Grip Type Alters Maximal Pinch Forces in Syringe Use

MacDonald, Victoria; Wilson, Katherine; Sonne, Mette P.; Keir, Peter J.

doi:10.1177/0018720817720339

Cited by 6 publications

(7 citation statements)

References 11 publications

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“…MacDonald et al reported the maximum ejection force of healthcare workers to be 79.5 N, which agrees with the lab-generated benchmark [35]. Rhodes et al and Berretta et al reported ejection force values of 150 N and 30 N, respectively, with similar chitosan composites [20,21].…”

Section: Discussionsupporting

confidence: 61%

Development and Evaluation of an Injectable Chitosan/β-Glycerophosphate Paste as a Local Antibiotic Delivery System for Trauma Care

Boles

Alexander

Pace

et al. 2018

JFB

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Complex open musculoskeletal wounds are a leading cause of morbidity worldwide, partially due to a high risk of bacterial contamination. Local delivery systems may be used as adjunctive therapies to prevent infection, but they may be nondegradable, possess inadequate wound coverage, or migrate from the wound site. To address this issue, a thermo-responsive, injectable chitosan paste was fabricated by incorporating beta-glycerophosphate. The efficacy of thermo-paste as an adjunctive infection prevention tool was evaluated in terms of cytocompatibility, degradation, antibacterial, injectability, and inflammation properties. In vitro studies demonstrated thermo-paste may be loaded with amikacin and vancomycin and release inhibitory levels for at least 3 days. Further, approximately 60% of thermo-paste was enzymatically degraded within 7 days in vitro. The viability of cells exposed to thermo-paste exceeded ISO 10993-5 standards with approximately 73% relative viability of a control chitosan sponge. The ejection force of thermo-paste, approximately 20 N, was lower than previously studied paste formulations and within relevant clinical ejection force ranges. An in vivo murine biocompatibility study demonstrated that thermo-paste induced minimal inflammation after implantation for 7 days, similar to previously developed chitosan pastes. Results from these preliminary preclinical studies indicate that thermo-paste shows promise for further development as an antibiotic delivery system for infection prevention.

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Section: Discussionsupporting

confidence: 61%

Development and Evaluation of an Injectable Chitosan/β-Glycerophosphate Paste as a Local Antibiotic Delivery System for Trauma Care

Boles

Alexander

Pace

et al. 2018

JFB

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“…By hydrating paste with more aqueous antimicrobial solution, the injection force may be lowered, and more antimicrobials can be delivered. MacDonald et al determined the maximum ejection force of female healthcare workers using a standard chuck grip to be 79.5N [23]. Force values reported in this study are almost 10 times lower than this threshold value.…”

Section: Injectabilitymentioning

confidence: 45%

“…Toward demonstrating feasibility for this combination as an injectable infection prevention biomaterial, elution kinetics of vancomycin and amikacin, activity of antimicrobials, and degradation of the composite were compared to non-derivatized chitosan controls. Additionally, biocompatibility and injectability were evaluated against clinically relevant standards of 70% viability and 80N of force to assess feasibility of delivery for the complex geometry of open fractures [22,23].…”

Section: Introductionmentioning

confidence: 99%

Characterization of trimethyl chitosan/polyethylene glycol derivatized chitosan blend as an injectable and degradable antimicrobial delivery system

Boles

Bumgardner

Fujiwara

et al. 2019

International Journal of Biological Macromolecules

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Advanced local delivery systems are needed as adjunctive treatments for severe injuries with high infection rates, such as open fractures. Chitosan systems have been investigated as antimicrobial local delivery systems for orthopaedic infection but possess mismatches between elution and degradation properties. Derivatives of chitosan were chosen that have enhanced swelling ratios or tailorable degradation properties. A combination of trimethyl chitosan and poly(ethylene glycol) diacrylate chitosan was developed as an injectable local delivery system. Research objectives were elution of antimicrobials for 7 days, degradation as open fractures heal, and cytocompatibility. The derivative combination eluted increased active concentrations of vancomycin and amikacin compared to the non-derivatized chitosan paste, 6 vs. 5 days and 5 vs4 days, respectively. The derivative combination degraded slower than non-derivatized paste in an enzymatic degradation study, 14 vs. 3 days, which increased antimicrobial delivery duration. Cytocompatibility of the combination with fibroblast and pre-osteoblast cells exceed the cell viability standard set in ISO 10993-5. Combination paste requires an increased ejection force of 9.40N (vs. 0.64N), but this force was within an acceptable injection force threshold, 80N. These preliminary results indicate combination paste should be further developed into a clinically useful adjunctive local delivery system for infection prevention.

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“…While the experimental injections were performed with a linear actuator for the purpose of repeatability, they were generally representative of manual injection. The peak pressures measured in this study correspond to a force of approximately 4 to 5 N applied to a 1 mL syringe, which is less than one‐tenth of the average maximum thumb force reported in the literature . The fluorescent dye measurements (Figure ) likely overestimate the amount of injectate delivered in a typical clinical or laboratory protocol, as a post‐injection dwell of 4 minutes is impractical in those settings.…”

Section: Discussionmentioning

confidence: 69%

“…The peak pressures measured in this study correspond to a force of approximately 4 to 5 N applied to a 1 mL syringe, which is less than one-tenth of the average maximum thumb force reported in the literature. 26 The fluorescent dye measurements ( Figure 3 Our experiments were performed with excised discs constrained by porous metal platens, a common boundary condition in organ culture systems. [27][28][29] This condition was chosen for the present study to allow freezing and cryosectioning of the discs with minimal handling after injection, which was presumed to affect dye distribution.…”

Section: Discussionmentioning

confidence: 99%

Slow depressurization following intradiscal injection leads to injectate leakage in a large animal model

2019

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Needle injection has been indicated as the most practical method of delivering therapeutic agents to the intervertebral disc due to the disc's largely avascular nature. As the disc is characterized by both high stiffness and low permeability, injection requires substantial pressure, which may not relax on practical time scales. Additionally, needle puncture results in a localized disruption to the annulus fibrosus that can provide a leakage pathway for pressurized injectate. We hypothesized that intradiscal injection would result in slow relaxation of injectate pressure, followed by leakage upon needle retraction. This hypothesis was tested via controlled injection of fluorescently labeled saline into bovine caudal discs via a 21 gauge needle. Injections were performed with 10% of total disc volume injected at 3%/s followed by a 4‐minute dwell. An analytical poroelastic model was calibrated to the experimental data and used to estimate injectate delivery with time. Experimental results confirmed both pressurization (with a peak of 199 ± 45 kPa) and slow recovery (final pressure of 81 ± 23 kPa). Injectate leakage through the needle puncture was verified following needle retraction in all samples. Histological sections of the discs displayed a clear defect at each disc's injection site with strong fluorescent labeling indicating a leakage pathway. The modeling results suggest that less than one‐fourth of the injected volume was absorbed by the tissue in 4 minutes. Taken together these results suggest that needle injection is a feasible, albeit inefficient method for delivery of therapeutic agents into the intervertebral disc. Particular care should be taken to aspirate un‐absorbed injectate prior to needle retraction to prevent leakage and exposure of surrounding tissues.

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Grip Type Alters Maximal Pinch Forces in Syringe Use

Abstract: Determining maximal syringe press forces allows workers and ergonomists to develop better strategies for managing the cumulative loads during drug delivery and mixing.

Cited by 6 publications

References 11 publications

Development and Evaluation of an Injectable Chitosan/β-Glycerophosphate Paste as a Local Antibiotic Delivery System for Trauma Care

Development and Evaluation of an Injectable Chitosan/β-Glycerophosphate Paste as a Local Antibiotic Delivery System for Trauma Care

Characterization of trimethyl chitosan/polyethylene glycol derivatized chitosan blend as an injectable and degradable antimicrobial delivery system

Slow depressurization following intradiscal injection leads to injectate leakage in a large animal model

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