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Syftet med denna studie är dels att undersöka hur stor andel av arbetstiden som sjuksköterskor, inom kommunala hälso- och sjukvården i Kalmar kommun, använder för kontakt med apoteken, dels att belysa hur sjuksköterskorna ser på kontakten med apoteken med avseende på dess omfattning och innehåll. Kalmars kommunala sjuksköterskor förde under en vecka i februari 2009 tidsdagbok över sin apotekskontakt. I anslutning till detta utfördes även en enkätundersökning bland dessa sjuksköterskor. Svarsfrekvensen var låg; 43 % av sjuksköterskorna deltog i enkätstudien och endast 19 % deltog i tidsstudien. Den genomsnittliga andelen arbetstid som ägnades åt apotekskontakt fastställdes till 4,6 ± 3,9 %. Enkätstudien visade på en del önskemål om förändring i såväl kontakten med apoteken som i de kommunala rutinerna. Förslag som lades fram av sjuksköterskorna för en minskning av kontakttiden med apoteken var bland annat att annan personal inom hälso- och sjukvården eller anhöriga till patienten gör apoteksärenden i stället för sjuksköterskorna, samt att apoteken ska införa en särskild kö för vårdpersonal och därmed minska kötiden. Den låga svarsfrekvensen gör att inga statistiskt signifikanta slutsatser kan dras av studien och då i synnerhet inte av tidsstudien. Studien visar dock på stora variationer sjuksköterskorna emellan, i andel arbetstid som ägnas åt apotekskontakt. Validiteten och precisionen för denna variation är ej hög, delvis på grund av det låga deltagandet. Enkätundersökningen visade på problem som kan härröras till brist i kommunikationen mellan såväl sjuksköterskor och övrig hälso- och sjukvårdspersonal, som mellan sjuksköterskor och apotekspersonal. En förbättrad interprofessionell kommunikation skulle eventuellt kunna lösa denna problematik.

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.

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.

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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