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The prediction of right heart failure (RHF) after left ventricular assist device (LVAD) implantation remains a challenge. Recently, risk scores were derived from analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data, the EUROMACS-RHF, and the modified postoperative EUROMACS-RHF. The authors assessed the performance characteristics of these 2 risk score formulations in a continuous-flow LVAD cohort at their institution.A retrospective, observational study.At a tertiary-care academic medical center.Adult patients who underwent durable LVAD implantation between 2015 and 2018.None MEASUREMENTS AND MAIN RESULTS: Early post-LVAD RHF was defined as follows: (1) need for right ventricular assist device, or (2) inotropic or inhaled pulmonary vasodilator support for ≥14 postoperative days. The authors used logistic regression and examined receiver operating characteristic (ROC) curves to evaluate the ability of the 2 risk scores to distinguish between outcome groups. A total of 207 patients met the inclusion criteria. Of the patients, 16% developed RHF (33/207). The EUROMACS-RHF score was not predictive of RHF in the authors' cohort (odds ratio [OR] 1.25; 95% CI [0.99-1.60]; p = 0.06), but the postoperative EUROMACS-RHF CPB score was significantly associated (OR 1.38; 95% CI [1.03-1.89]; p = 0.03). The scores had similar ROC curves, with weak discriminatory performance: 0.601 (95% CI [0.509-0.692]) and 0.599 (95% CI [0.505-0.693]) for EUROMACS-RHF and postoperative EUROMACS-RHF, respectively.In the authors' single-center retrospective analysis, the EUROMACS-RHF risk score did not predict early RHF. An optimized risk score for the prediction of RHF after LVAD implantation remains an urgent unmet need.

The syndrome of cardiogenic shock (CS) manifests with a spectrum of severity. Categorizing CS into clinical stages may enable improved risk stratification and patient selection for therapies. We sought to determine whether the new 2019 Society for Cardiovascular Angiography and Interventions (SCAI)

The updated UNOS heart transplantation allocation system, implemented in 10/2018, gives priority to pts treated with non-dischargeable mechanical circulatory support (MCS) devices while awaiting heart transplant. Whether there has been a change in temporary MCS use in cardiac intensive care units (

The prevalence and prognosis of NSTEMI patients who require invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) are unknown We conducted a retrospective cohort study of patients with NSTEMI using the National Inpatient Sample between 2002 and 2014. The exposure variable was IMV

Clinical investigations of shock in CICUs have focused on cardiogenic shock (CS) in pts with acute MI. Few studies have evaluated the full spectrum of shock admitted to contemporary CICUs. The CCCTN is an investigator-initiated multicenter network of 16 advanced CICUs in the US & Canada. During a 2

With improvements in acute coronary syndromes (ACS) treatment, routine triage of many pts with ACS to the cardiac intensive care unit (CICU) may no longer be necessary. The Critical Care Cardiology Trials Network (CCCTN) is an investigator-initiated multicenter network of 16 advanced CICUs in the

Historically, there has been considerable variability in how formative evaluation has been conceptualized and practiced. FORmative Evaluation Consultation And Systems Technique (FORECAST) is a formative evaluation approach that develops a set of models and processes that can be used across settings and times, while allowing for local adaptations and innovations. FORECAST integrates specific models and tools to improve limitations in program theory, implementation, and evaluation. In the period since its initial use in a federally funded community prevention project in the early 1990s, evaluators have incorporated important formative evaluation innovations into FORECAST, including the integration of feedback loops and proximal outcome evaluation. In addition, FORECAST has been applied in a randomized community research trial. In this article, we describe updates to FORECAST and the implications of FORECAST for ameliorating failures in program theory, implementation, and evaluation.

Bringing evidence based programs to scale was a major initial impetus for the development of the Interactive Systems Framework for Dissemination and Implementation (ISF). The ISF demonstrates the importance of the Support System in facilitating the uptake of innovations in the community (the Delivery System). Two strategies that members of the Support System commonly use are training-of-trainers (TOT) models and technical assistance (TA). In this article, we focus on the role of the Support System in bringing evidence-based programs (EBPs) to scale in the Delivery System using a case example, with special attention on two strategies employed by Support Systems-training-of-trainers (TOT) and proactive technical assistance. We then report on findings from a case example from the Promoting Science Based Approaches to Teen Pregnancy Prevention project that furthers our conceptualization of these strategies and the evidence base for them. We also report on the limitations in the literature regarding research on TOTs and proactive TA and provide suggestions for future research on TOTs and proactive TA that will enhance the science and practice of support in the ISF.

OBJECTIVE Certified Peer Specialist training initiatives leading to paid peer support positions are increasing nationally. This longitudinal study examines a comprehensive set of outcomes associated with such an initiative undertaken in Pennsylvania beginning in 2004. METHODS Certified Peer Specialist Training participants in three regions of Pennsylvania responded to a 60-item, multiple choice knowledge test based on the Certified Peer Specialist training curriculum. Additionally, these individuals were asked to provide permission to be contacted up to one year after completing the program to obtain employment information related to their experience as a certified peer specialist. RESULTS Ninety-seven percent of the trainees successfully completed the program with a 22% increase in knowledge. Eighty-two percent were working one year later. Peer specialists were very satisfied with their employment; felt accepted by co-workers and reported receiving good, but infrequent supervision. CONCLUSIONS The results suggest that these initiatives can be successfully implemented, although greater attention is needed to ensure that new jobs are being created for trainees and that they are being properly supervised like all other employees.

Our policy of conducting biotransformation studies with extended chromatography prior to pharmacokinetic bioanalyses allowed us to quickly detect an unusual, cis/trans metabolite in rat plasma that was inseparable using a short chromatographic method. We caution investigators that short methods invite unknown isobaric metabolites to cause inaccuracies in plasma concentration measurements.

An individual or organization that sets out to implement an innovation (e.g., a new technology, program, or policy) generally requires support. In the Interactive Systems Framework for Dissemination and Implementation, a Support System should work with Delivery Systems (national, state and/or local entities such as health and human service organizations, community-based organizations, schools) to enhance their capacity for quality implementation of innovations. The literature on the Support System [corrected] has been underresearched and under-developedThis article begins to conceptualize theory, research, and action for an evidence-based system for innovation support (EBSIS). EBSIS describes key priorities for strengthening the science and practice of support. The major goal of EBSIS is to enhance the research and practice of support in order to build capacity in the Delivery System for implementing innovations with quality, and thereby, help the Delivery System achieve outcomes. EBSIS is guided by a logic model that includes four key support components: tools, training, technical assistance, and quality assurance/quality improvement. EBSIS uses the Getting To Outcomes approach to accountability to aid the identification and synthesis of concepts, tools, and evidence for support. We conclude with some discussion of the current status of EBSIS and possible next steps, including the development of collaborative researcher-practitioner-funder-consumer partnerships to accelerate accumulation of knowledge on the Support System.