Background: Hospital pharmacists make many recommendations that improve patients' quality of care and/or reduce drug costs. While the impact of quality-of-care interventions is difficult to quantify, those limited to cost savings could be assessed in a prospective, randomized fashion.

PrefaceConnecting the dots W ith the establishment of the Global Forest Expert Panels (GFEP) initiative in the year 2007, the Collaborative Partnership on Forests (CPF) created an international mechanism which effectively links scientific knowledge with political decision-making on forests. The GFEP responds directly to key forest-related policy questions by consolidating available scientific knowledge and expertise on these questions at a global level. It provides decision-makers with the most relevant, objective and accurate information, and thus makes an essential contribution to international forest governance.This report entitled "Forests, Trees and Landscapes for Food Security and Nutrition" presents the results of the fourth global scientific assessment undertaken so far in the framework of GFEP. Previous assessments addressed the adaptation of forests and people to climate change; international forest governance; and the relationship between biodiversity, carbon, forests and people. All assessment reports were prepared by internationally recognised scientists from a variety of biophysical and social science disciplines. They have all been presented to decision-makers across relevant international policy fora. In this way, GFEP supports a more coherent policy dialogue about the role of forests in addressing broader environmental, social and economic challenges.The current report reflects the importance of policy coherence and integration more than any previous GFEP assessment. It comes at a time when the United Nations General Assembly seeks to adopt a set of Sustainable Development Goals (SDGs) which build upon the Millennium Development Goals (MDGs) and converge with the post-2015 development agenda. In this context, the eradication of hunger, realisation of food security and the improvement of nutrition are of particular relevance. By 2050, the international community will face the challenge of providing 9 billion people with food, shelter and energy. Despite impressive productivity increases, there is growing evidence that conventional agricultural strategies will fall short of eliminating global hunger and malnutrition. The assessment report in hand provides comprehensive scientific evidence on how forests, trees and landscapes can be -and must be -an integral part of the solution to this global problem. In other words, we must connect the dots and see the bigger picture.The review of the International Arrangement on Forests by the member states of the United Nations Forum on Forests provides a unique opportunity to integrate forests into the SDGs in a holistic manner and to promote synergies in the implementation of the post-2015 development agenda across multiple levels of governance. It is my hope that those with a responsibility for forests, food security and nutrition at all levels will find this report, and its accompanying policy brief, a useful source of information and inspiration.

Line thickness represents the amount of evidence available; three weights are used. Line color indicates the agreement in the available evidence, where green suggests general agreement and purple suggests some disagreement.

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PURPOSE Although newer, heavily promoted medications are commonly prescribed, published evidence and consensus guidelines often support the use of less expensive alternatives. This study was designed to evaluate the impact on prescription costs of a computerized decision support system (CDSS) that provides evidence-based recommendations to clinicians during the electronic prescribing process.METHODS A retrospective cohort study was performed using a pharmacy claims database. Clinicians using the CDSS were matched with a control group by pharmacy billed amount, number of patients treated, and number of new prescriptions fi lled during a 6-month baseline period in which neither group used the system. The primary outcome measure was the difference in prescription costs between the 2 groups after implementation of the CDSS in the intervention group. RESULTSClinicians who received evidence-based messages had signifi cantly lower prescription costs than those in the control group. The average cost per new prescription was $4.16 lower (P = .02) in the intervention group, and the average cost for new and refi lled prescriptions was $4.99 lower (P = .01). The 6-month savings from new prescriptions and their refi lls are estimated to be $3,450 (95% CI, $1,030-$5,863) per clinician.CONCLUSIONS Providing electronic, evidence-based decision support during the prescribing process can shift prescribing decisions toward more evidence-based care and signifi cantly decrease primary care prescription costs.

ome computerized decision support systems (CDSS) have been shown to influence prescribing decisions; however, most published studies have been conducted in hospital settings and examined internally developed CDSS that are not easily exported to other settings. [1][2][3][4][5] Although a few trials have been performed in primary care, these have also typically used custom-built systems, and most have been performed in academically affiliated clinics, have limited their interventions to a single drug class or disease state, and provided relatively short follow-up.6-14 To our knowledge, there are no published studies that have adequately evaluated the long-term impact of commercially available CDSS or electronic prescribing products in a community-based primary care setting.We reported previously the results of a 6-month controlled trial of a commercially available electronic prescribing system with integrated clinical decision support in which new primary care prescription costs were reduced by more than 10% per prescription. 15 Because the original study focused only on new prescriptions (defined as a claim for a medication that the patient had not received in the previous 12 months), we were unable to fully assess the impact of the system on total pharmacy costs. The main objectives of this follow-up report were to determine if the 6-month savings on new prescriptions were sustained during a longer follow-up observation period (12 months) and to evaluate the impact of the CDSS on all p h a rmacy claims (i.e., new prescriptions plus older pre s c r i p t i o n s that were active prior to the intervention) and per-member-permonth (PMPM) expenditures.To help verify that the system was effective at changing prescribing behavior, we also evaluated the utilization of drugs within 8 high-cost therapeutic categories that were targets of the CDSS messaging function. To our knowledge, this is the first controlled study that has formally investigated the impact ABSTRACT OBJECTIVE: We reported previously the results of a 6-month controlled trial in which the use of a commercially available electronic prescribing system with integrated clinical decision support and evidence-based message capability was associated with significantly lower primary care drug costs. The original study focused on new prescriptions, defined as claims for a medication that the patient had not received in the previous 12 months. The main objectives of this follow-up report were to (a) determine if the 6-month savings on new prescriptions were sustained during 12 months of follow-up, (b) evaluate the impact of the computerized decision support system (CDSS) on all pharmacy claims and per-member-per-month (PMPM) expenditures, and (c) evaluate the prescribing behaviors within 8 high-cost therapeutic categories that were frequently targeted by the electronic messages to prescribers to help verify that the drug cost savings were due to the recommendations in the electronic prescribing system. METHODS: Two database queries were performed to identify add...

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A sufficient intake of fruits can alleviate micronutrient deficiencies and reduces the risks of a number of associated diseases. In many parts of sub-Saharan Africa, however, the production and consumption of fruits are inadequate on average and in particular so in specific seasons. To better incorporate fruits into local food systems while addressing the challenge of seasonal availability, World Agroforestry (ICRAF) has developed a methodology based on “fruit tree portfolios” that selects socio-ecologically suitable and nutritionally important fruit tree species for farm production, to meet local consumption needs. We here present this approach and illustrate it with data from a case study involving Western and Eastern Kenya. The approach uses mixed methods to capture on-farm fruit tree diversity and seasonality at a household level (n = 600 in our case study), the months of household’s food security and insecurity (n = 600) and food consumption patterns at an individual level, to identify dietary gaps (n = 294 women and child pairs in our example). In our case study, 31 fruit tree species were reported on farms in our Western Kenya sample (9 of which were indigenous) and 51 (27 indigenous) in Eastern Kenya. In addition, the median number of food-insecure months per household was four (ranging from 0 to 9 months) in Eastern Kenya and three (0 to 12 months) in Western Kenya. Finally, using 24-h recalls the proportion of women that had consumed a fruit the day before the interview was around 55% in Western Kenya and 80% in Eastern Kenya, with consumption averaging 93 and 131 g, respectively. Using these parameters for each site and fruit tree phenology and food composition data sets, we derived context-specific recommendations that involve promoting 11 fruit tree species to address micronutrient gaps.