Vernon P.S.,Scripps Mercy Hospital
Journal of Virology | Year: 2015
Susceptibility to alphavirus infection is age dependent, and host maturation is associated with decreased virus replication and less severe encephalitis. To identify factors associated with maturation-dependent restriction of virus replication, we studied AP-7 rat olfactory bulb neuronal cells, which can differentiate in vitro. Differentiation was associated with a 150- to 1,000-fold decrease in replication of the alphaviruses Sindbis virus and Venezuelan equine encephalitis virus, as well as La Crosse bunyavirus. Differentiation delayed synthesis of SINV RNA and protein but did not alter the susceptibility of neurons to infection or virion maturation. Additionally, differentiation slowed virus-induced translation arrest and death of infected cells. Differentiation of uninfected AP-7 neurons was associated with changes in expression of antiviral genes. Expression of key transcription factors was increased, including interferon regulatory factor 3 and 7 (IRF-3 and IRF-7) and STAT-1, suggesting that neuronal maturation may enhance the capacity for antiviral signaling upon infection. IRF-7 produced by undifferentiated AP-7 neurons was exclusively the short dominant negative γ-isoform, while that produced by differentiated neurons was the full-length α-isoform. A similar switch in IRF-7 isoforms also occurred in the brains of maturing C57BL/6J mice. Silencing of IRF expression did not improve virus multiplication in differentiated neurons. Therefore, neuronal differentiation is associated with upregulation of transcription factors that activate antiviral signaling, but this alone does not account for maturation-dependent restriction of virus replication. © 2015, American Society for Microbiology.
News Article | February 17, 2017
The Alliance Healthcare Foundation (AHF) announced a new initiative—InvestUp—to focus on foundational and sustainable systems change designed to further positively impact the health and wellness of our community in San Diego and Imperial Counties. “The Board of Trustees has long considered it our duty to seriously consider releasing our assets beyond our 5% targeted distribution each year for opportunities that hold meaningful potential to solve the health and wellness issues in our community. The distinction in this announcement is we are no longer waiting for something to come to us. Our InvestUp initiative signals a shift in our practice to now actively look for opportunities," said Elizabeth Dreicer, Board Chair for AHF. "With this announcement, we also hope to inspire more to come to us with their ideas. The hurdle is appropriately high as we are looking for projects designed to drive meaningful and sustained impact in our community.” "InvestUp programs will be greater than our $1M Innovation Initiative and may be funded by grants, loans and investments. They are expected to be long term relationships solving complex issues," said Nancy Sasaki, Executive Director of AHF. She further explained that this approach is "important in order to establish programs that have sustainably greater impact on health and wellness over years and decades. These programs will have a long term plan to ultimately impact thousands, even though they may start as smaller pilot projects." Through InvestUp, AHF will direct funds towards health and well-being with an emphasis on behavioral health as we recognize that Health is a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity. Wellness is an active process of becoming aware of making choices toward a more successful existence. AHF anticipates utilizing a variety of mechanisms to support positive, long lasting and sustainable change for our community. AHF further announced that its first InvestUp recipient is the 2011 Innovation Initiative awardee, 2-1-1 San Diego’s Community Information Exchange (CIE) program. Rob McCray, Immediate Past Chairman of AHF and Chairman of the InvestUp Committee said, “The promise of CIE has evolved from a database for better care coordination to a system that links individuals and organizations together for not only better care coordination, but also more efficient exchange of information, less duplication of services and effort, as well as faster identification of need and connection to appropriate services.” Starting as a coordinating platform between the social services including St. Vincent de Paul, PATH, Emergency Services and law enforcement and healthcare communities Scripps Mercy Hospital, UCSD Hospital, and San Diego County Health & Human Services, AHF has just “invested up” to combine the CIE service program with 2-1-1 San Diego service overall as a person-centered system to better support the health and social needs of all 2-1-1 participants—both individuals and the 6000+ service providers. 2-1-1 San Diego receives over 500,000 requests for assistance each year and the addition of the CIE allows for the connection between all the programs they provide, both internally and externally, with the full range of providers in the community. The CIE program is now poised to expand from the homeless population and seniors aging in the community to all people in needed of a social service in San Diego County. John Ohanian, CEO, 2-1-1 San Diego reflected, “It is an exciting time for 2-1-1 San Diego. Alliance Healthcare Foundation’s InvestUp initiative furthers the work we’re doing to build a 360º Community Coordination platform that uses a person-centric approach to care. Leveraging the success of CIE, we are transforming the work we do. AHF is a true partner working alongside 2-1-1 to build a region-wide ecosystem, utilizing bi-directional referrals, establishing a community care plan for all sectors and allowing for efficient and effective client care and measurement of a client’s success over time. Recognizing the importance of social determinants of health, AHF bridges social and health services and their providers. AHF’s InvestUp initiative is a great opportunity for nonprofit organizations to make substantive and long-lasting innovations in our community.” “There is a growing consensus that the current health care delivery system, which focuses on treating diseases and conditions, only goes so far in containing cost and ensuring quality,” said Nick Macchione, Director, San Diego County Health and Human Services Agency. “But with policy focus and payment reform moving from volume to value, there is recognition that there are numerous factors that influence and impact health. Our regional vision, Live Well San Diego, focuses on developing a person-centered culture of health and wellness. We are fortunate to have partners like 2-1-1 San Diego and the Community Information Exchange (CIE), which will provide critical data about those community based factors impacting health. Bringing together our regional health information exchange – San Diego Health Connect – and the County Health and Human Services Agency’s data-sharing platform – ConnectWellSD – we are quickly approaching the day where we will have the 360º person-centered view that allows integration of valuable data that is currently fragmented and often out of reach.” “The 2-1-1/CIE project is fundamental to delivering a complete picture of a person receiving care. Presenting social services and medical information in a single presentation will give our providers much needed insights to a person that will not only impact diagnosis but treatment. San Diego Health Connect is excited about the opportunity to work with 2-1-1/CIE going forward in delivering whole person coordinated care,” said Dan Chavez, CEO, San Diego Health Connect. “Person-centered care helps reduce health care spending. It is even more powerful to represent all the needs of the poor, children, the uninsured, homeless and other challenged populations with respect to access to services,” said Ms. Sasaki. Through the InvestUp initiative, AHF will provide funding for the types of systemic initiatives designed to truly address the needs, gaps and advocacy necessary to change the system so people are receiving the highest quality of service with the greatest impact for positive change while reducing costs. More details, including how to connect with AHF to learn more, can be found on the AHF website at http://alliancehealthcarefoundation.org. Alliance Healthcare Foundation is a San Diego-based organization which works with nonprofit, government and community agencies to advance health and wellness throughout San Diego and Imperial Counties. AHF works to serve the most vulnerable – the poor, uninsured, homeless and children by providing grants, advocacy, and education to support its region.
Crum-Cianflone N.F.,Naval Medical Center San Diego |
Crum-Cianflone N.F.,Scripps Mercy Hospital |
Wallace M.R.,Orlando Regional Medical Center
AIDS Patient Care and STDs | Year: 2014
Vaccines are critical components for protecting HIV-infected adults from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected persons persist, likely due to concerns regarding the safety and efficacy of vaccines, as well as the changing nature of vaccine guidelines. In addition, the optimal timing of vaccination among HIV-infected adults in regards to HIV stage and receipt of antiretroviral therapy remain important questions. This article provides a review of the current recommendations regarding vaccines among HIV-infected adults and a comprehensive summary of the evidence-based literature of the benefits and risks of vaccines among this vulnerable population. © Copyright 2014, Mary Ann Liebert, Inc. 2014.
Shaw D.J.,Scripps Mercy Hospital |
Davidson J.E.,Scripps Clinical Research Center |
Smilde R.I.,Scripps Mercy Hospital |
Sondoozi T.,Scripps Mercy Hospital |
Agan D.,Scripps Mercy Hospital
Critical Care Medicine | Year: 2014
OBJECTIVES:: Current guidelines from the U.S. Society for Critical Care Medicine state that training in "good communication skills...should become a standard component of medical education and ... available for all ICU caregivers". We sought to train multidisciplinary teams of ICU caregivers in communicating with the families of critically ill patients to improve staff confidence in communicating with families, as well as family satisfaction with their experiences in the ICU. DESIGN:: Pre- and postintervention design. SETTING:: Community hospital medical and surgical ICUs. PATIENTS:: All patients admitted to ICU during the two time periods. INTERVENTION:: Ninety-eight caregivers in multidisciplinary teams of five to eight individuals trained in a standardized approach to communicating with families of ICU patients using the Setup, Perception, Invitation, Knowledge, Emotions, Strategy (or Subsequent) (SPIKES) protocol followed by participation in a simulated family conference. MEASUREMENTS:: Staff confidence in communicating with family members of critically ill patients was measured immediately before and 6-8 weeks after training sessions using a validated tool. Family satisfaction using seven items measuring effectiveness of communication from the Family Satisfaction in the ICU (24) tool in surveys received from family members of 121 patients admitted to the ICU before and 121 patients admitted to the ICU after trainings was completed. MAIN RESULTS:: Using 46 matched pre- and postsurveys, staff confidence in communicating with family members of critically ill patients increased significantly (p < 0.001) in each of 21 separate measures. Family satisfaction with communication showed significant (p < 0.05 or better) improvement in three of seven individual items compared with those same items pretraining. There was no decline in any individual item. CONCLUSIONS:: A simple intervention resulted in improvement in staff confidence, as well as in multiple measures of family satisfaction with communication. This intervention is easily reproduced. © 2013 by the Society of Critical Care Medicine and Lippincott.
Lome B.,Scripps Mercy Hospital
Journal of trauma nursing : the official journal of the Society of Trauma Nurses | Year: 2010
There are many different roles in which acute care nurse practitioners can function. At our institution, the trauma nurse practitioners work in partnership with the trauma attendings to lead the plan of care. The nurse practitioners' holistic approach, emphasis on communication, attention to detail, flexibility and availability has had a substantial impact on patient outcomes as well as staff satisfaction. In this article, we provide an overview of our unique role and the impact on quality of care.
Tadlock M.D.,Scripps Mercy Hospital
Vascular and endovascular surgery | Year: 2010
This study compared damage control measures (DCM), including operative techniques (DCO) and resuscitative measures (DCR), with standard treatment (ST) for ruptured abdominal aortic aneurysm (rAAA). Historical cohort study methodology was used to evaluate outcomes for rAAA repairs related to DCM or ST over a 74-month period at a level I trauma center. Of 28 repairs, 13 (46.4%) were DCM. Compared to ST patients, DCM patients had a lower mean preoperative BP (64.6 vs. 83.2 mm Hg, P = .03) and greater intraoperative blood loss (4.6 vs. 2.1 liters, P = .033). Patients who had both DCR and DCO (DCO & DCR) received more plasma (6.8 vs 2.6 units, P = .039) and less crystalloid (2.8 vs 10.5 liters, P = .005) than those receiving DCO only. A modest decrease in mortality was seen in the DCO & DCR group compared to DCO only. No DCO-related graft infections were observed. DCR use may prove beneficial in the management of rAAA.
Fabi D.W.,Scripps Mercy Hospital
Journal of Orthopaedic Trauma | Year: 2016
Hip fracture is one of the most common injuries among the elderly and, because the population is aging, it is expected to remain a major clinical challenge and public health problem for the foreseeable future. The clinical importance of early mobilization and prompt participation in physical therapy after hip fracture surgery is now widely recognized. Because postoperative pain can impair mobility and delay physical therapy, much attention is now being paid to finding more effective ways of controlling pain after hip fracture. Oversedation with opioid drugs inhibits communication between the patient and the health care team, can delay ambulation and rehabilitation therapy, and may increase the probability of the patient requiring a skilled nursing facility, which adds further cost to the overall health care system. Multiple pain pathways contribute to the perception of postoperative pain, and although opioids are highly effective in blocking nociceptive pain through inhibition of the mu receptors, they do not block other pain pathways. Multimodal analgesia involves the use of several anesthetic and analgesic modalities that are strategically combined to block pain perception at different sites in the peripheral and central nervous systems. This balanced, multifaceted approach provides more effective control of postoperative pain than opioid drugs alone, allows lower doses of opioids to be used as part of the multimodal regimen (thereby reducing the risk of opioid-related adverse events and complications), and may facilitate more rapid recovery and improve certain outcome measures related to recovery time. One prospective randomized study evaluating the clinical value of multimodal pain management in elderly patients undergoing bipolar hip hemiarthroplasty found that a multimodal regimen, including preemptive pain medication and intraoperative periarticular injections, reduced pain on postoperative days 1 and 4, and reduced overall opioid use. This article describes an effective multimodal pain management regimen for hip fracture patients. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Sise M.J.,University of California at San Diego |
Sise M.J.,Scripps Mercy Hospital
Surgical Clinics of North America | Year: 2014
Acute mesenteric ischemia is uncommon and always occurs in the setting of preexisting comorbidities. Mortality rates remain high. The 4 major types of acute mesenteric ischemia are acute superior mesenteric artery thromboembolic occlusion, mesenteric arterial thrombosis, mesenteric venous thrombosis, and nonocclusive mesenteric ischemia, including ischemic colitis. Delays in diagnosis are common and associated with high rates of morbidity and mortality. Prompt diagnosis requires attention to history and physical examination, a high index of suspicion, and early contract CT scanning. Selective use of nonoperative therapy has an important role in nonocclusive mesenteric ischemia of the small bowel and colon. © 2014 Elsevier Inc.
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.
Crum-Cianflone N.F.,Scripps Mercy Hospital |
Crum-Cianflone N.F.,Naval Medical Center San Diego |
Sullivan E.,Scripps Mercy Hospital |
Ballon-Landa G.,Scripps Mercy Hospital
Journal of Clinical Microbiology | Year: 2015
We report a case in which fecal microbiota transplantation (FMT) utilized for relapsing Clostridium difficile colitis successfully eradicated colonization with several multidrug-resistant organisms (MDROs). FMT may have an additive benefit of reducing MDRO carriage and should be further investigated as a potential measure to eradicate additional potentially virulent organisms beyond C. difficile. Copyright © 2015, American Society for Microbiology. All Rights Reserved.