27 research outputs found
Inhalation characteristics of asthma patients, COPD patients and healthy volunteers with the Spiromax® and Turbuhaler® devices: a randomised, cross-over study.
No full textBACKGROUND: Spiromax® is a novel dry-powder inhaler containing formulations of budesonide plus formoterol (BF). The device is intended to provide dose equivalence with enhanced user-friendliness compared to BF Turbuhaler® in asthma and chronic obstructive pulmonary disease (COPD). The present study was performed to compare inhalation parameters with empty versions of the two devices, and to investigate the effects of enhanced training designed to encourage faster inhalation. METHODS: This randomised, open-label, cross-over study included children with asthma (n = 23), adolescents with asthma (n = 27), adults with asthma (n = 50), adults with COPD (n = 50) and healthy adult volunteers (n = 50). Inhalation manoeuvres were recorded with each device after training with the patient information leaflet (PIL) and after enhanced training using an In-Check Dial device. RESULTS: After PIL training, peak inspiratory flow (PIF), maximum change in pressure (∆P) and the inhalation volume (IV) were significantly higher with Spiromax than with the Turbuhaler device (p values were at least <0.05 in all patient groups). After enhanced training, numerically or significantly higher values for PIF, ∆P, IV and acceleration remained with Spiromax versus Turbuhaler, except for ∆P in COPD patients. After PIL training, one adult asthma patient and one COPD patient inhaled <30 L/min through the Spiromax compared to one adult asthma patient and five COPD patients with the Turbuhaler. All patients achieved PIF values of at least 30 L/min after enhanced training. CONCLUSIONS: The two inhalers have similar resistance so inhalation flows and pressure changes would be expected to be similar. The higher flow-related values noted for Spiromax versus Turbuhaler after PIL training suggest that Spiromax might have human factor advantages in real-world use. After enhanced training, the flow-related differences between devices persisted; increased flow rates were achieved with both devices, and all patients achieved the minimal flow required for adequate drug delivery. Enhanced training could be useful, especially in COPD patients
The Inhalation Characteristics of Patients When They Use Different Dry Powder Inhalers
No full textBackground: The characteristics of each inhalation maneuver when patients use dry powder inhalers (DPIs) are important, because they control the quality of the emitted dose.
Methods: We have measured the inhalation profiles of asthmatic children [CHILD; n=16, mean forced expiratory volume in 1 sec (FEV1) 79% predicted], asthmatic adults (ADULT; n=53, mean predicted FEV1 72%), and chronic obstructive pulmonary disease (COPD; n=29, mean predicted FEV1 42%) patients when they inhaled through an Aerolizer, Diskus, Turbuhaler, and Easyhaler using their “real-life” DPI inhalation technique. These are low-, medium-, medium/high-, and high-resistance DPIs, respectively. The inhalation flow against time was recorded to provide the peak inhalation flow (PIF; in L/min), the maximum pressure change (ΔP; in kPa), acceleration rates (ACCEL; in kPa/sec), time to maximum inhalation, the length of each inhalation (in sec), and the inhalation volume (IV; in liters) of each inhalation maneuver.
Results: PIF, ΔP, and ACCEL values were consistent with the order of the inhaler's resistance. For each device, the inhalation characteristics were in the order ADULT>COPD>CHILD for PIF, ΔP, and ACCEL (p4 L and ΔP >4 kPa.
Conclusion: The large variability of these inhalation characteristics and their range highlights that if inhalation profiles were used with compendial in vitro dose emission measurements, then the results would provide useful information about the dose patients inhale during routine use. The inhalation characteristics highlight that adults with asthma have greater inspiratory capacity than patients with COPD, whereas children with asthma have the lowest. The significance of the inhaled volume to empty doses from each device requires investigation
Improved Metered Dose Inhaler Technique When a Coordination Cap Is Used
No full textAbstract Background: Patients often experience problems using metered dose inhalers (MDIs), particularly poor coordination between inhalation start and dose actuation (TsIn: time difference between the start of an inhalation and the actuation of a dose), and fast peak inspiratory flow (PIF). We investigated if a coordination cap (CAP), with instruction to prolong inhalation, solved these problems. Methods: Inhalation profiles [PIF, TsIn, inhalation volume (Vi), inhalation time (Ti)] of patients with stable asthma prescribed an MDI were measured using their real-life technique (MDI). Inhalation profiles were then measured with the cap fitted (MDI+CAP). These patients were then instructed to inhale through the MDI+CAP for 5 sec, and inhalation profiles measured (MDI+CAP+TRAIN). TsIn was only measured for the MDI. Results: Resistances of MDI and MDI+CAP were 0.0135 and 0.0243 (cm H2O)½/(L/min), respectively. Seventy-one patients were evaluated, with mean [standard deviation (SD)] forced expiratory volume over 1 sec % predicted normal of 78.3% (21.0). Following MDI, MDI+CAP, and MDI+CAP+TRAIN: mean (SD) PIF was 155.6 (61.5), 112.3 (48.4), and 73.8 (34.9) L/min, respectively (p<0.001); mean (SD) Ti was 1.60 (0.60), 1.92 (0.80), and 2.99 (1.03) sec, respectively (p<0.001); and Vi was similar between stages. Twelve patients used a slow flow with the MDI alone, but only two of these patients demonstrated good coordination. With the cap in place (which ensures good coordination), the number of patients using a slow flow increased to 25 for MDI+CAP and to 50 following MDI+CAP+TRAIN. Conclusions: The cap with its effect of increasing resistance to airflow combined with the instruction to prolong inhalation time significantly decreased the inhalation flow
Novel methodology to characterise how asthma and chronic obstructive pulmonary disease patients use their inhalers and methods to improve their inhaler technique Objective assessment of how patients use inhalers
No full textInhaled administration is the mainstay of asthma and chronic obstructive pulmonary disease (COPD) management using either a pressurised metered dose inhaler (pMDI) or a dry powder inhaler (DPI). Poor disease control and increased hospitalisations is linked to poor inhaler technique. Previous studies to assess inhaler technique have used subjective measures and there is very limited data about the inhalation characteristics used by patients when they use their inhalers.
Inhalation flow profiles when patients use their pMDI and inhalation pressure profiles when they use DPIs have been measured using 659 subjects (106 children with asthma [CHILD], 361 adults with asthma [ADULT], 142 COPD [COPD] and 50 healthy volunteers [HEALTHY]) in 5 separate studies. All patient studies used their real life inhaler technique. One of the studies also evaluated the value of using a pMDI co-ordination aid and training these patients to prolong their inhalation whilst a different one investigated the impact of using enhanced training when using a DPI.
The first study, 20 CHILD, 57 ADULT and 32 COPD subjects, revealed that the mean (SD) inhalation flows through a pMDI were 108.9 (40.4), 146.0 (58.8) and 107 (50.6) L/min, respectively and only 7, 10 and 10 used a slow flow. In the second pMDI study involving, 20 CHILD, 130 ADULTS, 31 COPD patients, their flows were 70.5 (36.4), 131.4 (60.8) and 70.9 (28.1) L/min and 5, 53 and 10 used their pMDI with good co-ordination. However only 3, 6 and 9 patients had good co-ordination and slow flow. In the third study, 71 ADULT patients, the mean (SD) pMDI inhalation flow was 155.6 (61.5) L/min which decreased (p<0.001) to 112.3 (48.4) when the pMDI was fitted with a co-ordination aid. This was due to the increased resistance to airflow from the aid. Inhalation flow further reduced (p<0.001) to 73.9 (34.9) L/min when patients were trained to prolong their inhalations. Their inhaled volumes did not change whereas mean (SD) inhalation times were 1.60 (0.21), 1.92 (0.80) and 2.66 (1.03) seconds (p< 0.001) respectively. There was a good correlation between their inhaled volume and forced vital capacity with a ratio of 0.7 suggesting that the patient used a full inhalation.
A DPI study, involving 16 CHILD, 53 ADULT and 29 COPD patients, measured inhalation characteristics through different DPIs (low to high resistance) when patients used their real life DPI inhalation manoeuvres. The inhalation characteristics were lower in CHILD and highest in ADULT. Overall flows were higher when using low resistance DPIs but the pressure changes and the acceleration of the inhalation flow were significantly higher with high resistance DPIs which suggest more efficient de-aggregation of the formulation. There was a tendency for more problems with low resistance DPIs than high resistance DPIs. The last study involved CHILD, ADULT, COPD and HEALTHY subjects (50 of each) when they inhaled through a Spiromax and a Turbuhaler (similar resistance) after standard verbal inhalation technique training and when using enhanced training with an IN-Check Dial. The order of inhalation characteristics was HEALTHY > ADULT > COPD > CHILD. Significant (p<0.001) improvements in the inhalation flows, pressure changes and acceleration of the flow were achieved in all groups after the enhanced training.
The studies provide an insight into the inhalation characteristics of patients when they use different inhalers. The main problem with pMDI use was short inhalation times and when patients were trained to prolong their inhalation then flows reduced. Enhanced training when using a DPI significantly improved the technique of all patients
Phantom used in non-destructive testing calibration: a bibliometric study / An Najjah Wahida Jasli
No full textA phantom is a highly specialised item used in medical imaging for quality control, calibration, dosimetry, and education. Regardless of their differences, the term is used interchangeably for both. Phantoms were first employed in 2D x-ray imaging techniques such as radiography or fluoroscopy, but more recently, phantoms with specialised imaging properties such as SPECT, MRI, CT, Ultrasound, PET, and other imaging methods or modalities have been developed. In this study, a bibliometric study has been conducted to recognize the trends of scientific research and the key topics related to phantoms and non-destructive testing by the available literature review. The study interval is from 1985 to 2022. The database such as Scopus and Web of Science (WoS) were used in this study. Several classifications has been made, including an analysis of the year of publication, publications by country, research area, methods and co-occurrences of author keywords, co-authorship between countries and authors. Corresponding to the specific keywords, the outcome presented by WoS and Scopus was a sum of 197 publications. The main findings show that the trends of research in this field have shown significant increase in the past two decades. Both websites have seen a regular increase in publications and has a positive impact since researchers are focusing on the phantom used in non-destructive testing. United Stated is the country that published phantom related study the most and the majority of the primary research areas are Physics and Engineering. The most common researcher’s method used in the study was an experimental method
Clarifying the dilemmas about inhalation techniques for dry powder inhalers: integrating science with clinical practice
No full textThis review integrates pharmaceutical science with routine clinical practice to explain why inhalation manoeuvres through a dry powder inhaler (DPI) should start with a gentle exhalation, away from the inhaler. Place the inhaler in the mouth and ensure the lips form a tight seal. This should be followed by an immediate forceful inhalation that is as fast as possible and continued for as long as the patient can comfortably achieve. Although this is universally accepted, there has been a lot of attention on inhalation flow as an indicator of adequate inspiratory effort. This has led to the wrong assumption that inhalation flows through each DPI should be the same, and that low flows through some DPIs suggest that dose delivery is impaired. Most miss the concept that inhalation flow together with the resistance of the DPI combine to create a turbulent energy which de-aggregates the formulation and provides an effective emitted dose. A low flow through a DPI with high resistance generates the same turbulent energy as fast flow with low resistance. Therefore, depending on the device, different inhalation flows are compatible with potentially effective use. Flow measurements should be a guide to train patients to inhale faster. The focus of inhaler technique training should be the use of the above generic inhalation manoeuvre
Training tools for inhalation devices: the need for more sophistication
No full textFrequent inhaler technique training is recommended, but methods of assessing a patient’s
existing technique are subjective. Recent publications in this journal1,2 have highlighted how
the aerosol inhalation monitor (AIM) and IN-Check device provide useful information about
metered-dose inhaler (MDI) and dry powder inhaler (DPI) use. However, more sophisticated
generic evaluations are possible; for example, useful data can be obtained by recording and
interpreting inhalation profiles in the same fashion as a flow-volume loop
Enhanced mechanical energy harvesting ability of electrospun poly(vinylidene fluoride)/hectorite clay nanocomposites
No full textPEMBIAYAAN AKAD MURABAHAH DALAM FIKIH ISLAM DAN PRAKTIKNYA PADA PERBANKAN SYARIAH DI INDONESIA
No full textAbstrak
Penelitian ini bertujuan untuk menganalisis praktik pembiayaan akad murabahah di perbankan syariah. Pembiayaan akad murabahah akan dikaji dengan perspektif fikih Islam dengan mengkomparasikan pendapat empat imam mazhab. Jenis penelitian ini adalah penelitian kepustakaan (library research). Setelah melakukan teknik pengumpulan data dengan menggunakan metode studi pustaka, penulis akan menginterpretasikan data-data tersebut menggunakan metode analisis deskriptif kualitatif. Hasil dalam penelitian ini adalah menunjukkan bahwa penambahan margin pada pembiayaan akad murabahah di perbankan syariah diperbolehkan selama tidak memberatkan pihak lainnya.
Kata Kunci: Akad Murabahah, Pembiayaan, Perbankan Syariah.
Abstract
This study aims to analyze the practice defferet payment sale in Islamic banking. The defferet payment sale will be studied from the perspective of Islamic jurisprudence by comparing the opinions of the four imams madhab. Type of this research is library research. After carrying out data collection techniques by using the literature study method, the author will interpret the data using qualitative descriptive analysis methods. The results of this study indicate that the addition of a margin on murabaha contract financing in Islamic banking is allowed as long as it does not burden other parties.
Keywords: Deffered Payment, Financing, Islamic Banking
BERMAIN PERSEPSI DAN TANDA
No full textPlaying with Perception and Sign. The art creation aims at making art works based on the spirit of playing with perception and sign, criticizing mass culture phenomena and giving new alternative in the creative process of making visual arts. The author uses the approach of lateral thinking method, brainstorming and playing in making the art work. The creating stages include exploration, improvisation and forming. The exploration is conducted to directly gather the information of mass culture in both printed or electronic media. The improvisation is made to find out various possible ideas and concepts found in the exploration stage, while the forming stage is conducted to materialize the concept into theplanned art work. The spirit of playing in the creating process of the art work can bring mental enlightenment and joyful and pleasing atmosphere. The playing with perception and sign can help construct idea and open freedom space that results in variousalternative manifestations not bound by conventional and standard norms.Playing with perception and sign enables free selection of cultural signs in order to construct the perception building. The resulting work is two-dimension painting with realistic painting technique. The painting represents the perception of thephenomena and the sign of the mass culture, while its subject matter may be classifi ed into some categories such as fashion trend phenomena, idol, communication technology, consumerism, and education as the symbol of prestige andappearance dominance. Keywords: playing, perception, sign, and mass cultur
