Designing and Solving Location-Routing-Allocation Problems in a Sustainable Blood Supply Chain Network of Blood Transport in Uncertainty Conditions

Purpose: In this paper, a location-routing-allocation problem in a multi-objective blood supply chain network was designed to reduce the total cost of the supply chain network, the maximum unmet demand from distribution of goods, and decline greenhouse gas emissions due to the transport of goods among different levels of the network. The network levels considered for modeling include blood donation clusters, permanent and temporary blood transfusion centers, major laboratory centers and blood supply points. Other objectives included determining the optimal number and location of potential facilities, optimal allocation of the flow of goods between the selected facilities and determining the most suitable transport route to distribute the goods to customer areas in uncertainty conditions. Methodology: Given that the model was NP-hard, the NSGA II and MOPSO algorithms were used to solve the model with a priority-based solution. Findings: The results of the design of the experiments showed the high efficiency of the NSGA II algorithm in comparison with the MOPSO algorithm in finding efficient solutions. Originality/Value: This study addresses the issue of blood perishability from blood sampling to distribution to customer demand areas

Blood Shortage Reduction by Deployment of Lateral Transshipment Approach

The healing effects of human blood make it one of the essential, life-saving components in a variety of medical procedures. However, assuring timely and sufficient blood supply for use in life-critical medical procedures is one of the major challenges that most health care networks around the world are persistently facing and trying to resolve. Based on the WHO’s latest statistics, 107 out of 180 countries all around the world have an insufficient amount of blood units to meet their demands. For two years in the row (2018-19), Canadian Blood Services have called for 100,000 new donors to sign up in order to meet the anticipated demand for blood. The perishability of blood components and uncertainty in both donation and demand scale are two important reasons that contribute to the blood shortage. Due to the poor inventory planning, the high rate of discarded units is another worldwide issue that exists in the blood supply chain and needs to be urgently addressed. Canadian blood supply chain network consists of several organizational entities and each of them impacts the blood units’ inventory levels in its own, unique way. In this study, an integrated supply chain model has been considered, and it consists of three main networked organizations: 1. Mobile Collection Centers, 2. Blood Centers, and 3. Hospitals. The main goal of this research is to develop a mathematical optimization model that can improve the proposed supply chain’s performance by reducing its related costs, and the currently existing shortage rate from about 25% to less than 15%. Lateral Transshipment and Emergency Ordering are two main approaches that have been implemented in the proposed model in order to improve both performance and efficiency. The Greater Toronto Area (GTA) has been considered as the case study focus for this research, and both models have been applied in this case study. All the further necessary actions and recommendations would be taken based on the case study’s results

Health technology assessment of pathogen reduction technologies applied to plasma for clinical use

Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains.Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed

A collective mindfulness perspective of information sharing in the blood supply chain.

Purpose: This thesis aims to determine and unravel the underlying mechanisms of how inter-organisational information sharing influences blood safety and availability in the dyadic blood supply chain in normal, high tempo, and emergency conditions. Design/methodology/approach: Grounded in the critical realism paradigm and the perspective of high reliability theory particularly the collective mindfulness concept, this thesis uses an embedded multiple case study designed for theory elaboration. A combined retroductive-abductive and the basic qualitative description has been adopted as a research strategy. Two contrasting cases with three embedded cases for each main case are selected using convenient and context-based approaches, representing a centralised and tightly regulated blood supply chain in the UK as well as a decentralised and loosely regulated blood supply chain in Indonesia. The data are collected using the triangulation of semi- structured interviews, walkthroughs, and other supporting documents including artefacts and archives. Template analysis coupled with within-case and cross- case analyses are then used to analyse the data. Findings: This thesis finds that inter-organisational information sharing influences blood safety and availability through the dynamic enactments of collective mindfulness principles that reflect the inter-organisational information sharing behaviour across the operational conditions. It also finds that the blood supply chain actors in the centralised and tightly regulated context are collectively more mindful when sharing information than those in the decentralised and loosely regulated context, so that more positive changes in the blood safety and availability performance are observed in the former compared to that in the latter context. Interestingly, whilst the data reveal an emerging mechanism of heedful interrelating across a range of operational conditions, this thesis also reveals the fact that inter-organisational information sharing does not necessarily lead to positive changes in blood safety and availability. In fact, negatively enacted collective mindfulness principles can lead inter-organisational information sharing to unimproved and even potentially worse blood safety and availability performance. Originality/value: The primary contribution of this thesis lies in understanding the underlying mechanisms of how inter-organisational information sharing influences blood safety and availability in the dyadic blood supply chain across a range of operational conditions. Whilst offering practical and conceptually relevant knowledge to the blood supply chain literature, it informs the wider supply chain literature on the different collective mindfulness principles that make inter- organisational information sharing influence supply chain performance across a range of operational conditions. The use of the collective mindfulness concept offers a novel perspective that extends the current discussion on the effectiveness of that information sharing for supply chains.PhD in Leadership and Managemen

A feasibility study examining the potential of introducing a whole blood component for the management of traumatic major haemorrhage

Background The timely and organised approach of transfusing trauma patients in the pre-hospital setting with a 1:1:1 ratio of red blood cells, plasma and platelets has resulted in an increased interest in re-introducing whole blood (WB) components for the management of these patients. WB components are not used routinely in NHS hospitals, but should the blood service decide to implement this component in the prehospital setting, further evidence is required on: a) its safety, because these patients will be transfused group O WB which contains anti-A and anti- B in the plasma that can result in haemolytic transfusion reactions and b) the logistics of supplying group O negative WB to prehospital services, considering that demand for this component currently outstrips supply. The overall research question in this thesis was to establish whether it is safe and feasible to introduce a WB component in the NHS for the treatment of traumatic major haemorrhage in the pre-hospital setting. Specific objectives were to: a) Determine the lowest observable anti-A and anti-B titre (measured by IgG or IgM), and the lowest observable ABO incompatible plasma volume that have been reported in the literature to have resulted in haemolysis in recipients receiving ABO incompatible plasma containing components (scoping review). b) Determine a) the clinical safety of transfusing LD-RCP to trauma patients; b) whether the component was delivered to hospital on time in full (OTIF) and c) the overall component wastage for the hospital. Through the evaluation of a similar component to WB (i.e., leucocyte-depleted Red Cell and Plasma [LD-RCP]) with regards to shelf life, logistical and serological issues (2-year observational study). c) Explore the stock management of a WB component using data collected from the 2- year observational study (stock management). Results Scoping review In this first ever systematic scoping review, assessing the risk of haemolysis following the transfusion of ABO incompatible plasma-containing components, 62 eligible cases were identified. There were no completed or ongoing randomised trials. There was heterogeneity between cases in the methods for reporting haemolysis and ABO titration methods, while the volume was poorly reported. Putting all these aside, results showed that platelet components were the most reported components to result in haemolysis in both paediatrics and adults. The lowest anti-A titre reported to cause haemolysis was 32 (paediatrics and adult), while for anti-B it was 512 (IgG and IgM) for adults, 16,384 for paediatrics (IgG and IgM) and 128 (IgM) in cases where the age was not specified. The lowest component volume transfused that was reported to have caused a haemolytic transfusion reaction was 100ml in adults and 15mls in paediatric. Observational study Of the 204 patients who were transfused group O RhD negative LD-RCP (a maximum of 4 units), 96 patients had a blood group recorded and were non-group O. Based on the results of haemoglobin, bilirubin and Direct Antiglobulin Tests (DAT), there was no evidence of increased haemolysis compared to patients who were blood group O and who also received group O RhD negative LD-RCP. During the study, 1208 units (96.5%) of LD-RCP units were delivered to hospital on time and as per specifications, which met the pre-agreed study target of 97% (95% Confidence Interval: 96% - 98%). Despite this, not all units were delivered at age 2 days old with only 64.7% of the total units being delivered on the agreed age. Following the quality improvement work undertaken by the study team, there was a marked improvement in the age of units delivered with 91.7% being delivered at the pre-agreed age towards the end of the study, demonstrating that delivering at age 2 days old is feasible. Component wastage (39%) was a major concern during this study and the pre-agreed wastage level target of <8% was not met. Nevertheless, incremental reductions were demonstrated across the study period, reducing the weekly wastage from a mean of 8.36 units per week (70%) to 3.19 (27%) by the end of the study period. Stock management Based on the data collected from the observational study, evaluation of pre-hospital component demand using ARIMA time series forecasting showed that the demand for prehospital transfusion was random and could not be forecasted to a usable degree. Using a combination of a First In First Out (FIFO) inventory model and a Poisson distribution to model component demand, two stock management models were developed (14-day shelf life and 21-day shelf life). Using heuristically generated component supply algorithms the stock management model demonstrated that component wastage could be reduced to 16% and 4% for a 14-day and 21-day shelf-life component, respectively. Conclusion Incorporating evidence from a scoping review, data collected as part of a 2-year observational study using a similar component to WB (LD-RCP) and mathematical modelling of the supply and demand, this thesis provides evidence that the transfusion of group O WB components in the prehospital setting is a safe and feasible intervention in the NHS for the treatment of traumatic haemorrhage. However, if the component is only used in this setting, the component wastage level for hospitals is likely to be high, and therefore measures such as extending the shelf-life of the WB component and incorporating a dynamic inventory model for component supply must be considered to minimise the wastage of this precious resource

Annual SHOT Report 2018

SHOT is affiliated to the Royal College of PathologistsAll NHS organisations must move away from a blame culture towards a just and learning culture. All clinical and laboratory staff should be encouraged to become familiar with human factors and ergonomics concepts. All transfusion decisions must be made after carefully assessing the risks and benefits of transfusion therapy. Collaboration and co-ordination among staff is vital

The European Hematology Association Roadmap for European Hematology Research: a consensus document

The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap. The EHA Roadmap identifies nine ‘sections’ in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders. The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients

The European Hematology Association Roadmap for European Hematology Research. A Consensus Document

Abstract The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at Euro 23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap. The EHA Roadmap identifies nine sections in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders. The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients. Received December 15, 2015. Accepted January 27, 2016. Copyright © 2016, Ferrata Storti Foundatio