A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices

ABSTRACT Purpose to critically review all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. Materials and Methods A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included. Results 741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive financial cost-effective decision model to flexible ureteroscope acquisition. Conclusions The cost-effectiveness of a flexible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.

Direct Cost of Reprocessing Cotton-woven Surgical Drapes: a Case Study / Costo Directo del Reprocesamiento de Campos Quirúrgicos de Tela de Algodón: un Estudio de Caso / Custo direto do reprocessamento de campos cirúrgicos de tecido de algodão: um estudo de caso

OBJECTIVE Identify the direct cost of reprocessing double and single cotton-woven drapes of the surgical LAP package. METHOD A quantitative, exploratory and descriptive case study, performed at a teaching hospital. The direct cost of reprocessing cotton-woven surgical drapes was calculated by multiplying the time spent by professionals involved in reprocessing the unit with the direct cost of labor, adding to the cost of materials. The Brazilian currency (R$) originally used for the calculations was converted to US currency at the rate of US$0.42/R$. RESULTS The average total cost for surgical LAP package was US$9.72, with the predominance being in the cost of materials (US$8.70 or 89.65%). It is noteworthy that the average total cost of materials was mostly impacted by the cost of the cotton-woven drapes (US$7.99 or 91.90%). CONCLUSION The knowledge gained will subsidize discussions about replacing reusable cotton-woven surgical drapes for disposable ones, favoring arguments regarding the advantages and disadvantages of this possibility considering human resources, materials, as well as structural, environmental and financial resources. .

OBJETIVO Identificar el costo directo del reprocesamiento de campos de tela de algodón, dobles y sencillos, integrantes del paquete de LAP quirúrgico. MÉTODO Estudio de caso cuantitativo, exploratorio-descriptivo, llevado a cabo en un hospital de enseñanza. Se calculó el costo directo multiplicándose el tiempo empleado por los profesionales involucrados en el reprocesamiento por el costo unitario de la mano de obra directa, sumándose al costo de los materiales. La moneda brasileña (R$) utilizada originalmente para los cálculos se convirtió en moneda estadounidense a la tasa de US$ 0.42/R$. RESULTADOS El costo total medio, por paquete de LAP quirúrgico, fue US$ 9.72, con predominancia del costo con materiales (US$ 8.70), el 89.65%. Se destaca que el costo total medio de los materiales recibió fuerte impacto de los costos de los campos de tela de algodón (US$ 7.99), el 91.90%. CONCLUSIÓN El conocimiento obtenido subsidiará discusiones acerca del reemplazo de campos de tela reutilizables por campos desechables, favoreciendo argumentaciones relativas a las ventajas y desventajas de dicha posibilidad al considerarse los recursos humanos, materiales, estructurales, ambientales y financieros. .

OBJETIVO Identificar o custo direto do reprocessamento de campos de tecido de algodão, duplos e simples, integrantes do pacote de LAP cirúrgico. MÉTODO Estudo de caso quantitativo, exploratório-descritivo, realizado em um hospital de ensino. Calculou-se o custo direto multiplicando-se o tempo despendido por profissionais envolvidos no reprocessamento pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais. A moeda brasileira (R$) utilizada originalmente para os cálculos foi convertida para a moeda norte-americana pela taxa de US$ 0.42/R$. RESULTADOS O custo total médio, por pacote de LAP cirúrgico, foi de US$ 9.72, com predominância do custo com materiais (US$ 8.70) 89.65%. Destaca-se que o custo total médio dos materiais recebeu forte impacto dos custos dos campos de tecido de algodão (US$ 7.99) 91.90%. CONCLUSÃO O conhecimento obtido subsidiará discussões sobre a substituição de campos de tecido reutilizáveis por campos descartáveis, favorecendo argumentações relativas às vantagens e desvantagens dessa possibilidade considerando os recursos humanos, materiais, estruturais, ambientais e financeiros. .

Costs of reusable and disposable aprons in a public teaching hospital / Costos de delantales de tejido reutilizables y de desechables en hospital universitario público / Custos de aventais de tecido reutilizáveis e de descartáveis em hospital universitário público

Objective To analyze the direct cost of reusable and disposable aprons in a public teaching hospital. Method Cross-sectional study of quantitative approach, focusing on the direct cost of reusable and disposable aprons at a teaching hospital in northern Paraná. The study population consisted of secondary data collected in reports of the cost of services, laundry, materials and supplies division of the institution for the year 2012 Results We identified a lower average cost of using disposable apron when compared to the reusable apron. The direct cost of reusable apron was R$ 3.06, and the steps of preparation and washing were mainly responsible for the high cost, and disposable apron cost was R$ 0.94. Conclusion The results presented are important for hospital managers properly allocate resources and manage costs in hospitals
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Objetivo Analizar el costo directo de delantales de tejido reutilizables y de desechables en hospital universitario público. Método Estudio transversal de abordaje cuantitativo, con énfasis en el costo directo de los delantales de tejido reutilizables y desechables, realizado en hospital universitario del norte de Paraná. La población de estudio estuvo compuesta de datos secundarios recogidos en informes de los servicios de costo, lavandería, división de material y provisiones de la institución, referentes al año de 2012. Resultados Se identificó un menor costo medio de utilización del delantal desechable cuando comparado con el costo del delantal de tejido reutilizable. El costo directo de utilización del delantal de tejido fue de R$3,06, siendo las etapas de confección y lavado las principales responsables de la elevación del costo, y el delantal desechable costó R$0,94. Conclusión Los resultados presentados constituyen herramientas para que los gestores hospitalarios puedan destinar adecuadamente los recursos y gestionar los costos en instituciones hospitalarias. .

Objetivo Analisar o custo direto de aventais de tecido reutilizáveis e de descartáveis em hospital universitário público. Método Estudo transversal de abordagem quantitativa, com enfoque no custo direto de aventais de tecido reutilizáveis e de descartáveis, realizado em hospital universitário do norte do Paraná. A população de estudo foi composta por dados secundários coletados em relatórios dos serviços de custo, lavanderia, divisão de material e suprimentos da instituição, referentes ao ano de 2012. Resultados Identificou-se um menor custo médio de utilização do avental descartável quando comparado ao do avental de tecido reutilizável. O custo direto de utilização do avental de tecido foi de R$ 3,06, sendo as etapas de confecção e lavagem as principais responsáveis pela elevação do custo, e o avental descartável custou R$ 0,94. Conclusão Os resultados apresentados constituem ferramentas para que os gestores hospitalares possam alocar adequadamente os recursos e gerenciar custos em instituições hospitalares.


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Análise de custo-efetividade do reúso de cateteres de cinecoronariografia sob a perspectiva de uma instituição pública no Município do Rio de Janeiro, Brasil / Cost-effectiveness analysis on the reutilization of coronary artery catheters in a public hospital in Rio de Janeiro, Brazil / Análisis del coste-efectividad en la reutilización de catéteres bajo la perspectiva de una institución pública en la ciudad de Río de Janeiro, Brasil

O objetivo foi comparar a relação de custo-efetividade entre o uso de cateteres cardíacos novos com cateteres reprocessados sob a perspectiva de uma instituição pública federal. Foi elaborado um modelo analítico de decisão elaborado para estimar a razão de custo-efetividade entre duas estratégias de utilização de materiais para cateterismo cardíaco utilizando, como desfecho clínico, a ocorrência de reação pirogênica. Os custos foram estimados por coleta direta nos setores envolvidos e valorados em Real (R$) para o ano de 2012. A árvore de decisão foi construída com as probabilidades de pirogenia descritas em estudo clínico. O custo para o reúso foi de R$ 109,84, e, para cateteres novos, de R$ 283,43. A estratégia de reúso demonstrou ser custo-efetiva, e a razão de custo-efetividade incremental indicou que, para evitar um caso de pirogenia, serão gastos R$ 13.561,75. O estudo aponta o reúso de cateteres como uma estratégia de menor custo comparada ao uso exclusivo de cateteres novos e pode contribuir para a tomada de decisão dos gestores.

The aim of this study was to compare the cost-effectiveness ratio of new versus reprocessed coronary artery catheters in a Federal public hospital. This was an analytical decision-making model prepared to estimate the cost-effectiveness ratio between two strategies in the use of materials in coronary artery catheterization, with pyrogenic reaction as the clinical outcome. Costs were estimated using direct data collection in the respective catheterization services and expressed in Brazilian Reais (R$), with 2012 as the reference year. The decision-making tree was constructed with the probabilities of pyrogenic reaction as described in a clinical trial. The cost per catheter for reuse was R$ 109.84, as compared to R$ 283.43 for a new catheter. The reutilization strategy proved to be cost cost-effective, and the incremental cost-effectiveness ratio indicated that R$ 13,561.75 would be spent to avoid one case of pyrogenic reaction. The study identified reuse of coronary artery catheters as a lower cost strategy compared to the exclusive use of new catheters, thus potentially assisting decision-making by health administrators.

El objetivo fue comparar la relación coste-eficacia en la reutilización de catéteres cardíacos respecto a los nuevos, bajo la perspectiva de un servicio público. Se utilizó un modelo analítico con el objeto de estimar la relación coste-efectividad entre las dos estrategias para el uso de materiales en el cateterismo cardíaco, utilizando la ocurrencia de reacción pirogénica como resultados clínicos. Los costes fueron estimados por la recogida directa en los sectores implicados y se expresan en reales (R$) para el año 2012. Un diagrama de decisiones se construyó con las probabilidades pirogénicas descritas en el estudio clínico. El coste de la reutilización era de R$ 109,84 y de R$ 283,43 por catéteres nuevos. La estrategia de reutilización ha demostrado ser coste-efectiva y la tasa de coste-efectividad incremental indicó que para prevenir un caso pirogénico se gastarían R$ 13,561.75. El estudio demuestra que la reutilización de catéteres es una estrategia de menor coste, en comparación con el uso exclusivo de los nuevos catéteres, y puede contribuir a la toma de decisiones.

Interferência de introdutores reprocessados na oclusão da artéria radial após cateterismo cardíaco / Interference of reprocessed introducers in radial artery occlusion after cardiac catheterization

INTRODUÇÃO: A oclusão da artéria radial (OAR) é uma complicação clinicamente silenciosa do cateterismo transradial, mas pode predispor à isquemia da mão. Fatores associados a essa complicação conhecidos são o calibre dos introdutores e cateteres, a dose de heparina utilizada, o número de reutilizações da artéria radial e o tipo de curativo compressivo aplicado. O objetivo deste estudo foi avaliar se existe associação entre a utilização de introdutores vasculares hidrofílicos reprocessados e a OAR. MÉTODOS: Pacientes submetidos a cateterismo transradial foram randomizados para introdutores novos (Grupo I - GI) ou reprocessados (Grupo II - GII). A presença de OAR foi avaliada em 24 horas (precoce) e 30 dias (tardia), por meio do teste de Barbeau reverso. RESULTADOS: Foram alocados 228 pacientes no GI (n = 100) e no GII (n = 128). A idade foi de 60,1 ± 10,6 anos vs. 59,4 ± 10,9 anos (P = 0,64), 49% vs. 35,2% (P = 0,03) eram do sexo feminino e 25% vs. 27,3% (P = 0,70) eram diabéticos. Observaram-se incidências totais de OAR precoce de 10,5% e de 9,1% para OAR tardia. Dez pacientes do GI (10%) apresentaram OAR precoce, comparados a 14 (10,9%) do GII (χ² = 0,05; RR = 1,09; P = 0,82). Na avaliação de 30 dias, foi encontrada OAR em 6 pacientes do GI (7,5%) comparados a 11 pacientes (10,4%) do GII (χ² = 0,45; RR = 1,38; P = 0,50). CONCLUSÕES: Na casuística estudada, não foi encontrada associação entre a reutilização de introdutores vasculares e a OAR precoce e tardia em pacientes submetidos a cateterismo cardíaco.

BACKGROUND: Radial artery occlusion (RAO) is a clinically silent complication of transradial catheterization but may predispose to hand ischemia. Factors associated with this complication are the diameter of catheters and sheaths, the dose of heparin, repeated transradial procedures and the type of compressive dressing applied. The objective of this study was to evaluate if there is an association between reused hydrophilic vascular introducers and RAO. METHODS: Patients undergoing transradial catheterization were randomized to receive brand new introducers (Group I - GI) or reprocessed introducers (Group II - GII). The presence of RAO was evaluated at 24 hours (early) and day 30 (late) with the reverse Barbeau test. RESULTS: Two hundred and twenty-eight patients were assigned to GI (n = 100) and GII (n = 128). Mean age was 60.1 ± 10.6 years vs. 59.4 ± 10.9 years (P = 0.64), 49% vs. 35.2% (P = 0.03) were female and 25% vs. 27.3% (P = 0.70) were diabetic. An total early RAO incidence of 10.5% and a late RAO incidence of 9.1% were observed. Ten GI patients (10%) had early RAO when compared to 14 (19.9%) in GII (χ² = 0.05; HR: 1.09; P = 0.82). On the 30-day follow-up RAO was observed in 6 GI patients (7.5%) when compared to 11 GII patients (10.4%) (χ² = 0.45; HR = 1.38; P = 0.50). CONCLUSIONS: In our study no association was found between reused vascular introducers and early and late RAO in patients undergoing cardiac catheterization.

Reuse of single-use devices: Looking back, looking forward.

The reuse of medical devices marked as ‘single use’ by manufacturers has been going on for several decades. The process has been rationalized and legislated in the West as well as in Japan. However, the practice continues in an unregulated manner in India due to a paucity of guidance from the Food and Drug Administration in India. We trace the evolution of reuse policies, look at the prevalent practices in the Indian and international contexts, analyse the available Indian literature and address the ethical and economic implications of reuse. We also suggest some guidelines which may be adopted to formulate policies.

Reutilização de cateteres cardíacos de eletrofisiologia: [revisão] / Reuse of electrophysiology cardiac catheters: [review]

Objetivo: Exibir de forma ampla e criteriosa, os protocolos e conclusões dos principais pesquisadores em relação ao reprocessamento e reuso dos cateteres cardíacos de eletrofisiologia, em procedimentos diagnósticos e terapêuticos. Materiais e métodos: A fonte de busca desta pesquisa foi constituída da base eletrônica: PubMed/MEDLINE e SciELO/LILACS. Não houve restrições quanto ao período de análise dos artigos e não foram excluídos estudos por motivos de idiomas. Os termos iniciais de busca foram: reprocessamento, reutilização, dispositivos de uso único, cateter (reprocessing, reuse, single use devices, catheter). Na análise dos cateteres, são observados e testados alterações da integridade física e mecânicas, integridade elétrica, resíduos biológicos e químicos e por fim, potencial de infectividade dos cateteres submetidos a processos de reprocessamento. Resultados: A literatura aponta que há falta de protocolos validados para os diversos dispositivos de uso único reprocessados, dentre eles, os cateteres cardíacos. A maior parte dos estudos não demonstrou haver diferenças significativas entre o uso de dispositivos novos e reprocessados, entretanto, como não existem protocolos validados a respeito do tema, isto deve ser considerado antes de qualquer conclusão. Conclusão: Há uma carência de estudos clínicos controlados sobre o reprocessamento de cateteres cardíacos, sendo a maioria dos estudos de caráter experimental. O alto custo destes dispositivos e a possibilidade de reuso, sem prejuízo para os pacientes, têm estimulado a elaboração de trabalhos científicos com o objetivo de criar protocolos de reprocessamento válidos. Novos estudos de maior impacto e relevância serão necessários para responder estes questionamentos com segurança.

Segurança e eficácia da reutilização de materiais para angioplastia coronária percutânea: estudo REMCLI-ATC / Safety and effectiveness of reprocessed PTCA materials: the REMCLI-ATC study

Introdução: Apresentamos nossa experiência no estudo REMCLI-ATC (REutilization de Materiales no hospital das CLinicas-ATC), que foi desenvolvido no Setor de Hemodinâmica do Departameneto de Cardiologia do Hospital de Clínicas da Faculdade de Medicina de Montevidéu, Uruguai , entre setembro de 2001 e agosto de 2002 e entre janeiro de 2003 e dezembro de 2004. Método: Foram incluídos, prospectivamente, 100 pacientes submetidos a angioplastia transluminal coronária (ATC), nos quais se utilizou aleatoriamente material novo (grupo 1, n = 49) ou reesterilizado (grupo 2, n = 51), analisando-se uma série de variáveis que avaliaram a eficácia e a segurança de cada um dos grupos. Resultados: O sucesso clínico e angiográfico no grupo 1 foi de 100 por cento e no grupo 2, de 96 por cento (p = 0,54). Não foram observadas diferenças em relação ao número de cateteres-guia e balões utilizados na ATC entre os grupos. O volume de contraste e os tempos de radioscopia e do procedimento também não apresentaram diferenças. As complicações maiores ocorreram somente no grupo 2 (0 por cento vs. 3,9 por cento; p = 0,17) e as menores ocorreram em ambos os grupos (6,1 por cento e 9,8 por cento, respectivamente; p = 0,48). Conclusão: concluímos, portanto, que é técnicamente factível e seguro utilizar material reesterilizado nas ATCs, o que permitiria, uma economia considerável para países como o Uruguai, com recursos econômicos limitados.

Background: We describe our experience in the REMCLIATC (REutilización de Materiales no hospital das CLInicasATC) study, which was developed at the Hemodynamics Section of the Department of Cardiology of the Hospital de Clínicas of the Medicine School of Montevideo, Uruguay, from September 2001 to August 2002 and from January 2003 to December 2004. Methods: A hundred patients were prospectively included and treated with Percutaneous Transluminal Coronary Angioplasty (PTCA) with new (group 1, n = 49) or reprocessed (group 2, n = 51) material. Both groups were evaluated through variables that tested safety and efficacy of each strategy. Results: The clinical and angiographic success rate was 96% with reprocessed material and 100% with new material (p = 0.54). No significant differences were found between the groups regarding the number of guide catheters, guides and balloons used in the PTCA. The volume of contrast medium, radioscopy times and procedure times were also similar. Major complications were seen only in group 2 (0% vs. 3.9%, p = 0.17), while minor complications occurred in both groups (6.1% and 9.8%, respectively; p = 0.48). Conclusion: Our data showed that it is technically possible and also safe to treat patients using reprocessed material in PTCA procedures. Theoretically this would result in an important resource saving in economically limited countries like Uruguay.

Cálculo dos custos do reprocessamento de pinças de uso único utilizadas em cirurgia video-assistida / Calculation of the reprocessing costs of single-use tongs used in video-assisted surgeries

O trabalho objetivou desenvolver proposta metodológica para cálculo dos custos do reprocessamento de pinças de cirurgia vídeoassistida de uso único. O reuso freqüente desses artigos ocorre pelo alto custo, entretanto, poucos estudos foram desenvolvidos a respeito desse enfoque. Elaborou- se um fluxograma com cada fase de reprocessamento, permitindo identificação dos componentes dos custos quanto à mão- de- obra, materiais e gastos indiretos. Pautado nesses dados, pôde-se construir a proposta metodológica para o cálculo de custos, baseada no método de custeio por absorção, incluindo a planilha para coleta de dados.

The frequent reuse of disposable forceps instruments is justified by their high cost. However, few studies have been carried out on this topic. The objective ofthis study was to develop a methodological proposal for calculatingthe reprocessing costs for these instruments used in videoassistedsurgery. A flowchart was developed for each phase of the reprocessing. This allowed subsequent identification of the cost components in terms of labor, materials and indirect expenses. From these data, a methodological proposal for cost calculation could be created, based on the Full Absorption Costing Method, including the spreadsheet for data collection.

El trabajo tuvo como objetivo desarrollar propuesta metodológicapara el cálculo de los costos del reprocesamiento de pinzas de cirugía video-asistida de uso único. El uso frecuente de esos artículos ocurre por el alto costo, no obstante, pocos estudiosfueron desarrollados respecto a ese enfoque. Se elaboró un fluxogramacon cada fase del reprocesamiento,permitiendo la identificación de los componentes de los costos en cuanto a la mano de obra, materiales y gastosindirectos. Teniendo como pauta esos datos, se puede construir la propuesta metodológica para el cálculo de costos, con base en el método de costeo por absorción, incluyendo la planilla pararecolección de datos.

A study on powdering of reusable surgical gloves.

OBJECTIVES: To study the need of powdering surgical gloves and to produce a powdering machine. MATERIAL AND METHOD: The need of powdering surgical gloves was done by questionnaires to directors or chiefs of purchase departments in 29 hospitals across the country. The practice in powdering surgical gloves was given by chiefs of the central sterile supply department (CSSD). A powdering machine was produced by the researchers in consultation with CSSD personnel in a hospital. The quality of powdering surgical gloves was evaluated by infection control nurses in the hospital. Cost comparison was done by a health economist. RESULTS: The study in 2002 revealed that all of the 29 hospitals used recycled surgical gloves. Powdering of surgical gloves was done by hand in 27.6% and by powdering machine in 62.10%. Corn powder was used in 55.2% and talc in 41.4%.Defects in powdering ranged from 1.1% to 51.7%. No defects was found in surgical gloves powdered by the machine produced by the researchers. The costs for powdering and one pair of reused surgical gloves were 0.10 and 5.59 baht respectively. CONCLUSION: Surgical gloves were reused in all hospitals in Thailand The powdering machine was effective and was not difficult to make.

Cost-effectiveness and safety of reusable tracheal suction tubes.

OBJECTIVES: To evaluate whether the repetitive use of disposable tracheal suction tubes is cost-effective and safe over the single use. MATERIAL AND METHOD: The cost intrinsic to the washing, cleaning, re-sterilization by ethylene oxide gas, and processing was determined and compared to the cost generated by disposable tubes. The reused disposable suction tubes were also determined for their properties in physical characters and probable contamination and damages. RESULTS: The evaluation showed that cost from single-use disposable suction tubes (8.66 baht) was cheaper than expenses generated from processing steps for recycling of disposable tubes (9.92 baht). The use of a disposable tube only once should minimize the risks posed by the use of the potentially unsafe reused disposable tubes both to the patients and health care workers. CONCLUSION: Recycling of tracheal suction tubes was neither cost-effective nor safe.

Reuse of cellulose acetate membrane strips for protein and haemoglobin electrophoretic analysis.

The exorbidant cost of electrophoretic analysis, many a times becomes the major limitation factor. As most of the clinical laboratories import the cellulose acetate membrane which costs 5 to 6 U.S. $ that is Rs. 180/- to Rs. 210/-, the final cost goes upto Rs. 350/- to Rs. 500/-. We have observed that CAN strips can be effectively reused 6 to 7 times for subsequent electrophoretic analysis.

Reuse of pacemaker.

Implantation of a permanent pacemaker is an expensive proposition for the poor patients of our country. Many patients on permanent pacemaker die prematurely due to diseases or conditions not related to pacemaker function. The purpose of this study was to reuse these pacemakers after thorough cleansing and proper sterilisation in other suitable patients and compare the efficiency of the reused pacemakers with that of newly implanted ones. Between April 1979 and April 1992, 642 patients implanted with reused pacemakers were studied. The study population consisted of patients ranging in age from 15-85 years and included patients of both sexes (M:F = 4:1). The mean period of follow-up was 7.5 +/- 5.6 years. Removal and reimplantation of the pulse generators was carried out after obtaining the State Government's approval, informed consent of the donors, relatives and recipients. The functional status of the pulse generators was tested by a "pacing system analyser". The clinical indications for reuse were chronic complete heart block, symptomatic bifascicular heart block, sick sinus syndrome and chronic complete heart block with congestive heart failure, in decreasing order of frequency. In terms of morbidity and mortality, the efficacy of reused pacemakers was highly comparable with that of newly implanted ones. The infection rate in cases of reuse from dead patients was comparable to that in cases of new implantation. However, pacemakers reused in the same patient showed a high rate of infection. With the aid of newer generations of antimicrobials, infection when matched with efficacy and economy (of reuse) does not seem to be a major factor against pacemaker reuse.

Utilization of used human immunodeficiency virus ELISA microplates & surplus reagents for HIV antibody testing.

Used non-competitive enzyme-linked immunosorbent assay (ELISA) microplates were washed and reused to test samples and positive and negative controls, utilising the surplus reagents provided with the kit, which otherwise would have been discarded as useless after the entire 960 test kit had been utilized. These surplus reagents could be used for additional 220 tests over and above the recommended 960 tests per kit. A total of 839 unknown serum samples, 54 negative controls and 36 positive controls were tested using both washed and fresh (new) ELISA plates simultaneously. The optical density (OD) value of the control sera was within the prescribed limits in both the methods and 15 samples were found to be positive for HIV antibodies by the fresh plates whereas the washed plates showed 18 samples to be positive for HIV antibodies. None of the samples positive by fresh plates were negative by washed plates.

Comparison of costs for reusable and disposable syringes.

The cost for reusable and disposable syringes was studied in Maharaj Nakorn Chiang Mai Hospital, a university hospital in the northern part of Thailand. The cost for operating reusable syringes includes that for cleaning and sterilization. This consists of labour, replacement for defective syringes, tap water, electricity, depreciation of instruments. The cost for disposable items was calculated from the number of syringes used multiplied by the price of the individual size. Results showed that 34,598 syringes were used monthly from August to October 1989. The cost for reusable syringes was 84,714 baht in comparison with 81,874 baht for disposable items. The latter was cheaper by 2,840 baht per month. It is concluded that disposable syringes are cheaper, at least in this university hospital.

Validación de una hoja de cálculo electrónica comercial para la prescripción de hemodiálisis según el modelo cinético de la úrea, considerando el reuso del dializador / Mathematical scheme to prescribe chronic hemodialysis considering the kinetic model and dializer reuse

Se presenta un modelo matemático de prescripción dialítica para pacientes con Insuficiencia Renal Crónica Terminal, basado en la cinética de úrea formulada por Gotch y Sargent, con modificaciones en su aplicación al tomar en cuenta el reuso del filtro y usar un software comercial (Lotus 1-2-3). Los resultados vistos a través de las concentraciones de úrea sérica esperadas y observadas en 17 pacientes sujetos del estudio, demostrarón una correlación lineal de r=0.77. La prescripción fue réalizada con cambios dietéticos para ajustar la ingesta proteica a 0.8 g/Kg/día, lo que ocurrió en el 70.5 por ciento de los pacientes, y cambios en el esquema dialítico medido para obtener un Kt/V en 1, lo que ocurrió en el 82 por ciento de los pacientes. Se discute la utilidad del modelo propuesto en la valoración de la ingesta proteica de los pacientes y el mejor uso de las variables intradialíticas