Crisis management in community pharmacies during a pandemic.

BACKGROUND: Although the COVID-19 pandemic required community pharmacies to implement several adaptation strategies to ensure medicines' and services' availability, related empirical research based on crisis management theory is lacking. OBJECTIVE: This study sought to holistically depict crisis management in Finnish community pharmacies and explore whether (1) pre-existing crisis plans, (2) crisis teams, (3) shared decision-making or (4) collaboration and communication with external stakeholders can protect staff resilience, pharmacy owners' resilience, organisational cohesion ('team spirit') and pharmacies' resources or finances during the pandemic. METHODS: A cross-sectional survey was developed based on the crisis management process model and sent to Finnish community pharmacy owners (n = 602) during the pandemic's second wave in October-November 2020. Descriptive statistics were calculated, and logistic regression analysis was performed to explore effects of crisis management efforts. Open-field responses were analysed qualitatively using deductive content analysis. RESULTS: In total, 221 (36.7 %) pharmacy owners participated in the study. Pharmacies responded to the pandemic with increased order volumes and new suppliers, home deliveries and remote consultations, hand sanitiser production and additional customer counselling concerning the COVID-19. Shared decision-making with pharmacy colleagues (p = 0.025) and collaboration with peers or stakeholders in the supply chain (p = 0.015) protected pharmacy owners' resilience during the pandemic. Additionally, shared decision-making protected pharmacies' finances (p = 0.040). Crisis teams or collaboration with social and healthcare operators did not provide advantage to pharmacies. However, pre-existing pandemic plans associated with reduction of pharmacies' resources (p = 0.006). CONCLUSIONS: Community pharmacies responded to the COVID-19 pandemic with several measures to ensure the continuity of pharmaceutical services and care and the availability of medicines, disinfectants and personal protective equipment. Developing shared decision-making in pharmacies and active collaboration with peers and supply-chain stakeholders could improve pharmacies' finances and their owners' resilience in future crises.

Organisation of cross-sector collaboration and its influence on crisis management effectiveness among pharmaceutical supply chain stakeholders during the COVID-19 pandemic.

OBJECTIVES: To investigate the organisation of cross-sector collaboration and how it influenced crisis management effectiveness among pharmaceutical supply chain stakeholders in Finland during the COVID-19 pandemic. STUDY DESIGN: Qualitative semi-structured interview study. METHODS: Purposeful selection was used to obtain the study sample consisting of leaders and specialists from the pharmaceutical industry and wholesalers (n = 9), community pharmacy owners (n = 9), hospital pharmacy heads (n = 6), government agency directors and officials (n = 5) and advocacy organisation representatives (n = 2). Inductive content analysis was performed to examine the data from the semi-structured individual (n = 29) and paired (n = 2) interviews in March-May 2021. RESULTS: A new conceptual model was developed to describe the organisation of collaborative crisis management. Without a predefined crisis management organisation, cross-sector collaboration was organised based on previous collaboration structures, channels and relationships and through the establishment of issue-specific groups by government agencies as per legal mandates. Crisis dynamics and related issues guided the group formation and meeting frequency. Advocacy organisations and government agencies acted in bridging role between stakeholders. Shared knowledge among pharmaceutical supply chain stakeholders enabled anticipation and preparedness during crisis; shared resources fostered maintenance of core functions; and shared problem-solving facilitated cross-sectoral solutions. CONCLUSION: This was the first study exploring cross-sector collaboration among pharmaceutical supply chain stakeholders during a crisis. Sharing knowledge, resources and problem-solving increased the crisis management effectiveness. The study presented a new illustration of organising for collaborative crisis management and added knowledge about private-third sector collaboration and issue-specific groups to the cross-sector collaboration and crisis management literature.

Genetic engineering of Escherichia coli inorganic pyrophosphatase. Tyr55 and Tyr141 are important for the structural integrity.

Two tyrosines are supposed to be essential for the activity and to participate in the stabilization of Escherichia coli inorganic pyrophosphatase (PPiase) against heat denaturation [Samejima, T., Tamagawa, Y., Kondo, Y., Hachimori, A., Kaji, H., Takeda, A. and Shiroya, Y. (1988) J. Biochem. (Tokyo) 103, 766-772]. To locate these two tyrosines in the amino acid sequence, we substituted all the eight tyrosines of E. coli PPiase with phenylalanine and studied the properties of these YF mutant PPiases. Interestingly, substitution of the tyrosines (Tyr51, Tyr55 and Tyr141) conserved with the amino acid sequence of yeast PPiase [Lahti, R., Kolakowski, L. F., Heinonen, J., Vihinen, M., Pohjanoksa, K. and Cooperman, B. (1990) Biochim. Biophys. Acta 1038, 338-345] exerted the most drastic effects on the structure and activity of E. coli PPiase. PPiase variants YF51, YF55 and YF141 had 64%, 7% and 22% of the wild-type PPiase activity, respectively. Furthermore, PPiase variant YF141 had an increased sensitivity to heat denaturation, whereas mutant PPiase YF55 displayed a profound conformational change, as demonstrated by the binding of the fluorescent dye 9-(diethylamino)-5H-benzo(alpha) phenoxazine-5-one (Nile red) that monitors the hydrophobicity of protein surfaces. None of the tyrosines of E. coli PPiase seem to be essential for catalysis, but Tyr55 and Tyr141 are important for the structural integrity of E. coli PPiase.