Precision livestock farming (PLF) is the management of livestock using the principles and technology of process engineering. Key to PLF is the dense monitoring of variegated parameters, including animal growth, output of produce (e.g. milk, eggs), diseases, animal behaviour, and the physical environment (e.g. thermal micro-environment, ammonia emissions). While its proponents consider PLF a win-win strategy that combines production efficiency with sustainability goals and animal welfare, critics emphasise, inter alia, the potential interruption of human-animal relationships. This paper discusses the notion that the objectification of animals by PLF influences the developmental pathways of conventional industrial farming. We conduct a conceptual analysis of objectification by comparing discussions in feminist ethics and animal ethics. We find that in animal ethics, objectification includes deontological arguments regarding instrumentalisation, de-animalisation, alienation, commodification and quantification of animals. The focus on socio-political context and relationality connects these debates to central ideas in care ethics. We adopt a care ethics perspective to assess the implications of the objectification of animals in livestock farming. The basic claim is that sensory knowledge symbolised by the farmers' unity of hand, head and heart would make it harder to objectify animals than abstract and instrumental reasoning where the pursuit of knowledge is intertwined with the pursuit of control, as in mainstream PLF. Despite of what can be considered as a good caring relationship between farmers and animals that is mediated by PLF, people involved in conventional industrial farming still seem to become further detached from farmers and animals, because the PLF system itself is objectifying. PLF redefines the notion of care, in terms of data transparency, standardisation of methods for analysis, real-time collection and processing of data, remote control, and the use of digital platforms. This creates new expectations and requires a redistribution of responsibilities within a wider scope of relations in the value chain.

AIMThe P-REVIEW study was a prospective, multicenter, open intervention study, designed to determine whether a multifaceted intervention of educating the prescriber combined with medication review and pharmaceutical visits to the ward by the hospital pharmacist could lead to a reduction in drug-related complications among surgical patients. METHODSA total of 6780 admissions of 5940 patients to surgical, urological and orthopaedic wards during the usual care period and 6484 admissions of 5711 patients during the intervention period were included. An educational programme covering pain management, antithrombotics, fluid and electrolyte management, prescription in case of renal insufficiency and antibiotics was developed. National and local hospital guidelines were included. Hospital pharmacists performed medication safety consultations, combining medication review of high-risk patients and a visit to the physician on the ward. RESULTSA significantly lower proportion of admissions with one or more clinically relevant, potentially preventable, drug-related problems (including death, temporary or sustained disability, increased length of hospital stay or readmission within 30 days) occurred in the intervention period (1.1% (73/6484) compared to the usual care period [1.6% (106/6780)] (P = 0.029). The relative risk (RR) was 0.72 (95% CI 0.53-0.97). Several types of drug-related problems occurred less frequently. Costs incurred as result of time spent on study-related activities were not different before and after the intervention. CONCLUSIONSThe P-REVIEW study shows that education and support of the prescribing physician with respect to high-risk patients in surgical departments leads to a significant, clinically relevant benefit for patients without generating additional costs. British Journal of Clinical PharmacologyBr J Clin Pharmacol (2017) 83 664-677 664

Although firm evidence is lacking, metamizole may be safer for the upper intestinal tract and kidneys than other NSAIDs, and could alternatively be used in patients with an increased risk for stomach or renal problems. Hereby, improved postoperative pain relief can potentially be achieved. The risk for metamizole-induced agranulocytosis is judged to be acceptable.

BackgroundRisk stratification of hospital patients for adverse drug events would enable targeting patients who may benefit from interventions aimed at reducing drug-related morbidity. It would support clinicians and hospital pharmacists in selecting patients to deliver a more efficient health care service. This study aimed to develop a prediction model that helps to identify patients on the day of hospital admission who are at increased risk of developing a clinically relevant, preventable adverse drug event during their stay on a surgical ward.MethodsData of the pre-intervention measurement period of the P-REVIEW study were used. This study was designed to assess the impact of a multifaceted educational intervention on clinically relevant, preventable adverse drug events in surgical patients. Thirty-nine variables were evaluated in a univariate and multivariate logistic regression analysis, respectively. Model performance was expressed in the Area Under the Receiver Operating Characteristics. Bootstrapping was used for model validation.Results6780 admissions of patients at surgical wards were included during the pre-intervention period of the PREVIEW trial. 102 patients experienced a clinically relevant, adverse drug event during their hospital stay. The prediction model comprised five variables: age, number of biochemical tests ordered, heparin/LMWH in therapeutic dose, use of opioids, and use of cardiovascular drugs. The AUROC was 0.86 (95% CI 0.83–0.88). The model had a sensitivity of 80.4% and a specificity of 73.4%. The positive and negative predictive values were 4.5% and 99.6%, respectively. Bootstrapping generated parameters in the same boundaries.ConclusionsThe combined use of a limited set of easily ascertainable patient characteristics can help physicians and pharmacists to identify, at the time of admission, surgical patients who are at increased risk of developing ADEs during their hospital stay. This may serve as a basis for taking extra precautions to ensure medication safety in those patients.

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