A multicentre comparative evaluation: washable pants with an integral pad for light incontinence

Formulation, characterization and physicochemical evaluation of ranitidine effervescent tablets

PURPOSE

The aim of this study was to design, formulate and physicochemically evaluate effervescent ranitidine hydrochloride (HCl) tablets since they are easily administered while the elderly and children sometimes have difficulties in swallowing oral dosage forms.

METHODS

Effervescent ranitidine HCl tablets were prepared in a dosage of 300 mg by fusion and direct compression methods. The powder blend and granule mixture were evaluated for various pre-compression characteristics, such as angle of repose, compressibility index, mean particle size and Hausner's ratio. The tablets were evaluated for post-compression features including weight variation, hardness, friability, drug content, dissolution time, carbon dioxide content, effervescence time, pH, content uniformity and water content. Effervescent systems with appropriate pre and post-compression qualities dissolved rapidly in water were selected as the best formulations.

RESULTS

The results showed that the flowability of fusion method is more than that of direct compression and the F5 and F6 formulations of 300 mg tablets were selected as the best formulations because of their physicochemical characteristics.

CONCLUSION

In this study, citric acid, sodium bicarbonate and sweeteners (including mannitol, sucrose and aspartame) were selected. Aspartame, mint and orange flavors were more effective for masking the bitter taste of ranitidine. The fusion method is the best alternative in terms of physicochemical and physical properties.

Absorbent products for incontinence: ?treatment effects? and impact on quality of life

AIM

This study aimed to determine how the use and characteristics of absorbent products for incontinence impact on women's quality of life, and to examine the concept of 'treatment effects' in the context of pad use.

METHOD

Key pad performance characteristics were identified from the literature and focus group work. Semi-structured interviews with 99 women with light incontinence were used to investigate the impact of pad use on women's quality of life, including both positive and negative 'treatment effects', and to rank pad characteristics by their importance.

RESULTS

Achieving effective and discrete containment of urine was the dominant factor impacting on women's lives. Sub-themes embraced physical effects, psychological impact and social functioning. The five pad characteristics ranked most important for day time use were: 'to hold urine, to contain smell, to stay in place, discreteness, and comfort when wet. For night use discreteness was replaced by to keep skin dry'. High levels of reported anxiety were associated with perceived risk of poor pad performance, lack of discreteness and need for complex regimes for pad management.

CONCLUSION

Insufficient attention has been paid to the balance between the beneficial and negative treatment effects of absorbent pads to date. Existing continence-related quality of life measures are not designed for conditions where change in symptoms is not an outcome measure. The study findings provide the basis for developing a more sensitive, patient-oriented, quality of life measure for pad-users which can aid product selection, new product development and inform future evaluative comparisons between products/products and treatments.

RELEVANCE TO CLINICAL PRACTICE

This paper illustrates the complex influence on quality of life caused by using absorbent pads to contain incontinence. It raises awareness of the importance of careful selection of the most appropriate pad for each individual to minimize unfavourable side effects, and the need for a new quality of life measure designed for pad-users.

Absorbent products for light urinary incontinence in women

BACKGROUND

Incontinence is a common and embarrassing problem which has a profound effect on social and psychological well-being. Many people wear absorbent products to contain urine leakage and protect their clothes. It can be difficult to define light urinary incontinence because urine volumes, flow and frequency rates may vary substantially whilst still being considered 'light'. Light incontinence may encompass occasional (monthly) leaks of very small amounts (e.g. 1 g to 2 g) up to frequent leaks (several times per day) of larger amounts (e.g. 20 g to 50 g). A practical definition is urine loss that can be contained within a small absorbent pad (typically 50 g to 500 g; ISO 1996).

OBJECTIVES

To assess the effectiveness of different types of absorbent product designs for women with light urinary incontinence.

SEARCH STRATEGY

We searched the Cochrane Incontinence Group Specialised Trials Register (3 May 2006) and the reference lists of relevant articles were perused.

SELECTION CRITERIA

TYPES OF STUDIES: All randomised or quasi-randomised trials of absorbent products for women with light urinary incontinence.

TYPES OF PARTICIPANTS

Women with light urinary incontinence. TYPES OF INTERVENTION: Absorbent products (disposable insert pads, menstrual pads, washable pants with integral pad, washable insert pads) suitable for light incontinence.

DATA COLLECTION AND ANALYSIS

Two review authors assessed the methodological quality of potentially eligible studies and independently extracted data from the included trial.

MAIN RESULTS

One study with 85 participants met the selection criteria. This trial studied all the absorbent product designs included in this review. Data were presented on all included outcomes. For preventing leakage, for preference and for overall acceptability disposable insert pads are better than disposable menstrual pads which are better than washable pants with integral pad which are better than washable insert pads. There is no strong evidence that either disposables or washables are better for skin health. The disposable insert is the most expensive design and there is no dominant design for cost-effectiveness. There is evidence that some women will prefer alternative designs which are all cheaper than disposable inserts.

AUTHORS' CONCLUSIONS

Although data were available from only one eligible trial the data were sufficiently robust to make recommendations for practice. Disposable insert pads are typically more effective than the other designs considered. However, because they are the most expensive, providing choice of designs (or combinations of designs for different circumstances) is likely to be cost-effective.

A multi-centre evaluation of absorbent products for men with light urinary incontinence

AIMS

This study compared the performance of the four main designs of absorbents for men with light incontinence: pouches (shields), leafs (guards), washable pant with integral pad (pantegral), and small disposable pad.

MATERIALS AND METHODS

We did a multiple crossover trial. Men with light urinary incontinence were recruited. All pouches and leafs available in the UK were identified for inclusion. A single pantegral and small pad were selected based on previous evaluations for design comparison. Products were tested in random order for up to 1 week. Performance criteria (e.g., leakage and comfort) were rated using a validated product performance questionnaire. Wet product weights and amount of leakage were recorded in pad leakage diaries. "Overall opinion" for design performance was used as the primary outcome indicator.

RESULTS

Seventy-four men tested six leafs, six pouches, one pantegral, and one small pad. Leakage data was taken from 3,386 wet pads. The pouches generally performed poorly with few significant differences between products. The leafs were more variable with large and significant differences in ratings. Overall the leaf, pantegral, and small pad designs performed significantly better than the pouch (P <or= 0.01) and the pantegral design performed significantly worse than the leaf (P = 0.01). One leaf product was outstanding and performed significantly better than all other designs (P <or= 0.001).

CONCLUSION

This is the first published trial of absorbent products specifically designed for men. Results show that one particular leaf product works best, the pantegral is most suitable only for very light incontinence and the pouches are least successful.

A multicenter comparative evaluation: disposable pads for women with light incontinence

OBJECTIVE

The purpose of this study was to evaluate the current range of disposable pads for women with light incontinence available in the United Kingdom.

SETTING AND SUBJECTS

Sixty community-based women aged 50 years or older were recruited to the study from several locations throughout the United Kingdom.

METHODS

A multiple crossover design was used, which enabled all subjects to test all of the 12 products that were available on the UK market at the time of the evaluation. Two tools were used to evaluate the products: a product performance questionnaire and a pad leakage diary. This incorporated both subjective and objective outcome measures.

RESULTS

Statistically significant differences were found between the products in 13 of the 17 performance aspects, eg, ability to hold urine without leaking and the fit of the pad.

CONCLUSIONS

As a group, all of the products tested performed well in terms of their ability to hold urine without leakage. However, two products performed particularly well and scored highly on most aspects of performance and represented successful "all-round" products; these were the Tena Lady Extra and the Prevail Extra Plus.

Review of current technologies for urinary incontinence: strengths and limitations

A wide range of continence products is available, and this paper focuses on products to prevent incontinence (such as urinals and commodes) and to contain or manage urinary incontinence (such as absorbent pads, penile sheaths and urethral catheters). Drawing on results from published clinical evaluations at the Continence Product Evaluation Network at UCL and at other centres, the strengths and limitations of the major categories of incontinence products currently on the market are reviewed. It is concluded that, although products for continence have improved considerably over the last 20 years, there is considerable scope for the designer and engineer to improve on current products.

Absorbent products for the containment of urinary and/or faecal incontinence in adults

BACKGROUND

Incontinence is a distressing condition with significant medical, social and economic implications. People suffering from incontinence, who cannot be successfully cured, depend, almost exclusively, on the use of containment products to manage their symptoms.

OBJECTIVES

Many people with incontinence cannot be cured and so depend on symptomatic management. The objective was to assess the effects of different types of absorbent product for the containment of urinary and/or faecal incontinence.

SEARCH STRATEGY

We searched the Cochrane Incontinence Group trials register (March 1999), Embase (to January 1999), Cinahl (to January 1999), HealthSTAR (to January 1999) and the reference lists of relevant articles. We contacted investigators in the field to locate studies. Date of the most recent searches: March 1999.

SELECTION CRITERIA

Types of studies All randomised or quasi-randomised trials of absorbent products for the containment of urinary and/or faecal incontinence. Types of participants All adults with urinary and/or faecal incontinence were eligible. The intention was to subdivide participants by severity of underlying incontinence, level of mobility and gender, but this proved not to be feasible. Types of intervention Absorbent products (bodyworns, underpads, and different fabric types for disposable products), for any severity of incontinence.

DATA COLLECTION AND ANALYSIS

Trials were evaluated for subject relevance and methodological quality using a standard methodological quality assessment form. If applicable, data on relevant outcomes were then abstracted using a standardised data abstraction form.

MAIN RESULTS

Five studies with a total of 345 participants met the selection criteria. Two studies compared disposable with non-disposable bodyworns, one disposable with non-disposable underpads, two fluff pulp with superabsorbent polymers, and one bodyworns with underpads. Data presented on effects were available for few outcomes and were subject to potential bias.

REVIEWER'S CONCLUSIONS

The data were too few and of insufficient quality to provide a firm basis for practice. Disposable products may be more effective than non-disposable products in decreasing the incidence of skin problems and superabsorbent products may perform better than fluff pulp products. However, based on the available evidence, these conclusions can only be tentative.