| 1. |
- Fritzell, Peter, et al.
(författare)
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Bacteria : back pain, leg pain and Modic sign—a surgical multicentre comparative study
- 2019
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Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 28:12, s. 2981-2989
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence.Methods: Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33–49) and 20 control patients with scoliosis (median age 17, IQR 15–20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes.Results: No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated.Conclusions: Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned.
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| 2. |
- Hägg, Anette, et al.
(författare)
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Need for strategic rightsourcing decision model : Case studies at ABB and Volvo
- 2004
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Ingår i: Proceedings of the TMCE 2004. - 9059660188 ; , s. 1033-1042
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Konferensbidrag (refereegranskat)abstract
- Companies of today act on a global competitive market. This dynamic business environment requires operational efficiency and capabilities to produce and develop products and services required by the market at the necessary rate of change. To achieve this many companies focus on core competencies, moving the rest to external suppliers. The trend has therefore turned from producing internally to buying from external suppliers. The objective in this paper is to identify critical parameters, which affects (or are affected) by the make or buy decision, based on the two case studies. This paper is based upon a literature overview and two case studies conducted at Volvo and ABB in Sweden. Both companies have out-sourced different components. Some of the parameters found in the case studies are; competitive priorities, resources, the logistic cost, core competencies, the feed-back loop and long time survival. The case study shows that not all outsourcing cases were such a success as expected, indicating the need for a "Rightsourcing model".
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| 3. |
- Hägg, Maria, et al.
(författare)
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EGF and dextran-conjugated EGF induces differential phosphorylation of the EGF receptor
- 2002
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Ingår i: International Journal of Molecular Medicine. - 1107-3756 .- 1791-244X. ; 10:5, s. 655-659
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Tidskriftsartikel (refereegranskat)abstract
- Dextran-conjugated EGF (EGF-dextran) has a potential use for targeted radionuclide therapy of tumors that overexpress the epidermal growth factor receptor (EGFR). There are plans to treat both bladder carcinomas and malignant gliomas with local injections of radiolabeled EGF-dextran since these tumors often express high levels of EGFR. In this report we show that EGF and EGF-dextran differentially activate the EGFR. In the human glioma cell line U-343, activation of the serine/threonine kinases Erk and Akt is identical upon stimulation with EGF or EGF-dextran. However, the effect on phospholipase Cgamma1 (PLCgamma1) phosphorylation differs. In cells stimulated with EGF-dextran, the PLCgamma1 phosphorylation is lower than in cells stimulated with EGF. This observation could be explained by the fact that the PLCgamma1 association sites in the EGFR, tyrosine residues 992 and 1173, were phosphorylated to a lower degree when the receptor was stimulated with EGF-dextran as compared to with EGF.
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| 6. |
- Nordén-Hägg, Annika, et al.
(författare)
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Culture at work in Swedish pharmacies: Safety, stress, and dispensing errors
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Relationships between domains of safety culture and medical errors have been established in health care. Such an association could also be expected between safety culture domains and dispensing errors at pharmacies. The relationship has however never been studied. Methods: A cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. The pharmacies were at the time of the study organised by the National Corporation of Pharmacies. All staff listed as employed in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to examine the relationship between dimensions of pharmacy climate and dispensing errors. Results: Significant relationships between SAQ dimensions safety climate, teamwork climate, job satisfaction, and stress recognition were found, when regressed onto dispensing errors. These relationships disappeared after controlling for respondent and pharmacy demographic variables. When controlling for demographic variables, only Stress Recognition was still associated with dispensing errors. Conclusion: This study replicated previous work linking safety to errors, but went one step further and controlled for a variety of demographic variables. After controlling these variables, the relationship between safety climate and dispensing errors was rendered insignificant, while the relationship to stress recognition remained significant. The directional arrow between stress recognition and dispensing errors could not be established, but implications for future research into incident reporting, safety culture, and risk management are discussed.
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| 7. |
- Nordén-Hägg, Annika, et al.
(författare)
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Experiences of a nationwide web-based system : reporting dispensing errors in Swedish pharmacies
- 2012
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Ingår i: International Journal of Pharmacy Practice. - : Oxford University Press (OUP). - 2042-7174 .- 0961-7671. ; 20:1, s. 25-32
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To design and evaluate a national web-based dispensing error reporting system for all Swedish pharmacies, replacing the currently used paper-based system.METHODS: A working group designed the new system. The number of reports before (1999-2003) and after (2004-2005) introduction was studied in a descriptive analysis. The completeness of reports was evaluated through the study of 100 randomly selected reports from the third quarter of 2003 and 2004 from each system. Evaluation was done by chi-square analysis; P>0.05. Perceptions on introduction were collected in semi-structured interviews (working group and one assistant) and subjected to descriptive analysis.KEY FINDINGS: Reported error rate per 100,000 dispensed items was 12.9 pre- and 21.4 post implementation. Completeness-analysis revealed that information was more comprehensively reported in the new system. A significant difference existed in the extent to which incidents were described as well as details provided of the medicine and the patient. According to the interviewees, users initially found the web-based system difficult to handle. It took more than 6 months to change this perception.CONCLUSIONS: Introducing a web-based system for reporting dispensing errors had an impact on quantity of reports and completeness. Time and patience was needed to implement the changes.
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| 8. |
- Nordén Hägg, Annika, et al.
(författare)
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Exploring the relationship between safety culture and reported dispensing errors in a large sample of Swedish community pharmacies
- 2012
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Ingår i: BMC pharmacology & toxicology. - : Springer Science and Business Media LLC. - 2050-6511. ; 13, s. 4-
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Tidskriftsartikel (refereegranskat)abstract
- The potential for unsafe acts to result in harm to patients is constant risks to be managed in any health care delivery system including pharmacies. The number of reported errors is influenced by a various elements including safety culture. The aim of this study is to investigate a possible relationship between reported dispensing errors and safety culture, taking into account demographic and pharmacy variables, in Swedish community pharmacies. A cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. All staff in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to further examine the relationship between the variables and dispensing errors. The first analysis demonstrated a number of significant correlations between reported dispensing errors and the variables examined. Negative correlations were found with SAQ domains Teamwork Climate, Safety Climate, Job Satisfaction as well as mean age and response rates. Positive relationships were demonstrated with Stress Recognition (SAQ), number of employees, educational diversity, birth country diversity, education country diversity and number of dispensed prescription items. Variables displaying a significant relationship to errors in this analysis were included in the regression analysis. When controlling for demographic variables, only Stress Recognition, mean age, educational diversity and number of dispensed prescription items and employees, were still associated with dispensing errors. This study replicated previous work linking safety to errors, but went one step further and controlled for a variety of variables. Controlling rendered the relationship between Safety Climate and dispensing insignificant, while the relationship to Stress Recognition remained significant. Variables such as age and education country diversity were found also to correlate with reporting behaviour. Further studies on the demographic variables might generate interesting results.
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| 9. |
- Nordén-Hägg, Annika
(författare)
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Failure-Free Pharmacies? : An Exploration of Dispensing Errors and Safety Culture in Swedish Community Pharmacies
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Quality in pharmacies includes aspects such as error management and safety issues. The objective of this thesis was to explore these aspects of quality in Swedish community phar-macies. The specific aims were to compare a paper-based and a web-based reporting system for dispensing errors, regarding reporting behaviour and data quality. The impact of an intervention; a technical barrier, for preventing dispensing errors was evaluated. A survey tool, the Safety Attitudes Questionnaire (SAQ), was adapted to Swedish pharmacies and used to describe the safety culture in these pharmacies. The potential relationship between safety culture and dispensing errors was also explored. Data was retrieved from the paper- and web-based reporting systems, semi-structured interviews as well as from a survey, using SAQ. The change in reporting system for dispensing errors increased the reporting of errors and enhanced the completeness of reported data. The web-based system facilitated follow-up and identification of preventive measures, but was associated with implementation problems. The intervention was associated with a significant decrease in the overall number of dispensing errors and, specifically, reports on errors with the wrong strength, and errors caused by registration failure in the pharmacy computers. The Swedish version of the survey tool, SAQ, demonstrated satisfying psychometric properties. No correlation between the SAQ Safety Climate dimension and dispensing errors was seen, while a positive relationship between the SAQ Stress Recognition dimension and dispensing errors was established. A number of other pharmacy characteristics, such as number of dispensed prescription items and employees, displayed positive relationships with dispensing errors. Staff age demonstrated a negative relationship with dispensing errors while other demographic variables such as national education background showed a positive relationship.
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| 10. |
- Nordén-Hägg, Annika, et al.
(författare)
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Reducing dispensing errors in Swedish pharmacies : the impact of a barrier in the computer system
- 2010
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Ingår i: Quality and Safety in Healthcare. - : BMJ. - 1475-3898 .- 1470-7934. ; 19:6, s. e22-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Since 2004, a web-based reporting system enables monitoring of dispensing errors in all Swedish pharmacies. The adoption of this system was followed by an overall increase in reports, mainly explained by the dispensing of medicines of improper strength. In 2006 an intervention was implemented, aimed at reducing these errors. The objective of this study was to assess the impact of the intervention on the number of errors. METHODS: Monthly data on the reported number of dispensing errors from July 2004 until December 2007 were used. These were analysed in total and subdivided by type and cause of error. A time-series design was applied, and linear segmented regression analysis used to analyse whether changes in slope or level occurred; shifts in intercept or slope where p<0.01 were considered as statistically significant. RESULTS: The intervention coincided with a distinct decrease in error reports and a statistically significant change in slope that switched from a slight increase, 0.09, to a decrease, -0.26 (p = 0.0035). Medicines dispensed with wrong strength also displayed a significant change in slope, from 0.08 to -0.27 (p<0.0001), as well as dispensing errors caused by registration failure, that is, failure of the registration of a prescription in pharmacy computers, which changed from 0.05 to -0.29 (p<0.0001). CONCLUSION: The intervention was associated with a decrease in the number of reports on drugs dispensed with the wrong strength, but also had a decreasing effect on errors caused by registration failure and on the dispensing errors in total as well.
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