| 1. |
- Ahlqvist, Victoria, et al.
(författare)
-
Supply chain risk management strategies in normal and abnormal times: policymakers' role in reducing generic medicine shortages
- 2023
-
Ingår i: International Journal of Physical Distribution & Logistics Management. - 0960-0035. ; 53:2, s. 206-230
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose – This paper links supply chain risk management to medicine supply chains to explore the role ofpolicymakers in employing supply chain risk management strategies (SCRMS) to reduce generic medicineshortages.Design/methodology/approach – Using secondary data supplemented with primary data, the authors mapand compare seven countries’ SCRMS for handling shortage risks in their paracetamol supply chains beforeand during the first two waves of the COVID-19 pandemic.Findings – Consistent with recent research, the study finds that policymakers had implemented few SCRMSspecifically for responding to disruptions caused by COVID-19. However, shortages were largely avoided sincemultiple strategies for coping with business-as-usual disruptions had been implemented prior to the pandemic.The authors did find that SCRMS implemented during COVID-19 were not always aligned with thoseimplemented pre-pandemic. The authors also found that policymakers played both direct and indirect roles.Research limitations/implications – Combining longitudinal secondary data with interviews sheds lighton how, regardless of the level of preparedness during normal times, SCRMS can be leveraged to avertshortages in abnormal times. However, the problem is highly complex, which warrants further research.Practical implications – Supply chain professionals and policymakers in the healthcare sector can use thefindings when developing preparedness and response plans.Social implications – The insights developed can help policymakers improve the availability of high-volumegeneric medicines in (ab)normal times.Originality/value – The authors contribute to prior SCRM research in two ways. First, the authorsoperationalize SCRMS in the medicine supply chain context in (ab)normal times, thereby opening avenues forfuture research on SCRM in this context. Second, the authors develop insights on the role policymakers playand how they directly implement and indirectly influence the adoption of SCRMS. Based on the study findings,the authors develop a framework that captures the diverse roles of policymakers in SCRM.
|
|
| 2. |
- Gamble, Carrol, et al.
(författare)
-
Timing of Primary Surgery for Cleft Palate.
- 2023
-
Ingår i: The New England journal of medicine. - : Massachusetts Medical Society. - 1533-4406 .- 0028-4793. ; 389:9, s. 795-807
-
Tidskriftsartikel (refereegranskat)abstract
- Among infants with isolated cleft palate, whether primary surgery at 6 months of age is more beneficial than surgery at 12 months of age with respect to speech outcomes, hearing outcomes, dentofacial development, and safety is unknown.We randomly assigned infants with nonsyndromic isolated cleft palate, in a 1:1 ratio, to undergo standardized primary surgery at 6 months of age (6-month group) or at 12 months of age (12-month group) for closure of the cleft. Standardized assessments of quality-checked video and audio recordings at 1, 3, and 5 years of age were performed independently by speech and language therapists who were unaware of the trial-group assignments. The primary outcome was velopharyngeal insufficiency at 5 years of age, defined as a velopharyngeal composite summary score of at least 4 (scores range from 0 to 6, with higher scores indicating greater severity). Secondary outcomes included speech development, postoperative complications, hearing sensitivity, dentofacial development, and growth.We randomly assigned 558 infants at 23 centers across Europe and South America to undergo surgery at 6 months of age (281 infants) or at 12 months of age (277 infants). Speech recordings from 235 infants (83.6%) in the 6-month group and 226 (81.6%) in the 12-month group were analyzable. Insufficient velopharyngeal function at 5 years of age was observed in 21 of 235 infants (8.9%) in the 6-month group as compared with 34 of 226 (15.0%) in the 12-month group (risk ratio, 0.59; 95% confidence interval, 0.36 to 0.99; P=0.04). Postoperative complications were infrequent and similar in the 6-month and 12-month groups. Four serious adverse events were reported (three in the 6-month group and one in the 12-month group) and had resolved at follow-up.Medically fit infants who underwent primary surgery for isolated cleft palate in adequately resourced settings at 6 months of age were less likely to have velopharyngeal insufficiency at the age of 5 years than those who had surgery at 12 months of age. (Funded by the National Institute of Dental and Craniofacial Research; TOPS ClinicalTrials.gov number, NCT00993551.).
|
|
