13 research outputs found
The Use of an Integrative Wellness Care Plan in Primary Care
Background: The United States health care system has a segmented approach to patient care when it comes to primary care delivery. Many individuals demand new models of healthcare and choose to integrate non-traditional methods into their health regimen beyond what is typically offered in many primary care settings. This project surveyed a group of patients receiving care at an integrative clinic and explored satisfaction with services based on an Integrative Wellness Care Plan.
Materials and Methods: An Integrative Wellness Care Plan (IWCP) that combines standard primary care services with integrative therapies was reviewed, and a six-question survey was developed to evaluate the patient experience. An invitation to participate in a survey was emailed to 52 patients. Each survey participant was screened to ensure that at least one previous clinic appointment incorporated the use of the IWCP. The response rate of the survey was 38%. Content analysis method of data analysis was utilized, and findings were categorized into major themes.
Results: Themes identified through analysis of qualitative data suggest that patients are highly satisfied with their integrative primary care experience and believe this model of care supports wellness and achievement of individual health goals.
Conclusions: Survey responses suggest patients are highly satisfied with the IWCP and value the provision of integrative care as an adjunct to typical primary care services. Respondents mention preferring this model of care over traditional primary care
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Mitochondrial iron chelation ameliorates cigarette-smoke induced bronchitis and emphysema in mice
Chronic obstructive pulmonary disease (COPD) is linked to both cigarette smoking and genetic determinants. We have previously identified iron-responsive element binding protein 2 (IRP2) as an important COPD susceptibility gene, with IRP2 protein increased in the lungs of individuals with COPD. Here we demonstrate that mice deficient in Irp2 were protected from cigarette smoke (CS)-induced experimental COPD. By integrating RIP-Seq, RNA-Seq, gene expression and functional enrichment clustering analysis, we identified IRP2 as a regulator of mitochondrial function in the lung. IRP2 increased mitochondrial iron loading and cytochrome c oxidase (COX), which led to mitochondrial dysfunction and subsequent experimental COPD. Frataxin-deficient mice with higher mitochondrial iron loading had impaired airway mucociliary clearance (MCC) and higher pulmonary inflammation at baseline, whereas synthesis of cytochrome c oxidase (Sco2)-deficient mice with reduced COX were protected from CS-induced pulmonary inflammation and impairment of MCC. Mice treated with a mitochondrial iron chelator or mice fed a low-iron diet were protected from CS-induced COPD. Mitochondrial iron chelation also alleviated CS-impairment of MCC, CS-induced pulmonary inflammation and CS-associated lung injury in mice with established COPD, suggesting a critical functional role and potential therapeutic intervention for the mitochondrial-iron axis in COPD
Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
Introduction: Aortic graft infection remains a considerable clinical
challenge, and it is unclear which variables are associated with adverse
outcomes among patients undergoing partial resection.
Methods: A retrospective, multi-institutional study of patients who
underwent partial resection of infected aortic grafts from 2002 to 2014
was performed using a standard database. Baseline demographics,
comorbidities, operative, and postoperative variables were recorded. The
primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM)
survival analysis, and Cox regression analysis were performed.
Results: One hundred fourteen patients at 22 medical centers in 6
countries underwent partial resection of an infected aortic graft.
Seventy percent were men with median age 70 years. Ninety-seven percent
had a history of open aortic bypass graft: 88 (77%) patients had
infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac
bypass, and 1 (0.8%) had an infected thoracic graft. Infection was
diagnosed at a median 4.3 years post-implant. All patients underwent
partial resection followed by either extra-anatomic (47%) or in situ
(53%) vascular reconstruction. Median follow-up period was 17 months
(IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated
median survival from time of partial resection was 3.6 years. There was
no significant survival difference between those undergoing in situ
reconstruction or extra-anatomic bypass (P = 0.6). During follow up,
72% of repairs remained patent and 11% of patients underwent major
amputation. On univariate Cox regression analysis, Candida infection was
associated with increased risk of mortality (HR 2.4; P = 0.01) as well
as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft
limb only to resection of abdominal (graft main body) infection was
associated with decreased risk of mortality (HR 0.57, P = 0.04), as well
as those with American Society of Anesthesiologists classification less
than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any
factors significantly associated with mortality. Persistent early
infection was noted in 26% of patients within 30 days postoperatively,
and 39% of patients were found to have any post-repair infection during
the follow-up period. Two patients (1.8%) were found to have a late
reinfection without early persistent postoperative infection. Patients
with any post-repair infection were older (67 vs . 60 years, P = 0.01)
and less likely to have patent repairs during follow up (59% vs. 32%,
P = 0.01). Patients with aortoenteric fistula had a higher rate of any
post-repair infection (63% vs . 29%, P < 0.01)
Conclusion: This large multi-center study suggests that patients who
have undergone partial resection of infected aortic grafts may be at
high risk of death or post-repair infection, especially older patients
with abdominal infection not isolated to a single graft limb, or with
Candida infection or aortoenteric fistula. Late reinfection correlated
strongly with early persistent postoperative infection, raising concern
for occult retained infected graft material
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