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Johnson M.,Scripps Mercy Hospital | Bakas T.,Indiana University
Journal of Neuroscience Nursing | Year: 2010

Despite stroke being the third leading cause of death and a leading cause of disability in the United States, less than 7% of stroke survivors receive tissue plasminogen activator (tPA) in the treatment of acute stroke. The purpose of this review was to determine what research is available on barriers to tPA use and to determine gaps in the literature. A search of the literature was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and PubMed. Keywords were stroke, emergency, nursing, thrombolytics, cerebrovascular accident, ischemia, intervention, tPA, and barriers. Pertinent references from articles obtained were searched as well. The search yielded 45 articles for review. Barriers to tPA use were found in both prehospital and in-hospital settings. Prehospital delays were related to contacting primary care physicians, mode of arrival to the hospital, and survivors' lack of knowledge regarding stroke. Sources of in-hospital delays included non-stroke center status, lack of training of emergency department staff, delays in computed tomography scans, and poor understanding regarding priority stroke treatment (e.g., mild or improving symptoms and disparities related to age, gender, and race). Future research to evaluate the impact of nursing care and attitudes toward stroke patients on the administration of tPA is recommended. Copyright © 2010 American Association of Neuroscience Nurses.

Burnell L.,Scripps Mercy Hospital
Journal of Christian nursing : a quarterly publication of Nurses Christian Fellowship | Year: 2010

Although the word "compassion" is an integral component of nursing care, a clear conceptualization of the term is lacking. This article examines compassion from historical, biblical, and global perspectives; spiritual connections; and calls for research to help build our understanding of what compassion means and how to enter into other's suffering.

Mai T.V.,Scripps Mercy Hospital | Agan D.L.,Scripps Mercy Hospital | Clopton P.,Vet Stats Core | Demaria A.N.,University of California at San Diego
Journal of the American College of Cardiology | Year: 2013

Objectives: The aim of this study was to determine the extent, type (e.g., staff, equipment), and sources of funding for published cardiovascular research. Background: Important cardiovascular research is often performed without direct financial support. The degree to which medical research is conducted on an unfunded basis remains uncertain. Methods: We sent an electronic survey (Survey Monkey) to 938 corresponding authors who published papers in the Journal of the American College of Cardiology from 2007 through 2009. The data sought included the authors' characteristics (e.g., age, institution, type of research), funding, sources of funding, and types of support for their research. Results: The response rate was 41% (388 of 938). The percentage of authors who were fully funded was 26%, 44.1% were partially funded, and those without any direct funding amounted to 30%. Most funding came from government (41.8%) and industry (35.1%), whereas institutional, foundation, association, philanthropy, and other grants contributed the remaining 23.1%. Funded authors received supplies (43.6%), staff (41.5%), and salary (39.7%) to a greater extent than equipment (27.3%) or administrative (24.7%) support. Significantly fewer authors 40 years of age or younger (24.3%) were partially funded relative to authors older than 40 years of age (≥47%) (p = 0.001). Significantly fewer authors from a community hospital (0%), from Europe (16.7%), or conducting interventional (7.3%) or heart rhythm (11.5%) studies were fully funded (all p < 0.05). Although only a trend, clinical investigators were more likely to be unfunded (35.7%) relative to basic/basic and clinical investigators (19.1%) (p = 0.001). Those significantly more likely to be fully funded were authors from the United States (35.3%) relative to non-American authors (≤28.6%) (p = 0.006). In addition, authors received more funding working in a government or VA hospital (45.9%) than nongovernment hospitals (≤27.1%) (p = 0.001). The authors who were 50 years of age or older, from the United States, had PhD degrees, doing basic as well as clinical research, or studying genetics/genomics had significantly more sources of funding and types of support (all p < 0.05). Conclusions: Considerable published cardiovascular research is currently being conducted without direct financial support. This is particularly true for young clinical investigators. The inability to accommodate this investigation in the medical enterprise might substantially diminish the amount of new knowledge coming forth. © 2013 American College of Cardiology Foundation.

Fernandez G.,University of Utah | Spatz E.S.,Yale University | Jablecki C.,University of California at San Diego | Phillips P.S.,Scripps Mercy Hospital
Cleveland Clinic Journal of Medicine | Year: 2011

Although statins are remarkably effective, they are still underprescribed because of concerns about muscle toxicity. We review the aspects of statin myopathy that are important to the primary care physician and provide a guide for evaluating patients on statins who present with muscle complaints. We outline the differential diagnosis, the risks and benefits of statin therapy in patients with possible toxicity, and the subsequent treatment options.

Gilcrease G.W.,Scripps Mercy Hospital | Stein J.B.,Scripps Mercy Hospital | Stein J.B.,University of California at San Diego
Journal of Cardiovascular Electrophysiology | Year: 2010

A Delayed Case of Fatal Atrioesophageal Fistula. We describe the case of a 61-year-old man with a fatal atrioesophageal fistula following radiofrequency ablation (RFA) for paroxysmal atrial fibrillation (PAF). Esophageal injury was first noted on computed tomography (CT) scan 10 days following RFA. Fistulization occurred 41 days following the procedure. This is a delayed time course in comparison with published reports. The patient declined intervention and we have serial CT imaging documenting the natural progression from ulceration to fistula. Although the patient was on acid suppression, he received 2 courses of corticosteroids, which may have contributed to the progression of his esophageal ulcer. © 2010 Wiley Periodicals, Inc.

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