| 1. |
- Böttiger, Ylva, 1965-
(författare)
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Förskrivningsrätt bör kopplas till nationell läkemedelsexamen [The license to prescribe should be linked to a national examination]
- 2020
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Ingår i: Läkartidningen. - Stockholm, Sweden : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- The prescription of medicines is one of the most common acts performed by physicians. Yet, several studies have shown that junior doctors are not well prepared for the task. The teaching of basic and clinical pharmacology varies greatly between universities, both within Sweden and in Europe. National prescribing exams have been introduced in the UK, the Netherlands and Belgium, and there is an on-going project to develop a European exam, focusing on a list of essential medicines and patient safety. With the new six year curriculum for medical education in Sweden, the license to prescribe could be linked to a national prescribing exam, to ensure good knowledge of both therapeutics and Swedish drug regulation.
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| 2. |
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| 3. |
- Donker, Erik, et al.
(författare)
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European List of Essential Medicines for Medical Education : a protocol for a modified Delphi study
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Junior doctors are responsible for a substantial number of prescribing errors, and final-year medical students lack sufficient prescribing knowledge and skills just before they graduate. Various national and international projects have been initiated to reform the teaching of clinical pharmacology and therapeutics (CP&T) during undergraduate medical training. However, there is as yet no list of commonly prescribed and available medicines that European doctors should be able to independently prescribe safely and effectively without direct supervision. Such a list could form the basis for a European Prescribing Exam and would harmonise European CP&T education. Therefore, the aim of this study is to reach consensus on a list of widely prescribed medicines, available in most European countries, that European junior doctors should be able to independently prescribe safely and effectively without direct supervision: the European List of Essential Medicines for Medical Education. Methods and analysis This modified Delphi study will recruit European CP&T teachers (expert group). Two Delphi rounds will be carried out to enable a list to be drawn up of medicines that are available in >= 80% of European countries, which are considered standard prescribing practice, and which junior doctors should be able to prescribe safely and effectively without supervision. Ethics and dissemination The study has been approved by the Medical Ethics Review Committee of VU University Medical Center (no. 2020.335) and by the Ethical Review Board of the Netherlands Association for Medical Education (approved project no. NVMO-ERB 2020.4.8). The European List of Essential Medicines for Medical Education will be presented at national and international conferences and will be submitted to international peer-reviewed journals. It will also be used to develop and implement the European Prescribing Exam.
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| 4. |
- Donker, Erik M., et al.
(författare)
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The European List of Key Medicines for Medical Education: A Modified Delphi Study
- 2024
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Ingår i: Clinical Pharmacology and Therapeutics. - : WILEY. - 0009-9236 .- 1532-6535. ; 115:3, s. 515-524
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Tidskriftsartikel (refereegranskat)abstract
- Rational prescribing is essential for the quality of health care. However, many final-year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2-round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti-infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country-specific lists and could be used for the training and assessment of CPT.
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| 6. |
- Ginstman, Charlotte, 1975-, et al.
(författare)
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Pharmacokinetics of Oral Levonorgestrel in Women After Roux-en-Y Gastric Bypass Surgery and in BMI-Matched Controls
- 2020
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 30:6, s. 2217-2224
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Tidskriftsartikel (refereegranskat)abstract
- Background: Women are advised to primarily use non-oral contraceptive alternatives after Roux-en-Y gastric bypass since it is not known if the surgery affects the pharmacokinetics of oral contraceptives.Methods: This is a multi-center, open label, phase 2 pharmacokinetic study performed at the University Hospital of Linkoping and the Clinical Trials Center, Department of Obstetrics and Gynecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. Fifteen women aged 18-40 years who had previously undergone Roux-en-Y gastric bypass surgery and reached a BMI < 30 were included. Fifteen BMI-matched women with no previous history of Roux-en-Y gastric bypass surgery served as a control group. After administration of a single dose of a combined oral contraceptive containing 0.03 mg ethinylestradiol/0.15 mg levonorgestrel, serum levonorgestrel concentrations were determined during a 24-h period using ultra performance liquid chromatography/tandem mass spectrometry. The area under the plasma concentration time curve of levonorgestrel (AUC(0-24h)) was the main outcome measure.Results: There were no significant differences in the studied pharmacokinetic parameters, AUC(0-24h), total AUC, peak serum concentration (C-max), time to peak serum concentrations (T-max), apparent oral clearances of levonorgestrel (CLoral), or terminal half-lives (t1/2) between the groups.Conclusion: This is to our knowledge the first study to evaluate the pharmacokinetics of oral levonorgestrel in women with a BMI < 30 at least 1 year after RYGB compared with a BMI-matched group of women. We could not find any significant pharmacokinetic differences between the groups, suggesting that oral levonorgestrel may be used in non-obese women after Roux-en-Y gastric bypass once a stable body weight has been reached.
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| 7. |
- Hoffmann, Mikael, 1960-, et al.
(författare)
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Nationell process för värdering av off label-användning behövs
- 2020
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Ingår i: Läkartidningen. - Stockholm, Sweden : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- Läkemedelsverket rapporterar att man inte, utifrån sitt etablerade arbetssätt, kan genomföra nytta–riskvärdering av läkemedel utanför godkänd indikation. Sjukvården har ett behov av en nationell process för värdering av off label-användning av vissa läkemedel. Sjukvården behöver också fler och innovativa akademiskt drivna läkemedelsstudier.
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| 8. |
- Soderman, Lisa, et al.
(författare)
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Adjuvant use of melatonin for pain management in endometriosis-associated pelvic pain-A randomized double-blinded, placebo-controlled trial
- 2023
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 18:6
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Tidskriftsartikel (refereegranskat)abstract
- Considering the pharmacological treatment options for endometriosis-associated pain are confined to hormonal therapy and analgesics, we studied the analgesic effect of 20 mg melatonin as an adjuvant therapy in women with endometriosis-associated pain. This randomized double-blinded, placebo-controlled trial was conducted at the Research Center for Womens Health at Sodersjukhuset, a university hospital in Stockholm, Sweden. Forty women from 18 to 50 years of age with endometriosis and severe dysmenorrhea with or without chronic pelvic pain were given 20 mg Melatonin or placebo orally daily for two consecutive menstrual cycles or months. The level of pain was recorded daily on the 11-point numeric rating scale, a difference of 1.3 units was considered clinically significant. Clincaltrials.gov nr NCT03782740. Sixteen participants completed the study in the placebo group and 18 in the melatonin group. The difference in endometriosis-associated pain between the groups showed to be non-significant statistically as well as clinically, 2.9 (SD 1.9) in the melatonin group and 3.3 (SD 2.0) in the placebo group, p = 0.45. This randomized, double-blinded, placebo-controlled trial could not show that 20 mg of melatonin given orally at bedtime had better analgesic effect on endometriosis-associated pain compared with placebo. No adverse effects were observed.
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| 9. |
- Söderman, Lisa, et al.
(författare)
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Adjuvant use of melatonin for pain management in dysmenorrhea - a randomized double-blinded, placebo-controlled trial
- 2022
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Heidelberg. - 0031-6970 .- 1432-1041. ; 78:2, s. 191-196
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Dysmenorrhea is a common, recurring, painful condition with a global prevalence of 71%. The treatment regime for dysmenorrhea includes hormonal therapies and NSAID, both of which are associated with side effects. A dose of 10 mg melatonin daily has previously been shown to reduce the level of pelvic pain in women with endometriosis. We chose to investigate how this regime, administered during the week of menstruation, would affect women with dysmenorrhea but without any signs of endometriosis, as adjuvant analgesic treatment. Methods Forty participants with severe dysmenorrhea were randomized to either melatonin or placebo, 20 in each group. Our primary outcome was pain measured with numeric rating scale (NRS); a difference of at least 1.3 units between the groups was considered clinically significant. Secondary outcomes were use of analgesics, as well as absenteeism and amount of bleeding. Mixed model was used for statistical analysis. Results Eighteen participants completed the study in the placebo group and 19 in the melatonin group. Mean NRS in the placebo group was 2.45 and 3.18 in the melatonin group, which proved to be statistically, although not clinically significant. Conclusion This randomized, double-blinded, placebo-controlled trial could not show that 10 mg of melatonin given orally at bedtime during the menstrual week had better analgesic effect on dysmenorrhea as compared with placebo. However, no adverse effects were observed.
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| 10. |
- Sönnerstam, Eva, 1984-
(författare)
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Potentially inappropriate drug treatment among older people with cognitive impairment
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The aging process contributes to alterations in organ systems, which lead to an increased risk for chronic conditions. Drug treatment is an important strategy in the management of chronic conditions; however, pharmacokinetic and pharmacodynamic alterations contribute to increased sensitivity to drug effects. This sensitivity is even more pronounced among older people with major neurocognitive disorder. Nevertheless, this group of people is often exposed to potentially inappropriate drug treatment associated with serious adverse drug reactions.Aim: To identify patterns of potentially inappropriate drug treatment and factors associated with this type of drug treatment among older people with cognitive impairment to enable further improvement of drug treatment and diminish the risk of adverse drug reactions among this vulnerable group of people.Method: Explicit criteria were utilized to identify inappropriate prescriptions based on renal function, potentially inappropriate medications according to age and clinically relevant drug-drug interactions among older people with cognitive impairment admitted to two hospitals in Northern Sweden. The first two studies included 428 people and the third study 458 people. Medical records were used as the data source. Moreover, explicit criteria were used to identify potentially inappropriate medications according to age among 1,881 and 1,305 nursing home residents in Västerbotten county in 2007 and 2013, respectively. The association between the length of nursing home stay and the use of potentially inappropriate medications were investigated based on information in questionnaires. Finally, the use of potentially inappropriate medications according to age were investigated three years pre- and post-diagnosis of major neurocognitive disorder among 67,226 older people registered in the Swedish registry for cognitive/dementia disorders.Results: Every tenth of the people admitted to hospital had at least one inappropriate prescription based on their estimated renal function. Moreover, 40.9% had at least one potentially inappropriate medication and 43.2% had at least one clinically relevant drug-drug interaction. Pharmacodynamic interactions were found to be the most common type. Increasing number of prescribed medications was significantly associated with having at least one potentially inappropriate medication according tovage and at least one clinically relevant drug-drug interaction, respectively. Moreover, potentially inappropriate medications were common among nursing home residents but had decreased 2013 compared to 2007 and were only to a lesser extent associated with the length of stay. In the nationwide study population, it was found that potentially inappropriate medications according to age were overall low and decreased continuously three years pre-diagnosis until three years post-diagnosis of major neurocognitive disorder. Consequently, the use of potentially inappropriate medications was found to be significantly lower post- diagnosis except when concerning antipsychotic drug treatment, which was significantly higher post-diagnosis when compared with the pre- diagnosis period.Conclusion: Potentially inappropriate drug treatment is common among older people with cognitive impairment admitted to the hospitals in Västerbotten regardless of their type of living. Increasing number of medications was significantly associated with potentially inappropriate medications and clinically relevant drug-drug interactions. The decreasing trend of potentially inappropriate medications among nursing home residents and among older people with a major neurocognitive disorder is positive and indicates an increased awareness of potentially inappropriate drug treatment in healthcare.
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