Background: Anorexia nervosa is known as an eating disorder that is associated with significant low body-weight, self-starvation and food restrictions. It all usually starts with thoughts of a desire wanting to eat healthier and look thinner. The sickness has become increasingly common in the recent time where 0,5-1% of Sweden’s population suffers from the disease. Most of those who suffer from anorexia nervosa are young girls in their teenage years.The disease comes with consequences and needs to be treated. A person sick in anorexia nervosa can feel a loss of strength which is associated with the lack of energy. Other symptoms that come along with anorexia nervosa are usually low blood pressure, low pulse (bradycardia) and amenorrhea.Anorexia nervosa is an eating disorder, but it also has psychological effects that often come with depression and obsessive-compulsive disorder. These symptoms combined makes it difficult to treat anorexia nervosa and usually demands a combination of supervised weight gain and psychological therapy. Objective: The aim of this study was to evaluate the efficacy of olanzapine treatment regarding weight gain in patients suffering from anorexia nervosa. Olanzapine is an atypical antipsychotic drug that has a well-known adverse effect known as weight gain. In this study this adverse effect of olanzapine is used to see if the drug can be well tolerated and applied to patients suffering from anorexia nervosa. Method: This literature review study analyzed six studies and their results regarding the efficacy of olanzapine on weight gaining in anorexia nervosa patients. One study that was included in this literature review was a case study of a young 15-year-old girl's journey to become healthy from anorexia nervosa while using olanzapine. Three of the six studies were randomized controlled trials that compared olanzapine against placebo while two of the six studies were open label studies that evaluated olanzapine efficacy in anorexia nervosa patients. Results: The results based on the six studies show that olanzapine has positive effects regarding weight gaining in patients suffering low weight from anorexia nervosa. The randomized controlled trials that were included in this literature review study show that olanzapine had a greater significant effect on weight gain compared to placebo. The side effects of olanzapine presented in the studies were very mild to moderate and included sleepiness and headache. The doses of olanzapine used in the six studies were similar and contained 10-15 mg olanzapine each day. Conclusion: In summary, olanzapine has the benefit of increasing weight in anorexia nervosa patients, but the evidence is limited because of the small number of participants in the studies and only a few studies have been made. It would be of interest to see if olanzapine still has a beneficial effect in larger studies with more participants.

Background: During the last century, closure in rural pharmacies has been increasing in Sweden resulting in unequal access to pharmaceutical services among the population. Telepharmacy is a provision of pharmaceutical care to patients at distance thereby increasing access to health care. Previous studies have shown promising results regarding various clinical outcomes, attitudes of patients and pharmacists in addition to high-quality drug counseling. As pharmaceutical care is essential for safe drug utilization, it is of importance to induce new approaches in Sweden to maintain pharmaceutical care in these areas. Aim: This study aimed to evaluate a telepharmacy system named Farmaceut på Distans at a local pharmacy in Sweden concerning; patient's and pharmacists’ attitudes, areas of improvements, and safety of the method. Methods: The study was performed between 26/4,-7/5 2021. The objectives of this study were evaluated through a questionnaire and short semi-structured interviews with patients, a semi-structured observation, a semi-structured interview with the project leader, and a focus group with included pharmacists. Additionally, a medicine dispensing error protocol was established.  Results: Eleven patients, three pharmacists, and the project leader were included in this study. This study shows that patients and pharmacists expressed optimistic attitudes towards Farmaceut på Distans. However, the method requires to be improved regarding technical aspects in advance of implementation. Further, no medicine dispensing errors were obtained.  Conclusions: Due to the small sample size, no conclusions can be drawn regarding the safety of the method. Farmaceut på Distans is a promising approach to maintain safe drug utilization in Sweden. However, further studies require to be performed regarding safety and attitudes among users.

8 Abstract Analysis of antibiotic administration in prophylaxis I Author: Petr Domecký Tutor: PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Lucie Hauschke, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Antibiotic prophylaxis (AP) plays an important role in reduction of surgical site infection (SSI). It is the administration of an eligible antibiotic or chemotherapeutic (ATB) in a single dose, usually 30 minutes before surgery, followed by two to three doses during or after the surgery, regarding the selected ATB and the surgical procedure. The aim of this work was to analyse the AP in surgical procedures at the Masaryk Hospital in Ústí nad Labem (MNUL) in the context of the MNUL guideline (DP) and the research on available AP work. Methods: A cross-sectional observational study ran from January 2018 to March 2018 in surgical departments at MNUL. The study included patients aged ≥ 18 years who underwent surgery in a defined period (5 February 2018 to 9 February 2018) and gave their consent to the study. The practicability of the study was verified by a pilot part. Initially, a research of published studies concerning AP was carried out which provided outputs for AP establishment (PPA). Subsequently, a form for...

Analysis of antibiotic administration in prophylaxis II Author: Martina Bobčíková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Anna Patková, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: The term antibacterial prophylaxis (AP) refers to antibiotic (ATB) administration in prevention of surgical site infection (SSI). There are many factors in population which can potentially raise the risk of the incidence of SSI. The maintenance of basic rules of the AP and knowledge, influence and timely elimination of risk factors of SSI are the most important measures which can reduce a number of postoperative SSI. The aim of this study was to analyze antibiotic administration in prophylaxis in the local hospital in the Czech Republic and compare the results to well known international guidelines (ASHP-G) and latest scientific knowledge (LSK). Methods: The cross-sectional study was conducted in October 2019. During the period from 2nd to 23rd October, the data of surgeries and used AP were collected. The patients who passed the entry criteria have been included in this study. Into prepared form, patient's identification, agreement, diagnosis, surgery type, operation date, the beginning and the end of surgery,...

Analysis of antibiotic prophylaxis in patients with osteosynthesis of the proximal femur Author: Anna Baťková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: Mgr. Markéta Dlouhá Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: This work is part of the continuous monitoring of antibiotic prophylaxis (AP) at the Department of Traumatology, University Hospital. The aim was to analyze and compare key parameters of AP in osteosynthesis of pertrochanteric fractures with the previous investigation and the methodological guidelines of the University Hospital. Methods: This retrospective cross-sectional study took place from 1st April 2019 to 31st March 2020 at the Department of Traumatology at the University Hospital. AP was analyzed in 50 patients above 18 years of age and who underwent a pertrochanteric fracture of the proximal femur. Data was collected with a form, prepared in cooperation with the Department of Medical Microbiology, physicians and clinical pharmacists of the University Hospital. Information on the patient, surgery, indication of AP, selected antibiotic/chemotherapeutic (ATB) and its dose, time, route of administration, as well as the size, number and interval of administered postoperative doses and...

Abstract Background: In the last decades, services that community pharmacies provide to the consumers have increased. Pharmacies and consumers discuses information related to medicine use, which lead to optimal treatment. Protection av patient privacy and confidentiality is one of the most important factors to achieve in such discussions. Several international studies showed that achieving this factor in community pharmacies is challenging to both pharmacists and consumers. According to our knowledge, there are no similar studies on consumers’ perceptions of privacy in community pharmacies in Sweden Objective: The aim of this study is to explore consumer’s positive and negative experiences of privacy practice in community pharmacies in Sweden. Method: Semi-structured interviews were conducted with consumers of community pharmacies in three different regions in Sweden. Consumers were interviewed by zoom with camera. All interviews were audio-recorded, transcribed verbatim and then analyzed and organized into different themes. The interviews were conducted between April and May 2021. Results: 14 themes and privacy issues were identified, such as variety in privacy definition in community pharmacies for Swedish consumers, trusting pharmacists by most of the consumers, seeing bought sensitive medicines through packaging and overhearing private conversations. The majority of the consumers showed positive reactions about consultation areas and agreed about the need for better privacy practice in community pharmacies. Conclusion: Some findings of this study met other similar studies conducted in other countries. The optimization of the privacy practice was challenging in community pharmacies. Since protecting the privacy could be achieved by cooperation between the staffs and the consumers, the findings of this study were preliminary and needed further exploration, such as interviewing pharmacists and considering their perspectives.

What is Known and Objective: The development of rapid diagnostics has revolutionized antimicrobial stewardship with efforts targeting earlier de-escalation or discontinuation of antibiotics. The respiratory viral panel (RVP) is one tool quickly able to detect common viral and bacterial pathogens using polymerase chain reaction technology. Utility may be further enhanced in conjunction with procalcitonin (PCT). However, the optimal use of the RVP to the clinical pharmacist in the treatment of community-acquired respiratory infections remains unclear. Methods: The purpose of this guide is to review the available literature regarding the impact of the RVP with and without procalcitonin on antimicrobial stewardship efforts and to provide guidance on how to use each of these tools. Results and Discussion: In total, 13 studies were included, 5 of which utilized PCT in conjunction with RVP and 8 of which did not use PCT. The majority of studies were retrospective in nature, and the most common outcomes evaluated were antibiotic days of therapy (DOT) and time to antibiotic discontinuation. What is New and Conclusion: After review, RVP alone has limited value to antimicrobial stewardship; however, when used in conjunction with procalcitonin, RVP has the potential to reduce antibiotic use and duration.

Prescription of opioids in Sweden. Regional variation from a quantitative and qualitative perspective. Introduction: Opioids plays an important role in healthcare as they are used primarily for severe acute pain, postoperative purposes and cancer-related pain. However, they also carry a risk for drug addiction, which can lead to many health and societal problems. Consequently, prescribing of opioids should be very restrictive. Aim: Describe and evaluate the change in the prescribing of opioids in different Swedish regions, as well as to assess potential reasons behind the change over time in selected regions. Methods: Quantitative data on dispensed prescriptions with opioids between 2015 and 2020 were collected from the Swedish Prescribed Drug Register held by National Board of Health and Welfare. The data was used to identify the change in opioid prescribing in the country and the variation between regions. The quantitative assessment was complemented with qualitative semi-structured interviews with representants from four regions that had the largest and smallest change in opioid prescribing, respectively, to discuss factors that may have influenced the prescribing. Results: The number of individuals per 1000 inhabitants who were dispensed opioid prescriptions decreased from 85 to 67 during the study period. The choice of opioid substances changed with a decrease in prescription of tramadol and codeine/paracetamol, and increase in oxycodone prescription. The variation in opioid prescription between different regions was around 45 %. This variation was not associated with socio-economic factors. Regions that worked actively with information campaigns, training courses and implementation of the recommendations for more rational use of opioids prescribed less opioids and decreased the most during the study period. Conclusion: The number of individuals per 1000 inhabitants who obtained opioid prescriptions decreased overall but there was a substantial variation between regions showing the potential to improve drug prescribing with local activities. Continuous implementation of recommendations needs to be done for more rational opioid use.

What is Known and Objective: The development of rapid diagnostics has revolutionized antimicrobial stewardship with efforts targeting earlier de-escalation or discontinuation of antibiotics. The respiratory viral panel (RVP) is one tool quickly able to detect common viral and bacterial pathogens using polymerase chain reaction technology. Utility may be further enhanced in conjunction with procalcitonin (PCT). However, the optimal use of the RVP to the clinical pharmacist in the treatment of community-acquired respiratory infections remains unclear. Methods: The purpose of this guide is to review the available literature regarding the impact of the RVP with and without procalcitonin on antimicrobial stewardship efforts and to provide guidance on how to use each of these tools. Results and Discussion: In total, 13 studies were included, 5 of which utilized PCT in conjunction with RVP and 8 of which did not use PCT. The majority of studies were retrospective in nature, and the most common outcomes evaluated were antibiotic days of therapy (DOT) and time to antibiotic discontinuation. What is New and Conclusion: After review, RVP alone has limited value to antimicrobial stewardship; however, when used in conjunction with procalcitonin, RVP has the potential to reduce antibiotic use and duration.

Literature review of pharmacogenomics in pediatric oncology patients related to chemotherapy-induced toxicity Abstract Background: As children are expected to live long after their treatment of cancer, it is important to reduce the risk of toxicities. Chemotherapy-induced toxicities can result in interruption or discontinuation of treatment, and the variability in toxicities among pediatric patients can be explained by inter-individual variability in pharmacodynamics and pharmacokinetics. Part of this variability can be explained by genetic variations. By establishing an individualized treatment in pediatric oncology, the risk of chemotherapy-induced toxicities can be reduced.  Aim: The aim of the project is to map positive and negative associations between genetic variations and the various chemotherapy-induced toxicities that affect pediatric oncology patients. Method: This literature search was performed by using Embase, Web of Science and PubMed. The articles that were included are those that describe an association between one or more genetic variations and side effects caused of chemotherapy in children between 0-18 years with a cancer diagnosis. Only articles written in English were included. Results: Only articles published 2021 were included. Eleven out of 26 articles were included where associations between different genetic variants and the risk of developing anthracycline-induced cardiotoxicity, myelosuppression, hepatotoxicity, mucositis, ototoxicity, and vincristine-induced peripheral neurotoxicity were identified. Conclusions: The results of this literature review indicate that there are several gene polymorphisms that have the potential to be used to predict the risk of developing chemotherapy-induced toxicity in pediatric oncology patients. Although some studies may observe significant evidence between some toxicity and gene polymorphism, further studies are required to achieve better validation before any guidelines can be established.