Analysis of Challenges of the Medical Supply Chain – A Case of Zambia Medicines and Medical Supplies Agency

Medical supply chains play a vital role in delivering essential health commodities and ensuring the availability of medicines and medical supplies, especially in developing countries. Recent technological, organizational, and economic advancements in healthcare systems have provided increased access to treatment for patients. Therefore, the availability of the right medicine with the right composition for the right patient in the right quantity at the right time is essential for the patient’s safety and recovery. This paper aims to analyse the supply chain operations of the Zambia Medical Stores (ZAMMSA). The study adopted a descriptive study design and employed a mixed research approach. The population comprised of Third-Party Logistics providers, ZAMMSA facilities supported by Third-Party Logistics partners and the health facilities. The study used simple random sampling technique and data was collected with the help of structured questionnaires. Quantitative data was analysed using descriptive statistics and regression analysis while qualitative data was analysed using thematic analysis. The study revealed that, there are persistent operational challenges like procurement delays, incomplete tracking visibility, and inadequate storage capacities. The study also revealed that, strengthened communication channels, collaborative regulatory compliance efforts, contingency planning for disruptions, feedback mechanisms on product issues, transportation route optimization and provider training were the main strategies needed for improving challenges at each supply chain stage

The IVS data input to ITRF2014

2015ivs..data....1N - GFZ Data Services, Helmoltz Centre, Potsdam, GermanyVery Long Baseline Interferometry (VLBI) is a primary space-geodetic technique for determining precise coordinates on the Earth, for monitoring the variable Earth rotation and orientation with highest precision, and for deriving many other parameters of the Earth system. The International VLBI Service for Geodesy and Astrometry (IVS, http://ivscc.gsfc.nasa.gov/) is a service of the International Association of Geodesy (IAG) and the International Astronomical Union (IAU). The datasets published here are the results of individual Very Long Baseline Interferometry (VLBI) sessions in the form of normal equations in SINEX 2.0 format (http://www.iers.org/IERS/EN/Organization/AnalysisCoordinator/SinexFormat/sinex.html, the SINEX 2.0 description is attached as pdf) provided by IVS as the input for the next release of the International Terrestrial Reference System (ITRF): ITRF2014. This is a new version of the ITRF2008 release (Bockmann et al., 2009). For each session/ file, the normal equation systems contain elements for the coordinate components of all stations having participated in the respective session as well as for the Earth orientation parameters (x-pole, y-pole, UT1 and its time derivatives plus offset to the IAU2006 precession-nutation components dX, dY (https://www.iau.org/static/resolutions/IAU2006_Resol1.pdf). The terrestrial part is free of datum. The data sets are the result of a weighted combination of the input of several IVS Analysis Centers. The IVS contribution for ITRF2014 is described in Bachmann et al (2015), Schuh and Behrend (2012) provide a general overview on the VLBI method, details on the internal data handling can be found at Behrend (2013)

Chronic coronary syndromes without standard modifiable cardiovascular risk factors and outcomes: the CLARIFY registry

Background and Aims: It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD). Methods: CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE—CV death, non-fatal MI, or non-fatal stroke). Results: Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08–7.19] vs. 7.68% [95% CI 7.30–8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women. Conclusions: SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors