The bone-bonding polymer known as Polyactive is a block copolymer composed of a polyethylene oxide (PEO) soft segment and a polybutylene terephthalate (PBT) hard segment. This study focuses on the in vitro induction of hydroxyapatite by Polyactive. Our results show that Polyactive is capable of inducing hydroxycarbonate apatite (HCAp) formation from a metastable calcium phosphate solution analogous to a physiological solution. In a 4-day incubation, the HCAp formation extended approximately 100 microm deep from the surface. A great number of globules about 1 microm large were found in the calcified Polyactive. These globules were composed of HCAp crystals embedded in the polymer matrix. There were so many globules in the surface that they connected with each other and formed a calcified layer. Next to the calcified layer was a zone where the globules were scattered. The calcified surface may have acted to promote HCAp growth from the solution, bringing about the formation of a HCAp layer on top of the calcified layer. The transition of solid Polyactive into a Polyactive hydrogel in calcium phosphate solution permitted HCAp formation within the polymer. It is proposed that the COOH groups produced during hydrolysis of Polyactive play an important role in nucleating hydroxyapatite. A remarkable affinity of the PEO segment of the polymer for calcium ions may facilitate moving calcium and phosphate from the solution into the polymer for the growth of HCAp.
Objectives: Specialty drugs often offer medical advances, but high out-of-pockets costs may impede access. This is particularly true with Medicare Part D, as CMS allows plans to place drugs costing ≥ $600/month on "specialty tiers" and virtually all plans using tiered benefit structures have created such tiers. After meeting a deductible, patients without low-income subsidies (LIS) typically face 25%-33% coinsurance (initial coverage phase), followed by ~50% coinsurance (coverage gap phase), and then 5% coinsurance (catastrophic phase). Yet no studies have examined the impact of such high cost sharing on specialty drug initiation under Part D. Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), making it an apt case study. MethOds: Utilizing 2011-2013 100% Medicare claims, we examined TKI initiation rates and time to initiation among fee-for-service non-LIS Part D patients newly diagnosed with CML (captured via diagnostic and lab test codes), as compared to their LIS counterparts who faced nominal cost sharing of ≤ $5. Results: The first 30-day TKI fill "straddled" benefit phases, resulting in a mean out-of-pocket cost ≥ $2,600 for non-LIS patients. Non-LIS patients were less likely than LIS patients to have a TKI claim within 6 months of diagnosis (45.3% vs. 66.9%, p< 0.001) and took twice as long to fill one (mean 50.9 vs. 23.7 days, p< 0.001). Cox regressions controlling for sociodemographic, clinical, and plan characteristics (e.g., utilization management tools) confirmed descriptive findings (HR= 0.59, p< 0.001). Sensitivity analyses using 6 alternate algorithms to identify new CML patients, and using plan formulary fixed effects to ensure both groups were facing the same formulary restrictions, showed consistent findings. cOnclusiOns: High cost sharing was associated with reduced and/or delayed TKI access under Medicare Part D. Although the coverage gap will be phased out by 2020, 25%-33% specialty tier cost sharing will remain and may create barriers to use of lifesaving treatments. ME3 PotEntially inaPProPriatE antidEPrEssant UsE aMong oldEr adUlts in officE-BasEd sEttings in thE UnitEd statEs: trEnds froM 2002 to 2012
Objectives: Adoption of Drug Utilization Review (DUR) program is essential to optimize the safety and effectiveness of medication use in health care sitting. The aim of the study is to explore the enabling factors to adopt DUR program and to explore DUR program implementation in Saudi Hospitals. MethOds: A cross-sectional survey targeted mangers at hospital pharmacy with in-patient and out-patient pharmacies in Riyadh City in 2014. The survey gathered information about the hospital pharmacy services, pharmacy information system (PIS), Pharmacy & Therapeutics (P&T) Committee activities. Results: Of the 30 hospital pharmacies, 23 (76.6%) pharmacy managers responded, and only 21(70%) hospital pharmacies met the inclusion criteria. 18(85.7% ) hospitals have Electronic Medical Record (EMR) and 14(66.67%) of them have Computerized Physician Order Entry (CPOE). 12 (57.2 %) of the hospitals have Pharmacy and laboratory integrated information systems, 6 (28.6%) hospitals have Clinical Decision-Support Systems (CDSSs), 7(33.3%) hospital pharmacies provide Patient Discharge Counseling Services (PDCS), 13 (61.9%) provide Inpatient Clinical Pharmacy Services(ICPS), 14 (66.7%) provide Therapeutic Drug Monitoring (TDM) services. 8 (38.1%) hospitals have PIS which can detect incorrect dose and duration, 8 (38.1%) for drug-drug interaction, 6(28.6%) for drug-disease Interaction, 7 (33.3%) for contraindication and 11 (52.3%) for early refill detection. Only 6 (28.6%) hospitals PISs have the capability to generate four types of retrospective reports (ranking physicians by utilization, drug they prescribe, most utilized drug by number of patients, most utilized drug by diagnosis. 18 (85.7%) hospitals ' P&T Committee discuss the DUR reports at least once annually. 10 (45.2%) of the hospitals have designated subcommittees for DUR. cOnclusiOns: The enabling factors for the prospective and concurrent DUR such as CDSSs, PDCS, ICPS, and PIS detection capabilities are not adopted widely as standard process or services in Saudi hospitals, likewise the retrospective DUR. The DUR programs at these hospitals have huge opportunity to improve.
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