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.

Sjukhusfarmacin i Sverige genomgick en omfattande utveckling underandra halvan av 1900-talet. Följande arbete undersöker utvecklingen avläkemedelstillverkning på sjukhusapotek i Sverige år 1950–2000 och besvararfrågorna när, var, hur och varför den skedde. För detta ändamål har olika material(böcker, artiklar, intervjuer, etc.) studerats. Under 1950-talet bestod tillverkningenpå sjukhusapoteken främst av enkla beredningar som injektions- ochinfusionslösningar. År 1963 utförde Apotekarsocieteten en utredning av uppgifteroch resurser och började diskutera vad som bör gälla för tillverkning påsjukhusapoteken. Sterila lösningar började tillverkades i plastförpackningaristället för i glas, vilket eliminerade sprickbildning och ledde till en mindre riskför bakteriekontamination. Radiofarmacin växte fram under 1960-talet ochfortsatte sin utveckling under 1970- och 1980-talet. Reagensberedning,dialyslösningar och extemporetillverkning av olika beredningsformer ökade iomfattning. Centralisering och rationalisering av tillverkning var betydande för attförenkla tillverkning av läkemedel. TPN, parenteral smärtlindring och cytostatikavar tillverkningsmoment som tillkom under 1980-talet. Endos- ochflerdosförpackningar blev vanliga under 1990-talet. Tillverkning av TPN ochradiofarmaka fortsatte att öka och utvecklas. Många faktorer har bidragit tillutvecklingen som skedde under 50-årsperioden. Till en början bestodtillverkningen av enkla produkter och utvecklades efter hand till att omfatta alltmer komplexa beredningar. Denna utveckling har kunnat ske på grund av blandannat ökade resurser (antal sjukhusapotek, personal, material, lokaler, utbildning),utveckling inom vetenskap, medicin och teknik, centralisering och rationalisering,regleringar, samarbete mellan farmaceuter och sjukhuspersonal, samt ambitionoch engagemang från de som varit med och fört utvecklingen framåt. / Drug manufacturing in Sweden underwent a large-scale evolutionduring the second half of the 20th century. The following essay examines thisdevelopment and investigates when, where, how and why it occurred. For thispurpose, various materials (books, articles, interviews, etc.) have been studied. Inthe 1950s, manufacturing consisted of simple preparations such as injection andinfusion solutions. In 1963, Apotekarsocieteten carried out an investigationregarding how and to what extent manufacturing should be carried out in hospitalpharmacies. Sterile solutions were now manufactured in plastic packaging insteadof in glass, which eliminated cracking and led to a smaller risk of bacterialcontamination. Radiopharmaceuticals evolved during the 1960s, 1970s and 1980s.Preparation of reagent solutions, dialysis solutions and extemporaneouspreparation of various other products became a frequent occurrence.Centralization and rationalization were of major importance to facilitatemanufacturing. Production of TPN, parenteral pain management and cytostaticsemerged in the 1980s. Simple- and multidose packaging became commonplaceduring the 1990s. Manufacturing of TPN and radiopharmaceuticals continued toincrease and develop. Multiple factors have contributed to the development thatoccurred during the 50-year period that this essay covers. Initially, manufacturingconsisted of simple products and gradually evolved to include increasinglycomplex preparations. This evolution has been possible due to increased resources(number of hospital pharmacies, personnel, materials, premises, education),development in fields such as science, medicine and technology, centralizationand rationalization, collaboration between pharmacists and hospital staff,regulations, and the ambition and commitment of those who have been involvedin the evolution of manufacturing in Swedish hospital pharmacies.

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.

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.

Quality of drug use in asthma Background: The National Airway Register is a quality register, which provides opportunities for quality follow-up and improvement. It contains data on individuals with asthma disease, their drug treatment and outcomes obtained in health care.  Aim: To examine how representative data on drug treatment contained in the National Airway Register are for adult patients with asthma in Region Stockholm and Sweden, respectively. Methods: A cross-sectional study based on data from the National Airway Register and the Prescribed Drug Register, where the study population consisted of asthma patients aged 18-44. Open data from the Prescribed Drug Register was limited to 15–44-year-old patients. Data were collected for the period 2016–2020 regarding drugs within ATC code R03 and dupilumab with ATC code D11AH05.  Results: A difference in the use of asthma drugs between the National Airway Register and Prescribed Drug Register with the same trend for all studied years was seen. In the National Airway Register, the proportion of individuals who used bronchodilators without having obtained any ICS was lower and a higher proportion (74-82% vs 65-70%) had obtained ICS. Drugs administered in clinics cannot be studied in the Prescribed Drug Register. Conclusions: Drug treatment in the National Airway Register generally seems to comply better with international guidelines than in the Prescribed Drug Register, which may be an indication that the quality of asthma treatment is higher for patients registered in the National Airway Register. This causes problems in generalizability since obtained data only correspond to individuals who are selected.

Pharmaceutical services in pharmacies from the pharmacist’s perspective- with focus on inhalation check  Background: Wrong use of drugs is a major problem today. Pharmaceutical services can be a solution to this problem. By ensuring that the patient receives sufficient information to be able to use his/her drugs in the right way. Developments in performing new pharmaceutical services at Swedish pharmacies are currently under investigation. Previous studies showed that pharmacists have a major impact on the development of pharmaceutical services.  Aim: The aim is to investigate the attitude of community pharmacists to perform pharmaceutical services in pharmacies with focus on the service of inhalation check.   Method: A qualitative semi-structured interview was conducted in this study among 9 pharmacists who work at community pharmacies. The interviews took place at 7 different pharmacies in the Stockholm area.  Results: The results showed that pharmacists who participated in the study have a positive attitude towards the introduction of the inhalation check service in pharmacies. The inhalation check service is considered a service that can contribute to reducing incorrect inhalation technique and optimal treatment. Prerequisites for being able to implement the service in pharmacies from the participant’s perspective are more employees, more time, a suitable place, and some type of financial compensation.  Conclusion: Pharmaceutical services provide an opportunity for pharmacies to show their usefulness in society, while at the same time providing an opportunity for pharmacists to utilize their expertise. The inhalation check service is a service needed in a Swedish pharmacy. To be able to perform the service at Swedish pharmacies, different conditions are required.

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Background: Uppsala University Hospital Sweden is planning to implement a closed loop medication system, with the aim of reducing risk prescriptions from the point of drugs being prescribed to orders being produced and administered. With inspiration from Leuven, an advanced system for pharmaceutical validation; System Assisted Pharmaceutical VALidation (SAPVAL) is planned to be developed. Aim: The aim of the study was to obtain a deeper understanding of clinical rules as an important element for building the SAPVAL system. This study will review and further develop a first set of clinical rules and validate these on the intended study population.  Methods: A retrospective cross-sectional study was performed to validate the clinical rules on a study population of 500 patients who were discharged from Uppsala University Hospital between May to July 2020. The clinical rules were applied cross-sectionally based on patient data from the electronic health records. From the total generated alerts, 10 % was randomly selected for assessment of the clinical relevance. Results: The clinical rules generated 893 alerts in 500 patients, of which 84 % alerts still remained two days after the patient was admitted to the hospital or at discharge. From the randomly selected alerts, 26 % were deemed clinically relevant. Conclusions: The developed clinical rules generate a large number of alerts for risk prescriptions for inpatients at Uppsala University hospital. The majority of the alerts remained during the care period and approximately a quarter of them were considered to be clinically relevant to remedy.

Background: Drugs are an important part of treating diseases but can also come with its risks. To reduce the risks, a system assisted pharmaceutical validation (SAPVAL) is being developed at Uppsala University Hospital. This will include the generation of alerts regarding different risks, sent to a clinical pharmacist who assesses whether the alerts should be forwarded to a physician or not. One of the risks included is QT prolongation, a relatively uncommon condition which however can result in sudden cardiac death. Aim: The aim was to map the management and the consequences of QT-related risk prescriptions and to determine the clinical relevance of QT-related alerts. Method: A retrospective cross-sectional study was performed at Uppsala University Hospital. It included the review of patients´ electronic health records (EHR) and determination of risk periods. The clinical relevance of the alerts was assessed by a physician and a developed flowchart. Results: 65 patients (age=71 ± 15 years, 54% women), and their 85 QT-related alerts were included, with a median risk period of 145 days. Within the risk period, 46 patients had an ECG taken with 35% having one or more prolonged QTc ≥ 480 ms. The risk of QT prolongation had been noticed or mitigated for 23% of the 65 patients. 89% of the alerts were concluded to be clinically relevant. Conclusion: The management and documentation of QT-related risks could be improved. It is also important to further study QT-related risk factors to better assess which patients are at the highest risk.