Causes Of Shortages Research Articles

Medicines shortages in the UK: review of the causes and analysis of serious shortage protocols – a mixed methods study

Abstract Introduction Causes of medicines shortages are multifactorial. In February 2019, the Human Medicines Regulations 2012 introduced Serious Shortage Protocols (SSPs) to address medicines shortages. SSPs are issued by the Department of Health and Social Care and enable pharmacists to supply alternative medicines without amended prescriptions1. Aim This review aimed to explore contemporary reasons attributed to medicines shortages in the United Kingdom (UK) and analyse expired SSP records. Methods A rapid scoping literature review was conducted using National Library of Medicine (PubMed®) and Elsevier (ScienceDirect). Grey literatures were collated from the Pharmaceutical Journal, Google, and Public Health England’s grey literature index. Searches were limited to publications written in English, published since 2014, which met the inclusion criteria (medicines OR drugs AND shortages AND causes). Data extraction and analysis was performed using Microsoft Excel. Expired SSPs were extracted to Microsoft Excel and analysed using descriptive and inferential statistics on R software (v.4.3.2). SSP data is publicly available; therefore, no ethical approval was required. Results Causes of Medication Shortages A total of 11 papers were selected, in which 77 medicines shortage causes were discussed. Narrative analysis identified 10 shortage-drivers. The most frequent were Manufacturing and Quality Challenges (30%,23/77), Business and Commercial Issues (21%,16/77), and Regulatory Changes and Challenges (10%,8/77). Content analysis found that supply-driven issues were more frequently cited than demand-driven issues. SSP Analysis Between October 2019 and June 2024, 59 SSPs had expired2. Menopausal Hormonal Treatments (MHTs) were the most common medication class in shortage (41%,24/59), followed by antibiotics (17%,10/59), and antidepressants (12%,7/59). The mean shortage length was 129.2 days (IQR=51–196), the longest lasting 359 days (oestradiol 0.5mg/1mg gel sachets). Oestradiol transdermal medications accounted for 19 of 24 MHT SSPs. The mean MHT shortage length was 152.6 days (IQR=51.0–216.0). Phenoxymethylpenicillin accounted for 8 of 10 antibiotic shortages. All 8 phenoxymethylpenicillin SSPs were active from 15 December 2022 to 12 May 2023; 7 of 8 were oral solution formulations. The mean antibiotic shortage length was 168.8 days, which is significantly longer than the whole sample average (p<0.05, IQR=147.0–148.0). All antidepressant SSPs were fluoxetine capsules. The mean shortage length was 99 days (IQR= 35.5–122.0). Discussion Existing literature suggests supply-driven rather than demand-driven causes of medication shortages are more pertinent; however, most expired SSPs were issued in response to demand-driven factors, such as disease outbreaks and changing prescribing demand. This suggests the extent of demand-driven shortages is not reflected in current literature. Future research should explore how demand-driven causes of shortages can be mitigated. As a rapid scoping review was conducted, the full breadth of literature may not be presented. Additionally, the grey literature findings are limited by potential inaccuracies. Finally, the use of narrative analysis may limit the generalisability of identified shortage drivers. As of 05 June 2024, there are 5 active SSPs. With medicines shortages becoming normalised within the UK health system3, there is an urgent need to mitigate supply- and demand-driven causes. Additionally, further research should explore why certain medication classes are more frequently in shortage than others.

Эра персонализации: развитие креативного потенциала личности, «стена фильтров» и «информационные пузыри»

The prospects for the development of the personal potential of the student relate to the possibilities of personalised learning. The study identified key methodological approaches in understanding the process of personalisation of learning. On the basis of analysis of domestic and foreign sources, the main consequences of wide distribution and increasing influence on the person of digital personalisation tools have been determined. In education, they can become an insurmountable obstacle to the development of students' personal potential. The concepts of “wall of filters” and “information bubbles” are considered in order to determine the causes of shortage of creative resources of the person in a competitive digital environment. The development of a personalised learning model must take into account the potential dangers of Internet technology. The author focuses on the emerging anthropological threats in the digital environment to the development of the creative potential of the individual. The conclusions were confirmed by the results of sociological research. The importance of finding solutions to minimise and overcome risks of digital bases of personalisation was emphasised.

Results of EAHP’s 2023 shortages survey

Aims and objectiveThe aim of the European Association of Hospital Pharmacists (EAHP)’s 2023 shortages survey was to collect data on causes and mitigation strategies of shortages of medicines and medical...

Nurse Wage Status and Wage determinants

Purpose: The purpose of this study is to identify the causes of the shortage of nurses in local small and medium-sized hospitals by confirming the wage status according to the characteristics of nurses and the characteristics of medical institutions and analyzing the factors affecting the wages of nurses.Methods: The study was conducted by linking the DB of medical institutions owned by the National Health Insurance Corporation, DB of medical personnel, and DB of health insurance qualification. As of the end of 2018, only nurses working at hospital-level medical institutions who were reported to the Health Insurance Review & Assessment Service were registered as registered members of the health insurance at the medical institution. The dependent variables were the monthly average wage of nurses, and the independent variables were age, institution establishment, medical institution type, region, and number of beds. In the analysis, first, wages by individual and institutional characteristics were identified through basic statistical analysis, and factors affecting wages were analyzed through regression analysis.Result: As a result, the wages of nurses increased 71,184 won as the age increased, and the establishment of medical institutions was 291,574 won less and corporations 660,725 won less than the national government. The types of medical institutions were 400,964 won less and 675,829 won less than general hospitals. The size of the city was 325,989 won less in metropolitan cities and 263,672 won less in metropolitan areas than in the metropolitan area. As the number of beds at medical institutions increased by one bed, it was 708 won higher.Conclusion: According to the analysis of the wage status according to the characteristics of nurses’ personal characteristics and medical institutions, and the wage determinants of nurses, the relatively low wages of nurses in local small and medium hospitals were the main cause of job shortage. The market principle is that the wage increases if there is a shortage of supply in the labor market compared to the demand of nurses. On the contrary, the wage is lower in local SMEs. As a result, there seems to be some nurses who give up their activities. In order to resolve the labor shortage in local small and medium-sized hospitals, it is necessary to narrow the wage gap, and to create a working environment such as elastic working so that the daily work can be balanced.

IMPLEMENTATION OF MSME INVENTORY MANAGEMENT IN CIPULIR VILLAGE – JAKARTA SELATAN

Community Service Activities (CSA) were carried out in the Cipulir sub-district. The activity participants are MSMEs who live in Cipulir sub-district. The people at the location generally work as traders and small industries. MSMEs often face problems with shortages or excess supplies which have the impact of hampering business activities. The causes of shortages or excess inventory include: a) MSME actors do not forecast sales, so MSME actors only order inventory according to previous order history. This causes ambiguity between the production plan and the raw material requirements plan, which is the reference for purchasing inventory, b) the absence of safety stock, which is useful for guarding against the possibility of stock outs, c) the absence of clear inventory management, with no there is evidence of inventory recording, as well as inventory control. Based on an analysis of the situation faced by partners, the Community Service Team intends to provide solutions to partner problems by increasing knowledge and understanding regarding inventory management for MSMEs. The method used in this activity is sharing sessions and discussions, which are then given training related to inventory management. Then the activity continued with questions and answers and case study simulations. The results of the evaluation showed that most participants understood the material presented. The evaluation results also illustrate that all participants felt they had benefited from this activity, and were satisfied with the implementation of this activity.

Prevention and management of health products shortages by the French national agency (ANSM), 10 years of experience.

Shortages of drugs and medical devices have tended to increase in France and worldwide, with consequences for patients and healthcare professionals. Preventing shortages of health products has become a priority for regulatory authorities, including the French National Agency for Medicines and Health Products Safety (ANSM). To highlight perspectives for a better prevention, we described and analyzed the management of shortages in the availability of health products in France over the last 10 years. The supply chain was mapped to identify the main causes of shortages and stakeholders involved in managing shortages throughout the supply chain. National and European initiatives and regulatory measures were reviewed. A retrospective nationwide data analysis from the French reporting system of health product shortage reports was conducted over 10 years for drugs (2013-2022) and over an 18-month period for medical devices, from 1st March 2022 to 31st August 2023. An increase in drug shortage reports was observed, rising from 404 in 2013 to 3,761 in 2022 for drugs, with a relatively constant distribution of affected therapeutic classes. In 2022, the main reported causes of drug shortage risk were insufficient production capacity (27.1%), increased sales volume (21.5%), or lack of supply (13.6%). Over half of the reports on medical devices (55.4%) were objectified as indispensable, and their causes were mainly due to a lack of supply (48.2%), discontinuation of marketing (14.9%), increased sales volume (13.2%), and regulatory reasons (9.6%). ANSM and French authorities have engaged a public health policy for prevention and management of health product shortages including financial penalties, minimum safety stocks for Major Therapeutic Interest drugs, and a shortage management plan. Based on 10 years of experience, four priority measures have been identified to anticipate the risk of heath products shortages based: the importance of a national coordination from raw materials to local market, the implementation of new prevention and management actions in the supply chain, strengthening European cooperation and regulation including the establishment of a list of critical drugs, and promoting transparency and information.

Drug shortages. Part 2: Trends, causes and solutions.

Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations. In the first part of this review we proposed an operational definition that incorporates the processes by which products are manufactured, the causes of shortages and stock-outs (local shortages), and the contributory factors. Here we discuss causes and possible solutions. Drug shortages have complex causes, and a single cause cannot always be identified. Reasons include lack or shortage of raw materials, manufacturing difficulties, regulatory and political actions, voluntary recalls, just-in-time inventory systems, halts in production for financial or other business reasons, low demand (eg, orphan products, reduced usage), mergers, market shifts (eg, diversion to home markets) and unexpected increases in demand (eg, improved diagnosis, new trial information, epidemics and pandemics, inappropriate use, off-label use). Potential solutions are as diverse as the potential causes. Prevention is hard, because shortages are not easily predicted. Everyone in the supply chain is involved in anticipating and managing shortages, with responsibilities for preventing them or at least trying to mitigate their effects. This includes manufacturers and suppliers, particularly of generic formulations, pharmacists, prescribers, patients and governments. Solutions can therefore be linked to the causes and classified according to where the responsibility for implementing them lies.

Clinical Rounds.

In Brief Understaffing a likely cause of shortage... Link between extreme temperatures, excess deaths... AUD-ED injury visits associated with increased mortality risk... Early-onset type 2 diabetes a growing adolescent concern

Tough times never last too long: the future of psychopharmacology.

Tough times never last too long: the future of psychopharmacology.

Graphene Oxide Nanoadsorbent for the Removal of Fluoride Ion from Groundwater: Adsorbent Performance and Adsorption Mechanism

The deterioration of the quality of groundwater by fluoride is the cause of shortage of drinking water supply in the rift valley region. Most people living in the rural areas are using groundwater as the source of their potable water; however, it is contaminated with high concentrations of fluoride ion above the permissible level. Hence, this study was designed to investigate the adsorption of fluoride from groundwater by graphene oxide (GO) under specific conditions, such as: agitation rate of 120 rpm, contact time of 90 minutes, adsorbent dosage of 0.42 mg/L, initial fluoride concentration of 10 mg/L, and pH of 6.8. The result obtained showed 99.3% fluoride removal from the NaF prepared solution and 91.6% fluoride removal from the real sample. The retained properties of GO after adsorption observed on UV–Vis analysis confirmed that the adsorbent can be recyclable. The result obtained also showed that the adsorption kinetics with the coefficient of determination (R2) for pseudo-second order (SSO) and pseudo-first order (SFO) were 0.99 and 0.96, respectively. Based on these results, the adsorption of fluoride onto GO is a pseudo-second-order kinetics type. According to the result, the Freundlich isotherm model showed a good fit to the experiment with R2 (0.99). The adsorption capacity of the adsorbent was found to be 301.43 mg/g. Hence, this study showed that GO is the preferred adsorbent for the removal of fluoride from groundwater.

Drug shortages worsening, pharmacists say.

Pharmacists have successfully managed drug product shortages for many years, but the problem facing the profession today is unlike anything seen before. “The volume of shortages is extreme,” said Parwana Shah, associate director of inpatient pharmacy services for Penn-Presbyterian Medical Center in Philadelphia, PA. “It used to be 1 or 2 here and there, and we’d manage it. But now, every day there’s a different one.” Shah said recent drug product shortages are worsened by concurrent shortages of critical supplies, such as IV bags and needles, that are needed to administer medications. “We can’t even get the tubing so the nurses can hang the drugs,” Shah said, adding that the nurses must sometimes “push” medication doses through a syringe instead of using an infusion pump. “Every step of the way you’re hit with roadblocks,” she said. According to the Food and Drug Administration (FDA), typical causes of shortages include manufacturing...

Government agencies overseeing municipal council funds: رقابة الأجهزة الحكومية على أموال المجالس البلدية

The research aims to identify the main internal and external monetary supplies to municipalities and their role in turning municipalities to development institutions. IN addition, this research identified the main supervision practices over the municipal councils, which are carried out by some government agencies. The effect of such practices on the adequacy of work has also been identified. the descriptive approach has been used to handle these monetary supplies based on the legislations and regulations that are related to them. the analytical approach has also been employed by analyzing some legal provisions that are related to the research. In conclusion, after having handled the surveillance of the government agencies over municipal councils funds. It is essential to show the main results that we concluded as well as stating some recommendations, which are five. Among the most important results of the study: The financial autonomy that municipalities have is not absolute and relative, which emphasizes the idea that municipalities funds are subject to control by the central authority. this can sometimes lead to imposing some restrains on the jurisdiction of the municipal councils. The study recommended Increasing the financial autonomy of the municipalities as imposing censorship over the financial autonomy may be a cause of shortage of funds.

Short of drugs? Call upon operations and supply chain management

PurposeThis “impact pathways” paper argues that operations and supply chain management (OSCM) could help address the worsening drug shortage problem in high-income countries. This significant societal problem poses difficult challenges to stakeholders given the complex and dynamic nature of drug supply chains. OSCM scholars are well positioned to provide answers, introducing new research directions for OSCM in the process.Design/methodology/approachTo substantiate this, the authors carried out a review of stakeholder reports from six European countries and the academic literature.FindingsThere is little academic research and no fundamental agreement among stakeholders about causes of shortages. Stakeholders have suggested many government measures, but little evidence exists on their comparative cost-effectiveness.Originality/valueThe authors discuss three pathways of impactful research on drug shortages to which OSCM could contribute: (1) Developing an evidence-based system view of drug shortages; (2) Studying the comparative cost-effectiveness of key government interventions; (3) Bringing supply chain risk management into the government and economics perspectives and vice versa. Our study provides a baseline for future COVID-19-related research on this topic.

SHORTAGE OF FUNDS IN THE NIGERIAN PUBLIC UNIVERSITIES: CAUSES, EFFECTS AND WAYS FORWARD

The university education is one of the most expensive forms of educational system in the World. The university education is very complex and capital intensive. The public universities in Nigeria are under-funded, and this is affecting the development of the system. This paper examined factors/causes responsible for shortage of funds in the Nigerian public universities. Print materials and online publication were sorted and used in the paper. This paper identified; lack of political will to implement UNESCO 26% for education, poor internally generated revenue, corruption and insecurity problems as causes of shortage of funds in the public universities while the effects of shortage funds in the administration of universities includes; inadequate infrastructural facilities, inadequate manpower, poor quality of education, strike actions and brain-drain. To address these problems of shortage of funds in the Nigerian public universities, the paper recommended that the government should develop the political will to implement the UNESCO 26% recommendation for annual education budget, the school administrators should generated ideas to increase the internally generated revenue and all forms of corruption should be fought in the university education system.

Drug Shortage: Causes, Impact, and Mitigation Strategies.

Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.

Structural dynamics and determinants of abscisic acid-receptor binding preference in different aggregation states.

In the 21st century, drought has been the main cause of shortages in world grain production and has created problems with food security. Abscisic acid (ABA) is a key plant hormone involved in the response to abiotic stress, especially drought. The pyrabactin resistance (PYR)/PYR1-like (PYL)/regulatory component of abscisic acid receptor (RCAR) family of proteins (simplified as PYLs) is a well-known ABA receptor family, which can be divided into dimeric and monomeric forms. PYLs can recognize ABA and activate downstream plant drought-resistance signals. However, the difference between monomeric and dimeric receptors in the mechanism of the response to ABA is unclear. Here, we reveal that monomeric receptors have a competitive advantage over dimeric receptors for binding to ABA, driven by the energy penalty resulting from dimer dissociation. ABA also plays different roles with the monomer and the dimer: in the monomer, it acts as a 'conformational stabilizer' for stabilizing the closed gate, whereas for the dimer, it serves as an 'allosteric promoter' for promoting gate closure, which leads to dissociation of the two subunits. This work illustrates how receptor oligomerization could modulate hormonal responses and provides a new concept for novel engineered plants based on ABA binding of monomers.

Principales causas que provoca el desabastecimiento en las operaciones logísticas y su impacto en la promesa de entrega

This article will present the main causes that companies present in their supply process, as well as how these are directly affecting the promise of delivery. The promise of delivery in a Company should be considered as the most important indicator, it assesses customer satisfaction in terms of delivery quality and delivery time. Many authors have spoken over time about the different causes of shortages in the logistics process; As a Company it is important to know that these causes exist and which of them is the one that most impacts customer satisfaction. The authors who have studied these causes will be mentioned, we will analyze their conclusions and confront Colombia's contemporaneity.

Overview of the causes and management of drug shortages in the United States and in Hungary

Drug shortages are a multifactorial international concern that is increasingly reported all over the world. A continuously rising number of cases could be observed since 2001, but the issue is particularly significant since 2009. In Hungary, the same increasing tendency was observed; while in 2012 464 shortages occurred, in 2020 1466 cases were reported. According to the Food and Drug Administration, there are three root causes behind the shortages, but several factors can be derived from them. This paper aims at conducting a comprehensive review of literature, exploring these factors in detail and thereby explaining how each of these factors contributes to shortages. Furthermore, it will illustrate how the lack of sufficient information due to an imperfect warning system also contributes to the issue. As the problem affects every stakeholder in the supply chain from patients to Marketing Authorisation Holders, each party should be involved in the development and implementation of mitigating strategies that can provide the basis of policy measures. The article highlights how international trends both in terms of affected therapeutic areas and causes of shortages are reflected in the Hungarian markets; therefore similar approaches could be adapted to tackle the issue domestically and deliver enduring solutions.

Results of EAHP’s 2019 Medicines Shortages Survey

Aims and objectivesThe aim of the 2019 EAHP Medicines Shortages Survey was to collect information on reasons and management strategies for medicines shortages as well as details on their impact...

Задачи экономического анализа, применяемые в процессе организации местного самоуправления

The relevance of the studied topic is indicated by the fact that the eco­nomic analysis of economic activity is applied not only at the level of a single enterprise, but also at the level of local governments and the state as a whole. In this case, economic analysis is used to make the most correct deci­sions in relation to the direction of the use of budgetary funds, eliminate the causes of shortage of funds in a particular subject of the Russian Federation, increase the importance of goods exported from the region to other subjects of the Russian Federation and other countries. In order for the above-men­tioned goals to be fully achieved, it is necessary to correctly define the tasks of economic analysis, solved by local authorities.