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Coats N.P.,Mission Medical, Inc. | Baranyay J.,Baranyay Consulting Services Corporation
Journal of Cardiovascular Nursing | Year: 2012

Pharmacologic stress myocardial perfusion imaging is a noninvasive method for evaluating coronary artery disease in patients unable to exercise sufficiently to achieve a heart rate high enough to facilitate satisfactory imaging. The nuclear cardiology nurse is an invaluable member of the laboratory team that performs these tests. In this specialist role, the nurse must have a thorough knowledge of the different pharmacologic stress agents (dipyridamole, adenosine, regadenoson, and dobutamine) that can be used. This should comprise an understanding of their mechanisms of action, contraindications, drug-drug interactions, adverse effects, and administration protocols. By drawing on this knowledge, the nurse is able to verify that the right agent has been selected for each patient based on his/her medical history. The nurse also can help patients follow pretest instructions (such as withholding caffeine and certain medications) by explaining that the measures are necessary for a safe and successful procedure and that violation may result in test cancellation or postponement. On the day of the stress test, the nurse has an important role in safeguarding the patient as well as providing support and reassurance throughout the different stages of the examination. Responsibilities include explaining the entire procedure to the patients, notably, what they will be asked to do, the effect of the stress agent, the timing of each step, the adverse effects that they may experience, how any adverse events will be managed, and the importance of remaining still during imaging. This central role of the nuclear cardiology nurse in overseeing the practical aspects of the pharmacologic stress test has important implications in terms of optimizing the productivity and efficiency of their noninvasive cardiology laboratory and nuclear medicine department. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Reed D.C.,University of California at Los Angeles | Shah K.H.,Mission Medical, Inc. | Hubschman J.-P.,University of California at Los Angeles
Seminars in Ophthalmology | Year: 2013

Introduction: Coccidioides immitis endophthalmitis usually results in enucleation, and there is evidence that vitrectomized eyes are more likely to become enucleated. Methods: A 55-year-old man presented to us with steroid-resistant granulomatous uveitis and was eventually diagnosed with C. immitis endophthalmitis. He was treated with an aggressive medical and surgical approach, receiving a total of 16 intravitreal antifungal injections and three vitrectomies, as well as lensectomy and penetrating keratoplasty. Results: At 13 months after presentation, the patient's eye was free of inflammation, and his best corrected visual acuity was 20/25. Discussion: This is the first reported case of culture-proven C. immitis endophthalmitis with a favorable final outcome. We propose that the good outcome may have been due to our aggressive therapeutic approach. © 2013 Informa Healthcare USA, Inc. Source

Tunstall T.D.,Mission Medical, Inc.
Journal of Diagnostic Medical Sonography | Year: 2010

Knowledge of how to prevent healthcare-associated infections within the sonography department is an important step in providing quality care. Employing scientifically based preventative measures will ensure that the tools we use do not become vectors for the spread of pathogens that cause infections. These avoidable infections have not only an added financial cost to patients and the already burdened healthcare system but also physical and emotional costs to the patients we treat. Specific infection control guidelines for the sonography department are lacking, and the guidelines that are available are often based on proven infection control practiced in similar situations. Within this article are the applicable infection guidelines sonographers can use to provide safe quality care. © 2010 The Author(s). Source

Bitar R.A.,Mission Medical, Inc. | Bitar R.A.,Pomerado Medical Center
Emerging Infectious Diseases | Year: 2016

Lacking population-specific data, activity of seasonal and pandemic influenza is usually tracked by counting the number of diagnoses and visits to medical facilities above a baseline. This type of data does not address the delivery of services in a specific population. To provide population-specific data, this retrospective study of patients with influenza- like illness, influenza, and pneumonia among members of a Kaiser Permanente health plan in San Diego, California, USA, during October-December 2009 was initiated. Population data included the number of outpatients accessing healthcare; the number of patients diagnosed with pneumonia; antimicrobial therapy administered; number of patients hospitalized with influenza, influenza-like illness, or pneumonia; level of care provided; and number of patients requiring specialized treatments (e.g., oxygen, ventilation, vasopressors). The rate of admissions specific to weeks and predictions of 2 epidemiologic models shows the strengths and weaknesses of those tools. Data collected in this study may improve planning for influenza pandemics. © 2016, Centers for Disease Control and Prevention (CDC). All rights reserved. Source

Panikulam A.,Mission Medical, Inc.
Indian Journal of Palliative Care | Year: 2011

We CanSupport provide holistic care to the patients and family. This means, physical, emotional, psychosocial and spiritual care. The objective of this article is to implement a plan for improved high quality care, within a dynamic and complex health care system for palliative care. Twelve years of working experience with palliative care in CanSupport ′India′ and 10 years of working palliative care aboard (USA). High level satisfaction of the patient of the patient and families due to the psycho, socio, spiritual model and help for income generation and vocational training. We suggest and encourage, to we this model for all palliative care centre and institutions. Source

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