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Flike K, St Pierre C, Howard A, Tsai J. Changes in Pain Among Housed and Unhoused U.S. Veterans After Receiving Battlefield Acupuncture at One Medical Center. J Integr Complement Med 2024; 30:306-309. [PMID: 37878270 DOI: 10.1089/jicm.2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
This study reports on 54 homeless and 53 stably housed veterans who received battlefield acupuncture (BFA) between September 2018 and October 2022. Linear mixed-effects regressions were used to examine change in overall pain score and how pain impacted four areas: (1) activity, (2) sleep, (3) mood, and (4) stress over the course of 8 weeks from the baseline visit at one BFA clinic. Results indicated significant reductions in the impact of pain on activity, sleep, and stress among both homeless and housed veterans. Although overall pain levels were not significantly impacted, further research on the impact of BFA on homeless populations is warranted.
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Affiliation(s)
- Kimberlee Flike
- Center for Health Care Organization and Implementation Research, VA Bedford Health Care System, Bedford, MA, USA
| | - Cathy St Pierre
- Center for Health Care Organization and Implementation Research, VA Bedford Health Care System, Bedford, MA, USA
| | - Alexandra Howard
- Center for Health Care Organization and Implementation Research, VA Bedford Health Care System, Bedford, MA, USA
| | - Jack Tsai
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Winer M, Dunlap S, St Pierre C, McInnes DK, Schutt R. Housing and Social Connection: Older Formerly Homeless Veterans Living in Subsidized Housing and Receiving Supportive Services. Clin Gerontol 2021; 44:460-469. [PMID: 33501886 DOI: 10.1080/07317115.2021.1879336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: The purpose of this study was to (Aim 1) describe United States military veterans' experiences and attitudes about project-based housing (PBH) and tenant-based housing (TBH), including perceptions of their new environment, self-sufficiency, and social integration. We identified (Aim 2) features of program design and housing facilities associated with self-sufficiency and social integration including describing differences in veterans' experiences of housing (PBH vs. TBH).Methods: Interviews were conducted with 30 Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program (25 male and 5 female; average age 63). Thirteen lived in PBH and 17 in TBH in the Greater Boston Metro Area.Results: Social isolation may be a particular challenge of older formerly homeless adults. Veterans in both types of supportive housing struggled with social isolation despite social engagement opportunities available in PBH. Healthcare and transportation issues were important for veterans living in TBH while behavioral health issues were a major factor for those living in both types of housing. Both groups of veterans relied on their case management teams as a means of support and social engagement.Conclusions: To reduce social isolation and loneliness, more attention is needed by program staff to provide varied social engagement opportunities, from one-on-one to group activities.Clinical Implications: These findings can help providers recognize issues inhibiting formerly homeless veterans from being successful in supportive housing. Clinicians should consider how veterans' behavioral health impacts their ability to engage in social activities. Substance use disorder remains a challenge for many veterans interviewed. Its effects impact their perceptions of fellow residents, perceptions of housing, and recovery.
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Affiliation(s)
- Max Winer
- Primary Care, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
| | - Shawn Dunlap
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers VA Medical Center, Bedford, Massachusetts, USA
| | - Cathy St Pierre
- Housing and Urban Development -Veterans Affairs Supportive Housing program, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers VA Medical Center, Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Russell Schutt
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers VA Medical Center, Bedford, Massachusetts, USA.,Department of Sociology, University of Massachusetts Boston, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Lynch J, DuVall SL, Berse B, Whatley A, St Pierre C, Oloruntoba O, Hunt CM. Implementation of Pharmacogenetic Testing Within the Veterans Health Administration From 2011 to 2013. Mil Med 2016; 181:1375-1381. [PMID: 27753578 DOI: 10.7205/milmed-d-15-00523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We assessed implementation of precision medicine within the Veterans Health Administration. We analyzed the use of interleukin-28B (IL28B) pharmacogenetic test, which predicts interferon-α treatment response in patients with hepatitis C. Patients with favorable CC genotype exhibit a two-fold higher response than patients with less favorable genotypes (CT and TT). Linking IL28B tests to Veterans Health Administration clinical data, we analyzed test use, concordance with guidelines, subsequent interferon-α treatment, and site variations. From January 2011 until December 2013, 3,529 Veterans underwent IL28B testing. There were 2,988 (85%) tests linked to electronic health record data. Demographics in those with clinical data: 97% male, mean age 59 years (SD 6.8), race: White 50%, Black 43%, Hispanic 3%, and other 3%. In Whites, the favorable CC genotype was three-fold more prevalent (541, 36%) than in Blacks (151, 12%). Analysis of IL28B timing revealed 2,373 (79%) Veterans were appropriately tested before interferon-α, 49 (2%) tested concurrent with interferon-α, and 566 (19%) tested post interferon-α treatment. Of the 630 treatment-naïve Veterans with CC genotype, only 144 (23%) initiated interferon-α treatment post-testing. Although 35% of IL28B tests overall did not influence care, the majority of tests were guideline concordant and clinically useful. IL28B testing varied substantially by site and state.
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Affiliation(s)
- Julie Lynch
- VA Salt Lake City Health Care System, 500 Foothill Boulevard, Salt Lake City, UT 84148
| | - Scott L DuVall
- VA Salt Lake City Health Care System, 500 Foothill Boulevard, Salt Lake City, UT 84148
| | - Brygida Berse
- RTI International, 307 Waverley Oaks Road, Waltham, MA 02452
| | - Angela Whatley
- Veterans Health Administration, 810 Vermont Avenue Northwest, Washington, DC 20420
| | - Cathy St Pierre
- Veterans Health Administration, 200 Springs Road, Bedford, MA 01730
| | | | - Christine M Hunt
- Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC 27710
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Benatar MJ, Dassonville O, Chamorey E, Poissonnet G, Ettaiche M, Pierre CS, Benezery K, Hechema R, Demard F, Santini J, Bozec A. Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg 2013; 66:478-82. [PMID: 23352884 DOI: 10.1016/j.bjps.2012.12.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/04/2012] [Accepted: 12/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND The primary objective of this study was to evaluate the impact of preoperative radiotherapy on the outcomes of head and neck microvascular reconstruction. The secondary objective was to assess the specific effects of irradiation doses (IDs) ≥60 Gy on the outcomes of head and neck microvascular reconstruction. METHODS All patients who underwent head and neck free-flap reconstruction in our institution between 2000 and 2010 were included in this retrospective study. A total of 429 patients were enrolled including 136 patients previously irradiated on the head and neck. The impact of preoperative radiotherapy on free-flap success, local and general complications, postoperative mortality, time of decannulation, duration of enteral nutrition and length of stay was assessed in univariate and multivariate analyses. RESULTS In multivariate analysis, preoperative radiotherapy (irrespective of ID) was a significant risk factor for fistula formation (p = 0.003) and wound infection (p = 0.005). Previous neck irradiation at doses ≥60 Gy was associated with an increased risk of free-flap failure (p = 0.04), overall local complications (p = 0.05), haematoma (p = 0.04) and longer duration of enteral nutrition (p = 0.006) and hospital stay (p = 0.004). CONCLUSIONS Preoperative radiotherapy, particularly for ID ≥ 60 Gy, is one of the main determinants of the outcomes of head and neck microvascular reconstruction.
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Affiliation(s)
- M J Benatar
- Department of Surgery, Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103 Nice, France
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Agopian B, Dassonville O, Chamorey E, Poissonnet G, Pierre CS, Peyrade F, Hebert C, Benezery K, Viel D, Sudaka A, Vallicioni J, Demard F, Santini J, Bozec A. [Total pharyngolaryngectomy in the 21st century: indications, oncologic and functional outcomes]. Rev Laryngol Otol Rhinol (Bord) 2011; 132:209-214. [PMID: 22908542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The development of laryngeal preservation protocols has considerably modified the indications for total (pharyngo-)laryngectomy (TPL). The objectives of our study are to analyze the current indications for TPL and to evaluate the oncologic and functional outcomes after TPL and their predictive factors. METHODS All patients who underwent TPL for squamous cell carcinoma of the larynx or hypopharynx, at our institution, between 2000 and 2009, were included in this retrospective study. Predictive factors of oncologic and functional outcomes were assessed in univariate and multivariate analyzes. RESULTS A total of 130 patients were enrolled in our study including 119 men and 11 women, with a mean age of 65.9 years. TPL was realized for salvage in 65 patients. Extra-laryngeal tumor extension (n = 42) was the main indication for TPL in the 65 remaining patients. Overall survival was 49 and 41% at 3 and 5 years respectively. In multivariate analysis, primary tumor site (hypopharynx in comparison to larynx; p = 0.04) has a significant pejorative impact on overall survival. Oral alimentation (no enteral nutrition) was recovered successfully by 94% of the patients. In multivariate analysis, primary tumor site (hypopharynx) has a significant pejorative impact on functional results (deglutition: p < 0.0001; phonation: p = 0.03). CONCLUSION Primary tumor site is one of the main predictive factor of oncologic and functional outcomes after TPL.
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Affiliation(s)
- B Agopian
- Centre Antoine Lacassagne, Institut Universitaire de la Face et du Cou, Département de Chirurgie, 31 Av de Valombrose, 06103 Nice, France
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Gueguen V, Macherel D, Neuburger M, Pierre CS, Jaquinod M, Gans P, Douce R, Bourguignon J. Structural and functional characterization of H protein mutants of the glycine decarboxylase complex. J Biol Chem 1999; 274:26344-52. [PMID: 10473591 DOI: 10.1074/jbc.274.37.26344] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The mitochondrial glycine decarboxylase complex (GDC) consists of four component enzymes (P, H, T, and L proteins) involved in the breakdown of glycine. In order to investigate structural interactions involved in the stabilization of the methylamine-loaded H protein (a transient species in the GDC reaction), we designed several mutants of H apoprotein. Structural analysis of the wild-type and mutants of H apoprotein emphasized the necessity to carefully assess, by biophysical techniques, the correct folding of mutated proteins prior to investigate their biochemical properties. The correctly folded wild-type and mutants of H apoprotein were in vitro lipoylated and then characterized in the context of GDC reaction by studying the reconstituted complex and partial reactions. We showed that Val(62) and Ala(64), surrounding the lipoyl-lysine, play an important role in the molecular events that govern the reaction between P and H protein but do not intervene in the recognition of the binding site of lipoic acid by lipoyl ligase. The biochemical results obtained with the HE14A mutant of H protein pointed out the major role of the Glu(14) amino acid residue in the GDC catalysis and highlighted the importance of the ionic and hydrogen bounds in the hydrophobic cleft of H protein for the stabilization of the methylamine-loaded lipoyl arm.
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Affiliation(s)
- V Gueguen
- Laboratoire de Physiologie Cellulaire Végétale, URA 576, Commissariat à l'Energie Atomique/CNRS/Université Joseph Fourier, Département de Biologie Moléculaire et Structurale, 328097 Grenoble cedex 1, France
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Pierre CS. Brown Medical School and the Rhode Island community--an arrangement of mutual benefit? R I Med J (1976) 1976; 59:197-205. [PMID: 1064057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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