Applying principles of pharmacoeconomic evaluation to perflenapent emulsion, a new echocardiographic contrast agent for use in cardiac function testing

A pharmacoeconomic evaluation was performed to determine the cost-effectiveness of perflenapent emulsion, a new contrast agent for use in echocardiography. A decision tree analysis was performed on data from the charts of 108 patients who had undergone stress echocardiography without contrast enhancement as part of a cardiac function or wall-motion study. An analysis of a theoretical cohort of patients was conducted to determine shifts in cost associated with enhancement of stress echocardiography with perflenapent emulsion. Outcome was determined by the point at which the clinician was able to determine a treatment course for the patient based on the diagnostic information given. Stress echocardiography without contrast was identified as the most cost-effective path in terms of a conclusive test. Perflenapent emulsion shows a positive cost impact in patients who have had an inconclusive stress echocardiogram without the use of a contrast agent. These results are supported by a sensitivity analysis across a wide range of pricing for perflenapent emulsion, a wide range of cost for a stress echocardiogram, and up to 99% efficacy of contrast-enhanced stress echocardiography.

A novel comprehensive DUE program--five years of experience

A comprehensive program has been developed to evaluate prescribing practices in diverse drug therapy categories and in all areas of the institution. Input for topic selection comes not only from the pharmacy department, but also from QA, medical staff, and nursing. The development of monitoring criteria and review of the results by the P&T Committee, Medical Executive Committee, and other key medical staff members, promotes ownership of the program by the medical staff. The benefit of this ownership is active support for the program and participation in peer review. Overall, the results of this cost-effective program include limited use of broad spectrum antibiotics, select prescribing of high-risk drugs, and focused educational efforts to improve quality of patient care. The primary goal for the future of the program is to develop criteria and documentation mechanisms for reporting measurable clinical outcomes. In making the transition, it is important to use the success and impact of the current program as the foundation. This is particularly true for the concurrent monitoring program and its immediate feedback mechanism. The major challenge will be evaluating negative clinical outcomes and developing corrective actions as well as documenting the positive outcomes and the avoidance of negative outcomes of the current program. To meet this challenge, the DUE program must be integrated with all other institutional QA programs. Although a difficult task, this is a significant yet necessary step in the right direction for assuring optimal patient care.

The aminoglycoside antibiotics.IV. Synthesis of aminodeoxy analogs of neamine

An efficient synthesis of the key 3',4'-galacto epoxide intermediate 4 obtained from the known 5,6-O,O'-cyclohexylidene-N,N'-bis-(methoxycarbonyl)-4-O-[2,6-bis(methoxycarbony lamino)-alpha-D-glucopyranosyl]-2-deoxystreptamine (5) is described. Treatment of this epoxide with sodium azide, followed by reduction and acetylation, yielded the protected4'-amino-4'-deoxyneamine 18 (3',4'-diequatorial), whereas treatment with ammonia followed by acetylation yielded the protected 3'-amino-3'-deoxyneamine analog 19 with a diaxial configuration of its 3' and 4' positions. Reaction of the previously described protected 3',4'-allo epoxide 3 with sodium azide yielded separable mixtures of the protected 3'-amino-3'-deoxyneamine 14 and the protected diaxial 4'-amino-4'-deoxyneamine isomer 13, the ratios of products depending on the solvent temperature. Structural assignments for 13, 14, 18 and 19 were based on their PMR spectra. An additional 4'-amino-4'-deoxyneamine analog (24) with an axial configuration as its 4' position was also prepared by azide displacement of an approximately protected 4'-methanesulfonyl neamine intermediate 10. The five protected isomers were deblocked to yield a series of aminodeoxyneamine analogs (15, 16, 20, 21 and 25), all of which were less active in vitro than neamine against a group of Gram-positive and Gram-negative bacteria.