lnu.sePublications
Change search
Refine search result
12345 1 - 50 of 229
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Aalto, Mervi Anneli
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Vill kunder handla receptfria läkemedel i dagligvaruhandeln?: - En enkätundersökning2008Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpStudent thesis
    Abstract [sv]

    Sammanfattning

    I Sverige har det statliga apoteketsmonopolet ifrågasatts en längre tid och regeringen utreder nu möjligheten att konkurrensutsätta läkemedelsförsäljningen. Det har även föreslagits i den statliga utredningen (SOU 2008:4 del 2) att ett begränsat sortiment av OTC läkemedel (over the counter = receptfria läkemedel) ska få säljas i dagligvaruhandeln utan farmaceutiskt kompetenskrav. Vid korrekt användning och tillgång till rätt rådgivning kan OTC läkemedel vara till en stor hjälp för den enskilde individen vid egenvård och därigenom också bidra till avlastning på sjukvårdens resursers. Vid felanvändning av OTC läkemedel (över/underdosering, fel indikationsområde etc.), kan de istället få motsatt effekt. Syftet med denna enkätstudie var därför att utforska om konsumenter av OTC läkemedel i Sverige önskar få tillgång till dessa läkemedel i t ex livsmedelsbutiker, där de inte har tillgång till personlig farmaceutisk rådgivning, vidare var avsikten att undersöka hur de i dagligvaruhandeln önskade få läkemedelsinformation. I februari 2008 gjordes en enkätstudie i Västervik som inkluderade 48 deltagare varav 29 kvinnor och 19 män. Studien visade att 71 % av deltagarna hade en positiv inställning till att köpa OTC läkemedel i livsmedelsbutiker, 58 % skulle skaffa information genom läkemedelsförpackning och bipacksedel i kombination med att de tidigare använt läkemedlet. Önskan om tillgång till personlig rådgivning på inköpsstället var störst i åldern ≤ 35 år, där 38 % ansåg sig vilja det. Slutsats av studien är att majoriteten vill kunna handla OTC läkemedel i dagligvaruhandeln och information skulle de få främst från läkemedelsförpackning/bipacksedel i kombination med erfarenheter från tidigare användning.

    2008:F5

    Download full text (pdf)
    FULLTEXT01
  • 2.
    Abada, Mariam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Vilka problem finns det med förfalskade läkemedel?2014Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Världsmarknaden för läkemedlen beräknades år 2011 till 900 miljarder US$ enligt IMS-health. Marknaden för illegala läkemedel uppskattas vara värd mellan 75-200 miljarder dollar. I Sverige uppskattas den illegala läkemedelsmarknaden till motsvarande ≤0,5 %. Straffet för insmuggling av läkemedel till Sverige är böter eller max 2 års fängelse. Tullverket räknar med att man endast hittar 10 % av det som smugglas in. I andra länder kan straffet variera mellan böter (ekonomisk brottslighet i Afrika) till dödsstraff i Kina.

    I Utvecklingsländerna uppskattas 10-30 % av alla läkemedel som säljs vara förfalskade, jmf 1 % I-länderna. l. Förekomsten av förfalskade läkemedel har många allvarliga konsekvenser på människor som exempelvis, utebliven effekt, toxiska reaktioner, förgiftningar, som kan i värsta fall leda till döden. Ett annat alvarligt problem är resistensutveckling, ökad spridning av smittsamammasjukdomar som exempel, tuberkulos och/ eller HIV/AIDS.

    Syftet med detta examensarbete är att besvara frågan: Vilka problem ger den ökande förekomsten av förfalskade läkemedel i samhället. Undersökningen fokuserar på livstidsläkemedel, dvs ett läkemedel en person måste ta resten av sitt liv för behandling av sin kroniska sjukdom.

    För att komma till rätta med de problem, som förfalskade läkemedel, skapar krävs ett mer utvecklat samarbete mellan olika läkemedelsmyndigheter, läkemedelsföretag, internationella polisorganisationer, tull m.fl. Arbetet med att utveckla förpackningar som är svåra att förfalska bör intensifieras. Straffsatser bör kanske ses över. Det är viktigt att öka medvetandet bland allmänheten om risker med att köpa läkemedel utanför apotek (t ex via nätet).

    Download full text (pdf)
    fulltext
  • 3.
    Abdo, Jasmin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Tidig insulinbehandling för typ II diabetiker2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Diabetes mellitus är en av de vanligaste endokrina sjukdomarna och de vanligaste formerna är typ I och typ II. Idag har ca 350 000 personer i Sverige diabetes och av dessa har 85-90% diabetes typ II. Typ II diabetes börjar med insulinresistens och så småningom blir det avtagande funktion av β- cellerna vilket leder till nedsatt insulinkänslighet och främsta orsakerna till typ II diabetes är övervikt och fetma. Det finns olika behandlingsrekommendationer för att behandla typ II diabetiker för att minska att sena komplikationer uppstår. Främst genom livsstilsförändringar som kost och fysisk aktivitet, men då dessa inte räcker till kan perorala läkemedel komma i efterhand och om inte det heller ger tillräcklig effekt kan insulinbehandling sättas in. Ca 50 % av typ II diabetiker får insulin efter 10 års sjukdom.

    Syftet med arbetet är att undersöka om det finns en god implikation av att sätta in insulin tidigare än det som redan är rekommenderat.

    Denna litteraturstudie är baserad på artiklar hämtade från databasen PubMed. Sammanlagt har fem randomiserade kontrollerade studier granskats.

    Resultaten visar att en HbA1c-sänkning med ca 1,5 - 2,0 % kan erhållas samt också en bibehållen β- cellfunktion vid insättning av insulin. Insulinbehandlingen bör sättas in så snart HbA1c går över 7,5 % istället för att vänta en viss tid. Den kan sättas in hos behandlingsnaiva personer med framträdande symtom eftersom insulin fortfarande sänker HbA1c och det finns inget som tyder på att insulin inte kan sättas in tidigare än det som är rekommenderat.

    Slutsatsen som dras är att stödja intensiv behandling som gör att HbA1c hålls på en så låg nivå det är möjligt och när målvärden för HbA1c inte kan hållas kan insulin med fördel sättas in hos typ II diabetiker som behandlats med perorala antidiabetika.

    Download full text (pdf)
    fulltext
  • 4.
    Acuña, Ulyana Muñoz
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Ohio State Univ, USA.
    Ezzone, Nathan
    Ohio State Univ, USA.
    Rakotondraibe, L. Harinantenaina
    Ohio State Univ, USA.
    De Blanco, Esperanza J. Carcache
    Ohio State Univ, USA.
    Activity in MCF-7 Estrogen-sensitive Breast Cancer Cells of Capsicodendrin from Cinnamosma fragrans2021In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 41, no 12, p. 5935-5944Article in journal (Refereed)
    Abstract [en]

    Background/Aim: Effect of capsicodendrin on the NF-KB pathway was studied in MCF-7 cancer cells. Materials and Methods: The transcription factor assay was used to screen for NF-KB activity. The effect on IKK beta, ICAM-1, and caspase-7 were studied using western blot. Caspase-1 was studied using Promega Caspase-Glo (R) assay. Reactive oxygen species (ROS) were detected using the fluorescent probe DCFH-DA. The potentiometric dye JC-1 was used to assess mitochondrial membrane potential (Delta psi m) and the cell cycle was examined using a fluorescence-activated cell sorter. Results: NF-kappa B p65 inhibitory effect was IC50=8.6 mu M and cytotoxic activity was IC50=7.5 mu M. The upstream IKK and the downstream ICAM-1 were down-regulated. Sub G1-phase population increased to 81% after 12 h of treatment with capsicodendrin (10 mu M) and there was no loss of Delta psi M. Conclusion: Increased levels of intracellular ROS promoted activity of caspase-1 and induced cell death in MCF-7 cells. Capsicodendrin may be a future anticancer agent that prevents the progression of metastatic breast cancer.

  • 5.
    Adolfsson, Matilda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Anthelmintika mot hästens inälvsparasiter: en studie av effekt, resistensförekomst och försäljning2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Download full text (pdf)
    fulltext
  • 6.
    Ahmad Ghafour, Soz
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kan behandling med antidepressiva läkemedel påverka sjukdomens svårighetsgrad och självmordstankar/självmordshändelser hos barn och ungdomar med egentlig depression?2018Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Suicide is a public health problem that, in addition to loss of human life, leads to extensive psychological suffering and impairment of the health of relatives. It is common that suicide occurs under the influence of mental illness such as personality disorders and depression. Depression is a serious condition that often causes severe suffering. Depression can affect all ages, i.e. children, adolescents, adults and the elderly and it is as costly as heart disease. In Sweden, depression is one of the most common psychiatric diagnoses. About 19 percent of the population (16-84 years) have been diagnosed with depression at least once in their lifetime.  Of these, almost one in three have been diagnosed more than once. The affected individual performs poorly in daily activities such as school, work and in social settings. Additionally, there is increased risk of suicide in depressed individuals. Accordingly, it is important to treat depression to reduce suffering. Depression in children was accepted as the same disease as in adults since 1980. Today, depression is treated primarily with first-line therapy SSRIs. The aim of this work was to examine the effect and safety of antidepressants in the treatment of major depresive disorder in chlidren and adolescents with special reference to suicidal activity and self-injury. To implement this study, scientific articles were obtained in Pubmed, and five articles were selected. Study 1 showed that the combination of fluoxetine and CBT, cognitive behavior therapy, had better effect than treatment with only flouxetin or with only CBT. Study 2 showed that suicidal events and ideation were least among the group treated with the combination of fluoxetine and CBT compared to the treatment with only fluoxetine or only CBT. Study 3 showed that more suicide-related events occurred among the group with previous non-suicidal self-injury, NSSI. Study 4 resulted in greater medical response and better remission in escitalopram patients compared to placebo. Study 5 showed that treatment with venlafaxine caused serious adverse events that led to many discontinuing treatment. Treatment with antidepressants, especially in combination with CBT, can reduce the severity of depression in children and adolescents and reduce suicidal ideation and suicide attempts in some patients. In cases of treatment failure a risk of suicide and self-injury remains. Previous self-injury increases the risk of future self-injury as well as the risk of future suicide attempts.

    Download full text (pdf)
    fulltext
  • 7.
    Al-Assadi, Obaidah
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Järnbristanemi och behandlingsmetoder: Jämförelse av effektivitet och säkerhet av intravenösa och orala järnbehandlingar av järnbristanemi vid graviditet och postpartum hos kvinnor.2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Oxygen is transported in the body from the lungs to tissues while bound to hemoglobin in erythrocytes. Specifically in hemoglobin it is the iron atom that binds the oxygen. Synthesis of erythrocytes place iron, folic acid and vitamin B12. A lack of these compounds leads to anemia.

    Anemia affects about 1/3 of the world's population. It is defined as lower-than-normal levels of healthy erythrocytes and deprives the body's tissues of oxygen. The most common form of anemia is caused by iron deficiency. Iron deficiency occurs in two forms, absolute or functional iron deficiency. Absolute iron deficiency is central for this study. Absolute iron deficiency implies low or empty iron storages which can cause iron deficiency anemia. This occurs in the event of, among other factors, increased demand for iron, reduced iron content in the food, malabsorption or chronic bleedings. Approximately 1.2 billion people have iron deficiency anemia worldwide. The most common side effects are headache, paleness, fatigue and dyspnea. During pregnancy the need for iron triples to be able to support the mother's increase of blood plasma, erythrocytes, the growth of the fetus and the placenta and to compensate for the blood loss during childbirth. If you have low or empty iron stores before pregnancy, you are at risk for iron deficiency anemia. Iron deficiency anemia in pregnant women increases the risk of prematurity, low birth weight and miscarriage. The risk of maternal mortality has a direct correlation with the severity of iron deficiency anemia. If iron deficiency anemia is left untreated, the newborn has an increased risk of suffering from iron deficiency anemia and also a negative impact on the cognitive development. When treating iron deficiency anemia, oral iron is the primarily treatment but in more severe cases intravenous iron is given.

    The objective of this study was to compare the efficacy and safety of intravenous and oral iron treatment for iron deficiency anemia in pregnancy and postpartum women.

    The method used consists of several searches on Pubmed where six clinical studies that fit the aim of this report were chosen.

    The results from all these articles indicate that intravenous treatment of iron deficiency anemia is more effective at increasing Hb values ​​and iron storages with increased compliance and fewer side effects. The iron preparation that was most promising was ferric carboxymaltose.

    Although this study had several limitations that could have been improved by using more homogeneous clinical studies, the results from all six studies favored the intravenous treatment over the oral treatment. However, all pregnant women should take oral iron supplements early on as a preventive measure in the first trimester to avoid developing iron deficiency anemia. Intravenous iron should be used as a last resort in more severe types of anemia, malabsorption and to increase compliance.

    Download full text (pdf)
    Järnbristanemi och behandlingsmetoder
  • 8.
    Alexandersson, Sandra
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Akutpreventivmedel: Hur skiljer sig effektivitet och säkerhet för de tre godkända metoderna levonorgestrel, ulipristal och kopparspiral?2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    I Sverige är abort en laglig rättighet och det finns flera godkända metoder för regelbunden antikonception. Ändå finns ett behov av akutmetoder för att förhindra oönskad graviditet.  Det finns tre godkända akutpreventivmedelsmetoder; levonorgestrel, ulipristal och kopparspiral. Detta arbetes syfte var att undersöka effektivitet och säkerhet för dessa tre godkända metoder. En litteratursökning gjordes i databasen PubMed,  7 artiklar valdes ut för analys. Artikel 1och 2 undersökte levonorgestrels effektivitet och säkerhet och kunde redovisa graviditetsfrekvenser på 0, 57%  och 0,67 % , samt en graviditetsförebyggande effektivitet på 68 %. Artikel 3 jämförde ulipristal och levonorgestrel och redovisade graviditetsfrekvenser på 1,8 % för ulipristal och 2,6 % för levonorgestrel. Även ”non-inferiority” konstaterades med OR på 0,68. Artikel 4 undersökte levonorgestrels effektivitet och redovisade graviditetsfrekvenser på 2,0 % (12 h- gruppen) och 1,9 % (24 h- gruppen), dessutom redovisades en graviditetsförebyggande effektivitet på 72 % (12 h- gruppen) och 75 % (24 h- gruppen). Artikel 5 jämförde ulipristal och levonorgestrel och fann att ulipristalbehandling  är ”non-inferiority” till levonorgestrelbehandling. Artikel 6 undersökte ulipristals effektivitet och redovisade en graviditetsfrekvens på 2, 1 % och en graviditetsförebyggande effektivitet på  62, 3%. Artikel 7 undersökte kopparspiralens effektivitet och kunde redovisa 100 % graviditetsförebyggande effektivitet. Akutpreventivmedel fungerar inte alltid, men förhindrar oönskade graviditeter. Slutsatsen är att resultaten ger stöd för gällande behandlingsrekommendationer.

    Download full text (pdf)
    fulltext
  • 9.
    Ali, Dholfoqar
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Vilken effekt har statiner vid primär- och sekundärprevention av hjärt- och kärlsjukdomar?2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Lipid-lowering drugs, mostly statines, were dispensed during 2011 to 815 000 people from the pharmacies in Sweden. High cholesterol is a major risk factor for development of coronary heart disease (myocardial infarction, angina, intermittent claudicatio intermittens and stroke). Coronary heart disease is the causes of more than 40% of all deaths in Sweden.Lifestyle changes, together with lipid-lowering drugs, statines, are effective treatments. Statines can be administered either to patients that have had a cardiac event i.e. heart attack, stroke (secondary care) or to persons with risk factors i.e. high levels of cholesterol, diabetes, primary care.

    Objective: with the help of published clinical trials and meta-analysis examine what effect statines have on morbidity / mortality in cardiovascular diseases in primary and secondary care.

    Results: The studies showed that statins reduce TC, LDL and TG and increase HDL. They also showed that statins reduce major coronary events, cerebrovascular events, mortality from coronary heart disease, unstable angina and revascularization. Statin therapy was associated with increased risk of moderate or severe liver failure, acute renal failure, moderate or severe myopathy and cataracts in both men and women. The risk was dose-dependent and greatest at the first year of treatment.

    Conclusion: The studies showed that statine treatment reduced the blood level of harmful cholesterol, prevented the atherosclerotic process and thus reduced the need for revascularization. Statin therapy is about two - three times as effective in secondary care as in primary care. One need to treat 60 people, who have had a coronary heart event, during about 5 years to prevent one death and 180 people to prevent a nonfatal cardiovascular event. The effect is similar for men and women and for older and middle aged people. Life expectancy increases by two years. For patients who not have had a coronary heart event but have risk factors i.e. high cholesterol levels, diabetes, one need to treat two - three times as many to achieve the same results (120 patients to prevent one death and 330 to prevent one nonfatal cardiovascular event). The effects of treating healthy individuals with statines are low.Statines are well-established and safe drugs. One noteworthy side effect is myopathy, (rhablomyelos) which is quite unusual as reported from studies.One problem that exists in all prescribed preventive treatments is poor adherence to prescriptions.

    Download full text (pdf)
    statiners effekt
  • 10.
    Alimjanova, Aziza
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Hur vanligt är det med terapimisslyckande med SSRI-preparat?2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Download full text (pdf)
    fulltext
  • 11.
    Almqvist, Sara
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Apotekskunders upplevelser av att tabletterna smular vid delning och vad de gör med smulorna2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In Sweden, about 10 percent of the prescriptions have a dosage with split tablets. Many patients have problems with breaking tablets into two or more parts as the tablet may crumble or break into many small pieces. The aim with this work is to examine to which extent patients experience crumbled tablets when trying to split tablets and what the patient does with the crumbles.

    In order to examine patients experience with crumbled tablets, interviews with patients who collected a prescription with a dosage with divided tablets in one of twelve pharmacies, were done. Included patients had to be 18 years or older.

    Of the 416 included patients with experience of splitting tablets, 123 had problems with tablet splitting and out of these 29 found the issue with tablets crumbling to be a problem. Overall, 174 patients experienced crumbled tablets. Patients, who didn’t experience crumbled tablets, were less likely to split tablets with a tool than patients who did experience crumbled tablets. 93 of 380 patients collected crumbles equivalent to half a tablet and consumed the crumbles while 80 patients discarded the crumbles (threw them away).

    Many patients use the crumbles instead of throwing them away even though it is difficult to tell how much of the drug you obtain with the crumbles. It seems as if the way you choose to divide the tablet (with or with out a tool) is affecting whether you experience crumbling or not. Most people don’t experience crumbling and of those who do only one out of six considers it to be a problem. In Sweden in whole the interviews give a slight estimate for how many patients the problem is persistent. In rough numbers it is estimated that 37- 47.000 had experienced crumbled tablets whereas 4.500-10.500 found it be a problem.

    Download full text (pdf)
    FULLTEXT01
  • 12.
    Alqaysi, Faeza
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Effekter av befintliga och eventuella framtida läkemedelsbehandlingar på morbiditet och mortalitet hos patienter med hjärtsvikt.2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:  Heart failure is a multidimensional phenomenon with high mortality. Heart failure is treated with angiotensin converting enzyme (ACE) - inhibitors or angiotensin receptor blockers (ARBs) that counteract neurohormonal stimuli that occur in heart failure, as well as providing vessel dilatation, which reduces symptoms and the need for hospitalization and increases survival. Despite this, only about 50% of heart failure patients survive 6 years after diagnosis with drug therapy, and as heart failure is increasing globally, due to improved care and treatment and increasing life expectancy of the population, there is a great need for new drugs such as LCZ696 that acts by dual inhibition of the renin - angiotensin - aldosterone system and neprilysin inhibition.

    Objective: The aim of this literature study was to evaluate the efficacy of current treatment and possible future treatments on mortality and morbidity in heart failure patients.

    Results: The examined articles show that treatment with ACE inhibitors in patients with symptomatic heart failure reduces the risk of total mortality by 16% over 3.5 years, reduces all-cause mortality or hospitalization due to heart failure with NNT (number needed to treat) = 10.4 over 3.5 years and increases median survival by 9.2 months over 12.1 years in patients with asymptomatic heart failure. Treatments with high-dose ACE inhibitors reduce mortality and hospitalization because of cardiovascular causes and hospitalizations from any cause by NNT = 30 over 3 years. Beta-blockers reduce sudden death and total mortality and cardiac death or non - fatal myocardial infarction with NNT = 38 and NNT = 23, respectively, over 12 months. Treatment with the new drug LCZ696 reduces mortality due to cardiovascular causes with NNT = 21 over 27 months, reduces hospitalizations due to heart failure with NNT = 36 over 27 months and reduces deaths from any cause with NNT = 34 compared to treatment with ACE inhibitors.

    Conclusion: The studies show that both ACE inhibitors and beta-blockers have clear beneficial effects in the treatment of heart failure. Treatment with ACE inhibitors for 3.5 years compared to placebo reduces total mortality by a NNT value of about 22. Treatment with beta-blockers during 1 year compared with placebo reduces total mortality by a NNT value of 24. Treatment with the new drug LCZ 696 for 27 months compared with ACE inhibitors reduces total mortality with a NNT value of 36. One remaining problem is that 50% of patients with severe heart failure (NYHA class IV) die within a year.

    Download full text (pdf)
    fulltext
  • 13.
    Andersson, Angelica
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Pimobendan som humanläkemedel: Varför inte?2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Heart failure is a heterogeneous disease where the heart due to functional or structural reasons fails to provide the body with adequate blood flow. One treatment strategy is to increase the contraction of the cardiac muscle through the use of positive inotropic agents. Since long term use of PDE 3 inhibitors proved harmfull instead calcium sensitizers where developed. Calcium sensitizers work by affecting the contractile mechanism of the heart muscle cells directly and independently of calcium concentrations. The development of the calcium sensitizing drug pimobendan for treatment of heart failure in humans was discontinued in 1996. Since then the drug has proved very effective for veterinary use and is registered and in clinical use for the treatment of clinical and preclinical heart failure in dogs.

    Aim: With respect to the effects of the drug in veterinary use the author wanted to investigate whether the reasons for discontinuing development of pimobendan for use in humans where well grounded.

    Method: In this literature study six articles where included. The database PubMed was used for searching articles with the search terms ‘pimobendan’ and ‘pimobendan and heart failure’. Three articles described double blinded randomized controlled clinical trials. Three articles described the effects of pimobendan when used as an additional drug for the treatment of specific subgroups.

    Results: Six studies where investigated. These studies showed positive effects from pimobendan treatment on physical activity and NYHA functional class as well as with respect to neurohormonal functions and the need for emergency treatment and hospitalization. Pimobendan was described as well tolerated. One studie showed a non significant increase in mortality rate associated wih the use of pimobendan.

    Conclusion: The developement of pimobendan as a drug for human use where discontinued the same year one studie showed tendencies for an increase in mortality for patients treated with the drug. This happened at the same time as other inotropic agents where abandoned. Today the knowledge about heart failure and its optimal background treatment has increased. The causes for abandoning pimobendan may have been reasonable in 1996 but new studies today could prove very interesting.

    Download full text (pdf)
    fulltext
  • 14.
    Andersson, Elena
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kan kombinationsterapi CTLA-4 hämmare ipilimumab och PD-1 hämmare nivolumab eller pembrolizumab ge en bättre behandlingseffekt mot malignt melanom?2020Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Malignt melanom är den tredje vanligaste cancersjukdomen i Sverige och drabbar både kvinnor och män. Det kännetecknas av en växande mörk fläck större än 5 mm som oftast uppstår i befintliga nevi, dock kan det även börja som ny förändring i huden. Malignt melanom bör misstänkas om gamla nevi ändrar storlek, form, växer snabbt, kliar och blöder. Den vanligaste formen är ytligt spridande malignt melanom som botas med kirurgi. Om tumören inte opereras bort, kan den med tiden sträcka sig ner i huden och ge metastaser. Behandlingen av melanom som spridit sig beror på i vilket stadie (I-IV) tumören befinner sig, där stadie IV är det allvarligaste. Prognosen vid malignt melanom har länge varit dålig men nu finns det immunterapi som ger bättre totalöverlevnad (OS) och en längre progressionsfri överlevnad (PFS). CTLA-4-hämmare, ipilimumab och PD-1-hämmare, nivolumab alternativt pembrolizumab är T-cellsaktivernade antikroppar som används vid melanombehandling. Syftet med detta arbete var att undersöka vilken behandling som ger bättre klinisk nytta med avseende på bättre OS och längre PFS hos patienter med malignt melanom, om behandling med ipilimumab som monoterapi eller i kombination med nivolumab eller pembrolizumab är att föredra? Detta är en litteraturstudie där fem artiklar om effekten av ipilimumab som monoterapi samt i kombination med nivolumab eller pembrolizumab ensamt analyseras. Alla fem studier hämtades från Pubmed. Patienter som fick kombinationsbehandlig av ipilimumab + novilimumab fick en bättre OS och en längre PFS jämfört med patienter som fick ipilimumab som monoterapi. Efter en medianuppföljningstid på 3 år var median PFS 2,9 månader (95% konfidensintervall (CI), 2,8 – 3,2) för ipilimumabgruppen jämfört med 11,5 månader (95% CI, 8,7 – 19,3, p <0,001) i ipilimumab+nivolumabgruppen. Det var 34% patienter som överlevde efter tre år med ipilimumab ensamt jämfört med 58% med kombinationsbehandling. Kombinationsbehandling gav bättre effekt på OS och PFS men på bekostnad av flera toxiska, behandlingsrelaterade biverkningar. Det behövs mer forskning kring dessa läkemedel för att hitta biomarkörer och för att minska biverkningarna.

    Download full text (pdf)
    fulltext
  • 15.
    Andersson, Jeanette
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Finns det något värde i att mäta Peptide tyrosine tyrosine, Glucose-dependent insulinotropic polypeptide och Oxyntomodulin postprandialt vid måltidsstudier?2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Övervikt och fetma sprider sig likt en epidemi över världen. Omkring 1,9 miljarder vuxna varöverviktiga år 2014 och av dessa klassificerades 600 miljoner som feta. Forskning kring fetmas uppkomst och nya former av behandlingsalternativ pågår. En viktig faktor för uppkomst av övervikt är aptitreglering, där t.ex. Peptide tyrosine tyrosine (PYY), Oxyntomodulin (OXM) och Glucosedependent insulinotropic polypeptide (GIP) har betydelse. En litteraturstudie genomfördes där totalt nio originalartiklar från PubMed utvärderades. Syftet var att undersöka om det finns något värde i att mäta dessa hormon postprandialt. Finns det någon skillnad mellan normalviktiga, överviktiga och obesa och finns det någon skillnad mellan individer med typ 2-diabetes mellitus (T2DM) och friska individer? Finns det någon pålitlig analysmetod? Samtliga studier var måltidsstudier där olika näringsämnens påverkan på den postprandiala responsen undersöktes. Peptide tyrosine tyrosine ochGlucose-dependent insulinotropic polypeptide mättes i sex resp. fem av artiklarna och OXM mättes ien artikel. Protein, fett och kolhydrater ger en postprandial respons på PYY och GIP. Responsen av PYY var starkast efter stimuli från fett och protein. Fett tycks ge starkast respons på GIP. Fastevärden av PYY och GIP var inte olika hos normalviktiga och överviktiga i de studier som undersöktes. Det fanns en signifikant skillnad (p=0,01) mellan normalviktiga och överviktiga tonårsflickor av den postprandiala utsöndringen av PYY efter fettrik måltid, där de obesa flickorna hade lägre procentuell ändring jämfört med de normalviktiga. Pålitliga analysmetoder vid koncentrationsbestämning av dessa tre hormon i plasma är Radioimmunoassay (RIA) och Enzyme-linked immunosorbent assay (ELISA).

    Download full text (pdf)
    fulltext
  • 16.
    Andersson, Louise
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Hur sker prioriteringar av resurser för att bekosta särläkemedel?: Cerezyme® – en fallstudie2013Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The choice of my thesis is based on orphan drugs, which individuals with rare diseases use as treatment, diagnostics or to prevent the progress of the disease. In order to get a classification as an orphan drug, the drug must be used for a condition that affects 5 or less of 10 000 individuals, based on the European classification. The clinical trials for this type of medicines are as every medical trial, expensive and orphan drugs have the smallest patient groups. Therefore there is no justification to the pharmaceutical companies in development in orphan drugs. This project is made by a case study and answer survey, and the literature research was based on articles written in English or Swedish, and articles older than 2000 were excluded.The purpose of this thesis is to evaluate how priorities of resources are made, to fund expensive drugs, in Sweden. Tandvårds- och läkemedelsförmånsverket (TLV) has the authority to decide whether different kind of medicines are subjects to the Swedish pharmaceutical benefits, which are funding a great amount of medicines. The thesis is based on evaluations from various stakeholder, Swedish laws and previous research in priority.Sweden is financing the orphan drugs in three ways. Orphan drugs included in Swedish pharmaceutical benefits are funded by customs fee to 2200 SEK, and the rest of the costs are financed by the state through the council counties. Orphan drugs in hospitalization are financed by the hospital, clinic or the county where the patient is registered. The orphan drugs which are prescribed but still excluded from the benefits are financed either by the patient, county or the hospital. The investigation of pricing and financial proposition of orphan drugs in Sweden is delayed but still in progress, and are expected to be presented in April, 2014.TLV make the decisions regarding pharmaceutical benefits through calculations of QALY’s and by three ethical grounds or principles. The principles stand for human dignity, cost-effectiveness, solidarity and needs. TLV could either approve the drug, which makes the drug included to pharmaceutical benefits, or disapprove the drug and makes it unavailable through state funding. TLV decided to exclude Cerezyme® from the Swedish pharmaceutical benefits. The decisions were made of calculations of QALY’s, which was calculated much higher costs than previously approved by TLV. The manufacturers of Cerezyme® did not agree with TLV’s decision, and went to higher courts. The recent decision of higher courts was to re-include Cerezyme® from pharmaceutical benefits, which makes the drug available to patients in desperate need again.Processes of different kinds of orphan drugs to include these to pharmaceutical benefits are not treated equally. Depending of the state of the disease, prevalence and geographic location, are patients treated variously. This is a major problem in management of orphan drugs, and should be prevented as soon as possible. All citizens should on equal terms, have access to same health care, this through Swedish Health Care laws.

    Download full text (pdf)
    fulltext
  • 17.
    Andersson, Michaela
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    På vilket sätt är oxytocin intressant för behandling av autism?2012Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Autism är ett medfött funktionshinder som innebär symtom inom tre huvudområden; bristande social förmåga,kommunikationssvårigheter och upprepade stereotypa rörelser. Idag saknas effektiv behandling för dessa komplexa symtom, något som förbryllar forskarna. Oxytocin är ett neurohormon i kroppen som påverkar våra relationer till andra människor på olika sätt, hur väl vi knyter an, litar på och förhåller oss till andra. Studier som testat oxytocinets effekter på olika sociala beteenden har väckt intresse för huruvida oxytocin kan vara användbart för behandling av autism.

    Syfte: att med hjälp av randomiserade kliniska studier undersöka på vilket sätt oxytocin kan vara användbart för behandling av autism.

    Resultat: Oxytocin hade goda effekter på de olika autistiska symtom som det i studierna testades förså som repetitiva beteendemönster, förmåga att läsa av känslor hos andra, förmåga att uppfatta känslomässigt innehåll i tal och påverkan på det sociala beteendet. Dessutom fann man i en studie att barn med autism generellt hade lägre halt oxytocin i blodet än friska barn i samma ålder och att det förekom avvikelser i hur halten oxytocin hängde samman med olika färdigheter.

    Slutsats: Det som är intressant för behandling av autism är oxytocinets förmåga att både stärka det sociala engagemanget och samtidigt dämpa de repetitiva beteendena. Dock verkar det inte vara så enkelt som att oxytocin ensamt ligger bakom hela orsaken och att låg halt oxytocin inte alltid är associerat med autism. En egen spekulation om möjlig orsak till autism är att det skulle kunna vara en form av oxytocinresistens inblandad som innebär att receptorerna inte fungerar normalt och således kan inte effekten medieras på ett adekvat sätt. Produktionen ökar därför som kompensation men utan att för den skull öka effekten. Det är viktigt att komma ihåg att oxytocin ingår i ett komplext system som arbetar tätt tillsammans med ett stort antal olika signalsubstanser. Resultat från forskningen visar dock att oxytocin onekligen verkar spela en viktig roll i etnologin bakom autism vilket gör den intressant för framtiden.

    Download full text (pdf)
    fulltext
  • 18.
    Andersson, Sanna
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Hur har det påverkat apoteken att receptfria läkemedel får säljas i dagligvaruhandeln?2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Den 1 november 2009 infördes en ny lag med bestämmelser som säger att det är tillåtet att bedriva detaljhandel utanför öppenvårdsapotek med nikotinläkemedel och vissa andra receptfria läkemedel. Under 2010, som var det första hela året då receptfria läkemedel fick säljas utanför apotek, uppgick den totala försäljningen av dessa till ungefär 614 miljoner kronor. Det motsvarade ungefär 15 % av den totala försäljningen av receptfria läkemedel för egenvård. De läkemedel som säljs mest utanför apotek är smärtstillande läkemedel, nässprayer mot förkylningsnästäppa och nikotinläkemedel.      Att receptfria läkemedel får säljas i dagligvaruhandeln påverkar sannolikt apotekens omsättning. Hur mycket detta påverkat är dock svårt att säga, då även avregleringen av apoteksmarknaden skett inom samma tidsperiod. Syftet med denna uppsats var att därför ta reda på hur försäljningen av receptfria läkemedel i dagligvaruhandeln har påverkat apoteken.   För att besvara frågeställningen har en kvalitativ metod använts.  Intervjuer har genomförts med åtta apotekschefer i ett geografiskt område i västra Östergötland  inkluderandes orterna Mjölby, Motala och Skänninge.   Generellt sett har apotekscheferna varit positiva till den ökade tillgänglighet av läkemedel som uppstått då receptfria läkemedel får säljas i dagligvaruhandeln. De påpekar dock att det kan föreligga en risk för felanvändning av ett läkemedel som säljs utan rådgivning.   Sortimenten på apoteken har påverkats och de flesta apotekskedjorna har valt att ta fram egna märkesvaror, vilket ger en ytterligare skillnad i sortiment mellan de olika apoteken. En annan förändring som har skett på apoteken är att apoteksmedarbetarna inom de flesta kedjorna har fått säljutbildning.    De resultat som framkommit i denna studie visar att avregleringen av apoteksmarknaden och konkurrensen från andra apotekskedjor har påverkat apoteken mer än det faktum att receptfria läkemedel numera får säljas i dagligvaruhandeln. Det krävs dock en studie över ett större geografiskt område och därmed med ett större antal apotek involverade för att komma fram till om det är så och få ett mer rättvisande resultat.

    Download full text (pdf)
    fulltext
  • 19.
    Andersson, Sofie
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Lipashämmaren orlistats effekt på viktnedgång och typ 2-diabetes2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Fetma är ett växande hälsoproblem, såväl i Sverige som i övriga världen. Idag räknar man med att cirka 10 % av männen och 12 % av kvinnorna i Sverige lider av fetma (BMI≥30). Komplikationerna till följd av fetma är många, och inkluderar många allvarliga sjukdomar och tillstånd. Typ 2-diabetes är en av dessa sjukdomar och risken att insjukna ökar kraftigt med ett stigande BMI. Man räknar med att cirka 90 % av alla som diagnosticerats med sjukdomen också uppvisar fetma. Grunden i all fetmabehandling utgörs av livsstilsförändringar, som kost och fysisk aktivitet. En viktnedgång på 5-10 % är ofta tillräckligt för att man ska se en förbättring av kardiovaskulära och metabola riskfaktorer. När en tillfredsställande viktnedgång inte uppnås genom livsstilsförändringar kan farmakologisk behandling bli aktuell. Ett av de läkemedel som idag är godkänt för behandling av fetma är orlistat (Xenical®). Läkemedlet verkar genom att hämma gastro- och pankreaslipaser, vilket resulterar i en minskad fettabsorption på cirka 30 %.

    Syftet med detta arbete var att undersöka orlistats additiva effekt på viktnedgång hos personer med en samtidigt mild minskning av kaloriintaget. Förutom viktnedgång har även dess effekt vid typ 2-diabetes, med avseende på HbA1C, fasteglukos samt förändringar i diabetesmedicinering undersökts i vissa studier.

    Metoden som har använts i detta arbete är en litteraturstudie. De artiklar som användes hämtades från databasen PubMed, och sammanlagt var det fem studier som granskades. Två studier som fokuserade på orlistats effekt på viktnedgång, och tre studier som fokuserade på både dess effekt på viktnedgång och typ 2-diabetes.

    Samtliga studier visade på en signifikant större viktnedgång hos orlistatbehandlade individer jämfört med placebogruppen. I tre av studierna låg viktnedgången mellan 3,9-6,5 kg, och i de övriga två studierna mellan 5,0-8,5 %. När det gäller HbA1C så minskades det med mellan 0,6-1,1 procentenheter och fasteglukos mellan 1,3-1,9 mmol/l. Det var även fler orlistatbehandlade som kunde minska, eller till och med upphöra med, medicineringen mot sin diabetes. Slutsats blir därför att orlistat kan vara ett användbart läkemedel i kampen mot fetma och dess riskfaktorer, som i det här fallet typ 2-diabetes.

    Download full text (pdf)
    FULLTEXT01
  • 20.
    Awde, Naser
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Androgenetic alopecia and the effectiveness of the combinations of the available treatments and monotherapy with 5ɑ-reductase inhibitors2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Androgenetic alopecia, also known as male pattern baldness, affects the majority of menat some point during their life. This can significantly damage the mental health of theindividuals suffering, especially at a young age. The pathophysiology is not fullyunderstood, but according to the scientific literature, it is mediated by androgensignaling in the scalp. A lack of androgen signaling completely eliminates thepossibility of developing the condition. This is the primary reason behind theeffectiveness of 5ɑ-reductase inhibitors, which effectively reduce androgen signaling bylowering dihydrotestosterone (DHT) concentrations by 98%. These medications areassociated with adverse effects such as sexual dysfunction and anxiety. Use of topicalforms of 5ɑ-reductase inhibitors and minoxidil is therefore on the rise. The purpose ofthis work was to examine the effectiveness of the combinations of the availabletreatments and the most effective monotherapy option. The results indicate thatdutasteride is the most effective option as monotherapy and that a combination of a5ɑ-reductase inhibitor and minoxidil is more effective than either on their own. It wasalso shown that microneedling is a valid adjuvant therapy to minoxidil. 

    Download full text (pdf)
    fulltext
  • 21.
    Baftijaj, Jehon
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Etniska skillnader i läkemedelsrespons för substanser relevanta vid hjärt-kärlsjukdomar2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    There are many factors that play a role in the response of a drug. An interesting factor that is often discussed in the academia is the role of ethnicity. Differences in the expression of CYP enzyme, protein transporters and receptors between different ethnic groups believed to affect the outcome of many drugs relevant to cardiovascular disease. Polymorphism is believed to play an important role in this regard. Genetic alleles that differ through ethnicity-based polymorphism causes CYP enzymes and protein transporters to respond differently to different drugs. It is nevertheless not always fully explored if these ethnic differences are always due to genetic or non-genetic causes.

    There are however important changes toward the notion of recognizing ethnicity as a key role in pharmaceutical development. The Food and Drug Administration in the US have for example released guidance on how to define and work towards categorizing ethnicity in clinical research. There are also several western countries creating guidelines for drug therapy specific to ethnic groups.

    The purpose of this literary work was to study the differences between ethnic groups in terms of dosing, efficacy and pharmacokinetics of drugs used in cardiovascular disease.

    Five studies were used in the literary work. The first study examined the differences in dosing for warfarin therapy between different ethnicities. The second trial studied the plasma exposure of rosuvastatin between Caucasian and Asian people. The third study examined the effect of the ACE inhibitor enalapril in black and white patients with left ventricular dysfunction. The fourth study investigated the effect of beta blocker atenolol in white and black participants. The last study was done to compare the effect of the thiazide diuretic chlorthalidone against calcium channel inhibitors and ACE inhibitors in black and non-black patients.

     

    The results showed that warfarin dosage differs between ethnicities. Plasma exposure of rosuvastatin is different between Caucasian and Asian people. ACE inhibitors work better with white patients, atenolol is more effective for white patients and chlorthalidone works better in black patients with certain cardiovascular diseases.

     

    The studies presented indicate that there are differences in drug response in various ethnicities and these distinctions are different in extent and significance. It can be argued for genetic and non-genetic causes of differences depending on the drug being studied. 

    Download full text (pdf)
    fulltext
  • 22.
    Barzanji, Tara
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kan användning av paracetamol under graviditeten medföra risk för barnet och leda till beteendeproblem?2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Paracetamol is the most common medicine used as painkiller in the world. Since it has been on the market for a very long time it has been thought to be one of the safest medicines to use during pregnancy. Many women use this medicine for different indications during pregnancy thinking it is safe for the fetus. However, the mechanism of action for paracetamol is still unknown and therefore there is no information about how it could affect the fetus.

    Objective: To study paracetamol safety during pregnancy and its effect on the fetus and behaviour in childhood.

    Method: The information search for this literature study has been done through searching for different articles in the database pubmed. In these articles, pregnant women who used paracetamol during pregnancy have been analysed to see the effect on their children.

    Result: Different articles used in this literature study have shown an association between prenatal paracetamol exposure and behavioural problems in children. One study shows that if paracetamol is used during pregnancy the risk increases to get a Hyperkinetic disorder, HKD diagnosis (Hazard ratio (HR)= 1,37; 95% confidence interval (CI), 1,19-1,59), similarly the risk to get an ADHD-diagnosis increases (HR=1,29: 95% CI, 1,15-1,44).

    Discussion: The association between prenatal paracetamol exposure and behavioural problems has been shown in different studies made om pregnant women even though the exact mechanism is still unknown. Changes in children’s epigenetics seem to be associated with prenatal paracetamol exposure. Changes in DNA-methylation of genes previously linked to ADHD have been detected.  

    Conclusion: Prenatal paracetamol exposure seems to be associated with child behavioural problems. Therefore, paracetamol may not be a completely safe medicine in pregnancy and all pregnant women should have this information available to avoid unnecessary use especially during the second and third trimester.

    Download full text (pdf)
    fulltext
  • 23.
    Bergman, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Har förskrivningen av antibiotika till våra vanligaste husdjur, hund och katt förändrats från 2009 till 2014 och i så fall, hur?2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Baserat på en rapport från e-hälsomyndigheten tillsammans med allmänt tillgänglig material från Statens Veterinärmedicinska Anstalt och Statens Jordbruksverk fastslås att expedieringen av antimikrobiella medel till hund och katt i Sverige har minskat med c:a 27 % mellan 2009 och 2014. Största delen av de antimikrobiellamedlen förskrivs till hund (70 %). Den mesta använda gruppen av antimikrobiella medel till båda djurslagenär penicilliner. Därefter vanligast använda grupper av antimikrobiella medel till hund är linkosamider,övriga antibakteriella betalaktamer och antibakteriella kinolonderivat. Till katt används näst penicillinerfrämst antibakteriella kinolonderivat och linkosamider. Samma grupper dominerar år efter år men förskrivningenav de enskilda medlen varierar inom respektive grupp. Minskningen är mer framträdande gällandehund och ses främst för cefalexin, enrofloxacin och klindamycin. De senaste åren ses, för bådadjurslagen enviss ökning i användningen av kombinationer med sulfametoxazol och trimetoprim. Mellan 6 och 7 % av dentotala mängden läkemedel till hund och katt utgörs av humanläkemedel. Baserat på de dokument som sammanställtsi detta arbete tycks det som att svenska veterinärer tar sitt ansvar och bidrar till den minskandeanvändningen av antimikrobiella medel i samhället. Med fortsatt medveten och kontrollerad användning av antimikrobiella medel till djur kommer Sverige att kunna fortsätta att föregå som gott exempel och som en förebild för övriga Europa och kanske även för resten av världen.

    Download full text (pdf)
    fulltext
  • 24.
    Bergqvist, Petronella
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Towards novel therapies and diagnostics: Studies of a novel polymer system2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 25.
    Bernestrå, Isadora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Ebolaviruset - nu och då: varför har utbrottet 2013-2015 blivit så stort?2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Ebola upptäcktes för första gången 1976 i ett dubbelt utbrott i Sudan och Zaire i Afrika. Det pågående utbrottet av ebola virus sjukdom (EVD) startade i Guinea 2013 och har sedan dess spridits vidare till Liberia, Sierra Leone, Nigeria, Mali och Senegal. T.o.m. 4 mars 2015 har nästan 24 000 smittats och 10 000 avlidit vilket är mer än 50 gånger fler än i det tidigare största utbrottet i Uganda 2000. Viruset består av fem arter: Bundibugyo, Reston, Sudan, Tai Forest och Zaire. Vektorn för viruset är fortfarande okänd men förmodas vara flygande hundar (fruit bats) som själva är resistenta. Symtomen innefattar bl.a. feber, trötthet, kräkning, diarré, ledsmärtor och mukosala blödningar. Behandlingen består vanligen av vätskeersättning. Det finns varken godkänt vaccin eller läkemedel i dagsläget men flertalet studier pågår för att utveckla bl.a. antikropparna ZMapp och antiviral behandling med Brincidofovir.

    Syfte: Redogöra för tidigare och pågående utbrott av ebola och undersöka vilka faktorer som bidragit till att epidemin 2013-2015 inträffat och fått stora proportioner i Västafrika.

    Metod: Till det aktuella ämnet har den senaste informationen inhämtats via WHO och CDCs respektive hemsidor mellan 23/2-9/3 2015.

    Resultat: En kombination av faktorer har bidragit till att det pågående utbrottet blivit större än tidigare. Länderna som drabbats har inte varit förberedda, virusarten ebola Zaire har hög dödlighet, sjukvård och infrastruktur är svag och kulturen är djupt grundad i ett samhälle där utbildningen är låg. Befolkningen behöver respekteras och utbildas för att de aktivt ska kunna vara delaktiga i att stoppa smittspridningen av viruset. Ju mindre geografisk yta viruset är fördelat på desto lättare blir det att kontrollera och bekämpa det.

    Diskussion: Guinea, Liberia och Sierra Leone har alla drabbats extra hårt av pågående EVD utbrott och behöver nu få hjälp med återuppbyggnad av ett fungerande sjukvårdssystem som befolkningen kan lita på och med personal som kan arbeta under säkra förhållanden. Stort fokus bör också läggas på att implementera kulturen i de skyddsåtgärder som behövs för att förhindra ytterligare spridning och framtida utbrott. Ytterligare forskning krävs för att kunna erbjuda bättre behandling och profylax.

    Download full text (pdf)
    Ebolaviruset - nu och då: varför har utbrottet 2013-2015 blivit så stort?
  • 26.
    Berthelsen, Isabell
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Naturens Läkemedel: Harmin mot cancer?2016Independent thesis Basic level (university diploma), 180 HE creditsStudent thesis
    Abstract [sv]

    Harmine is a beta-carboline present in medical plants such as Peganum harmala that have been used traditionally as anticancer therapy. In this study, the aim was to examine if it really does have an effect on cancer and if so, mechanism of action. To do so several earlier studies on the subject have been examined. The result is promising but there is still a lot to study on the subject.

    Harmine really does inhibit tumour growth. It has been tested on both cellcultures and mice and has proven to decrease tumourgrowth significantly with little effect on normal cells. There have also been studies were harmine has been modified to be more efficient and less harmful. One way to make Harmine more effective is to put a 2-amino-2deoxy-D-glucose on the molecule. Since the cancer cell uses a lot of energy for its growth a big proportion of the medicine will end up here. Another way is to attach a methionin-group to it. This is also taken up exccessively by the cancer cells. Substitution in different areas may reduce it’s toxicity; Substitution with a formiat at R3 for example decreased its toxicity so that no side effects were seen in the mice in the study whereas harmine in large doses gave neurotoxic symptoms. Harmines antitumour activity seems to be due to several mechanisms of action. For example a higher level of p53 has been observed efter treatment with harmine. P53 has been called ”the guardian of the genome” because of its role in preventing genome mutation. In some studies a decrease in vascular endothelial growth factor (VEGF) has also been seen. This is an important factor for the growth of new vessels toward the tumour-site. A reduction in COX-2 has also been seen. Inhibition of COX-2, for example by NSAID, is associated with lower risk for coloncancer. A fourth possible mechanism of action could be a decrease or inhibtion of CDKs/Cyklins wich are necessary for the cellcycle-progression. Although a promising substance, there is still a lot to study. It would be interesting to se comparations to established drugs on the market and also what the long term side effects of Harmine could be. The studies so far have only been done under a short period of time, i.e., weeks or months.

    Download full text (pdf)
    fulltext
  • 27.
    Björnsson, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Helparasitvaccination mot malaria - status idag och utmaningar för framtiden2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Malaria is still one of the most common infectious diseases in the world and there is an overwhelming threat to the development of resistance to different control methods such as drugs and insecticides. A durable vaccine with sterile protection would reduce and maybe eradicate the disease. The most serious cases of malaria are caused by Plasmodium falciparum that is transmitted through the bites of infected Anopheles mosquitoes. The life cycle of malaria is extremely complex and different vaccine candidates have effects at different stages. Naturally acquired immunity develops gradually after many years of clinical episodes but never becomes sterile. RTS,S is the only vaccine candidate who has been in phase III clinical trials. Unfortunately this vaccine has limited efficacy, like many other subunit vaccines, due to rapidly diminishing antibody titers. Whole parasite vaccines have the ability to generate a greater quantity and breadth of antigenic exposure within both the humoral and cellular immunity. This results in stronger immune response and can provide sterile protection. The development of whole parasite vaccines has mainly focused on the pre-erythrocytic stage and the most tested vaccine candidates that are in early clinical trial are radiation-attenuated sporozoites (RAS), chemoprophylaxis and sporozoites (CPS) and genetically attenuated parasites (GAP).

    Aim: The purpose of this literature study is to examine and compare the vaccine efficacy and durability towards P. falciparum of the two whole parasite vaccine candidates: RAS and CPS and to examine the importance of dose and different routes of administration.

    Methods: Fourteen different clinical studies were selected from PubMed to be included in this literature study. Different variables were selected for study: the vaccine efficacy and it´s durability after controlled human malaria infection (CHMI) using P. falciparum parasites homologous or heterologous to the vaccine strain, the correlation between the immunogenicity and protection, the importance of the dose and different kinds of administration and vaccine safety.

    Results: According to the findings in the literature study, direct venous inoculation of RAS-vaccine and CPS-vaccine have the ability to give short and longlasting protection against CHMI using P. falciparum parasites homologous to the vaccine strain. The dose is of great importance to the vaccine efficacy and CPS-vaccine has the ability to give potent protection with much lower doses than RAS-vaccine. Some immune mechanisms in the blood correlate with protection but it seems to be the number of CD8+ T-cells in the liver that are of greatest importance for longlasting and steril protection. Whole parasite vaccines are safe but transient parasitemia is common when using CPS-vaccine. Unfortunately, vaccines with longlasting protection against CHMI using P. falciparum parasites heterologous to the vaccine strain has limited efficacy.

    Conclusion: RAS-vaccine and CPS-vaccine have the ability to give a potent vaccine efficacy against CHMI using P. falciparum parasites homologous to the vaccine strain when used in sufficiently high doses. Longterm protection against CHMI using P. falciparum parasites heterologous to the vaccine strain is limited and this in turn affects the use in endemic areas. In the future, the vaccine effect can be improved by higher doses, more infectious vaccine strains or vaccine cocktails. An alternative to RAS-vaccine and CPS-vaccine could be direct venous inoculation of late arresting GAP.

    Download full text (pdf)
    fulltext
  • 28.
    Blinkowska, Nathalie
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Kan man påvisa något samband mellan högt sojaintag och bröstcancerrisk?2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Download full text (pdf)
    FULLTEXT01
  • 29.
    Boletini, Faik
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Ger tillägg av ARB till redan pågående behandling med ACE-hämmare hos hjärtsviktspatienter bättre hälso- och kostnadseffekt?2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Heart failure is a condition where the heart is incapable of providing adequate blood supply to different organs in the body. The underlying causes of heart failure is some kind of disorder in the heart function, and require careful diagnostics. The basic symptoms that arise from heart failure is difficulty in breathing, that aggravate when lying down, and fatigue. The patients’ symptoms and impaired quality of life can be in different stages depending on the severity of the heart failure. Heart failure is a present widespread disease with numerical superiority which is more likely to affect elderly patients. Heart failure is a very expensive condition and causes enormous costs for the society. The basic treatment of heart failure consists of ACE-inhibitors in combination with beta blockers and with additional diuretics. If intolerance occurs with ACE-inhibitors, often in the form of dry cough, then treatment with angiotensin receptor inhibitors (ARB) will be used instead. The aim of the study was to find out if additional treatment with ARB in patients diagnosed with heart failure and receiving basic treatment with ACE-inhibitors lead to better health or had any economic advantage.

    The method used consists of literature search studies in the Pubmed database. The search gave a total of 103 articles of which six were chosen. The criteria for inclusion was that it should be clinical trials which were not older than 14 years and that the studies should be based on humans. Two of the six studies that were chosen were health economic studies. The studies were randomized, double blind, placebo controlled and included a large number of patients.

    The results from the studies showed that there were no significant improvements on mortality or morbidity, when additional treatment with ARB was given to heart failure patients already receiving treatment with ACE-inhibitors. A decrease in hospital admission was seen, but at the same time there were more adverse events arising that lead to discontinuation of study treatment. The economic studies showed a higher medical service cost when treatment with ARB was added and the reason for this were that ARB drugs were more expensive than ACE-inhibitors.

    It is concluded that the additional treatment with ARB in patients diagnosed with heart failure and already receiving treatment with ACE-inhibitors had no favorable effect neither from a health perspective or an economic perspective. However, health economic studies that are made from a society point of view are required to be able to draw definite conclusions regarding the economic part.

    Download full text (pdf)
    fulltext
  • 30.
    Boye, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Viktminskning med liraglutid2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Övervikt och fetma har ökat i världen de senaste åren. För att behandla dessa tillstånd finns idag endast ett godkänt läkemedel och det är orlistat. Liraglutid, som är en långverkande GLP-1 analog, kanske kan vara ett alternativ till orlistat. Idag är Liraglutid ett läkemedel som används som tilläggsterapi vid behandling av diabetes mellitus typ 2 (DM2). Flera studier visar att Liraglutid har en viktminskande effekt som troligtvis beror på en kombination av effekter. Dessa effekter involverar troligen aptitregleringen som styrs av hypotalamus och effekter på magtarmkanalen.   

    Syfte: Syftet med detta arbete är att undersöka vilken viktminskningseffekt liraglutid har när det används som monoterapi hos patienter med eller utan DM2.                                                                                                           

    Metod: Detta arbete är en litteraturstudie. Sökning efter randomiserade kliniska studier skedde på PubMed. 6 studier inkluderades i arbetet.                                                                                                                                

    Resultat: Patienterna som gick ner mest i vikt fick liraglutid dosen 3,0 mg. Dessa patienter var individer med fetma utan DM2 och gick i medel ner 7,2 kg efter 20 veckor samt 7,8 kg efter 1 år. Patienter som behandlades med liraglutid i doser från 1,2 mg till 2,4 mg gick ner mellan 2,1 kg (1,2 mg i 52 veckor) och 6,3 kg (2,4 mg i 20 veckor). Bland patienterna med diabetes mellitus typ 2 gick gruppen behandlad med 1,9 mg liraglutid ner mest i vikt (-2,99 kg). Lägre doser från 0,045 mg till 0,75 mg gav inte lika stora resultat på viktminskning.

    Slutsats: Liraglutids viktminskningseffekt är dosberoende. Patienterna som gick ner mest i vikt fick högsta dosen och också instruktioner om att hålla en kalorisnål diet. Grupperna som fick de lägsta doserna av liraglutid tappade inget eller väldigt lite i vikt. Både patienter med och utan DM2 gick ner i vikt. I behandlingen utav DM2 kan viktminskningseffekten vara till värde på grund av kopplingen till övervikt och fetma. För att rekommendera liraglutid som ett läkemedel för behandling av övervikt och fetma kan det troligtvis krävas fler studier där viktminskning är ett primärt effektmått och fler studier som undersöker säkerheten av läkemedlet i högre doser hos patienter både med och utan DM2. 

    Download full text (pdf)
    fulltext
  • 31.
    Brahimi, Kaltrina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Ökar medicinering med protonpumpshämmare risken för Clostridium difficile infektion?2014Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Protonpumpshämmare är en grupp läkemedel som globalt sett tillhör de mest använda läkemedlen. De används vid t.ex. magsårssjukdomar och hämmar utsöndring av saltsyra i magsäcken vilket leder till att pH ökar. Clostridium difficile är en grampositiv stav- och sporbildande bakterie som vid antibiotikabehandling kan orsaka svåra diarréer. Det misstänks att protonpumpshämmare (PPI) kan orsaka överväxt av Clostridium difficile. Mekanismen bakom detta är fortfarande oklar men den vegetativa formens och sporernas överlevnad i magsäcken verkar underlättas vid minskning av magsyran, d.v.s. medicinering med PPI.

    Syftet med denna studie var att undersöka om medicinering med syrahämmande läkemedel, protonpumpshämmare, ökar risken för utveckling av Clostridium difficile infektion.

    Metoden som användes var en litteraturstudie av fall-kontroll-och kohortstudier samt metaanalyser från databasen Pubmed.

    Resultaten från samtliga studier, förutom en fall-kontrollstudie, påvisade ett statistiskt signifikant ökat odds att drabbas av Clostridium difficile infektion och även återkommande infektion vid PPI-användning.

    Slutsatsen är att det krävs kliniska prövningar för att styrka denna observation, dock är det sannolikt omöjligt att genomföra sådana dels p.g.a. behovet av ett stort antal försökspersoner samt kostnaden. De granskade studierna är inga kliniska prövningar med högt bevisvärde, utan av typen fall-kontroll- och kohort-studier. Dock påvisas statistiskt signifikant koppling mellan behandlingen med PPI och utveckling av Clostridium difficile infektion i samma riktning även i många andra studier. Åtgärder bör vidtas för att minska överanvändning av PPI och för att använda dem endast när det välmotiverat. Läkare och befolkningen i allmänhet bör också uppmärksammas på denna allvarliga komplikation som är kopplad till medicinering med protonpumpshämmare.

    Download full text (pdf)
    fulltext
  • 32.
    Brandeby, Jessika
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Påverkar behandling med karbamazepin minnesfunktioner och därmed inlärningsförmåga?2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Epilepsy is a neurological disease in which there is a sudden and unprovoked discharge of neocortical neurons at more than one occasion. Pharmacological treatment with carbamazepine is the first choice for partial onset seizures with or without secondary generalization. Both seizures and carbamazepine can cause patients to experience impaired memory functions which also their relatives notice. Epileptic seizures depend on high-frequency stimulation in cerebral nerve cells. The drug carbamazepine acts by stabilizing neuronal membranes and thereby reduces neuronal excitability. The storage of processed sensory information seems to require stimulation that activates glutamate release, AMPA receptors and NMDA receptors which are mechanisms that may be disturbed by carbamazepine.

    Objective: The aim of this study was to investigate whether treatment with carbamazepine is affecting memory functions and thereby learning ability.

    Methods: This literature study was based on eight scientific articles that have been searched for at PubMed in January 2015. They related to different factors (in addition to antiepileptic drugs) that could be important for memory functions and how carbamazepine (antiepileptic drug) might influence memory in healthy volunteers, after withdrawal, in epilepsy patients and in animal tests.

    Results: The influence of factors such as electroconvulsive therapy (human study) and short versus long seizures (animal study) on memory functions showed a reduction in both subjective and objective assessment and neuron loss in the hippocampus with 14-26 % against 34-50 %. In rodent brain slices carbamazepine caused a reduction in long-term potentiation size by 55 % compared to the control group (p < 0.01). Human studies investigating the effects of carbamazepine on memory functions showed ambiguous results.

    Conclusions: Some animal studies indicate that carbamazepine and epileptic seizures have a negative effect on long-term potentiation and spatial memory, which both seem to be dependent on NMDA-receptor activation in the hippocampus area. Extrapolating to human effects at therapeutic doses can be difficult since rodents are less developed. The human studies on carbamazepine effects on memory functions gave no clear information to draw any conclusions from. Randomized and blinded studies with sufficiently large populations, with comparable groups, conducted in epilepsy seizure-free patients with carefully selected, standardized objective tests could possibly provide answers with clinical relevance.

    Download full text (pdf)
    fulltext
  • 33.
    Brosius, Helen
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Läkemedelsavstämning mellan patientjournalens läkemedelslista på hälsocentral, ReceptRegistret på apotek samt patientens uppgift om aktuella ordinationer2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Ett läkemedels uppgift är att erbjuda bot, lindra och/eller förebygga sjukdomstillstånd. Men de kan även ge negativa effekter i form av läkemedelsrelaterade problem på grund av felmedicinering.

    En anledning till felaktig läkemedelsanvändning hos patienter med många läkemedel kan vara att de, speciellt vid ordinationsändringar, inte har en uppdaterad uppgift om vilka läkemedel som är aktuella för behandlingen. Tidigare studier har visat att det finns stora avvikelser mellan vilka läkemedel patienter ordinerats och vad de i själva verket tar. Bland äldre patienter och patienter med flera läkemedel är risken för avvikelser som störst.

    Syftet med studien var att undersöka förekomsten av avvikelser mellan ”Mina sparade recept på apoteket”/recept i receptregistret (RR), patientens aktuella ordinationer i patientjournalsystemet på Hälsocentral samt vad patienten uppger är aktuella, gällande ordinationer för patienter med diabetes mellitus, anslutna till Stensö Hälsocentral i Kalmar.

    Studien genomfördes dels som en registerstudie genom avstämning av aktuella ordinationer i journalens läkemedelslista mot sparade recept i RR, och dels som en intervju med patienterna om vilka recept som utgjorde hans/hennes aktuella ordinationer.

    Studien visade att hos patienter med diabetes mellitus var 17 % av recepten i RR och 15 % av ordinationerna i läkemedelslista inaktuella, receptdubbletter eller dubbelmedicinering.

    Studien tyder på att endast 62 % av läkemedelsposterna hos patienter med diabetes mellitus förekom i både RR och läkemedelslista samt var aktuell enligt patientuppgift.

    Studien indikerar att en stor andel av recepten i RR utgörs av inaktuella recept, receptdubbletter och dubbelmedicinering. Studiens begränsade storlek gör emellertid att den får betraktas som en pilotstudie.

    Download full text (pdf)
    FULLTEXT02
  • 34.
    Bunmeepom, Wiphawee
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Pertuzumab som tillägg till behandling med trastuzumab och docetaxel vid metastaserad HER2-positiv bröstcancer2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In Sweden, about one in ten women develop breast cancer, which makes this the most common type of cancer disease in women. The risk of getting cancer increases with age. Almost 8000 women are diagnosed with breast cancer every year in Sweden. Human epidermal growth factor receptor 2 (HER2) – positive breast cancer, is an aggressive phenotype. About 25 % of the breast cancer tumors are overexpressing HER2 on the cell surface. HER2 is a subunit of the dimeric tyrosin kinase EFGR (HER) that stimulates cell proliferation. Every year, about 1300- 1400 patients advance in their illness and form metastases. Pertuzumab and trastuzumab, are both HER2 monoclonal antibodies. Pertuzumab inhibits the HER2 from heterodimerization with HER3, while trastuzumab inhibits HER2 homodimerization. Since 2007 trastuzumab and cytostatics were approved for treatment of metastatic HER2-positive breast cancer. The aim of this study was to evaluate if pertuzumab as an addition to trastuzumab and docetaxel (cytostatic) could prolong the time patients with metastatic HER2-positive breast cancer experienced free from progression of their illness in comparison with treatment with only trastuzumab and docetaxel. This study was based on scientific articles identified from the database PubMed. Five studies were selected, one of the studies was the CLEOPATRA-study. CLEOPATRA compared the efficiency and safety of the two selected treatments. Three studies further analyzed and followed up results of the CLEOPATRA-study. Study five investigated the effect of pertuzumab in patients with metastatic HER2-positive breast cancer, where disease progression had occurred during trastuzumab treatment. The primary endpoint was progression-free survival (PFS) and overall survival (OS). All articles showed that PFS increased in patients treated with pertuzumab as addition to trastuzumab and docetaxel. Overall survival was also improved during and after the follow-up. The conclusion of this study was that pertuzumab, trastuzumab and docetaxel as treatment for metastatic HER2-positive breast cancer is promising and should be used as first-line treatment of metastatic breast cancer with HER2 overexpression.  

    Download full text (pdf)
    fulltext
  • 35.
    Börjesson, Kristin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Metformins effekt på endometriecancer2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Metformin är ett biguanidderivat som främst används vid diabetes mellitus typ 2. Det verkar genom ett flertal mekanismer och ökar bland annat insulinkänsligheten. Forskning har visat att det finns ett samband mellan metformin och överlevnad i cancer. Studier pågår för att undersöka metformins antineoplastiska effekt. Övervikt och diabetes ökar risken för endometriecancer och epidemiologiska studier har visat att metformin ger bättre total överlevnad vid endometriecancer. Genom artikelsökning via PubMed erhölls fem studier där metformins effekt på endometriecancervävnad undersöktes. Resultaten i dem varierar men majoriteten pekar på en antiproliferativ effekt av metformin, med avseende på Ki-67. Med vilken verkningsmekanism den effekten erhålls är tvetydligt, då vissa resultat tyder på inhiberad mTOR-signalering medan andra inte visar effekt på de variablerna. En minskning i cirkulerande tillväxtfaktorer insulin och IGF-1 ses, vilket kan ha en inhiberande effekt. Större studier krävs för att kunna avgöra vilken effekt metformin har på endometriecancer.

    Download full text (pdf)
    fulltext
  • 36.
    Capri, Vlora
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Värktabletter i dagligvaruhandel: Positivt eller negativt?2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sedan 1 november 2009 är det tillåtet att sälja ett stort antal receptfria läkemedel i dagligvaruhandel. Målet med den här reformen är att konsumenterna ska få ökad tillgänglighet och fortsatt säker och ändamålsenlig läkemedelsanvändning. Syftet med den här uppsatsen är att belysa de problem/möjligheter som skapats genom att receptfria smärtstillande läkemedel säljs utanför apotek. Uppsatsen belyser bl.a. aspekter som värdet av ökad tillgänglighet. En kvalitativ metod med intervjuer användes för studien och ett avsiktligt urval av personer som kunde tänkas ha åsikter inom området gjordes.

    Totalt intervjuades 12 personer. Majoriteten av de intervjuade anser att det är positivt att receptfria smärtstillande läkemedel säljs i dagligvaruhandel och att det därmed är lättare att få tag på läkemedlen vid akuta besvär. Negativt är att det finns en ökad risk för överkonsumtion och missbruk med en ökad tillgänglighet av värktabletter i samhället i kombination med att det i dagligvaruhandel inte finns tillgång till farmacevtisk rådgivning.

    Slutsats av studien är att det finns både positiva och negativa aspekter med den nya handeln, men i slutändan är det ändå positivt att det säljs i dagligvaruhandel. En säkrare och mer ändamålsenlig läkemedelsanvändning utan rådgivning skulle kunna bevaras genom att man strikt väljer ut vilka läkemedel som får säljas utanför apotek, har en 18-årsgräns och eventuellt minskar förpackningsstorlekarna.

    Download full text (pdf)
    FULLTEXT02
  • 37.
    Carlsson, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    En enkätstudie om apotekskunders syn på och kännedom om farmaceuters användning av elektroniskt expertstöd, EES2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Drugs are an essential part of health care today. They improve and extend the lives of many people. If drugs are wrongfully combined or given in inaccurate dose, it may lead to poorer quality of life, hospital admissions and even deaths. Drug-related problems cost society a large amount of money each year.

    To minimize these problems, there are now electronic decision supports that doctors and pharmacists can use. At all pharmacies in Sweden, the electronic expert support system available. The EES analyzes electronic prescriptions and doses prescribed and indicates if it detects any potential drug-related problems. Such risks may be that the customer has several drugs with the same effect, drug interactions or that the drug is inappropriate due to age. For children, there are special warnings that may be that the doctor on the prescription has prescribed a higher dose of the drug against what is commonly given to a child.

    The purpose of the study was to investigate pharmacy customers view of and knowledge about pharmacist use of EES. Data were collected via surveys for 100 hours at several different pharmacies in Sweden.

    The vast majority of pharmacy customers did not know of EES, only one fifth of the survey respondents knew what EES meant. Consent from the customer is required for the pharmacist to use EES when dispensing drugs and one third of the customers did not know if they agreed to this or not. Half of the customers did not know if the pharmacist used EES when the drugs were dispensed. Most of the customers also did not know whether their drug dispensing would be safer, if they would get better advice if the EES was used or if they wanted the pharmacist to use EES as a tool in the prescription expedition.

    The study shows that pharmacy customers' views and knowledge about the use of  EES by pharmacists are limited. The reason for this may be that it takes extra time for pharmacists to inform customers about what EES means and ask them for consent that the expert support should be used in the prescription expedition. Many times the pharmacist is experiencing a shortage of time to do this. The reason why EES is not used may be because the pharmacist does not feel adequately educated in how the decision support works and therefore chooses not to use it. It may also be due to communication difficulties such as language problems, hearing impairment or the customer's reduced cognitive ability.

    There is a need for communicative improvements between the customer and the pharmacist so that the pharmacists will increase the use of EES when dispensing drugs. There is also a need for pharmacists to get education in how EES works and how to use the decision support. If this is done, it will provide the customer with a better drug use with reduced risk of side effects and drug-related problems.

    Download full text (pdf)
    fulltext
  • 38.
    Chureteh, Arij
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Hur påverkas kliniska effekter och följsamhet till behandling då flera antihypertensiva läkemedelssubstanser kombineras i en enda tablett?2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background Hypertension is a risk factor for serious cardiovascular diseases. Different drug classes are used in the treatment of hypertension. These include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, and thiazide diuretics. Although current drug therapies can be effective, few are able to achieve target blood pressure therefore it has become well-known that most hypertensive patients require at least two antihypertensive drugs to reach their target blood pressure. This led to complicated treatment methods, which in turn has become a significant contributing factor to poor patient compliance. When two or more drug classes are combined, this contributes to improved efficacy, as different mechanisms of action work together to block different pathways to high blood pressure. This leads to lower doses of the individual components being used, which results in a reduced likelihood of side effects. Although a large number of drugs are available for treatment, there is still poor control of blood pressure due to patients' poor adherence to medication, which is usually a combination of several substances. Adherence decreases with the number of tablets a patient needs to take, leading to a complicated treatment strategy. Lower levels of adherence are associated with poorer blood pressure control.

    Aim The aim of the work is to investigate the blood pressure-lowering effect with a simple tablet form "Single-Pill Combination" (SPC) that contains a combination of several antihypertensive drug classes and to investigate the patients' adherence to this form of treatment (SPC).

    Method This work is a literature study carried out in Pubmed. Different search terms were used: "single-pill combination for the treatment of hypertension", "Fixed dose combination in hypertension", and "Adherence to single-pill combination for hypertension". The search was filtered to "Randomized controlled trial". New studies were selected that investigated the effect of single-pill combination and blood pressure control and adherence to treatment.

    Results Studies 1, 2, 3, and 4 investigating the efficacy produced positive results favoring SPC over standard monotherapy and placebo. SPC was able to reduce blood pressure statically significantly in all studies. In Study 1, the primary outcome variable was the mean difference in SBT between groups (–6.9) mm Hg with (p-value <0.001). In Study 2, the difference in mean 24-hour SBT between SPC and placebo periods was (–18.7) mm Hg with a p-value <0.0001. Whereas in Study 3, in-clinic SBT changes were -16.5 ± (15.5) mm Hg (p < 0.001) with amlodipine/valsartan FDC and -6.9 ± (11.4) mm Hg (p = 0.012) with valsartan monotherapy while the corresponding changes in DBP in Office were -9.8 ± (7.7) mm Hg (p <0.001) and -2.5 ± (6.6) mm Hg (p = 0.095), respectively. The results of study 4 were that the percentage of participants who achieved target blood pressure after 6 months (SBT <140, DBT <90 mm Hg) was 69% in the SPC group and 55.3% in the monotherapy group. In study 5, no significant difference in compliance could be observed between the SPC group and the FEC group. The compliance rate was 98% in both groups. While study 6 reported significant results where PDT was 95.1% in the SPC group and 92.1% in the control group p-value <0.05.

    Conclusion All results in studies 1,2,3and 4 significantly favored SPC in terms of efficacy. Study 6 showed that patients’ adherence to treatment was better in the SPC group than in the control group. While study 5 which was the first RCT study in this area could not provide positive and significant results regarding the adherence to SPC compared to FEC. More RCT studies are needed to investigate whether SPC can lead to better adherence in hypertensive patients.

    Download full text (pdf)
    fulltext
  • 39.
    Danielsson, Elena
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Varför används inte e-dos i större utsträckning?2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective. The aim of this study is to increase the understanding of why physicians don’t use e-dos (a computerized prescription system) to a greater extent than about 50-60 % when prescribing medicine to patients within the specific medication dispensing system (ApoDos).

    Methods. This study has a qualitative approach. Data was collected via interviews with general practitioners and physicians from a hospital in the municipality of Kalmar during a couple of weeks in April 2010.

    Results. The physicians feel that e-dos is a good system, that provides a complete picture of the patient’s prescriptions. But because the electronic medical record systems “Cosmic” and e-dos aren’t able to share the same information in between them, this leads to an extra workload for the physicians. An integration of these two systems would decrease the workload and maybe also increase the use of e-dos. The graphic design is experienced as complicated and difficult to grasp. To make a change in a patient’s medication within e-dos requires a great quantity of information. Physicians are required to carry out a number of steps before a change is completed. Even experienced users choose not to use e-dos in some circumstances, i.e. then the prescription is urgent or temporary, and they use ordinary prescriptions instead.  After a change in a patient’s medication is prescribed, the system is locked until the change is approved by a pharmacist. This is a course of irritation among the physicians.   

    Conclusion. The majority of physicians considered the use of e-dos as safe for the patient.  They also pointed on the need of integration between the electronic medical record system, “Cosmic” and e-dos. Physicians expressed that the lack of integration was a risk factor for medical errors and that it increased the physicians’ workload. Several physicians also described the system as difficult to handle and wished a simpler design.  

    Download full text (pdf)
    FULLTEXT01
  • 40.
    Drajem, Veronica
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Apotekskunders uppfattning om trygghet med sina läkemedel och behandling. Hur de erhållit information om dessa samt deras kunskap om EES.: - En enkätundersökning om det förekommer skillnader mellan olika åldersgrupper på apoteket2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Pharmacists have for many years been an important part of health care. They have rescued many people from diseases and poisoning. It´s important that they ensure the right drug, dosage and administration in right time for each customer. Elderly people usually have more prescribes than younger which increases the risk of interactions.

    Poor compliance may result in increased morbidity or premature death. There are several reasons why treatment is not followed. Lack of information about the treatment of disease or information about the medications for both indication and side effects are some of them

    At all pharmacies in Sweden, EES, Electronic Expert Support, is available. The introduction of e-prescription in the 21st century has enabled an additional safety check for the pharmacist, using Electronic Expert Support (EES) for dispatching prescriptions. The current recipe is compared with other prescriptions where there are withdrawals and the prescriptions where there should be pharmaceuticals left to consume. If there is a risk of incorrect dose, double prescription, age warning, interactions, gender specific or if drug affecting disease, a signal is given at EES control showing strength and action that may, should be done.

    The purpose of the study was to investigate customers perception of advice at the pharmacy and if the use and knowledge of the EES (Elektroniskt Expertstöd) differed between different age groups. The survey was conducted using data collection from seven pharmacies located in five locations spread across Sweden. The collection was conducted for about 100 hours and generated in 277 participants. All participation was voluntary and anonymous. The participants were divided into three age groups: 40 years or younger, 41-60 and over 60 years. The collected data was analyzed by using IBM SPSS and a chi2 test was performed to see if there were any significant differences between the age-groups. The result was compiled and demonstrated in excel diagrams.

    There was no significant difference between the groups in terms of safety and information they received about their drugs. Most people received information about their medicines by the doctor, pharmacist or by reading the package leaflet. However, there was some difference regarding the use of the Internet in a search for information retrieval among those over 60 years. This may be due to lack of internet knowledge or physical impairment. There was also a significant difference when it came to the question of calling 1177 for information on medicines, where people 40 years or younger, called more often than other groups. This may be because they usually have younger children and may need advice regarding illness or injuries.

    There was a significant difference between the age-groups in consent to use EES were elderly people had consented more often. Elderly people usually have more drug prescribes than younger and therefore is it more useful for people over 60 years. The risk of interactions increases with the number of drugs.

    Download full text (pdf)
    fulltext
  • 41.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Hoffman, Mikael
    The NEPI Foundation, Linköping, Sweden.
    Patients' information on the prescribed current treatment2012In: Journal of Pharmaceutical Health Services Research, ISSN 1759-8885, Vol. 3, no 2, p. 79-84Article in journal (Refereed)
    Abstract [en]

    Objective To investigate how many patients, with five or more prescriptions in the Swedish National Prescription Repository (NPR) had received (1) the Medication List (ML) from the electronic medical record and (2) the Prescription List (PL) on prescriptions stored in the NPR and how these lists were used.

    Methods Patients> 18 years of age, with five or more prescriptions stored electronically in the NPR, collecting medicines on prescription for themselves at nine pharmacies all around Sweden were interviewed about their knowledge of, and if they had received, the ML, the PL and/or the pharmacy record (PR) on medicines purchased on prescription during the last 15 months, and what documentation they used to track their current, prescribed treatment.

    Key findings A total of 777 consensual patients (485 women) were interviewed. Of these, 32% were aware of the ML, but only 13% had received the MLat least once a year, and only 9% used the MLto track their current, prescribed medicines. Virtually all patients (99%) had received the PL at every pharmacy dispensing and 68% said they used the PL as documentation on their current, prescribed medicines. 52% used the dispensed packs to track their medication and 10% said they used a handwritten list. Only few patients were aware of the PR.

    Conclusion Our study shows that patients’ access to information on their prescribed medicines is not in accordance with intentions in health care. The risk for errors in medicine use at home is substantial.

  • 42.
    Ekelund, Philip
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Effekt av Tracleer (bosentan) vid behandling av pulmonell arteriell hypertension2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Pulmonell arteriell hypertension är en sjukdom som engagerar de små arteriolerna och venolerna i lungkärlbädden. Det är främst arterioler som drabbas och det handlar om en ökad proliferation, remodellering samt minskad apoptos vilket leder till en hypertrof kärlvägg med minskat kärllumen. Det föreligger samtidigt en obalans av mediatorer som reglerar kärltonus. Tillsammans ökar förändringarna flödesmotståndet eller den pulmonella vaskulära resistensen och höger kammare försöker att kompensera för det ökade trycket samt upprätthålla normala hjärtminutvolymer. Det höga lungartärtrycket leder till ökat afterload, minskad slagvolym, högersidig hypertrofi av hjärtmuskelceller  och efterföljande högerkammarsvikt samt död. Tracleer (bosentan) är en endotelin-receptor antagonist och syftet med denna litteraturstudie var att utvärdera Tracleers effekt vid behandling av pulmonell arteriell hypertension. I studien granskades 6 artiklar hämtade från pubmed, 4 randomiserade kliniska prövningar och 2 långtidsstudier utan kontrollgrupp. Resultatet visar att Tracleer (bosentan) har klinisk effekt vid behandling av pulmonell arteriell hypertension, men det behövs flera studier för att helt kartlägga substansens effekt i samtliga undergrupper av sjukdomen. I två av fyra placebokontrollerade studier förbättrade patienter statistiskt signifikant sina funktionella klassificeringar. I tre av studierna förbättrade patienterna sitt resultat i ett 6 minuters gångtest statistiskt signifikant. Sammanfattningsvis är Tracleer (bosentan) ett bra alternativ för behandling av pulmonell arteriell hypertension, men nya behandlingsalternativ behövs och kombinationsterapi av flera preparatgrupper bör övervägas om patienterna är svårt sjuka eller befinner sig i funktionell klass IV som Tracleer (bosentan) inte är indicerat för. I framtida forskning skulle adekvata långtidsstudier och kombinationsterapi vara intressanta områden att utvärdera. 

    Download full text (pdf)
    fulltext
  • 43.
    Ekman, Elisabet
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Tågerud, Sven
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Bäckström, Martin
    Awareness among nurses about reporting of adverse drug reactions in Sweden2012In: Drug, Healthcare and Patient Safety, E-ISSN 1179-1365, Vol. 4, p. 61-66Article in journal (Refereed)
    Abstract [en]

    Background: The purpose of this study was to investigate awareness among nurses regarding their new role as reporters of adverse drug reactions in Sweden and factors that may influence reporting by nurses.

    Methods: In 2007, all nurses were included in the adverse drug reaction reporting scheme in Sweden. A questionnaire was sent to 753 randomly selected nurses in September 2010.

    Results: Of the 453 (60%) responding nurses, 265 (58%) were aware that nurses were included in the reporting of adverse drug reactions. Sixty-one nurses (14%) stated that they had reported an adverse drug reaction. Fifteen percent (n = 70) of the respondents had received training about reporting of adverse drug reactions. Almost one third of these (n = 21, 30%) had reported an adverse drug reaction on at least one occasion. Among nurses without training, a smaller proportion (n = 40, 11%, P < 0.05) had reported an adverse drug reaction on at least one occasion. The two factors considered most important by nurses for reporting were the severity of the adverse drug reaction and if the reaction was to a newly approved drug. A majority of the nurses (n = 397, 88%) were interested in a training course in pharmacology as part of their ongoing professional development. One third (32%) of all nurses stated that one reason for not reporting a suspected adverse drug reaction was that the physician responsible did not regard the reaction necessary to report.

    Conclusion: We found that more than half of the study population of nurses in Sweden were aware of their new role as reporters of adverse drug reactions, but few of the responding nurses had reported an adverse drug reaction. Given that training seems to be associated with high reporting frequency, we suggest more training in pharmacovigilance for nurses.

  • 44.
    Elias, Ali
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Vankomycins effektivitet i jämförelse med andra läkemedel mot meticillinresistent Staphylococcus aureus2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Staphylococcus aureus (S. aureus) är en av många bakterier som har utvecklat resistens mot olika typer av antibiotika. På mitten av 1940-talet detekterades penicillinresistent S. aureus. Meticillinresistent S. aureus (MRSA) identifierades sedan år 1961. Vankomycin, en tricyklisk hydrofil glykopeptid, används fortfarande som ett förstahandsläkemedel mot allvarliga MRSA-infektioner trots förekomsten av vankomycinresistens och tillgången till nya MRSA-läkemedel. Syftet med detta arbete är att jämföra effektiviteten av vankomycin med andra läkemedel vid behandlingen av MRSA. Detta görs för att kunna bedöma om användningen av vankomycin som ett förstahandsläkemedel mot MRSA bör omprövas. Detta arbete är en litteraturstudie som är gjord med hjälp av artiklar från databasen PubMed. Det hittades fem studier om behandlingen av olika MRSA-infektioner. Linezolid visade sig vara effektivare än vankomycin vid behandlingen av hud- och mjukdelsinfektioner samt nosokomial pneumoni. Daptomycin var inte underlägset vankomycin mot bakteriemi och endokardit. Arbekacin visade sig vara mindre effektiv än vankomycin mot kronisk mediaotit. Kombinationen trimetoprim/ sulfametoxazol (TMP/SMX) verkade vara överlägset vankomycin vid behandlingen av hälsovårdsförvärvad pneumoni och ventilatorförvärvad pneumoni. Den slutsats som kan dras i detta arbete är att vid en jämförelse av vankomycin med linezolid, daptomycin, TMP/SMX och arbekacin vid behandling av olika MRSA-infektioner var vankomycin överlag mindre effektiv. Det kan därför vara lämpligt att ompröva ifall vankomycin bör användas som ett förstahandsläkemedel mot MRSA.

    Download full text (pdf)
    fulltext
  • 45.
    Elofsson, Olivia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kombinationsbehandling med Lactobacillus och Bifidobacterium vid irritable bowel syndrome2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Irritable bowel syndrome (IBS) is one of the most common functional bowel disorders without any detectable biochemical or structural changes with a prevalence of about 10 % worldwide. The diagnosis is based on the ROME-criteria which is a symptom based diagnostic tool and also exclusion of other severe diseases. Further on, IBS can be divided into different subgroups based on stool texture evaluated by the Bristol stool form scale (BSFS).  The pathology behind IBS is not fully understood but several factors and mechanisms are thought to be involved. Amongst those are hypersensitivity in the gut and divergent pain transmission, disturbance in gut microbiota, genetics, increased inflammation, defective mucosal barrier function with increased permeability, psychosocial factors and diet. Treatment is mainly used to alleviate symptoms so as to help the patients to manage the disease by education and by avoiding the triggering factors that may exacerbate the symptoms.  Probiotics are living non-pathogen microorganisms, meaning they are not harmful, used to treat or favor the host. Some of the most studied genera of bacteria, both in general and used as treatment of IBS, are Lactobacillus and Bifidobacterium. These bacteria are often referred to as lactic acid bacteria due to their ability to metabolize specific carbohydrates and produce lactic acid.  This study aimed to investigate the effect of probiotics consisting of these two genera on symptom relief for patients with IBS. It was achieved by carrying out a literature review in the PubMed database. Five articles were found based on set criteria.  The results showed that probiotics based on Lactobacillus and Bifidobacterium have potential to alter the gut microbiota and that levels of Bifidobacterium corresponding to level of symptoms and inflammatory markers. Also, the intestinal permeability was lowered by probiotics administration. The overall symptoms and severity were decreased as well as several specific symptoms. Despite that, a significant increase in quality of life was not observed.  The dose used was between 5-10 billion colony forming units (CFU) in all but one study. This study used a much higher dose of 52 billion CFU and did also last a longer period of time but did not get better results than the other studies. The study population was in general similar in all studies and did also reflect the most common patient group based on prevalence.  In conclusion, probiotics consisting of Lactobacillus and Bifidobacterium can be used to improve severity of IBS and to relieve general and specific symptoms. 

    Download full text (pdf)
    fulltext
  • 46.
    Emilsson, Erica
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Vilka underlag för sin receptordinerade läkemedelsbehandling använder sig kvinnor respektive män av?2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Obtaining accurate and sufficient information about prescribed drug therapy is a prerequisite for a patient to implement the treatment in a satisfying way. Which medicines should be used, why should they be used, how should they be used (dosage, administration) and for how long should the therapy last – all these questions should be answered with an accurate source. The information on different sources can differ and therefore contain incorrect information. This may result in medication errors, which in turn can have serious consequences for the patient’s health.

    From the electronic patient record (EMR), the patient can receive a list of the doctor’s prescriptions. This list contains information about product name, dosage and indication of the medicine prescribed. In the national prescription repository (NPR), the prescriptions sent electronically (almost all of the Swedish prescriptions) are saved and can be obtained and dispensed at any pharmacy. The patient can also receive a list from the NPR, containing information about all saved prescriptions in the repository. The list contains information about product name, dosage and indication. The doctor can not make changes in this repository. To be informed of what dispenses has been executed during the last 15 months, the patient can ask for another list from the national prescription repository (NPR). This list contains information about what dispenses has been executed, independently of prescribing doctor and dispensing pharmacy. This list can for example be used to complement a patient’s medical records and to give the doctor information about what medicines the patient eventually has taken.

    The aim of this study was, from a gender perspective, to examine if pharmacy custumers where aware of the different sources mentioned above and/or which sources they use to implement the medication treatment. Furthermore, it was examined how many used are presentative for their pharmacy errands. It was also examined if there were problems keeping track of the medicine prescriptions. The extent of discrepancies between the number of prescriptions and number of medicines the patient specify they used, was also examined.

    The study was conducted at Apoteket Lejonet (Apoteksgruppen AB) in Kalmar by interviewing pharmacy custumers. Patients with five or more prescriptions in the NPR were asked about sources, prescriptions, potential problems and socio-economic survey.

    The study showed that 223 of 699 respondents (32 %) knew of the list from the EMR, slightly more common among men then women. A third of them used it as a source to implement the medication treatment. Almost all of the respondents knew of the list from the NPR. This was also the most common source – used by almost 70 %. Nine percent used a representative for their pharmacy errands. Fifteen percent said there were problems keeping track of the medicine prescriptions. The problem most of them specified was about generic substitution.

    It is important that the sources contain accurate and sufficent information about the prescriptions. In that way the patient can achieve a safe treatment with satisfying results. Both pharmacies and the health care can and should make reconciliations when changes in the treatment are done. Then, the sources can be kept updated and correct, thereby reducing the risk of medication errors, and the patients’ safety is promoted.

    Download full text (pdf)
    fulltext
  • 47.
    Enbom, Nathalie
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Behandlingsalternativ vid egentlig depression: en jämförelse mellan agomelatin och SSRI/SNRI2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aims of the study were to compare the effects on depressive symptoms and insomnia between agomelatine and SSRIs/SNRIs in adult patients with major depression disorder.

    Method: Materials were collected from the database Pubmed and selected through the aims of the study and certain selection criterias. It was required that the studies fulfilled at least one of the study´s aims to be eligible for inclusion. Eight randomised clinical trials were included in the study. The results from the studies were compared according to statistical and clinical significance.

    Results: Depressive symtoms were reduced both with agomelatin and SSRIs/SNRIs. Generally the rates of respone and remission were similar of agomelatine and SSRIs/SNRIs. There were advantages for agomelatine in the individual studies concerning rates of respone and remission. Six of the included studies investigated the effect on insomnia. In a majority of these studies agomelatine caused a statistically significant improvement compared to SSRIs/SNRIs. Clinically, both agomelatine och SSRIs/SNRIs improved most of the variables related to insomnia that were examinated according to patient-reported outcome results.

    Conclusion: Statistically both SSRIs/SNRIs and agomelatine achieved similiar effects on depressive symptoms. In the majority of the included studies that examinated effect on insomnia agomelatine showed a statistically significant improvement compared to SSRIs/SNRIs. Clinically, agomelatine is viewed as a viable option for adult patients with major depressive disorder with unsuccessful response or remission from SSRIs/SNRIs. A similiar clinical relevance were shown for agomelatine and SSRIs/SNRIs concerning improvement of insomnia according to patient-reported outcome results.

    Download full text (pdf)
    fulltext
  • 48.
    Engman, Maria
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Utgör användningen av citalopram, metoprolol och simvastatin inom slutenvården vid Kalmar Länssjukhus någon miljörisk?2008Independent thesis Basic level (degree of Bachelor), 15 poäng / 22,5 hpStudent thesis
    Abstract [sv]

    ABSTRACT

    Läkemedel i miljön har under de senaste decennierna uppmärksammats alltmer som angelägna miljöföroreningar. De sprids till miljön antingen genom att substanserna eller deras metaboliter utsöndras ur kroppen via urin och faeces eller att oanvända läkemedel spolas ut i avloppet. Vilka effekterna blir i miljön beror på substansernas inneboende egenskaper, som att bioackumuleras i växter och djur, samt på hur persistenta, potenta eller toxiska de är. Dagens reningsverk är inte konstruerade för att ta hand om läkemedelssubstanser, men framförallt genom den biologiska reningen, minskas halterna av några.

    Syftet med arbetet är att utifrån uppmätta koncentrationer uppskatta de mängder av citalopram, metoprolol och simvastatin som lämnar Länssjukhusets i Kalmar slutenvårdsverksamhet, och att göra en riskbedömning utgående från de halter som når recipienten (Kalmarsund). Miljörisken är baserad på kvoten mellan förväntad koncentration av substansen (PEC) i miljön och högsta koncentrationen av substansen som inte har någon skadlig effekt i vattenmiljön (PNEC). Därför jämfördes denna kvot med kvoten mellan den funna koncentrationen (MEC) i detta arbete och PNEC.

    Resultatet visar att för metoprolol och citalopram är risken för miljöpåverkan liten eftersom de båda substanserna har en riskkvot < 0,1. Simvastatin kunde inte detekteras och inga beräkningar gjordes därför för substansen. Resultatet av analysen visar också att substansernas halter är likartade i det inkommande och utgående vattnet från Kalmar avloppsreningsverk, vilket tyder på att dessa substanser bara passerar rakt igenom reningsverket. Utifrån erhållna resultat kan slutsatsen dras att inga akuta effekter i vattenmiljön förväntas. Det utesluter dock inte att substanserna kan ha kroniska effekter i vattenmiljön. Riskerna för ekosystemen förväntas vara större än riskerna för människors hälsa.

    2008:F17

    Download full text (pdf)
    FULLTEXT01
  • 49.
    Ericson, Lisa
    et al.
    Nordic Health Economics AB.
    Ambring, Anneli
    Björholt, Ingela
    Dahm, Peter
    Opioid rotation in patients initiated on oxycodone or morphine: a register study.2013In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 6, p. 379-86Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Strong opioids are recommended for the treatment of moderate to severe pain. However, some patients do not achieve a successful treatment outcome due to intolerable adverse events and/or inadequate analgesia, thus may benefit from switching to another opioid, a procedure known as "opioid rotation." The type of opioid at treatment initiation may influence the risk of opioid rotation and the objective of this study was to assess such rotation after treatment initiation with two alternative treatments, controlled-release (CR) oxycodone versus CR morphine in patients suffering from non-cancer pain.

    METHOD: The study reported here was a real-life study based on Swedish register data: the Prescribed Drug, National Patient, and Cause of Death registers. The captured data cover the entire Swedish population treated in specialist care. A statistical analysis plan was agreed and signed before data were accessed.

    RESULTS: Data from 50,223 cases were included in the analyses. The risk of rotation was 19% higher in patients initiating treatment with morphine compared with oxycodone (hazard ratio 1.19; 95% confidence interval 1.11-1.27; P < 0.001), after adjusting for such baseline variables that were both significantly correlated with the outcome variable (time to rotation) and significantly different between the groups; age at index date, osteoarthritis and number of pain-related drugs.

    CONCLUSION: Patients with non-cancer pain who initiated treatment with CR morphine had a higher risk of opioid rotation than patients initiated with CR oxycodone.

  • 50.
    Ericsson Bergman, Molly
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Effektivitet och säkerhet av Nivolumab och Ipilimumab som kombinationsterapi jämfört med som monoterapi hos patienter med malignt melanom2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Malignt melanom är den allvarligaste formen av hudcancer och orsakas av att friska melanocyter börjar dela sig okontrollerat, vilket resulterar i en tumör. Det finns flera riskfaktorer för melanom men en av de främsta är exponering av UV-strålning. En ytterligare riskfaktor för malignt melanom är olika genmutationer varav av en vanligt förekommande genmutation är BRAF-mutation. Det finns flera behandlingsmetoder men en nyare behandling som används vid de senare stadierna av melanom är immunterapi. Programmed cell death 1 (PD-1)-hämmaren nivolumab och cytotoxic T-lymphocyte antigen 4 (CTLA-4)-hämmaren ipilimumab är två checkpointhämmare som på olika sätt hämmar tumörtillväxten. 

    Syftet med denna litteraturstudie var att undersöka nivolumab och ipilimumabs effekt samt säkerhet både som monoterapi och kombinationsterapi. Databasen PubMed användes för att välja ut fem RCT-studier. Vid sökningen användes sökord som ”melanoma”, ”nivolumab” och ”ipilimumab”. Några av inklusionskriterierna var att patienterna hade melanom i stadie III och IV, och både patienter med BRAF V600-mutation och med BRAF wild-type inkluderades. Ett av exklusionskriterierna var artiklar som var inriktade på melanom i hjärna, lunga eller ögon.

    Resultatet visade att nivolumab och ipilimumab som kombinationsterapi var mer effektiv avseende både total överlevnad och progressionsfri överlevnad jämfört med nivolumab och ipilimumab som monoterapi. Nivolumab som monoterapi var mer effektiv än vad ipilimumab som monoterapi var avseende total överlevnad och progressionsfri överlevnad. Behandlingen med nivolumab och ipilimumab som kombinationsterapi resulterade däremot i fler biverkningar jämfört med nivolumab och ipilimumab som monoterapi. Patienter som behandlades med nivolumab som monoterapi upplevde färre biverkningar än vad patienterna som behandlades med ipilimumab som monoterapi upplevde.

    Utifrån resultaten i de studier som granskats så är slutsatsen att kombinationsbehandlingen var den mest effektiva, men om även säkerhet inkluderas är nivolumab som monoterapi det bättre alternativet då det hade både god effekt och en lägre biverkningsprofil jämfört med de andra behandlingsalternativen. För ett mer tillförlitligt resultat bör ytterligare studier genomföras under längre tid och i en större skala.

    Download full text (pdf)
    fulltext
12345 1 - 50 of 229
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf