A multilayer polyurethane foam dressing for pressure ulcer prevention in older hip fracture patients: an economic evaluation.

OBJECTIVE: Hospital-acquired pressure ulcers (PU) have a substantial negative impact on patients and continue to impose a cost burden on hospital providers. Since the incidence of fragility fracture is growing, driven by the increase in the older population, it is expected that the overall incidence of associated complications will also increase accordingly. The aim of this economic evaluation was to determine whether the use of a multilayer, silicone-adhesive polyurethane foam dressing (ALLEVYN LIFE, Smith & Nephew, UK) alongside standard prevention (SP) for the prevention of PUs in older patients with hip fractures is a cost-effective strategy, compared with SP alone. METHOD: A decision-analytic model was constructed to determine the incremental cost and effectiveness of the foam dressing strategy from the perspectives of the Italian and US hospital systems. We also performed one-way and probabilistic sensitivity analyses. RESULTS: The foam dressing intervention was found to be cost saving and more effective than SP in both Italy and the US. Switching to foam dressing and standard prevention would result in an expected cost saving of €733 per patient in Italy and $840 per patient in the US, reducing the per-patient cost of treating PUs by 37-69% and 36-68%, respectively. The one-way and probabilistic sensitivity analyses demonstrate that the strategy remains dominant over a range of values of the input variables. CONCLUSION: The foam dressing intervention is likely to be a cost-effective strategy compared with standard prevention alone.

Design and development of low cost polyurethane biopolymer based on castor oil and glycerol for biomedical applications.

In the current study, we present the synthesis of novel low cost bio-polyurethane compositions with variable mechanical properties based on castor oil and glycerol for biomedical applications. A detailed investigation of the physicochemical properties of the polymer was carried out by using mechanical testing, ATR-FTIR, and X-ray photoelectron spectroscopy (XPS). Polymers were also tested in short term in-vitro cell culture with human mesenchymal stem cells to evaluate their biocompatibility for potential applications as biomaterial. FTIR analysis confirmed the synthesis of castor oil and glycerol based PU polymers. FTIR also showed that the addition of glycerol as co-polyol increases crosslinking within the polymer backbone hence enhancing the bulk mechanical properties of the polymer. XPS data showed that glycerol incorporation leads to an enrichment of oxidized organic species on the surface of the polymers. Preliminary investigation into in vitro biocompatibility showed that serum protein adsorption can be controlled by varying the glycerol content with polymer backbone. An alamar blue assay looking at the metabolic activity of the cells indicated that castor oil based PU and its variants containing glycerol are non-toxic to the cells. This study opens an avenue for using low cost bio-polyurethane based on castor oil and glycerol for biomedical applications.

A cost-effective treatment for severe generalized erosion and loss of vertical dimension of occlusion: laboratory-fabricated composite resin restorations.

This case report describes preventive and restorative treatment planning for a 56-year-old female patient with severe, chronic, poorly controlled gastroesophageal reflux disease and resulting loss of vertical dimension of occlusion. First, the demineralization process was controlled through collaboration with the patient's physician, and measures were taken to restore adequate stimulated salivary flow. Then, for financial reasons, indirect laboratory-fabricated composite resin restorations were adhesively bonded to replace lost tooth structure and reestablish the patient's collapsed vertical dimension. Indirect-laboratory fabricated restorations can be a cost-effective alternative to direct composite resin or all-ceramic restorations for the treatment of chronic severe erosion, but there are no long-term clinical reports in the current literature to support or contraindicate the use of indirect composites for this type of clinical application. Therefore, careful, long-term follow-up evaluations are planned for this patient.

Avaliação de custo-efetividade de dois tipos de curativos para prevenção de úlcera por pressão / Cost-effectiveness of two types of dressing for prevention of pressure ulcer

Objetivo: Analisar a relação custo-efetividade de dois tipos de curativos para a prevenção de úlcera por pressão na região sacral. Métodos : Pesquisa de análise secundária, comparativa, que incluiu 25 pacientes dos quais dez utilizaram a cobertura hidrocoloide e 15 o filme transparente, para prevenção de úlcera por pressão na região sacral. Foram contabilizados custos de aquisição com cada tipo de cobertura; verificados desfechos intermediário e final; e foi estimada a relação custo-efetividade. Resultados : A relação custo-efetividade do hidrocoloide para o desfecho intermediário foi de R$174,68 enquanto do filme transparente foi de R$45,74. Para o desfecho final, essa relação foi de respectivamente R$272,00 e R$28,97. Conclusão : O filme transparente foi mais custo-efetivo do que o hidrocoloide na prevenção de úlcera por pressão sacral.

Objective: To analyze the cost-effectiveness relationship of two types of dressing for prevention of sacral pressure ulcer. Methods : This secondary analysis and comparative study included 25 patients. Of these, 10 used a hydrocolloid dressing and 15 used a transparent film dressing for prevention of sacral pressure ulcer. We measured costs of each dressing type, verified intermediate and final results, and estimated the cost-effectiveness relationship. Results : The cost-effectiveness relationships for the intermediate results were R$174.68 for the hydrocolloid dressing and R$45.75 for the transparent film dressing. For the final result, the values were R$272.00 and R$28.97, respectively. Conclusion : For sacral pressure ulcers, transparent film dressing was cost-effective compared with hydrocolloid dressing.

[Cost-effectiveness of a TLC-NOSF polyurethane foam dressing]. / Coste-Efectividad de un apósito de espuma de poliuretano con TLC-NOSF.

Chronic wounds represent a drain on the Spanish health system, nowdays is necessary an optimization of the resources used and that is for this that is necessary justify the use of the products over others through cost-effective studies for to show the economic benefit to professionals and the life quality of patient. This article compares the use of a new technology for format polyurethane foam, TLC-NOSF, with the most commonly used products for treating wounds. This comparison is made using a cost-effectiveness model (Markov Model). The results demonstrate that treatment with polyurethane foam dressing with TLC-NOSF are cost-effective versus treatments with polyurethane foams most commonly used in Spain.

Preventing pressure ulcers on the heel: a Canadian cost study.

An adaptation of a clinical study of 130 patients at risk of developing a pressure ulcer on the heels was performed using Canadian costs. The aim of the study was to compare the cost effectiveness of a specially shaped hydrocellular dressing (Allevyn Heel) versus that of a protective heel bandage (Soffban and gauze) in pressure ulcer prevention over an 8-week period.

[Primary definitive cast therapy on the upper and lower extremities. Indications and cost analysis]. / Primäre definitive Stützverbandbehandlung mit Softcast an der oberen und unteren Extremität. Anwendung und Kostenanalyse.

BACKGROUND: Soft cast (SC) is a semirigid cast material which opened new possibilities for fracture care in adults and children. The primary definitive cast technique (PDCT) with SC is a new casting method that uses a combination of fiberglass and polyurethane resin. Time, personnel, and material costs for producing plaster casts using the conventional technique (primary plaster cast and secondary hard cast, or POPHC) were prospectively compared with PDCT using SC on upper and lower extremities. METHODS: Time, personnel, and material costs for producing plaster casts using the conventional technique (primary plaster cast and secondary hard cast, or POPHC) were prospectively compared with PDCT using SC on upper and lower extremities. RESULTS: Compared with PDCT, the costs for POPHC were always higher: 138% for upper arm casts, 142% for lower arm and scaphoid casts, 219% for ankle joint casts, 157% for ankle splints, 336% for first-toe bandage/orthesis, and 289% for geisha shoes. CONCLUSION: The procedure using PDCT with SC can contribute to cost savings and improve patient comfort.

Evaluation of dressings used with local anaesthetic cream and for peripheral venous cannulation.

AIM: To compare four polyurethane dressings manufactured by two different companies for use in children. METHOD: Seventy-eight dressings were applied to secure either local anaesthetic creams (n = 62) or intravenous cannulae (n = 16). Each dressing was evaluated for ease of application, security and ease of removal, using a simple scoring system. RESULTS: 84 per cent of Opsite flexigrid and 90 per cent of Tegaderm local anaesthetic cream dressings were rated as easy or very easy to apply. Opsite flexigrid was felt to be more secure, whereas Tegaderm was easier to remove. The Tegaderm cannula dressing was easier to apply than the iv3000 dressing. CONCLUSION: There was little difference between the two brands, including costs.

Costs and prices of single dental fillings in Europe: a micro-costing study.

Dental fillings represent an established procedure to treat tooth decay. The present paper provides a cost comparison of dental filling procedures across nine European countries. More specifically, the paper aims to estimate the costs and prices (i.e. reimbursement fees) of a single dental filling procedure in an approximately 12-year-old child with a toothache in a lower molar who presents at a dental practice, as described in a case vignette. Both amalgam and composite fillings were examined. Total costs were determined by identifying resource use and unit costs for the following cost components: diagnostic procedures, labour, materials, drugs, and overheads. Altogether, 49 practices provided data for the cost calculations. Mean total costs per country varied considerably, ranging from 8 euros to 156 euros. Labour costs were the most important cost driver in all practices, comprising 58% of total costs. Overhead costs were the second-most important cost component in the majority of countries. Actual cost differences across practices within countries were relatively small. Cost variations between countries were primarily due to differences in unit costs, especially for labour and overheads, and only to a lesser extent to differences in resource use. Finally, cost estimates for a single dental filling procedure based on reimbursement fees led to an underestimation of the total costs by approximately 50%.

Cost of composite and glass ionomer class II molar restorations and theoretical analyses of cost per year of function at public dental services in Sweden.

The aim was to evaluate the cost of direct composite and glass ionomer class II molar restorations, and the theoretical cost per year of function, at Public Dental Services (PDS) in Sweden, years 2000 and 2005. Costs for patients, Social Insurance Offices (SI; Försäkringskassan), and total cost, were calculated based on fee schedules from all PDS in Sweden. Theoretical cost per year calculations were based on the median survival times (MST) of failed direct composite and glass ionomer class II molar restorations, derived from a set of clinical studies conducted in Nordic general practices. Due to lack of national statistics from SI, the number of direct restorations including more than one surface, made in adults, in general dentistry at PDS in the county of Halland were studied. From the year 2000 to year 2005, the total cost of composite class II molar restorations increased by 25%, whereas the total cost of glass ionomer restorations more than doubled. Theoretical calculations implied a higher cost per year of function for composite restorations in year 2000, whereas in year 2005, glass ionomer restorations had a higher cost per year of function. The cost of direct composite and glass ionomer class II molar restorations increased from year 2000 to 2005, at PDS in Sweden. In the context of planning public health care funding, theoretical models for cost prediction may prove useful.

Choice of dressing has a major impact on blistering and healing outcomes in orthopaedic patients.

OBJECTIVE: To investigate the effect of three postoperative dressings on orthopaedic wound healing. METHOD: Three hundred orthopaedic patients were divided into three treatment groups and allocated to management with one of three dressings: Primapore, Tegaderm with pad, and OpSite Post-Op. Staff completed a questionnaire to evaluate the wound progression. Outcome measures were the presence of infection, blistering and the number of dressing changes required. RESULTS: There was a significantly lower incidence of blistering with OpSite Post-Op (6%) than Tegaderm with pad (16%) and Primapore (24%) (p<0.001). Patients in the OpSite Post-Op group had the lowest exudate levels. CONCLUSION: Dressings that employ a clear film and have a high moisture vapour transmission rate have been shown to reduce both the rate of blistering and wound discharge. The additional expense inherent in using such dressings may, in reality, prove cost-effective because of the reduced need for dressings changes and the subsequent earlier discharge of these patients from hospital with an uncomplicated wound.

Effect of three wound dressings on infection, healing comfort, and cost in patients with sternotomy wounds: a randomized trial.

STUDY OBJECTIVE: To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness. DESIGN: Prospective, randomized controlled trial. SETTING: Major metropolitan, academically affiliated, tertiary referral center. PATIENTS: Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith & Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith & Nephew] in the operating theater on skin closure. RESULTS: There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p < 0.001), poor dressing integrity (p < 0.001), more frequent dressing changes (p < 0.001), more discomfort with removal (p < 0.05), and increased cost (p < 0.001). CONCLUSIONS: In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.

Comparison of hydrocellular foam and calcium alginate in the healing and comfort of split-thickness skin-graft donor sites.

This is a comparative study of a hydrocellular foam (Allevyn, Smith and Nephew) and a calcium alginate (Kaltostat, ConvaTec) in dressing split-thickness skin-graft donor sites. The dressing materials were used in equal halves of each donor site in 20 patients undergoing skin-graft harvest. The donor sites dressed with Allevyn showed a tendency to earlier healing, but this was not confirmed statistically. However, Allevyn was found to be more comfortable than Kaltostat and this difference was statistically significant. Due to its increased patient comfort, cheaper cost and comparable time to healing with Kaltostat, the authors recommend the use of Allevyn as a dressing for split-thickness skin-graft donor sites.

OpSite Plus in the management of exuding wounds.

This article discusses the use of OpSite Plus (formerly known as OpSite Post-Op ) in the community setting. This semi permeable film dressing with an absorbent pad was evaluated by the community hospital and by practice and district nurses within Plymouth's NHS Primary Care Trust.

Experimental and numerical predictions of the ultimate strength of a low-cost composite transtibial prosthesis.

Saito et al. (Modern Plastics 1997;74:175-7) have developed a low-cost transtibial prosthesis made of fiber-reinforced plastic (FRP). The prosthesis is comprised of an aluminum pylon, a cosmetic cover, and a constant cross-section composite foot into which aluminum supports are screwed to increase load-bearing capacity. Replacing these supports with a single integrated FRP stiffener significantly reduced manufacturing cost while providing high strength, great durability, and smooth walking. The optimal location and orientation of the proposed FRP stiffener were determined by finite element (FE) analysis. When a replica of this component was tested according to ISO standard 10328, the experimental prosthesis catastrophically failed under 6,600 N of force. Maximum percent error of strain between experimental and numerical results was 18.6%, showing good correlation between the two data sets. The optimized design provides sufficient strength and reduces the cost of manufacturing and thus can be used to replace the original design.

Thermoplastic vulcanizates: new materials of choice.

Increasingly, thermoplastic vulcanizates of ethylene propylene diene monomer rubber-polypropylene are being specified for medical applications. This article describes their properties and advantages over thermoset rubbers and other conventional medical elastomeric materials.

Central line exit sites: which dressing?

Recent developments in dressings for intravenous access sites include a transparent dressing which does not retain moisture. This article describes a randomised controlled trial to compare the new dressing with a standard dressing. There was no difference in sepsis rates between the two groups, and both methods had advantages and disadvantages. The authors suggest that cost may be a factor in choice of dressing.

Retention of supportive properties by eggcrate and foam wheelchair cushions.

This study investigated the reported lack of ability of the eggcrate cushion (EC) to provide wheelchair users with adequate support necessary for comfort and tolerably low-peak sitting pressures over time. The primary parameter used to quantify the ability of the cushion to distribute load was the indention force deflection (IFD) metric. The EC was compared to a high-density planar foam cushion (HD). The IFD was measured for both cushions after successive periods of compression to simulate use. Study results failed to support the common perception that the soft EC would lose its supportive properties more rapidly than the much firmer HD cushion. Although the initial IFD of the EC was much lower than that of the HD, a smaller percentage of its IFD was lost after compression. This difference between the two cushions likely was due to differences in packaging. The EC was rolled into a cylinder, compressing it to 60% of its original thickness; the HD was packaged without compression.