Unbuckling the stroke belt: answering the call through the Eastern North Carolina Stroke Network.

The Eastern North Carolina Stroke Network was formed in 2006 by local partners in 30 counties in what is known as the buckle of the stroke belt, where stroke mortality is alarmingly high. The organization's goal is to improve the continuum of stroke care from community prevention through recovery.

The implantable cardioverter defibrillator: its history, current psychological impact and future.

The innovation of the implantable cardioverter defibrillator (ICD) represents a modern medical achievement with substantial life-saving benefits for patients at risk for potentially life-threatening arrhythmias. Over a decade of research resulted in the first ICD implantation in 1980, dramatically changing the face of cardiac care. The introduction of the device was met by skepticism and outright rejection by some, yet large-scale clinical trials clearly demonstrated the mortality benefit of the ICD. Today, specific challenges for this technology have emerged, including barriers to individual and social acceptance of the ICD as a viable form of technology, as well as psychosocial adjustment difficulties and fears in patients. To address these challenges, scientific research, improved communication regarding devices and psychosocial interventions have been developed and extended to this patient population. As such, it is hypothesized that the future will hold expanding indications for ICD implantation, while further meeting patients' medical and psychosocial adjustment needs. The purposes of this paper are to review the history of ICD innovation, describe past and present research on psychosocial adjustment to the ICD, and corresponding psychosocial interventions, analyze individual and social acceptance and utilization of device technology, and forecast future applications and developments of the ICD.