Health Management Research Articles

Developing analytical skills for biomarkers of exposure in a university laboratory for research, health management and risk assessment in Uruguay

Developing analytical skills for biomarkers of exposure in a university laboratory for research, health management and risk assessment in Uruguay

Advancements in electrochemical immunosensors towards point-of-care detection of cardiac biomarkers.

Cardiovascular disease remains the leading cause of death worldwide, with mortality rates increasing annually. This underscores the urgent need for accurate diagnostic and monitoring tools. Electrochemical detection has emerged as a promising method for swiftly and precisely measuring specific biomarkers in bodily fluids. This approach is not only cost-effective and efficient compared to traditional clinical methods, but it can also be tailored to detect individual biomarkers, which makes it particularly well-suited for point-of-care (POC) applications. The ability to conduct testing at the point of care is crucial for timely interventions and personalized disease management, empowering healthcare providers to tailor treatment plans based on real-time biomarker data. Thanks to recent advancements in nanomaterials, we've seen significant progress in electrochemical detection, leading to the development of specialized rapid immunoassay systems. These systems utilize specific antibodies to target molecules, expanding the range of detectable biomarkers. This innovation has the potential to revolutionize the diagnosis and treatment of cardiovascular diseases by enhancing detection sensitivity and specificity. Ultimately, these advancements aim to improve patient outcomes by enabling earlier diagnosis, more precise monitoring, and personalized therapeutic interventions, which will contribute to more effective management of cardiovascular health globally.

Optimizing preoperative bone health assessment for adult spinal deformity: a prospective correlation analysis of intraoperative pedicle screw insertion torque and imaging modalities in Japan.

Prospective cohort study. This study aimed to identify the optimal preoperative bone health assessment for adult spinal deformity (ASD) surgery through correlation analysis between intraoperative pedicle screw (PS) insertion torque and various bone quality measures, including bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DEXA), Hounsfield unit (HU) by computed tomography (CT), and vertebral bone quality (VBQ) score by magnetic resonance imaging. Existing data on optimal assessment tools for ASD surgery are limited. The study included patients with ASD aged >60 years who underwent spinal corrective fusion surgery from the lower thoracic spine to the pelvis. The intraoperative PS insertion torque was measured using a torque meter. Pearson correlation coefficients were calculated between the PS insertion torque and the BMD, HU, and VBQ score. Preoperative bone quality was compared between the proximal junctional failure (PJF) and non-PJF groups. Thirty-one patients with 177 PS at T10, T11, and T12 were analyzed. The PS insertion torque showed a moderate positive correlation with lumbar spine BMD (r=0.59-0.69, p<0.01), total hip BMD (0.58-0.62, p<0.01), and HU value (r=0.58-0.66, p<0.01). However, the VBQ score did not show significant correlation (r=-0.28 to -0.23, p >0.05). Notably, a strong correlation was found between the PS insertion torque and the HU value for screws of the same size (r=0.71 and 0.74, p<0.01). The HU value at T12 and the PS insertion torque at T10 were significantly lower in the PJF group than in the non-PJF group. This study demonstrates a positive correlation between the PS insertion torque and HU value in the lower thoracic spine and a moderate correlation with BMD but not the VBQ score. Preoperative assessment using DEXA and CT is crucial for optimizing bone health management in ASD surgery.

Ethnic differences in the patterns, sources, and reasons for cannabis use among cancer patients at an NCI-Designated Cancer Center.

This study aims to describe patterns, sources, and reasons for cannabis use among cancer patients by ethnic group. Data are from a cross-sectional study of 416 surveys collected via RedCap anonymously from adult cancer patients seen at a National Cancer Institute-designated comprehensive cancer center within the last 5 years. A harmonized survey was created with 11 other National Cancer Institute centers to assess cannabis use patterns, sources, and reasons for use. Sociodemographics and cancer details were also collected via self-report. Descriptive statistics by ethnic group were compared using χ2 and Fisher exact tests. Among the sample (age mean = 50.4 [15.7] years; 53% male; 8.3% lesbian, gay, bisexual, transgender, queer; 46.7% Hispanic and Latinx individuals), 69.6% reported lifetime use of cannabis, 33.7% began cannabis use after cancer diagnosis, 48.1% of those consuming cannabis did not have a prescription for cannabis, and 29.4% of cannabis users consumed daily. The frequency of cannabis use (P = .04) and reasons for cannabis use (P = .02) varied by ethnic group. Sleep and pain were the most prevalent reasons for use among the Hispanics and Latinx populations; pain, mental health management, and neuropathy were the most prevalent reasons for cannabis use among non-Hispanic White individuals. Patterns and reasons for cannabis use differed among cancer patients by ethnic group in this exploratory cross-sectional study aimed to provide data for more rigorous study. Understanding these distinctions are pivotal in conducting more rigorous studies that address the unique needs of diverse populations utilizing cannabis for managing cancer-related symptoms.

Oral hygiene changes & compliance with telemonitoring device in individuals with intellectual/developmental disabilities: a randomized controlled crossover trial.

Advances in mobile technology are helping with health management practices, and smart toothbrushes provide proper dental care by collecting and analyzing users' toothbrushing data. The purpose of this study is to assess the effect of a telemonitoring device on oral hygiene management in individuals with intellectual or developmental disabilities and its role in promoting oral health. Participants were split into two groups: one initially using the telemonitoring device (telemonitoring device/manual toothbrush) and the other using it later (manual toothbrush/telemonitoring device), with a one-month washout period. The study compared plaque index, halitosis, changes in oral microbiota, and guardian questionnaire responses between the groups. In period 1, the QHI index score significantly decreased from 1.93 to 0.83 in the group using the remote monitoring device, compared to an increase from 1.75 to 2.01 in the manual toothbrush group. Additionally, toothbrushing frequency, time, and cooperation increased by 0.82 ± 0.60, 0.82 ± 1.16, and 1.09 ± 0.94, respectively, with initial telemonitoring device use. However, these measures decreased by -1.45 ± 0.68, -1.09 ± 0.70, and - 1.00 ± 1.00 after switching to a manual toothbrush, and decreased by -0.64 ± 0.67, -0.27 ± 1.19, and 0.09 ± 0.94 overall, respectively. However, there were no significant differences in oral microbiota between the groups at these different time points. The study shows that telemonitoring devices effectively reduce plaque index and improve toothbrushing frequency, time, and cooperation. However, these benefits decrease after switching to a manual toothbrush. Follow-up is needed to assess satisfaction and compliance with telemonitoring device use. Using telemonitoring devices in the oral health management of individuals with intellectual and developmental disabilities can improve their oral health quality.

Puzzle: taking livestock tracking to the next level

Animal behavior is a critical aspect for a better understanding and management of animal health and welfare. The combination of cameras with artificial intelligence holds significant potential, particularly as it eliminates the need to handle animals and allows for the simultaneous measurement of various traits, including activity, space utilization, and inter-individual distance. The primary challenge in using these techniques is dealing with the individualization of data, known as the multiple object tracking problem in computer science. In this article, we propose an original solution called “Puzzle.” Similar to solving a puzzle, where you start with the border pieces that are easy to position, our approach involves commencing with video sequences where tracking is straightforward. This initial phase aims to train a Convolutional Neural Network (CNN) capable of deriving the appearance clues of each animal. The CNN is then used on the entire video, together with distance-based metrics, in order to associate detections and animal id. We illustrated our method in the context of outdoor goat tracking, achieving a high percentage of good tracking, exceeding 90%. We discussed the impact of different criteria used for animal ID association, considering whether they are based solely on location, appearance, or a combination of both. Our findings indicate that, by adopting the puzzle paradigm and tailoring the appearance CNN to the specific video, relying solely on appearance can yield satisfactory results. Finally, we explored the influence of tracking efficacy on two behavioral studies, estimating space utilization and activity. The results demonstrated that the estimation error remained below 10%. The code is entirely open-source and extensively documented. Additionally, it is linked to a data-paper to facilitate the training of any automatic detection algorithm for goats, with the goal of fostering open access within the deep-learning livestock community.

A rapid on-site loop-mediated isothermal amplification technology as an early warning system for the detection of Shiga toxin-producing Escherichia coli in water.

Shiga toxin-producing Escherichia coli (STEC) is an important waterborne pathogen capable of causing serious gastrointestinal infections with potentially fatal complications, including haemolytic-uremic syndrome. All STEC serogroups harbour genes that encode at least one Shiga toxin (stx1 and/or stx2), which constitute the primary virulence factors of STEC. Loop-mediated isothermal amplification (LAMP) enables rapid real-time pathogen detection with a high degree of specificity and sensitivity. The aim of this study was to develop and validate an on-site portable diagnostics workstation employing LAMP technology to permit rapid real-time STEC detection in environmental water samples. Water samples (n=28) were collected from groundwater wells (n=13), rivers (n=12), a turlough (n=2) and an agricultural drain (n=1) from the Corrib catchment in Galway. Water samples (100 ml) were passed through a 0.22 µm filter, and buffer was added to elute captured cells. Following filtration, eluates were tested directly using LAMP assays targeting stx1, stx2 and E. coli phoA genes. The portable diagnostics workstation was used in field studies to demonstrate the on-site testing capabilities of the instrument. Real-time PCR assays targeting stx1 and stx2 genes were used to confirm the results. The limit of detection for stx1, stx2 and phoA LAMP assays were 2, 2 and 6 copies, respectively. Overall, stx1, stx2 and phoA genes were detected by LAMP in 15/28 (53.6 %), 9/28 (32.2 %) and 24/28 (85.7 %) samples, respectively. For confirmation, the LAMP results for stx1 and stx2 correlated perfectly (100 %) with those obtained using PCR. The portable diagnostics workstation exhibited high sensitivity throughout the on-site operation, and the average time from sample collection to final result was 40 min. We describe a simple, transferable and efficient diagnostic technology for on-site molecular analysis of various water sources. This method allows on-site testing of drinking water, enabling evidence-based decision-making by public health and water management authorities.

Reviving Ancient Wisdom: Evidence-Based Study of Unani Medicines on Management of Migraine and Arthritis.

Unani medicine, rooted in Greco-Arabic traditions, offers a holistic approach to healthcare, focusing on the balance of bodily humors and natural medications from plants, minerals, and animals. Unani medicine's holistic perspective emphasizes comprehensive care by addressing the root causes of diseases, particularly in chronic conditions like cancer and neurological disorders. The system's emphasis on Mizaj, preventive measures, and health promotion reflects its relevance in contemporary healthcare. Integrating traditional knowledge with modern scientific validation, Unani medicine offers valuable insights into alternative approaches to health management. This review article explores the management of migraine and arthritis using Unani medicine, drawing insights from various case reports. The objective is to evaluate the efficacy of Unani treatments in providing relief and improving the quality of life for patients suffering from these conditions. The review analyzes multiple case reports detailing the use of specific Unani formulations and therapies. Key findings indicate that Unani medicine, with its holistic approach and reliance on natural medications, has shown promising results in managing both migraine and arthritis.Unani medicine offers a valuable alternative approach to managing migraine and arthritis, aligning traditional knowledge with modern therapeutic needs.

A study on the professional attention and career commitment of health management students.

The education process is based on leading the choice of profession in line with the interests and abilities of the individual and helping them with their career plans in these professions. The aim of this study is to investigate the effect of the occupational interest levels of the Health Management Department students on their career commitment. In the study, descriptive findings were included by using a quantitative research design. In the research, data were collected from 282 students studying Department of Health Management. SPSS 26.0 package program was used for statistical analysis of research data. Parametric tests (t-test, analysis of variance, Pearson correlation analysis, normal linear regression analysis) were utilized since the data fit the normal distribution. 57.1% of the individuals participating in the research are female, 47.8% have the age range of 21 to 22. There is a positive, moderate (r = 0.677 p < 0.01) significant relationship between professional interest and career commitment scales. The level of professional interest and career dedication varies according to gender, age, income status and the class of the student. It is very important that health management students have an interest in their profession. Because this interest will guide them in what kind of a career they should make in their business life after graduation.

Assessment of epidemic risk state and its change trend of public hospital in underdeveloped area in different stages

ObjectiveEpidemics are sudden and rapidly spreading. Hospitals in underdeveloped areas are particularly vulnerable in case of an outbreak. This paper aims to assess the epidemic risk state and its change trend of hospitals in different epidemic stages, identify the key factors affecting hospital epidemic risk change, provide priority reference for hospital epidemic risk control, and enhance the hospital's ability to respond to sudden epidemics.MethodsBased on Grounded theory, the epidemic risk indicators that affect hospital safety are summarized. The concept of epidemic risk state and its random state space is proposed according to Markov chain theory. The impact of each indicator on the random risk state and its change is comprehensively assessed from two aspects: risk occurrence probability and risk loss. Finally, the assessment of the hospital epidemic risk state and its change at different stages is achieved.ResultsThe stable risk states of public hospitals in underdeveloped areas in non-epidemic stage t0, early epidemic stage t1, and outbreak stage t2 are P^t0(Sn)={0.142,0.546,0.220,0.093}, P^t1(Sn)={0.025,0.364,0.254,0.357}, and P^t2(Sn)={0.020,0.241,0.191,0.548}, respectively. In non-epidemic stage, the key factor in improving the hospital epidemic risk state is emergency funding. In early epidemic stage, the key factors in improving the hospital epidemic risk state are the training of medical staff in epidemic prevention skills and the management of public health. In outbreak state, the key factor in improving the hospital epidemic risk state is the training of medical staff in epidemic prevention skills and psychological awareness.ConclusionThis paper proposes the concept of epidemic risk state, providing an effective assessment method for the epidemic risk state and its change trend in public hospitals. According to the assessment, public hospitals in underdeveloped areas in different epidemic stages should adopt different risk control strategies to improve their current risk state. Blind risk control is inefficient and may even cause the epidemic risk to transition toward a more dangerous state.

Estimating and planning hospital costs of public hospitals in Brazil.

While the estimate of hospital costs concerns the past, its planning focuses on the future. However, in many low and middle-income countries, public hospitals do not have robust accounting health systems to evaluate and project their expenses. In Brazil, public hospitals are funded based on government estimates of available hospital infrastructure, historical expenditures and population needs. However, these pieces of information are not always readily available for all hospitals. To solve this challenge, we propose a flexible simulation-based optimisation algorithm that integrates this dual task: estimating and planning hospital costs. The method was applied to a network of 17 public hospitals in Brazil to produce the estimates. Setting the model parameters for population needs and future hospital infrastructure can be used as a cost-projection tool for divestment, maintenance, or investment. Results show that the method can aid health managers in hospitals' global budgeting and policymakers in improving fairness in hospitals' financing.

Building a digital supportive supervision system for improving health service delivery in Low- and Middle-Income countries through the collaborative requirements development methodology (CRDM): Experience from Tanzania

Background Supportive supervision is pivotal for both health service providers and managers to improve the quality of services and health outcomes. Tanzania's digital supportive supervision system is called Afya Supportive Supervision System (AfyaSS ®). The latter was designed and developed using a human-centered approach called Collaborative Requirements Development Methodology (CRDM). This paper describes the experiences of building the digital supportive supervision system through CRDM in Tanzania, a transition from the paper-based supportive supervision system. Methods In 2018, with the support of PATH, the government of Tanzania adopted a participatory human-centered design by carrying out desk reviews of existing guidelines and tools, field visits, stakeholder workshops, and user advisory groups to gather information for developing a digital supportive supervision system. The gathered information was analyzed with the lens of identifying the common challenges and system requirements. Results AfyaSS was successfully developed using CRDM and deployed in all regions across the country. It has consolidated multiple checklists for distinct health domains, and dashboard functionalities to track progress toward health system indicators, objectives, and action plans. As part of the deployment, several resources were developed to aid in the deployment process, such as a comprehensive user manual, facilitator's guide, training slides, and video tutorials. Health workers and managers can be empowered and motivated to implement comprehensive and coherent supportive supervision by using the lessons learned from this digitalization process to transform the current supervision processes to improve the quality of care by offering instruments that promote evidence-based actions. Conclusion A human-centered approach has been shown to be useful in developing digital tools for use in Tanzania’s health system. Tanzania's lessons can be applied in other low- and middle- income countries (LMICs) with similar contexts when considering implementing digital health interventions. While using the human-centered approach, it is crucial to establish a system development roadmap, conduct appropriate training, provide sustained information and communication technology, and management support for unforeseen issues, and ensure ongoing maintenance.

Challenges and way forward in the handling and disposal of battery waste: Towards sustainable practices

&lt;p&gt;The management and disposal of battery waste, particularly lead-acid batteries, present numerous challenges that must be addressed to ensure environmental protection, public health, and sustainable resource management. This thesis examines the multifaceted nature of these challenges and explores potential solutions for sustainable battery management. Drawing on insights from prior research, field observations, stakeholder interviews, and literature reviews, the study synthesizes existing knowledge to inform strategies for mitigating the environmental, safety, and economic impacts associated with battery waste. The current scenario on battery waste management highlights significant challenges, including environmental pollution, health risks, safety hazards, recycling challenges, regulatory compliance issues, technological limitations, infrastructure constraints, and the need for public awareness and education. Countermeasures to address these challenges encompass regulatory interventions, technological innovations, infrastructure development, capacity building, and public engagement initiatives. By integrating findings from diverse sources, this thesis aims to contribute to the existing knowledge base on battery waste management and propel strategies for sustainable resource management.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Enhancing qualification via the use of diagnostics and prognostics techniques

AbstractQualification is a process that demonstrates whether a product meets or exceeds specified requirements. Testing and data analysis performed within a qualification procedure should verify that products satisfy those requirements, including reliability requirements. Most of the electronics industry qualifies products using procedures dictated within qualification standards. A review of common qualification standards reveals that those standards do not consider customer requirements or the product physics‐of‐failure in that intended application. As a result, qualification, as represented in the reviewed qualification standards, would not meet our definition of qualification for reliability assessment. This paper introduces the application of diagnostics and prognostics techniques to analyze real‐time data trends while conducting qualification tests. Diagnostics techniques identify anomalous behavior exhibited by the product, and prognostics techniques forecast how the product will behave during the remainder of the qualification test and how the product would have behaved if the test continued. As a result, combining diagnostics and prognostics techniques can enable the prediction of the remaining time‐to‐failure for the product undergoing qualification. Several ancillary benefits related to an improved testing strategy, parts selection and management, and support of a prognostics and health management system in operation also arise from applying prognostics and diagnostics techniques to qualification.

Temporal trends of ischemic stroke attributable to high fasting plasma glucose in China from the global burden of disease study 2019

BackgroundCurrently ischemic stroke poses a serious disease burden globally, and high fasting plasma glucose is one of the important risk factors. The aim of this study was to investigate the disease burden of ischemic stroke due to fasting glucose during 1990-2019 in China, to estimate the effect of age, period, and cohort on the trend of ischemic stroke disease burden, and to predict the disease burden of ischemic stroke in 2020-2030.MethodsIschemic stroke burden data were obtained by screening from the Global Burden of Disease Study 2019 (GBD 2019) database for high-risk populations in China. Annual average percentage change (AAPC) was calculated using the Joinpoint regression model to assess the trend of ischemic stroke burden between 1990 and 2019. Age-period-cohort models were introduced to estimate the independent effects of age, period, and cohort on ischemic stroke burden, and to predict the ischemic stroke burden in 2020-2030 based on Bayesian age-period-cohort models.ResultsFrom 1990 to 2019, the number of ischemic stroke deaths due to high fasting plasma glucose in China continued to increase with an AAPC of 3.61. Trends in age-standardized incidence rates did not show statistical significance. In the age-period-cohort analysis, the age effect of ischemic stroke burden showed a continuously increasing trend over the study period. The period effect showed an overall favorable trend over the study period. The overall and cohort effects for males showed an overall increasing trend, whereas the cohort effect for females showed a decreasing trend after a decreasing trend for the 1945 birth cohort.ConclusionsThis study found that ischemic stroke due to high fasting plasma glucose in China has generally fluctuated between 1990 and 2019, with a decreasing trend in recent years, and projections also suggest that it will continue to show a decreasing trend in the future. Age and period of birth were the main elements influencing the burden of disease, especially among the elderly and men. Policies should be used to promote the prevention of known risk factors and to strengthen health management for key populations.

The impact of medical insurance and old-age security on the utilization of medical services by the older population with disabilities

ObjectiveIn this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population.MethodsData were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction.ResultsIn terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver.ConclusionMedical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.

Interplay of Food-Derived Bioactive Peptides with Gut Microbiota: Implications for Health and Disease Management.

Bioactive peptides (BPs) are protein fragments with beneficial effects on metabolism, physiology, and diseases. This review focuses on proteolytic BPs, which are produced by the action of gut microbiota on proteins in food and have demonstrated to influence the composition of gut microbes. And gut microbiota are candidate targets of BPs to alleviate oxidative stress, enhance immunity, and control diseases, including diabetes, hypertension, obesity, cancer, and immune and neurodegenerative diseases. Despite promising results, further research is needed to understand the mechanisms underlying the interactions between BPs and gut microbes, and to identify and screen more BPs for industrial applications. Overall, BPs offer potential as therapeutic agents for various diseases through their interactions with gut microbes, highlighting the importance of continued research in this area.

Rotating machine bearing health prognosis using a data driven approach based on KS‐density and BiLSTM

AbstractRolling element bearings are vital components within rotating machinery, making them a central focus of maintenance in the prognostics and health management sector. This involves closely monitoring their condition to accurately predict the remaining useful life, increasing reliability while minimizing unexpected breakdowns, thereby enabling cost savings through planned maintenance, and enhancing operational stability and security. To achieve this goal, it is necessary to build an online intelligent system for degradation monitoring and failure prognosis by the construction of a robust health indicator and making quantitative measure for bearing degradation. In this paper, an efficient and reliable approach is proposed to estimate the remaining useful life of bearing. A new prediction method is presented by the combination of kernel smoothing density (KS‐density) and bidirectional long short‐term memory (BiLSTM). Firstly, KS‐density smoothens the preliminarily estimated probability distribution function using machinery degradation data. Secondly, the obtained KS‐density is used in feed deep learning technique based on BiLSTM models. On this basis, the variation of the signal distribution models between the current faulty state and the normal conditions state is quantified for bearing health assessment. The effective recognition of bearing degradation by the proposed Weibull‐based health index is demonstrated through experimental validations utilizing run‐to‐failure datasets, provided by the centre for intelligent maintenance systems. The comparison with the literature's review show that the prediction results of the proposed approach are more accurate.

Analysis of the National Formulary Drug Supply Chain with Its Availability in the Pharmacy Installation of the Government General Hospital (RSUD) Dr. Sitanala Tangerang City

This study explores the pharmaceutical supply chain management of the National Formulary at RSUP Dr. Sitanala in Tangerang City, aiming to identify obstacles to drug availability and formulate effective and efficient solutions. Acknowledging quality healthcare as a fundamental human right and a critical investment for a nation's future, this research emphasizes the importance of high-quality healthcare services. These services encompass not only treatment but also health promotion and disease prevention through the adoption of clean and healthy living habits. Drug availability is a major pillar in the provision of quality healthcare services. Effective and efficient management of the pharmaceutical supply chain, particularly regarding National Formulary drugs, is crucial in ensuring the availability of medications at healthcare facilities. This research employs a comprehensive analysis of the supply chain processes at RSUP Dr. Sitanala, examining stages such as drug selection, demand planning, procurement, receipt, storage, distribution, drug control, therapy monitoring, prescription preparation, drug dispensation, and medication administration. The study's methodology involves a case study approach, integrating theoretical management principles and interdisciplinary pharmacy management with compliance to regulations, as outlined in Permenkes No. 76 of 2016. Findings from RSUP Dr. Sitanala indicate that the hospital's pharmaceutical management practices align with contemporary health and pharmacy management theories, emphasizing structured systems, stringent verification, and effective interprofessional communication to ensure medication safety and efficacy. The study identifies challenges in information technology and interdisciplinary coordination as areas needing improvement. Nonetheless, a commitment to continuous improvement and adherence to regulatory standards reflects RSUP Dr. Sitanala's dedication to enhancing the quality of pharmaceutical management and healthcare services. The implications of this research extend beyond RSUP Dr. Sitanala, offering valuable recommendations for improving drug supply chain management in other healthcare institutions in Indonesia. By enhancing access to and the quality of healthcare services, this study contributes to the broader goal of achieving the highest possible level of health for individuals, reflecting the perspective of human rights and investment in the nation's future health.

Implementation of a Fracture Liaison Service in a tertiary hospital in Malaysia: a feasibility study.

To assess the feasibility of a Fracture Liaison Service in Malaysia and to benchmark our service against the International Osteoporosis Foundation Best Practice Framework. This feasibility study was conducted at a tertiary hospital in Malaysia from March 2021 to March 2022. Patients aged ≥ 50years admitted with fragility fractures were recruited. Excluded were those with poor prognosis or transferred out from the hospital during admission. Patients were screened, assessed, and followed up at months 4 and 12 post-fracture presentations. Data was collected using Microsoft Excel and the REDCap database. The feasibility of the Fracture Liaison Service was evaluated using the typology of feasibility. A total of 140 patients (female (93/140, 66.4%), median age 77 (IQR 72, 83), hip fractures (100/140, 65.8%)) were recruited into the Fracture Liaison Service. The recruitment rate was (140/215, 65.1%), as some patients were "missed" due to the COVID-19 pandemic. The completion rate was high (101/114, 88.6%). Among those indicated for antiosteoporosis medication, 82/100 (82%) were initiated on treatment. Various "Best Practice Standards," such as patient evaluation (140/140, 100%), fall prevention (130/140, 92.9%), and medication review standards (15/15, 100%) were high. Complicated referral pathways, inexperienced staff, lack of resources, and communication issues were some of the barriers identified while implementing the Fracture Liaison Service. Challenges were overcome by modifying the service workflow and coordinating with different departments. The Fracture Liaison Service was found to be feasible in Malaysia. It demonstrated promise in improving bone health management; however, several changes were needed to adapt the service to suit our environment.