Impact of in-house specialty pharmacy on access to novel androgen axis inhibitors in men with advanced prostate cancer

Introduction: Novel androgen axis inhibitors are standard of care treatments in advanced prostate cancer. The billed amounts for these medications are often very high, which may create significant financial toxicity for patients and lead to delays in treatment. Our institution implemented an in-house specialty pharmacy in 2014, that provides these medications and evaluates copay assistance options for all patients. We evaluated the program’s impact on out of pocket cost (OOP) and turnaround time (TAT). Methods: We reviewed available internal specialty pharmacy records to identify prescriptions for abiraterone or enzalutamide filled between 1/1/17 and 12/31/18. Payments were stratified by primary payment (amount reimbursed by the patient’s prescription plan based on the benefit’s design) and copayment assistance. Turnaround times (TAT) in business days were stratified by prescriptions requiring intervention (prior authorization, copayment assistance, or insufficient inventory) and clean prescriptions (those requiring no intervention). Results: One thousand four hundred seventeen prescriptions for 175 unique patients requiring abiraterone (n=869, 61.3%) or enzalutamide (n=548, 38.7%) were filled through the institution’s specialty pharmacy. The average amount paid by primary payer was $9,492.96 for a 30 day supply (range:$3,382.48-$12,939.84). Average quoted copay was$577.53 (range $3.08-$10,560.39). 64% of patients received copayment assistance. Average OOP cost per prescription after co-pay assistance was $100.83 (range$0-$8556.64). Three patients declined treatment due to cost (1.7% of overall). Average TAT was 2.98 days for clean prescriptions and 3.36 days for prescriptions needing intervention (p=0.055). Discussion: OOP cost varied significantly based on plan design and copayment assistance eligibility. The majority of patients received copayment assistance, which markedly reduced OOP cost. Cost rarely precluded access to treatment. TAT was not significantly prolonged for prescriptions requiring intervention. Further studies to determine impact of pharmacy type on access to specialty medications are indicated

O SERVIÇO SOCIAL NO CENTRO DE REFERÊNCIA ESPECIALIZADO EM ASSISTÊNCIA SOCIAL DE DUQUE DE CAXIAS – RJ: RELAÇÕES DE TRABALHO A PARTIR DA PRECARIZAÇÃO DOS VÍNCULOS EMPREGATÍCIOS

Resumo Este trabalho visa analisar a prática do Serviço Social nos Centros de Referência Especializados em Assistência Social de Duque de Caxias a partir da precarização dos vínculos empregatícios decorrentes da ofensiva neoliberal. Atualmente o município conta com dois (02) CREAS localizados nos bairros: Centenário e Figueira, respectivamente. A escolha do tema se deu através da experiência que obtive como estagiária por dois anos no CREAS Figueira – DC, onde pude perceber o comprometimento com o projeto ético político dos profissionais, porém a limitação na prática devido à perda de autonomia profissional devido aos vínculos de trabalho relacionados aos chamados “cargos comissionados”. Logo, através desta pesquisa teremos uma dimensão dos principais desafios encontrados pelos Assistentes Sociais dos Centros de Referência Especializados em Assistência Social de Duque de Caxias

O SERVIÇO SOCIAL NO CENTRO DE REFERÊNCIA ESPECIALIZADO EM ASSISTÊNCIA SOCIAL DE DUQUE DE CAXIAS – RJ: RELAÇÕES DE TRABALHO A PARTIR DA PRECARIZAÇÃO DOS VÍNCULOS EMPREGATÍCIOS

Resumo Este trabalho visa analisar a prática do Serviço Social nos Centros de Referência Especializados em Assistência Social de Duque de Caxias a partir da precarização dos vínculos empregatícios decorrentes da ofensiva neoliberal. Atualmente o município conta com dois (02) CREAS localizados nos bairros: Centenário e Figueira, respectivamente. A escolha do tema se deu através da experiência que obtive como estagiária por dois anos no CREAS Figueira – DC, onde pude perceber o comprometimento com o projeto ético político dos profissionais, porém a limitação na prática devido à perda de autonomia profissional devido aos vínculos de trabalho relacionados aos chamados “cargos comissionados”. Logo, através desta pesquisa teremos uma dimensão dos principais desafios encontrados pelos Assistentes Sociais dos Centros de Referência Especializados em Assistência Social de Duque de Caxias

Development of Interdisciplinary Communication Tools to Improve Handoffs for Emergent Airway Management

Project goal Improve response time from airway alert to intubation while ensuring pertinent critical patient information is communicated to the airway team to reduce negative patient outcomes and better mobilize anesthesia resources

The Fate of Binaries in the Galactic Center: The Mundane and the Exotic

The Galactic Center (GC) is dominated by the gravity of a super-massive black hole (SMBH), Sagittarius A$^*$, and is suspected to contain a sizable population of binary stars. Such binaries form hierarchical triples with the SMBH, undergoing Eccentric Kozai-Lidov (EKL) evolution, which can lead to high eccentricity excitations for the binary companions' mutual orbit. This effect can lead to stellar collisions or Roche-lobe crossings, as well as orbital shrinking due to tidal dissipation. In this work we investigate the dynamical and stellar evolution of such binary systems, especially with regards to the binaries' post-main-sequence evolution. We find that the majority of binaries (~75%) is eventually separated into single stars, while the remaining binaries (~25%) undergo phases of common-envelope evolution and/or stellar mergers. These objects can produce a number of different exotic outcomes, including rejuvenated stars, G2-like infrared-excess objects, stripped giant stars, Type Ia supernovae (SNe), cataclysmic variables (CVs), symbiotic binaries (SBs), or compact object binaries. We estimate that, within a sphere of 250 Mpc radius, about 7.5 to 15 Type Ia SNe per year should occur in galactic nuclei due to this mechanism, potentially detectable by ZTF and ASAS-SN. Likewise we estimate that, within a sphere of 1 Gpc$^3$ volume, about 10 to 20 compact object binaries form per year that could become gravitational wave sources. Based on results of EKL-driven compact object binary mergers in galactic nuclei by Hoang at al. (2018), this compact object binary formation rate translates to about 15 to 30 events per year detectable by Advanced LIGO.Comment: 8 pages, 3 figures, accepted by Ap

Multiple languages and mathematics in the process of argumentation in a physics class: Analysis of data from an Inquiry Laboratory

We analyzed within the framework of Stephen Toulmin (2006), the process of argument started by a teacher, to build the mathematical language as a way of interpreting data from an inquiry lab about heating water. The activity was part of a inquiry teaching class that was applied in the first year of high school, at a public school in the State of São Paulo. The cooperative use of several languages was important to strengthen the various elements of the argument, while the mathematical languages such as graphical and algebraic had the role of guarantees and refuted the conclusions, giving strength to the latter

RFID and its impacts to the hospital supply chain

A radio frequency identification device (RFID) is a type of information technology used to improve supply chain management through an enhanced visualization of products. The RFID market in the U.S healthcare industry has been projected to be approximately $297 million and has been expected to grow at a rapid speed. RFID had a great impact on the hospital supply chain. It has been demonstrated that 30$100 million had already deployed RFID technology. RFID is the latest technology to reduce costs by tracking both equipment and employees. This technology can also reduce medical error, thus creating a safer environment for patients