Sustainability challenges concerning the effects of high-priced drugs on the day-to-day operations of community pharmacies in Finland.

BACKGROUND: High-priced drugs pose a challenge for health budgets, policies, and patient safety. One of the key roles of community pharmacies is to ensure availability to prescription drugs regardless of their price. This has been identified as challenging in certain situations concerning high-priced drugs. OBJECTIVES: The aim is to investigate the views of proprietary pharmacists regarding the effects of high-priced drugs on the day-to-day operations of pharmacies. METHODS: The data collection of the study was performed as a national cross-sectional online survey. The inclusion criteria were being a proprietary pharmacist and a member of the Association of Finnish Pharmacies. The survey contained questions yielding both quantitative and qualitative answers. The study focused on the qualitative data which was analysed by deductive thematic analysis. RESULTS: In total 604 proprietary pharmacists were sent the survey, and 174 eligible answers were included in the study, giving a response rate of 29%. The result describes the relationships between the economic, social, and environmental dimensions of sustainable development based on a framework by Wanamaker, with respect to high-priced drugs and community pharmacy operations as viewed by proprietary pharmacists. The main findings of the study show that proprietary pharmacists find the implementation of real-time reimbursement payments, a further reform of the pharmacy tax, and the abolishment of return bans to the wholesaler as risk mitigations and means to attain sustainability with respect to high-priced drugs and pharmacy practice. They experience that these changes would diminish high-priced drugs unnecessarily ending up as medical waste and improve the working conditions of the pharmacy staff by alleviating stress. CONCLUSIONS: According to the respondents, high-priced drugs pose challenges for community pharmacies and the legislation and reimbursement system need to adapt to these challenges. If not, community pharmacies in Finland continue to face severe financial declines based on the study results.

Social robots counselling in community pharmacies - Helping or harming? A qualitative study of pharmacists' views.

Background: Welfare technological solutions such as social robots attempt to meet the growing needs of the healthcare sector. Social robots may be able to respond to the shortage of pharmaceutical personnel at community pharmacies. However, there is a lack of previous studies regarding the use of social robots for medication counselling purposes in a pharmacy setting. Objectives: The objective of this qualitative study was to explore pharmacists' views on the potential role of social robots in medication counselling. Methods: Pharmacists, purposively sampled based on having recent experience of counselling customers in community pharmacies in Finland, first acted as customers interacting with the social robot in a simulated setting, before taking part in a focus group where their perspectives were explored. The focus group discussions were conducted in October and November 2022. The qualitative data was transcribed and analysed using reflexive thematic analysis. Results: The number of participants was eight in total. A main theme of how the robot may either help or harm concerning medication safety within a pharmacy setting was identified. The six sub-themes found, according to pharmacists' views on robot counselling in community pharmacies, are context, digital competence, customer integrity, interaction, pharmacists' professional role and human skills. Conclusions: According to the study findings, pharmacists experience that the social robot can offer a potential complement to a human pharmacist. The robot is seen as beneficial with respect to certain customer groups and in the light of personnel shortages, and may in the future add to trust, equality, freedom of choice and multilingualism, among other things, in the customer service situation at community pharmacies, thus improving medication safety.

A qualitative study on the views of experts on the social impact of the high-priced orphan drug nusinersen.

Background: Escalating medical costs due to the increasing occurrence of high-priced orphan drugs is a topic discussed in the media and specialist literature. However, there is no study investigating the social impact of such drugs through the views of experts. Objectives: The aim was to demonstrate the social impact of the orphan drug nusinersen based on the views of experts within the community. Methods: The study was conducted using two methods for data collection: a media analysis and qualitative semi-structured interviews. In the media analysis, expert comments on nusinersen were extracted from the Finnish media. Interviews were conducted with experts from the fields of pharmacy, medicine, politics/academia, law/economics, hospital management and patient organisations from different parts of Finland, who encountered nusinersen in their profession. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and the overall data were analysed thematically. Results: Twenty-nine media references were collected, and 16 interviews conducted. Three main themes were identified: ethical aspects, financial aspects, and call for new strategies. Expert views were divided between the ethical and financial aspects of nusinersen. These existed alongside each other, showing that different attitudes and values compete with each other, and may be classified in different ways depending on the situation. However, the discussion quickly evolved into a call for new strategies in order to find solutions to issues concerning orphan drugs and the social impact created as a result. Conclusions: This study reveals the social impact of nusinersen thus far within the community and it appears somewhat different when seen from the perspectives of patients and decision-makers. Even though impact has been created, such as the establishment of a disease-specific patient organisation, other issues still require further research. Among these are the potential establishment of international collaboration forums for price negotiations with pharmaceutical companies.

Retrograde transport of masseter muscle-derived neprilysin to hippocampus.

Although the effects of neprilysin (NEP), also called CD10, on the clearance of Alzheimer's disease (AD)-associated amyloid-ß (Aß) have been reported, NEP is not made in the brain, and the mechanism for the transport of NEP to the brain has not been investigated. Our hypothesis is that muscle packages NEP in exosomes in response to a neuromuscular signal and sends it to the brain via retrograde axonal transport. The masseter muscle (MM) and the trigeminal nerve (TGN) are good candidates for this mechanism by virtue of their proximity to the brain. The aim of this study was to trace the NEP protein from the MM, through the TGN, and to the hippocampus (HPC) in muscle contraction models in vitro and in vivo. NEP expression in mouse tissue lysates was analyzed by RT-PCR and Western blot. Four-week-old mice were perfused to remove blood NEP contamination. The MM expressed substantial levels of NEP protein and mRNA. On the other hand, a remarkably high level of NEP protein was measured in the TGN in the absence of mRNA. NEP protein, without the corresponding mRNA, was also detected in the HPC. These results suggested that the MM derived NEP was taken up by the TGN, which in turn permitted NEP access to the central nervous system and within it the HPC. When the MM was induced to contract by electric stimulation in freshly euthanized mice, NEP protein decreased in the MM in a stimulus time-dependent manner, while that in the TGN and the HPC increased sequentially. Furthermore, NIR-labeled exosomes tracked along the same route. Finally, carbachol induced secretion of exosomal NEP in C2C12-derived myotube cells. These results support our hypothesis that MM-derived NEP is transported along the TGN to reach the HPC following electrical or cholinergic stimulation.

The Effect of a Toothbrush Handle Design in Combating Microbial Contamination.

OBJECTIVES: This study aims to assess the difference in microbial contamination of a toothbrush with a smooth handle versus a toothbrush with a grooved handle design. METHODS: Twenty-six volunteers were randomized into two groups. The first group used a smooth handle toothbrush for two months, followed by a grooved handle toothbrush for two months. The second group had the order reversed. Following the two-month use, the toothbrushes were submitted for microbial analysis. Effect size, as well as Wilcoxon signed-rank test were used to calculate the differences between total colony count, bacterial DNA, and endotoxin levels from the two toothbrush handle types. RESULTS: There was no significant difference in colony count between the smooth (mean 580 CFU/mL, SD 1,684 CFU/mL) and grooved (mean 19,059 CFU/mL, SD 80,972 CFU/mL) handles (p = 0.12). Total DNA count was significantly less (p = 0.01) on the smooth handle (mean 68,038 RFU/mL, SD 81,659) compared to the grooved handle (mean 209,312 RFU/mL, SD 257,169 RFU/mL). Endotoxin levels were significantly less (p = 0.01) on the smooth handle (mean 0.16 EU/mL, SD 0.30 EU/mL) compared to the grooved handle (mean 0.43 EU/mL, SD 0.49 EU/mL). CONCLUSIONS: The smooth handle toothbrush had significantly less bacterial contamination compared to the grooved handle toothbrush, as measured by total DNA count and endotoxin levels.