Origin and Loss of Nested LRRTM/alpha-Catenin Genes during Vertebrate Evolution

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Eteisvärinän rytminsiirto - milloin, kenelle ja kuinka monta kertaa?

Rytminsiirto on tärkeä akuutin eteisvärinäkohtauksen hoitomuoto. Sitä on syytä käyttää harkitusti, sillä se voi pahimmillaan olla hyödytön ja potilasturvallisuutta vaarantava toimenpide. Eteisvärinän keston varma selvittäminen on keskeinen tekijä akuutin eteisvärinäkohtauksen rytminsiirron turvallisuuden takaamiseksi. Elektiiviseen rytminsiirtoon liittyy asianmukaisen antikoagulaation aikanakin lyhytaikaisesti noin nelinkertainen aivohalvausriski verrattuna rytminsiirrosta pidättäytymiseen. Eteisvärinä uusiutuu varsin usein onnistuneenkin rytminsiirron jälkeen, ja siksi sen yhteydessä tulee aina arvioida eteisvärinän estohoidon tarve tai harkita sykkeenhallintaan siirtymistä. Sinusrytmin tavoittelu ei tuo ennustehyötyä edes nuorille eteisvärinäpotilaille.</p

The Price and Market Share Evolution of the Original Biologics and Their Biosimilars in Finland

Background Biological drugs are generally expensive and produce a continuously growing share of drug costs. Yet they are essential in the treatment of many chronic diseases. Biosimilars, clinically equivalent to biological originator products, are expected to restrain drug costs in the biological market. Objective This study aimed to examine the impact of the biosimilar market entry on the prices of the reference products in outpatient care in Finland, investigate the impact of biosimilar market entries on price competition among biological medicinal products, and examine how the prices and market shares of outpatient biosimilars have developed in Finland during 2009-2020. Methods This retrospective register study applied data from IQVIA covering national community pharmacy wholesale data between 1 January, 2009, and 31 August, 2020, for somatropin, epoetin, filgrastim, follitropin, insulin glargine, insulin lispro, etanercept, pegfilgrastim, adalimumab, teriparatide, and enoxaparin biosimilars and their reference products, in addition to two relevant insulin products. We determined the monthly wholesale amounts in defined daily doses and wholesale weighted average prices (excluding value-added tax) per defined daily dose for each product. We analyzed the evolution of the price and market shares. We performed a linear segmented regression analysis to examine the impact of the market entry of biosimilars on the prices of reference products. Results The prices of the reference products mainly decreased after the biosimilar entered the market. If the reference product price was not reduced, it was no longer reimbursable after evaluation under the Health Insurance Act, leading to marginal market shares. The changes in the prices of biosimilars were not as remarkable as the changes in the prices of reference products after the biosimilar market entry. For most active substances, biosimilar prices were stable or decreased. The utilization of biosimilars varied widely between different active substances at the end of the observation period. Conclusions Changes in pricing policy and the public reimbursement scheme related to the market entry of biosimilars were the main reasons for the decrease in the prices of reference products. Therefore, biosimilars did not generate genuine price competition between biological products. In many of the drug groups examined, the market shares of biosimilars have growth potential in the future.Peer reviewe

How far are we from a medication use process aiming at well-informed adherent patients with long-term medications in Finland? Qualitative study

Objective Finland is one of the few countries that has established a national Medicines Information (MI) Strategy. The ultimate goal of the strategy is a well-implemented medication use process resulting in well-informed adherent patients. This study aimed at evaluating the implementation of the strategy 3years after its launch. Design The evaluation applied a pragmatic approach and was conducted by interviewing stakeholders involved in the National MI Network enhancing the MI Strategy's implementation. The network comprises national key stakeholders producing and using MI. Data were deductively analysed according to the medication use process of the MI Strategy using the framework method, complemented with inductively derived categories. Setting National implementation of the MI Strategy throughout the healthcare system after the first operational period (2012-2014) in 2015. Participants The members of the National MI Network (n=79/111, participation rate 71%, representing 42/53 stakeholder organisations). Outcome measures A new conceptual framework was developed based on stakeholders' views on well-implemented actions and actions needing development in the medication use process at (1) infrastructure (macro), (2) healthcare professionals (meso) and (3) patient (micro) levels. Results Medication counselling by community pharmacists was the primary implemented action, followed by physicians' actions while starting a new medication, and advice given by nurses. The major development needs concerned (1) poor access to patient information and its transfer in healthcare, particularly the lack of reconciled medication lists and electronic health records (macro); (2) poorly functioning medication use process in home care and social care units, such as nursing homes (meso); and (3) limited patient involvement in their care (micro). Conclusions Far more actions for development than well-established practices in the medication use process were identified. Major challenges found in this evaluation are considered in the ongoing Rational Pharmacotherapy Action Plan 2018-2022 by the Ministry of Social Affairs and Health.Peer reviewe

Different Requirements for GFR alpha 2-Signaling in Three Populations of Cutaneous Sensory Neurons

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Organisation of cross-sector collaboration and its influence on crisis management effectiveness among pharmaceutical supply chain stakeholders during the COVID-19 pandemic

Objectives: To investigate the organisation of cross-sector collaboration and how it influenced crisis management effectiveness among pharmaceutical supply chain stakeholders in Finland during the COVID-19 pandemic. Study design: Qualitative semi-structured interview study. Methods: Purposeful selection was used to obtain the study sample consisting of leaders and specialists from the pharmaceutical industry and wholesalers (n = 9), community pharmacy owners (n = 9), hospital pharmacy heads (n = 6), government agency directors and officials (n = 5) and advocacy organisation representatives (n = 2). Inductive content analysis was performed to examine the data from the semi-structured individual (n = 29) and paired (n = 2) interviews in March–May 2021. Results: A new conceptual model was developed to describe the organisation of collaborative crisis management. Without a predefined crisis management organisation, cross-sector collaboration was organised based on previous collaboration structures, channels and relationships and through the establishment of issue-specific groups by government agencies as per legal mandates. Crisis dynamics and related issues guided the group formation and meeting frequency. Advocacy organisations and government agencies acted in bridging role between stakeholders. Shared knowledge among pharmaceutical supply chain stakeholders enabled anticipation and preparedness during crisis; shared resources fostered maintenance of core functions; and shared problem-solving facilitated cross-sectoral solutions. Conclusion: This was the first study exploring cross-sector collaboration among pharmaceutical supply chain stakeholders during a crisis. Sharing knowledge, resources and problem-solving increased the crisis management effectiveness. The study presented a new illustration of organising for collaborative crisis management and added knowledge about private-third sector collaboration and issue-specific groups to the cross-sector collaboration and crisis management literature

Simulating atomic force microscopy imaging of the ideal and defected TiO2 (110) surface

In this study we simulate noncontact atomic force microscopy imaging of the TiO2 (110) surface using first-principles and atomistic methods. We use three different tip models to investigate the tip-surface interaction on the ideal surface, and find that agreement with experiment is found for either a silicon tip or a tip with a net positive electrostatic potential from the apex. Both predict bright contrast over the bridging oxygen rows. We then study the interaction of this tip with a bridging oxygen vacancy on the surface, and find that the much weaker interaction observed would result in vacancies appearing as dark contrast along the bright rows in images.Peer reviewe

Minor troponin T elevation and mortality in patients with atrial fibrillation presenting to the emergency department

Background There are limited data on the association of minor troponin elevation in unselected patients with atrial fibrillation (AF) presenting to the emergency department (ED) with adverse events. In this study, we sought to assess the early and mid-term mortality of these patients. Methods In this observational study, 2911 patients with AF were admitted to the ED. They were divided into 3 groups based on peak high-sensitivity troponin (TnT) levels: normal ( Results All-cause mortality was 6.7% (n = 196) at 30 days and 22.2% (n = 646) at 1 year. Mortality rate increased along with increasing levels of TnT irrespective of baseline covariates, primary discharge diagnosis and type of AF. A significant association between TnT levels and all-cause mortality was observed. The adjusted hazard ratio (HR) at 30 days was 6.02 (95% CI 2.62-13.83) for TnT 15-50 ng/L and 11.28 (95% CI 4.87-26.12) for TnT 51-100 ng/L (P Conclusions Among patients with AF admitted to the ED, increased TnT levels were associated with increased early and mid-term all-cause mortality irrespective of baseline covariates and type of AF.Peer reviewe