Blinded Comparative Review of Lubricants Commonly Used for Split-Thickness Skin Graft Harvest.

Lubricating agents facilitate effective harvesting of split-thickness skin grafts. Multiple agents, including water-based gel, mineral oil, glycerin, and poloxamer 188, have been utilized in this capacity. The agent selected is typically at the discretion of the provider and institution, as a single "ideal" lubricant remains to be objectively established. Furthermore, a recent discontinuation of Shur-Clens® Skin Wound Cleanser1 (a wound cleansing solution consisting of the surfactant poloxamer 188) has prompted the search for a suitable substitute for many providers. The purpose of this study is to directly compare five lubricants (including a novel surgical lubricant-based solution) to select a preferred agent. Four practitioners blindly tested five lubricants while harvesting a split-thickness skin graft on a porcine skin model (glycerin, mineral oil, saline, poloxamer 188, and a novel lubricant solution created with surgical lube and sterile water). The results were recorded on a Likert scale where 1 indicated poor performance and 5 indicated excellent performance. Data were pooled, and means were compared with analysis of variance and post hoc Tukey test. The cost of each lubricating solution was also reported. Mean scores for each of the solutions were as follows: dry control = 1.1 ± 0.1; glycerin = 2.62 ± 1.02, saline = 3.88 ± 0.81, mineral oil = 3.75 ± 1.00, novel water-based lubricant solution = 4.63 ± 0.71, and poloxamer 188 = 3.88 ± 0.81. All solutions were superior to dry control (P < .01). Glycerin was noted to have statistically lower scores than all of the other solutions (P < .01). The novel water-based surgical lubricant solution had significantly higher mean scores than both glycerin (P < .01) and mineral oil (P < .05). Each solution was compared according to dollars per 100cc with glycerin and Shur-Clens® representing the most expensive options at almost $3/100cc and saline the least expensive at less than $0.15/100cc. In a porcine skin model, the novel water-based surgical lubricant solution had the best performance. It was statistically superior to glycerin and mineral oil and was also found to be the most cost-effective option in terms of overall performance compared with relative cost. Glycerin had the worst performance with statistically lower scores than all other solutions. Glycerin was also found to be the least cost-effective due to a large discrepancy between high cost and low overall performance. Saline performed better than expected. These results may be skewed due to the inherently greasy nature of the butcher shop porcine skin, creating limitations and decreasing the fidelity of the model. In a search for the "ideal" lubricant, other models should be further studied.

Manual de procedimientos para el control de combustibles y lubricantes en la Universidad de Ciencias Médicas de Santiago de Cuba / Manual of procedures for control of fuels and lubricants at the University of Medical Sciences of Santiago de Cuba

La investigación se fundamentó en la carencia de un manual de procedimientos para el control de combustibles y lubricantes en la Universidad de Ciencias Médicas de Santiago de Cuba, por lo cual se procedió a la elaboración de uno que permitiera un mayor control de estos portadores energéticos en las áreas de economía y servicios. Se realizó un estudio exploratorio para conocer las funciones ejecutadas por cada funcionario que interviene en el proceso de planificación, compra, uso y control del preciado liquido; para ello se tuvieron en cuenta, además de la Norma ISO 9001:2000, indicaciones, circulares, resoluciones, normativas y lineamientos de carácter obligatorio, emitidos por los ministerios correspondientes, así como también otros materiales de apoyo, incluidas entrevistas personales con trabajadores de experiencia. Se cuidó en todo momento que no se perdiera la interrelación e identificación de los procedimientos para mantener la congruencia entre las partes

The research was based on the lack of a procedures manual for the control of fuels and lubricants at the University of Medical Sciences in Santiago de Cuba, so that it was proceeded to develop the one providing a greater control of these energetic carriers in the economy and services areas. An exploratory study was carried out to know the functions of each staff member involved in the planning, purchase, use and control of the precious liquid. For this purpose, besides the Norma ISO 9001:2000, indications, circulars, resolutions, regulations and mandatory guidelines issued by relevant ministries were taken into consideration, as well as other supporting materials, including interviews with experienced workers. At all times care was taken not to lose the relationship and identification of procedures to maintain consistency between the parties

Manual de procedimientos para el control de combustibles y lubricantes en la Universidad de Ciencias Médicas de Santiago de Cuba / Manual of procedures for control of fuels and lubricants at the University of Medical Sciences of Santiago de Cuba

La investigación se fundamentó en la carencia de un manual de procedimientos para el control de combustibles y lubricantes en la Universidad de Ciencias Médicas de Santiago de Cuba, por lo cual se procedió a la elaboración de uno que permitiera un mayor control de estos portadores energéticos en las áreas de economía y servicios. Se realizó un estudio exploratorio para conocer las funciones ejecutadas por cada funcionario que interviene en el proceso de planificación, compra, uso y control del preciado liquido; para ello se tuvieron en cuenta, además de la Norma ISO 9001:2000, indicaciones, circulares, resoluciones, normativas y lineamientos de carácter obligatorio, emitidos por los ministerios correspondientes, así como también otros materiales de apoyo, incluidas entrevistas personales con trabajadores de experiencia. Se cuidó en todo momento que no se perdiera la interrelación e identificación de los procedimientos para mantener la congruencia entre las partes(AU)

The research was based on the lack of a procedures manual for the control of fuels and lubricants at the University of Medical Sciences in Santiago de Cuba, so that it was proceeded to develop the one providing a greater control of these energetic carriers in the economy and services areas. An exploratory study was carried out to know the functions of each staff member involved in the planning, purchase, use and control of the precious liquid. For this purpose, besides the Norma ISO 9001:2000, indications, circulars, resolutions, regulations and mandatory guidelines issued by relevant ministries were taken into consideration, as well as other supporting materials, including interviews with experienced workers. At all times care was taken not to lose the relationship and identification of procedures to maintain consistency between the parties(AU)

Intraurethral lubricants: a critical literature review and recommendations.

In current clinical practice, lidocaine gel is widely used as a local anesthetic lubricant before various forms of transurethral instrumentation. Over the past few years, the value of local anesthesia during urethral catheterization and flexible or rigid cystoscopy has been questioned. Strong data are lacking, and the results from the different studies are contradictory. As a result, the correct use of the intraurethral gels is, for the most part, left to individual preference. The purpose of this review is to provide an overview of the characteristics of the intraurethral gels, to assess the effectiveness, and to define evidence-based indications for their use.

Review of recycling performance indicators: a study on collection rate in Taiwan.

The Taiwan Environmental Protection Administration (Taiwan EPA) launched a national Extended Producer Responsibility (EPR) system after integrating eight private recycling organizations in 1998. After that, the environmental performance of the EPR system brought a lot of attention to policy makers. Many studies show positive environmental effects of the EPR system in Taiwan. However, there are controversial questions remained, such as whether the performance indicators used are the right choice to estimate the environmental effects of the recycling policy? Can those estimated results really reflect the performance of the system? This paper would therefore like to more accurately evaluate the performance indicators of the EPR system based on data observed over the past decade in Taiwan. In the process of evaluating the performance indicators, we have found that the collection rates for durable goods are often ignored in countries that pursue a zero waste policy. This may affect the actual recycling outcome and resource direction targeted by producers. However, in order for the collection rate to be adopted as a policy indicator, how to estimate the amounts of retired or waste products during a period is critical. In this paper, we estimate the collection rate for electrical and electronic waste by using the survival analysis and ownership data analysis approaches. We also provide a comparison of both approaches and put forward suggestions for directions in the future in solid waste management.

United States cost-effectiveness study of two dry eye ophthalmic lubricants.

PURPOSE: Dry eye is thought to be the most common ocular problem in the United States. However, it is only recently that it has been recognized as a disease with significant economic burden and impact on quality of life. This article presents an economic model of cost-effectiveness of two ophthalmic lubricants commonly used in the treatment of dry eye-Systane and Refresh Tears. METHOD: We conducted a meta-analysis, pooling the results of two clinical trials of patients with dry eye treated with Systane and Refresh Tears which presented response rates for improvements in ocular dryness, the key symptom of dry eye. An economic model was used to estimate the incremental cost-effectiveness ratio (ICER) for Systane versus Refresh Tears over a 12 month treatment period. RESULTS: Systane is significantly more effective than Refresh Tears at improving symptoms of "dryness" (75% vs 41%). Systane costs on average $57.79 per year more than Refresh Tears. Assigning a quality-adjusted life year (QALY) gain of 0.03 to responders results in an incremental cost per QALY gain of $5,837. CONCLUSION: Both Refresh Tears and Systane are effective and cost-effective interventions. Systane costs more than Refresh Tears, however clinical trial evidence shows it to be more effective. The ICER for Systane versus Refresh Tears is well below the generally accepted $50,000 per QALY threshold.