Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital. Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate. Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated. Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced. / Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen

Background: Oral contraceptives are common among female athletes. Still, its effects on athletic performance are poorly investigated. Research in the area has increased in recent years. However, the study qualities and designs are often insufficient and with small sample sizes. Women are currently underrepresented in sport research, and to recruit more women in future studies and to facilitate female athletes’ choices about contraceptives, the impact of oral contraceptives on performance must be better understood. Aim: The aim was to investigate whether monophasic, combined oral contraceptive phases affected maximal muscle strength, anaerobic performance and the corresponding blood lactate response, or perceived mental and physical energy level among young women. Method: The study used a cross-over design where six participants were tested on two occasions. The participants were healthy women between 18 and 29 years old who had beenusing monophasic combined oral contraceptives for at least three months prior to the study. No criteria for training level was set. The Isometric mid-thigh pull (N) was used as an indicator ofmaximal muscle strength; and the Wingate anaerobic test (W) measured anaerobic performance and power with corresponding blood lactate levels (mmol/L) measured at 0, 3 and 5 minutes after termination of the test. The participants rated their current physical and mental energy level on both test occasions using a visual analog scale (0-10). Statistical analyses were madeusing Wilcoxon signed-ranked test. Results: Nine participants were recruited, of which six performed tests on both occasions. The participants had a mean (SD) age of 22.3 (1.8) years, a BMI of 23.3 (2.6) and all reached WHO’sphysical activity recommendations. No statistically significant differences in muscle strengthor anaerobic performance were found regarding peak force (p=0.60), peak power (p=0.35) oraverage power (p=0.60) between oral contraceptive phases. Neither were there any differencesin the blood lactate response to the Wingate test directly after (p=0.92), 3 minutes after (p=0.17) or 5 minutes after (p=0.60) the test. No differences in perceived mental energy level (p=0.35)or perceived physical energy level (p=0.17) between oral contraceptive phases were evident. Conclusion: Oral contraceptive phases did not affect maximal muscle strength, anaerobicperformance, blood lactate response or perceived mental or physical energy levels. Accordingly, there is no need to adapt training to oral contraceptive phases and women can berecruited in future research without consideration of oral contraceptive phases.

Glioblastoma is the most aggressive type of primary tumor in the central nervous system (CNS tumors). It is hard to treat and has a poor prognosis for survival. Primary CSN tumors occur in approximately 1400 adults in Sweden every year and is the third most common cause of cancer-related deaths in individuals between 15-24 years of age.   There is no prophylaxis for primary CNS tumors. The causes of most CNS-tumors are unknown, but there are several risk factors that have been identified. Both heredity and environmental factors are likely to come into play, but clinical data does not suggest any convincing evidence of CNS tumor formation. Some cases of CNS tumors are related to known genetic conditions that cause rare syndromes and have an increased risk of getting a brain tumor.   The treatments for glioblastoma are surgery, radiotherapy, chemotherapy, TTField treatment and immunotherapy. Immunotherapy is a type of cancer treatment that uses the patient’s immune system to fight CNS tumors. New cancer immunotherapies, such as dendritic cell (DC)-based vaccines are under development to enhance anti-tumor presentation and to prime anti-tumor T-cell responses.   The objective of this study was to investigate the efficacy of DC vaccines for the treatment of glioblastoma.    Seven clinical studies from PubMed were found after searching in the Pubmed database, and filtering through the inclusion and exclusion criteria. All seven studies explored the efficacy of DC vaccines on overall survival and progression-free survival for patients with glioblastoma. In addition to investigating the safety and adverse events, the clinical trials evaluated the immune response to the DC vaccines against glioblastoma.   Combining standard of care (SOC) with DC vaccines prolonged the overall survival by several months compared to SOC alone. Severe adverse reactions (grade 3) were reported in two studies, while the rest of the studies showed that patients tolerated the DC vaccines and had only mild grade 1-2 adverse events. Half of the studies correlated prolonged median survival or progressions- free survival with immune response.   Further research is required to compare the efficacy of DC vaccines and other immunotherapies in order to conclude whether DC vaccines are a feasible effective treatment of glioblastoma in the future.