Study DesignRandomized controlled trial. BackgroundLow back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises. ObjectiveTo compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise. MethodsSeventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms. MethodsParticipants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region. ResultsBoth interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P = .505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001). ConclusionAn LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance. Registered at ClinicalTrials.gov (NCT01061632).

Purpose: The specific objectives were to: 1) describe the level of pain intensity, disability, activity limitation, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical back pain, and 2) investigate whether differences between these patients in physical and psychosocial factors can be distinguished when the patients are further sub-grouped.Relevance: To improve assessment among patients with chronic low back pain (CLBP) it is important to investigate the prevalence of physical and psychosocial features in homogenous sub-groups.Participants: Seventy-one patients with CLBP, 20-60 years old, with peripherally mediated mechanical pain at the the moment for the study, were included and each patient was sub-classified into one of five sub-groups based on their pain behaviour and functional movement pattern (flexion n=20, flexion/lateral shift, n=11, active extension n=23 , passive extension n=8, and multidirectional pattern n=9).Methods: Data on pain intensity (Visual Analogue Scale), disability (the Roland and Morris Questionnaire), activity limitation (the Patient Specific Functional Scale), kinesiophobia (the Tampa Scale of Kinesiophobia) and physical capacity (lifting capacity and trunk extensor endurance) was collected.Analysis: Mean and standard deviation for parametric and median and interquartile range for non-parametric data were used for descriptive statistics. One-way ANOVA for normally distributed data and Kruskal-Wallis for non-normally distributed data were used for analyses of differences between the sub-groups. The subjects were also divided into two age-groups (20-40 and 41-60 years) and measures of physical capacity were compared to women and men at the ages of 34 and 50, respectively, in the general Swedish population using one sample T-test.Results: The patients reported low to moderate pain intensity (3.1/10±2.4), disability (RMDQ (7.27/24 ±4.2) and kinesiophobia (33.4/68 ±7) and these levels were lower than reported levels in other studies including more heterogenous groups of patients with CLBP. The patiens reported activity limitations (PSFS 13/30±23). Lifting capacity and trunk extensor endurance were significantly lower than in the general population in the youngest age-group. No significant differences in pain intensity, disability, kinesiophobia or physical capacity were found between the sub-groups.Conclusions: This research highlights that patients with predominantly peripherally mediated mechanical back pain may differ from other sub-groups of patients with CLBP (e.g., patients with central sensitization as dominating pain mechanism) regarding physical and psychosocial factors. The individual variation in pain intensity, disability, kinesiophbia and physical capacity among the patients indicates the importance to assess these factors in every patient. Due to the fact that there were few patients in the sub-groups, further research is necessary to explore whether there are differences, that we were not able to disingjish, between patients with different movement patterns.

Bakgrund: Typ 1 diabetes är en sjukdom som mer än 500 000 barn och unga under 17 år lever med och kräver livslång behandling. För barnens föräldrar innebär detta en omställning i det dagliga livet och i deras föräldraskap. Föräldrarna kan ha behov av stöttning från vårdpersonal. Syfte: Att beskriva föräldrars upplevelse av att ha ett barn med typ 1 diabetes. Metod: Kvalitativ manifest innehållsanalys användes som analysmetod och 12 vetenskapliga artiklar med kvalitativ ansats ingick i resultatet. Analysen resulterade i fem slutgiltiga kategorier. Resultat: Föräldrar till ett barn med typ 1 diabetes kan uppleva att diagnosen förändrar livet. Vardagen styrs av kontroll och planering vilket leder till många känslor som är svåra att hantera. Föräldrarna behöver tillgänglighet från vårdpersonal och andra för att känna trygghet och för att kunna hantera livet med ett barn med diabetes typ 1. Slutsatser: För att sjuksköterskan ska kunna ge en god omvårdnad är det av betydelse att hen kan relatera till både patienter och anhöriga. Sjukvården har en viktig roll att genom stor tillgänglighet och uppbackning vara ett stöd och därmed vara en trygghet för familjerna i vardagen. Denna studies resultat kan ge en ökad förståelse för föräldrars upplevelse av att ha barn med diabetes typ 1. Det behövs mer kunskap inom området för att sjuksköterskor ska kunna bemöta och stötta familjerna vilket kan leda till förbättrad omvårdnad.

Hjärtstopp drabbar cirka 10 000 personer årligen i Sverige. Antalet personer som överlever ett hjärtstopp har ökat stadigt de sista åren, men fortfarande är det den vanligaste orsaken till plötslig död utanför sjukhus. För de personen som överlever innebär det att livet plötsligt förändras och fokus i det dagliga livet blir på händelsen och dess konsekvenser. Syftet med denna litteraturstudie var att beskriva de drabbades upplevelser av ett hjärtstopp. En kvalitativ design användes och nio vetenskapliga studier analyserades systematiskt med innehållsanalys. Analysen resulterade i fem kategorier: Att känna oro, att få ett nytt livsperspektiv, att kroppsliga begränsningar leder till känslor av rädsla och maktlöshet, att känna tacksamhet men vara i behov av stödsamtal, att vara i behov av information. Resultatet visade att personer som överlevt ett hjärtstopp hade många frågor och funderingar kring det inträffade men upplevde att de fick bristande information från sjukvården. Känslor som otrygghet, ångest och osäkerhet var vanligt samt oro inför framtiden. Resultatet från denna litteraturstudie kan användas för att öka kunskapen om hur personerna mår psykiskt och fysiskt, samt vilka behov de har för att hantera livet. Det behövs mer omvårdnadsforskning inom området med fokus på sjuksköterskors upplevelser av att vårda de drabbade personerna. Målet är att skapa trygghet hos sjukvårdspersonal så att de kan stötta dessa personer på bästa sätt och främja en läkning hos dem och anhöriga.

Traditionally scaphoid waist fractures have been treated with a long period, 10–12 weeks, of immobilization in a plaster cast until radiological union. The long period of immobilization sometimes infers great discomfort for the patients. To avoid this, surgical treatment with screw fixation has for the last decade been advocated as an option also for undisplaced fractures. In this report, we present five cases with undisplaced scaphoid waist fractures that have healed both radiologically and clinically without any immobilization at all or after a very short period of protection in a cast. These observations challenge the current treatment guidelines.

Background: The aim of palliative care is to keep the quality of life by integrating a person-centered care at the end of life. Palliative care and hospice care do not focus only on symptoms and medication. Self-esteem, dignity and support were major components for the patient at the end of life. Aim: The aim of this study was to describe how palliative care is given at a hospice in a developing country. Method: The used method was a qualitative participant observation study. The participants were health care staff at a hospice, they were chosen before the study began. The observation took place three times per week for six weeks. The researcher intertwined volunteering and observing at the same time. The data was analyzed with a qualitative content analysis. Result: The study resulted in six categories: environment, nursing records, nursing care, infection control and meals. Conclusion: The conclusion was that nature and safety had a big impact on the environment. The health care staff worked as a team to fulfill their goals.

Bakgrund: Inom den prehospitala akutsjukvården kan specialistsjuksköterskan möta en stor variation av luftvägsproblematik. Att ställas inför situationer med patienter med ofri luftväg prehospitalt ställer höga krav på specialistsjuksköterskans kunskap och erfarenhet. En ofri luftväg är ett livshotande tillstånd där snabb och korrekt handläggning krävs för att minimera risken för hypoxi, med risk för efterföljande men som fatal utgång. Att identifiera ett luftvägsproblem och sätta in adekvata metoder för att skapa fria luftvägar är något som specialistsjuksköterskan behöver känna sig säker att utföra, vilket innebär att ha en god förmåga att hantera de tekniker och hjälpmedel som finns att tillgå. Syfte: Syftet med studien är att undersöka anestesisjuksköterskors och ambulanssjuksköterskors kunskapsnivå och erfarenhet av att hantera patientens ofria luftväg prehospitalt. Metod: Studien har en kvantitativ ansats. Specialistsjuksköterskor (n=145) verksamma inom den prehospitala akutsjukvården i en region i södra Sverige deltog i studien. Datainsamlingen genomfördes i form av enkäter och datan analyserades i programmet SPSS. Resultat: Studiens fyra huvudsakliga fynd var att ungefär 20 % av respondenterna hade minst en gång under det senaste året varit med om att inte lyckas skapa fria luftvägar. Anestesisjuksköterskor hade en högre självskattad säkerhet inför ofria luftvägar än ambulanssjuksköterskor. Två tredjedelar av respondenterna ville genomföra en repetitionsutbildning i hantering av ofria luftvägar, och hela 83 % av ambulanssjuksköterskorna ansåg att de var i behov av en repetitionsutbildning i att hantera ofri luftväg. Slutsats: Det finns en signifikant skillnad mellan yrkesgrupperna där anestesisjuksköterskor skattar sig säkrare med att hantera utrustningen vid ofria luftvägar jämfört med ambulanssjuksköterskor. Specialistsjuksköterskorna upplever ett behov av ytterligare utbildning samt kompetenskontroll av luftvägshantering. 

Inledning: Den största anledningen till att barn kommer i kontakt med sjukvården är på grund av misstänkt fraktur, vilket innebär att röntgensjuksköterskor ofta möter barn i det dagliga arbetet på röntgenavdelningen. Trots det är dessa sällan utbildade i bemötande av barn, eller inom pediatrisk bildtagning. Vuxna som inte är vana vid att hantera barn kan känna viss tveksamhet eller rädsla inför att vårda ett barn. För att kunna förbättra mötet med barn är det viktigt att veta vilka känslor sjukvårdpersonal känner i mötet, och varför. Syfte: att beskriva vilka upplevelser sjukvårdpersonal känner i mötet med barn. Metod: Studien utfördes som en litteraturöversikt med 10 artiklar som granskades med en induktiv kvalitativ innehållsanalys. De 10 artiklarna var av kvalitativ ansats och intervjuade sjukvårdspersonal som bestod av ambulanspersonal, akutsjuksköterskor, allmänsjuksköterskor och radioterapeuter. Resultat: Fyra kategorier; bemötande, hanterbarhet, tiden har betydelse och föräldrar. Dessa beskriver i vilka situationer sjukvårdspersonal upplever både negativa och positiva känslor i mötet med barn. Slutsats: att identifiera vilka känslor som uppstår är grunden för fortsatta studier för att förbättra arbetsmiljön för såväl röntgensjuksköterskor som övrig sjukvårdspersonal. 

Purpose: To describe occupational therapists' experiences of identifying and promoting meaningful activities with people aged 80 years and over, with homecare. Method: The authors chose a qualitative approach to describe the subjective experiences of the occupational therapists. Eight semi- structured interviews were conducted and analyzed on the basis of qualitative content analysis. Result: The data resulted in three categories, one with two subcategories these were: Identification of individual needs for meaningful activities, Work promoting against meaningful activities with subcategories: Problems occupational therapists meet with the elderly as well as supportive resources to maintain meaningful activities,as well as the category of Occupational Therapists' lack of and the wish for resources to work towards meaningful activities. Conclusion: The study shows that occupational therapists in the field of home care focus on starting from the patient's individual life story and they see a danger with generalizing when working with patients aged 80 years and over. Occupational therapists' experiences also showed that minor efforts and the social network of relatives and friends are important for the patients to be able to carry out meaningful activities. The participants in the study showed a great commitment to their work while expressing a wish to do more for the patients.

Sepsis är ett globalt hälsoproblem och en stor del av personerna som överlever får restsymtom som påverkar deras livskvalité. Syftet med denna studie var att sammanställa faktorer som påverkar livskvalitén för personer som överlevt en sepsis. En integrerad kunskapsöversikt genomfördes där 19 artiklar ur den systematiska litteratursökningen valdes ut för analys. Resultatet visar att faktorer såsom psykiska, fysiska och kognitiva funktionsnedsättningar påverkar personernas livskvalité, då det medför en känsla av att inte vara en fri individ. Andra faktorer som påverkade livskvalitén var förändringar i det sociala livet vilket innebar att personer upplevde en känsla av att inte vara en del av gemenskapen. Detta på grund av att relationer påverkades samt svårigheter att återgå till arbetet. Känslomässiga faktorer som framkom och påverkade personer som överlevt en sepsis var rädsla och oro för att drabbas igen samt existentiella funderingar kring varför just dem drabbats. För att sjuksköterskor ska kunna vara ett sådant stöd till återhämtning som behövs utifrån personernas individuella behov, är det av stor vikt att sjuksköterskor har kunskap kring vilka faktorer som påverkar livskvalité för personer som överlevt sepsis. Det är också av stor vikt att möjliggöra tidig upptäckt och adekvat omvårdnad för personer med sepsis. Föreslagna interventioner var arbetsträning, stödjande samtal samt personcentrerad omvårdnad för att stärka empowerment och återhämtning även efter vårdtidens slut. Kvalitativ forskning utifrån personers perspektiv behövs för att öka kunskapen om och möjliggöra en tidig upptäckt och adekvat vård och omvårdnad för personer med sepsis.

Att som förälder få uppleva att barnet drabbas av en kronisk sjukdom är en omvälvande händelse för många föräldrar. När ett barn blir sjuk är det oftast en hel familj som drabbas och i vården finns det en utmaning i att möta hela familjen som är i behov av stöd och vård. Syfte var att beskriva upplevelser av att vara förälder till barn med kronisk sjukdom. I denna litteraturstudie utgick vi från Graneheim och Lundmans metod för kvalitativ innehållsanalys med en manifest ansats. Resultat visar att diagnosen och sjukdomen upplevdes svår att hantera. Känslor som sorg, förtvivlan och skuld beskrevs komma i samband med sjukdomen. Känslan av att behöva stöd från hälso- och sjukvården upplevdes viktig av föräldrarna. Familjen upplevde svårigheter att hantera det vardagliga livet och få det att fungera. Mycket oro över det sjuka barnets framtid upplevdes. Fortsatt forskning som handlar om hur hälso- och sjukvården ska kunna ta hand om föräldrar till kroniskt sjukt barn bör utföras. Hälso- och sjukvårdspersonal behöver få tillgång till verktyg som hjälper dem att bemöta föräldrar till kroniskt sjuka barn.

Nyckelord: Föräldrar, kroniskt sjuka barn, familjer, lidande, omvårdnad, upplevelser

Demenssjukdom är en av de mest vanligt förekommande sjukdomarna och det är främst äldre människor som drabbas. Detta kommer att leda till att antalet personer med demenssjukdom kommer att öka och deras komplexa sjukdomsproblematik kommer att leda till ökat behov av sjukhusvistelse och särskilt boende. Syftet med denna litteraturstudie var att beskriva vårdpersonals upplevelser av att vårda människor med demenssjukdom. En systematisk litteratursökning av vetenskaplig studier genomfördes inom området, vilket resulterade i tio studier som svarade på syftet. Studiernas innehåll analyserades med en kvalitativ manifest innehållsanalys med en induktiv ansats, som resulterade i fyra kategorier: Att vårdandet kan vara en utmaning, Att både ha kunskaps- och tidsbrist, Att vårdmiljön inte är utformad för personer med demenssjukdom och Att ha en god relation och kommunikation har stor betydelse. Studiens resultat diskuteras främst utifrån personcentrerad vård och hur ett personcentrerat förhållningsätt skulle kunna etableras inom vården av personer med demenssjukdom, i syfte att stärka personen med demenssjukdom utifrån dennes unika förutsättningar. Slutsatsen belyser vikten av att arbeta personcentrerat inom demensvården och att kunskap om demenssjukdomar kan underlätta svåra situationer. 

Background: Missed appointments is a problem that effects the hospital economics and the patients’ health, No- show patients is a term for patients thats without informing don't come to their booked appointment.This patient’s group has a higher risk of falling ill urgently or aggravate the already existing disease. A patient cost too the health care system is bigger when they miss booked appointments. Patient’s who decline or select not to participate in screening also increases their risk of falling ill. the Screening patients that’s participate decreases risk of sickness or finding it early. Purpose: The purpose of this study was to examine factors to no show patient’s in radiology. Method: A literature review was conducted. Articles searches using databases PubMed and Cinhal resulted in 15 articles that’s matched the purpose of the study. Result: Six different factors/reasons was found, fear, practical factors, aged, administrations, family and social status. Conclusions: Similar results was found in study’s in other departments of the hospital and there for a generalization was possible. More research needs to be done in to how the seven main branches actually effects missed appointments and no show patient’s. It is of importance to the radiology nurse to know the reasons so they can work towards a positive change in both hospital economics and patient’s health.

Oral tablets are convenient and widely administered drugdosage forms.The mechanical properties of a drug substance such as plasticity, ability to cohere into compacts and friction/adhesion are important in the development of a tablet formulation. Crystal engineering is an interesting and viabletool for improving or optimizing these technical properties of a drug substance.The creation of a lternative polymorphic forms, cocrystals, salts or hydrates of a drug substance can result in structural variations in the molecular packing of the crystals and, thereby, can alter the deformation behavior of the materials.Knowledge of the relationships between crystal modifications and the technical properties in multicomponent systems is limited, but represents a possibility to predict mechanical properties based on crystalstructure that facilitates engineering particles for the optimal processing performance. The overall objective of this thesis is thus to gain better understanding of the relationships between the crystal structure features and the mechanical properties of cocrystals and salts. Paracetamol form I, its cocrystals with oxalic acid and 4,4´-bipyridine, and its hydrochloride salt were selected as model systems in the study.The materials were scaled-up using rational crystallization methods and the physical purity was confirmed. The relevant properties of these powders were determined.Tablets were then made at applied pressures of50-250 MPa under controlled conditions.The tabletability and compactability of the powders were determined. The compression mechanics of the powders were the investigated according to a material classification protocol.Slip planes were identified by visually observing the crystal structures and based on the attachment energies calculated using different force fields in the materialsstudio.The tensile strengths of the powders increased with increasing pressure and the tabletability decreased in the order oxalic acid>paracetamol-hydrochloride salt≈paracetamol-oxalic acid>4,4´-bipyridine>paracetamol-4,4´-bipyridine.The tensile strength of the tablets decreased exponentially with increasing porosity,with some exceptions.Ingeneral, the cocrystals and the salt displayed intermediate compression characteristics as compared to the reference substances.The elastic recovery of the cocrystal and salt forms of paracetamol was not markedly different from that of paracetamol.It was found that slip plane prediction based on the attachment energies was not reliable. While it was possible to explain the improved tableting properties of powders based on the crystal features (i.e. the presence of slip planes and flat layers), no clear relationship was found with yield pressure. This may be attributed to possible brittle material characteristics and the surface energies of the crystals,which need to be further studied.Thus, cocrystallization and salt formation introduced structural features that were responsible for changes in the compaction and compression properties of drug substances. In future work, we intend to extend these studies to provide a clear picture of structure-mechanical property relationships in organic molecular crystals over multiple length scales;molecules to crystals to bulk powder.Key words Crystal engineering, solid forms, cocrystals, salts, tableting, crystal structure, mechanical properties, compression analysis

Objectives were to study mechanical properties of various solid forms of paracetamol and relate to their crystal structures. Paracetamol Form I (PRA), its cocrystals with oxalic acid (PRA-OXA) and 4,4-bipyridine (PRA-BPY) and hydrochloride salt (PRA-HCL) were selected. Cocrystals and salt were scaled-up using rational crystallization methods. The resulting materials were subjected to differential scanning solid-state characterization. The powders were sieved and 90-360 µm sieve fraction was considered. These powders were examined by scanning electron microscopy (SEM) and densities were determined. Tablets were made at applied pressures of 35-180 MPa under controlled conditions and the tablet height, diameter and hardness were measured. Tensile strength and porosity of the tablets were estimated using well known models. Crystal structures of these systems were visualized and slips planed were identified. Cocrystal and salt of PRA were physically pure. Sieved powders had comparable morphologies and particle size. The apparent and theoretical densities of powders were similar but no clear trends were observed. The tensile strengths of these compacts were increased with increasing pressure whereas tabletability decreased in the order oxalic acid > PRA-HCL ≈ PRA-OXA > BPY > PRA-BPY. Tablet tensile strength decreases exponentially with increasing porosity with the exception of PRY-BPY and BPY. Slip plane prediction based on attachment energies may not be independently considered. However, it was possible to explain the improved mechanical properties of powders based on the crystal structure. Cocrystallization and salt formation have introduced structural features that are responsible for improved tableting properties of PRA.

Abstract

Introduction: Social development in Sweden points to an environment where shootings with firearms become an increasingly common phenomenon among criminal groups. With the Terrorist attack of April 7, 2017, the Civil Protection and Preparedness Authority (MSB) has been commissioned by the government to investigate what needs to be resolved in order for society to be better prepared for events with ongoing fatalities. It is important that the experiences created by the staff exposed to these challenges are taken care of and that you can integrate and identify the best strategies that you can use to prepare yourself best for the mission. Aim: The aim was to identify the strategies used by ambulance nurses for preparation during the drive out in a situation where a patient has received a gunshot wound. Method: The study has been conducted with a descriptive qualitative approach. Semi-structured interviews were used to collect retrospective data from 10 ambulance nurses. The collected data was analyzed by critical incident technique and resulted in five final categories. Result: The results show that ambulance nurses use both mental and practical strategies to prepare for the care of a patient with a gunshot wound. The five final categories identified during the analysis were as follows: To talk to the colleague and to get a common strategy for structuring and distributing work, reviewing and repeating relevant algorithms, searching for a policy and thinking about safety, mental stability through calm and structured thoughts with an open mind, going through which equipment is the priority for a life-threatening bleeding and where it is located. Clinical implications: The result of this research project helps staff in the field of ambulance care receive different strategies that can be used to prepare for the care of patients who have been shot. The preparations are linked to their own mental strategies, collaboration with colleagues, collaboration with other actors and preparation for patient care. Key words: Preparation strategies, prehospital care, ambulance nurses, shot injury, critical incident technique.

Abstract

Aim:  As pain is common in children and adolescents and musculoskeletal pain is an emerging research field in adolescents, one way to measure the pain and impact is to use questionnaires. The purpose was to develop and test-retest a questionnaire in musculoskeletal pain in adolescents.

Method: The Teen Nordic Musculoskeletal Questionnaire Extended version (TNMQ-E) was developed and tested in a pilot study. Thereafter, and with consultation of a group of experts in the area, the questionnaire was revised to the final version.  82 participants (age range 9-15, 52 boys and 30 girls) answered the final version of the questionnaire with a 24-hour interval in a school in the Stockholm area and it was subsequently collected to assess the test-retest reliability. Cohen´s kappa coefficient (κ), 95 % confidence interval and ICC 2,1 was used to evaluate the correlation.

Results: The questionnaire can be divided in three parts, pain prevalence, pain experience and pain impact. Pain prevalence showed moderate correlation overall (κ 0,42-0,92), but pain experience (κ0,5-0,93 & ICC 2,1 0,5-0,99) and pain impact (-0,03-1) demonstrated a substantial to high correlation. TNMQ-E questionnaire demonstrated overall substantial test-retest reliability.

Conclusion: TNMQ-E is a questionnaire that seems to be a tool epidemiological purposes that can be self-administered in an adolescent population with substantial correlation.

ObjectivesPatients admitted to an intensive care unit (ICU) often experience distressing memories during recovery that have been associated with poor psychological and cognitive outcomes. The aim of this literature review was to synthesise the literature reporting on relationships between elements of ICU treatment and memories after discharge in adult ICU survivors.Review method usedIntegrative review methods were used to systematically search, select, extract, appraise and summarise current knowledge from the available research and identify gaps in the literature.Data sourcesThe following electronic databases were systematically searched: PubMed, Ovid EMBASE, EBSCOhost CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials. Additional studies were identified through searches of bibliographies. Original quantitative research articles written in English that were published in peer-review journals were included.Review methodsData extracted from studies included authors, study aims, population, sample size and characteristics, methods, ICU treatments, ICU memory definitions, data collection strategies and findings. Study quality assessment was based on elements of the Critical Appraisal Skills Programme using the checklists developed for randomised controlled trials and cohort studies.ResultsFourteen articles containing data from 13 studies met the inclusion criteria and were included in the final analysis. The relatively limited evidence about the association between elements of ICU treatment and memories after ICU discharge suggest that deep sedation, corticoids and administration of glucose 50% due to hypoglycaemia contribute to the development of delusional memories and amnesia of ICU stay.ConclusionsThe body of literature on the relationship between elements of ICU treatment and memories after ICU discharge is small and at its early stages. Larger studies using rigorous study design are needed in order to evaluate the effects of different elements of ICU treatment on the development of memories of the ICU during recovery.

Bakgrund: I Sverige insjuknar ett barn i cancer nästan varje dag. Sveriges cancervård är världsledande och överlevnadsprocenten ligger på 85%. I låg- och medelinkomstländer där majoriteten av världens barn lever är överlevnaden inte lika hög. Anledningen till att överlevnaden i Sverige är hög beror främst på kunskap inom området samt bra förutsättningar gällande behandlingar. Syfte: Syftet med denna litteraturstudie var att undersöka föräldrars upplevelser av att ha ett barn med cancer. Metod: Till studien användes en kvalitativ design där 13 stycken vetenskapliga artiklar valdes ut som sedan analyserades genom en kvalitativ innehållsanalys med manifest ansats. Analysen resulterade i sex kategorier. Resultat: Studiens resultat visar att föräldrarna känner ett stort lidande relaterat till barnets sjukdom. Föräldrarna använde olika strategier för att klara av den svåra situationen. Något som hade stor betydelse för föräldrarnas välmående var stödet från omgivningen samt att de fått vara involvera i och blivit välinformerade om sjukdomsförloppet. Resultatet visar även att föräldrarna både hade positiva och negativa upplevelser från vården och vårdpersonalen. Det var många av familjerna som kände att efter lång tid på sjukhus var det svårt att hitta egna rutiner i hemmet. Samt att eftervården inte uppfyllde några av föräldrarnas behov. Slutsats: Föräldrarna upplever många olika känslor i samband med att deras barn får en cancerdiagnos. God kommunikation och anpassad information från vårdpersonalen är en god förutsättning för relationsskapande till föräldrarna. Relationsskapandet medför trygghet och tillit till vården som sedan föräldrarna överför till sina barn. Vidare forskning inom området med fokus på hur man som vårdpersonal bemöter föräldrar samt hur man stöttar dem krävs för att skapa bättre upplevelser.

Hjärtinfarkt är i dag en av de största orsakerna till funktionsnedsättning och död runt om i världen. Egenvård är en stor del av behandlingen efter en hjärtinfarkt och innebär att personen på egen hand eller med hjälp av andra utför vissa delar av sin behandling. Syftet med denna litteraturstudie var att beskriva personers upplevelser av att förändra sina levnadsvanor efter genomgången hjärtinfarkt. Studien gjordes med fokus på ett inifrånperspektiv och är baserad på elva artiklar som analyserats med kvalitativ innehållsanalys med manifest ansats. Analysen resulterade i fyra kategorier; att stöd från andra ger trygghet till att genomföra förändringar, att rädsla hämmar och bidrar till förändring, att vilja ta hand om sig själv och att hindras från att kunna ta hand om sig själv. Resultatet visar att personer som genomgått en hjärtinfarkt behöver motivation för att kunna förändra sina levnadsvanor. Personerna har ett stort behov av information och kunskap för att kunna förstå sambandet mellan sjukdom och behovet av egenvård. Genom att personen har stöd ifrån ett socialt nätverk och från sjukvården upplever personen en trygghet i att genomföra och motiveras till att behålla de nya levnadsvanorna. Sjukvården bör fokusera på att ge en personcentrerad omvårdnad och kontinuerligt utvärdera hur personens motivation, behov och kunskap förändras över tid.

Bakgrund: Träning under en graviditet är viktigt både ur ett fysiologiskt samt psykologiskt perspektiv. Bristande fysisk aktivitet är en stor riskfaktor för hälsan. Livshändelser såsom graviditet och förlossning kan utgöra en större risk för bristande fysisk aktivitet hos kvinnor. Gravida kvinnor rekommenderas att vara fysiskt aktiva minst 30 minuter per dag. Informationen kring fysisk aktivitet och träning är ofta bristfällig inom mödrahälsovården varför det efterlyses ett närmare samarbete mellan till exempel barnmorskor och fysioterapeuter. Genom att förbättra kvantiteten och kvaliteten på informationen angående fysisk aktivitet hos gravida finns det en möjlighet att korrigera felaktiga uppfattningar och på så sätt främja en god hälsa. Syfte: Syftet var att beskriva kvinnors egen uppfattning om fysisk aktivitet och träning under och efter en graviditet samt upplevelse av mottagen information från sjukvården angående ämnet. Metod: En kvalitativ intervjustudie genomfördes med fem kvinnor, vilka rekryterades via ett strategiskt urval. Därefter genomfördes en innehållsanalys av intervjuerna. Resultat: Analysen av intervjutexterna resulterade i en huvudkategori “Den gravida kroppen - individens eller sjukvårdens ansvar?”. Huvudkategorin innehöll följande kategorier “Kunskapsinhämtning - individens ansvar” samt “Aktivitetsnivå - individens val” med tillhörande underkategorier. Konklusion: Studien visade positiva upplevelser och uppfattningar av fysisk aktivitet och träning i samband med graviditeten. De intervjuade kvinnorna upplevde bristande information från sjukvården gällande detta ämne. De råd som kvinnorna hade fått från sjukvården upplevdes som osäkra och väldigt generella, därför fanns en önskan om att individanpassa råden.

Research suggests that team sports can constitute an arena for health promotion and encompass an important societal function. Despite this, many choose to leave the team sport context at a young age, whereas elite athletes form a group that has chosen to continue participating. The purpose of this study was to investigate elite athletes’ experiences of the team sport’s health promotion characteristics and which factors can contribute to the motivation to continue with sports participation. The research method was of a qualitative nature and the data collection consisted of interviews with focus groups. Twenty participants were recruited from four different sporting clubs, each in a different field of sport respectively. The data was analyzed using a manifest content analysis method, where four categories - “Something bigger’’, “Body and mind’’, “Professional conditions’’ and “The motivation of the game” - created the main theme “Elite team sport - to be driven together by something health promotive’’. The result shows that elite team sports can contribute with health promotive qualities, that together with the work of the sports clubs and the element of competition creates motivation for continuing sports participation. The conclusion is that health promotive qualities in elite team sports can constitute something bigger than just the sport itself and promote both mental and physical health. This effect, together with assistance from the sports club, as well as the element of the competition, constitute motivational factors for continued sports participation.  

Att gå från att vara en person till att bli en patient innebär att livet kan förändras. Sårbarhet, utsatthet, förlust av kontroll, rädsla för det okända och stress är vanligt förekommande känslor i samband med operation. Patienter har beskrivit att de upplever operation som att balansera mellan att vara delaktig och osynlig, inte vilja störa men samtidigt bli sedd, samt att känna sig ensam, övergiven och exponerad. Som blivande operationssjuksköterskor är det viktigt att ha kunskap om patientens upplevelse, samt reflektera över det egna arbetet. Flertalet studier har fokuserat på patientens upplevelse och visar att personalens bemötande och kommunikation är avgörande för patientens upplevelse. Studies syfte var att kartlägga operationssjuksköterskors uppfattningar av operation med vaken patient. Studien var en tvärsnittsstudie med kvantitativ ansats, och tillämpade enkätformulär som datainsamlingsmetod med bekvämlighetsurval. Analysen genomfördes med deskriptiv analys, samt hypotesprövning för att stärka resultatet. Resultatet presenterades med tabeller, grafer och text. Den öppna kvalitativa frågan sammanställdes i kategorier och presenterades med citat. Resultatet visade att operationssjuksköterskor uppfattade att vid en operation med vaken patient skedde förändringar av kommunikationen och bemötandet, samt att operationssalen uppfattades lugnare och mer harmonisk när musik spelades. Författarna rekommenderar fortsatta studier för djupare förståelse av operationssjuksköterskors uppfattningar av förändringar av kommunikationen och bemötandet vid operation med vaken patient, samt musikens påverkan. Resultatet från denna studie kan användas som reflektionsstöd dels hos arbetsgivaren och dels hos den enskilda operationspersonalen, samt som stöd vid handledning av studenter och nyutbildade operationssjuksköterskor. 

Objective

Differences in the content and distribution of body fat and ectopic lipids may be responsible for ethnic variations in metabolic disease susceptibility. The aim of this study was to examine the ethnic distribution of body fat in two separate UK‐based populations.

Methods

Anthropometry and body composition were assessed in two separate UK cohorts: the Hammersmith cohort and the UK Biobank, both comprising individuals of South Asian descent (SA), individuals of Afro‐Caribbean descent (AC), and individuals of European descent (EUR). Regional adipose tissue stores and liver fat were measured by magnetic resonance techniques.

Results

The Hammersmith cohort (n = 747) had a mean (SD) age of 41.1 (14.5) years (EUR: 374 men, 240 women; SA: 68 men, 22 women; AC: 14 men, 29 women), and the UK Biobank (n = 9,533) had a mean (SD) age of 55.5 (7.5) years (EUR: 4,483 men, 4,873 women; SA: 80 men, 43 women, AC: 31 men, 25 women). Following adjustment for age and BMI, no significant differences in visceral adipose tissue or liver fat were observed between SA and EUR individuals in the either cohort.

Conclusions

Our data, consistent across two independent UK‐based cohorts, present a limited number of ethnic differences in the distribution of body fat depots associated with metabolic disease. These results suggest that the ethnic variation in susceptibility to features of the metabolic syndrome may not arise from differences in body fat.

Inom ramen för denna artikel diskuterar vi såväl den psykosociala som den fysiska miljön i skolan. Vidare argumenterar vi för att skolans miljö är av betydelse för elevernas möjligheter att lära sig, likväl som för deras upplevelser av lärandesituationerna. Särskilt intressant blir då att lyssna till eleverna. Syftet med denna artikel är därför att synliggöra och diskutera elevers röster i förhållande till hur skolan kan bli den bästa platsen för lärande. Detta görs med utgångspunkt i forskningsprojektet ”Skolan suger” eller?, där drygt 200 elever i åldrarna 11–15 år deltog. Eleverna fick skriftligen reflektera över hur skolan ska bli en riktigt bra lärandemiljö. För att utveckla skolan till den bästa platsen för lärande uttryckte eleverna en önskan att kunna påverka sin lärandemiljö, att uppnå ömsesidighet och samspel, att kunna hantera tidsregleringen i skolan, samt att uppfylla behov för välbefinnande.

What can we do to improve our knowledge and understanding of school children health and well being? This question was raised when the ArctiChildren project started. The aim of this presentation is to share some methodological perspectives on research within schools. It is crucial to develop a number of different options of collaboration between researchers, teachers and students, as well as different possible methods. We will highlight the importance of developing collaboration between the researchers and the schools. We will also discuss projective methods, for example drawings, as one way to gain knowledge and understanding of schoolchildren's school experiences. Another method we will discuss is working on consulting basis with the staff in order to decrease bullying and harassment in school.

"Dammed taxi cab!" A twelve year old student wrote these words in the margins of a questionnaire in school concerning psychosocial well-being. Within this paper they will serve as a point of departure for the discussion. Can the messages found on the sides of the squares intended for an X in a questionnaire be considered non-messages? Or are these expressions indeed messages that are made silent and therefore can be considered silent messages? Then one might wonder what the meanings of the silent messages are that often occurs in questionnaires? Can, or maybe should, we take notice of these silent messages? According to Polanyi every human being has silent and unexpressed dimensions within themselves, which acknowledge situations where we recognise that we know more than we can explain. This is also stressed by Merleau-Ponty, who argued that something exists beyond what is said, and Bateson emphasised that a non-message is also a message - the silence tells us something. Within this paper we will highlight and discuss the significance of silent messages of communication in general, and especially in questionnaires.

'Dammed taxi cab' - a 12-year-old boy wrote these words in the margins of a questionnaire, and within this paper they will serve as a point of departure for the discussion of the use of questionnaires as a way to voice children's experiences. The overall aim of this paper is to enable understanding of and discuss the use of questionnaires as a way to voice children's experiences. An analysis in accordance with a life-world approach has provided the lens through which to explore messages that can occur in questionnaires. The key research questions that will be explored in an attempt to answer the overall aim are: (i) how can unanswered questions and notes in the margins of a questionnaire be understood? and (ii) why is a questionnaire not always completed, according to the intention of its creators? To develop an understanding of this we analysed a number of questionnaires with unanswered questions and notes in the margins using a life-world approach. During the analysis two themes emerged: silent messages and messages being silenced. Finally, we discuss the legitimacy of questionnaires in childhood research and possible implications for practice when using this method to give voice to children's experiences.

Understanding how much exercise is necessary to trigger stress-buffer effects is important in designing health interventions. At present, evidence suggests that there is a stressbuffering effect after 30 minutes of cycling at 60% of VO2peak. Purpose: The purpose of the study was to investigate whether 12 minutes of moderate physical activity contributes to an increase in the stress buffer effect. Methods: Data was collected using Google Forms with a total of 50 participants, ages 20-70, and was analysed with unpaired t-test using GraphPad Prism 8. Results: All participants experienced a stress-buffer effect. Women experienced a greater reduction in grief compared with men (p=0.0275),  an increase in security (p=0.0053) and a decrease in fatigue (p=0.0291). In addition, women experienced a decrease in physical weakness while men experienced an increase (p=0.0096). Participants whose main occupation was work experienced, to a greater extent, an reduced stress compared to participants whose main occupation was study (p=0.0147). Conclusions: This paper underscores the relevance of using 12 minutes of moderate physical activity as a stress-buffering and health promoting activity. More information is needed to provide insight into moderate physical activity as a physiological stress regulator. Furthermore, more experimental studies are needed to conclude if 12 minutes of moderate physical activity causes reduceduction of secretion of stress hormones.

Bakgrund: hjärtsvikt är ett stort folkhälsoproblem som har ett progressivt tillstånd och hög mortalitet. För närvarande finns det inte något botemedel mot hjärtsvikt, och dålig prognos har förknippats med dålig hälsorelaterad livskvalitet hos hjärtsviktpatienter. Syfte: Syftet med litteraturstudien var att systematiskt sammanställa befintlig kunskap om hälsofrämjande interventioner som ökar livskvaliteten för personer med kronisk hjärtsvikt. Metod: Studien är en litteraturstudie, där systematisk sökning genomförts i databaser; PubMed, Cinahl, samt artikelsökning i Ltu:s databas. Sökord som användes var Chronic Heart Failure, Nurse Intervention, Nonpharmacological Intervention, Quality of Life och Health. Inklusionskriterierna var interventioner för patienter med Kronisk hjärtsvikt, artiklar från fem år tillbaka (2013–2018), ytterligare avgränsning som gjordes var peer reviewed artiklar som publicerats på engelska. Resultat: litteraturstudien grundar sig på 13 vetenskapliga artiklar med både kvantitativa och kvalitativa ansatser, med olika hälsofrämjande interventioner. Samtliga interventioner visade ha en god effekt, som lindrade symtom och därigenom ökade livskvalité. Slutsats: Många personer som lever med hjärtsvikt kan på grund av sina symtom inte utföra dagliga vårdaktiviteter vilket påverkar personens fysiska och känslomässiga funktion negativt och leder slutligen till signifikant försämring av individens livskvalité. Det är dock möjligt att leva ett tillfredställande liv med god livskvalité genom att ta till olika hälsofrämjande icke farmakologiska interventioner.

The primary aim of pharmaceutical materials engineering is the successful formulation and process development of pharmaceutical products. The diversity of solid forms available offers attractive opportunities for tailoring material properties. In this context, pharmaceutical cocrystals, multicomponent crystalline materials with definite stoichiometries often stabilised by hydrogen bonding, have recently emerged as interesting alternative solid forms with potential for improving the physical and biopharmaceutical properties of a drug substance. There are, however, gaps in our understanding of the screening, scale-up and formulation operations required for effective use of cocrystals in drug product development. The objective of this thesis was to improve fundamental understanding of the formation mechanisms, solution behaviour and solid-state properties of pharmaceutical cocrystals. The solution chemistry and solubility behaviour of a diverse set of cocrystals were studied. It was found that the thermodynamic stability regions of the cocrystals and their components were defined by the phase solubility diagrams. Spray drying was introduced as a new method of preparing cocrystals; the formation mechanisms are illustrated. The cocrystals were more soluble than the respective drugs alone and the solubility-pH profiles were able to be predicted by mathematical models using a eutectic point determination approach. The cocrystal solubility was pH-dependent and could be engineered by the choice of coformers; this is valuable information for designing robust formulations. The solubility advantage of cocrystals was retained by the use of excipients that imparted kinetic and thermodynamic stability. The retention of drug-coformer association in processed cocrystals has been revealed, introducing a novel concept with potential implications for solid dosage form development. The final study demonstrated that the structure of the crystals and the particle engineering processes affected the solidstate and bulk particle properties of the cocrystals.This thesis contributes to the field of pharmaceutical science by advancing our understanding of crystallization processes and formulation development, thus enabling pharmaceutical cocrystals into drug products.

Capturing solubility advantages of cocrystals is of great interest, and thus to understand the mechanism by which different excipients could maintain the supersaturation generated by cocrystals at the course of absorption in aqueous media is essential. To achieve this aim, the impact of different excipients on dissolution behavior of indomethacin-saccharin (IND-SAC) were monitored by measuring the concentrations of cocrystal components in the absence and presence of various concentration of excipients by HPLC, and solid phases were analyzed by differential scanning calorimetry after each experiment and the potential of Raman spectroscopy for monitoring phase transformations in situ was tested. No dissolution advantage was offered by cocrystals in the absence of any solution additive. The polymer and surfactant used in the study increased the solubility of IND but not SAC. This differential solubilization effect is believed to have stabilized the cocrystals for a relevant period for the absorption to take place. This could be attributed to either decreased gap between supersaturation and saturation of the drug or drug interaction with the additives. Understanding the effects of excipients type and concentration on the transformation profile is vital for designing enabling formulations for cocrystals. The eutectic constant may be useful in selecting excipients for stabilizing cocrystals.

Computational data mining is of interest in the pharmaceutical arena for the analysis of massive amounts of data and to assist in the management and utilization of the data. In this study, a data mining approach was used to predict the miscibility of a drug and several excipients, using Hansen solubility parameters (HSPs) as the data set. The K-means clustering algorithm was applied to predict the miscibility of indomethacin with a set of more than 30 compounds based on their partial solubility parameters [dispersion forces , polar forces and hydrogen bonding ]. The miscibility of the compounds was determined experimentally, using differential scanning calorimetry (DSC), in a separate study. The results of the K-means algorithm and DSC were compared to evaluate the K-means clustering prediction performance using the HSPs three-dimensional parameters, the two-dimensional parameters such as volume-dependent solubility and hydrogen bonding , and selected single (one-dimensional) parameters. Using HSPs, the prediction of miscibility by the K-means algorithm correlated well with the DSC results, with an overall accuracy of 94%. The prediction accuracy was the same (94%) when the two-dimensional parameters or the hydrogen-bonding (one-dimensional) parameter were used. The hydrogen-bonding parameter was thus a determining factor in predicting miscibility in such set of compounds, whereas the dispersive and polar parameters had only a weak correlation. The results show that data mining approach is a valuable tool for predicting drug–excipient miscibility because it is easy to use, is time and cost-effective, and is material sparing.

The objective of this study was to use spray drying to prepare mucoadhesive dry powders of the antimigraine drug, zolmitriptan, in combination with the natural polymer, chitosan, for nasal administration. The effect of type, molecular weight, and proportion of chitosan on the powder and particle characteristics was also studied. Solutions containing different proportions of chitosans were prepared and spray dried. The chemical stability and content of the drug were determined by HPLC. The morphology and size range of the microparticles were also determined. Solid-state analysis was undertaken using thermal methods (DSC/MDSC and TGA), powder X-ray diffraction (PXRD), and Fourier transform infra-red spectroscopy (FT-IR). The drug release profiles were investigated and the time required to reach maximum solution concentrations (Tmax) was used for comparison. The drug was chemically stable, with a 93-105% loading in the microparticles. The microparticles were spherical with a narrow size distribution, irrespective of the formulation. Phase separation was observed for formulations containing less than 90% (w/w) chitosan, irrespective of the type. In contrast, in the formulation containing 90% (w/w) chitosan, the drug was molecularly dispersed. FT-IR studies showed that the bands corresponding to intermolecular hydrogen bonding were broader and more diffuse when zolmitriptan was amorphous. The formation of a hydrogen bond between drug and chitosans was also observed. Tmax increased as the proportion of chitosan decreased, and was proportional to the molecular weight of the chitosan in the formulation containing 90% (w/w) chitosan. Spray drying is a suitable technique for making mucoadhesive dry powders of zolmitriptan and chitosan for nasal application. The dispersion and release of the drug was affected by the properties and composition of the chitosan.

The objective of this study was to screen and prepare cocrystals of the poorly soluble drug nitrofurantoin (NTF) with the aim of increasing its solubility. Screening for cocrystals of NTF using 47 coformers was performed by high-throughput (HT) screening using liquid assisted grinding (LAG) methods. Raman spectroscopy and powder X-ray diffraction (PXRD) were used as the primary analytical tools to identify the new crystalline solid forms. Manual LAG and reaction crystallization (RC) experiments were carried out to confirm and scale-up the hits. Seven hits were confirmed to be cocrystals. The cocrystals were characterized by PXRD, Raman and IR spectroscopy, thermal analysis (DSC and TGA) and liquid-state NMR or elemental analysis. The solution stability of the scaled-up cocrystals in water was tested by slurrying the cocrystals at 25 °C for one week. NTF forms cocrystals with a 1:1 stoichiometric ratio with urea (1), 4-hydroxybenzoic acid (2), nicotinamide (3), citric acid (4), l-proline (5) and vanillic acid (6). In addition, NTF forms a 1:2 cocrystal with vanillin (7). All but one of the NTF cocrystals transformed (dissociated) in water, resulting in NTF hydrate crystalline material or NTF hydrate plus the coformer, which indicates that the transforming cocrystals have a higher solubility than the NTF hydrate under these conditions. The crystal structures of 1:1 NTF-citric acid (4) and 1:2 NTF-vanillin (7) were solved by single-crystal X-ray diffraction. The crystal structures of these two cocrystals were analyzed in terms of their supramolecular synthons.

The aim of this work was to study the crystal structures of 1:1 and 2:1 urea-succinic acid (U-SA) cocrystals and to investigate the role of solution chemistry in the formation and stability of different stoichiometric cocrystals. The structural diversity of other urea-dicarboxylic acid cocrystals is also discussed. The 1:1 U-SA cocrystal was stabilized by an acid-amide heterosynthon while acid-amide heterosynthons and amide-amide homosynthons stabilized the 2:1 cocrystals. The hydrogen bonding motifs in 1:1 and 2:1 U-SA cocrystals were consistent with other urea-dicarboxylic acid systems with similar stoichiometries. The 1:1 cocrystals were transformed to 2:1 cocrystals upon slurrying in various solvents at 25 °C. The phase solubility diagram was used to define the stability regions of different solid phases in 2-propanol at 25 °C. While no phase stability region for 1:1 cocrystal could be found, the stable regions for the 2:1 cocrystals and their pure components were defined by eutectic points. The solubility of the 2:1 cocrystals was dependent on the concentration of the ligand in the solution and explained by the solubility product and 1:1 solution complexation. The mathematical models predicting the solubility of the 2:1 cocrystals were evaluated and found to fit the experimental data

The purpose of this work was to characterize theophylline (THF) cocrystals prepared by spray drying in terms of the physicochemical properties and inhalation performance when aerosolized from a dry powder inhaler. Cocrystals of theophylline with urea (THF-URE), saccharin (THF-SAC) and nicotinamide (THF-NIC) were prepared by spray drying. Milled THF and THF-SAC cocrystals were also used for comparison. The physical purity, particle size, particle morphology and surface energy of the materials were determined. The in vitro aerosol performance of the spray-dried cocrystals, drug-alone and a drug-carrier aerosol, was assessed. The spray-dried particles had different size distributions, morphologies and surface energies. The milled samples had higher surface energy than those prepared by spray drying. Good agreement was observed between multi-stage liquid impinger and next-generation impactor in terms of assessing spray-dried THF particles. The fine particle fractions of both formulations were similar for THF, but drug-alone formulations outperformed drug-carrier formulations for the THF cocrystals. The aerosolization performance of different THF cocrystals was within the following rank order as obtained from both drug-alone and drug-carrier formulations: THF-NIC > THF-URE > THF-SAC. It was proposed that micromeritic properties dominate over particle surface energy in terms of determining the aerosol performance of THF cocrystals. Spray drying could be a potential technique for preparing cocrystals with modified physical properties.

Cocrystals constitute an important class of pharmaceutical solids for their remarkable ability to modulate solubility and pH dependence of water insoluble drugs. Here we show how cocrystals of indomethacin-saccharin (IND-SAC) and carbamazepine-saccharin (CBZ-SAC) enhance solubility and impart a pH-sensitivity different from that of the drugs. IND-SAC exhibited solubilities 13 to 65 times higher than IND at pH values of 1 to 3, whereas CBZ-SAC exhibited a 2 to 10 times higher solubility than CBZ dihydrate. Cocrystal solubility dependence on pH predicted from mathematical models using cocrystal K(sp), and cocrystal component K(a) values, was in excellent agreement with experimental measurements. The cocrystal solubility increase relative to drug was predicted to reach a limiting value for a cocrystal with two acidic components. This limiting value is determined by the ionization constants of cocrystal components. Eutectic constants are shown to be meaningful indicators of cocrystal solubility and its pH dependence. The two contributions to solubility, cocrystal lattice and solvation, were evaluated by thermal and solubility determinations. The results show that solvation is the main barrier for the aqueous solubility of these drugs and their cocrystals, which are orders of magnitude higher than their lattice barriers. Cocrystal increase in solubility is thus a result of decreasing the solvation barrier compared to that of the drug. This work demonstrates the favorable properties of cocrystals and strategies that facilitate their meaningful characterization.

The main objective of this study was to investigate the solubility behavior and solution chemistry of indomethacin-saccharin (IND-SAC) cocrystals in organic media. We also evaluated previously proposed models of cocrystal solubility in organic solvents. In addition, the solubility behavior of IND-SAC cocrystals was compared with that of indomethacin-nicotinamide (IND-NIC) cocrystals using the eutectic constant approach. Phase solubility diagrams of IND-SAC cocrystals in various solvents were generated and the transition concentrations, at which drug and cocrystals are in equilibrium with the solvents, were determined. The solubility of IND-SAC cocrystals was explained by the solubility product and solution complexation. The tested models were found to fit the experimental data and to adequately explain the solubility behavior of the cocrystals. The solution complexation of IND and SAC is negligible in ethyl acetate and low in methanol and ethanol. The IND-NIC cocrystals were more soluble than the IND-SAC cocrystals in all the solvents studied. The eutectic constants predicted both the solubility and the stability of the cocrystals. Understanding the solubility behavior and solution chemistry of cocrystals has important implications for the screening, scale-up, and formulation development of this solid form. Further, the determination of eutectic constants is a simple and resource sparing means of obtaining key information on cocrystal stability and solution behavior

Spray drying is a widely used technique for material processing and scale-up. The cocrystals formation by spray drying is studied. In contrast to solvent evaporation method, spray drying of stiochiometric solutions of incongruently saturating cocrystals had generated pure cocrystals. The formation phenomena in spray drying could be kinetically controlled or mediated by glassy state.

Spray drying is a well established technique for material processing and scale-up. This study investigated the formation of pharmaceutical cocrystals by spray drying. The cocrystal formation mechanisms in spray-drying and solution methods, based on triangular phase diagrams, are discussed. The solvent evaporation of stoichiometric solutions of incongruently saturating cocrystals resulted in a mixture of phases, as dictated by the thermodynamic phase diagram. In contrast, spray drying of similar solutions of incongruently saturating systems generated pure cocrystals. It is thus suggested that the formation of cocrystals by spray drying could be kinetically controlled and/or mediated by the glassy state of the material.