The aim of this study was to evaluate the clinical, economic, and organizational impact of clinical pharmacist services added to an adult orthopedic and trauma surgery unit in a university hospital.Methods: This was a prospective, observational study performed from January to February 2017. All pharmacists' interventions were documented, and their clinical, economic, and organizational impact and the probability of adverse drug events (ADEs) were assessed using the clinical, economic and organizational scale three-dimensional scale. An expert panel composed of three clinical pharmacists, one surgeon and one anesthetist classified the pharmacist intervention. The potential clinical impact was determined through a consensus by the expert panel. Cost avoidance was calculated for serious ADEs with a major impact by avoiding an additional cost of €4912 per event and taking into account the probability of ADE occurrence. Results:The pharmacists performed 1014 interventions for 28 days with a 95.3% acceptance rate by prescribers. Thirty-nine interventions were rated to have a major clinical impact (3.8%). The organizational impact was estimated favorable for 856 (84.4%) pharmacist interventions. Cost avoidance was estimated at €24,364, and the indirect costs benefit was estimated at €11,864 during the study. The cost-benefit ratio of the clinical pharmacist intervention was €1.94 in savings for every €1 invested.Conclusions: Clinical pharmacist services in an orthopedic and trauma surgery department have the potential to improve patient outcomes and avoid healthcare costs. Furthermore, the presence of a pharmacist in surgical units allows for communication between the unit and the pharmacy, which produces better fluidity and improves the quality of care.

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All extant toothed whales (Cetacea, Odontoceti) are aquatic mammals with homodont dentitions. Fossil evidence from the late Oligocene suggests a greater diversity of tooth forms among odontocetes, including heterodont species with a variety of tooth shapes and orientations. A new fossil dolphin from the late Oligocene of New Zealand, Nihohae matakoi gen. et sp. nov., consisting of a near complete skull, earbones, dentition and some postcranial material, represents this diverse dentition. Several preserved teeth are horizontally procumbent, including all incisors and canines. These tusk-like teeth suggest adaptive advantages for horizontally procumbent teeth in basal dolphins. Phylogenetic analysis places Nihohae among the poorly constrained basal waipatiid group, many with similarly procumbent teeth. Features of N. matakoi such as its dorsoventrally flattened and long rostrum, long mandibular symphysis, unfused cervical vertebrae, lack of attritional or occlusal wear on the teeth and thin enamel cover suggest the rostrum and horizontally procumbent teeth were used to injure and stun prey though swift lateral head movements, a feeding mode that did not persist in extant odontocetes.

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