Cost comparison of pressure ulcer preventive dressings: hydrocolloid dressing versus transparent polyurethane film.

OBJECTIVE: To evaluate and compare the costs of using a transparent polyurethane film (PF) and hydrocolloid dressing (HD) in the prevention of pressure ulcers (PUs). METHOD: This descriptive, observational, longitudinal, comparative study was conducted in the intensive care units, coronary care unit and medical clinic of a charity hospital in Brazil. Data were collected during a 30-day study period, consisting of physical examination, assessment of risk factors for PU development and application of the Braden scale, which were performed at inclusion in the study and once daily during hospitalisation. Either PF or HD was applied bilaterally in the sacral and trochanteric regions for prevention of PUs in patients at a moderate to high risk of PUs according to the Braden scale, and costs of using PU preventive dressings were estimated. RESULTS: The mean total costs per dressing change per patient when using the HD and PF to prevent PUs were 413.60 BRL and 74.04 BRL, respectively. There were significant between-group differences in mean costs for all variables, except for saline solution and nurse-technician services. CONCLUSION: Results showed that the mean cost per dressing change per patient was lower when using the transparent PF than when using the HD.

Radial head implant diameter: A biomechanical assessment of the forgotten dimension.

BACKGROUND: The effect of radial head implant length has been a subject of controversy, with the impact on clinical outcomes and forearm biomechanics being extensively studied. However, the impact of radial head diameter on forearm load transfer has not been examined. This study examined the influence of radial head implant diameter on forearm load transfer as measured by interosseous membrane tension and radiocapitellar joint contact characteristics. METHODS: An upper extremity simulator was utilized to study five cadaveric specimens with three different radial head implant diameters (-2mm, anatomically sized, +2mm). A load sensing device was woven into the fibers of the central band of the interosseous membrane to quantify its tension. An inter-positional pressure measurement sensor was used to quantify radiocapitellar joint contact force and area. Axial loads of 160N were applied to the forearm during forearm rotation with the elbow at 90° of flexion. FINDINGS: Changes to the radial head diameter did not change radiocapitellar contact force or area (P=0.4 and P=0.5 respectively). There was a linear relationship between radial head diameter and interosseous membrane tension; increasing radial head diameter increases the interosseous membrane tension (P=0.01). INTERPRETATION: Although radial head diameter was not found to alter radiocapitellar contact area or force, the interosseous membrane tension was impacted. After radial head arthroplasty, an increase in radial head implant diameter increases the interosseous membrane tension, with a potential for increased pain and stiffness. There is also a potential for increased proximal radioulnar joint contact pressures; resulting in stem loosening or radio-ulnar pain.

Evaluating keloid recurrence after surgical excision with prospective longitudinal scar assessment scales.

INTRODUCTION: Evaluation tools are used to quantify scar evolution and determine treatment effectiveness. In clinical practice, scar assessment scales are less costly, tend to cover a greater number of aspects related to scar characteristics and can incorporate a patient's opinion in the assessment. However, the scales have not yet been used as an evaluation method for the postoperative recurrence of keloids. OBJECTIVE: The study aims to evaluate the effectiveness of scar rating scales for keloid recurrence after surgical excision. METHODS: Patients (n = 25) with keloids on the trunk were treated by surgical resection and postoperative beta radiation therapy. On the 3rd, 6th, 9th and 12th postoperative months, two specialists classified the lesions qualitatively in recurrent and non-recurrent cases. Furthermore, in the objective evaluation, the items on the Seattle Scar Scale (SSS) and the Stony Brook Scar Evaluation Scale (SBSES) were assessed by specialists, and the patients assessed items on the Patient Scar Assessment Scale (PSAS) for the pre- and postoperative periods. The scars were classified qualitatively as "good" or "poor." RESULTS: Recurrence was observed in 18 patients (72%), according to the specialists' qualitative assessments. The best scores on the SSS and SBSES were given to the non-recurrent (p < 0.001) scars. The highest PSAS values were for the scars classified as "poor" (p < 0.001). There were no differences in the PSAS values for the preoperative period and outcomes for the recurrent scars (p = 0.519). The outcomes showed that the non-recurrent scars had lower values on the PSAS compared to the recurrent scars (p = 0.001) and compared to the preoperative period (p = 0.004). CONCLUSIONS: The PSAS, SSS and SBSES scales were effective methods in distinguishing keloid postoperative recurrence. It is necessary to establish the recurrence cut-off scores for each of the scales according to the treatment used.

Assessment of DGAT1 and LEP gene polymorphisms in three Nelore (Bos indicus) lines selected for growth and their relationship with growth and carcass traits.

The aim of this study was to analyze LEP and DGAT1 gene polymorphisms in 3 Nelore lines selected for growth and to evaluate their effects on growth and carcass traits. Traits analyzed were birth, weaning, and yearling weight, rump height, LM area, backfat thickness, and rump fat thickness obtained by ultrasound. Two SNP in the LEP gene [LEP 1620(A/G) and LEP 305(T/C)] and the K232A mutation in the DGAT1 gene were analyzed. The sample consisted of 357 Nelore heifers from 2 lines selected for yearling weight and a control line, established in 1980, at the Estação Experimental de Zootecnia de Sertãozinho (Sertãozinho, Brazil). Three genotypes were obtained for each marker. Differences in allele frequencies among the 3 lines were only observed for the DGAT1 K232A polymorphism, with the frequency of the A allele being greater in the control line than in the selected lines. The DGAT1 K232A mutation was associated only with rump height, whereas LEP 1620(A/G) was associated with weaning weight and LEP 305(T/C) with birth weight and backfat thickness. However, more studies, with larger data sets, are necessary before these makers can be used for marker-assisted selection.

Assessment of very long-chain fatty acids as complementary or alternative natural fecal markers to n-alkanes for estimating diet composition of goats feeding on mixed diets.

This study aimed to assess the use of very long-chain fatty acids (VLCFA) as an alternative or a complement to n-alkane markers for estimation of diet composition of goats fed 7 different diets, composed of different proportions of herbaceous (Lolium perenne and Trifolium repens) and heathland woody species (Erica umbellata, Erica cinerea, Calluna vulgaris, Erica arborea, and Ulex gallii), in a metabolism study. Diet composition was estimated from VLCFA (i.e., C(22) to C(34)) and alkane (i.e., C(25) to C(33)) concentrations in diet and feces, by least squares procedures. For all plant species VLCFA concentrations were greater than their alkane concentrations, especially for the herbaceous species and U. gallii. In general, fecal recovery of both markers was incomplete and increased in a curvilinear (P < 0.001) fashion with carbon-chain length. The plants comprising the diets had a significant effect (P < 0.001) on fecal recovery of VLCFA and alkanes. Diet composition estimates based on VLCFA alone were less accurate (P = 0.013) than those obtained using alkanes alone. Combination of VLCFA and alkane data resulted in the most accurate (P < 0.05) estimates, indicating an increase on the discriminatory power among plant species. Use of uncorrected fecal marker concentrations provided the poorest estimates of diet composition, and use of individual recovery data and mean fecal recovery data of the dietary treatment yielded the most accurate ones. Results obtained in this study show that VLCFA have potential to be used as diet composition markers along with alkanes.

Health-related quality of life of primary caregivers of persons with paraplegia.

STUDY DESIGN: A cross-sectional descriptive study was performed with structured questionnaires and interviews conducted with 60 primary caregivers of persons with paraplegia (T1 to S2) owing to traumatic spinal cord injury (SCI). OBJECTIVES: The purpose of this study was the assessment of the health-related quality of life (HRQoL) of primary caregivers of persons with paraplegia owing to traumatic SCI. SETTING: São Paulo, SP, Brazil. METHODS: The HRQoL was assessed by the Short Form-36 (SF-36) health survey questionnaire and caregiver burden was evaluated by the Caregiver Burden Scale (CBS). RESULTS: Among 60 caregivers evaluated, 49 (81.7%) were female, with mean age of 35.8 (SD=12.91) years, 16 (26.6%) being wives and 14 (23.4%) sisters of persons with paraplegia. It was found that the caregivers spend an average of 11.3 h/day caring for individuals with paraplegia. Twenty-three caregivers (38.3%) had a chronic disease and 32 (53.3%) were sole caregivers taking upon themselves the full responsibility of caring for the persons with paraplegia. The subjects reported lower scores on bodily pain and vitality than the other dimensions of the SF-36. The mean global CBS score was 1.71 (SD=0.50) and mean scores for each dimension ranged from 1.39 (SD=0.64) for emotional involvement to 2.44 (SD=0.79) for environment dimension. CONCLUSION: The primary caregivers of spinal cord-injured persons reported low scores on all of the SF-36 and CBS dimensions, bodily pain and vitality being the SF-36 dimensions that received the lowest scores.

Monte Carlo studies for irradiation process planning at the Portuguese gamma irradiation facility.

The paper describes a Monte Carlo study for planning the irradiation of test samples for microbiological validation of distinct products in the Portuguese Gamma Irradiation Facility. Three different irradiation geometries have been used. Simulated and experimental results are compared and good agreement is observed. It is shown that Monte Carlo simulation improves process understanding, predicts absorbed dose distributions and calculates dose uniformity in different products. Based on these results, irradiation planning of the product can be performed.