Lessons learned from the pandemic: expanding the collaboration between clinical and logistics activities in a hospital.

PURPOSE: The Covid-19 pandemic generated significant changes in the operating methods of hospital logistics departments. The objective of this research is to understand how these changes took place, what collaboration mechanisms were developed with clinical authorities and, to what extent, logistics and clinical care activities should be decoupled to maximize each area's contribution? DESIGN/METHODOLOGY/APPROACH: The case study is selected to investigate practices implemented during the COVID-19 pandemic in hospitals in Canada. The pandemic presented an opportunity to contrast practices implemented in response to this crisis with those historically used in this environment. FINDINGS: The strategy of decoupling logistical tasks of an operational nature from clinical activities is well-founded and helps free clinical staff from tasks for which they are not trained. However, the decoupling of operational tasks should be combined with an integration of the clinical information flow to the logistics hub players. With this clinical information, the logistics hub can generate its full potential enabling better inventory management decisions to be made. ORIGINALITY/VALUE: The concept of decoupling is studied to identify configurations that offer the best benefits for clinical staff.

Citizen Science and Phytosanitary Surveillance Systems Are Complementary Tools to Follow the Invasion of Harmonia axyridis.

Citizen science is a valuable tool for early detection, distribution, and spread of invasive alien species (IAS). Nevertheless, citizen science initiatives have several potential biases and may be complemented with long-term structured monitoring schemes. We analyzed the spatial-temporal dynamics of the invasion of Harmonia axyridis (Pallas) (Coleoptera: Coccinellidae) in Chile, based upon two citizen sciences databases (WEB and INAT) and one structured monitoring (SAG). We collected 8638 H. axyridis occurrences between 2009 and 2020. WEB had a higher number of records than SAG and INAT, and in all databases, the number of records has increased over time. The three databases showed that the invasion started in central Chile and then spread toward the north and south. The WEB and SAG recorded occurrences in the extreme north and south, whereas INAT concentrated all the occurrences in a more limited area, included in WEB and SAG. Both citizen science initiatives concentrated their records in areas of high human populations whereas SAG records had a more even distribution across regions. At 2020, WEB accounted for 55%, SAG 54%, and INAT 8% of the total area accumulated with H. axyridis, with only 16% of area shared among databases. WEB and INAT obtained most of their records in urban and industrial land cover types, while SAG records were more evenly represented in different land cover types. Our results confirm that combined methods, including citizen science initiatives, national surveillance system, and localized samplings, complement each other in providing knowledge to understand the patterns, processes, and consequences of this invasion.

Fostering Innovation through Procurement in the Healthcare Sector: The Danish Experience.

Healthcare institutions have been searching for ways to increase the value they deliver to patients and to society. Innovation is an effective way to boost this value, and procurement strategies are key to bringing innovation into healthcare organizations. However, hospitals are one of the most challenging organizations to implement innovations. Thus, this research highlights some lessons learned and the best practices of a healthcare organization in Denmark that has successfully implemented the value-based procurement approach.

The management of personal protective equipment during the COVID-19 pandemic: The case of the province of Quebec.

Like other Canadian provinces, Quebec managed shortages of Personal Protective Equipment (PPE) in the early weeks of the COVID-19 pandemic. Two years later, with hindsight, what lessons can we learn from this logistics crisis? It is precisely to better understand the decisions made by the supply chain players in the province of Quebec that this paper was written. To fully understand the events, this paper first describes the Quebec healthcare system. Then it retraces the series of events and actions during the first wave, at a time when it was most challenging to procure PPE. It also specifies the main characteristics of the supply chain in the Quebec healthcare sector. Finally, it analyzed these data to come up with recommendations to help public decision makers adopt better supply chain management practices.

Anti-proliferative, pro-apoptotic and anti-invasive effect of the copper coordination compound Cas III-La through the induction of reactive oxygen species and regulation of Wnt/ß-catenin pathway in glioma.

Gliomas are the most aggressive neoplasms that affect the central nervous system, being glioblastoma multiforme (GBM) the most malignant. The resistance of GBM to therapies is attributed to its high rate of cell proliferation, angiogenesis, invasion, and resistance to apoptosis; thus, finding alternative therapeutic approaches is vital. In this work, the anti-proliferative, pro-apoptotic, and anti-invasive effect of the copper coordination compound Casiopeina III-La (Cas III-La) on human U373 MG cells was determined in vitro and in vivo. Our results indicate that Cas III-La exerts an anti-proliferative effect, promoting apoptotic cell death and inactivating the invasive process by generating reactive oxygen species (ROS), inactivating GSK3ß, activating JNK and ERK, and promoting the nuclear accumulation of ß-catenin. The inhibition of ROS generation by N-acetyl-l-cysteine not only recovered cell migration and viability, but also reduced ß-catenin accumulation and JNK and ERK activation. Additionally, Cas III-La significantly reduced tumor volume, cell proliferation and mitotic indices, and increased the apoptotic index in mice xenotransplanted with U373 glioma cells. Thus, Cas III-La is a promising agent to treat GBM.

Currículo para la administración de sedación fuera del quirófano en pacientes mayores de 12 años / Curriculum for the administration of sedation outside the operating room in patients over 12 years of age ,

Abstract Introduction: The "Curriculum for the administration of sedation outside the OR in patients over 12 years of age" was developed by the Universidad Nacional de Colombia, by invitation of the Colombian Society of Anesthesiology and Resuscitation - S.C.A.R.E. Objective: Identify the essential knowledge and the skills required by practitioners for the safe and effective administration of sedation to develop of a curriculum for the administration of sedation outside the operating room in patients over 12 years of age. Materials and methods: The curriculum was developed based on the methodological guiding principles of the Clinical Practice Guidelines for the administration of sedation outside the OR, using the PICO approach, in addition to the recommendations according to levels of evidence under the GRADE methodology. Results: The Curriculum was designed with ten (10) recommendations about the competencies that the professional administering sedation to patients older than 12 years of age must have, for diagnostic or therapeutic procedures outside the OR. Conclusions: The Curriculum collects the best available evidence with a view to determine the competencies that the professional administering sedation to patients older than 12 years old shall develop, for diagnostic or therapeutic procedures outside the OR, and hence to contribute to improved quality, reducing the variability and morbidity of patients requiring sedation outside the OR.

Resumen Introducción: El «Currículo para 1a administración de sedación fuera del quirófano en pacientes mayores de 12 años¼ fue desarrollado por la Universidad Nacional de Colombia por convocatoria de la Sociedad Colombiana de Anestesia y Reanimación (S.C.A.R.E.). Objetivo: Identificar los conocimientos indispensables y las competencias necesarias en los profesionales proveedores para que administren sedación de manera segura y efectiva para el desarrollo de un currículo para la administración de sedación fuera del quirófano en pacientes mayores de 12 años. Materiales y métodos: La construcción del Currículo se basó en los lineamientos metodológicos de la Guía Práctica Clínica para la administración de sedación fuera del quirófano en pacientes mayores de 12 años (publicada en este número), en los resultados de la búsqueda sistemática de la literatura orientada por la pregunta PICO y en la formulación de recomendaciones según niveles de evidencia graduados bajo la metodología GRADE. Resultados: Se desarrolló el Currículo con 10 recomendaciones de las competencias que debe tener el profesional que administra sedación a los pacientes mayores de 12 años para procedimientos diagnósticos o terapéuticos fuera del quirófano. Conclusiones: El Currículo recoge la mejor evidencia disponible, con el propósito de determinar las competencias que debe desarrollar el profesional que administra sedación a los pacientes mayores de 12 anos sometidos a procedimientos diagnósticos o terapéuticos fuera del quirófano, y así contribuir a mejorar la calidad, disminuir la variabilidad y la morbilidad de los pacientes que requieran sedación fuera del quirófano.

A new parasiticidal compound in T. solium cysticercosis.

The effect of 16α-bromoepiandrosterone (EpiBr), a dehydroepiandrosterone (DHEA) analogue, was tested on the cysticerci of Taenia solium, both in vitro and in vivo. In vitro treatment of T. solium cultures with EpiBr reduced scolex evagination, growth, motility, and viability in dose- and time-dependent fashions. Administration of EpiBr prior to infection with T. solium cysticerci in hamsters reduced the number and size of developed taenias in the intestine, compared with controls. These effects were associated to an increase in splenocyte proliferation in infected hamsters. These results leave open the possibility of assessing the potential of this hormonal analogue as a possible antiparasite drug, particularly in cysticercosis and taeniosis.

Parasiticidal effect of 16alpha-bromoepiandrosterone (EpiBr) in amoebiasis and cysticercosis.

The effect of the dehydroepiandrosterone analog 16alpha-bromoepiandrosterone (EpiBr) was tested on the tapeworm Taenia crassiceps and the protist Entamoeba histolytica, both in vivo and in vitro. Administration of EpiBr prior to infection with cysticerci in mice reduced the parasite load by 50% compared with controls. EpiBr treatment induced 20% reduction on the development of amoebic liver abscesses in hamsters. In vitro treatment of T. crassiceps and E. histolytica cultures with EpiBr, reduced reproduction, motility and viability in a dose- and time-dependent fashion. These results leave open the possibility of assessing the potential of this hormonal analog as a possible anti-parasite drug, including cysticercosis and amoebiasis.

High antibody level: an accurate serologic marker of viremia in asymptomatic people with hepatitis C infection.

BACKGROUND: The screening and diagnosis of hepatitis C virus (HCV) infection is initiated by testing for antibody to HCV (anti-HCV). A positive anti-HCV test in blood donors represents ongoing infection in only a variable proportion of individuals. Because a high anti-HCV level has been associated with viremia, a study was conducted to determine whether a high antibody level is an accurate serologic marker for viremia in asymptomatic anti-HCV-positive persons. STUDY DESIGN AND METHODS: In a diagnostic test study, we included 856 anti-HCV-positive blood donors in a blood bank at Guadalajara, Jalisco, Mexico, between 2002 and 2007. A third-generation amplified chemiluminescence assay (ChLIA HCV) was used to detect anti-HCV. A positive result of the qualitative nucleic acid test (HCV RNA) was considered the gold standard for viremia. RESULTS: By receiver operating characteristic analysis, the signal-to-cutoff (S/CO) ratio of 20 or more was chosen as optimal to identify viremia and so was defined as high anti-HCV level. There was a significant difference in the proportion of viremia between subjects with high antibody level and those with lower levels (93.7% vs. 1.8%, respectively; p < 0.001). A high antibody level showed a sensitivity for viremia of 96.6% (95% confidence interval [CI], 93.8%-98.1%), a specificity of 96.6% (95% CI, 94.8%-97.8%), and a likelihood ratio of 28.6 (95% CI, 18.4%-44.6%). CONCLUSION: A high antibody level (S/CO ratio >/=20 by ChLIA HCV) clearly divides the viremic from the nonviremic blood donors and functions as an accurate serologic marker to guide the use of routine HCV RNA testing to confirm hepatitis C infection.