Fullercaspersen7603

The loads of biochemical oxygen demand (BOD) in the Chao Phraya River Basin (CPRB), Thailand were analyzed in terms of how they were generated (BODgen), stocked in the environment (BODen-stock), and discharged into the Chao Phraya River (BODCPR) using material flow analysis. BODgen from the industrial sector was the highest; however, BODen-stock and BODCPR from this point source were not significantly higher than those from the domestic sector. BODgen, BODen-stock, and BODCPR from swine farming and aquaculture across the river basin were lower than those from the domestic and industrial sectors. Of the total 251,884 tons per year (t/year) BODCPR, 49,614 t/year were in the upper river section, 35,976 t/year in the middle river section, and 166,294 t/year in the lower river section. These amounts were more than the carrying capacities of the relevant river sections (i.e., 7230 t/year, 18,380 t/year, and 37,851 t/year of the BOD loads for the upper, middle, and lower river sections, respectively). The first priority in BOD reduction in the CPRB should emphasize domestic wastewater by increasing wastewater treatment efficiency and onsite installations of wastewater treatment systems, while the second should be on paddy fields and other nonpoint sources. Specific best management practices may be considered, e.g., creating constructed wetlands or preserving riverbank vegetation as natural swales to alleviate BOD discharge from agricultural activities into water sources.In Pharmaceutical Freedom Professor Flanigan argues we ought to grant people self-medication rights for the same reasons we respect people's right to give (or refuse to give) informed consent to treatment. Cediranib purchase Despite being the most comprehensive argument in favour of self-medication written to date, Flanigan's Pharmaceutical Freedom leaves a number of questions unanswered, making it unclear how the safe-guards Flanigan incorporates to protect people from harming themselves would work in practice. In this paper, I extend Professor Flanigan's account by discussing a hypothetical case to illustrate how these safe-guards could work together to protect people from harms caused by their own ignorance or incompetence.Background Polypharmacy is prevalent among long-term care residents in Canada, with 48.4% receiving ten or more different medications and 40.7% chronically prescribed potentially inappropriate medications. Objective We implemented a pharmacist-administered deprescribing program in a long-term care facility to determine if the number of medications taken per resident could be reduced. Setting A long-term care facility in Newfoundland and Labrador, Canada from February 2017 to February 2018. Method Residents were randomized to receive either a deprescribing-focused medication review by a pharmacist or usual care. Main outcome measure Change in the number of medications at 3 and 6 months. Results Forty-five residents enrolled in the study (n = 22 intervention, n = 23 control). Seventy-eight deprescribing recommendations were made, and 85.1% were successfully implemented. The average number of medications taken by residents in the intervention group was 2.68 less than the control group (p less then 0.02; 95% CI - 4.284, - 1.071) at 3 months and 2.88 less (p = 0.02, 95% CI - 4.543, - 1.112) at 6 months. In 14.9% of cases, a medication had to be restarted after deprescribing was attempted because symptoms returned. Conclusion A pharmacist-led deprescribing intervention can reduce the number of unnecessary and potentially harmful medications taken by LTC residents.Background Medication errors are the most common types of medical errors that occur in health care organisations; however, these errors are largely underreported. Objective This study assessed knowledge on medication error reporting, perceived barriers to reporting medication errors, motivations for reporting medication errors and medication error reporting practices among various health care practitioners working at primary care clinics. Setting This study was conducted in 27 primary care clinics in Malaysia. Methods A self-administered survey was distributed to family medicine specialists, doctors, pharmacists, pharmacist assistants, nurses and assistant medical officers. Main outcome measures Health care practitioners' knowledge, perceived barriers and motivations for reporting medication errors. Results Of all respondents (N = 376), nurses represented 31.9% (n = 120), followed by doctors (n = 87, 23.1%), pharmacists (n = 63, 16.8%), assistant medical officers (n = 53, 14.1%), pharmacist assistants (n = 46Doctors and nurses indicated that they would report if they thought reporting could improve the current practices. Assistant medical officers reported that anonymous reporting would encourage them to submit a report. Pharmacists would report if they have enough time to do so. Conclusion Policy makers should consider using the information on identified barriers and facilitators to reporting medication errors in this study to improve the reporting system to reduce under-reported medication errors in primary care.Background With expansion of more advanced clinical roles for pharmacists we need to be mindful that the extent to which clinical pharmacy services are implemented varies from one country to another. To date no comprehensive assessment of number and types of services provided by either community or hospital pharmacies in Austria exists. Objective To analyse and describe the number and types of clinical pharmacy services provided in both community and hospital pharmacies, as well as the level of clinical pharmacy education of pharmacists across Austria. Setting Austrian community and hospital pharmacies. Method An electronic questionnaire to determine number and types of clinical pharmacy services provided was send to all chief pharmacists at all community (n = 1365) and hospital pharmacies (n = 40) across Austria. Besides current and future services provision, education and training provision were also assessed. Main outcome measure Extent of and attitude towards CPS in Austria. Results Response rates to the surveys were 19.