Browsing by master's degree program "Utbildningsprogrammet för provisorsexamen"

The package leaflet (PL) is a technical document sheet included in medicine packages to provide guidance on safety and rational use of medicines for the user. The EU is increasingly encouraging the adoption of digital product information, which in time should be seen as the basic medicine information. The outdated package leaflet has for a long time been criticized by both patients and pharmaceutical operators. As a result, it is important to map the perspectives of various pharmaceutical operators on the electronic package leaflet. The aim of the study was to gain broader knowledge and deeper understanding of what opportunities and challenges the electronic package leaflet entails from the perspective of different pharmaceutical operators, and whether there are differences between opinions of the pharmaceutical operators. The study also sought to find out how the electronic package leaflet compared with the printed current leaflet from an environmental perspective. The study was conducted as a questionnaire e-survey, whose target groups were companies in the pharmaceutical industry, The Finnish Medical Agency (Fimea) and hospital pharmacies / departmental pharmacists. The material was collected over a three-week period in April 2022. The data was analysed both quantitatively and qualitatively. Based on the results of the study, it emerged that 55 experts, broadly across the pharmaceutical field, took part in the study. According to the pharmaceutical operators, the main opportunities of the electronic package leaflet were its ease of use and environmental friendliness. Patient safety, which is always a focal point when discussing medicines, would also increase as the users would have access to the most up-to-date medicine information (75 %, n = 41). In addition, the QR code on the medicine packages could be utilized when introducing ePL. The challenges, however, mainly concerned the user's lack of internet connectivity and incompetence in the use of e-services. Although pharmaceutical operators are of different opinion on the electronic package leaflet, it is highlighted that the majority of respondents (69 %, n = 38) believe that ePL would be an improvement and a more environmentally friendly alternative than the current printed leaflet. The study shown that there are differences in the perspectives on ePL between different pharmaceutical operators. The varying opinions on the electronic package leaflet depends on the respondent's position in the pharmaceutical sector. Despite the disagreement, the majority believe that ePL would be a positive development and a prerequisite for achieving the challenges of the future.

Liposomes are biocompatible spherical nanosized vesicles consisting of hydrophobic phospholipid bilayer encasing an aqueous core. They can be utilized as drug carriers by either encapsulating molecules inside the core or embedding them in the bilayer accordingly to achieve numerous advantages such as prevention of rapid clearance and reduction of adverse effects as systemic exposure is reduced. Despite the marked efforts in designing the liposomes to improve therapeutic outcomes, only limited drug concentrations are achieved at the target sites such as in solid tumors. Stimuli-responsive liposomes could be applied as potential delivery systems to achieve spatiotemporally controlled drug delivery, i.e., the drug release could be pinpointed and restrained to the target site. In this thesis, the objective was to study the light-activated indocyanine green (ICG) liposomes as nanocarriers for peptide-based anti-tumor agents. The physicochemical characteristics, stability and functionality of the prepared liposomes were determined alongside optimizing the formulation as needed and utilizing different model peptides as encapsulated compounds. Additionally, the peptide stability during near-infrared (NIR) light illumination and the effects of the anti-angiogenic model peptides in vitro were investigated. The stability of the liposomes was assessed by monitoring the size of the liposomes, intactness of ICG, and passive leakage of the peptides over time, and by determining the phase transition temperatures of the different formulations. The liposomes remained adequately stable in different relevant conditions, and the observed phase transition temperatures did not indicate the lipid bilayer becoming permeable in physiological temperatures. However, the rate of passive leakage was rather high in all formulations, although with stiffer lipid bilayer in the “rigid” formulation, the unintended release was able to be decreased slightly in comparison to the other formulations. On the other hand, light-triggered release upon illuminating the liposomes remained considerably low in all formulations. The intactness of peptides seemed to not be impacted by the illumination. Also, no cytotoxic effects were observed after exposing human umbilical vein endothelial cells (HUVEC) to the peptides. The final “rigid” formulation showed the best functionality out of those included in the studies. It remains to be investigated whether the formulation could be improved further for optimal functionality and stability, and to what degree do the properties of the cargo molecule affect the performance of the liposomes.

Obesity has increased in our society for decades and is still increasing. It is a burden for individuals and societies. The healthcare costs, disability, illnesses, and deaths caused by it are unfortunately a big burden on global scale. Binge eating disorder is an eating disorder in which a person uncontrollably devours an excessive amount of food due to a lack of self-control. Binge eating disorder is strongly linked to obesity and it further increases the weight of both normal weight and obese people. Many mechanisms influence the regulation of eating. A long-term research subject and affecting the regulation of eating, serotonergic and serotonin receptors, affect the amount of food eaten and the reward system, and disturbances in serotonin signaling have been linked to obesity. Aim of this study was to exam binge-like eating modelled C57Bl/6J mice and their food consumption, while affecting serotonergic signaling. I studied psychoactive LSD and antipsychotic MDL 100907 effects on serotonergic signaling in a binge-like eating model, using drugs both separately and simultaneously. Mice were induced into a stress-free model of binge-like eating by providing high-energy food once a week for 24 hours. When the binge eating model was runnig, once a week the mice were dosed with a drug or substances and given energy-dense food to binge on. In the study, consumed food and water were measured. The mice were also subjected to locomotor tests to ensure that they were able to eat motorically. Induction of the binge-like eating model was successful and a reduction in binge eating was observed in mice under LSD alone at significant time points. MDL reduced binge-like eating at the first time point. No significant changes were observed in the water intake. The locomotor tests ensured a sufficient amount of movement to enable eating. Even though the drugs individually reduced binge-like eating, it should be noted that the properties of the drugs, and especially the trials of their combined use, which did not show significant results, do not promise significant discoveries in terms of similar research.

The long-term use of antidepressants has increased significantly worldwide in recent decades. Deprescribing and the expertise related to it is an important part of the individual drug treatment optimization, the management of long-term diseases, the avoidance of adverse drug effects and the improvement of treatment outcomes. The aim of this thesis was to examine the information found in the statutory Summary of Product Characteristics (SmPC) and other key information sources for healthcare professionals about antidepressant deprescribing. A qualitative content analysis was conducted on SmPC (n=15) of the antidepressants (escitalopram, mirtazapine, sertraline, citalopram, venlafaxine) selected for the study, three national depression treatment guidelines (Suomalainen Lääkäriseura Duodecim: Depressio Käypä hoito -suositus, American Psychological Association APA: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, United States and National Institute for Health and Care Excellence NICE: Depression in Adults: Treatment and Management, United Kingdom) and one decision supporting deprescribing tool (MedStopper). The content, quantity, and quality of information about antidepressant deprescribing varied between the information sources included in the study. However, the information found in the SmPC and the MedStopper -tool was mostly in line with the information found in the clinical practice guidelines included in the study. Most general information about antidepressant deprescribing or measures that can be used to guide deprescribing was found in the clinical practice guidelines. In all examined sources, antidepressants were recommended to be discontinued in a controlled manner by gradually reducing the dose. However, the recommended duration of the dose reduction varied in different information sources. A detailed dose reduction program was not found in most of the information sources. A detailed dose reduction program was found in only one clinical practice guideline (NICE) and the MedStopper -tool. The continuation of antidepressant treatment after remission and the timing of stopping the medication was discussed in only two clinical practice guidelines (APA and Käypä hoito). However, instructions for action if severe or intolerable discontinuation symptoms appears were found in almost all information sources. Only the clinical practice guidelines mentioned the recurrence of depression as a possible harm when stopping the medication and instructed how to act in the event of a possible relapse. Benefits related to antidepressant discontinuation was not mentioned in any of the examined information sources and only one clinical practice guideline (NICE) discussed barriers related to stopping antidepressants. The information found in individual information sources was insufficient and provided little support for healthcare professionals to guide deprescribing. Current key sources of information for healthcare professionals provide limited information and relatively imprecise guidance on antidepressant deprescribing and how to support the antidepressant discontinuation process. Better randomized clinical trials are needed to develop clearer and more extensive evidence-based guidelines for healthcare professionals on antidepressant deprescribing and to prevent unnecessary long-term antidepressant treatment and patient exposure to possible adverse drug effects.

Medication safety is critical in health and social care, and community pharmacies significantly participate in managing medication safety risks. The information systems in community pharmacies are pivotal, yet understudied tools supporting this task. This study investigates community pharmacy information system-related medication safety incidents reported by Finnish community pharmacies, focusing on how information systems act as defences or contributing factors to such incidents. The study is based on 1222 information system-related medication safety incident reports from the HaiPro system between October 2022 and September 2023. The structured fields of the incident reports were analysed with descriptive quantitative analysis using Microsoft Excel. An abductive content analysis was performed on narrative texts of the incident reports to identify information system-related risks or defences in the incidents. Reason's human error theory acted as a theoretical framework in this study. Results indicated that in 96% (n=1168) of the incidents, information systems were contributing factors, primarily during the selection of medicinal products for dispensing (n=945). The most common issue was the community pharmacy information system not offering generic substitutes for market-exited medicinal products (n=282). Another notable issue was compatibility problems between community pharmacy information systems and Electronic Patient Record (EPR) systems or between different community pharmacy information systems (n=154). Conversely, barcode recognition emerged as the most reported defence, preventing errors in 96% (n=52) of defensive cases (n=54). The study underscores the dual role of community pharmacy information systems in medication safety both as defences and contributing factors. It highlights the need for continuous system development and possible regulatory changes to enhance their effectiveness as defences. Future research should explore these systems' roles using alternative methodologies to address underreporting and better quantify their impact on medication safety.

Chronic wounds are a worldwide health problem that produce a lot of costs for society and can have a substantial impact on patients’ quality of life. Human adipose stem cells (hASCs) have been studied as a treatment option for chronic wounds as they can induce wound healing in many ways. Extracellular vesicles (EVs) produced by hASCs are a great solution to acquire the benefits of hASCs while avoiding their problems such as possible mutagenicity. HASC-EVs have been found to induce wound healing by for example enhancing angiogenesis and fibroblast proliferation. HASCs can be grown in 2D where the cells attach to the bottom of the cell culture vessel or in 3D where the cells attach to each other and create a spheroid. 2D cell culturing is easy and inexpensive but 3D cultured cells resemble in vivo –like conditions more. Because of these in vivo -like features, hASCs grown in 3D might produce EVs that resemble the properties of host cells in natural environment more than 2D. The aim of this thesis was to compare 2D culture, matrix-based nanofibrillar cellulose (NFC) hydrogel culture, and matrix-free suspension culture in ultra-low attachment (ULA) wells as growing platforms for hASCs and as continuous EV production methods. During culturing, the conditioned media was collected after which, the EVs were isolated, and the EV concentration and size range was measured with nanoparticle tracking analysis (NTA). After culturing, the metabolic activity of hASCs was measured and the cells were collected for immunocytochemistry (ICC) assay, western blot (WB) assay, and for quantitative PCR (qPCR) to examine the stemness and differentiation of hASCs grown in different cell cultures. The hypothesis of this thesis was that the NFC cell culture would produce the best EV yield and the best EVs for therapeutic use. Based on the acquired results, this hypothesis could not be supported. When visually inspecting the cells, all three cell cultures were viable but the metabolic activity of hASCs in NFC hydrogel was low compared to 2D and suspension cultures. Also, the EV, protein and RNA yield were lower in NFC. ICC, western blotting, and qPCR results were inadequate to make a straightforward implication of what cell culturing condition is the best for EV production and they would need repetition and optimization. Looking at the overall results, 2D cell culturing produced the best EV and RNA yield, had the highest metabolic activity and was least laborious cell culturing method which makes it a good option for continuous EV production. Suspension culture on the other hand resembles in vivo -like environment which could possibly produce better EVs for therapeutic use. The metabolomic assays on the EVs would be interesting to perform in the future to examine if the in vivo –like features affect the quality of EVs.

Migreeni on toistuvia päänsärkykohtauksia aiheuttava neurologinen sairaus, jonka esiintyvyys on hyvin laajaa – Suomessa migreeniä sairastaa lähes joka kymmenes väestöstä. Migreenin puhkeamisella on tutkimusten mukaan vahva yhteys genetiikkaan, ja migreenin hoidossa käytettyjen lääkevalmisteiden metabolia on oleellisesti sidoksissa geeneihin. Farmakogenetiikka tutkii tieteenalana, miten perintötekijät vaikuttavat lääkeaineiden aineenvaihduntaan ja niistä syntyvään lääkevasteeseen. Tässä tutkimuksessa tarkasteltiin migreenin estolääkkeenä käytetyn trisyklisen masennuslääkkeen, amitriptyliinin, metaboliassa esiintyviä mahdollisia geneettisiä eroja itä- ja länsisuomalaisten välillä. Tutkimus toteutettiin tarkastelemalla yli 10 000 Terveystalon Biopankin biopankkinäytettä, joista määritettiin kolmen CYP-entsyymin (CYP2C9, CYP2C19, CYP2D6) fenotyyppien esiintyvyys itä- ja länsisuomalaisissa. Tutkimustulosten mukaan eroavaisuudet fenotyyppien esiintyvyydessä itä- ja länsisuomalaisten välillä olivat maltillisia. Amitriptyliinin metaboliassa erityisen oleellisen CYP2C19 geenin osalta sekä normaalia hitaampi että hidas metabolia olivat yleisempiä idässä kuin lännessä. Hitaan metabolian riskinä on tavallista suuremmat plasmapitoisuudet ja siten lisääntyneet lääkevalmisteen haittavaikutusriskit. Näin ollen amitriptyliiniä tulisi hitailla metaboloijilla käyttää harkiten, aloittaa vaihtoehtoinen lääkitys tai pienentää aloitusannosta puoleen tavanomaisesta. Oikean annostuksen löytämisessä tulisi hyödyntää laboratorion pitoisuusmäärityskokeita. Lisäksi farmakogeneettisillä testeillä voitaisiin havaita mahdollinen geenien tarkempi polymorfia, ja siten varmistaa sekä turvallinen että tehokas yksilöllinen lääkehoito.

Heart failure is a global health issue that can result from various factors, one of which is myocardial infarction. The adult human heart has limited regenerative capacity to cover the loss of cardiomyocytes after myocardial infarction with new cardiomyocytes. The main responses to the loss of cardiomyocytes are fibrotic scar formation and the hypertrophy of remaining cardiomyocytes. Prolonged hypertrophy eventually leads to heart failure. Current treatments for heart failure only relieve the symptoms. Inducing cardiac regeneration could be one possible way to prevent and treat heart failure. Thus, to develop medical treatments that enhance the regenerative capacity, a comprehensive understanding of precise cellular mechanisms behind heart regeneration is crucial. The objective of this study was to establish a high-content analysis method for human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) utilizing the Cell Painting assay to identify and categorize morphological alterations induced by various compounds in hiPSC-CMs. To evaluate the morphological impacts, dozens or even hundreds of cell features were measured at the same time. hiPSC-CMs were exposed to two hypertrophy inducers, endothelin-1 and angiotensin II, and to doxorubicin, which is known to be a cardiotoxic compound. In addition, the effects of a GATA4- targeting compound, C-2021, on hiPSC-CMs were examined. C-2021, was expected to have antihypertrophic effect on the cells. Previously used methods, proBNP staining and qPCR, were used to validate the novel method. According to proBNP staining and qPCR, endothelin-1 induced cardiomyocyte hypertrophy greater than angiotensin II. Compound C-2021 did not show statistically significant antihypertrophic properties after hypertrophic stimuli, but some tendency the alleviate the hypertrophy was noticed. Moreover, by utilizing different data processing programs a novel analysis method was developed. With this method, the different treatment groups were clustered based on the morphological alterations caused by compounds exposures. The hiPSC-CMs exposed to endothelin-1, angiotensin II or doxorubicin showed a different morphological profile compared to the control group hiPSC-CMs. Compound C-2021 was also observed to affect cell morphology. However, the data analysis still needs improvements in order to detect which cell features these compounds affect.

Diseases caused by foodborne pathogens are a global threat, which is why new bioactive compounds are expected in the food industry. The purpose of this work was to investigate the antimicrobial effects of three different plants, blackcurrant (Ribes nigrum), rhubarb (Rheum spp.), and Scots pine (Pinus sylvestris), against seven pathogenic bacteria. Bioactivity of these plants has been previously shown, but results have varied widely depending for example on the plant part, extraction solvent and pathogen. The plant samples were extracted with 30 % or 80 % ethanol-water solution. There was a total of 12 extracts: rhubarb petiole (dried at 45 °C or lyophilized), rhubarb root (dried at 50 °C), blackcurrant berry (dried at 45 °C or lyophilized) and lyophilized juice of Scots pine needles. Extracts were dissolved in dimethyl sulfoxide and bioactivity screening of the extracts was determined at a concentration of 1,0 mg/ml, after which the active extracts were subjected to minimum inhibitory concentration (MIC) determination (n=2-3) at eight concentrations (0,0625-4,0 mg/ml). Antimicrobial experiments were performed on a 96-well plate following Clinical and Laboratory Standards Institute guidelines. Bioactivity was determined based on absorbance measurements and visual inspection. The extract of rhubarb root showed most potential against tested bacteria. The lowest MIC values (0,25 mg/ml and 0,50 mg/ml) were obtained with rhubarb root extracts (extracted with 80% or 30 % ethanol-water solution) against Staphylococcus aureus and Bacillus cereus and 1,0 mg/ml against Listeria monocytogenes. Based on this study rhubarb root extract could be a potential natural antimicrobial against foodborne pathogens.

Lääkehoitoa toteutetaan erilaisissa toimintaympäristöissä sekä sosiaali- ja terveydenhuollossa, että sen ulkopuolella. Lääkehoitoa toteuttavat pääsääntöisesti sosiaali- ja terveydenhuollon ammattihenkilöt, mutta ympäristön mukaan vaihdellen myös lääkehoidon koulutusta vähän tai ei lainkaan saaneet. Lääkehoidon osaamisen varmistaminen on aina työnantajan vastuulla. Keski-Uudenmaan hyvinvointialueella on ruuhkautuneiden näyttöjen myötä tunnistettu tarvetta keskitetyille näytöille. Tehty pilottitutkimus tuo arvokasta tutkimustietoa näyttötyöpajasta osana lääkehoidon käytännön osaamisen varmistamisen prosessia, sillä aikaisempia tutkimuksia aiheesta ei ole. Tutkimuksen keskeisenä tavoitteena oli tutkia näyttötyöpajan toimivuutta lääkehoidon käytännön osaamisen varmistamisessa, sekä mitä resursseja näyttötyöpajan järjestäminen organisaatiolta vaatii ja mikä olisi optimaalinen näyttötyöpajan osallistujamäärä. Pilottitutkimus toteutettiin järjestämällä näyttötyöpaja, jossa Keusoten yksiköissä työskentelevät nimikesuojatut terveydenhuollon ammattihenkilöt (n=15) osoittivat lääkehoidon käytännön osaamistaan. Näyttötyöpajassa lääkkeiden jakamisen näyttöjä ottivat vastaan farmaseutit (n=3) ja lääkkeiden antamisen näyttöjä sairaanhoitajat (n=2). Aineistona tutkimuksessa toimi näyttötyöpajassa näyttöjä antavien ja vastaanottavien antama palaute, joka kerättiin puolistrukturoidulla palautelomakkeella paikan päällä. Palautekysely lähetettiin myös näyttöjä antaneiden esihenkilöille ja vastaaville sairaanhoitajille sähköisellä Microsoft Forms- lomakkeella. Aineistoa analysoitiin tilastollisesti kuvaavalla tavalla sekä induktiivisella sisällönanalyysillä hyödyntäen Microsoft Excel -ohjelmaa. Näyttötyöpajaan osallistuneet kokivat näyttötyöpajan kehittävän lääkehoidon osaamista. Näyttötyöpajan koettiin nopeuttavan ja helpottavan osaamisen varmistamista sekä. Esihenkilöt ja vastaavat sairaanhoitajat kuvailivat näyttötyöpajan myös vapauttavan näyttöjen järjestämiseen kuluvia resursseja muuhun hoitotyöhön. Sekä osallistujat että näytön vastaanottajat kokivat näyttötyöpajan vertautuvan huonosti aitoon työtilanteeseen. Keskeisiksi näyttötyöpajan kehityskohteiksi nousivat parempi organisointi, tiedonkulun vahvistaminen ja näyttöjen tasalaatuistaminen. Mukauttamalla näyttötyöpajaa enemmän aidon työtilanteen kaltaiseksi voisi näyttötyöpaja tukea osaamisen kehittymistä paremmin, sekä parantaa työyksikön lääkitysturvallisuutta. Näyttötyöpajaa tulisi tutkia ja kehittää lisää, jotta siitä saataisiin sujuva osa osaamisen varmistamisen prosessia. Näyttötyöpaja koettiin pääosin hyödylliseksi ja se koettiin tarpeelliseksi interventioksi helpottamaan ruuhkautunutta lääkehoidon osaamisen varmistamista.