Kajian Penurunan Kehilangan Air di DMA Tamanan Perumda Tirta Dhaha Kota Kediri

Permasalahan umum yang paling sering terjadi pada penyediaan air minum adalah Air Tak Berekening (ATR) atau Non-Revenue Water (NRW). Penanggulangan besarnya nilai NRW perlu disesuaikan dengan jenis kehilangan air yang terjadi. Perumda Tirta Dhaha Kota Kediri membentuk District Meter Area (DMA) dalam upaya menekan tingkat kehilangan air. Pembentukan DMA ini merupakan program kemitraan yang difasilitasi oleh PERPAMSI. Hasil dari program kemitraan menyatakan NRW DMA Tamanan sebesar 51,40%. Akan tetapi angka tersebut masih sangat tinggi jika dibandingkan dengan target kehilangan air nasional rata-rata 20%. Penelitian ini mengidentifikasi penyebab kehilangan air dengan melakukan penyusunan penyebab kehilangan air dengan melakukan penyusunan neraca air pada software WB EasyCalc dan menentukan target dan strategi dalam menurunkan kehilangan air di DMA Tamanan dengan melakukan aspek teknis. Analisis aspek teknis berfokus pada tekanan dan kecepatan aliran disimulasikan dengan software EPANET 2.2. Hasil dari penelitian adalah kehilangan air DMA Tamanan pada bulan November 2022 sebesar 37% dan Desember 2022 sebesar 37,3%. Sehingga target penurunan kehilangan air di DMA Tamanan adalah 17,3% dalam kurun waktu 4 tahun. Strategi penurunan kehilangan air adalah manajemen tekanan dengan pengaturan jam operasional pompa dan pemasangan PRV. Selain itu, dilakukan penggantian meter air pelanggan. Hasil strategi adalah kehilangan air dapat turun menjadi 19,9%. Jumlah air yang dapat diselamatkan dengan adanya strategi Pengendalian adalah sebesar 20.147 m³ dengan keuntungan yang didapatkan Rp25.106.680

Pharmacists’ confidence when providing pharmaceutical care on anticoagulants, a multinational survey

Background: Guidelines on the management of orally anticoagulated patients are continuously evolving, leading to an increased need for pharmacists to be fully integrated in care provision.Objective: To identify self-reported gaps in confidence among practicing pharmacists in the area of anticoagulation. Setting Pharmacists in different work settings in different countries.Method: Cross-sectional international survey from October 2015 till November 2016 among pharmacists working in different settings to assess their level of confidence when delivering anticoagulants as well as to identify possible educational needs regarding this medication class. Validation of the survey was ensured.Results: Responses from 4212 pharmacists originating from 18 countries were obtained. Pharmacists’ level of confidence was significantly higher (p < 0.001) when advising patients on vitamin K antagonists (VKAs) versus non-vitamin K antagonists (NOACs). In general, hospital pharmacists displayed higher confidence levels compared to community pharmacists when advising patients on anticoagulation (p < 0.001). Two distinct patterns of confidence levels emerged relating to basic and advanced pharmaceutical care. Confidence levels when providing advanced pharmaceutical care were significantly higher for Oceania and lower for South America (p < 0.005).Conclusions: Pharmacists felt more confident in supporting patients receiving VKAs compared to the more recently introduced NOACs. With the increasing use of NOACs and the risks pertaining to anticoagulation therapy, it is essential to invest in education for pharmacists to address their knowledge gaps enabling them to confidently support patients receiving oral anticoagulants.The project was funded by the Davie-Ratnoff-Macfarlane (DRM) foundation.info:eu-repo/semantics/publishedVersio

Evaluation of medication safety assessment tools for pharmacist-led medication reviews: the Eastern European pilot project

Background: Pharmacist-led medication reviews (MR) are one of the key methods to support medication safety in polypharmacy patients. The aims of this study were to pilot MRs in Eastern European community pharmacies, describe medication use in polypharmacy patients, and evaluate the usability of medication safety assessment tools.Methods: The MR pilot was undertaken in Estonia, Latvia, Poland, Hungary, Romania, and Bulgaria. Patients who used at least five medicines were directed to the service by their GPs. Data on drug-related problems (DRPs) and adherence were collected by pharmacists through structured patient interviews. Databases for identification of potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) named Inxbase/Riskbase, as well as an integrated tool comprising potentially inappropriate medicines (PIMs) lists EU(7)-PIM and EURO-FORTA, were applied retroactively to the MR pilot data to investigate possibilities for their use and to describe medication use and potential risks in the study population.Results: A total of 318 patients were included in the study, 250 of them elderly (≥65 years). One hundred and eighty (56.6%) participants had a total of 504 pDDIs based on Inxbase analysis. On average, there were 1.6 pDDIs per participant. Twenty-five (5.0%) of the 504 pDDIs were in a high-risk category. A total of 279 (87.7%) participants had a potential ADR in at least one of 10 Riskbase categories. One hundred and fifty-four (20.8%) of the potential ADRs were in a high-risk category. Twenty-seven pDDIs and 68 ADRs documented as DRPs during the service were not included in the databases. Using the integrated EU(7)-PIM/EURO-FORTA PIM list, a total of 816 PIMs were found in 240 (96%) of the 250 elderly participants (on average 3.4 PIMs per elderly participant). Seventy-one (29.6%) of the participants were using high-risk PIMs. Twenty-one percent of high-risk PIMs and 13.8% of medium-risk PIMs were documented as DRPs by the pharmacists during the pilot.Conclusion: Medication safety assessment tools can be useful in guiding decision-making during MRs; however, these tools cannot replace patient interviews and monitoring. Tools that include a thorough explanation of the potential risks and are easy to use are more beneficial for MRs

Awareness campaigns of atrial fibrillation as an opportunity for early detection by pharmacists: an international cross-sectional study

Atrial fibrillation (AF) accounts for up to one third of strokes, one of the lead mortality causes worldwide. The European Society of Cardiology guidelines recommend opportunistic screening as a means to increase the odds of early detection and institution of appropriate treatment according to risk factors identified. However, in most countries there are various barriers to effective uptake of screening, including low awareness. The Atrial Fibrillation Association is a patient association engaged with raising awareness of AF. Establishing a partnership with the International Pharmacists for Anticoagulation Care Taskforce, we set as goals to test a model for raising awareness of AF involving pharmacists globally; and to identify barriers and enablers to its implementation. A cross-sectional study was conducted during the Arrhythmia Alliance World Heart Rhythm Week. Pharmacists from 10 countries invited individuals (≥ 40 years; without anticoagulation therapy of AF) to participate in the awareness campaign. Participants agreeing were engaged in the early detection of AF (EDAF) using pulse palpation. Individuals with rhythm discrepancies were referred and prospectively assessed to have information on the proportion of confirmed diagnosis, leading to estimate the detection rate. Interviews with country coordinators explored barriers and enablers to implementation. The study involved 4193 participants in the awareness campaign and 2762 in the EDAF event (mean age 65.3 ± 13.0), of whom 46.2% individuals were asymptomatic, recruited across 120 sites. Most common CHA2DS2-VASc risk factor was hypertension. Among 161 patients referred to physician, feedback was obtained for 32 cases, of whom 12 new arrhythmia diagnoses were confirmed (5 for AF, 2 for atrial flutter), all among elders (≥ 65 years). Qualitative evaluation suggested a local champion to enable pharmacists’ success; technology enhanced engagement amongst patients and increased pharmacists’ confidence in referring to physicians; interprofessional relationship was crucial in success. This study suggests pharmacists can contribute to greater outreach of awareness campaigns. Effective communication pathways for inter-professional collaboration were suggested enablers to gain full benefits of EDAF

Kajian Penurunan Kehilangan Air di DMA Tamanan Perumda Tirta Dhaha Kota Kediri

Permasalahan umum yang paling sering terjadi pada penyediaan air minum adalah Air Tidak Berekening (ATR) atau Non-Revenue Water (NRW). Penanggulangan besarnya nilai NRW perlu disesuaikan dengan jenis kehilangan air yang terjadi. Perumda Tirta Dhaha Kota Kediri membentuk District Meter Area (DMA) dalam upaya menekan tingkat kehilangan air. Pembentukan DMA ini merupakan program kemitraan yang difasilitasi oleh PERPAMSI. Hasil dari program kemitraan menyatakan bahwa DMA Tamanan Perumda Tirta Dhaha Kota Kediri adalah sebesar 51,40%. Akan tetapi angka tersebut masih sangat tinggi jika dibandingkan dengan target kehilangan air nasional rata-rata 20%. Tujuan dari penelitian ini adalah mengidentifikasi penyebab kehilangan air dengan melakukan penyusunan neraca air pada software WB EasyCalc dan menentukan target dan strategi komprehensif dalam menurunkan kehilangan air di DMA Tamanan dengan melakukan analisis aspek teknis. Analisis aspek teknis yang berfokus pada tekanan dan kecepatan aliran disimulasikan dengan software EPANET 2.2. Hasil dari penelitian ini adalah kehilangan air DMA Tamanan pada bulan November 2022 sebesar 37% dan bulan Desember 2022 sebesar 37,3%. Sehingga target pengendalian kehilangan air di DMA Tamanan adalah 17,3% dalam kurun waktu 4 tahun. Strategi penurunan kehilangan air adalah manajemen tekanan dengan pengaturan jam operasional pompa dan pemasangan PRV. Selain itu, dilakukan penggantian meter air pada pelanggan. Hasil strategi adalah kehilangan air dapat turun menjadi 19,9%. Jumlah air yang dapat diselamatkan dengan adanya strategi pengendalian adalah sebesar 20.147 m³ dengan keuntungan yang didapatkan Rp25.106.680. ============================================================================================================================= The most common general problem in drinking water supply is Non-Revenue Water (NRW). Countermeasures for the magnitude of the NRW value need to be adjusted to the type of water loss that occur. Perumda Tirta Dhaha, Kediri City, established District Meter Areas (DMA) to reduce the level of water loss. The formation of DMA is a partnership program facilitated by PERPAMSI. The results of the partnership program indicate that the NRW in DMA Tamanan, Perumda Tirta Dhaha, Kediri City, is 51,40%. However, this figure is still very high when compared to the national average water loss target of 20%. This research aims is to identify the causes of water loss by creating a water balance using WB EasyCalc software and determining comprehensive targets and strategies to reduce water loss in DMA Tamanan through a technical aspect analysis. The technical aspect analysis focuses on pressure and flow velocity is simulated with EPANET 2.2 software. The result of this study is water loss in DMA Tamanan was 37% in November 2022 and 37,3% in December 2022. Therefore, the target for water loss control in DMA Tamanan is 17,3% within 4-year period. The water loss reduction strategy involves pressure management through pump operational hours and installation of PRV. Additionally, water meters will be replaced for customers. The result of the strategy is a decrease in water loss to 19,9%. The amount of water that can be saved the control strategy is 20,147 m³ with a profit of IDR 25.106.680

Dosage form data used for estimating pediatric antibiotic use

We aimed to report a simple estimation method to enable quantification of pediatric antibiotic exposure in large aggregated datasets. Secondly, we aimed to quantify and benchmark Hungarian pediatric antibiotic use. First we intended to examine whether a correlation existed between dosage form data and the patient’s age. Therefore, issued prescriptions were analyzed in pharmacies. As a correlation was found between the share of liquid oral antibacterial products and the rate of pediatric antibiotic prescriptions (R=0.884; p<0.001), we extrapolated this finding to a large aggregated dataset and estimated that 34.6% of prescriptions were issued for pediatric cases (95% confidence interval: 19.7–60.0). Taking into account the demography of the population, children were exposed to antibiotics three times more often than adults with a corresponding annual prescription rate of 2.6. We demonstrated that simple drug-related data can be linked to a patient-related measure as we found strong associations between dosage form data and patients’ age. Based on this association, massive pediatric antibiotic exposure was found. Due to the general availability of dosage form data and the ease of the estimation method, the reported concept can be used to quantify pediatric antibiotic use in large aggregated datasets or when age stratification is absent