Role of Buffers in Protein Formulations

Aim
The primary objective of this study was to evaluate the impact of fluid injection viscosity in combination with different injection volumes and flow rates on subcutaneous (SC) injection pain tolerance.

/pdf/evaluation-of-the-impact-of-viscosity-injection-volume-and-4ugxonfm7u.pdf

Evaluation of the impact of viscosity, injection volume, and injection flow rate on subcutaneous injection tolerance

Psychosocial effects on caregivers for children on chronic peritoneal dialysis. Commentary

Subcutaneous injection of drug solution is widely used for continuous and low dose drug treatment. Although the drug injections have been administered for a long time, challenges in the design of injection devices are still needed to minimize the variability, pain, or skin disorder by repeated drug injections. To avoid these adverse effects, systematic study on the effects of injection conditions should be conducted to improve the predictability of drug effect. Here, the effects of injection conditions on the drug permeation in tissues were investigated using X-ray imaging technique which provides real-time images of drug permeation with high spatial resolution. The shape and concentration distribution of the injected drug solution in the porcine subcutaneous and muscle tissues are visualized. Dynamic movements of the wetting front (WF) and temporal variations of water contents in the two tissues are quantitatively analyzed. Based on the quantitative analysis of the experimental data, the permeability of drug solution through the tissues are estimated according to permeation direction, injection speed, and tissue. The present results would be helpful for improving the performance of drug injection devices and for predicting the drug efficacy in tissues using biomedical simulation.

/pdf/effective-method-for-drug-injection-into-subcutaneous-tissue-4xwp8aznkc.pdf

Effective method for drug injection into subcutaneous tissue

Aim
The aim of this study was to assess pain associated with subcutaneous injection into the abdomen and thigh of different combinations of injection speeds and volumes.

Methods
The study was a single-centre, one-visit, double-blinded, randomized controlled trial in 82 adults with type 1 or type 2 diabetes receiving daily injections of insulin or glucagon-like peptide-1 (GLP-1) agonists. Participants received 17 subcutaneous injections (12 in abdomen, 5 in thigh) of saline at different injection speeds (150, 300 and 450 µl/s), with different volumes (400, 800, 1200 and 1600 µl), and two needle insertions without any injection. Pain was evaluated on a 100-mm visual analogue scale (VAS) (0 mm no pain, 100 mm worst pain) and on a yes/no scale for pain acceptability.

Results
Injection speed had no impact on injection pain (p = 0.833). Injection of larger volumes caused significantly more pain [VAS least square mean differences 1600 vs. 400 µl, 7·2 mm (95% confidence interval – CI; 4.6–9.7; p < 0.0001); 1600 vs. 800 µl, 7.2 mm (4.4–10.0; p < 0.0001); 1200 vs. 400 µl, 3.5 mm (0.4–6.6; p = 0.025) and 1200 vs. 800 µl, 3.6 mm (0.4–6.7; p = 0.027)]. Significantly more pain occurred in the thigh versus the abdomen [9.0 mm (6.7–11.3; p < 0.0001)].

Conclusions
Injection speed had no effect on injection pain, whereas higher injection volumes caused more pain. The results of this study may be of value for guiding patients to use the appropriate injection site and technique to reduce their injection pain. Furthermore, these findings may have important implications for the development of new injection devices and drug formulations for clinical practice.

Impact of injection speed and volume on perceived pain during subcutaneous injections into the abdomen and thigh: a single‐centre, randomized controlled trial

Aims and objectives
To determine and compare the effects of four methods of subcutaneous heparin injection on pain and bruising in abdomen and thighs

Background
Subcutaneous heparin injection is a common nursing clinical intervention Nurses frequently inject heparin subcutaneously and this action often results in some complications such as bruising, haematoma, pain and induration in the injection site There are also some other factors inducing complications associated with heparin injection, including the injection site and the injection duration

Design
A quasi-experimental within-subject design

Methods
This study was conducted on 90 patients with COPD hospitalised in two ICU wards at two teaching hospitals in urban areas of Iran They were administered heparin subcutaneously, 4000 units every 12 hours Each patient received four injections in their abdomen and thighs, using four different methods The number and size of bruising at the injection site were measured through a flexible millimetre ruler, 48 hours after each injection The severity of pain was measured through pain visual analogue scale immediately after each injection Collected data were analysed by descriptive and analytical statistics using spss 115 software

Results
In the method 15 seconds injection duration and waiting for 5 seconds before withdrawing the needle, the number of bruising was significantly lower and size of bruising was significantly smaller, but no significant difference was found in the severity of pain However, in other methods, the severity of pain in thighs was significantly higher than in abdomen, but no statistically significant difference was reported between the size and number of bruising in abdomen and thighs

Conclusions
The method 15 seconds injection duration and waiting for 5 seconds before withdrawing the needle is recommended to be used for subcutaneous heparin injection by clinical nurses As to the results, the severity of pain in abdomen was lower than in thighs

Relevance to clinical practice
This study proposed a suitable method for subcutaneous heparin injection in order to reduce pain and bruising

The effect of injection duration and injection site on pain and bruising of subcutaneous injection of heparin

Iranian mothers' Experiences with Children Undergoing Hemodialysis: A Hermeneutic Phenomenological Study.

Since the outbreak of the New Corona Virus in Wuhan, China and its spreading to Iran, first casesof COVID-19 positive were identified in Qom, Iran and in a short period of time many other mainprovinces including Isfahan, Tehran, Markazi, and Semnan were also infected with the virus shortlyafter that in all 31 provinces the virus spread.1 Super Spreading power of this disease is the reasonwhy we have many infected people daily and according to global epidemiological information, thenumber of infected people will reach to 74877 in April 15,2020.2 like many other countries, Iran startedmedical and hygienic measures with the establishment of a National committee for fighting CoronaVirus. Our country imposed limited commuting to religious, recreational places and trading centers,closed schools and universities, decreased working hours, and cleaned crowded areas and passagewayswith disinfectants (subway stations, bus stations, and gas stations). Other efforts include: Establishingoutposts in order to identify cases of Corona Virus at City entrances and Telephone screening through4030\"that is a hotline for COVID-19 detection and providing relevant health information1.\" Despite thenecessary precautions taken, there were problems in fighting the Corona Disease, the most importantof which include: Insufficiency regarding personal protective equipment like masks, disinfectants andhospital gowns,3 Inadequate number of hospital beds and equipment in some of the cities and shortageof health workers. This issue has caused a high concern in the society and amongst the health workerswho take care of Corona virus cases in hospitals. Also, due to the experienced mental disorders ofthe health care workers while COVID-19 outbreak,4 the role of such shortages in the fight against thisdisease is crucial. In a situation like this where the number of infected people shoots up, hygienic needsof Iran increases, too. A new trend in fighting the disease has begun. In this trend, different groups ofpeople like clerics and cleric students, Basij, medical and non-medical students have taken measuresin fighting the Corona Virus which are in line with the World health organization and Ministry ofHealth and Medical Education standards. These measures are taken in 4 general areas, including:1. disinfecting the pssageways (Streets, Alleys), highly populated areas (Trading Centers, Bus andSubway stations, Gas stations) and vehicles, 2. producing personal protective equipment (Masks, faceshields, gowns and disinfectants), 3. helping with the Telephone Screening by Medical students, and4. Volunteer medical students participation in health care centers and hospitals.Now, despite the exigent circumstances regarding the spread of COVID-19 worldwide,volunteer measures and organized activities in Iran have led to provision of telephone screeninginformation and details about the COVID-19 to more than 65 million people until March 31, 2020;5and production of thousands of hygienic products daily has had a significant role in controllingand fighting the Corona Virus Pandemic. Although in the early period of the virus outbreak,Iran was the third country to have the most cases of Corona positive cases after China and Koreauntil 2nd of March, and the number of identified cases increased in April 15, 2020 which mightbe due to the efficient and comprehensive screening process, it became the 8th country with themost positive cases of Corona after the United States, Spain, Italy, France, Germany, England,and China.2 It is also expected that with adequate health equipment, specialized human resourcesand provision of scientific information to the community, the public and health workers who takecare of Corona virus cases will have tranquility.Therefore, Iran’s approach towards facing the COVID-19 clearly states the fact that nationalapproach in fighting the Corona Virus is an important factor among other measures taken and itis mentioned as a modern approach in managing a health crisis in a large scale.

https://ijcbnm.sums.ac.ir/article_46529_85e1013e93626f6c30e06333a6855378.pdf

National approach in response to the COVID-19 pandemic in Iran

Background: Mothers of children undergoing hemodialysis encounter severe changes in their daily lives. It is of utmost importance to raise the awareness of treatment teams about the needs of these specific groups of mothers and different problems they may experience. The reason is that it can help health care professionals to support the mothers to fulfill their roles as the primary caregivers of such children.
Aim: This study aimed to identify basic needs in mothers of children undergoing hemodialysis.
Method: This meta-synthesis review of qualitative studies investigating the needs and experience of mothers whose children had kidney disease and published from January 1997 to October 2017. The articles were searched in four databases, including Web of Science, EMBASE, PubMed, and ProQuest. The search process was accomplished using the keywords “chronic kidney disease,” “hemodialysis,” “children,” “mothers,” “parents,” “caregivers,” “needs,” “experiences,” “perspectives,” and “perceptions”. Finally, 7 articles were chosen out of 567 papers and theses. The MAXQDA software was used to facilitate data management.
Results: The systematic review of the qualitative studies revealed three main themes, including the need for child care management skills, the need to maintain family cohesion, and the need for emotional–psychological support.
Implications for Practice: Mothers of children under hemodialysis should be considered as nursing clients. Accordingly, a multidisciplinary team can empower mothers to take care of the children under hemodialysis and preserve family coherence, as well as supporting them emotionally and psychologically.

https://ebcj.mums.ac.ir/article_12015_177eaff194569ba5daa63dda41200fb2.pdf

Basic Needs of Mothers with Children Undergoing Hemodialysis: A Meta-synthesis of Qualitative Studies

/pdf/critical-appraisal-of-the-ethical-considerations-reports-in-3y4pijquly.pdf

Tayebe Pourghaznein

Papers

The effect of injection duration and injection site on pain and bruising of subcutaneous injection of heparin

Iranian mothers' Experiences with Children Undergoing Hemodialysis: A Hermeneutic Phenomenological Study.

National approach in response to the COVID-19 pandemic in Iran

Basic Needs of Mothers with Children Undergoing Hemodialysis: A Meta-synthesis of Qualitative Studies

Critical Appraisal of the Ethical Considerations’ Reports in Nursing Studies Published by Iranian Nursing Journals