A game theory data science-based mechanism for licensed pharmaceutical products concerning their deterioration: a case of a micro, small, and medium enterprise in Iran.

One of the main characteristics of health systems and pharmaceutical supply chains is their significant costs in the public sector, which has forced governments and companies active in this field to find ways to reduce costs. In this paper, the deterioration of imported pharmaceutical items is investigated as one of the challenges of the supply chain of pharmaceutical firms. Specifically, the micro, small medium enterprise (MSME), and a collaborative strategy to reduce its costs is presented. The technical solution of the cooperative strategy is the formation of a partnership alliance between the foreign patent holder of brand drugs and a domestic manufacturer through an exclusive license contract in the local country. This leads to a significant reduction of costs in the distribution network of the pharmaceutical supply chain. On the other hand, supply chain management techniques in the cooperative strategy provide the necessary motivation for its practical implementation by splitting fair profits between producers and other members, namely local government, distributors, and pharmacies. For these purposes, a cooperative game theory-based contract is utilized to set the parameters of the license agreement, and then a profit-sharing mechanism is introduced that splits the benefits of cooperation among the supply chain members based on their afforded costs. The most important contribution of the current research is to propose an integrated framework that combines the logistics network models, valuation methods, and profit split mechanisms that embody more facts from real-world problems than separate models in this regard in previous studies. Moreover, results of the proposed strategy in the supply chain of a drug for thalassemia patients in Iran indicate the effectiveness of the proposed strategy in reducing costs and deterioration. Further, it is shown that the higher the ordering costs of the imported drugs, the lower the market share of the patent holder, and the lower the financing expenses of the cooperative alliance, the more efficient is the proposed strategy.

Strategies for ensuring required service level for COVID-19 herd immunity in Indian vaccine supply chain.

Post COVID-19 vaccine development, nations are now getting ready to face another challenge: how to effectively distribute vaccines amongst the masses to quickly achieve herd immunity against the infection. According to some experts, herd immunity for COVID-19 can be achieved by inoculating 67% of the population. India may find it difficult to achieve this service level target, owing to several infrastructural deficiencies in its vaccine supply chain. Effect of these deficiencies is to cause frequent lead time disruptions. In this context, we develop a novel modelling approach to identify few nodes, which require additional inventory allocations (strategic inventory reserves) to ensure minimum service level (67%) under the possibility of lead time disruptions. Later, through an illustrative case study on distribution of Japanese Encephalitis vaccine, we identify conditions under which strategic inventory reserve policy cannot be practically implemented to meet service level targets. Nodes fulfilling these conditions are termed as critical nodes and must be overhauled structurally to make the implementation of strategic inventory policy practically viable again. Structural overhauling may entail installation of better cold storage facilities, purchasing more quality transport vans, improving reliability of transport network, and skills of cold storage manager by training. Ideally, conditions for identifying critical nodes for COVID-19 vaccine distribution must be derived separately by substituting COVID-19 specific parametric values in our model. In the absence of the required data for COVID-19 scenario, JE specific criteria can be used heuristically to identify critical nodes and structurally overhaul them later for efficiently achieving service level targets.

Social media effectiveness as a humanitarian response to mitigate influenza epidemic and COVID-19 pandemic.

Influenza and COVID-19 are infectious diseases with significant burdens. Information and awareness on preventative techniques can be spread through the use of social media, which has become an increasingly utilized tool in recent years. This study developed a dynamic transmission model to investigate the impact of social media, particularly tweets via the social networking platform, Twitter on the number of influenza and COVID-19 cases of infection and deaths. We modified the traditional Susceptible-Exposed-Infectious-Recovered (SEIR-V) model with an additional social media component, in order to increase the accuracy of transmission dynamics and gain insight on whether social media is a beneficial behavioral intervention for these infectious diseases. The analysis found that social media has a positive effect in mitigating the spread of contagious disease in terms of peak time, peak magnitude, total infected, and total death; and the results also showed that social media's effect has a non-linear relationship with the reproduction number R 0 and it will be amplified when a vaccine is available. The findings indicate that social media is an integral part in the humanitarian logistics of pandemic and emergency preparedness, and contributes to the literature by informing best practices in the response to similar disasters.

Forgotten Vaginal Foreign Body Presenting as Cervical Dystocia.

Generally encountered in paediatrics age group, vaginal foreign body is a rare presentation in gynaecological clinics. Inserted as a part of sexual abuse, gratification or psychiatric disorder, these foreign bodies can present with a varied symptomatology. We report a case of 22-year-old female, a victim of domestic violence, who had a foreign body inserted in the vagina which was forgotten. Later it was discovered when she presented at term with cervical dystocia.

RFID in healthcare: a Six Sigma DMAIC and simulation case study.

PURPOSE: The purpose of this paper is to develop a business model to generate quantitative evidence of the benefits of implementing radio frequency identification (RFID) technology, limiting the scope to outpatient surgical processes in hospitals. DESIGN/METHODOLOGY/APPROACH: The study primarily uses the define-measure-analyze-improve-control (DMAIC) approach, and draws on various analytical tools such as work flow diagrams, value stream mapping, and discrete event simulation to examine the effect of implementing RFID technology on improving effectiveness (quality and timeliness) and efficiency (cost reduction) of outpatient surgical processes. FINDINGS: The analysis showed significant estimated annual cost and time savings in carrying out patients' surgical procedures with RFID technology implementation for the outpatient surgery processes in a hospital. This is largely due to the elimination of both non-value added activities of locating supplies and equipment and also the elimination of the "return" loop created by preventable post operative infections. Several poka-yokes developed using RFID technology were identified to eliminate those two issues. PRACTICAL IMPLICATIONS: Several poka-yokes developed using RFID technology were identified for improving the safety of the patient and cost effectiveness of the operation to ensure the success of the outpatient surgical process. ORIGINALITY/VALUE: Many stakeholders in the hospital environment will be impacted including patients, physicians, nurses, technicians, administrators and other hospital personnel. Different levels of training of hospital personnel will be required, based on the degree of interaction with the RFID system. Computations of costs and savings will help decision makers understand the benefits and implications of the technology in the hospital environment.

Hospital cost structure in the USA: what's behind the costs? A business case.

PURPOSE: Hospital costs in the USA are a large part of the national GDP. Medical billing and supplies processes are significant and growing contributors to hospital operations costs in the USA. This article aims to identify cost drivers associated with these processes and to suggest improvements to reduce hospital costs. DESIGN/METHODOLOGY/APPROACH: A Monte Carlo simulation model that uses @Risk software facilitates cost analysis and captures variability associated with the medical billing process (administrative) and medical supplies process (variable). The model produces estimated savings for implementing new processes. FINDINGS: Significant waste exists across the entire medical supply process that needs to be eliminated. Annual savings, by implementing the improved process, have the potential to save several billion dollars annually in US hospitals. The other analysis in this study is related to hospital billing processes. Increased spending on hospital billing processes is not entirely due to hospital inefficiency. RESEARCH LIMITATIONS/IMPLICATIONS: The study lacks concrete data for accurately measuring cost savings, but there is obviously room for improvement in the two US healthcare processes. This article only looks at two specific costs associated with medical supply and medical billing processes, respectively. PRACTICAL IMPLICATIONS: This study facilitates awareness of escalating US hospital expenditures. Cost categories, namely, fixed, variable and administrative, are presented to identify the greatest areas for improvement. ORIGINALITY/VALUE: The study will be valuable to US Congress policy makers and US healthcare industry decision makers. Medical billing process, part of a hospital's administrative costs, and hospital supplies management processes are part of variable costs. These are the two major cost drivers of US hospitals' expenditures that were examined and analyzed.