Elucidating determinants of medication disposal programs at retail pharmacies in North Carolina.

Background: Pharmacy-based medication disposal programs is one approach to prevent diversion of unused prescription opioids.

Objective(s): The objective of this study was to assess the extent to which disposal programs have been implemented by retail pharmacies and identify determinants of implementation using the Consolidated Framework for Implementation Research.

Methods: A sequential mixed-method design was used to examine implementation of medication disposal programs at pharmacies in Pitt County, NC.

AAV4-mediated expression of IGF-1 and VEGF within cellular components of the ventricular system improves survival outcome in familial ALS mice.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by motor neuron cell death in the cortex, brainstem, and spinal cord. Extensive efforts have been made to develop trophic factor-based therapies to enhance motor neuron survival; however, achievement of adequate therapeutic delivery to all regions of the corticospinal tract has remained a significant challenge. Here, we show that adeno-associated virus serotype 4 (AAV4)-mediated expression of insulin-like growth factor-1 (IGF-1) or vascular endothelial growth factor (VEGF)-165 in the cellular components of the ventricular system including the ependymal cell layer, choroid plexus [the primary cerebrospinal fluid (CSF)-producing cells of the central nervous system (CNS)] and spinal cord central canal leads to trophic factor delivery throughout the CNS, delayed motor decline and a significant extension of survival in SOD1(G93A) transgenic mice.

Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality.

Background: The Model for End-Stage Liver Disease (MELD) predicts events in cirrhotic subjects undergoing major surgery and may offer similar prognostication in left ventricular assist device candidates with comparable degrees of multisystem dysfunction.

Methods And Results: Preoperative MELD scores were calculated for subjects enrolled in the University of Michigan Health System (UMHS) mechanical circulatory support database. Univariate and multiple regression analyses were performed to investigate the ability of patient characteristics, laboratory data (including MELD scores), and hemodynamic measurements to predict total perioperative blood product exposure and operative mortality.

Short- and long-term survival of patients transferred to a tertiary care center on temporary extracorporeal circulatory support.

Background: Mechanical circulatory support (MCS) with temporary, extracorporeal assist devices restores hemodynamics in patients with refractory cardiogenic shock. These devices are frequently used in community hospitals, with subsequent referral to tertiary care centers. We sought to determine the outcomes of such referrals and identify prognostic variables that may influence management decisions.

Right-sided heart failure: diagnosis and treatment strategies.

Right ventricular (RV) dysfunction in the setting of cardiomyopathy, ischemia, and pulmonary hypertension is associated with high morbidity and mortality, but therapeutic clinical trials examining RV failure as a primary outcome are lacking. This review focuses on the ontologic, morphologic, and microscopic differences between the right and left ventricles. It also discusses the rationale and potential risks associated with the extrapolation of medical therapies used in left ventricular failure and pulmonary arterial hypertension management to the treatment of RV failure.

The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates.

Objectives: This study sought to develop a model that estimates the post-operative risk of right ventricular (RV) failure in left ventricular assist device (LVAD) candidates.

Background: Right ventricular failure after LVAD surgery is associated with increased morbidity and mortality, but identifying LVAD candidates at risk for RV failure remains difficult.

Methods: A prospectively collected LVAD database was evaluated for pre-operative clinical, laboratory, echocardiographic, and hemodynamic predictors of RV failure.

Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management.

The right ventricle (RV) is integral to normal cardiac function, but receives little attention in the medical literature. The etiologic causes of acute RV failure often differ from those encountered in left ventricular dysfunction. Thus, RV failure frequently requires diagnostic procedures and management strategies that differ from those routinely used in the management of intrinsic left ventricular dysfunction.

The impact of patient-specific quality-of-care report cards on guideline adherence in heart failure.

Background: It is unknown if physician education through heart failure (HF) patient-specific quality-of-care report cards (HFRC) impacts outpatient HF guideline adherence.

Methods: A prospective pre-post design study was performed to test the hypothesis that a one-time, patient-specific HFRC delivered to physicians after HF patient (ejection fraction < or = 40%) discharge would lead to improved HF guideline adherence compared with control practitioners. Patients were contacted at 1, 3, and 6 months after discharge to assess medication usage and intolerances.

Heart transplantation: assessment of heart failure mortality risk.

Heart failure (HF) presents with a wide spectrum of disease severity and with a broad risk of associated morbidity and mortality. Identification of individuals at high risk for HF death is important for assessment of candidacy for heart transplantation and mechanical circulatory assistance and, more broadly, for guiding pharmaceutical, surgical, or palliative interventions. In this article, we review and compare several of the HF risk prediction tools currently available, highlighting their clinical utilities and potential shortcomings.

Adverse interaction between a left ventricular assist device and an implantable cardioverter defibrillator.

An increasing number of patients have a coexisting implantable cardioverter defibrillator (ICD) and left ventricular assist device (LVAD) to treat ventricular arrhythmias and refractory heart failure, respectively. To date, there have been no published reports of negative interactions between these devices that have impacted appropriate ICD or LVAD function. In this case report, we describe a patient with an LVAD-ICD interaction that necessitated replacement of the implantable defibrillator.