Association of Patient Out-of-Pocket Costs With Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents

High out-of-pocket (OOP) costs may limit access to novel oral cancer medications. In a retrospective study, nearly one third of patients whose OOP costs were $100 to$500 and nearly half of patients whose OOP costs were more than $2,000 failed to pick up their new prescription for an oral cancer medication, compared to 10$10 at the time of purchase. Delays in picking up prescriptions were also more frequent among patients facing higher OOP costs

Study, Survey and Analysis for Media Selection

This paper is a literature review on practical techniques and rules using PowerPoint, animation, and video effectively for instruction. Instruction may be teaching, training, coaching, tutoring, schooling etc. This paper must be of awareness to mentors and instructional technology staff who support faculty members in the development of instructional media. Main objective of this paper is to identify and select the proper technologies for enhancing a particular pedagogy or learning goal. Choose media that support instructor's activity

Nuclear Import of the Thyroid Hormone Receptor α1 is Mediated by Importin 7, Importin β1, and Adaptor Importin α1

The thyroid hormone receptor a1 (TRa1) is a nuclear receptor for thyroid hormone that shuttles rapidly between the nucleus and cytoplasm. Our prior studies showed that nuclear import of TRa1 is directed by two nuclear localization signals, one in the N-terminal A/B domain and the other in the hinge domain. Here, we showed using in vitro nuclear import assays that TRa1 nuclear localization is temperature and energy-dependent and can be reconstituted by the addition of cytosol. In HeLa cells expressing green fluorescent protein (GFP)-tagged TRa1, knockdown of importin 7, importin B1 and importin a1 by RNA interference, or treatment with an importin B1-specific inhibitor, significantly reduced nuclear localization of TRa1, while knockdown of other importins had no effect. Coimmunoprecipitation assays confirmed that TRa1 interacts with importin 7, as well as importin B1 and the adapter importin B1, suggesting that TRa1 trafficking into the nucleus is mediated by two distinct pathways

Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children

BACKGROUND: Neuraminidase inhibitors (NIs) are stockpiled and recommended by public health agencies for treating and preventing seasonal and pandemic influenza. They are used clinically worldwide. OBJECTIVES: To describe the potential benefits and harms of NIs for influenza in all age groups by reviewing all clinical study reports of published and unpublished randomised, placebo-controlled trials and regulatory comments. SEARCH METHODS: We searched trial registries, electronic databases (to 22 July 2013) and regulatory archives, and corresponded with manufacturers to identify all trials. We also requested clinical study reports. We focused on the primary data sources of manufacturers but we checked that there were no published randomised controlled trials (RCTs) from non-manufacturer sources by running electronic searches in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE (Ovid), EMBASE, Embase.com, PubMed (not MEDLINE), the Database of Reviews of Effects, the NHS Economic Evaluation Database and the Health Economic Evaluations Database. SELECTION CRITERIA: Randomised, placebo-controlled trials on adults and children with confirmed or suspected exposure to naturally occurring influenza. DATA COLLECTION AND ANALYSIS: We extracted clinical study reports and assessed risk of bias using purpose-built instruments. We analysed the effects of zanamivir and oseltamivir on time to first alleviation of symptoms, influenza outcomes, complications, hospitalisations and adverse events in the intention-to-treat (ITT) population. All trials were sponsored by the manufacturers. MAIN RESULTS: We obtained 107 clinical study reports from the European Medicines Agency (EMA), GlaxoSmithKline and Roche. We accessed comments by the US Food and Drug Administration (FDA), EMA and Japanese regulator. We included 53 trials in Stage 1 (a judgement of appropriate study design) and 46 in Stage 2 (formal analysis), including 20 oseltamivir (9623 participants) and 26 zanamivir trials (14,628 participants). Inadequate reporting put most of the zanamivir studies and half of the oseltamivir studies at a high risk of selection bias. There were inadequate measures in place to protect 11 studies of oseltamivir from performance bias due to non-identical presentation of placebo. Attrition bias was high across the oseltamivir studies and there was also evidence of selective reporting for both the zanamivir and oseltamivir studies. The placebo interventions in both sets of trials may have contained active substances. Time to first symptom alleviation. For the treatment of adults, oseltamivir reduced the time to first alleviation of symptoms by 16.8 hours (95% confidence interval (CI) 8.4 to 25.1 hours, P 1000) and nausea whilst on treatment (RD 4.15%, 95% CI 0.86 to 9.51); NNTH = 25 (95% CI 11 to 116). AUTHORS' CONCLUSIONS: Oseltamivir and zanamivir have small, non-specific effects on reducing the time to alleviation of influenza symptoms in adults, but not in asthmatic children. Using either drug as prophylaxis reduces the risk of developing symptomatic influenza. Treatment trials with oseltamivir or zanamivir do not settle the question of whether the complications of influenza (such as pneumonia) are reduced, because of a lack of diagnostic definitions. The use of oseltamivir increases the risk of adverse effects, such as nausea, vomiting, psychiatric effects and renal events in adults and vomiting in children. The lower bioavailability may explain the lower toxicity of zanamivir compared to oseltamivir. The balance between benefits and harms should be considered when making decisions about use of both NIs for either the prophylaxis or treatment of influenza. The influenza virus-specific mechanism of action proposed by the producers does not fit the clinical evidence

Drug utilization pattern of antiseizure drugs and their adverse effects in the pediatric population, in a tertiary care hospital attached to a medical college

Background: Epilepsy is “a condition characterized by recurrent (two or more) seizure, unprovoked by any immediate identified cause.” The desired outcome of antiseizure drug (ASD) therapy is to be seizure-free throughout the rest of life. The objective was to study the utilization pattern and adverse drug reactions (ADRs) associated with the use of ASDs in pediatric outpatients in epilepsy clinic.Methods: This cross-sectional, observational and single center study was carried out over a period of 1 year in 430 pediatric patients. Analyzed data included demographic details and drugs prescribed in respective seizure types along with ADRs due to ASDs. Results: In a total 430 patients analyzed, seizure were most commonly observed in boys (69.8%) in 6-10 year of age (45.3%), with a positive family history in (16%), with no specific cause of seizure in (71.6%), with most common type was focal seizure in (62.3%), which was mainly treated with carbamazepine (73.8%). Most common ADR was irritability (32.2%) with Valproate being main drug. 87.3% ADRs were in “ possible” as per World Health Organization causality assessment scale, 94.9% ADRs were “mild” as per Hartwig and Siegel severity assessment scale and 98.3% ADRs were “preventable” as per Schumock and Thornton preventability scale.Conclusion: Focal seizure was most common type of seizure observed mainly in boys of 6-10 year with carbamazepine as mainly prescribed drug. Use of appropriate ASDs in the majority of patients as per guidelines, has decreased number of ADRs in our study. Prescribing drugs were mainly from essential drug list and by generic names

Recasting Food: An Ethnographic Study on How Caste and Resource Inequality Perpetuate Social Disadvantage in India

Integrated Child Development Services (ICDS) is the principal programme operating in India to address issues around child development, malnutrition and pre-school education. A package of services – including the Supplementary Nutrition Programme (SNP), pre-school education, immunization, health check-ups, referral services, and nutrition and health education – are provided through an Anganwadi Centre (AWC) with an Anganwadi Worker (AWW) and an Anganwadi Helper (AWH) for roughly every one thousand people. From the mid-1990s, there have been successive efforts on the part of the Government of India to universalize ICDS, and there has been a multi-fold increase in funds allocated to this programme between the 8th Five-Year Plan (1992–93 to 1996–97) and the 12th Five-Year Plan (2012–17) (1-2). However, the utilization of all services under ICDS continues to be grossly low. Close to 75 percent of children aged 0–71 months in the areas covered by AWCs did not receive any supplementary food from the centres, and less than 12 percent of children received supplementary food ‘almost daily’. For children aged 36–71 months this figure is 15.5 percent. More than 80 percent of children were not weighed at all. It has been reported that children belonging to economically backward and socially marginalised families, including Dalit, tribal, and religious minorities, are excluded from utilising these services through unfavourable institutional rules and structural factors. Equally, members of well-off families do not use services provided by AWCs – especially the SNP – for under-6 children. A multi-sited ethnographic study was conducted in four villages in Gujarat in order to identify the reasons behind poor utilisation of AWCs, especially the SNP services. The study aimed to understand everyday experience of households around the SNP in rural settings and an opportunity to study AWCs as institutions embedded in the context of village cultural life. The authors hypothesise that a study focusing on AWCs could serve as an illustrative case to highlight challenges in implementing other entitlement-based programmes

Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo.

BackgroundMeasles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS).MethodsWe examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence.ResultsUrban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas.ConclusionsResults indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control

High Cost Sharing and Specialty Drug Initiation Under Medicare Part D: A Case Study in Patients With Newly Diagnosed Chronic Myeloid Leukemia

Medicare Part D beneficiaries with higher out-of-pocket costs are more likely to delay starting or not start a recommended specialty drug when newly diagnosed with leukemia. Policy changes are needed to ensure optimal access to specialty medications under Medicare Part D

EVALUATION OF GENOTOXICITY PROFILE OF JASADA BHASMA (A ZINC-BASED MINERAL FORMULATION) IN SWISS ALBINO MICE

  Objective: Genotoxicity is regarded as one of the potential risk factors for causing pathological diseases. It was confirmed that many chemicals have the mutagenic activity which leads to cancer. A compound which interacts with genetic material DNA and shows adverse effects by altering its structure or function is referred to as genotoxic.Methods: The present study involved 40 Swiss albino mice weighing between 25 and 30 g body weights categorized into four different groups. Group-I (normal control) received 0.5% carboxymethyl cellulose as vehicle. Group-II (toxicant control) received 40 mg/kg/body weight cyclophosphamide on the 28th day. Group-III and IV received test drug JB 15.6 mg/kg and 78 mg/kg, respectively, for 28 consecutive days. Blood samples were collected and processed for evaluating by comet assay. The animals were sacrificed and collected the bone marrow from both the femur for chromosomal aberration and micronuclei assay.Results: JB administered at two different dose levels did not show any significant changes in the comet assay parameters, no micronucleus was found and did not produce any chromosomal aberrations both numerically and structurally when compared to positive test control group.Conclusion: The genotoxicity evaluation of JB did not show any chromosomal aberrations and presence of micronucleus. Thus, the safety data will refine therapeutic utility of JB encouraging their rationale use and translate into greater and broader utilization of JB