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What we do
Most of the work of the CSTG focuses on the management of incontinence, particularly involving absorbent and other continence products, and falls into four main areas:
A bewildering plethora of incontinence products is available, posing major challenges to purchasers. Accordingly, one of the main aims of the CSTG is to provide buyers with independent data to help them make informed choices.
From 1996 to 2005 the Medical Devices Agency (latterly the Medicines and Healthcare products Regulatory Agency) funded the CSTG to run a programme (the Continence Products Evaluation Network) of multi-centre clinical evaluations of most the major incontinent product categories. The results were disseminated through a series of reports.
A major current project - funded under the Health Technology Assessment programme - is using the methodologies developed during the MDA work to evaluate the main categories of body worn absorbent products in use. The focus is in evaluating designs (eg diapers, inserts, pull ups) rather than specific products. One aspect of the project involves studying the health economics and quality of life issues associated with pad use. These are important matters in determining how to deliver cost-effective care. The project is scheduled to finish in the first half of 2006.
The CSTG has contributed to the generation of several national and international standards for incontinence products, especially pads. One of them - ISO 11948-1: the Rothwell Method - is used by the Purchasing and Supplies Agency as a basis for banding pads by absorbency to help them with purchasing decisions
Current research in product evaluation:
Product Design and Development
Apart from providing incontinent people and caregivers with advice on making the best use of existing products, products evaluation work produces a stream of data that is the life-blood of the CSTG technical programme, yielding insights into problems that need addressing and ideas for better products. The CSTG holds around 20 product patents of which the most successful is for Kylie Pants washable pants with integral pad for lightly incontinent men, women and children.
Current development work focuses on NICMS (Non-Invasive Continence Management Systems) - a series of products which use pump and sensor technology to replenish the storage capacity of hand-held urinals and body-worn (non-absorbent) pads for those with mobility problems. This is an EU funded project headed up by the Brunel Institute for Bioengineering.
Absorbent pads account for more than half of UK expenditure on products tpo manage incontinence. Pads have improved enormously in recent years but they still often leak. The CSTG is working on mathematical models to describe the interaction of urine with absorbent materials, so providing a more robust scientific foundation for the development of improved products. Such models aim to help pad designers develop less leaky, more comfortable products by providing tools capable of predicting how products made from different materials would perform.
Incontinence and Skin Health
If freedom from leakage is the most important goal for pads, comfort and the preservation of skin health is the second. Accordingly, the CSTG has been working for some years on understanding how wet pads and skin interact, with the ultimate objective of creating predictive mathematical models to aid designers. For the moment, however, the primary focus is on developing methods and protocols for characterising the interaction between pads, skin and urine. Incontinence and pressure sores are two mutually compounding problems and work has begun on measuring the impact of incontinence pads on pressure relieving mattresses (it can make them less effective) and of mattresses on the performance of pads (not yet clear). A further strand of work is focused on the efficacy of skin barrier creams in keeping skin dry.
Urinary incontinence and skin health: An investigation into the effects of absorbent and topical products on skin hydration and pressure distribution.
Incontinence: some facts and figures
About 6% of adult members of the UK general public (ie ~3m) experience urinary incontinence and about 50% of nursing home residents (ie ~200k). People of all ages can be incontinent but most heavily incontinent people are older. Urinary incontinence is particularly common among women: 1 in 3 women will suffer from incontinence at some stage of their life. Dealing with incontinence costs the UK NHS around £425m pa (approaching 1% of the total cost of the NHS).
Embarrassment, low self-esteem, discomfort and sore skin are common among incontinence sufferers and the fear of smelling and/or leaking in public often causes social isolation. The smell of stale urine that pervades many nursing and private homes discourages visiting. Dealing with incontinence is known to be high on the list of unpleasant tasks among caregivers (professional and informal). Incontinence is second only to dementia as a precipitating factor for moving an elderly relative into a nursing home.
Much incontinence can be cured by addressing the underlying cause using drugs, surgery or physiotherapy. However, complete cure is not always possible and even those who are successfully treated may have to live with incontinence while they wait for surgery or for physiotherapy to yield its benefits. Still others may not be candidates for treatment or may choose management over attempted cure. For all such people, the challenge is to minimise the impact of incontinence on their quality of life, and this usually involves using some kind of continence product. The UK market for pads and appliances to contain incontinence is estimated at £143m, of which pads consume more than half (about 58%).