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Background: There are some health care centers in Region Västmanland that always turn a profit, and other health care centers which always go at a loss.   Aim: The aim of this study was to analyze the potential reasons as to why the same health care centers always profit, and the other health care centers always go at a loss under year 2022.   Methods: A cross-sectional study with register data for the year 2022 was used as a method. The analysis was performed by aggregating different indicators and measures. For example, the age and sex of the patients, socioeconomic status, morbidity, and number of listed patients that the health centers have. Two different therapy areas were chosen for deeper analysis - diabetes and atrial fibrillation. Medicines for these diagnoses have the highest cost for the health centers. In addition to this, differences between the health care centers in prescribing of over-the-counter medicines and in selection of generic drugs were also considered.  Results: The results show that the three health centers that lost the most had 29 percent higher costs per diabetes patient of the more expensive diabetes drugs compared to other three health centers that always make a profit. The health centers that had the largest loss had higher costs of Lyrica, a more expensive drug compared to other bioequivalent drugs, than the other health centers. The health centers that lost the most had older patients, and more patients who were socioeconomically disadvantaged. Two of the health centers that lost the most had higher CNI scores, which means that the patients at these health centers had a lower socio-economic status.   In conclusion, the health care centers that lost the most had the highest diabetes costs, especially from the more expensive drugs and they had also more older patients.

When drugs need to be delivered to the respiratory system dry powder inhalers (DPIs) are often used. The powders in DPIs often consists of a micronized active pharmaceutical ingredient (API) that is adhered to a larger carrier particle forming an adhesive mixture. To achieve a good drug delivery aerosolization is very important and to improve the aerosolization a force control agent such as magnesium stearate (MgSt) may be used. The aim of this project is to investigate how MgSt effects the aerosolization and bulk properties of adhesive mixtures containing different amount of API. Several analyses of bulk properties such as density, bulk density and compressibility were made. The results from these experiments showed that the only bulk properties that had a significant change when MgSt was added was the bulk density. When investigating if the aerosolization properties changed with added MgSt a fast-screening impactor (FSI) and a next generation impactor (NGI) were used. The results showed a clear improvement of aerosolization properties for all the powder containing MgSt. The fine particle fraction (FPF) and fine particle dose (FPD) both increased for all the powder when MgSt was added. The pressure drop sensitivity decreased when MgSt was added which also was desired. In conclusion adding MgSt seems to be beneficial for the aerosolization properties regardless of the amount of API in the powder.

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Background: Patient harm is a global problem that causes hundreds of millions of hospitalizations every year. Part of the problem is medicinal harm, many of which are preventable. One way to improve rational treatment is the use of clinical pharmacists within healthcare. By conducting medication reviews medical related problems can be identified and actions set in before further harm is made. Those directly impacted by any complication are the patients, yet in Sweden studies have focused on experiences of health personnel. To promote person-centered care, it is therefore important to focus on patients’ point of view. Aim: To explore inpatients’ knowledge about and experiences with clinical pharmacists. Method: Individual semi-structured interviews with inpatients from a Swedish hospital. The patients had met with a clinical pharmacist earlier in the day and were asked questions related to that meeting. Interviews were audio-recorded, transcribed, and qualitative analyzed withthematic analysis. Results: In total 20 patients were interviewed from four different wards: 55 % were female and the average age was 75 years (41-89 years). Four main themes were identified: 1) Earlier knowledge about clinical pharmacists; 2) Pharmacists integration into care; 3) Personal traits of a pharmacist; and 4) Patient benefit of the meeting. Conclusion: Inpatients’ knowledge about clinical pharmacists is low and few expect to meet one during hospitalization. Still, the general impression is mostly positive, and patients appreciate both the person and the context. Future research should focus on how to promote clinical pharmacists to increase patient awareness and their involvement in care.

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Bakgrund: Vitamin D är ett steroidvitamin och tillförs oss från vissa livsmedel eller syntetiseras när vår hud utsätts för solen. Inuti cellerna fungerar det som en transkriptionsfaktor för en grupp gener. 1,25-dihydroxivitamin D3 (1,25D3) är den aktiva vitamin D-metaboliten, men den cirkulerar mest i kroppen som 25-dihydroxivitamin D3 (25D3). ER-stress uppstår när proteinsyntesen inte fungerar för att försöka rädda cellen. Tidigare studier har föreslagit en skyddande effekt av vitamin D på ER-stress.  Syfte: Syftet med denna studie var att undersöka effekterna av metaboliter av vitamin D på ER-stress i PC3 och NSC34-celler. Metoder: PC3-celler och NSC34-celler behandlades med 1,25D3 eller 25 D3 i kombination med ER-stressorn tunicamycin. Stressnivåerna mättes med realtids-PCR med BiP som biomarkör för ER-stress och CYP24A1 som biomarkör för D-vitamininduktion. Resultat: Resultaten från qPCR-analysen var varierande och motsägelsefulla i de behandlade PC3-cellerna. Den genomsnittliga dubbla skillnaden i uttrycket av BiP för tunikamycin-behandlade celler var endast något större än för celler behandlade med en kombination av tunicamycin och 1,25D3 eller 25D3. När det gäller NSC34-celler verkar kombinationen av tunicamycin och en vitamin D-metabolit öka ER-stressen. När celler behandlades med tunicamycin minskade metabolismen av D-vitaminmetaboliterna. Slutsats: Denna studie ger information om inte bara effekten av den tidigare studerade 1,25D3 på ER-stress, utan även effekten av 25D3. Studien antyder också en tidigare okänd biologisk funktion av 25D3, vilket utmanar tidigare antaganden om en inaktiv metabolit.

Background: The last decades, advances in drug development have resulted in many biological drugs being launched on the market. There is limited knowledge of how they are being used. The aim of this study was compare volumes and expenditure of biologics in between 2017 and 2021 to get an overview of the most used biologicals in Stockholm, Sweden.   Methods: Descriptive cross-sectional analyses were made om data for region Stockholm on utilization and expenditure of biologics 2017 and 2021. Data were collected using databases on dispensed drugs and hospital sales from Socialstyrelsen and Region Stockholm, respectively. Measurement units used in the study were Defined Daily Doses, amount of sold packages and total expenditure in Swedish crowns.  Results: Volumes of biologics have increased over time.  Also cost of most biologic drugs increased except for the cancer drug trastuzumab. TNF-a inhibitors were the biologics accoutning for the highest cost. Some of the drugs were sold either by prescription or hospital sales only.   Conclusion: Volumes and expenditure of biologics increase in use and belong to the top-drugs by expenditure. Further research and analyses are needed to assess the appropriateness.