Healthcare procurement in the race to net-zero: Practical steps for healthcare leadership.

Although it is challenging to assess the greenhouse gas emission footprint associated with individual products and services, health leaders can play a pivotal role in emissions reduction by understanding and utilizing available tools and certifications that measure suppliers' operational environmental performance. Integrating environmental standards into procurement and supplier selection has the potential to greatly impact emissions production across the healthcare landscape as it will pressure suppliers to improve their operations in order to be selected. The purpose of this article is to emphasize the importance of the supply chain in addressing healthcare-related greenhouse gas emissions. We provide an overview of the types of tools available that can be used to evaluate the carbon footprints of individual companies and rate their performances, as well as certifications that formally recognize companies' sustainability practices and commitments.

Target Landscape of Conserved Plant MicroRNAs and the Complexities of Their Ancient MicroRNA-Binding Sites.

In plants, microRNA (miRNA)-target interactions (MTIs) require high complementarity, a feature from which bioinformatic programs have predicted numerous and diverse targets for any given miRNA, promoting the idea of complex miRNA networks. Opposing this is a hypothesis of constrained miRNA specificity, in which functional MTIs are restricted to the few targets whose required expression output is compatible with the expression of the miRNA. To explore these opposing views, the bioinformatic pipeline Targets Ranked Using Experimental Evidence was applied to strongly conserved miRNAs to identity their high-evidence (HE) targets across species. For each miRNA family, HE targets predominantly consisted of homologs from one conserved target gene family (primary family). These primary families corresponded to the known canonical miRNA-target families, validating the approach. Very few additional HE target families were identified (secondary family), and if so, they were likely functionally related to the primary family. Many primary target families contained highly conserved nucleotide sequences flanking their miRNA-binding sites that were enriched in HE homologs across species. A number of these flanking sequences are predicted to form conserved RNA secondary structures that preferentially base pair with the miRNA-binding site, implying that these sites are highly structured. Our findings support a target landscape view that is dominated by the conserved primary target families, with a minority of either secondary target families or non-conserved targets. This is consistent with the constrained hypothesis of functional miRNA specificity, which potentially in part is being facilitated by features beyond complementarity.

TRUEE; a bioinformatic pipeline to define the functional microRNA targetome of Arabidopsis.

Central to plant microRNA (miRNA) biology is the identification of functional miRNA-target interactions (MTIs). However, the complementarity basis of bioinformatic target prediction results in mostly false positives, and the degree of complementarity does not equate with regulation. Here, we develop a bioinformatic workflow named TRUEE (Targets Ranked Using Experimental Evidence) that ranks MTIs on the extent to which they are subjected to miRNA-mediated cleavage. It sorts predicted targets into high (HE) and low evidence (LE) groupings based on the frequency and strength of miRNA-guided cleavage degradome signals across multiple degradome experiments. From this, each target is assigned a numerical value, termed a Category Score, ranking the extent to which it is subjected to miRNA-mediated cleavage. As a proof-of-concept, the 428 Arabidopsis miRNAs annotated in miRBase were processed through the TRUEE pipeline to determine the miRNA 'targetome'. The majority of high-ranking Category Score targets corresponded to highly conserved MTIs, validating the workflow. Very few Arabidopsis-specific, Brassicaceae-specific, or Conserved-passenger miRNAs had HE targets with high Category Scores. In total, only several hundred MTIs were found to have Category Scores characteristic of currently known physiologically significance MTIs. Although non-exhaustive, clearly the number of functional MTIs is much narrower than many studies claim. Therefore, using TRUEE to numerically rank targets directly on experimental evidence has given insights into the scope of the functional miRNA targetome of Arabidopsis.

Cost impact of using patients' own multidose medications in hospital.

BACKGROUND: The use of patients' own medications may allow minimization of drug wastage and costs. However, the cost impact of this practice, taking into account the time that pharmacy personnel spend on verification, is unknown. OBJECTIVES: To determine the cost impact of using patients' own multidose medications within a surgical population, relative to the cost of routine dispensing; to describe the prescribing of multidose medications with regard to type, prevalence, quantity, and formulary status; and to determine the percentage of medications suitable for use after verification. METHODS: In this prospective, consecutive, time-and-motion case series, admission orders for patients newly admitted to 6 surgical units were screened to identify patients' own multidose medications that required verification. The total time required for all verification-related activities was captured. Data were collected over 3 weeks in early 2011. RESULTS: Of the 250 patients admitted, 51 (20.4%) had a prescription for one of their own multidose medications. Verification was completed for 67 (79%) of 85 prescribed items, of which 61 (91%) were deemed suitable for use. Thirty-five different medication types were identified. Of the 85 prescribed medications, 57 (67%) were on formulary. The most common routes of administration for these 85 prescribed items were inhalation (56 [66%]), nasal (9 [11%]), and ophthalmic (8 [9%]). The average cost ± standard deviation was $24.54 ± $32.33 per multi-dose item. The average time required for verification was 10.5 ± 6.7 min per patient (4.8 ± 3.3 min per medication). The cost impact was calculated as the difference between the drug cost with routine hospital dispensing and the cost of verifying home medications, where a positive value indicated a lower cost with verification of home medications (i.e., a saving for the hospital). The average cost impact was $40.05 ± $42.60 per patient (p < 0.001 by 1-sample t test) ($18.85 ± $15.42 per medication). A total cost saving of $1601.85 was realized. CONCLUSIONS: Using patients' own multidose medications instead of routine dispensing resulted in a cost saving of 74%, including labour costs for verification by the pharmacist.

CONTEXTE: L'utilisation des propres médicaments des patients peut permettre de réduire le gaspillage et les coûts de médicaments. Par contre, la répercussion sur les coûts de cette pratique, en tenant compte du temps passé par le personnel de la pharmacie à la vérification, est inconnue. OBJECTIFS: Déterminer la répercussion sur les coûts de l'utilisation des propres médicaments multidoses des patients chez une population de personnes ayant subi une intervention chirurgicale, par rapport aux coûts de la distribution habituelle; décrire la prescription de médicaments multidoses relativement au type, à la prévalence, à la quantité et à l'inscription sur la liste des médicaments (formulaire thérapeutique); et déterminer le pourcentage de médicaments pouvant être utilisés, après vérification. MÉTHODES: Dans cette série prospective analysant les temps et mouvements de cas consécutifs, les ordonnances d'admission de patients nouvellement admis dans six différentes unités de soins chirurgicaux ont été examinées afin d'identifier quels étaient les propres médicaments multidoses des patients devant être vérifiés. Le temps total nécessaire pour effectuer l'ensemble des activités de vérification a été noté. Les données ont été recueillies sur une période de trois semaines au début de 2011. RÉSULTATS: Des 250 patients admis, 51 (20,4 %) avaient une prescription pour un de leurs propres médicaments multidoses. Une vérification a été effectuée pour 67 (79 %) des 85 médicaments prescrits dont 61 (91 %) ont été jugés aptes à l'utilisation. On a identifié 35 différents types de médicament. Des 85 médicaments prescrits, 57 (67 %) étaient inscrits sur la liste des médicaments. Les voies d'administration les plus courantes parmi ces 85 médicaments étaient l'inhalation (56 [66 %]), la voie nasale (9 [11 %]) et la voie oculaire (8 [9 %]). Le coût moyen ± l'écart-type était de 24,54 $ ± 32,33 $ par médicament multidose. Le temps moyen nécessaire pour la vérification était de 10,5 ± 6,7 minutes par patient (4,8 ± 3,3 minutes par médicament). La répercussion sur les coûts a été calculée comme étant la différence entre le coût des médicaments s'ils avaient été délivrés selon le circuit habituel de l'hôpital et le coût de la vérification des médicaments apportés par les patients. Une valeur positive indiquait que la vérification des médicaments apportés par les patients était moins coûteuse, donc une économie pour l'hôpital. La moyenne de la répercussion sur les coûts était de 40,05 $ ± 42,60 $ par patient (p < 0,001 au moyen du test T pour échantillon unique) (18,85 $ ± 15,42 $ par médicament). Une économie de coûts de 1601,85 $ a été réalisée. CONCLUSIONS: Utiliser les propres médicaments multidoses des patients plutôt que de faire appel à la délivrance habituelle de médicaments par l'hôpital s'est traduit par une économie de coûts de 74 %, ce qui tient compte des frais de personnel pour la vérification par le pharmacien. [Traduction par l'éditeur].