Critical care specialists,the missing link in organ procurement for transplantation

The procurement process for organ donation begins with the identification of potential organ donors in emergency or critical care units(CCU),followed by their clinical evaluation,diagnostic procedures,and therapeutic interventions,mostly conducted in CCUs.It concludes with the request for organ donation and,if accepted,the retrieval of organs.Despite most interventions occurring in detection units,there has been a neglect of the strategic role played by critical care specialists(CCS)in managing and caring for brain-dead or near-brain-death patients.Questions arise:Are they willing to undertake this responsibility?Do they fully comprehend the nature of organ procurement?Are they aware of the specific interventions required to maintain possible organ donors in optimal physiological condition?Our objective is to examine the role of CCS in organ procurement and propose ways to enhance it,ultimately aiming to increase and enhance organ donation rates.

An Assessment of Procurement Risks Management Systems in the Public Sector

Risk management in public procurement is a critical aspect that needs to be addressed in the public sector.Several studies have been conducted to understand the challenges and factors influencing risk management in public procurement.These studies have explored the importance of risk management principles,the role of political influence,and the need for effective risk assessment and anticipation.The research has also highlighted the need for specific risk management mechanisms and tools to be implemented in public procurement processes.Risk management reforms in the public sector are essential but often circumvented due to assorted reasons,such as political influence and the emergence of new risks.The research investigation employs a quantitative research design.A total of 380 questionnaires were recovered from respondents.The study showed that the public sector has a procurement risk management system that is effective,but there may be some areas for improvement in the prequalification process,onboarding process,and support provided to newly onboarded suppliers.Additionally,the public sector used some strategies to mitigate and control contract risks during the procurement process,but there were some areas for improvement in the review and lessons learned process,risk mitigation measures,contract monitoring and performance evaluation mechanisms,and communication and documentation process.Finally,the results suggest that there were constraints placed on the risk management strategies currently utilized by professionals working in the public sector.These constraints include insufficient support and buy-in from senior management and stakeholders,bureaucratic or administrative hurdles,inadequate policies and regulations,insufficient training and skill development opportunities,and insufficient resources.The study highlights the significance of tackling risk management in the realm of public procurement and offers valuable perspectives on avenues for enhancement,obstacles encountered by practitioners,and the necessity of thorough evaluation and revisions.Through the adoption of the suggestions originating from this study,governmental entities can improve their procurement risk management frameworks and guarantee improved adherence to risk management principles.

Research on the Status Quo and Optimization of Centralized Procurement of Coronary Stents

Objective To study the impact of the first national centralized procurement of coronary stents on patients’psychology,the economy of medical institutions,and the survival and development of the coronary stents industry,and to provide suggestions on perfecting procedures to better carry out the centralized procurement of coronary stents.Methods Literature analysis was used to investigate the results of the procurement of coronary stent in a province and a hospital.Results and Conclusion The centralized procurement of coronary stents has alleviated the economic pressure of patients,but it has many problems.Therefore,this paper proposes some suggestions,such as promoting the orderly development of the coronary stent industry,improving the evaluation link of the centralized procurement of coronary stents,adopting the accurate reporting model to ensure the quality of coronary stents and improving the standardization of clinical services.

Research on Procurement Cost Control Based on Supply Chain Management

In modern enterprise management,strengthening the control and management of procurement processes can effectively reduce operational costs.However,with the continuous reform and improvement of China’s market economy system,competition among supply chain enterprises has intensified.The traditional procurement management model is no longer able to meet the needs of enterprise development in the current era.As a result,procurement management based on supply chain management has emerged,offering significant improvements in the scientific management of procurement processes.It has become an important means of promoting the long-term development of enterprises.This paper primarily analyzes and studies procurement cost control based on supply chain management,providing insights for reference.

Study on the Winning Probability for a Bid in Procurement Combinational Auction with Tree Structure

In this paper, the processes to determine winning probability for the corresponding bidder's deterministic bid are presented. The analysis of the winning probability is crucial for studying the bidding equilibria and designing the mechanism of procurement combinational auctions (CAs), and it also provides the decision making support for bidders who are in commercial synergies surrounding. Finally, an example is used to illustrate the feasibility and detailed processes of calculating winning probability.

Personal experience with the procurement of 32 liver allografts

AIM: To introduce the American Pittsburgh's method of rapid liver procurement under the condition of brain death and factors influencing the quality of donor liver.METHODS: To analyze 32 cases of allograft liver procurement retrospectively and observe the clinical outcome of orthotopic liver transplantation.RESULTS: Average age of donors was 38.24±12.78 years,with a male:female ratio of 23:9. The causes of brain death included 21 cases of trauma (65.63%) and nine cases of cerebrovascular accident (28.13%). Fourteen grafts (43.75%) had hepatic arterial anomalies, seven cases only right hepatic arterial anomalies (21.88%), five cases only left hepatic arterial anomalies (15.63%) and two cases of both right and left hepatic arterial anomalies (6.25%) among them. Eight cases (57.14%) of hepatic arterial anomalies required arterial reconstruction prior to transplantation. Of the 32 grafts evaluated for early function, 27 (84.38%) functioned well, whereas three (9.38%) functioned poorly and two (6.25%) failed to function at all. Only one recipient died after transplantation and thirty-one recipients recovered. Four recipients needed retransplantation. The variables associated with less than optimal function of the graft consisted of donor age (35.6±12.9 years vs 54.1±4.3 years, P＜0.05), duration of donor's stay in the intensive care unit (ICU) (3.5±2.4 d vs 7.4±2.1 d, P＜0.005), abnormal graft appearance (19.0% vs 100%, P＜0.05), and such recipient problems as vascular thromboses during or immediately following transplantation (89.3% vs 50.0%, P＜0.005).CONCLUSION: During liver procurement, complete heparization, perfusion in situ with localized low temperature and standard technique procedures are the basis ensuring the quality of the graft. The hepatic arterial anomalies should be taken care of to avoid injury. The donor age,duration of donor's staying in ICU, abnormal graft appearance and recipient problem are important factors influencing the quality of the liver graft.

Vodafone Signs Handset Procurement Agreement with China's ZTE

Vodafone Group and ZTE Corporation announced a handset procurement agreement which will see the Chinese company produce a range of Vodafone-only branded, ultra-low cost handsets for sale across Vodafone’s Markets.

Discussion on Drug Procurement with Target Quantity in China and Its Problem

Objective To provide reference for improving drug procurement with target quantity in China.Methods Documents on drug centralized procurement such as the “Guidance on Drug Procurement with Target Quantity for 4+7 Cities” issued by National Healthcare Security Administration in November 2018 and “Notice on the National Organization of the Pilot Program for Drug Centralized Procurement and Use of Bidding Drugs” issued by the State Council were studied to summarize the mode and result of drug procurement with target quantity.Results and Conclusion Drug procurement with target quantity led by National Healthcare Security Administration solved some problems in the previous centralized drug procurement.For instance,quantity could not determine drug price,and medical institutions didn’t pay to pharmaceutical companies on time.However,this new mode may also arouse new problems such as procurement monopoly,drug shortage,drug quality and inhibition of innovation.

Analysis of Drug Purchase and Pricing Decision under the Mode of Procurement with Target Quantity

Objective To study the reasonable pricing strategy to effectively reduce the risk of drug supply disruption.This paper studies the vertical competition between drug purchasers and pharmaceutical enterprises,and the horizontal competition between different pharmaceutical enterprises.Based on the wholesale price of drugs made by pharmaceutical enterprises,drug purchasers adopt different procurement strategies.Methods A multi-stage game model was used to analyze the collusion and competition between two drug procurement parties.Results and Conclusion(1)Enterprise B can choose the optimal game strategies according to the stability of enterprise A;(2)Two procurement parties should choose collusion when the risk of supply interruption is low;(3)Emergency dual sourcing strategy is better than single sourcing strategy;(4)The optimal procurement quantity is irrelevant to the monotonicity of the stability of enterprise A in Cournot game.Through numerical analysis,the optimal decisions of pharmaceutical enterprises and drug purchasers are obtained respectively.

Suggestions on Foreign Pharmaceutical Enterprises Dealing with China’s Drug Centralized Procurement - Taking the First Batch of Implementation Results as an Example

Objective To analyze the impact of the first batch of centralized drug procurement on foreign pharmaceutical enterprises since the national centralized drug procurement policy has brought great impact on pharmaceutical market,and put forward some suggestions on their marketing transformation in China.Methods Firstly,the documents of the drug centralized procurement were studied,and then the sales figures before and after the implementation of the policy were retrieved from MiNET.At the same time,the relevant business adjustment information of foreign pharmaceutical enterprises was collected for analysis.Results and Conclusion The sales of related products of foreign pharmaceutical enterprises have dropped sharply,so they have stripped off these products and reduced their staff.It is suggested that foreign pharmaceutical enterprises should adjust the structure of sales team,strengthen the layout of the market in the county,and accelerate the introduction of innovative drugs to cope with centralized drug procurement.

Policy Suggestions on Procurement of Basic Infusion Against the Background of Volume Procurement

Objective To evaluate the clinical value of basic infusion packaging materials for providing suggestions on formulating basic infusion volume procurement policies.Methods Combined with market data,questionnaire surveys were used to rank different basic infusion packaging materials.Pharmacists,nurses,and experts in the field of packaging respectively assess the safety,compatibility,effectiveness,convenience,and environmental friendliness of the materials.Results and Conclusion Products with the best clinical value have a lower market share than other products with average clinical value.The best three packaging materials only account for 15%of the market share.The order of clinical value from good to bad is inner-sealed polypropylene infusion bag(BFS)>soft aseptic bag with double valves and layers>upright polypropylene infusion bag>non-PVC soft bag>plastic bottle>glass bottle.The order of market share is non-PVC soft bag>soft aseptic bag with double valves and layers>plastic bottle>vertical polypropylene infusion bag>inner-sealed polypropylene infusion bag(BFS)>glass bottle.Therefore,the clinical values of various basic infusion packaging materials are different.The following countermeasures are put forward such as separating bidding for basic infusions with different packaging materials,combining volume and price with procurement,and priority procurement of packaging materials with better clinical values.

Analysis on the Development Strategy of China’s Pharmaceutical Enterprises under the Background of Volume Procurement

Objective To provide reference for the development strategy of China’s enterprises under the current policy background of generic drug consistency evaluation and volume procurement.Methods China’s current policies on generic drugs and market environment were analyzed and the development paths of international top pharmaceutical enterprises were studied as well.Results and Conclusion There are four transformation and upgrading paths for China’s pharmaceutical enterprises.First,they should invest more in innovation to realize the globalization of new drugs.Second,overseas patented new drugs should be introduced actively.Third,they must focus on the research and development of high-end generic drugs.Lastly,the transformation from active pharmaceutical ingredients into pharmaceutic preparation should be carried out quickly.Under the background of volume procurement,the pharmaceutical market pattern will be completely changed.The research and development capability and patented drugs will become the core competitive advantages of enterprises.

Current Effect of“4+7”Drug Centralized Volume Procurement and Suggestions for Future Improvement

Objective To explore the impact of the“4+7”city drug centralized procurement policy implemented from April 1st,2019 on China’s pharmaceutical market and the differences between this pilot scheme and the first volume procurement,so as to put forward some suggestions for this policy and improve the drug price formation mechanism.Methods The characteristics of the“4+7”volume procurement policy and its improvements were summarized through literature research,and the distribution of the winning enterprises in volume procurement was shown by the chart.Then the overall situation of pharmaceutical enterprises in China was analyzed.Results and Conclusion According to the main distribution of enterprises in the alliance region,we can see that the first round of bid-winning enterprises with 25 varieties are mainly distributed in the eastern coastal cities of Jiangsu,Zhejiang,Shandong,and Guangdong,which shows a trend of developing to provinces of Sichuan,Hubei,and Hunan.With the increase of volume procurement inland cities will be included in the future.This pilot scheme of volume procurement is a reform of the entire pharmaceutical industry.It has improved the market structure and promoted the transformation and upgrading of regional medicine representatives.The most important thing is to enable the public to better enjoy the benefits brought by the low-priced drugs.However,for some pharmaceutical enterprises and drug retail industry,it is a challenge.Therefore,it is necessary to improve the policy and strengthen market supervision and management.

Renal allograft procurement from living unrelated donors in Iran: What falls under the eclipse

Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a significant increase in the number of patients on transplant waiting lists globally.Societies worldwide have employed different methods to address this,each with specific ethical concerns surrounding them.Over three decades ago,a governmentally regulated program of kidney transplantation from living unrelated donors was introduced in Iran and since practiced which has been the subject of hot debate in the literature.Nevertheless,despite all these extensive discussions and publications,several key aspects of the program have still not been properly elucidated and addressed.In this article,the author aims to illuminate some dark corners related to this issue that have largely escaped the notice of ethicists.

Research on choice of emergency procurement vendors

In order to make the supply chain select the best emergency procurement suppliers in case the procurement system encounters unexpected risks,six indices which can reflect the comprehensive abilities of alternative suppliers are selected,i.e.,the product yield,the toll standard,the on-time-delivery rate,the rate of turnover industry experience and customer satisfaction.Then standardized processing of evaluation is performed.For quantitative indices,vector normalization is adopted to perform standardized processing,and qualitative fuzziness indices are quantified through assignment.Finally,each index can be transformed into a standardized mark which has dimensionless 1 and the same magnitude.And an expert method is used to determine the index weights and then the linear weighted sum method is used to calculate the alternative supplier's comprehensive ability score and by comparing these scores,the optimal emergency procurement supplier is selected.

Issues and Challenges in Implementing China’sGreen Public Procurement Program

Sustainable development and environmental protection are the themes of the day. One popular policy tool that government uses to promote sustainable development and to protect the environment is green public procurement. Chinese government established its public procurement system in the late 1990s. It has moved to implement green procurement since 2004. In this paper, the authors will first trace the development of Chinese green public procurement program. The authors will then examine the issues involved in its implementation and make suggestions as to how to make green public procurement program more effective. This is one of the first papers examining China’s green public procurement program.

Optimizing Bidders Selection of Multi-Round Procurement Problem in Software Project Management Using Parallel Max-Min Ant System Algorithm

This paper presents a Game-theoretic optimization via Parallel Min-Max Ant System(PMMAS)algorithm is used in practice to determine the Nash equilibrium value to resolve the confusion in choosing appropriate bidders of multi-round procurement problem in software project management.To this end,we introduce an approach that proposes:(i)A Game-theoretic model of multiround procurement problem(ii)A Nash equilibrium strategy corresponds to multi-round strategy bid(iii)An application of PSO for the determination of global Nash equilibrium.The balance point in Nash Equilibrium can help to maintain a sustainable structure not only in terms of project management but also in terms of future cooperation.As an alternative of procuring entities subjectively,a methodology to support decision making has been studied using Nash equilibrium to create a balance point on benefit in procurement where buyers and suppliers need multiple rounds of bidding.Our goal focus on the balance point in Nash Equilibrium to optimizing bidder selection in multi-round procurement which is the most beneficial for both investors and selected tenderers.Our PMMAS algorithm is implemented based on MPI(message passing interface)to find the approximate optimal solution for the question of how to choose bidders and ensure a path for a win-win relationship of all participants in the procurement process.We also evaluate the speedup ratio and parallel efficiency between our algorithm and other proposed algorithms.As the experiment results,the high feasibility and effectiveness of the PMMAS algorithm are verified.

Aspects of International Public Procurement Regulation

The public procurement market is classified as one of the most important segments of the world economy with share of 7-18%in the world GDP.The importance of this segment leads to continuous liberalization.Despite the existing legislative framework,the share of cross-border public procurement remains limited due to several obstacles including discrimination in public procurement that was raised by governments as one of the non-tariff barriers to international trade.Surveys of the European Commission or the European Bank for Reconstruction and Development(EBRD)indicate that there are many other obstacles to entry to international public procurement markets.These obstacles are discussed in the first chapter of this article.The goal of this paper is to review aspects of international public procurement regulation and find ways of eliminating the obstacles through this regulation.Therefore,the second,third,and fourth chapters of the paper analyse the WTO Government Procurement Agreement(GPA),the United Nations Commission on International Trade Law(UNCITRAL)Model Law on Public Procurement,and the role of regional trade agreements.

Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report

The combination of kidney paired donation(KPD) with desensitization represents a promising method of increasing the rate of living donor kidney transplantation(LDKT) in immunologically challenging patients. Patients who are difficult to match and desensitize due to strong donor specific antibody are may be transplanted by a combination of desensitization and KPD protocol with more immunologically favorable donor. We present our experience of combination of desensitization protocol with three-way KPD which contributed to successful LDKT in highly sensitized end stage renal disease patient. All recipients were discharged with normal and stable allograft function at 24 mo follow up. We believe that this is first report from India where three-way KPD exchange was performed with the combination of KPD and desensitization. The combination of desensitization protocol with KPD improves access and outcomes of LDKT.

Beyond the Audit: Making Efficiency Easy and Enticing by Addressing Project Procurement

Many states have implemented an Energy Efficiency Resource Standard (EERS) or target to curtail greenhouse gas (GHG) emissions. California alone has set a target of doubling energy efficiency savings in existing buildings by 2030. As more states rely on energy efficiency to reduce GHG emissions, programs designed to support the planning and implementation of energy efficiency projects will become more important. Identifying energy efficiency projects has traditionally been the focus of these programs, however delivering savings remains a key challenge. Strategies to address procurement are often overlooked as program resources focus more on technical resources, such as audits and monetary incentives. Then once identified, specialized energy efficiency projects are often folded in with standard maintenance or capital improvement projects, putting them at risk of compromising the expected performance. This paper focuses on procurement as a key component of program implementation and success and outlines key issues and challenges specifically faced by the public sector. Furthermore, the paper shares a procurement strategy implemented through the Southern California Regional Energy Network (SoCalREN) Public Agency Program that addresses these problems in order to assure intended project performance. The strategy includes engaging procurement stakeholders early in the project process, exploring the different types of procurement pathways and following an implementation checklist to enhance project success. With this systematic approach to procurement, there will be fewer barriers and energy efficiency will be easy and enticing, which will further enable states to achieve their GHG emission reduction targets.