Comparative evaluation of canine cadaver embalming methods for veterinary anatomy education.

Formalin-embalmed cadavers have been extensively used to teach anatomy. Although they ensure the preservation of anatomical structures without microbial contamination, they are considerably rigid and cannot be used to study the joint and muscle movements. Moreover, formalin irritates the eyes and airways and is carcinogenic on chronic exposure. To overcome the disadvantages of formalin-fixed cadavers, we investigated the usefulness of alternative embalming methods using saturated salt solution (SS) and Thiel's solution (TS). We compared the three solutions based on the following parameters: cost of the embalming solution; preservation of anatomical structure, color, flexibility, and texture; and microbial contamination. Convenience of anatomical structure identification and preferences in anatomical laboratory practice were evaluated using questionnaires answered by veterinary undergraduate students. Cost of the embalming solution was the lowest for formalin solution (FS) and most expensive for TS. All cadavers were successfully preserved without significant putrefaction and were useful for teaching veterinary anatomy. Cadavers embalmed with SS or TS were superior in facilitating joint and muscle movement. Compared to FS, the color and texture of muscles and internal organs were similar to those of living animals and there was no irritating and offensive smell in SS and TS cadavers. Students preferred the SS and TS cadavers for their usefulness in identification of anatomical structures, highlighting their usefulness in veterinary anatomy education.

The presence of S-sulfonated transthyretin in commercial human serum albumin solutions: Potential contribution to neuropathy.

BACKGROUND: Commercial solutions of human serum albumin (HSA) are administered to critically ill patients for the treatment of shock, restoration of blood volume, and the acute management of burns. Previously, conflicting results on the effects of HSA administration have been reported varying from a favorable increase in total plasma antioxidant capacity to a higher mortality rate in traumatic brain injury (TBI) patients. These results could be partially explained due to the known heterogeneity of HSA solutions. We report the discovery of S-sulfonated human transthyretin (hTTR) in HSA solutions. METHODS: Proteomics was performed on commercially available solutions of 5% HSA by LC-MS analysis. The MS charge envelope for hTTR was deconvolved to the uncharged native hTTR parent mass (13,762 Da). The parent mass was then integrated, and relative proportions of the 2 major species of hTTR, native and S-sulfonated hTTR (13,842 Da), were calculated. RESULTS: The majority of hTTR found in 5% commercial HSA solutions is in the S-sulfonated form regardless of the age of the HSA solution. S-sulfonation of hTTR at the free cysteine residue in position 10 appears to be the result of a mixed disulfide exchange possibly with S-cysteinylated hTTR or S-cysteinylated HSA. hTTR is a tetramer composed of four identical monomers each containing a reduced cysteine residue in position 10. S-sulfonation of hTTR at this cysteine residue can destabilize the hTTR tetramer, an important step in the formation of TTR-related amyloid fibrils. CONCLUSIONS: Administration of a commercial HSA solution that already contains S-sulfonated hTTR could potentially contribute to the development of amyloid-related/polyneuropathy in the critically ill.

Applicability of papain solutions in immunohematology.

OBJECTIVE: To compare the enzyme activity of different presentations of papain solution to validate in-house preparations. METHODS: Two papain solutions were prepared, and the third presentation was a commercial solution. Tests were carried out with samples of red cells typed as weak RhD. RESULTS: In-house prepared papain solutions showed similar enzyme reactivity, and statistically no differences compared to the enzyme activity of the commercial solution. CONCLUSION: Evaluating the cost-benefit ratio, the in-house prepared papain solutions present more economic advantages, and can be incorporated into immunohematological routines as a way to cope with periods of financial crisis and cost-containment policies.

Applicability of papain solutions in immunohematology / Aplicabilidade de soluções de papaína em imuno-hematologia

ABSTRACT Objective: To compare the enzyme activity of different presentations of papain solution to validate in-house preparations. Methods: Two papain solutions were prepared, and the third presentation was a commercial solution. Tests were carried out with samples of red cells typed as weak RhD. Results: In-house prepared papain solutions showed similar enzyme reactivity, and statistically no differences compared to the enzyme activity of the commercial solution. Conclusion: Evaluating the cost-benefit ratio, the in-house prepared papain solutions present more economic advantages, and can be incorporated into immunohematological routines as a way to cope with periods of financial crisis and cost-containment policies.

RESUMO Objetivo: Comparar a atividade enzimática de diferentes apresentações de solução de papaína para validação de preparados in-house. Métodos: Foram preparadas duas soluções de papaína, e a terceira apresentação tratou-se de uma solução comercial. Os testes comparativos das reações enzimáticas foram realizados com amostras de hemácias tipadas como RhD fraco. Resultados: As soluções de papaína preparadas in-house apresentaram reatividade enzimática semelhante e estatisticamente sem diferenças em comparação com a atividade enzimática da solução comercial. Conclusão: Avaliando-se a relação entre custo e benefício, as soluções de papaína preparadas in-house são economicamente vantajosas, podendo ser incorporadas às rotinas imuno-hematológicas como forma de enfrentamento em períodos de crise financeira e em políticas de retenção de gastos.

Cost-Effectiveness of Posaconazole Tablets for Invasive Fungal Infections Prevention in Acute Myelogenous Leukemia or Myelodysplastic Syndrome Patients in Spain.

INTRODUCTION: Posaconazole is superior to fluconazole (FLU) and itraconazole (ITRA) in the prevention of invasive fungal diseases (IFDs) in neutropenic patients with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS). A new tablet formulation of posaconazole with improved pharmacokinetic and pharmacodynamic properties compared to posaconazole oral solution has recently been approved. The objective of this study is to estimate the cost-effectiveness of the newly developed posaconazole tablets versus FLU oral suspension or ITRA oral solution for preventing IFDs in high-risk neutropenic patients with AML or MDS and from the perspective of the Spanish National Health System (NHS). METHODS: A previously validated economic model was used. The probabilities of experiencing an IFD, an IFD-related death or death from other causes over 100 days were based on clinical trial data and input into a decision tree. Surviving patients were entered into a Markov model to calculate total costs, number of IFDs and number of life-years gained per patient over a lifetime horizon in each disease and treatment group. Two health states, alive and dead, were considered. Health effects were discounted using a rate of 3%. Univariate and probabilistic sensitivity analyses were conducted. RESULTS: During the first 100 days, posaconazole tablets were associated with a lower risk of IFDs (0.046 vs. 0.111), longer life expectancy (2.92 vs. 2.69 years) and lower total costs (€5906.06 vs. €7847.20 per patient) over the patients' lifetimes compared to FLU or ITRA treatments. Thus, posaconazole tablets were more effective and less costly than FLU or ITRA. Probabilistic sensitivity analysis indicated that there was a 79.9% probability of posaconazole tablets being cost-saving compared to FLU or ITRA. CONCLUSION: From the Spanish NHS perspective, posaconazole tablets are cost-effective compared to FLU or ITRA in AML or MSD patients with chemotherapy-induced neutropenia and at high risk for IFDs. FUNDING: MSD Sharp & Dohme.

Targeting health subsidies through a nonprice mechanism: A randomized controlled trial in Kenya.

Free provision of preventive health products can markedly increase access in low-income countries. A cost concern about free provision is that some recipients may not use the product, wasting resources (overinclusion). Yet, charging a price to screen out nonusers may screen out poor people who need and would use the product (overexclusion). We report on a randomized controlled trial of a screening mechanism that combines the free provision of chlorine solution for water treatment with a small nonmonetary cost (household vouchers that need to be redeemed monthly in order). Relative to a nonvoucher free distribution program, this mechanism reduces the quantity of chlorine procured by 60 percentage points, but reduces the share of households whose stored water tests positive for chlorine residual by only one percentage point, substantially improving the trade-off between overinclusion and overexclusion.

A modified GEWF solution is cost-saving and effective for lymph node retrieval in resected colorectal carcinoma specimens.

Lymph node (LN) retrieval is important for proper staging of colorectal carcinoma. Although various assistant techniques were recommended to facilitate LN identification, most of them were unavoidably time-consuming, resource intensive and costly. We prepared a modified GEWF solution (RE-GEWF) by use of recycled alcohol and a familiar dye, eosin and investigated its efficacy on 55 colorectal carcinoma specimens. Of the 55 studied cases, 33 of them with <12 LNs (Group A) and 22 with ≥12 LNs were detected (Group B) before RE-GEWF treatment. All were subsequently treated with RE-GEWF for 14-16h and were inspected again for LNs. The number of LNs revealed before and after RE-GEWF treatment was 539 and 476 respectively. The mean number of LNs per cases increased from 9.80±6.27 to 18.43±8.77. Twelve accessory LN metastases were found in 9 cases. Upgrade of pN stage was only present in 7 of the Group A cases. The results show that RE-GEWF is as effective as other reported LN revealing solutions. Use of RE-GEWF not only can assure the quality of LN detection, but also minimize the cost and reduce the release of waste.

Cost-effective recovery and purification of polyhydroxyalkanoates by selective dissolution of cell mass.

Highly efficient separation and purification of polyhydroxyalkanoates (PHAs) from PHA-containing cell mass is essential to production of the bioplastics from renewable resources in a cost-effective, environmentally friendly way. Based on selective dissolution of non-PHA cell mass (NPCM) by protons in aqueous solution and crystallization kinetics of PHA biopolymers, a simple process is developed and demonstrated to recover PHAs from cell mass to high purity (>97 wt %) with high yield (>95 wt %). The average molecular weight of biopolyesters is controlled, which follows an exponential function of process severity, a combined factor of processing conditions. Compared with conventional chemical treatment such as sequential surfactant and hypochlorite treatment, this new technology substantially reduces the chemical cost for PHA recovery and purification from PHA-containing cell mass.

[Economical assessment of intravenous mixture centralization]. / Evaluación económica de la centralización de mezclas intravenosas.

OBJECTIVE: To evaluate the cost of preparing intravenous mixtures in the centralized pharmacy service of the hospital as compared to the cost of their preparation by nurses on wards, assuming that the results are clinically analogous for the patients. METHOD: A cost-minimization analysis has been carried out. Data concerning types of mixtures and quantities has been analyzed retrospectively. The fixed and variable costs in both drug preparation options have been assessed using the real costs of the hospital in 2003. This study considered the productive time of nurses in our hospital as well as time described in bibliography. The materials used and their cost has been quantified, along with the cost of recycled mixtures. A sensitivity analysis was conducted considering the most influential variables. RESULTS: The preparation times of nurses in pharmacy are equal or shorter. The material costs/100 intravenous mixtures represent a fifth part in pharmacy (1.10 euro compared to 5.69-12.37 euro). The minimum ratio of cost between pharmacy and ward was 1:2.94 (10,619:31,265 euro) and the maximum was 1:3.77 (37,075:139,633 euro). The savings due to recycling of intravenous mixtures (36,168 to 118,110 euro) always favours the pharmacy. The sensibility analysis indicates that centralization maintains the usefulness level (ratio total annual cost 1:3.23), with a ratio of minimum annual productive time between pharmacy and ward nurses of 1:3.5. CONCLUSIONS: In our hospital the preparation of intravenous mixtures at the pharmacy department minimizes costs compared to preparation on wards, allowing nurses to devote more time to patient care, and thus improving the efficiency of management.

Identifying costs of intravenous solution wastage.

A monitoring programme to systematically evaluate and decrease wastage of intravenous (i.v.) solutions was developed. Documentation of type and quantity of wasted solutions can help identify potential causes of waste. Subsequent systems changes intended to decrease waste can then be evaluated. Pharmacy technicians daily recorded the number, identity and locations of discarded i.v. solutions. A computer spreadsheet application was developed and used to produce a monthly summary identifying the number, drug cost and solutions wasted by hospital unit, thus establishing specific areas to target for i.v. wastage control. Investigators conducted a 12-month retrospective evaluation of i.v. wastage, revealing that over 14,000 i.v. preparations were destroyed at an estimated $US90,000 in drug costs. This equates to 2.5% of total drug costs wasted in small volume parenterals. Target programmes were implemented for drugs that were frequently wasted and systems changes implemented that decreased overall wastage of i.v. solutions.

Does perioperative total parenteral nutrition reduce medical care costs?

An economic analysis accompanied a multicenter Department of Veterans Affairs randomized, controlled trial of perioperative total parenteral nutrition (TPN). The cost of providing TPN for an average of 16.15 days before and after surgery was $2405, more than half of which ($1025) included costs of purchasing, preparing, and delivering the TPN solution itself; lipid solutions accounted for another $181, additional nursing care for $843, and miscellaneous costs for $356. Prolonged hospital stay added another $764 per patient to the $2405 cost of providing TPN, bringing the total to $3169. The incremental costs attributed to perioperative TPN were highest ($3921) for the patients least likely to benefit, that is, those who were less malnourished and at low risk of nutrition-related complications. Incremental costs were lowest ($3071) for high-risk patients. On the basis of the hospital-based method of administering TPN that was used in the clinical trial, perioperative TPN did not result in decreased costs for any subgroup of patients.

[Topical treatment of otorrhea]. / Tratamiento tópico de las otorreas.

A study has been carried out with 167 cases of discharging ears treated topically by means of lavages with a formic solution followed by the instillation of a quantity of boric drops. The material and methods used are exposed, together with the results achieved, taking into account that most the cases had been previously multi-treated with antibiotherapy, with adverse outcome. This procedure is cheap, effective and with scarce side-effects.