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  • Tyni, Oona (2023)
    Verensiirtoja tarvitaan monissa erilaisissa tilanteissa, kuten akuutissa verenhukassa, leikkauksissa ja sairauksien hoidoissa. Verivalmisteiden laajan käytön takia, on tärkeää varmistaa veriturvatoiminnalla niiden laatu sekä turvallisuus. Olennainen osa verivalmisteiden laadunvalvontaa on seuloa veren välityksellä leviäviä taudinaiheuttajia. Suomessa veren välityksellä leviävien tautien leviämisen riski on lähes olematon tarkan laadunhallinnan ansioista. Verenluovutusajankohtana oireettomat taudit aiheuttavat kuitenkin riskin laadunhallinnalle. Koska krooninen Chlamydia pneumoniae -infektio voi olla oireeton, on tärkeää tutkia taudin kykyä levitä verivalmisteiden välityksellä. Tätä ennen on kuitenkin tutkittava, löytyykö verivalmisteista edes kyseistä bakteeria. C. pneumoniae on gram-negatiivinen solunsisäinen bakteeri, joka aiheuttaa ihmisillä erilaisia akuutteja hengitystieinfektioita, kuten keuhkokuumetta, nielutulehdusta ja sinuiittiä. Vaikka suurin osa tartunnoista on oireettomia tai lieväoireisia, voi infektio muuttua hoitamattomana krooniseksi. Akuutissa infektiossa C. pneumoniae infektoi pääasiassa keuhkojen epiteelisoluja sekä alveolaarisia makrofageja. Infektion pitkittyessä bakteeri voi levitä muihin elimistön soluihin valkosolujen välityksellä. Tämä bakteerin kyky aiheuttaa kroonista infektiota sen muuttuessa persistenttiin muotoon tekee bakteerista hyvin menestyvän. Tämän tutkimuksen tavoitteena oli selvittää, kuinka paljon C. pneumoniae -bakteeria esiintyy suomalaisessa luovutusveressä. C. pneumoniae -bakteerin DNA:n tunnistamiseen kokoverestä käytettiin kolmea eri PCR-menetelmää: kvantitatiivista PCR:ää, sisäkkäistä PCR:ää ja digitaalista pisara PCR:ää. Työn ensimmäinen vaihe oli suunnitella ja optimoida nämä kolme PCR-menetelmää. Menetelmien pystyttämisen jälkeen 40 verinäytettä tutkittiin kyseisillä PCR-menetelmillä. Lisäksi samoista verinäytteistä määritettiin C. pneumoniae spesifisen vasta-aineen, immunoglobuliini G:n, määrät ELISA-immunomäärityksellä. Verinäytteitä tutkittaessa C. pneumoniae -bakteerin esiintyvyys suomalaisessa luovutusveressä oli hyvin pieni. Vain kahden näytteen (2/40) epäiltiin olevan mahdollisesti positiivisia, sillä nämä antoivat mahdollisia positiivisia tunnistuksia vähintään kahdessa PCR-ajossa. C. pneumoniae spesifisten IgG vasta-aineiden esiintyvyys oli suurempi; näytteistä 50 % oli igG positiivisia. IgG vasta-aineiden esiintyvyyden ei todettu korreloivan iän tai sukupuolen kanssa. Aiemmissa tutkimuksia C. pneumoniae -bakteerin esiintyvyys luovutusveressä on vaihdellut 7–46 %:n välillä. Bakteerin esiintyvyyden jäädessä hyvin alhaiseksi on mahdollista, että PCR-menetelmien detektioherkkyys ei riittänyt tässä tutkimuksessa tunnistamaan toistettavasti mahdollisia positiivisia näytteitä. Näin ollen PCR-menetelmien lisäoptimointi olisi tarpeen.
  • Ukkonen, Hanna (2012)
    In medicines APIs are most oftenly at solid form. Crystal forms are more stable than amorphic solid form. Crystals are hold together by intermolecular interactions. Strongest and most common intermolecular interaction in crystals is hydrogen bond. Crystallisation is affected by thermodynamics and kinetics. Same phenomena effect also dissolving of crystals. New APIs often have a poor water solubility which makes them difficult to use. Cocrystals are one way to improve physical characteristics of molecules and most of all solubility. In co-crystals two different solid molecules are crystalliced in a same crystall lattice. Itraconatzole is an API with a poor water solubility. Itraconatzole can form cocrystals with many bicarbocsylicacids. The smallest bicarbocsylicacid that had formed co-crystal with itraconazole is malonic acid. The purpose of the experiment was to grow itraconazole malonic acid co-crystal, which is big enough for single crystall x-ray diffraktion. With SXRD it is possible to find out how molecyles are placed in a crystall lattice. For SXRD the single crystal is not allowed to have a single mistake in its lattice. Itraconazole and malonic acid were dissolved to 1,2-dichloroethane-2-butanone and tetrahydrofurane-chloroform for growing up a single crystal. Crystallisation methods used were evaporation of solvent, adding antisolvent and cooling down of solution. Formed crystalls were analysed with DSC, raman, XRD and TGA. It was succeeded to crystallise itraconazole malonic acid co-crystals with used methods. The formed crystalls were needlelike and packed in small drifts. Any crystall big enough for SXRD was not succeeded to grow up with the methods used. Growing up a bigger co-crystal needs the use of new methods or optimation of the ones used in this experiment.
  • Neuvonen, Janina (2019)
    Flowability of powders is in critical role when manufacturing the most popular dosage forms, tablets and capsules, of pharmaceutical industry. Re-formulation is expensive and time-consuming, so it is important to determine powder flow properties at the initial stage of drug development prior to tabletting and encapsulation processes. There are many different methods, like shear cell, flow through an orifice and bulk and tapped density, to examine powder flowability. Despite the methods, the most reliable means of examining powder flowability is often empirical. In early stages of drug development, it would be good to have faster, more reliable and cheaper methods to examine powder flowability. FT4 Powder Rheometer is a relatively new flowability characterization technique. The aim of this study is to find out whether the library created using the FT4 Powder Rheometer methods makes it possible to characterize the rheological properties of solids in the early stages of drug development. In addition, the aim is to investigate whether FT4 Powder Rheometer methods can predict the success of masses in tableting and encapsulation processes. The information gained from the research can be used in the future, for example, in continuous processes, because flowability plays an important role, especially in the supply of raw materials to the process, which is the most important division of continuous processes. To the library were selected for particle size and shape 15 different types of material. These materials were subjected to five different FT4 Powder Rheometer basic test methods. In addition, the particle size and shape of the materials and the flow through an orifice and the bulk and tapped density were determined to support the results of the powder rheometer. The principal component analysis was used to process the results. As the tablet and capsule masses examined, the masses of a previous study were utilized. Those masses were tableted and encapsulated in that previous study. These tablet and capsule masses contain a variable amount of cohesive drug substance. FT4 Powder Rheometer methods provide more complex information about materials and their behaviour than conventional flowability test methods. From the powder rheometer parameters pressure drop, compressibility and specific energy distinguish the cohesive and the non-cohesive materials, because the cohesive materials with these parameters obtain clearly higher values than non-cohesive materials. Additionally, the cohesion of FT4 Powder Rheometer shear cell test mainly distinguishes highly cohesive materials from other materials. The flow rate index makes it possible to separate the materials to which the change in flow rate particularly affects. Fluidizing materials, due to the air flow, are distinguished by the aeration test. Avicel PH-102 could be used as a rough limit value for well and poorly flowing materials in the created library (excluding the aeration and shear cell test). Stability index -, flow rate index -, specific energy -, pressure drop -, and compressibility-results of the FT4 Powder Rheometer correlated to the proportional proportion of the cohesive drug in the mixture. These parameters could possibly be used to distinguish mixtures containing the cohesive material. Additionally, specific energy, compressibility, pressure drop, basic flowability energy, stability index and flow rate index correlated with the weight variation of the tablets. With these parameters one could possibly assess the tabletability of the mixtures. A much larger library is needed to evaluate and predict the rheological properties of new materials. FT4 Powder Rheometer can possibly be used to predict the tableting success of tablet and capsule masses. This would be interesting to look more extensively, for example as part of a library. Additionally, it would be good to investigate whether the results of powder rheometer correlate to continuous production.
  • Naukkarinen, Noora (2013)
    The pet medication industry is growing but there are still challenges especially in feline medication. Palatable flavours, efficient taste masking technologies and easily administrable dosage forms are needed to facilitate feline medication. Based on the literature review, there is only little information about cat's preference to individual flavours. The methods for palatability testing should be improved to achieve reliable results. Most common taste masking technologies are flavouring and tablet coating. In experimental section different flavours for taste masking were studied. Five main flavours were selected: phenylalanine, leucine and methionine as possibly good flavours and arginine and denatonium benzoate as bad flavours. In preformulation experiments tableting characteristics, thermal behaviour and crystal structure of flavours were analysed. The aim was also to study their possible incompatibilities with tablet excipients. The main compatilibility study method was X-ray powder diffraction (XRPD), but differential scanning calorimetry (DSC) was also used. Excipient povidone (PVP) was incompatible with nearly all of the main flavours. The use of lactose as an excipient was excluded because of the risk of the Maillard reaction. In tableting studies a tablet mass containing microcrystalline cellulose (MCC), calcium hydrogen phosphate dihydrate, mannitol, hydroxypropyl cellulose (HPC), crospovidone, talc and sodium stearyl fumarate was produced. Minitablets of diameter 3 mm without any flavours were compressed. Also minitablets with flavours phenylalanine and denatonium benzoate were compressed. Minitablets complied with the European Pharmacopoeia tests for uniformity of mass, disintegration and friability. However, characterization and handling of minitablets was found to be challenging due to very small size of the tablets. Minitablets are a promising technology for facilitating feline medication in the future.
  • Räntilä, Sanna (2010)
    The purpose of this study was to describe cat owners' problems that relate to cat medication, especially from the drug formulation point of view. Oral, topical, eye and ear administration routes were included into study. There are few compliance and palatability studies made for cats and dogs in Finland and abroad, but this kind of descriptive study relating different drug formulation has never been done before. This study was carried out as Internet survey questionnaire study and it was addressed to cat owners who visited in academic veterinary hospital for small animals and those municipal and private veterinary offices that were randomized into the study. Additionally, the survey study was addressed to cat owners who had medicated their cats during January-March 2010. Those cat owners were contacted through Internet discussion sites. In the veterinary offices the office staff selected the proper candidates for the study and distributed invitations to participate. For distributing invitations the main criteria was that the cat owner received veterinary medication prescription or got directions for using some medication in cat. 59 answers were received in the study and 84 % of all formulation were administered via oral route. The products were antimicrobial and paracite medicines, cardiovascular and anti-inflammatory medicines. Based on the study results most of the problems were related to oral and ear administration routes. Cat showed low compliance and unwillingness to take pills and capsules because of the unpleasant smell, taste and mouth feel of the product. Tablet and capsule form medicines caused problems to the owners, because it was often necessary to adjust the dose by splitting and cutting half the tablet. This made it difficult for owners to follow given medication instructions. The consistency of liquid medicine forms was described sticky and package material thick and stiff. Because of these factors cat owners had difficulties to evaluate the amount of drops to administer to cats ear or eye and the amount remaining in the medicine bottle. According to the study results there is a need for palatable and easily administered medicines that will be taken readily by cats. It should also be possible to adjust to dose as described. The survey questionnaire is a convenient study method for descriptive purposes and it should be carefully considered what kind of sampling method to use and how to carry out the sampling in practice.
  • Leino, Teppo (2013)
    Voltage-gated sodium channels play an essential role in the function of the nervous system as they are responsible for producing action potentials. Abnormal activity of sodium channels is in connection to several diseases such as epilepsy and chronic pain. Voltage-gated sodium channel blockers which are selective towards a specific isoform could provide more efficient and better tolerated drugs to treat these diseases when compared to the drugs used today. Clathrodin is an alkaloid isolated from Caribbean sea sponge Agelas clathrodes. Bioactivity studies have shown that clathrodin changes the function of voltage-gated sodium channels. The aim of this study was to synthesize two kinds of structure analogs of clathrodin and study their structure-activity relationship towards different isoforms of voltage-gated sodium channels. The study is part of the MAREX project (Exploring Marine Resources for Bioactive Compounds: From Discovery to Sustainable Production and Industrial Applications) funded by the European Union. Intention of the project is to find new bioactive compounds in marine organisms. A four-step route was developed for synthesizing 2-aminobenzothiazole analogs. A three-step route was developed as well but the last step seemed to be problematic for some of the compounds. The three-step route provided new compounds as intermediates and some of them were sent to tests for activity. Synthesis of 1H-pyrrole-2-carboxamide analogs of clathrodin failed. 4,5-dihydrooxazole was recognized as a problem as it was formed as a result of a cyclization reaction when bromination was tried on the intermediate. The formed structure was used in synthesizing 2-(1H-pyrrol-2-yl)-4,5-dihydrooxazole analogs of clathrodin. These reactions failed to give any final products which could have been tested for activity. Eight synthesized compounds were sent to tests for activity. Results were received from two of them and they showed no activity towards the voltage-gated sodium channels in 10 µM concentrations. Discussion about structure-activity relationship is not possible based on two compounds only.
  • Taipale, Heidi (2020)
    The national legislation, based on EU Directive 93/42, has regulated the high-risk medical devices in Europe to this day. It requires that in order to enter the market, the device must be safe, suitable for the intended use and acceptable in performance. The demonstration of clinical efficacy is not required. The information on which clinical evidence is based, is not publicly available, as clinical evaluation data and the results of a clinical trial are not required as a condition of market access in Europe. This has given the opportunity for manufacturers for faster and more cost-effective pathway to bring the medical devices to market in Europe. This has boosted the activity of device industry in Europe. However, the weaknesses of European legislation are considered to be one of the reasons caused the large-scale device scandals (lack of safety and effectiveness) in the early 2000s. As a result, a new EU Regulation 2027/745 on medical devices has been created and will enter into force in all Member States in May 2021. The aim of this study was to create an overview of the clinical evidence on high-risk medical devices marketed in Europe and how the issue has been investigated. A systematic literature review was used as the method in this study. The challenge was that there was lack of material available on the subject in question. This is probably due to the limited availability on clinical information of marketed devices, as a public database (Eudamed) does not exist yet in Europe and the device manufacturer may not publish the results of clinical studies. This issue has been investigated by using some reimbursement assessment decisions could be found from few European countries. The level of clinical evidence of devices in the United States has been extensively investigated. Medical devices marketed in Europe have been submitted for registration to United States, so information on European devices can be found in United States public sources. This information will provide a stronger insight of the level of clinical evidence regarding the devices marketed in Europe and thus the publication has been justified to be included in this study. According to the information obtained from this study, the clinical evidence of high-risk medical devices is mostly incomplete and of poor quality. This has negative effects on physicians making treatment decisions, patients using the devices, as well as device manufacturers. Clinical trial methods do not fully comply with the gold standard and the use of other methods is not clearly justified. The requirements for new devices will be significantly tightened and the clinical evidence of already approved devices will need to be updated due to the new device regulation. Clinical data will be publicly available in Eudamed database in the near future. Guidance from Notified Bodies and Authorities regarding alternative methods for clinical trials expected to be also clarified. New requirements of clinical evidence will increase manufacturer´s costs. It may also be the case that, clinical evidence updates of current devices cannot be implemented from a safety point of view. It is likely that important devices will exit the European market and the industry will suffer. An agreement should be reached together with authorities and industry to ensure self-sufficient European device manufacturing and the promptly availability of vital devices for patients.
  • Ryynänen, Eeva (2013)
    During the past few decades the focus of the pharmacy profession has shifted from medicinal products towards ensuring the welfare of the patient. The concept of pharmaceutical care emphasizes that the role of the pharmacist is to ensure the quality and safety of pharmaceutical therapy in collaboration with the patient. The concept of clinical pharmacy, on the other hand, highlights that the pharmacist should take the responsibility of the efficiency, safety and cost efficiency of the patient's pharmaceutical treatment together with other health-care professionals. Patient centered pharmacy services have been increased in Finnish hospitals and health care-centers during the last 10 years, for example, in the form of pharmacy services provided on the wards. Previous studies have shown that Finnish hospital pharmacists want to develop and increase clinical pharmacy services in hospitals but feel they are not competent enough to manage them. To develop and increase the number of clinical pharmacy services it is important to ensure the pharmacy professionals have support to their continuing professional development. The General Level Framework (GLF) has been developed in the UK to support the professional development of pharmacy professionals and its value has been shown in various studies. The aim of this study was to give information of the state of Finnish hospital pharmacy and its development needs as perceived by Finnish hospital pharmacists, and to investigate how the GLF can be utilized in Finnish hospital pharmacy. The study was conducted using two different research methods: a semi-structured interview was designed to investigate hospital pharmacists' perceptions of hospital pharmacy, it's development needs and utilization of the GLF; in addition, hospital pharmacists selfassessed their clinical pharmacy related competencies using the GLF. All of the participants of the study were participants of a clinical pharmacy course by University of Helsinki. In total 11 hospital pharmacists took part in the interview. Also 41 pharmacists self-assessed their competencies in clinical pharmacy using the GLF: eight of them completed the self-assessment twice with a six month period between the assessments. The interviewed pharmacists felt that the pharmacy curriculum should focus more on the skills and competencies needed in hospital pharmacy. On the other hand, they felt that the tasks of hospital pharmacists did not necessarily allow them to use their actual knowledge of pharmacy. They perceived that the future of hospital pharmacy lies in services of clinical pharmacy, although they felt that they were not competent enough to manage them. The GLF self-assessment showed that the clinical competencies of the participants were average, and there was no change in the competence of the participants during the six month period. However, the interviewed pharmacists felt that the GLF can be used as a tool for support the hospital pharmacists' professional development and continuing professional development in clinical pharmacy. They also perceived that there is a need for further studies on the clinical pharmacy services and their benefits, and that the task distribution of health care professionals in hospitals must be re-considered. With these actions, the challenges hindering the development and increase of clinical pharmacy services in Finnish hospitals could be overcome. They described that the greatest challenges to overcome were prejudices against pharmacist working on the wards and a lack of resources. In order to develop and increase clinical pharmacy services in Finnish hospitals and other health-care organizations further reseacrh on the benefits of clinical pharmacy should be conducted. It must also be ensured that all health-care professionals and decision makers are aware of the studies already made about clinical pharmacy and its benefits. The skill-mix of health care professionals taking part in a patient's treatment must be reconsidered in order to ensure that the patient receives the best, most efficient and safest possible medicinal care. The GLF can be used as a tool to define the role of a clinical pharmacist in Finland. There is a need for more clinical pharmacy education so that Finnish pharmacists can feel competent enough to manage clinical pharmacy tasks. The GLF can be used as a tool to support the professional development and continuing professional development also in Finland.
  • Hiltunen, Anukka (2010)
    The major problem in cancer treatment is toxic side effects of the chemotherapy. Typically less than 1 % of the administered free drug reaches target cells while the rest damages non-diseased cells. Toxic side effects often limit dose escalation of anticancer drugs which leads to incomplete tumor response, early disease relapse and possible the development of drug resistance. Liposomes can be targeted in cancer tissue with passive or active targeting. In passive targeting the liposomes accumulate in abnormally formed cancer tissue through the process of extravasation and enhance the concentration of liposomal drug in solid tumor. To further improve the anticancer efficiency of passive targeted liposomes is to couple a targeting ligand to the surface of the drug carrier (i.e. active targeting). The ligand specifically binds to a surface epitope on the target cell leading to the accumulation of the liposomal drug inside the tumor cells. The aim of this study was to investigate the cytotoxicity of targeted immunoliposomes. In experimental part the liposomes were constructed using cetuximab (C225, Erbitux®) antibody and evaluated for specific cellular uptake and cytotoxicity in vitro. Cetuximab antibody is specific and selective inhibitor of HER-1 -protein (ErbB-1, EGFR, epidermal growth factor receptor). HER1 -protein is frequently expressed in high levels in human carcinomas (for example in lung and colorectal cancers, head, neck and breast cancers and in pancreatic, ovarian, prostate and bladder carcinomas). Specific immunoliposome uptake and cytotoxicity were studied in SKOV-3cells (ovarian adenocarsinoma cell line) which overexpress the EGF -receptor. Monkey kidney epithelial cells (CV-1) were used as a control cell line which represents non-diseased cells. Active targeting and cellular uptake of liposomes were investigated in cell uptake studies. Non-targeted pegylated liposomes were used as control liposomes. Specific binding of the cetuximab antibody to EGF -receptor was noticed in competition studies. The in vitro cytotoxicity of doxorubicin containing immunoliposomes was studied with Alamar Blue® cell viability assay. Liposome size was determined at intervals of about two weeks during the experimental part. In conclusions, antibody targeted immunoliposomes showed greater cellular uptake and cytotoxicity in EGFRoverexpressing target cells (SKOV-3) than the corresponding non-targeted liposomal drug. Immunoliposomes showed greater cytotoxicity after five days incubation, which can be a consequence of liposome formulation and slow rate of release of doxorubicin. In contrast, antibody targeted liposomes did not show specific cellular uptake or cytotoxicity in CV-1 control cell line. In clinical cancer therapy actively targeted liposomes could improve the therapeutic effectiveness of the liposomal preparations. Many studies have shown that ligand-bearing liposomes will selectively bind to target cells in vitro, but only few studies have shown the possibility in vivo.
  • Lehtinen, Katariina (2011)
    In cancer therapy nanocarriers can be loaded with therapeutic or diagnostic agent and nucleic acid sequences. Targeting moieties can be attached to the nanocarrier for passive or active targeting or carrier can be labeled with radioactive isotope for imaging or radiotherapeutic purposes. Enclosing the drug in a nanocarrier may improve the molecule's physico-chemical properties, bioavailability, reduce side-effects, longer the circulation time and dosing interval, and improve uptake in the target tissues. Thus, the efficacy of chemo- or radiotherapeutic could be improved. It may lead to improved survival. Pro gradu investigates nanocarriers' role in cancer therapy. Regardless of research, continued for decades, only 2 (Europe) or 3 (United States) nanoparticle formulations are approved in cancer therapy. Major limiations are inefficient uptake in the target tissue, immunogenicity of nanoparticles and targeting ligands, and lability. The aim of this study was to investigate pre-targeting of 99mTc-labeled, PEGylated and biotinylated liposomes into human ovarian adenocarcinoma cells in vitro and in mice in vivo. Targeting moiety used was biotinylated cetuximab (Erbitux®), an antibody that binds into EGF-receptors, over-expressed in these cells. Pre-targeting was compared to active one step-targeting, with antibody attached to liposomes, and passive targeting. Development of more accurate imaging techniques has accelerated the investigation of targeted nanoparticles. Molecular imaging enables real-time tracking of nanoparticle distribution and metabolic changes. In literature review, SPECT and PET imaging in cancer therapy and nanoparticle research, will be discussed. These imaging methods overcome challenges in sensitivity and accuracy, faced by other imaging methods. In this study we also investigated the biodistribution of 99mTc-labeled liposomes in mice using NanoSPECT-CT-device. Activity in tumor, spleen and liver was quantified using InVivoScope-software and gamma counter and these results were compared. In in vitro study, pre-targeting method was 2,7and 3,5-times more efficient compared to the liposome controls in SKOV3 and SKOV3.ip1 cell lines, respectively. Although, one-step targeting formulation targeted the cells even better. In in vivo -study, i.p.-administered liposomes distributed into tumor more efficiently compared to i.v.-administered liposomes. I.p. pre-targeting method was 1,24-fold more efficient compared to passive targeting, considering the % ID / g tissue. However, %ID/organ in pre-targeting method was 5,9 % whereas passive targeting reached the value of 5,4 %. Conclusively, the difference between pre-targeting and passive targeting was modest. InVivoScope and gamma counter quantification results didn't correlate. Further investigation is needed and protocol optimization required in targetin liposomes into tumors.
  • Heininen, Susanna (2022)
    The medication-use process in hospitals includes several risks which can lead to medication errors. Medication errors can be prevented and managed by adding automation and technology solutions to the medication-use process, such as clinical decision support system (CDSS) integrated into electronic medication administration record (eMAR), unit dose drug distribution system (UDDDS), automated dispensing cabinet (ADC) and bar-code medication administration (BCMA). A closed loop medication management process can be created by integrating different methods and technologies seamlessly. It improves medication safety by decreasing human errors and allows the access to the patient’s medication information in real time. The closed loop medication management process is not yet fully in use in any Finnish hospital, but parts of it have already been implemented. Helsinki University Hospital (HUS) wants to improve the closed loop medication management process by piloting the use of unit dose (UD) bags in the medication- use process and to study its effects on medication safety. The aim of the study was to determine the incidence of the medication dispensing errors and procedural errors, the working time of the nurses, and the nurses' opinions on the current drug dispensing model in a hospital ward before the introduction of the unit dose drug distribution system. The study was conducted as a mixed-method study, which utilized an observational method and an online survey. The data were collected at HUS internal medicine inpatient ward by observing the dispensing of morning medicines for ten days and through an electronic survey sent to the ward’s nurses. The overall incidence of dispensing errors in the current drug dispensing process was 40,1 % (553/1379). Of these, 3,2 % (44/1379) were medication dispensing errors, and after the excluding prescribing errors (n=22), the incidence was 1,6 %. These prescription errors were mainly related to prescribing medications outside the hospital's formulary. In addition, the incidence of procedural errors was 37 % (509/1379). Of the procedural errors, 57 % (292/509) were related to the unattached or missing barcodes and 37 % (186/509) to hygiene deficiencies in drug dispensing. On average, nurses spent 4,5 minutes per patient on medication dispensing and patients had 7 morning medications. The results of the survey also revealed problems related to barcodes as well as hygiene deficiencies, which supported the results of the observations. Significant safety risks, such as unattached barcodes, missing barcodes, and deficiencies in hygiene were identified in the current drug dispensing process. The study indicates that system-based risk management approach is not yet fully understood in hospital units. The root cause of procedural errors should be investigated more and review the ward's instructions with staff, to reduce their incidence in the future. At the end of 2021 a unit dose drug distribution model will be piloted in the ward, which may be one possible way to reduce errors related barcodes and hygiene. In addition, to improve the medication safety, physicians should order medications from hospital's formulary, so that generic substitution would no longer need to be made at the distribution stage. It would be useful to include a category of incorrect orders in the future research setups that investigate medication errors in the dispensing phase to identify such potential risk situations.
  • Larkiala, Jonna (2018)
    Obesity is a health problem linked to Western lifestyle and it is becoming more general. The complexity of regulation of eating makes it difficult to regulate body weight, when multiple neural networks and regions of brain have overlapping functions regarding to energy gain. Sufficient amount of energy is vital for individuals surviving in their living environment. Cholinergic messaging in brain is wide and for example nicotine is known for its appetite reducing effect. Anorexigenic proopiomelanocortin neurons mediate the effect of nicotine. In nucleus accumbens and central nucleus of amygdala extracellular levels of acetylcholine rise during meal, which promotes satiety. Satiety inhibits eating behavior between meals. Amygdala is a part of limbic system and in earlier knowledge it was associated only to regulation of memory, conditioning and fear. Nowadays importance of amygdala in eating behavior research is rising, but most of the studies focus on the effect of cue in regulation of eating. Cholinergic messaging is vigorous in the amygdala and is received from opposite areas of brain between basolateral and central amygdala and therefore this master’s thesis examined the effect of cholinergic messaging in amygdala on regulation of eating behavior. C57BL/6JRcc male mice were stereotaxically implanted with guide cannulas either in the basolateral complex of amygdala (n=10) or central nucleus (n=13). After recovering and habituation to automated pellet dispenser mice were treated with nicotinic and muscarinic receptor agonists and antagonists and eating behavior was recorded for six hours. Nicotine, administered to central and basolateral part of amygdala, lowered the number of pellets mice ate. In central nucleus effect was dose dependent. Mecamylamine had time related effect on eating behavior in basolateral amygdala, but dose dependent response was seen only in cumulative results. Oxotremorine was the only compound which created statistically significant interaction between time and dose. Result was seen in both groups. Scopolamine reduced eating behavior in central nucleus and dose dependency was seen. In basolateral complex scopolamine had time related effect, similar to mecamylamine. The results suggest that amygdala regulates eating behavior even without cue.
  • Volotinen, Katariina (2012)
    Kolinergiset α6*-nikotiinireseptorit ovat kiinnostavia, koska ne liittyvät mahdollisesti Parkinsonin tautiin ja nikotiiniriippuvuuteen. Ionikanavina toimivat nikotiinireseptorit ovat muodostuneet viidestä alayksiköstä, jotka esiintyvät erilaisina yhdistelminä. α6-alayksikköä sisältävät nikotiinireseptorit sijaitsevat presynaptisesti ja säätelevät dopamiinin vapautumista dopaminergisessä hermopäätteessä. α6*-nikotiinireseptorit ovat keskittyneet vain tietyille aivoalueille ja niitä esiintyy runsaasti dopaminergisissä hermosoluissa. α6*-nikotiinireseptoreita on erityisesti mesolimbisen ja nigrostriataalisen hermoradan dopaminergisissä hermosoluissa. Lisäksi niitä on paljon näkemiseen liittyvillä aivoalueilla. Nikotiini toimii asetyylikoliinin tavoin aktivoimalla α6*-nikotiinireseptoreita, mikä johtaa dopamiinin vapautumiseen hermopäätteessä. α6*-nikotiinireseptoreiden sijainnin, määrän ja toiminnan tutkimisessa on käytetty apuna muun muassa niille selektiivisiä antagonisteja, saalistavista merietanoista peräisin olevia α-konotoksiineja, erityisesti α-konotoksiini MII:ta. Nigrostriataalisella hermoradalla, joka ulottuu substantia nigrasta striatumiin, α6*-nikotiinireseptorit voivat vaikuttaa liikkeen säätelyyn. Nikotiini vapauttaa dopamiinia nigrostriataalisen hermoradan päätepisteessä, striatumissa, mikä voi lisätä liikeaktiivisuutta. Nikotiinilla on havaittu olevan hyödyllisiä vaikutuksia Parkinsonin taudin eläinmalleissa, mutta Parkinsonin tautipotilailla nikotiinihoidosta saadut tutkimustulokset ovat ristiriitaisia ja puutteellisia. α6*-nikotiinireseptoreille voitaisiin kehittää selektiivisiä agonisteja, joiden avulla lääkehoito voitaisiin kohdentaa paremmin ja vältyttäisiin mahdollisilta haittavaikutuksilta. Tupakanvieroitukseen tarvittaisiin lisää uusia selektiivisiä lääkehoitoja, joilla olisi hyvä hoitomyöntyvyys ja mahdollisimman vähän haittavaikutuksia. Mesolimbinen hermorata, joka ulottuu ventraaliselta tegmentaalialueelta nucleus accumbensiin, liittyy riippuvuuden syntyyn. Nikotiinin vaikutukset välittyvät VTA:n kautta nucleus accumbensiin, jossa vapautuu dopamiinia. Osa nikotiinin vaikutuksista välittyy myös presynaptisten α6*-nikotiinireseptorien kautta. Selektiivisistä α6*-nikotiinireseptoreiden antagonisteista voisi olla hyötyä nikotiiniriippuvuuden hoidossa, sillä niiden vaikutus vastaisi osittaisagonistin vaikutusta. α-konotoksiini PIA:n vaikutuksia nikotiinin aiheuttamaan dopamiinin vapautumiseen tutkittiin in vivo mikrodialyysimenetelmällä. α-konotoksiini PIA saalistavasta merietanasta eristetty selektiivinen α6*-nikotiinireseptoreiden antagonisti. Tutkimuksessa käytettiin vapaana liikkuvia urospuoleisia Wistar-rottia. Tutkimuksen kohteena olevat aivoalueet olivat striatum ja nucleus accumbens. Rotille asennettiin anestesiassa ohjauskanyyli joko striatumiin tai nucleus accum-bensiin stereotaktisen laitteen avulla. Mikrodialyysikokeessa koetinten tasapainotuksen jälkeen kerättiin perustason näytteet ja pistettiin saliini tai nomifensiini tai vaihdettiin Ringer-ruiskun tilalle α-konotoksiini PIA-ruisku. Puolen tunnin päästä pistettiin saliini tai nikotiini ja vaihdettiin Ringer-ruisku takaisin. Näytteitä kerättiin 15 minuutin välein yhteensä 5,5 tuntia. Lopuksi aivot otettiin talteen ja niistä tehtyjen aivoleikkeiden avulla tarkastettiin koetinten paikat. Mikrodialyysinäytteistä määritettiin HPLC-menetelmällä dopamiinin ja sen metaboliittien DO-PAC:n ja homovaniliinihapon sekä koejärjestelyssä oletettavasti muuttumattomana pysyvän 5-HIAA:n pitoisuudet. Koejärjestelyssä päätettiin käyttää tutkittavien aivoalueiden dopamiinipitoisuuden nostamiseen nomifensiinia, joka estää dopamiinin takaisinottoa hermopäätteissä. Käsittelyryhminä olivat saliini-saliini (n=striatum ja nucleus accumbens, 8+7), saliini-nomifensiini (n=8+4), saliini-nikotiini (n=3+4), nomifensiini-nikotiini (n=10+13) ja nomifensiini-nikotiini-α-konotoksiini PIA (n=8+5). Rottia jouduttiin hylkäämään eri syistä joko ennen mikrodialyysia, mikrodialyysin aikana tai sen jälkeen. Rottia hylättiin yhteensä 70 kpl. Tilastollisessa analyysissä tutkittujen käsittelyiden tai aivoalueiden välille ei saatu merkitseviä eroja, koska eläinten välinen hajonta oli liian suurta. Silmämääräisesti nomifensiini-nikotiinikäsittely nosti striatumin ja nucleus accumbensin dopamiinipitoisuuksia. α-konotoksiini PIA näytti estävän dopamiinin vapautumista striatumissa ja nucleus accumbensissa, mutta erot nomifensiini-nikotiinikäsittelyyn eivät olleet tilastollisesti merkitseviä. AUC-arvolla mitattuna α-konotoksiini PIA esti dopamiinin vapautumista striatumissa 39,6 % ja nucleus accumbensissa 31,3 %. Aivoalueiden välillä ei ollut tilastollisesti merkitseviä eroja.
  • Savelainen, Timo (2013)
    Some problems in dry powder inhaler formulation include low dose efficiency and changes in dispersibility during storage. For lung deposition particles should have aerodynamic size of 1 - 5µm. Poor dispersion of drug particles from carriers' surface is thought to be the main reason for low dose efficacy. A tertiary component of small particles has been generally added to formulation to improve fine particle dose. Small particles are usually manufactured by micronization. This may induce crystal defects and amorphous sites on the surface of crystals. Amorphous sites are metastable and they may crystallize during storing. Changes in particles crystallinity may have an action on efficiency and stability of dry powder inhalers. Conditioning is designated as stabilisation of particles surface by mixture of solvent vapour and inert gas. Vapour may also dissolve surface roughness. This is called deliquescence. Ostwald ripening is phenomenon whereby small particles dissolves and recrystallizes onto larger crystals. This can be extended for surface asperities. Amorphous materials have also better solubility than crystalline materials so amorphous sites may also dissolve and recrystallize onto crystalline surface. Amorphous sites may crystallize spontaneously by absorbing plasticizing agents from vapour phase or by influence of temperature. The purpose of this work was to study process variables in conditioning and their effect on modification of surface roughness and stabilization of micronized α-lactose monohydrate and test drug substance. The purpose was also to study how surface modification and stabilization effects on powders flowability and stability of dry powder inhaler. The dry powder inhaler contained two different vicinity of lactose and two different drug substances. Conditioning was based on evaporation of liquid from open surface. Studied process variables were temperature of powder, temperature of bath of liquid phase and flow rate of nitrogen gas. The aim of this study was to form a process design for conditioning of new substances, to improve powders flowability and to remove changes in fine particle dose during storage. Surface roughness was studied by laser diffraction analysis and specific surface area measurements and also by electron microscopy. Specific surface area was measured by nitrogen adsorption method. Stabilization of amorphous sites ware studied by dynamic vapour sorption. Flowability was measured by angle of repose and with FlowPro device. Fine particle dose was measured with next generator impactor device. The study showed that increasing the amount of solvent in vapour increases surface smoothness and stabilization. Also increase of temperature of sample increased stabilization. Influence of temperature on surface smoothness was not as clear. Changes in temperature may have altered adsorption and kinetic of crystallization of dissolved molecules. Flowability of lactose was significantly improved. Condition did not improve dry powder inhalers fine particle dose, but there was significant difference between different process conditions. This was concluded to be caused of surface modification. It was also shown that different process conditions affected on formulations stability.
  • Hannula, Sara (2011)
    Pharmaceutical services refer to services in community pharmacies which are based on knowledge and skills of the pharmaceutical personnel. Pharmaceutical services can be divided into basic and special services. Pharmaceutical basic services relate to community pharmacy's legislative functions, while pharmaceutical special services try more proactively contribute to consumers' health.. Automated dose dispensing is pharmaceutical special service. Dose dispensing means that the patient's medication are packed in disposable bags corresponding to the dose that he or she needs to take during the course of one day. When a new patient starts to use the automated dose dispensing service, his medication is reviewed to assure there would not be severe interactions or unnecessary drugs The drugs suitability to the service and the timing of the medication is noted when the service is started. Automated dose dispensing service produces a medication list of customer's medication. The survey studied the level of the checks made to patient's medication and how can the medication history be explaned. In the survey were also interested in the level of review that was done to patient's medication. Information of patient's medication was also collected with a questionnaire. Background information showed how well the results of the survey can be generalized to pharmacies offering services and customers using the service. The questionnaire was sent to all pharmacies that ordered automated dose dispensing as contract manufacturing from Espoonlahti Pharmacy in September 2010. In the semi structured questionnaire was multiple choice and open-ended questions. Response rate in this study was 45. Background information showed that questionnaires were returned from pharmacies all around the Finland and all sizes of pharmacies. Mostly the patients starting the automated dose dispensing service are aged, homecare patients, nursing home residents or service home residents. Medication cards are used in collecting the information of patient's medication, but information to the medication card can be updated from other sources too. Medication review to patient's medication is made usually in multi-professional cooperation. Changes made to patient's medication are mainly caused by generic substitutions, selection of the dispensing machine or avoidance to halving. Medications have only few interactions that lead into discontinuing use of some medicine. Checking the medication has only little effect on the amount of drugs used by the patient. New patients starting the automated dose dispensing service have on the average 11 medicines in use, from which 7 medicines are taken to automated dose dispensing. The most widely used ATC groups are cardiovascular and nervous system medicines. Each new patient uses an average of three preparations in both groups before and after the initiation of automated dose dispensing service.
  • Rojalin, Tatu (2015)
    Raman spectroscopy is based on vibrations that occur between the atoms of a compound. The overall structural energy is derived from the electronical energy as well as vibrational, rotational and translational energy. In Raman spectroscopy the vibrational and rotational energies are essential. Usually the excitation energy used in Raman spectroscopy can be either in the region of visible light or NIR. The sample absorbs the energy and energy is also scattered back to all possible directions. Elastic scattering is called the Rayleigh scattering. In that case the back-scattered photons have an equal energy as the original excitation energy. However, some of the scattering happens inelastically and it forms the basis of Raman-phenomena. If the detected photons have smaller energy than the original, it is called the Stokes scattering. If the energy is bigger, it is anti-Stokes scattering. Raman is typically very rare and weak phenomenon. The spectral features in Raman spectra consist of the intensities and energies of the back scattered photons. Raman spectroscopy provides very accurate and detailed structural information on the molecule. It is basically a label-free technique with minimal need for sample preparation and the measurements can also be carried out e.g. through container walls. Further, Raman is quite insensitive to hydrous samples and it is suitable to solutions and biological assessments. However, there are some drawbacks that are formed by the luminescence phenomena i.e. fluorescence. Strong fluorescent backgrounds can mask the relevant Raman features in spectra because Raman and fluorescence are competetive processes. For instance many drug molecules have such structures that they cause strong fluorescence. It is also one of the reasons that pharmaceutical applications and measurements have been partly limited due to this problem. There are applications to improve and enhance a Raman signal. For example resonance phenomena and SERS are favored. To solve the fluorescence-related problems there are also means; one can change the laser wavelenght, photobleach the sample or apply different kinds of data manipulation techniques to the spectral data achieved. There are drawbacks with these methods. They can be slow, complex, damage the samples and still insufficient fluorescence suppression is a problem. In this study a novel time-gated CMOS-SPAD detection technique is applied to non-fluorescent and fluorescent drug measurements. The new detection system has a programmable on-chip delay time and it is synchronized with a picosecond pulsed laser. The scattered photons can be measured in the time scale when they are simultaneously measured in traditional energy and intensity wise. Raman scattering occurs in the timescale of sub-picoseconds while the fluorescence phenomena happen typically in the order of nanoseconds. This time difference can be exploited effectively to suppress the fluorescence. In the literature review of this study the basis of vibrational spectroscopy is introduced - especially Raman spectroscopy. The techniques related, as well as the novel time-resolved technique are covered. Further, different kinds of applications in the field of Raman spectroscopy are reviewed, mainly pharmaceutics-related and biologically relevant applications. In the experimental work the focus was to compare a continuous-wave 785 nm laser setup coupled with the CCD-detector to the pulsed picosecond 523 nm laser coupled with the CMOS-SPAD-detector. The measurements were performed on different kinds of drugs, both non-fluorescent and fluorescent. The aim was to obtain information on the effectiveness of CMOS-SPAD-technique on fluorescence suppression for solid drugs and solutions. Secondary goals were to collect knowledge on the similarities and differences between the Raman setups used for solution measurements, to optimize and discuss the key elements of setups for solids and solutions and to show preliminarily the applicability of the CMOS-SPAD-system on fluorescent drug's solutions as well as find out the requirements related to quantitative assessments using Raman spectroscopy. In drug research there is also constant need for reliable in vitro cell assays. The assessments made in this study may prove useful to the future applications e.g. measurements with living cells. An effective fluorescence suppression was achieved to strong fluorescent backgrounds using the novel time-resolved CMOS-SPAD-detection system coupled with the pulsed picosecond 532 nm laser. The setup is potentially a convenient tool to overcome many fluorescence-related limitations of Raman spectroscopy for laboratory and process analytical technology (PAT) use in the pharmaceutical setting. The results achieved encourage to consider that with careful calibration and method validation there is potential for quantitative analysis, biopharmaceutical and biological applications e.g. in vitro cell studies where most Raman techniques suffer from strong fluorescence backgrounds. Other potential fields for future applications can be also considered.
  • Niemi, Matias (2021)
    Yhteiskunnan digitalisaatio on lisännyt verkkopalveluiden käyttöä monilla aloilla, ja suurin osa suomalaisista käyttää internetiä esimerkiksi palveluiden tai tuotteiden hankintaan. Erilaisten digitaalisten terveyspalveluiden käyttö on kasvanut viime vuosina, ja koronapandemia on nopeuttanut muutosta. Suomessa useat apteekit ovat perustaneet viime vuosina verkkopalveluita, mutta niiden käyttö on ollut edelleen vähäistä. Tämän tutkimuksen tavoitteena oli tutkia koronapandemian vaikutuksia Yliopiston Apteekin (YA) verkkopalvelun käyttöön. Tutkimuksessa tutkittiin rekisteriaineistojen perusteella kokonais- ja reseptiasiakasmäärän sekä reseptimäärän ja asiakasprofiilin muutosta ennen koronapandemiaa ja sen aikana vuosina 2018-2020. Lisäksi tutkittiin YA:n Lääkeneuvonta- ja asiakaspalveluyksikön (Tiepa) vastaanottamien puhelin- ja chat-yhteydenottojen määrää ja sisältöä sekä kyselyaineiston perusteella apteekin verkkopalvelun käyttäjien näkemyksiä koronapandemian vaikutuksista heidän apteekin verkkopalvelun käyttöön. Monimenetelmätutkimuksessa tutkittiin apteekin verkkopalvelussa tapahtunutta muutosta apteekin asiakas- ja myyntitietojen sekä asiakaskyselyn avulla. Tutkimuksessa hyödynnettiin YA:n myynti-, asiakas-, Tiepa- ja pikanoutorekisteriaineistoja sekä YA:n toteuttaman ’’Verkkoapteekki 2020’’ -kyselytutkimuksen aineistoa. Aineistot analysoitiin kvantitatiivisesti Microsoft Excel (16.0) ja IBM SPSS (26) ja R (4.0.3) tilasto-ohjelmistoilla. Myyntiä tai asiakasmääriä mittaavia aineistoja analysoitiin indeksin pisteluvuilla. Kokonais- ja reseptiasiakasmäärälle sekä reseptiasiakkaille keskimäärin toimitettujen reseptien lukumäärälle laskettiin myös tilastollinen merkitsevyys lineaarisella regressioanalyysillä 95 % luottamusvälein. Kyselytutkimuksen lopputulosmuuttujista tehtiin kuvaileva tilastoanalyysi frekvenssijakaumien ja prosenttiosuuksien avulla. YA:n verkkopalvelun käyttö lisääntyi merkittävästi tarkastelujaksolla 2018 – 2020. Kokonais- ja reseptiasiakasmäärän muutokset koronapandemian aikana olivat tilastollisesti merkitseviä. Pandemian vaikutus verkkopalvelussa vastasi pandemiaa edeltävän lineaarisen kehityksen perusteella kokonaisasiakasmäärässä 6 kuukauden ja reseptiasiakasmäärässä yli 3 vuoden kehitystä. Apteekin verkkopalvelun käyttö ja tiettyjen koronasairauden hoitoon median mukaan soveltuvien valmisteiden myynnit lisääntyivät merkittävästi kevään 2020 aikana. Tiepan chat-palvelua käytettiin paljon terveyteen ja hyvinvointiin liittyvien kysymysten selvittämiseen. Koronapandemia lisäsi erityisesti iäkkäämpien asiakkaiden (yli 55- ja erityisesti yli 65-vuotiaiden) apteekin verkkopalvelun käyttöä. Infektioriskin vähentäminen oli tärkeä syy apteekin verkkopalvelun käyttöön. Vuoden 2020 aikana apteekin verkkopalvelussa tapahtui digiloikka. Koronapandemia lisäsi merkittävästi ja tilastollisesti merkitsevästi apteekin verkkopalvelun käyttöä ja toi sen uusiksi käyttäjiksi myös iäkkäämpiä asiakkaita. Erityisesti reseptilääkkeiden hankinta apteekin verkkopalvelusta lisääntyi. Tiepa oli tärkeä tietolähde ennen koronapandemiaa ja sen aikana. Pandemia-aikana luotettavan lääkeinformaation tarve korostuu. Jatkotutkimuksissa on tärkeä tutkia apteekin verkkopalvelun käytön ja asiakasryhmien muutoksia sekä asiakkaiden kokemuksia verkkopalvelusta osana YA:n monikanavaista apteekkipalvelua.
  • Kannela, Niina (2013)
    Cortisol is a vital hormone for normal bodily functions. Both physical and mental stress, as well as many diseases like the Cushing syndrome are known to increase the human cortisol levels. These levels can be measured in many biological matrixes, such as saliva. Traditionally, these measurements have been done by using immunoassays or liquid chromatographic-mass spectrometric methods (LC-MS). However, in the last few years, ambient ionization techniques, which are quick and easy to use, have also proven suitable for quantitative analysis of compounds in biological matrixes. Thus, these techniques could offer an alternative to traditional methods in the analysis of cortisol from human saliva. The aim of this study was to investigate the suitability of desorption atmospheric pressure photoionization (DAPPI) for quantitative analysis of steroids in saliva. The investigated steroids were dehydroepiandrosterone (DHEA), cortisol and testosterone. Because of the low quantities of testosterone and DHEA in saliva, the study was mainly focused on cortisol analysis. In this study, the ionization mechanism for the steroids was observed to be proton transfer with every tested spray solvent (acetone, chlorobentzene and toluene). Even though the choice of spray solvent did not change the ionization mechanism, it affected the efficiency of ionization. In cortisol measurements acetone was observed to be the best solvent. The temperature of the microchip, as well as the UV-lamp used (dc- or rf-lamp), only affected the ionization slightly. In this study, measuring cortisol in non-pretreated saliva was not successful. However, solid phase extraction (SPE) method for the pretreatment of saliva was optimized with high recovery for cortisol (106 %). The detection limit for cortisol (50 nM) in water samples and the linear area of cortisol in both water and pretreated saliva samples (500 nM - 10 µM) were also determined. Poor repeatability of DAPPI-system was the main challenge in these measurements. The DAPPI-MS-method developed in this study is suitable for analyzing cortisol in pretreated saliva samples. However, without further development it is not sensitive enough to be used in quantitative analysis of cortisol in salivary levels.
  • Jyrkkä, Anu (2017)
    The number of home-dwelling aged is increasing in Finland. Rational medication use is one of the factors, which ensures the good functional abilities needed for independent or assisted living at home. No timely research on the medication use of the home-dwelling aged in Finland is published. Research on their medication use makes it possible to identify the drug related problems. Identifying drug related problems and rationalizing or deprescribing medications belong to risk management which aims at avoiding adverse drug events that might impair functional abilities. The aim of this Master's Thesis was to describe the medications used by the home services assisted home-dwelling aged, to study the prevalence of potentially inappropriate medication use (PIM) and clinically significant (SFINX Class D) drug-drug interactions and to study anticholinergic and serotonergic loads of medications used. Additionally, correlation between the use of PIMs according to Beers criteria and functional abilities measured by RAVA™ was studied. This study was conducted as a part of a larger interventional and randomized study in Town of Lohja, 'Development of a Coordinated, Community-Based Medication Management Model for Home-Dwelling Aged in Primary Care'. The cross-sectional baseline data was collected in autumn 2015. The study cohort (n=188) consisted of home-dwelling aged who were assisted by home services aged 65 or older and living in Lohja. They were randomized into intervention (n=101) and control groups (n=87). Majority of them were women (69%) and their mean age was 83 years. The mean number of medications used was 13. Data on prescription drugs (both regular and irregular) was collected from their medication lists. Most severe, class D drug interactions were checked out from reports of SFINX database. Potentially inappropriate medication (Beers 2015), anticholinergic load and serotonergic load were checked out from reports of Salko database. Medications were analyzed in both groups separately. RAVA evaluation was conducted by home care nurses and practical nurses. Pearson's correlation coefficient was calculated to analyse the associations between the amount of potentially inappropriate medication and functional ability in addition on crosstabs. The most commonly used drug classes were central nervous system medications (n=184, 98 %) and cardiovascular medications (n=176, 94 %). The most common drug was paracetamol (n=155, 82 %). Benzodiazepines and related drugs was used by 43 % (n=80) and antipsychotics 17 % (n=32) participants. At least one anticholinergic medication (two or three points) according to Salko database was used by 27 % participants; 13 % had concomitantly more than one serotonergic drugs. Prevalence of the clinical significant drug-drug interaction was 8 %. Almost four out of five had potentially inappropriate medications according to the Beers 2015 criteria of which the most common drug was pantoprazol (n=60, 21 %). The number of the PIMs used by the study participants did not correlate between the functional ability measured by RAVA class (Pearson correlation coefficient 0.024). Aged among home care services are highly medicated and the potentially inpropriate medication use is common. Coordinated models and interprofessional medication reviews are needed to ensure rational and safe medication therapy of the aged. However, correlation between functional ability measured by RAVA class and Beers medicines use was not shown.
  • Suominen, Riina (2022)
    COVID-19 pandemic has caused a global crisis and its effects have also been reflected to pharmaceutical supply in Finland. At the beginning of the crisis the effects were especially evident in the consumption of self-medication analgesics, prescription drugs and drugs related to respiratory diseases. In a global crisis, collaboration between the public, private and third sector is becoming increasingly important, and it is important to consider how to develop the capacity for collaboration between organizations in different sectors during a pandemic. The purpose of this study was to find out how the cross-sector collaboration between the public, private and third sector of the pharmaceutical supply in Finland was organized in the crisis caused by the COVID-19 pandemic, what was the role of the cross-sector collaboration and how the preparedness and crisis management of the drug supply could be improved. The study was conducted as a semi-structured interview survey and the interviewees were selected to cover the various sectors of Finnish pharmaceutical care as well as possible. The analysis was performed by the Gioia method and thematic design. Based on the study the organization of cross-sector collaboration was both operator- and authority-oriented and the legislation and environment in the drug supply created the framework for the crisis management. Both the authorities and the advocacy organizations can be described as having acted as hubs for organization. There was no clear crisis organization in drug supply, but different actors were involved in the crisis management at different stages of the crisis. The role of collaboration was emphasized in the sharing of information and resources and in joint solution of problems. The collaboration enabled foresight and preparedness, a focus on core tasks and crisis management, and mutual benefit. Lessons learned from the COVID-19 pandemic include the need to increase and intensify collaboration, increase crisis plans and crisis training, update the system of security of supply and mandatory reserve supplies, increase self-sufficiency, and increase overall governance. Cross-sectoral collaboration was seen as useful in crisis management of the crisis in the drug supply chain. The collaboration promotes the formation of a common picture of the situation and the flow of information from the field to decision-makers. Comparing the results of this study with the literature it can be said that the results partially support the previous literature. However, crisis management of the pharmaceutical supply chain from the organization of cross-sectoral collaboration point of view has not been studied in the past.