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Ewe deaths affect the productivity and profitability in sheep farming systems and have potential animal welfare and market perception implications. Internationally, there is scant data on the timing and causes of ewe deaths in extensive grazing systems. There is no published literature on the incidence and risk factors associated with casting (ewe in late gestation accidentally immobilised, often in dorsal recumbency). This study, undertaken using a cohort of 1789 ewes on a New Zealand farm, reports on the timing and risk factors associated with production parameters for ewe deaths through an almost two-year period, along with causes of death during both peripartum periods. Ewe deaths occurred throughout both years but were most frequent during the peripartum (pre-lambing to mid-lactation) period. Casting was the most commonly identified cause of death in both years, responsible for approximately a quarter to a third of potential annual mortality. Few risk factors for death or casting were identified. In conclusion, the peripartum period is a high-risk time period for ewe deaths (and, by extension, will also contribute to lamb perinatal mortality). In extensively grazed flocks where casting events occur, it is recommended that all ewes are monitored daily during the peripartum period.

MATERIALS AND METHODS: A total of 457 blood transfusion requests for 244 patients were received over a 3-month period. Registered demographic characteristics (age, sex, and nationality), ward, type of blood, and hemoglobin concentration before transfusion for all the patients were collected. RESULTS: A total of 1328 blood products were requested, while 780 (59%) units were transfused. The cross-matched packed red cells/transfusion ratio was 1.8, while request/transfusion was 1.7 for the fresh frozen plasma and 1.23 for platelets. Packed red blood cells were the main blood product used in blood transfusion (BT). General surgery/orthopedics and intensive care unit were reported with a greater number of requests. The main indications noted for blood requisition were surgery and anemia. CONCLUSIONS: Current guidelines appear to be respected within services regarding BT decision criteria. However, about half of the requested blood is not transfused which suggest further improvement. Adherence to established guidelines seems variables among different departments. Elective transfusion medicine rotations for all trainees and specialized dedicated sessions for doctors may help in further betterment of utilization of blood bank services.

Highlights • Fear of vaccine wastage may lead to lower immunization coverage. • Mixed method study compared the use of 5-dose and 10-dose vials of measles-rubella. • Districts using 5-dose MR saw increase coverage and reduced wastage. • Health workers reported more willing to open a 5-dose MR vial. • Switching to 5-dose MR vials can be accommodated within existing cold chain capacity and the wastage-adjusted cost differential per dose is negligible., Introduction Vaccines procured for low-income countries are often packaged in multi-dose vials to reduce program costs. To avoid wastage, health workers may refrain from opening a vial if few children attend an immunization session, possibly leading to lower coverage. Lowering the number of doses in a vial may increase coverage and reduce wastage. Methods We used a mixed methods approach to measure the effects of switching from conventional 10-dose measles containing vaccine (MCV) vials to 5-dose MCV vials on coverage and open vial wastage in 14 districts purposely selected from two provinces in Zambia. The districts were paired based on the number of health facilities and the average size of the health facility catchment population. One district from each pair was randomly allocated to receive 5-dose vials while the other continued with the conventional vials. We applied propensity score matched difference-in-difference analysis to estimate intervention effects on coverage using pre-intervention household survey and post-intervention household survey after 11 months of the intervention. The intervention effects on wastage rates were estimated from multivariate analysis of the administrative data. Key informant interviews were conducted to better understand health workers’ behavior and preferences at baseline, midline and endline, and analyzed using thematic analysis techniques. Results MCV coverage rates increased across both arms for both doses. A five percentage-point intervention effect was detected for MCV1 and 3.5 percentage-point effect for MCV2. The MCV wastage rate was 47% lower in facilities using 5-dose vials (16.2%) versus 10-dose vials (30.5%). Healthcare workers reported being more willing to open a 5-dose vial than a 10-dose vial for one child, as they were less concerned about wastage. Discussion Switching 10-dose MCV vials to 5-dose vials improved coverage, decreased wastage, and improved willingness to open a vial. These findings can contribute to strategies for reducing missed opportunities for vaccination.

Background Medicines wastage is one of the challenges of health supply chain management in developing countries including Ethiopia. However, there is lack of objective evidence on the detailed underlying causes of medicines wastage. Therefore, the aim of this study is to explore factors contributing for medicines wastage in selected public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia. Methods A qualitative study was conducted in 10 public health facilities (1 General hospital and 9 health centers). An in-depth interview with flexible probing techniques was employed to collect the data from 20 key informants from May 2, 2016 to May 27, 2016. A semi structured interview guide was prepared to explore key informants’ idea about current situation of contributing factors and efforts made to reduce medicines wastage in public health facilities. A thematic analysis was then used to analyze the data. Results Almost all key informants felt that medicines wastage is increasing from time to time in their health facility due to supplier’s issuing of medicines without health facilities’ needs and request, failure to follow first expired first out principle in issuing medicines from stores to different dispensing units, lack of communication between supplier and health facilities, inadequate number of pharmacy personnel and weak monitoring system of supply chain in the health facilities. They also revealed budget constraint, stock out of medicines and congested store are of the major challenge that are compromising their service provision. Conclusion Medicine wastage is an ever-increasing problem in public health facilities of South West Shoa Zone. The problem is exacerbated due to absence of mechanisms to minimize the wastage. Health facilities, therefore, should place a mechanism to exchange medicines from overstocked facilities to under stocked ones; has to improve store management capacity by employing competent professionals, equipping the store with necessary technology and introducing a monitoring and evaluating health supply chain performance system in the health facilities.

Simple Summary Ewe wastage is the combination of on-farm mortality and premature culling. Increased wastage results in a reduction in flock productivity and profitability, yet internationally, there is limited research on actual wastage incidence and causes in commercial flocks. This study reports both lifetime wastage and detailed annual wastage for 13,142 ewes from four cohorts on three commercial New Zealand farms. This study also describes the relationship between ewe pre-mating body condition score and wastage. Of the 13,142 enrolled ewes, 50.4% and 40.0% exited their respective flocks due to premature culling and on-farm dead/missing, respectively. Annual mortality incidence ranged from 3.5 to 40.2%. Wastage as a hogget was identified as an area in which improvements can be made to reduce overall wastage. Pre-mating body condition score was a predictor of wastage, with ewes with greater pre-mating body condition score having lower odds of wastage due to both premature culling and mortality. Therefore, farmers should focus on improving the body condition score of their ewes prior to breeding. Abstract Ewe wastage is the combination of on-farm mortality and premature culling. Internationally, there is limited research on actual wastage incidence and causes in commercial sheep flocks. To the authors’ knowledge, this is the first study that reports both lifetime wastage and detailed annual wastage in a sample of commercial New Zealand flocks. This study utilized data collected from 13,142 ewes from four cohorts on three commercial New Zealand farms (Farm A 2010-born, Farm A 2011-born, Farm B, Farm C), during the period 2011–2017, as they aged from replacement hoggets to 6-year-old ewes (Farm A and Farm B) or 3-year-old ewes (Farm C). Data collection visits occurred at three or four key management times each year, namely pre-mating, pregnancy diagnosis, pre-lambing and weaning. At each visit, body condition score (BCS) was assessed and any ewes that were culled or had died on farm were recorded. As this was a lifetime study, each ewe was assigned an outcome and corresponding ‘exit age’. By the end of the study, all ewes that had exited their respective flocks, were classified as either prematurely culled, or dead/missing, or if still in the flock, as censored, and either the exact date or interval in which they exited the flock was recorded. Semi-parametric competing risk (premature culling vs. dead/missing), interval-censored survival models were developed to: 1. describe the association between hogget reproductive outcomes and risk of subsequent wastage, and 2. assess pre-mating BCS as a predictor of wastage in that production year. Of the 13,142 enrolled ewes, 50.4% exited their respective flocks due to premature culling and 40.0% due to on-farm dead/missing, giving a total of 90.4% that exited due to wastage. Annual mortality incidence ranged from 3.5 to 40.2%. As a hogget, wastage incidence ranged from 7.6 to 45.4%. Pregnancy or rearing a lamb as a hogget did not increase risk of subsequent wastage. In all years, pre-mating BCS was a predictor of ewe wastage, with odds of wastage lower with increasing BCS. Therefore, farmers should focus on improving pre-mating BCS to 3.5/5.0 by assessing ewe BCS at weaning, allowing poorer-BCS ewes to be managed to gain BCS before re-breeding.

BackgroundIrrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates.MethodsHousehold surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions.ResultsFrom the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage.ConclusionsFactors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.

Musculoskeletal injuries (MSI) remain a concerning cause of racehorse morbidity and mortality with important ethical and welfare consequences. Previous research examining risk factors for MSI report inconsistent findings. Age is thought to affect MSI risk, but, to date, there have been no prospective studies comparing MSI in two-year-old versus older horses. This study aimed to: (1) determine the incidence of MSI for two-year-old and older horses, and whether this was affected by training track, season, or rainfall, and (2) determine the types of MSI affecting two-year-old and older horses, and whether horses trialled or raced after injury. A prospective survey was conducted with data collected through personal structured weekly interviews with participating trainers over a 13-month period. Data were analysed using Poisson regression. The incidence of MSI in the current study was low (0.6%). The incidence of MSI in two-year-old horses was higher than older horses (p &lt, 0.001). Types of MSI varied between two-year-old and older horses (p &lt, 0.001) and affected whether horses subsequently trailed or raced from 11 to 23 months after injury (p &lt, 0.001). A larger proportion of two-year-old horses had dorsal metacarpal disease and traumatic lacerations. A smaller proportion of two-year-old horses had suspensory ligament desmitis, superficial digital flexor tendonitis, proximal sesamoid bone fractures, and fetlock joint injuries than older horses. Training track and rainfall did not affect MSI. The season affected MSI in two-year-old horses (p &lt, 0.001) but not older horses. The major limitation was that trainers in this study were metropolitan (city) and our findings may not be generalisable to racehorses in regional (country) areas. Another significant limitation was the assumption that MSI was the reason for failure to trial or race after injury. In conclusion, the incidence of MSI was low in the current study and the types and the risk factors for MSI are different for two-year-old and older horses.

Platelet transfusions are vital for the prevention of fatal hemorrhage. Therefore, a stable inventory of platelets is required for an efficient and effective delivery of services in all the hospitals and medical centers. However, over the past decades, the requirement for platelets seems to be continuously increasing, while the number of potential donors is decreasing. Moreover, due to its very short life span of just five days, a large volume of platelets expires while they are on the shelves, resulting unnecessary shortages of platelets. Furthermore, it is very costly and difficult to get platelets from another blood bank in a short notice. Hence, these unexpected shortages put the life of patients at risk. This study is focused on addressing the issues discussed, by developing an efficient blood inventory management model to reduce the platelet shortages, and wastages, while reducing the related inventory costs. Currently, the blood banks are managing platelet inventory according to their own instincts, which result to shortages and wastages. As a solution, we propose a model to manage the daily supply of platelets by forecasting the daily demand. Three different algorithms were developed using lower bound, average and upper bound values and tested to find the optimal solution that best fits to manage platelet inventory. These models were tested using data for 60 days obtained from two different levels of blood banks in Sri Lanka, namely a General Hospital blood bank and a Base Hospital blood bank. In General hospitals, the demand for blood components including platelets is very high when compared to the Base hospitals. The study was able to come up with two different inventory management models for the two different types of blood banks. The model that best fits the General Hospital blood bank where the demand is high and was able to reduce the shortages by 46.74%, wastage by 89.82% and total inventory level by 39.10% and, the model that best fits the Base Hospital blood bank was able to reduce the shortages by 100%, wastage by 81.48% and total inventory level by 37.95%. It can be concluded that the same models can be adopted by other blood banks with similar characteristics to manage their blood inventory efficiently.

Background Preoperative autologous blood donation (PABD) has been declining in use nationally. A subset of patients scheduled for elective surgery, however, continue to be offered and choose this option. Our study aimed to understand the current impact of PABD before scheduled surgical procedures. Study design and methods A retrospective review was conducted in a single large academic center. Medical records associated with autologous units received in the transfusion service over a two-year period (1/1/2016-12/31/2017) were reviewed. Demographics, units donated, units transfused, wastage, pre-donation hemoglobin (Hb), pre-operative Hb, estimated blood loss (EBL), and clinical specialty were collected. Results During the study period, 118 patients underwent PABD, donating a total of 141 autologous red blood cell units. Patients who donated autologous units and were subsequently transfused had lower pre-donation Hb compared to patients who were not transfused (13.3 ± 1.4 g/dL vs. 14.3 ± 1.5 g/dL, p=0.004). Pre-operative Hb was lower than pre-donation Hb among both groups (12.1 ± 1.2 g/dL for patients receiving transfusion; 12.9 ± 1.5 g/dL, p=0.011 for patients who were not transfused). The majority of PABD patients (71%) had an estimated blood loss of less than 500 mL. Wastage rate of autologous units was 67%. PABD was disproportionately associated with a minority of surgeons and clinical services. Conclusion Within our institution, PABD is heavily used amongst a small subset of physicians across multiple surgical specialties and is associated with lower pre-operative Hb, tendency towards overtransfusion, and high rates of wastage of donated units. Our findings reinforce reports of inefficiencies in patient blood management and increased risks to patient health associated with PABD.

Musculoskeletal injuries (MSI) continue to affect Thoroughbred racehorses internationally. There is a strong interest in developing training and management strategies to reduce their impact, however, studies of risk factors report inconsistent findings. Furthermore, many injuries and fatalities occur during training rather than during racing, yet most studies report racing data only. By combining racing and training data a larger exposure to risk factors and a larger number of musculoskeletal injuries are captured and the true effect of risk factors may be more accurately represented. Furthermore, modifications to reduce the impact of MSI are more readily implemented at the training level. Our study aimed to: (1) determine the risk factors for musculoskeletal injuries and whether these are different for two-year-old and older horses and (2) determine whether risk factors vary with type of injury. This was performed by repeating analyses by age category and injury type. Data from 202 cases and 202 matched controls were collected through weekly interviews with trainers and analysed using conditional logistic regression. Increasing dam parity significantly reduced the odds of injury in horses of all age groups because of the effect in two-year-old horses (odds ratio (OR) 0.08, 95% confidence interval (CI) 0.02, 0.36, p &lt, 0.001). Increasing total preparation length is associated with higher odds of injury in horses of all ages (OR 5.56, 95% CI 1.59, 19.46, p = 0.01), but particularly in two-year-old horses (OR 8.05, 95% CI 1.92, 33.76, p = 0.004). Increasing number of days exercised at a slow pace decreased the odds of injury in horses of all ages (OR 0.09, 95% CI 0.03, 0.28, 0.001). The distance travelled at three-quarter pace and above (faster than 13 m/s, 15 s/furlong, 800 m/min, 48 km/h) and the total distance travelled at a gallop (faster than 15 m/s, 13 s/furlong, 900 m/min, 55 km/h) in the past four weeks significantly affected the odds of injury. There was a non-linear association between high-speed exercise and injury whereby the odds of injury initially increased and subsequently decreased as accumulated high-speed exercise distance increased. None of the racing career and performance indices affected the odds of injury. We identified horses in this population that have particularly high odds of injury. Two-year-old horses from primiparous mares are at increased odds of injury, particularly dorsal metacarpal disease. Two-year-old horses that have had a total preparation length of between 10 and 14 weeks also have increased odds of injury. Horses of all ages that travelled a total distance of 2.4–3.8 km (12–19 furlongs) at a gallop in the last four weeks and horses three years and older that travelled 3.0–4.8 km (15–24 furlongs) at three-quarter pace and above also have increased odds of injury. We recommend that these horses should be monitored closely for impending signs of injury. Increasing the number of days worked at a slow pace may be more effective for preventing injury, if horses are perceived at a higher risk, than resting the horse altogether. Early identification of horses at increased risk and appropriate intervention could substantially reduce the impact of musculoskeletal injuries in Thoroughbred racehorses.

Simple Summary Despite extensive international research, musculoskeletal injuries remain a key problem for the Thoroughbred racing industry, with multiple welfare and ethical consequences. High-speed exercise (HSE) history is an important risk factor for injury. However, studies report conflicting findings concerning the effect of HSE on the risk of injury. Although most injuries and fatalities occur during training rather than racing, many research studies only evaluate injuries reported on race day, which likely underrepresents the injuries acquired by these horses. This study aimed to determine the effect of combined training and racing HSE on injuries in racehorses. We performed a systematic search of the relevant literature and evaluated the effect of seven measures of HSE on injury through meta-analyses. The total career HSE distance significantly affected the odds of musculoskeletal injuries (MSI). With every 5-furlong (1 km) increase in career HSE distance, the odds of MSI increased by 2%. The average HSE distance per day also affected the odds of MSI. With every additional furlong (200 m) of average HSE per day, the odds of MSI increased by 73%. However, the strength of the available evidence is restricted by methodological limitations, which will need to be addressed in the future, to explore the level of risk and mechanisms for injury in more detail. Abstract Despite over three decades of active research, musculoskeletal injuries (MSI) remain a global problem for the Thoroughbred (TB) racing industry. High-speed exercise history (HSEH) has been identified as an important risk factor for MSI. However, the nature of this relationship remains unclear, with an apparent protective effect of HSE against injury, before it becomes potentially harmful. Many MSI cases and fatalities occur during training rather than during racing, resulting in an underestimation of injury from studies focused on race day. The objective of this study was to examine the current evidence of the effect of combined training and racing HSEH on MSI in TB flat racehorses, through a systematic review and meta-analysis. A systematic search of the relevant literature was performed using PubMed®, Scopus®, Web of Science®, and Embase® online databases and the gray literature using sites containing “.edu” or “.edu.au”. Studies included in the review had explored seven different measures of HSE, including total career HSE distance, cumulative HSE distance in the 30 and 60 days before MSI, average HSE distance per day, per event and per 30 days, and the total number of HSE events. The total cumulative career HSE distance significantly affected the odds of MSI, with every 5-furlong increase, the odds of MSI increased by 2% (OR = 1.02; 95% CI 1.01, 1.03; p = 0.004). The average HSE distance per day also affected the odds of MSI, with every additional furlong increasing the odds of MSI by 73% (OR = 1.73; 95% CI 1.29, 2.31; p < 0.001). Other measures of HSE were not found to be consistently associated with risk of MSI, but these results should be interpreted with caution. Significant methodological limitations were identified and influence the comparability of studies. Standardizing the measures of HSE in studies of MSI, and describing training conditions in more detail, would support a more thorough investigation of the relationship between HSE and MSI. An improved understanding of this relationship is critical to mitigating the impact of MSI in the Thoroughbred racehorse.

Background and Objectives: Anesthetic drugs and material wastage are common in operation rooms (ORs). In this era of escalating health-care expenditure, cost reduction strategies are highly relevant. The aim of this study was to assess the amount of daily intravenous anesthetic drug wastage from major ORs and to estimate its financial burden. Any preventive measures to minimize drug wastage are also looked for. Methods: It was a prospective study conducted at the major ORs of a tertiary care hospital after getting the Institutional Research Committee approval. The total amount of all drugs wasted at the end of a surgical day from each major OR was audited for five nonconsecutive weeks. Drug wasted includes the drugs leftover in the syringes unutilized and opened vials/ampoules. The total cost of the wasted drugs and average daily loss were estimated. Results: The drugs wasted in large quantities included propofol, thiopentone sodium, vecuronium, mephentermine, lignocaine, midazolam, atropine, succinylcholine, and atracurium in that order. The total cost of the wasted drugs during the study period was Rs. 59,631.49, and the average daily loss was Rs. 1987.67. The average daily cost of wasted drug was maximum for vecuronium (Rs. 699.93) followed by propofol (Rs. 662.26). Interpretation and Conclusions: Financial implications of anesthetic drug wastage can be significant. Propofol and vecuronium contributed maximum to the financial burden. Suggestions for preventive measures to minimize the wastage include education of staff and residents about the cost of drugs, emphasizing on the judicial use of costly drugs.

Purpose: Drug wastage is a major concern in anaesthesia. In addition to increasing the cost on the patient, it can increase the occupational hazard to the health care and sanitary workers and also cause environmental pollution. The principal objective of this study was to ascertain the extent of drug wastage in anaesthetics and ancillary drugs and calculate the financial costs of it at a tertiary care hospital. Methodology: This was a prospective study and was conducted to ascertain the quantity of drug wastage. This pilot study was conducted in the operation theatre between the months of March and April 2016. The prescription of the anaesthetic drugs, the recommended dose, the quantity used and remainder (waste) left were recorded. Costs of the drugs used and wasted were calculated. The financial loss incurred was thus calculated. Results: The results of this study indicated that maximum wastage of the anaesthetic drugs was for atropine sulphate (71.67%), fentanyl (40%), mephentermine sulphate (40%) and bupivacaine (33.62%). The cost analysis indicated that propofol contributed to the maximum as the financial loss was estimated to be 29.27% of the total loss, followed by bupivacaine 18.95%. Conclusion: The results indicate that the quantity and the financial impact of anaesthetic drug wastage were considerable and that efforts should be at minimising the expenditure without risking the patient's life or health.

The purpose of this study was to determine the rate and causes of wastage of blood and blood products (packed red cells, plasma, platelets, and cryoprecipitate) in Qazvin hospitals.The study was conducted in all hospitals in Qazvin, including 5 teaching hospitals, 2 social welfare hospitals, 3 private hospitals, 1 charity hospital, and 1 military hospital. This descriptive study was based on available data from hospital blood banks in the province of Qazvin. The research instrument was a 2-part questionnaire. The first part was related to demographic characteristics of hospitals and the second part elicited information about blood and blood component wastage. The collected data were then analyzed using descriptive statistic methods and SPSS 11.5.Blood wastage may occur for a number of reasons, including time expiry, wasted imports, blood medically or surgically ordered but not used, stock time expired, hemolysis, or miscellaneous reasons. Data indicated that approximately 77.9% of wasted pack cell units were wasted for the reason of time expiry. Pack cell wastage in hospitals is reported to range from 1.93% to 30.7%. Wastage at all hospitals averaged 9.8% among 30.913 issued blood products. Overall blood and blood product (packed red cells, plasma, platelets, and cryoprecipitate) wastage was 3048 units and average total wastage per participant hospital for all blood groups was 254 units per year.Blood transfusion is an essential part of patient care. The blood transfusion system has made significant advancements in areas such as donor management, storage of blood, cross-matching, rational use of blood, and distribution. In order to improve the standards of blood banks and the blood transfusion services in Iran, comprehensive standards have been formulated to ensure better quality control in collection, storage, testing, and distribution of blood and its components for the identified major factors affecting blood product wastage.Bu çalışmanın amacı, Qazvin hastanelerinde kan ve kan ürünleri (eritrosit süspansiyonu, plazma, trombosit ve kriyopresipitat) israfının oran ve nedenlerinin belirlenmesiydi.Bu çalışma, 5 eğitim hastanesi, 2 sosyal yardım hastanesi, 3 özel hastane, 1 hayır kurumu hastanesi ve 1 askeri hastaneyi içerecek şekilde Qazvin’in tüm hastanelerinde yürütüldü. Çalışmada, Qazvin sınırları dahilindeki hastanelerin kan bankalarından elde edilen veriler temel alındı. Araştırma materyali, iki bölümden oluşan bir anket formuydu. İlk bölüm, hastanelerin demografik özellikleriyle alakalıyken, diğer bölümde ise hastanelerde israf edilen kan ve kan ürünleri hakkında aydınlatıcı bilgiler irdelenmekteydi. Elde edilen veriler, tanımlayıcı istatistiki yöntem ve SPSS 11.5 kullanılarak analiz edildi.Kan israfı, son kullanma tarihinin dolması, cerrahi ya da diğer kliniklerden istem yapılmasına karşın kullanılmaması, raf ömrünün dolması, hemoliz ve çeşitli başka nedenler dahil olmak üzere pek çok nedenden ötürü olabilmektedir. Verilere göre, israf edilen eritrosit süspansiyonlarının %77,9’u son kullanma tarihinin geçmesi nedeniyle kullanılamamıştır. Kan ürünlerinin israfı, hastane verilerine göre %1,93 ile %30,7 arasında değişmektedir. Tüm hastanelerdeki 30,913 kan ürünü için ortalama kan ürünü israfı %9,8 olmuştur. Toplam kan ve kan ürünü (eritrosit süspansiyonu, plazma, trombosit ve kriyopresipitat) israfının 3048 unite, tüm kan grupları için hastane başına yıllık ortalamanın ise 254 ünite olduğu saptanmıştır.Kan transfüzyonu hasta bakımının yaşamsal bir parçasıdır. Kan transfüzyonu disiplini ise verici yönetimi, kan depolanması, cross-match, kanın akılcı kullanımı ve ayrımı gibi alanlar başta olmak üzere pek çok alanda belirgin ilerlemeler kaydetmiştir. İran’daki kan transfüzyonu yapılan servislerin ve kan bankalarının standartlarının geliştirilmesi için, kan ürünleri israfını etkileyen en önemli nedenleri göz önünde tutacak şekilde kan ve kan ürünlerinin toplanması, depolanması, test edilmesi ve dağıtılmasında yüksek kalite kontrolün elde edilmesine yönelik olarak geniş kapsamlı standartlar oturtulmaktadır.

Background: Reducing vaccine wastage is important. Bacille Calmette-Guérin (BCG) vaccine is produced in vials of 20 infant doses. The reconstituted vaccine is discarded after 4–6 hours. Therefore, to reduce vaccine wastage, a 20-dose vial of BCG is often only opened if at least 10–12 infants are present, jeopardising BCG vaccination coverage and timely vaccination. We observed that nurses were not able to withdraw 20 doses from the vials and aimed to quantify how many doses could be obtained from these vials by experienced nurses under real-life circumstances.Methods: At the maternity ward of the national hospital in Guinea-Bissau, since 2002 the same two nurses have been vaccinating all eligible children with BCG before discharge. During a month in 2015, within a randomised trial comparing BCG-Denmark and BCG-Russia, we registered how many doses the nurses were able to withdraw from the two types of vaccine vials.Results: The median number of doses which it was possible to withdraw from the vials was 13 (range 11–17): 13 (11–16) for BCG-Denmark (based on 39 vials) and 15 (12–17) for BCG-Russia (based on 29 vials).Conclusions: In real life, experienced nurses could only obtain 13–15 doses from the 20-dose vials. Thus, vaccine wastage is much lower than assumed. Adjusting practice to the real-life number of doses would immediately suggest vials should be opened if 7 rather than 10 infants are present. As other studies have indicated that BCG may have beneficial non-specific effects on overall mortality, the potential gain by opening a 20-dose vial even for one child may be considerable.

Context: The cost of anesthetic technique has three main components, i.e., disposable supplies, equipments, and anesthetic drugs. Drug budgets are an easily identifiable area for short-term savings. Aim: To assess and estimate the amount of anesthetic drug wastage in the general surgical operation room. Also, to analyze the financial implications to the hospital due to drug wastage and suggest appropriate steps to prevent or minimize this wastage. Settings and Design: A prospective observational study conducted in the general surgical operation room of a tertiary care hospital. Materials and Methods: Drug wastage was considered as the amount of drug left unutilized in the syringes/vials after completion of a case and any ampoule or vial broken while loading. An estimation of the cost of wasted drug was made. Results: Maximal wastage was associated with adrenaline and lignocaine (100% and 93.63%, respectively). The drugs which accounted for maximum wastage due to not being used after loading into a syringe were adrenaline (95.24%), succinylcholine (92.63%), lignocaine (92.51%), mephentermine (83.80%), and atropine (81.82%). The cost of wasted drugs for the study duration was 46.57% (Rs. 16,044.01) of the total cost of drugs issued/loaded (Rs. 34,449.44). Of this, the cost of wastage of propofol was maximum being 56.27% (Rs. 9028.16) of the total wastage cost, followed by rocuronium 17.80% (Rs. 2856), vecuronium 5.23% (Rs. 840), and neostigmine 4.12% (Rs. 661.50). Conclusions: Drug wastage and the ensuing financial loss can be significant during the anesthetic management of surgical cases. Propofol, rocuronium, vecuronium, and neostigmine are the drugs which contribute maximally to the total wastage cost. Judicious use of these and other drugs and appropriate prudent measures as suggested can effectively decrease this cost.

Background: Anesthesiologists draw up a selection of drugs for emergency use at the start of their list; unused drugs are discarded at the end of the list, to prevent contamination and spread of infections. We audited the practice in our department to evaluate the scale and cost impact of anesthesia emergency drugs wastage. Subjects and Methods: A questionnaire was randomly given to anesthesiologists in our department, working in some of the operating rooms in our main floor, every morning over 7 working days. Completed forms were collected at the end of respective lists. Results: A total of 93 completed forms were returned. Ephedrine (96%) and phenyepherine (95%) were the most frequently drawn drugs; atropine (96%) and suxamthonium (92%) were the most frequently discarded drugs. Phenylepherine was the single most expensive item wasted, representing 160% of the cost of all other drugs wasted together, and the price of discarded ephedrine and phenylephrine together represented 3/4th of the total wastage. Some practices carried room for rationalization, such as drawing up of atropine and glycopyrolate simultaneously, of both the vasopressors in patients unsuspected for developing significant hypotension, or of suxamethonium in a patient planned to be intubated and postoperative ventilation. Conclusion: Significant savings may be realized through switching to prefilled syringes, making protocols available for rational use of emergency drugs, and safe pooling of expensive drugs between adjacent operating rooms, in an anesthesia department.

Many classification systems for perinatal mortality are available, all with their own strengths and weaknesses: none of them has been universally accepted. We present a systematic multilayered approach for the analysis of perinatal mortality based on information related to the moment of death, the conditions associated with death and the underlying cause of death, using a combination of representatives of existing classification systems. We compared the existing classification systems regarding their definition of the perinatal period, level of complexity, inclusion of maternal, foetal and/or placental factors and whether they focus at a clinical or pathological viewpoint. Furthermore. we allocated the classification systems to one of three categories: 'when', 'what' or 'why', dependent on whether the allocation of the individual cases of perinatal mortality is based on the moment of death ('when'), the clinical conditions associated with death ('what'), or the underlying cause of death ('why'). A multilayered approach for the analysis and classification of perinatal mortality is possible by using combinations of existing systems; for example the Wigglesworth or Nordic Baltic ('when'), ReCoDe ('what') and Tulip ('why') classification systems. This approach is useful not only for in depth analysis of perinatal mortality in the developed world but also for analysis of perinatal mortality in the developing countries, where resources to investigate death are often limited. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Introduction Drug cost is essential component of anaesthesia pharmacoeconomics. Recently pharmacoeconomics has emerged to measure, compare and evaluate cost of drug therapy to health system and decide which strategies produce best outcomes for resources allocated. The present study was planned to find utilization of intravenous anaesthetic agents in a tertiary care hospital and to find the pharmacoeconomics related to utilized and un-utilized drug data. Materials and methods Prospective observational study was conducted for 3 months and 200 cases were recorded undergoing surgical procedures under general anaesthesia only. Intravenous drugs were considered excluding inhalational anaesthetics. Data for drug utilized and un-utilized was collected. Cost estimation was done. Results Thiopentone sodium was frequently used intravenous inducing anaesthetic agent in 75% of patients. On average 6.5 drugs were prescribed per patient as pre-anaesthetic and intravenous inducing anaesthetic medications. 100% of drugs were prescribed by generic name, 92.30% were from National Essential Drug List. Amongst intravenous anaesthetic agents maximum wastage was associated with propofol of about 36.59% and in pre-anaesthetics, wastage was maximum for atropine 79% followed by glycopyrrolate 45.95%, pentazocine 45.95%. The cost of wasted drugs for study duration was 29.82% (Rs. 10,276.25) of the total cost of drugs was loaded (Rs.34458.84). Of this, the cost of wastage of vecuronium was maximum being 16.82% (Rs.1728) of the total cost wastage, followed by rocuronium 15.38% (Rs.1580.80), glycopyrrolate 15.22% (Rs.1564), and neostigmine 10.95% (Rs.1125.12). The cost of wasted drug per case was maximum for rocuronium being Rs.158.08 and least for ketamine Rs. 1.18. Conclusion There is need to formulate indicators for intravenous anaesthetic agents utilization. The most commonly prescribed drug glycopyrrolate is still not in National Essential Drug List. The judicious use of these drugs and appropriate measures can effectively decrease the cost in terms of un-utilized drugs.

Wastage is the term used to describe the phenomenon of the loss of racehorses from conception to adulthood due to death or injuries (i.e. they never reach a race-track), or the days lost by racehorses due to not training or being withdrawn from a race. This epizoological study was conducted to investigate wastage in Thoroughbred horses used for flat racing in the Gauteng Province of South Africa. Data from 6 racing stables were recorded from 1 March 1993 to 28 February 1994. Each trainer completed a daily training record of the horses in his stable. This questionnaire included reasons why a horse failed to train on a specific day, or was withdrawn from a race. During the year, 8480 days (8.1 %) of the 105 108 total potential training days were lost by horses in the stables investigated. Of the days lost, 72.1 % were due to lameness, 8.6 % to respiratory problems, and 19.3 % to other causes. The lost training days for the individual trainers ranged from 5.4 to 12.6 %. Of the 579 horses included in the study, 291 horses (50.3 %) lost one or more training days; 541 problems resulting in wastage were found in these 291 horses; 263 (48.6 %) cases were due to lameness and 49 (9.0 %) were caused by coughing. The balance were caused by poor weather conditions (11.3 %), vaccinations (7.2 %), wounds (4.6 %), abnormal haematology results (1.8 %), inappetence (2.2 %), nasal discharge (2.0 %), epistaxis (1.8 %), babesiosis (1.8 %), miscellaneous other conditions (7.9 %) and unknown causes (1.8 %). An attempt was made to continue the study for a 2nd year but too few questionnaires were returned. However, it was evident that the percentage of lost training days (8.2 %) was similar to that of the previous year. The training days lost due to lameness (66.9 %) and respiratory problems (8.4 %) were also similar to those of the previous year. From the findings of the present study, it was concluded that lameness and respiratory disorders were the major causes of wastage in Thoroughbred racehorses in Gauteng. Further research into these causes of wastage in racehorses is needed.