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Physical and Technological Modulation of Topical and Transdermal Drug Delivery
Published in Marc B. Brown, Adrian C. Williams, The Art and Science of Dermal Formulation Development, 2019
Marc B. Brown, Adrian C. Williams
The concept of a needleless injection is not new – indeed the U.S. military experimented with such devices for vaccination during the Vietnam War – but it is only since the early 1990s, when Professor Bellhouse, Head of the University of Oxford’s Medical Engineering Unit, developed a gas powered “gun” to fire particles into skin, that many alternative devices and formulations have been proposed to deliver varied agents to and through the tissue based on both liquid (Ped-O-Jet®, Iject® Biojector2000®, Medi-jector®, Tjet®, and Intraject®) and powder systems (PMED™ device, formerly known as the Powderject® injector). Transdermal delivery is achieved by firing the liquid or solid (drug powder alone or engineered particles, including gold) at supersonic speeds (100 to 200 m/s) through the outer layers of the skin using a suitable energy source, such as a helium gas cylinder. Amongst the many potential benefits claimed of this technology are: Pain-free administration can be achieved, since particles fired into the skin are too small to trigger pain receptors within the tissue – though some sensation may be felt.Specific skin strata can be targeted. This is beneficial during, for example, vaccination when delivery to the viable epidermal cells is desired.The fear of needles is avoided.Accurate dosing can be achieved.The technology should reduce accidental needle-stick injuries and should avoid infection or splash-back from bodily fluids.
I'd Rather Be Jabbed Than Shot
Published in Norman Begg, The Remarkable Story of Vaccines, 2023
I spent a year working as a community paediatrician in South East London. I would travel to clinics in Bermondsey, Lewisham, New Cross, Deptford and Rotherhithe. It was 1981, unemployment in the UK had just reached 3 million, and social deprivation was rife. My job was to check on the development of babies and young children, and vaccinate them against infectious diseases. Injecting a baby with a vaccine is simple. The more challenging – and interesting – part of the job was the conversations I had with parents about their concerns. I didn’t have any children at the time, but years later when my two-month-old daughter had her first vaccination, I can’t deny that I felt a tad anxious. The prospect of sticking a needle into a perfectly healthy baby is surely enough to make the most rational parent ask questions. Not surprisingly, the fact that the vaccine had to be given by injection was a big issue for many parents. Almost daily, someone would ask why their baby had to have “the needle”. I tried different approaches to tackle this anxiety. “We do vaccinations here all the time, nothing to worry about” (patronising); “You need to do this for your baby’s health” (scare mongering); “Your baby will hardly feel anything” (a bit of an exaggeration and not convincing); however, some parents were simply not prepared to let their children be injected with a needle. I ended up running a specialist clinic for parents that had major concerns about having their children vaccinated, where I was able to devote more time to talk through their concerns. Once a week I would drive round the North Circular to a rather drab-looking health centre in Redbridge, where I spent the day talking to parents about the reasons they were hesitant to get their child vaccinated. There were a few common themes – my child is allergic to eggs (some vaccines are grown on cells derived from chicks), there’s a family history of fits, I had reactions to vaccines myself as a child. Being able to discuss their concerns, explain how vaccines work and their side effects, usually resulted in the parent deciding to go ahead. Sometimes this only happened after two or three consultations. My experience at the Redbridge clinic really helped my understanding of parents’ anxieties about vaccines. I was struck by the fact that every discussion was about a vaccine that was given by injection. No-one ever asked me about the polio vaccine, which at the time was given by mouth. Not once – although, paradoxically, that is the one vaccine for which there is a known serious (but fortunately rare) side effect: paralysis. The bottom line is that people do not like needles. Fear of needles – needle phobia – is a recognised medical condition. It’s estimated that up to ten percent of people suffer from needle phobia. I used to run a research programme at Nottingham University. Once a year I would take a blood sample from all the first-year medical students, to measure their antibodies. Without fail, someone would faint at the prospect of me sticking a needle in their arm (typically it would be a strapping, rugby-playing male who keeled over). Needles put people off getting vaccinated; removing them would be a game changer for vaccination.
Advances in subcutaneous injections: PRECISE II: a study of safety and subject preference for an innovative needle-free injection system
Published in Drug Delivery, 2021
E. Lynne Kelley, Richard H. Smith, Gillian Corcoran, Sandra Nygren, Mary V. Jacoski, Andrea Fernandes
Needle phobia is a prevalent and yet under recognized health issue. Fear of needles is common in both children (∼33–63%) and adults (∼14–38%) (Orenius et al. 2018) and can contribute to poor adherence among patients as well as negative experiences for caregivers, clinicians and health professionals (Deacon & Abramowitz 2006; Orenius et al. 2018). A study by Taddio and colleagues estimated that as many as 2 out of 3 people are afraid of needles (Taddio et al. 2012). The relatively high prevalence of needle phobia also raises significant health concerns in light of the COVID-19 pandemic, as fear of needles can lead to vaccine avoidance (Taddio et al. 2015; Love & Love 2021). Finally, the use of needle and syringe devices have an added risk of needle-stick injuries and require special needle disposal.
Children’s distress during intravenous placement: The role of child life specialists
Published in Children's Health Care, 2019
Marissa L. Diener, Abigail Owens Lofgren, Russell A. Isabella, Sydney Magana, Chansong Choi, Chelsea Gourley
Medical procedures that use needles are feared by children and adolescents, considered painful, and cause distress. Medical procedures, including those involving needles, are reported to be the second most commonly occurring fear in children, more common than a fear of the dark or fear of thunderstorms, heights, or water (Meltzer et al., 2008). Needle fear, which may actually increase with age, is prevalent in children, and IVs are perceived to be among the most painful and distressing procedures for hospitalized children (Babl, Mandrawa, O’Sullivan, & Crellin, 2008; Ellis, Sharp, Newhook, & Cohen, 2004; Gullone, 2000; Hart & Bossert, 1994; Kennedy, Luhmann, & Zempsky, 2008; Sparks, Setlik, & Luhman, 2007). At the extreme end of fear of needles is a blood-injection-injury phobia, which is a disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (American Psychiatric Association, 2013) that can cause significant subsequent distress and noncompliance with medical care in adulthood (Kennedy et al., 2008). Individuals with fear and anxiety around needles may avoid medical visits and procedures and make medical procedures more difficult (e.g., by fainting or requiring restraint); furthermore, traditional pain interventions may be less effective for patients with severe fear of needles (McMurtry et al., 2015; Noel, McMurtry, Chambers, & McGrath, 2010).
College students’ influenza vaccination adoption: Self-reported barriers and facilitators
Published in Journal of American College Health, 2023
I have a very deep-rooted fear of needles. Every time that I get my blood drawn or get any type of shot I hyperventilate or pass out. No matter what I do to keep myself calm, I always end up doing one of those two things. It is an ordeal to get my flu shot, therefore I tend to avoid it all together.