Reverse Auction: A Potential Strategy for Reduction of Pharmacological Therapy Cost

Background:Polypharmacy is a significant economic burden.Objective:We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients.Methods:We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost.Results:The monthly cost per patient for HF drugs acquired via RA was $10.15 (IQ 3.51-40.22) versus $161.76 (IQ 86.05‑340.15) via CP; for HT, those costs were $393.08 (IQ 124.74-774.76) and $1,207.70 (IQ 604.48-2,499.97), respectively.Conclusion:RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment.

Reports of the Princeton University Expeditions to Patagonia, 1896-1899. J. B. Hatcher in charge. Edited by William B. Scott.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Report of the United States Geological Survey of the territories. F.V. Hayden, United States geologist in charge ... [Final reports or monographs. vol. I]-III, V-XIII.

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Surface electrical charge of bloodstream trypomastigotes of Trypanosoma cruzi strains

Bloodstream trypomastigotes of some Trypanosoma cruzi strains were processed through DEAE-cellulose columns under standardized conditions. The results obtained suggest mainly that these strains present different surface charges, that there are subpopulations of bloodstream trypomastigotes as regards electrical charges and that the broad forms are less negative than the slender ones.

Diarrhées aiguës: propositions de prise en charge ambulatoire [Acute diarrhea: proposal for outpatient management]

Dans la majorité des cas, les diarrhées aiguës sont bénignes et d'évolution spontanément favorable. Il faut cependant savoir reconnaître les situations pouvant mener à des complications, en l'occurrence identifier les diarrhées invasives, inflammatoires, caractérisées par la présence de fièvre, de douleurs abdominales, de ténesmes, de mucus et, ou de sang dans les selles. Celles-ci sont à distinguer des diarrhées sécrétoires, non invasives, non inflammatoires, sans fièvre, généralement aqueuses et volumineuses. En cas de doute diagnostique, l'identification de leucocytes par microscopie ou test à la lactoferrine dans les selles permet d'évoquer une gastroentérite invasive. Les indications à une antibiothérapie empirique dans l'attente du résultat de la coproculture sont la présence d'un syndrome dysentérique (T > 38°C, > 6 selles/24 heures, douleurs abdominales, diarrhées mucopurulentes), l'âge avancé, des comorbidités significatives, une immunosuppression et la présence d'une prothèse endovasculaire. In the majority of the cases, an acute diarrhea is mild and of spontaneously favorable evolution. It is however necessary to know how to recognize the situations being able to lead to complications, in particular to identify the invasive, inflammatory diarrheas, characterized by the presence of fever, abdominal pains, mucus and\or blood. The identification of leukocytes by microscopy or lactoferrine test is helpful. Empiric quinolones treatment is recommended in the presence of dysenteric syndrome (T > 38 degrees C, > 6 stods/24 h 00, abdominal pain muco-purulent diarrhea), advanced age, significant comorbidities, immunosuppression or presence of an endovascular prothesis