Trial of a family-based education program for patients with heart failure and their carers in rural Thailand

Introduction: Heart failure is a major public health problem, affecting over 26 million people worldwide. It is associated with a high rate of mortality, symptom burden and diminished quality of life. Best practice guidelines for the management of chronic heart failure recommend that patients and carers/family members are educated about heart failure self-care. Effective heart failure self-care has the potential to improve health outcomes. Studies conducted in Thailand addressing heart failure self-care are limited and none have investigated the potential benefits of education programs on the health outcomes of both parties within the dyad: the patient with heart failure and their carer. Aims: The primary aim of this research was to examine the effectiveness of a family-based education program for patients with heart failure and their carers in rural Thailand. The research comprises a series of studies, each with specific aims: i) to investigate current heart failure family-based education provision – a global review, ii) to develop a family-based heart failure education program, and iii) to evaluate the effectiveness of this program in rural Thailand. Methods: After completing a systematic review of the literature, a study protocol for development and evaluation of a culturally specific family-based education program was developed. A randomised controlled trial was then conducted in rural Thailand to examine the effectiveness of the program. For patients, the primary outcome was heart failure knowledge as measured by the Dutch Heart Failure Knowledge Scale (DHFKS). The main outcome for carers was perceived control over managing patients’ heart failure symptoms as measured by the Control Attitudes Scale-Revised (CAS-R). Secondary outcomes for patients were self-care as measured by the Self-Care of Heart Failure Index (SCHFI) and health-related quality of life as measured by the Minnesota Living with Heart Failure (MLHF) questionnaire. For carers, additional outcomes were heart failure knowledge as measured by the Dutch Heart Failure Knowledge Scale (DHFKS) and health-related quality of life as measured by the Short Form 12-Item (SF-12) Health Survey. In total, 100 dyads from two public hospitals in Thailand were randomly assigned in a 1:1 ratio in blocks of 10 to the intervention (family-based education program) or usual care (control) group. The education group received usual care in addition to a family-based education program, which consisted of face-to-face education and counselling sessions, a manual, a DVD, and telephone support. Data were collected at baseline, three months, and six months. Results: The systematic review identified six trials reported in nine papers. A dearth of HF studies was found that specifically developed and evaluated an education intervention for both patient and carer. There was a wide variation in the quality of the studies. A family-based HF education program, underpinned by adult learning theory, was developed in strict adherence to CONSORT guidelines. This comprised a culturally specific heart failure manual and DVD that were reviewed for content and cultural validity by a Thai cardiologist and heart failure nurses; minimal changes were recommended. Patients and carers in the education group (those who received the heart failure manual and DVD) had higher knowledge scores than the usual care group at three and six months (p < 0.01). Patients in the education group had better self-care maintenance, confidence, and quality of life scores than the usual care group (p < 0.05) at three and six months, as well as better self-care management scores (p < 0.05) at six months. Carers in the education group had higher perceived control over managing patients’ heart failure symptom scores than the usual care group (p < 0.05) at three months. Conclusion: This is the first ramdonised controlled trial to evaluate a family-based heart failure education program developed for patients and their carers in rural Thailand. The education program improved heart failure knowledge (in patients and carers), patients’ self-care behaviours and emotional dimension of quality of life, and carers’ perceived control over managing patients’ heart failure symptoms. This program provides evidence supporting the positive influence of self-care education by engaging family members/carers. Despite the lack of access to heart failure disease management programs in rural Thailand, it may be possible to improve patient engagement in self-care through educational programs that can be easily introduced, guided and followed-up by a Thai nurse, and which are predominantly self-administered (i.e. manual and DVD) in the patient’s home

PREPARATION AND CHARACTERIZATION OF GRAPEFRUIT OIL BASE MICROEMULSIONS OF CAFFEINE

Objective: The objective of the present work was to prepare and characterize grapefruit oil base microemulsions loaded with caffeine as a model hydrophilic compound. Methods: The formulation ingredients were selected based on surfactant efficiency and solubility studies. Ternary phase diagrams of grapefruit oil were constructed using the water titration method. Nine O/W microemulsions were constructed and prepared by mixing surfactant system, grapefruit oil, water and caffeine together. The resulting microemulsions were investigated for viscosity using Brookfield viscometer, for pH value using a digital pH meter, and for average particle size and polydispersity index (PDI) using a Zetasizer Nano. Ex vivo skin permeation through porcine ear skin was conducted using a side-by-side diffusion cell. The amount of caffeine was analyzed using HPLC-UV method. Results: Tween 20 yielded the highest emulsification ability for grapefruit oil and the highest caffeine solubility. It was selected as a major surfactant. Caffeine was slightly soluble in ethanol and isopropyl alcohol, but sparingly soluble in propylene glycol (PG). These ingredients were used as the cosurfactants. Nine grapefruit oil base microemulsions were prepared and characterized. The pH of microemulsions was within the range of 4.48-5.96. Particle size was in the range of 10.81±0.03 to 62.18±21.04 µm with the PDI of 0.13±0.02 to 0.64±0.11. Viscosity and particle size of microemulsions increased significantly with increasing grapefruit oil or tween 20 content. Addition of PG as cosurfactant resulted in the increases of viscosity, particle size and PDI. Depending on the formulation parameters, the permeation fluxes of caffeine from grapefruit oil base microemulsions were in the range of 28.4±3.4-361.4±15.2 µg/cm2/h. Conclusion: The grapefruit oil base microemulsions were successfully formulated. The physical properties and caffeine permeation of these microemulsions were found to be dependent on the grapefruit oil content, tween 20 content, cosurfactant type and content, as well as caffeine loading. The optimal formulation of grapefruit oil base microemulsion suggested composition of 5% grapefruit oil, 50% surfactant system (tween 20 and ethanol at the ratio of 9:1), and water

การใช้แป้งข้าวเหนียวดัดแปรด้วยเทคนิคไมโครเวฟเป็นสารยึดเกาะในยาเม็ด Microwave-treated Glutinous Rice Starch as A Tablet Binder

บทคัดย่อ วัตถุประสงค์: เพื่อศึกษาการใช้แป้งข้าวเหนียวที่ดัดแปรด้วยไมโครเวฟ (GRMi) เป็นสารยึดเกาะในการผลิตยาเม็ดที่เตรียมด้วยวิธีแกรนูลเปียก วิธีการศึกษา: เตรียมยาเม็ดด้วยวิธีแกรนูลเปียกที่ประกอบด้วยไมโครคริสทัลไลน์เซลลูโลส (MCC) หรือแลคโตสโมโนไฮเดรต (Lac) โดยใช้สารยึดเกาะในปริมาณร้อยละโดยน้ำหนักดังนี้ 1) ร้อยละ 0, 2) GRMi ร้อยละ 2.5 และ 3) แป้งข้าวเหนียวที่ให้ความร้อนโดยตรง (GRB) ร้อยละ 2.5 และใช้แมกนีเซียมสเตียเรตร้อยละ 1 โดยน้ำหนัก โดยตอกอัดยาเม็ดด้วยแรงที่ต่างกัน (40, 60 และ 80 kgf/cm2) แล้วประเมินสมบัติของยาเม็ด ผลการศึกษา: ยาเม็ดที่ใช้ MCC มีความต้านแรงอัดแตกในช่วง 9.52 - 17.72 kgf ซึ่งสูงกว่า Lac (1.10 - 5.98 kgf) เวลาในการแตกตัวและสภาพกร่อนของยาเม็ดที่ใช้ MCC อยู่ในช่วง 11.40 - 59.40 วินาที และร้อยละ 0.08 - 0.41 โดยน้ำหนัก ตามลำดับ ซึ่งต่ำกว่ายาเม็ดที่ใช้ Lac ที่อยู่ในช่วง 70.80 - 5,170.20 วินาที และร้อยละ 0.88 - 3.89 โดยน้ำหนัก ตามลำดับ และยังพบว่าการเพิ่มแรงตอกอัดทำให้ยาเม็ดมีค่าความต้านแรงอัดแตกและเวลาในการแตกตัวเพิ่มขึ้น แต่มีสภาพกร่อนลดลง เมื่อเพิ่มแรงอัดให้แก่ยาเม็ดที่ใช้สารยึดเกาะ GRMi และ GRB พบว่าสามารถทำให้ยาเม็ดมีค่าความแข็งแรง (CSFR) และดัชนีชี้วัดคุณภาพยาเม็ด (CSFR/DT index) เพิ่มมากขึ้นได้ แสดงถึงความสามารถในการยึดเกาะที่ดีและสมบัติการเป็นยาเม็ดที่ดีขึ้น สรุป: สามารถใช้แป้งข้าวเหนียวที่ดัดแปรด้วยไมโครเวฟเป็นสารยึดเกาะในการเตรียมยาเม็ดด้วยวิธีแกรนูลเปียกได้ คำสำคัญ: แป้งข้าวเหนียว, แป้งดัดแปรด้วยไมโครเวฟ, การเตรียมด้วยวิธีแกรนูลเปียก, สารยึดเกาะ Abstract Objective: To investigate microwave-treated glutinous rice starch (GRMi) used as a binder in wet granulation tablets. Methods: Being prepared with wet granulation method, each tablet consisted of filler (microcrystalline cellulose (MCC) or lactose monohydrate (Lac)), binder (0% w/w, 2.5% w/w of GRMi, or 2.5% w/w of heated glutinous rice starch (GRB)) and 1% w/w of magnesium stearate. All tablet formulations were compressed by various compression forces (40, 60, and 80 kgf/cm2) and tablet properties were evaluated. Results: The MCC-tablets had a crushing strength (CS) of 9.52-17.72 kgf. which was higher than that of Lac-tablets (1.10 - 5.98 kgf.). The disintegration time (DT) and friability (F) of MCC-tablets (11.40 - 59.40 sec and 0.08 - 0.41%, respectively) were lower than those of Lac-tablets (70.80 - 5,170.20 sec and 0.88 - 3.89%, respectively). The increase of compression force resulted in increased CS and DT and decreased F. When compression force was increased to tablets using GRMi and GRB as a binder, the higher crushing strength-friability ratio (CSFR) and crushing strength-friability/disintegration time ratio (CSFR/DT index) in both tablets were observed. These results indicated better binding capability with improved tablet properties. Conclusions: microwave-treated glutinous rice starch could be used as a binder in wet granulation tablets. Keywords: glutinous rice starch, microwave-treated starch, wet granulation method, binde

Preparation and Evaluation of Alcohol-Alkaline-Treated Rice Starch as a Tablet Disintegrant

Purpose: To prepare and characterize alcohol-alkaline modified rice starch (MRS) as a disintegrant for tablets.Methods: The preparation of MRS was carried out using 3 M NaOH and 40 % ethanol solution. Characterization carried out for MRS include morphology, swelling capacity, thermal and pasting properties. Direct-compressed tablets (DCT) containing either propranolol hydrochloride (PPNL) or hydrochlorothiazide (HCTZ) were evaluated for hardness, friability, disintegration time and drug release.Results: The microstructure of MRS was different in shape and dimension from that of rice starch (RS). The absence of gelatinization endotherm and FT-IR spectral peak for MRS correlated with change in MRS structure and arrangement. MRS showed significantly higher swelling capacity (p &lt; 0.05) than RS, and also proved to be a disintegrant in DCT. The disintegration time of the tablets containing MRS was lower in the presence of large particles (3.55 ± 0.56 min); high content of MRS (1.03 ± 0.06 min); low content of lubricant (3.16 ± 0.44 min); water soluble filler (1.55 ± 0.16 min for Super-tab®); and model drug (0.84 ± 0.09 min for HCTZ) (p &lt; 0.05).Conclusion: MRS exhibits improved water solubility and swelling capacity compared with RS, and is thus a good disintegrant for direct-compressed tablet formulations, especially in the presence of water insoluble fillers.Keywords: Rice starch, Alcohol-alkaline treatment, Disintegrant, Directly compressed tablet, Insoluble filler

The black ocean strategy in Thailand logistic industry

The logistic is the core of Thai economy. While many business authors are focused on blue ocean strategy in pursuit of tapping into uncontested market space by using differentiation and low cost. There is another strategy that are most commonly use but not much revealed in the literature. It is named black ocean strategy and commonly use in logistic industry. It is the secret mantra from the past which still widely use in today business world. This paper has focus on used car sector as a part of logistic industry to study the viable of this strategy and found that black ocean is commonly used by used car companies. Since the automotive tax in Thailand is pretty high many logistic companies prefer to go for used car which is more economy. The study found that black ocean strategy is the viable tools to reduce the purchasing cost as well as increase the selling price for both logistic buyer and purchaser.The article is licensed under a Creative Commons Attribution-NonCommercial (CC BY-NC) 4.0 International License, https://creativecommons.org/licenses/by-nc/4.0/fi=vertaisarvioitu|en=peerReviewed

Tree Planting to Build Student Character at TGBC Thailand

Plantation of trees is an activity to shape the character of students who care about the environment. This community service activity aims to foster a sense of environmental awareness to shape students' character through tree planting, which is one of the efforts to green the environment. This activity is a collaboration between the Faculty of Economics and Business of Swadaya Gunung Jati University Indonesia, Panca Sakti University Tegal Indonesia, Thai Globa Business Administration Technological College Thailand (TGBC Thailand), Suan Dusit University and Eastern Institute for Integrated Learning in Management University India. Community service activities were conducted at TGBC Thailand, with 50 participants consisting of 20 students and 30 lecturers.  With this community service activity, students' character is formed by caring for the environment through tree planting activities in the surrounding environment. Besides, students can work together as a team, support each other, and strengthen their social ties to protect the environment

Redox activity of melanin from the ink sac of Sepia officinalis by means of colorimetric oxidative assay

The redox properties of natural extract from cuttlefish ink sac (Sepia officinalis) and synthetic melanin used as a biomimetic in melanin structural investigation were determined by comparison of this phenol-based heterogeneous pigment with gallic acid used as a standard in Folinâ Ciocalteu colorimetric assay widely employed for characterisation of oxidative properties of biomaterials. Reactivity of sepia melanin reported here is much higher than previously indicated and this protocol should allow the redox characterisation of all melanins irrespective of their origin and composition.European Union’s Seventh Framework Programme (FP7/2007-2013) [grant agreement number REGPOT-CT2012-316331-POLARIS