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Climate change threatens global biodiversity. Many species vulnerable to climate change are important to humans for nutritional, cultural, and economic reasons. Polar bears Ursus maritimus are threatened by sea‐ice loss and represent a subsistence resource for Indigenous people. We applied a novel population modeling‐management framework that is based on species life history and accounts for habitat loss to evaluate subsistence harvest for the Chukchi Sea (CS) polar bear subpopulation. Harvest strategies followed a state‐dependent approach under which new data were used to update the harvest on a predetermined management interval. We found that a harvest strategy with a starting total harvest rate of 2.7% (˜85 bears/yr at current abundance), a 2:1 male‐to‐female ratio, and a 10‐yr management interval would likely maintain subpopulation abundance above maximum net productivity level for the next 35 yr (approximately three polar bear generations), our primary criterion for sustainability. Plausible bounds on starting total harvest rate were 1.7–3.9%, where the range reflects uncertainty due to sampling variation, environmental variation, model selection, and differing levels of risk tolerance. The risk of undesired demographic outcomes (e.g., overharvest) was positively related to harvest rate, management interval, and projected declines in environmental carrying capacity; and negatively related to precision in population data. Results reflect several lines of evidence that the CS subpopulation has been productive in recent years, although it is uncertain how long this will last as sea‐ice loss continues. Our methods provide a template for balancing trade‐offs among protection, use, research investment, and other factors. Demographic risk assessment and state‐dependent management will become increasingly important for harvested species, like polar bears, that exhibit spatiotemporal variation in their response to climate change. [ABSTRACT FROM AUTHOR]

Background: Medication errors are a leading cause of harm to patients in hospital that can be decreased by electronic medication management systems. Aims: This study determined the effects of electronic prescribing using the Enterprise Patient Administration System (EPAS) on prescribing errors and adverse drug reaction (ADR) documentation in South Australian public hospitals. Methods: A prospective structured medication chart audit was conducted before (in 2012) and after the implementation (in Dec 2014) of EPAS, comparing the paper‐based National Inpatient Medication Chart (NIMC) with prescribing. All inpatients were eligible for inclusion in the study. Prescribing order errors were determined by the percentage of medication orders that had unclear, illegal or unsafe prescriptions. The quality of ADR documentation was assessed by the percentage of patients with correct documentation. Results: The total number of prescribing errors before and after the implementation of EPAS was 67.7 and 2.8 per 100 orders, respectively. The frequency of prescribing order errors due to unclear, illegal and unsafe prescriptions decreased to almost zero with EPAS. Prescriptions classified as unsafe due to incorrect dose, route of administration or dosing frequency decreased from 5.8% to 0.03% of medication orders before versus after EPAS implementation (p < 0.0001). Completed ADR documentation was similar between the paper‐based NIMC and EPAS, but the percentage of patients with ADR alerts who required them was 100% in EPAS compared with 27% on the NIMC (p < 0.0001). Conclusions: E‐prescribing using EPAS significantly decreased prescribing errors and increased ADR alerts. Continued implementation of electronic medication management systems is an important approach to improve medication safety. [ABSTRACT FROM AUTHOR]

Zolpidem is one of the most commonly used drugs for insomnia but it has been associated with adverse neuropsychiatric effects and complex sleep-related behaviours. In this report, the pharmacokinetics, pharmacodynamics and putative serious adverse drug reactions ( ADRs) to zolpidem are briefly described. Nine 'hypothesis generating' cases from a psychiatry practice are presented to suggest that in cytochrome P450 poor metabolisers, inhibitory metabolic drug-drug interactions and pharmacodynamic synergies with selective serotonin reuptake inhibitor/serotonin-noradrenaline reuptake inhibitor antidepressants may increase the risk of serious ADRs to zolpidem. [ABSTRACT FROM AUTHOR]

Due to variants in I CYP2D6 i , some patients are poor metabolisers (5-10%), have low CNS exposure to morphine, and are unlikely to benefit from or be harmed by codeine. Conversely, other patients are ultrarapid metabolisers of codeine (up to 10%), resulting in high and prolonged CNS exposure to morphine and an increased risk of CNS depression.[3] To reduce harm from opioids, we recommend testing for I CYP2D6 i variants as part of a benefit-risk assessment when prescribing codeine, especially for patients with other risk factors for opioid toxicity. [Extracted from the article]

The article discusses the paper "Paraoxonase-1 Is a Major Determinant of Clopidogrel Efficacy" by H. J. Bouman et al. In the article the author offers his opinions on several points which are raised in Bouman et al.'s article and on a debate on clopidogrel which developed between Bouman and other researchers after Bouman's article was published.

A letter to the editor is presented which is concerned with clinically relevant information on pharmacokinetic drug-drug interactions.

The author reflects on antiplatelet therapy with the drugs clopidogrel and aspirin which is used in patients who have undergone coronary artery stenting. He suggests that there is considerable inter-individual variability in platelet response to clopidogrel and that patients with a low response are at a significant risk of thromboembolic complications. He argues that additional research on the use of antiplatelet therapy is needed to discover more effective and safer drugs.