Introduction:Malaria is a killer disease in the tropical environment; artemisinin-basedcombination therapies (ACTs) play a central role in treating malaria. Thus,the supply and presence of ACT drugs in hospitals are a key feature in thefight against malaria. Supply chain management literature has focused on theprivate sector, and less attention has been paid to the public sector,especially hospitals.Aim:This study uses an interdisciplinary lens in investigating how to boost thesupply and distribution of ACTs to save lives in low-income countries,specifically in Uganda.Methodology:The study adopted a quantitative research design using a questionnaire as thedata collection instrument. Of the 440-population size, 304 of the samplepopulation participated in the study. The model was estimated usingstructural equation modeling (SEM) to establish the causal relationshipamong the variables.Results:From the SEM analysis, all the hypotheses were significant atp < 0.05. The availability of ACTs is stronglyaffected by strategic dimensions (0.612), followed by operation dimensions(0.257); strategic determinants significantly affect operationaldeterminants by a magnitude of 0.599. The indirect influence of thestrategic determinants via operational determinants on the availability ofACTs is not significant. Overall, the factors explained 63.9% of theobserved variance in the availability of ACTs, and the ACT availability canbe predicted as follows: ACT availability = 0.612 × strategicdeterminants + 0.256 × operation determinants. Top management commitment andorganizational responsiveness are among the items that positively affect theavailability of ACTs.Conclusion:Strategically, hospital management should invest in cheap technology andsoftware to minimize the unavailability of medicines. Our research suggeststhat strategic and operational determinants should be integrated into thehospitals’ core business and implemented by the top management. The articlecontributes to theoretical and policy direction in the public sectormedicine supply chain, specifically in public hospitals.

Background:The point of care in many health systems is increasingly a point of healthdata generation, data which may be shared and used in a variety of ways by arange of different actors.Aim:We set out to gather data about the perspectives on health data-sharing ofpeople living in North East England who have been underrepresented withinother public engagement activities and who are marginalized in society.Methods:Multi-site ethnographic fieldwork was carried out in the Teesside region ofEngland over a 6-month period in 2019 as part of a large-scale health datainnovation program called Connected Health Cities. Organizations workingwith marginalized groups were contacted to recruit staff, volunteers, andbeneficiaries for participation in qualitative research. The data gatheredwere analyzed thematically and vignettes constructed to illustratefindings.Results:Previous encounters with health and social care professionals and the broadersocio-political contexts of people’s lives shape the perspectives of peoplefrom marginalized groups about sharing of data from their health records.While many would welcome improved care, the risks to people with sociallyproduced vulnerabilities must be appreciated by those advocating systemsthat share data for personalized medicine or other forms of data-drivencare.Conclusion:Forms of innovation in medicine which rely on greater data-sharing maypresent risks to groups and individuals with existing vulnerabilities, andadvocates of these innovations should address the lack of trustworthiness ofthose receiving data before asking that people trust new systems to providehealth benefits.

Background:Over 10% of antibiotics in low- and middle-income countries (LMICs) aresubstandard or falsified. Detection of poor-quality antibiotics via the goldstandard method, high-performance liquid chromatography (HPLC), is slow andcostly. Paper analytical devices (PADs) and antibiotic paper analyticaldevices (aPADs) have been developed as an inexpensive way to estimateantibiotic quality in LMICs.Aim:To model the impact of using a rapid screening tools, PADs/aPADs, to improvethe quality of amoxicillin used for treatment of childhood pneumonia inKenya.Methods:We developed an agent-based model, ESTEEM (Examining Screening Technologieswith Economic Evaluations for Medicines), to estimate the effectiveness andcost savings of incorporating PADs and aPADs in amoxicillin qualitysurveillance in Kenya. We compared the current testing scenario (batches ofentire samples tested by HPLC) with an expedited HPLC scenario (testingsmaller batches at a time), as well as a screening scenario using PADs/aPADsto identify poor-quality amoxicillin followed by confirmatory analysis withHPLC.Results:Scenarios using PADs/aPADs or expedited HPLC yielded greater incrementalbenefits than the current testing scenario by annually averting 586 (90%uncertainty range (UR) 364–874) and 221 (90% UR 126–332) child pneumoniadeaths, respectively. The PADs/aPADs screening scenario identified andremoved poor-quality antibiotics faster than the expedited or regular HPLCscenarios, and reduced costs significantly. The PADs/aPADs scenario resultedin an incremental return of $14.9 million annually compared with thereference scenario of only using HPLC.Conclusion:This analysis shows the significant value of PADs/aPADs as a medicine qualityscreening and testing tool in LMICs with limited resources.

Aim:Although the levels of cardiac troponin I (cTnI) have proved to be a usefuldiagnostic biomarker of acute myocardial infarction, there are a widevariety of point-of-care (POC) analysers, which provide measurements ofcTnI. The aim of this study was to compare the results obtained by the ADVIACentaur ultra-assay cTnI assay (us-cTnI), ADVIA Centaur high-sensitive cTnIassay (hs-cTnI) and a POC high-sensitivity assay using PATHFAST. We alsoaimed to explore total turnaround time (TAT) for laboratory results usingthe POC PATHFAST analyser.Methods:Samples from 161 patients were taken. Of these samples, 129 were tested withall three assays (us-cTnI, hs-cTnI and PATHFAST), and 32 samples were testedon PATHFAST for the comparison of whole blood, serum and plasma.Results:Comparison of the POC testing methods in this study demonstrated that thereare strong linear relationships between all three cTnI assays (us-cTnI,hs-cTnI and POC on PATHFAST). Furthermore, we also show there are stronglinear relationships between the two high-sensitive cTnI assays (hs-cTnI andPATHFAST) for blood serum samples, as determined by Passing–Bablokregression analyses. In our comparison of our new data with our older study,the TAT went down.Conclusion:The timeliness of laboratory results is, in addition to accuracy andprecision, one of the key indicators of laboratory performance, and at thesame time has a significant impact on the course of the patient’s condition.It is therefore important that the laboratory strives to meet theexpectations of clinicians regarding the time from the order to the resultof the analysis.

Background:Monoclonal antibodies (mAbs) represent the most numerous and significantgroup of biotherapeutics. While mAbs have undoubtedly improved treatment formany chronic diseases, including inflammatory diseases, they are typicallyexpensive for health care systems and patients. Consequently, access to mAbshas been a problem for many patients especially among Central and EasternEuropean (CEE) countries. However, biosimilars can potentially help withcosts, although there are concerns with their effectiveness and safety. Thisincludes biosimilars for long-acting insulin analogues.Aim:Assess the availability and use of biological medicines, includingbiosimilars within Bosnia and Herzegovina (B&H).Methods:Assess the availability of mAbs via the current lists of approved andaccessed mAbs versus those licenced in Europe and the United States andtheir utilisation, as well as specifically insulin glargine and itsbiosimilars, within B&H.Results:The availability of the mAbs in B&H appears satisfactory, which isencouraging. However, current usage is limited to a few mAbs which is aconcern for subsequent patient care especially with limited use ofbiosimilars to address issues of affordability. We also see limited use ofbiosimilar insulin glargine.ConclusionThe limited use of mAbs including biosimilars needs to be addressed inB&H to improve the future care of patients within finite resources. Wewill monitor these developments.

Background:Up to two-thirds of pregnancies among young, unmarried women in the UnitedStates are unintended, despite increased access to highly effectivecontraceptive options.Aim:This study implemented and evaluated a social marketing campaign designed toincrease access to a full range of contraceptive methods among women aged18–24 years on a southeastern university campus.Methods:Researchers partnered with Choose Well and Student Health Services to design,implement, and evaluate You Have Options, a 10-weekmulti-media social marketing campaign. The campaign aimed to raiseawareness, increase knowledge, and improve access to contraceptive options,including long-acting reversible contraception (LARC) methods among collegewomen. A pretest-posttest web-based survey design measured campaignawareness and recognition, as well as attitudes, subjective norms, andbehavior.Results:Participants demonstrated a significant increase in knowledge aboutintrauterine devices (IUDs) between pretest (M = 2.66,SD = 1.30) and posttest (M = 3.06;SD = 1.96); t(671) = −2.60,p < .01). Analysis revealed that frequent exposureto the campaign prompted participants to engage in discussions about LARCwith friends (p < .05). In addition, 20- to 24-year-oldswho reported seeing the campaign messages were more likely to seek outinformation (p < .01) and adopt a LARC method(p = .001) than 18- or 19-year-olds who saw thecampaign messages.Conclusion:Findings from the study offer practical recommendations for implementingsocial marketing campaigns aimed at increasing access to LARC and reducingunintended pregnancy.

Background:During pregnancy, due to the physiological and hormonal change, therequirement of iron–folic acid is enhanced. Therefore, the occurrence ofiron/folic acid deficiency is relatively high and it is responsible for 95%of anemia during pregnancy.Objectives:The aim of this study was to assess adherence to prenatal iron–folic acidsupplementation (IFAS) and associated factors among pregnant women attendingantenatal care services at public health facilities of Dilla town.Methods:Facility-based cross-sectional study design was employed selecting 403pregnant women attending antenatal care services in three public healthinstitutions of Dilla town. The women were included in the study by simplerandom sampling. Data were collected by interview and document review. Thenit was entered into EPI Data version 3.1 and exported to SPSS version 20 foranalysis. Bivariate and multivariate binary logistic regression techniqueswere used to identify independent predictors. A p-value<0.05 was taken as indication of statistical significance.Results:From the total of planned 403 pregnant women, 396 participated in the study,with a response rate of 98.2%. Of these, 172 (43.4%) pregnant women wereadhered to IFAS. The study also revealed that history of previous anemia(adjusted odds ratio (AOR) = 1.87; 95% confidence interval (CI):(1.01–3.47); p = 0.04), frequency of antenatal care center(ANC) visits (AOR = 2.51; 95% CI: (1.17–5.37); p = 0.01),knowledge of IFA supplement (AOR = 2.28; 95% CI: (1.36–3.82);p = 0.002), and knowledge of anemia (AOR = 2.30; 95%CI: (1.40–3.77); p = 0.001) were independent predictors ofadherence to IFAS.Conclusion:The finding of this study showed that less than half of the pregnant womenwere adhered to IFAS. History of previous anemia, frequency of ANC visits,knowledge of IFA supplement, and knowledge of anemia were the factorsassociated with adherence to IFA supplement.

Background:Proton-pump inhibitor (PPI) is a widely used medication class globally. Because of its good safety profile, there is a huge likelihood of inappropriate use.Objectives:To determine the prevalence of PPI use and indications, describe its pattern of usage, and identify factors associated with inappropriate prescriptions at a federal tertiary teaching hospital in Maiduguri, Nigeria.Methods:PPI prescriptions were retrospectively assessed in the General Outpatients’ Department (GOPD) and Gastroenterology Unit (GITU) of a teaching hospital. Relevant data for the study were extracted from the patients’ medical records. Chi-square or Fisher’s exact tests where appropriate were used to identify factors associated with inappropriate PPI prescriptions. A p < 0.05 was considered to be significant.Results:PPIs were prescribed to 73.3% (220/300) of patients, while inappropriate prescriptions were noted in 91.4% (201/220) of these patients. Epigastric pain (49.5%) was the most common PPI indication, while omeprazole was the highest prescribed (53.4%). Nearly all inpatients (98.2%), those with epigastric pain (95.7%), and patients who were prescribed intravenous PPIs had more inappropriate PPI prescriptions compared to others.Conclusion:This study revealed a high prevalence of PPI use and inappropriate prescriptions at the study hospital. As a result, these findings highlight the importance PPI-based stewardship program at the study hospital.

Objective:Amid COVID-19 disruptions, e-therapy has become even more essential and has rapidly expanded across statutory, private and third sectors to meet growing demands for digital mental health support. A challenge in digital therapeutic care is how to develop and maintain a supportive, collaborative therapeutic relationship, built upon mutual trust and respect; intrinsic values of relationships that are often implied through complex non-verbal cues. Online practitioners are eager to learn how to adapt to online delivery, although platform-specific training is limited. The aim of the current study was to focus upon the therapist experience of online therapeutic relationships with young people, exploring a range of factors through their perspectives, including the impact of anonymity.Methods:Eight e-therapy practitioners were recruited from Kooth, an online mental health service. Narrative interviews undertaken via Skype facilitated reflective conversational one-to-one discussions, based upon the practitioners’ individual experiences, led by the interviewee. Following transcription and anonymisation, a narrative analysis was undertaken to explore participants’ experiences, perspectives and reflections.Results:Four analytic layers arose from the narratives, which explored the challenging learning experience of translating existing therapeutic skills to online working, rapidly building therapeutic relationships, managing risk in the online therapeutic relationship, and techniques for maintaining a digital therapeutic relationship.Conclusion:The study provides novel insights into the flexibility and adjustments therapists can make to improve online interventions and delivery through the development and maintenance of positive therapeutic relationships. Recommendations are also made in relation to platform-specific training, communicative adaptations, risk management and practitioner support.

Introduction:Physicians in the United States play an essential role guiding patients through single patient pre-approval access (PAA) to investigational medical products via either the Food and Drug Administration (FDA)’s Expanded Access (EA) or the federal Right To Try (RTT) pathways. In this study, we sought to better understand pediatric hematologist/oncologists’ attitudes about seeking PAA, on behalf of single patients, to investigational drugs outside of clinical trials.Methods:A cross-sectional survey was developed and sent to pediatric hematologist/oncologists via St. Baldrick’s Foundation’s email distribution list.Results:Of 73 respondents (10.1% of those who received the survey), 56 met eligibility criteria and are included in the analysis. Over 80% (n = 46) had prior experience with single patient PAA. Respondents were most concerned about the unknown risks and benefits of investigational drugs and financial implications of PAA for patients. One hundred percent and 91.1% of respondents indicated a willingness to support patients through EA and RTT pathways, respectively. When asked about their most recent experience with PAA, 40 out of 46 indicated that they used the FDA’s EA pathway to seek PAA and 4 out of 46 indicated that they used the RTT pathway. Of 44 respondents who had used the EA or RTT pathway, 43 indicated that the biotechnology or pharmaceutical company they solicited granted access to the requested product.Conclusion:Survey results support other findings suggesting a need for additional physician support and education about PAA and that physicians may have unequal access to information about investigational drugs and concerns about financial implications of PAA for their patients.