Anatomic and MRI bases for medullary infarctions with patients' presentation

Objective: There is a low incidence of the medullary infarctions and sparse data about the vascular territories, as well as a correlation among the anatomic, magnetic resonance imaging (MRI) and neurologic signs. Materials and methods: Arteries of the 10 right and left sides of the brain stem were injected with India ink, fixed in formalin and microdissected. The enrolled 34 patients with medullary infarctions underwent a neurologic, MRI and Doppler examination. Results: Four types of the infarctions were distinguished according to the involved vascular territories. The isolated medial medullary infarctions (MMIs) were present in 14.7%. The complete MMIs comprised one bilateral infarction (2.9%), whilst the incomplete and partial MMIs were observed in 5.9% and 8.9%, respectively. The anterolateral infarctions (ALMIs) were very rare (2.9%). The complete and incomplete lateral infarctions (LMIs), noted in 35.3%, comprised 11.8% and 23.6%, respectively, that is, the anterior (5.9%), posterior (8.9%), deep (2.9%), and peripheral (5.9%). Dorsal ischemic lesions (DMIs) occurred in 11.8%, either as a complete (2.9%), or isolated lateral (5.9%) or medial infarctions (2.9%). The remaining ischemic regions belonged to various combined infarctions of the MMI, ALMI, LMI and DMI (35.3%). The infarctions most often affected the upper medulla (47.1%), middle (11.8%), or both (29.5%). Several motor and sensory signs were manifested following infarctions, including vestibular, cerebellar, ocular, sympathetic, respiratory and auditory symptoms. Conclusions: There was a good correlation among the vascular territories, MRI ischemia features, and neurologic findings regarding the medullary infarctions.Peer reviewe

Conceptual model for outsourcing process in pharmaceutical supply chain

Pharmaceutical companies are regularly being challenged to meet the rising standards of quality, so as to comply with rigorous regulatory requirements. At the same time, the global pharmaceutical market has seen significant changes, forcing pharmaceutical companies to focus more than ever before on customer needs and their own internal efficiencies in order to continue to compete effectively on a local and global arena. Outsourcing services to a third party is a commonly accepted approach to reduce costs and to provide sites of excellence (manufacturing, distribution, research and development, analysis and testing, marketing), but it also holds many hidden risks. The winning formula of outsourcing processes is developing and sustaining a reliable Quality Management System, capable to control efficacy and efficiency of outsourced activities. In this article the conceptual model of outsourcing process has been proposed under the frame of PDCA cycle (Plan, Do, Check, Act). Proposed model has been applied in outsourcing process of transport of medicines, as a case study. Furthermore, this case study has been implemented in the curriculum of postgraduate education in Pharmaceutical management in Faculty of pharmacy on University of Belgrade, as a practical course for understanding the complexity of outsourcing process in pharmaceutical supply chain

Critical incidents of outsourcing processes in pharmaceutical supply chain : a mixed-methods approach

Purpose: In this paper, a practical framework is presented for the successful integration of buyers and contract organizations based on the Critical Incident Technique (CIT). Methodology: The initial pool of situations was developed inductively according to qualitative data provided by ten experts in the field of outsourcing in pharmaceutical supply chain. Another group of experts evaluated these situations regarding to their degree of realism as well as relevance and allocated them to the five constructs (1) employee competence, (2) management commitment, (3) communication between organizations, (4) organizational culture, and (5) regulatory framework. Findings: The findings of the study show that communication appears to be the most frequent reason while regulatory framework seems to be the last frequent reason for critical incidents during outsourcing. Contract giver and service provide show diverging perceptions about the situations’ degree of realism and relevance. Analysis of the interrater agreement shows that the allocation to a single construct is a challenge due to the critical incidents’ complexity and multidimensionality. Originality: The critical incidents database and the presented framework serve as preventive behavioral-based quality management for the pharmaceutical supply chainPeer Reviewe

Supporting innovative person-centred care in financially constrained environments : the we care exploratory health laboratory evaluation strategy

The COST CARES project aims to support healthcare cost containment and improve healthcare quality across Europe by developing the research and development necessary for person-centred care (PCC) and health promotion. This paper presents an overview evaluation strategy for testing ‘Exploratory Health Laboratories’ to deliver these aims. Our strategy is theory driven and evidence based, and developed through a multi-disciplinary and European-wide team. Specifically, we define the key approach and essential criteria necessary to evaluate initial testing, and on-going large-scale implementation with a core set of accompanying methods (metrics, models, and measurements). This paper also outlines the enabling mechanisms that support the development of the “Health Labs” towards innovative models of ethically grounded and evidenced-based PCC.peer-reviewe

Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies)

Introduction: The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the “age-blind” approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. Methodology: A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). Results: Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. Conclusion: Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.The work has been supported by the EU COST Action IS1402 initiative BAgeism - a multi-national, interdisciplinary perspective^ (2015–2018), the EUROAGEISM H2020 project no. 764632, Horizon 2020-MSCA-ITN -764632 (2017–2021), and by the scientific program PROGRESS Q42 at the Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Czech Republic.info:eu-repo/semantics/publishedVersio