for research purposes. The DOR Today: Currently, DOR’s 400-plus staff is employed in more than 220 epidemiological and health services research projects. The work is primarily supported by federal, state, and other outside institutions, as well as by The Permanente Medical Group and Kaiser Foundation Health Plan's Community Services funds. DOR’s total funding level exceeds $30 million. The research is conducted among the three million health plan members of Kaiser Permanente, Northern California Region (29 percent of the Bay Area/Sacramento population) using interviews, automated data, medical records, and clinical examinations. Researchers from DOR have contributed more than 1,200 papers to medical and public health literature. This work covers a wide range of topics that include heart disease, cancer, alcohol use, mental health, reproductive health, women's health, children's health, and many other health related problems. DOR Biostatistical Consulting: The Division of Research Biostatistical Consulting Unit, under the direction of Mary Anne Armstrong, MA, provides biostatistical and analytic consulting services to residents, and includes advice on statistical methods, power and sample size estimation and feasibility, IRB applications, access to Kaiser Permanente databases, programming of data analysis, interpretation of results, manuscript development and recommendations for revising biostatistical methodology and results sections in publication drafts. Examples of Resident Research Conducted with the Division of Research: Kaiser Northern California Essure Experience (Ulrike Savage, San Francisco) The Essure permanent birth control device offers women the option of an office-based, transcervical approach to a permanent birth control method. It consists of an expanding spring device surrounding Dacron fibers that induce a local tissue response when inserted into the Fallopian tubes, causing tubal occlusion. It was introduced as a low-cost alternative to surgical permanent sterilization. The device was FDA approved in 2002, and the manufacturers quote a >99% effectiveness rate. This study aims to describe the Kaiser Northern California regional experience with this new birth control device. A retrospective CIPS system and paper chart review will be used to determine the success rate of Essure placement and its effectiveness in causing tubal occlusion. It will also seek to identify factors that may influence the successful placement rate. The study population will be selected through a CIPS review of all northern California members who have undergone an Essure placement procedure. Women who have undergone this procedure from its first use in the northern California region through June 2006 will be included, to allow sufficient time for collection of follow-up data. All information will be obtained entirely by electronic and paper medical chart review; no patients will be contacted. This study will allow a comparison of the Kaiser Northern California Essure experience with previously reported placement and effectiveness rates, and will help to delineate factors that may influence the success of this new birth control method. Surgical Management of Grade 1 Endometrial Adenocarcinoma by Obstetrician-Gynecologists or Gynecologic Oncologists: A comparison of endometrial cancer survival (Noah Rodriguez, Santa Clara) OBJECTIVE: To determine the overall and endometrial cancer survival rates in patients with preoperative grade I endometrial cancer when operated by obstetrician-gynecologists compared to gynecologic oncologists. METHODS: A retrospective cohort study of the Kaiser Permanente Northern California Cancer Registry for the 2 years period from 2000-2001 was conducted. All patients with preoperative biopsies demonstrating grade 1 endometrial cancer were included. Patients without preoperative biopsies, biopsies demonstrating benign processes, complex hyperplasia or > grade 2, and patients with other coexisting primary malignancies were excluded. Data on patietns’ age, race, co-morbidities, surgical procedure, final grade, final stage, additional therapy, recurrences, and survival were reported. Survival analysis was conducted for examining the relationship between doctor specialty and overall survival rate and endometrial cancer survival rate. The average patient follow-up time is 58 months. RESULTS: Of 621 patients with endometrial adenocarcinoma, 338 patients with a diagnosis of preoperative grade 1 endometrial cancer were identified. 336 patients underwent surgical management. 332 patients met inclusion criteria. Obstetrician-gynecologists operated on 200 patients while gynecologic oncologists operated on 132 patients. Patient demographics and co-morbidities including tobacco use, obesity, hypertension and diabetes were similar between the two groups of surgeons. The recurrence rate for patients operated by obstetrician-gynecologists was 4.6% compared to 5.3% when operated by gynecologic oncologists. The overall survival rate was 88% versus 86% respectively. The endometrial cancer survival rate was 97% versus 95%. CONCLUSIONS: Five-year survival rates for patients with grade 1 endometrial cancer are favorable. This study did not show a significant difference in overall survival rates or endometrial cancer survival rates in patients with grade 1 endometrial cancer managed by obstetrician-gynecologists compared to patients managed by gynecologic oncologists. Long Term Follow Up of Endometrial Ablation (Mindyn Longinotti, San Francisco) Our objective is to investigate the long-term rate of failure for endometrial ablation (EA), as well as risk factors for failure (eg. age, indication) among women undergoing EA in Kaiser Permanente Northern California. Failure will be defined as repeat uterine conserving procedure (UCP) or hysterectomy after EA. Retrospective analysis of the Admission, Discharge and Transfer (ADT) database will identify all women at least four years status post EA. The ADT database will then be used to identify which women underwent subsequent UCPs (eg, repeat EA) and/or hysterectomy. Survival analysis using life-table method will be done to estimate probability of failure over time as well as tests for trend and log rank tests to compare curves for risk factor analysis. We hope to establish the long-term risk of failure for EA as well as possible risk factors for failure. Predictors of Hysterectomy after Uterine Artery Embolization for Leiomyoma (Katherine Gabriel-Cox, San Francisco) Gabriel-Cox K, Jacobson GF, Armstrong MA, Hung YY, et al. Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol 2007;196:588.e1-588.e6. OBJECTIVE: This study was undertaken to describe long-term outcomes after uterine artery embolization for leiomyoma. STUDY DESIGN: Data from Kaiser Permanente Northern California members undergoing uterine artery embolization for leiomyoma before July 2001 were collected. Survival analysis was performed to describe hysterectomy rates and identify predictors of hysterectomy. RESULTS: Uterine artery embolization was performed in 562 women from 1997-2001. Thirty-three women (5.9%) had unilateral uterine artery embolization. One hundred women (18%) underwent hysterectomy after uterine artery embolization, and 32 (5.7%) had additional uterine sparing procedures. Only unilateral uterine artery embolization predicted subsequent hysterectomy (relative risk _ 2.19; 95% CI 1.34-3.57), whereas age, indication, uterine volume, embolizing particle, and radiologist experience did not. The rate of hysterectomy at 5 years was 19.7%; rates for bilateral and unilateral uterine artery embolizations were 18.5% and 39.2%, respectively. Fifty-four women (9.6%) had emergency room visits and 17 (3%) had unplanned readmissions. CONCLUSIONS: Uterine artery embolization for leiomyoma permits uterine conservation in more than 80% of women monitored longterm. When bilateral procedures cannot be performed, failure rates are considerably higher.