Just In Case Research Articles

What are the right configurations of just-in-time and just-in-case when supply chain shocks increase?

Shocks caused by COVID-19 pandemic have compelled manufacturers to decrease their reliance upon just-in-time (JIT) and embrace a more just-in-case (JIC) approach. This study clarifies the right configurations of JIT and JIC under low/high upstream and downstream shocks. Drawing upon contingency theory and configuration theory, a framework is developed to differentiate configurations of JIT/JIC under low/high magnitude SC shocks. Survey data from China's manufacturing industry, which experienced SC shocks due to COVID-19, are analysed by regression and sub-group analyses. The results show that only upstream shocks have a negative impact on operational performance. The effect of JIC (but not JIT) on operational performance is strengthened by upstream and downstream shocks. When shocks are high, increasing JIC is effective only when JIT is low. These empirical findings demonstrate that manufacturers can improve operational performance by emphasising JIC models under high SC shocks. Those with high JIT benefit from low JIC under low shock settings.

Leveraging supply chain visibility for implementing just-in-case practices: the roles of knowledge and digital resources bundling

PurposeThis study aims to explore how bundling knowledge resources (i.e. knowledge integration mechanisms [KIMs]) and digital resources (i.e. big data-powered artificial intelligence [BDAI]) can enhance supply chain visibility (SCV) capabilities for implementing just-in-case (JIC) practices.Design/methodology/approachAnalysis of survey data from Chinese manufacturers was conducted to test the proposed hypotheses.FindingsThe results reveal a significant positive effect of KIMs on BDAI, as well as positive effects of both BDAI and KIMs on SCV. Furthermore, the results suggest that SCV partially mediates the KIMs–JIC relationship and fully mediates the BDAI–JIC relationship.Originality/valueThis study advances the digital SC and inventory management literature by proposing and empirically testing a digital JIC model that explores how to bundle knowledge and digital resources into SC capabilities for managing JIC inventory in uncertain and digital times.

Just in case: undergraduate students identifying and mitigating barriers to their sexual and reproductive health needs

BackgroundMany U.S. colleges and universities offer access to a healthcare center that provides sexual and reproductive health (SRH) resources, services, and products. The importance of health centers in college and university settings in reducing sexual health disparities in student populations cannot be stressed enough. This article evaluates a student-led, mutual-aid, grassroots health promotion strategy for students with limited access to healthcare services, supplies, and tools via an anonymous and discrete distribution of SRH resources without charge.MethodsIn partnership with faculty, undergraduate students worked to address their school’s unmet SRH needs by increasing on-campus access to comprehensive, evidence-based, and sex-positive resources. Referred to as Just in Case, this student-led, grassroots health promotion program provided students with supply kits containing contraceptives, sexual health wellness products, basic hygiene supplies, and education materials. Students were surveyed in a pre- (n = 95) post- (n = 73) pilot study to identify contraception acquisition barriers, discern perceptions of on-campus SRH resources, and elucidate trends in this program’s use and impact. Chi-square tests of independence were used to compare survey group responses, and association rule mining was employed in tandem to identify SRH items that students requested.ResultsStudents identified cost and privacy as significant barriers to acquiring sexual health products on campus. Of the 182 Just in Case supply kits requested by students during the 2022–2023 academic year, condoms were requested most frequently in 75% of fulfilled kits, while emergency contraception and pregnancy tests were asked most often in 61% of kits. 50% of students reported access to contraceptives on campus before this program’s implementation, growing to 75% (p < 0.001) 1 year later post-implementation. Similar jumps were observed for reported access to sexual health education (30 to 73%, p < 0.001) and services (36 to 73%, p < 0.001).ConclusionA student-led SRH supply and resource delivery strategy may immediately reduce SRH inequities and decrease barriers to contraceptive use for students with limited access to on-site SRH product availability.

Impact of paramedics carrying just-in-case end-of-life care medication

Background: Early in the COVID-19 pandemic, it was predicted that frail community patients with symptoms of severe COVID-19 infection may need urgent symptom management—and that unless they had already been identified as being in their last weeks of life, they would be unlikely to have just-in-case (JIC) medications at home. The Welsh Ambulance Services NHS Trust therefore placed JIC medications on emergency ambulances to increase symptom management options for paramedics treating patients with symptoms of severe COVID-19 infection and/or associated with advanced end-stage illness. Methods: A review of medications to palliate symptoms of severe COVID-19 infection and advanced and terminal illness was undertaken. A verbal order process was implemented, allowing prescription-only medications to be administered by paramedics. Guidance, training and data capture processes were designed and implemented. Results: Symptoms associated with advanced cancer were the main reason for giving ambulance-based JIC medications, and midazolam and morphine were the most administered medicines. No adverse incidents were reported or recorded. Conclusion: Ambulance-based JIC medications were and continue to be appropriately administered, irrespective of life-limiting illness diagnosis. Although carrying JIC medicines on ambulances was introduced in response to the COVID-19 pandemic, 12 months of data collection indicates this is a safe, cost-effective, patient-centred practice.

New Approaches to Continuing Medical Education in Radiology in the Era of the Internet and Artificial Intelligence: From “Just in Case” to “Just in Time”

New Approaches to Continuing Medical Education in Radiology in the Era of the Internet and Artificial Intelligence: From “Just in Case” to “Just in Time”

‘Just in case’ medicine at the end of life: what nurses need to know

Anticipatory medicines can cause distress as well as bring reassurance and relief. Find out how to optimise their use

‘Just in case’ medicines for end of life care

Anticipatory medicines can cause distress – so a study has useful pointers for how nurses can optimise their use

”Just in case to just in time” curriculum! Are we ready for this paradigm shift?

”Just in case to just in time” curriculum! Are we ready for this paradigm shift?

Documentation of Just in Case (JiC) medication for end of life patients in care homes looked after by a general practice.

This project was undertaken to improve the documentation of Just in Case (JiC) medication in a general practice. The outcome of a Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis highlighted this as an area where awareness within the practice could be improved. A Plan-Do-Study-Act (PDSA) approach was taken to the project and involved collaborative working and data collection from the general practice and relevant care homes. JiC medications are used to promptly manage symptoms experienced at the end of a patient's life and are part of the Gold Standard Framework (2006). Of the patients registered at the practice with JiC medication, 37.5% were incorrectly documented. This included errors/ inaccuracy with the clinical coding, orthe medication. Three patients on practice generated searches had no JiC medication in the care homes, and 4 patients had JiC boxes in the care home that was not identified by the search. This evaluation has identified documentation errors and discrepancies between practice and community records of JiC medication. A newly generated practice specific flowchart was created, with an aim of reducing the discrepancies. A guide of how to carry out a QI project like this was created for the RCGP and can be found on their website. A seminar at Bristol, North Somerset, and South Gloucestershire (BNSSG) CCG to present this project took place in 2021.

A literacy review of tertiary levels teacher’s modern technological literacy ratio in rural area of Bangladesh

Modern technology has enhanced the aptitude of tertiary level education worldwide but just in the case of Bangladesh, we've got seen an adulthood educational method belief among the teachers, instructors, and facilitators in recent covid 19 outbreaks especially on the remote educational institutions. Most of the explanations we've found are inaccessibility of contemporary technology especially android multimedia devices together with a computer device, together with internet accessibility just in case of using the multiterminal platform for using local remote teaching. Especially unaffordability, internet expense, fragile financial condition, illiterate behavior towards acceptancy, low percentage of the sophistication monitoring system, absence of scholars and systemic review, proper liability towards authority who is additionally incapable to handle modern technological properties fluently. Our research has found 82% of grade school instructors and teachers don’t use modern devices like android devices, computers, laptops, printers, routers, internet connections in Debidwar, Comillam Chittagong, Bangladesh where our study found among 185 grade schools which serves over 35000 students approximately. In a recent case, the change has been made by Swaniti Initiative SPARC Fellow, USA Mr. Engr. Arun kanti Howlader with the support of local constituency Member of Parliament Mr. Razee Mohammad Fakhrul in before covid 19 outbreak where now the proportion become 3% just in case of illiteracy of primary education instructor’s modern technology literacy. Our study finds the subsequent outbreaks shown below:

Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans.

BackgroundReducing access to lethal means is one of the few empirically supported approaches for lowering suicide rates, and safe firearms storage practices have been associated with reduced risk of death by suicide. Although there is substantial opportunity for primary care to assist in addressing lethal means with veterans, approaches to intervention and educating staff are not well documented. We sought to 1) describe development of an education program for primary care teams to help them discuss firearms storage safety (FSS) with veterans during primary care visits; and 2) conduct a preliminary evaluation of the pilot education program.MethodsWe used an iterative process involving veterans and primary care staff stakeholders to develop program content, format, and supplemental materials. A grounded theory approach was used to analyze data from focus groups and individual interviews. Following piloting of the program with 71 staff members in two primary care clinics, we analyzed pre- and post-training participant surveys of program satisfaction and attitudes comfort related to firearms safety discussions.ResultsDuring the development phase, 68 veterans and 107 staff members participated in four veteran focus groups and four primary care focus groups, respectively, and/or individual interviews. The program that was developed, “‘Just in Case’: Discussing means safety with veterans at elevated risk for suicide,” addresses knowledge and skills learning objectives, and includes video demonstrations and skills practice. Survey data obtained just prior to the pilot training sessions showed low self-reported rates of discussing firearms safety with veterans who may be at elevated risk for suicide. Immediate post-training data showed generally high satisfaction with the program and significant improvements in participant self-reported ratings of the importance of, and comfort with FSS.ConclusionsThis interactive knowledge and skill-based means safety curriculum shows promise as a means for educating primary care staff to deliver messaging about firearms safety to veterans. Additional research is needed to refine and evaluate impacts of this or similar training programs on clinician and veteran behaviors over time.

Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City.

Background: In 2017, The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital became a registered Opioid Overdose Prevention Program (OOPP) and received funding from the New York City Department of Health and Mental Hygiene to develop a program to provide overdose education and naloxone distribution (OEND) training to at risk population and bystanders. We report on the programmatic quality improvement initiatives conducted. Methods: From April 2017 to December 2020, the REACH OOPP conducted 290 opioid overdose reversal trainings, throughout the Mount Sinai Health System and in multiple other community settings. OEND training was at times offered alone and in other settings alongside Hepatitis C Virus point of care testing. Additionally, a “train the trainer” model was implemented whereby medical students and nurses at outpatient clinics were trained to train others. Results: There were 4235 naloxone kits distributed to 3,906 participants. The training venues included hospital settings (patients and medical staff), public events, substance use programs, educational facilities, homeless prevention programs, faith-based organizations, alternative to incarceration programs, and community-based organizations. We implemented two types of training. During outreach sessions, we utilized one-on-one personalized sessions to train bystanders. When training clinic staff in the “train the trainer” model we utilized a standardized didactic presentation with slides. The two top reasons participants reported for being trained were “Just in case I see someone overdose” (59.3%) and “I'm worried that someone I know will overdose OR that I will overdose” (20.2%). Conclusion: The REACH program at Mount Sinai Hospital developed an effective model to train community bystanders and health care staff by leveraging administrative support and building on broader programmatic initiatives to promote drug user health and stigma-free care for people who use drugs. Hospitals do not currently mandate staff training or keeping naloxone stocked at inpatient units or outpatients clinics posing a challenge when implementing an OEND program in this setting. A recommended policy change needed to decrease overdose deaths is for hospitals to be required to implement systematic naloxone education and access for all health care personal and at risk patients.

“Just in case”: Too much litigation?

This Oñati Socio-Legal Series publication is the product of an Oñati workshop on Too much litigation, held June 2019. This is the third and final part of a trilogy of workshops held in Oñati; the first two parts dealt with the legal professionals: lawyers (Oñati workshop 2012, titled Too Many Lawyers?); and judges (Oñati workshop 2016, titled Too Few Judges?). In this final workshop, we focused on litigants and litigation – the “clients” of both judges and lawyers. The overall finding is that too much/not enough litigation might endanger access to justice. In a wider context, putting the three themes together creates a better understanding of the importance of access to justice and the role of the legal profession and the professionals in ensuring this basic right.

Media Representations of (Auto)biography Using Examples from Michał Buszewicz’s and Weronika Szczawińska’s Performances

This article seeks to examine (auto)biographical plays. Texts and performances inspired by biographical material form a significant part of contemporary dramaturgy and theatrical projects. In Poland, this type of activity is the domain of directors coming from different generations and representing various styles, for example, Krystian Lupa, Maciej Wojtyszko, Wiktor Rubin, Michał Buszewicz, Weronika Szczawińska. Both dramatic texts and stage performances inspired by (auto)biography are non-uniform messages with updates of various genre forms. They may thus be classified as “blurred genres.” Two plays (An Autobiography Just in Case by Michał Buszewicz and Simply by Weronika Szczawińska) shown online during the Divine Comedy theatrical festival in Krakow in 2020 were used to analyze the diverse genre features of stage statements (characteristic of, among other things, intimate journal, autobiography, performance or theatre of fact) and the phenomenon of media mediation of theatrical performances made available to the audience via the streaming platform. The form of the theatrical texts is of great importance in the staging process. Regardless of whether they are autonomous dramatic texts that exist prior to their performance or scripts written specifically for the needs of a given theater project, their dramatic model contributes substantially to the aesthetics of the spectacle. In specific stage productions, these texts — due to their performative properties — combine other stage matter in a coherent manner, thus creating an important tool for representing (auto)biography and an instrument for engaging the audience.

“Just in case”. Use of large-bore peripheral intravenous catheters in parturient women: A global study

Objective: The aim of the current study was to map a global picture of the practice of inserting large-bore peripheral intravenous catheters in parturient women. Methods: We analysed a sub-set of data from a prospective, multi-centre, international prevalence study, the One Million Global peripheral intravenous catheter study. The obstetric cohort was drawn from 163 maternity units in 35 countries (1477 women, 1577 catheters) and was collected between 1 June 2014 and 31 July 2015. Clinicians at each of the participating sites collected data using tools that had been previously validated. Results are reported as frequencies and proportions. Results: Overall, 42% of all peripheral intravenous catheters were large bore and of all catheters placed in females in obstetric units, 438 (70%) of these were placed in the hand or wrist. The phlebitis rate was higher in the large-bore group (12%) compared with those with smaller catheters (7%). Only 2% of women received blood products, but it was unclear which catheter was used for this purpose. Conclusion: Large-bore peripheral intravenous catheters are overused for vascular access in parturient women. They are painful and may cause vascular damage. If there is no indication, a catheter should not be placed at all.

Reduction in ‘Just in Case’ cannula rates with a structured assessment and decision tool: An interrupted time-series study

Reduction in ‘Just in Case’ cannula rates with a structured assessment and decision tool: An interrupted time-series study

204 “I’m Keeping Them Just in Case”: Patients Rationale for Retaining Unused Opioid Pills

A significant proportion of misused opioids are diverted from unused prescriptions. Lack of risk communication on proper opioid disposal is one contributing factor to patients’ retaining unused opioids, which may lead to later misuse. Little is known regarding patients’ rationale for retaining their opioids after completing treatment. The objective of this study was to characterize patients’ reasons for keeping their leftover opioids. This is a qualitative study utilizing patient interview data obtained as part of a larger intervention trial promoting safe opioid use. Consecutively discharged patients at an urban academic ED (annual volume >88,000 visits) with a new opioid prescription were enrolled. Participants were eligible if they were age 18+, English-speaking and not chronic opioid users. Follow-up interviews were conducted 1-2 weeks and 1 month after ED discharge. Patients who had unused pills at the time of these interviews were asked “What do you plan to do with the leftover pills when you are finished taking them?” Participants who indicated a current intention to keep the pills were asked to elaborate on their reasons why. This study used content and constant comparative analysis to explore verbatim responses to this question. Responses were analyzed for a total of 144 participants; mean age was 45, and 45% were male. Analyses revealed six predominant themes. One emergent theme reflected patients’ decision to keep their pills “just in case,” in the context of a specific medical condition (“In case I ever get kidney stones again”). Additionally, some participants similarly described their intention to keep pills “just in case,” without mentioning any specific condition (“Just in case, you never know. There’s other symptoms for Norco too, so you never know what could come up with me personally”). Plans for disposal of the opioid at some time in the future formed another theme. These participants voiced their intention to dispose of the medication, but often after a certain time had elapsed (“Hold onto them until they expire⋯”). Also under this theme, patients voiced uncertainty regarding methods of medication disposal (“I don't know, what should I do? I know I'm not supposed to flush them down the toilet.”). Additional, but less frequently expressed themes included: lack of anticipation of having unused pills (“I probably won’t have any left at this rate.”); no identified plans, yet intention to keep pills nonetheless, sometimes citing habit or financial rationale (“They usually just sit there”; “waste not want not”); and plans to keep pills specifically for “emergencies” or to avoid seeking emergent care (“Save them for emergencies, I’m accident prone”). Patients note diverse reasons for keeping their unused opioid pills. Awareness of the range of intentions underlying patient motivations provides critical information for future development of tailored risk communication messages to improve opioid disposal.

Safety of Stopping Antibiotics Prescribed “Just in Case” – Comparison of Mortality, Readmissions and Clostridium difficile in Patients with Accepted Stewardship Interventions Compared with Declined

BackgroundAntibiotics are often prescribed “just in case” when clinical conditions mimic an infection, such as the shortness of breath in heart failure, the erythema of venous stasis or when bacterial culture results are misleading such as asymptomatic bacteriuria (ABU) and C difficile colonization. Through prospective audit and feedback (PAF), antimicrobial stewardship programs (ASP) may guide providers toward appropriate antibiotic use. However, the safety of stopping antibiotics needs to be assessed. We retrospectively reviewed the clinical outcomes of patients with accepted ASP recommendations and compared these to patients in whom the primary team declined ASP recommendations.MethodsThe ASP database was used to identify patients receiving written PAF to stop antibiotics prescribed for noninfectious conditions from January 1, 2016 to December 31, 2016. The primary objective was to compare antibiotic days of therapy (DOT), total length of therapy (LOT), hospital length of stay (LOS), 30-day mortality, and the incidence of C. difficile within 6 months of the ASP intervention, occurring among patients whose primary treating team accepted vs. rejected the ASP recommendation. We compared the two groups using Chi-square and student t-test to determine statistical significance for categorical and continuous variables, respectively.ResultsThere were 232 ASP recommendations to stop antibiotics for noninfectious conditions: 150 (65%) interventions were accepted. Baseline demographic characteristics, comorbidities, intensive care admission and surgery during that hospitalization were similar between the two groups. The most common noninfectious conditions were ABU (55%), followed by respiratory (19%) and intra-abdominal (17%). The median antibiotic DOT and LOT were significantly reduced in the accepted group, 3 (3–5) vs. 8 (5–12.25) days (P < 0.001) and 3 (2–4) vs. 7 (5–10) days (P < 0.001), respectively. There were no statistical differences in 30-day mortality, 30-day readmission, and C.difficilewithin 6 months.ConclusionOur institutional ASP’s PAF to stop antibiotics for noninfectious conditions led to a significant reduction in antimicrobial exposure without negatively affecting mortality or hospital outcomes.Disclosures All authors: No reported disclosures.

Disposition and Musical Embodiment of the Texts in Y. Galperin’s Choral cycle “Just in Case”

Disposition and Musical Embodiment of the Texts in Y. Galperin’s Choral cycle “Just in Case”

ANTICIPATORY PRESCRIBING: COMPARISON OF THE NUMBER OF DISCHARGE PRESCRIPTIONS WITH THE NUMBER OF FAST-TRACK DISCHARGES

BackgroundIn September 2012, an anticipatory prescribing policy, the ‘Just in Case Four Core Drugs’ (JiC4CD) was introduced across the healthcare economy after a multidisciplinary group of clinical experts reviewed current...