Hyponatremia is common in preterm infants. The causes are usually related to the inability of the premature kidneys to excrete a given water load, excessive sodium losses, or inadequate sodium intake. Here, we present a case of severe hyponatremia in an extreme preterm infant, associated with the use of aminophylline. Aminophylline was administered intravenously on day 1 for the treatment of apnea of prematurity. On day 3, the patient developed hyponatremia which was not responsive to sodium replacement and fluid restriction. Due to concerns of aminophylline‑induced hyponatremia, aminophylline was discontinued on day 6, and within 48 h of discontinuation, serum sodium normalized without the need for sodium supplementation. The purpose of the case report is to present a rare complication associated with aminophylline use and to shed light on potential deleterious effects associated with drug shortages.

A Mail Survey to Assess the Incidence and Impact of Drug Shortages within Texas Non – Government Acute Care Hospitals Tawfik Rajab Rajab, M.S.Phr. The University of Texas at Austin, 2013 Supervisor: Marvin D. Shepherd The objective of this study was to explore the incidence and impact of drug shortages within Texas Non-Government Acute Care Hospitals. A self-administered mail survey instrument was used to collect data. A convenience sample of 321 pharmacy directors of non-government acute care hospitals in the state of Texas was selected from the Texas Department of State Health Services (DSHS) Hospital List for 2012. A total of 125 completed surveys were received by mail and 8 surveys were returned as undelivered, resulting in a response rate of 39.84% (125/313). A total of 56 (45.5%) respondents reported 11 or more drug shortages for the month of April 2013. There was a significant association between the number of drug shortages experienced and hospital size (p = 0.003), inpatient medication budget (p = 0.001) and hospital location (p=0.015). Of the 124 respondents, 78 (62.9%) spent four to 12 hours a week on managing drug shortage situations. There was a significant association between the number of hours spent per week by hospital pharmacy personnel when managing drug shortages controlling for hospital size (p < 0.001), number of drug shortages experienced (p < 0.001), number of pharmacist FTEs (p < 0.001), and number of pharmacy technician FTEs (p < 0.001). A total of 107 (85.6%) reported that grey market vendors have contacted hospital pharmacy personnel in the month of April, 2013. A total of 96 (76.8%) ‘strongly agreed’ that grey market vendors are more likely to contact health care facility when drug shortage exists, 110 (88%) ‘strongly agreed’ that grey market vendors sell drugs in short supply at inflated prices and 70 (56%) ‘strongly agreed’ that the practice of buying drug products from grey market vendors should be eliminated. In summary, all surveyed hospitals experienced at least one drug shortage for the month of April 2013, pharmacy personnel devoted a significant amount of time managing drug shortages and the majority of the hospitals were contacted by grey market vendors with the aim of selling drugs in short supply. / text

This dissertation investigates the consequences of supply chain disruptions in pharmaceutical supply chains. Across different studies, I examine various impacts of pharmaceutical supply chain disruptions on buyer’s behavior, medication errors, and market share. In Chapter 1, coauthored with Anita Carson, Erin Fox, and Rena Conti, we demonstrate the stockpiling behaviors of buyers during the early phase of the COVID-19 pandemic. Leveraging a quasi-experimental design on IQVIA’s National Sales Perspectives™ data, we show that the sales volume of essential medicines related to U.S. hospital-based COVID-19 treatment concentrated only for the first two months of the pandemic. After these two months, the sales volume of drugs for COVID-19 treatment decreases significantly despite a nationwide increase in COVID-19-related hospitalizations. In Chapter 2, coauthored with Anita Carson and Rena Conti, we examine the impact of a hurricane that decimated the factories of major producers of heparin, an important drug used frequently in hospitals. Using a natural experiment, we find that the hurricane-related pharmaceutical supply chain disruption increased medication error rates of heparin. In addition, we find significant spillover effects. The supply chain disruption increased the medication error rates of a substitute drug. In Chapter 3, coauthored with Anita Carson and Rena Conti, we study how long it takes to recover the market share after the supply chain disruptions using a new metric we propose, Time to Recover Market Share. We explore the differential effects by the brand type of products, the competition level in markets, and the duration of the supply disruptions. With the extensive global supply chain disruptions that we are facing today, understanding their potential consequences is significant. This dissertation advances our understanding of the different impacts of supply chain disruptions and provides practical implications for supply chain members to build resilient supply chains and minimize the effects of supply chain disruptions.

No / Supply chain resilience has been suggested to curb the impact of disruptions on supply chains. While this proposition seems coherent in theory, empirical evidence supporting this is limited, as existing literature has centred on exploring the impact of supply chain resilience on disruptions which are based on set time frames, non-supply chain specific as well as examining non-dynamic disruptive events. This study contends that resilience strategies are dynamic and as such their applications within supply chains differ. Therefore examining the impact of resilience will be appropriate on a dynamic disruption within a specific supply chain. In view of this, the paper examines through existing literature the applicability of agility within the pharmaceutical supply chain when dynamic disruptions like drug shortages occur. The study finds alertness, accessibility, connectivity and visibility as dimensions of supply chain agility that are capable of reducing the impact of drug shortages.

Yes / Purpose Medicine shortages have a detrimental impact on stakeholders in the pharmaceutical supply chain (PSC). Existing studies suggest that building resilience strategies can mitigate the effects of these shortages. As such, this research aims to examine whether resilience strategies can reduce the impact of medicine shortages in the United Kingdom's (UK) PSC. Design/methodology/approach A sequential mixed-methods approach that involved qualitative and quantitative research enquiry was employed in this study. The data were collected using semi-structured interviews with 23 key UK PSC actors at the qualitative stage. During the quantitative phase, 106 respondents completed the survey questionnaires. The data were analysed using partial least square-structural equation modelling (PLS-SEM). Findings The results revealed that reactive and proactive elements of resilience strategies helped tackle medicine shortages. Reactive strategies increased relational issues such as behavioural uncertainty, whilst proactive strategies mitigated them. Practical implications The findings suggest that PSC managers and decision-makers can benefit from adopting structural flexibility and proactive strategies, which are cost-effective measures to tackle medicine shortages. Also engaging in strategic alliances as a proactive strategy mitigates relational issues that may arise in a complex supply chain (SC). Originality/value This study is the first to provide empirical evidence of the impact of resilience strategies in mitigating medicine shortages in the UK's PSC.

Backround. Based of my personal observations when employed as a pharmacist in a Saudi hospital it was clear that there were problems with medicine supply to outpatients. This thesis was designed to scientifically investigate the types of shortages, the reason(s) for such problems and potential solutions to the problem. Methods . This study was undertaken using a variety of experimental techniques to determine the views and perceptions of patients, pharmacists, physicians and administrative staff of the hospital under examination. To establish the scale of the problem: focus groups (n=25), structured questionnaires, structured interviews/meetings for health care professionals and a national survey (n=650) were the research tools used to objectively determine the relevant data. The data were analyzed by appropriate statistical methods. Results and Discussion That there was a real problem was quickly established in the data obtained from patients. A similar finding was made for each of the 'professional groups'. The central problem was one of shortages of medicines for prescriptions presented by outpatients. It was not a case the medicines were simply not available because they were never stocked but rather a simple shortage in the dispensary stock. It was established the lack of medicines was not due to central budget arrangements but involved prescribing quantities outside of the hospital guidelines which no degree of planning could accommodate. There was also the very unexpected finding that a prescription could be filled in a variety of hospital dispensaries as individuals could access more than one hospital or they could consult more than one physician for the same condition and obtain effectively double the supplies. Communications between the hospital and patients and the health care professionals could all be improved by perhaps increasing the knowledge of the patient about the correct use of medicines. Recommendations. A series of recommendations for future work is provided

Backround. Based of my personal observations when employed as a pharmacist in a Saudi hospital it was clear that there were problems with medicine supply to outpatients. This thesis was designed to scientifically investigate the types of shortages, the reason(s) for such problems and potential solutions to the problem. Methods . This study was undertaken using a variety of experimental techniques to determine the views and perceptions of patients, pharmacists, physicians and administrative staff of the hospital under examination. To establish the scale of the problem: focus groups (n=25), structured questionnaires, structured interviews/meetings for health care professionals and a national survey (n=650) were the research tools used to objectively determine the relevant data. The data were analyzed by appropriate statistical methods. Results and Discussion That there was a real problem was quickly established in the data obtained from patients. A similar finding was made for each of the ¿professional groups¿. The central problem was one of shortages of medicines for prescriptions presented by outpatients. It was not a case the medicines were simply not available because they were never stocked but rather a simple shortage in the dispensary stock. It was established the lack of medicines was not due to central budget arrangements but involved prescribing quantities outside of the hospital guidelines which no degree of planning could accommodate. There was also the very unexpected finding that a prescription could be filled in a variety of hospital dispensaries as individuals could access more than one hospital or they could consult more than one physician for the same condition and obtain effectively double the supplies. Communications between the hospital and patients and the health care professionals could all be improved by perhaps increasing the knowledge of the patient about the correct use of medicines. Recommendations. A series of recommendations for future work is provided / Government of the Kingdom of Saudi Arabia