Hantering av läkemedelsförpackningar - ett patientperspektiv

Problem: Undersöker hur läkemedelsförpackningar interagerar med patienter i deras vardag och beskriver patienters behov på läkemedelsförpackningar. Syfte: Fördjupa mig i vilka användarbehov det finns på läkemedelsförpackningar ur patientens perspektiv. Och därigenom ökar medvetenheten och förståelsen av patientens behov på läkemedelsförpackningar och därigenom förhoppningsvis leda till förbättrade läkemedelsförpackningar för patienten. Begränsningar: Jag undersöker interaktionen av läkemedelsförpackningen ur ett patientperspektiv och inte ur ett tillverknings- och distributionsperspektiv. Därför är det primärförpackningen som studeras i detta arbete. Jag har valt att titta på receptbelagda läkemedel för oralt bruk. Metod: Som forskningsstrategi valdes flerfallsstudier med en analysenhet, som analysenhet valdes interaktionen mellan patienten och dess läkemedelsförpackningar. För att samla in data genomfördes kvalitativa djupintervjuer och observationer i patienternas hemmiljö. Två olika metoder användes för att identifiera de behov patienterna hade ”Mänskocentrerad design” och ”Behovsidentifiering”. Slutsats: Idag är läkemedelsförpackningar så säkra att det resulterar i problem för patienten. I användarvänliga ingår säkra läkemedelsförpackningar, är dem inte användarvänliga är dem inte säkra. Patienters läkemedelshantering påverkas av olika aktörer. De aktörer jag har identifierat är läkaren, apoteket, anhörig och utomstående. Om patienten tar ett fåtal läkemedel har patienten inte så stora problem med sin hantering av läkemedelsförpackningar. Det är dock viktigt att belysa de behov och problem som den grupp av individer jag observerat har i den här fallstudien. De kan uppmärksamma behov som är viktiga även förpackning som tar några få läkemedel. Patienten känner oro över sin läkemedelshantering men det är inte oron över förpackningsegenskaper som att förvara och skydda läkemedlet och dess användare. Utan snarare en psykologisk oro över om patienten kommit ihåg att ta sina läkemedel, har tagit rätt läkemedel eller rätt läkemedelsmängd. Den billigaste läkemedelsförpackningen behöver inte betyda att den är den mest användarvänliga för patienten. Känslan av självständighet ökar, om patienten fått den läkemedelsförpackning som patienten lättast hanterar. Patienten har behov av interaktion mellan läkare och apotek för att informationsflödet ska bli tydligt och tryggt för patienten. Periodens vara på apoteket kan för patienten innebära att läkemedelsförpackning och namn är olika från månad till månad. Det kan leda till bristande kontroll, oro och felmedicinering eller att patienten skadar sig för att det är en förpackning som kräver ett verktyg för patienten att öppna.Problem discussion: Examine how pharmaceutical packaging interact with patients in their everyday lives and describe patients’ needs off pharmaceutical packaging. Purpose: Immerse myself in what user needs are on pharmaceutical packaging from the patient's perspective. Thereby increasing awareness and understanding of patient needs in pharmaceutical packaging and thereby hopefully lead to improved pharmaceutical packaging for the patient. Restrictions: I examine the interaction of pharmaceutical packaging from a patient perspective and not from a manufacturing and distribution perspective. Therefore, the primary packaging is studied in this work. I have chosen to look at prescription drug for oral use. Methodology: As a research strategy multiple-case studies was chosen with one unit of analysis. The unit of analysis with was chosen was the interaction between the patient and the pharmaceutical packaging. In order to collect data, qualitative in-depth interviews and observations was conducted in the patient's home environment. Two different methods were used to identify the needs of the patients "Human Centered Design" and "Need finding". Conclusions: Today's pharmaceutical packaging is so secure that it will result in problems. User friendly included safe pharmaceutical packaging, if they are not user friendly they are not safe. The Patient´s medication is influenced by different actors. The actors I have identified is the doctor, the pharmacist, family and outsiders. If the patient takes few medicines, the patient has not so big problems with their handling of pharmaceutical packaging. However, it is important to highlight the needs and problems that the group of individuals have in this case study, I have observed. They can draw attention to needs that are important to patients taking few medicines. The patient is concerned about his medication but it is not packing properties to store and protect the drug and its users. But rather a psychological concern about if the patient remember to take their medicines, have taken the right medication or the right dosage. The cheapest medicine package does not necessarily mean that it is the most user-friendly for the patient. The sense of autonomy increases, if the patient received the pharmaceutical packaging that patient easiest handling. The patient is in need of interaction between doctors and pharmacies for the flow of information to be clear and safe for the patient. The exchange of drug at the pharmacy can for the patient mean that pharmaceutical packaging and names are different from month to month. It can lead to loss of control, anxiety and medication errors or patient harm themselves because it is a package that requires a tool for the patient to open

Tellurium Behavior in the Containment Sump: Dissolution, Redox, and Radiolysis Effects

In the event of a severe nuclear accident, one major concern is the release of radioactive material into the environment causing potential exposure of the general public to radiation. Among the volatile radionuclides are a range of tellurium isotopes. Due to the radioactivity and the volatility of tellurium, it has to be taken into account when assessing the overall effects of an accident. The interest in tellurium is not limited only to its release but also to the fact that some tellurium isotopes decay to iodine, and thus affect the iodine release behavior. The release and transport behavior of tellurium has been investigated over the past decades, however, the aqueous chemistry of tellurium in the complex containment sump system is still unclear. This study presents the behavior of tellurium dioxide in simplified containment sump conditions in relation to dissolution, redox reactions, and interactions with water radiolysis products. The results indicate that radiolysis products have a significant effect on tellurium chemistry in both a reducing and oxidizing manner depending on the solution composition. The redox reactions also affect the solubility of tellurium. The results show that the current information used to assess tellurium source term needs to be reevaluated for both severe accident management and for code validation purposes

Simultaneous inhibition of B7 and LFA-1 signaling prevents rejection of discordant neural xenografts in mice lacking CD40L.

Transplantation of embryonic human neural tissue can restore dopamine neurotransmission and improve neurological function in patients with Parkinson's disease. Logistical and ethical factors limit the availability of human embryonic allogeneic tissue. Embryonic xenogeneic neural tissue from porcine donors is an alternative form of donor tissue, but effective immunomodulatory techniques are warranted for neural xenotransplantation to become clinically feasible. We transplanted embryonic porcine ventral mesencephalic tissue into the brains of adult untreated C57BL/6 mice, untreated CD40L-/-mice and CD40L-/-mice that received injections of anti-LFA-1, CTLA41g or both compounds. Double-treated CD40L-/-mice had large grafts with high numbers of dopaminergic neurons 4 wk after transplantation. The grafts were completely devoid of lymphocytes, macrophages and activated microglia. Untreated C57BL/6 mice had rejected their grafts. Untreated CD40L-/-mice and CD40L-/-mice treated with monotherapy of anti-LFA-1 or CTLA41g had smaller grafts and more microglial and lymphocytic infiltration than double-treated CD40L-/-mice. We conclude that immunomodulation with concomitant inhibition of LFA-1 and B7 signaling in the perioperative period in CD40L-/-mice prevented the rejection of discordant neural xenografts. The treatment most likely reduced antigen presenting capacity and interfered with the costimulatory signaling needed for T cell activation to occur

Chemical interaction between sea-salt and tellurium, between 300 and 1180 K

As an emergency action during the Fukushima accident, seawater was used to maintain cooling. To evaluate the effect of the salt on fission-products, sodium chloride, and tellurium were heated together using different ratios in different atmospheres (inert or oxidizing) using thermogravimetric analysis. The experiment under inert conditions showed no indication of interaction. However, under oxidizing conditions an interaction for all samples was observed that prevented an otherwise observed mass increase of the tellurium reference. The change in the appearance of the samples at increasing temperatures was studied by heating them in a furnace

Reduced exposure to calcineurin inhibitors in renal transplantation

Background: immunosuppressive regimens with the fewest possible toxic effects are desirable for transplant recipients. This study evaluated the efficacy and relative toxic effects of four immunosuppressive regimens. Methods: we randomly assigned 1645 renal-transplant recipients to receive standard-dose cyclosporine, mycophenolate mofetil, and corticosteroids, or daclizumab induction, mycophenolate mofetil, and corticosteroids in combination with low-dose cyclosporine, low-dose tacrolimus, or low-dose sirolimus. The primary end point was the estimated glomerular filtration rate (GFR), as calculated by the Cockcroft-Gault formula, 12 months after transplantation. Secondary end points included acute rejection and allograft survival. Results: the mean calculated GFR was higher in patients receiving low-dose tacrolimus (65.4 ml per minute) than in the other three groups (range, 56.7 to 59.4 ml per minute). The rate of biopsy-proven acute rejection was lower in patients receiving low-dose tacrolimus (12.3%) than in those receiving standard-dose cyclosporine (25.8%), low-dose cyclosporine (24.0%), or low-dose sirolimus (37.2%). Allograft survival differed significantly among the four groups (P=0.02) and was highest in the low-dose tacrolimus group (94.2%), followed by the low-dose cyclosporine group (93.1%), the standard-dose cyclosporine group (89.3%), and the low-dose sirolimus group (89.3%). Serious adverse events were more common in the low-dose sirolimus group than in the other groups (53.2% vs. a range of 43.4 to 44.3%), although a similar proportion of patients in each group had at least one adverse event during treatment (86.3 to 90.5%). Conclusions: a regimen of daclizumab, mycophenolate mofetil, and corticosteroids in combination with low-dose tacrolimus may be advantageous for renal function, allograft survival, and acute rejection rates, as compared with regimens containing daclizumab induction plus either low-dose cyclosporine or low-dose sirolimus or with standard-dose cyclosporine without induction

Current status of transplantation and organ donation in the Balkans-could it be improved through the South-eastern European health Network (SEEHN) initiative?

Organ donation and transplantation activity in the majority of Balkan countries (Albania, Bosnia and Herzegovina, Croatia, Macedonia, Moldova, Montenegro, Serbia, Romania and Bulgaria) are lagging far behind international averages. Inadequate financial resources, unclear regional data and lack of governmental infrastructure are some of the issues which should be recognized to draw attention and problem-solving decisions. The Regional Health Development Centre (RHDC) Croatia, being a technical body of the South-eastern European Health Network (SEEHN), was created in 2011 after Croatia's great success in the field over the last 10 years. The aim of the RHDC is to network the region and provide individualized country support to increase donation and transplantation activity in collaboration with professional societies (European Society of Organ Transplantation, European Transplant Coordinators Organization, The Transplantation Society and International Society of Organ Donation and Procurement). Such an improvement would in turn likely prevent transplant tourism. The regional data from 2010 show large discrepancies in donation and transplantation activities within geographically neighbouring countries. Thus, proposed actions to improve regional donation and transplantation rates include advancing living and deceased donation through regular public education, creating current and accurate waiting lists and increasing number of educated transplant nephrologists and hospital coordinators. In addition to the effort from the professionals, the governmental support with allocated funds per deceased donation, updated legislation and established national coordinating body is ultimately recognized as essential for the successful donation and transplantation programmes. By continuous RHDC communication and support asked from the health authorities and motivated professionals from the SEEHN initiative, an increased number of deceased as well as living donor kidney transplantations in the future should be more realistic

Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data

Objective To examine risk of malignancy and death in patients with kidney transplant who receive the immunosuppressive drug sirolimus.Design Systematic review and meta-analysis of individual patient data.Data sources Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2013.Eligibility Randomized controlled trials comparing immunosuppressive regimens with and without sirolimus in recipients of kidney or combined pancreatic and renal transplant for which the author was willing to provide individual patient level data. Two reviewers independently screened titles/abstracts and full text reports of potentially eligible trials to identify studies for inclusion. All eligible trials reported data on malignancy or survival.Results the search yielded 2365 unique citations. Patient level data were available from 5876 patients from 21 randomized trials. Sirolimus was associated with a 40% reduction in the risk of malignancy (adjusted hazard ratio 0.60, 95% confidence interval 0.39 to 0.93) and a 56% reduction in the risk of non-melanoma skin cancer (0.44, 0.30 to 0.63) compared with controls. the most pronounced effect was seen in patients who converted to sirolimus from an established immunosuppressive regimen, resulting in a reduction in risk of malignancy (0.34, 0.28 to 0.41), non-melanoma skin cancer (0.32, 0.24 to 0.42), and other cancers (0.52, 0.38 to 0.69). Sirolimus was associated with an increased risk of death (1.43, 1.21 to 1.71) compared with controls.Conclusions Sirolimus was associated with a reduction in the risk of malignancy and non-melanoma skin cancer in transplant recipients. the benefit was most pronounced in patients who converted from an established immunosuppressive regimen to sirolimus. Given the risk of mortality, however, the use of this drug does not seem warranted for most patients with kidney transplant. Further research is needed to determine if different populations, such as those at high risk of cancer, might benefit from sirolimus.PfizerOttawa Hosp, Res Inst, Ottawa, ON K1H 7W9, CanadaUniv Ottawa, Ottawa, ON, CanadaCairo Univ, Cairo Kidney Ctr, Cairo, EgyptLimites Med Res, Vacallo, SwitzerlandUniv Manitoba, Dept Pediat & Childs Hlth, Winnipeg, MB, CanadaLund Univ, Dept Nephrol & Transplantat, Malmo, SwedenUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, São Paulo, BrazilAddenbrookes Hosp, Dept Renal Med, Cambridge, EnglandNorthwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USAMaastricht Univ, Med Ctr, Maastricht, NetherlandsSt Louis Hosp, Dept Nephrol, Paris, FranceHosp JW Goethe, Div Nephrol, Frankfurt, GermanyUniv Munich, Dept Surg, Munich, GermanyGoethe Univ Frankfurt, JW Goethe Clin, Clin Dermatol Venerol & Allergol, Frankfurt, GermanyInst Klin Expt Med, Dept Nephrol, Prague, Czech RepublicUniv Cambridge, Addenbrookes Hosp, Dept Surg, NIHR Cambridge Biomed Res Ctr, Cambridge CB2 2QQ, EnglandUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, São Paulo, BrazilWeb of Scienc