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

Rational, or prudent, use of medicines is one of the cornerstones of Finnish politics guiding the public procurement of medicines as a part of the medicines supply. The definition of rational use of medicines, however, takes into account the sustainability aspects of neither the drugs used nor the manufacturers behind them even though, according to One Health way of thinking, there is a connection between the sustainability of medicines and people's health. Motivated by this contradiction, the aim of the research was to map the different dimensions and usability of the corporate social responsibility (CSR) reports of pharmaceutical companies in promoting the sustainable public procurement of medicines. The values guiding the companies' sustainability actions and the impact of the COVID-19 pandemic on the companies were also researched. The materials consisted of CSR reports from years 2019-2020 of seven pharmaceutical companies that participated in public drug procurement in 2019. Two classification systems for sustainability and key performance indicators presented in previous research literature were used as a theoretical basis. Public procurement of medicines was used as a framework through which the research was carried out by using the means of qualitative content analysis. The CSR reports typically discussed the company, the environment, people, stakeholders, ethics and CSR reporting itself. CSR activities completed in the financial year in question consisted mostly of social sustainability. As for the environmental issues, emissions and climate issues played a great role. Governance-related CSR actions were the least reported and usually discussed risk management, research, and ethics. Success and pioneering, robustness and sustainability, and community spirit were recognized as themes uniting the values that guide CSR. As for in promoting sustainable public procurement, information about CSR activities, adoption of principles set by external stakeholders, CSR-related metadata, sustainability rankings, and management of sustainability in the supply chain, among other things, were found potential. The CSR reports of pharmaceutical companies contain comprehensive information about the companies’ operations, response to global trends and the values guiding the CSR activities. The use of CSR reports in public procurement of medicines necessitates further uniformity of CSR reporting practices in the pharmaceutical industry.

Tausta: Lääkehoitoon liittyvät haittatapahtumat aiheuttavat merkittävää inhimillistä kärsimystä ja taloudellista taakkaa yhteiskunnalle. Lääkitykseen liittyviä haittatapahtumia voidaan ehkäistä tunnistamalla ja puuttumalla lääkitysriskejä aiheuttaviin tekijöihin. Tavoitteet: Tutkimuksen tavoitteena oli tutkia lääkitysriskien hallintakeinoja lääkkeen toimittamisen yhteydessä suomalaisissa avohuollon apteekeissa. Tavoitteena oli selvittää, miten apteekeissa tunnistetaan ja puututaan asiakkaan lääkehoitoon liittyviin ongelmiin ja millaista lääkitysriskien hallintaan liittyvää osaamista ja lisäkoulutustarvetta apteekeissa työskentelevillä farmaseuteilla ja proviisoreilla on. Aineisto ja menetelmät: Tutkimus oli valtakunnallinen poikkileikkaustutkimus, jonka aineisto kerättiin syksyllä 2022 sähköisellä kyselyllä. Alkuperäinen kyselylomake luotiin vuonna 2015 kirjallisuuden ja järjestelmälähtöisen riskien hallinnan teorian pohjalta ja päivitettiin tätä tutkimusta varten. Tulokset: Kyselyyn vastasi 192 apteekkia (n=610). Apteekeissa tunnistettiin ja puututtiin lääkehoito-ongelmiin, mutta toimintatavat olivat harvoin systemaattisia. Yleisin puuttumistapa oli keskustelu asiakkaan kanssa ja kehotus ottaa yhteyttä lääkäriin, näin toimi 78 % apteekeista tilanteessa, joissa asiakkaan lääkitys ei toiminut toivotulla tavalla. Suurimmalla osalla apteekeista ei ollut muun terveydenhuollon kanssa yhteisesti sovittuja toimintatapoja lääkehoito-ongelmien ratkaisemiseksi. Myös apteekin sisäiset toimintaohjeet olivat puutteellisia Johtopäätökset: Apteekkien ja muun terveydenhuollon välinen nopea viestintäkanava ja yhteisesti sovitut toimintatavat voisivat parantaa apteekkien mahdollisuuksia puuttua lääkehoito-ongelmiin. Apteekkien rooli lääkitysriskien hallinnassa tulee määritellä tarkemmin. Apteekkien ja muun terveydenhuollon välisessä yhteistyössä on paljon hyödyntämätöntä potentiaalia.

Poor adherence to and non-compliant use of medications are common in long-term patients, and it is estimated that only half of medication use worldwide is appropriate. Poor adherence to medication undermines public health, reduces the cost-benefit of resources invested in medication care, and burdens health care. Various interventions have sought to improve adherence to drug treatment, but they have not brought about the desired change in medication adherence. The aim of this master's thesis was to develop a method and pilot it to investigate the reasons for the non-compliant use of medications in the context of the medication reconciliation process. The aim of this new method was to find out the reason for non-compliant use of a medicine in a patient-centered way, and the possibility for the pharmacist to motivate the patient to use the medicine according to the instructions. In addition, it was examined whether the method can measure prevalence of non-compliant use of medicines differs according to the ATC classification of medicines and whether the total number of medicines contributes to the non-compliant use of medicines. The pilot study was carried out as part of a standard pharmacist's medication reconciliation process at Vantaa primary health care. The data required for the study were collected on the electronic HUSeCRF platform. Patients were collected to the extent that we were able to verify the functionality of the method and to plan the reporting of the results of the actual study with larger research data. The data were collected during the year of 2021. The theoretical framework of the study was the Medication-Related Burden model and the iceberg model of non-compliant use of medicines. The research material was analyzed using descriptive statistical analysis in IBM SPSS 27. The analysis of the data was done in terms of the functionality and development of the new method. A total of 8 patients participated in the pilot study (women 63% n = 5). Patients had an average of 16 medications per patient (range 8-22), and the last time their medications were reconciliated was on average 1 year ago. Non-compliant use of medicines was observed in 88% of patients (n = 7). In total, there were non-compliant use of medicines in the data for 21 drugs. The most common medicines which were used non-compliant were for the treatment of cardiovascular diseases. The total number of medicines and the number of non-compliant use correlated with each other (Pearson correlation coefficient 0.472), but the result was not statistically significant (p = 0.238). The most common reason for non-compliant use was a drug-induced side effect. After a motivational discussion which was involved in the medication reconciliation process with pharmacists, in 14 % of non-compliantly used medicines, patients decided to start taking the medication as directed. The pharmacist was able to motivate the patient to use the medicine as directed when the reason for non-compliant use of medicine was unclear instructions. In this study, a method was developed and validated to determine the reasons for non-compliant use of medicines. During medication reconciliation process, the pharmacist was able to find out the reasons for non-compliant use of medicines. Pharmacists may motivate the patient to use the drug as directed, however, most patients did not want to change the use of the medicine as directed. As the total number of medications increase, the probability of non-compliant use of medicines may increase.

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.

Cardiovascular diseases are the most common causes of mortality worldwide. More adequate human-based models would be needed for the purposes of disease modeling and drug development. One of the most promising fields of in vitro modeling is the use of human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs). A central problem of hPSC-CMs is their immature or fetal-like phenotype compared to adult human cardiomyocytes regarding many structural, functional, and metabolic properties. The development of metabolic properties is considered to be a central driver of cardiomyocyte maturation. One practicable way to promote the metabolic maturation of hPSC-CMs in vitro is the use of various biochemical cues in the cell culturing media. The topic of this study was the metabolic maturation of hPSC-CMs. The research questions were: What biochemical cues have been suggested to be involved in the hPSC-CM maturation in vitro? What signaling pathways connected to the biochemical cues have been explored in the context of the maturation of hPSC-CM? What experimental results have been achieved on the effects of the biochemical cues and the involvement of the signaling pathways? The study was conducted as a systematic review with the database Scopus (Elsevier). The final set of materials consisted of 46 original research articles published in peer-reviewed journals in English in the years 2013–2022. Out of the materials, 11 articles (24%) were characteristically longitudinal studies. They indicated that the pathways leading to metabolic changes such as PPARs (peroxisome proliferator-activated receptors) and PGC-1α (peroxisome proliferator-activated receptor γ coactivator 1α) are activated already in early stages. In 12 articles (26%), pharmacological agents were used to target the metabolic pathways, and in 8 articles (17%) techniques affecting the gene expression were utilized. The most recent studies involved ever more frequently combinations of different techniques. Considering the use of biochemical cues, the trend has been to favor fatty acids, thyroid hormone and dexamethasone over glucose, insulin and insulin-like growth factor. Some cues such as retinoic acid and neuregulin 1 have been tested only in single experiments. In addition to the nuclear receptor mediated pathways, the energy sensors AMPK (AMP-activated protein kinase) and mTOR (mechanistic target of rapamycin), the oxygen sensor HIF-1α (hypoxia-inducible factor 1α), and the microRNAs turned out to be central.

A clean area is an area isolated from its environment to prevent contamination of final product during aseptic processing. The clean area can be divided into four different grades from A to D, which all have different cleanliness standards. Grade A is the highest grade where preparing products that are not terminally sterilized must be performed. Airlocks are located between different grades to prevent free airflow, and enable necessary precautions, such as putting on protective garments and disinfecting material surface. These procedures reduce risk of contamination of the higher grade. The purpose of this study was to create a protocol to help evaluate material disinfection and transfer processes in the hospital pharmacy of Turku University Central Hospital and to determine surface bioburden of material stored in the grade C area. Surface samples of the examined material were taken in accordance with in-house guidelines by using contact plates and swabs depending on the surface of the material examined. After incubation, colony forming units were counted. Samples were taken from primary packages of ingredients and equipment stored in grade C area, as well as from material transfer boxes and cut flush plastic folders used in the clean area. Samples were taken both before and after routine disinfection of this material. 45 % of the samples taken before disinfection were contaminated. The lowest contamination rates were observed from items made from glass and those that were stored in their secondary package. In five plates grew more than 25 colonies, of which two had biofilm covering the whole surface of the plate. These samples were taken from larger plastic items, such as an infusion bag and a plastic folder. High bioburden is possible on the surface of material stored in grade C clean room, despite precautions. 25 % of the samples taken after routine disinfection were contaminated with a maximum of two colonies per plate. Despite disinfection, viable microbes may remain on the surface of material. Material with risk of high bioburden were selected for the protocol. Items were disinfected and transferred to grade B area as a simulation of normal processes. Different operators performed the protocol a total of eight times. 14 % of samples were contaminated with a maximum of two colonies per plate, except for one plate with 15 colonies. This repetition exceeded the limits set for the protocol. One repetition had zero contaminated samples. The bioburden of material surface after disinfection is affected by operators, cleanliness of the grade C area, and manipulation of the storage. A high bioburden increases risk of unsuccessful disinfection, and recontamination is possible in a non-sterile environment. Bacillus and Staphylococcus -species were identified from the samples taken during the protocol. Bacillus-species are usually isolated from soil, can tolerate harsh and low nutrient environments, and can form spores. Staphylococcus-species are part of the human skin microbiome. Microbes inside clean area are originated from personnel or surface of material transferred there. Material surface bioburden creates a contamination risk of aseptically prepared products, and thus material transfer and disinfection are critical stages during aseptic processing.

Microcrystalline cellulose is a compactable, versatile, and popular excipient in tableting. Microcrystalline cellulose is produced using acid hydrolysis where most of the amorphous areas are removed and the crystalline part is left. Particle size affects most on the functionality of microcrystalline cellulose and that can be altered by changing the duration of acid hydrolysis or the drying method. The aim of this Master’s thesis was to compare new microcrystalline materials produced using energy efficient methods, to commercial Avicel-powders. The used formulation consisted of microcrystalline cellulose, hydroxypropyl methylcellulose, magnesium stearate and dried colloidal silicon dioxide. Due to the small particle size of AaltoCell™ samples it was not possible to use it for direct compaction, but with wet granulation this was successful. The tablets were tested by the standards of European pharmacopoeia and the tablets from wet granulated Avicel PH-101, AaltoCell™ sample B and C passed all the tests. Probably the problem with the rejected formulations was poor flowability, which caused poor reproducibility in the experiments with direct compressed tablets. The wet granulated Avicel PH-101 produced the best tablets with the used formulation.