Medical Logistics Research Articles

COVID-19 Pandemic: What can Nepal do to Curb the Potential Public Health Disaster?

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the pandemic. Since its first report in late December from Wuhan, China, it has spread in 211 countries and has infected more than a million population claiming more than 81,000 lives until 7th April 2020. Although heterogeneous between countries, the recent trend shows that almost 10% of the infected persons are at the risk of death. The case-fatality has been reported to be at 2.3% in China, 7.2% in Italy, 1.73% in South Korea. One of the dreadful characteristics of the COVID-19 is that it is highly efficient at transmission from human to human. SARS-CoV-2 transmits from one human to another through respiratory droplets and close physical contact. Droplet transmission may also occur through fomites in the immediate environment around the infected person. Although there have been multiple studies and trials, no effective vaccines or anti-viral treatments have been effective to prevent or treat SARS-CoV-2 infection and can take another 12-18 months for the evidence to be generated. In this context, the only remained options would be to explore the epidemiological trend and learn from countries who have controlled the infection successfully. The early detection of cases and community containment have been some of the successful strategies. South Korea was able to lower the COVID-19 cases by an extensive and concerted community testing. The traditional strategies of isolation, quarantine, social distancing and community containment helped China to hold its level of infection after the second half of March 2020. With the increasing number of cases, Italy, the United State and the United Kingdom have increased their testing facilities. Germany, for instance, started mass testing and community surveillance quite early on (proactive community testing) reflected on its low fatality rate.
 In Nepal by 5 April 2020, only 1,521 tests have been performed only among the suspected cases (a reactive testing method) who attend the hospital and so far 9 has been confirmed cases. Though the case was identified in January, the country-wide lockdown came into effect only on 24 March 2020. Based on the report provided by the Ministry of Health and Population, Nepal is trying its best to increase the number of isolation and quarantine facilities along with the provision of essential PPE. Nepal is at stage II (evidence of local transmission as opposed to imported cases only) of a pandemic but it is difficult to say how the disease is circulating in our population due to poor testing coverage and no proactive community testing. Current public health measures that are cost-effective, although not ideal would be to stringently follow social distancing. Social distance alone would be futile unless, other measures are in place that includes proactive community testing, providing essential medical equipment such as personal protective equipment (PPE), isolation and quarantine spaces, medical logistics such as infection control gears, and ICU facilities with adequate ventilators. While social distancing is the best measure, for now, community outreach for proactive testing with mobilization of community health workers and the use of technologies to inform the preventive measures and to dispel the fears, and rumors can be promising. Including the general public, health workers and policymakers require a strong collaborative platform to work together to consolidate the measures ahead to prevent the COVID-19 disaster in Nepal.

Enhancing Patient Safety

Internet of things (IoT) technologies are revolutionizing industries through enabling object identification, traceability, real-time communication, and monitoring. In healthcare (HC), IoT has potential to contribute to several areas, from patient-related smart services to medical logistics. One area of paramount importance in HC is patient safety, which includes the correct identification, treatment, tracking, and monitoring of patients. Published statistics suggest that there is a mounting number of patient mistreatments due to the erroneous identification of the patient or the drug administered. Radio Frequency Identification (RFID) technology is envisioned as a disruptive innovation in HC & represents several opportunities for increased safety. However, the adoption of RFID in HC still lags behind other industries. Through a literature review, the authors explore the potentials & challenges of RFID adoptions in HC, with a focus on patient safety. Our findings suggest that high costs of adoption, security & privacy concerns and human safety risks are the main barriers for adoption.

EXPLORING CRUCIAL FACTORS FOR INTEGRATING MEDICAL CLOUD AND HEALTHCARE LOGISTICS BY DANP

This study aims to investigate and explore the critical success factors which affect the integration of medical cloud and pharmaceutical logistics operations. To achieve research objective, we firstly collected the opinions of medical management experts through the process of the Delphi method, and then affecting the integration of medical cloud and healthcare logistics operations were screened and summarized. Secondly, the questionnaire was conducted and 11 experts’ assessments of the influence between every two factors were acquired. Furthermore, this study employed DANP to calculate the weight for each factor when there exists interaction relationship among the factors and to plot causal map. Reviewing the causal map and the weights for each factor, “To induct artificial intelligence (AI) into medical treatment” and “To develop intelligent healthcare logistics” are significantly higher than other factors in terms of total influence value, net influence value and relative importance. Our findings can provide hospitals and pharmaceutical companies as a basis in formulating cloud medical development strategy.

Green Medical Reserve Logistics Provider Selection Using DEMATEL Method

Compared with general commercial reverse logistics operators, the recovery and treatment of expired drugs and medical waste is a complex and highly technically difficult project. The qualifications required by the relevant service providers are also more stringent. For medical institutions, the selection of reverse logistics operators is always a critical issue. On the perspective of sustainability, this paper aims to investigate and explore the critical factors of selecting a medical reverse logistics service provider. Through the process of the Delphi method, the experts’ assessments were collected, and 24 factors affecting the selection of medical reverse logistics service provider were screened and summarized. Then, Decision-Making Trial and Evaluation Laboratory (DEMATEL) was employed to calculate the total influence values and net influence values between factors that could be used to draw the visual causal map. Referring the causal map, “Green process operation level” and “Recycling process greening degree” are significantly higher than other factors in terms of total influence value and net influence value. Therefore, they can be regarded as crucial factors. This finding implies that medical reverse logistics providers must have the ability to improve the greening of facilities, as well as equipment, integrating existing processes to make it greener and environmentally friendly.

International Globalization and Spreading of Novel Coronavirus 2019 Infection: How Far and Fast? A Medical Logistics Assessment.

International Globalization and Spreading of Novel Coronavirus 2019 Infection: How Far and Fast? A Medical Logistics Assessment.

Prevention and Control of the Novel Coronavirus in the Stomatological Hospital

The 2019 novel coronavirus is a new coronavirus of the beta genus and defined as category B infectious disease, prevented as category A infectious disease. The infection of new novel coronavirus causes a diversity of clinical manifestations, including fever, dry cough, shortness of breath, muscle soreness etc. The infected are believed to be the principal source of infection, including the asymptomatic individuals who are infected. Droplet transmission and contact transmission are considered the major route of influenza spread. In some condition, aerosol transmission works as well. Alimentary tract transmission remains to be confirmed. Most of the treatment is operated in oral cavity in stomatological hospitals. The dentists, the nurses and the patients have an intimate contact with each other. By analyzing the nosocomial infection routes of novel coronavirus in stomatological hospitals, prevention and control measures were formulated to strengthen infection management, so as to control and minimize infection risks. Oral health workers should strictly implement the infection management measures in medical institutions, and do a good job in the protection of all staff, including medical care, logistics, property management and administration, the environment of the clinic, disinfection and sterilization of instruments and medical waste management, so as to prevent cross-infection and contain the spread of the epidemic.

Planning and designing of intelligent medical logistics system

Planning and designing of intelligent medical logistics system

Ruin and Recreate Approach Applied to Multi-objective Optimization of HHC VRPTW in the Case of Medical Waste Collection

Objectives: The management of Medical Waste in Morocco has always been the concern of the health department. Recently, the WHO classified the Medical Waste in Morocco as a time bomb, recommended involving of professionals interested in that management. Methods/Findings: Through this study we proposed a model of collectors’ management, on behalf of clinics in case of Casablanca region. This model, as part of a heterogeneous fleet vehicle routing problem, aims at multiobjective optimization between the pillars of sustainable development. The complexity of the model is managed using a Ruin and Recreate heuristic. Application: Finally, the tuning of weighting parameters is being experimented to show how it will be possible to find a compromise between conflicting objectives in the case of Medical Waste logistics. Keywords: Heterogeneous Fleet, Medical Waste, Multi-objective Optimization, Ruin and Recreate

The Brazilian experience of implementing the active pharmacovigilance of dolutegravir.

In 2017, the Ministry of Health Brazilian started using dolutegravir (DTG) 50 mg to all people living with HIV who began antiretroviral therapy (ART) or rescue regimens. Although DTG is thought to have better tolerability levels and a lower possibility of causing adverse reactions, it is necessary to continuously evaluate the safety profile of the drug in the population. Therefore, an active pharmacovigilance project for DTG was implemented. The objective of this study was to describe the Brazilian experience of implementing pharmacovigilance and the results obtained during the period between April and December 2017.Active pharmacovigilance was implemented through patient interviews and an online questionnaire developed in the Medication Logistics Control System (SICLOM).Of the total number of people on DTG in Brazil (79,742) 90.33% participated in the project, and 2.24% of those who participated reported adverse reactions to the drug; of those who reported adverse reactions, 73.86% were on first-line ART regimens, and 26.13% were on third-line regimens. The mean age of the patients who had adverse reactions to DTG was 39 years; 68.79% were male, and 31.21% were female. Of the adverse reactions reported, 50.39% were considered persistent. The 3 most frequent reactions were nausea (13.34%), diarrhea (9.83%), and headaches (9.23%).The Brazilian experience with this project has been deemed successful by federal and local managers, and the online tool to collect data has proved to be an important strategy for the pharmacovigilance of DTG as well as that of other drugs.

Use of telephone and web interfaces of interactive response technology at clinical investigator sites in clinical trials.

Interactive response technologies are used in clinical trials to provide services such as automated randomization and medication logistics management. The objective of this article is to investigate the usage of telephone (Interactive Voice Response) and web (Interactive Web Response) interfaces of interactive response technologies at clinical investigator sites in clinical trials, to obtain information about the preferences of interactive response technology end users between the telephone and web interfaces, and to explore the relevance of the telephone interface in this setting. The data consist of an online survey conducted in spring 2016 with clinical investigators, study nurses, and pharmacists in 13 countries. Ninety-eight percent of survey respondents preferred the web interface over the telephone interface, the most important reason being superior usability. However, the respondents indicated the usability of interactive response technology interfaces is not optimal, and lack of integration and consistency across systems is common. A vast majority of interactive response technology end users at clinical sites prefer to use the web interface over the telephone interface, but most also feel there would need to be a back-up system. Based on the results, it would be beneficial to improve the usability of the interactive response technology interfaces, and to increase consistency across systems from the current level. Support to and training of the users, as well as clarifying the responsibilities between sites and the sponsor should also be a focal point. Study sponsors should explore with interactive response technology service providers how removing the telephone interface would impact future studies, and whether there could be a more efficient means to achieve a reliable back-up to the web interface instead of a dedicated telephone interface.

A review of medical distribution logistics in pharmaceutical supply chain

The management of inventories and distribution networks of medical supplies are among the most important issues in the healthcare world. Indeed, medicine shortage cannot only result in financial losses but can also endanger a patient's life. Thus, many hospitals transfer managerial practices developed in the industrial sector to the healthcare environment. This paper presents a literature of operations research models developed for inventory control and distribution management across the pharmaceutical supply chain. For that purpose, this work begins by classifying the reviewed articles into three groups: 1) inventory management; 2) transportation management; 3) coordination between inventory control and distribution activities. Starting from an analysis of current literature we intend to discuss different modes of pharmaceutical supply chain coordination. Also, in doing so, we point out potential future research directions. Finally, we shed light on different barriers faced by practitioners when implementing supply chain management philosophy in the pharmaceutical supply chain.

A review of medical distribution logistics in pharmaceutical supply chain

The management of inventories and distribution networks of medical supplies are among the most important issues in the healthcare world. Indeed, medicine shortage cannot only result in financial losses but can also endanger a patient's life. Thus, many hospitals transfer managerial practices developed in the industrial sector to the healthcare environment. This paper presents a literature of operations research models developed for inventory control and distribution management across the pharmaceutical supply chain. For that purpose, this work begins by classifying the reviewed articles into three groups: 1) inventory management; 2) transportation management; 3) coordination between inventory control and distribution activities. Starting from an analysis of current literature we intend to discuss different modes of pharmaceutical supply chain coordination. Also, in doing so, we point out potential future research directions. Finally, we shed light on different barriers faced by practitioners when implementing supply chain management philosophy in the pharmaceutical supply chain.

Structural Barriers to Pre-exposure Prophylaxis Use Among Young Sexual Minority Men: The P18 Cohort Study.

Despite decreasing rates of HIV among many populations, HIV-related health disparities among gay, bisexual and other men who have sex with men persist, with disproportional percentages of new HIV diagnoses among racial and ethnic minority men. Despite increasing awareness of HIV pre-exposure prophylaxis (PrEP), PrEP use remains low. In addition to exploring individual-level factors for this slow uptake, structural drivers of PrEP use must also be identified in order to maximize the effectiveness of biomedical HIV prevention strategies. Using cross-sectional data from an ongoing cohort study of young sexual minority men (N=492), we examine the extent to which structural-level barriers, including access to health care, medication logistics, counseling support, and stigma are related to PrEP use. While almost all participants indicated awareness of PrEP, only 14% had ever used PrEP. PrEP use was associated with lower concerns about health care access, particularly paying for PrEP. Those with greater concerns talking with their provider about their sexual behaviors were less likely to use PrEP. Paying for PrEP and talking to one's provider about sexual behaviors are concerns for young sexual minority men. In particular, stigma from healthcare providers poses a significant barrier to PrEP use in this population. Providers need not only to increase their own awareness of and advocacy for PrEP as an effective risk-management strategy for HIV prevention, but also must work to create open and non-judgmental spaces in which patients can discuss sexual behaviors without the fear of stigma.

Design and research of the medical logistics system based on automated guided vehicles

Based on the applicability analysis of various medical logistics systems, the design and research of medical logistics system based on automated guided vehicle (AGV) are discussed in depth in such aspects as requirement analysis, system architecture and the function of the upper software platform. According to the implementation environment of specific projects, the relationship between the professional lines is coordinated and the building information modeling technology is used to assist in the professional cooperative work of the building structure. The establishment of medical logistics system based on AGV can effectively make up for the deficiency of other mainstream logistics methods, achieve efficient and speedy logistics, and further improve the quality of hospital service. Key words: Automated guided vehicle; Medical logistics system; Building information modeling; Professional synergy

Mission overwatch: Emphasising a Joint One MEDLOG Concept

Within the US military, when a soldier is injured on the battlefield, they may observe a US Army Medic submitting a nine-line medical evacuation (MEDEVAC) request which is executed by an Air Force para-jumper rescue team that evacuates them to a US Navy medical facility, where they are treated by a US Navy Corpsmen detailed to the US Marines. The injured soldier ultimately receives their care, thanks to a complex evacuation management system, that, if executed correctly, returns the soldier to duty with limited disruption to themselves, family and branch of service. This scenario is not uncommon, yet includes multiple layers of bureaucracy that goes unnoticed and is underpinned by an equally complex logistics system. Medical supplies and equipment used to treat soldiers originate from a number of locations and sources of supply. Historically, each branch of service has its own distinct medical logistics agency through whom all such requirements are identified, communicated and purchased. This paper is concerned with examining the importance of a Joint One MEDLOG Concept.

A lean-TOC approach for improving Emergency Medical Services (EMS) transport and logistics operations

ABSTRACTThe improvement of transport and logistics performance of Emergency Medical Services (EMSs) systems has been mainly addressed through mathematical modelling, operations research, and simulation methods. This paper proposes an alternative and/or complementary improvement approach based on the adaptation and simultaneous deployment of lean thinking and Theory of Constraint (TOC) methods and tools. The paper briefly reviews key aspects of the application of lean in the logistics and healthcare industries and conceptually develops the proposed lean-TOC approach. The approach is then tested, through an individual detail case study, in the EMS transport and logistic system of the Red Cross operating in the metropolitan area of Monterrey, Mexico. The results obtained from the case study suggest that the proposed systematic lean-TOC approach may be an effective alternative and/or complement to mathematical modelling, operations research, and simulation methods to improve EMS transport and logistics operations.

Medical Drone Delivery in Developing Countries

Developing countries often have difficulties in the field of medicine, and many of these problems do not relate to missing knowledge but on the transportation possibilities to bring patient, doctor and the necessary medical supplies together. In a research study for the country of Mongolia the advantages of a drone delivery system are shown and the unique challenges such as temperature, elevation and range are discussed to choose a suitable system design for countries with enormous size and low population. Airplane like drones with their wider distances seem to be the most promising solution to connect rural areas to the medical logistics network.

Patient-pharmacist communication during a post-discharge pharmacist home visit

Background With the shifting role of community pharmacists towards patient education and counselling, they are well-positioned to conduct a post-discharge home visit which could prevent or solve drug-related problems. Gaining insight into the communication during these home visits could be valuable for optimizing and consequently improving patient safety at readmission to primary care. Objective To assess patient-pharmacist communication during a post-discharge home visit. Setting The homes of patients recently discharged from a single general hospital in the Netherlands. Methods Pharmacists used a semi-structured protocol to guide the consultations and audiorecorded them. Sixty audio-recordings were included for a qualitative analysis in this study with the help of NVivo version 11 software. Main outcome measure (1) Initiator and topics under discussion. (2) Frequency of discussion of topics as per coded in themes and subthemes. Results Issues regarding the administration and use of medication, e.g. regimen and actual drug-taking issues, knowledge gaps regarding their medication and patients’ health were discussed most frequently, followed by medication logistics and medication effectiveness. Patients’ beliefs about their medication and adherence were less frequently discussed. The pharmacist initiated the majority of these topics. Additional non-protocolled topics were scarce and consisted mainly of patient-initiated dissatisfaction regarding the community pharmacy or health insurers. Conclusion Community pharmacists most frequently initiated practical issues, but explored patients’ medication beliefs less adequately. Discussing these beliefs might be easier by increasing patient engagement in the consultation and providing training programs for pharmacists.

Development and practice of IT-based intelligent transport systems for hospitals

Under the mission of patient safety first , this paper discussed the development of a hospital intelligent transport system by means of information technology, and its successful practice in the hospital. Information technology, internet of things, internet plus concept, and intelligent platform can provide logistic transport services of high efficiency and quality, and achieve the development of hospital meticulous management and intelligent medical logistics in China. Key words: Hospital information systems; Information services; Transport platform; Application

Perhitungan Konsumsi Obat Untuk Logistik Medik di Rumah Sakit Islam Jemursari Surabaya

Inaccurate drugs planning may cause excessive budget, stagnant, and stockout. This research aims to analyze drugs planning in medical logistics of Rumah Sakit Islam Jemursari Surabaya. This research is a descriptive study using cross sectional design. Primary data were obtained through observations and interviews. Secondary data were obtained through drugs planning and drugs consumption data from November to December 2016. Afterward, data were processed and found that 40% drugs item on November 2016 have greater amount of consumption than their planning and 65% drugs item on December 2016 have greater amount of consumption than their planning. The method of drugs planning that used in medical logistics of Rumah Sakit Islam Jemursari Surabaya was consumption method, but it was not calculate the average of drugs consumption. After the calculation based on Keputusan Menteri Kesehatan Nomor 1121 Tahun 2008, there is only 20% drugs item on November 2016 which have greater amount of consumption than their planning and 20% drugs item on December 2016 which have greater amount of consumption than their planning. This research showed that the calculation of drugs consumption for medical logistics in Rumah Sakit Islam Jemursari Surabaya need repairement.Keywords: consumption method, drugs planning, hospital