201 research outputs found

    Injection Drug Use Among West Virginia Medicaid Beneficiaries: An Analysis of Health Outcomes, Service Utilization, and Cost

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    In the United States, injection drug use is a serious public health concern associated with an array of negative health outcomes and substantial financial consequences for systems of care. The purpose of this study was to characterize a statewide sample of Medicaid insured persons who inject drugs in terms of health outcomes, service utilization and cost. A cross-sectional, retrospective analysis of West Virginia Medicaid claims data between 2014 and 2016 was conducted. Between 2014 and 2016, 5,082 West Virginia Medicaid beneficiaries amassed 14,414 service visits, among which inpatient, emergency room, and mental health and substance abuse were the most common. Drug poisonings (n=5,077), soft-tissue infections (n=4,127) and other infectious diseases (n=2,141) were the most common clinical conditions within this sample. Medicaid claims data were not a suitable proxy for state surveillance data as it pertains to new cases of Hepatitis B, Hepatitis C, HIV and heroin overdoses. Ordinal logistic regression results indicate that infectious diseases like endocarditis and soft-tissue infections are associated with increased service utilization. Similarly, multiple regression models show increased cost among individuals with HIV, endocarditis, and Hepatitis B. Preventative services, e.g. syringe exchange programs, are important tools to reducing the spread of infectious diseases, and thereby decrease frequent service utilization and cost among injection drug users

    In Vivo rapid delivery of vasopressin from an implantable drug delivery micro-electro-mechanical device

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    A miniaturized implantable rapid drug delivery device based on micro-electro-mechanical-systems technology was recently developed and characterized. This device is intended to address acute conditions in high-risk subjects. This work provides an in vivo proof-of-concept for the device in a rabbit model, by releasing a physiologically active dose of vasopressin, a vasoconstrictor. The devices were implanted subcutaneously and activated to rapidly release vasopressin, with monitoring of mean arterial pressure and plasma levels.Device releases showed a rapid and measurable effect on mean arterial pressure as well as a continuous diffusion of vasopressin into the bloodstream, consistent with a depot effect. Plasma levels in rabbits receiving vasopressin with the device rose monotonically to 24.4 ± 2.9 ng/mL after one hour. Bioavailability after one hour was calculated to be 6.2 ± 2.8 % (mean ± s.d.).A new modality for rapid and controlled drug delivery has been developed. The device can be used as a new implantable device controlled by medical algorithms (based on heart rate or mean arterial pressure, for example) for autonomous operation in high-risk populations that require immediate ambulatory intervention.Keywords: Subcutaneous drug delivery; vasopressin; MEMS; rabbit; bioavailability

    In Vivo rapid delivery of vasopressin from an implantable drug delivery micro-electro-mechanical device

    Get PDF
    A miniaturized implantable rapid drug delivery device based on micro-electro-mechanical-systems technology was recently developed and characterized. This device is intended to address acute conditions in high-risk subjects. This work provides an in vivo proof-of-concept for the device in a rabbit model, by releasing a physiologically active dose of vasopressin, a vasoconstrictor. The devices were implanted subcutaneously and activated to rapidly release vasopressin, with monitoring of mean arterial pressure and plasma levels.Device releases showed a rapid and measurable effect on mean arterial pressure as well as a continuous diffusion of vasopressin into the bloodstream, consistent with a depot effect. Plasma levels in rabbits receiving vasopressin with the device rose monotonically to 24.4 ± 2.9 ng/mL after one hour. Bioavailability after one hour was calculated to be 6.2 ± 2.8 % (mean ± s.d.).A new modality for rapid and controlled drug delivery has been developed. The device can be used as a new implantable device controlled by medical algorithms (based on heart rate or mean arterial pressure, for example) for autonomous operation in high-risk populations that require immediate ambulatory intervention.Keywords: Subcutaneous drug delivery; vasopressin; MEMS; rabbit; bioavailability

    Zero-order controlled release of ciprofloxacin-HCl from a reservoir-based, bioresorbable and elastomeric device

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    A reservoir-based device constructed of a completely biodegradable elastomer can enable several new implantation and insertion options for localized drug therapy, particularly in the case of urological therapies. We performed an in vitro performance evaluation of an implantable, bio-resorbable device that supplies short-term controlled release of ciprofloxacin-HCl (CIP). The proposed device functions through a combination of osmosis and diffusion mechanisms to release CIP for short-term therapies of a few weeks duration. Poly(glycerol-co-sebacic acid) (PGS) was cast in a tubular geometry with solid drug powder packed into its core and a micro-machined release orifice drilled through its wall. Drug release experiments were performed to determine the effective release rate from a single orifice and the range of orifice sizes in which controlled zero-order release was the main form of drug expulsion from the device. It is demonstrated that PGS is sufficiently permeable to water to allow the design of an elementary osmotic pump for drug delivery. Indeed, PGS's water permeability is several orders of magnitude larger than commonly used cellulose acetate for elementary osmotic pumps.Deshpande Center for Technological InnovationSamsung Scholarship Foundatio
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