Feasibility of a centralized specialty biologic medication management clinic at a VA hospital.

BACKGROUND: Given the cost and complexity of home subcutaneous biologic use, a centralized specialty medication management (CSMM) service was developed utilizing clinical pharmacist practitioners (CPPs). OBJECTIVE: To determine the implementation feasibility of the CSMM service. PRACTICE DESCRIPTION: The CSMM service was implemented in a Veterans Health Administration (VHA) hospital. The VHA does not use dedicated specialty pharmacies. PRACTICE INNOVATION: The CSMM service was developed utilizing CPPs who operated as an advance practice provider under a national VHA scope of practice. The CPP staffing the CSMM service performed patient education, screened for medication appropriateness, and monitored for safety and efficacy via videoconference or telephone. All patients newly starting a home subcutaneous biologic were offered the service from allergy, cardiology, dermatology, gastroenterology, and rheumatology clinics, as appropriate. EVALUATION METHODS: A retrospective chart review was completed through the first year the service was offered, which included the recruitment and retention of patients, number of follow-up appointments, and interventions made. RESULTS: Of the 68 patients offered clinic enrollment, 54 were enrolled in the service (79.4%). Of the 44 who had completed an initial appointment with the CPP, 42 had either received an initial follow-up or were scheduled for a follow-up (95.5%). A total of 161 clinical outcomes have been performed by the CSMM CPP including administrative assistance (33.5%), initial patient education (17.4%), technique correction (7.5%), and medication changes or discontinuations (6.8%). CONCLUSION: Given the high rate of enrollment and retention, the implementation of the CSMM service at a VA hospital was feasible. The service contributed to safe and effective medication use for enrolled patients and continues to grow in both patient enrollment and services offered.

Characterization of Carbon-Black-Based Nanocomposite Mixtures of Varying Dispersion for Improving Stochastic Model Fidelity.

Carbon black nanocomposites are complex systems that show potential for engineering applications. Understanding the influence of preparation methods on the engineering properties of these materials is critical for widespread deployment. In this study, the fidelity of a stochastic fractal aggregate placement algorithm is explored. A high-speed spin-coater is deployed for the creation of nanocomposite thin films of varying dispersion characteristics, which are imaged via light microscopy. Statistical analysis is performed and compared to 2D image statistics of stochastically generated RVEs with comparable volumetric properties. Correlations between simulation variables and image statistics are examined. Future and current works are discussed.

Investigating the Electromechanical Properties of Carbon Black-Based Conductive Polymer Composites via Stochastic Modeling.

Conductive polymer composites (CPCs) have shown potential for structural health monitoring applications based on repeated findings of irreversible transducer electromechanical property change due to fatigue. In this research, a high-fidelity stochastic modeling framework is explored for predicting the electromechanical properties of spherical element-based CPC materials at bulk scales. CPC dogbone specimens are manufactured via casting and their electromechanical properties are characterized via uniaxial tensile testing. Model parameter tuning, demonstrated in previous works, is deployed for improved simulation fidelity. Modeled predictions are found in agreement with experimental results and compared to predictions from a popular analytical model in the literature.

A Review of Ferric Pyrophosphate Citrate (Triferic) Use in Hemodialysis Patients.

PURPOSE: The objective of this short review is to evaluate the efficacy of ferric pyrophosphate citrate and to determine its place in therapy based on the current published literature. METHODS: A literature search was conducted and pared down to yield 4 placebo controlled Phase II and III clinically relevant trials. FINDINGS: Ferric pyrophosphate citrate is a new intradialytic iron supplementation product that has been found to reduce the dose of erythropoiesis-stimulating agents and intravenous iron supplementation and to increase serum ferritin concentrations. IMPLICATIONS: This agent may be administered to patients with stage 5 chronic kidney disease receiving hemodialysis as a new iron supplementation option to maintain hemoglobin, transferrin saturation, and ferritin concentrations.