APOM-project: a pilot study of pharmacy organization and management

Recently, in a joint cooperation of Stichting VNA, SAL Apotheken, the Faculty of Management and Organization, and the University Centre for Pharmacy, University of Groningen in the Netherlands, a Ph.D-study started regarding Apot(he)ek, Organization and Management (APOM). The APOM-project deals with the structuring and steering of pharmacy organization. The manageability of the internal pharmacy organization, and the manageability of the direct environment of pharmacy organization is the subject matter. The theoretical background of the APOM-project is described. A literature study was made to find mixes of objectives. Three mixes of objectives in pharmacy organization are postulated; the product mix, the process mix, and the customer mix. The typology will be used as a basic starting point for the empirical study in the next phase of the APOM-project.

APOM-project: an investigation of pharmacy organization and management

Recently, in a joint cooperation of Stichting VNA, SAL Apotheken, the Faculty of Management and Organization, and the University Centre for Pharmacy, University of Groningen in the Netherlands, a Ph.D-study started regarding Apot(he)ek, Organization and Management (APOM). The APOM-project deals with the structuring and steering of pharmacy organization. The manageability of the internal pharmacy organization, and the manageability of the direct environment of pharmacy organization is the subject matter. The theoretical background of the APOM-project is described. A literature study was made to find mixes of objectives. Three mixes of objectives in pharmacy organization are postulated; the product mix, the process mix, and the customer mix. The typology will be used as a basic starting point for the empirical study in the next phase of the APOM-project.

APOM-project : a study of pharmacy practice

In 1994, a Ph.D-study started regarding pharmacy, organization and management (APOM) in the Netherlands. The APOM-project deals with the structuring and steering of pharmacy organization. This article describes the summary of the empirical results of a survey in a relatively large sample (n=169). Generalization to the population of pharmacies in the Netherlands was made. The results for thought, the perceived importance of activities, comprised a total number of seven clusters of priorities of pharmacy mixes. Most pharmacy managers perceived the product (pharmaceutical) activities and the customer activities as the most important. The results for action, the actual performance of activities, comprised a total number of five clusters of activities of pharmacy mixes. Most pharmacy managers performed the product activities and the process (financial-economic) activities most frequently. The results showed that the traditional conception of the work in the community pharmacy is still vividly present.

Non-restrictive open vial policy combined with the home visit vaccinations for improving BCG coverage in a high-incidence outreach region:A model-based cost-effectiveness analysis for Indonesia

Background Bacillus Calmette-Guérin (BCG) vaccination is recommended at birth or in the first week of life to achieve the most beneficial effects in protecting against the most severe type of tuberculosis (TB) disease in children. However, delayed vaccination is commonly reported, especially in outreach or rural areas. We assessed the cost-effectiveness of combining non-restrictive open vial and home visit vaccination strategies in order to increase timely BCG vaccination in a high-incidence outreach setting. Methods We applied a simplified Markov model for the Papua setting, which resembled a high-incidence outreach setting in Indonesia, to assess the cost-effectiveness of these strategies from a health care and a societal perspective. A moderate increase (75% wastage rate and 25% home vaccination) and a large increase (95% wastage rate and 75% home vaccination) scenario were assessed in the analysis. We calculated incremental cost-effectiveness ratios (ICER) based on the incremental costs and quality-adjusted life years (QALYs) gained by comparing the two strategies to the base case scenario (35% wastage rate and no home vaccination). Results The costs per vaccinated child were US$10.25 in the base case scenario, increasing slightly in the moderate (US$10.54) and large increase scenarios (US$12.38). The moderate increase scenario was predicted to prevent 5783 TB-related deaths and 790 TB cases while the large increase scenario predicted the prevention of 9865 TB-related deaths and 1348 TB cases for the entire lifespan of our cohort. From a health care perspective, the ICERs were predicted to be US$288/QALY and US$487/QALY, respectively, for the moderate and large increase scenarios. Using Indonesia’s gross domestic product (GDP) per person as a threshold, both strategies were considered to be cost-effective. Conclusions We found that the allocation of resources for timely BCG vaccination based on combining home vaccination and a less restrictive open vial strategy could substantially reduce childhood TB cases and TB-related mortality. Although outreach activities are more expensive than vaccination at a health care facility only, these activities proved to be cost-effective. These strategies might also be beneficial in other high-incidence outreach settings.</p

Risk factors contributing to a low darunavir plasma concentration

Darunavir is an efficacious drug; however, pharmacokinetic variability has been reported. The objective of this study was to find predisposing factors for low darunavir plasma concentrations in patients starting the once- or twice-daily dosage. Darunavir plasma concentrations from January 2010 till December 2014 of human immunodeficiency virus-infected individuals treated in the outpatient clinic of the University Medical Center Groningen were retrospectively reviewed. The first darunavir plasma concentration of patients within 8weeks after initiation of darunavir therapy was selected. A dichotomous logistic regression analysis was conducted to select the set of variables best predicting a darunavir concentration below median population pharmacokinetic curve. In total 113 patients were included. The variables best predicting a darunavir concentration besides food intake included age together with estimated glomerular filtration rate (Hosmer-Lemeshow test P=0.945, Nagelkerke R-2=0.284). Systematic evaluation of therapeutic drug monitoring results may help to identify patients at risk for low drug exposure

Treatment outcomes of patients with MDR-TB in Nepal on a current programmatic standardised regimen:retrospective single-centre study

OBJECTIVES: The objectives of this study were to evaluate treatment in patients on current programmatic multidrug-resistant tuberculosis (MDR-TB) regimen and verify eligibility for the 9-month regimen and therapeutic drug monitoring (TDM). METHODS: We performed a retrospective chart review of patients with MDR-TB receiving standardised regimen at the German Nepal TB Project Clinic, Nepal, between 2014 and 2016. Eligibility for the 9-month regimen and indications for TDM were evaluated. RESULTS: Out of 107 available patients' medical records, 98 were included. In this centre, the MDR-TB treatment success rates were 69.0% in 2015, 86.6% in 2016 and 86.5% in 2017. The median time to sputum smear conversion was 60 days (60-90 IQR) and culture conversion was 60 days (60-90 IQR). Observed side effects did not impact treatment outcomes. No difference in treatment success rates was observed between patients with predisposing risk factors and those without. Only 49% (36/74) of patients were eligible for the 9-month regimen and 23 patients for TDM according to American Thoracic Society guideline criteria. CONCLUSIONS: Nepalese patients with MDR-TB on ambulatory care had good treatment outcome after programmatic treatment. Implementation of the new WHO oral MDR-TB treatment regimen may further improve treatment results. The 9-month regimen and TDM should be considered as part of programmatic care

Simplivariate Models: Ideas and First Examples

One of the new expanding areas in functional genomics is metabolomics: measuring the metabolome of an organism. Data being generated in metabolomics studies are very diverse in nature depending on the design underlying the experiment. Traditionally, variation in measurements is conceptually broken down in systematic variation and noise where the latter contains, e.g. technical variation. There is increasing evidence that this distinction does not hold (or is too simple) for metabolomics data. A more useful distinction is in terms of informative and non-informative variation where informative relates to the problem being studied. In most common methods for analyzing metabolomics (or any other high-dimensional x-omics) data this distinction is ignored thereby severely hampering the results of the analysis. This leads to poorly interpretable models and may even obscure the relevant biological information. We developed a framework from first data analysis principles by explicitly formulating the problem of analyzing metabolomics data in terms of informative and non-informative parts. This framework allows for flexible interactions with the biologists involved in formulating prior knowledge of underlying structures. The basic idea is that the informative parts of the complex metabolomics data are approximated by simple components with a biological meaning, e.g. in terms of metabolic pathways or their regulation. Hence, we termed the framework ‘simplivariate models’ which constitutes a new way of looking at metabolomics data. The framework is given in its full generality and exemplified with two methods, IDR analysis and plaid modeling, that fit into the framework. Using this strategy of ‘divide and conquer’, we show that meaningful simplivariate models can be obtained using a real-life microbial metabolomics data set. For instance, one of the simple components contained all the measured intermediates of the Krebs cycle of E. coli. Moreover, these simplivariate models were able to uncover regulatory mechanisms present in the phenylalanine biosynthesis route of E. coli