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Our findings establish the left ventricular assist device as a new long-term myocardial replacement therapy, joining cardiac transplantation in the treatment options for end-stage heart failure. Although transplantation has never been compared with medical therapy in a randomized trial, the 1-year survival rate of more than 80 percent and the 10-year survival rate of nearly 50 percent for transplantation far exceed the survival rate for left ventricular assist devices in our study. However, the outcomes of transplantation do not include the substantial mortality rates among patients who are awaiting transplantation. Currently, fewer than 3000 donor hearts per year are available worldwide. The combination of the availability of left ventricular assist devices and the encouraging one-year survival rate of 74 percent in our patients who were younger than 60 years suggests that a comparison of the long-term use of these devices and transplantation may soon be appropriate.

Early experience with artificial hearts suggested that any potential survival benefit would be achieved at an unacceptable cost in the quality of life. In our study, measurements of the quality of life at base line and during the study in the medical-therapy group reflected the severe physical, emotional, and functional impairment of these terminally ill patients. Although the scores at one year on the physical-function and emotional-role subscales of the SF-36 were significantly better in the device group than in the medical-therapy group, they were not those of healthy people in the general population. However, the physical-function scores were similar to those reported for patients receiving long-term hemodialysis and ambulatory patients with heart failure, and the emotional-role scores were better than those reported for patients with clinical depression and similar to those for ambulatory patients with heart failure. Although not statistically significant, the difference of 17 points in the mean scores on the Minnesota Living with Heart Failure questionnaire at one year between patients in the device group and patients in the medical-therapy group greatly exceeded the 5-point threshold for meaningful improvement used in other studies.

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Sherry K. Milfred-LaForest, Sheryl L. Chow, Robert J. DiDomenico, Kathleen Dracup, Christopher R. Ensor, Wendy Gattis-Stough, J. Thomas Heywood, JoAnn Lindenfeld, Robert L. Page, J. Herbert Patterson, Orly Vardeny, Barry M. Massie. . (2013) Clinical Pharmacy Services in Heart Failure: An Opinion Paper From the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. 19, 354-369.

William L. Holman, David C. Naftel, Chad E. Eckert, Robert L. Kormos, Daniel J. Goldstein, James K. Kirklin. . (2013) Durability of left ventricular assist devices: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 2006 to 2011. 146:2, 437-441.e1.

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Akan Emin, Chris A. Rogers, Jayan Parameshwar, Guy MacGowan, Rhiannon Taylor, Nizar Yonan, Andre Simon, Steven Tsui, Stephan Schueler, Nicholas R. Banner, , Nicholas Banner, Peter Braidley, Mike Burch, Stephen Clark, Dave Collett, David Cromwell, Kate Haire, Jorge Mascaro, Jayan Parameshwar, Mark Petrie, Andre Simon, Steven Tsui, Nizar Yonan, Ms Katherine Collins, Saleem Haj-Yahia, Guy MacGowan, Steven Shaw, Stephan Schueler, John Townsend, Rajamiyer Venkateswaran, Ian Wilson, Mike Winter, Nizar Yonan. . (2013) Trends in long-term mechanical circulatory support for advanced heart failure in the UK. 15, 1185-1193.

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When you do choose a perspective to explore in your paper, it is important to choose one that is interesting to you. It doesn’t necessarily have to be something that you agree with, or your own personal opinion. But if your term paper deals with a historical period or work of literature, choose the aspect of it that you find most interesting, or choose a related topic that you can compare and contrast with.

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Most term papers will have a significant number of sources. It is important to keep track of the sources, from the point where you begin researching to the point where you are formatting your final paper. Keep a Word document with all of your sources, with both their reference citation and their in text citations formatted properly. That way, when you want to use that source in your paper, you an just copy and paste in the citation. If you aren’t sure which format to use for your citations, don’t be afraid to ask your teacher which they prefer. Most are very similar, with small differences in commas and order of information. The most important this is that you choose one citation format and stick with it consistently throughout the paper.

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