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  1. Decision tree model for early use of semi-elemental formula versus standard polymeric formula in critically ill Malaysian patients: A cost-effectiveness study
    Adam A, Ibrahim NA, Tah PC, Liu XY, Dainelli L, Foo CY
    JPEN J Parenter Enteral Nutr, 2023 Nov;47(8):1003-1010.
    PMID: 37497593 DOI: 10.1002/jpen.2554
    BACKGROUND: Prevention of enteral feeding interruption (EFI) improves clinical outcomes of critically ill intensive care unit (ICU) patients. This leads to shorter ICU stays and thereby lowers healthcare costs. This study compared the cost of early use of semi-elemental formula (SEF) in ICU vs standard polymeric formula (SPF) under the Ministry of Health (MOH) system in Malaysia.

    METHODS: A decision tree model was developed based on literature and expert inputs. An epidemiological projection model was then added to the decision tree to calculate the target population size. The budget impact of adapting the different enteral nutrition (EN) formulas was calculated by multiplying the population size with the costs of the formula and ICU length of stay (LOS). A one-way sensitivity analysis (OWSA) was conducted to examine the effect each input parameter has on the calculated output.

    RESULTS: Replacing SPF with SEF would lower ICU cost by MYR 1059 (USD 216) per patient. The additional cost of increased LOS due to EFI was MYR 5460 (USD 1114) per patient. If the MOH replaces SPF with SEF for ICU patients with high EFI risk (estimated 7981 patients in 2022), an annual net cost reduction of MYR 8.4 million (USD 1.7 million) could potentially be realized in the MOH system. The cost-reduction finding of replacing SPF with SEF remained unchanged despite the input uncertainties assessed via OWSA.

    CONCLUSION: Early use of SEF in ICU patients with high EFI risk could potentially lower the cost of ICU care for the MOH system in Malaysia.

  2. Fulltext Bioinspired Conductive Enhanced Polyurethane Ionic Skin as Reliable Multifunctional Sensors
    Zhao B, Yan J, Long F, Qiu W, Meng G, Zeng Z, et al.
    Adv Sci (Weinh), 2023 Jul;10(19):e2300857.
    PMID: 37092565 DOI: 10.1002/advs.202300857
    Ionogels prepared from ionic liquid (IL) have the characteristics of nonevaporation and stable performance relative to traditional hydrogels. However, the conductivities of commonly used ionogels are at very low relative to traditional hydrogels because the large sizes of the cation and anion in an IL impedes ion migration in polymer networks. In this study, ultradurable ionogels with suitable mechanical properties and high conductivities are prepared by impregnating IL into a safe, environmentally friendly water-based polyurethane (WPU) network by mimicking the ion transport channels in the phospholipid bilayer of the cell membrane. The increase in electrical conductivity is attributed to the introduction of carboxylic acid in the hard segment of WPU; this phenomenon regularly arranges hard segment structural domains by hydrogen bonding, forming ionic conduction channels. The conductivities of their ionogels are >28-39 mS cm-1 . These ionogels have adjustable mechanical properties that make the Young's modulus value (0.1-0.6 MPa) similar to that of natural skin. The strain sensor has an ultrahigh sensitivity that ranges from 0.99 to 1.35, with a wide sensing range of 0.1%-200%. The findings are promising for various ionotronics requiring environmental stability and high conductivity characteristics.
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