The adherence impact of a program offering specialty pharmacy services to patients using retail pharmacies.

Background: A new service model integrates the specialty pharmacy's comprehensive service with the retail pharmacy's patient contact, giving patients options for medication delivery to home, pharmacy, or doctor's office.

Objective: Evaluate the impact of the new service model on medication adherence.

Design: Retrospective cohort study

Settings: One hundred fifteen CVS retail stores in Philadelphia participated in a pilot from May 2012 to October 2013, and 115 matched CVS retail stores from around the nation served as controls.

Specialty medications: traditional and novel tools can address rising spending on these costly drugs.

Spending on specialty medications, which represented a small proportion of US pharmacy spending at the beginning of this decade, is growing by more than 15 percent annually. It is expected to account for approximately half ($235 billion) of total annual pharmacy spending by 2018. Among the numerous reasons for the high cost of this heterogeneous group of medications are the increasing size of target patient populations, the high cost of drug development, and a complex and uncoordinated delivery system.

"Bow-tie" mitral valve repair: an adjuvant technique for ischemic mitral regurgitation.

Background: Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double-orifice valve, with reported adequate control of mitral regurgitation.

Methods: We started to use the "bow-tie" repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4).

Usefulness of intermittent monitoring of mixed venous oxygen saturation after stage I palliation for hypoplastic left heart syndrome.

Most deaths after stage I palliation for hypoplastic left heart syndrome have occurred within the first 24 hours after surgery. Efforts to improve 1-day survival should therefore have significant impact on improving overall survival. Early death has most often been attributed to low cardiac output and abnormalities of pulmonary to systemic flow ratio (Qp/Qs).