The long-term burden of work-related carpal tunnel syndrome relative to upper-extremity fractures and dermatitis in Washington State.

BACKGROUND: Carpal tunnel syndrome (CTS) is among the most burdensome of all musculoskeletal disorders as measured by workers' compensation claims costs and lost earnings. But the burden of CTS extends beyond direct claim costs. METHODS: A survey covering health, social, economic and work-related outcomes was administered to 1,255 injured workers whose Washington State Fund workers' compensation claims had closed 6 years previously. Logistic and linear regression methods were used to model the outcomes of CTS claimants across four separate outcome domains. RESULTS: Workers diagnosed with CTS suffer substantial deficits across all four outcome domains as compared to the two comparison groups of claimants. Former CTS claimants were almost twice as likely not to be working as compared to the fractures cohort. CONCLUSIONS: A comprehensive measurement of the burden of CTS shows losses extend beyond direct claims costs to include continuing pain, loss of function, adverse financial impacts and household disruption which extend long after claim closure. Am. J. Ind. Med. 58:1255-1269, 2015. © 2015 Wiley Periodicals, Inc.

Strategies to reduce treatment costs of peristomal skin complications.

Peristomal skin complications (PSCs) are common and troublesome and the consequences are substantial both for the patient and from a health-economic viewpoint. The purpose of this article is to demonstrate that early detection and treatment of PSCs, combined with the use of a correctly fitted and appropriate pouching system, can reduce treatment costs-in the UK, it is estimated to save £28.1m annually. A model for cost estimation of PSCs and a real-life global data set of people with stomas are used for the calculations. A high priority should be given to ensuring resources are available to provide education, guidance and assistance to people with a stoma. This would support increased awareness of the first signs of PSCs and enable self-management at an early stage.

The effects of a multi-intervention incontinence care program on clinical, economic, and environmental outcomes.

PURPOSE: The aim of the study was to assess the effects of a multi-intervention program consisting of use of new absorbent products, a structured skin care regimen, and nursing advice on clinical (incontinence-associated dermatitis [IAD]), economic, and environmental outcomes. SUBJECTS AND SETTING: The study setting was a nursing home in northern Italy. Sixty-three patients with urinary incontinence participated, including 46 women and 17 men. Their average was 84.0 ± 9.1 years (mean ± SD). Thirty-five participants were entirely dependent on others for activities of daily living, such as bathing or dressing. DESIGN: Single-group, pre-/postintervention study. METHODS: The multi-intervention program was implemented in 3 phases: (1) initial assessment of incontinence care (phase 0, baseline measurement), (2) introduction of new absorbent products for incontinence and a structured skin care regimen (phase 1), and (3) introduction of advice provided by continence nurses (phase 2). RESULTS: All 63 subjects were found to have IAD at baseline.When compared to baseline measurement, the relative risk of IAD following implementation of phase 1 (new absorbent products and structured skin care regimen) was 0.24 (95% confidence interval [CI], 0.16-0.35). Adding advice from continence nurses during this final phase (2) of the study further diminished the relative risk of IAD to 0.15 (95% CI, 0.04-0.59). In addition,the relative risk of IAD was 0.03 (95% CI 0.01-0.12) when the complete intervention (new absorbent products, structured skin care regimen, and continence nurse advice) was compared to baseline measurement. Baseline evaluation revealed that incontinent residents used an average of 5.19 absorbent products,at a mean cost of € 1.79 per day. Following introduction of the multi-intervention program, the mean number of absorbent products consumed per day was 2.02 per incontinent patient, at a mean cost of € 0.97 per day. In addition to these clinical and economic outcomes, implementation of the multi-intervention program reduced the daily production of waste generated by the nursing home from 33 to 11 kg/d. CONCLUSIONS: Results of this study suggest that a multi-intervention program, including introduction of new absorbent products, a structured skin hygiene program, and advice from continence nurses, reduce the relative risk of IAD, absorbent product use, and generation of waste materials.

EpiDex® Swiss field trial 2004-2008.

BACKGROUND: Approximately 20% of leg ulcers remain unresponsive to the best conservative standard of care. So far, these patients could either receive conventional skin grafts or had to accept their intractable wound. Skin substitutes from cell culture may represent a promising alternative to heal a major part of these patients on a non-surgical, potentially more cost-effective basis. OBJECTIVE: To systematically evaluate the first 68 patients treated in Switzerland (Swiss EpiDex® field trial 2004-2008). METHODS: Retrospective study on EpiDex treatment of a complete consecutive series of 68 patients with chronic wounds (66 chronic leg ulcers, 2 sores) unresponsive to best conservative standard of care. The primary end point was complete wound closure within 9 months after transplantation, the secondary end points change of wound surface area, pain reduction and overall judgement by the patient. Adverse effects were infection, dermatitis and others. Calculation of treatment costs was made. RESULTS: By the end of the study, 50/68 (74%) of patients had their wound completely healed [venous 29/37 (78%); mixed 7/9 (78%); others 14/22 (64%)]; 10/68 (15%) had the wound surface area reduced by >50%, and 8/68 (12%) did not respond to the EpiDex treatment. Wound pain disappeared completely in 78% and partially in 13%. Fifteen patients (22%) received antibiotics for wound infection, and 2 (3%) developed dermatitis (not related to the local therapy). Average treatment costs for venous ulcers amounted to EUR 5,357, compared to EUR 5,722-8,622 reimbursed according to the German DRG system (2010) for an in-patient skin graft. CONCLUSION: EpiDex may effectively heal up to three quarters of recalcitrant chronic leg ulcers. Thus, it represents an intermediate step to avoid costly in-patient split-skin mesh graft treatments. Patients remain mobilized, and a donor site is avoided. Large wound size or a necrotic wound bed limit the use of EpiDex. Otherwise, it offers the opportunity to avoid conventional skin grafts in a significant number of chronic leg ulcer patients.

An economic evaluation of four skin damage prevention regimens in nursing home residents with incontinence: economics of skin damage prevention.

PURPOSE: To determine the cost and efficacy of 4 different regimens of incontinence-associated dermatitis (IAD) prevention in nursing home residents. METHODS: A multi-site open-label quasi-experimental study was conducted in 16 nursing homes stratified by location in 1 of 4 regions of the United States and randomly selected. In 3 of the 4 regimens, a moisture barrier ointment or cream of different compositions was applied after each episode of incontinence, and in 1 regimen, a polymer-based barrier film was applied 3 times per week. All regimens used a pH-balanced moisturizing cleanser. Time and motion measures were documented for the amount of skin care products used; the number, type, and time of caregivers performing IAD prevention care; and the number and type of supplies used. Rates of incontinence in each nursing home were determined during a 3-day surveillance period. RESULTS: A total of 1,918 nursing home residents were screened, and 51% (n = 981) qualified for prospective surveillance of incontinence dermatitis; the majority were female (80.1%) and elderly (96% > or = 65 years old). A total of 78.6% (771/981) of the participants were incontinent of both urine and feces. Compared to the 3 regimens in which a barrier was applied after each episode of incontinence, the use of a regimen in which a barrier film was applied 3 times weekly had significantly lower costs for the barrier product, labor associated with barrier application, and total cost, which included products, labor, and supplies. There were also savings in total product (cleanser and barrier) and total labor costs. CONCLUSIONS: The use of a defined skin care regimen that includes a cleanser and a moisture barrier is associated with a low rate of IAD in nursing home residents who are incontinent. Use of a polymer skin barrier film 3 times weekly is effective for preventing incontinence-associated skin breakdown and can provide significant cost savings.

Perdas econômicas ocasionadas pelas enfermidades podais em vacas leiteiras confinadas em sistema free stall / Economic losses caused by sequels of lameness in free-stall-housed dairy cows

Avaliaram-se 55 casos clínicos de manqueira em um rebanho de 100 vacas em lactação confinadas em sistema de free stall, durante um ano. As afecções mais observadas foram abscessos de sola e talão, úlcera de sola e dermatite digital que representaram 87,3 por cento (48/55) das ocorrências. O tratamento empregado mostrou-se satisfatório com recuperação de todos os animais tratados com 24,5 dias, em média, sem ocorrência de descarte. O custo com tratamento e redução na produção de leite foi de US$95.80/vaca, o que representou US$52.69 por vaca alojada/ano. Quando se computaram as perdas reprodutivas e com mastite, obtiveram-se US$227.94 adicionais em vaca com problema de manqueira. O custo adicional anual total no rebanho decorrente de seqüelas de manqueira foi de US$12,536.70, que representou US$125.36 por vaca alojada/ano. O período de serviço e o número de serviços por concepção em vacas com problemas de manqueira e normais foram 266 e 200,5 dias e 4,3 e 3,3 serviços, respectivamente. As incidências de mastite e metrite na mesma ordem de citação anterior foram 60 por cento e 25 por cento e 29 por cento e 12,5 por cento.

Fifty-five clinical cases of lameness were evaluated in 100 lactating cows housed in a free-stall system during one year. The most observed affections were sole and heel abscesses, sole ulcers and digital dermatitis that accounted for 87.3 percent (48/55) of the occurrences. The treated cows showed satisfactory recovery (24.5 average days) without culling. The total individual cost including treatment and reduction of milk production was US$95.80/cow or US$52.69 per housed cow/year. When reproductive losses and mastitis were considered an additional cost of US$227.94 per lameness cow was estimated. The total additional annual cost from sequels of lameness was US$12.536.70 or US$152.36 per housed cow/year. The number of days open and the number of services per conception in lameness and normal cows were, respectively, 266 and 200.5 days and 4.3 and 3.3 services. Mastitis and metritis incidences, regarding the same animals, were, respectively, 60 percent and 25 percent and 29 percent and 12.5 percent.

Impact of chronic hand dermatitis on quality of life, work productivity, activity impairment, and medical costs.

BACKGROUND: The impact of chronic hand dermatitis (ChHD) on patient-reported outcomes and economic costs has not been assessed in a US population. OBJECTIVE: We sought to evaluate the quality of life, work productivity, activity impairment, and health care costs of patients with ChHD versus those without ChHD. METHODS: A 13-item self-assessment questionnaire to identify ChHD was developed and validated. Skindex-29 and Work Productivity and Activity Impairment questionnaires were used to assess quality of life and work productivity for ChHD. The survey was mailed to a random sample of 1380 members of a Massachusetts managed care organization (N = 507, response rate = 36.74%). Univariate and multivariate analyses were conducted to determine the incremental effect of ChHD on quality of life, work productivity, and activity impairment. Health insurance claims were used to assess medical costs. RESULTS: Quality of life, along with work productivity and activity impairment, were significantly worse for patients with CHD than for those without ChHD; however, there was no significant difference in work time missed. After adjusting for significant covariates, a 25% cost increase in total medical costs was found attributable to ChHD, which translates to an incremental cost of $70 per patient per month. LIMITATIONS: Survey response rate is not high; the survey respondents may not be completely representative of the nonrespondents. The cost burden of ChHD is underestimated because of the omission of over-the-counter drug and indirect costs. The multivariate models had a low goodness of fit indicated by the low R2 statistics. CONCLUSIONS: ChHD has a significant detrimental effect on quality of life, work productivity, activity impairment, and heath care costs. More awareness and treatment of this condition are needed to improve patient outcomes and decrease health care cost.

[Diagnostic cost-effectiveness of the skin biopsy in inflammatory diseases of the skin]. / Rentabilidad diagnóstica de la biopsia cutánea en las enfermedades inflamatorias de la piel. Estudio comparativo según el servicio que la realiza.

INTRODUCTION: Inflammatory skin diseases are a very heterogeneous and extensive group of entities whose clinical and pathological diagnosis is difficult. In cases where the clinical diagnosis is doubtful, the histopathological study of one or more lesions can be of great help. The aim of our work is to compare the effectiveness of the histopathological diagnosis in inflammatory skin lesions according to the department performing the biopsy. MATERIAL AND METHODS: A retrospective study was carried out on the reports for pathological study requests and the histopathological reports from the year 2003 from the Pathology Department of Hospital Santa María del Rosell. In the reports for the pathological study requests, the following data was assessed: department performing the biopsy, whether or not the type of lesion was stated on the request form, location, evolution and clinical diagnosis. The histopathological diagnoses were reviewed by one of the authors and classified into two major groups: a) specific diagnoses and b) non-specific diagnoses. Five departments took part in performing biopsies on inflammatory skin lesions: Dermatology, General Surgery, Primary Care, Internal Medicine and Gynecology. To better compare the data, we have divided the departments into two groups: 1. Dermatology Department and 2. Non-dermatology departments. We performed a statistical analysis (proportion comparison) of the specific diagnoses between the two groups and among the specific diagnoses of the non-dermatology departments. RESULTS: The total number of inflammatory skin lesions studied was 97. The Dermatology Department performed 48 biopsies, and the non-dermatology departments performed 49. There was less clinical data in the reports sent by the non-dermatological departments than in those from the Dermatology Department. The pathologist made a specific diagnosis in 77 % of the biopsies performed by the Dermatology Department, compared to 41 % of the biopsies sent by the non-dermatology departments (p < 0.001). There are no statistically significant differences among the specific diagnoses made by the departments that make up the non-dermatology group. CONCLUSION: The histopathological diagnoses made in the biopsies sent from the Dermatology Department are more specific (77 %) than those made in the biopsies performed by the non-dermatology departments (41 %). Thus, biopsies on inflammatory skin lesions should be performed by the Dermatology Department so that diagnostic effectiveness is maximized, and in order to prevent delays and inappropriate treatments that might be harmful to the patient.

Asthma and other allergic conditions in Colombia: a study in 6 cities.

BACKGROUND: No detailed information is available on the burden and impact of allergic diseases simultaneously for adults and children in Colombia and most Latin American countries. OBJECTIVES: To investigate the prevalence of asthma, allergic rhinitis, and atopic dermatitis symptoms in 6 cities in Colombia; to measure patient expenses and school days and workdays lost; to describe disease severity; and to determine levels of total and specific IgE in asthmatic subjects. METHODS: A multistage stratified random sample selection of schools with subjects aged 5 to 18 years in each city was used. Guardian subjects selected were contacted, and home visits were arranged. Subjects aged 1 to 4 years and older than 19 years were also selected randomly by systematic sampling based on the addresses of the subjects aged 5 to 18 years. Subjects with asthma symptoms were invited to provide a blood sample. RESULTS: Information was obtained from 6,507 subjects. The prevalence of asthma, rhinitis, and atopic dermatitis symptoms in the past 12 months was 10.4% (95% confidence interval [CI], 9.7%-11.1%), 22.6% (95% CI, 21.6%-23.6%), and 3.9% (95% CI, 3.4%-4.4%), respectively. Thirty-eight percent of asthmatic subjects had visited the emergency department or have been hospitalized, and 50% reported lost school days and workdays. Seventy-six percent of sampled asthmatic patients were considered to be atopic. CONCLUSIONS: The burden of disease and societal consequences of allergic entities in urban settings in countries such as Colombia are of concern but are largely ignored, perhaps because of the misconception that these diseases are of public health importance only in industrialized nations.

Clinical and cost effectiveness of a cleanser protectant lotion for treatment of perineal skin breakdown in low-risk patients with incontinence.

Perineal dermatitis due to urinary and/or fecal incontinence is a common problem. A multicenter, open label, phase II product evaluation was conducted to determine the effectiveness of a new cleanser protectant lotion in reducing perineal erythema and pain in patients at low-risk for perineal dermatitis and to compare the cost of this product to standard protocols of care. Nineteen elderly patients (14 male, 5 female, mean age 73.1 years) participated in the study. Average baseline scores for erythema and pain were 2.3 (+/- 0.5) and 1.5 (+/- 1.0), respectively (scale 0 to 4). After 7 days, both scores were significantly lower (mean scores 0.6 +/- 0.8 and 0.3 +/- 0.8, respectively; P < 0.01). Based on an average of 2.6 perineal episodes per day, the one-step product evaluated would cost $136 per patient/year less than standard protocols of care while reducing caregiver time (average 23 seconds per episode of care). Optimal perineal care may reduce the incidence of complications; studies to ascertain the safety and effectiveness of commonly used products and procedures are needed.

Munchausen syndrome in obstetrics and gynecology.

Munchausen syndrome (MS) is a well-defined clinical psychiatric entity. Furthermore, it is a complicated and intriguing problem in medicine in general and in obstetrics and gynecology in particular. The proportion of MS cases in obstetrics and gynecology is rising. This review covers relevant reports from the last four decades. Emphasis is put on the clinical expression of MS cases in obstetrics and gynecology. A discussion about their validity as such is included. Awareness of attending physicians to this type of illness in the era of patient rights, on the one hand, and the existence of defensive medicine on the other, is crucial.

Diapers and underpads, Part 2: Cost outcomes.

A randomized clinical trial was conducted at three acute care facilities between August and December 1993 to compare cost outcomes between patients managed with diapers or with underpads. The 166 patients were divided into five groups: polymer or nonpolymer underpads, polymer or nonpolymer diapers, and cloth underpads. Among other results, the average number of nonpolymer underpads used (3.4) compared to other products used (1.4 polymer underpads, 1.1 cloth underpads, 1.0 nonpolymer diapers, 1.0 polymer diapers) quantified nurses' perceptions that nonpolymer pads were not as effective as their polymer counterparts in absorbing incontinence. The nonpolymer underpad was, however, the least expensive of the products studied, even taking into account the volume of product used. The nonpolymer underpad group also took the most time for cleanup. The cloth underpad group consistently used all of the linen items, suggesting that complete bed changes were necessary. The polymer underpad group consistently used the least linen, suggesting that the incontinence episodes were successfully contained by the product. When all costs were combined for time (at $13.50 hourly aide wage), linen use and product type, there was a statistically significant difference between the five treatment groups (F 9.3, p < 0.0000). Total costs (product, linen and staff time) for diaper products were higher than either the polymer or cloth underpad groups. Recommendations, based on both parts 1 and 2 of this study are that the polymer diaper is the product of choice for the ambulatory patient, and the polymer underpad is the product of choice for the bedridden patient. The nonpolymer underpad should no longer have a place in incontinence management.

[Dermatitis in slaughtering pigs. A study of the incidence, pathology and its economic significance]. / Ontstoken huiden bij slachtvarkens. Een onderzoek naar het voorkomen, de pathologie en de economische betekenis.

The economic loss resulting from the skinning and trimming of pig carcases is estimated at from 2.5 to 3 million Netherlands guilders per annum. In addition, this dermatitis also gives rise to logistic problems. The pilot project 'Integrated Quality Control' (IQC) is concerned, among other things, with studies designed to result in an optimum method of inspection. For this purpose, the meat inspectors recorded a number of pathological findings on ante-mortem inspection, including 'dermatitis'. Living animals did not show any clinical symptoms, and the dermatitis recorded by the meat inspectors was non-specific. There was believed to be a relationship between scabies (Sarcoptes scabiei var. suis infection) on the farm and the prevalence of dermatitis on the carcases of pigs. To determine whether this dermatitis was due to scabies, pathological and histological investigations were carried out in twenty animals. The recordings of the meat inspector were also analysed. Histopathological findings suggested parasitic infection, also in view of the fact that sarcoptic infection is known to coincide with allergic reactions. Dermatitis was detected in 5,712 out of 722,273 carcases (0.79 per cent) examined in a single plant in 1987; 1,855 cases (1.27 per cent) occurring in the winter, 1,798 cases (0.96 per cent) in the spring, 1,357 cases (0.65 per cent) in the summer and 710 cases (0.39 per cent) in the autumn. With the exception of the winter and spring, the consecutive seasons differed significantly (p less than 0.01). 136,434 animals of sixty-nine pig farms which took part in the IQC programme, were examined in 1987. The prevalence of carcases showing dermatitis on these farms varied from 0 to 6.3 per cent, averaging 0.66 per cent. The pathological findings in these investigations suggest a causal relationship between scabies and 'dermatitis' as recorded by the meat inspector.