Photoactive and conductive biohybrid films by polymerization of pyrrole through voids in photosystem I multilayer films.

The combination of conducting polymers with electro- and photoactive proteins into thin films holds promise for advanced energy conversion materials and devices. The emerging field of protein electronics requires conductive soft materials in a composite with electrically insulating proteins. The electropolymerization of pyrrole through voids in a drop-casted photosystem I (PSI) multilayer film enables the straightforward fabrication of photoactive and conductive biohybrid films. The rate of polypyrrole (PPy) growth is reduced by the presence of the PSI film but is insensitive to its thickness, suggesting that rapid diffusion of pyrrole through the voids within the PSI film enables initiation at vacant areas on the gold surface. The base thickness of the composite tends to increase with time, as PPy chains propagate through and beyond the PSI film, coalescing to exhibit a tubule-like morphology as observed by scanning electron microscopy. Increasing amounts of PPy greatly increase the capacitance of the composite films in a manner almost identical to that of pure PPy films grown from unmodified gold, consistent with a high polymer/aqueous interfacial area and a conductive composite film. While PPy is not photoactive here, all composite films, including those with large amounts of PPy, exhibit photocurrents when irradiated by white light in the presence of redox mediator species. Optimization of the Py electropolymerization time is necessary, as increasing amounts of PPy lead to decreased photocurrent density due to a combination of light absorbance by the polymer and reduced accessibility of redox species to active PSI sites.

Rationale and design of the Post-MI FREEE trial: a randomized evaluation of first-dollar drug coverage for post-myocardial infarction secondary preventive therapies.

BACKGROUND: Medication nonadherence is a major public health problem, especially for patients with coronary artery disease. The cost of prescription drugs is a central reason for nonadherence, even for patients with drug insurance. Removing patient out-of-pocket drug costs may increase adherence, improve clinical outcomes, and even reduce overall health costs for high-risk patients. The existing data are inadequate to assess whether this strategy is effective. TRIAL DESIGN: The Post-Myocardial Infarction Free Rx and Economic Evaluation (Post-MI FREEE) trial aims to evaluate the effect of providing full prescription drug coverage (ie, no copays, coinsurance, or deductibles) for statins, beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers to patients after being recently discharged from the hospital. Potentially eligible patients will be those individuals who receive their health and pharmacy benefits through Aetna, Inc. Patients enrolled in a Health Savings Account plan, who are > or =65 years of age, whose plan sponsor (ie, the employer, union, government, or association that sponsors the particular benefits package) has opted out of participating in the study, and who do not receive both medical services and pharmacy coverage through Aetna will be excluded. The plan sponsor of each eligible patient will be block randomized to either full drug coverage or current levels of pharmacy benefit, and all subsequently eligible patients of that same plan sponsor will be assigned to the same benefits group. The primary outcome of the trial is a composite clinical outcome of readmission for acute MI, unstable angina, stroke, congestive heart failure, revascularization, or inhospital cardiovascular death. Secondary outcomes include medication adherence and health care costs. All patients will be followed up for a minimum of 1 year. CONCLUSION: The Post-MI FREEE trial will be the first randomized study to evaluate the impact of reducing cost-sharing for essential cardiac medications in high-risk patients on clinical and economic outcomes.

Challenges of program implementation in a managed care environment: a case study in measuring medication persistence.

OBJECTIVE: To describe the challenges of implementing a disease management program in a managed care environment. SUMMARY: A key element in the successful management of depression is ensuring persistent consumption of medication throughout the duration of a standard course of therapy. However, treating physicians rarely have easy access to the exact records necessary to determine medication persistence. Prescription claims databases do contain this information. Properly identifying problem consumption patterns from these data is one of the most valuable services that managed care pharmacists can provide in a disease management program. The experiences of Aetna Inc. in implementing a depression management program illustrate some of the most important factors to be considered when designing a program: obtaining approval from senior management, measuring baseline performance before program initiation, selecting plan members and physicians based on patterns of consumption in prescription claims data, and quantifying effectiveness. CONCLUSION: A visual representation of prescription refill dates and quantities available in prescription claims databases allowed member physicians to determine, at a glance, each patient.s medication persistence. Such representations of data are valuable for helping identify problem consumption patterns that require further analysis, such as noncontinuous treatment, low usage, and nonpersistence. However, such data are not recommended for use in a vacuum. that excludes considerations such as therapeutic indication and environment.