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  • 1.
    Abberud, Madelene
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Time to first antibiotic administration in The Alfred Emergency and Trauma Centre for suspected febrile neutropenia: a retrospective chart review2012Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Febrile neutropenia (FN) is a frequent complication of chemotherapy use in cancer patients. There is evidence to suggest that the time to antibiotic administration is associated with increase survival and effective clinical outcome. The Australian consensus guidelines for the management of FN in adult cancer patients recommends treatment within 30 minutes to patients with features of systemic compromise. A study performed at The Alfred Hospital in 2010 revealed a median time of 145 minutes to first antibiotic administration. A new guideline was therefore developed and education was implemented. This study was conducted to evaluate the intervention. Aim: To determine time to first antibiotic prescribing and administration for patients with suspected FN presenting to the Alfred Emergency and Trauma centre. Materials and Methods: The electronic medical record of 112 episodes of suspected FN presenting between March and August 2012 were reviewed.  Data were retrospective collected according to a FN data spreadsheet. An observational study were also performed at  The Alfred Emergency and Trauma centre during October and November 2012 to determine time to first antimicrobial prescribing, because this data could not be collected from the electronic medical record. Results: The median time from presentation to antibiotic prescribing was 68 minutes. The median time from presentation to antibiotic administration was 121 minutes. Conclusions: The implementation of the new guidelines has reduced the time with 16.6%, but the target first antibiotic administration within 30 minutes has not been reached.

  • 2.
    Abdulla, Salim
    et al.
    Ifakara Hlth Inst, Dar Es Salaam, Tanzania..
    Ashley, Elizabeth A.
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;Mahidol Univ, Mahidol Oxford Trop Med Res Unit MORU, Fac Trop Med, Bangkok 10700, Thailand..
    Bassat, Quique
    Univ Barcelona, Ctr Invest Saude Manhica Manhica Mozamb & ISGloba, Barcelona Ctr Int Hlth Res CRESIB, Hosp Clin, Barcelona, Spain..
    Bethell, Delia
    AFRIMS, Dept Immunol & Med, Bangkok, Thailand..
    Bjorkman, Anders
    Karolinska Inst, Dept Microbiol Tumour & Cell Biol, Malaria Res, Stockholm, Sweden..
    Borrmann, Steffen
    Kenya Govt Med Res Ctr, Wellcome Trust Res Programme, Kilifi, Kenya.;Univ Magdeburg, Sch Med, D-39106 Magdeburg, Germany..
    D'Alessandro, Umberto
    Inst Trop Med, Unit Malariol, B-2000 Antwerp, Belgium.;MRC Unit, Fajara, Gambia..
    Dahal, Prabin
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;WorldWide Antimalarial Resistance Network WWARN, Oxford, England..
    Day, Nicholas P.
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;Mahidol Univ, Mahidol Oxford Trop Med Res Unit MORU, Fac Trop Med, Bangkok 10700, Thailand..
    Diakite, Mahamadou
    Univ Bamako, Malaria Res & Training Ctr, Bamako, Mali..
    Djimde, Abdoulaye A.
    Dondorp, Arjen M.
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;Mahidol Univ, Mahidol Oxford Trop Med Res Unit MORU, Fac Trop Med, Bangkok 10700, Thailand..
    Duong, Socheat
    Ctr Parasitol Entomol & Malaria Control, Phnom Penh, Cambodia..
    Edstein, Michael D.
    Fairhurst, Rick M.
    NIAID, Lab Malaria & Vector Res, NIH, Rockville, MD USA..
    Faiz, M. Abul
    Malaria Res Grp MRG & Dev Care Fdn, Dhaka, Bangladesh..
    Falade, Catherine
    Univ Ibadan, Coll Med, Ibadan, Nigeria..
    Flegg, Jennifer A.
    Monash Univ, Sch Math Sci, Clayton, Vic 3800, Australia..
    Fogg, Carole
    Univ Portsmouth, Portsmouth, Hants, England..
    Gonzalez, Raquel
    Ctr Invest Saude Manhica Manhica Mozamb, Barcelona, Spain.;CRESIB, Barcelona, Spain..
    Greenwood, Brian
    London Sch Hyg & Trop Med, Fac Infect & Trop Dis, London WC1, England..
    Guerin, Philippe J.
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;WorldWide Antimalarial Resistance Network WWARN, Oxford, England..
    Guthmann, Jean-Paul
    Epicentre, Paris, France..
    Hamed, Kamal
    Novartis Pharmaceut, E Hanover, NJ USA..
    Hien, Tran Tinh
    Htut, Ye
    Dept Med Res, Lower Myanmar, Yangon, Myanmar..
    Juma, Elizabeth
    Kenya Govt Med Res Ctr, Nairobi, Kenya..
    Lim, Pharath
    NIAID, Lab Malaria & Vector Res, NIH, Rockville, MD USA.;US & Natl Ctr Parasitol Entomol & Malaria Control, Phnom Penh, Cambodia..
    Mårtensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Microbiol Cell & Tumour Biol, Dept Publ Hlth Sci, Malaria Res, Stockholm, Sweden..
    Mayxay, Mayfong
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;Mahosot Hosp, Lao Oxford Mahosot Hosp, Wellcome Trust Res Unit LOMWRU, Viangchan, Laos.;Univ Hlth Sci, Fac Postgrad Studies, Viangchan, Laos..
    Mokuolu, Olugbenga A.
    Univ Ilorin, Dept Paediat & Child Hlth, Ilorin, Nigeria..
    Moreira, Clarissa
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;WorldWide Antimalarial Resistance Network WWARN, Oxford, England..
    Newton, Paul
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;Mahosot Hosp, Lao Oxford Mahosot Hosp, Wellcome Trust Res Unit LOMWRU, Viangchan, Laos..
    Noedl, Harald
    Med Univ Vienna, Inst Specif Prophylaxis & Trop Med, Vienna, Austria..
    Nosten, Francois
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;Mahidol Univ, Shoklo Malaria Res Unit, Mahidol Oxford Trop Med Res Unit, Fac Trop Med, Bangkok 10700, Thailand..
    Ogutu, Bernhards R.
    Kenya Govt Med Res Ctr, US Army Med Res Unit, Kisumu, Kenya..
    Onyamboko, Marie A.
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;Kinshasa Sch Publ Hlth, Kinshasa, DEM REP CONGO..
    Owusu-Agyei, Seth
    Kintampo Hlth Res Ctr, Kintampo, Ghana..
    Phyo, Aung Pyae
    Mahidol Univ, Shoklo Malaria Res Unit, Mahidol Oxford Trop Med Res Unit, Fac Trop Med, Bangkok 10700, Thailand..
    Premji, Zul
    Muhimbili Univ Hlth & Allied Sci, Dar Es Salaam, Tanzania..
    Price, Ric N.
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;WorldWide Antimalarial Resistance Network WWARN, Oxford, England.;Menzies Sch Hlth Res, Global & Trop Hlth Div, Darwin, NT, Australia.;Charles Darwin Univ, Darwin, NT 0909, Australia..
    Pukrittayakamee, Sasithon
    Mahidol Univ, Fac Trop Med, Bangkok 10700, Thailand..
    Ramharter, Michael
    Med Univ Vienna, Div Infect Dis & Trop Med, Dept Med 1, Vienna, Austria.;Univ Tubingen, Inst Tropenmed, Tubingen, Germany.;Ctr Rech Med Lambarene, Lambarene, Gabon..
    Sagara, Issaka
    Univ Bamako, Fac Med Pharm & Odontostomatol, Dept Epidemiol Parasit Dis, Malaria Res & Training Ctr, Bamako, Mali..
    Se, Youry
    AFRIMS, Phnom Penh, Cambodia..
    Suon, Seila
    Natl Ctr Parasitol Entomol & Malaria Control, Phnom Penh, Cambodia..
    Stepniewska, Kasia
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;WorldWide Antimalarial Resistance Network WWARN, Oxford, England..
    Ward, Stephen A.
    Univ Liverpool, Liverpool Sch Trop Med, Dept Parasitol, Liverpool L3 5QA, Merseyside, England..
    White, Nicholas J.
    Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med & Global Hlth, Oxford, England.;Mahidol Univ, Mahidol Oxford Trop Med Res Unit MORU, Fac Trop Med, Bangkok 10700, Thailand..
    Winstanley, Peter A.
    Univ Warwick, Warwick Med Sch, Coventry CV4 7AL, W Midlands, England..
    Baseline data of parasite clearance in patients with falciparum malaria treated with an artemisinin derivative: an individual patient data meta-analysis2015In: Malaria Journal, ISSN 1475-2875, E-ISSN 1475-2875, Vol. 14, 359Article in journal (Refereed)
    Abstract [en]

    Background: Artemisinin resistance in Plasmodium falciparum manifests as slow parasite clearance but this measure is also influenced by host immunity, initial parasite biomass and partner drug efficacy. This study collated data from clinical trials of artemisinin derivatives in falciparum malaria with frequent parasite counts to provide reference parasite clearance estimates stratified by location, treatment and time, to examine host factors affecting parasite clearance, and to assess the relationships between parasite clearance and risk of recrudescence during follow-up. Methods: Data from 24 studies, conducted from 1996 to 2013, with frequent parasite counts were pooled. Parasite clearance half-life (PC1/2) was estimated using the WWARN Parasite Clearance Estimator. Random effects regression models accounting for study and site heterogeneity were used to explore factors affecting PC1/2 and risk of recrudescence within areas with reported delayed parasite clearance (western Cambodia, western Thailand after 2000, southern Vietnam, southern Myanmar) and in all other areas where parasite populations are artemisinin sensitive. Results: PC1/2 was estimated in 6975 patients, 3288 of whom also had treatment outcomes evaluate d during 28-63 days follow-up, with 93 (2.8 %) PCR-confirmed recrudescences. In areas with artemisinin-sensitive parasites, the median PC1/2 following three-day artesunate treatment (4 mg/kg/day) ranged from 1.8 to 3.0 h and the proportion of patients with PC1/2 > 5 h from 0 to 10 %. Artesunate doses of 4 mg/kg/day decreased PC1/2 by 8.1 % (95 % CI 3.2-12.6) compared to 2 mg/kg/day, except in populations with delayed parasite clearance. PC1/2 was longer in children and in patients with fever or anaemia at enrolment. Long PC1/2 (HR = 2.91, 95 % CI 1.95-4.34 for twofold increase, p < 0.001) and high initial parasitaemia (HR = 2.23, 95 % CI 1.44-3.45 for tenfold increase, p < 0.001) were associated independently with an increased risk of recrudescence. In western Cambodia, the region with the highest prevalence of artemisinin resistance, there was no evidence for increasing PC1/2 since 2007. Conclusions: Several factors affect PC1/2. As substantial heterogeneity in parasite clearance exists between locations, early detection of artemisinin resistance requires reference PC1/2 data. Studies with frequent parasite count measurements to characterize PC1/2 should be encouraged. In western Cambodia, where PC1/2 values are longest, there is no evidence for recent emergence of higher levels of artemisinin resistance.

  • 3.
    Aftab, Obaid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cancer Pharmacology and Computational Medicine.
    Fryknäs, Mårten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cancer Pharmacology and Computational Medicine.
    Hammerling, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cancer Pharmacology and Computational Medicine.
    Larsson, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cancer Pharmacology and Computational Medicine.
    Gustafsson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cancer Pharmacology and Computational Medicine.
    Detection of cell aggregation and altered cell viability by automated label-free video microscopy: A promising alternative to endpoint viability assays in high throughput screening2015In: Journal of Biomolecular Screening, ISSN 1087-0571, E-ISSN 1552-454X, Vol. 20, no 3, 372-381 p.Article in journal (Refereed)
    Abstract [en]

    Automated phase-contrast video microscopy now makes it feasible to monitor a high-throughput (HT) screening experiment in a 384-well microtiter plate format by collecting one time-lapse video per well. Being a very cost-effective and label-free monitoring method, its potential as an alternative to cell viability assays was evaluated. Three simple morphology feature extraction and comparison algorithms were developed and implemented for analysis of differentially time-evolving morphologies (DTEMs) monitored in phase-contrast microscopy videos. The most promising layout, pixel histogram hierarchy comparison (PHHC), was able to detect several compounds that did not induce any significant change in cell viability, but made the cell population appear as spheroidal cell aggregates. According to recent reports, all these compounds seem to be involved in inhibition of platelet-derived growth factor receptor (PDGFR) signaling. Thus, automated quantification of DTEM (AQDTEM) holds strong promise as an alternative or complement to viability assays in HT in vitro screening of chemical compounds.

  • 4.
    Akay, Mervan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    En kartläggning av läkemedelsanvändning och köpbeteende vid köp av receptfria NSAID på apotek2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    En kartläggning av läkemedelsanvändning och köpbeteende vid köp av receptfria NSAID på apotek

    Mervan Akay

    Handledare: Pia Frisk, Hälso- och sjukvårdsförvaltningen SLL Institutionen för farmaceutisk biovetenskap, avdelningen för farmakokinetik och läkemedelsterapi Examinator: Margareta Hammarlund-UdenaesFördjupningsprojekt i farmakoterapi D, 30 hp

    Introduktion: NSAID är en av de mest förskrivna läkemedelsgrupperna över hela världen. Efter omregleringen av apoteksmarknaden har tillgängligheten av NSAID-preparat ökat. Syfte: Att kartlägga läkemedelsanvändningen och köpbeteendet avseende receptfria läkemedel med diklofenak, ibuprofen, naproxen och acetylsalicylsyra, hos kunder som köper dessa läkemedel på öppenvårdsapotek. Detta med anledning av att det finns begränsad information om användningen av dessa receptfria substanser. Material och metoder: En prospektiv tvärsnittsstudie som omfattade fyra apotek i Stockholm-Uppsala regionen under tidsperioden 2014-09-15 till 2014-10-21. Data samlades in med hjälp av en enkät som delades ut av en observatör till individer som köpt ett preparat med diklofenak, ibuprofen, naproxen eller acetylsalicylsyra. Resultat: Det var fler kvinnor (148 stycken, 64,1 %) än män som köpte ett receptfritt NSAID-preparat. Den vanligaste åldersgruppen som köpte receptfritt NSAID var 40-49 år (20,8 %) medan det var 11,7 % som tillhörde åldersgruppen 70+. Den mest använda substansen bland NSAID var ibuprofen (46,3 %). De två vanligaste användningsområden för bägge könen var huvudvärk (43,1 %) och muskelvärk (30,4 %). Av samtliga deltagare var det 14 stycken (6,7 %) som kombinerade det köpta läkemedlet med ett annat receptfritt NSAID. Konklusion: Det var fler kvinnor än män som köpte receptfritt NSAID på apotek. Drygt 12 % av deltagarna, som var 70 år och äldre använde sig utav NSAID vilket är en olämplig läkemedelsklass för äldre personer.    

  • 5.
    Alassaad, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Gillespie, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences, Division of Pharmacokinetics and Drug Therapy.
    Bertilsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Hammarlund-Udenaes, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences, Division of Pharmacokinetics and Drug Therapy.
    Prescription and transcription errors in multidose-dispensed medications on discharge from hospital: an observationaland interventional study2013In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 1, 185-191 p.Article in journal (Refereed)
    Abstract [en]

    Background 

    Medication errors frequently occur when patients are transferred between health care settings. The main objective of this study was to investigate the frequency, type and severity of prescribing and transcribing errors for drugs dispensed in multidose plastic packs when patients are discharged from the hospital. The secondary objective was to correct identified errors and suggest measures to promote safe prescribing.

    Methods 

    The drugs on the patients' multidose drug dispensing (MDD) order sheets and the medication administration records were reconciled prior to the MDD orders being sent to the pharmacy for dispensing. Discrepancies were recorded and the prescribing physician was notified and given the opportunity to change the order. Discrepancies categorized as unintentional and related to the discharge process were subject to further analysis.

    Results 

    Seventy-two (25%) of the 290 reviewed MDD orders had at least one discharge error. In total, 120 discharge errors were identified, of which 49 (41%) were assessed as being of moderate and three (3%) of major severity. Orders with a higher number of medications and orders from the orthopaedic wards had a significantly higher error rate.

    Conclusion 

    The main purpose of the MDD system is to increase patient safety by reducing medication errors. However, this study shows that prescribing and transcribing errors frequently occur when patients are hospitalized. Because the population enrolled in the MDD system is an elderly, physically vulnerable group with a high number of prescribed drugs, preventive measures to ensure safe prescribing of MDD drugs are warranted.

  • 6.
    Andersson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences. UCL School of Pharmacy.
    Delivery of patient adherence support: The role of pharmacists and doctors.2013Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction:  Patient non-adherence is a well-known issue that causes problems on many levels, and many interventions regarding improving adherence have been evaluated. Pharmacists and doctors are in good positions to influence and support patient adherence, which makes them suitable intervention targets. However, to date, no one has specifically reviewed interventions with a defined role of pharmacists and/or doctors. Aim:  To evaluate the role of pharmacists and doctors in the delivery of patient adherence support.  Materials and Methods:  A systematic review was carried out. An electronic search was performed in MEDLINE, EMBASE, International Pharmaceutical Abstracts, PsycINFO and CINAHL for papers including randomised controlled trials of interventions to improve adherence, where pharmacists and/or doctors had a defined role in terms of delivery. The retrieved papers were screened to decide whether to include or exclude. The results of the included papers were then summarized, discussed and evaluated in line with the objectives. Results:  A total of 103 papers met the inclusion criteria and was included in the review. Only 14 of the interventions (14%) were delivered by doctors, and the rest by different kinds of pharmacists. The overall effectiveness was very good in most studies. Sixty-eight of the 103 papers resulted in enhanced medication adherence. However, 35 interventions failed to show improvement in adherence. Conclusions:  This review shows that pharmacists and doctors have a good potential to influence patients’ adherence. However, it also shows that more research is needed to get control over this growing global issue.  

  • 7.
    Andersson, Marielle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Pharmaceutical Interventions to Support Carers in Promoting Medicines Optimization for Older People2012Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Carers, unpaid relatives or friends, are recognized as providing important assistance to older people with their medicines. These activities have been associated with medication-related problems and carer stress.  Aim: This project is aimed to characterize and evaluate pharmaceutical interventions to support carers of older people and inform of ways for future developments. Materials and Methods: A systematic review was conducted together with a descriptive cross-sectional study, where interviews were done with eleven purposely selected pharmacists and eight carers in London. The electronic databases: Cochrane Library, Embase, International Pharmaceutical Abstract, PubMed and Web of Knowledge were searched systematically for studies from 1990 to 2012 regarding pharmaceutical interventions to support carers of older people. Results: Based on the systematic review, twenty-two interventions were identified, of which twenty were evaluated. The most common interventions were services provided to assist in medication administration and education or skills training programs. Some evidence supported education and drug formulations. Field-work revealed that diverse needs could arise and all participants had comments about the subject. Views added from concerned stakeholders included improvements of currently available services and changes on systemic levels. Conclusions: The evidence supporting pharmaceutical interventions for carers of older people is low and it was not considered credible to recommend any details regarding duration, format or provider of the interventions. Field-work reflected that services are needed but that standards are lacking. Future work including other study populations, settings, locations and evaluations is thus required to establish the evidence, regarding interventions that are likely to be effective, and standardize the support. 

  • 8.
    André, Malin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department Public Health and Caring Science, Sweden.
    Grondal, Hedvig
    Uppsala University, Sweden.
    Strandberg, Eva-Lena
    Lund University, Sweden; Blekinge County Council, Sweden.
    Brorsson, Annika
    Lund University, Sweden; Skåne Reg, Sweden.
    Hedin, Katarina
    Lund University, Sweden; Kronoberg County Council, Sweden.
    Uncertainty in clinical practice - an interview study with Swedish GPs on patients with sore throat2016In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, no 56Article in journal (Refereed)
    Abstract [en]

    Background: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines. Methods: An interview study was conducted among a strategic sample of 25 general practitioners (GPs). Results: All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and " Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy " Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis. Conclusion: The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPs did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.

  • 9.
    Anna, Pettersson
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Inhalationsläkemedel och läkemedelsrelaterade problem hos KOL-patienter med syrgasbehandling i hemmet respektive KOL-patienter inlagda på lungavdelning2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 10.
    Atac, Bilal
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Kartläggning av benzodiazepinanvändning och dess inverkan på fall-frakturhändelser, samt olämplig läkemedelsanvändning hos äldre2014Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Benzodiazepiner (BzD) och benzodiazepinliknande preparat (BzDLP) kan leda till beroende vid långtidsanvändning. En prövning för utsättning bör därför övervägas efter 4 veckors användning och utsättningen bör ske med utfasning vid långtidsanvändning. Tidigare studier är otillräckligt för att dra säkra slutsatser om BzD/BzDLPs inverkan på fall-frakturhändelser. Socialstyrelsen har sammanställt de substanser som inte är lämplig för användning av äldre personer om det inte finns särskilda skäl. Syftet med denna studie var att analysera läkemedelsbehandling hos äldre avseende följande områden: 1. Behandlingsfrekvens och behandlingslängd, samt utsättningsmetoden av BzD/BzDLP. 2. BzD/BzDLPs inverkan på fall-frakturhändelser. 3. Behandlingsfrekvens av Socialstyrelsens icke-rekommenderade preparat hos personer som är 75 år och äldre. Material och metoder: Journalerna för 84 patienter som behandlades på en geriatrisk avdelning i Uppsala län granskades under en 2 månaders period. Resultat: Behandlingsandel av BzD/BzDLP hos de undersökta patienterna var 80 procent och 70 procent av användningen skedde minst 5 veckor eller mer. Att byta ut preparatet med ett annat preparat, eller ändra stående ordination till vid behovsordination var den vanligaste utsättningsformen. BzD/BzDLP användningen var 49 procent vid fall-frakturhändelser i denna studie och Socialstyrelsens icke-rekommenderade läkemedelsbehandling förekom hos 14 procent av de icke-palliativa patienterna. Konklusion: Användning av BzD/BzDLP var högre hos deltagarna i studien, jämfört med användningen i riket. En större del av behandlingslängden var högre än Socialstyrelsens rekommendationer och utfasning vid utsättningen förekom inte. Inget samband mellan BzD/BzDLP och fall-frakturhändelser kunde ses i materialet. Den icke-rekommenderade läkemedelsanvändning var lägre hos deltagarna i studien jämfört med i riket.

  • 11.
    Ax, Fredrik
    et al.
    Apoteket AB.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Electronic transmitted prescriptions not picked up at pharmacies in Sweden2010In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, Vol. 6, no 1, 70-77 p.Article in journal (Refereed)
    Abstract [en]

    Background: Electronic transmitted prescriptions (ETPs) became common after 1995 in Sweden; however, it is accompanied by a substantial increase in the number of prescriptions not picked up at pharmacies.

    Objective: To investigate the ‘‘no pick-up’’ rates of ETPs at pharmacies across type of drug and patient age and gender and the reasons patients’ report for no pick-up.

    Methods: A cross-sectional study examining no pick-up of ETPs transmitted during 3 months in 2002, and a mail survey of patients to determine the reasons for failure to pick-up in the county of Sormland, Sweden, with a population of 261,000, and 21 pharmacies. Chi-square tests were used for calculations of frequency differences among groups.

    Results: The overall no pick-up rate of ETPs was 2.5%; men had consistently higher rates than women. The highest rates were seen for adolescents and young adults. Rates were higher than average for antibiotics. About 60% of the answers indicated that prescriptions not picked up were duplicate prescriptions or not needed. ‘‘Unintentional nonadherence’’ was reported by one-fifth of patients.

    Conclusions: No pick-up rate in general was low (2.5%), but there were differences across patient age and sex, the rates being higher among adolescents and young adults. Duplicate prescriptions may explain a significant share of the abandoned prescriptions.

  • 12.
    Bardage, Carola
    et al.
    Uppsala University.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ring, Lena
    Uppsala University.
    Health care professionals’ perspectives on automated multi-dose drug dispensing2014In: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 12, no 4, 470Article in journal (Refereed)
    Abstract [en]

    Background: During the 1980s, manual repackaging of multi-dose medications from pharmacies in Sweden was successively substituted with automated multi-dose drug dispensing (MDD). There are few studies evaluating the consequences of automated MDD with regard to patient safety, and those that investigate this issue are not very extensive.

    Objectives: To investigate Swedish health care professionals’ perceived experience of automated MDD and its effects on patient adherence and patient safety.

    Methods: Three questionnaire forms, one for physicians, nurses, and assistant nurses/nursing assistants, were developed based on reviews of the literature and pilot testing of the questions in the intended target groups. The target groups were health professionals prescribing or administrating MDD to patients. A sample (every sixth municipality) was drawn from the sampling frame of Swedish municipalities, resulting in 40 municipalities, about 14% of all municipalities in Sweden. Email addresses of general practitioners were obtained from county councils, while the municipalities assisted in getting contact details for nurses, assistant nurses and nursing assistants. A total of 915 questionnaires were distributed electronically to physicians, 515 to nurses, and 4,118 to assistant nurses/nursing assistants. The data were collected in September and October 2012.

    Results: The response rate among physicians, nurses and assistant nurses/nursing assistants was 31%, 43% and 23%, respectively. The professionals reported that automated MDD reduces duplication of medication, contributes to correct dosages, helps patients take their medication at the right time, and reduces confusion among patients. Fifteen per cent of the physicians and about onethird of the nurses and assistant nurses/nursing assistants reported that generic substitution makes it more difficult for the patient to identify the various medicines available in the sachets. The physicians did, however, note that prescribing medicine to patients with automated MDD is complicated and can be a risk for patient safety. Both physicians and nurses requested more information on and training in automated MDD. They also asked for more medication reviews.

    Conclusions: The professionals generally had a positive attitude to automated MDD with regard to improved medication adherence, but said they believed that the electronic prescribing system posed a safety risk for patients.

  • 13.
    Bardage, Carola
    et al.
    Med Prod Agcy, Uppsala / Uppsala Univ.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Med Prod Agcy, Uppsala.
    Ring, Lena
    Med Prod Agcy, Uppsala / Uppsala Univ.
    Health-Care Professionals' Perspectives on Multi-Dose Dispensed Medicines2013In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, 251-251 p.Article in journal (Other academic)
  • 14.
    Behnan, Tamara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Validation of a new vancomycin dosing nomogram within a pharmacist- led therapeutic drug monitoring program2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Vancomycin is a glycopeptide antibiotic used to treat different kinds of severe Gram positive infections. Alfred Health is the leading hospital in Australia in using vancomycin. Today, there are many guidelines for initiation of vancomycin but little evidence on maintenance dosing. Alfred Health has introduced a nomogram as a guideline for maintenance dosing. Aim: To measure the extent to which the clinical pharmacists have followed the nomogram to achieve the target trough range (15-20 mg/L) in vancomycin maintenance dosing at Alfred Health. Materials and Methods: Vancomycin levels from 161 patients in Alfred Health were collected. Patients’ clinical characteristics were recorded, as well as initiation and maintenance dosing of vancomycin using a Data Collection Tool. The data was then analyzed in Microsoft Excel 2003. Results: Of the 161 collected patients, 130 were included with a total of 491 levels taken. Of these levels, 32.8% were therapeutic, 57.6% were above minimum target and 15.2% were supratherapeutic. Twenty-nine patients (5.9%) had a new incidence of acute renal failure. There were a total of 113 patients that reached steady state with a total of 312 levels taken. Out of these levels, 86.5% were adjusted according to the nomogram. Conclusions: The majority of steady state levels were adjusted according to the nomogram. Opportunity exists to use this only as a pilot study and later repeat in larger population. It has been shown in the study that various dosage adjustment practices exist. Further work to improve today’s practice is required. 

  • 15.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Müssener, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lopez-Pelayo, Hugo
    University of Barcelona, Spain.
    Palacio-Vieira, Jorge
    Govt Catalonia, Spain.
    Colom, Joan
    Govt Catalonia, Spain.
    Gual, Antoni
    University of Barcelona, Spain.
    Reynolds, Jillian
    University of Barcelona, Spain.
    Wallace, Paul
    UCL, England.
    Segura, Lidia
    Govt Catalonia, Spain.
    Anderson, Peter
    Newcastle University, England; Maastricht University, Netherlands.
    Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, e010271Article in journal (Refereed)
    Abstract [en]

    Objectives The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice. Design The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking. Setting A total of 120 primary healthcare centres from 5 jurisdictions in Europe. Participants 746 individual providers (general practitioners, nurses or other professionals) participated in the study. Primary outcome Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period. Results The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (pamp;lt;0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (pamp;lt;0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%. Conclusions Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI.

  • 16.
    Benkirane, Raja
    et al.
    Moroccan Pharmacovigilance Centre, Rabat, Morocco; Centre AntiPoison et de Pharmacovigilance, Rabat, Morocco.
    Soulaymani-Bencheikh, Rachida
    Faculty of Medicine, Mohamed V, Rabat, Morocco.
    Khattabi, Asmae
    Institut National Administration Sanitaire, Rabat, Morocco.
    Benabdallah, Ghita
    Moroccan Pharmacovigilance Centre, Rabat, Morocco.
    Alj, Loubna
    Moroccan Pharmacovigilance Centre, Rabat, Morocco.
    Sefiani, Houda
    Moroccan Pharmacovigilance Centre, Rabat, Morocco.
    Hedna, Khedidja
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences.
    Ouammi, Lahcen
    Moroccan Pharmacovigilance Centre, Rabat, Morocco.
    Olsson, Sten
    Uppsala Monitoring Centre, Uppsala, Sweden.
    Pal, Shanti N
    World Health Organization, Geneva, Switzerland.
    Assessment of a New Instrument for Detecting Preventable Adverse Drug Reactions.2015In: Drug safety, ISSN 0114-5916, Vol. 38, no 4, 383-393 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pharmacovigilance centres (PVCs) in the World Health Organization (WHO) Programme for International Drug Monitoring have demonstrated their ability to detect preventable adverse drug reactions (ADRs) in their databases. In this field, there is no gold-standard method for detecting medication errors and evaluating ADR preventability. Therefore, we developed, from existing tools, a preventability assessment method: the 'P Method' (PM).

    OBJECTIVE: To present the PM and to evaluate its inter-rater reliability.

    METHODS: The PM includes 20 explicit criteria for assessing ADR preventability. This approach is based on identification of any potentially preventable risk factor that increases the likelihood of ADR occurrence. The outcome of the preventability assessment results in one of three possible scores: 'preventable', 'non-preventable' or 'not assessable'. The PM was tested in a multicentre study involving nine national PVCs. Two experienced reviewers at each participating PVC independently analysed the preventability of 183 ADRs, applying the PM.

    RESULTS: The overall agreement between all reviewers for assessment of ADR preventability was 'fair', with a kappa value of 0.27 [95 % confidence interval (CI) 0.21-0.40]. The level of agreement between reviewer pairs ranged from 'slight', with a kappa value of 0.12 (95 % CI -0.03 to 0.27), to 'substantial', with a kappa value of 0.69 (95 % CI 0.48-0.89).

    CONCLUSION: The analysis of the agreements and disagreements between reviewers highlighted where improvements might be made. Given that no standard assessment tool exists in the WHO Programme, the transparency of the assessment process in this method provides a substantial basis for further development and for support in signalling possible preventability.

  • 17.
    Berg, Christer
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Dosages involving split tablets - common but unnecessary?2010In: Journal of Pharmaceutical Health Services Research, ISSN 1759-8885, Vol. 1, no 3, 137-141 p.Article in journal (Refereed)
  • 18.
    Berg, Christer
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Haupt, Dan
    Department of Health Sciences, Lulea University of Technology, Lulea.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Prescriptions on split tablets: a common drug related problem - but unnecessary?2007In: ESCP 7th Spring Conference on Clinical Pharmacy 16-19 May 2007, Edinburgh: Tackling Inequalities in the Delivery of Pharmaceutical Care, 2007, 1-16 p.Conference paper (Refereed)
  • 19.
    Berglund, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Plasmaoxytocin och salivkortisol hos äldre patienter med depression – 3 patientfall vid Akademiska Sjukhuset2012Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion Hypotalamus-hypofys-binjurebarksaxeln (HPA-axeln) är det huvudsakliga endokrina systemet som aktiveras vid stress och det är välkänt att dess funktion är förändrad vid psykiatriska tillstånd såsom depression. Vid depression och ångest kan man därför se en förhöjd utsöndring av kortisol. Hormonet oxytocin har förutom dess perifera verkan vid födsel och amning visats fungera som neurotransmittor i det centrala nervsystemet och reglerar flera centrala funktioner. Flera studier har visat att oxytocin har en ångestdämpande effekt samt att oxytocinnivåer skiljer sig mellan patienter med depression och friska kontroller. Detta gör oxytocinsystemet till ett intressant område att studera ur farmakologisk synvinkel.

    Syfte Syftet med arbetet är att undersöka om någon förändring i oxytocin- och kortisolnivåer kan ses vid förbättringar av depressiva symtom hos äldre patienter.

    Material och metoder Tre patienter med depression på avdelning 1, äldrepsykiatriska verksamhetsområdet vid Akademiska Sjukhuset valdes ut. Provtagning av plasmaoxytocin och salivkortisol utfördes vid två olika tillfällen med så lång tid mellan mätningarna som möjligt, dock ej längre än en månad. I nära anslutning till provtagningstillfällena skattades även patienternas depression för att kunna följa sjukdomsförloppet och relatera resultaten från provtagningarna till graden av depressiva symtom.

    Resultat Inga trender i oxytocin- och kortisolnivåer kunde ses hos de tre patienterna relaterat till respektive depressionsgrad. 

    Slutsats För att ordentligt kunna studera och dra några slutsatser kring hur oxytocin- och kortisolnivåer förändras vid förbättringar av depressiva symtom, behöver en kontrollerad studie med ett större patientunderlag genomföras.

  • 20.
    Bidi, Maliheh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Polyfarmaci på Danderyds sjukhus: En kartläggning hos patienter som fått läkemedel förskrivna från Danderyds sjukhus2011Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Polyfarmaci på Danderyds sjukhus AB

    Maliheh Bidi

    Fördjupningsprojekt i farmakoterapi D, 30 hp

    Handledare: Desirée Loikas, Björn Wettermark, Thomas Cars. Enheten för Analys & Jämförelser, Utvecklingsavdelningen, Hälso- och sjukvårdsförvaltningen, Stockholms Läns Landsting

    Examinator: Margareta Hammarlund-Udenaes

    Institutionen för farmaceutisk biovetenskap, Avdelningen för farmakokinetik och läkemedelsterapi

     

    Introduktion: Polyfarmaci, det vill säga när en patient står på flera läkemedel samtidigt, har ökat under de senaste åren. Ökningen syns i alla åldersgrupper men är mest omfattande hos äldre multisjuka individer och vanligast bland kvinnor. Användning av onödiga läkemedel ökar risken för interaktioner, biverkningar och minskad följsamhet hos patienterna till läkemedelsordinationen. De flesta läkemedelssubstanser utsöndras via urinen, antingen i helt oförändrad form eller som metaboliter och ofta finns de kvar i miljön. Det är därmed viktigt även ur miljöhänsyn att minimera mängden onödiga läkemedel så att de inte orsakar miljöproblem i framtiden. Syfte: Att kartlägga förekomsten av polyfarmaci bland patienter som har hämtat ut minst ett recept utskrivet från Danderyds sjukhus AB under perioden juli 2010- juni 2011. Material och metod: Studien baserades på data över uthämtade läkemedel från Stockholms läns landsting innehållande information om patienternas ålder, kön och förskrivande vårdenhet för alla uthämtade läkemedel under juli 2010 - juni 2011 för patienter som fått minst ett recept från Danderyds sjukhus. Omfattningen av polyfarmaci (utköp av tio eller fler läkemedel) studerades per kön och åldersgrupp. Ytterligare analyser gjordes över vilka substanser som förskrevs mest till polyfarmacipatienterna, och hur stor del av dessa förskrivningar som kom från Danderyds sjukhus. Även substansernas miljöklassificering studerades. Resultat: Förekomsten av polyfarmaci ökade med åldern och var vanligare hos kvinnor i alla åldersgrupper. 48 procent av alla kvinnor i åldrarna 90+ hade tio eller fler läkemedel jämfört med 36 procent av männen i samma åldersgrupp. Några av de mest förskrivna läkemedlen till polyfarmacipatienterna var paracetamol (45 procent av de med polyfarmaci), acetylsalicylsyra, simvastatin, omeprazol och metoprolol. Andra verksamheter än Danderyds sjukhus stod för huvuddelen av förskrivningarna av dessa substanser. Miljörisken för de flesta substanser på topplistan var försumbar. Konklusion: Det finns inga direkt olämpliga läkemedel för behandling av äldre bland substanser som förskrivs mest till polyfarmacipatienter på Danderyds sjukhus. Behandling med substanserna på topplistan för polyfarmacipatienter kan vara helt ok, vid rätt diagnos, rätt ordination, rätt dosering/dosregim och rätta kombinationer.

  • 21.
    Bildsten, Meriem
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Antibiotikaanvänding i öppenvård i Stockholms län2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 22.
    Bimay, Sevgi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Biverkningsrapporter med dolda interaktioner2011Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 23.
    Björkman, Ingeborg
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Viberg, Nina
    Rydberg, Linda
    Stålsby Lundborg, Cecilia
    Health promotion at Swedish pharmacies: views of the staff2008In: Pharmacy Practice (Internet), ISSN 1886-3655, Vol. 6, no 4, 211-218 p.Article in journal (Refereed)
    Abstract [en]

    The role of pharmacy has changed dramatically during the last decades, which has led to new demands on pharmacy personnel. Objective: This study aims at exploring the attitudes of Swedish pharmacy personnel on their role as public health promoters and to look at the opportunities and obstacles they identify in the efforts to widen the pharmacy remit to include a wider health approach. Method Eight focus group discussions were conducted with a strategic sample of pharmacy personnel working in two counties in Sweden. The discussions were transcribed verbatim and analysed by qualitative inductive analysis. Results Five themes were identified, “Pharmacy activities impact on public health”, “The employer, Apoteket AB”, “The new role welcomed”, “Obstacles in the new role”, and “Need of change and support”. Conclusion The concept of pharmacy personnel as public health promoters was not initially in the mindset of the participants. In the process of discussion, the impact of traditional pharmacy practice as well as new pharmacy based initiatives on public health gradually became more obvious to them. The findings show a pharmacy staff involved in a process of change. The participants have not yet landed in their new role as public health promoters and the study shows that practical as well as conceptual support is needed in order for pharmacy personnel to play a more important role in public health.

  • 24.
    Bondesson, Åsa
    et al.
    Lunds Universitet.
    Hellström, Lina
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Eriksson, Tommy
    Lunds Universitet.
    Höglund, Peter
    Lunds Universitet.
    A structured questionnaire to assess patient compliance and beliefs about medicines taking into account the ordered categorical structure of data2009In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 4, 713-723 p.Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS AND OBJECTIVE: The objectives were to describe and evaluate the structured medication questionnaire and to improve data handling of results from the Morisky four-item scale for patient compliance and Beliefs about Medicines Questionnaire-specific (BMQ-specific). METHODS: A questionnaire was developed with the purpose of being used when identifying medication errors and assessing patient compliance to and beliefs about medicines. RESULTS: A majority of the respondents (62%; CI 45-77%) had at least one medication error. Assuming that all items are equally important in the Morisky four-item scale we presented four alternative ways to create a unidimensional global scale. A two-dimensional global scale was also constructed. The results from the BMQ-specific were presented in different ways, all taking into account that the scale has ordered verbal categories: at the level addressing each specific question, at the sub-scales 'concern' and 'necessity' level and at the global level. CONCLUSIONS: The structured medication questionnaire can be used in daily practice as a tool to identify drug-related problems. The choice of how to use and present data from those scales in research depends on patient characteristics and how discriminating one would like the scales to be.

  • 25.
    Carlberg, Bo
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Samuelsson, Ola
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Finns möjligen hela bilden om atenolol hos Kent Forsén?2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 3, 151-152 p.Article in journal (Other academic)
  • 26.
    Carlsson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Vilka faktorer samvarierar med låg respektive hög tilltro till generiskt utbyte bland apotekskunder?: En kvantitativ enkätstudie utförd på svenska öppenvårdsapotek.2015Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Abstract Introduktion: Generiskt utbyte infördes i Sverige år 2002 och reformen sänker årligen samhällets läkemedelskostnader. Reformen har dock fått kritik och påstås kunna påverka patientsäkerheten negativt. Få studier har tidigare gjorts om vilka faktorer som påverkar patienters tilltro till det generiska utbytet och likvärdiga läkemedels bioekvivalens.

    Syfte: Syftet med denna studie var att analysera hur farmaceuters och läkares information till patienter samt förändringar i läkemedlets namn och fysiska attribut samvarierar med låg respektive hög tilltro till generiskt utbyte bland apotekskunder i Sverige. Detta för att ge betydelsefull information till hälso- och sjukvårdspersonal och beslutsfattare.

    Material och metoder: I denna kvantitativa tvärsnittsstudie insamlades data med enkäter på svenska öppenvårdsapotek. Dataanalys och statistikbehandling utfördes i SPSS i form av bivariat regressionsanalys och variansanalyser. Ett indexvärde, mellan 4 och 20, för varje respondents tilltro beräknades och ett högre indexvärde innebar en lägre tilltro.  

    Resultat: Totalt inhämtades 719 enkäter och medianen för tilltrosindex beräknades till 9. Statistisk samvariation återfanns mellan tilltro och farmaceuters information till patienter om utbyte och läkemedels likvärdighet. Detsamma gällde samvariationen mellan tilltro och läkares information till patienter om likvärdighet, förändringar i tabletters och förpackningars utseende samt förändringar i läkemedlets namn.

    Konklusion: I studiepopulationen varierade tilltron till generiskt utbyte och i genomsnitt hade apotekskunderna en högre än en lägre tilltro. Samvariationerna indikerar på att ökad information från farmaceuter och läkare ökar tilltron hos apotekskunder men att förändringar i tabletters och förpackningars utseende samt förändringar i läkemedlets namn minskar tilltron.

  • 27.
    Castensson, Staffan
    et al.
    Forskning och Utveckling, Apoteket AB.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Pharmaceutical Waste: The Patient Role2010In: Green and Sustainable Pharmacy / [ed] Kümmerer, Klaus; Hempel, Maximilian, Heidelberg Dordrecht London New York: Springer, 2010, 1, 179-200 p.Chapter in book (Other academic)
  • 28. Cisneros, Jose Antonio
    et al.
    Vandevoorde, Severine
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Ortega-Gutierrez, Silvia
    Paris, Clement
    Fowler, Christopher J
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Lopez-Rodriguez, Maria L
    Structure-activity relationship of a series of inhibitors of monoacylglycerol hydrolysis-comparison with effects upon fatty acid amide hydrolase2007In: Journal of Medicinal Chemistry, ISSN 0022-2623, E-ISSN 1520-4804, Vol. 50, no 20, 5012-5023 p.Article in journal (Refereed)
    Abstract [en]

    A series of 32 heterocyclic analogues based on the structure of 2-arachidonoylglycerol (2-AG) were synthesized and tested for their ability to inhibit monoacylglycerol lipase and fatty acid an-tide hydrolase activities. The designed compounds feature a hydrophobic moiety and different heterocyclic subunits that mimic the glycerol fragment. This series has allowed us to carry out the first systematic structure activity relationship study on inhibition of 2-AG hydrolysis. The most promising compounds were oxiran-2-ylmethyl (5Z,8Z,l 11Z,14Z)-icosa-5,8,11,14-tetraenoate (1) and tetrahydro-2H-pyran-2-ylmethyl (5Z,8Z,11Z,14z)-icosa5,8,11,14-tetraenoate (5). They inhibited cytosolic 2-oleoylglycerol (2-OG) hydrolysis completely (IC50 values of 4.5 and 5.6 mu M, respectively). They also blocked, albeit less potently, 2-OG hydrolysis in membrane fractions (IC50 values of 19 and 26,mu M, respectively) and anandamide hydrolysis (IC50 values of 12 and 51 mu M, respectively). These compounds will be useful in delineating the importance of the cytosolic hydrolytic activity in the regulation of 2-AG levels and, hence, its potential as a target for drug development.

  • 29.
    Dee, Katrina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Kartläggning av rutiner kring läkemedelsinformation vid utskrivning från en internmedicinsk avdelning – vad görs och hur görs det till äldre patienter?2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Kartläggning av rutiner kring läkemedelsinformation vid utskrivning från en internmedicinsk avdelning – vad görs och hur görs det till äldre patienter?

    Katrina Dee

    Hanledare: Anna Alassaad. Institutionen för farmaceutisk biovetenskap, avdelning för farmakokinetik och läkemedelsterapi, 30 hp. Examinator: Margareta Hammarlund-Udenaes.

    Introduktion: Olika studier har visat att läkemedelsavvikelser och bristfällig läkemedelsinformation i samband med patienters utskrivning från sjukhus, innebär en ökad risk för läkemedelsrelaterade problem. Detta kan i sin tur bidra till ett ökat antal återinläggningar. Syfte: Att kartlägga rutiner kring läkemedelsinformation till äldre patienter, 65 år och äldre, vid utskrivning från en medicinavdelning vid Akademiska sjukhuset i Uppsala. Material och metoder: I denna prospektiva och observationella kartläggning, användes journalgranskning dels för att se vilka läkemedelsändringar som utfördes under vårdtiden, men även för att granska läkarens dokumentation om läkemedelsändringar i patientens journal samt läkemedelsinformationen i patienternas utskrivningsmeddelanden. Patientintervjuer och uppföljningssamtal utfördes för att få patienternas perspektiv på den läkemedelsinformation som getts vid utskrivning samt huruvida de fått med sig en läkemedelslista. Resultat: Totalt erhöll 71 av 100 patienter varsitt utskrivningsmeddelande och 38 av de 57 patienter med patientsamtal fick en läkemedelslista vid utskrivning. Under patientsamtalen uppgav patienterna att de kände till 61 av 110 (55,5%) läkemedelsinsättningar, 22 av 70 (31,4%) läkemedelsutsättningar och 19 av 40 (47,5%) dosändringar. Antalet läkemedelsändringar som var dokumenterade i patienternas journaler med respektive orsak till ändring var 151 stycken. Totalt ansågs 36 av 100 epikriser innehålla fullständig läkemedelsinformation angående de läkemedelsändringar som utfördes under patienternas vårdtid på avdelningen. Konklusion: Patienternas journaler innehåller bristfälligt med information om patienternas läkemedelsändringar. Studien indikerar även att kommunikationen mellan läkaren och patienten kan förbättras i samband med utskrivningen. 

  • 30. Dåderman, Anna Maria
    et al.
    Lidberg, Lars
    Karolinska Institutet, Department of Forensic Psychiatry, University Hospital, Huddinge, Sweden.
    Flunitrazepam (Rohypnol) abuse in combination with alcohol causes premeditated, grievous violence in male juvenile offenders1999In: The journal of the American Academy of Psychiatry and the Law, ISSN 1093-6793, Vol. 27, no 1, 83-99 p.Article in journal (Refereed)
    Abstract [en]

    This study focuses on 19 juvenile offenders who were frequently intoxicated by flunitrazepam (FZ), almost exclusively under the brand name Rohypnol. Street names for Rohypnol tablets are Rophies, Ropies, Roofies, Ropes, Roches, Rochas, Rochas Dos, Rophs, Ropers, Ribs, R-25, Roach-2s, Trip and Fall, Remember All, Mind Erasers, Forget Pills, and the Date Rape Drug. An overdose of FZ gives an increased feeling of power and self-esteem, reduces fear and insecurity, and provides the belief that everything is possible. FZ is also associated with loss of episodic memory and with impulsive violence, particularly when combined with alcohol. The subjects were taken from a subpopulation of 47 male juvenile offenders from Swedish national correctional institutions. Background information for subjects was obtained by in-depth interviewing and personality inventories including the Zuckerman Sensation-Seeking Scales, the Eysenck Personality Questionnaire, and the Karolinska Scales of Personality. Data concerning previous criminal offenses was obtained from the Swedish National Police Board. Almost all of the FZ abusers had been previously sentenced for serious violent offenses. Our data suggest that FZ abused by psychiatrically vulnerable subjects (i.e., with high scores on boredom susceptibility and verbal aggression) poses a serious hazard both to the abusers as well as the community. Our results support the finding that FZ should be classified as a Schedule I drug (i.e., a drug similar to heavy narcotics).

  • 31.
    Dåderman, Anna Maria
    et al.
    Karolinska Institutet, Stockholms universitet.
    Lidberg, Lars
    Karolinska Institutet.
    Rohypnol bör klassas som narkotika [Flunitrazepam should be classified as a controlled substance in Sweden]1999In: Läkartidningen, ISSN 0023-7205, Vol. 96, no 9, 1005-1007 p.Article in journal (Refereed)
    Abstract [en]

    Flunitrazepam, widely known by its trade names (e.g. Rohypnol®), may cause severe violence, especially in combination with alcohol. Flunitrazepam abusers become coldblooded, ruthless and violent, and do not remember their violence. Reputedly it is supplied to professional hit-men and enforcers by their bosses to promote ruthless efficacy. One case report describes how a young man, intoxicated with flunitrazepam and involved in causing serious knife and gunshot wounds and taking hostages, felt so invincible that he openly challenged the police, threatening them with an assault rifle, but was himself shot. Flunitrazepam may exert pharmacological effects on GABA-ergic systems, thus lowering serotonin levels. The impulsive execution of violent crimes and suicid attempts in which a violent method (hanging, shooting, selfstabbing) has been used are associated with the presence of low serotonin levels. It is therefore recommended that flunitrazepam should be classified as a controlled substance in Sweden as it is elsewhere.

  • 32.
    Ekberg, Annabel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    The Impact of Polypharmacy and Age on the Need for Medication Reviews2014Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Polypharmacy and high age are factors associated with increased occurrence of inappropriate prescribing, side effects and hospital admissions. The medication review is a model used to increase appropriateness of prescribing and optimize pharmacotherapy for the individual patient. The National Board of Health and Welfare of Sweden has determined that the population targeted for medication reviews are 75 years or older with five or more prescribed drugs. Aim: To assess the need for medication reviews for elderly patients, divided into subgroups, admitted to Uppsala University Hospital. Materials and Methods: The study population (n=102) was divided into four groups based on age (65-74 and ≥75) and number of prescribed drugs on admission (<5 and ≥5). Validated tools (START/STOPP) were applied to patient's medication lists along with national recommendations to evaluate the quality of the drug therapy. Results: Younger elderly (65-74) had more potentially inappropriate medications (PIMs) in comparison with elder elderly (≥75) (p=0.002). In the patient groups with ≥5 drugs younger elderly were in greater need of a medication review based on PIMs (p=0.009). Patients with ≥5 drugs had more PIMs than patients with <5 prescribed drugs (p=0.001). The subgroups were not statistically different regarding START or STOPP in other perspective. National recommendations were not statistically different between patients (≥75 years) with <5 or ≥5 prescribed drugs (p=0.290). Conclusions: The results suggest there is a need for a medication review among all subgroups in the elderly population, in particular younger elderly with many prescribed drugs.

  • 33.
    Ekblom, Emelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Kartläggning av behandlingen av ovarialcancer i Uppsala med hjälp av RealQ-systemet2011Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Abstract

    Introduktion: Ovarialcancer har ofta en allvarlig prognos. Behandlingen består av kirurgi och kemoterapi. Den pågår p.g.a. upprepade återfall ofta under många år med flera olika linjer cytostatika. För optimal behandling krävs utförlig information om sjukdomen och dess förlopp. Vanliga journalsystem tillgodoser inte detta behov. RealQ är en databas med beslutsstöd för läkare för användning i kliniskt vardagsarbete.

    Syfte: Att anpassa RealQ för ovarialcancer för användning som beslutsstöd i kliniken samt att med denna databas undersöka hur behandling och utfall ser ut för ovarialcancerpatienter på Uppsala Akademiska sjukhus (UAS) i dag jämfört med tidigare.

    Material och metoder: Data lades in i RealQ som anpassades för ovarialcancer och extraherades anonymt för patienter diagnostiserade med ovarialcancer, tubarcancer och cancer peritonei mellan juni 2008 och juni 2011. De följdes från diagnos fram t.o.m. oktober 2011. Data som utvanns var sjukdomskarakteristika, behandling samt respons, tid till recidiv och överlevnad.

    Resultat: 97 patienter redovisas varav 64 med ovarialcancer, 18 med primärcancer peritonei, 2 tubarcancer, 4 med borderlinetumör och 9 med övriga maligna ovarialtumörer.  Av ovarialcancerpatienterna primäropererades 42 (65,6%) varav 23 radikalt, 12 optimalt och 7 ej optimalt. Kemoterapi gavs till 56 patienter med ovarialcancer. Frekvensen objektiv respons var 74 %. Progressionsfri överlevnadstid för patienter med invasiv cancer var 13,3 månader.  Data relaterades till internationella resultat och data från UAS 1991-98.

    Konklusion: Databasen och beslutstödet redovisar relevant information om sjukdomsförlopp och behandlingsresultat vid ovarialcancer, individuellt och i grupp.

  • 34.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Medical Products Agency / Läkemedelsverket.
    Patients' "self-reconciliation" of the medication list compared with medication verification with pharmacist2013In: International Journal of Clinical Pharmacy, ISSN 2210-7703, Vol. 35, no 3, 505-505 p.Article in journal (Other academic)
  • 35.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Occurrence of prescriptions for noncurrent - changed or terminated -treatment and prescription duplicates in electronic medical records and the Swedish national prescription repository2010In: The 14th European Symposium on Patient Adherence, COMpliance and Persistence, LODZ, POLAND 17-18.09.2010, Lodz.Polen, 2010Conference paper (Refereed)
    Abstract [en]

    Patient adherence to prescribed treatment for chronic conditions has been estimated to be on average about 50% [1] and drug related problems may cause as much as 30% of acute admittances to hospital care [2]. Discrepancies between medical records and patients’ actual current medication are common [3-5].

     

    The objective of the present study was to compare current prescribed treatment stated by patients with the printouts from the electronic medical record (EMR) and the Swedish national prescription repository (NPR) with regard to (1) prescriptions for noncurrent (previously changed or terminated) treatment, (2) prescription duplicates and (3) missing prescriptions.

     

    Design: Cross-sectional study. Patients over 18 years of age with 5 or more prescriptions stored in the NPR or the EMR, with follow-up visit at a health care centre or visiting a pharmacy, were invited to the study. Patients giving written informed consent to participate were interviewed. The stated prescribed current, ongoing treatment was compared with printouts of prescribed medication from the EMR and of the stored prescriptions in the NPR.

     

    Main Outcome Measures: Proportions of prescriptions for (a) noncurrent treatment (changed or terminated), (b) prescription duplicates and (c) missing prescriptions in the EMR and the NPR.

     

    Results: 216 patients with altogether 2515 prescriptions were included. In total, 71% were unique prescriptions for current ongoing treatment, 17% were prescriptions for noncurrent treatment (changed or terminated therapy) and 11% were prescription duplicates. Of 2195 prescriptions in the EMR, 75% were unique prescriptions for current treatment, 13% were noncurrent, 11% were prescription duplicates and 8% of the current prescriptions were missing. Of 1904 prescriptions in the NPR, 75% were unique prescriptions for current ongoing medication, 13% were noncurrent prescriptions, 11% were prescription duplicates and 20% of the current prescriptions were missing. The EMR and the NPR contained ≥1 noncurrent prescription or duplicate for 76% and 69% of patients.

     

    Conclusion: Prescriptions for noncurrent treatment and prescription duplicates as well as missing prescriptions are common in both EMR and the Swedish NPR. Consequently, claims data based on data of prescribed medicines in the EMR or the stored prescriptions in NPR contain many errors. Adherence estimates measured as “claims data” for prescriptions in the EMR and NPR may deviate significantly from true figures.

  • 36.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Reasons why medicines are returned to Swedish pharmacies unused.2006In: Pharmacy World & Science, ISSN 0928-1231, Vol. 28, no 6, 352-8 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify the reasons and their relative importance why medicines are returned to Swedish pharmacies unused. SETTING: A random sample of the pharmacies in Sweden. METHOD: Interviews using a semi-structured interview form with pharmacy customers returning unused medicines to the pharmacy. MAIN OUTCOME MEASURE: Reasons given by patients/relatives/carers for returning unused medicines to the pharmacy. RESULTS: The four main reasons for returning unused medicines to the pharmacy were: (1) the medicines were too old, (2) the user had died, (3) there was no need for the medicine anymore, and (4) therapy changes. These reasons made up 75% of all reported reasons. CONCLUSION: Hoarding or over-supply of prescribed medicines may explain a large part of the volume of medicines that remain unused. Actions aiming to reduce waste of prescribed medicines ought to focus on those patients who contribute to a substantial part of all unused medicines.

  • 37.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Al-Fakhri, Marwa
    Institutionen för farmaceutisk biovetenskap, Uppsala universitet.
    Andersson, Clara
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Babic, Dina
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Lubarsky, Nadja
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Ly, Helen
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Comparison of prescription data in the electronic medical record, stored prescriptions in the Swedish national prescription repository and the current prescribed treatment stated by patients2010In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, 678-679 p.Article in journal (Other academic)
    Abstract [en]

    Thirty percent of the prescriptions in the EMR and one fourth of all prescriptions in the NPR were either non-current treatment or prescription duplicates. The present data show that printouts of the prescriptions in both the EMR and the NPR contain many errors. Printouts may be confusing and if patients are not fully aware of their prescribed present treatment, medical errors may occur. The problem may be aggravated by generic substitution

  • 38.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Brosius, Helen
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Jönsson, Julia
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Karlsson, Hanna
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Yngvesson, M
    Differences between the data in the electronic medical record, the prescriptions stored in the Swedish national prescription repository and and the patient’s knowledge of the present treatment2010In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, no 5, 679- p.Article in journal (Other academic)
    Abstract [en]

    Background and objective Patient adherence to prescribed treatmentfor chronic conditions has been estimated to be on average about 50%(1), drug related problems may cause as much as 30% of acuteadmittances to hospital care (2), and the costs have been estimated tobe of the same magnitude as the direct costs for pharmaceutical drugs.A reason for lack of adherence to the treatment and medication errorsmay be that patients with many drugs, especially when changes in thetreatment have occurred, may have knowledge gaps on the drugsrepresenting the actual prescribed treatment.

    E-prescribing, from the physicians’ electronic medical record(EMR) directly to the pharmacies, constitute[75% of all prescriptionsin Sweden and [70% of patients in Sweden store theirprescriptions electronically at the national prescription repository(NPR), accessible from any pharmacy in Sweden. Any new e-prescriptionwill automatically be stored in the NPR.However, the NPR may contain both prescriptions for the present,actual treatment, prescription duplicates, and prescriptions for previous,terminated or changed treatment. For patients with manymedications and/or many changes in the treatment it is obvious thatthe risk for medication errors is increased.The objective of the present study was to compare the prescribedtreatment in the EMR, the prescriptions in the NPR, and patient’sknowledge of her/his present prescribed treatment.Design Compare prescribed treatment in the EMR with the prescriptionsin the NPR, and patients knowledge of her/his presentprescribed treatment with regard to prescriptions; prescribed drug,strength; formula and dosing.Setting Ten HCCs in four cities in Sweden, February 2010.Main outcome measures Differences between the computerisedpatients health care journal record and the prescriptions in the NPR,and patients view of her/his actual present prescribed treatment withregard to prescriptions; prescribed drug, strength; formula and dosing.Results The results are available in March 2010.Conclusions Conclusion.

    References1. Adherence to long-term therapies: evidence for action. WHO,2003.2. Fryckstedt J, Asker-Hagelberg C. Drug-related problems commonat the medical acute care clinic—the cause of admission foralmost one-third of patients. [Läkemedelsrelaterade problemvanliga på medicinakuten - Orsak till inläggning hos nästan vartredje patient, enligt kvalitetsuppföljning] Läkartidningen 2008;105(12–13): 894–898.

  • 39.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Brosius, Helen
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Jönsson, Julia
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Karlsson, Hanna
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Yngvesson, Maria
    Discrepancies between the electronic medical record, the prescriptions in the Swedish national prescription repository and the current medication reported by patients.2011In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 20, no 11, 1177-1183 p.Article in journal (Refereed)
    Abstract [en]

    Purpose To study discrepancies between (i) the prescribed current treatment stated by patients with congestive heart failure (CHF) compared with patients with other chronic diseases, (ii) the data in the medication list (ML) in the electronic medical record and (iii) the data in the prescription list (PL) on the prescriptions stored in the national prescription repository in Sweden, to determine current, noncurrent, duplicate and missing prescriptions.

    Methods At one healthcare centre, a random sample of patients 18 years and older with a diagnosis of CHF, diabetes mellitus (DM) or osteoarthritis (OA) provided written informed consent to participate. Participants were interviewed by telephone on the prescribed current treatment.

    Results Of 161 invited patients (61 CHF, 50 DM and 50 OA), 66 patients were included. More than 80% of the patients had at least one discrepancy, a noncurrent, a duplicate or a missing prescription, in the ML and PL. The overall congruence for unique prescriptions on current treatment between the ML and the PL was only 55%. Patients with CHF had overall more discrepancies and patients with DM fewer discrepancies in the ML.

    Conclusions Prescriptions for noncurrent treatment, duplicates and missing prescriptions are common in both the ML in the electronic medical record and the list on prescriptions stored in the Swedish National Prescription Repository. Patients with CHF had more discrepancies in the ML. The risk for medication errors in primary care due to incorrect information on prescribed treatment may be substantial.

  • 40.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Mattsson, Johanna
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Patients’ knowledge of prescriptions stored in the Swedishnational prescription repository—prescription duplicates,double medications and changed treatment2010In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, no 5, 688-689 p.Article in journal (Other academic)
    Abstract [en]

    Prescriptions for non-current treatment that previously has been changed or terminated and prescription duplicates are common in the Swedish NPR. The risk for medication errors in the open care setting may be substantial.

  • 41.
    Ekedahl, Anders
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Oskarsson, Vivianne
    Sundberg, Barbro
    Gustafsson, Veronica
    Lundberg, Therese
    Impact of postal and telephone reminders to patients not claiming their e-prescriptions”2006In: 35th European Symposium on Clinical Pharmacy: The Role of Communication in Patient Safety and Pharmacotherapy Effectiveness 18 – 21 October 2006, Vienna, Austria, 2006Conference paper (Refereed)
  • 42.
    Ekedahl, Anders
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Oskarsson, Vivianne
    Luleå University of Technology, Lulea, Sweden.
    Sundberg, Barbro
    Luleå University of Technology, Lulea, Sweden.
    Gustafsson, Veronica
    Luleå University of Technology, Lulea, Sweden.
    Lundberg, Therese
    Luleå University of Technology, Lulea, Sweden.
    Gullberg, Bo
    Department of Clinical Sciences, Lund University, Malmo.
    Impact of postal and telephone reminders on pick-up rates of unclaimed e-prescriptions.2008In: Pharmacy World & Science, ISSN 0928-1231, Vol. 30, no 5, 503-508 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the impact of a reminder (i.e., a mailed letter or short telephone call) from the pharmacy to patients, compared with no reminder in a control group, on the pick-up rates of unclaimed e-prescriptions. METHOD: Patients, with e-prescriptions transmitted to four large community pharmacies in two counties in northern Sweden and remaining unclaimed after 4 weekdays, were randomised to one of two intervention groups (a mailed reminder or a short telephonic reminder) or a control group. MAIN OUTCOME MEASURES: Rates of patients' pick-up of their e-prescriptions at follow-up after about 1, 2 and 3 weeks. RESULTS: Altogether, 320 patients with e-prescriptions, transmitted from March 21 through April 6 and not picked-up or dispensed, were identified and randomised to the study. There were no statistically significant differences in overall pick-up rates between the groups or with respect to gender. However, pick-up rates increased with increasing age. Higher pick-up rates were observed for two subgroups (but only in the mailed reminder group compared with controls)--for cardiovascular drugs to men and for respiratory drugs to adolescents and young adults. CONCLUSION: A reminder (i.e., a mailed letter or short telephone call) from the pharmacy to the patient had no statistically significant effect on overall pick-up rates of unclaimed e-prescriptions compared with no reminders.

  • 43.
    Elobeid, Adila
    et al.
    Uppsala, Sweden.
    Laurell, Katarina
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Cesarini, Kristina Giuliana
    Uppsala, Sweden.
    Alafuzoff, Irina
    Uppsala, Sweden.
    Correlations Between Mini-Mental State Examination Score, Cerebrospinal Fluid Biomarkers, and Pathology Observed in Brain Biopsies of Patients With Normal-Pressure Hydrocephalus2015In: Journal of Neuropathology and Experimental Neurology, ISSN 0022-3069, E-ISSN 1554-6578, Vol. 74, no 5, 470-479 p.Article in journal (Refereed)
    Abstract [en]

    Alzheimer disease (AD)-related pathology was assessed in cortical biopsy samples of 111 patients with idiopathic normal-pressure hydrocephalus. Alzheimer disease hallmark lesions-beta-amyloid (A beta) and hyperphosphorylated tau (HPtau)-were observed in 47% of subjects, a percentage consistent with that for whole-brain assessment reported postmortem in unselected cohorts. Higher-immunostained area fraction of AD pathology corresponded with lower preoperative mini-mental state examination scores. Concomitant A beta and HPtau pathology, reminiscent of that observed in patients with AD, was observed in 22% of study subjects. There was a significant correlation between A beta-immunostained area fraction in tissue and A beta 42 (42-amino-acid form of A beta) in cerebrospinal fluid (CSF). Levels of A beta 42 were significantly lower in CSF in subjects with concomitant A beta and HPtau pathology compared with subjects lacking pathology. Moreover, a significant correlation between HPtau-immunostained area fraction and HPtau in CSF was noted. Both HPtau and total tau were significantly higher in CSF in subjects with concomitant A beta and HPtau pathology compared with subjects lacking pathology. The 42-amino-acid form of A beta (A beta 42) and HPtau in CSF were the most significant predictors of the presence of AD pathology in cortical biopsies. Long-term follow-up studies are warranted to assess whether all patients with idiopathic normal-pressure hydrocephalus with AD pathology progress to AD and to determine the pathologic substrate of idiopathic normal-pressure hydrocephalus.

  • 44.
    Fagerlind, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Patient-Physician Communication in Oncology Care: The character of, barriers against, and ways to evaluate patient-physician communication, with focus on the psychosocial dimensions2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to characterize patient-physician communication in oncology care with focus on the content and quality of the consultations from the perspectives of patients, oncologists and observer. Further, the aim was to explore oncologists’ perceived barriers against psychosocial communication in out-patient consultations. Finally, the aim was to evaluate different methods for evaluating communication in this setting.

    Routine oncology out-patient consultations from two different hospitals were audio-recorded. After the consultations, patients and oncologists perceptions of the content and quality of the communication were assessed using a self-report questionnaire. A nation-wide survey was performed to assess oncologists’ perceived barriers against psychosocial communication. Finally, the audio-recorded consultations were used for evaluating inter-rater reliability and feasibility of two different communication analysis instruments.

    Patient-physician consultations in oncology care are focused on the physical aspects of disease and treatment, both in terms of how often these issues were discussed and in terms of the amount of time spent on discussing them. Psychosocial issues, such as the disease’s effects on patients’ emotional or social functioning, are not always discussed during consultations, and the time spent on such discussions is limited. When psychosocial issues are discussed during the medical consultations, they are most often patient-initiated. Reasons for why psychosocial aspects are seldom discussed during the medical consultations can be the barriers concerning this kind of communication perceived by a large majority (93%) of the oncologists. Barriers against psychosocial communication were identified at organizational levels (including guidelines, routines, and resources) and individual levels (including physicians’ knowledge and attitudes).

    Furthermore, this thesis shows that there are methods with high feasibility and reliability for evaluating the content of patient-physician communication, in large study samples in oncology care. The method (observation/self-report) and perspective (patient, physician, and observer) used when evaluating communication affects the results. This needs to be considered when choosing evaluation methods in intervention studies.

    There are reasons to continue to evaluate, promote and implement promising ways of achieving better communication in clinical practice. Research should focus on how to overcome barriers against psychosocial communication.

  • 45.
    Fjellvind, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Läkemedelsgenomgångar inom psykiatrin- en initial pilotutvärdering2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Inom psykiatrin finns det få studier som har undersökt effekten av läkemedelsgenomgångar och beskrivit läkemedelsgenomgångsprocessen. Syfte: Arbetet syftar främst till att analysera de läkemedelsrelaterade problem som identifieras under själva läkemedelsgenomgångsprocessen inom psykiatrin avseende antal, typ samt åtgärd. Material och metoder: Läkemedelsgenomgångar inom psykiatrin testades i tre piloter (≥ 2 bensodiazepiner, psykos och ≥ 2 neuroleptika, rättspsykiatri) på psykiatriska avdelningar i Skåne. Information från läkemedelsgenomgångarna; identifierade läkemedelsrelaterade problem samt åtgärder för dessa, extraherades från journalsystemet Melior. Resultat: Totalt 54 patienter inkluderades i de tre piloterna. För patienter med psykos och ≥ 2 neuroleptika identifierades flest läkemedelsrelaterade problem (i genomsnitt 3,2 (SD 3,8)); ≥ 2 bensodiazepiner (1,4 (SD 1,7)) och rättspsykiatrin (1,3 (SD 1,6)). De vanligaste läkemedelsrelaterade problemen var onödig läkemedelsterapi samt oklar indikation och de vanligaste åtgärderna var utsättning av läkemedel samt utvärdering av läkemedelsbehandlingen. Konklusion: Sammanfattningsvis visar arbetet att det är vanligt förekommande med läkemedelsrelaterade problem hos den studerade patientpopulationen inom psykiatrin samt att läkemedelsgenomgångar kan vara en metod för att identifiera, monitorera och åtgärda läkemedelsrelaterade problem. För att dra vidare slutsatser kring läkemedelsgenomgångars effekter inom psykiatrin krävs dock ytterligare studier.

  • 46. Fransson, Martin N.
    et al.
    Brugård, Jan
    Aronsson, Peter
    Gréen, Henrik
    KTH, School of Biotechnology (BIO), Gene Technology. KTH, Centres, Science for Life Laboratory, SciLifeLab.
    Semi-physiologically based pharmacokinetic modeling of paclitaxel metabolism and in silico-based study of the dynamic sensitivities in pathway kinetics2012In: European Journal of Pharmaceutical Sciences, ISSN 0928-0987, E-ISSN 1879-0720, Vol. 47, no 4, 759-767 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: To build a semi-physiologically based pharmacokinetic model describing the uptake, metabolism and efflux of paclitaxel and its metabolites and investigate the effect of hypothetical genetic polymorphisms causing reduced uptake, metabolism or efflux in the pathway by model simulation and sensitivity analysis. Methods: A previously described intracellular pharmacokinetic model was used as a starting point for model development. Kinetics for metabolism, transport, binding and systemic and output compartments were added to mimic a physiological model with hepatic elimination. Model parameters were calibrated using constraints postulated as ratios of concentrations and amounts of metabolites and drug in the systemic plasma and output compartments. The sensitivity in kinetic parameters was tested using dynamic sensitivity analysis. Results: Predicted plasma concentrations of drug and metabolites were in the range of what has been observed in clinical studies. Given the final model, plasma concentrations of paclitaxel seems to be relatively little affected by changes in metabolism or transport, while its main metabolite may be largely affected even by small changes. If metabolites prove to be clinically relevant, genetic polymorphisms may play an important role for individualizing paclitaxel treatment.

  • 47.
    Fredriksson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Läkemedelsgenomgångar av apotekare inom slutenvårdspsykiatrin i Kalmar - typ av läkemedelsrelaterade problem samt åtgärdsfrekvens2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Title: Medication reviews by a clinical pharmacist in psychiatric wards in Kalmar - type of drug-related problems and implementation rate of recommended interventions

    Author: Fredriksson E. Supervisor: Hedebäck F. and Hellström L. Examiner: Nielsen E. Institute: Uppsala University, Uppsala, Sweden.

    Background and Objective: Drug-related problems (DRPs) are common and medication reviews can reduce their frequency. Few studies have evaluated medication reviews by pharmacists in psychiatry. The objective of this study is to describe type of DRPs identified through medication reviews conducted by a pharmacist, recommendations made by the pharmacist during ward rounds and/or in the medical record and implementation rate of recommended interventions in adult inpatient psychiatry in Kalmar. Also to describe drug types involved in DRPs and precipitating factors that some patients receive a detailed medication review.

    Design: Observational, prospective study. A clinical pharmacist identified DRPs through medication reviews in three psychiatric wards. The pharmacist participated on ward rounds making recommendations for solutions of identified problems and/or documenting recommended interventions in the medical record. Type of DRPs, type of and implemented interventions and drugs involved in DRPs were analysed with descriptive statistics.

    Setting: The study was conducted at Kalmar hospital between February 2nd and April 2nd 2015.

    Main outcome measures: Type of DRPs, recommendations made by the pharmacist and rate of implementation of recommended interventions.

    Results: The study included 50 patients with median (interquartile range) 2 (1-4) DRPs per patient. The most common DRP was no valid indication (25 %). Most common intervention was discontinuing drug therapy (46 %). Implementation rate was 74 %, including doctor’s implementation of recommendations and problems resolved by the pharmacist during patient conversation. Drugs involved in DRPs were primarily drugs affecting the nervous system, mainly antipsychotics. The precipitating factor for more detailed reviews was request from psychiatrists.

    Conclusion: This study implies that medication reviews by a clinical pharmacist participating in psychiatric ward rounds can help identify and resolve DRPs, with high implementation rate of recommended interventions. Antipsychotics is the medication type most often involved in DRPs. Further studies are needed to assess the clinical benefit of medication reviews by pharmacists in psychiatry.

  • 48.
    Frisk, Pia
    et al.
    Hälsa och Farmaci, Apoteket AB.
    Carlsten, Anders
    Forskning och Utveckling, Apoteket AB.
    Rydberg, Tony
    Hälsa och Farmaci, Apoteket AB.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Patients' experiences with generic substitution-a Swedish pharmacy survey2010In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, no 5, 681- p.Article in journal (Other academic)
    Abstract [en]

    Background and objective Generic substitution for reimbursed drugs was introduced in Sweden 1 of October 2002. Concerns have been expressed that generic substitution may compromise patient safety. This study aimed to evaluate how Swedish drug consumers experience generic substitution, more than 5 year after implementation. 

    Design Survey study with an electronic questionnaire, offered to 1551 pharmacy customers/patients presenting with a prescription on one of the 2688 drugs included. The selected drugs constituted 75% of the total volume of dispensed drugs subjected to generic substitution in August 2007.

    Setting Fifty-eight Swedish community pharmacies. 

    Main outcome measures Positive experiences with generic substitution; problems and their degree of seriousness; and the reported incidence of medication errors. Consumers’ suggestions of improvements to the generic substitution system were also captured.

     Results Of 1551 respondents (602 male, 949 female), 35% (n = 536) reported one or more positive experiences, the most common being the lower drug price. Sixty percent (n= 932) claimed they had not experienced any problems. Forty percent reported at least one problem related to substitution. Seven percent (n=109) reported medication errors attributed to generic substitution. Twenty-two percent (n=342) of the respondents offered suggestions for improvement. The most common suggestions were to revise the criteria for assessing interchangeability between brand-name and generic alternatives and to abolish substitution.

    Conclusions A majority of respondents do not experience any problems related to generic substitution. A sizeable minority experience problems, partly resulting in medication errors. Over- and undermedication, lack of compliance, and intake of wrong drug or of both the original and the generic were the problems most often reported. Future system changes should consider the importance of revised criteria for generic and brand name interchangeability.

  • 49.
    Gillespie, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Effects of Clinical Pharmacists' Interventions: on Drug-Related Hospitalisation and Appropriateness of Prescribing in Elderly Patients2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to evaluate clinical pharmacist interventions with the focus on methods aiming to improve the quality of drug therapy and increase patient safety. Adverse drug events caused by medication errors, suboptimal dosages and inappropriate prescribing are common causes of drug-related morbidity and mortality. Clinical pharmacists integrated in multi-professional health-care teams are increasingly addressing these issues. A randomised controlled trial (RCT) was conducted to investigate the effectiveness of clinical pharmacists’ interventions in reducing morbidity and use of hospital care for patients 80 years or older. The results showed that the intervention group had fewer visits to hospital and that the intervention was cost-effective. In a subsequent study based on the population in the RCT, the appropriateness of prescribing was assessed using three validated tools. The results indicated improved appropriateness of prescribing for the intervention group as a result of the intervention. The tools and the number of drugs at discharge were then tested for validity in terms of causal links between the scores at discharge and hospitalisation. No clear correlations between high scores for the tools or a high number of drugs and increased risk of hospitalisation could be detected. During the inclusion period of the RCT a survey based study was conducted where the perceived value of ward-based clinical pharmacists, from the perspective of hospital-based physicians and nurses as well as from general practitioners (GPs) was evaluated. The respondents were positive to the new collaboration to a high degree and stated increased patient safety and improvements in patients’ drug therapy as the main advantages. In the last study the frequency and severity of prescription and transcription errors, when patients enrolled in the multidose-dispensed medications (MDD) system are discharged from hospital, was investigated. The results showed that errors frequently occur when MDD patients are hospitalised.

     

     

  • 50.
    Gillespie, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Alassaad, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Mörlin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Henrohn, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Bertilsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Hammarlund-Udenaes, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Effects of pharmacists’ interventions on appropriateness of prescribing for elderly and exploration of a possible correlation between scores for appropriateness and clinical outcomes: analyses from a randomized controlled trialManuscript (preprint) (Other academic)
    Abstract [en]

    Background:

    Inappropriate prescribing can cause substantial morbidity and represents a clinical and economic burden for patients and society. Appropriateness of prescribing can be assessed by various measures and screening tools, however, for a tool to be valid there should be casual links to important clinical health outcomes. The aim of this study was to investigate the effect of a pharmacist intervention on appropriateness of prescribing, and to explore the relationship between these results and clinical health outcomes defined as re-visits to hospital.

    Methods:

    The study population from a previous randomized controlled study, in which the effects of a comprehensive pharmacist intervention on re-hospitalisation was investigated, was used. The criteria from the validated instruments STOPP, START and MAI were applied retrospectively to the study patients (368 patients; intervention group n=182, control group n=186). The quality assessments were done on admission and at discharge to detect differences over time between the control- and the intervention group. Hospital care consumption one year after admission was recorded and the correlation between scores for appropriateness, as well as number of drugs at discharge, and hospital visits was analysed.

    Results:

    The number of Potentially Inappropriate Medicines (PIMs) per patient as identified by STOPP was reduced for the intervention group but not for the control group (1.42 and 0.93 vs. 1.46 and 1.66 respectively, p<0.01) The number of Potential Prescription Omissions (PPOs) per patient as identified by START was reduced for the intervention group but not for the control group (0.36 and 0.09 vs. 0.42 and 0.45 respectively, p<0.001). The summated score for MAI was reduced for the intervention group but not for the control group (8.5 to 5.0 and 8.7 to 10.0 respectively, p< 0.001). There was no correlation between the scores of the tools and total visits to hospital. Number of drugs (unadjusted) correlated with visits to hospital and the rate ratio was 4%. For readmissions to hospital, MAI (unadjusted) and the number of drugs showed a positive correlation. There was a correlation between MAI and STOPP and drug-related readmissions (RR 8-9% and 30-34% respectively).

    Conclusion:

    The addition of a comprehensive pharmacist service to standard care significantly improved the appropriateness of prescribing for patients in the intervention group that participated in the randomized controlled trial, as evaluated by all three instruments used; STOPP, START and MAI. However, the results on correlation between the tools and re-visits to hospital were inconclusive.

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