Heparin-bonded, expanded polytetrafluoroethylene-lined stent graft in the treatment of femoropopliteal artery disease: 1-year results of the VIPER (Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease) trial.

PURPOSE: To evaluate the performance of a heparin-bonded, expanded polytetrafluoroethylene (ePTFE)-lined nitinol endoprosthesis in the treatment of long-segment occlusive disease of the femoropopliteal artery (FPA) and to identify factors associated with loss of patency. MATERIALS AND METHODS: In a single-arm, prospective, 11-center study (VIPER [Gore Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease] trial), 119 limbs (113 patients; 69 men; mean age, 67 y), including 88 with Rutherford category 3-5 disease and 72 with Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) C or D lesions of the FPA, underwent stent graft implantation. The mean lesion length was 19 cm; 56% of lesions were occlusions. Follow-up evaluations included color duplex ultrasonography in all patients, with patency defined as a peak systolic velocity ratio< 2.5. RESULTS: At 12 months, Rutherford category and ankle-brachial index (ABI) were significantly improved (mean category improvement, 2.4; ABI increased from 0.6±0.2 to 0.9±0.19; P<.0001). Primary and secondary patency rates were 73% and 92%. The primary patency for devices oversized<20% at the proximal landing zone was 88%, whereas the primary patency for devices oversized by>20% was 70% (P = .047). Primary patency was not significantly affected by device diameter (5 vs 6 vs 7 mm) or lesion length (≤20 cm vs>20 cm). The 30-day major adverse event rate was 0.8%. CONCLUSIONS: The heparin-bonded, ePTFE/nitinol stent graft provided clinical improvement and a primary patency rate of 73% at 1 year in the treatment of long-segment FPA disease. Careful sizing of the device relative to vessel landing zones is essential for achieving optimal outcomes.

Impact of a 12-week, pharmacist-directed walking program in an established employee preventive care clinic.

PURPOSE: The impact on physical activity and health of a 12-week, pharmacist-directed walking program incorporated into an employee health and wellness clinic was evaluated. METHODS: Clinic participants were eligible for study inclusion if they or their spouse was a current or retired employee of Ohio Northern University. Participants received a pedometer, a calendar with specific daily walking goals for the 12-week period, and maps with walking routes. Participants also met with a pharmacist and a student pharmacist for point-of-care tests measuring lipid and fasting glucose concentrations and blood pressure. Participants reported to weekly pedometer checks where steps were recorded and medications were reassessed by the pharmacist or student pharmacist. As an incentive to meet the walking goals, the participants received a raffle ticket each week their goal had been achieved. After 12 weeks, participants reported for a final appointment when all baseline variables were reassessed by a team of health care professionals. RESULTS: A total of 144 participants were screened at baseline and included in the study, 65 of whom completed the program. At baseline, there were 240 abnormal laboratory test values found in participants with no prior history of dyslipidemia, hyperglycemia, or hypertension. After 12 weeks, significant changes in high-density-lipoprotein (HDL) cholesterol concentrations (p = 0.0012), fasting blood glucose concentrations (p = 0.0017), and blood pressure (p = 0.021) were noted. CONCLUSION: A pharmacist-directed walking program that included clinical assessments, walking goals, and weekly pedometer checks was an effective approach to increase employee activity levels, identify previously unknown health conditions, lower blood glucose concentrations and blood pressure values, and increase HDL cholesterol concentrations.

Design and implementation of a pharmacist-directed preventive care program.

PURPOSE: The design and implementation of pharmacist-directed preventive care services within a university-based, employee health and wellness clinic are described. SUMMARY: Ohio Northern University (ONU) HealthWise is a multidisciplinary employee health and wellness clinic located on the campus of ONU that offers medication therapy management, disease management, nutrition counseling, and physical wellness coaching services. A pharmacist-directed preventive care program based on recommendations from the U.S. Preventive Services Task Force (USPSTF) was designed for incorporation into the clinic. Using an electronic search tool provided by USPSTF, pharmacists are able to provide a review of recommended preventive services that are appropriate for each individual patient. Whenever possible, pharmacists within the clinic perform the screenings and other interventions that are recommended by USP-STF; when necessary, patients are referred to other health care providers to receive recommended interventions. To date, nine patients have participated in the preventive care program. For these nine patients 112 recommendations have been reviewed by pharmacists in the clinic. Of these, 16 were found to be inappropriate after further discussion with the patients and 36 were verified as already completed by the patient, resulting in a total of 60 unmet recommendations. Of these 60, 52 recommendations were met through interventions by the pharmacist in the clinic, while 5 possible screenings were declined by patients and 3 unmet recommendations required referral to a provider outside of the clinic. CONCLUSION: A pharmacist-directed preventive care service offered within an employee health clinic helped ensure that employees receive appropriate screenings and preventive care according to current guidelines.

Employee attitudes toward participation in a work site-based health and wellness clinic.

PURPOSE: To conduct a needs assessment to determine employee attitudes and barriers toward participation in a multidisciplinary work site-based health and wellness clinic. METHODS: A 21-question survey was developed and sent electronically to all available (n = 874) employees of a self-insured employer. RESULTS: Of the 303 survey respondents (34.7% response rate), 67.3% (n = 204) individuals indicated a desire to meet with a pharmacist regarding medication information. Medication therapy management (MTM) services most often selected by survey respondents included basic education about each medication and its intended purpose (33%, n = 100); education on self-care (30%, n = 91); and information on generic or less expensive alternative medications and strategies for cost savings (25.1%, n = 76). Eighty-eight (29%) respondents indicated a desire for preventive care counseling to receive guidance on recommended disease screenings, immunizations, and other recommended services. Additional interest was observed in nutrition coaching (n = 131, 43.2%) and exercise programming (n = 272, 89.4%). CONCLUSIONS: The majority of respondents indicated a desire to participate in a work site-based health and wellness clinic, regardless of baseline health status or medication use. These data provide insight into the needs and preferences of participants in work site wellness programs and shows the value of a needs assessment.