Enhancement of resilience and quality of cold supply chain under the disruptions caused by COVID-19: A case of a developing country

Cold supply chain (CSC) comprises temperature-sensitive processes, starting from the supply of raw materials, manufacturing, and finally the delivery of finished goods to the end consumers via transport services. Pandemics such as COVID-19 pose threats to its overall functioning and to cater to this issue, the study will ensure the sustainable functioning of CSC by recommending resilience strategies. To do so, the COVID-19 disruptions in the CSC and the resilient sustainability strategies were collected via a vigorous literature review and were analyzed via a Fuzzy QFD technique. The results concluded “crisis simulation,” “identification and securing of logistics,” and “digitalization of cold supply chain” as the top three strategies to ensure the resilience of CSC under disruptions caused by COVID-19. The study recommends necessary steps to the policymakers to ensure a resilient and quality effective CSC. The application of the study proves to be the first of its kind in a developing country such as Pakistan.

JEL Classification: C54, D81, H12

Reducing Nighttime Interruptions and Improving Sleep for Hospitalized Patients by Restructuring Nighttime Clinical Workflow

BACKGROUND

Nighttime sleep disruptions negatively impact the experience of hospitalized patients.

OBJECTIVE

To determine the impact of adopting a sleep-promoting nighttime clinical workflow for hospitalized patients on nocturnal disruptions and sleep.

DESIGN

Survey-based pre- and post-intervention cross-sectional study using convenience samples.

PARTICIPANTS

Hospitalized veterans on a 23-bed general medical ward at a tertiary Veterans Administration Hospital.

INTERVENTIONS

Baseline sleep surveys (N=149) identified two major sources of interruptions: blood pressure checks at 4 am for telemetry patients and subcutaneous (SQ) heparin injections between 4:30 and 6 am for venous thromboembolism prophylaxis. Clinical workflow was restructured to eliminate these disruptions: moving 4 am blood pressure checks to 6 am and providing daily SQ enoxaparin at 9 am as an alternative to Q 8-h SQ heparin, which had prompted an injection between 4:30 and 6 am. The impact of these changes was assessed in a second round of surveys (N=99).

MAIN MEASURES

Frequency and sources for nighttime sleep disruptions; percentage of patients reporting longer time to fall asleep, more interruptions, and worse sleep quality (vs. home) before and after restructuring nighttime clinical workflow.

KEY RESULTS

After restructuring nighttime clinical workflow, medication administration as a source of nighttime disruption decreased from 40% (59/149) to 4% (4/99) (p<0.001). Blood pressure checks as a source of disruption decreased from 56% (84/149) to 42% (42/99) (p=0.033). Fewer patients reported taking longer to fall asleep in the hospital vs. home (39% pre-intervention vs. 25% post-intervention, p=0.021). Similarly, fewer patients experienced waking up more frequently in the hospital vs. home (46% pre-intervention vs. 32% post-intervention, p=0.036). Fewer patients reported sleeping worse in the hospital (44% pre-intervention vs. 39% post-intervention), though this trend was not statistically significant (p=0.54).

CONCLUSIONS

Nighttime disruptions in hospitalized patients frequently interfere with sleep. Restructuring of the clinical workflow significantly reduced disruptions and improved sleep.

Young onset Parkinson's disease: Biographical disruption as a repetitive process

Young Onset Parkinson's Disease (YOPD) is a complex condition which raises issues of interpretation and understanding of individuals' biographies. While interviewing seventeen people with YOPD from Greece, the issue of biographical disruption emerged. Parkinson's is a neurodegenerative disorder divided in five stages and has no permanent cure; based on this knowledge, individuals reconstruct their past and see their future. Under this perspective, unlike other chronic illnesses, in the case of Parkinson's disease interviewees have designated dimensions of disruption that are experienced due to continuous degeneration and while narrating their stories they designated disruptions even before diagnosis. In this article, biographical disruption is understood as a repetitive process and the latter is perceived as a continuous process caused by neurodegeneration; it never stops and is constructed through multiple dimensions: (a) bodily, (b) daily, (c) in stages and (d) biographical. These dimensions are interrelated and construct, both theoretically and analytically, the concept of disruption in daily life with a neurodegenerative disorder. Through the concept of repetitiveness, the complexity of living with PD is understood and also the need for deconstructing expected social roles.

Evolution of urban mobility behaviour in Brussels as a result of the COVID‐19 pandemic

The goal of this research is to understand the impact of COVID‐19 restriction measures on the change in urban mobility in Brussels, Belgium. With daily data over the past 2 years depicting both the affluence to different places and the level and type of restrictions, we investigate through regression analysis their impacts on the changes in driving, public transport and cycling use. We find that cycling increased significantly (+63%), and that driving levels have returned to pre‐COVID levels after a significant reduction in spring 2020, while the return to public transport has been slower. We also find that the change in cycling use was not influenced by COVID‐19 restrictions, although telework and closing of retail establishments strongly affected the other modes.

Comparing Primary Health-Care Service Delivery Disruptions Across Disasters

OBJECTIVE

The aim of this study was to compare primary care appointment disruptions around Hurricanes Ike (2008) and Harvey (2017) and identify patterns that indicate differing continuity of primary care or care systems across events.

METHODS

Primary care appointment records covering 5 wk before and after each storm were identified for Veterans Health Affairs (VA) facilities in the greater Houston and surrounding areas and a comparison group of VA facilities located elsewhere. Appointment disposition percentages were compared within and across storm events to assess care disruptions.

RESULTS

For Hurricane Harvey, 14% of primary care appointments were completed during the week of landfall (vs 33% for Hurricane Ike and 69% in comparison clinics), and 49% were completed the following week (vs 58% for Hurricane Ike and 71% for comparison clinics). By the second week after Hurricane Ike and third week after Harvey, the scheduled appointment completion percentage returned to prestorm levels of approximately 60%.

CONCLUSIONS

There were greater and more persistent care disruptions for Hurricane Harvey relative to Hurricane Ike. As catastrophic emergencies including major natural disasters and infectious disease pandemics become a more recognized threat to primary and preventive care delivery, health-care systems should consider implementing strategies to monitor and ensure primary care appointment continuity.

Invisible burden of COVID-19: enzyme replacement therapy disruptions

OBJECTIVES

Lysosomal storage diseases (LSD) constitute an important group of metabolic diseases, consisting of approximately 60 disorders. In some types of lysosomal diseases, enzyme replacement therapy (ERT) is administered intravenously in weekly or biweekly doses. Unfortunately, scheduled ERT during COVID-19 was disrupted. We considered the possibility of adverse outcomes caused by the disruption in the treatment of patients with lysosomal storage disorders.

METHODS

During the COVID-19 pandemic, we conducted a questionnaire that was delivered via Internet to assess how this vulnerable patient group was affected by the pandemic in terms of their access to treatment and their disease-related symptoms.

RESULTS

The questionnaire was filled out by 75 patients. There were 35 patients whose treatment dose was missed because of COVID-19. The most common reason for skipping treatment was not wanting to go to the hospital for fear of contracting COVID-19. These 35 patients missed a median of four doses of ERT (range: 1-16 dosages). Twenty-one patients (60%) claimed that they were affected physically by not taking ERT (20 mucopolysaccaridoses, 1 Fabry disease), whereas 14 (40%) did not.

CONCLUSIONS

Interruption of ERT during the COVID-19 pandemic may have significant consequences. It may be beneficial to switch to home treatment or reserve dedicated facilities. With proper planning and management, the treatment disruptions of this particular group can be avoided.

COVID-19 - A Covert Catalyst for Pedagogical Stocktake and Transformation: Perspectives of a Global Hub

This article was migrated. The article was marked as recommended. Education in Hong Kong was shifted online on an abrupt and massive scale as the city faced unprecedented disruptions, first from social unrest in 2019 and then again with the COVID-19 pandemic. Concurrent modernization initiatives since early 2019 in The University of Hong Kong's Medical Faculty (HKUMed), conferred a fortuitous head start for this rapid change. Pre-clinical and clinical teaching were restructured for online delivery through e-learning solutions for didactic teaching, and new innovative approaches were developed to convert bedside to"webside" teaching. E-learning in the current circumstances provided necessary social distancing while being pedagogically sound. Students were also able to develop key communication and collaboration skills via online platforms, developing digital skills critical to their future profession. However, unforeseen issues including socioeconomic inequality, privacy concerns, and social isolation became apparent and should be addressed as medical education progresses further down the digital path. The goal must entail a sustainable and scholarly approach towards optimizing medical education in an increasingly online environment. This will help safeguard the medical curriculum against disruption and empower future medical professionals for tomorrow's practice. Here, we share experiences and perspectives from educators in a global city characterised by land scarcity and income inequality.

The Alarming Rate of Major Disruptive Events in Primary Care Practices in Oklahoma

PURPOSE

In primary care practices, sustainability of performance improvements and ability to deliver continuity of care to patients can be adversely affected by major disruptive events, such as relocations and changes in ownership, clinicians, and key staff. This study documented the rates of major disruptive events in a cohort of primary care practices in Oklahoma.

METHODS

Practices were included if they had existed for 1 year before enrollment and remained in the project for at least 1 year after enrollment. Practice characteristics for 208 practices and major disruptive events during the preenrollment year were collected by survey. Postenrollment major disruptive events were prospectively collected by practice facilitators. We compiled frequency statistics and conducted bivariate analyses for each data set.

RESULTS

Of 208 eligible practices, 81 (39%) were clinician owned, and 51 (25%) were health system owned. One hundred nine practices (52%) were in nonmetropolitan counties. One hundred seventy-five major disruptive events occurred in 120 (58%) practices during the preenrollment year, with 42 practices having experienced multiple events. During the first year of the project, 89 major disruptive events occurred in 67 (32%) practices, with 20 practices experiencing multiple events. The major disruptive events reported most often during both periods were loss of personnel and implementation of electronic health records and billing systems. Practice size was associated with occurrence of these events.

CONCLUSIONS

During a 2-year period, major disruptive events occurred at an alarming rate, adversely affecting quality improvement efforts. Most reported events involved losses of clinicians and staff. More research is needed to identify and address the root causes of these events.

Awakenings? Patient and Hospital Staff Perceptions of Nighttime Disruptions and Their Effect on Patient Sleep

STUDY OBJECTIVES

Although important to recovery, sleeping in the hospital is difficult because of disruptions. Understanding how patients, hospital physicians, and nurses perceive sleep disruptions and identifying which disruptions are associated with objective sleep loss can help target improvement initiatives.

METHODS

Patients and hospital staff completed the Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ). Cutoff points were defined based on means, and responses were dichotomized. Perceived percent disrupted for each item was calculated, and responses were compared across groups using chi-square tests. Objective sleep time of patients was measured using wrist actigraphy. The association between patient-reported disruptions and objective sleep time was assessed using a multivariable linear regression model controlling for subject random effects.

RESULTS

Twenty-eight physicians (78%), 37 nurses (88%), and 166 of their patients completed the PHSDNQ. Patients, physicians, and nurses agreed that pain, vital signs and tests were the top three disrupters to patient sleep. Significant differences among the groups' perceptions existed for alarms [24% (patients) vs. 46% (physicians) vs. 27% (nurses), p < 0.040], room temperature (15% vs. 0% vs. 5%, p < 0.031) and anxiety (18% vs. 21% vs. 38%, p < 0.031). Using survey and actigraphy data from 645 nights and 379 patients, the presence of pain was the only disruption associated with lower objective sleep duration (minutes) [-38.1 (95% confidence interval -63.2, -12.9) p < 0.003].

CONCLUSION

Hospital staff and patients agreed that pain, vital signs and tests were top sleep disrupters. However, pain was associated with the greatest objective sleep loss, highlighting the need for proactive screening and management of patient pain to improve sleep in hospitals.

Eye opener: exploring complexity using rich pictures

Historically, approaches to exploring complexity have mainly focused on the notion that complex problems must be deconstructed into simpler parts if we are to make sense of them; this is the so-called reductionist approach. When dealing with the complexity of human experience, however, deconstructing the experience without diminishing it is a daunting, perhaps impossible task. Researchers wishing to make sense of complex experiences often begin by interviewing the individuals at the centre of those experiences. But interviews can be frustratingly limited. Visual methods, such as drawings, are beginning to show promise for designing research that taps into the complexity of professional practice. The promise of visual methods may relate to a key notion in complexity research: 'disruptions'. In this paper I introduce the notion of 'disruptions' as articulated by complexity approaches from 'systems engineering' and suggest 'rich pictures' as an effective visual method to describe and understand complex problems in medical education research.

Climate change and peak oil—two large-scale disruptions likely to adversely affect long-term tourism growth in the Asia Pacific

Climate change and peak oil are likely to have a significant impact on future tourism growth in the Asia Pacific region. Dealing with these issues and the policies and strategies required for mitigation and adaptation need to be given far greater attention by the tourism industry and the public sector than has hitherto been the case. Existing approaches based on crisis and disaster management may be inadequate and a new approach to deal with shocks of this nature is required. This regional spotlight suggests a new approach based on the concept of disruption which is defined as an event that causes substantial and long-term change in the structure of the tourism industry.

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Peak oil and climate change are likely to adversely affect projected tourism growth in the Asia Pacific region.

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Current definitions of the terms crisis and disaster are inadequate to describe the impact of large scale events such as peak oil and climate change.

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The term ‘disruption’ provides a more comprehensive approach to dealing with these issues.

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The tourism industry in the Asia Pacific region needs to become more proactive in planning to cope with future large scale disruptions.