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- Frisk, Pia, 1968-
(författare)
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Surveys and services : The feasibility of conducting research in Swedish community pharmacies
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- For the past decades, there has been a shift in community pharmacy practice from dispensing and compounding towards provision of pharmacy services. Research is important to generate evidence for new services within pharmacy practice. Pharmacy practice research can be divided in two main themes: research related to pharmacy as a data source and to the pharmacy as the object of research, respectively.The purpose of this thesis is to increase the understanding of the conditions required for successful involvement of Swedish community pharmacy staff in pharmacy-based research, and to evaluate the data generated through a certain type of research: pharmacy-based patient surveys on drug utilization.Specific aims were to evaluate if there is a selection bias in drug utilization surveys conducted in Swedish community pharmacies, to explore the experiences of pharmacists either conducting the surveys or recruiting patients to research on adherence-promoting services, and to describe barriers and facilitators to conducting research in community pharmacies.Data were collected via pharmacy-based patient surveys, dispensing data, individual interviews, a cross-sectional staff survey and focus group interviews.In community pharmacy-based surveys or services research, with the dispensed drug as the trigger for inclusion, patients aged 75 years or older are underrepresented since they less often visit the pharmacy to redeem their prescriptions themselves. Due to their perceived workload, dispensing pharmacists sometimes avoid including patients perceived as complex due to age, polypharmacy or communication difficulties. These processes contribute to a healthy selection effect in both types of research and pharmacy services not reaching the patients in most need of support with their medication.The pharmacists were generally positive to conducting surveys and being involved in services research, but reported a perceived lack of sufficient communication and research skills, and a lack of time.Since competing commercial priorities hamper pharmacists’ research involvement, separate research funding is an important facilitator. For surveys to include all eligible patients, services to be relevant for both practice and patients and to target the patients in most need of support with their medication, research collaboration with healthcare, other professions and across pharmacies is also necessary.
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- Andrén, Elinor, et al.
(författare)
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Holocene climate and environmental change in north-eastern Kamchatka (Russian Far East), inferred from a multi-proxy study of lake sediments
- 2015
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Ingår i: Global and Planetary Change. - : Elsevier BV. - 0921-8181 .- 1872-6364. ; 134, s. 41-54
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Tidskriftsartikel (refereegranskat)abstract
- A sediment record from a small lake in the north-eastern part of the Kamchatka Peninsula has been investigated in a multi-proxy study to gain knowledge of Holocene climatic and environmental change. Pollen, diatoms, chironomids and selected geochemical parameters were analysed and the sediment record was dated with radiocarbon. The study shows Holocene changes in the terrestrial vegetation as well as responses of the lake ecosystem to catchment maturity and multiple stressors, such as climate change and volcanic eruptions. Climate change is the major driving force resulting in the recorded environmental changes in the lake, although recurrent tephra deposition events also contributed. The sediment record has an age at the base of about 10,000 cal yrs BP, and during the first 400 years the climate was cold and the lake exhibited extensive ice-cover during winter and relatively low primary production. Soils in the catchment were poor with shrub alder and birches dominatingthe vegetation surrounding the lake. At about 9600–8900 cal yrs BP the climate was cold and moist, and strong seasonal wind stress resulted in reduced ice-cover and increased primary production. After ca. 8900 cal yrs BP the forest density increased around the lake, runoff decreased in a generally drier climate resulting in decreasedprimary production in the lake until ca. 7000 cal yrs BP. This generally dry climate was interrupted by a brief climatic perturbation, possibly attributed to the 8.2 ka event, indicating increasingly windy conditions with thick snow cover, reduced ice-cover and slightly elevated primary production in the lake. The diatom record shows maximum thermal stratification at ca. 6300–5800 cal yrs BP and indicates together with the geochemical proxies a dry and slightly warmer climate resulting in a high productive lake. The most remarkably change in the catchment vegetation occurred at ca. 4200 cal yrs BP in the form of a conspicuous increase in Siberian dwarf pine (Pinus pumila), indicating a shift to a cooler climate with a thicker and more long-lasting snow cover. Thisvegetational change was accompanied by marked shifts in the diatom and chironomid stratigraphies, which are also indicative of colder climate and more extensive ice-cover.
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| 5. |
- Berglund, B. E., et al.
(författare)
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Holocene forest dynamics and climate changes in the Abisko area, northern Sweden : the Sonesson model of vegetation history reconsidered and confirmed
- 1996
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Ingår i: Ecological Bulletins. - 0346-6868. ; 1996:1, s. 15-30
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Tidskriftsartikel (refereegranskat)abstract
- A new palaeoecological and palaeoclimatic project in the subalpine Abisko area, N Scandes, founded upon the pollen zone system defined by Sonesson is described. This model of vegetation history has been confirmed, although the chronology is partly revised. Sonesson's pollen diagrams are combined with new results from a lake sediment sequence at the tree-limit, which include sedimentologic, mineral magnetic, oxygen isotope and plant macrofossil studies. Since the deglaciation at c9000-8500 14C yr BP the vegetation of the Abisko area has generally been dominated by a subalpine birch Betula woodland tundra. The cliamte has generally been subarctic-oceanic since the deglaciation except for the period c.5500-3500 BP when temperate-continental conditions prevailed. This climatic development differs from the situation in the central Scandes.
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| 6. |
- Bjorck, S, et al.
(författare)
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Synchronized terrestrial-atmospheric deglacial records around the North Atlantic
- 1996
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Ingår i: SCIENCE. - : AMER ASSOC ADVANCEMENT SCIENCE. - 0036-8075. ; 274:5290, s. 1155-1160
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- On the basis of synchronization of three carbon-14 (C-14)-dated lacustrine sequences from Sweden With tree ring and ice core records, the absolute age of the Younger Dryas-Preboreal climatic shift was determined to be 11,450 to 11,390 +/- 80 years before
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| 7. |
- Boström, Emma, 1975-
(författare)
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Pharmacokinetics and Pharmacodynamics of Oxycodone and Morphine with Emphasis on Blood-Brain Barrier Transport
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The pharmacokinetics and pharmacodynamics of oxycodone and morphine was investigated and related to the transport across the blood-brain barrier (BBB) in rats. The influence of a P-glycoprotein (P-gp) inhibitor on the plasma pharmacokinetics and pharmacodynamics of oxycodone was evaluated. Microdialysis experiments were conducted to evaluate the unbound pharmacokinetics, including the rate and extent of transport across the BBB, of oxycodone and morphine. Mathematical models were used to assess the pharmacokinetics and also the relationship between pharmacokinetics and pharmacodynamics of the drugs.Oxycodone clearance, volume of distribution at steady-state, half-life, total brain tissue concentrations and tail-flick latency were all unaffected when a P-gp inhibitor was co-administered with oxycodone as compared to a control group. The lack of differences between the groups indicates that oxycodone BBB transport is not affected by P-gp inhibition. Investigating the unbound concentrations of oxycodone in brain and blood using microdialysis revealed an exciting finding. At steady-state, the unbound concentration in brain was 3 times higher than in blood (i.e. a Kp,uu of 3), indicating that active influx is involved in the BBB transport of oxycodone. In contrast, the Kp,uu of morphine was estimated to 0.56, which is an indication that active efflux mechanisms are involved in the BBB transport of morphine. This means that based on the same unbound concentration in blood, an approximately 6-fold higher unbound concentration of oxycodone compared to morphine will be reached in the brain. Using pharmacokinetic-pharmacodynamic modelling, the unbound brain concentrations of oxycodone and morphine were correlated to the tail-flick latency in vivo. The relative potency of the drugs was found to be concentration dependent with an infliction point of 55 nM.In summary, this thesis emphasise the importance of taking the local brain pharmacokinetics into consideration when investigating the pharmacokinetics and the pharmacokinetic-pharmacodynamic relationships of centrally acting drugs.
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| 9. |
- Chaurasia, Chandra S., et al.
(författare)
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AAPS-FDA workshop white paper : microdialysis principles, application and regulatory perspectives
- 2007
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Ingår i: Pharmaceutical research. - : Springer Science and Business Media LLC. - 0724-8741 .- 1573-904X. ; 24:5, s. 1014-1025
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Tidskriftsartikel (refereegranskat)abstract
- Many decisions in drug development and medical practice are based on measuring blood concentrations of endogenous and exogenous molecules. Yet most biochemical and pharmacological events take place in the tissues. Also, most drugs with few notable exceptions exert their effects not within the bloodstream, but in defined target tissues into which drugs have to distribute from the central compartment. Assessing tissue drug chemistry has, thus, for long been viewed as a more rational way to provide clinically meaningful data rather than gaining information from blood samples. More specifically, it is often the extracellular (interstitial) tissue space that is most closely related to the site of action (biophase) of the drug. Currently microdialysis (microD) is the only tool available that explicitly provides data on the extracellular space. Although microD as a preclinical and clinical tool has been available for two decades, there is still uncertainty about the use of microD in drug research and development, both from a methodological and a regulatory point of view. In an attempt to reduce this uncertainty and to provide an overview of the principles and applications of microD in preclinical and clinical settings, an AAPS-FDA workshop took place in November 2005 in Nashville, TN, USA. Stakeholders from academia, industry and regulatory agencies presented their views on microD as a tool in drug research and development.
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| 10. |
- Chaurasia, Chandra S., et al.
(författare)
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AAPS-FDA Workshop White Paper : microdialysis principles, application, and regulatory perspectives
- 2007
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Ingår i: Journal of clinical pharmacology. - : Wiley. - 0091-2700 .- 1552-4604. ; 47:5, s. 589-603
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Tidskriftsartikel (refereegranskat)abstract
- Many decisions in drug development and medical practice are based on measuring blood concentrations of endogenous and exogenous molecules. Yet most biochemical and pharmacological events take place in the tissues. Also, most drugs with few notable exceptions exert their effects not within the bloodstream, but in defined target tissues into which drugs have to distribute from the central compartment. Assessing tissue drug chemistry has, thus, for long been viewed as a more rational way to provide clinically meaningful data rather than gaining information from blood samples. More specifically, it is often the extracellular (interstitial) tissue space that is most closely related to the site of action (biophase) of the drug. Currently microdialysis (μD) is the only tool available that explicitly provides data on the extracellular space. Although μD as a preclinical and clinical tool has been available for two decades, there is still uncertainty about the use of μD in drug research and development, both from a methodological and a regulatory point of view. In an attempt to reduce this uncertainty and to provide an overview of the principles and applications of μD in preclinical and clinical settings, an AAPS-FDA workshop took place in November 2005 in Nashville, TN, USA. Stakeholders from academia, industry and regulatory agencies presented their views on μD as a tool in drug research and development.
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