Global drug shortages due to COVID-19: Impact on patient care and mitigation strategies

How do South African policies address provision of contraception among adolescents?

BACKGROUND

 The South African government has pioneered several policy documents that emphasise the importance of sexual and reproductive health (SRH).

AIM

 We examined how national policies address access and provision of contraception to adolescents in South Africa.

SETTING

 South African national policies.

METHODS

 We systematically searched various academic databases such as EbscoHost, Science Direct, Google Scholar, PubMed and Scopus, and other relevant sources to obtain 854 policy documents. Using a set of explicit inclusion criteria, we screened and selected 11 South African policies for analysis. Next, we analysed three international policies and frameworks to extract the key elements from them. Thereafter, we used these key elements to develop an analytical framework for conducting the analysis of the South African national policies.

RESULTS

 We found that South Africa's SRH policies largely address the provision of contraception by following international guidelines. These policies recognise the value of providing contraception to adolescent girls. However, we also found gaps in some policies, which could impede how they are translated into practice. These include recognising that adolescent boys can play a role in contraception; adolescents have varying SRH needs and are a key stakeholder not only for policy development but also for monitoring and accountability.

CONCLUSION

 With a specific focus on South Africa's contraception services in the public sector, these findings are relevant to policymakers, providers and users of contraceptives.Contribution: This review proposes recommendations that will assist with strengthening health policy development and thus improve primary health care services related to contraception for adolescents.

Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis

BACKGROUND

Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19's long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland.

RESEARCH DESIGN AND METHODS

A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and "4C"-antibiotics.

RESULTS

Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (β1), but a decline in the level immediately after the first (β2) and second lockdowns (β4) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (β5) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of "4C" antibiotic reduced significantly after the second lockdown.

CONCLUSIONS

Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.

Trend of pharmaceuticals 3D printing in the Middle East and North Africa (MENA) region: An overview, regulatory perspective and future outlook

The traditional method of producing medicine using the "one-size fits all" model is becoming a major issue for pharmaceutical manufacturers due to its inability to produce customizable medicines for individuals' needs. Three-dimensional (3D) printing is a new disruptive technology that offers many benefits to the pharmaceutical industry by revolutionizing the way pharmaceuticals are developed and manufactured. 3D printing technology enables the on-demand production of personalized medicine with tailored dosage, shape and release characteristics. Despite the lack of clear regulatory guidance, there is substantial interest in adopting 3D printing technology in the large-scale manufacturing of medicine. This review aims to evaluate the research efforts of 3D printing technology in the Middle East and North Africa (MENA) region, with a particular emphasis on pharmaceutical research and development. Our analysis indicates an upsurge in the overall research activity of 3D printing technology but there is limited progress in pharmaceuticals research and development. While the MENA region still lags, there is evidence of the regional interest in expanding the 3D printing technology applications in different sectors including pharmaceuticals. 3D printing holds great promise for pharmaceutical development within the MENA region and its advancement will require a strong collaboration between academic researchers and industry partners in parallel with drafting detailed guidelines from regulatory authorities.

Medicines Shortages Reporting Systems (MSRS): An exploratory review of access and sustainability

BACKGROUND

The efficacy of medicines depends on their accessibility and availability. Dedicated medicine shortage reporting systems (MSRS) have been set up in different countries, either mandatory or voluntary, following the recommendations of the World Health Organisation to ensure these.

OBJECTIVES

To explore how the Medicine Shortages Reporting System (MSRS) can tackle medicine shortages through improved access and sustainability.

METHODS

Personnel directly involved in the reporting mechanisms for medicine shortages in eight (8) countries participated in semi-structured interviews. An interview protocol based on the Dynamic Capabilities View and Organisational Information Processing Theory (OIPT) was developed. It contained questions related to participant's views on the process involved in MSRS and how it was used to tackle shortages. Data were thematically analysed.

RESULTS

Three core elements were identified to influence MSRS's ability to tackle shortages and ensure sustainability; (1) the ability to identify what information requirements the reporting system needs, (2) identify information processing capabilities, and (3) the ability to match requirements and information processing capabilities through a dynamic capability decision-making process. The dynamic decision-making process involves reiteratively sensing shortages by understanding and validating information received.

CONCLUSION

Building MSRS to tackle shortages for accessibility and sustainability is a systemic process that entails understanding the various elements and processes of MSRS. It includes defining medicine shortages, reconfiguring resources, defining accessibility and ensuring the system's sustainability. Our study provides insights into MSRS developed for mitigating medicine shortages and provides a framework for a sustainable MSRS. The findings extend the literature on medicine shortage management by identifying the various elements required to set up an MSRS. It also provides practical implications for countries that seek to establish MSRS to mitigate medicine shortages. Further studies could extend the number of participating countries to provide a clearer picture of the MSRS and how it can reduce medicine shortages.

Tackling medicine shortages during and after the COVID-19 pandemic: Compilation of governmental policy measures and developments in 38 countries

In response to increasing shortages of medicines, governments have implemented legislative and non-legislative policy measures. This study aimed to map these policies across high-income countries in Europe and beyond as of 2023 and to analyse developments in governmental approaches since the beginning of the pandemic. Information was collated from 38 countries (33 European countries, Australia, Brazil, Canada, Israel and Saudi Arabia) based on a survey conducted with public authorities involved in the Pharmaceutical Pricing and Reimbursement Information (PPRI) network in 2023. 34 countries requested pharmaceutical companies to notify national registers of upcoming shortages and 20 countries obliged manufacturers and/or wholesalers to stock supply reserves of critically needed medicines. Further common measures included export bans for defined medicines (18 countries), regulatory measures to facilitate import and use of alternative medicines (35 countries) and multi-stakeholder coordination (28 countries). While the legislation of 26 countries allows imposing sanctions, particularly for non-compliance to reporting requirements, fines were rather rarely imposed. Since 2022, at least 18 countries provided financial incentives, usually in the form of price increases of some off-patent medicines. Overall, several policies to address medicine shortages were taken in recent years, in some countries as part of a comprehensive package (e.g., Australia, Germany). Further initiatives to secure medicine supply in a sustainable manner were being prepared or discussed.

Global insight into the occurrence, treatment technologies and ecological risk of emerging contaminants in sanitary sewers: Effects of the SARS-CoV-2 coronavirus pandemic

The SARS-CoV-2 pandemic caused changes in the consumption of prescribed/non-prescribed drugs and the population's habits, influencing the detection and concentration of emerging contaminants (ECs) in sanitary sewage and harming environmental and health risks. Therefore, the present work sought to discuss current literature data on the effects of the "COVID-19 pandemic factor" on the quality of raw sewage produced over a five-year period (2018-2019: pre-pandemic; 2020-2022: during the pandemic) and biological, physical, chemical and hybrid treatment technologies, influencing factors in the removal of ECs and potential ecological risks (RQs). Seven hundred thirty-one publications correlating sewage and COVID-19 were identified: 184 pre-pandemic and 547 during the pandemic. Eight classes and 37 ECs were detected in sewage between 2018 and 2022, with the "COVID-19 pandemic factor" promoting an increase in estrogens (+31,775 %), antibiotics (+19,544 %), antiepileptics and antipsychotics (+722 %), pesticides (+200 %), analgesics, anti-inflammatories and anticoagulants (+173 %), and stimulant medications (+157 %) in sanitary sewage. Among the treatment systems, aerated reactors integrated into biomembranes removed >90 % of cephalexin, clarithromycin, ibuprofen, estrone, and 17β-estradiol. The absorption, adsorption, and biodegradation mechanisms of planted wetland systems contributed to better cost-benefit in reducing the polluting load of sewage ECs in the COVID-19 pandemic, individually or integrated into the WWTP. The COVID-19 pandemic factor increased the potential ecological risks (RQs) for aquatic organisms by 40 %, with emphasis on clarithromycin and sulfamethoxazole, which changed from negligible risk and low risk to (very) high risk and caffeine with RQ > 2500. Therefore, it is possible to suggest that the COVID-19 pandemic intensified physiological, metabolic, and physical changes to different organisms in aquatic biota by ECs during 2020 and 2022.

Global Health Commodities Supply Chain in the Era of COVID-19 Pandemic: Challenges, Impacts, and Prospects: A Systematic Review

Background

The COVID-19 pandemic led to the most substantial health crisis in the 21st Century. This pandemic interrupted the supply of essential commodities for human beings. Among the essential commodities for human survival, disruption of the supply of essential health commodities has become a global concern.

Objective

The study aimed to systematically analyze published articles on the challenges, impacts, and prospects of the global health commodities' supply chain in the era of the COVID-19 pandemic.

Methods

A standard searching strategy was conducted in seven research databases to retrieve pertinent articles. Finally, 459 articles were retrieved for further screening, and only 13 articles were selected for final synthesis.

Results

Almost 38.5% of the studies targeted the supply chain of health commodities used to treat HIV, TB, and malaria. Lockdown policies, travel restrictions, lack of transportation, low manufacturing capacity, and rising costs were the significant challenges indicated for the supply interruption of essential health commodities and COVID-19 vaccines. Findings indicated that the supply interruption of essential health commodities leads to a devastating impact on global health.

Conclusion

Global medicine shortages due to the pandemic crisis can have a devastatingly harmful impact on patient outcomes and might result in a devastatingly long-lasting effect on the health of the world community. Supply-related challenges of the COVID-19 vaccine affect countries' ambitions for achieving herd immunity quickly. Monitoring the pandemic's effect on the health commodities' supply system and designing a short-term and long-term resilient health supply chain system that can cope with current and future health catastrophes is pivotal.

Inefficacious drugs against covid-19: analysis of sales, tweets, and search engines

OBJECTIVE

Assess the correlation between the sales of two drugs with no proven efficacy against covid-19, ivermectin and chloroquine, and other relevant variables, such as Google® searches, number of tweets related to these drugs, number of cases and deaths resulting from covid-19.

METHODS

The methodology adopted in this study has four stages: data collection, data processing, exploratory data analysis, and correlation analysis. Spearman's method was used to obtain cross-correlations between each pair of variables.

RESULTS

The results show similar behaviors between variables. Peaks occurred in the same or near periods. The exploratory data analysis showed shortage of chloroquine in the period corresponding to the beginning of advertising for the application of these drugs against covid-19. Both drugs showed a high and statistically significant correlation with the other variables. Also, some of them showed a higher correlation with drug sales when we employed a one-month lag. In the case of chloroquine, this was observed for the number of deaths. In the case of ivermectin, this was observed for the number of tweets, cases, and deaths.

CONCLUSIONS

The results contribute to decision making in crisis management by governments, industries, and stores. In times of crisis, as observed during the covid-19 pandemic, some variables can help sales forecasting, especially Google® and tweets, which provide a real-time analysis of the situation. Monitoring social media platforms and search engines would allow the determination of drug use by the population and better prediction of potential peaks in the demand for these drugs.

Price increase negotiations to address drug shortages in South Korea's national health insurance

South Korea has adopted a unique approach to address drug shortages by increasing reimbursement prices within its National Health Insurance Service. This study aims to analyze the characteristics, increase rates, affecting factors, and budget impacts of products that have increased price through the negotiation system. Between 2007 and 2022, there were price increase negotiations over 244 items. Of these, price increase negotiations were successful for 217 items, resulting in an agreement rate of 89%. The average rate of price increase for the agreed-upon products was 37.8%, and the overall budget increase for drugs with price increases (n = 217) was approximately 24.5%. Budget impact of each variable of the negotiated agreements showed that the number of negotiated agreement items was smaller after 2015 than before 2015, but each total budget impact (initial budget, increased budget, and final budget) and the average budget impact were higher. Although domestic companies accounted for a larger overall budget, the average budget per item was larger for multinational companies. The correlation analysis of the ratio of price increase and budget impact variables showed that the ratio of price increase was positively and significantly correlated with the increased budget, while it was negatively but not significantly correlated with the initial and final budgets. The South Korean model of increasing reimbursement prices in public insurance for drugs at risk of shortages serves as an exemplary case for not only securing patient access but also considering budget management.

Avoidance of medical care among American Indians with a history of cancer during the coronavirus pandemic

Objectives

Assess the percentage of cancer-related appointment delays, cancelations, and the unavailability of medications experienced by American Indian participants during the COVID-19 pandemic.

Methods

This cross-sectional survey study was completed between October 2020 and July 2021 by 360 individuals with cancer who lived in California and Oklahoma. Binary and multivariate logistic regression analysis was completed in SAS 9.4.

Results

During the initial Covid-19 pandemic, almost one-third (30%) of respondents delayed cancer-related appointments, 42% canceled cancer-related appointments, and one-quarter (24%) were unable to access prescription medications or over-the-counter medications (27%) due to COVID-19. People who underwent testing for COVID-19 were five times more likely to delay a medical appointment [adjusted odds ratio (aOR) = 5.3, 95% CI:2.4, 11.7] and people who followed three or more social distancing measures were more than six times more likely to cancel medical appointments (aOR:6.3, 95% CI:2.9, 13.9).

Conclusion

This study identifies delays, cancelations, and medication inaccessibility people identifying as American Indian faced during the coronavirus pandemic. Disparities in healthcare delivery could contribute to increased morbidity and mortality rates of cancer.

The Effect of COVID-19 Restrictions on General and HIV Positive Inpatient Admissions and Treatment Outcomes: An Uncontrolled Before-and-after Study at a Ugandan Tertiary Hospital

Measures to contain the Corona Virus Disease 2019 (COVID-19) pandemic curtailed access to prevention and treatment services for endemic infectious diseases like HIV. We used an uncontrolled before-and-after study design to compare general and HIV positive (HIV+) inpatient outcomes at a tertiary hospital in Uganda, using electronic records of medical inpatients. Data was downloaded, cleaned in Microsoft Excel, and exported to STATA for analysis. We determined the difference in number of admissions and median length of hospital stay using Mann-Whitney U test; and difference in median survival and incidence rates of mortality using Kaplan - Meier statistics, between the pre- and peri-COVID-19 groups. Of 7506 patients admitted to Kiruddu NRH, 50.8% (3812) were female and 18.7% (1,401) were aged 31-40 years, and 18.8% (1,411) were HIV+. Overall, 24.6% (1849) died. Total admissions were lower (2192 vs. 5314 patients), overall mortality rate higher (41.8% vs. 17.6%, p < 0.01), median length of hospital stay longer (6 vs. 4 days, p < 0.01) and median survival shorter (11 vs. 20 days, Chi-square = 252.05, p < 0.01) in the peri- than in pre-COVID-19 period. The adjusted hazard ratio (aHR) of death was 2.08 (95% CI: 1.85-2.23, p < 0.01) in the peri- compared to the pre-COVID-19 period. These differences were more pronounced in HIV + patients. Compared to pre-COVID-19, the peri-COVID-19 period registered lower inpatient admissions but poorer treatment outcomes for general and HIV + inpatients. Emerging epidemic responses should minimize disruption to inpatient care, especially for HIV + individuals.

Managing the COVID-19 health crisis: a survey of Swiss hospital pharmacies

BACKGROUND

The COVID-19 pandemic strained healthcare systems immensely as of 2020. Switzerland's hospital pharmacies' responses during the first wave were surveyed with a view to improving the quality of pharmaceutical management in future health crises.

METHODS

An online survey was sent to the heads of all of Switzerland's hospital pharmacies. The questionnaire was organised into eleven sections of questions covering many topics regarding the management of COVID-19's first wave. Data collection occurred from May to June 2020.

RESULTS

Analyses were performed using the 43 questionnaires (66%), with at least one answer per questionnaire, out of 65 distributed. Seventeen of 41 pharmacies responding (41%) had existing standard operating procedures or pandemic plans and 95% of these (39/41) set up crisis management steering committees. Twenty-nine of 43 pharmacies responding (67%) created new activities to respond to the pandemic's specific needs. Twenty-six of 39 pharmacies responding (67%) created new drug lists for: COVID-19-specific treatments (85%; 22/26), sedatives (81%; 21/26), anaesthetics (77%; 20/26) and antibiotics (73%; 19/26). Drug availability in designated COVID-19 wards was managed by increasing existing stocks (54%; 22/41 pharmacies) and creating extra storage space (51%; 21/41). Two drugs generated the greatest concern about shortages: propofol (49%; 19/39 pharmacies) and midazolam (44%; 17/39). Remdesivir stocks ran out in 26% of pharmacies (10/39). Twelve of 43 pharmacies (28%) drafted specific new documents to respond to medical needs regarding drug administration, 12 (28%) did so for drug preparation and 10 (23%) did so for treatment choices.

CONCLUSIONS

Switzerland's hospital pharmacies encountered many challenges related to the COVID-19 crisis and had to find solutions quickly, effectively and safely. The survey highlighted the key role that hospital pharmacies played in many aspects of the pandemic by providing logistical and clinical support to medical and nursing care teams. The lessons and experiences outlined could be used to improve the quality of hospital pharmacies' readiness for similar future events.

Exploring Drug Shortages in the United Kingdom

Drugs can become short in supply for many reasons including increased demand and reduced production. Drug shortages have the potential to impact patients and pharmacists. This study aimed to highlight the challenges pharmacists face and the constraints of how they manage drug shortages. An online survey was designed with its link distributed electronically to community pharmacists in the UK with the assistance of pharmacy organizations during the period from September to December 2021. Survey data were analysed using descriptive statistics. A total of 83% of the respondents (n= 100) were experiencing drug shortages three or more times per week, and more than 70% of these spent 1-3 h per week dealing with them. A total of 93% of the respondents indicated that the issue of drug shortages was a problem for them, and 61% reported that it has worsened since the start of the pandemic. In addition, 65% of the respondents believed that drug shortages had had an impact on patient care. Drug shortages were shown to impact on the pharmacists' workloads with a potential to affect the quality of patient care. There was a variation between how pharmacists dealt with drug shortages, which needs to be explored further with the reasons behind it.

Impact of COVID-19 on the supply chain of essential health commodities: a mixed method study, in Dar es Salaam, Tanzania

BACKGROUND

The outbreak of COVID-19 in the late 2019 led to major global health crises, including morbidities and mortalities. The pandemic has adversely affected the supply chain of essential health commodities globally. However, such data from sub-Saharan Africa including Tanzania are largely limited. We assessed the impact of COVID-19 on the supply chain of essential health commodities in Tanzania.

METHOD

A cross-sectional study with pragmatic mixed method design was conducted in Dar es Salaam region from January to June 2021. Grounded theory was adopted to purposeful select key informants (n = 15) from importers of essential health commodities and local pharmaceutical manufacturers. Community pharmacy dispensers (n = 242) were also recruited for the quantitative part of this study. The prices of selected tracer health commodities were extracted from the Tanzania Medicine and Medical Device Authority (TMDA) Regulatory Information Management system. The mean unit prices 1 year before the pandemic were compared with the mean prices 1 year during the pandemic using paired t test. Thematic analysis was used for qualitative data.

RESULTS

The information regarding the impact of COVID-19 on the supply chain of essential health commodities was synthesized into three main themes namely, reduced availability of health commodities, increased price of health commodities and increased lead time for imported essential health commodities during COVID-19. Majority (90%) of community pharmacy dispensers reported that COVID-19 reduced the availability of essential health commodities. Azithromycin, Paracetamol, Multivitamin and Vitamin C tablets were the highly demanded products and their mean unit prices increased significantly during COVID-19 as compared to 1 year before the pandemic (p < 0.05).

CONCLUSIONS

COVID-19 led to shortage, increased prices and delayed delivery of essential health commodities. This might happen in the future whenever unexpected crises causing disruption in the supply chain occur underscoring the need for the country preparedness measures.

Sevoflurane sedation in COVID-19 acute respiratory distress syndrome: an observational study with a propensity score matching model

Introduction

The management of severe COVID-19-induced acute respiratory distress syndrome (C-ARDS) often involves deep sedation. This study evaluated the efficacy of sevoflurane, a volatile anesthetic, as an alternative to traditional intravenous sedation in this patient population.

Methods

This single-center, retrospective cohort study enrolled 112 patients with C-ARDS requiring invasive mechanical ventilation. A propensity score matching model was utilized to pair 56 patients receiving sevoflurane sedation with 56 patients receiving intravenous sedation. The primary outcome was mortality, with secondary outcomes being changes in oxygenation (PaO2/FiO2 ratio), pulmonary compliance, and levels of D-Dimer, CRP, and creatinine.

Results

The use of sevoflurane was associated with a statistically significant reduction in mortality (OR 0.40, 95% CI 0.18-0.87, beta = -0.9, p = 0.02). In terms of secondary outcomes, an increase in the PaO2/FiO2 ratio and pulmonary static compliance was observed, although the results were not statistically significant. No significant differences were noted in the levels of D-Dimer, CRP, and creatinine between the two groups.

Conclusion

Our findings suggest an association between the use of sevoflurane and improved outcomes in C-ARDS patients requiring invasive mechanical ventilation. However, due to the single-center, retrospective design of the study, caution should be taken in interpreting these results, and further research is needed to corroborate these findings. The study offers promising insights into potential alternative sedation strategies in the management of severe C-ARDS.

Evaluation of Activated Clotting Times With a Heparin Reversal Protocol Designed to Conserve Protamine During Drug Shortages: A Retrospective, Cohort Study

OBJECTIVE

To retrospectively evaluate a protamine conservation approach to heparin reversal implemented during times of critical shortages. This approach was aimed at maintaining access to cardiac surgical services.

SETTING

In-patient hospital setting.

PARTICIPANTS

Eight hundred-one cardiac surgical patients>18 years old.

INTERVENTIONS

Patients undergoing cardiac surgery who received >30,000 U of heparin were given a single fixed vial protamine dose of 250 mg or a standard 1 mg of protamine to 100 U of heparin ratio-based dose to reverse heparin.

MEASUREMENTS AND MAIN RESULTS

The primary endpoint was differences in post-reversal activated clotting times between the 2 groups. The secondary endpoint was differences in the number of protamine vials used between the 2 reversal strategies. The first activated clotting times values measured after initial protamine administration were not different between the Low Dose and Conventional Dose groups (122.3 s v 120.6 s, 1.47 s, 99% CI -1.47 to 4.94, p = 0.16). The total amount of protamine administered in the Low Dose group was less than that in the Conventional Dose group (-100.5 mg, 99% CI -110.0 to -91.0, p < 0.0001), as were the number of 250 mg vials used per case (-0.69, 99% CI -0.75 to -0.63, p < 0.0001). The mean initial protamine doses between groups were 250 mg and 352 mg, p < 0.0001. The mean protamine vials used were 1.33 v 2.02, p < 0.0001. When the calculations were based on 50 mg vials, the number of vials used per case in the Low Dose group was even less (-2.16, 99% CI -2.36 to -1.97, p < 0.0001).) CONCLUSIONS: Conservation measures regarding critical medications and supplies during times of shortages can maintain access to important services within a community.

Medicine shortages in France: a 6-year retrospective study in a university medical centre

OBJECTIVES

Medicine procurement disorders, commonly referred to as 'shortages', are a health-threatening phenomenon that have been reported by several stakeholders around the world. This study aimed to describe data from a mitigation tool, namely a shortages report implemented within one of the largest university hospitals in France over a 6-year period.

METHODS

For 6 years (from 1 June 2014 to 31 May 2020) the data used were collected from different sources: purchasing groups, distributors, manufacturers and the national health agency. The report included: medicine identification, disorder duration, starting and ending dates, available alternative products, the Anatomical Therapeutic and Chemical (ATC) classification. Different situations were described: medicine shortages, quotas, supply tensions and market withdrawals.

RESULTS

Over the 6-year period, 1780 disorders were registered comprising 0.67% market withdrawals, 16.97% quotas, 79.89% shortages and 2.47% supply tensions. The median duration of a disorder was 56 days and the most affected ATC classes were the nervous system (N), anti-infectives (J) and the cardiovascular system (C). A substitute medicine was registered for one-third of the disorders. In the N class, the most frequent level 4 classes were N01BB (local anaesthetic amids such as lidocaine, levobupivacaine and ropivacaine), N03AX (other antiepileptics) and N05AX (other antipsychotics). In the J class, the most frequent level 4 classes were J01CR (penicillin combinations), J01CA (extended-spectrum penicillins such as piperacillin and amoxicillin) and J01XX (other antibiotics for systematic use).

CONCLUSIONS

Procurement disorders are still spreading. The study results are similar to those of other research teams around the world. Common answers have to be found to deal with the phenomenon, that include standardisation and risk assessment methods.

Reasons that lead people to buy prescription medicines on the internet: a systematic review

Aim: This systematic review explores the factors that could influence consumer's decision of purchasing prescription medicines using the Internet. Methods: Relevant databases were searched to retrieve studies published from 2012 to 2021. The studies selected for inclusion were those focused on the consumer's perspective and the purchase of prescription medicines. A narrative synthesis was employed. The Capability Opportunity Motivation-Behaviour (COM-B) and the Theoretical Domains Framework (TDF) were employed as conceptual lenses that guided the analysis. Results: Seventeen studies were included. These studies have adopted various methodologies: qualitative method (n = 4), quantitative method (n = 12), and mixed methods (n = 1). The studies were based in Europe (n = 8), North America (n = 3), Middle East (n = 4), and 2 studies were conducted in several countries (multinational). The analysis of these studies revealed 7 themes that represent the reasons that lead people to buy prescription medicines via the Internet. These themes were the consumers' beliefs about the outcomes of the purchase (perceived benefits and risks of the purchase), consumer's emotions that could influence the purchasing decision, the factors that increase or decrease consumer's level of behavioural control over the purchase (facilitators and barriers of the purchase), consumers knowledge about the purchase, the trusting beliefs that lead consumers to trust the online sellers of medicines, the social influencing factors, and the external environmental factors that could encourage the purchase. Discussion: This study provides a comprehensive review of the breadth of reasons that drive people to buy prescription medicines via the Internet. Identifying those reasons could provide the basis for regulators to design evidence-based awareness campaigns to minimise the purchase of prescription medicines via the Internet. Furthermore, future research directions have been provided in this review to build upon the existing knowledge and address the research gaps in this area.

Shortages of Medicines to Treat COVID-19 Symptoms during the First Wave and Fourth Wave: Analysis of Notifications Reported to Registers in Austria, Italy, and Spain

The study aimed to investigate medicine shortages of critical relevance in the pandemic. A total of 487 active substances for the treatment of COVID-19-related symptoms and therapeutically similar medicines were reviewed as to whether or not a shortage had been notified in Austria, Italy, and Spain for February 2020, March 2020, April 2020 (first wave of the pandemic), and, in comparison, in November 2021 (fourth wave). Publicly accessible shortage registers managed by the national regulatory authorities were consulted. For 48 active substances, a shortage was notified for at least one of the study months, mostly March and April 2020. Out of these 48 active substances, 30 had been explicitly recommended as COVID-19 therapy options. A total of 71% of the active substances with notified shortage concerned medicines labeled as essential by the World Health Organization. During the first wave, Spain and Italy had higher numbers of shortage notifications for the product sample, in terms of active substances as well as medicine presentations, than Austria. In November 2021, the number of shortage notifications for the studied substances reached lower levels in Austria and Spain. The study showed an increase in shortage notifications for COVID-19-relevant medicines in the first months of the pandemic.

Impacts of the COVID-19 pandemic on patients with chronic conditions in Vietnam: A cross-sectional study

OBJECTIVES

We assess the impact of the COVID-19 pandemic on health, treatment adherence and expectations of patients with chronic diseases in Vietnam.

METHODS

We conducted a national cross-sectional study using a questionnaire survey, distributed through social networks and presented on Google Forms. The survey was performed during two months of the most stringent social distancing in Vietnam (between 21 July and 21 September 2021).

RESULTS

Most of the participants said that the COVID-19 epidemic had affected their daily activities (91.9%), health (53.6%), sleep behavior (52.3%), and mental health (79.8%). During social distancing in Vietnam, three-quarter could not go to hospitals for periodic health examination; nearly half of respondents did not do daily physical activity; a quarter of respondents did not adhere to recommended diet plan. Factors associated with the effect of the COVID-19 epidemic on patient's health included those living in Ho Chi Minh City (p = 0.015), lived alone (p = 0.027), uncontrolled chronic conditions (p < 0.001), treatment dissatisfaction or experienced anxiety/stress (p < 0.001). Factors associated with medication adherence included the elderly (p = 0.015), having periodic health examination (p = 0.012), direct consultation (p = 0.003), and telemedicine (p = 0.007).

CONCLUSION

This study highlights the urgent need for better chronic management strategies for the new post-COVID era in the future.

Supply chain planning of vaccine and pharmaceutical clusters under uncertainty: The case of COVID-19

As an abrupt epidemic occurs, healthcare systems are shocked by the surge in the number of susceptible patients' demands, and decision-makers mostly rely on their frame of reference for urgent decision-making. Many reports have declared the COVID-19 impediments to trading and global economic growth. This study aims to provide a mathematical model to support pharmaceutical supply chain planning during the COVID-19 epidemic. Additionally, it aims to offer new insights into hospital supply chain problems by unifying cold and non-cold chains and considering a wide range of pharmaceuticals and vaccines. This approach is unprecedented and includes an analysis of various pharmaceutical features such as temperature, shelf life, priority, and clustering. To propose a model for planning the pharmaceutical supply chains, a mixed-integer linear programming (MILP) model is used for a four-echelon supply chain design. This model aims to minimize the costs involved in the pharmaceutical supply chain by maintaining an acceptable service level. Also, this paper considers uncertainty as an intrinsic part of the problem and addresses it through the wait-and-see method. Furthermore, an unexplored unsupervised learning method in the realm of supply chain planning has been used to cluster the pharmaceuticals and the vaccines and its merits and drawbacks are proposed. A case of Tehran hospitals with real data has been used to show the model's capabilities, as well. Based on the obtained results, the proposed approach is able to reach the optimum service level in the COVID conditions while maintaining a reduced cost. The experiment illustrates that the hospitals' adjacency and emergency orders alleviated the service level significantly. The proposed MILP model has proven to be efficient in providing a practical intuition for decision-makers. The clustering technique reduced the size of the problem and the time required to solve the model considerably.

Local causes of essential medicines shortages from the perspective of supply chain professionals in Saudi Arabia

Background

The global supply chains of essential medicines faced frequent disruptions over the past five years, particularly during the COVID-19 pandemic. Different causes of prescription drug supply interruptions have been identified in Saudi Arabia. However, studies have yet to explore the views of pharmaceutical supply chain personnel regarding the causes of these interruptions. Therefore, this study aimed to survey individuals working in the pharmaceutical supply chains about their views on the observed interruptions in the supply of some essential drugs.

Methods

This was a questionnaire-based cross-sectional study. The 10-item questionnaire was created based on the findings of previously published research that investigated the root causes of essential drug shortages and the impact of COVID-19 pandemic on the supply chains of essential drugs in Saudi Arabia. Purposive sampling was used to identify individuals with at least one year of experience in the area of the pharmaceutical supply chain, and the data collection occurred between April 19th, 2022 and October 23rd, 2022. In addition, descriptive statistics (e.g., frequencies and percentages) were conducted to present the views of the respondents.

Results

Seventy-nine pharmaceutical supply chain specialists accepted the invitation and completed the questionnaire. About two-thirds (69.62%) of the respondents reported that centralized pharmaceutical procurement negatively affected the supply chain of essential drugs. Procurement of unregistered medications by the Saudi Food and Drug Authority (SFDA), as well as generic drugs with a history of recalls, and failure to supply requested quantities were the three most commonly reported reasons behind the observed interruptions in the supply of some essential drugs according to those respondents with a negative view of the centralized procurement. Furthermore, failure of pharmaceutical companies to inform SFDA of potential drug shortages, manufacturing issues, poor demand forecasting, unpredictable increase in demand, and low prices of essential drugs were also believed to be behind the observed interruptions in the supply of some essential medicines.

Conclusion

The majority of surveyed pharmaceutical supply chain professionals held negative views about the role of centralized pharmaceutical procurement in exacerbating the issues with essential medicines supply chain. Future research should examine different strategies to improve purchasing and procurement practices in Saudi Arabia.

Oral contraceptive pills shortage in Lebanon amidst the economic collapse: a nationwide exploratory study

BACKGROUND

The political instability, economic crisis, and devaluation of the national currency left Lebanese females suffering from a scarcity of oral contraceptive pills (OCPs). Therefore, we aimed to identify the incidence of OCPs shortage in Lebanon and its impact on women's sexual and reproductive health, as well as physical and psychological well-being.

METHODS

Community pharmacies were selected randomly across Lebanon, using a stratified sampling approach, where female clients asking for OCPs were interviewed using a standardized data collection form.

RESULTS

A total of 440 females were interviewed. More than three-quarters of the participants (76.4%) reported not finding their preferred OCPs brands, almost 40% were affected by the increased prices, and 28.4% declared stockpiling OCPs. More than half of the participants using OCPs for pregnancy prevention reported adopting alternative traditional contraceptive methods (55.3%). Unplanned pregnancy was reported by 9.5% of participants, where 75% of them disclosed intentional abortion while the remaining (25%) reported experiencing a spontaneous miscarriage. Other consequences of OCPs shortage included mood disturbances (52.3%), dysregulation of menses (49.7%), dysmenorrhea (21.1%), weight gain (19.6%), acne (15.7%), and hirsutism (12.5%). Of the participants taking OCPs for birth control, 48.6% reported a reduced frequency of sexual intercourse, which led to conflicts with their partners (46%) and a decreased libido (26.7%).

CONCLUSIONS

OCPs shortage has seriously and negatively exposed women to various undesirable consequences including unplanned pregnancy and dysregulation of menses. Therefore, there is an urgent need to bring the attention of healthcare authorities to support the national pharmaceutical industry in manufacturing affordable OCPs generics to meet women's reproductive health demands.

The green anaesthesia dilemma: to which extent is it important to preserve as many drugs available as possible

PURPOSE OF REVIEW

This article aims to summarize the current literature describing the availability of different anaesthetic drugs, and to discuss the advantages and limitations of a self-imposed restriction on the scarcely existing anaesthetic drugs.

RECENT FINDINGS

Earth temperature has risen 1.2°C since the beginning of industrial age, and it is expected to exceed a 1.5°C increase by 2050. The Intergovernmental Panel on Climate Change depicts five different scenarios depending on how these increased temperatures will be controlled in the future. The European Commission has formulated a proposal to regulate fluorinated greenhouse gases (F-gases), among which desflurane, isoflurane and sevoflurane belong to, due to their high global warming potential. This proposal shall ban, or severely restrict, the use of desflurane starting January 2026. It is not clear what might happen with other F-gas anaesthetics in the future. Due to climate change, a higher number of health crisis are expected to happen, which might impair the exiting supply chains, as it has happened in previous years with propofol scarcity.

SUMMARY

There are just a handful number of available anaesthetics that provide for a safe hypnosis. Major stakeholders should be consulted prior making such severe decisions that affect patient safety.

Current and future prospective of pharmaceutical manufacturing in Saudi Arabia

This observational descriptive study that was carried out with the objective of exploring the contribution of the local pharmaceutical industry to the Saudi drug security. Using a drug formulary provided from the Saudi Food and Drug Authority, containing all registered pharmaceutical products available in Saudi Arabia, we extracted information about drug class, drug type, country and place of manufacturing, shelf-life and price. Results showed that the majority of drugs in the market are manufactured in Europe (43.86%), followed by Saudi Arabia (22.55%), China and India (20.47%), Americas (10.24%), and other nations (2.61%). Most of the manufactured drugs were prescription drugs (90.62%). In this work, the local pharmaceutical industry with the highest percentage of contribution to local drug security was Pharmaceutical Solution Industries (PSI), representing the 5% of the items available in the Saudi market. The second highest percentage was 4% by TABUK Pharmaceutical Manufacturing CO., followed by SPIMACO (3%), JAMJOOM pharmaceutical company (2%), Riyadh pharma (2%), and Jazeera pharmaceutical industries (2%). In addition, results from this study provide information about the most essential pharmaceutical products that needs to be nationally manufactured or increased in production in order to rise the contribution of local pharmaceutical industries in Saudi drug security. Unfortunately, the small contribution of the Saudi pharmaceutical industry in local drug security increases the burden on the Kingdom's annual budget due to the over-reliance on international pharmaceuticals.

Effects of the July 2018 worldwide valsartan recall and shortage on global trends in antihypertensive medication use: a time-series analysis in 83 countries

OBJECTIVES

This study aims to examine the effects of the July 2018 worldwide valsartan recall and shortage on global trends of antihypertensive medication use in 83 countries.

METHODS

A time-series analysis of monthly purchases of valsartan, other angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) across 83 countries from January 2017 to July 2020 was conducted using the IQVIA MIDAS database. Trends in outcomes were investigated globally and by economic level (developed vs developing economies). The valsartan recall's impact on antihypertensive use was assessed with interventional autoregressive integrated moving average modelling.

RESULTS

Global valsartan utilisation trends decreased significantly by 15.7% (-61 166 515 SU; p<0.0001), while global purchases of other ARBs increased by 44.8% (+958 069 420 SU; p=0.8523) and ACEIs increased by 1.6% (+44 106 747 SU; p=0.1102). Of the 32 developed countries, 20 (62.5%) showed a decline in 1-month percentage change in valsartan purchases, whereas only 10 out of 33 developing countries (30.3%) experienced a decrease in valsartan purchases. Mean 1-month, 3-month and 6-month percentage changes for developed countries were -1.2%, -9.3% and -12.2%, respectively, while the changes for developing countries were 25.0%, 7.3% and -1.2%.

CONCLUSIONS

Global valsartan purchases substantially decreased post-recall, highlighting the far-reaching impacts of drug shortages. Opposing utilisation trends by economic level raise concerns of potential distribution of contaminated medications from developed countries to developing countries. Concerted actions for equitable global access to quality medications and mitigation of drug shortages are needed.

HIV Patients' Satisfaction with Pharmaceutical Care at a Nigerian Tertiary Healthcare Facility During the Covid-19 Pandemic

Background: Patients' satisfaction is an important indicator of determining the quality of pharmaceutical care (PC). This study investigated Human Immunodeficiency Virus (HIV) patients' satisfaction with PC at Federal Medical Centre, Keffi-Nigeria and determined the statistical correlation between the respondents' socio-demographic variables and their satisfaction with PC. Methods: This cross-sectional survey study involved 351 randomly selected HIV-positive patients receiving PC in the facility. A Likert-type questionnaire was used for the data collection. Results: The Cronbach's alpha of the questionnaire was .916. The "overall perception of pharmacists' care or service" had a mean satisfaction score of 4.24 ± 0.749 and "the amount of time spent with the pharmacists" had a mean score of 3.94 ± 0.791. No significant association was found between socio-demographic variables and overall patients' satisfaction with PC. Conclusion: The reliability of the questionnaire was high and the HIV patients had a good satisfaction with the PC they received in the facility.

Analyzing factors contributing to COVID-19 mortality in the United States using artificial intelligence techniques

Having started since late 2019, COVID-19 has spread through far many nations around the globe. Not being known profoundly, the novel virus of the Coronaviruses family has already caused more than half a million deaths and put the lives of many more people in danger. Policymakers have implemented preventive measures to curb the outbreak of the virus, and health practitioners along with epidemiologists have pointed out many social and hygienic factors associated with the virus incidence and mortality. However, a clearer vision of how the various factors cited hitherto can affect total death in different communities is yet to be analyzed. This study has put this issue forward. Applying artificial intelligence techniques, the relationship between COVID-19 death toll and determinants mentioned as strongly influential in earlier studies was investigated. In the first stage, employing Best-Worst Method, the weight of the primer contributing factor, effectiveness of strategies, was estimated. Then, using an integrated Best-Worst Method-local linear neuro-fuzzy-adaptive neuro-fuzzy inference system approach, the relationship between COVID-19 mortality rate and all factors namely effectiveness of strategies, age pyramid, health system status, and community health status was elucidated more specifically.

Experience of Pharmacists with Anti-Cancer Medicine Shortages in Pakistan: Results of a Qualitative Study

This study aimed to examine the current situation of anti-cancer drug shortages in Pakistan, namely its determinants, impacts, adopted mitigation strategies, and proposed solutions. Qualitative semi-structured, in-depth interviews were conducted with 25 pharmacists in oncology hospitals in Pakistan from August to October 2021. Data were collected in person and online, recorded, and subjected to inductive thematic analysis after being transcribed verbatim. Most participants experienced anti-cancer drug shortages that increased during the pandemic. Etoposide, paclitaxel, vincristine, dacarbazine, and methotrexate were frequently short. Important causes included the compromised role of regulatory authorities, lack of local production, and inventory mismanagement. The impacts were delayed/suboptimal treatment and out-of-pocket costs for patients, patients' prioritization, increased workload, negative work environment, and patients' trust issues for pharmacists. The participants proposed that a cautious regulator's role is needed to revise policies for all stakeholders and support all stakeholders financially at their level to increase access to these medicines. Based on the outcomes, it is clear that anti-cancer medicine shortages are a current issue in Pakistan. Governmental authorities need to play a role in revising policies for all levels of the drug supply chain and promoting local production of these drugs. Stakeholders should also collaborate and manage inventory.

Generic switching: Do future physicians in Jordan have enough knowledge and a positive attitude?

Background: Generic switching is a policy that has shown success in minimising pharmaceutical costs. It has also been used to mitigate recurrent and sudden drug shortages. Not all countries have policies that allow pharmacists to switch to generic drugs independently. In Jordan, only pharmacists at Ministry of Health hospitals automatically switch to generics if doctors had not already done INN prescribing. Objectives: This study targeted medical students to assess their experience with generic switching as patients, their knowledge of the subject as students, and their attitude towards it as future prescribers and policymakers. Methods: This is a descriptive, cross-sectional study conducted online. Eligibility criteria were being a fourth, fifth, or sixth-year medical school student enrolled at any of the six Jordanian universities. The questionnaire was developed by the researchers after a careful review of the relevant literature. Results: Three hundred and ninety students responded to the online questionnaire. Most participants were females (244, 62.6%), senior students in their final (6th) year (162, 41.5%) and with very good academic achievement (166, 42.6%). The highest knowledge scores concerned patient rights (0.73/1.00), followed by knowledge about monitoring after generic switching (0.66/1.00), and patients with known drug allergies (0.66/1.00). Almost half of the participants believe that pharmacists should not be given the right to do generic switching and only 16% stated that they would choose generic drugs if they needed treatment in the future. Multivariate linear regression analysis showed that significant predictors of knowledge were gender, GPA, and family income. No correlations were found between participants' knowledge scores and their attitudes towards giving pharmacists the right to independently switch drugs, or whether they would accept a substitute from pharmacists rather than having to refer to the physician. Conclusion: Medical students in Jordan lack sufficient knowledge about generic switching. Students need to be more aware of the current policies and regulations of this practice, and the role of each healthcare worker involved in it. They also need to have a more positive attitude toward generic drugs and generic switching practice to facilitate its future implementation.

Role of Pharmacists in Antimicrobial Stewardship During COVID-19 Outbreak: A Scoping Review

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, pharmacists have been on the front lines of health care, offering vital services. Consequently, the need for pharmacists to support an effective antibiotic stewardship (AMS) program during the COVID-19 outbreak has become increasingly evident. This scoping review was performed to examine related articles in 2020-2022 published in the Scopus, SAGE, and Cochrane databases with the keywords "Pharmacist" and "Antibiotic Stewardship" and "COVID-19". The inclusion criteria were full-text articles written in English. A total of 15 articles were included in this review to describe the role of pharmacists in AMS during the COVID-19 outbreak. In general, pharmacists are responsible for identifying and treating patients during pandemics, ensuring the continued supply and accessibility of medications, promoting health policies, and monitoring antibiotic use for COVID-19 cases and co-infections. At the hospital, as the most significant element for pharmacists on the AMS team, the apparent change is demonstrated in educating patients on telehealth services, clarifying misconceptions about treatments and antibiotic consumption, as well as taking a leadership position to establish local guidelines for the COVID-19 treatment protocol. Pharmacists have an important role in the AMS program, and the COVID-19 pandemic was perceived as a highlight their importance. Therefore, their work with the AMS program needs to be improved as they learn to extend their role in telehealth services, educate and clarify the misconceptions about COVID-19 treatments and other antibiotic consumption in the community, inventory control the COVID-19 drug, antibiotics, and vaccine, as well as take the lead in establishing local guidelines on antibiotic consumption during the pandemic outbreak.

Health supply chain system in Uganda: assessment of status and of performance of health facilities

Background

Health supply chain systems are essential for effective and efficient healthcare system by ensuring availability of quality essential medicines and health supplies. While several interventions have been made to ensure the availability of quality essential medicines and health supplies, health facilities continue to report stockouts in Uganda.

Objectives

This study aimed to assess the status and performance of the supply chain system across all levels of care in health facilities in Uganda.

Methods

This was a cross-sectional study conducted in 128 public and private-not-for-profit health facilities across 48 districts in Uganda. These facilities included all levels of care from Health Centres II, III, IV, general and referral hospitals, and national referral hospitals. Data were collected using desk reviews, health facility surveys, and key informant interviews with key personnel. Stock registers were reviewed to assess the availability of a basket of essential medicines based on the essential medicines list of the Ministry of Health.

Results

Less than half (42%) of health facilities had computer hardware. Most (84%) of health facilities were using a form of Logistics Management Information System with only (6%) were using the Electronic Logistics Management Information System. Just under a third (33%) of health information officers and (51%) of public health officers’ positions were filled in the health facilities. Nearly (66%) of health facilities used supply chain data to support decision-making. Most (84%) of health facilities reported stockouts of Essential Medicines and Health Supplies in the past 6 months. The main reasons for stockouts were (59%) a sudden increase in demand (40%) delivery gaps/delayed deliveries and (35%) discrepancies in orders and deliveries. Health facilities responded to stockouts through various means including (75%) redistribution (43%) purchased from a distributor, and (30%) placing emergency orders.

Conclusions

The findings from this study show that the performance of health facilities in different supply chain processes and functions was defective. To improve the supply chain performance of health facilities, it is important to invest in infrastructure development, provide computer hardware and internet connection and strengthen  the capacity key personnel. This is key for ensuring full functionality of the supply chain and availability of quality medicines and health supplies to the end-user.

Implementation of supply management strategies by the pharmacy service in a general hospital during the COVID-19 pandemic

Objective

Given the global uncertainty faced due to the Covid-19 pandemic, health services were forced to adjust inventory management and purchase projections. This publication aims to describe the strategies taken and their impact on the supply chain indicators by the pharmacy service in the management of drug purchases during the pandemic to expose the importance of pharmacist in charge of the supply chain.

Methods

This observational study describes the drug purchasing system in a general hospital and the strategies used to manage drug supply. The actions proposed by the pharmacy department are listed chronologically related to inventory issues and purchasing decisions. The accuracy of the purchase forecast was evaluated by calculating indicators such as the mean absolute standard deviation (MAD) and the variance of the forecast error (MSE). Inventory days and inventory turnover indicators were also compared in pre-pandemic and pre-pandemic periods.

Findings

In general, the forecast error given by MAD and MSE tended to decrease. Specifically, from the 82 drug categories, during the pandemic period, this indicator decreased in 72 (88%), increased in 9 (11%), and remained the same in only 1 (1%) of the categories. In financial terms, comparing the 2018–2019 and 2020–2021 periods, a favorable result was obtained when evaluating the inventory turnover indicators, which decreased by 0.01 points and the days of inventory increased on average by two days.

Conclusions

The implementation and use of these indicators prevented drug shortages, reducing inventory forecast errors. A pharmacist with knowledge in inventory management allows managing a process of continuous improvement and tactics for efficient inventory management without neglecting the benefit to patients or the economic profitability of the service. There were limitations since digital operating systems do not generate centralized or organized data for this type of analysis.

Two-years antibody responses following SARS-CoV-2 infection in humans: A study protocol

The long-term antibody response to the novel SARS-CoV-2 in infected patients and their residential neighborhood remains unknown in Indonesia. This information will provide insights into the antibody kinetics over a relatively long period as well as transmission risk factors in the community. We aim to prospectively observe and determine the kinetics of the anti-SARS-CoV-2 antibody for 2 years after infection in relation to disease severity and to determine the risk and protective factors of SARS CoV-2 infections in the community. A cohort of RT-PCR confirmed SARS-CoV-2 patients (case) will be prospectively followed for 2 years and will be compared to a control population. The control group comprises SARS-CoV-2 non-infected people who live within a one-kilometer radius from the corresponding case (location matching). This study will recruit at least 165 patients and 495 controls. Demographics, community variables, behavioral characteristics, and relevant clinical data will be collected. Serum samples taken at various time points will be tested for IgM anti-Spike protein of SARS-CoV-2 and IgG anti-Spike RBD of SARS-CoV-2 by using Chemiluminescent Microparticle Immunoassay (CMIA) method. The Kaplan-Meier method will be used to calculate cumulative seroconversion rates, and their association with disease severity will be estimated by logistic regression. The risk and protective factors associated with the SARS-CoV-2 infection will be determined using conditional (matched) logistic regression and presented as an odds ratio and 95% confidence interval.

Creation of a State Drug Shortage Dashboard in the COVID-19 Pandemic

Purpose: Drug shortages are anticipated to worsen with time as the Coronavirus Disease 2019 (COVID-19) pandemic continues. The aim of this study is to track drug shortages within Illinois and identify causes and trends to this time-sensitive problem. Methods: In order to communicate between health systems within the state, the Illinois Council of Health-System Pharmacists (ICHP) developed a medication shortage dashboard, which collects information from health systems in the state on current drug shortages. Classes of medications inquired about included: anti-infectives, neuromuscular blocking agents (NMBAs), sedatives/analgesics, vasopressors, and "others." Data was gathered from 6 different medication shortage dashboards, ranging from May 20, 2020 to June 22, 2020 and was used to track drug shortages within Illinois. Additionally, this data was analyzed in conjunction with the number of hospital beds utilized by COVID-19 patients at the time. Results: Illinois's medication shortage dashboard tracked the supply level of 42 medications used in the treatment of patient's hospitalized with COVID-19. Data from an average of 75 health systems was analyzed each week (average response rate: 52%). For each medication, health systems identified if they had ample supply, mild shortage, moderate shortage, or critical shortage. Overall the trends of these medications positively correlated with the number of hospital beds utilized by COVID-19 patients in Illinois (r ² = 0.7). Conclusion: The data from this study supports the conclusion that increased hospital bed utilization by COVID-19 patients is correlated with increased drug shortages of medications used in the treatment of COVID-19. It is imperative that health systems take appropriate action to prevent and manage drug shortages.

Emergency Preparedness for the COVID-19 Pandemic: Social Determinants Predicting the Community Pharmacists’ Preparedness and Perceived Response in Malaysia

Background: Pandemic preparedness of healthcare providers helps to mitigate future threats such as spread and fatality rates, as well as the management of the disease. Pharmacists are key partners with public health agencies, and the role of community pharmacists is becoming increasingly recognised in this COVID-19 pandemic. The study aimed to explore the emergency preparedness of community pharmacists (CPs) for COVID-19. Methods: A cross-sectional study was performed among community pharmacists using cluster sampling followed by convenient sampling. A self-administered questionnaire was formulated using references from the previous literature and the WHO preparedness checklist. Descriptive analysis was undertaken for the participants’ socio-demographic characteristics. All the data collected were entered into the Statistical Package for Social Sciences version 24 (SPSS V.24), (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.) for analysis. Results: Most of the CPs had five or fewer years of practice experience, and they had all the mandatory information relating to the needs of their communities regarding the disease. The participants knew where to acquire these resources whenever needed. They were able to recognise the signs and symptoms of the disease. Most participants felt that they were confident to provide patient education and carry out their duties during these challenging times. There was a strong position correlation between preparedness and the perceived response of the participants. Conclusion: The community pharmacists in Malaysia are prepared enough for COVID-19 pandemic management and perceive that they can respond during any unprecedented situations, such as COVID-19. Community pharmacists were aware of the challenges that they need to face in their community regarding COVID-19.

Full-scale simulations to improve disaster preparedness in hospital pharmacies

Purpose

Assess whether full-scale simulation exercises improved hospital pharmacies’ disaster preparedness.

Methods

Swiss hospital pharmacies performed successive full-scale simulation exercises at least four months apart. An interprofessional team created two scenarios, each representing credible regional-scale disasters involving approximately fifty casualties (a major road accident and a terrorist attack). Four exercise assessors used appraisal forms to evaluate participants’ actions and responses during the simulation (rating them using five-point Likert scales).

Results

Four hospital pharmacies performed two full-scale simulation exercises each. Differences between exercises one and two were observed. On average, the four hospitals accomplished 69% ± 6% of the actions expected of them during exercise one. The mean rate of expected actions accomplished increased to 84% ± 7% (p < 0.005) during exercise two. Moreover, the average quality of actions improved from 3.0/5 to 3.6/5 (p = 0.01), and the time required to gather a crisis management team drastically decreased between simulations (from 23 to 5 min). The main challenges were communication (reformulation) and crisis management. Simulation exercise number one resulted in three hospital pharmacies creating disaster action plans and the fourth improving its already existing plan.

Conclusion

This study highlighted the value of carrying out full-scale disaster simulations for hospital pharmacies as they improved overall institutional preparedness and increased staff awareness. The number of expected actions accomplished increased significantly. In the future, large-scale studies and concept dissemination are warranted.

Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia

Background

Since COVID-19 was first recognised, there has been ever-changing evidence and misinformation around effective use of medicines. Understanding how pandemics impact on medicine use can help policymakers act quickly to prevent harm. We quantified changes in dispensing of common medicines proposed for “re-purposing” due to their perceived benefits as therapeutic or preventive for COVID-19 in Australia.

Methods

We performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidized medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analog). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models and compared characteristics of initiators in 2020 and 2019.

Results

In March 2020, we observed a 99% (95%CI: 96%-103%) increase in hydroxychloroquine dispensing (approximately 22% attributable to new users), and a 199% increase (95%CI: 184%-213%) in initiation, with an increase in prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsided following regulatory restrictions on prescribing. There was a small but sustained increase in ivermectin dispensing over multiple months, with an 80% (95%CI 42%-118%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April. Other than increases in March related to stockpiling, we observed no change in the initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin was lower than expected from April through November 2020.

Conclusions

While most increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users, we observed increases in the initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns which may be related to the media hype around these medicines. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harm.

Impact of the Early COVID-19 Pandemic on Burn Care: A Multi-National Study

This qualitative study documents and analyzes COVID-19’s impacts on burn care in twelve nations. Burn care saw valuable improvements in surgical techniques, skin grafting, and other acute treatments during the decades before the COVID-19 pandemic which increased severely burned patients’ survival rates and quality of life. Detailed interviews, conducted in the 12 nations reveal that the COVID-19 pandemic greatly affected the delivery of acute and rehabilitation services for burn patients. Resources have been suctioned away from non-COVID healthcare and burn care has not been spared. Acute, post-acute rehabilitation, and mental health services have all suffered. Weak preparation has deeply burdened health care services in most nations, resulting in lower access to care. Access problems have accelerated innovations like telehealth in many nations. The spread of misinformation through social and traditional media has contributed to the varied responses to COVID-19. This compounded problems in health care delivery. Burn care providers delivered services for survivors during extremely difficult circumstances by continuing to furnish acute and long-term services for patients with complex disease. Emphasis on future pandemic preparedness will be vital because they undermine all aspects of burn care and patient outcomes. As the COVID-19 pandemic continues to unfold around the world, it will be important to continue to monitor and analyze the adaptability of nations, health care systems, and burn care providers.

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

Background

Service availability and readiness are critical for the delivery of quality and essential health care services. In Ghana, there is paucity of literature that describes general service readiness (GSR) of primary health care (PHC) facilities within the national context. This study therefore assessed the GSR of PHC facilities in Ghana to provide evidence to inform heath policy and drive action towards reducing health inequities.

Methods

We analysed data from 140 Service Delivery Points (SDPs) that were part of the Performance Monitoring and Accountability 2020 survey (PMA2020). GSR was computed using the Service Availability and Readiness Assessment (SARA) manual based on four out of five components. Descriptive statistics were computed for both continuous and categorical variables. A multivariable binary logistic regression model was fitted to assess predictors of scoring above the mean GSR. Analyses were performed using Stata version 16.0. Significance level was set at p<0.05.

Results

The average GSR index of SDPs in this study was 83.4%. Specifically, the mean GSR of hospitals was 92.8%, whereas health centres/clinics and CHPS compounds scored 78.0% and 64.3% respectively. The least average scores were observed in the essential medicines and standard precautions for infection prevention categories. We found significant sub-national, urban-rural and facility-related disparities in GSR. Compared to the Greater Accra Region, SDPs in the Eastern, Western, Upper East and Upper West Regions had significantly reduced odds of scoring above the overall GSR. Majority of SDPs with GSR below the average were from rural areas.

Conclusion

Overall, GSR among SDPs is appreciable as compared to other settings. The study highlights the existence of regional, urban-rural and facility-related differences in GSR of SDPs. The reality of health inequities has crucial policy implications which need to be addressed urgently to fast-track progress towards the achievement of the SDGs and UHC targets by 2030.

A Perspective towards Multi-Hazard Resilient Systems: Natural Hazards and Pandemics

The concept of resilience has been used extensively across the sciences in engineering and the humanities. It is applied to ecology, medicine, economics, and psychology. The novel coronavirus disease (COVID-19) has posed an extraordinary challenge to the resilience of healthcare systems, communities, and nations and has profoundly altered our previous day-to-day operations. This paper presents a discussion of the definitions and characteristics of resilient systems. Scenarios are utilized to qualitatively explore key relationships, responses, and paths for recovery across different system types. The purpose is to develop an integrated approach that can accommodate simultaneous threats to system resilience, in particular, impacts from a natural hazard in conjunction with COVID-19. This manuscript is the first to advocate for more in-depth and quantitative research utilizing transdisciplinary approaches that can accommodate considerations across our built environment and healthcare system infrastructures in pursuit of designing systems that are resilient to both natural hazards and pandemic impacts.

COVID-19 and the Rationale for Primary Selective Laser Trabeculoplasty and Diode Laser Transscleral Cyclophotocoagulation in Africa

The recent COVID-19 pandemic has affected ophthalmologists' practices worldwide. Consequent global drug shortages and the limitations of medical glaucoma treatments in sub-Saharan Africa have highlighted the need for innovation in global ophthalmology to provide accessible, affordable, and effective glaucoma care. The role of lasers rather than medications for glaucoma patients in developing nations is emerging. Since lasers are easier to master than glaucoma surgery, it is pertinent to discuss the primary use of lasers in treating glaucoma in such nations. In particular, selective laser trabeculoplasty and diode laser transscleral cyclophotocoagulation seem to present a promising future for the treatment of glaucoma in Africa. In this report, we provide an evidence-based discussion exploring the emerging role of lasers in Africa.

Perceptions Regarding the SARS-CoV-2 Pandemic's Impact on Neurocritical Care Delivery: Results From a Global Survey

BACKGROUND

The SARS-CoV-2 (COVID-19) pandemic has impacted many facets of critical care delivery.

METHODS

An electronic survey was distributed to explore the pandemic's perceived impact on neurocritical care delivery between June 2020 and March 2021. Variables were stratified by World Bank country income level, presence of a dedicated neurocritical care unit (NCCU) and experiencing a COVID-19 patient surge.

RESULTS

Respondents from 253 hospitals (78.3% response rate) from 47 countries (45.5% low/middle income countries; 54.5% with a dedicated NCCU; 78.6% experienced a first surge) participated in the study. Independent of country income level, NCCU and surge status, participants reported reductions in NCCU admissions (67%), critical care drug shortages (69%), reduction in ancillary services (43%) and routine diagnostic testing (61%), and temporary cancellation of didactic teaching (44%) and clinical/basic science research (70%). Respondents from low/middle income countries were more likely to report lack of surge preparedness (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8) and struggling to return to prepandemic standards of care (OR, 12.2; 95% CI, 4.4-34) compared with respondents from high-income countries. Respondents experiencing a surge were more likely to report conversion of NCCUs and general-mixed intensive care units (ICUs) to a COVID-ICU (OR 3.7; 95% CI, 1.9-7.3), conversion of non-ICU beds to ICU beds (OR, 3.4; 95% CI, 1.8-6.5), and deviations in critical care and pharmaceutical practices (OR, 4.2; 95% CI 2.1-8.2). Respondents from hospitals with a dedicated NCCU were less likely to report conversion to a COVID-ICU (OR, 0.5; 95% CI, 0.3-0.9) or conversion of non-ICU to ICU beds (OR, 0.5; 95% CI, 0.3-0.9).

CONCLUSION

This study reports the perceived impact of the COVID-19 pandemic on global neurocritical care delivery, and highlights shortcomings of health care infrastructures and the importance of pandemic preparedness.

Global Resilience and New Strategies Needed for Antimicrobial Stewardship during the COVID‐19 Pandemic and Beyond

Resilience is having the ability to respond to adversity proactively and resourcefully. The coronavirus disease 2019 (COVID‐19) pandemic's profound impact on antimicrobial stewardship programs (ASP) requires clinicians to call on their own resilience to manage the demands of the pandemic and the disruption of ASP activities. This article provides examples of ASP resilience from pharmacists and physicians from seven countries with different resources and approaches to ASP—The United States, The United Kingdom, Canada, Nigeria, Lebanon, South Africa, and Colombia. The lessons learned pertain to providing ASP clinical services in the context of a global pandemic, developing new ASP paradigms in the face of COVID‐19, leveraging technology to extend the reach of ASP, and conducting international collaborative ASP research remotely. This article serves as an example of how resilience and global collaboration is sustaining our ASPs by sharing new “how to” do antimicrobial stewardship practices during the COVID‐19 pandemic.

Health supply chain system in Uganda: current issues, structure, performance, and implications for systems strengthening

Background

The health supply chain system is essential for the optimum performance of the healthcare system. Despite increased investments in the health supply chain system, access to quality Essential Medicines and Health Supplies remain a big challenge in Uganda. This article discusses the structure, performance, and challenges of the health supply chain system in Uganda. It provides reflections and implications for ongoing interventions for system strengthening.

Discussions

The findings highlight several issues and challenges affecting the health supply chain system from functioning optimally across all levels of the health system. The challenges identified include an ineffective structure to support planning, coordination and management, inadequate funding, shortage of skilled staff, weak regulatory and governance structures at national and sub-national levels, and slow adoption and use of Electronic Logistics Information Systems to support supply chain processes and functions. Overcoming these challenges will require greater investments to improve policy development and implementation, infrastructure, equipment and support systems, knowledge and skills of supply chain personnel, increased funding and improving governance and accountability.

Triptorelin stimulated luteinizing hormone concentrations for diagnosing central precocious puberty: study of diagnostic accuracy

PURPOSE

Gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for diagnosing central precocious puberty (CPP). However, intravenous GnRH is not always readily available. The aim of the present study was to evaluate the diagnostic accuracy of triptorelin-stimulated luteinizing hormone (LH) concentrations in the diagnosis of CPP among girls presenting with premature thelarche compared to the gold standard GnRH test.

METHODS

A prospective, case-control (CPP vs isolated premature thelarche), clinical study evaluating the diagnostic accuracy of triptorelin-stimulated LH concentrations in 60 girls with premature thelarche was performed. All girls underwent stimulation with subcutaneous triptorelin injection and intravenous GnRH in a randomized order. During the stimulation test with triptorelin, LH and FSH were measured at time 0, 30, 60, 90, 120, and 180 min after the injection. Estradiol was sampled 24 h after the injection. During the GnRH test, LH and FSH were measured at time 0, 30, 45, and 60 min. Girls with peak GnRH-stimulated LH concentrations ≥5.0 IU/L were classified as having CPP. Area under the curve (AUC) for triptorelin-stimulated LH concentrations was assessed using the receiver operating characteristic (ROC) analysis.

RESULTS

Triptorelin-stimulated LH concentrations were significantly higher in girls who had CPP according to the GnRH test (53.3%). LH peaked at 180 min after the triptorelin injection. The highest diagnostic accuracy for CPP (AUC = 0.973, sensitivity 96.9%, specificity 89.3%) at 180 min was at a LH concentration ≥3.4 IU/L. The 24 h estradiol concentration did not improve the predictive model.

CONCLUSIONS

Measuring LH concentrations 180 min after triptorelin injection with a cut-off value of ≥3.4 IU/L demonstrated a high diagnostic accuracy compared to the GnRH test. Thus, stimulation with triptorelin can be used as a reliable alternative for diagnosing CPP in girls with premature thelarche.

Managing pharmaceutical shortages during the COVID pandemic: An exploratory analysis of European collective and national government responses

Prior to the outbreak of the COVID pandemic, pharmaceutical shortages were already recognised as a major policy problem by most, if not all, European governments; and virtually all European national governments today publicise official shortage lists. Policy making in the area has been centred on the national government level, which meant that the understanding, definition, and response to shortages has remained highly heterogeneous. When the advent of the COVID pandemic exacerbated shortages, this situation continued against a background of a weak collective European response. As part of their responses to COVID-shortages, the medicines regulators of European countries expanded the range of products pharmacies could manufacture, process and distribute as well as their procedural authority in issuing, handling and processing prescriptions. While these measures were fairly common across Europe and alleviated some bottlenecks or improved medicine access for some patient groups, other responses were highly individualistic and included export bans of certain medications as well as efforts to draw on veterinary supplies. Our own data analysis of officially recorded shortage data during the first COVID wave (to October 2020) indicates that countries that had prepared for these types of crisis and maintained an active policy stance (e.g. Germany and Norway) were more likely to encounter fewer shortages than others. We also note that there is no direct correlation between officially recorded numbers of shortages and the ways in which national governments responded to these – which indicates that cultural expectations also might have been a significant policy driver.