Visual assessment of hemolysis in red blood cell units and segments can be deceptive.

BACKGROUND: Blood components that appear hemolyzed are discarded. However, visual inspection is subjective and criteria for excessive hemolysis are poorly defined. STUDY DESIGN AND METHODS: Packed RBCs (10 CPDA-1, 10 Adsol) were collected. Half of each unit was leukoreduced. Plasma Hb was measured and compared in segments and units by three methods: 1) a HemoCue Plasma/Low Hb Photometer system; 2) a tetramethyl-benzidine (TMB) chemical method, and 3) a free Hb visual comparator. RESULTS: Visual assessment tended to overestimate hemolysis. Chemical methods were comparable (r(2)= 0.894; HemoCue = 0.043 +[0.770]x TMB; n = 400; range, 0.01-0.5 g/dL), although the mean plasma Hb (g/dL) for the HemoCue method was higher than that of the TMB method (0.12 vs. 0.10 g/dL, respectively; p < 0.001). No units would have been discarded based on a hemolysis level of at least 0.6 g/dL (approx. 1%) if measured by a chemical method. However, 50 percent of CPDA-1 and 10 percent of Adsol units would have been discarded if only visual criteria were used. Leukoreduction did not increase plasma Hb levels. Discrepancies in plasma Hb levels were noted between units and their corresponding segments. CONCLUSION: Visual assessment of hemolysis can result in unnecessary wastage of blood components. HemoCue offers an alternative, objective method to assess plasma Hb in the setting of blood collection and processing facilities for routine quality control and process validation, and may aid in the development of objective criteria for excessive hemolysis in blood components.

The comparative radiopacity of Fuji IX-GP, an intermediate restorative material.

The radiopacity of intermediate restorative materials should be sufficient to enable the clinician to distinguish the material from normal and decalcified tooth structure. The purpose of this study was to determine the relative radiopacities of intermediate restorative materials, including a newly introduced high-viscosity, self-cured, condensable glass ionomer material. Radiographs were made of six intermediate restorative materials: two reinforced zinc oxide-eugenol materials (IRM and Zinroc), a conventional glass ionomer material (Ketac-fil), a synthetic resin material (Cavit), a eugenol-free zinc oxide material (Tempit), and a new, general-purpose, condensable glass ionomer material (Fuji IX-GP). Optical density was measured using a densitometer. The optical density of dentin and enamel were used for radiographic comparison. Statistical analysis revealed significant differences among materials: Cavit = IRM = Tempit > Zinroc = Fuji IX-GP > Ketac-fil = enamel > dentin (where > indicates a statistical difference at p < or = 0.05). Although not as radiopaque as some other intermediate materials tested, the radiopacity of Fuji IX-GP appears sufficient to aid diagnosis.

Economic evaluation of antifungal agents in the treatment of toenail onychomycosis in Germany.

BACKGROUND: The strategies for the management of onychomycosis have changed since the availability of the newer generation of antifungal agents, particularly, itraconazole and terbinafine. Itraconazole (1-week pulse) therapy may have higher efficacy and an improved adverse-effects profile compared to the continuous therapy regimen. OBJECTIVE: We performed a pharmacoeconomic evaluation of the most commonly used treatments in Germany for toenail onychomycosis from a health care payer perspective. METHODS: A 5-step approach was used. Firstly, the purpose of the study, the comparator drugs, their dosage regimens and the time frame of the analysis were defined. Next, the medical practice and resource consumption patterns associated with the treatment of onychomycosis were identified. In step III, a meta-analysis was used to determine the relative efficacy of the comparator drugs. In step IV, a decision tree of the treatment algorithms was constructed for each comparator. The expected cost analysis and cost-effectiveness analysis were also performed. Finally, a sensitivity analysis was carried out. RESULTS: For the four main comparator drugs used to treat toenail onychomycosis in Germany, the clinical response rates (clinical cure plus marked improvement) at the end of the follow-up period (month 12 after starting therapy) were, for itraconazole (1-week pulse dosing): 89.8 +/- 3% (mean +/- SE), terbinafine: 79.4 +/- 10%, itraconazole (continuous dosing): 77.5 +/- 9%, and ciclopirox nail varnish: 55 +/- 5%. Itraconazole (1-week pulse dosing) was most cost-effective at DM 1,107 per successful treatment, followed by oral terbinafine at DM 1,224, ciclopirox nail varnish and itraconazole (continuous dosing). Sensitivity analyses indicated that itraconazole (1-week pulse dosing) and terbinafine had similar cost-effectiveness ratios. CONCLUSION: Itraconazole is an effective, broad-spectrum triazole used as continuous or pulse therapy in the treatment of onychomycosis. Itraconazole (1-week pulse) and terbinafine are the most cost-effective therapies for toenail onychomycosis.

Cost implications of alternative treatments for AIDS patients with cryptococcal meningitis. Comparison of fluconazole and amphotericin B-based therapies.

The extra demands placed upon health care resources by management of AIDS patients have increased the focus on cost implications of therapeutic alternatives. Cryptococcal meningitis is a common life-threatening infection in AIDS patients, usually treated with amphotericin B, often in combination with flucytosine. Administered intravenously, this therapy is associated with frequent and often severe side effects. Fluconazole is a new alternative which can be given orally once daily and has fewer such side effects. The purpose of this study was to examine the cost implications of these different therapies for both primary and maintenance treatment of cryptococcal meningitis. Comparison of these two therapies in recent clinical trials has indicated that fluconazole is at least as effective as amphotericin B, and therefore cost-minimisation analysis is an appropriate method to study the economic consequences of the alternative treatments. Patient management and resource-use information for both treatments was obtained using a modified Delphi technique with a panel of European physicians experienced in the treatment of this disease, and three models were developed to reflect the variability of practice evident among the panel members. U.K. health care costs were used to value these resources. The results indicated that, despite the higher cost of the drug itself, the costs associated with fluconazole were likely to be markedly less than those for amphotericin B for primary treatment, and similar or slightly cheaper for maintenance treatment. Over 1 year of treatment, the saving from the use of fluconazole would be in the range of 4000-14,000 pounds.