Using MRI to Study High Pressure Assisted Nutrient Infusion.

High pressure assisted infusion of nutrients into food was in situ monitored with magnetic resonance imaging (MRI). Modification of an off-the-shelf pressure reactor with an MRI detection circuit provided a large enough volume to accommodate food. The model food used here was peeled apple flesh as it is considered as a good mimic for fibrous food. The nuclear spin relaxation properties of the water surrounding the apple flesh were enhanced by adding paramagnetic manganese cations. In this way, MRI relaxation contrast can be used to monitor the location of doped bulk water in and around the apple flesh during pressurization. This work tracked the efficiency of pressure induced nutrient infusion in situ, demonstrating that pressure gating and ramping offer no nutrient mass transport advantage over operation at constant pressure and that the presence of a peel expectedly disrupts solute transport into the fruit. High pressure assisted infusion, with all pressurization strategies shown here, yielded nearly 100-fold faster infusion times than at ambient pressure.

Expansion of pharmacist practice in oral oncolytic therapy with a collaborative practice agreement.

INTRODUCTION: Collaborative practice agreements have been utilized to expand pharmacist roles and improve patient care outcomes. A need to reduce the time providers spend reviewing oral oncolytic prescriptions for therapy continuation or dose adjustments was identified in the oncology clinics of a community health system. A collaborative practice agreement was created to decrease turnaround time for processing oral oncolytic prescriptions, improve provider satisfaction, and decrease patient prescription costs. METHODS: A three-month pilot was initiated to evaluate feasibility and provider satisfaction by comparing two provider groups. An additional three months of data were collected post-collaborative practice agreement implementation to evaluate impact. Primary endpoints included: interventions, turnaround time, and patient cost savings. A survey was conducted to determine provider satisfaction. RESULTS: The mean turnaround time for pharmacist interventions in the pilot group (n = 54) was 7 min, compared to 3311 min in the control group (n = 87), which was statistically significant (p < 0.0001). Two interventions in the pilot group resulted in patient cost savings due to dose rounding by a pharmacist. The mean turnaround time of the post-collaborative practice agreement group (n = 197) was 6 min, which was statistically significant when compared to the control group (p < 0.0001). CONCLUSION: Turnaround time was significantly shorter for prescriptions in the pilot and post-collaborative practice agreement groups compared to the control group. Provider satisfaction increased as the collaborative practice agreement resulted in less time reviewing oral oncolytic prescriptions. Patient costs were also reduced during the pilot phase due to dose rounding by pharmacists.

Financial impact from in-office dispensing of oral chemotherapy.

BACKGROUND: Oral chemotherapy agents are being prescribed more frequently in many cancer types. In-office dispensing of oral chemotherapy agents has demonstrated clinical benefits and also shown financial benefit to third-party payers. A previous publication estimated over $200,000 in cost savings annually from in-office dispensing solely from medications returned to stock for credit. However, pharmacists in the in-office setting perform many other interventions that may affect financial outcomes. OBJECTIVE: Assess financial impact of oral chemotherapy in-office dispensing by a clinic-based oral chemotherapy program serving five outpatient cancer centers in Southern Idaho. Outcomes include calculated monetary waste and cost avoidance of oral chemotherapy prescriptions from in-office dispensing and mail-order pharmacies. METHODS: Prescriptions received by the clinic-based oral chemotherapy program for filling through in-office dispensing and mail-order pharmacies were monitored for monetary waste and cost avoidance events from December 2016 through May 2017. Information was collected on the number of returned medications, therapy discontinuations, and dose adjustments. Monetary outcomes were calculated using average wholesale price. RESULTS: During the six-month evaluation, prescriptions filled through in-office dispensing had a total cost avoidance of $1,020,193 (n = 154) and total waste of $154,985 (n = 36) resulting in an estimated net cost avoidance annually of $1,730,416. Prescriptions filled through mail-order had a total cost avoidance of $20,497 (n = 4) and a total waste of $80,394 (n = 15) resulting in an estimated $119,794 net annual waste. CONCLUSIONS: In-office dispensing of oral chemotherapy provided significant cost savings to third-party payers compared to mail-order pharmacy dispensing. Continued evaluation may help further justify the importance and value of in-office dispensing.

A low cost, portable NMR probe for high pressure, MR relaxometry.

A low cost, portable, high volume, stainless steel pressure reactor is modified to easily perform magnetic resonance relaxometry at industrially relevant pressures. Unlike existing pressurization strategies common to nuclear magnetic resonance (NMR) spectroscopy, this approach is amenable to realistic samples that feature heterogeneity and have traditionally escaped NMR study at pressure. This pressure reactor/NMR probe combination is easily accommodated by most single-sided and other low magnetic field permanent magnet assemblies. The performance of the probe is demonstrated by accomplishing NMR relaxometry on polydimethylsiloxane at different pressures with two types of unilateral magnets.

Neonatal effects of breast cancer chemotherapy administered during pregnancy.

A human fetus is most susceptible to teratogenic agents during the first trimester of pregnancy. Cyclophosphamide and doxorubicin are pregnancy category D agents; however, potential benefits may warrant treatment with these agents during pregnancy under special circumstances. During her first trimester of pregnancy, a 37-year-old Caucasian woman was diagnosed with stage IIB infiltrating ductal carcinoma in situ (breast cancer) that was estrogen and progesterone receptor negative and human epidermal growth factor receptor-2 positive. The patient was treated with doxorubicin and cyclophosphamide in the second and third trimesters and delivered a premature baby boy at 31 weeks' gestation. The neonate was intubated on delivery because of respiratory distress and failure; however, no physical anomalies were observed. He had neutropenia and anemia, quite possibly as a result of his mother's chemotherapy 1 week before delivery. He was prophylactically treated for sepsis, but all cultures were negative. The infant grew and developed normally during his first year of life and remained in good health. An objective causality assessment revealed that it was probable that the infant's adverse events (prematurity, neutropenia, and anemia) were related to his mother's doxorubicin and cyclophosphamide therapy; however, these were the only adverse events potentially linked to in utero exposure to chemotherapy during the second and third trimesters. Due to the special considerations of both mother and infant, optimal treatment for patients with pregnancy-associated breast cancer requires the expert opinion of a multidisciplinary care team.