Biomedical subjects
Publications and source records attributed to J M Kessler.
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The use of decision analysis as a tool in making formulary decisions is discussed. Decision analysis is best applied in formulary decisions when factors other than acquisition costs are important in determining overall treatment costs for two products. The decision-analysis process assigns probabilities and costs to various treatments and outcomes. In the case of acute myocardial infarction, the decision analyst would gather data on angioplasty and thrombolysis and assign probabilities and costs for each treatment and subsequent endpoints on the basis of clinical trial data. When such data do not exist, estimates may be generated by expert panels. Applying clinical trial data to an individual hospital is not straightforward because of differences between clinical trials and clinical practice. Analysts and clinicians should evaluate any proposed model for its robustness and adaptability to local conditions and practitioner variation. Access to internal hospital data is essential in developing the model. An ideal decision-analysis model includes all important available interventions and defines and discloses the analyst's time frame and financial perspective. After implementation of the formulary decision, the results can be monitored and, if necessary, adjustments can be made in the allocation of resources. Barriers to effective decision analysis include lack of data and differences in sources of cost and outcome data. Despite the current limitations of decision analysis, clinicians and policymakers may find this technique increasingly useful in the complex formulary process.
The stability of enoxaparin sodium in 0.9% sodium chloride injection in polyvinyl chloride (PVC) containers was studied. Triplicate solutions of 120 mg (1.2 mL) of enoxaparin (as the sodium salt) and 98.8 mL of 0.9% sodium chloride injection were prepared in 250-mL PVC containers and stored at room temperature (20-22 degrees C). Samples were taken immediately after preparation and at 0.25, 0.5, 0.75, 1, 4, 12, 16, 24, and 48 hours. Inspections for color change and precipitation were performed with a clarity inspection station and a magnifying glass. Samples of the three admixtures were evaluated in duplicate for pharmacologic activity by an automated coagulation heparin assay. Throughout the 48-hour study period, the enoxaparin admixtures were free of color change, evolution of gas, and precipitates. The pharmacologic activity of enoxaparin in the PVC containers remained > 94% of the initial measured activity for 48 hours. Enoxaparin 1.2 mg/mL (as the sodium salt) in 0.9% sodium chloride injection in PVC containers was stable for up to 48 hours at 20-22 degrees C.
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The effects on the quantity and quality of antimicrobial drug use of removing an antimicrobial restriction policy are reported. Monthly totals for the number of courses of antimicrobial therapy and expenditures based on grams used were obtained from pharmacy records on adult inpatients for a portion (July-December 1987) of the restriction policy term and for the six months (July-December 1988) immediately after the policy ended. Data were obtained for nine restricted drugs and for three that were never restricted. Retrospective drug-use reviews were conducted for ceftazidime and imipenem-cilastatin. For the restricted agents, the total number of courses of therapy increased by 158% after the restriction policy was removed, and total expenditures increased by 103%. There were no significant changes in the number of courses of therapy or cost for the unrestricted antimicrobials. In the postrestriction period, ceftazidime and imipenem-cilastatin were used more often in patients who were less critically ill. Inappropriate use of imipenem-cilastatin occurred significantly more often after the restrictions were removed. Other factors potentially affecting the use of antimicrobials, such as patient age and the incidence of nosocomial infections, did not differ substantially between the two periods. The removal of an antimicrobial restriction policy resulted in increased use of and higher expenditures for previously restricted agents, as well as an increase in the inappropriate use of at least one agent.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.