Dissertations / Theses: 'Samhällsfarmaci och klinisk farmaci'

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Hovorkova, Zuzana. "Monitoring of patients prescribed potassium supplements." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-389654.

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Monitoring of patients prescribed potassium supplements Zuzana Hovorkova Degree Project 30 hp, Pharmacotherapy Department of Pharmaceutical Biosciences/Division of Pharmacokinetics and Drug Therapy Supervisor: Linden Ashfield, Examiner: Margareta Hammarlund-Udenaes Introduction: In Northern Ireland, clinical technicians have been supporting pharmacist in their work in over five decades. From initially having mainly administrative tasks, the role of pharmacy technicians has progressed to more clinical activities. Following recent incidents caused by inadequate monitoring of potassium blood levels it was suggested pharmacy technicians could be utilized to improve patient care. Aim: Aim of this project was to ensure the appropriate monitoring and compliance with treatment guidelines for patients prescribed potassium supplements by extending the role of pharmacy technicians at Antrim Area Hospital. Methods: Training for extending the roles of clinical technicians was developed, following the structure of a regional training programme. Literature search was made to find appropriate background about the subject of interest. Data about monitoring of potassium levels in the relevant patients was collected. Daily monitoring of these patients before and after the change was implemented were compared. Results: Clinical technicians contribution to monitoring of patients prescribed potassium replacement therapy improved guidelines compliance from 66.6 % to 90 % (x2-test, p = 0.028). Percentage of successful treatment raised from 66 % to 89.7 % (x2-test, p = 0.028). Conclusion: By extending roles of the clinical technicians, better and appropriate monitoring of patients prescribed potassium supplements can be reached. In future, roles of the pharmacy technicians could be extended further, thus releasing pharmacists time to expand their role, leading to a more cost- effective system and ensuring medicines optimization.

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Relli, Matilda. "Kunders attityd till generiskt utbyte på apoteket." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-74522.

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Bakgrund: Generikareformen trädde i kraft i Sverige 1 oktober 2002 med avsikt att sänka kostnader för läkemedel dels för den enskilde individen men även för samhället. Detta innebar att receptförskrivna läkemedel började bytas ut mot billigare generiska preparat, om varken behandlande läkare, expedierande farmaceut eller kund motsatte sig utbytet. Reformen har minskat läkemedelskostnaderna, men har för kunderna i vissa fall lett till förvirring, osäkerhet och medicinska problem. Syfte: Syftet med denna studie är att undersöka vilken attityd kunder på apoteket har till generiskt utbyte 16 år efter att reformen trädde i kraft, vilka problem som eventuellt kan uppstå i samband med detta, samt att identifiera eventuella skillnader mellan kvinnor och män i deras inställning till generiskt utbyte. Material & Metod: För att besvara syftet med studien utfördes en enkätstudie på fem olika orter i Sverige, där kunden genom 11 flervalsfrågor fick ge sin syn på generisk substitution. Inkluderades i studien gjorde personer över 18 år som besökte apoteket för att hämta ut receptförskrivet läkemedel åt sig själv och i samband med detta gavs möjlighet att byta till generika. Svaren sammanställdes i databas (Excel). Kvalitetssäkring och korstabulering utfördes. Chi2-test användes för att testa om skillnader mellan könen är statistiskt signifikanta eller ej. Resultat: Övervägande del av kunderna som deltog i studien hade en positiv inställning till generisk substitution, ingen skillnad mellan könen. Dock uppgav en del av kunderna sig ha fått problem i samband med att deras läkemedel byts ut mot generika. Vanliga problem var att kunden ej kände igen namn på läkemedlet eller utseendet av beredningen respektive förpackningen. Större andel kvinnor än män angav sig ha problem med nya biverkningar efter utbytet samt skillnad i effekt. Slutsats: På grund av flera tänkbara biaser bör generella slutsatser utifrån denna studie dras med viss försiktighet. Men resultatet pekar till viss del i samma riktning som tidigare utförda studier och visar att övervägande del av kunderna på apoteket är både villiga att byta ut sina receptförskrivna läkemedel mot generiska preparat och är överlag nöjda med sitt utbyte. Ingen skillnad mellan könen. De problem som oftast uppstår i samband med generisk substitution är att kunden ej känner igen sitt läkemedel efter utbytet, därför finns det ett behov av att se över om det går att göra förbättringar som tydligare förpackningar och likartade tabletter. Kvinnor verkar stöta på problem i samband med generiskt utbyte i större utsträckning än män, detta samt eventuella orsaken bör dock studeras vidare.

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Lindh, Åsa. "Patienternas informationsunderlag för receptordinerade läkemedel samt avvikelser i receptlista." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-75804.

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För att uppnå en optimal läkemedelsbehandling krävs uppdaterade och korrekta ordinationsunderlag inom hela vårdkedjan. Studiens syfte var att kartlägga vad patienten använder som underlag för sin läkemedelsbehandling samt hur många som kände till läkemedelslistan, receptlistan och läkemedelsförteckningen. Vidare syftade studien till att kartlägga hur vanligt förekommande avvikelser är mellan receptlistan och vad patienten uppger vara inaktuella recept, inaktuella/aktuella dubbletter eller saknade recept, samt att jämföra resultatet med motsvarande studie gjord 2012. Datainsamlingen gjordes med hjälp av patientintervjuer på åtta olika apotek under fyra veckor mellan februari och mars 2018. Studiens resultat visade att nästan alla patienter kände till receptlistan och att mer än varannan patient använde den som underlag för sin läkemedelsbehandling. Fyra av tio patienter använde förpackningsetiketterna, drygt sex av tio patienter kände till läkemedelslistan, varav endast var åttonde patient använde den som underlag. Var sjätte patient kände till läkemedelsförteckningen men endast ett fåtal använde den som underlag. Ungefär 8 av 10 patienter hade en eller flera avvikelser i receptlistan. Varannan patient hade aktiva dubbletter vilket var den mest frekventa avvikelsen bland deltagarna. Jämförelse av avvikelser i aktuell studie med studien 2012 visade att ingen större förändring har skett mellan åren 2012 och 2018 med avseende på avvikelser mellan receptlistan och vad kunden uppgav vara inaktuella recept, aktuella dubbletter eller saknade recept i receptlistan. Studien visar dels att en stor andel patienter inte känner till nödvändiga informationsunderlag som behövs för en säker läkemedelsbehandling, samt att receptlistan ofta innehåller avvikelser, något som kan öka risken för felmedicinering.

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Bety, Santa. "Comparison between the Swedish healthcare regions regarding the use of different cancer medications : - breast cancer, colorectal cancer and gastric cancer." Thesis, Uppsala universitet, Institutionen för farmaci, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-439964.

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INTRODUCTION: Gastrointestinal cancers are one of the most fatal malignancies worldwide in both genders and all ages while breast cancer is the leading cause of cancer deaths in women internationally. Angiogenesis inhibitors and epidermal growth factor inhibitors are mainly used in colorectal and gastric cancer, while cyclin-dependent kinase inhibitors are mainly used in the treatment of breast cancer. However, studies of cost-effectiveness are needed to assess whether the high prices for these drugs can be justified with better outcomes and to what extent the total expenditure is acceptable for the health care system. Regional comparisons are important for future advancement within the field. PURPOSE: The aim with this study was to describe whether there were any differences regarding the use of selected cancer drugs in Sweden’s six healthcare regions from 2005 to 2020. METHOD: This research was a descriptive-comparative study. The aggregate-level data used in this paper was provided by the Swedish eHealth Agency and included the measurement total sales cost per 100,000 inhabitants of cyclin-dependent kinase inhibitors for both outpatient care as well as inpatient care. The angiogenesis inhibitors and epidermal growth factor receptor inhibitors were solely used in inpatient care. All data included both genders and all ages. RESULTS: The majority of the cancer drugs studied in this paper had an uneven use and major differences were noted between the regions as regards the consumption of specifically bevacizumab and palbociclib in all the healthcare regions. Notable was the uptake of bevacizumab with approximately a four-fold difference between the southeast healthcare region and the west healthcare region in the year 2020. Palbociclib demonstrated circa seven-fold difference in uptake in the year 2020 between the west healthcare region and the north healthcare region. CONCLUSION: Broadly, we can conclude that there are regional differences in the use of angiogenesis inhibitors and epidermal growth factor inhibitors in the treatment of colorectal cancer and gastric cancer. Cyclin-dependent kinase inhibitors also demonstrate regional differences in the treatment of breast cancer in Sweden’s six healthcare regions. It is of interest to further study why the regional differences exist in Sweden.

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Sehgelmeble, Torrejon Anna. "Hur tillfreds är patienter med informationen de fått av vårdpersonal om sina kardiovaskulära läkemedel." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-409871.

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Background and objectives: Medication is a source for improved health and increased life quality when used right but also a risk for unnecessary suffering when used wrong. Health personnel have a responsibility obligated by law to give patients individual information in order to enable safe usage and encourage concordance. This project aimed to investigate patients’ satisfaction with the information given about their cardiovascular medication by health personnel and to identify patients’ main sources of information. Design: This was a cross-sectional study with a duration of 2,5 weeks. The objectives were investigated using a survey. Participants were asked to rate the information they had received about their cardiovascular medications by health personnel on a response scale. Data was analyzed using descriptive statistics. Settings: Patients were recruited from four internal medicine wards in Trelleborg’s hospital. Main outcome measures: Satisfaction with information was categorized using the response scale. A score was calculated based on the survey in order to estimate the overall satisfaction and to compare subpopulations. Different options for information sources were listed in the survey. Results: Of 83 eligible patients 60 were included (32 women, age range 50-91). Populations satisfaction score median was 7,5 (5-10) out of 13. No significant difference could be found between subgroups based on gender (p=0,28), age (p=0,42) or educational level (p=0,85). Lowest satisfaction was seen with information about side effects, interactions and required life style changes while highest satisfaction was seen with information about the expected effect of the medicine and how to use it. Patients’ main sources for information were primary care physician, community pharmacist followed by the medicine leaflet which seemed to be the main source for information about side effects and handling of a missed dose. Conclusion: This study indicates that patients wish for more information linked to potential problems of their medicine usage. No difference was found between subgroups; however, this study is likely underpowered to confirm such a correlation. Although patients’ main sources were primary care physician and community pharmacist the medicine leaflet seemed to be an important complement and in some aspects a substitute for health personnel.

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Alali, Sara. "Administrering av läkemedel i högre koncentration än gängse praxis i syfte att minska vätskebelastning – en litteraturöversikt över fem läkemedel." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-416679.

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Abstrakt Inledning Övervätskning har under senare tid väckt ett stort intresse då de kan leda till ödem och organdysfunktion. Patienter som vårdas på intensivvårdsavdelningar (IVA) administreras ofta intravenöst med vätskor i form av läkemedel och näring. Genom att ge mer koncentrerad administrering av läkemedel kan problem med övervätskning hanteras. På begäran av IVA i Västmanlands sjukhus begränsades fem läkemedelssubstanser där syftet för arbetet skulle studeras och besvaras. Syftet med denna studie var att undersöka om man på ett säkert sätt kan administrera de intravenösa läkemedelssubstanserna trimetoprim/sulfametoxazol, remifentanil, dexmedetomidin, erytromycin samt aciclovir i högre koncentrationän gängse praxis på en intensivvårdsavdelning. Metod Studien utfördes under perioden januari – maj 2020 på enheten för sjukvårdsfarmaci på Västmanlands sjukhus i Västerås. Metoden som användes för detta arbete var en litteratursökning i databaserna Pubmed och Cinahl. För att komplettera sökningen användes databaserna Eped, Micromedex samt UKCPAs handbok Minimum infusion volumes for fluid restricted critically ill patients. Resultat Totalt erhölls elva artiklar som inkluderades i studien. Trimetoprim/sulfametoxazol, remifentanil, erytromycin samt aciclovir kunde administreras i högre koncentration på ett säkert sätt än gängse praxis på IVA i Västmanlands sjukhus. Ingen artikel visade att dexmedetomidin kan administreras intravenöst i högre koncentration medan en studie visade att den kan administreras subkutant i högre koncentration. Slutsats Det fanns sparsamt med information inom detta område i dagsläget. Stabilitetsstudier var av hög kvalité, men kliniska studier saknas. Fyra av fem läkemedel kan antas administreras i högre koncentration än vad IVA i Västmanlands sjukhus använder sig av idag. Som vidare forskning kan man göra studier på dexmedetomidin intravenöst eftersom den går att administreras subkutant i en högre koncentration. I framtiden krävs mer forskning inom detta område för att komma fram till fler resultat samt styrka resultaten av de studier som finns idag.

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Benström, Stig. "Prehospital pain management of traumatically injured adult patients." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-418917.

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Title Prehospital pain management of traumatically injured adult patients Authors Benström S Institute Uppsala University, Uppsala, Sweden Background and objective Traumatic injuries are a major cause behind moderate and severe pain in a prehospital setting. Therefore, the aim of this study is to evaluate prehospital use of analgesics among adult traumatically injured patients treated within Tartu Ambulance Foundation by analysing how ambulance personnel evaluates and treats pain. Secondary aim is to map prehospital factors influencing the process. Setting and Method A retrospective, single-centre service evaluation study with the primary selection of 7526 electronic patient records (EPR) with the main diagnosis of S00-T98 (ICD-10) was conducted and a polyvariant logistic regression model was created to map factors that influence pain management. Main outcome measures Primary outcome measures were prevalence of pain evaluation and the use of analgesics. Secondary outcome measures were significant changes in odds ratios for prehospital-related factors that affected primary outcome measures. Results Mean age of the study population was 54 years (SD 22) and 775 (58.9%) were male. Out of all the patients in this study 529 (40.3%) received analgesics. Pain assessment before administrating analgesics was documented on 15.9% of EPRs. Nurses assessed pain 3.3 times (95% CI 2.0-5.3; p<0.001) more likely than physicians. The odds for receiving analgesics were 2.3 (95% CI 1.68-3.08; p < 0,001) times smaller when patients had consumed alcohol. Brief assignment (0-10 min) and hospitalisation reduced the odds of using analgesics by 3.6 times (95% CI 1.9-6.8; p<0,001) and 1.59 times (95% CI 1.13-2.24; p<0.007) respectively while lengthy assignments (>50 min) increased the odds by 3.4 times (95% CI 1.9-6.5; p<0,001). Monotherapy was chosen for 73.2% of patients while 24.6% received a combination of 2 and 2.2% a combination of 3 analgesics. Conclusions Current study showed that although nurses as brigade leaders are more likely to assess pain the overall prevalence remains low. Alcohol consumption among patients, short assignment times, and hospitalization decreased the odds for pharmacological pain management. Longer assignment times on the contrary were associated with increased odds. Improvements in pain management can be made in choosing between specific therapeutic options.

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Ekenberg, Marie. "Swedish diabetes patients’ experiences of using GLP-1 receptor agonists (GLP-1 RAs) : A qualitative interview study." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-434750.

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Background: The world prevalence of diabetes mellitus in 2019 was 8.3%, out of which 85-90% have type 2 diabetes mellitus (T2DM). Numerous drugs for treating T2DM are approved, and one of the newer classes of drugs are GLP-1 receptor agonists (GLP-1 RAs). In Sweden during 2015 to 2019, the number of patients using GLP-1 RAs has increased by 280%. Despite this, few studies have explored the experiences of patients using these drugs. Aim: The aim of this study was to gain knowledge about how patients diagnosed with T2DM experience and understand their treatment with GLP-1 RAs in Sweden. Methods: Individual semi-structural interviews were conducted with seven patients and three persons from the healthcare staff during October and November 2020 in Region Uppsala, Sweden. The data was analyzed qualitatively with systematic text condensation. Results: The four main findings were: 1) Both patients with great effect and less effect were satisfied with treatment and preferred GLP-1 RAs compared to their other treatments, 2) GLP-1 RAs may have an impact on lifestyle by effect on appetite and hunger and through the stability in glucose level, more freedom, 3) The preferred administration frequency depended on how easy it was to remember taking the drug, 4) Patients mostly understood their treatment as well as they wanted to, but regular initiation follow-ups and more explanations of decisions could increase treatment motivation and reduce anxiety.The healthcare staff confirmed these experiences by patients but assumed patients preferred weekly administrations compared to daily administrations. Conclusions: Patients’ experiences of using GLP-1 RAs were positive and they described GLP-1 RAs as the best T2DM treatment they had.

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Bildsten, Meriem. "Antibiotikaanvänding i öppenvård i Stockholms län." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-267442.

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Byström, Jennifer. "Telepharmacy- a potential method of drug dispensing in Sweden? : An evaluation of a pilot project in a Swedish pharmacy." Thesis, Uppsala universitet, Institutionen för farmaci, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-448445.

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Background: During the last century, closure in rural pharmacies has been increasing in Sweden resulting in unequal access to pharmaceutical services among the population. Telepharmacy is a provision of pharmaceutical care to patients at distance thereby increasing access to health care. Previous studies have shown promising results regarding various clinical outcomes, attitudes of patients and pharmacists in addition to high-quality drug counseling. As pharmaceutical care is essential for safe drug utilization, it is of importance to induce new approaches in Sweden to maintain pharmaceutical care in these areas. Aim: This study aimed to evaluate a telepharmacy system named Farmaceut på Distans at a local pharmacy in Sweden concerning; patient's and pharmacists’ attitudes, areas of improvements, and safety of the method. Methods: The study was performed between 26/4,-7/5 2021. The objectives of this study were evaluated through a questionnaire and short semi-structured interviews with patients, a semi-structured observation, a semi-structured interview with the project leader, and a focus group with included pharmacists. Additionally, a medicine dispensing error protocol was established. Results: Eleven patients, three pharmacists, and the project leader were included in this study. This study shows that patients and pharmacists expressed optimistic attitudes towards Farmaceut på Distans. However, the method requires to be improved regarding technical aspects in advance of implementation. Further, no medicine dispensing errors were obtained. Conclusions: Due to the small sample size, no conclusions can be drawn regarding the safety of the method. Farmaceut på Distans is a promising approach to maintain safe drug utilization in Sweden. However, further studies require to be performed regarding safety and attitudes among users.

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Koljic, Emina. "Kan de metabola bieffekterna av läkemedlet olanzapin användas vid behandling av anorexia nervosa?" Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-100191.

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Background: Anorexia nervosa is known as an eating disorder that is associated with significant low body-weight, self-starvation and food restrictions. It all usually starts with thoughts of a desire wanting to eat healthier and look thinner. The sickness has become increasingly common in the recent time where 0,5-1% of Sweden’s population suffers from the disease. Most of those who suffer from anorexia nervosa are young girls in their teenage years.The disease comes with consequences and needs to be treated. A person sick in anorexia nervosa can feel a loss of strength which is associated with the lack of energy. Other symptoms that come along with anorexia nervosa are usually low blood pressure, low pulse (bradycardia) and amenorrhea.Anorexia nervosa is an eating disorder, but it also has psychological effects that often come with depression and obsessive-compulsive disorder. These symptoms combined makes it difficult to treat anorexia nervosa and usually demands a combination of supervised weight gain and psychological therapy. Objective: The aim of this study was to evaluate the efficacy of olanzapine treatment regarding weight gain in patients suffering from anorexia nervosa. Olanzapine is an atypical antipsychotic drug that has a well-known adverse effect known as weight gain. In this study this adverse effect of olanzapine is used to see if the drug can be well tolerated and applied to patients suffering from anorexia nervosa. Method: This literature review study analyzed six studies and their results regarding the efficacy of olanzapine on weight gaining in anorexia nervosa patients. One study that was included in this literature review was a case study of a young 15-year-old girl's journey to become healthy from anorexia nervosa while using olanzapine. Three of the six studies were randomized controlled trials that compared olanzapine against placebo while two of the six studies were open label studies that evaluated olanzapine efficacy in anorexia nervosa patients. Results: The results based on the six studies show that olanzapine has positive effects regarding weight gaining in patients suffering low weight from anorexia nervosa. The randomized controlled trials that were included in this literature review study show that olanzapine had a greater significant effect on weight gain compared to placebo. The side effects of olanzapine presented in the studies were very mild to moderate and included sleepiness and headache. The doses of olanzapine used in the six studies were similar and contained 10-15 mg olanzapine each day. Conclusion: In summary, olanzapine has the benefit of increasing weight in anorexia nervosa patients, but the evidence is limited because of the small number of participants in the studies and only a few studies have been made. It would be of interest to see if olanzapine still has a beneficial effect in larger studies with more participants.

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Juhlin, Madeleine. "Elektroniskt expertstöd ur kundens perspektiv : En enkätstudie om kundens kännedom och inställning till EES." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-74488.

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Abstract Medicines are substances used to prevent, alleviate or cure diseases which is an important part of health care. The role of the pharmacist in the healthcare chain is important because they are the patients last contact with healthcare professionals. After this contact they must assume responsibility over their own treatment. The pharmacist's responsibility is to make sure that the patient has received essential information about their drugs and to check that the prescribed dose is correct. The increased digitalization of society brings an opportunity for the patients to increase participation and understanding of their drug treatment. Decision support systems are different methods used to obtain a basis for decision making. Pharmacists use these systems to check if prescriptions are correct, for example by ensuring that the right medication, in the correct dose, has been prescribed to the right patient at the right time. In Sweden there is a decision support system called elektroniskt expertstöd (EES). This system offers pharmacy customers further drug control in addition to other controls that are available through the pharmacy's other systems. The benefit of this system is that the pharmacist has better support in detecting incorrect doses, interactions, duplicate medications and if the drug is inappropriate for the patient's gender or age. When the system alerts, the pharmacist makes an assessment which may be discussed with the patient or the physician if needed. Purpose The purpose of this survey study was to investigate what the pharmacy customers knows about EES and the pharmacists use of the system. Method Before the study started, approval from the southeast ethic committee was obtained which said that there were no ethical barriers for the performance of the study. The surveys were handed out to anyone who would receive prescriptions at different pharmacies in Luleå, Grängesberg, Värnamo, Kalmar and Torsås. The common goal was to spend 20 hours of handing out surveys per student. The results were put together and analyzed in IBM SPSS Statistics with descriptive statistics. Results and discussion The results show that most of the respondents did not know about EES and did not know if the pharmacists are using this support system. The results also show that most of the respondents had not given their consent to EES and did not know if EES could support the pharmacists work. More than half of the survey population answered “do not know” on a question asking if they wanted the pharmacist to use EES when dispensing drugs. Almost a quarter of the total population wanted the pharmacist to use EES and close to three quarters of the total population had no knowledge of the system. This could mean that the customers who have knowledge wants the system to be used. A reason for wanting the system to be used without having knowledge of it could be that customers trust it is beneficial for themselves and for the pharmacists. Building trust and showing care in each customer meeting is important to make the customer susceptible to information. Sufficient information can lead to better compliance in drug treatments. Before the pharmacist can use EES for the first time the customer must consent. Although it was a few years since the introduction of EES into pharmacies, some pharmacists find it difficult to connect customers to the system. It is a relatively new way of working with drug analysis at the pharmacies in Sweden. More practice in the system could provide increased use of it and help the pharmacists decision making. Conclusion Only a small proportion of the pharmacy customers have knowledge of EES. But even so, one fourth of them wanted the system to be used to analyze their medication which is considered positive.

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Burgol, Mohammed. "Integritet på Öppenvårdsapotek ur Kundperspektiv - Intervjustudie." Thesis, Uppsala universitet, Institutionen för farmaci, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-447808.

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Abstract Background: In the last decades, services that community pharmacies provide to the consumers have increased. Pharmacies and consumers discuses information related to medicine use, which lead to optimal treatment. Protection av patient privacy and confidentiality is one of the most important factors to achieve in such discussions. Several international studies showed that achieving this factor in community pharmacies is challenging to both pharmacists and consumers. According to our knowledge, there are no similar studies on consumers’ perceptions of privacy in community pharmacies in Sweden Objective: The aim of this study is to explore consumer’s positive and negative experiences of privacy practice in community pharmacies in Sweden. Method: Semi-structured interviews were conducted with consumers of community pharmacies in three different regions in Sweden. Consumers were interviewed by zoom with camera. All interviews were audio-recorded, transcribed verbatim and then analyzed and organized into different themes. The interviews were conducted between April and May 2021. Results: 14 themes and privacy issues were identified, such as variety in privacy definition in community pharmacies for Swedish consumers, trusting pharmacists by most of the consumers, seeing bought sensitive medicines through packaging and overhearing private conversations. The majority of the consumers showed positive reactions about consultation areas and agreed about the need for better privacy practice in community pharmacies. Conclusion: Some findings of this study met other similar studies conducted in other countries. The optimization of the privacy practice was challenging in community pharmacies. Since protecting the privacy could be achieved by cooperation between the staffs and the consumers, the findings of this study were preliminary and needed further exploration, such as interviewing pharmacists and considering their perspectives.

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Anderberg, Maria. "Hur väl stämmer patienternas läkemedelslistor? En kartläggning på medicinkliniken vid Capio S:t Görans Sjukhus." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-429617.

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Abstract [en] Title: Discrepancies in medication lists at hospital wards identified by medication reconciliation Authors: Anderberg M. Institute: Uppsala University, Uppsala, Sweden Background and objective: An accurate medication list is essential for a correct assessment of a patient´s condition at hospitals. Previous studies have shown that patients in emergency departments often are affected by discrepancies in medication lists at hospital admission. Less research has been done regarding discrepancies after transferring patients to medical wards. The aim of this study was to identify discrepancies in the electronic medical record in hospital wards for patients admitted via the emergency department. Design: Observational study. Medication reconciliation was performed by a pharmacist shortly after the arrival of patients from the emergency department. This included a patient interview and the investigation of the patient’s medical record. The discrepancies identified at the wards were classified as either omitted drug, wrong dose, additional drug, incorrect frequency or duplicate therapy. Descriptive statistics were used and the proportion of medication lists with at least one discrepancy was presented with 95 % confidence interval. Setting: Three medical wards at Capio S:t Görans Hospital in Stockholm. Main outcome measures: The proportion of medication lists with at least one discrepancy. The mean value of discrepancies among all patients. Classification and categorization of discrepancies regarding type and ATC index. Results: In total, 63 patients were included with a mean age of 63 years. At least one discrepancy was identified in 43 % (95 % CI 31-55) of the medication lists. 52 discrepancies were found in total generating a mean value of 0,83 ± 1,17 discrepancies per medication list. The two most common categories were Omitted drug(33%) and Wrong dose(33%). The most frequent drug class associated with medication discrepancies was Drugs for obstructive airway diseases. Conclusion: 43 % of the patients had at least one discrepancy in the medication list. This indicates the importance of medication reconciliations at medical wards even though the medication list has been updated at the emergency department.

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Stöger, Ulrika. "Kommunala sjuksköterskors kontakt med apoteken : en tids- och enkätstudie bland Kalmar kommuns sjuksköterskor." Thesis, University of Kalmar, School of Pure and Applied Natural Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hik:diva-1473.

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Syftet med denna studie är dels att undersöka hur stor andel av arbetstiden som sjuksköterskor, inom kommunala hälso- och sjukvården i Kalmar kommun, använder för kontakt med apoteken, dels att belysa hur sjuksköterskorna ser på kontakten med apoteken med avseende på dess omfattning och innehåll.

Kalmars kommunala sjuksköterskor förde under en vecka i februari 2009 tidsdagbok över sin apotekskontakt. I anslutning till detta utfördes även en enkätundersökning bland dessa sjuksköterskor.

Svarsfrekvensen var låg; 43 % av sjuksköterskorna deltog i enkätstudien och endast 19 % deltog i tidsstudien. Den genomsnittliga andelen arbetstid som ägnades åt apotekskontakt fastställdes till 4,6 ± 3,9 %. Enkätstudien visade på en del önskemål om förändring i såväl kontakten med apoteken som i de kommunala rutinerna. Förslag som lades fram av sjuksköterskorna för en minskning av kontakttiden med apoteken var bland annat att annan personal inom hälso- och sjukvården eller anhöriga till patienten gör apoteksärenden i stället för sjuksköterskorna, samt att apoteken ska införa en särskild kö för vårdpersonal och därmed minska kötiden.

Den låga svarsfrekvensen gör att inga statistiskt signifikanta slutsatser kan dras av studien och då i synnerhet inte av tidsstudien. Studien visar dock på stora variationer sjuksköterskorna emellan, i andel arbetstid som ägnas åt apotekskontakt. Validiteten och precisionen för denna variation är ej hög, delvis på grund av det låga deltagandet. Enkätundersökningen visade på problem som kan härröras till brist i kommunikationen mellan såväl sjuksköterskor och övrig hälso- och sjukvårdspersonal, som mellan sjuksköterskor och apotekspersonal. En förbättrad interprofessionell kommunikation skulle eventuellt kunna lösa denna problematik.

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Radivojevic, Aleksandra. "Användning av ciprofloxacin i primärvård i region Sörmland." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-415749.

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Introduction: Infections caused by bacteria can be treated with antibiotics. One type of antibiotic used to fight bacteria is ciprofloxacin, a group of fluoroquinolones. To prevent this, bacteria have developed resistance by mutating in various ways. Negative bacterial cultures, short- and long-term treatments, all favor the progression of bacterial resistance to antibiotics, as a consequence of mutation. Compared to other antibiotics, the resistance development has increased more extensively for ciprofloxacin. Also, ciprofloxacin is incorrectly prescribed in primary care, which contributes to the increase in resistance development. Because of this, doctors wish to be more restrictive with the prescription of ciprofloxacin. Aim: This study aimed to determine if ciprofloxacin in primary care in Sörmland is prescribed correctly by examining whether the prescriptions are in compliance with the treatment recommendations in Sweden. Methods: The study was conducted as a survey research and executed under two months; from start of February to middle of April. The inclusion criteria were the primary care in Sörmland and the prescribers who prescribed ciprofloxacin with ATC code J01MA02 from January 2020. Firstly, the head of the care unit was contacted. Prescribers were then contacted individually to take part in a phone interview. The collection of data was compiled and compared to the treatment recommendations in Sweden to determine if the prescriptions were correct, regarding indication, dosage, and treatment time. Results: A total of 236 prescriptions were obtained, of which 89 were included in this study. Out of these, 32 prescriptions (36%) were in accordance with the correct choice of preparation regarding indication, dosage and treatment time and were, therefore, considered to be correct. Prescriptions that were not in accordance with the Swedish treatment recommendations, regarding the use of correct preparation for a single indication, dosage or treatment time, amounted to 57 prescriptions (64%). These prescriptions were, thereby, considered incorrect. Conclusion: This study concludes that it appears that less than half of the prescriptions of ciprofloxacin in the primary care in Sörmland were correct during this time period.

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Sertkaya, Gizem. "Krossning/delning av tabletter till patienter medsväljsvårigheter : -Olika professioners syn." Thesis, Uppsala universitet, Institutionen för farmaci, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-446940.

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I samband med att den äldre populationen blir en större andel av jordens befolkning ökar även sväljningsproblematiken i befolkningen. Dysfagi är ett tillstånd som försvårar både födo- och vätskeintaget, följden av detta är att administreringen av fasta orala läkemedel (tabletter/kapslar) försvåras. Genom läkemedelsmanipulering, det vill säga krossning och delning av tabletter/kapslar kan läkemedelsadministreringen underlättas till dessa patienter. Riskerna med att krossa/dela fasta orala läkemedel kan bland annat ge upphov till irritation i magslemhinnan, obehaglig smak och i värsta fall förstärkt eller utebliven effekt. Syftet med detta fördjupningsprojekt är att få kunskap om olika professioners (läkare, logoped, klinisk farmakolog och klinisk apotekare) erfarenheter kring sväljbedömning, förskrivning och uppföljning av peroral läkemedelsbehandling till patienter med sväljsvårigheter. Denna kvalitativa intervjustudie utformades år 2021 och analyserades med en manifest innehållsanalys, där åtta studiedeltagare rekryterades. Resultatet visar att bedömning av sväljförmågan kan utföras av läkare och annan inblandad personal men att logopeden anses ha den centrala rollen. Vid förskrivning ser läkarna över läkemedelslistan med avseende på sväljsvårigheter och möjlighet till krossa/dela om det framkommer att patienten har sväljproblematik. För att inhämta information kring krossning/delning och alternativa beredningsformer utgår läkarna från ungefär samma källor och som stöd finns kliniska farmakologer och apotekare. Samtliga nämner att det kan finnas risker med krossa/dela som exempelvis ökad risk för biverkan. Det framkom även att uppföljningen av läkemedelsbehandlingen till patienter med dysfagi är bristande. Slutsatsen som kan dras är att det finns förbättringspotential kring sväljbedömning, förskrivning och uppföljning av peroral läkemedelsbehandling till patienter med sväljsvårigheter, detta genom exempelvis tillämpning av rutiner, utbildningsinsatser och ett tydligare teamsamarbete.

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Nygren, Jonas. "Patienters läkemedelsanvändning vid inskrivning inför elektiv urologisk kirurgi." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-418916.

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Abstract Elective urological patients’ medication usage at the time of admission Author: Nygren. J. Supervisor: Gillespie. U. Examiner: Nielsen. E. Department of Pharmaceutical Biosciences, division of pharmacokinetics and drug therapy. Faculty of pharmacy. Uppsala University, Sweden. Background and Objective: Information about the patient’s current medication treatment before elective urologic surgery has been based upon a prefilled self-reported health declaration or a patient provided medication list. A new work procedure has recently been adopted where a pharmacist performs a medication reconciliation in order to increase the patient safety, receive deeper insight into the patients ongoing treatment and to reduce the physician’s workload. The objective of the study was to map out how well the patients could account for their medication usage at the time of admission and to identify discrepancies between the health declaration/patient’s medication list and the medication list after medication reconciliation. Design: The study population consisted of adult men and women scheduled for elective urological surgery. A clinical pharmacist performed a medication reconciliation and stored appurtenant patient data and medication lists in anonymised forma. Data was then analysed by a student undertaking his degree project (MSc Clinical pharmacy). The population and discrepancies were divided into sub-groups and a t-test was performed to identify any statistical difference between selected sub-groups of the population. Setting: Urology department, Uppsala University Hospital Main outcome measures: The proportion of patients having at least one discrepancy were studied. Distribution of discrepancies per patient was compared between sub-groups; number of medications, age and county of residence. Results: At least one discrepancy (range 1-7) was observed in 51 (66%) out of the 77 patients included in the study. Patients using >5 medications at the time of admission had more discrepancies per patient than those using 0-5 medications (3.2 vs 1.0; p=5.6x10-6) and there was a trend towards Uppsala patients having more discrepancies per patient than those residing outside the region (2.4 vs 1.5; p=0.057). There was no significant difference observed between the age groups. Conclusion: The health declaration/medication list presented at the time of admission did not provide enough information to determine the patient’s complete medication usage.

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Karim, Lara. "Extravasering vid behandlingar med aciklovir, kaliumfosfat och kaliumklorid inom intensivvården." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-415750.

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Extravasation is a condition that can occur during an intravenous administration. This means that the solution administered intravenously goes extravascular. Depending on physiochemical properties of the substance and solution, this can cause different severity of the damage. Extravasation of acyclovir, potassium phosphate and potassium chloride causes severe tissue damage that can, in worst case, lead to tissue necrosis. The purpose was therefore to investigate how acyclovir, potassium phosphate and potassium chloride causes tissue damage due to pH and osmolality and how the tissue damage can be avoided. To answer the purpose, a comprehensive literature search was conducted on three different databases; Pubmed, CINAHL and Cochrane. The literature search was in progress from February 4 to May 14 2020. The literature search generated a total of 42 articles and case reports, of which 13 of these were relevant for the purpose. These 13 articles consisted of two animal studies, three experimental observational studies, two guidelines from Västra Götalands Region, three case reports about acyclovir and three case reports of potassium phosphate and potassium chloride. Two of the experimental observational studies showed that potassium chloride could be diluted with 100 mL of 0,9% sodium chloride or 5% dextrose in water to possibly avoid tissue damage due to extravasation. Such results were not found for either acyclovir or potassium phosphate. The conclusion that could be drawn was that acyclovir caused tissue damage because of its alkaline pH, potassium phosphate because of its hyperosmolality and potassium chloride because of its acidic pH and its hyperosmolality. One way to possibly avoid tissue damage caused by extravasation is to dilute the substances with higher dilution volumes. However, due to the lack of reliability of the included studies, it cannot be safely concluded that tissue damage can be avoided.

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Stefan, Elias. "Familjär hyperkolesterolemi (FH) – analys av prevalens i Stockholm och hälsoekonomiska konsekvenser av tidigdiagnostik och behandling." Thesis, Uppsala universitet, Institutionen för farmaci, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-434844.

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Background: Familial hypercholesterolemia (FH) is a genetic disorder estimated to affect 0,4 % of the world's population (1 in 250). Patients with FH have abnormally high LDL-cholesterol. Aim: The aim of this study was to estimate the prevalence of FH in Stockholm County and to evaluate the health economic impact of diagnosing people with FH early in life. Methods: Two algorithms were used to estimate the number of people with high LDLcholesterol. The first method applied data on cholesterol measurements from patients in Stockholm County between 2006-2008 and a modified version of Dutch Lipid Clinic Network. The second method was based on dispensed prescriptions of ezetimibe, lomitapide, evolucumab and alirocumab during 2019. A health economic model was created to estimate the economical outcome of diagnosing and treating patients early before undergoing a cardiovascular event. Results: The prevalence of FH in Stockholm County was estimated to 0.63 %, corresponding to a total of 12 000 individuals. The accumulated costs over 20 years for FH is estimated to be more than 1,1 billion SEK for diagnosed and treated patients, and 1,7 billion SEK for undiagnosed and untreated patients. Conclusions: The prevalence of FH in Stockholm County is probably higher than previously suggested. Early diagnosis and treatment is an investment for society and necessary for the patients to prevent cardiovascular events and improve quality of life.

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Vujovic, Sonja. "Brister i listan "Mina sparade recept på apotek" : Vilka avvikelser förekommer och finns det några särskilda läkemedelsgrupper som vanligare är felförskrivna?" Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-102120.

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Bakgrund: Användning av läkemedel ökar och därmed ökar också läkemedelsrelaterade problem. För att patienter ska kunna ha en säker läkemedelsbehandling krävs bland annat korrekt och fullständig läkemedelsinformation. I dagsläget finns det olika informationskällor som patienter använder för att hålla koll på sin läkemedelsbehandling men i många av dem förekommer avvikelser som gör att risken för felmedicinering eller överdosering ökar. Syfte: Syftet med det här arbetet var att undersöka prevalensen av avvikelser i läkemedelslista ”Mina sparade recept på apotek” (MSR), samt att se om vissa läkemedelsgrupper skulle förekomma oftare än andra bland avvikelserna. Även andra variabler, såsom informationskällor som patienter använder för att hålla reda på sin läkemedelsbehandling, avsaknad av receptbelagda läkemedel i MSR och användning av receptfria läkemedel mättes. Metod: Data for studien samlades in genom speciellt utformade läkemedelsintervjuer med patienter på ett öppenvårdsapotek i Sverige under veckorna 3–5 i början av 2021. Patienterna som inkluderades var vuxna patienter som hade åtminstone tre receptbelagda läkemedel i sin MSR och som hämtade ut läkemedel åt sig själva. Innan läkemedelsintervjuerna påbörjade erhölls också ett skriftligt samtycke från alla deltagare. Resultat: Nästan 70 procent av 69 intervjuade patienter hade minst en typ av avvikelse i MSR, därav dubbla och inaktuella recept var vanligaste. Bland avvikelserna var de vanligaste läkemedel för behandling av sjukdomar som rör nervsystemet, hjärta och kretslopp samt matsmältningsorgan och ämnesomsättning. En del av patienterna (35 procent) saknade receptbelagda läkemedel i sin MSR, medan 30 procent av dem uppgav att de använde receptfria läkemedel. Informationskällan som användes av de flesta patienterna för att hålla koll på deras läkemedelsbehandling var just MSR. Slutsats: Avvikelser i MSR förekommer hos nästan 7 av 10 patienter och de läkemedelsgrupperna som var vanligare bland avvikelser är också läkemedelsgrupper som orsakar mest läkemedelsrelaterade problem. Dessa avvikelser måste åtgärdas eftersom de påverkar patienternas säkerhet och förhoppningsvis kommer implementering av den nya nationella läkemedelslistan (NLL) kunna förbättra situationen för både patienten och hälso- och sjukvårdspersonalen.
Background: The use of medicines has increased in the past few years, which has also led to increased amount of drug-related problems (DRP), such as drug-drug interactions and serious adverse effects which lead to hospitalization. In order to decrease the amount of DRP, the medication lists of individual patients need to be accurate and updated. The most used medication list among those available is the one that is printed out at a pharmacy “My stored prescriptions at pharmacy”. It is also called “Prescription List” (PL). Even though a lot of patients use the PL, there are a lot of discrepancies in it, such as noncurrent and missing prescriptions, but also prescription duplicates. Aim: The aim of this study was to study the prevalence of discrepancies in the PL, such as noncurrent or duplicate prescriptions, wrong dosage or other unclarities, but also to see if there are some particular drug groups which are more common among the discrepancies. Secondary outcomes that were measured included the amount of missing prescriptions in the PL, as well as the usage of over-the-counter (OTC) medicines and primary information sources that patients use to keep track of their prescriptions. Methods: Data needed for the study was collected by interviewing patients at a local pharmacy. The interview was specially designed to answer to all the outcomes and the patient’s individual PL was also used to identify the discrepancies. In order to be included in the study patients needed to be at least 18 years old, have three or more prescriptions in the national prescription repository (NPR) and pick up their own medication, as well as provide a written consent to participate. Pharmacists that were dispensing patient’s prescriptions were also in charge of the recruitment of patients. Result: Out of the 103 patients that were informed about the study, 69 patients were included. Almost 70 percent of them had at least one type of discrepancy in the PL. The most common discrepancy was prescription duplicates (46 percent), followed by noncurrent prescriptions (44 percent). Drug groups which were common among the discrepancies were the drugs used to treat diseases in the nervous system, cardiovascular system and digestive system (including metabolism). Secondary outcomes showed that 35 percent of the patients had at least one missing prescription in the PL, but also that 30 percent of the patients used OTC medicines, the most common being paracetamol (acetaminophen). The most used information source was the PL with 32 percent of patients using it as their primary information source for their medication therapy. Conclusions: Prescription duplicates and noncurrent prescriptions are frequent in the PL and are a major source of medication errors for patients and health-care workers. Drug groups which where the most common among the discrepancies are also the ones responsible for half of the hospitalizations in Sweden. This implies that they could probably be prevented by improving the PL. The number of the missing prescriptions was quite low. The usage of OTC medicines showed that most of patients used painkillers. These are the drugs that Swedes often overuse and therefore, for future safety, monitoring of OTC sales should be implemented. Although it had 21 percent of inaccuracies, the PL was the most used information source for the patients, which gives the conclusion that the improvement of it is needed as soon as possible in order to prevent and decrease the frequency of DRP.

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Dhaif, Nadin. "Läkemedelsmanipulering Till Patienter Med Sväljsvårigheter : Att krossa/dela fasta orala läkemedel ur ett sjuksköterske- och klinikapotekarperspektiv." Thesis, Uppsala universitet, Institutionen för farmaci, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-446938.

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Dysfagi är ett vanligt förekommande och mindre uppmärksammat tillstånd som påverkar patientens hälsa och livskvalité. Dysfagi innebär en försämrad ät- och sväljförmåga som kan leda till undernäring, ökad sjuklighet och uttorkning, som i sin tur kan leda till ökad dödlighet. Patienter med sväljsvårigheter har oftast svårt med intag av orala läkemedel som tabletter/kapslar, vilket gör att läkemedel kan behöva manipuleras (krossas/delas) för att underlätta nedsväljningen. Därför är syftet med detta projekt att studera sjuksköterskornas och klinikapotekarnas beskrivning av hur sväljbedömningen, läkemedelshanteringen och uppföljningen går till för patienter med dysfagi. Projektet gjordes genom en kvalitativ intervjustudie med hjälp av en innehållsanalys. Totalt intervjuades sex sjuksköterskor och två klinikapotekare som arbetar inom Region Västmanland år 202. Resultatet presenterades under sex huvudkategorier; “Bedömning av sväljsvårigheter i praktiken”, “Tillvägagångssätt vid läkemedelshantering”, “Källor vid manipulering av läkemedel”, “Teamarbetets betydelse i vården”, “Läkemedelsgenomgångar för patienter med dysfagi” och “Förbättringsförslag”. Resultatet visade att sjuksköterskorna inte utför några djupgående bedömningar av sväljförmågan. Det visade även att majoriteten av sjuksköterskorna hanterade läkemedelsmanipulation på likartat sätt och använde gemensamma informationskällor. En regelbunden uppföljning av patienternas sväljförmåga fanns inte. Klinikapotekarna bidrog till en minskad läkemedelsmanipulering genom att utföra läkemedelsgenomgångar. Slutsatsen som kan dras är att det finns ett behov av fler insatser av vården som skulle kunna optimera läkemedelsbehandlingen till patienter med dysfagi. Detta kan ske genom ett ökat samarbete mellan olika professioner i vården och tydligare rutiner, informationskällor och utbildningar.

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Abood, Ekhlas. "Identifying Medication History Errors at Iraqi Hospital Admissions Using The Swedish-LIMM model." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-350150.

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Abstract Background and Objective: An accurate medication history list is an integral part of the patient assessment at hospital admission. The objective of the study was to describe the frequency, type, and predictors of unintentional medication errors and to evaluate the quality of the clinical pharmacy services focusing on the acceptance of the recommendations made by the clinical pharmacist. Setting and methods: A descriptive study was conducted at two internal medicine wards at Baghdad Teaching Hospital in Iraq using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. The study pharmacist conducted medication interviews for patients shortly after hospital admission to obtain the most accurate pre-admission medication history list. This list was compared with the medication list in the patient’s medical chart. Intended addition, withdrawal of a drug, or changes to the dose/ dosage form in the patient’s medical list was considered as medication discrepancies. However, medication discrepancies were considered as medication errors based on no identified clinical reason. Results: A total of 114 patients were included in this study. Over two-thirds of the study patients (73.7%) experienced 215 medication errors identified by a clinical pharmacist conducting medication reconciliation. Most errors were omission (87.9%). Cardiovascular agents followed by NSAID were commonly in error (53%) and (10.2%) respectively. In a logistic regression model, age (odds ratio (OR), 1.055: 95% confidence interval (CI) 1.010 - 1.102), female gender (OR, 3.468: 95% CI 1.232- 9.761) and number of medications at admission (OR, 0.810: 95% CI 0.681-0.963) were predictors for medication history errors at admission. Conclusions: Medication errors at the time of hospital admission are common and undetected. A structured approach like the LIMM-based medication reconciliation at Iraqi hospital is needed to detect these errors.

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Nasseri, Leo. "Nyinsättning av smärtstillande läkemedel till patienter med nedsatt njurfunktion - En registerbaserad studie." Thesis, Uppsala universitet, Institutionen för farmaci, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-447492.

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Introduction: The kidneys' ability to filter drug substances deteriorates with age. Some diseases accelerate this degradation. Patients with renal impairment are at increased risk of drug-related adverse reactions if dose adjustments are not made. Aim: To investigate the purchase and dosage of newly introduced opioids, gabapentinoids and NSAIDs between 2014 and 2019 for patients with impaired kidney function in the Stockholm Region. Method: A register-based cross-sectional study where data has been obtained from the database SCREAM (The Stockholm CREAtinine Measurements project). All patients ≥ 18 years of age, who live in Stockholm and have performed at least one creatinine measurement from January 2013 and received a prescription for selected drugs were included. The number of people and the dosage (DDD/prescription) were studied annually, by age, sex, and CKD. Results: The total number of patients was 362,964 with a mean age of 56 (SD 19) years. The study included 202,762 women (56%) and 160,201 men (44%). The mean value of eGFR was 88 (SD 24). Gabapentinoids were prescribed significantly less than NSAIDs and opioids, however, prescribing increased between 2014-2018. It was the only class of drugs with a clear reduction in dosage with respect to CKD level. NSAIDs were prescribed on few occasions to patients with impaired renal function, at the same time a reduction in the total number of prescriptions was seen between 2014-2018. No major difference in dosage was seen based on the patient's CKD level. Opioids were prescribed on most occasions with an increase in the number of prescriptions between 2014-2018. Only minor differences in dosage were noted between the different CKD levels. However, for all CKD levels, there had been a gradually reduced dosage from 2014 to 2018. Conclusion: Patients with renal impairment belong to a fragile group with a number of different comorbidities. Painkillers are prescribed on fewer occasions to patients with renal impairment. Prescribers, however, do not appear to adjust the dose with respect to renal function when re-introducing NSAIDs and opioids

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Svensson, Frida. "Imepitoin - framtidens förstahandsval vid epilepsi hos hund?" Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-82061.

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Bakgrund: I Sverige förekommer epilepsi hos 1-2 % av alla hundar. De första anfallen visar sig oftast när hunden är mellan ett och sex år gammal. Det nuvarande förstahandspreparatet är fenobarbital, en substans som ökar tröskeln för elektrisk stimulering av motorcortex samt minskar monosynaptisk transmission som leder till minskad neuronal retbarhet. I februari 2013 registrerades ett nytt antiepileptikum med det verksamma ämnet imepitoin. Imepitoin är en partiell agonist som binder till bensodiazepinsätet på GABAA-receptorn. Det förstärker de GABAA-receptormedierade effekterna på neuronen samt har en svag kalciumblockerande verkan. Syfte: Arbetets syfte var att undersöka om imepitoin har förutsättningar att bli det nya förstahandspreparatet vid behandling av idiopatisk epilepsi. Vidare var syftet att undersöka i vilken utsträckning imepitoin fungerar som antiepileptikum samt vilken biverkningsprofil det har. Resultat: Behandling med imepitoin gav en sänkning av antalet epileptiska anfall per månad (MSF), liknande den som erhölls vid fenobarbitalbehandling. Imepitoin sänkte MSF både som monoterapi och i kombination med fenobarbital eller kaliumbromid. Biverkningsprofilen var överlag skonsammare för imepitoin jämfört med fenobarbital. Fenobarbital visade en leverpåverkan medan imepitoin påverkade kolesterolvärdet. Slutsats: Imepitoin har en antiepileptisk effekt, liknande den som fås vid behandling med fenobarbital. Behandling med imepitoin kan ske både som mono- samt kombinationsterapi. Den mildare biverkningsprofilen talar för användning av imepitoin. Samtidigt har fenobarbital använts under en längre tid så biverkningar vid långtidsanvändning är mer välkända än de vid imepitoinanvändning.
Background: In Sweden, approximately 1-2 % of all dogs suffer from epilepsy. The first seizures often occur when the dog is between one and six years old. In Sweden the first-line drug is phenobarbital, a substance which increases the threshold of electrical stimulation in the motor cortex. It also decreases synaptic transmission which leads to decreased neuronal excitability. In February 2013 a new antiepileptic drug was registered with imepitoin as active substance. Imepitoin is a partial agonist which binds to the benzodiazepine binding site at the GABAA receptor and amplifies the effects mediated by GABAA receptors at the neurons. Additionally, imepitoin has a weak calcium channel blocking effect. Objective: The main aim of the study was to examine if imepitoin should be the first-line drug instead of phenobarbital when treating dogs diagnosed with idiopathic epilepsy. A further aim was to look into which effect imepitoin had in controlling the epilepsy and which adverse effects were experienced when dogs are treated with imepitoin. Results: Treatment with imepitoin resulted in a decrease in monthly seizure frequency (MSF), similar to the decrease seen upon treatment with phenobarbital. Imepitoin was decreasing MSF both when used as monotherapy and in combination with phenobarbital or potassium bromide. The adverse effects were in general less severe with imepitoin than with phenobarbital. Treatment with phenobarbital affected the liver while treatment with imepitoin affected the cholesterol levels. Conclusion: Imepitoin has a good antiepileptic effect, similar to that of phenobarbital. Treatment with imepitoin can be used both as monotherapy and in combination with other antiepileptic drugs. Less severe adverse effects makes imepitoin a possible choice for treating idiopathic epilepsy in dogs. On the other hand, phenobarbital has been used during a long period of time and adverse effects of long term use are therefore better known than for imepitoin.

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Abdul, Rahim Ranya. "Kommunikationsproblem på svenska apotek : Förekomst och orsak." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-82638.

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The word communication originates from the Latin word communicare that means to do something in common. When human beings communicate with each other, we share thoughts, emotions, values and actions. The foundation in communication is found within the interpersonal communication, which is the act of communication between two persons. All types of communications include of verbal and nonverbal acts of communication. The verbal communication consists of words either in speech or writing, the nonverbal act implies gestures, frequency of the tone and facial expressions. Within the pharmaceutical profession, good communication between the pharmacist and the customer is important and can affect the customer’s health and quality of life in both direct as well as indirect ways. In recent years, the pharmacist's role in the pharmacy has drastically changed. Nowadays the care of the customer has gained more significance than before. To improve customer health and quality of life it is important that the pharmacist acts to promote a good relationship with the customer and the foundation for this relationship should be built on good terms of communication. The purpose of this study was to study how common it is with communication errors between pharmacist and customer, and to demonstrate probable underlying causes. Secondary questions were, how is the drug advice the pharmacist provides affected by communication errors? Collection of data for the study was done with structured observation charts, where the customer and pharmacist were strictly observed. A total of 316 meetings were observed and the data collected referred to prescriptions. In more than one-third of the observed meetings, there were communication errors between the pharmacist and the customer. Communication errors that arose concerned lack of eye contact, language barriers, choice of questions, background noise from colleagues and customers and discussions from generic exchanges. To reduce future communication errors, the pharmacist's actions should be strengthened, such as eye contact, clear follow-up questions and improved feedback.

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Ruremesha, Patrimoine. "Differences in the prescribing patterns of diabetes medications among primary healthcare centers in Region Uppsala : A cross-sectional register studie." Thesis, Uppsala universitet, Institutionen för farmaci, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-434498.

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Background: Type II diabetes is a common disease worldwide and several drug treatments are available. Some of the more recently approved drugs are DPP4-inhibitors, GLP analogues and SGLT2-inhibitors. Most of the Type II diabetes drugs (T2DMD) are prescribed by primary care physicians. To ensure rational drug use it is important to follow up prescribing patterns to design strategies and interventions that can improve drug treatment, since consequences of inappropriate drug use might be poor health outcomes and increased health costs. Aim: To study differences in the prescribing pattern of T2DMD among primary healthcare centres (PHC) at a macro level in Region Uppsala. Method: A cross-sectional study based on data collected from Region Uppsala’s data register. Data consisted of individuals over 25 years of age with at least one prescription of a diabetes drug from the Anatomic Therapeutic Chemical (ATC) group A10 prescribed within the period of January 2018 to June 2020. Results: There is a moderate difference in the prescribing patterns of T2DMD among different PHCs in Region Uppsala. Overall, a larger proportion of oral antidiabetic drugs (OAD) were prescribed compared to Insulins. Most PHC prescribed a larger proportion of long acting insulins than other Insulins. Among OAD, a larger proportion of Biguanide derivative where prescribed. DPP-4 inhibitors, Sulphonylureas and SGLT2-inhibitors were prescribed to almost the same extent. Conclusion: Overall, there is a minor difference in the prescribing patterns of T2DMD among different PHCs in Region Uppsala during the study period. Lately, prescribing of DPP4-inhibitors, SGLT2-inhibitors and long acting insulins have increased.
I detta fördjupningsprojekt studerades förskrivningsmönstren av typ II diabetesläkemedel i Region Uppsala. Studieresultaten vissa skillnader i hur olika vårdcentraler i Region Uppsala förskriver typ II diabetesläkemedel. Från början var hypotesen att icke-insuliner förskrivs i större utsträckning än insuliner. Vilket visade sig stämma överens med resultaten. I studien jämförs också skillnaden mellan förskrivning av icke-insuliner som funnits längre på marknaden och de nyligen godkända (DPP4-hämmare och SGLT2-inhibitorer). Resultaten visar en tydlig ökning i förskrivning av de nya läkemedlen under studieperioden. En anledning till detta kan vara läkemedels positiva farmakologiska effekter. I studien jämförs också skillnaden i förskrivningen av de olika insuliner i Region Uppsala. Resultaten visar att långverkande insuliner förskrivs i större utsträckning i jämförelse med andra insuliner, vilket är inte enligt rekommendationslistan för förskrivning av typ II diabetesläkemedel Studieresultaten kan användas för att fortsätta följa upp och förbättra kvalitén på diabetesvården i Region Uppsala. Ytterligare studier skulle till exempel kunna utgå ifrån hela populationen med en typ 2 diabetesdiagnos för att studera utfall även för andra interventioner än läkemedel. Dessutom behövs fortfarande kunskap om det är kostnadseffektiv att fler nya typ 2 diabetesläkemedel används. Studien ger kunskap om förskrivningen av typ II diabetesläkemedel i Region Uppsala. Studien kan användas som grund för dialog om förskrivningen av typ II diabetesläkemedel i regionen, så att denna optimeras och fler individer får adekvat behandling. Detta arbete är viktigt eftersom typ II diabetes är en mycket vanlig sjukdom där prevalensen ökar. Denna studie är en tvärsnittsstudie baserat på sekundärdata från Region Uppsalas elektroniska medicinalt register och primärdata från två enkäter skickade till sjuksköterskor och läkare som jobbar på vårdcentraler med patienter med diabetes. Studien inkluderar data från de 26 offentliga vårdcentraler som hör till förvaltningen Nära, Vård och Hälsa i region Uppsala. Förskrivningsdata baseras på recept för ett diabetesläkemedel från Anatomic Therapeutic Chemical (ATC) gruppen A10, förskrivet mellan januari 2018-juni 2020.

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Abdul, Hadi Roza. "Avvikelser i receptlistan : En intervjustudie med patienter på apotek." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-101940.

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Background: Medications are used to treat, cure, or relieve symptoms of diseases, but there is a risk with the use of medications. Drug-related-problems are known to increase morbidity and mortality. Incorrect medical list and discrepancies in these lists can lead to drug-related problems as side effects, hospitalization, non-compliance, drug interactions and overtreated or undertreated patients. Discrepancies can be for example: more prescriptions than necessary, outdated prescriptions, i.e., medicines that will not be used, prescriptions with incorrect dosing and missing prescriptions i.e., medicines used by patients that cannot be seen in the medication list. Purpose: The aim of this study was to investigate discrepancies in the Swedish prescription list "My saved prescriptions at the pharmacy". The secondary aim was to investigate how common it is to use this prescription list or the dosage label on the medicine packaging to know which medicines to use and which dosage. Methods: The data collection was performed by four pharmacy students at seven pharmacies in Sweden over a period of three weeks during Jan-Feb. 2021 where the prescription list was investigated together with patients to identify any discrepancies. The study included patients who was over 18 years old, spoke Swedish, had three or more prescribed drugs, and agreed to participate. Results A total of 215 patients were interviewed, where 61% had one or more discrepancies in their medication list. A total of 1717 prescriptions were analyzed, of which 10% were double prescriptions (n = 167), 8% outdated prescriptions (n = 141) and 3% prescriptions with the wrong dosage (n = 42). When analyzing the primary sources of information used by patients to know which medicine to use, the printout of the list "my saved prescriptions at the pharmacy” dominated (n = 72). Most used information source to know drug dosage was the dosage label on the medicine packaging (n = 112). Conclusions: It is important to have an updated and correct information in the medication list, to prevent drug-related-problems caused by discrepancies. It becomes even more important when we see that the medication list "My saved prescriptions at the pharmacy" and dosage label (containing the same information in the medication list), are the most used primary sources by patients to know which drug to use and in what dosage. Finally, results show a relationship between the number of prescribed drugs and the number of discrepancies that occur, and therefore we see more discrepancies in elderly patients who are usually ill and are being treated for several diseases. There are opportunities for further research to study e.g., which drug-related-problems are caused by discrepancies in the medication list as well as the degree of danger in these problems.
Användning av läkemedel som avses behandla, lindra eller bota sjukdomar kan i vissa fall utgöra en risk för patientens hälsa. Läkemedelsrelaterade problem p.g.a. felmedicinering står för en stor andel av morbiditeten och mortaliteten bland patienter. En bidragande orsak är ofullständig information i patientens läkemedelslista. Syftet med studien var att undersöka antalet avvikelser som förekommer i receptlistan ”Mina sparade recept på apoteket”. Studiens sekundära syfte var att undersöka vilka informationskällor som användes av patienter för att veta vilka läkemedel som ska adminstreras och i vilken dos dosering. Studiens metod var att intervjua patienter som kom till apoteket för att hämta ut läkemedel till sig själva och uppfyllde inklusionskriterierna för att delta i studien. Studien utfördes av fyra farmaceutstudenter på sju olika apotek i fyra olika städer i Sverige som tillsammans med patienter gick igenom receptlistan för att identifiera avvikelser. Resultatet blev totalt 1717 recept som studerades varav 21% hade avvikelser. Av recepten var 10% dubbla recept (n = 167), 8% inaktuella recept (n = 141) och 3% recept med fel dosering (n = 42). Vid analys av primära informationskällor som används dominerade utskrift av listan ”Mina sparade recept på apoteket” (n = 72) resp. doseringsetiketten på läkemedelsförpackningen (n = 112). Resultaten visade även ett samband mellan ökade antal läkemedel och antalet avvikelser. Avvikelser i läkemedelslistan Mina sparade recept är vanligt förekommande därmed är listan inte alltid aktuell. Det är vanligt att denna lista och doseringsetikett på läkemedels-förpackningar används som primära källor av patienter under deras behandlingstid vilket kan innebära en risk för läkemedelsrelaterade problem. En gemensam nationell läkemedelslista är en möjlig lösning till att förebygga läkemedelsrelaterade problem orskade av infromationsbrist i läkemedelslistor. Det är dock nödvändigt med läkemedelsgenomgångar för att bibehålla uppdateringen av listan.

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Lindström, Emma Danell. "Towards a General Framework for Systems Analysis of Inefficiencies Along the Pharmacological Treatment Chain." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279126.

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In order for a medication treatment to be considered successful, several roles and functions along the pharmacological treatment chain must function and cooperate effectively. The chain can most easily be described as five transitions; diagnosis, prescription treatment, dispensing, drug use and finally results and follow-up. Unfortunately, there are many problems and inefficiencies in the pharmacological drug chain. Unfortunately, those who study medication errors and their solutions have focused on individual parts of the pharmacological treatment system. However, for this reason, this study aims to develop a general framework for system analysis of inefficiencies along the pharmacological treatment chain. Due to the size of the problem, this project focused on medication adherence. Adherence can be defined as to what extent the patient follows the medication treatment plan. Adherence has many known problems and difficulties, among other things, it has major financial consequences. It can also be difficult to measure compliance, and there is no recognized perfect method. A system dynamic model is a theoretical image of a real system or object, which is a model used to understand the nonlinear behavior of complex systems. These models are useful when considering interventions and their effects when there are complex relationships. The project started with a literature study, and then went into data collection. Here, a search design and refinements were designed to find relevant articles. Once the articles were selected, the data was compiled from the articles and the analysis began. Here, factors and effects on adherence were identified as well as other interesting information from the articles. When the information was compiled and analyzed, the system dynamic model was created. The model was then sent via email to experts in the field to validation and revise the model. During the data collection, 23 relevant articles were found, compiled into 38 factors associated with compliance. In addition to these factors, 8 were excluded because they were too disease-specific or too ambiguous in their effect of adherence. The various articles studied many different chronic diseases, but hypertension was the most common. How adherence was measured in the articles also varied greatly, however, some form of self-report or questionnaire was most common method used. Three out of seven experts responded to the sent-out model and provided valuable comments. Although these are not sufficient to validate the model, their views showed that a validation can be designed in this way. The model would have to be sent to a larger set of experts and stakeholders, but because these experts are recognized in their fields, it gave weight to the results even though they were few reviewers. With the support of the literature and the experts’ statement, it was concluded that this model provides a good foundation and structure to continue to build upon. In addition, the model has proven to have many key relationships and cornerstones with important and relevant factors. It is also concluded that it is possible to translate the model into quantitative patterns, which is based on the fact that the factor itself can be translated quantitatively. Overall, it is also finally concluded that the model created in this project could be of great use in future projects when working towards a framework for system analysis of inefficiencies along the pharmacological treatment chain.

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Mukwaya, Jovia Namugerwa. "An Investigation of Semantic Interoperability with EHR systems for Precision Dosing." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279143.

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In healthcare, vulnerable populations that are using medications with a narrow therapeutic index and wide interpatient PK/PD (pharmacokinetic/pharmacodynamic modelling) variability are increasing. As such, variable dosage regimens may result in severe therapeutic failures or adverse drug reactions (ADR). Improved monitoring of patient response to medication and personalization of treatment is therefore warranted. Precision dosing aims to individualize drug regimens for each patient based on independent factors obtained from a patient’s clinical records. Personalization of dosing increases the accuracy and efficiency of medication delivery. This can be achieved through utilizing the wide range of Electronic Health Records (EHR) contain the patients’ medical history, diagnoses, laboratory test results, demographics, treatment plans, biomarker data; information that can be exploited to generate a patient-specific treatment regimen. For example, Fast Healthcare Interoperability Resources (FHIR) is an existing healthcare standard that provides a framework on which semantic exchange of meaningful clinical information can be developed such as using an ontology as a decision support tool to achieve precision medicine. The purpose of this thesis is to make an investigation of the feasibility of interoperability in EHR and propose an ontology framework for precision dosing using currently existing health standards. The methodology involved carrying out of semi-structured interviews from professionals in relevant areas of expertise and document analysis of already existent literature, a precision dosing ontology framework is developed. Results show key tenants for an ontology framework and drugs and their covariates. The thesis therefore advances to investigate how data requirements in EHR systems, IT platforms, implementation, and integration of Model Imposed Precision Dosing (MIPD) and recommendations have been evaluated to cater to interoperability. With modern healthcare striving for personalized healthcare, precision medicine would offer an improved therapeutic experience for a patient.

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Woin, Nicolas. "Covid-19 - kortikosteroidbehandling vid svår sjukdom : En jämförande analys." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-100996.

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Sammanfattning Sedan sjukdomen Covid-19s uppdykande i början av 2020 har forskning pågått för att karaktärisera sjukdomen ur alla tänkbara vinklar för att på kortast möjliga tid bereda väg för ett fungerande botemedel. Effektiva läkemedel som kan minska risken för allvarligt sjuka patienter att avlida i sjukdomen behövs; många preparat har föreslagits och testats och i Sverige har hittills två läkemedel godkänts för Covid-19. Ett av dessa är kortikosteroiden dexametason som godkänts för Covid-19-patienter i behov av syrgas eller respirator. Syftet med detta arbete var att undersöka hur effektiv kortikosteroidbehandling av svårt sjuka Covid-19-patienter var i jämförelse med standardbehandling utan kortikosteroider. En litteratursökning gjordes i PubMed och i covid-nma efter randomiserade kliniska studier av kortikosteroider jämfört med standardbehandling till patienter med Covid-19. Ur resultatet som inkluderade 7 kontrollerade studier med 7784 svårt sjuka patienter från 11 länder och fem kontinenter, gjordes en sammanvägning av den primära utfallsvariabeln mortalitet 28 dagar efter randomisering varpå relativ risk (RR) räknades ut individuellt per studie och sammanvägt för alla studier. Analysen gjordes också med den mest dominanta studien borträknad. Vidare utforskades möjliga samband mellan sjukdomsgrad och effektstorlek, dels genom ett försök till metaregression av studiemortalitet och andningshjälpsnivå mot RR som var inkonklusivt, men också genom att leta efter speciellt sjuka undergrupper i studierna. 3 studier rapporterade mortalitet efter 28 dagar, 1 studie rapporterade mortalitet efter 21 dagar, 2 studier rapporterade död på sjukhus och en studie rapporterade död efter 15 dagar. Testade preparat var dexametason, hydrokortison och metylprednisolon. Av 2885 patienter som randomiserats till någon kortikosteroid, dog 739, medan det av de 4899 som randomiserats till standardbehandling dog 1347 patienter vilket gav en icke signifikant RR på 0,93 (95% CI 0,86–1,01). Vid borträkning av den största studien som bestod av relativt friskare patienter erhölls en starkare och signifikant effekt med RR 0,80 (95% CI 0,70–0,92) baserat på 257 av 781 döda i steroidgrupperna jämfört med 237av 578 döda i någon kontrollgrupp med standardbehandling. Resultatet var även i linje med analysen av olika sjuka undergrupper från största studien som visade bäst effekt hos de med invasiv mekanisk andningshjälp (absolut riskreduktion 12,1%) samt en icke signifikant försämring hos de friskaste patienterna utan syrgasbehov. Sammantaget tyder dessa resultat på att behandling av svårt sjuka Covid-19-patienter med kortikosteroider minskar mortaliteten efter 28 dagar. Dessutom ger studien en stark indikation på att bästa effekten fås om kortikosteroiderna ges till patienter där den systemiska inflammationen i lungorna nått en gasutbyteshämmande nivå
ABSTRACT Since the emergence of the new corona virus disease, Covid-19, much research effort has gone into characterising every possible angle of the disease to pave the way for a possible cure in the shortest possible time. Effective therapies are needed that will reduce the risk of dying for severely to critically ill Covid-19 patients. Many existing therapies have been suggested, tested and repurposed for the treatment of Covid-19 but so far only two drugs have been approved in Sweden for this indication, namely the antiviral drug remdesivir and the corticosteroid dexamethasone. Corticosteroids are both immunosuppressive and anti-inflammatory and when they were administered previously for severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS) and influenza they were found to increase the time to rid the body of virus. The purpose of this study was to investigate evidence found in the research literature of how effective corticosteroids are in reducing the risk of dying as compared to standard treatment with no corticosteroids when administered to hospitalised patients with severe Covid-19. A literature search was made in the PubMed and covid-nma databases for randomized clinical studies of corticosteroids versus standard treatment to patients with Covid-19. The result included 7 studies with 7784 patients from 11 countries and 5 continents which all reported death as an outcome in groups that were receiving corticosteroids compared to groups that were receiving standard care. The studies used one of the following corticosteroids as intervention: dexamethasone, methylprednisolone and hydrocortisone in different doses. In the groups receiving standard care, 1347 patients out of 4899 died while in the corticosteroid groups 739 of 2885 patients died. When doing a statistical calculation these figures indicated that the risk of dying when getting corticosteroids was 93% of the risk when not getting corticosteroids, however the difference was not statistically significant. After omitting the largest study from the material, that contributed the absolute majority of total participants, who were deemed relatively healthy or well taken care of, the results were instead that 257 out of 781 died in the steroid groups and 237 of 578 died in the control groups. This later comparison among supposedly sicker patients, gave a statistically significant 8,1% lower absolute risk of dying in the corticosteroid groups; an effect that could also be expressed as for every 25 patients treated, 2 more lives would be saved. A further control of a more severely sick subgroup of patients from the largest study, in need of invasive mechanical ventilation, revealed an absolute reduction of the risk of dying when given corticosteroids of 12,1%. This group showed the most effectful response to the administered corticosteroids in this study which could also be expressed as 1 more life saved for every 8 patients treated. Another sub group analysis of the patients from the largest study that were not in need of any type of oxygen support, indicated on the other hand a possible harm of corticosteroids. This potentially harmful effect was however not statistically significant. In summary, the results of this study imply that administration of corticosteroids to patients with severe Covid-19 will reduce the risk of dying. The greatest effect is seen in those patients that has reached a level of illness were the gas exchange in the lungs is impaired by the inflammation. Furthermore, caution must be taken not to introduce harm by giving corticosteroids to patients with milder disease in which the immunosuppressive properties of the drug could lead to unintended worsening of the illness.

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Tjäderborn, Micaela. "Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects." Doctoral thesis, Linköpings universitet, Avdelningen för läkemedelsforskning, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-130768.

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Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns. Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV). Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.

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Bladh, Emil. "Säkerhet vid val av apotek : Enkätundersökning om kunskap och uppfattningar om symboler för godkänt apotek." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-85657.

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Syfte: Syftet med examensarbetet var att undersöka individers kunskap om symboler för godkända apotek samt hur en sådan märkning och andra faktorer påverkar deras val av apotek ur ett säkerhetsperspektiv. Introduktion: I en kartläggning av Läkemedelsverket från 2008 hittades 51 illegala webbsidor som riktade sig till svenska apotekskunder. Dessa webbsidor sålde illegalt receptbelagda läkemedel utan krav på något recept från sina kunder. Att handla på illegala internetapotek kan utgöra risker såsom kontaminerade läkemedel, bristande information om läkemedlet eller att läkemedlet inte levereras. För att minska risken för att apotekskunder ska råka handla på illegala internetapotek finns det två symboler som används för att kontrollera internetapotek, en skapad av Läkemedelsverket (figur 1) och en skapad av Europeiska kommissionen (figur 2). Tanken är att kunden ska trycka på en av symbolerna på apotekets hemsida som sedan tar apotekskunden till Läkemedelsverkets lista på godkända internetapotek. Finns apotekets namn och webbadress i listan så är apoteket godkänt, gör det inte det så finns det en risk att webbsidan är ett illegalt internetapotek och bör därför inte handlas från. Material och metod: Ett elektroniskt frågeformulär med 10 frågor (bilaga A) togs fram utifrån syftet och skickades ut genom den sociala plattformen ”Facebook” genom studentens Facebook-konto. Formuläret innefattade frågor om vilka faktorer som får respondenter att välja internetapotek ur ett säkerhetsperspektiv och respondenternas kännedom om de två symbolerna för kontroll av internetapotek. Resultatet analyserades på gruppnivå så att ingen enskild kunde identifieras. Resultat och diskussion: Undersökningen visade att en majoritet av respondenterna (n=44, 59 %) hade sett den svenska symbolen för godkänt apotek (figur 1) från Läkemedelsverket. Dock var det en majoritet som inte visste vad den betydde (n=57, 77 %). När det gäller EU-symbolen för godkänt internetapotek (figur 2), visade sig att en majoritet av respondenterna varken hade sett den (n=58, 78 %) och ännu fler visste inte vad den betydde (n=62, 84 %). Respondenterna i studien kontrollerar apotek på lite olika sätt såsom att göra en egen bedömning om internetapoteket verkar säkert (n=21, 51 %) eller att de har sett apoteket i någon form av reklam (n=17, 41 %) (tabell II). För vissa var det dock inget de tänker på (n=10, 24 %) (tabell II). Slutsats: Examensarbetets slutsats är att majoriteten av respondenterna hade sett den svenska symbolen för godkända apotek men visste inte vad den innebär. EU-symbolen för godkända apotek hade få av respondenterna sett och ännu färre som visste vad den innebär. De vanligaste faktorerna för att välja internetapotek från ett säkerhetsperspektiv hos respondenterna var genom att de själva bedömde ifall ett internetapotek verkar säkert eller att de valde apotek som de tidigare sett från reklam. För vissa respondenter var det inte något de hade tänkt på direkt.
Aim: The aim of the degree project is to examine individual’s knowledge about symbols for approved pharmacy and how such a marking and other factors affect their choice of pharmacy from a safety perspective. Introduction: In a survey made by the Swedish Medical Products Agency (MPA) from 2008, 51 illegal websites targeting Swedish pharmacy customers were found. These websites illegally sold prescription pharmaceuticals without the requirement of a prescription from their customers. Shopping on illegal internet pharmacies can have great risks like contaminated drugs, lack of information about the drugs or that the drugs never gets delivered. To lower the risk that pharmacy customers accidently buys medications from the illegal online pharmacies, two symbols have been created for Swedish pharmacy customers, one by the MPA (figure 1) and one by the European Commission (figure 2). The idea is that the customer is supposed to click on one of the symbols on an online pharmacy’s website which is linked to a list for approved online pharmacies at the website of the MPA. If the customer finds the name and web address of the pharmacy on that list, the customer will know that the pharmacy is approved. But if the name and address isn’t found on the list, the pharmacy can be illegal, and the customer should avoid from shopping from the pharmacy. Material and methods: An electronic questionnaire with 10 question (Appendix A) was created in regard of the aim and sent out via the social platform “Facebook” through the students Facebook account. The survey included questions about which factors, from a security perspective, that influence the respondents to choose an online pharmacy and the respondents’ knowledge about the two symbols for controlling if an online pharmacy is approved. The results were analysed at a group level so that no individuals could be identified. Results and Discussion: The survey showed that a majority of the respondents had seen the Swedish symbol for approved pharmacy (figure 1) from the MPA (n=44, 59 %). However, a majority did not know what it means (n=57 or 77 %). Regarding the EU-symbol for approved pharmacy (figure 2), it turned out that most of the respondents had not seen it (n=58, 78 %) and even more didn’t know what it means (n=62, 84 %). The respondents in the study controlled pharmacies in different ways, for example making their own assessment if an online pharmacy seems safe (n=21, 51 %) or that they choose an online pharmacy that they have seen on some sort of commercial (n=17, 41 %) (Table II). For some it wasn’t something they thought about (n=10, 24 %) (Table II). Conclusions: The conclusion is that most of the respondents had seen the Swedish symbol for approved pharmacy but did not know what it means. Few respondents had seen the EU-symbol for approved pharmacy and even fewer knew what it means. The most common factors influencing the respondents’ choice of a pharmacy, from a security perspective, was by making their own assessment if the online pharmacy seems safe or choose a pharmacy which they have seen from a commercial. For some of the respondents, it wasn’t something they considered when choosing pharmacy.

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Isaksson, Emma. "Identifiering av kommunikativa interventioner från olika faciliteter inom sjukvården som kan implementeras på ett apotek : Metoder för att optimera kommunikationen med äldre med syfte att förbättra läkemedelsanvändningen." Thesis, Uppsala universitet, Institutionen för farmaci, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-433842.

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Background: The increasing elderly population is challenging todays management in healthcare. Elderly have a higher risk of adverse effect and inappropriate use of medication. The Swedish healthcare today pays 12-19 billion kronor due to adverse effects and inappropriate use of medications. By optimizing elderlies use of medicine, the social cost can decrease and contribute to a better healthcare management. Aim: Identify communication methods that can optimize counselling and communication to the elderly in pharmacies. In the sense of preventing inappropriate use of drugs and future side effects such as adverse effects or no effect. The questions that were answered are as follows: what methods are available to optimize counselling and communication? is it possible to use the methods in pharmacies? Methods: Systematic review, data search on pubmed and web of science. Results: Identified interventions were Alice-app, Geriatic Resources for Assessment and Care of Elders Team Care (GRACE), empathetic communication, communication education, motivational interviewing, my medical passport (MMP), in depth patient-centered care communication, smartwatch, smartphone, ingestible sensor system (ISS) and SPACE-program. Conclusions: Communication education helped to strengthen the patient-/carer relationship and management of medication counselling. Electronic notification systems helped elder with memory- and movement impairment. The implementation depends on the pharmacy resources and propensity of the patient. The most applicable methods were ALICE-app, smartwatch, smartphone, ISS, SPACE-team, empathetic communication, communication education in geriatric care, MI, MMP and partly GRACE-team concerning home visits by pharmacists and teamwork management.

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Catubig, Melander Axel. "Vad är den kliniska farmaceutens roll inom vården?" Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26834.

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Bakgrund: Den kliniska farmacin i Sverige har utvecklats markant det senaste årtiondet, var de kliniska farmaceuternas antal mer än fördubblats. Samtidigt som den kliniska farmacin utvecklas mer och mer så finns det i nuläget begränsade utbildningsmöjligheter. Mål: Denna rapport har som syfte att undersöka den kliniska farmaceutens roll inom vården, dennes arbetssätt och synen på yrkesrollen. Metod: En enkätundersökning utfördes riktad till alla verksamma kliniska farmaceuter i Sverige som arbetar patientnära. Resultat: Svarsfrekvens för undersökningen uppgick till 58%. Undersökningen kartlade den kliniska farmaceutens arbetssätt och gav en översiktlig bild av vad farmaceuten ansåg om sin yrkesroll samt visade hur farmaceuterna ansågs kunna föra den kliniska farmacin framåt i landet. Diskussion: Ett grundligt förarbete med pilottester och kvalitativa studier utfördes inte i samband med utformandet av enkäten, vilket resulterat i brister i studiens validitet. Slutsats: Det fanns skillnader gällande de olika regionernas arbetssätt med anledning av att yrkesrollen var svårdefinierad, samt att arbetssätten för farmaceuterna var olikartade. Majoriteten av deltagarna hade en positiv inställning till sina upplevelser inom det multidisciplinära teamet, däremot var de även av åsikten att klinisk farmaci inom Sverige bör vidareutvecklas.
Background: Clinical pharmacy have developed tremendously over the past decade, and the number of clinical pharmacists has more than doubled. Although clinical pharmacy is developing more and more, educational opportunities are currently a limited. Aim: This report aims to investigate the role of the clinical pharmacist in healthcare, its working procedures and the view of the profession. Method: A survey was conducted including all active clinical pharmacists in Sweden working in direct contact with the patients. Result: The response rate for the survey was 58%. The study surveyed the clinical pharmacist’s working procedures, gave some general knowledge of the pharmacist’s considerations for the profession and viewed the opinions of the pharmacist in the regard of expanding and developing clinical pharmacy in the country. Discussion: A thoroughly done preliminary work with pilot tests and qualitative studies was not carried out in connection with the development of the survey, which has resulted in deficiencies in the validity. Conclusion: There were differences regarding the working methods of the different regions because of the difficulty of defining the content of the profession, and the diversity of the working procedures between the regions. A majority of the participants had a positive attitude to their experiences within the multidisciplinary team, however, they were also of the opinion that clinical pharmacy in Sweden should be furthered developed.

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Dissertations / Theses on the topic 'Samhällsfarmaci och klinisk farmaci'

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