A Cost-Effectiveness Study Comparing Ready-toAdminister and Traditional Vial-and-Syringe Method for Opioids

OBJECTIVE: The purpose of this study was to develop a cost-effectiveness model for manufacturer-prepared prefilled ready-to-administer (RTA) syringe products versus the traditional vial-and-syringe administration of intravenous (IV) opioids. METHODS: Cost parameters included cost of manufacturer-prepared prefilled RTA syringe product, traditional vial and syringe, drug preparation, drug administration, drug waste, and severity of error. Effectiveness endpoint included number of preparation and administration errors in each comparator arm. Simple decision tree was used, and incremental cost-effectiveness ratio (ICER) was calculated as the reduction in the incremental errors per observation with RTA compared with traditional vial-and-syringe method. One-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) were conducted to test the robustness of the model. TreeAge Pro software was used to create and analyze the decision model. All the cost parameters were converted to USD 2021. RESULTS: Base-case analysis showed that the cost of the RTA arm was lower by $182.61 and the number of errors in the RTA arm was lower by 94$22,554 per additional error avoided. Sensitivity analysis showed that ICER value was most sensitive to the probability of errors; however, the results were robust in showing that RTA is the preferred cost-effective option, when both the costs and effectiveness parameters were varied substantially. CONCLUSION: This economic evaluation  analyzed costs of using manufacturer-prepared prefilled RTA syringe product IV opioids and incremental benefits in terms of reduced errors, adverse events, and their associated costs. Manufacturer-prepared prefilled RTA syringe product was found to be cost-effective, demonstrating cost savings by reduction in the error rates. Integrating and adopting RTA syringe products within a health system could play an important role in improving care, building efficiency, increasing patient safety, and saving money. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40122-022-00402-z

Pharmacists’ perceptions and attitudes toward drug importation into the State of Florida

Background: The Department of Health and Human Services and the Food and Drug Administration released the Safe Importation Action Plan in July 2020 detailing methods to import medicines from Canada to combat increasing drug costs. In November 2020, Florida became the first state in the United States to create and propose an importation plan from Canada. This study examines the proposal submitted by Florida, Florida pharmacists’ perceptions of the program on patient safety, and Florida pharmacists’ thoughts on the pharmacy operational impact. Methods: This was a cross-sectional study utilizing an electronic questionnaire sent to pharmacist members of the Florida Pharmacy Association. The survey incorporated closed-ended and open-ended questions. The results from the study were reported and analyzed through descriptive statistics, qualitative and quantitative data. Results: Two-hundred and forty-four pharmacists responded to the survey. Of those respondents, 25% stated they had no knowledge about Florida’s drug importation plan. Less than 12% of respondents stated they would trust the safety and quality of imported medicines. Seventy percent of pharmacists expressed concerns regarding the changes required in pharmacy operations to increase medicine safety. About half of the respondents questioned whether this plan would promote cost-savings as intended. Conclusion: Florida pharmacists believe the drug importation plan does not address all aspects of patient and medicine safety and expressed concerns regarding logistical operations of a pharmacy. This article highlights those concerns and acts as a summons to action

The relationship between fake news and fake medicines: how misinformation has fuelled the sale of COVID-19 substandard and falsified medical products

As waves of COVID-19 continue to threaten public health, an increasing volume of disease-related information is widely accessible, and not all of it is accurate or reliable. The World Health Organisation (WHO) described this overabundance of information, misinformation, and disinformation as an "infodemic", making it difficult for many to distinguish fact from fiction. These definitions are complex and transitional; however, misinformation is defined as the "inadvertent sharing of false information", whereas disinformation is more sinister in origin and constitutes "the deliberate creation and sharing of information known to be false." The infodemic encapsulates both intentional and unintentional erroneous sources. Ultimately, the patient safety consequences remain the same, including amplifying vaccine hesitancy and propagating dangerous "coronavirus cures" myths, leading to higher COVID related mortality rates. Disinformation, desperation, and panic drive the production and sale of falsified medical products. The WHO estimates 1 in 10 medical products in low-and-middle-income countries (LMIC) settings are substandard or falsified (SF), which may worsen diseases, cause disability or even death. Ultimately, SF products undermine public trust in COVID-19 vaccines and treatments, all sectors must come together in this crisis to ensure quality covid medical products are distributed safely and fairly to end the pandemic sooner rather than later. &nbsp

A Comparison of Error Rates Between Intravenous Push Methods: A Prospective, Multisite, Observational Study

Objectives Current literature estimates the error rate associated with the preparation and administration of all intravenous (IV) medications to be 9.4% to 97.7% worldwide. This study aims to compare the number of observed medication preparation and administration errors between the only commercially available ready-to-administer product (Simplist) and IV push traditional practice, including a cartridge-based syringe system (Carpuject) and vials and syringes. Methods A prospective, multisite, observational study was conducted in 3 health systems in various states within the United States between December 2015 and March 2016 to observe IV push medication preparation and administration. Researchers observed a ready-to-administer product and IV push traditional practice using a validated observational method and a modified data collection sheet. All observations were reconciled to the original medication order to determine if any errors occurred. Results Researchers collected 329 observations (ready to administer = 102; traditional practice = 227) and observed 260 errors (ready to administer = 25; traditional practice = 235). The overall observed error rate for ready-to-administer products was 2.5%, and the observed error rate for IV push traditional practice was 10.4%. Conclusions The ready-to-administer group demonstrated a statistically significant lower observed error rate, suggesting that use of this product is associated with fewer observed preparation and administration errors in the clinical setting. Future studies should be completed to determine the potential for patient harm associated with these errors and improve clinical practice because it relates to the safe administration of IV push medications

The promoter from SlREO, a highly-expressed, root-specific Solanum lycopersicum gene, directs expression to cortex of mature roots

Root-specific promoters are valuable tools for targeting transgene expression, but many of those already described have limitations to their general applicability. We present the expression characteristics of SlREO, a novel gene isolated from tomato (Solanum lycopersicum L.). This gene was highly expressed in roots but had a very low level of expression in aerial plant organs. A 2.4-kb region representing the SlREO promoter sequence was cloned upstream of the uidA GUS reporter gene and shown to direct expression in the root cortex. In mature, glasshouse-grown plants this strict root specificity was maintained. Furthermore, promoter activity was unaffected by dehydration or wounding stress but was somewhat suppressed by exposure to NaCl, salicylic acid and jasmonic acid. The predicted protein sequence of SlREO contains a domain found in enzymes of the 2-oxoglutarate and Fe(II)-dependent dioxygenase superfamily. The novel SlREO promoter has properties ideal for applications requiring strong and specific gene expression in the bulk of tomato root tissue growing in soil, and is also likely to be useful in other Solanaceous crop

Flow and geochemistry of groundwater beneath a back-barrier lagoon : the subterranean estuary at Chincoteague Bay, Maryland, USA

This paper is not subject to U.S. copyright. The definitive version was published in Marine Chemistry 113 (2009): 78-92, doi:10.1016/j.marchem.2009.01.004.To better understand large-scale interactions between fresh and saline groundwater beneath an Atlantic coastal estuary, an offshore drilling and sampling study was performed in a large barrier-bounded lagoon, Chincoteague Bay, Maryland, USA. Groundwater that was significantly fresher than overlying bay water was found in shallow plumes up to 8 m thick extending more than 1700 m offshore. Groundwater saltier than bay surface water was found locally beneath the lagoon and the barrier island, indicating recharge by saline water concentrated by evaporation prior to infiltration. Steep salinity and nutrient gradients occur within a few meters of the sediment surface in most locations studied, with buried peats and estuarine muds acting as confining units. Groundwater ages were generally more than 50 years in both fresh and brackish waters as deep as 23 m below the bay bottom. Water chemistry and isotopic data indicate that freshened plumes beneath the estuary are mixtures of water originally recharged on land and varying amounts of estuarine surface water that circulated through the bay floor, possibly at some distance from the sampling location. Ammonium is the dominant fixed nitrogen species in saline groundwater beneath the estuary at the locations sampled. Isotopic and dissolved-gas data from one location indicate that denitrification within the subsurface flow system removed terrestrial nitrate from fresh groundwater prior to discharge along the western side of the estuary. Similar situations, with one or more shallow semi-confined flow systems where groundwater geochemistry is strongly influenced by circulation of surface estuary water through organic-rich sediments, may be common on the Atlantic margin and elsewhere.Primary funding was provided by USGS (Coastal and Marine Geology Program and National Research Program in Water Resources) with additional material support from the National Park Service (C. Zimmerman) and the University of Toledo

How to assess the role of Pt and Zn in the nephrotoxicity of Pt anti-cancer drugs?: An investigation combining μXRF and statistical analysis. Part II: Clinical application

International audienceIn this contribution, an approach developed previously for mice is used for human biopsy. In the case of patient 1, Pt detection is performed 6 days after the last oxaliplatin infusion, while for patient 2, the biopsy was performed more than 15 days after his first platin infusion and several dialysis. Even for these biological samples, experiments show that synchrotron mediated mXRF is a suitable tool to detect Pt in kidney biopsy, and thus probably for any organ exposed to Pt. Therefore, mXRF could also be of major interest to decipher the mechanism beyond Pt induced neurotoxicity, ototoxicity on human biopsy. Pharmacoavailability of chemotherapies is a major concern because some treatment failures are explained by poor tumor penetration of the active molecule. mXRF could be an elegant way to map the distribution of Pt inside cancerous cells at the micrometer scale. Pt and Zn are only two of the numerous trace elements that mXRF can detect; heavy metal intoxication diagnosis and the toxicity mechanism probably could also benefit from this innovative technique