Is a decrease in capillary density dangerous? Editor-I would agree with the authors' interpretation of the interesting observations 1 that not only propofol by itself, but associated hyperoxia and increases in sympathetic discharge, may affect the microcirculation. What are the clinical implications of the observations? Could it be potentially dangerous deterioration of microcirculation induced by propofol, or could an observed decrease in capillary density simply reflect a decrease in oxygen demand within the tissues (due to slight decrease in temperature, hyperoxia, and propofol-induced decrease in metabolic requirements) and metabolically mediated autoregulation of nutritive flow? In other words, could tissues require less oxygen and decrease capillary density in order to meet this decreased requirement? The authors correctly speculate that as reported in the literature no change in capillary filtration coefficient during propofol anaesthesia probably reflects the absence of increase in microvascular permeability and, one can speculate further, may reflect also an absence of oxygen deprivation. Thus, the question is whether these observations reflect any real homeostatic disturbance or an adjustment to a decrease in metabolic/ oxygen requirements?
The primary goal of this study was to identify potential factors that might contribute to patient punctuality issues, while also assessing the satisfaction of a proposed intervention. In addition, we aimed to learn more about the psychosocial and behavioral implications that patients face with regards to arriving on time for their primary care visits. A mixed-method research study was used to identify and quantify potential factors that might contribute to patient punctuality issues, while also assessing the satisfaction of a proposed intervention. In addition to possible factors that contribute to punctuality, we aimed to learn more about how patients are affected when they arrive late for appointments. Through qualitative assessment, we explored the psychosocial and behavioral implications that patients face with regards to arriving on time for their primary care appointments. A total of 524 individuals out of 1050 patients (50%) responded to the paper-based survey. Of the 524 adult respondents, we excluded 103 (19.7%) participants due to the missing data on either of their historical behavior patterns, future intentions for arrival, or their definition of appointment time. We analyzed the data for the remaining 421 eligible survey participants. In addition, seven of the eight patient interviews were transcribed and analyzed in order to identify themes using the patient's own words to better understand the psychosocial and behavioral implications patients face on arriving to their appointment on time. Three primary themes emerge in the interviews related to the perception of arriving late to appointments at the FMC. The findings of this study indicate that regardless of patients' interpretation of appointment time, they typically arrive 10-15 minutes before the appointment time. In addition, there is a significant connection
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