ABSTRACT
The feed frame system is one of the key elements of a rotary tablet press. The powder in the funnel flows through the feed frame system, which ensures a uniform powder flow to the die disc. The objective of the present study was to investigate the effect of different feed frame designs of a production-scale rotary tablet press on the residence time distribution of two microcrystalline cellulose blends, one of them serving as a tracer blend and the other serving as a filling material. With these powder blends, the effect of a reduction of the filling volume of a three chamber feed frame on the powder residence time was investigated. It was shown, that the volume reduction of the three chamber feed frame equipped with three modified large hub wheels led to a decrease of the powder residence time as well as to low intermixing of the powder particles. Furthermore, the residence time distribution within the three chamber feed frame was compared to that within a single chamber cone-shaped feed frame. Both feed frame designs had a similar filling volume but different powder paths through the respective feed frame chambers. The results showed that the single chamber feed frame led to a narrower distribution of the powder residence time and a lower intermixing than the three chamber feed frame. An interesting output of the study was that the variation of the feed frame design had a more pronounced effect on the powder behavior than the variation of the filling volume.
Subject(s)
Powders/chemistry , Technology, Pharmaceutical , Cellulose/chemistry , Tablets/chemistry , Time FactorsABSTRACT
The present study focused on the effect of different feed frame components on the residence time distribution of a three-chamber feed frame system (Fill-O-Matic). A production-scale rotary tablet press was used to simulate the industrial manufacture of tablets. The powder residence time distribution was used to characterize the powder behavior in the Fill-O-Matic. Therefore, two powder blends based on microcrystalline cellulose, one of them serving as a plain powder blend (MCC blend) and the other blend (tracer blend) spray colored with an indigo carmine solution by a fluid bed granulator, were used. With these powder blends, the effect of the reduction of the Fill-O-Matic volume with a perspex disc on the residence time distribution was compared with the standard configuration of the Fill-O-Matic. Furthermore, the filling wheel design with regard to the rod shape and different gap size configurations between the feed frame and the die disc were investigated. Interestingly, the reduction of the feed frame volume led to a remarkable decrease of the mean residence time and the mean centered variance. Moreover, the results of the filling wheel design showed that the rod shape of the filling wheels had a high influence on the intermixing of the powder particles in the filling chamber, whereas the corresponding tablet weights and their relative standard deviation were not affected. The gap size between the feed frame and the die disc had low influence on the residence time distribution but an effect on the tablet weights and their standard deviation.
Subject(s)
Cellulose/chemistry , Drug Compounding/methods , Excipients/chemistry , Technology, Pharmaceutical/methods , Chemistry, Pharmaceutical/methods , Powders , Tablets , Time FactorsABSTRACT
This study focuses on the behavior of powder particles in a rotary tablet press with special focus on the feed frame system. To obtain a better knowledge of the continuous manufacturing of tablets, the experimental setup was carried out with a production scale rotary tablet press. The behavior of the powder particles at different flow rates through the tablet press, residual moisture contents, particle sizes, and amounts of tracer was investigated. The residence time distribution was evaluated using the tracer indigo carmine, which was sprayed onto microcrystalline cellulose particle as solution with fluidized bed spray granulator to obtain a tracer blend. The residence time distribution was increased by increasing the amount of tracer blend, and a transition from a plain MCC blend to the tracer blend with regard to continuous manufacturing was shown. Furthermore, it was found that an increase in the flow rates of the powder particles through the tablet press led to a decrease of the residence time distribution (Et). The variation of the flow rate had no influence on the mechanically applied strain at high throughputs, which was confirmed by a constant number of paddle passes (Npp). At the lowest flow rate, the Npp appears to be higher than the constant Npp values at higher flow rates. The residual moisture content did not shown any significant influence on the residence time distribution. The examination of the effect of different tracer blend particle sizes led to an interesting result: It was shown that the particle size segregation only had a low influence on Et. However, a comparably higher influence of the particle size segregation on the particle distribution in the produced tablets was demonstrated. Large particles were deposited at the top of the tablet surface whereas small particles were deposited at their bottom.
Subject(s)
Powders/chemistry , Tablets/chemistry , Cellulose/chemistry , Drug Compounding , Excipients/chemistry , Particle Size , Silicon Dioxide/chemistry , Time FactorsABSTRACT
AIM: The aim of this study was to investigate whether the filling level within the feed frame of a rotary tablet press can be quantified by laser triangulation combined with the angle recognition of one paddle wheel via rotary encoder. SIGNIFICANCE: Rotary tablet press feed frames are supposed to assure a uniform die filling and, thus, to guarantee the weight and content uniformity of the resulting tablets. Therefore, a constant bulk availability and flow within the feed frame is crucial and has to be ensured by the feed frame design and the operating conditions. So far, there is no instrument available to monitor the bulk filling level or the bulk distribution within feed frames. METHODS: Calcium phosphate dihydrate was used as model powder. The powder surface level was determined via laser triangulation and the angle position of the paddle wheel was monitored via incremental rotary encoder. The data of both parameters was acquired synchronously and evaluated by in-house written software. RESULTS: Different powder masses led to significantly different filling level signals. The experiments showed a high reproducibility of the determined filling levels. Furthermore, an influence of the rotational speed on the powder distribution was observed. CONCLUSIONS: The developed instrument may be used for quantification of the volumetric filling level within rotary tablet press feed frames. It may either be used to better understand the powder behavior within feed frames or for improvement of the die filling process by implementing the device into a feedback loop.
Subject(s)
Tablets , Technology, Pharmaceutical/methods , Calcium Phosphates/chemistry , Powders , Technology, Pharmaceutical/instrumentationABSTRACT
The objective of this study was to investigate the suitability of "Eudragit® RL/Eudragit® L55" (RL/L55) blend coatings for a pH-independent release of acidic drugs. A coating for ketoprofen and naproxen mini tablets was developed showing constant drug release rate under pharmacopeial two-stage test conditions for at least 300 min. To simulate drug release from the mini tablets coated with RL/L55 blends in the gastrointestinal (GI) tract, drug release profiles in Hanks buffer pH 6.8 were recorded and compared with drug release profiles in compendial media. RL/L55 blend coatings showed increased drug permeability in Hanks buffer pH 6.8 compared to phosphate buffer pH 6.8 due to its higher ion concentration. However, drug release rates of acidic drugs were lower in Hanks buffer pH 6.8 because of the lower buffer capacity resulting in reduced drug solubility. Further dissolution tests were performed in Hanks buffer using pH sequences simulating the physiological pH conditions in the GI tract. Drug release from mini tablets coated with an RL/L55 blend (8:1) was insensitive to pH changes of the medium within the pH range of 5.8-7.5. It was concluded that coatings of RL/L55 blends show a high potential for application in coated oral drug delivery systems with a special focus on pH-independent release of acidic drugs.
Subject(s)
Acids/chemistry , Bicarbonates/chemistry , Pharmaceutical Preparations/administration & dosage , Polymers/chemistry , Tablets , Buffers , SolubilityABSTRACT
Transdermal delivery systems (TDS) consisting of mixtures of adhesives also named multiple polymer adhesive systems are rarely found in the market and research has only been performed on a few of them. Following the principles of ICH Q8, a Design of Experiments (DOE) approach was selected for the formulation development. For evaluation of the statistical method of "mixture design", blends of silicon adhesive, acrylic adhesive, oleyl alcohol as a surfactant and ibuprofen as a model drug were considered to be combined at different concentrations. A randomized design of 16 runs with five replicates and five runs to estimate the lack of fit (LOF) was generated. Samples were tested for adhesion properties, stability of the wet mixes, solubility of the API in the matrix and appearance of the matrix. After performing an ANOVA with the results, response surfaces of tack, shear adhesion, extent of creaming, crystallization behavior, droplet size and droplet size range were derived as contour plots. It could be shown that crystal growth of ibuprofen correlates well with droplet size and droplet size range, where lowest values for crystallization were found with mixtures containing small droplets. However, it was observed that oleyl alcohol showed no positive effect on the miscibility of the polymers and no improvement of the solubility of ibuprofen in the mixtures. With a reasonable number of experiments, the development of a design space for a TDS via mixture design gave valuable information on the product as well as on the interactions of the components.
Subject(s)
Drug Delivery Systems , Ibuprofen/administration & dosage , Polymers/chemistry , Surface-Active Agents/chemistry , Adhesiveness , Adhesives/chemistry , Administration, Cutaneous , Chemistry, Pharmaceutical/methods , Crystallization , Fatty Alcohols/chemistry , Ibuprofen/chemistry , Silicon/chemistry , Solubility , Transdermal PatchABSTRACT
The aim of the present study was to investigate the drug release from theophylline pellets coated with blends of quaternary polymethacrylate and methacrylic acid-ethyl acrylate copolymers. Pellets were coated with blends of Eudragit(®) RL PO (RL) and Eudragit(®) L 100-55 (L55) in either organic solution or aqueous dispersion at various copolymer ratios. Generally, the coatings were less permeable for theophylline in phosphate buffer pH 6.8 than they were in hydrochloric acid pH 1.2. Further dissolution experiments revealed that the differences in drug release are caused by the different pH values. A design of experiments for historical data was performed on drug release data of pellets with different coating levels and blend ratios of RL and L55. Drug release in hydrochloric acid was predominantly affected by the coating level, whereas for drug release in phosphate buffer pH 6.8 the blend ratio was the determining factor. As expected, dissolution experiments at different pH values showed that drug release depends on the ratio of dissociated L55 to RL because ionization is a requirement for the functional groups to interact. With the dissolution test for delayed-release solid dosage forms (Ph. Eur.) it was demonstrated that the unique release behavior in neutral media is preserved after the exposition to hydrochloric acid. These findings indicate that the combination of RL and L55 in coatings prepared from solutions is a promising approach for controlled drug release.
Subject(s)
Acrylic Resins/chemistry , Excipients/chemistry , Polymers/chemistry , Theophylline/administration & dosage , Chemistry, Pharmaceutical/methods , Delayed-Action Preparations , Drug Liberation , Hydrogen-Ion Concentration , Solubility , Theophylline/chemistryABSTRACT
In transdermal patches, an unpredictable alteration of the mechanical behavior of the pressure sensitive adhesive (PSA) can occur if a drug is added. In the present study, the suitability of Dynamic Mechanical Analysis (DMA)/Dynamic Mechanical Thermal Analysis (DMTA) as methodologies to detect the change in adhesion properties caused by the addition of an API was examined. With DMA/DMTA, time- and temperature-dependent viscoelastic properties were determined. Tack and shear adhesion of blends of the acrylic adhesive DuroTak® 87-4287 and ibuprofen at increasing concentrations were investigated. Interestingly, the probe tack test showed highest values at 1% ibuprofen concentration in the PSA and decreasing values with increasing ibuprofen concentrations. The shear adhesion of the PSA was decreased at all investigated ibuprofen concentrations. With DMA/DMTA, it could be demonstrated that antiplasticization and plasticization are responsible for the change in tack. The main reason for the decrease in shear adhesion is a shift of the Tg to lower temperatures, while antiplasticization only has a marginal effect. The term "antiplasticizing space" was introduced because antiplasticization depends on time, temperature, stress, strain, and API concentration. In general, this antiplasticizing space can have an impact on processing, stability, and in vivo behavior of API/polymer blends in drug formulations.
Subject(s)
Adhesives/administration & dosage , Adhesives/chemistry , Ibuprofen/administration & dosage , Ibuprofen/chemistry , Plasticizers/administration & dosage , Plasticizers/chemistry , Administration, Cutaneous , Chemistry, Pharmaceutical/methods , Polymers/administration & dosage , Polymers/chemistry , Pressure , Temperature , Transdermal PatchABSTRACT
OBJECTIVES: To survey possible funding models and pricing practices as well as prices for the treatment package of trastuzumab and its accompanying diagnostic test in European countries, as an example of personalised medicines. METHODS: Qualitative descriptive data on national pharmaceutical pricing and funding policies applied to trastuzumab and its accompanying diagnostic test were obtained from a survey among competent authorities from 27 European countries as of August 2011. Further, price data (for the years 2005-2013) of trastuzumab in the respective European countries were surveyed and analysed. RESULTS: In 2011, testing and treatment mainly took place in hospitals or in specific day-care ambulatory clinics. In the European countries either both trastuzumab and the accompanying diagnostic test were funded from hospital budgets (n = 13) or only medicines were funded from the third party payers such social insurances and the test from hospital budgets (n = 14). Neither combined funding of both medicine and diagnostic test by third party payers was identified in the surveyed countries nor did the respondents from the competent authorities identify any managed entry agreements. National pricing procedures are different for trastuzumab versus its diagnostic test, as most countries apply price control policies for trastuzumab but have free pricing for the diagnostic test. The ex-factory price is, on average, 609 per 150 mg vial with powder in 2013; in nine countries the price of trastuzumab went down from 2005 till 2013. CONCLUSION: The example of trastuzumab and its accompanying diagnostic test highlights some problems of the interface between different funding streams (out-patient and hospital) but also with regard to the interface between the medicine applied in combination with a medical device. The findings suggest a need for further developing and refining policy options to address the identified interface issues.
Subject(s)
Antibodies, Monoclonal, Humanized/economics , Antineoplastic Agents/economics , Insurance, Health, Reimbursement , Precision Medicine , Europe , Financing, Government , Health Care Surveys , Humans , TrastuzumabABSTRACT
CONTEXT: Novel tableting excipients are continuously developed and advertised with superior flow and compaction characteristics. OBJECTIVE: The objective of this study was to compare two traditionally used and two novel tableting excipients with regard to their physical and tableting properties as well as their magnesium stearate sensitivity. Avicel(®) PH102 (microcrystalline cellulose) was compared to the novel co-processed excipient Prosolv(®) SMCC90 (silicified microcrystalline cellulose), whereas Anhydrous Emcompress(®) (anhydrous dicalcium phosphate) was compared to the novel spherically granulated excipient Fujicalin(®) (anhydrous dicalcium phosphate). MATERIALS AND METHODS: True density, particle size, specific surface area (SSA), flowability, tabletability, and magnesium stearate sensitivity of the excipients was determined. RESULTS AND DISCUSSION: Due to the silification process (Prosolv(®)) and the unique manufacturing process (Fujicalin(®)), the novel excipients showed a comparably larger SSA. Hardest tablets by far could be obtained with Prosolv(®), followed by Avicel(®) and Fujicalin(®). Avicel(®) and Prosolv(®) were sensitive to magnesium stearate, whereas Fujicalin(®) and Emcompress(®) did not show lubricant sensitivity. This confirms the plastic deformation behavior of microcrystalline cellulose and the brittle fracture of anhydrous dicalcium phosphate. CONCLUSION: Compared to the traditional excipients the investigated novel tableting excipients were advantageous with regard to their SSA and their tableting properties.
Subject(s)
Excipients/chemistry , Tablets/chemistry , Cellulose/chemistry , Drug Compounding/methods , Particle Size , Stearic Acids/chemistryABSTRACT
Antimicrobial peptides (AMP) defend epithelial surfaces against pathological micro-organisms. We know of no comparison of their expression between the oral mucosa and extraoral epithelium, but knowledge of differences in their quantities is of interest, possibly as a starting point for new treatments. Expression of AMP human beta-defensin (hBD)-1/-2/-3 and psoriasin in the oral mucosa and extraoral epithelium of the head and neck were measured by real-time polymerase chain reaction (RT-PCR) (n=14), immunohistochemistry (n=6), and western blot (n=8). RT-PCR showed that all the genes investigated were expressed significantly more in the oral mucosa than in the skin (hBD-1: p=0.002; hBD-2: p=0.006; hBD-3: p=0.035; psoriasin: p=0.02). Immunohistochemistry and western blot showed differential concentrations of proteins: hBD-2 (p=0.021) and hBD-3 (p=0.043) were pronounced in the oral mucosa, whereas psoriasin was raised in the extraoral skin (p=0.021). There was no difference in protein concentrations for hBD-1 (p=0.08). The observed differences in the expression of AMP may be important for new treatments such as topical application of AMP derivatives.
Subject(s)
Antimicrobial Cationic Peptides/metabolism , Epithelium/metabolism , Gene Expression Profiling , Mouth Mucosa/metabolism , Adolescent , Adult , Aged , Antimicrobial Cationic Peptides/chemistry , Antimicrobial Cationic Peptides/genetics , Blotting, Western , Case-Control Studies , Child , Epithelium/immunology , Female , Humans , Immunity, Innate , Immunohistochemistry , Male , Middle Aged , Mouth Mucosa/immunology , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , Sequence Analysis, Protein , Statistics, NonparametricABSTRACT
The potential of hydrophilic aerogel formulations and liquisolid systems to improve the release of poorly soluble drugs was investigated using griseofulvin as model drug. The in vitro release rates of this drug formulated as directly compressed tablets containing crystalline griseofulvin were compared to aerogel tablets with the drug adsorbed onto hydrophilic silica aerogel and to liquisolid compacts containing the drug dissolved or suspended in PEG 300. Furthermore, the commonly used carrier and coating materials in liquisolid systems Avicel® and Aerosil® were replaced by Neusilin®, an amorphous magnesium aluminometasilicate with an extremely high specific surface area of 339 m²/g to improve the liquisolid approach. Both the liquisolid compacts containing the drug dissolved in PEG 300 and the aerogel tablets showed a considerably faster drug release than the directly compressed tablets. With liquisolid compacts containing the drug suspended in PEG 300, the release rate increased with rising fraction of dissolved drug in the liquid portion. It could be shown that Neusilin® with its sevenfold higher liquid adsorption capacity than the commonly used Avicel® and Aerosil® allows the production of liquisolid formulations with lower tablet weights.
Subject(s)
Griseofulvin/chemistry , Polyethylene Glycols/chemistry , Cellulose/chemistry , Chemistry, Pharmaceutical/methods , Drug Compounding/methods , Excipients/chemistry , Hydrophobic and Hydrophilic Interactions , Particle Size , Solubility , Solutions/chemistry , Suspensions/chemistry , Tablets/chemistry , Tensile StrengthABSTRACT
CONTEXT: In solid oral dosage forms silicates are commonly used as glidants in low concentration. However, due to their large specific surface area, silicates may also be used as carrier materials for drugs. Moreover, silicates allow amorphisation of drugs by co-grinding or processing with supercritical fluids. OBJECTIVE: The aim of this study was to investigate the physical and the tableting properties of Silica Aerogel (special type of silica with an extremely large specific surface area), Neusilin(®) US2 (magnesium aluminometasilicate), Florite(®) (calcium silicate) and Aerosil(®) 200 (colloidal silica). MATERIALS AND METHODS: Powder blends of Avicel(®) PH102 (microcrystalline cellulose) and different amounts of the respective silicate were compacted and analyzed for their tabletability (tensile strength vs. compaction pressure) as well as their Heckel plot. RESULTS AND DISCUSSION: With Neusilin(®) the tabletability appeared to be independent of the silicate concentration, whereas with Florite(®) an increasing silicate concentration led to a higher tensile strength. In contrast, the addition of Silica Aerogel and Aerosil(®) resulted in a decrease of the tensile strength. With Aerosil(®) a maximum tolerable concentration of 20% [w/w] was determined. Plastic deformation of all powder blends decreased with increasing silicate concentration. This effect was most pronounced with Aerosil(®) and least with Florite(®). CONCLUSION: Tablets with acceptable tensile strength were obtained with all plain silicates except for Aerosil(®). Therefore, these silicates may be used in tablet formulations, e.g. as carrier materials for liquid or amorphous drugs.
Subject(s)
Silicates/chemistry , Silicon Dioxide/chemistry , Tablets/chemistry , Aluminum Compounds , Aluminum Silicates/chemistry , Cellulose/chemistry , Drug Carriers/chemistry , Magnesium/chemistry , Magnesium Compounds , Silica Gel/chemistry , Surface Properties , Tensile StrengthABSTRACT
OBJECTIVES: The 22q11 microdeletion is a chromosomal disorder detected by fluorescence in situ hybridization (FISH). It has been known since the 80s, and is involved in many malformative syndromes (DiGeorge sequence, VCFS syndrome, etc.). Airway abnormalities are frequently localized in the larynx, as reported in the following series. METHODS: A retrospective chart review of laryngeal abnormalities and 22q11 deletion in a tertiary referral center. RESULTS: Five cases of laryngeal abnormalities associated to 22q11 deletion syndrome (DS) were found in a series of 35 cases. Abnormalities encountered were subglottic stenosis (3%), glottic web (9%), laryngeal paralysis (9%), vocal nodule (3%), laryngomalacia (3%) associated with bronchial malposition (3%). CONCLUSION: Laryngeal abnormalities are relatively common (14% in this series) and important to recognize with the 22q11 deletion syndrome, especially if cardiac surgery is planed. Conversely, in case of laryngeal abnormalities associated to other malformation (like facial dysmorphia or cardiac malformation), the 22q11 deletion must be searched.
Subject(s)
22q11 Deletion Syndrome/diagnosis , Developmental Disabilities/therapy , Laryngeal Diseases/epidemiology , Larynx/abnormalities , 22q11 Deletion Syndrome/epidemiology , 22q11 Deletion Syndrome/therapy , Abnormalities, Multiple/diagnosis , Abnormalities, Multiple/epidemiology , Abnormalities, Multiple/therapy , Child , Cohort Studies , Combined Modality Therapy , Developmental Disabilities/diagnosis , Developmental Disabilities/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Infant, Newborn , Infant, Premature , Laryngeal Diseases/genetics , Laryngeal Diseases/therapy , Laryngoscopy/methods , Male , Retrospective Studies , Severity of Illness IndexABSTRACT
The stratum corneum, the outermost layer of the skin, regulates the passive loss of water to the environment. Furthermore, it is well accepted that drug penetration is influenced by skin hydration, which may be manipulated by the application of moisturizing or oleaginous vehicles. Measurements of transepidermal water loss (TEWL), and of skin hydration using a corneometer, were used to assess the effect of different vehicles on stratum corneum barrier function in vivo in human volunteers. A microemulsion significantly increased skin hydration relative to a reference vehicle based on medium chain triglycerides; in contrast, Transcutol(R) lowered skin hydration. TEWL measurements confirmed these observations.
Subject(s)
Dermatologic Agents/pharmacology , Pharmaceutical Vehicles , Skin/metabolism , Adult , Biological Availability , Dose-Response Relationship, Drug , Emulsions , Female , Humans , Pilot Projects , Skin/chemistry , Water/chemistry , Water Loss, Insensible , Young AdultABSTRACT
BACKGROUND: The bioavailability of most topically delivered drugs is difficult to quantify, but is generally believed to be very low. With the exception of the vasoconstrictor assay for corticosteroids, no methodology to quantify the rate and extent of drug delivery to the skin has been validated. Recent research has examined the dermatopharmacokinetic (DPK) technique, which is based on stratum corneum (SC) tape-stripping. OBJECTIVE: To compare the in vivo bioavailability of different topical formulations of betamethasone 17-valerate (BMV) using the vasoconstrictor assay and the DPK method. METHODS: BMV was formulated in different vehicles and the drug concentration was adjusted to either (i) equal thermodynamic activity, or (ii) a range of values up to that corresponding to 80% of maximum thermodynamic activity. Vasoconstriction, an accepted and widely used method to determine bioavailability and bioequivalence of topical steroids, was quantified with a chromameter over 24 h post-removal of the formulation. Drug uptake into the SC was assessed by tape-stripping. RESULTS: BMV at the same thermodynamic activity in different vehicles provoked similar skin blanching responses, while DPK profiles distinguished between the formulations. Further, skin blanching responses and drug uptake into the SC clearly depended upon the absolute BMV concentration applied. However, while the saturable nature of the pharmacodynamic response was clear, the tape-stripping method distinguished unequivocally between the different formulations and different concentrations. CONCLUSIONS: The DPK approach offers a reliable metric with which to quantify transfer of drug from the vehicle to the SC, and may be useful for topical bioavailability and bioequivalence determinations.
Subject(s)
Betamethasone Valerate/pharmacokinetics , Glucocorticoids/pharmacokinetics , Skin/metabolism , Administration, Cutaneous , Adult , Biological Availability , Chemistry, Pharmaceutical , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Pharmaceutical Vehicles , Reproducibility of Results , Skin/blood supply , Skin Absorption , Specimen Handling/methods , Surgical Tape , Thermodynamics , Vasoconstriction , Young AdultABSTRACT
Functional recovery and outcome from severe burns is oftentimes judged by the time required for a person to return to work (RTW) in civilian life. The equivalent in military terms is return to active duty. Many factors have been described in the literature as associated with this outcome. Hand function, in particular, is thought to have a great influence on the resumption of preburn activities. The purpose of this investigation was to compare factors associated with civilian RTW with combat injured military personnel. A review of the literature was performed to assimilate the many factors reported as involved with RTW or duty. Additionally, a focus on the influence of hand burns is included. Thirty-four different parameters influencing RTW have been reported inconsistently in the literature. In a military population of combat burns, TBSA burn, length of hospitalization and intensive care and inhalation injury were found as the most significant factors in determining return to duty status. In previous RTW investigations of civilian populations, there exists a scatter of factors reported to influence patient disposition with a mixture of conflicting results. In neither military nor civilian populations was the presence of a hand burn found as a dominant factor. Variety in patient information collected and statistical approaches used to analyze this information were found to influence the results and deter comparisons between patient populations. There is a need for a consensus data set and corresponding statistical approach used to evaluate RTW and duty outcomes after burn injury.
Subject(s)
Burns/rehabilitation , Military Medicine , Occupational Health , Adolescent , Adult , Burns/psychology , Female , Health Status , Health Status Indicators , Humans , Length of Stay , Male , Middle Aged , Time Factors , United States , Young AdultABSTRACT
The time of erythema onset may be used as a response parameter for quantification of the cutaneous erythema response induced by methyl nicotinate. The vehicles light mineral oil (LMO; test) and medium chain triglycerides (MCT; standard) were compared with regard to the pharmacodynamic response. Moreover, the influence of penetration enhancers on the time of erythema onset was investigated under zero order penetration kinetics. The enhancers dimethyl sulfoxide, diethylene glycol monoethyl ether and three different glycerides in different concentrations were added to MCT as a standard vehicle. All preparations were applied to the forearms of volunteers under infinite dose conditions at different thermodynamic drug activity levels (0.2-3.2% of the saturation level) and different drug concentrations (0.051-0.816%), respectively. Different penetration kinetics do not influence data of erythema onset, as these data are comparable to those obtained under finite dose conditions (first order penetration kinetics). With regard to the penetration enhancers, a significantly enhanced penetration of methyl nicotinate could be observed only for diethylene glycol monoethyl ether and dimethyl sulfoxide. However, no significant difference between light mineral oil and MCT could be found with regard to penetration enhancement. The time of erythema onset is an easy and efficient parameter for quantification of the pharmacodynamic response caused by nicotinates.
Subject(s)
Erythema/chemically induced , Nicotinic Acids/pharmacology , Nicotinic Acids/pharmacokinetics , Adult , Algorithms , Biological Availability , Chemistry, Pharmaceutical , Female , Humans , Lipid Bilayers , Male , Middle Aged , Nicotinic Acids/administration & dosage , Ointments , Skin Absorption/physiology , ThermodynamicsABSTRACT
The main determinants of mortality after burn injury that can be measured on admission include age, total burn size (% burn), and inhalation injury (INHAL). Other variables, measured during resuscitation, may provide additional information about injury severity. We assessed the utility of early arterial blood gas (ABG) data in predicting mortality after burn injury. Data were limited to samples obtained during the first 2 days after burn injury and to those obtained during high-frequency percussive ventilation. Mean values for each patient's ABG data were calculated; subsequent analysis used these derived variables. Logistic regression analysis (LRA) was used to generate a mortality predictor using burn, age (as a cubic age score, AGE), and INHAL. LRA was then repeated with the ABG variables. A total of 162 patients were included. By univariate analysis, death was associated with increased alveolar-arterial gradient (AaDO2), AGE, % burn, full-thickness burn size, INHAL, and with decreased pH and base excess. LRA of % burn, AGE, INHAL, and full-thickness burn size retained the first three variables. The addition of ABG data demonstrated that mean burn excess and mean AaDO2 also contributed independently to mortality. However, there was no difference in accuracy (86%) between the two equations. By Kaplan Meier analysis, AaDO2 but not BE predicted earlier death in those who died. Measured during resuscitation, metabolic acidosis (ie, a base deficit) and oxygenation failure (ie, increased AaDO2) contributed independently, but modestly, to ultimate mortality after burn injury. The inclusion of these variables did not improve predictive accuracy. Whether therapies targeted at these endpoints would improve outcome is unknown.