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Problem: Undersöker hur läkemedelsförpackningar interagerar med patienter i deras vardag och beskriver patienters behov på läkemedelsförpackningar. Syfte: Fördjupa mig i vilka användarbehov det finns på läkemedelsförpackningar ur patientens perspektiv. Och därigenom ökar medvetenheten och förståelsen av patientens behov på läkemedelsförpackningar och därigenom förhoppningsvis leda till förbättrade läkemedelsförpackningar för patienten. Begränsningar: Jag undersöker interaktionen av läkemedelsförpackningen ur ett patientperspektiv och inte ur ett tillverknings- och distributionsperspektiv. Därför är det primärförpackningen som studeras i detta arbete. Jag har valt att titta på receptbelagda läkemedel för oralt bruk. Metod: Som forskningsstrategi valdes flerfallsstudier med en analysenhet, som analysenhet valdes interaktionen mellan patienten och dess läkemedelsförpackningar. För att samla in data genomfördes kvalitativa djupintervjuer och observationer i patienternas hemmiljö. Två olika metoder användes för att identifiera de behov patienterna hade ”Mänskocentrerad design” och ”Behovsidentifiering”. Slutsats: Idag är läkemedelsförpackningar så säkra att det resulterar i problem för patienten. I användarvänliga ingår säkra läkemedelsförpackningar, är dem inte användarvänliga är dem inte säkra. Patienters läkemedelshantering påverkas av olika aktörer. De aktörer jag har identifierat är läkaren, apoteket, anhörig och utomstående. Om patienten tar ett fåtal läkemedel har patienten inte så stora problem med sin hantering av läkemedelsförpackningar. Det är dock viktigt att belysa de behov och problem som den grupp av individer jag observerat har i den här fallstudien. De kan uppmärksamma behov som är viktiga även förpackning som tar några få läkemedel. Patienten känner oro över sin läkemedelshantering men det är inte oron över förpackningsegenskaper som att förvara och skydda läkemedlet och dess användare. Utan snarare en psykologisk oro över om patienten kommit ihåg att t, Problem discussion: Examine how pharmaceutical packaging interact with patients in their everyday lives and describe patients’ needs off pharmaceutical packaging. Purpose: Immerse myself in what user needs are on pharmaceutical packaging from the patient's perspective. Thereby increasing awareness and understanding of patient needs in pharmaceutical packaging and thereby hopefully lead to improved pharmaceutical packaging for the patient. Restrictions: I examine the interaction of pharmaceutical packaging from a patient perspective and not from a manufacturing and distribution perspective. Therefore, the primary packaging is studied in this work. I have chosen to look at prescription drug for oral use. Methodology: As a research strategy multiple-case studies was chosen with one unit of analysis. The unit of analysis with was chosen was the interaction between the patient and the pharmaceutical packaging. In order to collect data, qualitative in-depth interviews and observations was conducted in the patient's home environment. Two different methods were used to identify the needs of the patients "Human Centered Design" and "Need finding". Conclusions: Today's pharmaceutical packaging is so secure that it will result in problems. User friendly included safe pharmaceutical packaging, if they are not user friendly they are not safe. The Patient´s medication is influenced by different actors. The actors I have identified is the doctor, the pharmacist, family and outsiders. If the patient takes few medicines, the patient has not so big problems with their handling of pharmaceutical packaging. However, it is important to highlight the needs and problems that the group of individuals have in this case study, I have observed. They can draw attention to needs that are important to patients taking few medicines. The patient is concerned about his medication but it is not packing properties to store and protect the drug and its users. But rather a psychological concern about i

Objective: To examine risk of malignancy and death in patients with kidney transplant who receive the immunosuppressive drug sirolimus. Design: Systematic review and meta-analysis of individual patient data. Data sources: Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2013. Eligibility: Randomized controlled trials comparing immunosuppressive regimens with and without sirolimus in recipients of kidney or combined pancreatic and renal transplant for which the author was willing to provide individual patient level data. Two reviewers independently screened titles/abstracts and full text reports of potentially eligible trials to identify studies for inclusion. All eligible trials reported data on malignancy or survival. Results: The search yielded 2365 unique citations. Patient level data were available from 5876 patients from 21 randomized trials. Sirolimus was associated with a 40% reduction in the risk of malignancy (adjusted hazard ratio 0.60, 95% confidence interval 0.39 to 0.93) and a 56% reduction in the risk of non-melanoma skin cancer (0.44, 0.30 to 0.63) compared with controls. The most pronounced effect was seen in patients who converted to sirolimus from an established immunosuppressive regimen, resulting in a reduction in risk of malignancy (0.34, 0.28 to 0.41), non-melanoma skin cancer (0.32, 0.24 to 0.42), and other cancers (0.52, 0.38 to 0.69). Sirolimus was associated with an increased risk of death (1.43, 1.21 to 1.71) compared with controls. Conclusions: Sirolimus was associated with a reduction in the risk of malignancy and non-melanoma skin cancer in transplant recipients. The benefit was most pronounced in patients who converted from an established immunosuppressive regimen to sirolimus. Given the risk of mortality, however, the use of this drug does not seem warranted for most patients with kidney transplant. Further research is needed to determine if different populations, such as those at high ri

I denna studie har fokus legat på sociala insatsgrupper i fyra områden i Stockholms län. Sociala insatsgrupper är en strukturerad samverkan på individnivå mellan i första hand socialtjänst, polis och skola som syftar till att förhindra nyrekrytering av ungdomar till kriminella grupperingar samt underlätta avhopp från kriminella grupperingar. Studiens övergripande syfte är att undersöka hur samverkan mellan socialarbetare och poliser ser ut inom projektet sociala insatsgrupper. Studien fokuserar på socialarbetarnas och polisernas yrkesroller samt stöd- och kontrollaspekter. Studiens resultat visar att sociala insatsgrupper uppfattas som ett framgångsrikt projekt, men också att det råder ett spänningsförhållande mellan en behandlingslogik och en straffrättslig logik som polis och socialarbetare måste förhålla sig till i samverkan kring ungdomen. Studiens resultat visar även att stöd och kontroll inte kan skiljas från varandra, något som kan härledas till en övergripande så kallad normaliseringslogik som delas av socialarbetarna och polisen i arbetet med ungdomen. För att belysa och problematisera resultaten har studien främst hämtat inspiration från den nyinstitutionella teoribildningen som riktar fokus på samverkansprocesser i organisationer., Community Intervention Team [social insatsgrupp] is a structured collaboration between social services, police, and schools. It is a project that aims to prevent new recruitment of youth into criminal groups, but also to facilitate defections from criminal groups. The study's main aim is to investigate the collaboration between social workers and police officers within the framework of the community intervention teams. The study focuses on the roles of socialworkers and police officers, and the their aspects of support and control. The results show that community intervention teams is perceived as a successful project, but there is also a visible tension between the logics of treatment and the logics of punishment, that both social workers and police officers have to deal with as a part of their collaboration. The study also shows that support and control cannot be separated from one another; which can be attributed to the over all logics of normalization shared by social workers and police officer's in their work with young people. In order to highlight and to problematize the results, the study has mainly been inspired by the new institutional theory that focuses on collaborative processes in organizations.

I denna studie har fokus legat på sociala insatsgrupper i fyra områden i Stockholms län. Sociala insatsgrupper är en strukturerad samverkan på individnivå mellan i första hand socialtjänst, polis och skola som syftar till att förhindra nyrekrytering av ungdomar till kriminella grupperingar samt underlätta avhopp från kriminella grupperingar. Studiens övergripande syfte är att undersöka hur samverkan mellan socialarbetare och poliser ser ut inom projektet sociala insatsgrupper. Studien fokuserar på socialarbetarnas och polisernas yrkesroller samt stöd- och kontrollaspekter. Studiens resultat visar att sociala insatsgrupper uppfattas som ett framgångsrikt projekt, men också att det råder ett spänningsförhållande mellan en behandlingslogik och en straffrättslig logik som polis och socialarbetare måste förhålla sig till i samverkan kring ungdomen. Studiens resultat visar även att stöd och kontroll inte kan skiljas från varandra, något som kan härledas till en övergripande så kallad normaliseringslogik som delas av socialarbetarna och polisen i arbetet med ungdomen. För att belysa och problematisera resultaten har studien främst hämtat inspiration från den nyinstitutionella teoribildningen som riktar fokus på samverkansprocesser i organisationer., Community Intervention Team [social insatsgrupp] is a structured collaboration between social services, police, and schools. It is a project that aims to prevent new recruitment of youth into criminal groups, but also to facilitate defections from criminal groups. The study's main aim is to investigate the collaboration between social workers and police officers within the framework of the community intervention teams. The study focuses on the roles of socialworkers and police officers, and the their aspects of support and control. The results show that community intervention teams is perceived as a successful project, but there is also a visible tension between the logics of treatment and the logics of punishment, that both social workers and police officers have to deal with as a part of their collaboration. The study also shows that support and control cannot be separated from one another; which can be attributed to the over all logics of normalization shared by social workers and police officer's in their work with young people. In order to highlight and to problematize the results, the study has mainly been inspired by the new institutional theory that focuses on collaborative processes in organizations.

Organ donation and transplantation activity in the majority of Balkan countries (Albania, Bosnia and Herzegovina, Croatia, Macedonia, Moldova, Montenegro, Serbia, Romania and Bulgaria) are lagging far behind international averages. Inadequate financial resources, unclear regional data and lack of governmental infrastructure are some of the issues which should be recognized to draw attention and problem-solving decisions. The Regional Health Development Centre (RHDC) Croatia, being a technical body of the South-eastern European Health Network (SEEHN), was created in 2011 after Croatia's great success in the field over the last 10 years. The aim of the RHDC is to network the region and provide individualized country support to increase donation and transplantation activity in collaboration with professional societies (European Society of Organ Transplantation, European Transplant Coordinators Organization, The Transplantation Society and International Society of Organ Donation and Procurement). Such an improvement would in turn likely prevent transplant tourism. The regional data from 2010 show large discrepancies in donation and transplantation activities within geographically neighbouring countries. Thus, proposed actions to improve regional donation and transplantation rates include advancing living and deceased donation through regular public education, creating current and accurate waiting lists and increasing number of educated transplant nephrologists and hospital coordinators. In addition to the effort from the professionals, the governmental support with allocated funds per deceased donation, updated legislation and established national coordinating body is ultimately recognized as essential for the successful donation and transplantation programmes. By continuous RHDC communication and support asked from the health authorities and motivated professionals from the SEEHN initiative, an increased number of deceased as well as living donor kidney transplantation

Background: Alloreactive memory T cells are a major obstacle to transplantation acceptance due to their capacity for accelerated rejection. Methods: C57BL/6 mice that had rejected BALB/c skin grafts 4 weeks earlier were used as recipients. The recipient mice were treated with anti-CD154/LFA-1 with or without anti-CD70 during the primary skin transplantation and anti-CD154/LFA-1 or not during the secondary transplantation of BALB/c heart. We evaluated the impact of combinations of antibody-mediated blockade on the generation of memory T cells and graft survival after fully MHC-mismatched transplantations. Results: One month after the primary skin transplantation, the proportions of CD4(+) memory T cells/CD4(+) T cells and CD8(+)memory T cells/CD8(+) T cells in the anti-CD154/LFA-1 combination group were 47.32 +/- 428% and 23.18 +/- 2.77%, respectively. In the group that included anti-CD70 treatment, the proportions were reduced to 34.10 +/- 2.71% and 12.19 +/- 3.52% (P<0.05 when comparing the proportion of memory T cells between the two groups). The addition of anti-CD70 to the treatment regimen prolonged the mean survival time following secondary heart transplantation from 10 days to more than 90 days (P<0.001). Furthermore, allogenic proliferation of recipient splenic T cells and graft-infiltrating lymphocytes were significantly decreased. Meanwhile, the proportion of regulatory T cells was increased to 9.46 +/- 1.48% on day 100 post-transplantation (P<0.05). Conclusions: The addition of anti-CD70 to the anti-CD154/LFA-1 combination given during the primary transplantation reduced the generation of memory T cells. This therapy regimen provided a potential means to alleviate the accelerated rejection mediated by memory T cells during secondary heart transplantation and markedly prolong the survival of heart allografts. (C) 2011 Elsevier B.V. All rights reserved.

We performed a prospective, double blind, randomized, placebo-controlled multicenter study on the efficacy and safety of rituximab as induction therapy, together with tacrolimus, mycophenolate mofetil, and steroids. The primary endpoint was defined as acute rejection, graft loss, or death during the first 6 months. Secondary endpoints were creatinine clearance, incidence of infections, and incidence of rituximab-related adverse event. RESULTS: We enrolled 140 patients (44 living donor and 96 deceased donor), and of those, 68 rituximab and 68 placebo patients fulfilled the study. In all the patients receiving rituximab, there was a complete depletion of CD19/CD20 cells, whereas there was no change in the number of CD19/CD20 cells in the placebo group. There were 10 treatment failures in the rituximab group versus 14 in the placebo group (P=0.348). There were eight rejection episodes in the rituximab group versus 12 in the placebo group (P=0.317) Creatinine clearance was 66+/-22 mL/min in the study group and 67+/-23 mL/min in the placebo group. There was no difference in the number of bacterial infections, cytomegalovirus infections, and BK virus infections or fungal infections. CONCLUSION: We performed a placebo-controlled study of rituximab induction in renal transplantation. There was a tendency toward fewer and milder rejections during the first 6 months in the rituximab group. Although induction with one dose of rituximab induced a complete depletion B cells, there was no increase in the incidence of infectious complications or leukopenia and it seems safe, therefore, to conduct further studies on the use of rituximab in transplantation.

Transplantation of embryonic human neural tissue can restore dopamine neurotransmission and improve neurological function in patients with Parkinson's disease. Logistical and ethical factors limit the availability of human embryonic allogeneic tissue. Embryonic xenogeneic neural tissue from porcine donors is an alternative form of donor tissue, but effective immunomodulatory techniques are warranted for neural xenotransplantation to become clinically feasible. We transplanted embryonic porcine ventral mesencephalic tissue into the brains of adult untreated C57BL/6 mice, untreated CD40L-/-mice and CD40L-/-mice that received injections of anti-LFA-1, CTLA41g or both compounds. Double-treated CD40L-/-mice had large grafts with high numbers of dopaminergic neurons 4 wk after transplantation. The grafts were completely devoid of lymphocytes, macrophages and activated microglia. Untreated C57BL/6 mice had rejected their grafts. Untreated CD40L-/-mice and CD40L-/-mice treated with monotherapy of anti-LFA-1 or CTLA41g had smaller grafts and more microglial and lymphocytic infiltration than double-treated CD40L-/-mice. We conclude that immunomodulation with concomitant inhibition of LFA-1 and B7 signaling in the perioperative period in CD40L-/-mice prevented the rejection of discordant neural xenografts. The treatment most likely reduced antigen presenting capacity and interfered with the costimulatory signaling needed for T cell activation to occur.

BACKGROUND: The aim of this study was to establish the outcome of renal transplantation in patients given pretransplant erythropoietin (EPO) treatment targeted at reaching a normal hemoglobin concentration (Hb), compared to those given EPO-treatment aimed at maintaining subnormal Hb. METHODS: A total of 416 patients from Scandinavian countries and with renal anaemia were enrolled to examine the effects of increasing Hb from a subnormal level (90-120 g/liter) to a normal level (135-160 g/liter) by EPO treatment. Half of the patients were randomized to have their Hb increased, with the other half randomized to maintain a subnormal Hb. Thirty-two patients from the normal Hb group and 24 patients from the subnormal group received a renal graft during the study period. The outcomes of these transplantations were examined prospectively for 6 months. RESULTS: Preoperative Hb levels were 143+/-17 and 121+/-14 g/liter in the two groups, respectively (P<0.0001). The Hb remained higher in the normal Hb group during the first 2 weeks after transplantation. The percentage of patients requiring postoperative blood transfusions in the normal Hb group was 16%, compared with 50% in the subnormal group (P<0.01). No statistically significant difference in the proportion of functioning grafts or in the serum creatinine levels could be detected. No correlation between EPO treatment and creatinine levels after transplantation was found. The frequency of adverse events was similar in the two groups. CONCLUSIONS: EPO treatment aimed at reaching a normal Hb in renal transplant recipients reduces the postoperative requirement for blood transfusions and has no deleterious effects on kidney graft function.