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

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

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

  • 3.
    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.

  • 4.
    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.

  • 5.
    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.    

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9.
    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.  

  • 10.
    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. 

  • 11.
    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
  • 12.
    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.

  • 13.
    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.

  • 14.
    Behnan, Tamara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Validation of a new vancomycin dosing nomogram within a pharmacist- led therapeutic drug monitoring program2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

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

  • 15.
    Berglund, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Plasmaoxytocin och salivkortisol hos äldre patienter med depression – 3 patientfall vid Akademiska Sjukhuset2012Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

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

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

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

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

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

  • 16.
    Bidi, Maliheh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Polyfarmaci på Danderyds sjukhus: En kartläggning hos patienter som fått läkemedel förskrivna från Danderyds sjukhus2011Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Polyfarmaci på Danderyds sjukhus AB

    Maliheh Bidi

    Fördjupningsprojekt i farmakoterapi D, 30 hp

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

    Examinator: Margareta Hammarlund-Udenaes

    Institutionen för farmaceutisk biovetenskap, Avdelningen för farmakokinetik och läkemedelsterapi

     

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

  • 17.
    Bildsten, Meriem
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Antibiotikaanvänding i öppenvård i Stockholms län2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 18.
    Bimay, Sevgi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Biverkningsrapporter med dolda interaktioner2011Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 19.
    Björkman, Ingeborg
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Viberg, Nina
    Rydberg, Linda
    Stålsby Lundborg, Cecilia
    Health promotion at Swedish pharmacies: views of the staff2008In: Pharmacy Practice (Internet), ISSN 1886-3655, Vol. 6, no 4, p. 211-218Article in journal (Refereed)
    Abstract [en]

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

  • 20. Bosnic-Anticevich, S
    et al.
    Costa, E
    Menditto, E
    Lourenço, O
    Novellino, E
    Bialek, S
    Briedis, V
    Buonaiuto, R
    Chrystyn, H
    Cvetkovski, B
    Capua, S Di
    Kritikos, V
    Mair, A
    Orlando, V
    Paulino, E
    Salimäki, J
    Söderlund, R
    Tan, R
    Williams, D M
    Wroczynski, P
    Agache, I
    Ansotegui, I J
    Anto, J M
    Bedbrook, A
    Bachert, C
    Bewick, M
    Bindslev-Jensen, C
    Brozek, J
    Canonica, G W
    Cardona, V
    Carr, W
    Casale, T
    Chavannes, N H
    Correia de Sousa, J
    Cruz, A A
    Czarlewski, W
    De Carlo, G
    Demoly, P
    Devillier, P
    Dykewicz, M S
    Gaga, M
    El-Gamal, Y
    Fonseca, J
    Fokkens, W J
    Guzmán, M A
    Haahtela, T
    Hellings, P W
    Illario, M
    Ivancevich, J C
    Just, J
    Kaidashev, I
    Khaitov, M
    Khaltaev, N
    Keil, T
    Klimek, L
    Kowalski, M L
    Kuna, P
    Kvedariene, V
    Larenas-Linnemann, D
    Laune, D
    Le, L T T
    Carlsen, K C Lodrup
    Mahboub, B
    Maier, D
    Malva, J
    Manning, P
    Morais-Almeida, M
    Mösges, R
    Mullol, J
    Münter, L
    Murray, R
    Naclerio, R
    Namazova-Baranova, L
    Nekam, K
    Nyembue, T D
    Okubo, K
    O'Hehir, R E
    Ohta, K
    Okamoto, Y
    Onorato, G L
    Palkonen, S
    Panzner, P
    Papadopoulos, N G
    Park, H S
    Pawankar, R
    Pfaar, O
    Phillips, J
    Plavec, D
    Popov, T A
    Potter, P
    Prokopakis, E P
    Roller-Wirnsberger, R E
    Rottem, M
    Ryan, D
    Samolinski, B
    Sanchez-Borges, M
    Schunemann, H J
    Sheikh, A
    Sisul, J C
    Somekh, D
    Stellato, C
    To, T
    Todo-Bom, A
    Tomazic, P V
    Toppila-Salmi, S
    Valero, A
    Valiulis, A
    Valovirta, E
    Ventura, M T
    Wagenmann, M
    Wallace, D
    Waserman, S
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Yiallouros, P K
    Yorgancioglu, A
    Yusuf, O M
    Zar, H J
    Zernotti, M E
    Zhang, L
    Zidarn, M
    Zuberbier, T
    Bousquet, J
    ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy".2018In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995Article in journal (Refereed)
    Abstract [en]

    Pharmacists are trusted health professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact of allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The ARIA-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses) and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of AR. However, the ARIA-pharmacy ICP should be adapted to local health care environments/situations as regional (national) differences exist in pharmacy care. This article is protected by copyright. All rights reserved.

  • 21.
    Cam, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Kempen, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Intervention fidelity within a randomised controlled trial on comprehensive medication reviews in hospitalised patients2018In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 40, no 1, p. 251-251Article in journal (Refereed)
  • 22.
    Carlsson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Vilka faktorer samvarierar med låg respektive hög tilltro till generiskt utbyte bland apotekskunder?: En kvantitativ enkätstudie utförd på svenska öppenvårdsapotek.2015Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

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

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

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

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

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

  • 23.
    Danieyko, Lucy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Prevalence of medication-related admissions in older patients in Sweden and comparison to existing literature2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Medication-related problems (MRPs) are a common cause of hospital admissions in older patients. An ongoing trial known as Medication Reviews Bridging Healthcare (MedBridge) aims to study the effects of hospital-initiated comprehensive medication reviews on older patients’ healthcare utilisation, including the incidence of medicationrelated admissions (MRAs) during 12-month follow-up. Data on MRAs in Sweden is still limited and it is unknown if the prevalence is similar to that presented in other studies from around the globe. 

    To assess the prevalence of MRAs among unplanned hospital readmissions in older patients in Sweden and to compare these results with existing international literature.

    A literature search was performed to determine the prevalence of MRAs in the recent literature. The population in this study included MedBridge trial participants aged ≥ 65 years, who were readmitted to the hospitals of Uppsala, Gävle, Enköping or Västerås during their 12-month follow-up period. Admission and discharge notes, medication list and lab results in the patients’ electronic medical record were assessed independently by two final-year pharmacy students with a validated tool (AT-HARM10) to classify the readmissions as possibly or unlikely medicine-related. Probable MRAs were subclassified within the readmissions classified a possibly medicine-related. Consensus was sought on conflicting results. Secondary outcome measures were the prevalence of ICD10 diagnosis codes among all readmissions and the prevalence of medicine classes involved in probably MRAs. A two-tailed z-test for one proportion was used to compare the prevalence of MRAs with existing literature. A Chi2-test was used to compare the distribution of ICD-10 codes between all readmissions and those classified as possible MRAs.

    Out of the 1687 readmissions assessed in this study, 25 % (95 %-confidence interval: 23-27 %) were classified as possibly medicine-related, which was higher than the 21 % found in the literature. Eight percent of all readmissions were sub-classified as probably medicine-related. The most common ICD-10 codes among readmissions classified as possible MRAs were circulatory problems (35 %), respiratory problems (14 %) and endocrine problems (9 %), which differed from all readmissions. The most common medicine classes involved were antithrombotic agents (20 %), diuretics (10 %), antidiabetics (10 %) as well as issues concerning multiple medicines (27 %).

    The prevalence of MRAs among unplanned hospital readmissions in older patients in Sweden is 25 %, which seems to be higher than the prevalence in existing literature. 

  • 24.
    Dee, Katrina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Kartläggning av rutiner kring läkemedelsinformation vid utskrivning från en internmedicinsk avdelning – vad görs och hur görs det till äldre patienter?2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

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

    Katrina Dee

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

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

  • 25.
    Ekberg, Annabel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    The Impact of Polypharmacy and Age on the Need for Medication Reviews2014Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

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

  • 26.
    Ekblom, Emelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Kartläggning av behandlingen av ovarialcancer i Uppsala med hjälp av RealQ-systemet2011Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Abstract

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

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

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

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

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

  • 27.
    Engström, Maria Svedbo
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Gothenburg; Dalarna Univ, Sch Educ Hlth & Social Studies, Falun.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun.
    Johansson, Unn-Britt
    Sophiahemmet Univ, Stockholm; Karolinska Inst, Dept Clin Sci & Educ, Södersjukhuset, Stockholm.
    Eeg-Olofsson, Katarina
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Gothenburg; Sahlgrens Univ Hosp, Gothenburg.
    Borg, Sixten
    Lund Univ, Dept Clin Sci Malmo, Hlth Econ Unit, Lund.
    Palaszewski, Bo
    Dept Data Management & Anal, Region Västra Götaland, Gothenburg.
    Gudbjornsdottir, Soffia
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Gothenburg; Register Ctr Västra Götaland, Gothenburg, Sweden..
    A disease-specific questionnaire for measuring patient-reported outcomes and experiences in the Swedish National Diabetes Register: Development and evaluation of content validity, face validity, and test-retest reliability2018In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 101, no 1, p. 139-146Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the development and evaluation of the content and face validity and test-retest reliability of a disease-specific questionnaire that measures patient-reported outcomes and experiences for the Swedish National Diabetes Register for adult patients who have type 1 or type 2 diabetes.

    Methods: In this methodological study, a questionnaire was developed over four phases using an iterative process. Expert reviews and cognitive interviews were conducted to evaluate content and face validity, and a postal survey was administered to evaluate test-retest reliability.

    Results: The expert reviews and cognitive interviews found the disease-specific questionnaire to be understandable, with relevant content and value for diabetes care. An item-level content validity index ranged from 0.6-1.0 and a scale content validity/average ranged from 0.7-1.0. The fourth version, with 33 items, two main parts and seven dimensions, was answered by 972 adults with type 1 and type 2 diabetes (response rate 61%). Weighted Kappa values ranged from 0.31-0.78 for type 1 diabetes and 0.27-0.74 for type 2 diabetes.

    Conclusions: This study describes the initial development of a disease-specific questionnaire in conjunction with the NDR. Content and face validity were confirmed and test-retest reliability was satisfactory. Practice implications: With the development of this questionnaire, the NDR becomes a clinical tool that contributes to further understanding the perspectives of adult individuals with diabetes.

  • 28.
    Eriksson, Elina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Management of osteoporosis following a low-impact fracture at Alfred Health2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Osteoporosis is a substantial health problem that is increasing in prevalence due to the increasingly ageing population. Despite the existence of evidence based treatment recommendations, osteoporosis is still underdiagnosed and undertreated both within Australia and around the world.

    Aim: The study aims to assess whether patients with low impact fractures at Alfred Health are being managed according to evidence based clinical recommendations.

    Methodology: The study was a retrospective review of randomly selected patients over 65 years of age who were admitted to The Alfred Hospital for longer than 48 hours, during 2015 with a low impact fracture. Relevant information about the patient’s medical history and in-patient management was collected from Powerchart and iPharmacy.

    Results: Out of 600 screened patients, 251 patients were included; 69 % (172 patients) were women and 31 % (79 patients) were men. Over a quarter of all the patients (26.7%) received vitamin D- and/or calcium supplementation as their only pharmacological management. Twenty two percent were left discharged with no osteoporosis management. The proportion of patients who were commenced on anti-resorptive treatment was 13,7 %, and the majority of them (89.9%) received it at Caulfield sub-acute hospital during rehabilitation.

    Conclusion: This study is consistent with other studies within Australia and around the world, which have found that osteoporosis is under-treated and under-diagnosed.  The study highlights the need for a systematic approach to the implantation of strategies to ensure the underlying reason for low impact fracture is investigated so that therapeutically proven medications to reduce the risk of subsequent fracture are commenced. 

  • 29.
    Fagerlind, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Patient-Physician Communication in Oncology Care: The character of, barriers against, and ways to evaluate patient-physician communication, with focus on the psychosocial dimensions2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

    List of papers
    1. Patient-physician communication during oncology consultations
    Open this publication in new window or tab >>Patient-physician communication during oncology consultations
    Show others...
    2008 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 17, no 10, p. 975-985Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: The aim of this study was to characterize the content of patient-physician communication in standard oncology care. METHODS: The sample consisted of 19 patients with gastrointestinal cancer. The consultations were audio-recorded, transcribed verbatim, and analyzed according to qualitative content analysis. RESULTS: The analysis resulted in seven main categories: Disease and treatment, Healthcare planning, Everyday living, Psychological well-being, Coping with disease, Expressions of concerns and feelings, and Other aspects of communication. The main focus during the consultations was on disease and treatment. Physicians tended to concentrate on response to treatment and types and severity of side effects and how to treat them. More patient-centered subjects of psychosocial character like coping and psychological well-being were discussed only briefly, if at all. CONCLUSIONS: This study adds to the information given by the existing communication analysis systems, and hence we suggest a development of the psychosocial content categories of those systems to make them more valid.

    Keywords
    cancer, oncology, patient-physician communication, consultation, qualitative
    National Category
    Pharmaceutical Sciences
    Identifiers
    urn:nbn:se:uu:diva-86840 (URN)10.1002/pon.1410 (DOI)000260351000003 ()18677715 (PubMedID)
    Available from: 2008-12-08 Created: 2008-12-08 Last updated: 2018-01-13Bibliographically approved
    2. Communication analysis in oncology care: Performance of a combination of a content analysis system and a global scale
    Open this publication in new window or tab >>Communication analysis in oncology care: Performance of a combination of a content analysis system and a global scale
    Show others...
    2011 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 20, no 9, p. 992-1000Article in journal (Refereed) Published
    Abstract [en]

    Objective: The aim was to assess the feasibility and reliability of Velikova's Content Analysis System (VCAS) and the Medical Interaction Process System (MIPS) global scale for evaluation of communication in oncology care.

    Methods: Seventy routine physician consultations with gastro-intestinal (GI) cancer patients were audio-recorded. Two coders applied VCAS and MIPS global scale to the consultations. VCAS captures aspects of communication like symptoms, side effects, functional issues (e.g. emotional, social, physical), health-related quality of life and medical decision making. MIPS global scale measures the total impression of the consultation, e.g. patient centredness and psychosocial focus.

    Results: In total, 61 of 70 consultations were coded. The coding took twice the consultations' actual durations in minutes for VCAS. The time for coding MIPS global scale equalled the consultations length. However, the coder had then listened to the consultation twice before, coding for VCAS. Cohen's kappa for all aspects measured by VCAS varied between 0.20 and 1, mean 0.80. One category (Info on test) had a kappa of 0.20, the other categories were all above 0.60. Weighted Kappa for MIPS global scale varied between 0.25 and 0.73, mean 0.42.

    Conclusions: VCAS and MIPS global scale is a feasible combination of tools for evaluating patient-physician communication regarding content, medical decision making and global aspects of communication. VCAS showed high reliability. The MIPS global scale showed lower reliability, due to its sensitivity to the individual coders' unique values, common for all global scales. Further development of the combination of content and global instruments would be valuable.

    Keywords
    oncology, cancer, patient-physician communication, content analysis systems, clinical practice
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-160203 (URN)10.1002/pon.1808 (DOI)000295122700011 ()
    Available from: 2011-10-18 Created: 2011-10-18 Last updated: 2017-12-08Bibliographically approved
    3. Different perspectives on communication quality and emotional functioning during routine oncology consultations
    Open this publication in new window or tab >>Different perspectives on communication quality and emotional functioning during routine oncology consultations
    Show others...
    2012 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 88, no 1, p. 16-22Article in journal (Refereed) Published
    Abstract [en]

    Objective: To determine quality of communication in routine oncology consultations from patient, physician, and observer perspectives, and to determine agreement of emotional function content in consultations from these three perspectives.

    Methods: In total, 69 consultations were included. Perceived quality of communication and whether or not emotional functioning had been discussed was evaluated with patient- and physician-reported questionnaires. Observer perspective was evaluated by content analysis of audio records of the consultations. Agreement between perspectives was analyzed and means compared using linear mixed models.

    Results: The patients' ratings of communication quality differed significantly from those of both the physician and observer. Observer and physician scores did not differ significantly. Physicians rated emotional functioning as discussed more often than was reported from patient and observer perspectives.

    Conclusion: The patients' view of the quality of communication differed from that of the physician and observer. Whether emotional functioning was discussed or not was also perceived differently by patients, physicians, and observer.

    Practice implications: The underpinnings and implications of these results need to be further explored regarding how to move toward a higher degree of shared understanding, where different perspectives are more in alignment, and how to develop more valid methods for evaluating communication.

    Keywords
    Oncology, Communication, Content analysis, Emotional functioning, Communication analysis, Clinical practice
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-179580 (URN)10.1016/j.pec.2011.12.002 (DOI)000306541300004 ()
    Available from: 2012-08-20 Created: 2012-08-20 Last updated: 2017-12-07Bibliographically approved
    4. Barriers against psychosocial communication: Oncologists' perceptions
    Open this publication in new window or tab >>Barriers against psychosocial communication: Oncologists' perceptions
    2013 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 31, no 30Article in journal (Refereed) Published
    Keywords
    oncology, communication, clinical practice, barriers, oncologists
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Pharmaceutical Sciences
    Research subject
    Social Pharmacy
    Identifiers
    urn:nbn:se:uu:diva-183660 (URN)10.1200/JCO.2012.45.1609 (DOI)000330540400019 ()
    Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2018-01-12Bibliographically approved
  • 30.
    Fjellvind, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Läkemedelsgenomgångar inom psykiatrin- en initial pilotutvärdering2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

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

  • 31.
    Forbes, C. A.
    et al.
    Kleijnen Systemat Reviews Ltd, York, N Yorkshire, England..
    Deshpande, S.
    Kleijnen Systemat Reviews Ltd, York, N Yorkshire, England..
    Sorio-Vilela, F.
    Amgen Europe, Zug, Switzerland.;EEMEA, Zug, Switzerland..
    Kutikova, L.
    Amgen Europe GmbH, Zug, Switzerland..
    Duffy, S.
    Kleijnen Systemat Reviews Ltd, York, N Yorkshire, England..
    Gouni-Berthold, I
    Univ Cologne, Cologne, Germany..
    Hagström, Emil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Comparison Of Methods To Measure Patient Adherence And Persistence With Pharmacological Therapy: A Systematic Review2017In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 20, no 9, p. A620-A620Article in journal (Other academic)
  • 32.
    Forbes, Carol A.
    et al.
    Kleijnen Systemat Reviews Ltd, York, N Yorkshire, England.
    Deshpande, Sohan
    Kleijnen Systemat Reviews Ltd, York, N Yorkshire, England.
    Sorio-Vilela, Francesc
    Amgen Europe GmbH, Global Hlth Econ, Zug, Switzerland.
    Kutikova, Lucie
    Amgen Europe GmbH, Global Hlth Econ, Zug, Switzerland.
    Duffy, Steven
    Kleijnen Systemat Reviews Ltd, York, N Yorkshire, England.
    Gouni-Berthold, Ioanna
    Univ Cologne, Polyclin Endocrinol Diabet & Prevent Med, Cologne, Germany.
    Hagström, Emil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala Univ, Dept Med Sci, Uppsala Clin Res Ctr UCR, Uppsala, Sweden.
    A systematic literature review comparing methods for the measurement of patient persistence and adherence2018In: Current Medical Research and Opinion, ISSN 0300-7995, E-ISSN 1473-4877, Vol. 34, no 9, p. 1613-1625Article, review/survey (Refereed)
    Abstract [en]

    Objectives: A systematic literature review was conducted comparing different approaches estimating persistence and adherence in chronic diseases with polypharmacy of oral and subcutaneous treatments. Methods: This work followed published guidance on performing systematic reviews. Twelve electronic databases and grey literature sources were used to identify studies and guidelines for persistence and adherence of oral and subcutaneous therapies in hypercholesterolemia, type 2 diabetes, hypertension, osteoporosis and rheumatoid arthritis. Outcomes of interest of each persistence and adherence data collection and calculation method included pros: accurate, easy to use, inexpensive; and cons: inaccurate, difficult to use, expensive. Results: A total of 4158 records were retrieved up to March 2017. We included 16 observational studies, 5 systematic reviews and 7 guidelines, in patients with hypercholesterolemia (n=8), type 2 diabetes (n=4), hypertension (n=2), rheumatoid arthritis (n=1) and mixed patient populations (n=13). Pharmacy and medical records offer an accurate, easy and inexpensive data collection method. Pill count, medication event monitoring systems (MEMs), self-report questionnaires and observer report are easy to use. MEMS and biochemical monitoring tests can be expensive. Proportion of days covered (PDC) was recommended as a gold standard calculation method for long-term treatments. PDC avoids use of days' supply in calculation, hence is more accurate compared to medication possession ratio (MPR) to assess adherence to treatments in chronic diseases. Conclusions: Decisions on what method to use should be based on considerations of the route of medication administration, the resources available, setting and aim of the assessment. Combining different methods may provide wider insights into adherence and persistence, including patient behavior.

  • 33.
    Fredriksson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Läkemedelsgenomgångar av apotekare inom slutenvårdspsykiatrin i Kalmar - typ av läkemedelsrelaterade problem samt åtgärdsfrekvens2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

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

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

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

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

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

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

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

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

  • 34.
    Frisk, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Surveys and services: The feasibility of conducting research in Swedish community pharmacies2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    For the past decades, there has been a shift in community pharmacy practice from dispensing and compounding towards provision of pharmacy services. Research is important to generate evidence for new services within pharmacy practice. Pharmacy practice research can be divided in two main themes: research related to pharmacy as a data source and to the pharmacy as the object of research, respectively.

    The purpose of this thesis is to increase the understanding of the conditions required for successful involvement of Swedish community pharmacy staff in pharmacy-based research, and to evaluate the data generated through a certain type of research: pharmacy-based patient surveys on drug utilization.

    Specific aims were to evaluate if there is a selection bias in drug utilization surveys conducted in Swedish community pharmacies, to explore the experiences of pharmacists either conducting the surveys or recruiting patients to research on adherence-promoting services, and to describe barriers and facilitators to conducting research in community pharmacies.

    Data were collected via pharmacy-based patient surveys, dispensing data, individual interviews, a cross-sectional staff survey and focus group interviews.

    In community pharmacy-based surveys or services research, with the dispensed drug as the trigger for inclusion, patients aged 75 years or older are underrepresented since they less often visit the pharmacy to redeem their prescriptions themselves. Due to their perceived workload, dispensing pharmacists sometimes avoid including patients perceived as complex due to age, polypharmacy or communication difficulties. These processes contribute to a healthy selection effect in both types of research and pharmacy services not reaching the patients in most need of support with their medication.

    The pharmacists were generally positive to conducting surveys and being involved in services research, but reported a perceived lack of sufficient communication and research skills, and a lack of time.

    Since competing commercial priorities hamper pharmacists’ research involvement, separate research funding is an important facilitator. For surveys to include all eligible patients, services to be relevant for both practice and patients and to target the patients in most need of support with their medication, research collaboration with healthcare, other professions and across pharmacies is also necessary.

    List of papers
    1. Selection bias in pharmacy-based patient surveys
    Open this publication in new window or tab >>Selection bias in pharmacy-based patient surveys
    2014 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 23, no 2, p. 128-139Article in journal (Refereed) Published
    Abstract [en]

    PurposeTo evaluate if there is a selection bias in drug utilization surveys on prescription drugs regularly conducted in Swedish pharmacies, to describe the direction of this potential bias and discuss the implications for the results. MethodsAge and gender distributions within patient survey samples from drug utilization surveys conducted during 2006-2010 are compared to the age and gender distribution of all Swedish patients, receiving the same drug or drugs, as given by the Swedish Prescribed Drug Register. The differences between the proportions of patients within the age and gender segments of each pair of survey/register data were calculated. ResultsIn 25 (81%) out of 31 included surveys, patients aged 75 years or older are significantly underrepresented, as they are less likely to visit the pharmacy to collect their prescription drugs themselves and thus disqualify for the interviews. Data on women show similar results as overall survey data, whereas the underrepresentation of the oldest age group among men appears in a lower proportion of the surveys, 67%. The general consequence is a selection towards a healthier survey sample, but the consequences in the individual surveys vary, depending on what drug is being studied. ConclusionPharmacy-based patient surveys provide a convenient data collection method for patient self-reported data, but patients aged 75 years or older are consistently underrepresented. In surveys where this may influence the main research question, data should also be collected with other methods reaching the oldest patients.

    Keywords
    patient survey, pharmacy, selection bias, drug utilization, self-report, pharmacoepidemiology
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-219194 (URN)10.1002/pds.3488 (DOI)000329999100003 ()
    Available from: 2014-02-25 Created: 2014-02-24 Last updated: 2018-01-19Bibliographically approved
    2. Exploring community pharmacists' experiences of surveying patients for drug utilization research purposes
    Open this publication in new window or tab >>Exploring community pharmacists' experiences of surveying patients for drug utilization research purposes
    2015 (English)In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 37, no 3, p. 522-528Article in journal (Refereed) Published
    Abstract [en]

    Background Patient self-reported data are important in drug utilization research, but often logistically difficult to collect. During 2006-2012, 72 Swedish community pharmacies regularly collected such data through structured survey interviews at the pharmacy counter, performed by the dispensing pharmacists. This study is part of a validation of that data acquisition method. Objectives (1) To explore the experiences of the pharmacists involved, (2) to explore a random or systematic exclusion of eligible patients by the pharmacists, and (3) to find areas of improvement to the applied method of surveying. Setting 72 Swedish community pharmacies, distributed all over the country. Method (a) A questionnaire was distributed to approximately 400 dispensing pharmacists at the pharmacies conducting the patient surveys; (b) semi-structured telephone interviews conducted with 19 pharmacists at 12 of the pharmacies. Main outcome measure Proportions of pharmacists reporting positive and negative experiences of structured survey interviews, the nature of their experiences, proportion of pharmacists reporting to avoid survey interviews and reasons for doing so, and suggested areas of improvement. Results A total of 126 pharmacists (32 %) completed the questionnaire. A majority (82 %) reported positive experiences of interviewing. In addition to the data generated as the primary goal of surveying, secondary benefits such as an improved patient-pharmacist dialogue and an increased detection and resolution of drug related problems were reported. However, a majority (63 %) of the pharmacists also reported negative experiences related to a perceived lack of time to fulfil one's professional obligations. Almost half of the pharmacists (44 %) in the survey admitted that they occasionally avoided interviewing eligible patients, due to the immediate increase in work load. The limited availability of staff resources was the most apparent area of improvement. Conclusion Under certain conditions, community pharmacies are feasible as a setting for conducting patient surveys in drug utilization research, and dispensing pharmacists suitable for conducting them. When regular dispensing staff perform the survey interviews as a part of the drug dispensing process, additional resources to manage the immediate increase in work load have to be considered. Otherwise, data quality may be compromised.

    Keywords
    Community pharmacy, Interview, Pharmacist, Survey, Sweden
    National Category
    Pharmaceutical Sciences
    Identifiers
    urn:nbn:se:uu:diva-252961 (URN)10.1007/s11096-015-0088-1 (DOI)000353472100016 ()25736386 (PubMedID)
    Available from: 2015-05-20 Created: 2015-05-18 Last updated: 2018-01-19Bibliographically approved
    3. Utilisation of prescription and over-the-counter triptans: a cross-sectional study in Stockholm, Sweden
    Open this publication in new window or tab >>Utilisation of prescription and over-the-counter triptans: a cross-sectional study in Stockholm, Sweden
    Show others...
    2016 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 72, no 6, p. 747-754Article in journal (Refereed) Published
    Abstract [en]

    Triptans are widely used in acute migraine, and in some countries, they are also available over-the-counter (OTC). In Sweden, sales have increased for both prescription and OTC triptans. This study aimed to describe current prescribing and utilisation patterns of prescription and OTC triptans in Stockholm, Sweden. Register data from 4759 patients dispensed triptans in 2014 were used to study documented diagnosis of migraine, concomitant acute and preventive treatment for migraine, and contraindications. Survey data from 49 patients purchasing OTC triptans in three pharmacies were used to capture physician-diagnosed migraine, concomitant acute and preventive treatment for migraine, a behaviour of combining or alternating between prescription and OTC triptans, and pharmacy counselling rates. Among the prescription triptan users, 52 % had a recorded diagnosis of migraine, 48 % had no other acute treatment, preventive treatment was rare (12 %) and contraindications were found in 2 % of the patients. Among the OTC triptan users, the majority (63 %) had been diagnosed by a physician and had a history of prescription triptan use, but combining or alternating between OTC and prescription triptans was rare. Concomitant acute treatment was reported in 53 % and preventive treatment was rare (4 %), despite high self-reported migraine frequencies. Some off-label use was detected, despite moderate to high counselling rates. Triptans are prescribed with attention to safety but with poor recording of migraine diagnosis. OTC triptan users generally have a history of prescription triptan use. Preventive treatment rates are low in both groups. Strategies to discern patients who need other treatment options should be considered.

    Keywords
    Triptans, Over-the-counter, OTC, Drug utilisation, Prescription, Survey
    National Category
    Pharmaceutical Sciences
    Identifiers
    urn:nbn:se:uu:diva-298065 (URN)10.1007/s00228-016-2028-y (DOI)000376245600014 ()26922586 (PubMedID)
    Available from: 2016-06-30 Created: 2016-06-29 Last updated: 2018-01-19Bibliographically approved
    4. Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services research
    Open this publication in new window or tab >>Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services research
    (English)Manuscript (preprint) (Other academic)
    Keywords
    community pharmacy, Sweden, cognitive pharmaceutical services, research, patient-centered care
    National Category
    Social and Clinical Pharmacy
    Research subject
    Pharmaceutical Science; Social Pharmacy
    Identifiers
    urn:nbn:se:uu:diva-338726 (URN)
    Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-01-19
  • 35.
    Frisk, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Holtendal, Clary
    Bastholm-Rahmner, Pia
    Kälvemark-Sporrong, Sofia
    Competence, competition and collaboration: Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services researchManuscript (preprint) (Other academic)
  • 36.
    Geissler, Jan
    et al.
    European Patients Acad Therapeut Innovat, Rothenanger 1b, D-85521 Riemerling, Germany..
    Ryll, Bettina
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Organismal Biology, Evolution and Developmental Biology. Melanoma Patient Network Europe, Uppsala, Sweden..
    di Priolo, Susanna Leto
    Novartis Oncol Reg Europe, Patient Strategy, Haematol & Profess Relat, Milan, Italy..
    Uhlenhopp, Mary
    Amgen Europe GmbH, Zug, Switzerland.;Shire, Global Advocacy, Oncol & Immunol, Zug, Switzerland..
    Improving Patient Involvement in Medicines Research and Development:: A Practical Roadmap2017In: Therapeutic Innovation and Regulatory Science, ISSN 2168-4790, E-ISSN 2168-4804, Vol. 51, no 5, p. 612-619Article in journal (Refereed)
    Abstract [en]

    The value of patient involvement (PI) in medicines research and development (R&D) is increasingly recognized by all health stakeholders. Despite numerous ongoing PI initiatives, PI so far lacks structure and consistency in approach. Limited formal documentation of PI activities further hampers the sharing of experience and learnings, preventing timely and systematic implementation. This article summarizes the outcomes of several multistakeholder discussions during 2013-2016 in a practical roadmap for PI in medicines R&D. The roadmap highlights specific opportunities for PI along the 4 key stages of the medicines R&D life cycle and is illustrated with concrete examples. This roadmap's aim is to provide a tool to facilitate PI during medicines research and development and is being shared to encourage implementation and further refinement.

  • 37.
    German, Olga
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Individanpassade orala läkemedelsdoser till barn med hjälp av pulverdispensering i kapslar: en experimentell studie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Inledning: Sjuka barn behöver anpassad vård och säkra, effektiva och väldokumenterade läkemedel. Förskrivning och uttag av preparat för pediatriska populationen ökar, men en tydlig uppskattning på problematik finns inte. Problem kan uppstå, när en lämplig beredning saknas, när redan registrerade läkemedel saknar avdelade doser för barn eller är tillgängliga enbart som en tablett med vuxen dos. Varje barn sägs vara en individ med unika läkemedelsomsättning, metabolism och biverkningspanorama, vilket komplicerar behandling. Lösningen på detta är i många fall ett extemporeläkemedel eller ett licenspreparat, men långa ledtider och dålig tillgänglighet kan medföra svårigheter att kunna ge rätt terapi.

    Syftet med denna studie är att i) kartlägga behov och befintliga lösningar, ii) testa handhållna pulverdispenser (HPD) Quantos, som en lämplig metod för fasta beredningar för att tillhandahålla individuella läkemedelsdoser till barn i de fall godkända läkemedel inte räcker. 

    Metod: Databassökning, intervjuer av hälso-sjukvårdspersonal, samt laborativt arbete för att omformulera registrerade läkemedel i tablettformer till individanpassade doser i hårdgelatin-kapslar med hjälp av Mettler-Toledos handhållna pulverdoseringsinstrument HPD Quantos.

    Resultat: Litteraturstudien och intervjuer överensstämmer med varandra: behov av barnanpassade läkemedel finns. HPD Quantos kan vara en alternativ metod för fasta beredningar för att tillhandahålla mängderför uppdosering med en femte- och/ eller en sjättedel av en tablett.

    Slutsats: För att ombesörja behoven för barnanpassade doser på ett sjukhus, måste HPD Quantos automatiseras till en inbyggd doseringsstation. Detta kommer att säkerställa dosering, dölja obehaglig smak, samt minska arbetsmiljörisken vid exponering av toxiska läkemedel.

  • 38.
    Gillespie, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Effects of Clinical Pharmacists' Interventions: on Drug-Related Hospitalisation and Appropriateness of Prescribing in Elderly Patients2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

     

     

    List of papers
    1. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial
    Open this publication in new window or tab >>A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial
    Show others...
    2009 (English)In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 169, no 9, p. 894-900Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND

    Patients 80 years or older are underrepresented in scientific studies. The objective of this study was to investigate the effectiveness of interventions performed by ward-based pharmacists in reducing morbidity and use of hospital care among older patients.

    METHODS

    A randomized controlled study of patients 80 years or older was conducted at the University Hospital of Uppsala, Uppsala, Sweden. Four hundred patients were recruited consecutively between October 1, 2005, and June 30, 2006, and were randomized to control (n = 201) and intervention (n = 199) groups. The interventions were performed by ward-based pharmacists. The control group received standard care without direct involvement of pharmacists at the ward level. The primary outcome measure was the frequency of hospital visits (emergency department and readmissions [total and drug-related]) during the 12-month follow-up period.

    RESULTS

    Three hundred sixty-eight patients (182 in the intervention group and 186 in the control group) were analyzed. For the intervention group, there was a 16% reduction in all visits to the hospital (quotient, 1.88 vs 2.24; estimate, 0.84; 95% confidence interval [CI], 0.72-0.99) and a 47% reduction in visits to the emergency department (quotient, 0.35 vs 0.66; estimate, 0.53; 95% CI, 0.37-0.75). Drug-related readmissions were reduced by 80% (quotient, 0.06 vs 0.32; estimate, 0.20; 95% CI, 0.10-0.41). After inclusion of the intervention costs, the total cost per patient in the intervention group was $230 lower than that in the control group.

    CONCLUSION

    If implemented on a population basis, the addition of pharmacists to health care teams would lead to major reductions in morbidity and health care costs.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-103205 (URN)10.1001/archinternmed.2009.71 (DOI)000265994000011 ()19433702 (PubMedID)
    Note

    De 2 första författarna delar förstaförfattarskapet.

    De 2 sista författarna delar sistaförfattarskapet.

    Available from: 2009-05-15 Created: 2009-05-15 Last updated: 2017-12-13Bibliographically approved
    2. Effects of pharmacists’ interventions on appropriateness of prescribing for elderly and exploration of a possible correlation between scores for appropriateness and clinical outcomes: analyses from a randomized controlled trial
    Open this publication in new window or tab >>Effects of pharmacists’ interventions on appropriateness of prescribing for elderly and exploration of a possible correlation between scores for appropriateness and clinical outcomes: analyses from a randomized controlled trial
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background:

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

    Methods:

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

    Results:

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

    Conclusion:

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

    Keywords
    appropriateness, quality of prescribing, hospitalisation, pharmacist intervention
    National Category
    Social and Clinical Pharmacy
    Identifiers
    urn:nbn:se:uu:diva-167138 (URN)
    Available from: 2012-01-22 Created: 2012-01-22 Last updated: 2018-01-12Bibliographically approved
    3. Perceived value of ward-based pharmacists from the perspective of physicians and nurses
    Open this publication in new window or tab >>Perceived value of ward-based pharmacists from the perspective of physicians and nurses
    2012 (English)In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 34, no 1, p. 127-135Article in journal (Refereed) Published
    Abstract [en]

    Background

    Clinical pharmacy in a hospital setting is relatively new in Sweden. Its recent introduction at the University Hospital in Uppsala has provided an opportunity for evaluation by other relevant professionals of the integration of clinical pharmacists into the health-care team.

    Objectives

    The objectives of this descriptive study were to evaluate the perceived value of wardbased clinical pharmacists from the perspective of hospital based physicians and nurses and to identify potential advantages and disadvantages related to the new inter professional collaboration. Another objective was to evaluate the experiences of general practitioners on receiving medication reports from wardbased clinical pharmacists.

    Setting

    Two acute internal medicine wards at the University Hospital in Uppsala, where a previously reported randomized controlled trial investigating the effects of ward based clinical pharmacists on re-visits to hospital was undertaken.

    Methods

    Data were collected by questionnaires containing closed- and openended questions. The questionnaires were distributed during the nine-month study period of the randomized controlled trial by an independent researcher to 29 hospital-based physicians and 44 nurses on the study wards and to 21 general practitioners who had received two or more medication reports. Answers were analysed descriptively for the closedended questions and by content analysis for the open-ended questions.

    Main outcome measure

    The main outcome measure was the physicians’ and nurses’ level of satisfaction with the new collaboration with clinical pharmacists, from a hospital and primary care perspective.

    Results

    Seventy-six percent of the hospital-based physicians and 81% of the nurses completed the questionnaire. Ninety-five percent of the physicians and 93% of the nurses were very satisfied with the collaboration. Out of the 17 general practitioners (81%) that completed the questionnaire 71% wanted to continue to receive medication reports in a similar way in the future. Increased patient safety and improvements in patients’ drug therapy were the main advantages stated by all three groups of respondents. Eighteen percent of the hospital-based physicians and 21% of the nurses thought that the collaboration had been time-consuming to certain or to a high extent.

    Conclusions

    The majority of the respondents, both GPs and hospital based physicians and nurses, were satisfied with the new collaboration with the ward based pharmacists and perceived that the quality of the patients’ drug therapy and drug-related patient safety had increased.

    Place, publisher, year, edition, pages
    Springer, 2012
    Keywords
    Clinical pharmacy, Collaboration, Inter-professional relationships, Multidisciplinary team, nurses, physicians, Sweden
    National Category
    Social and Clinical Pharmacy
    Research subject
    Pharmacokinetics and Drug Therapy
    Identifiers
    urn:nbn:se:uu:diva-167133 (URN)10.1007/s11096-011-9603-1 (DOI)000299329300019 ()
    Available from: 2012-01-22 Created: 2012-01-22 Last updated: 2018-01-12Bibliographically approved
    4. Prescription and transcription errors in multidose-dispensed medications on discharge from hospital: an observationaland interventional study
    Open this publication in new window or tab >>Prescription and transcription errors in multidose-dispensed medications on discharge from hospital: an observationaland interventional study
    Show others...
    2013 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 1, p. 185-191Article in journal (Refereed) Published
    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.

    Keywords
    medication error, medication reconciliation, multi-dose dispensed medications, patient safety, prescription error, transition of care
    National Category
    Social and Clinical Pharmacy
    Research subject
    Pharmaceutical Science; Pharmacokinetics and Drug Therapy
    Identifiers
    urn:nbn:se:uu:diva-167137 (URN)10.1111/j.1365-2753.2011.01798.x (DOI)000314114400026 ()
    Available from: 2012-01-22 Created: 2012-01-22 Last updated: 2018-01-12
  • 39.
    Gillespie, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Alassaad, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Mörlin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Henrohn, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Bertilsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Hammarlund-Udenaes, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Effects of pharmacists’ interventions on appropriateness of prescribing for elderly and exploration of a possible correlation between scores for appropriateness and clinical outcomes: analyses from a randomized controlled trialManuscript (preprint) (Other academic)
    Abstract [en]

    Background:

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

    Methods:

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

    Results:

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

    Conclusion:

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

  • 40.
    Gillespie, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Mörlin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hammarlund-Udenaes, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Perceived value of ward-based pharmacists from the perspective of physicians and nurses2012In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 34, no 1, p. 127-135Article in journal (Refereed)
    Abstract [en]

    Background

    Clinical pharmacy in a hospital setting is relatively new in Sweden. Its recent introduction at the University Hospital in Uppsala has provided an opportunity for evaluation by other relevant professionals of the integration of clinical pharmacists into the health-care team.

    Objectives

    The objectives of this descriptive study were to evaluate the perceived value of wardbased clinical pharmacists from the perspective of hospital based physicians and nurses and to identify potential advantages and disadvantages related to the new inter professional collaboration. Another objective was to evaluate the experiences of general practitioners on receiving medication reports from wardbased clinical pharmacists.

    Setting

    Two acute internal medicine wards at the University Hospital in Uppsala, where a previously reported randomized controlled trial investigating the effects of ward based clinical pharmacists on re-visits to hospital was undertaken.

    Methods

    Data were collected by questionnaires containing closed- and openended questions. The questionnaires were distributed during the nine-month study period of the randomized controlled trial by an independent researcher to 29 hospital-based physicians and 44 nurses on the study wards and to 21 general practitioners who had received two or more medication reports. Answers were analysed descriptively for the closedended questions and by content analysis for the open-ended questions.

    Main outcome measure

    The main outcome measure was the physicians’ and nurses’ level of satisfaction with the new collaboration with clinical pharmacists, from a hospital and primary care perspective.

    Results

    Seventy-six percent of the hospital-based physicians and 81% of the nurses completed the questionnaire. Ninety-five percent of the physicians and 93% of the nurses were very satisfied with the collaboration. Out of the 17 general practitioners (81%) that completed the questionnaire 71% wanted to continue to receive medication reports in a similar way in the future. Increased patient safety and improvements in patients’ drug therapy were the main advantages stated by all three groups of respondents. Eighteen percent of the hospital-based physicians and 21% of the nurses thought that the collaboration had been time-consuming to certain or to a high extent.

    Conclusions

    The majority of the respondents, both GPs and hospital based physicians and nurses, were satisfied with the new collaboration with the ward based pharmacists and perceived that the quality of the patients’ drug therapy and drug-related patient safety had increased.

  • 41.
    Glad, Josefine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Current status of pharmacist annotations at Alfred Health: An audit of pharmacists’ documentation on medication charts2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: In the majority of Australian hospitals inpatient medication orders are written by hand. Pharmacists annotate medication orders to assist administration of medications and to ensure patient safety. An annotation is a comment regarding the medication order. Are the annotations clear and easy to interpret and secondly, are they consistent among the clinical pharmacists?

    Aim: The aim of the project was to collect, quantify and analyze the annotations made by pharmacists to medication orders at The Alfred, to ensure that pharmacists use a consistent and clear approach to provide the best possible assistance for clinical staff administering and prescribing medications.

    Methods: Medication charts for every second inpatient at The Alfred were photographed. All the photos were reviewed and data was collected and entered into a predetermined datasheet. Annotations on the medication charts were compared to the Alfred Health Clinical Pharmacist Practice Manual and the proportions of annotations that followed the guidelines were determined.

    Results: Annotations made by clinical pharmacists were overall accurate compared to the Alfred Health Clinical Pharmacist Practice Manual. But annotations regarding some areas – indication, IV-orders, short-course orders, therapeutic drug monitoring and high dose steroid orders – were lacking in the correctitude of the use.

    Conclusions: Annotations made by pharmacists at The Alfred are overall accurate, but annotations regarding some areas – indication, short-course orders and therapeutic drug monitoring – need improvement.

  • 42.
    Gustavsson, Lovisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Läkemedelshantering och Patientsäkerhet - en mätning inför förändring av läkemedelshanteringen på en ortopedisk vårdavdelning2011Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Inom hälso- och sjukvården är en hög patientsäkerhet viktig. Patientsäkerheten innefattar läkemedelshantering och studier har visat att brister inom läkemedelshantering kan få katastrofala följder. Sjuksköterskan hanterar läkemedel under stor del av sin arbetstid. För att öka patientsäkerheten inom läkemedelshanteringen är det viktigt att sjuksköterskan får arbeta i lugnt tempo i en miljö där risken för störningsmoment har minimerats.   Syfte: Att kartlägga delar av läkemedelshanteringen på avdelning 70D2 på Akademiska sjukhuset i Uppsala, med avseende på patientsäkerhet och tidsåtgång. Material och metoder: Patientsäkerhetsaspekten undersöktes genom att frekvensen fel vid läkemedelsdelning till 67 patienter studerades samt att dosrecepten för 23 ApoDos-patienter jämfördes med ordinationslistorna vid inskrivning. Tidsåtgången för sjuksköterskornas läkemedelshantering mättes med hjälp av stoppur i en observationsstudie. Antalet störningsmoment samt deras art registrerades med hjälp av pinnstatistik.  Resultat: Under observationen av läkemedelsdelningen upptäcktes fel hos 40 % av patienterna där fel administreringstid dominerade (96 %). Diskrepanser mellan ordinationslista och dosrecept upptäcktes hos 96 % av de studerade ApoDos-patienterna. Totalt upptäcktes 88 diskrepanser vilket motsvarade 39 % av alla preparat och 3,83 diskrepanser per patient. Av 161 studerade arbetstimmar hanterade sjuksköterskorna läkemedel i totalt 40 timmar (25 %). Av dessa utgjordes cirka 15 timmar (38 %) av störningsmoment. Totalt stördes sjuksköterskorna 417 gånger och ”kollega frågar något” var vanligast (24 %). Konklusion: Sjuksköterskor lägger mycket tid på läkemedelshantering och de störs väldigt ofta under denna tid. Detta innebär en risk för patientsäkerheten. Ordinationslistor vid inskrivning har en hög frekvens av diskrepanser vilket även det riskerar patientsäkerheten.

  • 43.
    Haga, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    PIM-check; a newly developed screening tool to identify potentially inappropriate prescribing in non-elderly patients.: A first step to validate the tool for use in Swedish hospitals2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: To reduce the risk of inappropriate prescribing a number of screening tools have been developed. Current screening tools are designed to be applicable in elderly patients. PIM-check (Potentially Inappropriate Medication Check-list for prescriptions in internal medicine) is a new screening tool and the first directed toward patients 65 years and younger. Elderly patients are prioritized when it comes to medication reviews, and there is a lack of knowledge about the need of medication reviews among non-elderly patients.

    Aim: The aim of this study was to evaluate the need for medication reviews in patients between 45 – 75 years of age and to start a validation process to evaluate PIM-check’s applicability in Swedish healthcare.

    Materials and Methods: An electronic health record based study, including 101 patients admitted to three wards at Uppsala University Hospital. Potentially inappropriate medications (PIMs) were identified using the PIM-check tool. Patients were divided into subgroups regarding age and number of drugs and compared in number of patients with PIMs. Also, patients with and without identified PIMs were compared regarding characteristics.

    Results: There was a difference in number of drugs between patients with PIMs and patients without PIMs. No difference was seen regarding age.

    Conclusions: Patients with more drugs were shown to have more PIMs and this should lead to further discussions about the need for medication reviews in patients with five or more drugs, even when below 75 years. Some discrepancies were seen between PIM-check’s criteria and Swedish national guidelines and this should be taken into account when used in Swedish healthcare.

  • 44.
    Hallenberg, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Rituximab vid behandling av granulomatös polyangit (Wegener): En retrospektiv studie från Akademiska sjukhuset i Uppsala, Sverige2011Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion Granulomatös polyangit (Wegener) (GPA (WG)) är en allvarlig sjukdom som orsakar inflammation på insidan av kroppens små blodkärl. Behandling utgörs av höga doser kortison samt cyklofosfamid. När sjukdomen är under kontroll ersätts cyklofosfamid av andra, mildare läkemedel. Benägenhet för återfall och med det ökad risk för allvarliga biverkningar av cyklofosfamid gör att behovet av säkrare behandlingsalternativ är stort. Syfte Syftet med denna studie var att utvärdera det biologiska läkemedlet rituximab med avseende på indikation för behandling, effekt och säkerhet vid underhållsbehandling av patienter med återkommande GPA (WG).   Material och metoder Retrospektiv insamling av journaldata. Patienter diagnosticerade med GPA (WG) enligt vedertagna kriterier, vårdade på reumatologiska kliniken vid Akademiska sjukhuset, som fått minst en infusion rituximab inkluderades och följdes till och med 2011-11-30. Resultat Elva patienter inkluderades varav sex var kvinnor. För tio av patienterna var behandlingsindikationen terapivikt med tidigare behandling. Medianåldern vid diagnos var 46 år och uppföljningstiden i genomsnitt 28 månader. Patienterna hade haft i genomsnitt tre återfall innan rituximab och antal olika läkemedel i genomsnitt drygt fem. Nio patienter har fått minst tre kurer rituximab och alla har svarat på behandlingen varav sju inte har några symptom från sin GPA (WG). Ur säkerhetssynpunkt var rituximab vältolererat med drygt fyra oönskade händelser per patient och år. Konklusion Resultaten av denna studie indikerar att rituximab kan fungera som underhållsbehandling vid GPA (WG) med benägenhet för återfall. Resultaten begränsas av att rituximabs effekt i förhållande till konventionell underhållsbehandling inte har studerats. Inte heller har potentiella risker vid långtidsexponering kunnat utvärderas.

  • 45.
    Hamid, Deniz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Pharmacist-led anticoagulant dosing service in an inpatient setting: management of supratherapeutic INRs2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Warfarin is the most widely prescribed anticoagulant for preventing and treating thromboembolism. Treatment with warfarin is complex and presents many challenges. In June 2013 the General Medical Unit (GMU) at the Alfred Hospital introduced pharmacist-led inpatient warfarin dosing. In this study, the compliance to Alfred Health’s warfarin guideline, in regards of managing supratherapeutic INR was assessed before and after pharmacist started dosing.  Aim: To assess the effectiveness of a pharmacist-led anticoagulant dosing service for the management of inpatients receiving warfarin and experiencing a supratherapeutic INR.  Methods: This was a retrospective study of patients admitted to GMU Oct12 - Mar13 (physician-led, pre–implementation) and Oct13 – Mar14 (pharmacist-led, post- implementation). Patients were included if they received warfarin and had at least one supratherapeutic INR. Management of supratherapeutic INR was compared to the recommended management as outlined in the Alfred Health Anticoagulation Guideline. Results: In pre-implementation 62 patient’s experienced 122 supratherapeutic INR’s, in post-implementation 63 patients experienced 164 supratherapeutic INR’s. The two groups were similar in age (p=0.87), length of stay (p=0.51) and indication for anticoagulation (p=0.67). A non-statistically significant improvement in the proportion of supratherapeutic INR with appropriate management was demonstrated in the pharmacist-led service (77.7 % pre-implementation vs 86.0% post-implementation; p=0.069). The average number of supratherapeutic INRs per patient increased for the post-implementation group (p=0.047). Conclusion:  Pharmacist-led management resulted in a non-statistically improvement in compliance with the Guideline in the inpatient setting, however there were more supratherapeutic INRs observed. Further research is required to clarify the impact of this service initiative. 

  • 46.
    Hovorkova, Zuzana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Monitoring of patients prescribed potassium supplements2019Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Monitoring of patients prescribed potassium supplements

    Zuzana Hovorkova

    Degree Project 30 hp, Pharmacotherapy

    Department of Pharmaceutical Biosciences/Division of Pharmacokinetics and Drug Therapy

    Supervisor: Linden Ashfield, Examiner: Margareta Hammarlund-Udenaes

    Introduction: In Northern Ireland, clinical technicians have been supporting pharmacist in their work in over five decades. From initially having mainly administrative tasks, the role of pharmacy technicians has progressed to more clinical activities. Following recent incidents caused by inadequate monitoring of potassium blood levels it was suggested pharmacy technicians could be utilized to improve patient care.

    Aim: Aim of this project was to ensure the appropriate monitoring and compliance with treatment guidelines for patients prescribed potassium supplements by extending the role of pharmacy technicians at Antrim Area Hospital.

    Methods: Training for extending the roles of clinical technicians was developed, following the structure of  a regional training programme. Literature search was made to find appropriate background about the subject of interest. Data about monitoring of potassium levels in the relevant patients was collected. Daily monitoring of these patients before and after the change was implemented were compared.

    Results: Clinical technicians contribution to monitoring of patients prescribed potassium replacement therapy improved guidelines compliance from 66.6 %  to 90 % (x2-test, p = 0.028). Percentage of successful treatment raised from 66 % to 89.7 % (x2-test, p = 0.028).

    Conclusion: By extending roles of the clinical technicians, better and appropriate monitoring of patients prescribed potassium supplements can be reached. In future, roles of the pharmacy technicians could be extended further, thus releasing  pharmacists time to expand their role, leading to a more cost- effective system and ensuring medicines optimization.

  • 47.
    Hulo, Dina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    God läkemedelsbehandling för äldre- En kvalitativ studie kring landstingens arbete med läkemedelsmålen i överenskommelsen om sammanhållen vård och omsorg om de mest sjuka äldre.2012Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Under de senaste 20 åren har förskrivningen av läkemedel hos äldre ökat med ca 70 %. Polyfarmaci hos äldre i kombination med försämrade organfunktioner gör att äldre är mer benägna att drabbas avläkemedelsrelaterad sjuklighet. Läkemedelsbiverkningar ligger idag bakom 30 % av akuta sjukhusinläggningar av äldre. Staten och Sveriges Kommuner och Landsting, har slutit en överenskommelse i syftet att främja en sammanhållen vård och omsorg om de mest sjuka äldre, där god läkemedelsbehandling för äldre, är ett av de områden som prioriteras. Syfte: Att identifiera vilka insatser man i olika landsting har vidtagit för att nå läkemedelsmålen i överenskommelsen och att få en uppfattning om vilka svårigheter och framgångsfaktorer man upplever sig ha stött på under arbetet. Metod och Material: Studien är en explorativ kvalitativ intervjustudie. Fjorton landsting deltog i studien. Materialet analyserades med hjälp av manifest innehållsanalys. Resultat: Olika insatserna som landstingen har vidtagit för att nå läkemedelsmålen i äldreöverenskommelsen har identifierats. Sex olika kategorier erhölls från intervjuerna; arbetets framgångsfaktorer, svårigheter med arbetet, synpunkter på överenskommelsen/läkemedelsindikatorer, samverkan mellan kommuner och landsting, ledning och styrnings roll i arbetet, satsningen i primär-/slutenvård. Konklusion:Läkemedelsmålen i överenskommelsen om sammanhållen vård och omsorg om de mest sjuka äldre, upplevs ha gett en ökad fokus på området om äldres läkemedelsanvändning. Läkemedelsmålen bör dock enligt respondenterna utvecklas och valideras ytterligare för att nå den förbättringen i kvaliteten, dessa avses att ge.

  • 48.
    Hällkvist, Caroline
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Sociodemografiska faktorers koppling till tilltro vid generikautbyte.: En enkätstudie utförd på apotekskunder vid svenska öppenvårdsapotek.2015Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Generiskt utbyte genererar betydande besparingar för samhällets läkemedels-kostnader. Även patienters läkemedelskostnader sjunker. Kritik har riktats mot utbytet med en oro att det skulle kunna leda till försämrad patientsäkerhet. Sociodemografiska faktorer är underrepresenterade i forskning kring vilka faktorer som påverkar tilltron vid generiskt utbyte.

    Syfte: Denna studie syftar till att analysera om svenska apotekskunders tilltro till bioekvivalensen mellan utbytbara läkemedel varierar med sociodemografiska faktorer. Specifikt avses samvariationen mellan tilltro till bioekvivalens mellan utbytbara läkemedel och kön, ålder, inkomst, utbildningsnivå samt antalet läkemedel patienten tar dagligen, att studeras. Detta för att ge ny information till både hälso- och sjukvårdspersonal samt beslutsfattare för att göra det generiska utbytet så patientsäkert och effektivt som möjligt.

    Material och metoder: Data insamlades med enkäter på svenska öppenvårdsapotek till denna kvantitativa tvärsnittsstudie. En validerad skala användes för att bedöma respondenternas tilltro och data analyserades i statistikbehandlingsprogrammet SPSS.

    Resultat: Populationens (N = 719) median i tilltrosindex var 9,00. Lägsta möjliga värdet var 4 och högsta möjliga värdet var 20, högre värde innebär lägre tilltro. Tilltron hade statistisk samvariation med inkomstnivå samt acceptans av generiskt utbyte. Medelvärde i tilltrosindex skiljde sig signifikant mellan könen (p < 0,0001), mellan grundskole- och gymnasieutbildade (p = 0,013) och mellan grundskole- och högskole-/universitetsutbildade (p = 0,001).

    Konklusion: Nästan en femtedel av studiepopulationen hade högsta möjliga tilltro. Mer frekvent acceptans av generiskt utbyte indikerar högre tilltro liksom högre inkomst samt högre utbildningsgrad. Kvinnorna i studiepopulationen hade något lägre tilltro än män.

  • 49. Härmark, Linda
    et al.
    van Hunsel, Florence
    Grundmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    ADR Reporting by the General Public: Lessons Learnt from the Dutch and Swedish Systems2015In: Drug Safety, ISSN 0114-5916, E-ISSN 1179-1942, Vol. 38, no 4, p. 337-347Article, review/survey (Refereed)
    Abstract [en]

    Consumer reporting of adverse drug reactions (ADRs) has existed in several countries for decades, but throughout Europe the role of consumers as a source of information on ADRs has not been fully accepted until recently. In Europe, The Netherlands and Sweden were among the first countries to implement consumer reporting well before it was mandated by law throughout the EU. Consumer reporting is an integral part of the spontaneous reporting systems in both The Netherlands and Sweden, with yearly numbers of reports constantly increasing. Consumer reporting forms and handling procedures are essentially the same as for healthcare professional reporting; the message in the reports, not the type of messenger, is what is of importance. Studies have established the significant contribution of consumer reporting to ADR signal detection. Combining all reports regardless of reporter type is recommended since it yields the largest critical mass of reports for signal detection. Examples of signals where consumer reports have been of crucial importance for signal detection are electric shock-like sensations associated with the use of duloxetine, and persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. An example of consumer reporting significantly strengthening a detected signal is Pandemrix(®) (influenza H1N1 vaccine)-induced narcolepsy. Raising public awareness of ADR reporting is important, but time- and resource-consuming. The minimum effort taken should be to passively inform consumers, e.g. via stakeholders' homepages and via drug product information leaflets. Another possibility of reaching out to this target group could be through co-operation with other (non-government) organizations. Information from consumer reports may give a new perspective on ADRs via the consumers' unfiltered experiences. Consumers' views may change the way the benefit-harm balance of drugs is perceived and assessed today, and, being the ultimate users of drugs, consumers could have a relevant influence in the regulatory decision-making processes for drugs. All stakeholders in pharmacovigilance should embrace this new valuable source of information.

  • 50.
    Janssens, Rosanne
    et al.
    Department of Pharmaceutical and Pharmacological Sciences,KU Leuven, Leuven, Belgium.
    Russo, Selena
    Applied Research Division for Cognitive and Psychological ScienceIEO European Institute of Oncology, Milan, Italy; Faculty of Medicine, School of Women’s and Children’s HealthUniversity of New South Wales, Kensington, Australia; Behavioural Sciences Unit, Kids Cancer CentreSydney Children’s Hospital, Randwick, Australia.
    van Overbeeke, Eline
    Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
    Whichello, Chiara
    Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands.
    Harding, Sarah
    Takeda International, London, UK.
    Kübler, Jürgen
    QSciCon, Marburg, Germany.
    Juhaeri, Juhaeri
    Sanofi, Bridgewater, USA.
    Schölin Bywall, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Comanescu, Alina
    Community Health Association Romania, Bucharest, Romania.
    Heuber, Alex
    Department of Internal Medicine 3, Rheumatology and ImmunologyFriedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
    Englbrecht, Matthias
    Department of Internal Medicine 3, Rheumatology and ImmunologyFriedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
    Nikolenko, Nikoletta
    John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
    Pravettoni, Gabriella
    Applied Research Division for Cognitive and Psychological ScienceIEO European Institute of Oncology, Milan, Italy.
    Simoens, Steven
    Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
    Stevens, Hilde
    Institute for Interdisciplinary Innovation in Healthcare (I3h), Université libre de Bruxelles, Brussels, Belgium.
    Hermann, Richard
    AstraZeneca, Gaithersburg, USA.
    Levitan, Bennett
    Global R&D Epidemiology, Janssen Research & Development, Titusville, USA.
    Cleemput, Irina
    Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
    de Bekker-Grob, Esther
    Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands.
    Veldwijk, Jorien
    Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands.
    Huys, Isabelle
    Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
    Patient Preferences in the Medical Product Life Cycle: What do Stakeholders Think? Semi-Structured Qualitative Interviews in Europe and the USA2019In: Patient, ISSN 1178-1653, E-ISSN 1178-1661Article in journal (Refereed)
    Abstract [en]

    Background

    Patient preferences (PP), which are investigated in PP studies using qualitative or quantitative methods, are a growing area of interest to the following stakeholders involved in the medical product lifecycle: academics, health technology assessment bodies, payers, industry, patients, physicians, and regulators. However, the use of PP in decisions along the medical product lifecycle remains limited. As the adoption of PP heavily relies on these stakeholders, knowledge of their perceptions of PP is critical.

    Objective

    This study aimed to characterize stakeholders’ attitudes, needs, and concerns with respect to PP in decision making along the medical product lifecycle.

    Methods

    Semi-structured interviews (n = 143) were conducted with academics (n = 24), health technology assessment/payer representatives (n = 24), industry representatives (n = 24), patients, caregivers and patient representatives (n = 24), physicians (n = 24), and regulators (n = 23) from seven European countries and the USA. Interviews were conducted between April and August 2017. The framework method was used to organize the data and identify themes and key findings in each interviewed stakeholder group.

    Results

    Interviewees reported being unfamiliar (43%), moderately familiar (42%), or very familiar (15%) with preference methods and studies. Interviewees across stakeholder groups generally supported the idea of using PP in the medical product lifecycle but expressed mixed opinions about the feasibility and impact of using PP in decision making. Interviewees from all stakeholder groups stressed the importance of increasing stakeholders’ understanding of the concept of PP and preference methods and ensuring patients’ understanding of the questions asked in PP studies. Key concerns and needs in each interviewed stakeholder group were as follows: (1) academics: investigating the validity, reliability, reproducibility, and generalizability of preference methods; (2) health technology assessment/payer representatives: developing quality criteria for evaluating PP studies and gaining insights into how to weigh them in reimbursement/payer decision making; (3) industry representatives: obtaining guidance on PP studies and recognition on the importance of PP from decision makers; (4) patients, caregivers, and patient representatives: providing an incentive and adequate information towards patients when participating in PP studies; (5) physicians: avoiding bias as a result of commercial agendas in PP studies and clarifying how to deal with subjective and emotional elements when measuring PP; and (6) regulators: avoiding the misuse of PP study results to overrule the traditional efficacy and safety criteria used for marketing authorization and obtaining robust PP study results.

    Conclusions

    Despite the interest all interviewed stakeholder groups reported in PP, the effective use of PP in decision making across the medical product lifecycle is currently hampered by a lack of standardization and consensus on how to both measure and use PP.

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