Recycling unused medications in hospitals is financially viable and good for the environment.

OBJECTIVES: Considerable pharmaceutical waste is generated in hospital settings which can be reduced by recycling of unused medications. We sought to determine the recycling practices as well as quantify the volume and the value of oral solid medications returned from nursing units to the pharmacy departments at three urban hospitals. METHODS: Unused oral solid medications were recycled at three sites and the net financial impact of this practice was calculated (cost recovered - labour costs). The results were extrapolated to all 21 hospitals within the health system. KEY FINDINGS: Recycling medications in 21 hospitals could divert ~461 000 units of medication from the incinerator, with an estimated net value of ~$415 000 per year. CONCLUSIONS: Recycling unused medications could save substantial amounts of money and reduce negative environmental impacts from disposal/incineration.

Evaluation of Online Written Medication Educational Resources for People Living With Heart Failure.

Background: Patient educational resources on heart failure (HF) medications may improve patient understanding, which is critical for informed decision-making and patient self-efficacy. The purpose of our study was to evaluate the quality and readability of written medication educational resources available online. Methods: Two investigators searched Google, Yahoo, and Bing for written patient educational resources that addressed at least one HF medication. We assessed educational quality using the Ensuring Quality Information for Patients (EQIP) tool (range 0 [worst] to 100 [best]), and we evaluated readability using the Flesch-Kincaid Grade Level. Results: From 693 identified webpages, 39 HF medication educational resources met study eligibility. Among included resources, the median Ensuring Quality Information for Patients score was 61% (interquartile range 54%-68%), with 2 (5%) rated as high quality (score ≥ 75%). The median Flesch-Kincaid Grade Level was 8 (interquartile range 8-12), with 4 (10%) resources meeting the recommended 6th-grade reading level. Conclusions: Most HF medication educational resources available on the Internet are of acceptable educational quality, but could readily be improved. Most resources were beyond the recommended reading grade level for educational resources, limiting their utility for patients with a low literacy level.

Contexte: Les ressources éducatives destinées aux patients au sujet des médicaments contre l'insuffisance cardiaque (IC) pourraient améliorer la compréhension des patients, ce qui est essentiel pour la prise de décisions éclairées et pour le sentiment d'autoefficacité des patients. L'objectif de notre étude était d'évaluer la qualité et la lisibilité des ressources médicales éducatives écrites en ligne. Méthodologie: Deux membres de l'équipe de recherche ont utilisé Google, Yahoo et Bing pour repérer les ressources éducatives écrites destinées aux patients et portant sur au moins un médicament contre l'IC. La qualité éducative des ressources a été évaluée avec l'outil « Ensuring Quality Information for Patients ¼ (EQIP), qui fournit avec un score allant de 0 (pire) à 100 (meilleur), et la lisibilité a été évaluée avec le test « Flesch-Kincaid Grade Level ¼. Résultats: Sur 693 pages Web repérées, 39 ressources éducatives sur les médicaments contre l'IC répondaient aux critères de notre étude. Pour les ressources évaluées, le score médian sur l'échelle EQIP était de 61 % (intervalle interquartile de 54 % à 68 %), et deux d'entre elles (5 %) ont obtenu un score indiquant une qualité élevée (score ≥ 75 %). Le résultat médian au test Flesch-Kincaid Grade Level était de 8 années de scolarité (intervalle interquartile de 8 à 12), et quatre ressources (10 %) respectaient le niveau de lecture recommandé, qui correspond à une 6e année de scolarité. Conclusions: La plupart des ressources éducatives en ligne sur les médicaments contre l'IC sont d'une qualité éducative acceptable, mais des améliorations sont possibles. La plupart des ressources corres-pondent à un niveau de lecture plus élevé que ce qui est recommandé pour la rédaction de ressources éducatives, ce qui limite leur utilité pour les patients qui ont un faible niveau de littératie.

Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process.

Background: Transitions of care represent a vulnerable time for patients where unintended therapeutic changes are common and inadequate communication of information frequently results in medication errors. Pharmacists have a large impact on the success of patients during these care transitions; however, their role and experiences are largely absent from the literature. Objectives: The purpose of this study was to gain a greater understanding of British Columbian hospital pharmacists' perceptions of the hospital discharge process and their role in it. Methods: A qualitative study utilizing focus groups and key informant interviews of British Columbian hospital pharmacists was conducted from April to May 2021. Questions asked during interviews were developed following a detailed literature search and included questions regarding the use of frequently studied interventions. Interview sessions were transcribed and then thematically analyzed using both NVivo software and manual coding. Results: Three focus groups with a total of 20 participants and one key informant interview were conducted. Six themes were identified through data analysis: (1) overall perspectives; (2) important roles of pharmacists in discharges; (3) patient education; (4) barriers to optimal discharges; (5) solutions to current barriers; and (6) prioritization. Conclusions and Relevance: Pharmacists play a vital role in patient discharges but due to limited resources and inadequate staffing models, they are often unable to be optimally involved. Understanding the thoughts and perceptions of pharmacists on the discharge process can help us better allocate limited resources to ensure patients receive optimal care.

Selective Inhibition of the Lactate Transporter MCT4 Reduces Growth of Invasive Bladder Cancer.

The significance of lactate transporters has been recognized in various cancer types, but their role in urothelial carcinoma remains mostly unknown. The aim of this study was to investigate the functional importance of the monocarboxylate transporter (MCT) 4 in preclinical models of urothelial carcinoma and to assess its relevance in patient tumors. The association of MCT4 expression with molecular subtypes and outcome was determined in The Cancer Genome Atlas (TCGA) cohort and two independent cohorts of patients with urothelial carcinoma. Silencing of MCT4 was performed using siRNAs in urothelial carcinoma cell lines. Effects of MCT4 inhibition on cell growth, apoptosis, and production of reactive oxygen species (ROS) were assessed. Moreover, effects on lactate efflux were determined. The in vivo effects of MCT4 silencing were assessed in an orthotopic xenograft model. MCT4 expression was higher in the basal subtype. Decreased MCT4 methylation and increased RNA and protein expression were associated with worse overall survival (OS). Inhibition of MCT4 led to a reduction in cell growth, induction of apoptosis, and an increased synthesis of ROS. MCT4 inhibition resulted in intracellular accumulation of lactate. In vivo, stable knockdown of MCT4 reduced tumor growth. The expression of MCT4 in urothelial carcinoma is associated with features of aggressive tumor biology and portends a poor prognosis. Inhibition of MCT4 results in decreased tumor growth in vitro and in vivo Targeting lactate metabolism via MCT4 therefore provides a promising therapeutic approach for invasive urothelial carcinoma, especially in the basal subtype.