A systematic approach to improving pharmacotherapy in the elderly

The aim of this thesis was to investigate whether a structured and systematic approach on improving pharmacotherapy in the elderly (the LIMM-model) would lead to a more appropriate and accurate drug use in the elderly. The elderly use many drugs and are more prone to suffer from adverse drug reaction. It is therefore important to address the quality of their drug therapy. The first study presented in this thesis showed that medication errors in the transition of care are common. These results contributed to the development of the LIMM-model. The model consists of patient medication interview at admission (including medication reconciliation), medication review during the hospital stay and a discharge summary with a medication report at discharge (including medication reconciliation). The activities are performed by the clinical pharmacists and the health care team in close collaboration. The opportunity to study the full model arose as the department of internal medicine at Landskrona Hospital was interested in improving drug therapy in the elderly by using clinical pharmacy services. We therefore started the Landskrona Integrated Medicines management – the LIMM-study. The studies presented here add information and knowledge on clinical relevant topics regarding drug therapy in the elderly, as great room for improvement has been shown to exist in this field. The LIMM-model can help improve the drug therapy in the individual patient, the transfer of information between care levels, is highly appreciated by the health care personnel and is considered very beneficial both for the health care personnel and for the patients

Повышение эффективности использования трудовых ресурсов на предприятии (на примере ОАО «Гомсельмаш»)

Bakgrund: I Sverige är den vanligaste dödsorsaken kranskärlssjukdom, vilket kan innebära hjärtinfarkt. Riskfaktorer för hjärtinfarkt är låg fysisk aktivitet, höga blodfetter, rökning, låg inkomst och låg utbildning. En hjärtinfarkt uppstår vanligtvis på grund av att ett åderförfettningsplack har brustit och bildat en blodpropp.  Syfte: Syftet med denna litteraturstudie är att undersöka kvinnor och mäns erfarenheter efter en hjärtinfarkt. Metod: Nio kvalitativa vetenskapliga studier analyserades enligt Fribergs modell för litteraturöversikt. Resultat: Resultatet sammanställdes i de tre kategorierna Begränsningar i vardagen, Stöd respektive brist på stöd från omgivningen, Förändrad syn på livet.  Konklusion: De personer som drabbats av en hjärtinfarkt lider ofta av hälsoproblem som fatigue i efterförloppet. Livsstilsförändringar kan vara svåra att genomföra och framförallt att bibehålla. Hälso- och sjukvårdspersonal bör vara väl insatta i vad livet efter en hjärtinfarkt innebär och ge gott stöd till de som drabbats. Livsstilsförändringar bör genomföras några få i taget istället för alla på samma gång för att det ska bli hållbart på lång sikt. Background: The most common cause of death in Sweden is coronary heart disease, which can imply myocardial infarction. Risk factors for myocardial infarction are low physical activity, high blood lipids, smoking, low income and poor levels of education. A myocardial infarction occurs when a fatty, calcified plaque has ruptured and formed a trombosis. Aim: The aim of this literature study is to examine women and men’s experiences after a myocardial infarction. Method: Nine qualitative scientific studies were analyzed according to Friberg’s model for literature review. Results: The results were complied into three categories named Restrictions in daily life, Support or lack of support from the community, Altered life vision. Conclusion: The people who have suffered a myocardial infarction often sustain health problems such as fatigue in the aftermath. Lifestyle changes may be difficult to adopt and above all to maintain. Healthcare professionals should be well informed of what life after a myocardial infarction can implicate and give good support to those affected. Lifestyle changes should be carried out a few at a time rather than all at once to make them sustainable in the long term

Undersowing oats with clovers supports pollinators and suppresses arable weeds without reducing yields

Sustainable food production requires agriculture to conserve biodiversity and facilitate ecosystem services to maintain productivity levels while reducing inputs detrimental to ecosystem functioning. Increasing within-field vegetation diversity by legume intercropping seems promising to facilitate cropping system multi-functionality. Effects of intercropping with legumes on biodiversity-mediated ecosystem services such as pollination or natural pest control are, however, not sufficiently understood. Using 26 observation plots in a paired field design, we studied the effects of undersowing oats with a mixture of three annual clovers across different aspects of cropping system multi-functionality. We investigated 16 below- and above-ground ecosystem service indicators related to soil mineral nitrogen, arable weed control, pollination, disease and pest pressures, natural pest control and crop yield. We found lower arable weed cover, higher flower cover and pollinator densities as well as decreased root-feeding nematode densities in intercropped observation plots compared with the non-intercropped controls. However, intercropping decreased spider activity densities and oat yield nitrogen content. Root diseases, pest damages, natural pest control and crop yield were not affected by intercropping. The biomass of undersown clovers was positively related with the differences in flower cover and pollinator densities, and negatively related with the differences in arable weed cover between the intercropped and the control treatment. Synthesis and applications: We demonstrate that undersowing annual clovers suppresses arable weeds and simultaneously support pollinators without reducing crop yields or taking land out of arable production. Undersown plant mixtures should, however, be tailored to support a wider spectrum of pollinators and benefit natural pest control to support a higher level of overall cropping system multi-functionality

Modelling managed forest ecosystems in Sweden : Poster presentation:

In this work, the forestry-enabled dynamic vegetation model LPJ-GUESS was used to simulate forest standing volume for the three main regions of Sweden. At the regional scale, the model results were evaluated against observational data from the Swedish National Forest Inventory. Carbon fluxes of net ecosystem exchange (NEE), gross primary productivity (GPP), and ecosystem respiration (Reco) were simulated at the local scale on a daily time step for two sites in Sweden and results were evaluated against data from the Integrated Carbon Observation System (ICOS). The model produced adequate results of standing volume in monocultures of Norway spruce and Scots pine for southern and central Sweden, after an updated parameterization of the species. Stand-scale simulations of carbon fluxes produced mixed results after an evaluation against EC data from ICOS

Concentration- and time-dependent effects of isothiocyanates produced from Brassicaceae shoot tissues on the pea root rot pathogen Aphanomyces euteiches

Isothiocyanates (ITCs) hydrolyzed from glocosinolates (GSLs) in Brassicaceae tissue are toxic to soil organisms. In this study, the effect of aliphatic and aromatic ITCs from hydrated dy Brassicaceae shoot tissues on the mycelium and oospores of the pea root rot pathogen Aphanomyces euteiches was investigated. The profile and concentrations of GSLs in two test Brassicaceae species, Sinapis alba and Brassica juncea, and the ITCs from the dominant hydrolyzed parent GSLs were monitored. The concentrations of dominant ITCs and pathogen exposure time were evaluated in in vitro experiments. The greatest effect on the pathogen was observed from aliphatic ITCs hydrolyzed from B. juncea tissue, and the effect depended on the ITS concentration and exopsure time. ITCs were more effectively hydrolyzed from B. juncea GSLs than from S. alba GSLs; i.e., the ITC/GSL ratio was higher in B. juncea than in S. albatissue, giving a different release pattern. The release of phenylethyl isothiocyanate, which was common to both species, followed a pattern similar to that of the dominant ITC in each crop speices. This suggests that trait other than GSL content, e.g., plant cell structure, may affect the release of ITCs ans should therefore influence the choice of speices used for biofumigation purposes

The process of identifying, solving and preventing drug related problems in the LIMM-study

Objective To avoid negative effects of drug treatment and need for additional medical care, drug treatment must be individualised. Our research group has developed a model for clinical pharmacy which improves several aspects of the patient's drug treatment. This study describes the process behind these improvements, i.e. drug related problems identified by pharmacists within a clinical pharmacy service. Setting Three wards at a department of internal medicine. Method Pharmacists performed systematic interventions during the patient's hospital stay, aiming to identify, solve and prevent drug related problems in the elderly. Identified drug related problems were put forward to the health care team and discussed. Information on identified problems, and their outcomes was collected and analysed. A questionnaire was used to evaluate the health care personnel's attitudes towards the process. Main outcome measure The number of drug related problems identified by the clinical pharmacists, the proportion of problems discussed with the physicians, the proportion of problems adjusted by the physicians and whether pharmacists and physicians prioritised any subgroup of drug related problems when choosing which problems to address. Finally, we wanted to evaluate the health care personnel's attitudes towards the model. Results In total, 1,227 problem were identified in 190 patients. The pharmacists discussed 685 (55.8%) of the identified problems with the physicians who accepted 438 (63.9%) of the suggestions. There was no significant difference in which subgroup to put forward and which to adjust. There was a high response rate (84%) to the questionnaire, and the health care personnel estimated the benefits to be very high, both for the patients and for themselves. Conclusion The process for identifying, solving and preventing drug related problems was good and the different types of problems were considered equally important. The addition of a clinical pharmacy service was considered very useful. This suggests that the addition of our clinical pharmacy service to the hospital setting add skills of great importance

Early awareness and alert system in Sweden : history and current status

Abstract Summary: We describe the evolution and the current state of the Swedish Early Awareness and Alert System for new drugs, a national level EAA system successfully implemented in a country with decentralized health care managed by 21 regions. Our work is of interest to countries already having EAA systems in place as well as for those seeking to establish EAA activities. Introduction: Over the past decades, early awareness and alert (EAA) activities and systems have gained importance and become a key early health technology assessment (HTA) tool. While a pioneer in HTA, Sweden had no national level EAA activities until recently. We describe the evolution and current status of the Swedish EAA System. Methods: This was a historical analysis based on the knowledge and experience of the authors supplemented by a targeted review of published and grey literature as well as documents produced by or relating to the Swedish EAA System. Key milestones and a description of the current state of the Swedish EAA System is presented. Results: Initiatives to establish a system for the identification and assessment of emerging health technologies in Sweden date back to the 1980s. Since the 90s, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) supported the development of EuroScan and was one of its founder members. In the mid-00s, an independent regional initiative, driven by the Stockholm Drug and Therapeutics Committee, resulted in the establishment of a regional horizon scanning unit. By 2009, this work had expanded to a collaboration between the four biggest regions in Sweden. The following year it was further expanded to the national level. Today, the Swedish EAA System carries out identification, filtration and prioritization of new drugs, early assessment of the prioritized drugs, and dissemination of the information. Its outputs are used to select new drugs for inclusion in the Swedish national process for managed introduction and follow-up. Conclusions: The Swedish EAA System started as a regional initiative and rapidly grew to become a national level activity. An important feature of the System today is its complete integration into the national process for managed introduction and follow-up of new drugs. The System will continue to evolve as a response both to the changing landscape of health innovations and to new policy initiatives at the regional, national and international levels

Grain legume production and use in European agricultural systems

ISBN(print) 978-0-12-812419-2; Editor DL SparksThere is a great demand for high-protein materials for livestock feed in Europe and European agriculture has a deficit of about 70% high-protein materials of which 87% is met by imported soybean and soy meal. This reflects the fact that grain legumes are currently under represented in European agriculture and produced on only 1.5% of the arable land in Europe compared with 14.5%on aworldwide basis. Several grain legumes have the potential to replace at least some of the soya currently used in the diets of monogastric animals, ruminants, and fish. There are also opportunities for greater use of legumes in new foods. Here we review the contribution of ecosystem services by grain legumes in European agriculture startingwith provisioningservices in termsof food and feed and moving on to the contribution theymake to both regulating and supporting serviceswhich are in part due to the diversity which these crops bring to cropping systems. We explore the need to understand grain legume production on the time scale of a rotation rather than a cropping season in order to value and manage the agronomic challenges of weed, pests, and diseases alongside themaintenance or improvement of soil structure, soil organic matter, and nutrient cycling. A review of policy interventions to support grain legumes reveals that until very recently these have failed to make a difference in Europe. We contrast the European picture with the interventions that have allowed the development of grain legume production in both Canada and Australia. Whether farmers choose to grow more legumes will depend on market opportunities, the development of supply chains, and policy support aswell as technicalimprovementsof grainlegumeproductionsuchas breeding of new varieties and management development to improve yield stability. However, to really increase the production of grain legumes in Europe, the issues are far more wide reaching than agronomy or subsidy and require a fundamental rethinking of value chains to move grain legumes from being niche products to mainstream commodities.Peer reviewe