Prospective Risk Assessment of Medicine Shortages in Europe and Israel: Findings and Implications

Introduction: While medicine shortages are complex, their mitigation is more of a challenge. Prospective risk assessment as a means to mitigate possible shortages, has yet to be applied equally across healthcare settings. The aims of this study have been to: 1) gain insight into risk-prevention against possible medicine shortages among healthcare experts; 2) review existing strategies for minimizing patient-health risks through applied risk assessment; and 3) learn from experiences related to application in practice. Methodology: A semi-structured questionnaire focusing on medicine shortages was distributed electronically to members of the European Cooperation in Science and Technology (COST) Action 15105 (28 member countries) and to hospital pharmacists of the European Association of Hospital Pharmacists (EAHP) (including associated healthcare professionals). Their answers were subjected to both qualitative and quantitative analysis (Microsoft Office Excel 2010 and IBM SPSS Statistics®) with descriptive statistics based on the distribution of responses. Their proportional difference was tested by the chi-square test and Fisher's exact test for independence. Differences in the observed ordinal variables were tested by the Mann-Whitney or Kruskal-Wallis test. The qualitative data were tabulated and recombined with the quantitative data to observe, uncover and interpret meanings and patterns. Results: The participants (61.7%) are aware of the use of risk assessment procedures as a coping strategy for medicine shortages, and named the particular risk assessment procedure they are familiar with failure mode and effect analysis (FMEA) (26.4%), root cause analysis (RCA) (23.5%), the healthcare FMEA (HFMEA) (14.7%), and the hazard analysis and critical control point (HACCP) (14.7%). Only 29.4% report risk assessment as integrated into mitigation strategy protocols. Risk assessment is typically conducted within multidisciplinary teams (35.3%). Whereas 14.7% participants were aware of legislation stipulating risk assessment implementation in shortages, 88.2% claimed not to have reported their findings to their respective official institutions. 85.3% consider risk assessment a useful mitigation strategy. Conclusion: The study indicates a lack of systematically organized tools used to prospectively analyze clinical as well as operationalized risk stemming from medicine shortages in healthcare. There is also a lack of legal instruments and sufficient data confirming the necessity and usefulness of risk assessment in mitigating medicine shortages in Europe. © Copyright © 2020 Miljković, Godman, Kovačević, Polidori, Tzimis, Hoppe-Tichy, Saar, Antofie, Horvath, De Rijdt, Vida, Kkolou, Preece, Tubić, Peppard, Martinez, Yubero, Haddad, Rajinac, Zelić, Jenzer, Tartar, Gitler, Jeske, Davidescu, Beraud, Kuruc-Poje, Haag, Fischer, Sviestina, Ljubojević, Markestad, Vujić-Aleksić, Nežić, Crkvenčić, Linnolahti, Ašanin, Duborija-Kovačević, Bochenek, Huys and Miljković

Proizvodnja i percepcija govora

Zbornik radova okupio je 57 domaćih i inozemnih autora/ica, koji/e kroz 33 rada, iz različitih istraživačkih kutova, obrađuju recentne teme o proizvodnji i percepciji govora, te o njihovoj međuovisnosti u govornom procesu. Knjiga je posvećena profesoru Damiru Horgi povodom njegova sedamdesetog rođendana. Uz svaki rad naveden je sažetak na hrvatskom i engleskom jeziku. Zbornik je objavljen u suizdavaštvu Odsjeka za fonetiku Filozofskog fakulteta Sveučilišta u Zagrebu, Odjela za fonetiku Hrvatskoga filološkog društva i FF-pressa.Zbornik radova okupio je 57 domaćih i inozemnih autora/ica, koji/e kroz 33 rada, iz različitih istraživačkih kutova, obrađuju recentne teme o proizvodnji i percepciji govora, te o njihovoj međuovisnosti u govornom procesu. Knjiga je posvećena profesoru Damiru Horgi povodom njegova sedamdesetog rođendana. Uz svaki rad naveden je sažetak na hrvatskom i engleskom jeziku. Zbornik je objavljen u suizdavaštvu Odsjeka za fonetiku Filozofskog fakulteta Sveučilišta u Zagrebu, Odjela za fonetiku Hrvatskoga filološkog društva i FF-pressa

Proizvodnja i percepcija govora

Zbornik radova okupio je 57 domaćih i inozemnih autora/ica, koji/e kroz 33 rada, iz različitih istraživačkih kutova, obrađuju recentne teme o proizvodnji i percepciji govora, te o njihovoj međuovisnosti u govornom procesu. Knjiga je posvećena profesoru Damiru Horgi povodom njegova sedamdesetog rođendana. Uz svaki rad naveden je sažetak na hrvatskom i engleskom jeziku. Zbornik je objavljen u suizdavaštvu Odsjeka za fonetiku Filozofskog fakulteta Sveučilišta u Zagrebu, Odjela za fonetiku Hrvatskoga filološkog društva i FF-pressa.Zbornik radova okupio je 57 domaćih i inozemnih autora/ica, koji/e kroz 33 rada, iz različitih istraživačkih kutova, obrađuju recentne teme o proizvodnji i percepciji govora, te o njihovoj međuovisnosti u govornom procesu. Knjiga je posvećena profesoru Damiru Horgi povodom njegova sedamdesetog rođendana. Uz svaki rad naveden je sažetak na hrvatskom i engleskom jeziku. Zbornik je objavljen u suizdavaštvu Odsjeka za fonetiku Filozofskog fakulteta Sveučilišta u Zagrebu, Odjela za fonetiku Hrvatskoga filološkog društva i FF-pressa

Proactive Approach to Contracts as a Source of a Company Competitive Value

The aggravation of international trade relations makes it difficult for a contract to predict every single forthcoming event. However, an adequate response to this phenomenon would not be the contract complexity. The very process of contracting, as well as the role of the contract itself need some modifications. The traditional view on contracting is changing more towards relational approach to contracting. It is necessary to devise ways in which contracts may be used to focus on objectives through mutual understanding. In this regard, proactive contracting becomes the best solution which ensures contracts and contracting process itself to be successful, and also ethically and morally acceptable. Contracting process should start by building trust between future contractual partners, followed by a phase in which the parties negotiate the terms of the contract, and where eventually the contract defines the form of the agreed. Proactive legal approach strives to strengthen the adaptive capacity of a contract, creating a contractual system that is continuously being analyzed and adjusted to changing circumstances and the assessed effects, for example, by making appropriate annexes. This approach provides a basis for negotiating conflict management using the methods of alternative dispute resolution, such as mediation, conciliation, and/or arbitration. Proactive contracting makes an opportunity for managers to reformulate legal concerns into business opportunities. The aim of this paper is to analyze proactive rights, particularly in the field of contracting with preventive and promotional aspects and empirical research that should show the readiness of the Serbian companies to change their accents in contractual negotiations in order to ensure a successful outcome

Complications of Diabetes Mellitus on Muscles and Joints of Lower Extremities

Introduction: Non-enzymatic protein glycosylation in diabetic patients leads to stiffening of collagen-containing tissues affecting joint mobility. Motor dysfunction in diabetic patients can be detected as muscle weakness or atrophy.Objective: To determine the presence of muscles weakness and limited joint mobility at ankle (AJ), subtalar (SJ) and first metatarsophalangeal joint (I MTP) in diabetic patients and to determine impact of diabetes duration on those changes.Patients and Methods: A cross-sectional study was conducted among 100 diabetic patients in “Primary Health Care Centre Banjaluka” in 2014. Function of ten foot and ankle muscles has been evaluated by manual muscle testing. Muscle strength was scored by semiquantitative grading system used in the Michigan Diabetic Neuropathy Score. Range of motion (ROM) at the AJ, SJ and I MTP was measured with goniometer.Results: The average patients age was 61.91±10.74 and diabetes duration 12.25±8.60 years. The average strength of foot and ankle muscles expressed by muscle score was 11.56±5.08. The average ROM at AJ (47.85°) was significantly decreased compared to the reference value that is 65° (t =-15.378, P=000). The average ROM at SJ (35.10°) was significantly decreased compared to the reference value that is 50° (t =-15.378, P=000). The average ROM at the I MTP (72.70°) was significantly decreased compared to the reference value that is 120° (t =-15.378, P = ,000).Conclusion: Patients with diabetes have decreased foot and ankle muscle strength, and the average values of the range of motion at AJ, SJ and I MTP, but the duration of the diabetes does not correlate significantly with those changes

Problems, interventions, and their outcomes during the routine work of hospital pharmacists in Bosnia and Herzegovina

Background In the last 30 years, activities of hospital pharmacists have gone through significant changes. Pharmacists are increasingly involved in patient care. Objectives To explore drug-related and logistic problems, interventions, and their outcomes during routine everyday work of hospital pharmacists. Setting Institute for physical medicine and rehabilitation, Banja Luka, Bosnia and Herzegovina. Methods In the period of January 2013-October 2015 a prospective observational study was performed. Medical doctors, nurses, therapists, and patients addressed pharmacists, face-to-face or by telephone, with drug-related problems (DRPs) and/or logistic issues. Main outcome measure Type of DRP or logistic issue, intervention, outcome, initiator and time spent for solving the problem were documented for each consultation. Results Out of 1515 interventions, 48.8% were aimed at solving DRPs. The most common DRPs were the recommendation of a drug or dose and need for additional information about drugs. Drug price and supply were the most prevalent logistic issues. DRPs were more frequently initiated by medical doctors and required more time to solve the problem compared to logistic issues (Mann-Whitney U test, p lt = 0.001, respectively). The acceptance rate of interventions to solve DRPs (83.7%) was lower compared to logistic issues (95.2%; p lt = 0.001). Conclusions Hospital pharmacists were faced with an approximately equal number of DRPs and logistic issues during their routine everyday work. The overall acceptance rate of pharmacists' interventions was high, and the results of our study indicate that there is a need for more involvement of hospital pharmacists in Bosnia and Herzegovina in clinical activities. Impact on practice

High level of resistance to fluoroquinolones in commensal Escherichia coli isolated from wild animals and birds in Serbia

Коменсалне E. coli у цревима дивљих животиња нису изложене честим директним антимикробним притисцима, као што је случај са коменсалним E. coli у цревима домаћих, посебно фармских животиња и кућних љубимаца. Резистенција ових бактерија код дивљих животиња настала је индиректно, односно човековим немаром и загађењем животне средине, чиме су бактерије отпорне на антибиотике доспеле у ланац исхране дивљих животиња. Као последица тога, у бактеријској цревној флори дивљих животиња и птица, ипак постоји селективни притисак, који је одговоран за перзистенцију гена резистенције. У овом раду су приказани резултати истраживања резистенције индикаторске E. coli на флуорохинолоне, које је у последњих пет година спровела Национална референтна лабораторија за антимикорбну резистенцију у ветеринарској медицини у Србији. Детектован је висок ниво резистенције на флуорохинолоне коменсалне E. coli код дивљих свиња, зечева, срна и јелена у ловиштима на територији Аутономне покрајине Војводине. Oве бактерије су поред хромозомске резистенције имале и плазмидски преносиву резистенцију на флуорохинолоне (PMQR). Резистенција на флуорохинолоне је откривена и код коменсалне E. coli од орлова белорепана у Специјалном резревату природе „Горње Подунавље“, делу резервата биосфере „Бачко Подунавље“, које се налази на УНЕСКО-вој светској листи резервата биосфере. Такође, резистенција коменсалне E. coli на флуорохинолоне је детектована и код црноглавих галебова који се хране на депонији града Новог Сада. Забрињавајући је висок ниво резистенције на синтетске антибиотике, тј. на флуорохинолне у популацији дивљих животиња и птица јер ови антибиотици често представљају лек избора у терапији одређених бактеријских инфекција људи и домаћих животиња. Дивље животиње и птице су потенцијални резервоари гена резистенције и могу бити одговорне за ширење резистенције у бактеријским заједницама на нашој планети.Commensal E. coli in the intestines of wild animals are not exposed to frequent direct antimicrobial pressure, as is the case with commensal E. coli in the intestines of domestic, especially farm animals and pets. The resistance of these bacteria in wild animals was caused indirectly, that is, by human negligence and environmental pollution, which allowed antibiotic-resistant bacteria to enter the food chain of wild animals and birds. Consequently, in the bacterial intestinal flora of wild animals and birds, there is nevertheless a selective pressure, which is responsible for the persistence of resistance genes. This paper presents the results of the research on the resistance of indicator E. coli to fluoroquinolones, which was conducted in the last five years by the National Reference Laboratory for Antimicrobial Resistance in Veterinary Medicine in Serbia. A high level of resistance to fluoroquinolones of commensal E. coli was detected in wild boars, rabbits, roe deer and deer in hunting grounds on the territory of the Province of Vojvodina. In addition to chromosomal resistance, these bacteria also had plasmid-mediated resistance to fluoroquinolones (PMQR). Resistance to fluoroquinolones was also discovered in commensal E. coli from white-tailed eagles in the Gornje Podunavlje Special Natural Reserve, a part of Bačko Podunavlje Biosphere Reserve, approved as a UNESCO Biosphere Reserve. Also, resistance to fluoroquinolones of commensal E. coli was detected in Blackheaded gulls that feeding at the landfill of the city of Novi Sad. Very worrying the high level of resistance to synthetic antibiotics, ie. to fluoroquinolone in the population of wild animals and birds because these antibiotics are often the drug of choice in the treatment of certain bacterial infections of humans and domestic animals. Wild animals and birds are potential reservoirs of resistance genes and may be responsible for dissemination of resistance in bacterial communities on our planet.Zbornik kratkih sadržaj

Selection of Mulberry Genotypes from Northern Serbia for ‘Ornafruit’ Purposes

The genus Morus L., mulberry, is an interesting taxonomic group on account of its existing genetic variability, functional food potential and commercial importance. Mulberry trees are found in a wide range of areas in Serbia, accounting for a large phenotypic diversity in its genetic resources. Tree and fruit characteristics of more than 300 mulberry specimens were surveyed, and 15 genotypes of Morus alba, Morus nigra and Morus rubra species were selected for further analyses. These were located at various sites in the province of Vojvodina, Serbia. The present study was undertaken to investigate the diversity of the collected material aiming to pre-select genotypes suitable for landscaping/ornamental and/or fruit production purposes. Genotypes BP 3/9, DT1, ZP3 and MR1 have semi-vigorous growth, dropping growth habits, different leaf shapes (ovate, oval, cordate) and leaf color (from light to dark green), corresponding to ornamental mulberries. In addition, the semi-vigorous genotype ZD1 with a spreading tree and interesting palmate-lobed leaves was distinguished as a unique genotype for landscaping purposes. The most vigorous annual shoot growth was detected in the ZP3 genotype (118.5 cm), followed by DT1 (108.2 cm), MR1 (101.8 cm) and ZP1 (100.5 cm) genotypes. Contrary, genotype DJ1 exhibited the lowest annual growth with only a 32.9 cm average length of the shoots. Due to the greater fruit mass (4.2–6.1 g), sweetness and acidity balance as well as chemical composition, genotypes BP 1/4, DJ1, MG, MR1, DT1 and ZP3 may be recommended for fresh consumption, while genotypes DJ1, DT1, MR1, ZD1, ZP1 and BP 3/9 could be appropriate for home processing. According to fruit chemical analyses, the most promising genotypes were MR1 and DT1 combining high soluble solids content (21.2% and 18.5%, respectively), total sugar content (17.41% and 15.20%, respectively) and ascorbic acid content (42.24 and 49.28 mg/%, respectively). Additionally, DT1 genotype was also characterized by the highest total phenolic content (221.08 mg 27 GAE/100 g fresh weight). The most ornamental genotypes from this study (BP 3/9, DT1, ZD1, ZP3 and MR1) combined with their pomological and chemical characterization can be recommended for edible gardening purposes due to both aesthetic appearance and nutritive value of the fruits

Overview of Erasmus+ NETCHEM project: ICT networking for overcoming technical and social barriers in instrumental analytical chemistry education

The paper briefly presents goals, main activities, challenges and outcomes of the NetChem project (http://www.netchem.ac.rs/) that was co-funded by the Erasmus+ Programme of European Union (project no. 573885-EPP-1-2016-1-RS-EPPKA2- CBHE-JP). The project has been started in October 2016 and with extension lasts until April 2020. Western Balkan region has been targeted by upgrading capacities for education in environmental and food analysis of Albania and Serbia in cooperation with partners from France, United Kingdom and Czech Republic. Dedicated NETCHEM platform and SQL database were created to improve the cooperation and educational capacities of Higher Education Institutions (HEIs) involved