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Background Sleep apnea, hypertension, atherosclerosis, and obesity are features of metabolic syndrome associated with decreased restorative sleep and increased pain. These traits are relevant for anesthesiology because they confer increased risks of a negative anesthetic outcome. This study tested the one-tailed hypothesis that rats bred for low intrinsic aerobic capacity have enhanced nociception and disordered sleep. Methods Rats were from a breeding strategy that selected for low aerobic capacity runners (LCR) and high aerobic capacity runners (HCR). Four different phenotypes were quantified. Rats (n=12) underwent von Frey sensory testing, thermal nociceptive testing (n=12), electrographic recordings of sleep and wakefulness (n=16), and thermal nociceptive testing before and for six weeks after a unilateral chronic neuropathy of the sciatic nerve (n=14). Results Paw withdrawal latency to a thermal nociceptive stimulus was significantly (P<0.01) less in LCR than HCR rats. There were significant differences in sleep. LCR rats spent significantly (P<0.01) more time awake (18%) and less time in non-rapid eye movement sleep (−19%) than HCR rats. Non-rapid eye movement sleep episodes were of shorter duration (−34%) in LCR than HCR rats. Rapid eye movement sleep of LCR rats was significantly more fragmented than Rapid eye movement sleep of HCR rats. LCR rats required two weeks longer than HCR rats to recover from peripheral neuropathy. Conclusions Rodents with low aerobic capacity exhibit features homologous to human metabolic syndrome. This rodent model offers a novel tool for characterizing the mechanisms through which low aerobic function and obesity might confer increased risks for anesthesia.
The transplant community is divided regarding whether substitution with generic immunosuppressants is appropriate for organ transplant recipients. We estimated the rate of uptake over time of generic immunosuppressants using US Medicare Part D Prescription Drug Event (PDE) and Colorado pharmacy claims (including both Part D and non-Part D) data from 2008 to 2013. Data from 26 070 kidney, 15 548 liver, and 6685 heart recipients from Part D, and 1138 kidney and 389 liver recipients from Colorado were analyzed. The proportions of patients with PDEs or claims for generic and brand-name tacrolimus or mycophenolate mofetil were calculated over time by transplanted organ and drug. Among Part D kidney, liver, and heart beneficiaries, the proportion dispensed generic tacrolimus reached 50%-56% at 1 year after first generic approval and 78%-81% by December 2013. The proportion dispensed generic mycophenolate mofetil reached 70%-73% at 1 year after generic market entry and 88%-90% by December 2013. There was wide interstate variability in generic uptake, with faster uptake in Colorado compared with most other states. Overall, generic substitution for tacrolimus and mycophenolate mofetil for organ transplant recipients increased rapidly following first availability, and utilization of generic immunosuppressants exceeded that of brand-name products within a year of market entry.
Purpose Direct-acting antivirals (DAAs) used to treat hepatitis C virus (HCV) infection are associated with significant drug-drug interactions (DDIs). Pharmacists are well positioned to identify and mitigate these DDIs. Data to guide assessment of the impact of HCV specialty pharmacy services on identifying and addressing DDIs with DAAs are lacking. The overall purpose of the study described here was to determine the incidence and severity of DDIs identified by specialty pharmacists among patients treated with DAAs prior to and 1 month into therapy. Methods An observational, retrospective study was conducted to evaluate the impact of specialty pharmacy services in mitigating DDIs associated with use of DAAs. Adult patients with HCV infection (n = 200) who received DAAs and were enrolled with a specialty pharmacy service over a 1-year period were included. Endpoints included number, severity, and type of DDIs and DDIs per patient at baseline and 1 month into therapy, pharmacists’ interventions, and safety and clinical outcomes. Results Fifty-nine percent of patients had at least 1 DDI. A total of 170 DDIs were identified (137 at baseline and 33 at 1-month follow-up), and the mean number of DDIs per patient significantly decreased from baseline to 1-month follow-up (from 1.38 to 0.16, P < 0.0001). The rate of “potentially clinically significant” or “critical” interactions was significantly lower at 1-month follow-up vs baseline assessment (69.6% vs 81.7%, P < 0.0001). The most commonly identified DDIs involved acid suppressive medications (49.6% and 66.6% of DDIs at baseline and follow-up assessment, respectively) and cardiovascular medications (26.2% and 21.2%, respectively). Total number of DDI interventions was 131, with an acceptance rate of 85%. Most common intervention was patient education and monitoring. Conclusion Approximately 60% of patients had DDIs with DAAs. Implementing HCV specialty pharmacy services significantly decreased DDIs while maintaining SVR12.
Background: There is a significant clinical and economic burden of cancer and oral oncolytic nonadherence on healthcare systems, payers, and patients. As part of an integrated healthcare system, Credena Health (CH) specialty pharmacy provides patients with a unique level of service promoting the safe and effective use of specialty medications. Specialty Medication Management Services (SMMS) includes patient education and pharmacy follow-up assessments/interventions. All CH oncology patients are enrolled in SMMS, but can opt out of these services.Objectives: The goal of this study was to evaluate the clinical and economic value of a specialty pharmacy oral oncology patient management program.Methods: Data was collected using CPRþV R specialty pharmacy software for 695 patients receiving oral chemotherapy in 2017. All CH patients receive financial coordination and new patient consults (therapy appropriateness assessed, monitoring parameter evaluated, medications reconciled, drug interaction review, and therapy/disease education). Patients are then enrolled in SMMS for monthly/ cycle follow-up, coordinated with medication refills. Follow-up assessments are focused on adherence, medication/allergy reconciliation, drug interaction review, monitoring parameter evaluation, and adverse event management. Assigned intervention values are derived from a Truven Health AnalyticsV R national review of pharmacist interventions. Adherence was evaluated using medication possession ratio (MPR).Results: Of 695 unique patients, 480 new patient consults were completed. All 480 (100%) patients were evaluated for therapy appropriateness, 259 (54.0%) checked for laboratory monitoring, 464 (96.7%) assessed for drug interactions, 467 (97.3%) received medication reconciliation, 380 (79.2%) received education, and 435 (90.6%) enrolled in SMMS (along with 197 previously enrolled patients). There were 716 pharmacist interventions identified during the study period, with 520 (72.6%) related to adverse event management and 94 (13.1%) drug interactions. Medication issues were addressed using multiple strategies, including patient counseling (76.1%) and contacting providers (14.1%). Total cost avoidance value attributed to pharmacist interventions and patient education in 2017 was $299,415. Additionally, CH coordinated $1,067,572 in patient assistance. Average MPR was 0.93. Conclusions:The CH oral oncology clinical management program not only improved patient care and adherence, but also reduced healthcare and patient costs within this integrated health system.
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