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Background Older patients are at risk of drug related problems (DRPs), potentially leading to emergency department (ED) visits. Identifying DRPs with medication reviews is typically evaluated in restrictive clinical studies and not in a ‘real-world’ setting with organizational challenges and time-pressure. This study aims to assess the number of DRPs at the ED in older patients living with frailty, and to determine the acceptance rate of medication recommendations among physicians and the general practitioner. Additionally, practical recommendations are provided for implementing a medication review program. Methods A retrospective observational study was performed in patients ≥ 70 years living with frailty who visited the ED at Tergooi Medical Center. Medication reviews were conducted to identify and classify DRPs as part of a larger geriatric assessment. Also, the acceptance rate of given recommendations was assessed. Results A total of 356 ED visits were included. The mean age of patients was 83 years. About 76% of patients had at least one DRP. In total, 548 DRPs were identified with a mean of 1.5 DRP per patient. The acceptance rate of medication recommendations in admitted patients was 55%, and 32% among general practitioners/elderly care specialists in discharged patients. Conclusions Our results show that medication reviews lead to better assessment of DRPs at the ED. The acceptance rate was substantially higher in admitted patients compared to discharged patients. Results of our study reflect the real-life setting of conducting medication reviews at the ED for older patients living with frailty.

In this article we provide an overview of the current treatment recommendations for COVID-19. These recommendations are made by the SWAB (StichtingWerkgroepAntibioticabeleid), in cooperation with the FMS (FederatieMedischSpecialisten (online: swab.nl/nl/covid-19.). Treatment options for patients in both ambulatory care and admitted to the hospital are listed. These treatment options include both antiinflammatory and antiviral therapy.

Objective: Evaluation of the implementation of a new guideline for diagnosis and treatment of women with pregnancy of unknown location (PUL) or ectopic pregnancy (EP). Design: Multicenter retrospective cohort study Setting: Six hospitals in the Northern part of the Netherlands Population and methods: Women above 18-years old with a final diagnosis of PUL or EP between January 2012 to April 2020. Main outcome measures: Diagnostic findings, type of treatment and outcomes, before and after implementation of the guideline. User interpretation of the guidelines. Results: 1306 women with PUL or EP were included. The amount of women diagnosed with PUL has significantly increased between the guideline cohorts (28.4%;174/693 versus 16.6%;115/613 P

Day-to-day variations in surface air temperature affect society in many ways, but daily surface air temperature measurements are not available everywhere. Therefore, a global daily picture cannot be achieved with measurements made in situ alone and needs to incorporate estimates from satellite retrievals. This article presents the science developed in the EU Horizon 2020–funded EUSTACE project (2015–19, www.eustaceproject.org) to produce global and European multidecadal ensembles of daily analyses of surface air temperature complementary to those from dynamical reanalyses, integrating different ground-based and satellite-borne data types. Relationships between surface air temperature measurements and satellite-based estimates of surface skin temperature over all surfaces of Earth (land, ocean, ice, and lakes) are quantified. Information contained in the satellite retrievals then helps to estimate air temperature and create global fields in the past, using statistical models of how surface air temperature varies in a connected way from place to place; this needs efficient statistical analysis methods to cope with the considerable data volumes. Daily fields are presented as ensembles to enable propagation of uncertainties through applications. Estimated temperatures and their uncertainties are evaluated against independent measurements and other surface temperature datasets. Achievements in the EUSTACE project have also included fundamental preparatory work useful to others, for example, gathering user requirements, identifying inhomogeneities in daily surface air temperature measurement series from weather stations, carefully quantifying uncertainties in satellite skin and air temperature estimates, exploring the interaction between air temperature and lakes, developing statistical models relevant to non-Gaussian variables, and methods for efficient computation.

Reducing natural hazard risks and adapting to climate change are ever more important policy goals. Sound climate risk management will lessen the impacts of disaster risks and contribute to boosting resilience. Climate change adaptation and disaster risk reduction have to some extent been mainstreamed into international and national policies but it is important to ensure that the resulting efforts are consistent and mutually supportive. The EEA report »Climate change adaptation and disaster risk reduction in Europe: enhancing coherence of the knowledge base, policies and practices« identifies several ways how the coherence between CCA and DRR can be promoted.

Reducing disaster risks and adapting to climate change are ever more important policy goals in Europe and worldwide. The commitment to the 2030 Agenda for Sustainable Development and complementary multilateral frameworks, including the Sendai Framework for Disaster Risk Reduction 2015–2030 and the Paris Agreement on Climate Change, has galvanized pursuits for policy coherence. The report Climate change adaptation and disaster risk reduction in Europe: enhancing coherence of the knowledge base, policies and practices of the European Environment Agency identified several ways for how coherence and resilience can be built through knowledge sharing, collaboration and investments.

To determine the thromboprophylactic treatment pattern and occurrence of venous thromboembolism (VTE), major bleeding, and wound infections in patients undergoing total knee replacement (TKR) or total hip replacement (THR).From the PHARMO database, all patients ≥ 18 years hospitalized for TKR or THR between January 2003 and September 2008 were selected. Patients with pharmacy data up to 3 months after hospitalization were included in the study cohort. Duration and type of thromboprophylaxis were assessed. VTE, major bleeding, and wound infections were identified by hospitalizations. Regarding VTE, timing of event in relation to thromboprophylaxis was determined.The study population included 2930 patients with TKR, 5332 patients with THR without hip fracture, and 289 patients with THR and hip fracture. Mean duration of thromboprophylaxis was about 30 (± 20) days for all procedures, with low-molecular-weight heparin being the most frequently used drug. During 3 months of follow-up, 1% to 2% of patients were hospitalized for an event. The most observed event was wound infection (58%), followed by major bleeding (29%), and VTE (13%). For wound infection and major bleeding, median time after surgery was about 19 days. Median time between surgery and VTE was 24 days for TKR and 60 days for THR. Eighteen of 23 VTE occurred during thromboprophylaxis.Although patients are often treated for fewer days than recommended, thromboprophylaxis after TKR and THR in the Netherlands is adequate. Only 5 of 23 VTE hospitalizations occurred off-treatment and might have been prevented. Furthermore, fewer than 1% of patients were hospitalized for bleeding.

The European Commission is funding the ENSEMBLES project, which aims to provide policy makers with information from the latest climate modeling, analyses, and scenarios. Currently, the most comprehensive estimates of climate change are made using general circulation models (GCMs) and Earth system models, but these have been used mostly to simulate futures that do not factor in climate mitigation policy. The results of these simulations typically show global average warming greatly exceeding the European Union (EU) climate policy target of 2°C above preindustrial levels, with associated large impacts on human and natural systems. To date, simple climate models typically have been used to assess the emissions trajectories that are required for meeting this target. The ENSEMBLES project is the first international multiclimate model intercomparison using a politically relevant aggressive mitigation scenario, referred to as E1 (Figures 1a and 1b). This scenario leads to a peak in the carbon dioxide (CO2) equivalent concentration in the atmosphere at around 535 parts per million (ppm) in 2045 before eventually stabilizing at around 450 ppm during the 22nd century. The climate models used are generally improved or extended versions of models contributing to the Intergovernmental Panel on Climate Change's (IPCC) Fourth Assessment Report.

In this article we provide an overview of the current treatment recommendations for COVID-19. These recommendations are made by the SWAB (StichtingWerkgroepAntibioticabeleid), in cooperation with the FMS (FederatieMedischSpecialisten (online: swab.nl/nl/covid-19.). Treatment options for patients in both ambulatory care and admitted to the hospital are listed. These treatment options include both antiinflammatory and antiviral therapy.