Healthcare supply chain risk management in Rio de Janeiro, Brazil: What is the current situation?

BACKGROUND: Public hospital managers in Rio de Janeiro must deal with severe budget costs, which is the only source of income of public hospitals. In this sense, systematic supply chain risk management can contribute to identifying such risks, assessing their severity, and developing mitigating plans, or even revealing the lack of such plans. Private hospital networks must also map their risks since they are facing a diminishing of demand given that unemployment in Brazil, which is growing in the past years, generates an impossibility of affording private healthcare. OBJECTIVE: The purpose of this paper is to investigate how supply chain risk management is being applied in healthcare supply chains from Rio de Janeiro - Brazil. This study considers supply chains located in the state of Rio de Janeiro. To accomplish this objective, we provide answers to two Research Questions: RQ1 - Is SCRM known as a concept among Rio de Janeiro healthcare supply chains? RQ2 - How are risk identification, risk assessment, and risk mitigation being implemented by companies from the healthcare supply chains in Rio de Janeiro - Brazil? METHOD: Our research design is based on four steps: i) Research design; ii) Case selection: iii) Data collection (11 cases selected); iv) Data analysis. RESULTS: The interviews revealed that SCRM is an entirely unknown concept among healthcare supply chains from Rio de Janeiro - Brazil. Managers have empirical knowledge of the risks, and they can identify the most hazardous risks and can come up with solutions to mitigate them, nevertheless, in many situations they do not have the authority or the manpower to implement the solutions, at most, managers implement local risk mitigation initiatives that do not consider the supply chains broader context. CONCLUSION: The healthcare organizations studied by this paper do not apply SCRM. They only apply local isolated solutions not considering a supply chain scope. This can become hazardous since isolated risk mitigation initiatives are often innocuous and have the potential to generate other risks.

Coletiva de imprensa: anúncios do Governo SP - 30/09/2020

O Governador João Doria assinou nesta quarta-feira (30) o termo de compromisso com a biofarmacêutica Sinovac Life Science para fornecimento de 46 milhões de doses da Coronavac ao estado de São Paulo até dezembro de 2020. O potencial imunizante contra o coronavírus é desenvolvido em parceria com o Instituto Butantan. “São Paulo não perde tempo, São Paulo quer proteger a saúde e a vida dos brasileiros”, afirmou o Governador. Doria também esclareceu que já há um entendimento verbal entre a direção do Butantan e a Sinovac para que outras 14 milhões de doses da vacina sejam fornecidas em fevereiro de 2021. O acordo foi assinado no Palácio dos Bandeirantes pelo Governador Doria, o Diretor do Instituto Butantan, Dimas Covas, e o Vice-presidente mundial da Sinovac, Weining Meng. No valor de US$ 90 milhões, o contrato também formaliza a transferência de tecnologia para produção da vacina pelo Butantan. Até dezembro, a farmacêutica vai enviar 6 milhões de doses da vacina já prontas, enquanto outras 40 milhões serão formuladas e envasadas em São Paulo. A segurança do imunizante já foi comprovada em uma pesquisa com mais de 50 mil voluntários na China. A vacina também já vem sendo testada no Brasil desde julho e, atualmente, os estudos clínicos da última fase são acompanhados por 12 centros de pesquisa científica em cinco estados e no Distrito Federal. “É a vacina mais promissora neste momento no mundo. Esse acordo coloca o estado de São Paulo, o Instituto Butantan e a Sinovac em posição de destaque. E muito importante, é o início do processo de transferência de tecnologia para a produção da vacina”, completou o Diretor do Instituto Butantan Dimas Covas. Tanto na China como no Brasil, os testes clínicos passaram a envolver voluntários com mais de 60 anos, que são o grupo mais suscetível aos sintomas graves da COVID-19. De acordo com o Butantan, que coordena a pesquisa no Brasil, a expectativa é que os testes de eficácia da Coronavac sejam encerrados até o dia 15 de outubro. Se a Coronavac tiver sucesso na última etapa dos testes, o Butantan pedirá a aprovação emergencial do imunizante à Anvisa (Agência Nacional de Vigilância Sanitária. O objetivo do Governo de São Paulo é iniciar uma campanha de vacinação contra o coronavírus na segunda quinzena de dezembro, com prioridade para profissionais de todas as unidades públicas e privadas de saúde de São Paulo.

Staffing Up For The Surge: Expanding The New York City Public Hospital Workforce During The COVID-19 Pandemic.

Confronted with the coronavirus disease 2019 (COVID-19) pandemic, New York City Health + Hospitals, the city's public health care system, rapidly expanded capacity across its eleven acute care hospitals and three new field hospitals. To meet the unprecedented demand for patient care, NYC Health + Hospitals redeployed staff to the areas of greatest need and redesigned recruiting, onboarding, and training processes. The hospital system engaged private staffing agencies, partnered with the Department of Defense, and recruited volunteers throughout the country. A centralized onboarding team created a single-source portal for medical care providers requiring credentialing and established new staff positions to increase efficiency. Using new educational tools focused on COVID-19 content, the hospital system trained twenty thousand staff members, including nearly nine thousand nurses, within a two-month period. Creation of multidisciplinary teams, frequent enterprisewide communication, willingness to shift direction in response to changing needs, and innovative use of technology were the key factors that enabled the hospital system to meet its goals.

Intensity of nursing work in public hospitals.

OBJECTIVE: to analyze the intensity of nursing work in public hospitals. METHOD: cross-sectional, quantitative study, carried out in 22 public hospitals. The sample was composed of 265 nurses and 810 nursing technicians and assistants. Data were collected through a questionnaire and analyzed with Exploratory Factor Analysis. The calculation of the distribution of the work intensity by category was done using a score ranging from -1 to +1 standard deviation of the data. Fisher's exact test (0.05

Gestión Logística de Medicamentos / medication logistics management

Fecha de actualización: 22Mayo2020. Menciona el proceso de selección, adquisición, mantenimiento y distribución de medicamentos con el objetivo de que los servicios de Salud se encuentren abastecidos de los insumos correctos, en la cantidad óptima y con buenas prácticas de almacenamiento, para atender a la población frente al coronavirus, principalmente los Hospitales que cuenten con Área de aislamiento.

Development Path and Urgency of further Strengthening Construction of Public Hospitals Based on Novel Coronavirus Pneumonia Treatment.

During the outbreak of novel coronavirus pneumonia (NCP) in Wuhan, public hospitals have played an important role in intensive care, case guidance and scheme optimization. At the same time, it also faces unprecedented challenges and tests. Based on the treatment of severe patients in Wuhan, combined with the treatment practice in Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, this paper puts forward the urgency of further strengthening the construction of public hospitals, discusses the feasible path for promoting the development of public hospitals, so as to meet the growing medical needs of the people, improve the ability to respond to major public health emergencies, and effectively guarantee the safety of people's lives and the promotion of a healthy China construction.

Gestión logística de medicamentos: 06 de febrero 2020 / Medication logistics management

Menciona el proceso de selección, adquisición, mantenimiento y distribución de medicamentos con el objetivo de que los servicios de Salud se encuentren abastecidos de los insumos correctos, en la cantidad óptima y con buenas prácticas de almacenamiento, para atender a la población frente al coronavirus, principalmente los Hospitales que cuenten con Área de aislamiento.

Privatization in the Irish hospital sector since 1980.

Background: Privatization has transformed health care systems over the last several decades. This article examines trends in bed supply in Ireland between 1980 and 2015 within the context of government policy on bed provision in a system of inequitable access to care. Ireland has not published bed data on private hospitals since the 1980s, even if they comprise about one-quarter of all hospitals. However, this article presents, for the first time, annual bed data since the 1980s collected from private hospitals and used to trace the evolution of bed supply over time. Methods: Bed data were collected for private Irish hospitals for the years 1980-2015, mainly through direct requests to hospitals. Additional sources included the Irish Medical Directory, private health insurance data, hospital company records and newspaper archives. Results: Subject to data caveats explained in the article, between 1980 and 2015, total inpatient beds decreased by 25.5% nationally. Inpatient bed numbers in private for-profit (PFP) hospitals rose from 0 to 1075 but decreased from 9601 to 5216 in private not-for-profit (PNFP) hospitals and from 7028 to 6092 in public hospitals (using the Irish hospital classification, beds in private hospitals increased from 1518 to 1910 but decreased from 15 111 to 10 473 in public hospitals). Also, by 2015, 24.1% of PFP hospital beds were day beds, compared to 17.7% for PNFP and 15.7% for public hospitals (using the Irish classification, by 2015, day beds accounted for 23.8% of beds in private hospitals and 16.1% in public hospitals). Conclusions: Trends in bed supply in Ireland between 1980 and 2015 are documented empirically for all Irish acute hospitals and contextualized within government policy on bed provision. The Irish acute hospital system has experienced privatization reforms supported by the government over the last several decades.

Subjetividade dos trabalhadores de enfermagem e a prática de adaptar e improvisar materiais / Subjetividad de los trabajadores de enfermería y la práctica de adaptar e improvisar materiales / Subjectivity of the nursing workforce and the practice of adapting and improvising material

RESUMO Pesquisa qualitativa, descritiva, que objetivou analisar a subjetividade dos trabalhadores de enfermagem na prática de adaptar e improvisar materiais. Os participantes foram 20 trabalhadores de enfermagem de um hospital público universitário. O instrumento de coleta de dados foi a entrevista semiestruturada, submetendo-se os dados à análise de conteúdo. Os resultados evidenciaram insatisfação dos profissionais de enfermagem diante da necessidade de trabalhar em meio aos improvisos e adaptações, que surgem como táticas para minimizar a precarização das condições laborais, fruto de uma ideologia defensiva dos trabalhadores de enfermagem ante as adversidades do meio laboral. Conclui-se que as adaptações e improvisações desgastam os trabalhadores de enfermagem, repercutindo diretamente na qualidade de vida.

RESUMEN Investigación cualitativa, descriptiva que tuvo el objetivo de analizar la subjetividad de los trabajadores de enfermería en la práctica de adaptar e improvisar materiales, los participantes fueron 20 trabajadores de enfermería de un hospital público universitario. El instrumento de recolección de datos fue la entrevista semiestructurada y estos fueron sometidos al análisis de contenido. Los resultados evidenciaron insatisfacción de los profesionales de enfermería frente a la necesidad de trabajar en medio a los improvisos y adaptaciones, que surgen como tácticas para minimizar la precarización de las condiciones laborales, fruto de una ideología defensiva de los trabajadores de enfermería ante las adversidades del medio laboral. Se concluye que las adaptaciones e improvisaciones desgastan a los trabajadores de enfermería, reflejando directamente en la calidad de vida.

ABSTRACT Qualitative, descriptive research that aimed to analyze the subjectivity of the nursing workers in practice to adapt and improvise materials. The participants were 20 nursing workers from a university hospital. The instrument of data collection was the semi-structured interview. The data were submitted to content analysis. The results showed nursing professionals' dissatisfaction with the need to work in the midst of improvisations and adaptations, which appear as tactics to minimize the precariousness of working conditions, fruit of a defensive ideology of nursing workers in the face of adversity in the workplace. The conclusion is that the adaptations and improvisations wear out nursing workers, directly affecting their quality of life.

Caracterização dos potenciais doadores e estrutura de unidades hospitalares que desenvolvem o transplante / Characterization of the potential donors and structure of hospital units that develops the transplantations

Objetivou-se caracterizar os potenciais doadores e descrever a estrutura onde se desenvolve o processo de doação de órgãos e tecidos para transplantes. Estudo descritivo e quantitativo realizado em seis unidades hospitalares. A amostra compôs-se por 65 potenciais doadores e a coleta de dados ocorreu entre agosto de 2010 e fevereiro de 2011. A maioria era do sexo masculino (50,8%), com até 45 anos de idade (53,8%), cuja principal causa de Morte Encefálica (ME) foi acidente vascular encefálico (53,9%) e 86,2% foram assistidos em hospital público. Quanto à estrutura, a planta física apresentou como maior inadequação a climatização (80,0%) e espaço físico (40,0%). Nos recursos materiais, verificou-se a ausência de radiologia móvel, glicosímetro e cama hospitalar, ambos com o mesmo percentual (32,3%). Nos recursos humanos, o menor quantitativo era de técnicos em enfermagem (53,8%) e na estrutura organizacional observou-se a falta de protocolos assistenciais (86,2%).Concluiu-se que a estrutura dos serviços onde se desenvolve o processo de transplante encontrou-se inadequada. Para tanto, faz-se necessário a implementação de ações complementares a fim de melhorar a estrutura dos hospitais para atender melhor aos pacientes em ME.

It was aimed to characterizing potential donors and describing the structure of the units donated of organs and tissues for transplantations. This is a descriptive and quantitative study carried in six hospitals units. The probability consisted of 65 potential donorsand the data collection occurredbetween August 2010 and February 2011. The majority were male (50.8%), with up to 45 years of age (53.8%), whose main cause of Encephalic Death (ED) was vascular encephalic accident (53.9%) and86.2% were assisted in public hospital.Regarding the structure, the physical plant presented as highest inadequacy the climatization (80.5%) and physical space (40.0%). In material resources, it was found the absence mobile radiology, glucometer and hospital bed, both of with the same percentage (32.3%).In the human resources, the smallerquantity was nursing technicians (53.8%) and in the organizational structure there was a lack of care protocols (86.2%). It was concluded that the structure of services where develops the process of transplantationit was find inadequate. For both, becomes necessary to implement of complementary actions in order to improving the structure of the hospitals to better meet patients in ED.

Diferencias en supervivencia en pacientes con lupus eritematoso sistémico de un centro privado y uno público / Differences in survival between patients with systemic lupus erythematosus from a public and a private center

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Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers.

The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for "reshuffling" clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy.

Equitable Distribution of Public Hospitals According to Health Needs in Malaysia: Does It Exist or Not?

The goal of ensuring geographic equity of health care can be achieved if the geographic distribution of health care services is according to the health needs. This study aims to examine whether acute Ministry of Health hospital beds are distributed according to population health needs in various states within Peninsular Malaysia. The health needs of each state are indicated by the crude death rate. Comparisons of the share of hospital beds to that of population with differential health needs were assessed using concentration curve and index. In most years between 1995 and 2010, the distribution of hospital beds in Peninsular Malaysia were concentrated among states with higher health needs. This is in line with the principle of vertical equity and could be one advantage of a central federal government that can allocate health care resources to prioritize states with higher health care needs.

A critical analysis of ICU/HC beds in South Africa: 2008-2009.

OBJECTIVE: To determine the national distribution of intensive care unit (ICU)/high care (HC) beds and the implications for ICU bed availability in the envisaged national health insurance (NHI) scheme. METHODS: A descriptive, non-interventional, observational study design was used. A desk-top audit of all public and private sector ICUs, including ICU/HC beds, in South Africa was undertaken for the period 2008 - 2009. For this study, both categories were analysed and referred to as ICU beds, as they reflect the critical care component of the health service in South Africa. RESULTS: In 2008 - 2009, there were 4 719 ICU beds in the private and public sectors in South Africa, with 75% (3 533) in the former and 25% (1 186) in the latter. The majority of ICU beds in the two sectors were located in three provinces: Gauteng (49%), KwaZulu-Natal (14%) and Western Cape (15%), representing 78% of ICU beds (3 703/4 719) and catering for 54% of the country's population. Eastern Cape had fewer than 300 beds, North West and Mpumalanga had fewer than 150 beds, and Limpopo and Northern Cape had 66 and 47 beds respectively. With the proposed NHI scheme, the number of ICU beds available would be 4 719, which would translate into a bed:population ratio of approximately 1:10 000. However, there are large variations across the provinces, which makes the availability of this level of care in some provinces non-existent. CONCLUSION: While increasing the number of ICU beds in the public sector will open critical care services to more users, the NHI scheme would not solve the huge discrepancies of access to ICUs, and availability of critical care staff, across the provinces.

Prisons: the psychiatric institution of last resort?

The World Health Organization declared in 1948 that the enjoyment of the highest individual attainment of health for any person is a fundamental human right. Australia, the U.K. and the United States all legally ratified this declaration as becoming signatories to their founding treatise with the United Nations. Despite this, there are many conspicuous examples of inequities of public health as found within these nations. One of the more disparate and outrageous examples of inequities in public health has been an insidious trend towards criminalizing mental illness, and the largely unjust treatment of many mentally ill persons. This change has resulted in untold numbers of mentally ill persons being over-represented within the criminal justice system, experiencing higher morbidity, co-morbidity and mortality rates, and having difficulty in surviving in a society frequently dealing with their illness in a persecutory manner. Questions must be raised: that although over the passage of time medical science and technology has changed, but has western societies' attitudes to health equity kept pace?

An assessment of the hospital disease burden and the facilities for the in-hospital care of trauma in KwaZulu-Natal, South Africa.

BACKGROUND: Trauma is a significant cause of morbidity and mortality in South Africa. The present study was designed to review the hospital trauma disease burden in light of the facilities available for the care of the injured in KwaZulu-Natal (KZN), South Africa's most populous province. The primary outcomes were the annual hospital burden of trauma in KZN, determined through data extrapolation, and evaluation of the data in light of available hospital facilities within the province of KZN, a developing province. The data were obtained through review of the trauma load in relation to all emergency cases at all levels of hospitals. METHODS: Hospital administrators in KZN were requested to submit trauma caseloads for the months of March and September 2010. Caseloads were reviewed to determine the trauma load for the province per category using two extrapolation methods to determine the predicted range of annual incidence of trauma, intentional versus non-intentional trauma ratios and population-related incidence of trauma. The results were GIS mapped to demonstrate variations across districts. Hospital data were obtained from assessments of structure, process, and personnel undertaken prior to a major sporting event. These were compared to the ideal facilities required for accreditation of trauma care facilities of the Trauma Society of South Africa and other established documents. RESULTS: Data were obtained from 36 of the 47 public hospitals in KZN that manage acute emergency cases. The predicted annual trauma incidence in KZN ranges from 124,000 to 125,000, or 12.9 per 1,000 population. This would imply a national public hospital trauma load on the order of at least 750,000 cases per year. Most hospitals are required to treat trauma; however, within KZN many hospitals do not have adequate personnel, medical equipment, or structural integrity to be formally accredited as trauma care facilities in terms of existing criteria. CONCLUSIONS: There is a significant trauma load that consumes vital emergency center resources. Most hospitals will need extensive upgrading to provide appropriate care for trauma. An inclusive trauma system needs to be formalized and funded, especially in light of the planned National Health Insurance for South Africa.

[Location of radiotherapy centers: an exploratory geographic analysis for Belgium]. / Localisation des centres de radiothérapie : une analyse géographique exploratoire pour la Belgique.

PURPOSE: The distance between the patient's home and a radiotherapy department may represent a hurdle for the patient and influence treatment choice. Therefore, it is necessary to check whether the geographical distribution of radiotherapy centers is in accordance with cancer incidence, taking also into account the cost of travelling to the radiotherapy department. The objective of this study is double; first, to map the current locations of radiotherapy centers across the country and second, to evaluate the observed spatial disparities with appropriate tools. MATERIALS AND METHODS: A model of operational research (P-median) is used to suggest the optimal locations and allocations and to compare them with the current situation. This is an exploratory study with simple inputs. It helps to better understand the current geographical distribution of radiotherapy centers in Belgium as well as its possible limitations. RESULTS-CONCLUSION: It appears that the current situation is on the average acceptable in terms of accessibility to the service and that the method presents huge potentialities for decision making so as to yield a spatial system that is both efficient and equitable.

[Current problems for outpatients undergoing cancer chemotherapy in Ehime Priority Hospitals of Cancer Care Network (Ehime Cancer Kyoten Hospitals)].

Ehime Priority Hospitals of Cancer Care Network(Ehime Cancer Kyoten Hospitals)regularly have meetings to discus the current problems in cancer care in Ehime Prefecture. We established three subcommittees:"Registration of Cancer Incident," "Critical Paths for the Management of Patients with Cancer,"and"Palliative Care for Patients with Advanced Cancer"to exchange our opinions. We recently set up a new subcommittee related to the physical and spiritual care of patients undergoing chemotherapy treatment,"A Subcommittee dealing with Cancer Chemotherapy and its Management"."This subcommittee has tried to identify current problems with chemotherapy for outpatients in each institution through questionnaire and analysis. As a result of this survey, it was found that Ehime Priority Hospitals have total of seventy-three beds for outpatients undergoing chemotherapy, and that they performed chemotherapy 19, 671 times in 2008. A total of eight oncology physicians and sixteen oncology nurses were engaged in performing chemotherapy in this system. The questions patients most frequently asked during chemotherapy concerned the management of therapy-related complications, dealing with problems at night and during holidays after chemotherapy, and financial problems related to the costs of treatment. In this study we found three issues that need to be managed in Ehime Priority Hospitals. First, for the nursing of outpatients undergoing chemotherapy, more staff engaged in different types of care is required. Second, a new system to deal with emergencies at night and during holidays after chemotherapy is necessary, because Ehime Priority Hospitals use the same system to deal with chemotherapy patients as for other patients. Third, cooperation between pharmacies and out-clinics is important for patient compliance during chemotherapy, especially for the administration of oral anti-tumor agents. Ehime Priority Hospitals of Cancer Care Network is trying to improve each institution while dealing with these problems.