Medication Shortages Research Articles

Evaluation of indications and efficacy of doxycycline for surgical antibiotic prophylaxis.

Given medical advancements in global healthcare systems over the past decade, it may be reasonable to assume that the incidence of surgical site infections would have decreased; however, surveillance data indicate that these rates have held constant. Surgical prophylaxis guidelines from the United States and United Kingdom recommend cefazolin, vancomycin and clindamycin in most surgeries for no longer than 24 hours. As a result of medication shortages impacting the global supply chain, surgeons have needed to evaluate alternative perioperative antibiotics, such as doxycycline; however, research into using doxycycline for preventing surgical site infections is limited. The goal of this study is to retrospectively assess doxycycline's efficacy, safety and role in preventing surgical site infections.

Health system barriers to hypertension care in Peru: Rapid assessment to inform organizational-level change.

Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes.

Global Strategies for Postoperative Care and Bowel Management in Patients With Anorectal Malformations: Varied Practices and Barriers

BackgroundAnorectal malformations (ARMs) commonly result in constipation and fecal incontinence following primary surgical reconstruction. This study investigates global variations in postoperative care and resources. MethodsA survey was distributed via the International Pediatric Endosurgery Group (IPEG) and snowball sampling. Geographically, respondents were categorized into high-income countries (HICs) and low—or middle-income countries (LMICs). Results233 surveys were received, 64% from LMICs and 36% from HICs. Of these, 51% reported monitoring ARM patients for over a year, while 23% utilized digital technologies. Access to anesthesia for anorectal exams was available to 70% of respondents. Only 29% had established a one-week Bowel Management Program (BMP). Collaboration with urologists and gynecologists was more prevalent in HICs (59%) compared to LMICs (37%, p < 0.01). In HICs, nurses and advanced practice providers were significantly more involved in BMP (71% vs. 39% in LMICs; p < 0.01), and abdominal radiographs for regimen adjustments were used more frequently (80% vs. 69% in LMICs; p = 0.03). Treatment regimens were more varied in HICs, and quality of life tracking was more consistent (19% vs. 9% in LMICs; p = 0.02). LMICs reported significant shortages of medications and equipment (75% vs. 58% in HICs; p = 0.01), inadequate sanitation (48% vs. 24%; p < 0.01), and insufficient insurance coverage (58% vs. 44%; p = 0.04). ConclusionsThere are notable global disparities in the postoperative care of ARM patients, particularly in BMP protocols and treatment regimens, with LMICs facing severe socioeconomic challenges. This emphasizes the urgent need for targeted strategies and resources to enhance outcomes for ARM patients across different regions. Level of EvidenceLevel III.

Shortage of essential pediatric medications puts children's health at risk. Results from a European Confederation of Primary Care Paediatricians (ECPCP) Survey 2023

Unparalleled drug shortages during the winter of 2022/2023 had a profound impact on paediatric primary care across Europe. A survey conducted by the European Confederation of Primary Care Paediatricians (ECPCP) evaluated the availability of essential pediatric drugs and the resulting challenges. The survey was conducted between January and March 2023 and included responses from 640 paediatricians from 18 countries. The results of the survey indicated that there were substantial shortages, particularly of child friendly formulations of commonly prescribed medicines. Paediatricians in the survey feared that the use of less appropriate alternatives could potentially compromise the efficacy and safety of treatment. The survey findings highlight the urgent need for coordinated actions at multiple levels to ensure the availability of essential pediatric medications and safeguard children's health in future crises.

Exploring healthcare professionals' perspectives on neglected tropical diseases in Eastern Uganda: a qualitative study with a focus on schistosomiasis and soil-transmitted helminths.

Neglected tropical diseases (NTDs), including soil-transmitted helminths (STHs) and schistosomiasis, continue to impose a heavy burden, especially in sub-Saharan Africa and Uganda, despite being preventable. Integration of NTD management into primary healthcare has been inadequate. While researchers have explored community perspectives, there is a notable gap in understanding the viewpoints of healthcare workers (HCW), which is crucial for effective NTD control strategies. This study explores HCW' perspectives in Eastern Uganda, highlighting challenges in schistosomiasis and STH prevention and management. In this qualitative descriptive study, we conducted semistructured interviews with 10 key informants who were HCW in Eastern Uganda with experience in managing STHs and schistosomiasis. Participants were selected purposively and interviewed through Zoom guided by a comprehensive interview guide. The data were transcribed, coded and analyzed thematically. We identified five key themes regarding the impact and management of NTDs: (i) the burden of NTDs, where schistosomiasis and STHs were notably prevalent among children and communities adjacent to water bodies; (ii) transmission of NTDs, emphasizing water bodies and poor sanitation as primary routes of disease spread; (iii) clinical manifestations of NTDs, detailing the symptomatic presentations that complicate diagnosis and management; (iv) challenges in managing and diagnosing NTDs, highlighting the shortages of essential medications and diagnostic tools, along with the under-prioritization of NTDs within healthcare systems; and (v) fatalities and complications arising from NTDs, reporting on the severe outcomes and under-reporting of deaths associated with NTDs due to misdiagnosis, delayed treatment and traditional healing preferences. The interviewed Ugandan HCW demonstrated sufficient knowledge of schistosomiasis and STHs, but faced challenges due to inadequate diagnostic tools and medication shortages. The study underscores the need for NTD prioritization with direct funding and government involvement, alongside strategies that integrate continuous medical training, effective community outreach and an enhanced healthcare system response to reduce the burden of NTDs.

Natural Products from Brazilian Biodiversity Explored as Anti-EBV Drug Candidates: In-Silico Database Mining, Docking Computations, Molecular Dynamics and DFT Calculations

A DNA tumor virus called Epstein-Barr virus (EBV) is the cause of 1-2% of human cancers. EBV-associated carcinogenesis is caused by a persistent latent infection. The shortage of antiviral medications or vaccinations to control the virus led to a significant percentage of critically sickness individuals needing to be hospitalized. In the absence of an effective vaccine and approved drug, there is an immediate need for treatments that can combat EBV infection. Epstein Barr nuclear antigen 1 (EBNA1) is continually expressed in all malignancies linked to EBV; it is a desirable target for curative interference. Herein, natural product compounds from the Nuclei of Bioassays, Ecophysiology and Biosynthesis of Natural Products (NuBBE) database were mined to identify potent EBNA1 inhibitors. The performance of the molecular docking technique was initially assessed in expecting the ligand-target binding pose according to the available experimental data. On the basis of the estimated docking protocol, the NuBBE database was virtually screened toward the EBNA1 protein, and the natural compounds with binding scores less than KWG (calc. [Formula: see text] kcal/mol) were subjected to molecular dynamics (MD) simulations followed by binding energy ([Formula: see text]) calculation using MM/GBSA approach. Based on binding energy computations, NuBBE1460 revealed superior [Formula: see text] with a value of [Formula: see text] kcal/mol, compared to KWG (calc. [Formula: see text] kcal/mol). Post-MD analyses displayed a high steadiness of NuBBE1460 within the EBNA1 protein binding pocket. Furthermore, the physicochemical, pharmacokinetic and toxicity features of the identified compound were predicted, demonstrating high degrees of its oral bioavailability. The energetical and geometrical properties of NuBBE1460 were calculated using the DFT method. Conclusively, this study offers NuBBE1460 obtained from natural sources as a lead EBNA1 inhibitor for future investigation and development as a therapeutic for EBV.

Burn pain management in a female patient with severe burn injuries in Nepal: a case study and review.

Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.

Evaluation of Mental Health and Well-Being Among Kansas Pharmacists Post-COVID-19 Pandemic.

Background COVID-19 has profoundly affected pharmacists, causing burnout from heavier workloads, personal stressors, and disrupted healthcare delivery. Research on pharmacists' mental health during the pandemic, especially in rural areas like Kansas, remains limited. Objectives This study aimed to understand perceptions, experiences, and impacts on the mental, emotional, and psychological well-being of active Kansas pharmacists during the COVID-19 pandemic, includingevaluatingworkplace modifications on mental health. Methods Kansas licensed pharmacists were recruited via email distributions through five Kansas pharmacy organizations and informal referrals among colleagues. After consenting, respondents completed a 15-minute, 28-question survey via Qualtrics. The survey included 11 questions concerning demographics and employment characteristics, along with 17 questions designed to assess the impact of COVID-19 on mental health, structured according to existing literature. Participation was uncompensated, and incomplete surveys were omitted from the analysis. Results One hundred and seven respondents (83.59% completion) represented 3.25% of Kansas's 3,290 pharmacists. They were aged 26-66 (M=38.7), the majority female (72.57%) and white (84.84%), with 14.24 years average practice duration (SD=10.94). Data covered 12 rural and 11 urban counties, with 50.91% staff pharmacists and 22.73% pharmacy managers. Many worked over 40 hours weekly in 13 settings. Findings showed increased workload (24.68%), medication shortages (24.03%), and burnout (24.32%) affecting job considerations. Workplace changes impacted personal mental health, with the main stressors being work-related factors (19.21%), social distancing (18.95%), and health concerns (12.63%). Conclusion This study underscores the pandemic's profound toll on Kansas pharmacists' mental, emotional, and physical health, leading to burnout, job dissatisfaction, and decreased effectiveness. It emphasizes the urgency of organizational interventions.

Nursing leadership in disaster preparedness and response lessons learned and future directions

Nursing leadership is integral to effective disaster preparedness and response, demanding agility, strategic planning, and robust resource management. Disasters, both natural and man-made, present unique challenges that require nursing leaders to be adept in rapid decision-making and efficient coordination. The unpredictability of disasters necessitates comprehensive and regularly updated preparedness plans, ensuring nursing teams are well-versed in their roles through continuous training and simulations. Interprofessional collaboration and strong community partnerships are essential, fostering a unified response and efficient resource distribution. Communication remains a cornerstone of disaster management, with clear, timely information dissemination being crucial for coordinating efforts and maintaining public trust. Resource scarcity during disasters, such as shortages of medications and personal protective equipment (PPE), poses significant challenges. Effective resource management strategies are essential to maintain patient care standards and protect healthcare workers. The psychological toll on healthcare providers is another critical issue, with nursing leaders needing to implement support systems that address mental health and promote resilience. Integrating advanced technologies like telehealth and data analytics can enhance disaster response, providing remote care options and enabling predictive modeling for better resource allocation. Innovative approaches in nursing leadership include the use of telehealth for remote consultations and monitoring, data analytics for predictive modeling, and interprofessional education to improve teamwork and coordination. Strengthening community partnerships enhances overall disaster response capacity, ensuring that community-specific needs are addressed. Mental health support for healthcare providers, both immediate and long-term, is vital for maintaining a resilient workforce. Policy advocacy by nursing leaders is crucial to developing robust disaster preparedness frameworks and securing adequate funding. In summary, nursing leadership is pivotal in disaster preparedness and response, with a focus on strategic planning, interprofessional collaboration, effective communication, resource management, mental health support, and the integration of advanced technologies. Emphasizing these areas will enhance the resilience and responsiveness of healthcare systems, ultimately improving outcomes for patients and healthcare providers during disasters.

Lawsuits against the Brazilian Unified Health System regarding Bladder/Ureteral Cancer

Abstract Objective To evaluate the technical notes (TNs) issued by the Center for Technical Support of the Judiciary (Núcleo de Apoio Técnico do Poder Judiciário, NAT-Jus, in Portuguese) of the Brazilian Ministry of Justice regarding lawsuits against the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in Portuguese) concerning bladder/ureteral cancer, in order to better advise the formulation of public policies regarding oncologic care. Materials and Methods A cross-sectional study on the TNs issued by NAT-Jus regarding lawsuits from patients against SUS from 2019 to 2023 concerning bladder or ureteral cancer. Results A total of 137 TNs were issued. Most plaintiffs were male patients (70.8%), with a mean age of 69.1 ± 17.6 years. The lawsuits were filed in an attempt to obtain medications (67%), medical care or procedures (26%), or other health products (7%).The most common medications requested were immuno-oncology (IO) therapeutic agents, in 66 cases (pembrolizumab, avelumab, nivolumab, and atezolizumab), followed by the Bacillus Calmette-Guerin (BCG) vaccine (n = 13), chemotherapeutic agents in 5 cases, erdafitinib in 2 cases, and enfortumab vedotin in 1 case.Pembrolizumab was the medication most frequently requested by patients undergoing treatment for bladder or ureteral cancer. Out of more than 50 thousand TNs, there were 1,349 requests for this medication. Bladder or ureteral cancer was responsible for 3.4% of all the demands for pembrolizumab.It is also notable that lawsuits were more common in the Southern (n = 47), followed by the Southeastern (n = 26), Northeastern (n = 20), and Midwestern (n = 6) regions. The lawsuits in the South were more often related to expensive medications. In the Northeast and Midwest, there were proportionally more lawsuits demanding medical procedures. The Brazilian Federal Government lost the lawsuits, representing expenses of BRL 42.1 million with these novel medications within the period evaluated. Conclusion Bladder cancer treatment within SUS faces obstacles and shortages of essential medications. Moreover, advanced and costly therapies are not widely available, straining the public healthcare system and resulting in increasing legal costs. Collaboration among the government, the scientific community, and patient advocacy organizations is crucial to ensure the sustainability of SUS in the face of these challenges.

Lived experience, social support, and challenges to health service use during the COVID-19 pandemic among HIV key populations in Indonesia

The COVID-19 pandemic has greatly affected the lives, health, and social well-being of people globally including presenting special challenges in low to middle income countries for people living with HIV. This study investigates the pandemic experiences of the four key HIV-positive populations in Indonesia: men who have sex with men, transgender women, female sex workers, and people who use drugs. In-depth interviews were conducted with a convenience sample of 22 key population members recruited through 9 nongovernment HIV agencies in Jakarta and Bali, Indonesia. Indonesia’s Large-scale Social Restrictions Policy mandating physical distancing and stay-at-home orders had been in effect for 7–10 months at the time of the interviews. The interviews were audio-recorded, transcribed, and coded using NVivo™ (R1.7) software. A grounded theory approach identified key concepts along with similarities, differences, and reoccurring patterns of COVID-19 lived experience among participants. Participants recounted the impact of both the pandemic and the Restriction Policy on their interpersonal, financial, medical, and psychosocial well-being. When in need, they turned to formal and informal sources of financial and social support plus their own resourcefulness. Along with other factors, HIV medication shortages, HIV and COVID-19 related stigma, and fear of acquiring COVID-19 negatively impacted their antiretroviral adherence and the use of health services. The results point to the latent consequences of government attempts to curb a pandemic through public health lockdowns and enforced policies of physical separation. Its findings reveal the importance of ensuring that public safety nets for HIV key populations are available to supplement more informal personal sources of needed support.

Unveiling the Nexus: Sulphur Dioxide Exposure, Proximity to Mining, and Respiratory Illnesses in Kankoyo: A Mixed-Methods Investigation.

The emission of sulphur dioxide (SO 2) from mining activities presents significant health hazards, particularly to communities near industrial zones. This mixed-methods study investigates the nexus between (SO 2) exposure and respiratory health in Kankoyo Township, Zambia. Employing community engagement, expert interviews, spatial analysis, and a retrospective examination of 15 years of health and (SO 2) data, the research identified a troubling correlation between (SO 2) exposure and adverse respiratory health effects among the local population. Expert interviews highlighted that respiratory issues constituted approximately 75% of health complications, with a notable reduction in asthma cases following the installation of a monitoring station and upgrades to smelter operations. Spatial analysis demonstrated that (SO 2) levels in Kankoyo exceeded the Zambian Environmental Management Agency (ZEMA) limits by 1713% identifying it as a significant pollution hotspot. Additionally, wind profile analysis indicated frequent low-speed winds from the east-northeast (ENE), contributing to pollutant accumulation. Based on these insights, the study recommends implementing real-time pollution data sharing, affordable air quality sensors, addressing medication shortages, establishing specialized respiratory clinics, launching IT-driven awareness campaigns, and further research into additional pollutants and confounding factors.

Patient satisfaction with Saudi community pharmacy services (Wasfaty System)

IntroductionThe healthcare system in KSA has been substantially transformed as part of Vision 2030, including implementation of an electronic prescribing system, called Wasfaty, to enable patients to receive their prescriptions from community pharmacies (CPs). This study assessed patient satisfaction with CPs and the Wasfaty system. MethodsThis cross-sectional observational study used existing data from the Saudi Ministry of Health's patient experience program. Data were collected from patients (≥15 years of age) visiting governmental primary care clinics in 2022. Summary statistics were determined and multivariable logistic regression analyses were conducted. ResultsThe sample included 66,541 patients. More than 70% of patients were satisfied with the services of the CPs and the Wasfaty system. Being older and being female consistently showed a positive association with satisfaction across several services. Whereas patients in preventive clinics had higher odds of satisfaction with medication availability (OR: 1.19, 95% CI: 1.03–1.37) and waiting time (OR: 1.23; 95% CI: 1.03–1.47), patients in chronic disease clinics had lower satisfaction with medication availability (OR: 0.92, 95% CI: 0.85–0.99). Saudi patients had lower odds of being satisfied with multiple services. ConclusionsThe overall high satisfaction among patients suggested the success of the Wasfaty system in meeting patient needs and expectations. However, areas for improvement exist to increase patient satisfaction, such as addressing medication shortages and ensuring clear patient–pharmacist communication. The results highlight the importance of continued monitoring and evaluation to support the patient experience with pharmacy services, and to improve patients' journeys, medication adherence, and overall healthcare outcomes.

Society for Healthcare Epidemiology of America position statement on pandemic preparedness for policymakers: mitigating supply shortages.

The COVID-19 has had major direct (e.g., deaths) and indirect (e.g., social inequities) effects in the United States. While the public health response to the epidemic featured some important successes (e.g., universal masking ,and rapid development and approval of vaccines and therapeutics), there were systemic failures (e.g., inadequate public health infrastructure) that overshadowed these successes. Key deficiency in the U.S. response were shortages of personal protective equipment (PPE) and supply chain deficiencies. Recommendations are provided for mitigating supply shortages and supply chain failures in healthcare settings in future pandemics. Some key recommendations for preventing shortages of essential components of infection control and prevention include increasing the stockpile of PPE in the U.S. National Strategic Stockpile, increased transparency of the Stockpile, invoking the Defense Production Act at an early stage, and rapid review and authorization by FDA/EPA/OSHA of non-U.S. approved products. Recommendations are also provided for mitigating shortages of diagnostic testing, medications and medical equipment.

Efficacy of Shen Cao Gan Jiang Tang on Non-severe COVID-19 Patients: A Multicenter, Randomized, Open-Label Clinical Trial.

Background In the face of the escalating COVID-19 pandemic amid shortages of medications and vaccines, a Vietnamese herbal formula known as Shen Cao Gan Jiang Tang (SCGJT) has been put into use for non-severe COVID-19 patients. This study aims to assess its efficacy and safety. Methods A multicenter, open-label, randomized controlled trial was conducted on 300 patients with non-severe COVID-19, randomly assigned into two groups: 150 receiving standard care (control group) and 150 receiving additional SCGJT for 10 days (SCGJT group). Time to resolution of symptoms, symptom severity, disease progression, time to discharge, the National Early Warning Score 2 (NEWS2) score, usage of Western drugs, time to viral clearance, and safety outcomes were continuously monitored. Results The SCGJT group exhibited faster symptom resolution (median: 9 vs. 13 days) and improved symptom severity, including cough, fatigue, hypogeusia, muscle aches, nasal congestion, runny nose, and sore throat, compared to the control group. Although there was a lower rate of severe progression in the SCGJT group (0.7% vs. 4.7%), the difference was not statistically significant. The time to discharge was significantly shorter in the SCGJT group (median: 7 vs. 8 days). Changes in the NEWS2 score did not show significant differences between groups. SCGJT has been demonstrated to reduce the need for symptomatic relief medications and hasten SARS-CoV-2 viral clearance. No adverse events were reported, and routine tests showed no significant differences. Conclusions SCGJT is safe and has potential clinical efficacy in non-severe COVID-19 patients. However, data regarding preventing severe progression remains inconclusive. Further studies should be conducted in light of the current state of the COVID-19 pandemic.

Effects of lack of access to cancer medication on survival of patients with lung cancer.

e20585 Background: Lung cancer is the leading cause of cancer-related death. The treatment has evolved with the introduction of immunotherapy. During the economic crisis in Lebanon, cancer medications became unavailable forcing oncologists to adjust treatment protocols. This study aims to assess the effect of medication shortage on the progression-free survival (PFS) of lung cancer patients treated at a tertiary care center in Lebanon. Methods: A retrospective analysis of patients with metastatic NSCLC treated during the period of drug shortage (October 2021-December 2022) as compared to those treated in 2019-2020. The primary end point was progression-free survival (PFS) on first line of therapy and its association with dose density ratio (dose density given/standard dose density). Electronic medical records of 117 patients were reviewed and data of 83 eligible patients were collected and analyzed using IBM SPSS software. Results: The mean age at diagnosis was 68 years. Of the total, 63.5% were male. Additionally, 14.4% of the patients received chemotherapy, 39.7% received immunotherapy, and 42.1% received a combination of chemotherapy and immunotherapy. In total, 49 patients were eligible in the 2019/2020 category. 84% of the patients had the opportunity to receive immunotherapy. In contrast, 25 patients were eligible in the 2021/2022 category, and only 73% of them had the opportunity to receive immunotherapy. The median PFS of the 2019/2020 category was 11.2 months, compared to 5.4 months in 2021-2022 (p-value of 0.339). PFS was studied based on the dose density ratio for immunotherapy. Twenty-two patients received a full immunotherapy dose with a ratio of 1, and their PFS was 5.43 months. Twelve patients received a dose density ratio ranging from 0.01 to 0.50 and had a PFS of 10 months. Twenty-nine patients received a dose density ratio of 0.51-0.99 and had PFS of 12.8 months. Contrary to our initial expectations, we did not observe a statistically significant difference between the dose density of immunotherapy and PFS values with a p-value of 0.107. Conclusions: Despite significant shortages in immunotherapy medications, our study suggests that this has no significant detrimental effect on PFS. This unexpected discovery challenges the conventional notion that full immunotherapy doses are necessary and prompts further exploration of the complex relationship between dosage and treatment outcomes in patients.

SECUREMEDS: BLOCKCHAIN PROTECTION FOR DRUG CHANNELS

The World Health Organisation (WHO) highlights the global threat of medicine counterfeiting, particularly in low- and middle-income countries where 10% of drugs may be counterfeit or of inferior quality, hence creating serious health hazards to the general public. Because there are shortages of necessary medications during illness outbreaks, this problem gets worse. Fighting this issue requires increased public awareness campaigns, improved pharmaceutical accessibility, and international cooperation Our goal is to create a strong framework for monitoring pharmaceuticals at every stage of the supply chain—manufacturers, distributors, retailers, and government agencies such as the FDA. A tamper-proof and easily traceable supply chain can be ensured by implementing blockchain technology and using transparent contractual arrangements. Furthermore, cutting-edge techniques like smart contracts made possible by Ganache and Ethereum improve supply chain integrity. Verification codes are sent via email to strengthen authentication processes and provide an additional degree of protection. Moreover, batch number hashing is secured by SHA encryption, guaranteeing complete protection during the distribution process. Global pharmaceutical safety and efficacy are guaranteed by this all-encompassing strategy.. . Keywords— Pharmaceutical Supply Chain Counterfeit Medications Blockchain Technology FDA (Food and Drug Administration).

Understanding referral of patients with cancer in rural Ethiopia: a qualitative study

BackgroundCancer incidence is increasing in Ethiopia mainly due to increased life expectancy, while oncological capacities remain limited. Strong referral linkages between different levels of the healthcare system are key to provide timely access to cancer care. In this qualitative study, we assessed limitations and potential of cancer patient referral in the rural Southwest of Ethiopia.MethodsWe held four focus group discussions (FGD) with health professionals at one primary and three secondary hospitals and conducted eight in-depth interviews (IDI) with the hospitals´ medical executives and local health bureau representatives. Data was analysed inductively using thematic analysis and emerging themes were categorized within the revised concept of access by Penchansky and Saurman.ResultsThe inevitable referral of patients with cancer in the rural Southwest of Ethiopia is characterized by the absence of clear communication protocols and the lack of formal referral linkages. The newly implemented hub-system has improved emergency referrals and could be expanded to non-emergency referrals, sensitive to the needs of advanced oncological care. Liaison officers can pave the way but need to be trained and equipped adequately. Referred patients struggle with inadequate transportation systems, the lack of accommodation close to specialized facilities as well as the inability to navigate at those sites due to language barriers, illiteracy, and stigmatization. Few Non-Governmental Organizations (NGOs) help but cannot compensate the limited governmental support. The shortage of medications at public hospitals leads to patients being directed to costly private pharmacies. In the light of those challenges, cancer remains to be perceived as a “death sentence” within the rural communities.ConclusionsStandardized referral linkages and a multi-faceted support network throughout the cancer care continuum are necessary to make oncology care accessible to Ethiopia´s large rural population.

Did the COVID-19 pandemic affect medicine-related support for people living with HIV in the United Kingdom? – a cross-sectional survey

Abstract Introduction In 2019, there were 105,200 people living with HIV (PLWH) in the UK, most of whom (98%) were engaged in care and on antiretroviral medicines (ARVs). Globally, the COVID-19 pandemic was predicted to interrupt the HIV care continuum.[1] In England, early phases of the pandemic revealed a shift to online, or remote HIV service delivery and a decline in sexual health service provision generally.[2] Aim To investigate PLWH’s perceptions of the effects of the COVID-19 pandemic on their medicine-related support (MRS). Methods Institutional ethics approval was obtained to promote an online survey (1/09/2021 to 31/01/2023) among UK residents. Eligible participants were PLWH, aged 18 years or over, using ARVs and ≥1 non-ARV. Snowball sampling was used to recruit participants via social media. The survey asked participants to report their sources of medicine-related support and whether they experienced changes to how they obtained their medicines during the pandemic. An open-ended question was also asked to allow participants to report any other medicine-related issues experienced during the pandemic. The survey link was shared with HIV-related charities and their memberships. Descriptive statistics and thematic analysis were used for quantitative and free-text quotes respectively. Results One hundred and seventy-three participants who were eligible consented. Ninety-five participants provided free-text quotes. The mean age was 48.7 (SD±12.5) years and 50.5% (n=51/101) were aged ≥50 years. The majority were male (77.5%, n=79/102), white (86.1%, n=87/101), and gay/lesbian (60.8%, n=62/102), whilst 52.9% were employed (n=54/102). Approximately 1 in 5 (16%, n=8/50) of younger PLWH reported changes to their MRS, whilst 9.8% (n=5/51) of older PLWH, aged 50+, felt their MRS changed. Source of MRS: Most PLWH continued to use their specialist healthcare professionals for MRS and perceived no change in its availability due to COVID-19. Within primary care services, more participants reported using their general practitioner for MRS compared to their community pharmacist (12.5%, n=17/136 and 2.9%, n=4/136, respectively). Frequency of appointments and perceptions around person-centred care: Some reported that they had received more attention from healthcare professionals whilst others noted that after the first lockdown fewer, busier staff led to a less person-centred service. Mode of MRS: Whilst the majority of clinics moved to remote appointments, for many PLWH this was perceived as desirable particularly for those who preferred the convenience of remote appointments or were concerned about leaving their home due to being categorised in highest-risk patient groups. Ten participants stated that, due to COVID-19, they now get their medicines delivered to their homes instead of collecting them as previously from the local pharmacy or their specialist HIV clinic. One participant wrote “I had longer periods between blood tests and telephone consultations. I prefer face to face”, with another 52-year-old female stating that “Personally, don’t ever want to replace face to face with remote again”. Access to medicines: Only 8 (8.4%, n=8/95) reported changes to how they accessed their antiretroviral medicines. Two participants reported interruptions to treatment; “I had a shortage of medication. When I phoned my hospital to ask for a new prescription, they couldn’t give me one unless I came in physically. This was impossible for me during the first few months of lockdown” (male, aged 30). Conclusion While most PLWH did not perceive changes to their MRS due to the COVID-19 pandemic, a minority experienced treatment interruptions as revealed by this UK-wide survey. Patient preferences should be considered when delivering medicine-related consultations for PLWH. Future research is needed to explore clinicians’ perspectives and how to ensure continuity of HIV care during crises.

Shortages of clinical nutritional components and management strategies

Parenteral nutrition (PN) solution is a medication of high concern due to its intricate drug utilization procedure. It has been reported that since 2010, nearly every component involved in the preparation of PN admixtures has experienced a shortage at least once. Shortages may lead to therapy delays in hospitals, clinics and other health-related facilities or reductions in quality, prompting healthcare providers to recommend alternative treatments, potentially leading to medication errors, negatively influencing patient outcomes, and consume healthcare assets. The causes of medication shortages are diverse and encompass unidentified factors (44%), manufacturing complications (36%), supply and demand imbalances (8%), discontinued product lines (8%), insufficient access to raw materials (4%), and natural disasters. The duration for the resolution of these shortages was inconsistent, with certain product shortages that were resolved experiencing a recurrence, while others persisted for several months to years. The pharmacy department can take the lead in efficiently managing drug shortages by guaranteeing that its institution possesses the essential infrastructure and a clearly outlined management strategy well in advance of any shortages arising. During periods of shortages, it is extremely important to limit the use of nutritional products to patients with valid indications and those with nonfunctional gastrointestinal systems. Effective management of drug shortages, including PN components, necessitates a comprehensive plan and the involvement of an interprofessional team. This team should contribute to the development of the plan and be ready to implement it swiftly in case of a shortage or outage. Once the shortage of PN components is deemed resolved, all rationing and conservation strategies should be halted, as these measures are meant to be employed exclusively during shortages. Once the PN component shortage has been resolved, it is crucial to resume providing the full dosage of PN components to all patients in need of PN therapy.