GH Injector ^NEW^
We report here the results from the first study of adherence to treatment as recorded by the auto-injector. The primary objective of this study was to evaluate adherence to r-hGH therapy over 3 months of use. In addition, the survey explored perceptions of the electronic auto-injector device in a large multinational cohort. Study outcomes were also assessed separately for children who were either new to or had experience with r-hGH therapy, in order to identify any differences in adherence to therapy or opinions of the device.
The primary objective was to assess adherence to r-hGH treatment, following introduction of the electronic auto-injector, comparing adherence patterns of treatment-naïve and treatment-experienced children. The secondary objective was to assess the acceptability of the device.
Adherence to treatment was measured using data recorded by the injection device and reported via the survey. For reported adherence, children or their parents completed a questionnaire in which they were asked to tick one of a selection of boxes to indicate how many doses they had missed during each month of the 3-month period, and to give the main reason for missing doses. Recorded adherence data (from the auto-injector) were compared with reported adherence data (from the survey).
Acceptance of the electronic auto-injector device was evaluated using a standardized questionnaire administered by the nurse or investigator after 3 months of use (Table 1). Children or their parents were asked to rate the device (with respect to ease, speed, comfort of use, specific device features and future use) using 5-point scales or multiple-choice responses. The survey was completed by the child or parent based on each family's preference. This information was not collected during the survey; hence no psychometric properties of the survey were made available.
Overall, 834 children using the electronic auto-injector were recruited over a period of 1.5 years. Of these, 824 children were included in the evaluable population, with four children excluded due to incomplete data (age missing [n = 1], status missing [n = 3]) and six children excluded due to being aged >18 years. Of the 824 evaluable children, 601 were treatment-naïve and 223 were treatment-experienced. In total, 682/824 (82.8%) children provided 3 months of data: 496/601 (82.5%) of treatment-naïve children and 186/223 (83.4%) of treatment-experienced children. The remaining children had incomplete information for the numbers of reported and recorded injections.
Overall, 82.5% (664/805) of participants found the electronic auto-injector easy/very easy to prepare. Only 2.2% (18/805) of respondents rated the injection preparation as not easy at all (Table 5). The majority (684/806, 84.9%) of respondents also rated the duration of injection preparation as short/very short (Table 5).
The device was described by 89.1% (716/804) of participants as comfortable/very comfortable to use (Table 5). The majority of respondents (61.5% [480/780]) reported experiencing no pain when injecting with the electronic auto-injector. Those patients who experienced pain were then asked whether the injection hurt as much as they were expecting (although this question was also answered by some of those who said that they did not experience pain). Over half (57.9% [210/363]) of respondents to this question described it as being less or much less painful than expected. Few respondents (13.5% [49/363]) reported that the injection hurt more/much more than they thought it would.
Survey participants were also asked to answer questions concerning specific features of the electronic auto-injector. In total, 85.8% (687/801) and 82.9% (671/809) stated that the cartridge and needle, respectively, were easy/very easy to change (Table 5). Most participants found the device easy to hold and compact, as well as attractive and silent/quiet on injection (Table 5).
At the end of the 3-month survey period, 91.8% (732/797) of respondents stated a desire to continue using the electronic auto-injector: 92.7% (542/585) of treatment-naïve and 89.6% (190/212) of treatment-experienced children.
This multinational, observational survey of over 800 children using an electronic auto-injector device for up to 3 months found a good level of adherence to therapy. The dose history that had been automatically recorded by the device and reviewed by the physician showed that 87.5% of children were adherent to therapy (injecting at least 92% of doses over the 3-month period). Furthermore, 75.1% of all children did not miss any injections in month 1, 66.7% in both months 2 and 3.
The current survey also showed that children and their parents had a very good perception of the electronic auto-injector after 3 months of use, rating specific features of the device highly. The majority considered the device to be quick, easy and comfortable to use. There was little difference between treatment-naïve and treatment-experienced children in their responses to questions.
These results support the findings of previous, smaller (up to 61 patients), shorter-term (up to 60 days) studies, which together indicate a high level of patient acceptance of the electronic auto-injector for daily administration of r-hGH [14, 15]. Results from an open-label multicentre survey that included 61 patients showed that the majority of patients had a good overall impression of the device after 60 days of use . In addition, the nurses/physicians who trained them how to use the device also rated the device favourably with respect to participants' ease in learning to use the device . Unlike previous user trials of the electronic auto-injector [14, 15], the current study is the first to include data on adherence as captured using the device.
In a survey conducted at a UK hospital, patients commencing GH therapy were given the freedom to choose their delivery device . Of those switching devices, 74% changed to the electronic auto-injector. None of the patients who started on this novel device later switched to using another device. Although the present survey did not provide children or their parents with a free choice of injection device, at the end of the survey, 92% of children/parents stated that they would like to continue using it. Interestingly, adherence in children who did not want to continue using the device was slightly lower than that in the overall population (when considering all children in the evaluable population, 74.6% vs 84.1%, respectively).
Several studies have compared needle-free injectors to conventional syringes with needles.So far, the results have been conflicting: the needle-free injector has been reported to beboth less painful and more readily accepted by the patients and their families thanconventional needle injection (1, 2), while other reports found no differences betweenneedle-free injection and conventional syringes (3).
A needle-free injection group consisting of 18 subjects (11 males and 7 females, mean age5.87 2.05 yr at the start of hGH therapy) who have not used needle injectors to date, wereallowed to use VISION in their third to fifth years of GH therapy. In addition,a group of 8 subjects who had been using needle injectors at our clinic (6 males and 2females, mean age 6.54 2.78 at the start of GH therapy) was monitored as a control (Table 1). All subjects were pediatric patients with GH deficiency (GHD).
As for complaints on using VISION, only 3 syringes were damaged by 2 subjectsin 4.5 yr of use of VISION. All breakages occurred at the initial stage of usingVISION and could have been caused by inappropriate handling. Subsequently,there was no breakage observed up to the end of study. There were no other complaints.Therefore, it was concluded that there are no problems regarding safety and operationalityfor hGH treatment with VISION, a needle-free injector.
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Jin Ping (金平), Li Mao (李茂), Cai Guo-Biao (蔡国飙) Numerical and experimental study on shear coaxial injectors with hot hydrogen-rich gas/oxygen-rich gas and GH2/GO2 2013 Chin. Phys. B 22 044701
It is important to control the refrigerant mass rate accurately in a heat pump to obtain its optimum heating/cooling capacity. It is needed to secure optimized valve control technology to adjust the cycle which shows better performance in various environmental conditions giving optimum efficiencies at those operating conditions. In this study, we propose to use solenoid-driven injectors instead of conventional expansion valves. Unlike the conventional expansion valves that having a continuous flow, the injector can control the injection rate of refrigerant by opening frequency and at its duty, so it allows an accurate control of refrigerant mass flow rate. First, the authors introduce a driving mechanism of an injector. Second, the experimental setup is introduced to investigate the mass flow controllability of the injector. Third, the experimental result about the mass flow controllability of the injector is presented by using a refrigerant, HFC-134a. Finally, differences between the conventional expansion valve and the injector are discussed in the view of flow control mechanism. 041b061a72