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Karlsson, S. A., Jacobsson, I., Danell Boman, M., Hakkarainen, K. M., Lövborg, H., Hägg, S. & Jönsson, A. K. (2015). The impact of a changed legislation on reporting of adverse drug reactions in Sweden, with focus on nurses reporting. European Journal of Clinical Pharmacology, 71(5), 631-636
Open this publication in new window or tab >>The impact of a changed legislation on reporting of adverse drug reactions in Sweden, with focus on nurses reporting
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2015 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 71, no 5, p. 631-636Article in journal (Refereed) Published
Abstract [en]

In March 2007, a legislative amendment was issued in Sweden compelling nurses to report all suspected adverse drug reactions (ADRs) to the national pharmacovigilance system. The aims of this study were to describe the status of ADR reporting, before and after the implementation of the legislative changes, and to describe the general characteristics of suspected ADRs reported by nurses. The Swedish pharmacovigilance system during the study period constituted six regional centres responsible for the handling of all spontaneous ADR reports within their region. In this study, we identified all individual ADR reports from 2005 and 2010, analysed in depth the ADR reports from two regional centres and collated information about the reporter and the nature of the reported ADR. From the two regional centres, a total of 898 and 1074 reports were submitted in 2005 and 2010 respectively. Nurses submitted 31 % (275 reports) of the reports in 2005 and 24 % (260 reports) in 2010. Nurses reporting of serious ADRs was 3 % (seven reports) in 2005 and 7 % (17 reports) in 2010 with reporting of unlabelled ADRs at 4 % (11 reports) in 2005 and 17 % (45 reports) in 2010. Most of the serious and/or unlabelled reactions were related to vaccine administration (14 reports in 2005 and 36 reports in 2010). The overall ADR reporting by nurses did not appear to increase after the change in reporting legislation. The proportion of serious and/or unlabelled ADRs reported by nurses did however appear to increase during the same period. Taken together, our data suggests that further pro-active measures should be considered in order to involve nurses in the reporting of suspected ADRs.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keywords
Adverse drug reaction; Spontaneous reporting; Pharmacovigilance; Nurses
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-118037 (URN)10.1007/s00228-015-1839-6 (DOI)000353059900013 ()25845655 (PubMedID)
Available from: 2015-05-21 Created: 2015-05-20 Last updated: 2017-12-04
Lövborg, H., Holmlund, M. & Hägg, S. (2014). Medication errors related to transdermal opioid patches: lessons from a regional incident reporting system. BMC Pharmacology & Toxicology, 15, Article ID 31.
Open this publication in new window or tab >>Medication errors related to transdermal opioid patches: lessons from a regional incident reporting system
2014 (English)In: BMC Pharmacology & Toxicology, E-ISSN 2050-6511, Vol. 15, article id 31Article in journal (Refereed) Published
Abstract [en]

Objective: A few cases of adverse reactions linked to erroneous use of transdermal opioid patches have been reported in the literature. The aim of this study was to describe and characterize medication errors (MEs) associated with use of transdermal fentanyl and buprenorphine. Methods: All events concerning transdermal opioid patches reported between 2004 and 2011 to a regional incident reporting system and assessed as MEs were scrutinized and characterized. MEs were defined as "a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient". Results: In the study 151 MEs were identified. The three most common error types were wrong administration time 67 (44%), wrong dose 34 (23%), and omission of dose 20 (13%). Of all MEs, 118 (78%) occurred in the administration stage of the medication process. Harm was reported in 26 (17%) of the included cases, of which 2 (1%) were regarded as serious harm (nausea/vomiting and respiratory depression). Pain was the most common adverse reaction reported. Conclusions: Of the reported MEs related to transdermal fentanyl and buprenorphine, most occurred during administration. Improved routines to ascertain correct and timely administration and educational interventions to reduce MEs for these drugs are warranted.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Transdermal patch; Opioids; Fentanyl; Buprenorphine; Medication errors; Incident reporting system
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108926 (URN)10.1186/2050-6511-15-31 (DOI)000337473900002 ()
Available from: 2014-07-15 Created: 2014-07-13 Last updated: 2018-10-01
Lövborg, H., Jönsson, A. K. & Hägg, S. (2012). A fatal outcome after unintentional overdosing of rivastigmine patches. Current drug safety, 7(1), 30-32
Open this publication in new window or tab >>A fatal outcome after unintentional overdosing of rivastigmine patches
2012 (English)In: Current drug safety, ISSN 2212-3911, Vol. 7, no 1, p. 30-32Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Rivastigmine is an acetylcholine esterase inhibitor used in the treatment of dementia. Patches with rivastigmine for transdermal delivery have been used to increase compliance and to reduce side effects.

CASE REPORT: We describe an 87-year old male with dementia treated with multiple rivastigmine patches (Exelon 9,5 mg/24 h) who developed nausea, vomiting and renal failure with disturbed electrolytes resulting in death. The symptoms occurred after six rivastigmine patches had concomitantly been erroneously applied by health care personnel on two consecutive days. The terminal cause of death was considered to be uremia from an acute tubular necrosis that was assessed as a result of dehydration through vomiting. The rivastigmine intoxication was assessed as having caused or contributed to the dehydrated condition. The medication error occurred at least partly due to ambiguous labeling. The clinical signs were not initially recognized as adverse effects of rivastigmine.

DISCUSSION: The presented case is a description of a rivastigmine overdose due to a medication error involving patches. This case indicates the importance of clear and unambiguous instructions to avoid administration errors with patches and to be vigilant to adverse drug reactions for early detection and correction of drug administration errors. In particular, instructions clearly indicating that only one patch should be applied at a time are important.

Keywords
Adverse drug reactions; medication errors; overdose; rivastigmine; transdermal drug delivery
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80816 (URN)10.2174/157488612800492717 (DOI)22663954 (PubMedID)
Available from: 2012-08-30 Created: 2012-08-30 Last updated: 2014-10-24
Lövborg, H., Ring Eriksson, L., Jonsson, A. K., Bradley, T. & Hägg, S. (2012). A prospective analysis of the preventability of adverse drug reactions reported in Sweden. European Journal of Clinical Pharmacology, 68(8), 1183-1189
Open this publication in new window or tab >>A prospective analysis of the preventability of adverse drug reactions reported in Sweden
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2012 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 68, no 8, p. 1183-1189Article in journal (Refereed) Published
Abstract [en]

Adverse drug reactions (ADRs) are a major patient safety issue, and a substantial proportion of ADRs are, in fact, preventable. The aim of this study was to describe the proportion and pattern of preventable ADRs in spontaneously reported suspected ADRs and to study the feasibility of using data from an ADR reporting system for this purpose. less thanbrgreater than less thanbrgreater thanAll reports of ADRs, except those in which a vaccine was the suspected drug, submitted to the regional pharmacovigilance center of southeastern Sweden between 2008 and 2009 were analyzed. Causality between the suspected ADR and the medication was assessed using the World Health Organization (WHO) criteria, and preventability was assessed using Hallas criteria. less thanbrgreater than less thanbrgreater thanDuring the study period, 1,290 ADRs were received and 1,255 were classified as having at least a possible causality between a reaction and a drug. Of these, 172 (14%) ADRs were considered preventable, 35 (20%) were classified as definitely preventable, and 137 (80%) as possibly preventable. Of all preventable ADRs, 96 (56%) were related to prescribing, 35 (20%) to administration, and 41 (24%) to clinical and laboratory monitoring of treatment. Warfarin, oxycodone, and ioversol were the most common drugs with preventable ADRs. less thanbrgreater than less thanbrgreater thanThis study found that a substantial part of reported ADRs are preventable. Most of these are related to drug prescription, suggesting that interventions aiming to reduce preventable ADRs should focus on this process. Moreover, systems for ADR reporting may be useful in the mission of reducing the unsafe use of drugs.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2012
Keywords
Adverse drug reaction, Preventability, Spontaneous reporting system
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79979 (URN)10.1007/s00228-012-1237-2 (DOI)000306426800007 ()
Note

Funding Agencies|County Council of Ostergotland||Swedish Medical Product Agency||

Available from: 2012-08-17 Created: 2012-08-17 Last updated: 2017-12-07Bibliographically approved
Ring Eriksson, L., Hägg, S., Lövborg, H. & Bradley, T. (2011). Drug Related Morbidity among Patients with Complex Health Care Needs Visiting an Emergency Room - A Pilot Study in PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, vol 20, issue , pp S330-S331. In: PHARMACOEPIDEMIOLOGY AND DRUG SAFETY (pp. S330-S331). John Wiley and Sons, 20
Open this publication in new window or tab >>Drug Related Morbidity among Patients with Complex Health Care Needs Visiting an Emergency Room - A Pilot Study in PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, vol 20, issue , pp S330-S331
2011 (English)In: PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, John Wiley and Sons , 2011, Vol. 20, p. S330-S331Conference paper, Published paper (Refereed)
Abstract [en]

n/a

Place, publisher, year, edition, pages
John Wiley and Sons, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-71088 (URN)000294946600732 ()
Available from: 2011-09-30 Created: 2011-09-30 Last updated: 2013-09-10
Rickardson, L., Wickström, M., Larsson, R. & Lövborg, H. (2007). Image-based screening for the identification of novel proteasome inhibitors.. Journal of Biomolecular Screening, 12(2), 203-10
Open this publication in new window or tab >>Image-based screening for the identification of novel proteasome inhibitors.
2007 (English)In: Journal of Biomolecular Screening, ISSN 1087-0571, E-ISSN 1552-454X, Vol. 12, no 2, p. 203-10Article in journal (Refereed) Published
Abstract [en]

The proteasome is a new, interesting target in cancer drug therapy, and the proteasome inhibitor bortezomib has shown an effect in myeloma patients. It is of interest to efficiently discover and evaluate new proteasome inhibitors. The authors describe the development of an image-based screening assay for the identification of compounds with proteasome-inhibiting activity. The stably transfected human embryo kidney cell line HEK 293 ZsGreen Proteasome Sensor Cell Line expressing the ZsProSensor-1 fusion protein was used for screening and evaluation of proteasome inhibitors. Inhibition of the proteasome leads to accumulation of the green fluorescent protein ZsGreen, which is measured in the ArrayScan High Content Screening system, in which cell morphology is studied simultaneously. When screening the LOPAC(1280) substance library, several compounds with effect on the proteasome were found; among the hits were disulfiram and ammonium pyrrolidinedithiocarbamate (PDTC). Cytotoxic analysis of disulfiram and PDTC showed that the compounds induced cytotoxicity in the myeloma cell line RPMI 8226. The average Z' value for the assay was 0.66. The results indicate that the assay rapidly identifies new proteasome-inhibiting substances, and it will be further used as a tool for image-based screening of other chemically diverse compound libraries.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-69408 (URN)10.1177/1087057106297115 (DOI)17208922 (PubMedID)
Available from: 2011-06-27 Created: 2011-06-27 Last updated: 2017-12-11
Wickstrom, M., Johnsen, J., Ponthan, F., Segerstrom, L., Sveinbjornsson, B., Lindskog, M., . . . Gullbo, J. (2007). The novel melphalan prodrug J1 inhibits neuroblastoma growth in vitro and in vivo. Molecular Cancer Therapeutics, 6(9), 2409-2417
Open this publication in new window or tab >>The novel melphalan prodrug J1 inhibits neuroblastoma growth in vitro and in vivo
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2007 (English)In: Molecular Cancer Therapeutics, ISSN 1535-7163, E-ISSN 1538-8514, Vol. 6, no 9, p. 2409-2417Article in journal (Refereed) Published
Abstract [en]

Neuroblastoma is the most common extracranial solid tumor of childhood. The activity of J1 (L-melphalanyl-p-L-fluorophenylalanine ethyl ester), an enzymatically activated melphalan prodrug, was evaluated in neuroblastoma models in vitro and in vivo. Seven neuroblastoma cell lines with various levels of drug resistance were screened for cytotoxicity of J1 alone or in combination with standard cytotoxic drugs, using a fluorometric cytotoxicity assay. J1 displayed high cytotoxic activity in vitro against all neuroblastoma cell lines, with IC50 values in the submicromolar range, significantly more potent than melphalan. The cytotoxicity of J1, but not melphalan, could be significantly inhibited by the aminopeptidase inhibitor bestatin. J1 induced caspase-3 cleavage and apoptotic morphology, had additive effects in combination with doxorubicin, cyclophosphamide, carboplatin, and vincristine, and synergistically killed otherwise drug-resistant cells when combined with etoposide. Athymic rats and mice carrying neuroblastoma xenografts [SHSY5Y, SK-N-BE(2)] were treated with equimolar doses of melphalan, J1, or no drug, and effects on tumor growth and tissue morphology were analyzed. Tumor growth in vivo was significantly inhibited by J1 compared with untreated controls. Compared with melphalan, J1 more effectively inhibited the growth of mice with SH-SY5Y xenografts, was associated with higher caspase-3 activation, fewer proliferating tumor cells, and significantly decreased mean vascular density. In conclusion, the melphalan prodrug J1 is highly active in models of neuroblastoma in vitro and in vivo, encouraging further clinical development in this patient group. Copyright © 2007 American Association for Cancer Research.

National Category
Natural Sciences
Identifiers
urn:nbn:se:liu:diva-48688 (URN)10.1158/1535-7163.MCT-07-0156 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5371-3827

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