M. Masil. University of Cincinnati. 2019.

If you are involved purchase 2.5 mg amlodipine otc, how many years have you spent contributing Device to or assessing the security of medical devices? How familiar are you with your organization’s security practices in Device the development and/or use of medical devices? What best describes your organization’s role in development of Device medical devices for use by clinicians and/or patients? What type of medical devices does your organization design generic amlodipine 10 mg without prescription, Device develop and/or use? Please provide your response Device according to the proportion of medical devices by risk level amlodipine 5mg low cost. If your organization manufacturers medical devices, who is Device primarily responsible for their security? If your organization is a healthcare provider, who is primarily Device responsible for medical device security? Does your organization provide training/and or policies that defines the acceptable and secure use of medical devices in healthcare Device organizations? Do you feel empowered to raise concerns about the security of Device medical devices in your organization? How concerned are you about the security of medical devices designed or built by or for your organization for users of medical Device devices? How concerned are you that the medical device industry is not doing Device enough to protect patients/users of medical devices? How concerned are you that your security protocols cannot keep Device pace with changing medical device technologies? How concerned are you that your security protocols cannot keep Device pace with changing regulatory requirements? How concerned are you that hackers may target the devices Device designed and built by or for your organization? How confident are you that the security protocols or architecture built inside your organization’s devices adequately protects clinicians Device (users) and patients. How confident are you that you can detect security vulnerabilities Device in medical devices? Approximately, how many different types of medical devices or Device “products” are manufactured by your organization today? How likely is an attack on one or more medical devices built or in Device use by your organization over the next 12 months? How does the use of mobile devices affect the security risk posture Device of the healthcare organizations that use these devices? Has your organization been audited for compliance with medical Device device security standards? Does your organization disclose the privacy and security risks of Device its medical devices to clinicians and patients? Medical device security practices The following items are rated using a 10-point scale ranging from 1 = lowest to 10 = highest. On average, what percentage of medical devices is tested for Device security vulnerabilities? If your organization is a healthcare delivery organization, how Device often does it test medical devices? If your organization is a manufacturer, how often does it test released medical devices to find new or previously unidentified Device vulnerabilities? On average, what percentage of medical devices contains Device significant vulnerabilities? Where in the product development life cycle are medical devices Device tested for security vulnerabilities? Do you have an incident response plan in place in the event of an Device attack on vulnerable medical devices? What do you see as the main reason(s) why your organization’s Device medical devices contain vulnerable code? Are you aware of any adverse events or harms to patients because of an insecure medical device either developed by or deployed Device within your organization? If yes, does your organization use key management systems on Device encrypted traffic among IoT devices? Approximately, how much does your organization spend on medical device security each year? Please choose the range that best approximates the total investment in terms of technologies, personnel, Device managed or outsourced services and other cash outlays. Would any of the following factors influence your organization to Device increase the budget? Check the Primary Person you or your supervisor reports to within Device the organization. Our mission is to conduct high quality, empirical studies on critical issues affecting the management and security of sensitive information about people and organizations. As a member of the Insights Association, we uphold strict data confidentiality, privacy and ethical research standards. We do not collect any personally identifiable information from individuals (or company identifiable information in our business research). Furthermore, we have strict quality standards to ensure that subjects are not asked extraneous, irrelevant or improper questions. This leafet explains in more detail what ‘unlicensed’ and ‘off- label’ mean and why some medicines are used in this way. They can come as tablets, capsules, liquids, injections, inhalers, creams, eye drops/ointments, suppositories, and patches. The licence will state which illness or condition the medicine can be used for; the age of patients it can be given to; how much to give and how to give it. To get a licence, the drug company must prove that the drug works for the illness or condition to be treated and is safe. They do this by trying it frst in clinical trials, usually in adults aged 18-65 years. The drug company cannot advertise or make any recommendations about using a medicine outside the terms of its licence. This means that once a drug is on the market, the company may decide not to try getting the original licence extended if it is found to treat other symptoms. Some examples of “off-label” uses are: • Using a medicine for a different illness to that stated in the licence. Doctors may have found that the medicine works very well for this illness or condition. This use may be supported by expert groups, but the drug manufacturer has not extended the licence. This is usually as a specially- prepared liquid for someone who has diffculty swallowing the licensed tablets. The manufacturer may have decided that it was too expensive to carry out the clinical trials or it would be diffcult to fnd enough patients for the clinical trials needed to get a licence. Unlicensed and “off-label” medicines are only prescribed after careful consideration of other options available. Your doctors will have read information from medical publications supporting its use, and may have taken advice from other experts. An unlicensed or “off-label” medicine will only be used if it is the most appropriate medicine for you and your illness or condition. Your doctor or pharmacist will tell you that the medicine is not licensed or is being used outside of its license. The leafet that comes with the medicine may not say anything about how you should use it, or may say that the medicine is not suitable for being used in the way we are prescribing it. This does not mean that it cannot be used safely to treat your condition – it means that the drug company does not have a licence for using it in this way and so is not allowed to recommend this use. Sometimes it will take longer for the pharmacist to get you a supply of an unlicensed medicine. This means that you will need to also allow one or two weeks for them to get you further supplies of your medicine. If you need any further information about your medicine, please contact the Pharmacy Medicines Information department, at the John Radcliffe Hospital: Thel: 01865 228 906 (9. Chapter 5: Drug or alcohol misuse or dependence ‘Controlled drinking’ defned Chapter 6: Visual disorders No amendments. Information about the environment is via the visual and auditory senses and is acted on by many cognitive processes (including short-and long-term memory, and judgement) to effect decisions for the driving task in hand.

The tenets of this of stock movements purchase amlodipine 10 mg overnight delivery, and the management of secu- chapter amlodipine 5mg low price, therefore generic 5mg amlodipine with amex, apply to stores operating in either the rity—should be maintained. Medical stores management should assist both the fow • Staf should be appropriately qualifed, trained, dis- and reliability of supplies from source to user as economi- ciplined, and rewarded. This • To promote efciency, staf should have good work- materials management process is implemented through ing conditions and facilities. Consequently, it tication of medical stores varies widely, and each store provides essential information for procurement manage- approaches its system and documentation diferently. Warehouse management comprises the physical Therefore, the basic features presented in this chapter are movement of stock into, through, and out of a medical adaptable, depending on the complexity of the medical store warehouse. A warehouse management system monitors the physi- cal fow of goods within the system, such as receipts, The goals of medical stores management are to protect storage, and issues. A performance monitoring system checks that the sys- manage the reliable movement of supplies from source to tems are operating efectively. Efective management of information is the key to achieving these Information is essential to management (see Chapter goals. A fully developed system has three key components— tion may seem costly, but the cost of developing and main- taining an information system should be balanced against 1. An inventory control system ensures that the right the costs of inefective inventory control (see Chapter 23). Even with a computerized system, data must be entered, manipulated, and interpreted by skilled and Manual versus computerized systems knowledgeable staf. The information system must include data on products Procurement information entering and leaving the warehouse, products in stock, products on order, and ways to monitor the progress of The procurement process (Chapters 18–21) involves medi- orders in the supply pipeline. Key elements of the system are cal stores input at all levels of the distribution system. These well-designed forms, computerized information systems, inputs are described below. Procurement can be handled from a department within Two decades ago, most public supply systems relied the medical stores or from an external unit. The medical completely on manual stock records, but now, many pro- stores unit provides the (internal or external) procurement grams have changed to computerized systems. Even with unit with a list of the types and quantities of medicines computerization, however, many countries still maintain needed for its operation. Afer a supplier is selected and a a manual system, such as bin cards, as a backup, espe- purchase order is placed, the procurement unit informs the cially during the transition to computerization. There is a medical stores unit about suppliers, unit prices, the quanti- widely held belief that computerization solves the problem ties on order, the expected arrival dates of shipments, and of inventory control. Both manual status, new shipments received and taken into stock, issues and computerized systems perform the same fundamental made to health facilities, expired medicines, damaged medi- information-processing tasks: data input, data storage, data cines, and audit data from physical stock checks. Many utes medicines and supplies to the two regional medical functions that could have been handled by the system stores, all district hospitals, and local hospitals and clinics were done manually or with spreadsheets. Moreover, in the surrounding regions, while the regional stores and management personnel reported that they did not have district hospitals are responsible for distributing to other enough time to acquire the additional skills that would facilities within their geographic jurisdictions. Because the regional stores and stock records and use the computerized inventory con- health facilities had no efective systems for deciding trol system to their best advantage. If the shipment is satisfactory, the receiving cifc products, and how budget allocations are used. This report brings the procurement lead-time monitored until it is received at the central medical stores period to an end. A good monitoring system makes it possible to Individual health facilities are the end users of medi- estimate realistic delivery times and to decide whether any cal supplies. Maintaining information from health facili- supplementary or emergency orders are needed, well before ties is essential in order to monitor consumption, forecast a stockout occurs. Many medical stores information systems milestones during the lead-time period to facilitate com- also keep general information on facility location, facility munication with suppliers and to prompt corrective action status, population served, method of distribution, delivery if required. Important milestones of the procurement lead schedule, value of issues, and extent of current budget uti- time are— lization. Stock records are a vital source of information on how efectively the dis- An efective supplier information system should include tribution system is being managed; therefore, maintain- general information on suppliers and products, lead times, ing these records accurately and keeping them up-to-date merit ratings, value of purchases, product quality, payment is vital. They provide detailed evidence of how prod- methods, and prequalifcation based on good manufac- ucts fow through the system and can be used to identify turing practices. Information about supplier performance where problems are occurring so that corrective action should be compiled throughout the procurement cycle to can be taken. Chapter 21 discusses at two critical levels: from the supplier to the store, or the features of a procurement information system in more “upstream,” and from the store to clients, or “downstream. Upstream information includes lead-time from supplier to the store, number of medicines procured, and monthly Stock records stock status reports. At the downstream level, the store should collect routine lead-time information; distribution Stock records contain information about suppliers, custom- information by facility, district, and product; client sat- ers, prices, stock receipts, stock issues, stock losses, and stock isfaction and consumption data; and order-fll rate. The medical stores A stock record (manual or computerized) must be main- should prepare regular reports on stock and order status, tained for each item in the inventory. The stock record docu- such as those described in Chapter 23, and send them ments all transactions relating to an item. It may contain to relevant parties such as the ministry of health, pub- information about reorder level, reorder interval, reorder lic health programs, donors, lower-level warehouses, and quantity, lead time, stock on order, and estimated consump- health facilities. Many stores also maintain bin cards for each prod- uct in each storage area to record information on issues, Communications receipts, and stock balances. In some stores, this bin card is the most current and accurate record of inventory move- The medical stores must maintain efective communica- ment. Periodic the design, selection, and use of diferent types of inventory meetings with the staf members of client facilities can help control systems, see Chapter 23; examples of a stock record ensure good communications and a more efective supply card and a bin card are provided in Annexes 44-1 and 44-2. Order assembly: Individual orders are assembled and Examples of monitoring and evaluation checked in the packing area. Dispatch and delivery: The packed goods are held • Number of sites to which medicines are in designated secure areas pending shipment, then distributed loaded onto the transport and dispatched, accom- • Quarterly report delivered on time panied by the necessary documentation, including a • Payment voucher processing time packing list recording all items and quantities. Ideally, • Number of patients receiving treatment an invoice showing unit costs of medicines and total • Percentage of medicines that are wasted (as value should accompany the shipment. Signed delivery a result of breakages, expiries, pilferage) as a notes are checked when the vehicle returns. If errors proportion of overall stocks or damage have been reported, appropriate action is • Time elapsed from order receipt by store until taken. Port • Percentage of cost savings as a result of price clearing may, however, be contracted to a clearing agent or negotiations made the responsibility of the supplier. With the exception of locally purchased items, multiple Stock, and the information that accompanies it, should fow copies of the supplier’s shipping documents and supplier’s through the warehouse in an orderly manner. This information is recorded on a man- ual or computerized form to track each purchase order. Receiving: Goods that arrive in the receiving room are addition, the import unit should record the arrival informa- quarantined, inspected, and if found to be acceptable, tion. This advisory is clipped to the purchase order in the entered into the stock-recording system. Storage: Accepted goods are moved to their allocated the necessary customs forms are completed. Records for stocks on hand and on Containers are inspected against the supplier’s shipping order are adjusted. Any apparent damage and missing shipping determines whether to allocate the complete quantities cases are noted and reported to the port authorities, insur- requested when a requisition is received. Workers use this list to identify and col- predefned criteria is essential to quality assurance and as a 44. The annotated invoice is signed and dated by a senior staf In addition, managing these “strategic” stocks can be chal- member. Observations are summarized on the second part lenging; for example, in the case of what to do with “dead” of the receiving report. Stores, therefore, need to work One copy of the receiving report is fled according to the carefully with their clients to communicate about scale-up purchase order number to which it corresponds. The other of initiatives such as antiretroviral therapy and distribu- copy and the annotated supplier’s invoice are passed to the tion of bed nets to prevent malaria that will afect space and stock control section. In some warehouses, a separate copy distribution planning and to develop policies on managing goes to the accounting department. The new stock on hand and on order Stock storage totals are calculated, as well as the average cost per unit for each item.

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