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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.
    Abdallah, Nadia Younous
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Rekommenderade dygnsdoser för barn - Går det att beräkna?2021Independent thesis Basic level (degree of Bachelor), 12 HE creditsStudent thesis
    Abstract [en]

    Background: Defined daily dose (DDD) is a unit that gives an estimate of drug utilization. The DDDs that are developed today are only based on adult’s drug use. That means that the DDDs for adults may not necessarily apply to children. 

    Aim: To calculate recommended daily dose for boys and girls in different ages and compare it with DDD for adults for paracetamol, phenoxymethylpenicillin, desloratadine and melatonin.  

    Methods: This descriptive cross-sectional study was conducted September-October 2021. Boys and girls in ages 1, 5, 12 and 16 years were included. Data was retrieved from FASS.se, tillväxtkurvor.se and WHO Collaborating Centre for Drug Statistics Methodology. 

    Results: The children’s daily doses are lower than DDD for adults for paracetamol for all ages, phenoxymethylpenicillin for ages 1, 5 and 12 and desloratadine for ages 1 and 5. The daily doses of phenoxymethylpenicillin aged 16 are higher than DDD for adults. Daily doses for melatonin and desloratadine age 12 and 16 were the same as DDD for adults. Paracetamol and phenoxymethylpenicillin have variations in the daily doses for the children. Girls in all ages except from 12 years and the youngest children had lowers doses. Desloratadine ages 1 and 5 had the same dose and ages 12 and 16 had the same dose. For melatonin the children received the same doses. 

    Conclusion: The calculated recommended daily doses for children are to some extent in line with WHO DDDs. In order to use WHO DDDs in children, it is important to have knowledge of which drugs and ages they can be applied for.  

     

     

     

  • 3.
    Abdul Hadi, Roza
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Avvikelser i receptlistan: En intervjustudie med patienter på apotek2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Medications are used to treat, cure, or relieve symptoms of diseases, but there is a risk with the use of medications. Drug-related-problems are known to increase morbidity and mortality. Incorrect medical list and discrepancies in these lists can lead to drug-related problems as side effects, hospitalization, non-compliance, drug interactions and overtreated or undertreated patients. Discrepancies can be for example: more prescriptions than necessary, outdated prescriptions, i.e., medicines that will not be used, prescriptions with incorrect dosing and missing prescriptions i.e., medicines used by patients that cannot be seen in the medication list.

    Purpose:  The aim of this study was to investigate discrepancies in the Swedish prescription list "My saved prescriptions at the pharmacy". The secondary aim was to investigate how common it is to use this prescription list or the dosage label on the medicine packaging to know which medicines to use and which dosage.

    Methods: The data collection was performed by four pharmacy students at seven pharmacies in Sweden over a period of three weeks during Jan-Feb. 2021 where the prescription list was investigated together with patients to identify any discrepancies. The study included patients who was over 18 years old, spoke Swedish, had three or more prescribed drugs, and agreed to participate. 

    Results A total of 215 patients were interviewed, where 61% had one or more discrepancies in their medication list. A total of 1717 prescriptions were analyzed, of which 10% were double prescriptions (n = 167), 8% outdated prescriptions (n = 141) and 3% prescriptions with the wrong dosage (n = 42). When analyzing the primary sources of information used by patients to know which medicine to use, the printout of the list "my saved prescriptions at the pharmacy” dominated (n = 72).  Most used information source to know drug dosage was the dosage label on the medicine packaging (n = 112).

    Conclusions: It is important to have an updated and correct information in the medication list, to prevent drug-related-problems caused by discrepancies. It becomes even more important when we see that the medication list "My saved prescriptions at the pharmacy" and dosage label (containing the same information in the medication list), are the most used primary sources by patients to know which drug to use and in what dosage. Finally, results show a relationship between the number of prescribed drugs and the number of discrepancies that occur, and therefore we see more discrepancies in elderly patients who are usually ill and are being treated for several diseases. 

    There are opportunities for further research to study e.g., which drug-related-problems are caused by discrepancies in the medication list as well as the degree of danger in these problems. 

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  • 4.
    Abdul Rahim, Ranya
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kommunikationsproblem på svenska apotek: Förekomst och orsak2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The word communication originates from the Latin word communicare that means to do something in common. When human beings communicate with each other, we share thoughts, emotions, values and actions. The foundation in communication is found within the interpersonal communication, which is the act of communication between two persons. All types of communications include of verbal and nonverbal acts of communication.

    The verbal communication consists of words either in speech or writing, the nonverbal act implies gestures, frequency of the tone and facial expressions.

    Within the pharmaceutical profession, good communication between the pharmacist and the customer is important and can affect the customer’s health and quality of life in both direct as well as indirect ways. In recent years, the pharmacist's role in the pharmacy has drastically changed. Nowadays the care of the customer has gained more significance than before. To improve customer health and quality of life it is important that the pharmacist acts to promote a good relationship with the customer and the foundation for this relationship should be built on good terms of communication.

    The purpose of this study was to study how common it is with communication errors between pharmacist and customer, and to demonstrate probable underlying causes. Secondary questions were, how is the drug advice the pharmacist provides affected by communication errors?

    Collection of data for the study was done with structured observation charts, where the customer and pharmacist were strictly observed. A total of 316 meetings were observed and the data collected referred to prescriptions. In more than one-third of the observed meetings, there were communication errors between the pharmacist and the customer. Communication errors that arose concerned lack of eye contact, language barriers, choice of questions, background noise from colleagues and customers and discussions from generic exchanges. To reduce future communication errors, the pharmacist's actions should be strengthened, such as eye contact, clear follow-up questions and improved feedback.

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  • 5.
    Abdul Sattar Mehdi, Katrelneda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Läkemedelsgenomgång för äldrepatienter med demenssjukdom på ettsärskilt boende i region Dalarna2019Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Demens orsakas av hjärnskador som främst drabbar äldre. Antalet dementa personer i Sverige uppgår idag till ca. 150 000 och beräknas fördubblas de kommande 30 åren i och med den allt äldre befolkningen. De äldre har ofta flera diagnoser. Detta samt åldersrelaterade förändringar i fysiologiska funktioner leder till stor läkemedelsanvändning, vilket i sin tur ger upphov till läkemedelsrelaterade problem (LRP) i form av exempelvis biverkningar, interaktioner, avsaknad av indikation, indikation utan behandling, olämplig läkemedelsbehandling eller doseringsfel. LRP kan upptäckas, åtgärdas, minskas eller förebyggas med hjälp av läkemedelsgenomgång.

    Syfte: Syftet med detta arbete var att genomföra läkemedelsgenomgång för äldre patienter med demenssjukdom och med minst fem eller fler ordinerade läkemedel för att analysera förekomsten av LRP bland patienterna.

    Metod: Läkemedelsgenomgång för 20 patienter utfördes i ett särskilt demensboende genom avidentifierade patientdata i form av läkemedelslista, senaste labprover samt diagnoslista. Även frågeställningar baserade på en lathund för läkemedelsgenomgång besvarades. Aktuella frågeställningar var att rätt och uppdaterad läkemedelslista fanns i journalen, läkemedelsinteraktioner, olämpliga läkemedel för äldre, dosering anpassad till njur-, och leverfunktion, laboratorievärden, diagnos utan aktuell/rimlig behandling, läkemedel utan aktuell/rimlig indikation samt biverkningar. Även användningen av icke-farmakologisk behandling kontrollerades.

    Resultat: Studien visade att samtliga patienter hade korrekt och uppdaterad läkemedelslista registrerad i journalen. 55% av patienterna hade minst en läkemedelsinteraktion. 10% hade olämpliga läkemedel för äldre. 20% hade ett eller fler feldoserade läkemedel. 25% behövde åtgärder i form av komplettering av blodprover eller insättning av läkemedel efter utvärdering av labvärden i samband med existerande diagnos. 50% hade minst en diagnos registrerad, men saknade aktuell läkemedelsbehandling och 10% tog läkemedel utan att det fanns aktuell eller rimlig indikation registrerad i deras journal.Slutsats: Projektet tyder på att flera olika LRP upptäcktes bland dementa patienter i boendet där de vanligast förekommande är läkemedelsinteraktioner samt registrerad diagnos utan aktuellt läkemedel. Åtgärder utfördes i form av dosjustering av läkemedel, insättning av läkemedel, borttagning av olämpligt läkemedel, kontroll av diagnos som saknade behandling samt att ytterligare blodprover beställdes för en del patienter. Detta indikerar att läkemedelsgenomgång är en viktig procedur och därmed bör tillämpas på alla äldre patienter som använder sig av flera läkemedel för att upptäcka och åtgärda LRP. Målet med detta är i sin tur att förbättra livskvaliteten, välmåendet samt patientsäkerheten för äldre dementa patienter.

  • 6.
    Abdulfattah, Amenah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Variation in blood pressure target achievement in primary care centers2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: High blood pressure (BP) or hypertension is defined as a systolic and diastolic pressure over 140/90 mmHg. High blood pressure increases the risk for premature death, and previous research has shown that many patients do not reach targets and that there are differences between primary healthcare centers in the proportion of patient reaching targets. The reasons for these variations, however, are unknown. Aim: To investigate variations in blood pressure target achievement between primary care centers in Stockholm county and how different factors such as practice size, ownership, socioeconomic and antihypertensive drug treatment can influence this diversity. Method(s): This study was designed as a cross-sectional register study with a descriptive quantitative perspective. Data was collected from three sources: National Primary Care Quality register, Care Need Index for healthcare in Stockholm region and Stockholm County Council data warehouse VAL. The study included 179 out of all 227 primary care centers in the region. The proportion of all patients with hypertension reaching targets was assessed each year during 2019-2021, and correlations studied for potential predictors. Results: there was a variation between primary care centers in target blood pressure fulfillment, ranging from 22-66% during 2021, 23-63% during 2020 and 33-66% during 2019, respectively. There was no overall difference between public and private centers in the proportion of patients reaching targets, but a larger practice variation among private centers. No correlation was found between the other studied factors and target blood pressure fulfillment during 2021. Conclusion: There was a variation between primary care centers in the proportion of patients reaching blood pressure targets. Different practices may change ranking between years and other factors than practice size, ownership and socioeconomic appears to explain the variation.

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  • 7.
    Abdulkadir, Sazan Abass
    et al.
    Uppsala University, Sweden.
    Wettermark, Bjoern
    Uppsala University, Sweden.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Potential Drug-Related Problems in Pediatric Patients-Describing the Use of a Clinical Decision Support System at Pharmacies in Sweden2023In: Pharmacy, E-ISSN 2226-4787, Vol. 11, no 1, article id 35Article in journal (Refereed)
    Abstract [en]

    The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0-12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.

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  • 8.
    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, E-ISSN 1475-2875, Vol. 14, article id 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.

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  • 9.
    Abood, Ekhlas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Identifying Medication History Errors at Iraqi Hospital Admissions Using The Swedish-LIMM model2016Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Background and Objective: An accurate medication history list is an integral part of the patient assessment at hospital admission. The objective of the study was to describe the frequency, type, and predictors of unintentional medication errors and to evaluate the quality of the clinical pharmacy services focusing on the acceptance of the recommendations made by the clinical pharmacist.

    Setting and methods: A descriptive study was conducted at two internal medicine wards at Baghdad Teaching Hospital in Iraq using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. The study pharmacist conducted medication interviews for patients shortly after hospital admission to obtain the most accurate pre-admission medication history list. This list was compared with the medication list in the patient’s medical chart. Intended addition, withdrawal of a drug, or changes to the dose/ dosage form in the patient’s medical list was considered as medication discrepancies. However, medication discrepancies were considered as medication errors based on no identified clinical reason.

    Results: A total of 114 patients were included in this study. Over two-thirds of the study patients (73.7%) experienced 215 medication errors identified by a clinical pharmacist conducting medication reconciliation. Most errors were omission (87.9%). Cardiovascular agents followed by NSAID were commonly in error (53%) and (10.2%) respectively. In a logistic regression model, age (odds ratio (OR), 1.055: 95% confidence interval (CI) 1.010 - 1.102), female gender (OR, 3.468: 95% CI 1.232- 9.761) and number of medications at admission (OR, 0.810: 95% CI 0.681-0.963) were predictors for medication history errors at admission.

    Conclusions: Medication errors at the time of hospital admission are common and undetected.  A structured approach like the LIMM-based medication reconciliation at Iraqi hospital is needed to detect these errors.

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  • 10.
    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, p. 372-381Article 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.

  • 11.
    Agreus, Lars
    et al.
    Institutionen för neurobiologi, vårdvetenskap och samhälle, Karolinska institutet, Stockholm, Sverige; Öregrunds vårdcentral, Sverige.
    Borgquist, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Tsoposidis, Alexandros
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Wallenius, Ville
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Kostic, Srdjan
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Lundell, Lars
    Avdelningen för kirurgi, CLINTEC, Karolinska institutet, Stockholm, Sverige.
    Lindberg, Greger
    Institutionen för medicin Huddinge, Karolinska institutet, Sverige; PF mag- och tarmsjukdomar, Karolinska universitetssjukhuset, Stockholm, Sverige.
    Stor överförskrivning och ökat bruk av protonpumpshämmare: Utbildning och information är en nyckel till att vägleda läkare och allmänhet till rätt användning [Significant over- and misuse of PPIs]2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118Article in journal (Refereed)
    Abstract [en]

    PPIs (Proton-pump inhibitors) offers the best treatment for acid related diseases. The predominant indications for PPI prescription are:

    • GERD
    • eradication of H. pylori-infection in combination with antibiotics
    • H. pylori-negative peptic ulcer 
    • healing of and prophylaxis against NSAID/COXIB--induced gastroduodenal lesions 
    • acid hypersecretory states such as Zollinger-Ellisons syndrome.

    The market for PPIs continues to expand in most countries. A significant over- and misuse of PPIs prevails in hospital care as well as in general practice. The predominant reasons for and mechanisms behind the over- and misuse of PPIs are well recognised. The most important consequences of this overprescription of PPIs are increasing medical costs and risk for long-term adverse side effects. Continued education and dedicated information are key factors to guide physicians, medical personnel and patients to adopt to generally accepted principles for and balanced use of PPIs.

  • 12.
    Ahgere, Natali
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Integritet och tillämpning av etiska riktlinjer på öppenvårdsapotek ur farmaceuternas perspektiv2021Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
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  • 13.
    Ahmadi, Fatema
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Förbrukningen av smärtstillande läkemedel och miljörisk i region Uppsala2021Independent thesis Basic level (degree of Bachelor), 14 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Läkemedel har en stor roll i vårt liv och användning av läkemedel påverkar vår miljö. De största utsläppen av läkemedel sker efter användningen och utsöndras i urinen. Slutligen hamnar de i avloppet och vattendrag och därefter når de oss och fiskar genom vattnet. Det finns få studier om hur läkemedelsanvändningen ser ut i relation till miljörisk.

    Syfte: Syftet med denna tvärsnittsstudie var att undersöka data kring förbrukningen av NSAID och Paracetamol i relation till miljörisk.

    Metod: Studien genomfördes genom datainsamling från Socialstyrelsens statistikdatabas för smärtstillande läkemedel och E-hälsomyndigheten statistikverktyg Concise för perioden 2010–2020. Förbrukningen av paracetamol (N02BE01) och NSAID (M01A) analyserades i kg som sålts på recept, receptfritt, till sjukhus och på öppenvård-rekvisition och bedömdes i förhållande till klassifikation av miljörisk.

    Resultat: De mest använda läkemedlen var paracetamol, ibuprofen, naproxen och diklofenak. Paracetamol och ibuprofen har låg miljöfara och försumbar miljörisk. Naproxen har medium miljöfara och låg miljörisk. Miljöfara för diklofenak finns ej publicerat på regions Stockholms databas för läkemedelsmiljöpåverkan, men risken anses vara hög jämfört med andra NSAID. En stor andel av försäljningen av paracetamol, naproxen och diklofenak expedierades via recept. Förbrukningen av paracetamol, ibuprofen och naproxen har ökat medan konsumtionen av diklofenak har minskat med 71% under 2010–2020. Slutsats: Av de fyra mest använda smärtstillande läkemedel som inte är opioder, är naproxen och diklofenak skadliga för miljön eftersom de har högt respektive medium miljöfara. Det bästa alternativet är paracetamol och ibuprofen ur ett miljöperspektiv.

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  • 14.
    Ahmed Osman, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Kartläggning av följsamhetsgrad till Region Jönköpings läns rutin för dokumentation av läkemedelsförändring vid vårdcentraler inom Region Jönköping2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background and objective: Holistic patient care is dependent upon the accurate and reliable flow of information between care settings and healthcare professionals (HCP). Inaccurate medical records may increase the risk of patient harm as HCPs risk continuing to prescribe a medication that has been discontinued or re-prescribing a medication that has previously been discontinued. The aim of this project was to analyse the HCPs documentation of medical changes in the patients’ medical records and evaluate the extent of adherence to a predefined criteria within the regions guidelines at six general practices (GP) across Jönköping County.

    Study design: A retrospective observational study, reviewing 240 medical records between June-December 2019.

    Main outcome measures: The number and the type of medication changes registered, and the extent to which the documentations adhered to regional guidelines concerning the criteria of the information that ought to be included in a documentation upon a registration of a medical change.

    Results: There was an average of 63 (95% CI:53.4 – 73.2) medical changes identified across the six GPs. None of the documentations completely adhered to all points in the guideline. Follow-up plans was found to be the most omitted data point having only been mentioned in 2% of the medical changes. The name of the prescribed medication was mentioned on 378 occasions however, it was only accompanied with dosage form on 44% of occasions. In 9% of the medical records that were analysed it was not found to include any medical changes at all, instead it was either filled in with a “0” or the HCPs had for instance confirmed that the patients’ prescriptions had been renewed.

    Conclusions: Despite the clear guidance regarding the content of documentation for a medical change, no documentation followed the guidelines fully. Adherence to the guidelines may be enhanced by being easier to access for HCPs. As there were documents that were not classed as medical changes identified, the information regarding what is acceptable to be included in that section needs to be made clearer to the HCPs. The findings from this study can be further developed and used as a reference for future studies on this subject.

  • 15.
    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.    

  • 16.
    Al Musawi, Ahmed
    et al.
    Malmö University, Sweden.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kalmar County, Sweden.
    Axelsson, Malin
    Malmö University, Sweden.
    Midlöv, Patrik
    Lund University, Sweden.
    Rämgård, Margareta
    Malmö University, Sweden.
    Cheng, Yuanji
    Malmö University, Sweden.
    Eriksson, Tommy
    Malmö University, Sweden.
    Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions2024In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711Article in journal (Refereed)
    Abstract [en]

    BackgroundMedication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home.AimIn preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions.MethodParticipants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed.ResultsOf 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores.ConclusionBased on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.

  • 17.
    Al Musawi, Ahmed
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Hellström, Lina
    Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Kalmar; Pharmaceutical Department, Region Kalmar County, Kalmar.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Midlöv, Patrik
    Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University.
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Cheng, Yuanji
    Malmö University, Faculty of Technology and Society (TS), Department of Materials Science and Applied Mathematics (MTM).
    Eriksson, Tommy
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces.
    Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions2024In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711Article in journal (Refereed)
    Abstract [en]

    Background Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient’s medication use at home.

    Aim In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients and data collection to reduce medication discrepancies at discharge and improve medication adherence and (2) to explore the outcomes of the interventions.

    Method Participants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed.

    Results Of 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores.

    Conclusion Based on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.

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  • 18.
    Alali, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Administrering av läkemedel i högre koncentration än gängse praxis i syfte att minska vätskebelastning – en litteraturöversikt över fem läkemedel2020Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Abstrakt

     

    Inledning

    Övervätskning har under senare tid väckt ett stort intresse då de kan leda till ödem och organdysfunktion. Patienter som vårdas på intensivvårdsavdelningar (IVA) administreras ofta intravenöst med vätskor i form av läkemedel och näring. Genom att ge mer koncentrerad administrering av läkemedel kan problem med övervätskning hanteras. På begäran av IVA i Västmanlands sjukhus begränsades fem läkemedelssubstanser där syftet för arbetet skulle studeras och besvaras. Syftet med denna studie var att undersöka om man på ett säkert sätt kan administrera de intravenösa läkemedelssubstanserna trimetoprim/sulfametoxazol, remifentanil, dexmedetomidin, erytromycin samt aciclovir i högre koncentrationän gängse praxis på en intensivvårdsavdelning.

    Metod

    Studien utfördes under perioden januari – maj 2020 på enheten för sjukvårdsfarmaci på Västmanlands sjukhus i Västerås. Metoden som användes för detta arbete var en litteratursökning i databaserna Pubmed och Cinahl. För att komplettera sökningen användes databaserna Eped, Micromedex samt UKCPAs handbok Minimum infusion volumes for fluid restricted critically ill patients.

    Resultat

    Totalt erhölls elva artiklar som inkluderades i studien. Trimetoprim/sulfametoxazol, remifentanil, erytromycin samt aciclovir kunde administreras i högre koncentration på ett säkert sätt än gängse praxis på IVA i Västmanlands sjukhus. Ingen artikel visade att dexmedetomidin kan administreras intravenöst i högre koncentration medan en studie visade att den kan administreras subkutant i högre koncentration.

    Slutsats

    Det fanns sparsamt med information inom detta område i dagsläget. Stabilitetsstudier var av hög kvalité, men kliniska studier saknas. Fyra av fem läkemedel kan antas  administreras i högre koncentration än vad IVA i Västmanlands sjukhus använder sig av idag. Som vidare forskning kan man göra studier på dexmedetomidin intravenöst eftersom den går att administreras subkutant i en högre koncentration. I framtiden krävs mer forskning inom detta område för att komma fram till fler resultat samt styrka resultaten av de studier som finns idag.

     

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  • 19.
    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, p. 185-191Article 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.

  • 20.
    Alkhamisi, Rina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Applicerbarhet av ett riskskattningsverktyg för läkemedelsrelaterade problem hos patienter inneliggande på internmedicinsk respektive ortopedisk avdelning2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background and Objective: Medication reviews are important to identify drug related problems (DRP). Due to time limit it is unusual that all patients obtain a medication review. Priority of patients for medication reviews may be facilitated by using a DRP risk score that correlates to a patient’s risk for DRP. The objective of this study is to explore applicability of a specific Spanish risk score system in patients admitted to internal medicine or orthopedic wards in Skåne.

    Design and Setting: This is a cross-sectional study with collected data during 6 weeks from department of Medicine and department of Orthopaedics in Malmö, Lund and Ystad. Data was collected from patient’s medical journals and used to apply DRP risk score. Medication reviews conducted by clinical pharmacists were used to register identified DRP. Patients were divided into two groups, Medicine Department and Orthopaedics Department. Linear regression was performed on each group separately. 

    Main outcome measures: Correlation coefficient of DRP risk score and actual identified DRP. Area under ROC curve.  

    Results: Correlation coefficient of DRP risk score and actual identified DRP was 0,85 (p-value < 0,01) for patients admitted to a medical ward and 0,59 (p-value < 0,05) for orthopaedic ward. Area under the ROC curve was estimated to 0,72 (CI 95%: 0,70-0,74) for Medicine Department and 0,61 (CI 95%: 0,59-0,63) for Orthopaedics Department.

    Conclusion: There is a good capacity for the DRP risk score to identify patients with actual DRP at medicine department. For a 50% probability of at least one DRP for a patient a risk score of 6 points or more can be used. Acceptance of the risk taking of deprioritization of patients for medication reviews should be taken into consideration before using the risk score in clinical practice. The results for the orthoapedics department do not show certainty of correlation for the DRP risk score and actual DRP.  

  • 21.
    Amrullah Zaman, Zohra
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Uppföljning och utvärdering av farmaceuter som jobbar på pediatrisk vårdavdelning2018Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Uppföljning & utvärdering av farmaceuter som jobbar på pediatrisk vårdavdelning

    Introduktion

    År 2014 inledde barnläkemedelsgruppen på Astrid Lindgrens barnsjukhus (ALB) implementering av en funktion för vårdenhetsfarmaceut (VEF). Projektet resulterade i anställande av två apotekare som placerades på Barnonkologen respektive Neonatalverksamheten. Därefter har antalet VEF ökat.

    Syfte

    Deskriptiv uppföljningsstudie för att erhålla vetskap om hur projektet från 2014 fallit ut. Hur ser det ut idag sedan införandet av permanenta farmaceuttjänster inom pediatriska vårdavdelningar? Framförallt på Barnonkologen respektive Neonatalverksamhet, men även övriga vårdavdelningar.

    Material och metod

    En tidsstudie utfördes på de sju avdelningar på ALB som har VEF för att studera tiden för olika aktiviteter i läkemedelsrummet under givna tidpunkter. En enkätstudie genomfördes med syfte att följa upp hur sjuksköterskor upplevde läkemedelsarbetet med VEF på avdelningen. På de avdelningar med journalsystemet TakeCare utfördes läkemedelsförrådsstudie för kassationsberäkning av ett bestämt antal läkemedel. Vårdproduktionsstudie genomfördes för att ta reda på antalet läkemedelsdoser som enheterna exponeras för, därav läkemedelsbelastningen. Slutligen studerades databas för barnläkemedel (ePed) för att se hur stor andel av beställningarna på enheterna som har läkemedelsinstruktioner.

    Resultat

    För farmaceuter var mediantiden för faktiskt iordningställandetid (ställtid ej inkluderad) 53 min och för övrig aktivitet (ex; rådgivning, annat läkemedelsarbete) 47 min under tidsperiod om fyra timmar i läkemedelsrummet. Enkätstudien visade stor uppskattning bland sjuksköterskor och att VEF bidrar med mycket mer än bara iordningställande. Jämfört med 2014 fanns ökad positiv inställning på Neo Solna, dock utan signifikant skillnad. Läkemedelsförrådsstudien visade att en betydande kassation förekommer på barnavdelningar, därav ett viktigt mått vid framtida uppföljningar. Läkemedelsbelastningen på enheterna var likvärdig 2014 och kring 80% av beställningarna på enheterna har läkemedelsinstruktioner i ePed.

    Slutsats

    Farmaceuter uppfyller en avlastande och kvalitetshöjande funktion på ALB, samt fungerar som stöd vid läkemedelsrelaterade frågor. Farmaceuterna är mycket uppskattade bland sjuksköterskor, dels för iordningställande hjälpen (ca två timmar under arbetsdag om åtta timmar, ställtid ej inkluderad) men även för att de bidrar med annan nödvändig kompetens. Det finns gott om läkemedelsjobb samt annat typ av arbete för farmaceuter på ALB.

  • 22.
    Amundstuen Reppe, Linda
    et al.
    Nordic University, Norway; Norwegian University of Science and Technology, Norway; St Olavs Hospital, Norway.
    Spigset, Olav
    Norwegian University of Science and Technology, Norway; St Olavs Hospital, Norway.
    Kampmann, Jens Peter
    Bispebjerg Hospital, Denmark.
    Damkier, Per
    Odense University Hospital, Denmark.
    Rolighed Christensen, Hanne
    Bispebjerg Hospital, Denmark.
    Böttiger, Ylva
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Schjott, Jan
    Haukeland Hospital, Norway; University of Bergen, Norway; Haukeland Hospital, Norway.
    Quality assessment of structure and language elements of written responses given by seven Scandinavian drug information centres2017In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 73, no 5, p. 623-631Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify structure and language elements affecting the quality of responses from Scandinavian drug information centres (DICs). Six different fictitious drug-related queries were sent to each of seven Scandinavian DICs. The centres were blinded for which queries were part of the study. The responses were assessed qualitatively by six clinical pharmacologists (internal experts) and six general practitioners (GPs, external experts). In addition, linguistic aspects of the responses were evaluated by a plain language expert. The quality of responses was generally judged as satisfactory to good. Presenting specific advice and conclusions were considered to improve the quality of the responses. However, small nuances in language formulations could affect the individual judgments of the experts, e.g. on whether or not advice was given. Some experts preferred the use of primary sources to the use of secondary and tertiary sources. Both internal and external experts criticised the use of abbreviations, professional terminology and study findings that was left unexplained. The plain language expert emphasised the importance of defining and explaining pharmacological terms to ensure that enquirers understand the response as intended. In addition, more use of active voice and less compressed text structure would be desirable. This evaluation of responses to DIC queries may give some indications on how to improve written responses on drug-related queries with respect to language and text structure. Giving specific advice and precise conclusions and avoiding too compressed language and non-standard abbreviations may aid to reach this goal.

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  • 23.
    Anderberg, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Hur väl stämmer patienternas läkemedelslistor? En kartläggning på medicinkliniken vid Capio S:t Görans Sjukhus2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract [en]

    Title: Discrepancies in medication lists at hospital wards identified by medication reconciliation

    Authors: Anderberg M.

    Institute: Uppsala University, Uppsala, Sweden

    Background and objective: An accurate medication list is essential for a correct assessment of a patient´s condition at hospitals. Previous studies have shown that patients in emergency departments often are affected by discrepancies in medication lists at hospital admission. Less research has been done regarding discrepancies after transferring patients to medical wards. The aim of this study was to identify discrepancies in the electronic medical record in hospital wards for patients admitted via the emergency department.

    Design: Observational study. Medication reconciliation was performed by a pharmacist shortly after the arrival of patients from the emergency department. This included a patient interview and the investigation of the patient’s medical record. The discrepancies identified at the wards were classified as either omitted drug, wrong dose, additional drug, incorrect frequency or duplicate therapy. Descriptive statistics were used and the proportion of medication lists with at least one discrepancy was presented with 95 % confidence interval.

    Setting: Three medical wards at Capio S:t Görans Hospital in Stockholm. 

    Main outcome measures: The proportion of medication lists with at least one discrepancy. The mean value of discrepancies among all patients. Classification and categorization of discrepancies regarding type and ATC index. 

    Results: In total, 63 patients were included with a mean age of 63 years. At least one discrepancy was identified in 43 % (95 % CI 31-55) of the medication lists. 52 discrepancies were found in total generating a mean value of 0,83 ± 1,17 discrepancies per medication list. The two most common categories were Omitted drug(33%) and Wrong dose(33%). The most frequent drug class associated with medication discrepancies was Drugs for obstructive airway diseases. 

    Conclusion: 43 % of the patients had at least one discrepancy in the medication list. This indicates the importance of medication reconciliations at medical wards even though the medication list has been updated at the emergency department. 

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  • 24.
    Andersson, Ernst
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Description and categorisation of two pharmaceutical companies’ medical information enquiries and how well the Summary of Product Characteristics corresponds to these categories – a qualitative study2021Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 25.
    Andersson, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences. University of Auckland, Faculty of Medical and Health Sciences.
    Identifying and adapting a questionnaire to assess patient satisfaction with long-term conditions services2017Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: In order to deliver high quality pharmacy services, it is essential to evaluate patients’ satisfaction with the services. However, no study has yet assessed patient satisfaction with the Long-Term Conditions (LTC) service in New Zealand. Therefore, the aim of this study is twofold. Firstly, to identify questionnaires that are used to assess patient satisfaction with community pharmacy services. Secondly, to adapt a questionnaire that can be used to measure patient satisfaction with the LTC service in New Zealand.

    Methods: A literature review was conducted to identify questionnaires that had been used to measure patient satisfaction with community pharmacy services. The utilised databases were EMBASE, Medline, International Pharmaceutical Abstracts, and PsychInfo. Retrieved articles were evaluated against pre-determined inclusion and exclusion criteria. Upon completion of the review, a questionnaire was selected and modified before being pilot tested on six LTC patients from a community pharmacy in Auckland, New Zealand.

    Results: The database search yielded 13 articles that were eligible for the final review. In these articles, six different questionnaires for measuring patient satisfaction were identified. The questionnaire that was selected for adaptation had eight items removed, four modified, and 13 added from other sources. The final version consisted of 20 items. Overall, the questionnaire proved to be comprehensible and convenient to use during the piloting phase. However, the patients had a tendency to misunderstand two of the negative statements.

    Conclusions: Selecting and utilising an appropriate tool for measuring patient satisfaction could help to enhance the quality of pharmacy services, leading to improved patient care. This study has identified and adapted a questionnaire for measuring patient satisfaction with the LTC service in New Zealand. Based on the findings of the pilot study, alterations must be made to the questionnaire before it is psychometrically analysed in a larger sample. The final goal is then to apply it in a nation-wide survey in New Zealand.

  • 26.
    Andersson, Konny
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Univ Queensland, Australia.
    van Driel, Mieke
    Univ Queensland, Australia.
    Hedin, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Lund Univ, Sweden.
    Hollingworth, Samantha
    Univ Queensland, Australia.
    Merlo, Gregory
    Univ Queensland, Australia.
    Antibiotic use in Australian and Swedish primary care: a cross-country comparison2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 1, p. 95-103Article in journal (Refereed)
    Abstract [en]

    Objective Antimicrobial resistance is a growing worldwide problem and is considered to be one of the biggest threats to global health by the World Health Organization. Insights into the determinants of antibiotic prescribing may be gained by comparing the antibiotic usage patterns of Australia and Sweden. Design Publicly available data on dispensed use of antibiotics in Australia and Sweden between 2006 and 2018. Medicine use was measured using defined daily dose per 1,000 inhabitants per day (DDD/1000/day) and the number of dispensed prescriptions per 1000 inhabitants (prescriptions/1000). Results The use of antibiotics increased over the study period in Australia by 1.8% and decreased in Sweden by 26.3%. Use was consistently higher in Australia, double that of Sweden in 2018. Penicillin with extended spectrum was the most used class of antibiotics in Australia followed by penicillin with beta lactamase inhibitors. In Sweden, the most used class was beta lactamase-sensitive penicillin and the least used class was penicillin with beta lactamase inhibitors. Conclusion Antibiotic use in Australia is higher than in Sweden, with a higher proportion of broad-spectrum penicillin, including combinations with beta lactamase inhibitors, and cephalosporins. Factors that may contribute to these differences in antibiotic use include differences in guidelines, the duration of national antimicrobial stewardship programs, and differences in funding mechanisms.

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  • 27.
    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.  

  • 28.
    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. 

  • 29.
    Andersson, Åsa C
    et al.
    Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Lindemalm, Synnöve
    Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Onatli, Dilba
    Uppsala University, Uppsala.
    Chowdhury, Samia
    Uppsala University, Uppsala.
    Eksborg, Staffan
    Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Förberg, Ulrika
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Karolinska Institutet, Stockholm.
    'Working outside the box'-an interview study regarding manipulation of medicines with registered nurses and pharmacists at a Swedish paediatric hospital2023In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, no 12, p. 2551-2559Article in journal (Refereed)
    Abstract [en]

    AIM: Studies on frequencies of manipulated medicines in paediatric care are common, but there is little knowledge of experiences of pharmacists and registered nurses in this area. The aim of this study was to explore registered nurses' and pharmacists' reasoning in the manipulation of medicines to paediatric inpatients.

    METHODS: Semistructured interviews with twelve registered nurses and seven pharmacists were performed at a Swedish paediatric university hospital. The interviews were transcribed verbatim and analysed using content analysis.

    RESULTS: Four major categories emerged from the analysis of the interviews: medicines management, knowledge, consulting others and organisation. Medicines management involved the process of drug handling, which is prescribing, reconstitution or manipulation and administration. Knowledge concerned both the knowledge base and how healthcare personnel seek information. Consulting others involved colleagues, registered nurses and pharmacists, between registered nurses, pharmacists and physicians and between registered nurses, pharmacists and caregivers. Organisation covered documentation, time and working environment.

    CONCLUSION: Both pharmacists and registered nurses stated that manipulation of medicines to paediatric patients was often necessary but felt unsafe due to lack of supporting guidelines. Pharmacists were natural members of the ward team, contributing with specific knowledge about medicines and formulations.

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  • 30.
    Andersson, Åsa C.
    et al.
    Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Div Paediat, ePed Cent Editorial Off, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Barnlakemedelsgruppen, Eugeniavagen 18C, plan 3, S-17176 Stockholm, Sweden..
    Lindemalm, Synnöve
    Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Div Paediat, ePed Cent Editorial Off, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    Onatli, Dilba
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Chowdhury, Samia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Eksborg, Staffan
    Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Div Paediat, ePed Cent Editorial Off, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Förberg, Ulrika
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Dalarna Univ, Sch Hlth & Welf, Falun, Sweden..
    'Working outside the box'-an interview study regarding manipulation of medicines with registered nurses and pharmacists at a Swedish paediatric hospital2023In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, no 12, p. 2551-2559Article in journal (Refereed)
    Abstract [en]

    Aim: Studies on frequencies of manipulated medicines in paediatric care are common, but there is little knowledge of experiences of pharmacists and registered nurses in this area. The aim of this study was to explore registered nurses' and pharmacists' reasoning in the manipulation of medicines to paediatric inpatients.

    Methods: Semistructured interviews with twelve registered nurses and seven pharmacists were performed at a Swedish paediatric university hospital. The interviews were transcribed verbatim and analysed using content analysis.

    Results: Four major categories emerged from the analysis of the interviews: medicines management, knowledge, consulting others and organisation. Medicines management involved the process of drug handling, which is prescribing, reconstitution or manipulation and administration. Knowledge concerned both the knowledge base and how healthcare personnel seek information. Consulting others involved colleagues, registered nurses and pharmacists, between registered nurses, pharmacists and physicians and between registered nurses, pharmacists and caregivers. Organisation covered documentation, time and working environment.

    Conclusion: Both pharmacists and registered nurses stated that manipulation of medicines to paediatric patients was often necessary but felt unsafe due to lack of supporting guidelines. Pharmacists were natural members of the ward team, contributing with specific knowledge about medicines and formulations.

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  • 31.
    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, 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.

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  • 32.
    Angel, Jonathan B.
    et al.
    Division of Infectious Diseases, Ottawa Hospital-General Campus, ON, Ottawa, Canada.
    Freilich, Jonatan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Parexel International, Stockholm, Sweden.
    Arthurs, Erin
    Health Economics and Outcomes Research, GSK, ON, Mississauga, Canada.
    Ban, Joann K.
    Health Economics and Outcomes Research, GSK, ON, Mississauga, Canada.
    Lachaine, Jean
    Faculty of Pharmacy, Université de Montréal, Québec, Canada.
    Chounta, Vasiliki
    Global Health Outcomes, ViiV Healthcare Ltd, Brentford, Middlesex, UK.
    Harris, Marianne
    Department of Family Practice, Faculty of Medicine, University of British Columbia, BC, Vancouver, Canada.
    Adherence to oral antiretroviral therapy in Canada, 2010-20202023In: AIDS, ISSN 0269-9370, E-ISSN 1473-5571, Vol. 37, no 13, p. 2031-2040Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess antiretroviral therapy (ART) adherence among people with HIV (PWH) in Canada and identify baseline characteristics associated with suboptimal adherence (<95%). DESIGN: Retrospective observational study using data from the National Prescription Drug Utilization Information System and Régie de l'assurance maladie Quebec (RAMQ) Public Prescription Drug Insurance Plan. METHODS: This analysis included PWH aged 18 years or older who initiated an ART regimen and were followed for at least 12 months (2010-2020). Patient characteristics were summarized using medical/pharmacy claims data from seven provinces (Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Ontario, Saskatchewan, and Quebec). ART regimen at index date (first dispensing of a regimen including a core agent) was defined as a single-tablet or multitablet regimen (MTR). Adherence was calculated using a Proportion of Days Covered approach, based on ART dispensing, recorded between April 2010 and the last available date. Multivariate linear regression analysis was used to determine correlations between suboptimal adherence and baseline characteristics. RESULTS: We identified 19 322 eligible PWH, 44.7% of whom had suboptimal adherence (<95%). Among 12 594 PWH with evaluable baseline data, 10 673 (84.8%) were ART-naive, 74.2% were men, mean age was 42.9 years, and 54.1% received a MTR as their ART. Based on multivariate regression analysis, suboptimal adherence was significantly associated with multitablet ART ( P  < 0.001) and younger age ( P  < 0.001) but not sex. CONCLUSION: Almost half of adult PWH in Canada had suboptimal adherence to ART. Better understanding of factors influencing adherence may help address gaps in current care practices that may impact adherence.

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  • 33.
    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
  • 34.
    Anthony, Lowell
    et al.
    Univ Kentucky, Markey Canc Ctr, Lexington, KY USA..
    Ervin, Claire
    RTI Hlth Solut, Res Triangle Pk, NC USA..
    Lapuerta, Pablo
    Lexicon Pharmaceut Inc, 8800 Technol Forest Pl, The Woodlands, TX 77385 USA..
    Kulke, Matthew H.
    Dana Farber Canc Inst, Boston, MA 02115 USA..
    Kunz, Pamela
    Stanford Canc Ctr, Stanford, CA USA..
    Bergsland, Emily
    UCSF Helen Diller Family Comprehens Canc Ctr, San Francisco, CA USA..
    Hörsch, Dieter
    Zent Klin Bad Berka GmbH, Klin Innerre Med Gastroenterol & Endokrinol, Bad Berka, Germany..
    Metz, David C.
    Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA..
    Pasieka, Janice
    Tom Baker Canc Clin, Calgary, AB, Canada..
    Paylakis, Nick
    Royal North Shore Hosp, St Leonards, NSW, Australia..
    Pavel, Marianne
    Charite, Berlin, Germany..
    Caplin, Martyn
    Royal Free Hosp, London, England..
    Öberg, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrine Tumor Biology.
    Ramage, John
    Hampshire Hosp NHS Trust, Basingstoke & North Hampshire Hosp, Basingstoke, Hants, England..
    Evans, Emily
    RTI Hlth Solut, Res Triangle Pk, NC USA..
    Yang, Qi Melissa
    Lexicon Pharmaceut Inc, 8800 Technol Forest Pl, The Woodlands, TX 77385 USA..
    Jackson, Shanna
    Lexicon Pharmaceut Inc, 8800 Technol Forest Pl, The Woodlands, TX 77385 USA..
    Arnold, Katie
    Lexicon Pharmaceut Inc, 8800 Technol Forest Pl, The Woodlands, TX 77385 USA..
    Law, Linda
    Lexicon Pharmaceut Inc, 8800 Technol Forest Pl, The Woodlands, TX 77385 USA.;BioHealthConsult, 2143 Riverside Dr, Cincinnati, OH 45202 USA..
    DiBenedetti, Dana B.
    RTI Hlth Solut, Res Triangle Pk, NC USA..
    Understanding the Patient Experience with Carcinoid Syndrome: Exit Interviews from a Randomized, Placebo-controlled Study of Telotristat Ethyl2017In: Clinical Therapeutics, ISSN 0149-2918, E-ISSN 1879-114X, Vol. 39, no 11, p. 2158-2168Article in journal (Refereed)
    Abstract [en]

    Purpose: Telotristat ethyl, an oral tryptophan hydroxylase inhibitor, is intended to treat carcinoid syndrome by reducing serotonin production. Telotristat ethyl was evaluated in FELESTAR, a Phase HI study for patients who had carcinoid syndrome with at least 4 bowel movements (BMs) per day and who were receiving somatostatin analogue therapy. This interview sub study was conducted to provide insight into the patient experience in ILLESTAR and to help understand whether reductions in BM frequency (the primary end point) and other symptoms were clinically meaningful. Methods: Participating sites were asked to invite (before randomization) all eligible patients to telephone interviews scheduled at the end of the double-blind treatment period. Patients and interviewers were blinded to treatment. Findings: All 35 interviewed participants reported diarrhea and/or excessive BMs at baseline. Patients reported that these symptoms negatively affected emotional, social, physical, and occupational well-being. Prespecified criteria for treatment response (achieving >= 30% reduction in BM frequency for at least 50% of the days) were met by 8 of 26 patients taking telotristat ethyl and 1 of 9 patients taking placebo. All 8 patients taking telotristat ethyl described clinically meaningful reductions in BM frequency and were very satisfied with the ability of the study drug to control their carcinoidsyndrome symptoms. Overall, reports of being very satisfied were observed in 12 patients taking telotristat ethyl and 0 taking placebo. Implications: Patient interviews revealed that I ELESTAR patients, at baseline, were significantly affected by their high BM frequency. Patient reports of their clinical trial experience supported the significance of the primary end point and clinical responder analysis in TELESTAR, helping identify and understand clinically meaningful change produced by telotristat ethyl. (C) 2017 The Authors. Published by Elsevier HS Journals, Inc.

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  • 35.
    Anti, Magdalena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Pharmacogenetic testing for improved medication treatment in the elderly2021Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Individual differences in drug response are large and difficult to predict in a real-world setting. Some of these differences can be explained by the patient’s genes. Prescription guided by so called pharmacogenetic information alleviates the traditional “trial and error” approach, making drug treatment more safe, efficient and cost-effective. The major goal of this research is to investigate the potential need and benefit of pharmacogenetic testing in a vulnerable group at the hospital; the elderly with polypharmacy.  

    Aim: The main aim of this study was to determine the prevalence of elderly hospitalised patients with polypharmacy, who are expected to benefit from pharmacogenetic testing. The secondary aim was to prepare a study protocol for a pilot study where pharmacogenetic data is included in the medication reviews performed by clinical pharmacists.

    Methods: Three-hundred anonymized medications lists from elderly hospitalized patients were examined to determine the occurrence and types of medications involved with pharmacogenetics. A list of gene-drug interactions and recommendations, adapted to Swedish conditions, was compiled by using existing guidelines, and later applied to the medication lists. The findings were used in the design of a pilot study. 

    Results: Eighty-five percent of the patients had at least one medication with a pre-defined actionable gene–drug interaction. Most of the medications (56%) affected the nervous system, while the most reoccurring medications were metoprolol, omeprazole and atorvastatin, affecting the cardiovascular system and the alimentary tract and metabolism. 

    Conclusions: We can expect elderly hospitalised polypharmacy patients to benefit from pharmacogenetic testing, due to the high prevalence (85%) of patients having at least one medication involved with pharmacogenetics. A future prospective pharmacogenetic intervention study is therefore planned.

     

  • 36.
    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.

  • 37.
    Ax, Fredrik
    et al.
    Apoteket AB.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Electronically transmitted prescriptions not picked up at pharmacies in Sweden2010In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 6, no 1, p. 70-77Article 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.

  • 38.
    Axelsson, K. F.
    et al.
    Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden / Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Wallander, M.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Johansson, H.
    Institute for Health and Ageing, Catholic University of Australia, Melbourne, Vic., Australia.
    Lundh, Dan
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Lorentzon, M.
    Geriatric Medicine, Department of Internal Medicine and ClinicalNutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
    Hip fracture risk and safety with alendronate treatment in the oldest-old2017In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 282, no 6, p. 546-559Article in journal (Refereed)
    Abstract [en]

    Background. There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (80 years old), the population with the highest fracture risk, has not been studied. Objective. To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety. Methods. Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term. Results. The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI. Conclusion. In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients.

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  • 39.
    Bakir, Suzan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Modifiering av orala tabletter och kapslar på en sjukhusavdelning och två äldreboenden i Västmanland: en observationsstudie2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: It is common for medicine formulations such as oral tablets to need to be manipulated, i.e., crushed or divided. This is often seen in dysphagia patients where diseases such as stroke or dementia affect the swallowing reflex. The Handbook of Healthcare is a website which contains regulations for how medicines are to be handled which are used by healthcare workers in Sweden. The regulation is based on the Swedish Health and Medical Service Act and Social Services Act. 

    Aim: The aim of this study is to map how oral tablets and capsules that cannot be given as a whole or divided dose are manipulated and handled at different activities in Vastmanland. 

    Method: An observational study was performed for six weeks in a hospital ward and two nursing homes where handling and preparation of medicines were observed. The study was conducted between 1 Oct-12 Nov 2020. Study population were nurses, and delegated staff. The data collection was carried out using a checklist by consistently following the manual. The data collection from the checklists was transferred to an excel file. Frequencies were calculated for each question and study places. The results were presented in tables and pie charts. 

    Results: A total of 185 observations were observed for the study sites. There were 96 observation for hospital ward 1, 72 observation for nursing home 1 and 27 observation for nursing home 2. Approximately 50% of the 185 observations at the study sites were medicine manipulations. The tools were cleaned in 42% of cases for hospital ward 1, 100% for nursing home 2, and never for nursing home 1. Almost all observations showed that the tablets were crushed simultaneously for each patient. 

    Conclusion: The study shows a variation between the activities in how to handle oral medicines, where crushing tablets was the most common manipulation. To achieve a manipulation, different tools were used on the study places. What also differs between the study places was how the tools were cleaned and if it was cleaned, which did not occur in all study places. The handling of medicines was observed in different environments for the study site. 

  • 40.
    Bakir, Suzan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Modifiering av orala tabletter och kapslar på en sjukhusavdelning och två äldreboenden i Västmanland: en observationsstudie2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The manipulation of oral tablets and capsules on a hospital ward and two nursing homes in Västmanland: an observational study.

     

    Background: It is common for medicine formulations such as oral tablets to need to be manipulated, i.e., crushed or divided. This is often seen in dysphagia patients where diseases such as stroke or dementia affect the swallowing reflex. The Handbook of Healthcare is a website which contains regulations for how medicines are to be handled which are used by healthcare workers in Sweden. The regulation is based on the Swedish Health and Medical Service Act and Social Services Act.

     

    Aim: The aim of this study is to map how oral tablets and capsules that cannot be given as a whole or divided dose are manipulated and handled at different activities in Vastmanland.

     

    Method: An observational study was performed for six weeks in a hospital ward and two nursing homes where handling and preparation of medicines were observed. The study was conducted between 1 Oct-12 Nov 2020. Study population were nurses, and delegated staff. The data collection was carried out using a checklist by consistently following the manual. The data collection from the checklists was transferred to an excel file. Frequencies were calculated for each question and study places. The results were presented in tables and pie charts.

     

    Results: A total of 185 observations were observed for the study sites. There were 96 observation for hospital ward 1, 72 observation for nursing home 1 and 27 observation for nursing home 2. Approximately 50% of the 185 observations at the study sites were medicine manipulations. The tools were cleaned in 42% of cases for hospital ward 1, 100% for nursing home 2, and never for nursing home 1. Almost all observations showed that the tablets were crushed simultaneously for each patient.

     

    Conclusion: The study shows a variation between the activities in how to handle oral medicines, where crushing tablets was the most common manipulation. To achieve a manipulation, different tools were used on the study places. What also differs between the study places was how the

    tools were cleaned and if it was cleaned, which did not occur in all study places. The handling of medicines was observed in different environments for the study site.

     

  • 41.
    Balgård, Matts
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. Region Uppsala.
    Dobric, Srebrenka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Karlsson, Lina
    The Pharmaceutical Student Union.
    Klaren, Lena
    Region Uppsala.
    Swartling, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Inclusion of pharmacy students in an interprofessional training ward placement for health care students in Sweden2021Conference paper (Other academic)
    Abstract [en]

    What was done?: Final year undergraduate pharmacy students, specialising clinical pharmacy,were given the opportunity to spend two weeks of their six months pharmacypractice to participate in an interprofessional training ward placement(ITWP) together with medical, nursing and physiotherapy students. During thistwo-week clinical placement, the students were collaboratively responsiblefor managing the care of geriatric inpatients while under supervision oflicensed practitioners.

    Why was it done?: ITWP for health care students is established at various teaching hospitals.However, to our knowledge, no such program in Scandinavia has includedpharmacy students. Clinical pharmacy is a growing profession in Sweden andother health care students will in the future work alongside with clinicalpharmacists. Therefore we set out to add pharmacy students to the ITWP team,believing that it would be a valuable experience for them to collaborate andshare knowledge with students from other health care professions. Equallyimportant, it is a way to promote the pharmacist’s competence andcontribution to the multiprofessional health care team, prior to graduation.

    How was it done?: A working group was formed consisting of teachers from the faculty ofpharmacy, a student representative and a working clinical pharmacist. Thegroup developed the initiative, including among other things, prerequisites,an evaluation plan, a workflow tool for clinical rounds and suggested tasksfor pharmacy students during the placement.

    What has been achieved?: The program has been running for three semesters and 6–8 pharmacy studentshave participated in the ITWP each semester. The initiative has beenevaluated using surveys. Participating pharmacy students expressed gainingnew knowledge and better insight into nursing care and the roles of the otherprofessions. Nursing students appreciated the support in medicationmanagement and medical students found the pharmacy students to be valuablediscussion partners that could challenge their drug-related decisions. Tutorsexpressed that the pharmacy students brought a beneficial dynamic to the ITWPteam.

    What next?: The opportunity for students from different professions to work together witha common objective in a real-life setting gives them valuable insight in eachother’s professional roles early in their careers. This good practiceinitiative could be used in other interprofessional training ward placementswishing to involve pharmacy students.

  • 42.
    Bardage, Carola
    et al.
    Uppsala University, Sweden.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ring, Lena
    Uppsala University, Sweden.
    Health care professionals’ perspectives on automated multi-dose drug dispensing2014In: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 12, no 4, article id 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.

  • 43.
    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, p. 251-251Article in journal (Other academic)
  • 44.
    Beer, Netta
    et al.
    Univ Copenhagen, Dept Pharm, Copenhagen, Denmark..
    Hegger, Ingrid
    Natl Inst Publ Hlth & Environm RIVM, Ctr Hlth Protect, Bilthoven, Netherlands..
    Kaae, Susanne
    Univ Copenhagen, Dept Pharm, Copenhagen, Denmark..
    De Bruin, Marie Louise
    Natl Inst Publ Hlth & Environm RIVM, Ctr Hlth Protect, Bilthoven, Netherlands.;Univ Copenhagen, Copenhagen Ctr Regulatory Sci, Dept Pharm, Copenhagen, Denmark. Univ Utrecht, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands..
    Genina, Natalja
    Univ Copenhagen, Dept Pharm, Copenhagen, Denmark..
    Leonardo Alves, Teresa
    Natl Inst Publ Hlth & Environm RIVM, Ctr Hlth Protect, Bilthoven, Netherlands..
    Hoebert, Joelle
    Natl Inst Publ Hlth & Environm RIVM, Ctr Hlth Protect, Bilthoven, Netherlands..
    Kälvemark Sporrong, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. Univ Copenhagen, Dept Pharm, Copenhagen, Denmark.
    Scenarios for 3D printing of personalized medicines: A case study2021In: Exploratory Research in Clinical and Social Pharmacy, E-ISSN 2667-2766, Vol. 4, article id 100073Article in journal (Refereed)
    Abstract [en]

    Background

    3D printing is a promising new technology for medicines' production. It employs additive manufacturing techniques, and is ideal for producing personalized medicines (e.g., patient-tailored dose, dosage form, drug release kinetics).

    Objective

    To investigate how 3D printing technologies can be implemented in a European pharmaceutical system, by suggesting different scenarios and assessing aspects that could affect its implementation.

    Method

    Qualitative, semi-structured interviews were conducted with key stakeholders (e.g., from ministry, authorities, research organizations, pharmacies) in the Netherlands to elicit perspectives on 3D printing of personalized medicines. The Netherlands were chosen since it has a strong tradition in compounding. Five general scenarios were investigated: placing the 3D printers in industry, community pharmacies, hospital pharmacies, compounding facilities, and in patients' homes. Content analysis was used, building on verbatim transcripts.

    Results

    Fifteen stakeholders were interviewed. Regulatory, economic, ethical and organizational challenges were identified to varying degrees in the different scenarios. The industry and home scenarios were associated with the most challenges, hospital pharmacies and compounding facilities with the least. Other important aspects identified were the role of community pharmacies, and who should design the tablets to be printed.

    Conclusion

    All potential scenarios for 3D printing of personalized medicines include challenges. These should be taken into account when pursuing the use of 3D printing of medicine.

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  • 45.
    Beer, Netta
    et al.
    Univ Copenhagen, Fac Hlth & Med Sci, Dept Pharm, Social & Clin Pharm Res Grp, Univ Pk 2, DK-2100 Copenhagen O, Denmark..
    Kaae, Susanne
    Univ Copenhagen, Fac Hlth & Med Sci, Dept Pharm, Social & Clin Pharm Res Grp, Univ Pk 2, DK-2100 Copenhagen O, Denmark..
    Genina, Natalja
    Univ Copenhagen, Fac Hlth & Med Sci, Dept Pharm, Mfg & Mat Res Grp, Copenhagen O, Denmark..
    Sporrong, Sofia Kälvemark
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. Univ Copenhagen, Fac Hlth & Med Sci, Dept Pharm, Social & Clin Pharm Res Grp, Univ Pk 2, DK-2100 Copenhagen O, Denmark..
    Alves, Teresa Leonardo
    Natl Inst Publ Hlth & Environm RIVM, Ctr Hlth Protect, Bilthoven, Netherlands..
    Hoebert, Joelle
    Natl Inst Publ Hlth & Environm RIVM, Ctr Hlth Protect, Bilthoven, Netherlands..
    De Bruin, Marie Louise
    Univ Copenhagen, Fac Hlth & Med Sci, Dept Pharm, Copenhagen Ctr Regulatory Sci, Copenhagen O, Denmark.;Univ Utrecht, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands..
    Hegger, Ingrid
    Natl Inst Publ Hlth & Environm RIVM, Ctr Hlth Protect, Bilthoven, Netherlands..
    Magistral Compounding with 3D Printing: A Promising Way to Achieve Personalized Medicine2023In: Therapeutic Innovation and Regulatory Science, ISSN 2168-4790, E-ISSN 2168-4804, Vol. 57, no 1, p. 26-36Article in journal (Refereed)
    Abstract [en]

    Background Magistral compounding has always been an integral part of pharmacy practice. The increasing demand worldwide for personalized drug treatments might be accommodated by an increase in magistral compounding. The new, flexible technology of 3D medicine printing could advance this process even further. However, the issue of how 3D medicine printing can be implemented within the existing magistral compounding infrastructure has not been explored. Aims To investigate how 3D printing can be integrated into the existing compounding system by taking regulatory, economic, and profession-oriented aspects into account. Methods Semi-structured interviews were conducted with relevant Dutch stakeholders representing various health institutions, such as health ministries and boards, professional bodies, and different types of pharmacies. Participants were identified through purposeful sampling. Content analysis was applied to identify the main themes. Results A total of 15 Dutch stakeholders were interviewed. It was found that the prevalence of compounding in community pharmacies in the Netherlands has decreased as a result of the practice shifting to specialized compounding pharmacies due to higher costs, lack of space, and the need to fulfill quality requirements. All interviewees considered 3D printing to be a promising compounding technique for community pharmacies, as it offers an automated approach with high digital flexibility and enables adapted formulations, including 'polypills.' Regulatory and quality assurance challenges were considered comparable to those of normal magistral products; however, there remain pending regulatory issues regarding quality control, particularly for Active Pharmaceutical Ingredients containing intermediate feedstock materials (e.g., prefilled cartridges) in 3D printing. 3D printing was believed to become cost effective over time. Conclusion In the Netherlands, specialized compounding pharmacies have largely taken over compounding activities. 3D printing could be introduced within this system; however, challenges regarding how to regulate prefilled cartridges have yet to be addressed. Compounding using 3D printing in regular community pharmacies could enhance patients' individualized treatment; however, this activity would require incentives to stimulate the return of compounding to normal pharmacy practice.

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  • 46.
    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. 

  • 47.
    Ben Avraham, Binyamin
    et al.
    Tel Aviv Univ, Israel.
    Crespo-Leiro, Marisa Generosa
    Univ A Coruna UDC La Coruna, Spain.
    Filippatos, Gerasimos
    Natl & Kapodistrian Univ Athens, Greece; Univ Cyprus, Cyprus.
    Gotsman, Israel
    Hadassah Univ Hosp, Israel.
    Seferovic, Petar
    Belgrade Univ Med Ctr, Serbia.
    Hasin, Tal
    Shaare Zedek Med Ctr, Israel.
    Potena, Luciano
    Bologna Univ Hosp, Italy.
    Milicic, Davor
    Univ Zagreb, Croatia.
    Coats, Andrew J. S.
    Univ Warwick, England.
    Rosano, Giuseppe
    Univ London, England; IRCCS San Raffaele Pisana, Italy.
    Ruschitzka, Frank
    Univ Hosp, Switzerland.
    Metra, Marco
    Univ Brescia, Italy.
    Anker, Stefan
    Charite Univ Med Berlin, Germany.
    Altenberger, Johann
    SKA Rehabilitat zentrum Grossgmain, Austria.
    Adamopoulos, Stamatis
    Onassis Cardiac Surg Ctr, Greece.
    Barac, Yaron D.
    Tel Aviv Univ, Israel.
    Chioncel, Ovidiu
    Univ Med & Pharm Carol Davila, Romania.
    De Jonge, Nicolaas
    Univ Med Ctr Utrecht, Netherlands.
    Elliston, Jeremy
    Tel Aviv Univ, Israel.
    Frigeiro, Maria
    Osped Niguarda Ca Granda, Italy; Osped Niguarda Ca Granda, Italy.
    Goncalvesova, Eva
    Odd Srdcovehozlyhavania Transplantade, Slovakia.
    Grupper, Avishay
    Chaim Sheba Med Ctr, Israel; Tel Aviv Univ, Israel.
    Hamdan, Righab
    Beirut Cardiac Inst, Lebanon.
    Hammer, Yoav
    Tel Aviv Univ, Israel.
    Hill, Loreena
    Queens Univ, North Ireland.
    Ben Zadok, Osnat Itzhaki
    Tel Aviv Univ, Israel.
    Abuhazira, Miriam
    Tel Aviv Univ, Israel.
    Lavee, Jacob
    Tel Aviv Univ, Israel; Sheba Med Ctr, Israel.
    Mullens, Wilfried
    Univ Hasselt, Belgium.
    Nalbantgil, Sanemn
    Ege Univ Hosp, Turkey.
    Piepoli, Massimo F.
    Guglielmo da Saliceto Hosp, Italy.
    Ponikowski, Piotr
    Wroclaw Med Univ, Poland.
    Ristic, Arsen
    Univ Belgrade, Serbia.
    Ruhparwar, Arjang
    Heidelberg Univ, Germany.
    Shaul, Aviv
    Tel Aviv Univ, Israel.
    Tops, Laurens F.
    Leiden Univ Med Ctr, Netherlands.
    Tsui, Steven
    Royal Papworth Hosp, England.
    Winnik, Stephan
    Univ Hosp Zurich, Switzerland; Univ Zurich, Switzerland.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Gustafsson, Finn
    Rigshosp, Denmark.
    Ben Gal, Tuvia
    Tel Aviv Univ, Israel.
    HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider: Part 1: Introduction and at the non-hospital settings in the community2021In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 8, no 6, p. 4394-4408Article in journal (Refereed)
    Abstract [en]

    The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD-supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD-supported patients. The expected and non-expected device-related and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD-supported patients, mainly those supported with the destination therapy indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD-supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non-LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non-LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast-growing population of LVAD-supported patients. The different issues discussed will follow the patients pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD-supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD-supported patients.

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  • 48.
    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, E-ISSN 2044-6055, Vol. 6, no 6, article id 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.

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  • 49.
    Bengtsson Carlsson, Isabel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Systematic review of drug-drug-interactions mediated by CYP2C9: Classification of substrates, inhibitors, and inducers2021Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: CYP2C9 is one of the main drug metabolizing enzymes in the human liver. There is a substantial number of possible substrates, inhibitors, and inducers of this isoenzyme, leading to a high risk of drug-drug-interactions. Due to the lack of studies on each possible drug-drug-interaction, there is a need of predicting where it may exist, and to what extent it will affect the exposure of the substrate.

    Aim: To identify and classify substrates, inhibitors, and inducers of CYP2C9 by performing a systematic literature review. This is thought to constitute a basis for Karolic when updating the database Janusmed Interactions.

    Methods: A literature search was performed in PubMed, where original articles on drug-drug-interactions mediated by CYP2C9 were reviewed. Data was extracted on pharmacokinetic changes, and used to classify substrates, inhibitors, and inducers according to the extent of the interaction.

    Results: Fluconazole, amiodarone, and miconazole and rifampicin, and enzalutamide, were classified as moderate inhibitors and inducers of CYP2C9, respectively. Substrates were only able to be classified in studies with inhibitors, resulting in flurbiprofen and ospemifene being classified as highly sensitive of inhibition or induction of CYP2C9.

    Conclusions: Because of the non-specificity of identified inhibitors and inducers of CYP2C9, the classification of substrates showed difficult and unreliable. Thus, predictions on the extent of an interaction are not certain, however, the results implies where a risk of interaction is present and can be used as a warning for when precaution is needed.

  • 50.
    Bengtsson, Daniel
    et al.
    Department of Internal Medicine, Kalmar, Region of Kalmar County, Kalmar, Swede; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Ragnarsson, Oskar
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Berinder, Katarina
    Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Dahlqvist, Per
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Edén Engström, Britt
    Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden; Uppsala University Hospital, Uppsala, Sweden.
    Ekman, Bertil
    Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Höybye, Charlotte
    Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Burman, Pia
    Department of Endocrinology, Skåne University Hospital, University of Lund, Malmö, Sweden.
    Wahlberg, Jeanette
    Örebro University, School of Medical Sciences. Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Psychotropic drugs in patients with Cushing's disease before diagnosis and at long-term follow-up: a nationwide study2021In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 106, no 6, p. 1750-1760Article in journal (Refereed)
    Abstract [en]

    CONTEXT: Psychiatric symptoms are common in Cushing's disease (CD) and seem only partly reversible following treatment.

    OBJECTIVE: To investigate drug dispenses associated to psychiatric morbidity in CD patients before treatment and during long-term follow-up.

    DESIGN: Nationwide longitudinal register-based study.

    SETTING: University Hospitals in Sweden.

    SUBJECTS: CD patients diagnosed between 1990 and 2018 (N=372) were identified in the Swedish Pituitary Register. Longitudinal data was collected from 5 years before, at diagnosis and during follow-up. Four matched controls per patient were included. Cross-sectional subgroup analysis of 76 patients in sustained remission was also performed.

    MAIN OUTCOME MEASURES: Data from the Swedish Prescribed Drug Register and the Patient Register.

    RESULTS: In the 5-year period before, and at diagnosis, use of antidepressants (OR 2.2[95%CI 1.3-3.7] and 2.3[1.6-3.5]), anxiolytics (2.9[1.6-5.3] and 3.9[2.3-6.6]) and sleeping pills (2.1[1.2-3.7] and 3.8[2.4-5.9]) was more common in CD than controls. ORs remained elevated at 5-year follow-up for antidepressants (2.4[1.5-3.9]) and sleeping pills (3.1[1.9-5.3]). Proportions of CD patients using antidepressants (26%) and sleeping pills (22%) were unchanged at diagnosis and 5-year follow-up, whereas drugs for hypertension and diabetes decreased. Patients in sustained remission for median 9.3 years (IQR 8.1-10.4) had higher use of antidepressants (OR 2.0[1.1-3.8]) and sleeping pills (2.4[1.3-4.7]), but not of drugs for hypertension.

    CONCLUSIONS: Increased use of psychotropic drugs in CD was observed before diagnosis and remained elevated regardless of remission status, suggesting persisting negative effects on mental health. The study highlights the importance of early diagnosis of CD, and the need for long-term monitoring of mental health.

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