: INTRODUCTION : Osteoarthritis (OA) is a degenerative disease that predominantly affects geriatric population. However, geriatric patients are not often treated according to specific geriatric recommendations. OA also belongs to highly prevalent disorders managed mostly by symptomatic, analgetic drug treatment. The aim of this diploma thesis was to evaluate to which extend are clinical guidelines for management of OA focused (generallly and in areas of individual pharmacotherapeutic strategies) on specific aspects of rational geriatric pharmacotherapy. Diploma thesis was completed as a recherche thesis (part I.) for follow-up studies dealing with rationality of analgetic drug treatment in older patients (rigorous thesis of M. Miklasová MS, Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, 2016). METHOD : 4 national and 3 international clinical guidelines for management of osteoarthritis in accessible languages, published between 2005 and 2014 years, were identified by literature search conducted between 9/2015- 3/2017. Following guidelines were included : czech (2012), german (2009), australian (2009), american (2012) and recommendations of international societies OARSI (2008-2010), EULAR (2005, 2007) and NICE (2014).This diploma...

Research indicates that tobacco cessation rates are at least doubled when smokers receive assistance from a clinician; receiving tobacco cessation advice from multiple types of clinicians increases quit rates even further.¹ To address a decades-long deficiency in the tobacco cessation training of health professionals in general, a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, was developed in 1999 as a collaboration of the schools of pharmacy in California.^2,3 Between 2003 and 2005, pharmacy faculty members (n=191) participated in national train-the-trainer workshops designed to equip faculty with the necessary knowledge and skills to implement the Rx for Change curriculum at their academic institutions.⁴ <div><br></div><div> The studies that comprise this dissertation are a logical extension of this national initiative, applying a mixed-methods approach to: (a) evaluate the long-term impact of training pharmacy faculty using the Rx for Change program, (b) delineate recommendations for developing and disseminating shared curricula for health-care programs, and (c) evaluate utilization of the Rx for Change website, which hosts faculty resources and curricular files for download. In combination, these (along with a previously-conducted qualitative study) provide a comprehensive “view” of the long-term impact of this unique shared curriculum. </div><div><br></div><div>Results from the three studies provided evidence for: (1) reach to the majority of pharmacy institutions, (2) a high level of adoption of the Rx for Change in health professional schools, (3) a positive impact on faculty trainees’ careers and their level of confidence for teaching, precepting clinical students, and assisting tobacco users, (4) implementation of the Rx for Change curriculum with a variety of teaching methodologies, and (5) continuity of use within the core curriculum of pharmacy institutions. Seven key factors were found to have contributed to the success of the Rx for Change program, and thus the following are recommended for future shared curriculum developers: (1) appeal to attendees, (2) relate content to clinical practice, (3) deliver live training (in-person), (4) develop high quality materials delivered by experts, (5) meet accreditation standards, (6) provide support for teaching, and (7) demonstrate effectiveness. Data from the website analysis provided evidence for interprofessional reach of the Rx for Change website to educators, learners, and professionals.<br></div>

Abstract Elective urological patients’ medication usage at the time of admission Author: Nygren. J. Supervisor: Gillespie. U. Examiner: Nielsen. E. Department of Pharmaceutical Biosciences, division of pharmacokinetics and drug therapy. Faculty of pharmacy. Uppsala University, Sweden.   Background and Objective: Information about the patient’s current medication treatment before elective urologic surgery has been based upon a prefilled self-reported health declaration or a patient provided medication list. A new work procedure has recently been adopted where a pharmacist performs a medication reconciliation in order to increase the patient safety, receive deeper insight into the patients ongoing treatment and to reduce the physician’s workload. The objective of the study was to map out how well the patients could account for their medication usage at the time of admission and to identify discrepancies between the health declaration/patient’s medication list and the medication list after medication reconciliation. Design: The study population consisted of adult men and women scheduled for elective urological surgery.  A clinical pharmacist performed a medication reconciliation and stored appurtenant patient data and medication lists in anonymised forma. Data was then analysed by a student undertaking his degree project (MSc Clinical pharmacy). The population and discrepancies were divided into sub-groups and a t-test was performed to identify any statistical difference between selected sub-groups of the population. Setting: Urology department, Uppsala University Hospital Main outcome measures: The proportion of patients having at least one discrepancy were studied. Distribution of discrepancies per patient was compared between sub-groups; number of medications, age and county of residence. Results: At least one discrepancy (range 1-7) was observed in 51 (66%) out of the 77 patients included in the study. Patients using &gt;5 medications at the time of admission had more discrepancies per patient than those using 0-5 medications (3.2 vs 1.0; p=5.6x10-6) and there was a trend towards Uppsala patients having more discrepancies per patient than those residing outside the region (2.4 vs 1.5; p=0.057). There was no significant difference observed between the age groups. Conclusion: The health declaration/medication list presented at the time of admission did not provide enough information to determine the patient’s complete medication usage.

Bakgrund: Användning av läkemedel ökar och därmed ökar också läkemedelsrelaterade problem. För att patienter ska kunna ha en säker läkemedelsbehandling krävs bland annat korrekt och fullständig läkemedelsinformation. I dagsläget finns det olika informationskällor som patienter använder för att hålla koll på sin läkemedelsbehandling men i många av dem förekommer avvikelser som gör att risken för felmedicinering eller överdosering ökar. Syfte: Syftet med det här arbetet var att undersöka prevalensen av avvikelser i läkemedelslista ”Mina sparade recept på apotek” (MSR), samt att se om vissa läkemedelsgrupper skulle förekomma oftare än andra bland avvikelserna. Även andra variabler, såsom informationskällor som patienter använder för att hålla reda på sin läkemedelsbehandling, avsaknad av receptbelagda läkemedel i MSR och användning av receptfria läkemedel mättes. Metod: Data for studien samlades in genom speciellt utformade läkemedelsintervjuer med patienter på ett öppenvårdsapotek i Sverige under veckorna 3–5 i början av 2021. Patienterna som inkluderades var vuxna patienter som hade åtminstone tre receptbelagda läkemedel i sin MSR och som hämtade ut läkemedel åt sig själva. Innan läkemedelsintervjuerna påbörjade erhölls också ett skriftligt samtycke från alla deltagare. Resultat: Nästan 70 procent av 69 intervjuade patienter hade minst en typ av avvikelse i MSR, därav dubbla och inaktuella recept var vanligaste. Bland avvikelserna var de vanligaste läkemedel för behandling av sjukdomar som rör nervsystemet, hjärta och kretslopp samt matsmältningsorgan och ämnesomsättning. En del av patienterna (35 procent) saknade receptbelagda läkemedel i sin MSR, medan 30 procent av dem uppgav att de använde receptfria läkemedel. Informationskällan som användes av de flesta patienterna för att hålla koll på deras läkemedelsbehandling var just MSR.  Slutsats: Avvikelser i MSR förekommer hos nästan 7 av 10 patienter och de läkemedelsgrupperna som var vanligare bland avvikelser är också läkemedelsgrupper som orsakar mest läkemedelsrelaterade problem. Dessa avvikelser måste åtgärdas eftersom de påverkar patienternas säkerhet och förhoppningsvis kommer implementering av den nya nationella läkemedelslistan (NLL) kunna förbättra situationen för både patienten och hälso- och sjukvårdspersonalen. / Background: The use of medicines has increased in the past few years, which has also led to increased amount of drug-related problems (DRP), such as drug-drug interactions and serious adverse effects which lead to hospitalization. In order to decrease the amount of DRP, the medication lists of individual patients need to be accurate and updated. The most used medication list among those available is the one that is printed out at a pharmacy “My stored prescriptions at pharmacy”.  It is also called “Prescription List” (PL). Even though a lot of patients use the PL, there are a lot of discrepancies in it, such as noncurrent and missing prescriptions, but also prescription duplicates. Aim: The aim of this study was to study the prevalence of discrepancies in the PL, such as noncurrent or duplicate prescriptions, wrong dosage or other unclarities, but also to see if there are some particular drug groups which are more common among the discrepancies. Secondary outcomes that were measured included the amount of missing prescriptions in the PL, as well as the usage of over-the-counter (OTC) medicines and primary information sources that patients use to keep track of their prescriptions. Methods: Data needed for the study was collected by interviewing patients at a local pharmacy. The interview was specially designed to answer to all the outcomes and the patient’s individual PL was also used to identify the discrepancies. In order to be included in the study patients needed to be at least 18 years old, have three or more prescriptions in the national prescription repository (NPR) and pick up their own medication, as well as provide a written consent to participate. Pharmacists that were dispensing patient’s prescriptions were also in charge of the recruitment of patients. Result: Out of the 103 patients that were informed about the study, 69 patients were included. Almost 70 percent of them had at least one type of discrepancy in the PL. The most common discrepancy was prescription duplicates (46 percent), followed by noncurrent prescriptions (44 percent). Drug groups which were common among the discrepancies were the drugs used to treat diseases in the nervous system, cardiovascular system and digestive system (including metabolism). Secondary outcomes showed that 35 percent of the patients had at least one missing prescription in the PL, but also that 30 percent of the patients used OTC medicines, the most common being paracetamol (acetaminophen). The most used information source was the PL with 32 percent of patients using it as their primary information source for their medication therapy. Conclusions: Prescription duplicates and noncurrent prescriptions are frequent in the PL and are a major source of medication errors for patients and health-care workers. Drug groups which where the most common among the discrepancies are also the ones responsible for half of the hospitalizations in Sweden. This implies that they could probably be prevented by improving the PL. The number of the missing prescriptions was quite low. The usage of OTC medicines showed that most of patients used painkillers. These are the drugs that Swedes often overuse and therefore, for future safety, monitoring of OTC sales should be implemented. Although it had 21 percent of inaccuracies, the PL was the most used information source for the patients, which gives the conclusion that the improvement of it is needed as soon as possible in order to prevent and decrease the frequency of DRP.

Analysis of pharmacoterapy hospice care patients Author: Jakub Sládek Tutor: doc. PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and purpose: The therapy of hospice care patients is accompanied by many changes and pitfalls that need to be balanced when choosing appropriate therapy. In the teoretic part we can find available information about paliative therapy of hospice care patients, with emhasis on pain therapy. The aim of this thesis is the analysis of pharmacotherapy hospice care patients. Methods: The data were collected in a hospice from September 2019 to November 2019. The farmacotherapy was revised every first day of the month. Informations from personal, drug, family and occupational social history of patients were noted into an electronic database and, after revision, were classified and evaluated by frequency analysis. In four randomly selected patients was described the management of drug-related problems (DRP). Results: In total we noted medical therapy in 40 patients, women were 75 % of this number. Average patient's age was 72.4 years for men and 74.6 for women. Patients most often used drugs from group N (drugs of the nervous system) according to the ATC classification. We indentified 115...

<p><b>Background/ Objective:</b> In our current healthcare system, information seekers have a bulk of the responsibility to initiate conversations about medications. Although older adults report the need for more information about their medications, many do not accept offers to receive more information from pharmacists during the dispensing of prescription medications. Very little previous work focuses on how older adults make decisions about seeking and avoiding information about medicines, or how these decisions impact medication outcomes. Therefore, the specific aims of this study were to: 1) describe older adults’ attitudes about medication information seeking and the relationships between those attitudes and medication information management behaviors and 2) characterize the relationship between medication information management behaviors (MIMB), medication knowledge, medication beliefs, and attitudes towards medication information seeking. </p><p><b>Methods:</b> Older adults prescribed a new, chronic medication were recruited from a specialty geriatric clinic to participate in interviews that occurred either in-person or over the phone. Participates were randomized 1:1 to usual care or to patient-prompted medication counseling (PPMC). Participants in the PPMC group agreed to ask a pharmacist questions about their new medication at their next medication refill and received a brief education. A survey instrument based on the Theory of Motivated Information Management (TMIM) was adapted from past studies to assess participants’ attitudes about information seeking. Participants were asked to report their information seeking and avoidance over the previous six-months prior to the study and at baseline and month one. Open-ended questions from a national medication safety campaign were utilized to assess medication knowledge. A rubric was developed to score participants’ answers as incorrect knowledge, no knowledge, incomplete knowledge, or complete knowledge and used by two community pharmacists to determine patient medication knowledge (PMK) scores. Structural equation modeling was utilized to identify predictors of MIMB, and hierarchical and logistic regression were used to determine the relationship between MIMB and medication outcomes. </p><p><b>Results: </b>A total of 132 participants completed baseline surveys, and 126 participants completed the month one surveys. Overall, a structural model based on the TMIM met the a priori criteria for good fit (Bollen-Stine bootstrap=0.269). Participants’ positive outcomes assessments, negative outcomes assessments were direct, positive predictors of information seeking and direct, negative predictors of information avoidance. After controlling for baseline medication knowledge, the effect of the intervention, and information seeking there were statistically significant differences in medication knowledge between those participants that sought information from a pharmacist during refill dispensing and those who did not (B=0.259, p<0.001). Of those that sought information from a pharmacist, 70% gained information from baseline to month one, while 36.9% of those that did not seek information from a pharmacist gained information baseline to month. There were no differences in medication beliefs between those that sought information from a pharmacist and those that did not.</p><p><b>Discussion/ Conclusion:</b> Patient knowledge deficits continue well beyond the initial dispensing of a medication, and older adults are also at risk for knowledge loss over the course of prescription use. Receiving additional information from a pharmacist at the time of medication refill may be protective against this information loss, and even increase the change of gaining medication knowledge over time. However, medication counseling in its current form is likely not sufficient to alter older adults’ beliefs about medications. Only one pharmacist initiated a conversation with a participant at medication refill indicating that those participants who want additional information about their medications after the initial dispensing may have to initiate the conversation with a pharmacist.</p>

Analysis of the effect of pharmacotherapy on the risk of falls in inpatents III Author: Tereza Honsová Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction: Falls are frequent and unwanted events happening in healthcare facilities. The falls have a multifactorial character. The prevention is the best way how to improve a quality of healthcare and a quality of the patient's life. All of the doctors, clinical pharmacists and nurses can help to realize it by cooperating with each other, working with professional information and by individual attitude to each patient. Objective: The aim of this study was to analyze the effect of the fall risk-increasing drugs to falls in hospitalized patients and to recommend the right interventions to prevent the fall. Methodology: For the analysation, classification and quantification of the fall risk-increasing drugs, drug related problems and interventions a special online database was created. All of the doctors, clinical pharmacists and nurses were collecting details about the pacients and about how the fall happened. Fall risk-increasing drugs and drug-related problems were then analyzed by clinical pharmacists. Potential interventions were suggested. Also other...

Analysis of the effect of pharmacotherapy on the risk of fall in inpatients II Author: Nikola Szikorová Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and objectives: Falls are one of the most common problems of hospitalized patients. Their occurrence is associated with many problems and therefore should be avoided. Effective prevention involves analyzing risk factors and implementing interventions to minimize these risks. The aim of this work was to analyze the influence of drugs and other risk factors on the fall of hospitalized patients. Methods: Data was collected from April to December 2017 in 4 hospitals in South Bohemia. Only patients who had fallen during hospitalization participated in the study. An online database was created for the study to collect patient data (personal history, medications used, laboratory values and others). Population and individual fall risk-increasing drugs were analyzed. For each individual fall risk-increasing drug, the type of drug problem that could have been the cause of a fall was classified. Risk minimization interventions have been assigned to each drug problem. In addition to fall risk-increasing drug analysis, other risk factors that increased the risk...

Introduction: Infections caused by bacteria can be treated with antibiotics. One type of antibiotic used to fight bacteria is ciprofloxacin, a group of fluoroquinolones. To prevent this, bacteria have developed resistance by mutating in various ways. Negative bacterial cultures, short- and long-term treatments, all favor the progression of bacterial resistance to antibiotics, as a consequence of mutation. Compared to other antibiotics, the resistance development has increased more extensively for ciprofloxacin. Also, ciprofloxacin is incorrectly prescribed in primary care, which contributes to the increase in resistance development. Because of this, doctors wish to be more restrictive with the prescription of ciprofloxacin. Aim: This study aimed to determine if ciprofloxacin in primary care in Sörmland is prescribed correctly by examining whether the prescriptions are in compliance with the treatment recommendations in Sweden. Methods: The study was conducted as a survey research and executed under two months; from start of February to middle of April. The inclusion criteria were the primary care in Sörmland and the prescribers who prescribed ciprofloxacin with ATC code J01MA02 from January 2020. Firstly, the head of the care unit was contacted. Prescribers were then contacted individually to take part in a phone interview. The collection of data was compiled and compared to the treatment recommendations in Sweden to determine if the prescriptions were correct, regarding indication, dosage, and treatment time. Results: A total of 236 prescriptions were obtained, of which 89 were included in this study. Out of these, 32 prescriptions (36%) were in accordance with the correct choice of preparation regarding indication, dosage and treatment time and were, therefore, considered to be correct. Prescriptions that were not in accordance with the Swedish treatment recommendations, regarding the use of correct preparation for a single indication, dosage or treatment time, amounted to 57 prescriptions (64%). These prescriptions were, thereby, considered incorrect. Conclusion: This study concludes that it appears that less than half of the prescriptions of ciprofloxacin in the primary care in Sörmland were correct during this time period.

Extravasation is a condition that can occur during an intravenous administration. This means that the solution administered intravenously goes extravascular. Depending on physiochemical properties of the substance and solution, this can cause different severity of the damage. Extravasation of acyclovir, potassium phosphate and potassium chloride causes severe tissue damage that can, in worst case, lead to tissue necrosis. The purpose was therefore to investigate how acyclovir, potassium phosphate and potassium chloride causes tissue damage due to pH and osmolality and how the tissue damage can be avoided. To answer the purpose, a comprehensive literature search was conducted on three different databases; Pubmed, CINAHL and Cochrane. The literature search was in progress from February 4 to May 14 2020. The literature search generated a total of 42 articles and case reports, of which 13 of these were relevant for the purpose. These 13 articles consisted of two animal studies, three experimental observational studies, two guidelines from Västra Götalands Region, three case reports about acyclovir and three case reports of potassium phosphate and potassium chloride.   Two of the experimental observational studies showed that potassium chloride could be diluted with 100 mL of 0,9% sodium chloride or 5% dextrose in water to possibly avoid tissue damage due to extravasation. Such results were not found for either acyclovir or potassium phosphate. The conclusion that could be drawn was that acyclovir caused tissue damage because of its alkaline pH, potassium phosphate because of its hyperosmolality and potassium chloride because of its acidic pH and its hyperosmolality. One way to possibly avoid tissue damage caused by extravasation is to dilute the substances with higher dilution volumes. However, due to the lack of reliability of the included studies, it cannot be safely concluded that tissue damage can be avoided.